{"text": "Rhetorical inquires have shown connections between representation and power, workplace fashion and development of ethos, and the rhetoric of glamour through women\u2019s fashion and dress. One element absent from that conversation is how the life course, which typically differs for women because of existing power structures advantaging men, may impact the experience of women as they age, their choice of dress, and the rhetorical implications of those decisions. To explore dress and rhetoric from a life course perspective, this project traces the evolution of Serena Williams\u2019 work apparel across her professional tennis career to the catsuit worn at the 2018 French Open, which is the focus of the project. Press reports on the 2018 catsuit by Nike, New York Times, Sports Illustrated, Business Insider, BBC Sport, Washington Post, and Los Angeles Times, interviews given by Williams, and the television documentary, Becoming Serena, will be analyzed for their treatment of Williams\u2019 work attire and the life course. Responses to the catsuit emphasize attitudes about gender, race, and class, either discounting or ignoring the life course implications such as motherhood and changes in health status. Despite professional success, responses about the catsuit may reflect that Williams faces the same jeopardies, and invisibility, common to many women as they age, and the rhetorical perspective provides new methodological and pedagogical possibilities for instruction in aging."}
{"text": "The diagnosis of multiple sclerosis (MS) is difficult considering its complexity, variety in signs and symptoms, and its similarity to the signs and symptoms of other neurological diseases. The purpose of this study is to design and develop a clinical decision support system (CDSS) to help physicians diagnose MS with a relapsing-remitting phenotype. The CDSS software was developed in four stages: requirement analysis, system design, system development, and system evaluation. The Rational Rose and SQL Server were used to design the object-oriented conceptual model and develop the database. The C sharp programming language and the Visual Studio programming environment were used to develop the software. To evaluate the efficiency and applicability of the software, the data of 130 medical records of patients aged 20 to 40 between 2017 and 2019 were used along with the Nilsson standard questionnaire. SPSS Statistics was also used to analyze the data. For MS diagnosis, CDSS had a sensitivity, specificity and accuracy of 1, 0.97 and 0.99, respectively, and the area under the ROC curve was 0.98. The agreement rate of kappa coefficient (\u03ba) between software diagnosis and physician\u2019s diagnosis was 0.98. The average score of software users was 98.33%, 96.65%, and 96.9% regarding the ease of learning, memorability, and satisfaction, respectively. Therefore, the applicability of the CDSS for MS diagnosis was confirmed by the neurologists. The evaluation findings show that CDSS can help physicians in the accurate and timely diagnosis of MS by using the rule-based method. Multiple sclerosis (MS) is an inflammatory disease of the central nervous system -2. It us1.The diversity, instability and vagueness of the signs and symptoms , 5, 8, 92.Its differential diagnosis from other diseases such as acute disseminated encephalomyelitis (ADEM) and neuromyelitis optica (NMO), and small vessel ischemic disease (SVID) -16;3.The absence of any definitive diagnostic tests for it -5;4.Limited specificity and accuracy of laboratory methods , 12, 15,Moreover, there is a significant delay from the stage of awareness of the initial signs and symptoms of MS to its diagnosis , 14, 18,In recent years, intelligent systems such as the clinical decision support system (CDSS) have been used to solve many complicated issues -27. ThesMany researchers use software techniques to diagnose diseases and disorders of the nervous system , 33. VarThe purpose of this study is to develop a CDSS software and evaluate it in the case of relapsing-remitting MS to accelerate and improve the diagnosis of this disease.The software was developed in four stages, as shown in 1.Extraction of the requirements of system users: At the requirements analysis stage, data requirements, functional and non-functional requirements were determined in interviewers with 10 expert neurologists based on a semi-structured questionnaire. The questionnaire's validity was evaluated through its content validity, and its reliability was determined using the test-retest method (r = 0.87);2.Software design: The software was designed in two stages, including designing the software's knowledge base and designing an object-oriented conceptual model.In order to design a knowledge base, the following should be conducted:\u2022Knowledge acquisition: Acquiring medical knowledge and identifying important and effective parameters regarding the diagnosis of MS occurs in two steps. In the first step, books, specialized texts, and articles concerning central nervous system diseases, MS diagnostic criteria, and MS diagnosis guidelines are studied, followed by identifying clinical signs and symptoms of MS diagnosis. In the second step, targeted interviews are conducted with 10 expert neurologists to determine the effective parameters in the diagnosis of MS, the relationship between clinical decision-making parameters and MS, the incidence of clinical signs, and the relationship between clinical signs and symptoms and the location of plaques in the central nervous system.\u2022Knowledge representation: The decision tables  and 3 an\u2022Knowledge analysis: A rule-based method and MS diagnostic algorithm  are usedTo design the software database, the object-oriented methodology was developed using the IBM Rational Rose Enterprise v9. Operational, structural, and behavioral models of the software were created by drawing use cases, class-responsibility-collaboration (CRC), class, sequence, activity, state and collaboration diagrams.3.Software development and implementation: SQL SERVER 2017 and Visual Studio 2017 v 15.8.9 and the C sharp programming language were used to codify the decision support software. Finally, the CDSS was deployed at the Neurology Department of the Shahid Beheshti Hospital of Kashan.4.System evaluation: The software was evaluated in terms of efficiency and applicability. The efficiency of the CDSS for MS diagnosis was calculated using the real data recorded in 130 cases of patients admitted at the Shahid Beheshti Hospital of Kashan. Ninety-one patients with MS and 39 patients with stroke, neuromyelitis optica (NMO), brain and spinal cord tumors, and acute encephalomyelitis in the age range of 20 to 40 years between 2017 and 2019 were included based on sensitivity, specificity and accuracy with the use of IBM SPSS Statistics v25.0.The receiver-operating characteristic (ROC) curve and surface area under the curve were also plotted to judge the performance and efficiency of the system. Also, the Kappa test was conducted, and its results were interpreted to evaluate the agreement of the physician's diagnosis and the proposed system's. The software applicability was evaluated by 10 neurologists based on the Nielsen standard questionnaire in three distinct areas, including the ease of learning, memorability, and satisfaction. The validity of the applicability questionnaire designed in this study was evaluated using content validity based on valid sources, and its reliability was determined by calculating Cronbach's alpha (\u03b1 = 0.87).The findings of this study are presented in 5 parts, as seen below.The software input data were divided into five sections: demographic data, historical data, physical examinations, radiographic data, and laboratory data, which are described in The functional requirements of the system include simulation of the physician's decision-making process, thought and diagnosis, storing and creating a database of patients' data at each encounter, providing guidance and advice to the physician, providing reports required by physicians for decision making, presenting a summary of records to patients for them to find out the condition of their illness and back up their data to present to any neurologist.Non-functional requirements of the system features include maintaining privacy and security of patients' data, tracking users' operations in software, the capability of maintaining and updating the system knowledge base based on new criteria of MS diagnosis, the capability of software extension, addition of new features and heightening its processing speed in the future.The software includes the main sections of the patient profile, physician profiles, and reports. Patient profiles incorporate sub-parts for medical recording, recording explanations and examination data, recording MRI data, recording laboratory data, diagnosis, and a summary of the records. Physicians are able to edit their information on their profile and their patient's medical record. They can also provide their reports and information in the software reporting section. The system output is the diagnosis of MS with a degree of certainty as well as the diagnosis of other diseases and suggestions for the examination of the differential diagnosis of MS. The software developed in this study provides the output and new advice to the physician at each encounter of the patient based on newly recorded data in the system. The system also provides users with the capability of describing their responses and reasons. The decision support software developed in this paper has a sensitivity of 100%, a specificity of 97%, an accuracy of 99%, and a surface area under the ROC curve of 0.987 . Also, tThe average score of software users was 98.33%, 96.65%, and 96.9%, regarding ease of learning, memorability, and satisfaction, respectively. Therefore, the applicability of the CDS software for MS diagnosis was confirmed by the neurologists.The results of the software evaluation revealed that there was a complete consistency between the system diagnosis and the final diagnosis recorded in the patient records, and also reflected the high acceptability of the system and the satisfaction of all users' operational expectations, as well as the system's applicability in health environments.All the diagnostic parameters affected the efficiency and performance of software diagnosis. In this paper, 45 parameters presented in A powerful knowledge base is one of the strengths of CDSSs because it makes its inference engine optimal, smart, and more error-tolerant. According to the studies, decision tables, decision trees, and semantic networks are helpful in designing a knowledge base for decision support and expert systems and represent the link between signs and symptoms and diseases, and the rules of production are derived from them. The expert system for the diagnosis of neuromuscular disorders has used the decision tree, and the neurological expert system has used the decision table and the decision tree. The decision table has been used in the design of the knowledge base of the diagnostic system for nervous demyelination diseases and neurological disorders. The Fuzzy Expert System for MS diagnosis in Italy used the graphic diagram of the semantic network to organize and represent the knowledge base. In this paper, the approaches to the decision table and the semantic network are used to represent the production rules.et al. used the computer-assisted diagnostic system for the differential diagnosis of MS using logistic regression and artificial neural networks in Germany. The sensitivity and accuracy of the statistical method in the classification of patients were 0.84 and 0.54, respectively, and the sensitivity and accuracy for the artificial neural network in the classification of MS patients from other patients were 0.95 and 0.83, respectively [Using a suitable reasoning method and technique to diagnose in decision support systems is important in the efficiency of the software. A rule-based method is one of the most widely used methods to diagnose diseases, especially MS . This meectively . The difectively . The fuzectively . The artectively , 45.The use of an object-oriented conceptual model helps software analysts to design quick and logical systems in the changing conditions of the business atmosphere, enhancing the quality of analysis of the users' requirements and software design documentation. The system developed in this paper and the Neurology Diagnose System Project at the University of Tryp Habana used object-oriented design and UML modeling language diagrams, which are deemed to be strengths of the software and show the operational, structural, and behavioral perspectives of the software.In order to access the proposed system, we encountered limitations such as the limited number of medical records of patients with NMO and ADEM, incomplete data records in the medical records of patients, and their removal in the evaluation stage.Given that a rule-based method has limited flexibility, it is suggested that a combination of rule-based and case-based methods be used to overcome this problem in decision support systems. Also, to overcome the uncertainty problems in medicine, and the different parameters of MS diagnosis and their values in different patients, a combination of rule-based and fuzzy logic methods should be used. The proposed decision system in this study could be expanded for the diagnosis of other types of MS phenotypes and for their management and treatment.The results of the evaluations of the efficiency and applicability of the software demonstrate the high acceptability of the system and satisfaction of all the operational expectations of users, and that CDSS provides guidance in decision-making and helps physicians in the timely and accurate diagnosis of MS. These are the results of proper knowledge engineering and the use of effective parameters in the diagnosis, analysis process and object-oriented conceptual design of the software, the use of appropriate reasoning methods, and the development of MS diagnosis algorithm based on the latest McDonald's MS diagnosis criteria and guideline, as well as the centrality of final users and neurologists in the design of the graphical user interface of the system.The rule-based method is one of the most widely used reasoning methods for the diagnosis of MS having proper efficiency and benefits such as modularity and general combination and description of the results. Being understood and well accepted by physicians, this method manages well-defined issues with text-based knowledge. In CDSSs and expert systems, a combination of different reasoning methods can be used based on the system's objective in order to enhance the efficiency and intelligence of the system.The authors declare that there is no conflict of interest."}
{"text": "The relationship between diet and the diversity and function of the intestinal microbiome and its importance for human health is currently the subject of many studies. The type and proportion of microorganisms found in the intestines can determine the energy balance of the host. Intestinal microorganisms perform many important functions, one of which is participation in metabolic processes, e.g., in the production of short-chain fatty acids\u2014SCFAs . These acids represent the main carbon flow from the diet to the host microbiome. Maintaining intestinal balance is necessary to maintain the host\u2019s normal health and prevent many diseases. The results of many studies confirm the beneficial effect of probiotic microorganisms on the balance of the intestinal microbiome and produced metabolites, including SCFAs. The aim of this review is to summarize what is known on the effects of probiotics on the production of short-chain fatty acids by gut microbes. In addition, the mechanism of formation and properties of these metabolites is discussed and verified test results confirming the effectiveness of probiotics in human nutrition by modulating SCFAs production by intestinal microbiome is presented. Firmicutes, Bacteroides, Actinobacteria, Fusobacteria, Proteobacteria, Verrucomicrobia, Cyanobacteria, and Spirochaetes) ..BifidobaEnterobacteriaceae fermentation and is carried out by some bacteria belonging to this family, including Escherichia, Proteus, Salmonella, and Shigella . P. PLactobnfection  and in r disease .Maintaining the balance of the intestinal microbiome is crucial for maintaining normal human health and preventing many diseases. Short-chain fatty acids, as metabolites of intestinal bacteria, perform many important functions. The concentration of SCFAs depends on the composition and size of the population of intestinal microorganisms, genetic factors, environmental factors and the diet conditioning access to appropriate substrates. Imbalance of the intestinal microbiome and a decrease in the number of bacteria producing metabolites such as SCFAs  are often diagnosed in patients with inflammatory bowel diseases (IBD), irritable bowel syndrome (IBS), type 2 diabetes (T2D), obesity, infections bacterial, autoimmune disorders, or cancer patients. Numerous scientific reports confirm the effectiveness of probiotics in modulating the intestinal microbiome and their effect on the SCFAs content in the colon. Many studies, in addition to acting in the digestive system, concern the effect of SCFAs produced by intestinal microbiome on functions of distant tissues and organs. Researchers highlight the immunomodulatory effect of SCFAs produced by probiotics, but the mechanisms of their action still need further study. The use of probiotic microorganisms to prevent and treat intestinal dysbiosis, leading to an increase in SCFAs in the colon, seems to be an important direction for further research. Research on SCFAs in relation to diseases covered by the review is much-needed to understand their etiology and pathogenesis, and to propose new therapies. Clinical studies in human populations in this area are highly desirable."}
{"text": "In March 2020, the rapid increase in COVID-19 cases overburdened the Italian health system, with the country becoming the pandemic\u2019s epicenter.  We present a narrative review based on manuscripts, official documents, and newspaper articles regarding COVID-19 in Italy.  Characteristics of the epidemic, possible causes for its worsening, and the measures adopted across Italian regions are presented.  In the early stages of an epidemic, effective decision-making is essential to contain the number of cases. Medical support for patients and social isolation measures are the most appropriate strategies currently available to reduce the spread and lethality of COVID-19. In March 2020, the epidemic caused by the novel coronavirus (or SARS-CoV-2) turned into a global pandemic, with Italy leading the tally with regard to the number of COVID-19 cases as well as fatalities. This turn of events raises an important question: what happened in Italy, the first Western country to be hit by COVID-19, for it to become the epicenter of the pandemic? And, most significantly for us, what can we learn from the Italian experience to reduce the impact of the pandemic in Brazil? Here, we present a narrative review of articles published from February to April 2020 in scientific journals, on institutional websites, and in the press in general, referring to the COVID-19 pandemic in Italy.,During the month of March, the press and social networks broadcast shocking images of Italian hospitals-crowded emergency rooms, patients on stretchers in corridors, surgical centers transformed into intensive care units (ICUs), health professionals becoming ill (and dying), 50-70% of hospital beds occupied by patients with COVID-19, and so on. The scarcity of the necessary equipment put doctors in the position of having to make the drastic decision of who would be placed on respirators based on their chances of survivalIt should be noted that Italy has one of the best public health systems in the worldBased on data from May 17, Italy was the third country by number of COVID-19 deaths , behind the United States of America  and the United Kingdom Nursing homes for older adults in Italy have become high-risk locations for their residents, who, in addition to old age, have multiple comorbidities; the nursing home setting has witnessed a large number of deaths by COVID-19. The province of Bergamo, for example, recorded more than 600 deaths in 20 days , and 40% of the professionals working in these asylums were on sick leave or in isolationHarvard Business Review, Pisano et al.The advanced age of a large part of the Italian population may be one of the causes of the significant number of deaths, but it is not a comprehensive explanation. Political decisions aimed at limiting the spread of the epidemic across the entire territory were slow to be taken. In an article published in the The delay in adopting social isolation measures and restricting movement, together with a public event in late February that involved politicians in Milan exchanging handshakes to symbolize that the economy could not stop because of the epidemic, contributed to misinformation about the risks of virus transmission. In the same month, public events brought together thousands of people in Lombardy. Agricultural fairs in Bergamo and Brescia, a soccer match between Atalanta (Bergamo) and Valencia (Spain) for the Champions League in MilanIn the article by Pisano et al.The decentralization of the Italian health system also prevented uniform measures from being adopted across the countryIn Italy, hospitals receive around 45% of health system funding, which is higher than the Organisation for Economic Co-operation and Development average (38%)At the time of writing this article, on May 17, Italy had reported 223,885 cases of COVID-19. However, after so much desolation, the number of deaths, which in one day almost reached the quota of 1,000, began to fall to less than 200In Brazil, we are in the ascending phase of the pandemic curve, with an exponential progression of cases and, consequently, deathsFrom the above, and in the absence of proven effective treatments or a preventive vaccine, we must offer supportive treatment to patients and adopt non-pharmacological measures since, at the moment, the best way for each of us to contribute to slowing the spread of SARS-CoV-2 is to avoid contact with other people. Behaving in this way, we will allow time for the preparation of the health system, increasing our chances of receiving adequate medical care and surviving this new virus."}
{"text": "The highest Road Traffic Deaths (RTDs) are related to Low and Middle-Income Countries (LMIC). The efforts for decreasing the incidence and deaths of RTDs can be successful if there is precise information about its related risk factors. This study is aimed at modeling the effective factors of economic, population, road, and vehicles on road traffic deaths in Iran.This is an ecologic study which has been done using the covariates of; the proportion of the population, economic growth, urbanization, distance traveled (km) in 100 thousand people, the length of urban roads, the length of rural roads and the number of vehicles for each province in 2015. The regression model of Negative Binomial (NB) was used to modeling these covariates on the deaths of RTDs. The statistical software of STATA edition 14. Was used.The average of road traffic deaths was 474 (SD= 70.59) in 2015. The result of the multivariate negative binomial model showed that the covariates of the proportion of the population and Gross Domestic Production (GDP) were statistically significant on the number of RTDs.The covariates of the proportion of population and GDP were effective on the RTDs with the direct and indirect relationship respectively.Death, Road traffic crash, Modeling, Iran"}
{"text": "Cystic echinococcosis (CE) is distributed worldwide, extending from China to the Middle East and from Mediterranean countries to the sub-Saharan Africa and South America. According to WHO, one million people around the world are suffering from CE with an estimated burden of 183,573 DALYs. The annual monetary burden of the disease due to treatment costs and CE-related livestock losses has been estimated at US$ 3 billion. CE is endemic in all countries within the WHO Eastern Mediterranean Regional Office (EMRO). The region, which includes most of the Middle East and North Africa, is one of the most ancient foci of the domestic cycle of CE and is recognized as one of the major hotspots of CE. There are 22 countries in the EMRO, where about 688 million people are living at risk of CE. In many EMRO countries, little is known about CE epidemiology and transmission. WHO included echinococcosis in a list of 17 neglected tropical diseases (NTDs) and 12 neglected zoonotic diseases (NZDs). Accordingly, different regional offices of WHO organized several initiatives for CE control and prevention. WHO\u2019s Western Pacific regional office considered echinococcosis as one of the region\u2019s major health topics, and several preventive measures have been implemented in the American region with the support of Pan American Health Organization (PAHO) in Argentina, Peru, Uruguay, and Chile. Although CE is endemic in all 22 EMRO countries, surprisingly, CE is absent from the health topics list of diseases and conditions in this region. Therefore, CE clearly requires further attention in the WHO EMRO agenda, and the need for elaboration of specific measures for CE control is becoming apparent in EMRO countries, where substantial collaborations among the member states and WHO EMRO is of paramount importance. Major topics of collaborative activities include training programs and health communication on different aspects of CE control, analysis of CE burden, national and international surveillance and disease registry systems, technical support to promote epidemiological studies for collecting baseline data, cost\u2013benefit analysis of control interventions, and intersectoral cooperation among the agriculture, veterinary, medical, and health sectors. Echinococcus granulosus. CE is distributed worldwide, extending from China and Central Asia to the Middle East and Mediterranean countries  as well as sub-Saharan Africa and South America [Cystic echinococcosis (CE) is a major parasitic disease of humans and animals caused by the small intestinal tapeworm of carnivores,  America .According to WHO, 1 million people around the world are suffering from CE, and an estimated burden of 183,573  disability-adjusted life years (DALYs) has been attributed to this zoonotic infection [WHO Eastern Mediterranean Region (EMRO), which includes most of the Middle East and North Africa (MENA), is one of the most ancient foci of the domestic cycle of CE and is recognized as one of the major hotspots of CE ,5. The sThere are 22 countries in EMRO, where about 688 million people are living at risk of CE. Actually, CE is endemic in all EMRO countries. In many EMRO countries, little is known about CE epidemiology and transmission. For instance, although CE is endemic in Pakistan, the country has been neglected in international collaborations on echinococcosis control, largely due to the paucity of information in the country . There aWHO included echinococcosis in a list of 17 neglected tropical diseases (NTDs) and 12 neglected zoonotic diseases (NZDs) ,11. AccoCE as a major neglected infectious disease has received special attention in the Americas through the \u201cSouth American Initiative for the Control and Surveillance of Cystic Echinococcosis /Hydatidosis\u201d. Several preventive measures have been implemented in the region with the support of PAHO in Argentina, Peru, Uruguay, and China .WHO EMRO has announced plans for training, monitoring, and epidemiological evaluation of several NTDs, including lymphatic filariasis, trachoma, leishmaniasis, schistosomiasis, and soil-transmitted helminths . AlthougMajor topics of collaborative activities include training programs and health communication on different aspects of CE control, analysis of CE burden, national and international surveillance and disease registry systems, technical support to promote epidemiological studies for collecting baseline data, cost\u2013benefit analysis of control interventions, and intersectoral cooperation among the agriculture, veterinary, medical, and health sectors.As part of the new roadmap on NTDs, WHO would coordinate and support member states to develop intervention programs for the prevention and control of NTDS, including cystic and alveolar echinococcosis. Initiatives need to be started by EMRO and its members through practical participatory planning to mobilize resources for incorporating echinococcosis and other human zoonotic diseases into the One Health domains."}
{"text": "More than 5 million people die each year as a result of: injuries, resulting from acts of violence against oneself or others, road traffic crashes, burns, drowning, falls, poisonings, among other causes. That is the reason for Safe Community program in every part of the world. Because Safe Communities are an Essential need for a Modern-Day Society. Safe Community is our present and future. Safe Community does not know the state boundaries, nationality, religion, skin color, age and gender. Safe Community is a global program and global movement for the preservation and protection of the environment, life and health of every inhabitant of this planet. Safe Community is a safe environment in which people can develop all their work and productive potentials. European safe Community Network aims at strengthening existing International Safe Communities in Europe and promotion of the formation of new communities to be accepted into the Safe community movement. The Global Burden of Disease Studies has documented unfair distribution of injury by socioeconomic strata in Europe. This gradient, existing within and between countries, must be addressed. Our board has representatives from Novi Sad in South Eastern Europe through the Baltics and as far north in Scandinavia as 200 kilometers north of the Arctic Circle in Norway. Together we are working against public indifference towards the burden of injury and trying to promote community based interventions against injuries e.g. traffic accidents , drowning, burns, falls, violence, and suicide. In the 53 countries of the WHO European Region injuries are estimated to cause 790 000 deaths yearly. This is 9% of deaths from all causes. An estimate for the 27 countries in the European Union is 252 000 injury related deaths and about 7 million hospital admissions yearly . Injury is the greatest thief of life years in the age group from one year to the mid-forties. The first Safe Community was designated in 1989. Several Swedish and Norwegian communities followed in Falkopings, footsteps during the next two decades. There are 58 designated Safe Communities in Europe. Of these 36 are in Sweden and Norway. Norway has a strong National Safe Community Network, Norwegian Safety Forum and are steadily recruiting communities up to the present. Sweden he s recruited few new safe communities the last two decades, probably due to the dissolving of the Swedish National Network. However, existing Swedish Safe Communities are active and strong and thus redesigned. Key success on participation in National and International Safe Communities Networks are: Statistics, Research, Strategy, Motivation, Education, Training and Collaboration.Safe Community, European Network, Statistics, Research, Strategy, Motivation, Education, Training and Collaboration"}
{"text": "We examine the distribution of residential care in California, showing geographical disparities in care supply and need. We mapped the ratio of beds to older women in Los Angeles and San Diego County census tracts and concentrations of small and large facilities in the Cities of Los Angeles and San Diego. The largest ratios of residential care beds per older women occur on the border of the City of San Diego and on the periphery of Los Angeles County away from the City of Los Angeles. Clusters of small facilities take place in northern Los Angeles and southeastern San Diego, while clusters of large facilities occur in Downtown Los Angeles and near La Jolla. Understanding geographical disparities in residential care supply and need in California can help residential care developers, service providers, and local and state agencies partner in planning for residential care facility development in underserved areas. As lifeAs a result, the demand for residential care is expected to grow, putting pressure on cities and local governments to incentivize and plan for more care facilities to meet the growing long-term care need, particularly in the highly populated and urbanized regions of California, the largest state by older adult population. At present, more than a third of residential care facilities are located in the western US , and morLittle is known, however, regarding the number and distribution of residential care facilities in Californian cities and surrounding areas, containing large populations of older adults who need or will soon need such care. The vast majority of facilities in the state are situated near coastal areas, in major metropolitan centers, as demonstrated by Because residential care is regulated primarily at the state level in the US and is funded and developed almost exclusively by private means, it is subjected to less governmental oversight and regional planning than institutional facilities such as skilled nursing care, which have historically been planned and developed via federal partnerships . The devSince the residential care industry in California is concentrated in major metropolitan areas, and because the development of such facilities varies substantially by neighborhood, in this study, we present spatial and cartographic analyses of the availability of residential care in the two largest Californian cities and surrounding counties by census tract, using 2015 California Department of Social Services residential care for the elderly and American Community Survey data. To understand the geography of residential care in these areas, we map the ratio of facility beds to older women with a disability. To evaluate the spatial distribution of facilities, we present maps of locations and spatial clustering of small and large facilities in California\u2019s largest cities and residential care markets relative to the concentration of older women with disability.2.2.1.We acquired 2015 California Department of Social Services (CDSS) residential care facility data, a census of all licensed facilities in the state, and geocoded facilities based on their address information. We also used data from the 2015 American Community Survey (ACS) 5-year estimates to create measures of the proportion of older women with disability in the census tract, which serves as a proxy for the potential long-term care need in the older adult population. In ACS, disability is defined as having hearing, cognitive, ambulatory, self-care, or independent living difficulty . Geocode2.2.To spatially analyze residential care facility beds and older women with disability, we calculated the number of beds and older women in Los Angeles and San Diego County census tracts. In evaluating the relationship between beds and older women, we mapped the ratio of beds and older women, categorizing the ratio of the two as above and below the adequate supply and undersupply equilibrium break point of 1.0. Densities of beds and older women and the ratio of the two were categorized and illustrated in county choropleth maps, using graduated colors to show increases in values of each in census tracts.To investigate the spatial distribution of facilities, we employed hot spot analysis, testing for clusters of small and large sized facilities using the Getis-Ord Gi* statistic . Applyin3.We show the spatial distribution of residential care in Los Angeles County and its principal city, Los Angeles and in San Diego County and its principal city, San Diego.The main map portrays the ratio of residential care facility beds to older women in Los Angeles County census tracts in Figure \u2460, highlighting areas with no beds per older women, as shown in white, areas with less than one bed per older woman, as represented by the lightest shade of gray, and areas with more than one bed per older woman, as shown in darker gray and black. Ratios shown in the lightest gray represent areas of undersupply or fewer beds than older women. Ratios shown in darker gray to black represent areas of adequate supply or more beds than older women. The majority of county census tracts show no beds per older women or an undersupply of beds, whereas only select and widely scattered areas of the county indicate an adequate supply. The highest ratios of adequate supply in the county occur in Santa Monica, Claremont, south of Beverly Hills, portions of the San Fernando Valley, Long Beach, Alhambra, Arcadia, south of Torrance, and north of Humphreys and Lancaster, toward the northern end of the county.The map displays the location and clustering of residential care facilities in the City of Los Angeles in Figure \u2462, drawn over the concentration of older women with disability. The map shows where facilities are sited, where clusters of small and large facilities congregate, as shown in blue and red respectively, and where large enclaves of older women are located, increasing in density, as shown in dot patterning to gray to black, indicating zero to low to high density. Dot patterning in city census tracts specifies areas with no older women, typically representing open space or public areas, such as Griffith Park and Topanga State Park. Areas shown in white within the larger boundary of the City of Los Angeles denote independently incorporated cities, including San Fernando, Beverly Hills, and Culver City. The majority of facilities are located in the San Fernando Valley, most of them small board and care facilities, six or fewer beds in size. Fewer facilities are located south of this suburban area, inside and west of the downtown district, most of them large assisted living and CCRC facilities. In general, clusters of small facilities group in areas of lower densities of older women, such as the San Fernando Valley, while clusters of large facilities congregate in areas of higher densities of the demographic, surrounding and west of the downtown area. However, certain areas with high concentrations of older women lack an immediate residential care presence, such as portions of Hollywood and neighborhoods east, west, and south of the downtown area.The map document also shows the spatial distribution of residential care in San Diego County and the City of San Diego in Figure \u2461. It shows the ratio of residential care facility beds to older women in county census tracts, displaying areas with zero beds per older women, as depicted in white, areas with less than one bed per one older woman, as shown by the lightest shade of gray, and areas with more than one bed per one older woman, as shown in darker gray and black. Similar to Los Angeles, the majority of county census tracts show no beds per older women or an undersupply of beds, whereas only select and fairly dispersed areas of the county indicate adequate supply. The greatest ratios of adequate supply in the county take place in central San Diego, south of La Presa, south of Escondido, and north of Encinitas.The main map displays the siting and concentration of residential care facilities in the City of San Diego, illustrated on top of the density of older women with disability in Figure \u2463. It shows the location of facilities, clusters of small and large facilities, and enclaves of older women. As in Los Angeles, the categorization of the density of older women increases from dot patterning to gray to black, representing zero to low to high density. Dot patterning in city tracts indicates areas with no older women, representing military installations, including Miramar. The majority of facilities are located in the southern half of the city, where most of the clustering of small and large facilities arises. Fewer facilities are located in the northernmost portion of the city, where only small amounts of clustering take place. Unlike Los Angeles, clusters of small facilities in San Diego do not congregate in areas of lower densities of older women, and clusters of large facilities do not coalesce in areas of higher densities of the demographic. In fact, a nearly opposite pattern takes place in the map, in which significant groupings of large assisted living and CCRC facilities cluster adjacent to lower densities of older women in La Jolla, and substantial concentrations of small facilities cluster in neighborhoods of higher densities of older women near Lincoln Park. However, in general, facilities in the jurisdiction appear to follow the pattern of densities of older women, with the development of facilities in or near higher densities of older women, as opposed to the lowest density of older women, as shown in the lightest shade of gray.4.We show that residential care in California\u2019s two largest counties is largely undersupplied with respect to the potential long-term care need. We also demonstrate that the patterns of residential care facility development and hot spots of small and large facilities in terms of size more or less match the pattern of concentrations of older women with disability, with the exception of the City of San Diego, in which clusters of large facilities are located in neighborhoods with smaller densities of older women and clusters of small facilities are located in neighborhoods with larger densities of older women.The overwhelming majority of census tracts display no supply of residential care facility beds or an undersupply of beds, emphasizing the limited and exclusive nature of the industry, which faces many institutional and economic obstacles to growth. These obstacles include a shortage of land supply in metro areas, difficulties in facility development permitting where applicable, and a growing but privileged clientele, who pay an average of $3,500 per month for residential care in the US . These fIn focusing on areas of adequate supply in Los Angeles and San Diego Counties, a number of scattered census tracts come into high relief. In Los Angeles County, the most extreme examples of adequate supply occur in Santa Monica, Lakewood, Van Nuys, Claremont, and in and near Beverly Hills. Taking a closer look at the underlying data, in each of these tracts, which represent the highest ratios of facility beds to older women as shown in black in the map, there are less than ten older women per square mile, and in one case, as few as two per square mile. In these same tracts, however, there are as many as 80 beds per square mile. In comparison, in census tracts with lower ratios of beds to older women, the number of older women per square mile is typically greater, as is the number of beds per square mile. In other words, the typical configuration of the ratio of beds per older women is greater in both the numerator and denominator, creating a distribution of ratios above .9 that overwhelmingly falls beneath 6.0 and a distribution of ratios below 1.0 that represent the bulk of the dataset, as shown in the map.In San Diego County, the most extreme instances of adequate supply take place near La Presa, Oceanside, coastal and central San Diego, the eastern outskirts of San Diego, Escondido, and Encinitas. Due to the miniscule square mileage of some of these census tracts, which produce extremely large ratios of facility beds per square mile and older women per square mile, comparing the distribution of total beds and total women is more helpful in analyzing the greatest ratios of beds to older women in the county. The range of total women in these tracts is one to 357, whereas the range of total beds is six to 1334, the smallest and largest of each corresponding to each other. In comparison, the total number of beds appears to grow more stable in tracts with lower ratios of beds to women, and the total number of women seems to increase as well. As with Los Angeles, the vast majority of census tracts contain a ratio of beds to women under 3.4, as illustrated in the map, and a distribution of ratios below 1.0 that represent most of the data.Areas of adequate supply in both counties appear primarily to be the result of extremely low counts of older women compared to facility beds in census tracts, perhaps indicative of tracts that older women are pushed or pulled to move from to live in other locations . It is aAccordingly, understanding the spatial distribution of residential care can help city and regional planners, community stakeholders, and local representatives address areas of concentrated and underserviced long-term care need through administrative and discretionary planning tools that encourage development of this critically important type of senior housing. In other words, research of this kind, on the geographical disparities in healthcare, can help governmental agencies and communities pinpoint and address the long-term care need of older adults with respect to residential care supply and other forms of housing services and supports outside of the home.Related to counts of older women in tracts are some of the limitations of this research, including 2015 ACS census tract estimates. 2015 ACS estimates were based on sampling over 60 months of time and are not a complete enumeration of people, as in the 2010 Decennial Census . AlthougFuture research is needed to track the increase of residential care in Los Angeles and San Diego along with other major cities in California, investigating how residential care has increased by number of facilities and total beds in jurisdictions relative to the potential long-term care need of older adults through time series analysis of residential care and older age population growth.5.In decimal degrees, the geographical coordinates of the City and County of Los Angeles are 34.052235, \u2212118.243683 (WGS84 datum). The geographical coordinates of the City and County of San Diego are 32.715736, \u2212117.161087 (WGS84 datum) in decimal degrees.ArcMap as part of Esri\u2019s ArcGIS was used to produce all of the maps in this article. California Department of Social Services (CDSS) residential care facilities were geocoded and spatially joined with Los Angeles and San Diego County census tracts, and spatially referenced using the North American Datum (NAD) 1983, California State Plane 2011V FIPS 0405 Feet Lambert Conformal Conic projection. The spheroid of this datum and projection is the Geodetic Reference System (GRS) 1980. We symbolized the data in graduated color choropleth maps, using the Jenks Natural Breaks Classification Method, which maximizes the variance between classifications, while minimizing the variance within each classification. The only exception to this is the variable of the ratio of beds to older women in either county, in which we distinguished classifications as either above or below the equilibrium point of 1.0, between the second and third classifications, to categorize census tracts as having either oversupply or undersupply of residential care. Finally, we plotted residential care facilities, including clusters of small and large facilities, in the Cities of Los Angeles and San Diego, on top of choropleth maps of older women with disability, showing where concentrations of small board and care and large assisted living and continuing care retirement communities (CCRC) occur relative to the potential need in either jurisdiction.Main Map"}
{"text": "NMDA receptors, on its turn, control the impulses of dopamine neurons. Therefore following theories of schizophrenia are proposed. They are a) activation of astrocytes for neuroinflammation, b) glutamate and dopamine theory, as astrocyte products control the activity of NMDA receptors, which influence on the dopamine neurons.The levels of the astrocyte markers  were increased unevenly in patients with schizophrenia. Reactive astrogliosis was found in approximately 70% of patients with schizophrenia. The astrocytes play a major role in etiology and pathogenesis of schizophrenia. Astrocytes produce the components that altered in schizophrenia extracellular matrix system which are involved in inflammation, functioning of interneurons, glio-, and neurotransmitter system, especially glutamate system. Astrocytes activate the interneurons through glutamate release and ATP. Decreased expression of astrocyte glutamate transporters was observed in patients with schizophrenia. Astrocytes influence on N-methyl-d-aspartate (NMDA) receptors  Schizophrenia is a mental disorder, determined as a complex of positive, negative and cognitive symptoms . PositivThe dopamine theory of schizophrenia, based on hyperactive dopamine projections in the mesolimbic system and reduced dopamine projections in the mesocortical system , is the Glutamate theory of schizophrenia is based on the ability of N-methyl-d-aspartate (NMDA) antagonists, such as ketamine, induced schizophrenia-like psychosis . DisturbNeuroinflammation theory of schizophrenia is based on increased expression of proinflammatory agents and the presence of autoantibodies. Epidemiological studies associate schizophrenia with autoimmune disorders, autoantibodies affect synapses and NMDA-type glutamate receptors and cause damages in the brain . InflammThe glial theory of schizophrenia assumes that initial disturbances in glial cells can lead to the abnormalities of the neurons and neurotransmitters. The glial theory of schizophrenia based on the proven inflammatory response and elevated levels of the characteristic markers of active glia\u2014S100B and glial fibrillary acidic protein (GFAP) . In schiPatients with schizophrenia show increased activation of glia, especially astrocytes, which play a role in the development and functioning of synapses, glutamate release, water-electrolyte balance, regulation of blood circulation, and neuroprotection . The funpostmortem human studies of astrocyte alterations in schizophrenia have focused on the number of glial cells. The number of astrocytes was reduced in the cingulate cortex -12, and astrocytes inhibit the production of IL-12 and produce type 2 cytokines, for example, IL-10 . The dysStimulation of mGluR5 and a1-noradrenergic astrocyte receptors provokes mild inflammatory processes, including the release of prostaglandins and other eicosanoids, which can regulate communication between neurons and blood vessels .via secreted cytokines  including LPS and associated cytokines . Astrocyytokines .During pathogenesis of schizophrenia, glia loses the ability to form compartments and connections, which leads to disruption of perception and an inability to think, which can be included in the development of cognitive symptoms in schizophrenia. Supposing that astrocyte gap junctions are the site of memory formation and intentional programming, their functions must be essential for cognition and higher information processing . This suvia inhibitory GABAergic interneurons.Reduced expression of Reelin, which is also a part of extracellular matrix, was noted in patients with schizophrenia in several brain regions, including the hippocampus, prefrontal and temporal cortex, cerebellum and caudate nucleus . In adulIn schizophrenia, there is hypofunction of NMDA receptors, which leads to a decrease in prefrontal cortex functions . WeakeneThe basis of the modified glutamate transmission is increased glutamate excretion in the hippocampus, in which the dysfunction of inhibitory interneurons in the hippocampus and prefrontal cortex also plays a role . ReducedPostmortem studies of patients with schizophrenia showed a simultaneous decrease in the levels of parvalbumin interneurons  and glutamic acid decarboxylase in the dorsolateral prefrontal cortex  . Ninety KYNA acts as an antagonist of all 3 ionotropic glutamate receptors, including NMDA, AMPA, and receptors kainate, while KYNA is the only currently known endogenous antagonist of NMDA . KYNA prConversion kynurenine to KYNA occurs mainly in astrocytes since these cells contain kynurenine aminotransferase (KAT) . In adulThe possible role of KYNA as a functional link between the stimulation of dopamine receptors and the neurotoxicity of NMDA in the striatum was noted in rats . An incrThe impact of the increased level of KYNA in schizophrenia symptoms is ambiguous. Elevated levels of KYNA provoked cognitive defects in animals: auditory sensory gating, prepulse inhibition, contextual discriminations, spatial working memory . The levGABA acts on astrocytes through GABA receptors, contributing to the release of chlorine and depolarization of astrocytes, and GABA receptors, activating calcium-dependent mechanisms and contributing to the growth of gliotransmitter  . ActivatGABA entering the astrocyte is mediated by a GABA-transporter operating on the principle of symport with sodium, increasing the content of intracellular sodium can contribute to the reversible operation of GABA-transporter . ReducedAdenosine acts through two types of receptors\u2014A1 and A2 . A1-receRecently gaining popularity adenosine theory of schizophrenia. It consists of the hyper-activation of adenosine kinase, which reduces the level of adenosine . It is sStriatal astrocytes express the heterodimer native receptors A2A-D2 . D2 receThe morphological basis of the accepted dopaminergic theory of schizophrenia is the dysregulation of the dopaminergic system primarily in the striatum , which iPostmortem examinations showed an increase in the level of dopamine in the striatum and an increase in the density of the D2 receptor but without changes in dopamine active transporter (DAT) densities  also take part in it. The presence of markers of activation of glia  in serum and cerebrospinal fluid indicates a growing activation of astrocytes. Isolation of pro-inflammatory agents  and KYNA indicates a violation in the metabolism of astrocytes and surrounding cells. As a result, this leads to changes in the structure of the brain. Morphological manifestations include a decrease in astrocyte density in the frontal cortex, changes in the composition of the extracellular matrix and glial hypertrophy. Of course, in addition to the obvious changes in the brain, astrocytes make a significant contribution to the negative, positive, and cognitive symptoms of schizophrenia.The number of astrocytes was reduced in the prefrontal cortex, that connects altered astrocyte system with mesocortical system, and nucleus accumbens, anterior cingulate cortex, which proves the changes in glial cells in the mesolimbic system, although in the hippocampus it was increased. The differences between the number of astrocytes in the mesocortical and mesolimbic system can affect on the manifestation of schizophrenia symptoms. Associations between GFAP and symptoms have not been found. At the same time the levels of another astrocyte markers, S100B and myoinositol, positively correlated with negative and positive symptoms, respectively. This finding suggests the dual alterations in astrocyte in brain regions, related with different symptom complexes.The imbalance between microglia and astrocytes, which occurs in neuroinflammation, influence on different neurotransmitters, such as GABA and dopamine. GABAergic interneurons, affected by oxidative stress, modulate the activity of prefrontal cortex, hippocampus and amygdala, that worsen alterations in dopamine system and, therefore, symptoms of schizophrenia.The contribution of glia to the development of cognitive symptoms was unexpected; normally it forms compartments and connections between neurons, but altered astrocyte themselves and extracellular matrix, affected by them, disturbs these interconnections.via KYNA and altered in schizophrenia glutamate transporters, as on the glycine system via non-synaptic GlyT-1 and D-serine. NMDA receptors and adenosine receptors, on its turn, control the dopamine release which is still considered the main schizophrenia neurotransmitter.NMDA receptors, related with all the groups of schizophrenia symptoms, associated also with astrocytes, since NMDA antagonist increased the number of GFAP-positive astrocytes in the prefrontal cortex. Astrocyte affects as on the glutamate system The study of the contribution of astrocytes to the etiology, pathogenesis, and symptoms of schizophrenia is associated with certain problems. The researches have been focused on the study of glia in different areas of the brain, which not only makes it difficult to generalize and analyze heterogeneous reactions of astrocytes but also eliminates the relationship between these areas and their respective astrocytes. In particular, the glia of \u201cstriatum-prefrontal cortex\u201d axis, which supposedly plays a major role in the pathogenesis of schizophrenia, requires further analysis to study the contribution of NMDA receptors. Also, the study of the genetic patterns of astrocyte pathology is needed. Some problems are associated with the astrocytes themselves, for example, there is evidence of their heterogeneity, which means that it is impossible to accurately judge the suppression or activation of astrocytes in any structure of the brain. This problem is supplemented by the dependence of astrocyte functioning on the age of patients, which is not always taken into account in case-control studies.Further study of the effect of astrocytes on neurotransmission may clarify the currently controversial aspects of brain function in schizophrenia and explain the characteristic symptoms. For example, it is not clear why a decrease in the expression of NMDA receptors is observed in both the prefrontal cortex and the striatum, if NMDA receptors have an activating effect on dopamine neurons. A separate role in this can play KYNA, NMDA receptor antagonist, an association of which was found with all types of symptoms of schizophrenia. Special attention should be paid to the study of GLT-1, whose effect on the symptoms of schizophrenia is heterogeneous (VVT, AAS, VNC, SSS, PM, DL, SGS, CEK, SOB, and GA conceptualized and designed the study. PM and DL collected and analyzed the data. All of the authors discussed the analyses, the results, and their interpretation, revised and improved the various drafts. VT, AAS, VNC, SSS, PM, DL, SGS, CEK, SOB, and GA wrote the original draft. All authors have reviewed and approved the manuscript before submission.This research was supported within the framework of the grant provided by CSP Ministry of the Health Russian Federation, and by the IPAC RAS State Targets Project # 0090-2019-0005\u201d. This work was also supported by the Russian Academic Excellence Project \u201c5-100\u201d for the Sechenov University, Moscow, Russia.GA is employed by GALLY International Biomedical Research LLC, San Antonio, TX, USA.The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "In modern foods, the delivery systems for bioactive compounds play a fundamental role in health promotion, wellbeing, and disease prevention through diet. Nanotechnology has secured a fundamental role in the fabrication of delivery systems with the capability of modulating the in-product and in-body behavior for augmenting bioavailability and activity of bioactive compounds. Structured nanoemulsions and nanoparticles, liposomes, and niosomes can be designed to improve bioactives preservation after ingestion, mucoadhesion, as well as of their release and pathophysiological relevance. In the future, it is expected that the delivery systems will also contribute to augment the efficacy of the bioactive compounds, for example by improving the intestinal absorption and delivery in the bloodstream, as well as promoting the formation of additional bioactive metabolites by regulating the transformations taking place during digestion and the interaction with the intestinal microbiota. The growing demand for health promotion, wellbeing and disease prevention through diet and nutrition has stimulated the development of smart foods, characterized by advanced functionality for the delivery to the target sites of the bioactive compounds they contain. Until recently, the main challenges to the incorporation of bioactive compounds, such as phytochemicals, micronutrients, and dietary fibers, in foods were related to overcoming the issues of poor dispersibility in the food matrix, unpleasant taste and physicochemical instability under food processing conditions  ,2,3. HowThe food industry has extensively relied on the use of nanotechnology, as an essential tool to extend the capability of controlling the in-product and in-body behavior of delivery systems for bioactive compounds, with applications in agriculture, foodstuffs transformation, packaging, and storage, and the production of dietary supplements ,7. CoherRecently, Mart\u00ednez-Ballesta et al. have reviewed the use of novel nanosized encapsulation and delivery systems to expand the field of application of bio-functional nutraceutical compounds , which cNanoemulsions offer several inherent advantages for the food industry, especially the simplicity of production, high loading capability, high stability against creaming, and optical transparency ,13, but Although biocompatible particles are generally considered as safe for human consumption , the risBecause of the lack of knowledge on potential risks, Mart\u00ednez-Ballesta et al. suggest that the next generation of delivery systems for bioactive compounds should focus on enhancing the bioavailability and activity of the bioactive compounds, to reduce dosages . This ca"}
{"text": "The repercussions of the COVID-19 pandemic for medical students are enormous and not limited to the interruption of courses in medical schools and/or hospital training rotations, the introduction of teaching exclusively online, postponement of examinations, and of the new academic year, but extend beyond that. The mobility of students within the framework of the International Federation of Medical Students\u2019 Associations (IFMSA) is also strongly affected by the unexpected interruption of this program and the deprivation of thousands of students worldwide of this fine opportunity for training, exchange and sharing. The International Federation of Medical Students\u2019 Associations (IFMSA) was founded in 1951 and currently maintains 135 National Member Organizations (NMOs) from 125 countries, representing a network of 1.3 million medical students around the globe. Moroccan students, members of IFMSA like students from other countries, are also concerned. Clinical and research exchanges, carried out under the auspices of the IFMSA, allow all the students to discover the health care and medical education systems of another country in a different sociocultural environment. To maintain student motivation and deal with the repercussions of cancelled exchanges, IFMSA could propose online training programs, adapted to student needs during this period of confinement and deconfinement from June to September 2020. The repercussions of the COVID-19 pandemic for medical students are enormous and not limited to the interruption of courses in medical schools and/or hospital training rotations, the introduction of teaching exclusively online, postponement of examinations, and of the new academic year, but extend beyond that. The mobility of students within the framework of the International Federation of Medical Students\u2019 Associations (IFMSA) is also strongly affected by the unexpected interruption of this program and the deprivation of thousands of students worldwide of this fine opportunity for training, exchange and sharing. IFMSA was founded in 1951 and currently maintains 135 National Member Organizations (NMOs) from 125 countries, representing a network of 1.3 million medical students around the globe (1). IFMSA is recognized as a non-governmental organization within the United Nations system and the World Health Organization and works in collaboration with world medical associations. It thus represents one of the world\u2019s oldest and largest student-run organizations. Each year, more than 15,000 medical students embark on a journey to explore health care delivery and health systems in different cultural and social settings. An organization that annually, fulfills the dream of thousands of students, including those living in the most distant and most disadvantaged regions of the world. Students at all levels of medical studies are involved, from the first year to graduation with the degree in medicine. On average, these exchanges last four weeks and some may last eight weeks.Very excited, motivated, and involved, students will leave their countries for several weeks, perhaps for the first time, heading to different destinations on five continents with the aim of learning, and discovering the functioning of other systems of health care and medical education. IFMSA-Morocco is the national member organization that has represented Morocco at IFMSA since 2012, year that the country officially joined this giant international student organization (2). However, it required two years of preparation and acquisition of the necessary documents, including the agreements and signatures of the deans of the faculties of medicine and the directors of university hospital centers of Morocco, before exchanges could really occur and membership take effect. The first exchanges from and to Morocco thus began in 2014/2015. It should be noted that the \u2018academic year\u2019 for the exchange program corresponds to the period between April of the year in progress and March of the following year. From the year 2014\u20132015 to the year \u22122019, 1,039 non-Moroccan students came to do 861 clinical exchanges and 178 research exchanges in Morocco. During this same period, 1,202 Moroccan students did 991 clinical and 211 research exchanges abroad. The Faculty of Medicine of Oujda, a city in the northeast of Morocco, received 106 foreign students of 25 different nationalities  between the years 2015 and 2019, while 130 students left for 28 different destinations .The training programs through IFMSA provide an immense opportunity for Moroccan students to acquire new knowledge, develop new skills and consolidate acquired knowledge in two areas of medical studies, whether clinical or research. These exchanges are experiences that are not only very rich, rewarding, and interesting, but also marked by deep sharing and exchange between students of different nationalities and socio-cultural milieus. They also allow students to examine and participate in treatment of patients with diseases not usually encountered in their countries, such as malaria, brucellosis, typhoid, tuberculosis, leptospirosis, leishmaniasis, bilharziasis, hemorrhagic fevers, etc., diseases often studied in the lecture halls of the faculties or in medical textbooks, but rarely or never seen in hospital practice.The students, in the framework of IFMSA exchanges, are received in hospital departments and/or affiliated research facilities, participate in different educational activities of the department, are integrated into the medical and paramedical teams, and accomplish predetermined objectives stipulated in their training handbooks, objectives that are appropriate to their level of study and type of exchange, clinical or research. Their educational progress is directly supervised by a senior educator of the hospital department or the director of a research facility. These exchanges also aim to develop more than the student\u2019s medical and research abilities. Very important also for a young doctor, are the interpersonal, communication and management skills needed to communicate with all actors in the health system. Moreover, these exchanges provide an opportunity to strengthen language skills, and English is the universal language of communication between students of different nationalities. Students from Francophone countries may find difficulties in mastering English and language then becomes a real obstacle for some, limiting the choice of countries, and thus of exchange sites.Beyond the educational and research goals, the students discover other cultural and social environments in a climate of respect, tolerance, sympathy and generosity. They are thus better prepared to approach and treat patients of foreign nationalities in their respective countries and develop ethical and cultural competencies accordingly. The activities of IFMSA are far from being limited to training programs, and extend to the organization of general assemblies, large international and regional events, medical prevention campaigns, and conferences.The COVID-19 pandemic, triggered in December 2019, has affected more than seven million inhabitants in 218 countries, has immobilized air traffic in most of the affected countries, and has thus interrupted, across the world, the exchange program of students who should have started their assignments in April 2020. Thousands of students found themselves unable to take part in these exchanges, so desired and eagerly awaited. One part of these programs, notably those scheduled between August and March 2020, could resume if the land or air borders between countries were open and non-essential flights authorized. The exchanges that cannot be conducted this year will be postponed to next year, but this option deprives a great many students of the opportunity to participate.https://ifmsa.org/2020/05/26/climate-change-in-medical-curricula-a-need-for-current-and-future-physicians.International Federation of Medical Students\u2019 Associations. International Federation of Medical Students\u2019 Associations- Morocco.To maintain student motivation and to make up for the exchanges cancelled because of the COVID-19 pandemic, IFMSA could propose special, adapted online training programs during the period of suspension, between June and September 2020, in the form of webinars, workshops, videos of medical simulation scenarios, and courses on diseases with active teaching methods and evaluation tools. Training on the acquisition of the fundamental bases of clinical research could also be organized in the same way as clinical training. It could also organize training sessions on student stress during this period of confinement and deconfinement. These types of training could be moderated by expert senior educators and co-moderated by IFMSA students. IFMSA could also organize, in collaboration with major accredited language centers and organizations, a rigorous, accelerated, certifying program to strengthen language skills, especially in English and Spanish, to benefit the students. IFMSA should play its supportive role for medical students during this period of the COVID-19 pandemic.http://ifmsa-morocco.org"}
{"text": "Several approaches were proposed to describe the geomorphology of drainage networks and the abiotic/biotic factors determining their morphology. There is an intrinsic complexity of the explicit qualification of the morphological variations in response to various types of control factors and the difficulty of expressing the cause-effect links. Traditional methods of drainage network classification are based on the manual extraction of key characteristics, then applied as pattern recognition schemes. These approaches, however, have low predictive and uniform ability. We present a different approach, based on the data-driven supervised learning by images, extended also to extraterrestrial cases. With deep learning models, the extraction and classification phase is integrated within a more objective, analytical, and automatic framework. Despite the initial difficulties, due to the small number of training images available, and the similarity between the different shapes of the drainage samples, we obtained successful results, concluding that deep learning is a valid way for data exploration in geomorphology and related fields. The three-dimensional configuration of a watercourse is generally connected to the tectonic-climatic formation conditions and the evolving morpho-climatic system. The recurrence and ubiquity of some networks in different continental areas also depend on regional macroscale aspects, such as geological outcrops and substrate, gradient, climate, type, and extent of the plant cover. At the local microscale, rock fracturing degree, layers attitude, erosive-depositional processes extent, and resistance to erosion are also involved in the modeling process5.The hydrographic networks of the Earth represent morphologies of the continental landscape characterized by variable dimensions from hundreds of meters to thousands of kilometers and complex geometry, derived by the mutual interaction of numerous physical, biotic and anthropic factors evolving in space and time due to a non-linear physicse.g., Mars and Titan9.However, similar boundary conditions in different regions do not always lead to the same hydrographic patterns modeling: there are phenomena of superimposition of the most recent networks on inherited landscapes, modeled in tectonic and climatic contexts of the past, very different from the current ones. On the contrary, in very different climatic and geological-structural contexts, characterized by active tectonics or volcanism, similar patterns are often observed, due to the morphological convergence and morpho-selection phenomena. These considerations also apply to geometries present in environments very different from terrestrial ones, such as in regions of some Solar System planets and satellites, 10 and references therein). By comparing the various drainage systems present in the two planets and the satellite of Saturn, a greater similarity between those of Titan and Mars was found. In particular, unlike the Earth, in the other two cases the lack of telluric phenomena in the recent past, together with the absence of movements of the tectonic plates, avoided the succession of deviations and anomalies of the river paths, which instead have controlled the modeling of many drainage patterns on the Earth. This means that on the surface of both Mars and Titan, mainly mechanical erosion processes acted. A dense network of large basins was observed on Mars, due to the frequent impact of meteorite bodies and asteroids, which shaped the surface and also conditioned the course of rivers. Recently, this phenomenon was confirmed on Titan by standardizing the resolution of the maps available for the three bodies10. This favored the possibility of carrying out a comparative analysis of drainage patterns on different bodies of the Solar System, classifying them directly from the images, fully combining the experience acquired on Earth and the effectiveness of recent data-driven methodologies.As known, since the beginning of their history, about 4.5 billion years ago, the Earth and Mars planets shared the phenomenon of the modeling of their surface by watercourses, although today, unlike our planet, the surface of Mars appears completely arid. Even the largest moon in the Saturnian system, Titan, resembles the Earth, being the only planetary body in the Solar System characterized by rivers still flowing today, although in the case of Titan they are powered by liquid methane. Despite this, recently was highlighted how the evolutionary history of Titan is unknown  the overall drainage network symmetry and on (ii) the pattern dimensional scaling. The former is rarely present in these natural systems, while the latter is proven mostly for limited portions (sub-basins), rather than for the entire river network. This depends on the difficulty of the geomorphology physics interpretation12. Therefore, we tend to identify a series of main and recurrent dimensionless patterns and their derivations  processes from secondary ones (erosion), through the interpretation of the fractal dimension. As the latter increases, the effect linked to erosion processes compared to tectonic ones, increases, hence the irregularity of pattern too25.The geomorphic-quantitative analysis in river geomorphology26. The apophenia or astronomical \u201cpareidolia\u201d, that is the ability to see forms known or not in clouds, mountains, streams, stars, or planets, is one of the most extraordinary illusions of the human mind which permeates countless anthropic and scientific disciplines, such as religion, mythology, art, astronomy, and geology27. In such a context, the morphology of drainage patterns is perceived and described based on the prevalent configuration attributed to a single dominant pattern. However, this classification is unsatisfactory and imprecise.In short, the hydrographic networks appear formed by a set of minor networks of the tributaries of the mainstem, characterized by a different geometry. It is known that the human classification of bi- and tridimensional objects, natural or not, is based on complex and little understood brain perception models, which are also used in Robotics34, the Machine Learning (ML) paradigms allowed a rapid and growing diffusion of Artificial Intelligence (AI) in all sectors of anthropic and scientific activities. The real challenge of AI is that this sophisticated methodology proved to be decisive for computer tasks apparently easy for people, but difficult to describe formally and extremely time-consuming. Among these, there are problems that we solve intuitively and automatically such as recognizing words, faces, or structures within images38.In the analysis of many complex natural systems, e.g. in Astrophysics, Earth and Planetary Sciences41.The complexity of the human intelligence emulation of natural phenomena by data-driven systems highlights the need to acquire knowledge, extracting conceptual schemes and complex data correlations directly from the primary source, which is the observed data of the studied phenomenonThe Deep Learning (DL) models incorporate both the characterization of the parameter space and the classification system, becoming particularly suitable in use cases where: (i) the expert user can recognize the structures within images, but at the cost of an impractical and long process, often affected by interpretation controversies; (ii) it is extremely complex to extract the information potentially contained in the images. This implies the intrinsic difficulty of applying traditional analytical methods or classic ML models, particularly sensitive to the negative effects induced by incomplete, noisy, and/or insufficient data.The scientific problem of an unbiased classification of drainage networks is characterized by the two mentioned aspects, approached through DL in our research. Different from other methods, by adding data, the DL model reinforces the learning power based on its acquired experience, which is used to generalize the ability to classify new samples, thus improving the accuracy and reliability of the classification of new drainage patterns. Such method, directly applied to images, has the real potentiality to define a new, more objective classification of these complex natural elements, characterized by an irregular and asymmetrical geometry, thus contributing to a better characterization and analysis of terrestrial and extraterrestrial examples.In such a scenario, the primary objective of the present work is to classify the drainage networks in an unambiguous, reliable, and as automated as possible way. Unambiguous means guaranteeing the utmost accuracy in assigning the right class, in accordance, but also on a complementary base, with the broadest and most objective consensus provided by the community of experts in the field.In order to reach this consensus, this work intends to promote the \"River Zoo\" survey initiative, aimed primarily at involving the entire scientific community interested in the field and inspired by the well-known category of \"citizen science projects\". The idea behind such an initiative is mostly to solve the problem of the current lack of drainage network samples useful for facing the exercise of multi-class classification in a statistically consistent and balanced way. Therefore, the multiple participation in the expert survey would be able to guarantee a more reliable assignment of the class to each sample, improving the quality and ensuring an incremental strengthening of the training set for DL models.The DL approach is also able to guarantee the repeatability, coherence, and consistency of classification, by maximizing the incremental acquisition of experience , thus ensuring the application of same and consolidated criteria to other drainage network samples over time.Furthermore, another significant aspect of the presented method is to exploit the aseptic and complete information deriving directly from the analysis of the images, avoiding the use of potentially biased, incomplete, and ambiguous derived information, i.e., traditionally extrapolated from processed physical and environmental parameters. Finally, the method is intrinsically automated, thus able to minimize the human intervention in the classification process, relegating it to an a posteriori analysis and the scientific exploitation of the results obtained.Certainly, the long-term goal of the project, for which this work is a fundamental premise, is the multi-class classification using at least the taxonomy highlighted in Fig.\u00a0This work is organized as follows: \u201chttp://dame.oacn.inaf.it/riverzoo_files/DrainagePatternsReferences.txt). For the supervised DL experiments, we assigned class labels to the collected Earth examples by distinguishing between two classes, respectively, dendritic (D), including subtypes sub-dendritic, pinnate and high-relief pinnate, versus not-dendritic (ND), including other subtypes, such as trellis, parallel, rectangular, angular, annular, radial, centripetal, herringbone and barbed. The intrinsic difficulty to provide a sufficient amount of training samples motivated the choice to apply data augmentation techniques to improve the model training capability. This procedure included uniform sizing of all images to 540\u2009\u00d7\u2009540 pixels and their augmentation, obtaining five further samples for each original image, through three rotations of, respectively, 90, 180, and 270\u00a0degrees and two flipping operations concerning, respectively, horizontal and vertical axis. A further advantage was to make the trained model invariant to different orientations of drainage networks within images. Furthermore, we vectorized the images, to make the morphology of a network in a simple, but informative and quantitative form and converted them in grayscale, to simplify the extrapolation of the network pattern. Then the images were cleaned to remove residual noise and to re-arrange parts of the reticle partially lost by the conversion. The labeled dataset of 131 Earth samples was then subdivided into three subsets, using, respectively, 70% for training, 10% for training validation, and the last 20% as a blind test set used to estimate the statistical performances.Both Earth and extraterrestrial drainage network images have been extracted from public literature and dedicated websites  and two variants of gradient descent methods, respectively, Adadelta48 and ADAM49.As known, the experiments based on DL are characterized by a long test campaign for the heuristic optimization of its hyper-parameters, highly dependent on the degree of the intrinsic difficulty of the problem, and only partially mitigated by the experience in the use of such methods. Our test campaign led to the final selection of three customized models, respectively, VGGNet\u2009+\u2009Adam, VGGNet\u2009+\u2009RF, and AlexNet\u2009+\u2009Adadelta Fig.\u00a0. VGGNet 43 inspired by two typologies known in the literature. These neural networks are inspired by the behavior of the biological model (human brain). Artificial neurons are organized into several layers, hierarchically connected. As in the biological model, the variation in synaptic connections is related to the learning mechanism. During training, these connections between layers  are adapted through a mechanism of propagation of the signal back and forth in the network. At the end of the training process, the supervised model  establishes a non-linear input\u2013output relationship, coded by the resulting weight matrix.The two DL model architectures chosen downstream of a test campaign are two CNNs41.The CNN model represents one of the most widespread supervised DL methods, whose peculiarity is the presence of a set of so-called receptor fields that identify the synaptic activity of neurons. A receptor field can be represented by a matrix  that connects two consecutive layers through a convolution operation. Similar to the mechanism behind the adaptation of weights in a classic neural network, the kernels are modified during training. The important prerogative is the ability of a CNN to automatically extract the representative features of pixel regions distributed in the image, such as arcs, shapes, structures of various forms, variations in contrast and intensity. Then, these features are coded in a vector at the end of the sequence of internal layers, supplied as input to any classification model, which assigns the category to each structure identified in the starting image. The basic idea of a CNN is the multi-layer mechanism in which convolution and synthesis (pooling) levels of the propagated information alternate. This stratification process usually is made up of dozens of layers, in each of which the convolution level acts as a filter, thus emphasizing or suppressing different features of the image. The pooling level ensures the conservation and propagation of essential information (not redundant) extracted up to that pointUnlike the layers of a classic neural network, in which the neurons of one layer are all connected by weights with each neuron of the next layer, in a CNN these connections are \"scattered\", i.e., limited to a reduced fraction. This reduces the number and complexity of operations, the amount of memory required, and therefore the computing time. The output of each layer consists of a set of sub-images, smaller in size than the original image, called \"feature maps\".49.Another useful operation, even if optional, in the propagation process, is the so-called \"dropout\", which is a series of random interruptions between the neural connections, to avoid excessive \"specialization\" of the network to the images provided in phase training and keeping it more \"flexible\", that is, able to extrapolate the recognition of structures similar but different from those of the training set, a problem known as \"training overfitting\". In the tests carried out in this work, various dropout percentages were used in some cases, to avoid the occurrence of this problem, together with the use of the common early stopping training methodIn the case of classification problems, the final output of a CNN\u2009+\u2009classifier model is represented in the form of a probability matrix, in which each input sample (image) has associated a probability of belonging to each of the classes of the problem.50. The adaptation of the weights of the network, at each training cycle, is performed to minimize an error function . In the case of the models used in this work, this function is the \"cross-entropy\"51:The final attribution of the class takes place through the classic \"softmax\" function, which normalizes an array of values to a probability distribution47;Random Forest: ML method composed of a set of decision trees, built from subsets of features, randomly chosen, capable of attributing, through a \"majority\" mechanism, the class of belonging to each structure present in the image provided as input48;Adadelta: optimization method based on the descending gradient technique, which adapts the learning rate to each iteration, avoiding an excessive reduction of the gradient value of the error function49.ADAM (Adaptive Moment Estimation): a method similar to Adadelta which, in addition to reducing the gradient through the variable learning rate, introduces a mechanism for updating the weights taking into account the moments (mean and variance) of distribution of gradient functionThe first CNN model selected was derived from the VGGNet network45. The network consists of a series of layers, in which the alternation between convolution and pooling is performed by considering several consecutive convolution levels before each pooling level. This model was chosen by considering its high classification performances, already verified in other scientific fields, characterized by the high complexity of data52, like those subject of the present work.Amongst the various classification algorithms used during the test campaign, the so-called optimizers, placed as the last layer of the CNN models, three methods resulted in the best candidates:45. In addition to the succession of layers formed by the alternation of convolution and pooling, its main feature is the final \"dense\" triple-layer, composed of thousands of neurons fully connected.The second CNN model selected is inspired by the AlexNet network53: (i) the average efficiency (AE), obtained from the sum of the correctly classified samples, weighed concerning the total of the samples of the test set; (ii) purity (P), also known as precision; (iii) completeness (C), also known as recall; (iv) F1-score (F1), obtained as the harmonic mean of purity and completeness. These last three estimators were derived for each class  is about 2.65 times lower than Earth (0.981\u00a0g). In this case, the drainage networks were not modeled due to the lower weight of water and sediments, but from the higher speed of water and the intense surface run-off in the pastBy predicting the class of extraterrestrial patterns, using models trained only on Earth samples, the results were in agreement with human expert analysis in 88% of cases. Therefore, the DL approach appears quite robust in the prediction, even in cases of different morphologies, and with a high rate of generalization accuracy.As outlined in the previous sections, this work was mainly based on two fundamental aspects, both deriving from the intrinsic multidisciplinary nature of the pursued approach.First, the absolute novelty of the application of methodologies, already widely used and validated in other scientific fields, to a specific scientific use case, in this case, the geomorphology one. This had the primary purpose of (i) minimizing, in perspective, the subjective human interpretation in the classification of drainage patterns and (ii) performing the pattern recognition directly from images, thus avoiding any bias effect induced by the selection of the parameter space, i.e. the physical and environmental parameters extracted from images, which is at the base of most traditional approaches.Secondly, due to the novelty of the approach, we had to proceed from the initial level, that is, from the simplest and most general possible case of the two macro-class classification, for instance, dendritic versus non-dendritic, avoiding in the first instance the well-known problem of error propagation in the case of a hierarchical pairwise classification of different sub-classes. This, to validate the methodological approach and to acquire the necessary experience to be subsequently poured into the harder multi-class problem. Naturally, the simultaneous multi-class classification, that is the attribution of a drainage pattern to one of the ten classes, enucleated in Fig.\u00a0Precisely for this reason, we launched the River Zoo initiative, which aims at quantitatively enriching the database, both in terms of quantity and variety of examples suitable for training the Deep Learning models, through the direct involvement of the wider community of experts interested in the scientific problem.http://dame.oacn.inaf.it/riverzoo.html). Such initiative, inspired by what was done in Astrophysics60, by exploiting the scientist experience, has the role to provide reliable ground truth for DL-based classification.Due to the high sensitivity to the subjective class labeling of training samples, we implemented a public survey addressed to interested researchers, called \u201cRiver Zoo\u201d and available on the Web (Main goal of this project is to perform a statistical evaluation of the classification of terrestrial and extraterrestrial drainage networks by human experts.The idea is to analyze the degree of reliability of class assignment to drainage samples, driven by user expert decisions, taken just by looking at their image and choosing the right pattern type Fig.\u00a0. In thisThe DL approach represents a useful method for the analysis and classification of Earth and extraterrestrial physical geomorphological objects like drainage networks, here applied for the first time.The study of terrestrial drainage patterns is suitable for the research of geological processes responsible for the formation of a specific morphology and may have significant results even at a multidisciplinary level. Considering that the geological-climatic context and the network shape are mutually interconnected, the analysis of Earth, Mars, and Titan basins assumes an important relevance for the study of paleoclimate and indicates a morphological convergence of different and complex erosion processes, suggesting that some patterns could be ubiquitous in the Solar System.Finally, we are confident that the River Zoo public survey initiative could contribute to improving the knowledge about morphological and geologic-climatic aspects of drainage patterns, besides its potential to improve their classification and to extend the training ground truth."}
{"text": "Asthma is the most frequent chronic disease in children, and its pathogenesis involves genetic, epigenetic, and environmental factors. The rapid rise in the prevalence of asthma registered over the last few decades has stressed the need to identify the environmental and modifiable factors associated with the development of the disease. In particular, there is increasing interest in the role of modifiable nutritional factors specific to both the prenatal and post-natal early life as, during this time, the immune system is particularly vulnerable to exogenous interferences. Several dietary factors, including maternal diet during pregnancy, the duration of breastfeeding, the use of special milk formulas, the timing of the introduction of complementary foods, and prenatal and early life supplementation with vitamins and probiotics/prebiotics, have been addressed as potential targets for the prevention of asthma. In this review, we outline recent findings on the potential role of prenatal and perinatal dietary and nutritional interventions for the primary prevention of pediatric asthma. Moreover, we addressed unmet needs and areas for future research in the prevention of childhood-onset asthma. The role of several dietary factors, including maternal diet and vitamin status, composition of the microbiome, duration of breastfeeding, the use of hydrolyzed formulas and the introduction of complementary foods, has been investigated in recent clinical trials, to identify potential targets for the prevention of childhood-onset asthma , vitamin E, and zinc had a protective effect against early life wheezing in offspring, but not on childhood-onset asthma or other atopic conditions. One recently published study, assessing the impact of pre-pregnancy diet on the risk of allergic outcomes in children  in asthma prevention is still controversial. Two early RCTs showed no significant difference between pHF and eHF in the prevention of allergic diseases in children, including asthma , 42. In In a recent birth cohort study, infants received breast milk only, pHF with or without a hypoallergenic label, or non- hydrolyzed formula. The use of the pHF-with hypoallergenic label, compared to non-hydrolyzed formula, had no protective effect on the risk of asthma up to 2 years of age and was related to a higher risk of wheezing at 1 year in high-risk infants . A recenThe hypothesis that VD status in childhood might influence the susceptibility to childhood asthma and allergy is supported by the evidence on the role of VD as a key modulator of lung growth and innate and adaptive anti-inflammatory immune responses \u201350. ExpeInterestingly, VD supplementation during pregnancy and infancy has been related to a reduced risk of sensitization to house dust mites at age 18 months .in-utero  or a diet-limited supplementation (control group) showed a 34% reduced risk for recurrent wheezing by 12 months in the intervention group . There iin-utero  and postin-utero , and proin-utero . InterveThere is mounting evidence showing the relationship between the composition of the early-life gut microbiome and the risk of asthma in children , 58, whiIn a 2-year follow-up RCT involving 132 infants at risk of atopy, infants that were fed with a formula containing a mixture of prebiotic oligosaccharides reported a lower incidence for recurrent wheezing compared to the placebo group . In a 1-Taken together, the evidence on the effects of oral probiotics and prebiotics for the prevention of pediatric asthma is so controversial that no definitive recommendation can be made. Differences in the probiotic strain specificity, the population treated, the timing of administration, and the duration of the intervention all contribute to the heterogeneity of the meta-analysis and of RCT outcomes.The supplementation with omega-3 long-chain polyunsaturated fatty acids (LCPUFA) during pregnancy and early life, through the administration of fish oil, has been proposed for the prevention of allergic sensitization and atopic disease, including asthma , 73. LCPConflicting results have been found in studies investigating fish oil supplementation in infants and children for the prevention of allergic sensitization and asthma \u201367 Tabl. A meta-Recent advances in the field of allergy prevention showed that early 2000s recommendation to delay the introduction of solid allergenic foods to the infant's diet is not an effective approach to reduce the risk of allergic sensitization and atopic diseases in children \u201388. MoreThe timing of the introduction of fish is of particular interest to the purpose of primary prevention of asthma, given its high content in LCPUFA. Despite the heterogeneity in the methods of analysis and outcome measures, the early introduction of fish has been associated, in many observational studies, with a reduced risk of allergic sensitization , 94. HowThe significant increase in the prevalence of asthma and allergic diseases registered in recent years has promoted research on the identification of modifiable risk factors for the prevention of such disorders. It is well-acknowledged that respiratory health is determined by a complex interaction between genetic factors and environmental drivers that occur during prenatal and early postnatal life, including dietary factors. However, it remains difficult to define the contribution of specific dietary supplements and nutritional food sources to the risk of developing pediatric asthma, due to the heterogeneous pathogenesis of this disease and the limitations of the currently available evidence, in terms of study design, type and duration of interventions and outcomes measures.Further research is needed to accurately identify dietary and nutritional modifiable risk factors for asthma and to address whether the modulation of such factors, either alone or in combination, could contribute to the primary prevention strategies of pediatric asthma.DP, GN, IT, GC, and PC made substantial contributions to conception, design, and acquisition of data. GC, IT, GN, and PC drafted the initial manuscript. DP, EV, ED'A and PC critically reviewed it for important intellectual content. All authors approved the final version of the manuscript. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "Interstitial Lung Diseases (ILDs) are a large family of disorders characterized by inflammation and/or fibrosis of areas of the lung dedicated to gas exchange. In this Special Issue entitled \u201cClinical and Radiological Features of Interstitial Lung Diseases\u201d, we collected a series of contributions in which a multidisciplinary approach was crucial for the correct diagnostic assessment of ILD. Sharing knowledge between different specialties can significantly improve diagnostic approaches and the management of ILD patients. Interstitial Lung Diseases (ILDs) are a large family of disorders characterized by inflammation and/or fibrosis of areas of the lung dedicated to gas exchange. The impairment of lung parenchyma causes the occurrence of symptoms, and in some ILDs, such as idiopathic pulmonary fibrosis (IPF), it may lead to respiratory failure and death. Some ILDs, including IPF and sarcoidosis, are idiopathic, others such as hypersensitivity pneumonia and drug-induced ILDs recognize specific etiologic agents, some others are instead associated with systemic diseases, as in the case of connective tissue diseases (CTD-ILDs) . ILDs reAll articles of this Special Issue are comprehensive and innovative in their approaches, addressing practical and still controversial or unresolved clinical problems related to the diagnosis, follow-up, and prognosis of ILDs. The two editors, Stefano Palmucci and Sebastiano Torrisi, both have the merit to involve and coordinate in this Special Issue, a number of young clinicians and experts. Looking at the list of authors who contributed to the different articles, it is nice to note the variety of their specialties: Biologists, physicists, immunologists, rheumatologists, radiologists, internists, computer scientists, and pulmonologists have all contributed to the success of this issue dedicated to ILDs. The participation and commitment of young experts to this group of diseases, coming from very different scientific settings, confirm the relevance and the broad clinical interest for this important chapter of the respiratory diseases."}
{"text": "Using the time series of 1 Jan 2020 to 26 June 2020, I employ a machine learning technique, i.e. Least Absolute Shrinkage and Selection Operator (LASSO) to examine the research question for its benefits over the traditional regression methods. This further allows me to cater to the issue of limited data during the crisis and at the same time, allows both variable selection and regularization in the analysis. Additionally, LASSO is not susceptible to and sensitive to outliers and multi-collinearity. The European market is mostly affected by indices belonging to Singapore, Switzerland, Spain, France, Germany, and the S&P500 index. There is a significant difference in the predictors before and after the pandemic announcement by WHO. Before the Pandemic period announcement by WHO, Europe was hit by the gold market, EUR/USD exchange rate, Dow Jones index, Switzerland, Spain, France, Italy, Germany, and Turkey and after the announcement by WHO, only France and Germany were selected by the lasso approach. It is found that Germany and France are the most predictors in the European market.  Specifications tableThe world has seen enough of the catastrophic implication of the COVID-19. Till 27 June, confirmed COVID-19 infections have crossed 10 million and with the loss of 5,02,208 lives around the globe. This had a further devastating impact on the global economy See: . Global The international market integration has been a topic of interest in recent times. The coronavirus has had a significant impact on the global economy. This increased volatility and impact on the world financial market is well documented in the literature The literature on pandemic and financial markets is evolving and currently explores rising volatility due to COVID-19 and uncertainty in the financial markets see .In this study, we analyze the potential European and global markets that shook Europe. To do this, 21 different potential predictors of the European financial market including predictors inside and outside Europe are used. The 21 indicators include indices from countries which got impacted by the COVID-19 the most along with gold, oil and bitcoins. This is done using a machine learning approach named LASSO regression, which allows both the model selection and regularization in the analysis. Germany, France, Gold, the S&P500, Singapore, Switzerland, Spain, Italy, Turkey, the Dow Jones, and the EUR/USD are found to be among the most important predictors of Europe. Germany and France are found to be the top predictors of Europe.The remainder of the article is structured as follows: the following section provides information on data and methods which describe the data sources, the variables specification, and estimation methods. This followed by a detailed discussion on the analysis and discussion on the importance of the predictors found to be important to Europe. Finally, the conclusion section.We employ daily data from 1 January 2020 till 26 June 2020We employ a machine learning technique, known as the Least Absolute Shrinkage and Selection Operator (LASSO) for the default sample and subsample periods. The literature on LASSO provides two main advantages of employing lasso over other methodologies like wavelet or ANN; first, LASSO offers a special feature of coefficient shrinkage, which automates the model selection in linear regression due to the nature of 1-penalty, and while doing so it further removes some variables from the model. It also factors in the the issue of multicollinearity as it is not sensitive to outliers and multicollinearity LASSO combines the least-squares estimator with an extra constraint on the sum of the absolute values of the coefficients. The limited data availability, during the COVID-19 crisis, might be an issue for traditional times series analysis, however, learning from the data, lasso also takes care of this problem and gives the best predictors.Before the pandemic announcement, Gold, EUSDD, DJ, Switzerland, Spain, France, Italy, Germany, and Turkey indices are found to be the most important commodities and indices that impacted Europe. For the third sample, that is after the announcement of the global pandemic by WHO, only France and Germany are found to be impacting Europe. However, no commodity market is found to be impacting Europe. The plausible reason could be that oil prices were falling due to its own dynamics [23]y-axis and the L1 norm is shown on the x-axis. For the default sample, it is found that all the selected predictors shown in To get further insights into the degree of importance of the selected predictors, the coefficient paths obtained from models are plotted in Addressing the nature of the impact of these predictors, these figures suggest that overall, the impact on Europe is (1) negative from Gold, the S&P500, and Singapore. And (2) positive from, along with the indices from, Switzerland, Spain, Italy, Turkey, the Dow Jones, and the EUR/USD. While Germany and France are found to be the top positive predictors of Europe. Though the LASSO selects different variables across different subsamples, the impact of selected variables remains unchanged.We attempted to explore the potential predictors of the European financial market by examining the impact of protentional internal and external determinants. Germany, France, Gold prices, S&P500, Singapore, Switzerland, Spain, Italy, Turkey, Dow Jones, and the EUR/USD are found to be the predictors of the Europe market. Germany and France are found to be the most important determinants of the European market. Though the LASSO selects different variables across different subsamples, the impact of selected variables remains unchanged.The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper."}
{"text": "The authors wish to make the following correction to this paper .Biomolecules [The affiliation of Dr. Anuj Kumar was incorrect in the published paper in olecules .Therefore, this information was changed by the Biomolecules Editorial Office from:School of Chemical Engineering, Yyeongsan 38541, KoreaTo:School of Chemical Engineering, Yeungnam University, Gyeongsan 38541, KoreaWe apologize for any inconvenience caused to the readers. The manuscript will be updated, and the original will remain online on the article webpage with a reference to this Erratum."}
{"text": "The extractionof data from primary studies was performed using an instrument produced bythe authors and which allowed the construction of the categoriespresented.18 publications were included in this review. Among the most studied themesare the difficulties of the teams regarding the continuity of care in thehealth network; the importance of in-service education by themultidisciplinary team; professional unpreparedness; bioethics; thevalidation and application of scales for prognosis and care for somepathologies such as cancer and diabetes; among others.it became evident that palliative care in primary health care has beengradually developed, but it is necessary to consider the organization ofprimary health care and the social policies that support or weaken it, beingconsidered a complex challenge. Currently, PCs are defined as \u201cactive holistic care, offered to peopleof all ages who are in intense suffering related to their health, resulting fromserious illness, especially those who are at the end of life. The objective ofPalliative Care is, therefore, to improve the quality of life of patients, theirfamilies and their caregivers\u201d.The most recent definition of Palliative Care (PC) was published in 2018 anddeveloped after a large project involving more than 400 members from 88 countries ofthe International Association for Hospice & Palliative Care (IAHPC), anassociation that maintains close ties and official relations with the World HealthOrganization (WHO).Thus, offering palliative care to people with serious illnesses takes into accountnot only the person, but everyone involved in the care. As a definition, seriousillness is understood as \u201cany acute or chronic illness and/or condition that causesa significant disability and that can lead to a condition of disability and/orweakness for a long period, or even death\u201d.. It is noteworthy that, in the 1980s, the life expectancy of Brazilianswas 62.5 years. Currently, the reality is different, the numbers have increased, bothlife expectancy has risen to 76 years and the number of services that provide palliative care in the country.This increase in life expectancy is the result of investments in public policies bythe State, including the implantation and implementation of the Unified HealthSystem (UHS).In Brazil, isolated discussions and initiatives in PC have been found since the1970s. It is noteworthy, however, that it was in the 1990s that the first organizedservices began to appear. It is .5 years. Curren76 years and the.Until August 2018, after a survey carried out by the National Academy of PalliativeCare (NAPC), 177 palliative care services were identified, distributed in the fiveregions of Brazil. Of these, 58% (103 services) are concentrated in the Southeastregion, 20% (36 services), in the Northeast region, 14% (25 services), in the Southregion, 5% (eight services), in the Midwest region, while only 3% (five services)are located in the North of the country on primary health care (PHC) and PC, held in 2014, aimed to understandthe roles of PHC professionals in palliative care and pointed out that PHC can makea difference to patients and their families by having easy access to them, close tohome, be able to carry out constant management of symptoms and sensitivity to therealities of the community: \u201cProfessionals monitor the aging and fragility of theirpatients, the efforts of families to accommodate the new care needs of theirmembers, fears, financial insecurity and, therefore, cannot avoid this moment: it isexactly in situations like this that the full potential of PHC actions and theFamily Health Strategy (FHS) becomes more evident. No other health service can standside by side with these families with such property and face the path of palliationwith constant presence, guidance and welcome\u201d.As a result of the growth in the life expectancy of the population, there is anincrease in the occurrence of Chronic-degenerative Noncommunicable Diseases (CNCDs),which make the demand for PC a contemporary public health problem. An integrativereview on primwelcome\u201d., held in 2015 on palliative care and PHC, aimed to identify, in theview of health professionals, the ethical problems arising from practice in thiscontext. The ethical problems detected were the scarcity of resources, the lack ofknowledge about PC, the lack of communication skills, the difficulty of establishinglimits in the clinical relationship, the work overload and the lack of support fromthe reference services. The authors concluded that, in order to incorporate PCs inPHC, specific norms and training are required, in addition to the culture of sharedand co-responsible care.A systematic review, held ible care.Therefore, in order to know the current panorama of palliative care in PHC andbecause there are no studies like this, which synthesize scientific evidence inrelation to the theme, justifying this study and its importance, it is presented asan objective: to map the available evidence on the main topics investigated inpalliative care in primary health care.. The elaboration of the scoping review followed a process consisting offive stages: a) Identifying the research questions; b) Identify the relevant studiesvalid for the investigation; c) Selection of review studies; d) Mapping of data fromstudies included in the review; e) Confront, summarize and report theresults.This is a scoping review study, carried out based on a set of techniques in order tomap knowledge on certain topics in a research field. It differs from systematicreview because it aims to focus on broader themes and include studies with differentdesigns. The elresults.For this, the PICO strategy was used, acronym for Patient, Intervention, Comparisonand Outcomes, for the definition of the following guiding question: \u201cWhat evidenceis available about palliative care in primary health care?\u201d. For the construction ofthe aforementioned question and to carry out the search, the PICO strategy wasstipulated as: P for Population, Patient or Problem (what evidence is available); Iof Interest  and Context CO .This review was conducted in the databases Medical Literature Analyzes and RetrievalSystem Online (PubMed/MEDLINE), Latin American and Caribbean Literature in HealthSciences (LILACS), Web of Science, Scopus and Cumulative Index to Nursing &Allied Health Literature (CINAHL). For this, the controlled and indexed descriptorswere used for each of the databases in this review. For the combination of these,the boolean operators OR and AND were used.From the research question, terms were selected in the Health Sciences Descriptors(DeCS) and terms in the Medical Subject Headings (MeSH) containing the appropriatedescriptors for searching the databases. The controlled descriptors used were asfollows: a) PubMed/MEDLINE: palliative care , hospicecare (synonym: hospice program), terminal care, critical illness, primary healthcare (MeSH); b) LILACS: palliative care , palliative care at the end of life , terminal assistance ,terminal care , Primary Health Care ; c) Web of Science; d) Scopus; e)CINAHL: Palliative care , hospice care (synonym:hospice program), terminal care, critical illness, primary health care (MeSH).For the selection of studies, the following inclusion criteria were considered: a)original research articles; b) made available in the full version; c) published inthe period 2009 to 2019, the last ten years; d) Portuguese, French, Spanish andEnglish languages.Exclusion criteria were defined: a) studies whose theme palliative care is presentedas a \u201crecommendation\u201d in the results and conclusions, not being configured as acentral object of the study; b) dissertations, theses, public policies and videos.The search for jobs for primary research took place on April 27, 2019 via advancedform.After identification, primary studies were selected, according to the guidingquestion and the previously defined inclusion and exclusion criteria. This step wascarried out by two reviewers independently. The instrument, designed for the purposeof extracting and analyzing data from the included studies, was composed of thefollowing items: 1- article identification; 2- object and/or question and/orobjectives of the study; 3- type of study/design; 4- data production tools and/ortechniques; 5- year; 6- magazine; 7- participants and/or sample; 8- main results; 9-area; 10- country. The stages of selection of the studies included theidentification, screening, eligibility and inclusion.The categorization was the form adopted for the analysis of the results in which itwas extracted how the PC has been carried out in the PHC. The work of analyzing thestudies consisted of a careful task. There was an interest in knowing andcharacterizing the panorama of the studies according to its investigated object. Forthe presentation of the data, we chose to build sequential figures that sought todemonstrate how the CP theme in PHC was studied by different authors.(-) were relevant for this review, since they met the study question andpre-established criteria, as explained in the analysis flowchart  and from Brazilian authors, five were published in Spanish and three in English. Of the included studies, eight used the qualitative approach and ten, the quantitative. As for the instruments / techniques for data collection/production,questionnaires, interviews, observation, discussion groups and application of scaleswere used. Among the study participants, the following were identified: healthprofessionals; formal and informal caregivers; patients eligible for palliativecare. Two studies, also, had sample of medical records of patients, according toWith regard to language, eleven studies analyzed were published inPortuguese-,-,-26 annish-,-17 annglish,,22. Oht-,- used th; meaning of being a caregiver and on PC for health professionals; evaluation of tumor asthenia; validation and application of a tool for prognosis; identification and characterization of patients in PC andservices; pain evaluation; assessment of dignity at the end of life; difficulties in accessing PCs; the work process in PHC; perspectives of occupational therapists in PC in PHC; ethical problems; comfort of caregivers of patients in PC; relationship between social support, quality of life and depression inPC patients in PHC, the complexity and/or difficulties in palliative care athome, the peculiarities of palliative care with high cost demands -infrastructure, the insufficient number of visits by health professionals, limited multidisciplinary approaches, insufficient professional training, the reduced scientific production in the area, the need to structure PHC for this purpose,the existence of very general care protocols and difficulties in accessing psychological support.The analysis of scientific production has shown that, although there have beenadvances in recent years, palliative care practices in PHC have still been incipientand, when they occur, present limits, as described in the results in ,21, tthome-,23, ttructure, the inssionals, limiteproaches, insuffaining,-21, t purpose,the exirotocols and dif support..Such aspects are related to the organization of care networks and primary healthcare. In Brazil, Family Health teams represented advances in access and healthindicators, but face difficulties of various kinds, such as economics, withunderfunding of health, training of professionals and improvement of networkarticulation, among others.. Perhaps, the incipience of this practice in Brazilian services isdemonstrated by the absence of a public health policy that specifically structuresor guides the development of these actions.An analysis of the current panorama of the PC, carried out in 2018, indicated that,although aware that primary care may be the strategy with the lowest cost andgreatest impact on the health of a population, the provision of palliative care inthe country is centered on hospitals. Perhap actions..A study involving Brazil and France addressed the transition of patients betweenhospital palliative care services and homes and showed that, in both countries,there are difficulties in this transition related, among others, to caregiverfatigue and fear of death. In this study, hospital discharge was also addressed withrationalizing purposes such as the release of beds. addressed the insufficient training of professionals for palliativecare and this theme was also evidenced in research, pointing out that the professionals\u2019 unpreparedness to deal with thedemands and needs of chronic health conditions was present in countries that have anaging population longer than Brazil.The studies,-21 adresearch, pointiDeath, understood as a theme that is part of the daily life of health services,integrates the different phases of the human life cycle, but it is still a topicthat is treated in a reduced way, both in the training of health professionals andin health services, compromising the principle of integrality. it was shown that the request by family members not to reveal thediagnosis to the patient may coincide with the professional\u2019s option, reinforcingtheir own difficulties with the subject. An integrative review of PC in PHChighlighted that the monitoring of the process of death and grief and thecommunication of bad news, among other topics, are rarely addressed in training andhealth services.In the study it was services..In some speeches of the professionals and in their actions, the curative model stillprevails, focused on the disease and the specificity of care. The training ofprofessionals could favor health education for patients and families, especially inrelation to the implementation of PC in PHC,14.. Thus, it is believed that institutionalized spaces that can putprofessional practices in an interdisciplinary way, are essential for the promotionof comprehensive palliative care.In addition, Permanent Health Education (PHE) is considered learning at work, takeseveryday life as an open space and a permanent reviewer of professional practices,as a place of subjectivity and discussions. Thus, However, it is considered that the provision of palliative care in primary care isrelated not only to the professionals\u2019 capacity for the development of palliativecare, but also with universal health systems that are organized in a network andguided by an expanded conception of the health-disease process, taking into accountsocial determinants and social inequalities. \u201cPoor\u201d teams in poor locations thatmaterialize selective primary care are unable to take on the complexity of primaryhealth care and palliative care..Teams without adequate working conditions may, for example, make an insufficientnumber of visits by health professionals to these families. on Primary Health Care in Latin America addressed 12 countries anddiscussed the relationship between the implementation of comprehensive primary careand universal social protection. Certainly, this aspect does not match theimplementation of neoliberal policies and flexibility of social rights, as has beenseen not only in Brazil.A study on PrimThe authors addressed Primary Health Care in full, which considers the family andcommunity focus, the territorial base, the work in multi-professional teams andsocial participation and the expansion of this aspect in Latin America in left andcenter-left governments. Concerns were raised about the current political scenarioin this region of the world. articles brought the association of palliative care and cancer. Anotherfive articles mentioned cancer, but not in isolation, they also pointed outother diseases such as diabetes, Alzheimer\u2019s disease, as well as respiratory andcardiovascular diseases. The expansion of PCs to other diseases appeared in a studyon human rabies and suggested a review of clinical guidelines, proposing theintroduction of PCs for people with rabies in endemic countries.It was observed that five-,-,23 arfive,,-26 arountries..Initially, palliative practice was directed only to cancer patients, but gradually itstarted to be incorporated by other specialties involved in the care of patientswith chronic-degenerative diseases. In its first edition, published in 1995, the\u201cMedical guidelines of the National Palliative Care Organization (NPCO) fordetermining the prognosis in Selected Non-Cancerous Diseases\u201d determined theprognosis of non-cancer diseases and included them in the palliative care programs.The first non-cancer diseases to be included were: Congestive Heart Failure (CHF),Chronic Obstructive Pulmonary Disease (COPD) and Alzheimer\u2019s disease..Subsequently, the second edition, published in 1996, added the following pathologies:Aids (Acquired Immunodeficiency Syndrome); liver and kidney disease; leakage; comaand Amyotrophic Lateral Sclerosis (ALS)..If the association of diseases with palliative care can facilitate the specificity ofthe care to be offered, for Primary Health Care teams, other knowledge needs to bemobilized, such as, for example, the dynamics of family relationships and theproduction of unique therapeutic projects, as pointed out in a study. and the Karnofsky Performance Scale (KPS). Another article proposed the correlation between two scales, the KPSand the ICD-10 classification (ICD-10).The use of scales/instruments to define people eligible for palliative care wasaddressed in six articles, using the Palliative Performance Scale (PPS) and theKPS),,-26. A(ICD-10)., the General Comfort Questionnaire (GCQ), to assess the comfort offormal and informal caregivers, the European Cancer Research and Treatment Organization scale (EORTCQLQ-C15-PAL), to measure patients\u2019 quality of life, the Medical Outcome Study (MOS)scale, for assessing the level of social support, and the Center for EpidemiologicalStudies - Depression (CES-D) scale for identifying symptoms ofdepression.In addition to the scales to identify people\u2019s eligibility for palliative care, otherinstruments, such as the Visual Analog Scale (VAS), were used to assess painintensity, the Geregivers, the Eupression..An article that aimed to develop the Dignity Scale for Palliative Patients (PPDS) andused six other scales is highlighted: the Patient Dignity Inventory (PDI), whichidentifies sources of suffering in patients at the end of life; the Hospital Anxietyand Depression Scale (HADS); the Brief Resilient Coping Scale (BRCS), which measuresresilience; the GES Questionnaire, referring to spirituality; the IBPC C-30 Qualityof Life scale (EORTC-QLQ-C30) and the Duke-UNC-11 Functional Social SupportQuestionnaire, which assesses confidential and affective social support.In addition, it is essential that the primary health care professional knows andknows how to use the main scales used in palliative care, such as the EdmontonSymptom Assessment Scale, the Karnofsky Performance Scale and the PalliativePerformance Scale. Thus, professionals can have tools to help guide the specificcare plan for palliative care.; respect and willingness to understand the meaning attributed by thepatient and their family about death; communication used as a strategy to establish a bond; active and sensitive listening; non-judgment or abandonment of the patient and maintenance ofhope, even about the efficiency of the treatment for symptom relief. Thisdemonstrates that the way of doing, at this moment, emphasizes the ethical andinterpersonal dimensions in the professional-patient-family relationship.Regarding the work process of FHS professionals involved in the care of patients atthe end of the process of living, the following ways of caring can be identified:compassion-empathy-,-19; r death,,21; cning-,,21; n ofhope,19, etionship. publications, this subject was addressed. In one of them, ethics in palliative care was the central theme, includingaspects involving the communication of bad news, such as lack of sincerity andhiding the truth. Another article approached the subject, presenting a brief discussion about otherness,considered one of the references of bioethics.The discussion on bioethics was not a recurring theme in the selected articles and,in only two,21 pu article approacIt should be added that, for the effectiveness and guarantee of palliative care inprimary care, it is assumed that there is articulation between the various healthservices and several other sectors - consequently, other professional categories -such as: transport, to ensure accessibility; social security, guaranteeing socialrights; and justice, to ensure access and equity..In addition, in the intra-sectoral prism of the health system, relations with thevarious medical specialties  must besigned and perpetuated, in addition to different multi-professional categories,areas of epidemiological information and management, among others. articles, with an emphasis on the need for theoretical, scientificknowledge and specific clinical skills in the domain of different professions sothat the integrality of actions in the process of offering palliative care takesplace, thus contemplating the physical, psychosocial and spiritual dimensions of thepatient and their family.The importance of the multi-professional team was mentioned as fundamental infive,,-21 ar.In addition, within its scope, PHC has the potential to develop a set ofinterventions that favor the quality of life and continuity of palliative care,inside and outside the home, and can potentially favor and provide the patient withcare close to the patient family and friends, in addition to reducing the risk ofinfections and suffering from unnecessary hospitalizations,34.In addition, for the PC to evolve in PHC, it is necessary to plan the offer, identifyand meet the needs, the available resources, practice the sharing of informationthrough appropriate communication and define the commitments of the partiesinvolved. This is done in collaborative relationships and practices betweendifferent professionals, families and managers..In line with Resolution No. 41, of October 31, 2018, which provides for guidelinesfor the organization of palliative care, in the light of integrated continuous care,within the scope of the Unified Health System (UHS), it is advised that \u201cthepalliative care should be part of the integrated continuous care offered within thescope of the Health Care Network (HCN)\u201d, with PHC being considered the originator ofcare and territorial action..In order for changes to occur in the scope of management and care, the ability todialogue and problematize the current concepts within each health team is essential.The construction of new pacts, with the approximation of concepts aboutcomprehensive, humanized and quality care, in addition to equity and milestones thatoccurred strongly in the process of reforming the Brazilian health system, areessential for such changes to occur.This study has as its limit the non-problematization of the different health systemswhere the studies were produced, and primary health care is not always developed inits integral aspect, and there is still a strong orientation of health servicesaccording to the hospital logic. In addition, another limitation is the inclusion ofarticles in only four languages , which mayhave limited access to other publications on the topic.It is hoped that the compilation of the findings presented in this review may giverise to new lines of research and encourage other publications, contributing to thescientific advancement of the theme and performing the function of aid and supportfor the restructuring of practices and policies related to palliative care inprimary health care.The evidence and themes investigated relating palliative care in primary health carepoint to the possibility of this care, since these teams work closely with familiesand the territories where they live. Such a process could occur in health systemsthat implement primary care articulated with social policies, which ensure health asa human right, being difficult to implement in non-universal systems and withprimary care teams with few resources and poor articulation in a servicenetwork.The studies point out possibilities of using scales that can assist in theidentification and follow-up of people in palliative care, such as the EdmontonSymptom Assessment Scale, the Karnofsky Performance Scale and the PalliativePerformance Scale. There are also productions that point out aspects of subjectivityas important, highlighting empathy, listening and valuing cultural aspects.There are articles that deal with specific pathologies, with emphasis on cancer,diabetes and several pathologies that participate in the epidemiological anddemographic transition. It is emphasized that specific care needs to be recognizedat the same time that, in primary health care, other knowledge needs to be mobilizedto consider family and social dynamics and thus build unique therapeuticprojects.It was possible to identify, in this review, that there is a concern with the initialtraining of health professionals and on-the-job training, as this is stillincipient. To improve this situation, the insertion of the PC discipline in healthcourses is recommended and the implementation of permanent education and healtheducation actions to bring family members and professionals closer together, takinginto account cultural and social aspects of each family and team.However, it is reaffirmed that the provision of palliative care in primary care is acomplex challenge that goes beyond the preparation of professionals and familymembers, involves changing the logic and the care model that is still centered ondiseases, economic logic and professional practices that compete with each other ina corporate way. This process is also related to social policies that conflict withthe implementation of neoliberal policies and the flexibilization of socialrights."}
{"text": "The article analyzes how approaches to \u201cLiving Well\u201d as reflected in the Constitution of the State of Bolivia, the Law of the Rights of Mother Earth, and the American Declaration on the Rights of Indigenous Peoples of the Organization of American States (OAS) contribute to understanding the Andean cosmovision of indigenous peoples of the American continent. To do so, it first studied the most immediate precedents that led to incorporation of the notion of Living Well into Bolivian law. Second, it approached the right to development from the American Declaration on the Rights of Indigenous Peoples, which has as its source the United Nations Declaration of the Rights of Indigenous Peoples. The paper thus proposes reflections on the Bolivian State and the American Declaration that advance understanding of Living Well, a notion comparable in the West to the right to development  that enables the individual and collective realization of the individual. Fullness, understood in terms of well-being, is related to the protection of health and of the environment. Finally, the paper employs a qualitative methodology with a well-documented hermeneutic focus, as well as the tool of a semi-structured interview with a Bolivian scholar familiar on the topic. In 2017, the Economic Commission for Latin America and the Caribbean (ECLAC) counted 826 indigenous peoples, of which 200 live in voluntary isolation. In 2014, Bolivia had the largest proportion of indigenous persons in its total population of any country in the region, 62.2% or over 6 million people. Like Bolivia, other ECLAC countries have large numbers of indigenous inhabitants relative to their total population: Guatemala 41% or 5.9 million, and Peru 24% or 7 million  an inalienable human right by virtue of which every human person and all peoples are entitled to participate in, contribute to, and enjoy economic, social, cultural and political development, in which all human rights and fundamental freedoms can be fully realized.\u201dThese are the claims for the individual. In parallel, from the collective perspective, development implies \u201cthe right of peoples to self-determination which includes, subject to the relevant provisions of both International Covenants on Human Rights, the exercise of their inalienable right to full sovereignty over all their natural wealth and resources\u201d (Article 1). \u201cThe human person is the central subject of development and should be the active participant and beneficiary of the right to development\u201d (Article 2). Various legal instruments on indigenous issues have considered the right to development in their different articles. First, Convention 169 (Articles 7 and 23) of the ILO includes the right of indigenous peoples to take decisions about priorities concerning the process of development and the duty of States to lend their support (Article 7). The Convention also stresses the importance of the traditional activities of indigenous peoples to their development (Article 23) .Second, through the principle of free determination, the UN Declaration on the Rights of Indigenous Peoples recognizes \u201cpolitical, economic, social, and cultural development. And to end all forms of discrimination and oppression, wherever they occur.\u201dThese peoples should control the events that affect them and their lands, territories, and resources according to their needs and aspirations (Preamble). States must therefore adopt effective measures such as free, prior, and informed consent concerning these lands and territories (Article 29) .Indigenous peoples have the right to maintain and determine their own priorities with respect to their political, economic, social, and cultural development in conformity with their own cosmovision. They also have the right to be guaranteed the enjoyment of their own means of subsistence and development, and to engage freely in all their economic activities ,6.This right includes the \u201cdevelopment of policies, plans, programs, and strategies\u201d for the exercise of their right to development and to implement them in accordance with their legal, political, social, institutional structure and their cosmovisions.Indigenous peoples have the right to be actively involved in developing and determining development programs that affect them and, to the extent possible, to administer such programs through their own institutions and their cosmovision.States shall consult and cooperate in good faith with the indigenous peoples concerned through their own representative institutions in order to obtain their free and informed consent ,53 priorIndigenous peoples have the right to effective measures to mitigate adverse \u201cecological, economic, social, cultural, or spiritual impacts of the implementation of development projects\u201d that affect their rights. Indigenous peoples who have been deprived of their means of subsistence and development have the right to restitution and, where this is not possible, to fair and equitable compensation. This includes the right to compensation for any harm caused to them by the implementation of plans, programs, or projects of the State, international financial institutions, or private business.The OAS Declaration also materializes the right to development in Article 29. The content of this article is very similar that established by the UN Declaration mentioned above. More specifically, this article includes five situations:It is also important to mention briefly the legal development of the IHR Court on this issue. The IHR Court was a pioneer in expounding the close relationship of indigenous and tribal peoples to the land. Specifically, the IHR Court recognized the right of indigenous and tribal peoples to enjoy the earth without need of a formal title to property. It has decreed the adoption of special measures to guarantee exercise of the right to protection of physical and cultural survival, as in Mayagna (Sumo) Awas Tingni Community v. Nicaragua . SimilarFurther, the IHR Court stipulates indigenous and tribal peoples\u2019 right to property in the case of natural resources discovered in their territories. Without resources, the economic, social, and cultural survival of the peoples is at risk, as demonstrated in the case of Yakye Axa Indigenous Community v. Paraguay . SimilarOn this order of ideas, the IHR Court also identifies the tremendous importance of the right to consultation and prior, free, and informed consent. The right of indigenous peoples to participate and to have their institutions and cosmovision respected includes the definition, demarcation, and allocation of a title to an indigenous or tribal territory, taking into account \u201ctraditional law, values, uses, and customs.\u201d This assumption is reflected in Awas Tingniv. Nicaragua . In SaraOn the right to consultation, the Court determined in the case People of Sarayaku v. Ecuador that States have the obligation to consult with indigenous peoples. It based its decision not only on support for this notion in conventional law, but on also on the fact that the law of consultation constituted a general principle of international law that has been incorporated into domestic statutes and the jurisprudence of the great majority of the OAS member States .Finally, it is worth noting that, following the recent promulgation of the OAS Declaration for the International Day of the World\u2019s Indigenous Peoples (August 9), the Court Reporters of the UN and the Inter-American Commission of Human Rights (ICHR) published a joint press release reaffirming indigenous peoples\u2019 right to development, adding that a countries\u2019 development \u201chas been and continues to be driven at the expense of indigenous peoples of the continent.\u201d Ultimately, the right to development, on the one hand, implies the right of all indigenous peoples to define their own development priorities, whether political, economic, social, or culture, according to their cosmovision; on the other, it challenges the States to guarantee that indigenous peoples enjoy their own means of subsistence and development and dedicate themselves freely to their economic activities .The right to development cannot be interpreted in isolation from other rights that complement it and facilitate understanding it as a whole if we seek to equate the right to development to Andean Living Well, which goes beyond the satisfaction of needs for comfort or consumption in monetary terms. Two sets of rights follow. The first set, the rights established in the third Section on Cultural Identity, includes: the right to cultural identity and integrity (Article 13); the right to preserve, use, develop, revitalize, and transmit to future generations their own systems of knowledge, language, and communication (Article 14); the right to education, particularly of indigenous children, at all levels and in all forms, without discrimination (Article 15); the right freely to exercise their own spirituality and indigenous beliefs(Article 16); the right to preserve, maintain, and promote their own family systems (Article 17); collective and individual rights to the enjoyment of the highest attainable standard of physical, mental, and spiritual health;(Article 18); and the right to protection of a healthy environment (Article 19).The second set encompasses the rights in the Fifth Section on Social, Economic, and Property Rights, including: the right to maintain and strengthen their distinctive spiritual, cultural, and material relationship with their lands, territories, and resources(Article 25); the right to remain in voluntary isolation or initial contact, and to live freely and in accordance with their cultures (Article 26); labor rights, such that States shall take all specific measures necessary to prevent, punish, and remedy any discrimination (Article 27); the right to protection of their tangible and intangible cultural heritage and intellectual property, including its collective nature, transmitted over millennia from generation to generation (Article 28); and the right to peace, security, and protection(Article 30).We will now focus on the right to peace, which is linked most directly to the right to development. Previously, the UN Declaration on Development  had asseThe UN Declaration of the Rights of Indigenous Peoples understands the right to peace as the suppression of military activities in lands or territories of indigenous peoples, unless there is a public reason to justify intervention. In any case, the State must consult before using indigenous lands or territories (Article 30.) The OAS Declaration later views this matter similarly to that of its UN predecessor, but includes more extensive content. According to the Preamble of the OAS Declaration, only:\u201crecognition of the rights of indigenous peoples in this Declaration will foster harmonious and cooperative relations among States and indigenous peoples, based on the principles of justice, democracy, respect for human rights, nondiscrimination, and good faith.\u201dIn their totality, these factors enable harmonious coexistence, that is, realization of the right to peace. The Declaration also includes this right explicitly in Article 30, under the title, \u201cRight to peace, security, and protection\u201d of indigenous peoples, in which indigenous peoples are subject to protection under law. This formulation differs from the UN Declaration on the Rights of Indigenous Peoples, which considers indigenous persons as the subject of protection.Article 30 also recognizes the right to autonomy of indigenous institutions; the right to protection and security in situations of war , according to international humanitarian law; and the fourth Geneva Convention of 1949 on the protection due civil persons in times of war. In addition, Protocol II of 1977 on the protection of the victims of armed conflicts, which is not international in character, recognizes these rights. In the case of armed conflicts, States must take appropriate measures to protect the human rights, institutions, lands, territories, and resources of indigenous peoples and their communities.Special emphasis is placed on protecting the most vulnerable in the group, such as indigenous children and women, prohibiting their recruitment in the armed forces, providing effective compensation and reparations for the harm or damage caused by an armed conflict, taking special and effective measures to avoid all forms of violence ,simultaneously guaranteeing the right of access to effective justice, protection, and reparation of the damages caused to the victims, and protecting their right not to engage in military activities.Within this scenario, the last report of the Inter-American Commission on the situation of indigenous peoples of the Amazon states that \u201cIndigenous peoples have the right to be protected from forced displacement due to violence, as usually occurs in contexts of armed conflict.\u201d By analogy, forced displacement directly attacks the existence of indigenous peoples due to their bond with their territory, \u201con which they depend for their physical and cultural survival.\u201d The indigenous population displaced in urban environments is easy prey to poverty and discrimination, labor exploitation, sexual violence, human trafficking, and crime. For these reasons, States should adopt special protective measures, although such measures do not exclude taking measures to enable the return of indigenous people \u201cto their traditional territories safely and with dignity\u201d .Finally, the right to international peace and security are fundamental elements for constructing the right to development. The right to peace and the right to development are closely related to Andean Living Well, which are related to the individual and collective harmony of indigenous persons and their peoples and, above all, to living together in and for peace.As previously mentioned, Bolivia plays an important and critical role in contributing to issues concerning indigenous peoples, and this contribution spans the legal, political, economic, cultural, and environmental spheres. This section focuses on the legal sphere.First, Bolivia has taken an important step in including in its Constitution  the prohThis law originated to remedy the former prohibition of indigenous people and animals from access to public establishments. Specifically, the Framework Law of Mother Earth stipulates that Living Well means that indigenous persons live \u201cin a just, equitable, and solidary society, without material, social, and spiritual poverty\u201d (Article 4. Law 300).A catalog of constitutional rights (Article 30.II).The constitutional and hierarchical equivalence of ordinary and indigenous jurisdiction (Articles 190 to 192).Recognition of rural native indigenous autonomy (Articles 289 to 296).Second, recognition of the following matters in the Constitution of Bolivia  providesIn fact, there must be compatibility and complementarity of \u201cfundamental, civil, political, social, economic, and cultural rights to Living Well\u201d (Article 4. Law 300). This idea includes individual and collective rights and freedoms linked to free determination of rural native indigenous peoples. But the concept is also associated with consultation and consent, natural resources, lands, and territory, which are often the subject of controversy between indigenous peoples and the State. According to Article 349 of the Constitution of Bolivia, natural resources are the property and direct and indivisible domain of the Bolivian people.Third, on the right to development, Article 9 of the Constitution affirms that it is the goal and function of the State to guarantee the development, well-being, security, and equality of persons, nations, peoples, and communities. The State must therefore foster \u201cmutual respect and intracultural, intercultural, and plurilingual dialogue.\u201d Bolivia considers development to be integral, \u201cin harmony and equilibrium with Mother Earth\u201d (Article 1. Law 300), Integral Development for Living Well, understood as:\u201cthe continuous process of generating and implementing social, community, citizenly, and public management measures and actions for the creation, provision, and strengthening of conditions, capabilities, and material, social, and spiritual means within the framework of culturally sufficient and appropriate practices and actions\u201d (Article 5. Law 300).Fourth, on the topic of Peace, the Constitution includes in Article 10 that Bolivia is \u201ca pacifist State that promotes the culture of peace and the right to peace, as well as cooperation among the peoples of the region and the World\u2026\u201d (Article 10.I). Article 4 Section 12 of the Framework Law of Mother Earth speaks of the \u201charmonious, dynamic, adaptive, and balanced relationship\u201d between the needs of Bolivia and Mother Earth. Peace is related to harmony, which means \u201cLiving Well amongst ourselves, Living Well with those around us, and Living Well with oneself.\u201dFinally, the influence of the Andean world view is present in the text of the Constitution. As Baldivieso writes: \u201cPrimary laws are enriched with rural native indigenous values and principles that generate fundamental and organic laws, but the law also keeps the higher goods inherent in Western culture; an interesting axiological symbiosis that gives rise to the development of Bolivian legal pluralism\u2019\u2019 .Within this conceptual framework, we will now briefly tackle the contributions of the OAS Declaration. This is an international legal instrument, subsidiary to national law, and the State is the main organism responsible for and guarantor of protection of the rights of all of its citizens within its jurisdiction. As with the Constitution of Bolivia, one of the arguments for development of the OAS Declaration revolves around the vindication of indigenous and tribal populations, which were not historically included, but rather, were made victims century after century. The first checks were imposed on this situation at international level, with the OLI\u2019s Convention 107  and Convention 169 [The OAS Declaration recognizes that the vulnerability of indigenous and tribal populations led them to be dispossessed of their lands, territories, and resources, and that this has made it impossible for them to exercise their right to development, understood in terms of economic and social well-being. The Declaration recovers this respect for cultural identity and exercises the right to development according to one\u2019s needs. Finally, it supports development as an essential element to achieve Living Well.On the right to peace, the Declaration recognizes peace, along with security and protection, as a totality, in times of both peace and war or conflict  and draws on other international instruments and humanitarian international law. It seeks to protect its women, children, and adolescents, who are direct victims of conflicts . The Declaration also firmly rejects military activities in territories or lands of indigenous and tribal populations. The only exceptions are public interest and having reached an amicable agreement between the indigenous population and the State.Definitely, the OAS Declaration attempts to equate indigenous peoples\u2019 right to development and peace as integral elements of understanding Andean Good Living. Therefore, the right to development first recognizes the inseparable connection of indigenous peoples to the land, territory, and resources, which are conceived as a pillar of development. Second, the right to peace\u2014defined as peace, security, and protection of indigenous peoples\u2014incorporates essential elements for achieving the right to development. That is, both rights (peace and development) and other connected complementary rights  constitute the condition \u201csine qua non\u201d to make it possible to speak in terms of equivalents to Andean Living Well. At the same time, these rights are mechanisms to guarantee the protection and defense of indigenous and tribal peoples against State decisions that may go against their economy, politics, culture, environment, or institutions.Finally, the jurisprudence of the IHR Court plays a valuable role, first as the \u201ccement\u201d for establishing and consolidating the edifice of the rights of indigenous and tribal peoples, constructed primarily around the right to development and peace, both of which are intimately related to Andean Good Living. The Court also establishes that control and possession of land, territories, and natural resources are indispensable parameters for the survival and development of indigenous peoples. Further, it consolidates this inseparable association of indigenous populations and the Earth, their territories and natural resources  resources, energy, flora, fauna, etc.) as elements crucial to their economic, political, social, cultural, and institutional development from their Andean cosmovision. Finally, the Court seeks to construct the inseparable synergy between indigenous and tribal peoples and Mother Earth known as \u201cPacha Mama, Mucane, Tonanz\u00edn, Iwi, Nana Tlalli, Gaia\u201d .Appreciating and illustrating this close relationship that indigenous peoples have had historically with the environment and recognizing their rights are essential for the global implementation, monitoring, and fulfillment of the 17 Sustainable Development Goals (SDGs) in the Framework of the UN\u2019s Agenda 2030  along thAt the Inter-American regional level, the Commission and Court for Inter-American Human Rights, as organisms for the protection of the Inter-American Human Rights System, have been working on indigenous issues and the environment. Since 2019, the IHR Court has handed down 24 sentences in favor of indigenous populations. Its legal work on protection of the environment remains, however, incomplete. The Inter-American Commission on Human Rights, in contrast, is already working on these issues and has produced three reports. These are the 2013 report on the situation of \u201cIndigenous Peoples in Voluntary Isolation and Initial Contact in the Americas: Recommendation for the Full Respect of their Human Rights\u201d ; the 2012). This area is considered the most biodiverse in the world, with tremendous cultural and biological wealth. It is also a \u201csource of subsistence for the whole planet because it is a biome that operates as a global climatic stabilizer \u2026and as a reserve of flora, fauna, and genetic diversity.\u201d From the times of our ancestors to the present, this region has been inhabited and has served as the place where indigenous and tribal peoples develop their lives, knowledge, and traditional practices. It is home to around 350 peoples, including those in voluntary isolation and initial contact [We take the example of the Amazon Basin, part of which is located in Bolivia, with the rest distributed across eight other countries: Brazil, Colombia, Ecuador, Guyana, French Guiana, Peru, Suriname, and Venezuela  [The Bolivian Constitution\u2019s Article 390.II states that the country\u2019s Amazon territory includes the departments of Beni , Pando, La Paz , Cochabamba and Santa Cruz , 724,000g (CNPV) , there aBolivia\u2019s domestic law specifically includes the protection and preservation of the Amazon region at a Constitutional level . The State prioritizes the sustainable integral development of Bolivia for its \u201cenvironmental sensitivity, existing biodiversity, hydric resources, and ecoregions.\u201d The State also administrates this development, fostering the financing of tourism and ecotourism activities in coordination with the rural native indigenous peoples in the region. To do so, it facilitates dialogue through the creation of a special decentralized entity in the Amazon, fostering traditional extractive products. Finally, the State protects against cutting species such as the syringa and chestnut due to their \u201chistoric, cultural, and economic value,\u201d declaring them symbols of the Bolivian Amazon. Violating this law leads to criminal punishment except in cases of public interest.It is important to stress that Bolivia protects the environment as a right included in the Constitution (Article 30.II.10) and the laws favor Mother Earth and Living Well. Environmental law is protected by other constitutional clauses dedicated to its enforcement . This right is also linked to the right to health, as the State further promotes \u201cquality of life\u201d free access of the Bolivian population to healthcare and protection of the traditional medicine of indigenous populations (Article 35).These articles are also connected to Title II, on Environment, Natural Resources, Land, and Territory, which holds the State and the population responsible for the duty of preserving, protecting, and sustainably exploiting resources and biodiversity (Articles 342 to 347). To this end, environmental management policies are established, since this heritage is of public interest. There is also a special chapter on Hydric Resources. The right to water is recognized as \u201ca most fundamental right for life\u201d and health, through regulation of its use and integral management .Finally, we value very positively for a society like Bolivia its aspiration to collective and individual well-being of its citizens, reviewed in protection and guarantees of the right to the environment and its care. This strategy will be much more productive, however, if it not only includes national law but also makes the regional agenda of all States a priority, i.e., the agendas of both the American continent and the rest of the world. The first victims in this line of fire are always the most vulnerable, in this case, indigenous populations and those without contact or living in voluntary isolation, who live in harmony with nature and from whom we have much to learn. In fact, their participation and wisdom were fundamental elements in the processes that produced the UN\u2019s Agenda 2030 for Sustainable Development .The Amazon has significantly affected the way of life, culture, and harmony with nature of the Amazonian indigenous peoples, who have been threatened since the twentieth century by increased extraction activities, reflected in increased logging, that accelerated deforestation that have given way to problems with other land uses. In recent times, there have been many changes, at the regulatory level, in State policies and practices aimed at increasing the extraction of natural resources and advancing large infrastructure projects, exerting pressure on indigenous ancestral territories ,63.In this context, there is a debate among States regarding the ratified international legal instruments of the United Nations and the Inter-American Organizations, emphasizing among other duties deriving from these instruments: (a) Design and effectively implementation of an adequate normative framework for the protection of human rights, which may be affected by extractive, exploitative and development activities; (b) the need for a legal framework that adequately addresses the operation of foreign companies within the jurisdiction of a State; and (c) the duty to prevent illegal activities and forms of violence against the population in areas affected by extractive activities, exploitation, or development .Accordingly, the State must adopt the most appropriate legislation and not contradict these rights, for example, environmental protection standards are indispensable in domestic legislation, not to bring before the Court the State for violating the human rights of the affected populations, and for activities that affect the environment . In thisThe great contradiction between theory and practice makes it difficult for legislators to carry out their work and makes legal implementation difficult, in relation to the exploitation and extraction of the natural resources of the Amazon region, with a combination of interests of individuals and the State itself. The lack of regulation or inadequate regulation of the resources of the Amazon, and the excesses in their exploitation and indiscriminate use, is a pending problem not only at the national level, but also at the global level.In the case of Bolivia, legal implementation at the constitutional and legislative levels has been favorable with regard to the protection of natural resources and indigenous peoples. Thus, the aim of the State is \u201cto promote and guarantee the responsible and planned use of natural resources and to promote their industrialization\u201d (Article 9.6). In particular, Title II, entitled \u201cEnvironment, natural resources, land and territory\u201d, provides for their treatment . In thisThe new Constitution grants ownership of natural resources to the people of Bolivia and is administered by the State in the collective interest (Article 311.II); the State is responsible for the mineral wealth found in the soil and subsoil (Article 369.I). It also deals with biodiversity, forest resources, hydrocarbons, mining, land, and the Amazon (Articles 390 to 392) . In thisThe internal law of Bolivia (Constitution and Laws) is progressive and supports the rights and recognition of the indigenous worldview. This was reflected in different aspects such as identity, feminism and its struggle for equality and justice among different genders, ethnicities, and social classes, with indigenous communities and their traditions. As a result, the cross-cutting \u201cgeneric, cultural, ethnic, and generational diversity\u201d and the principles of equity, interculturality and non-discrimination are taken into account throughout the constitutional text .First, indigenous identity is one of the essential elements in order for a human community to be considered a native indigenous rural people and nation . In this context, these peoples enjoy, among other rights to their cultural identity, religious belief, spiritualities, practices and customs, and to their own worldview, so that, if they consider it, the possibility of registering it with Bolivian citizenship and other official identification documents (ethno-citizenship) .Second, is feminism and its struggle for gender equality and justice. The Constitution recognizes the equality of conditions between men and women, as well as a series of guidelines and rights in favor of equality in relation to political participation and internal election of leaders ; field of work and wages (Article 48); sexual and reproductive rights (Article 66); vocational and humanistic education (Article 78.IV); and more specific rights directed to women, such as: not to suffer physical, sexual or psychological violence, in the family and in society (Article 15.II); maternity and special care before, during, and after childbirth and in the pre-and post-natal periods (Article 45.V); and in this line, not to be dismissed or discriminated against for any of the above reasons, ensuring their occupational security until the child reaches the age of one (Article 48). Consequently, the State is responsible for promoting policies aimed at eliminating all forms of discrimination against women in access to, tenure in and inheritance of land (Article 402).With regard to indigenous women, according to PilarUriona, \u201cLiving Well\u201d is situated \u201cin the context of the recognition and revaluation of the various existing identities\u201d, with the \u201cchallenge to secure a permanently shared political gender agenda so that, in practice, the new legislation reflects the rights and claims that women demand and not the opposite of what is demanded\u201d .However,Third, is sethnic groups and social classes. Discrimination against indigenous people and their populations is a challenge to be overcome throughout the world. In Bolivia, the current Constitution (Article14 and other related articles) eliminates all types of discrimination; especially in 2010, with the entry of the Law against Racism and all forms of discrimination,  where ArThe ethnic and cultural diversity of the American continent characterizes some ethnic groups whose ancestors lived in Africa. People of African descent remain ethnically and culturally distinct collectives, sharing a common identity, origin, history, and tradition . Afro-deThe Constitution mentions all the original languages that make up Bolivia, considering the plurinational as part of its commitment to inclusion and social justice, promoting mutual respect and intra-cultural, intercultural and multilingual dialogue (Article 9). The premise is that Bolivia is made up of all Bolivians, the original indigenous peoples, the intercultural, and Afro-Bolivian communities, which together are the people (Article 3).In order to avoid conflicts, the economic, social, political, and cultural rights of the Afro-Bolivian peoples, as provided for in the Constitution for the native indigenous rural nations and peoples, are recognized in all matters of concern to them. The State also provides them with fiscal land that they do not possess or are insufficient, in accordance with State policy, with a policy of sustainable rural development and women\u2019s ownership of land without discrimination on the basis of their civil status (Article 395).Finally, with regard to indigenous peoples in danger of extinction, or in voluntary isolation and not contacted , their iHistorically, the Bolivian people have stood up in 10 marches against the measures and policies of exclusion implemented by various governments, demanding universal vote, agrarian reform, and the participation of the indigenous majority, women, and farmers in the public and political spheres. Subsequently, other marches have taken place, progressively achieving the inclusion and recognition of the rights of excluded groups, such as the native indigenous peasant populations .The political movement also achieved the legal recognition and inclusion of the Afro-descendant community , as wellThe vindication of indigenous persons and their peoples in Bolivia has brought important advances in recognition of their rights and dignity, but it has also revived their hope that they will not return to being excluded and oppressed in an unequal society. The question arises as to whether the protection of Bolivian constitutional law and international law in guaranteeing the rights and worldviews of indigenous peoples is sufficient. It is a collective that has been generationally marginalized throughout history, but, through the United Nations Declaration of Indigenous Peoples, significant progress has been made with the recognition of a number of essential rights  .Later, with the American Declaration on the Rights of Indigenous Peoples, it becomes clear that the States themselves are still the natural guarantors of the rights of their citizens, constituting the OAS protection bodies which promote a series of provisions for the promotion and protection of the rights of individuals, who are considered indigenous, and who are identified as such, among their parts. This represents a major step forward in the development of indigenous peoples\u2019 issues and inter-American jurisprudence. In this area, it constitutes an invaluable contribution to the protection of the rights of the indigenous and tribal peoples of the OAS member States. However, although a legal framework, both international and national  for the protection of indigenous peoples is fully in place , regulatWith the adoption of ancestral knowledges  State policies have given concrete form to a hopeful process of change toward Living Well. These policies have been incorporated in Bolivian national law, bringing favorable changes and reforms to benefit these populations. Living Well is care for \u201cMother Earth\u201d, for the person as individual being, social being, collective or group being, and spiritual being, and for the environment. Maintaining the equilibrium of these elements involves harmony within oneself, with one\u2019s environment, and with the cosmos, a plenitude that correlates with health . Although approaches to Living Well differ depending on whether one takes an international perspective or an Andean one, there are points of intersection that should be preserved in both dimensions. Specifically, both approaches pursue the protection and guarantee of the rights of indigenous populations, recognizing the unquestionable bond of indigenous populations with their land, their territory, and their natural resources.As a result, the State must respect the rights of indigenous populations, using the law of prior, free, and informed consultation to guarantee peaceful and harmonious coexistence among indigenous persons, their populations, and the State, as well as equilibrium of the environment and natural resources, such as water. Finally, these rights guarantee quality of life, dignity, health, culture, and preservation of their identity, customs, culture, and oral traditions, among other rights. A long road and many unfinished tasks remain to complete this process, the more so because the process is taking place in a framework conditioned by the individual interests of the States, which sometimes either fail to implement sufficient mechanisms or only do so partially, not taking into account the rights of indigenous populations. But this situation transcends not only our generation and any specific territory, but also the political or economic situation of a single country; it goes beyond even current deforestation of the flora and fauna and the impact on the environment and biodiversity. It involves us all, because if we do not do something to protect these indigenous populations and \u201cMother Earth\u201d as a whole, there will soon be little we can do. We will have destroyed any glimmer of hope for intergenerational equity.Finally, changes are not won in a single day. Promoting transformations of such magnitude requires time, courage, monitoring, and rigor to enable mature evaluation and reveal the aspects that need improvement and strengthening. We must also consolidate and continue the work to make the process of change toward Living Well possible, regardless of who comes to power and who dominates the world in any particular circumstances or at any given moment. Therefore, within the framework of the UN Agenda 2030 of SDGs, we must encourage and protect the knowledge of nature and the hereditary knowledge possessed by the rural native indigenous peoples of Bolivia and of other territories. They are an asset of incalculable value for the adoption and success of this crucial global strategy of humanity. This process will be aided by making a breakdown of data and inclusion of an \u201cindigenous identifier\u201d in the UN\u2019s official statistics on countries\u2019 progress toward fulfilment of Agenda 2030.The survival, dignity, wisdom, well-being, and respect of the rights of the indigenous peoples of Bolivia specifically, and of the whole world in general, constitute an essential foundation for successful dialogue between indigenous peoples and States. But above all, they represent hope for our future generations, for respect for our Mother Earth, for sustainable development, and ultimately for our common future on Earth, in the framework of the Andean vision of Living Well.In the case of the State of Bolivia, its Constitution makes it directly responsible for guaranteeing, protecting, and respecting the rights of indigenous nations and peoples (Article 30.III). It is a good start, that the first guarantor and responsible for a right is the State itself. These policy measures encourage the equal and non-discriminatory treatment of persons, regardless of their original social race, already covered by the Article 2 of the Universal Declaration of Human Rights. However, this does not mean that an ideal situation has been reached in this area. In this country, although the Constitution includes in part different important aspects that have been demanded since the first marches in the last century, there is still much work to be done, not only at the national level, but also at the regional and global levels. The task is not only for the State in question, but for everyone."}
{"text": "Medical service policy plays a prominent role in the development of a \u201cHealthy China.\u201d This paper constructs a three-dimensional framework for text mining of medical service policy using the elements of policy instruments, policy strength, and types of medical service activity. Taking Sichuan Province as an example, 221 medical service policy documents, issued by the government and related departments, are selected as the research sample; the policy instruments, policy strength, and medical service activity types are analyzed using ROST and Nvivo 11.0 software. It is concluded that the government needs to optimize the structure of policy instruments, to appropriately reduce the use of environmental policy instruments in particular, while increasing the use of demand-based policy instruments. It is necessary to strengthen the interaction between the various sub-policy instruments, and to increase the use of financial services, fiscal taxes, overseas communications, and strategic measures. An increase in the implementation of government policy assists the acceleration of the policy landing, the further improvement of the supervision system, and the safeguard mechanism of the three medicine policy linkage, which can improve the sustainability of the medical service policy, and further resolve the difficulty and expense of seeing a doctor. Health is the foundation of a better life for everyone, and, increasingly, attention has been paid to factors affecting health, ranging from global environmental problems , 2, climAdvice on progressing the reform of the medical and health system in 2019, which was issued by the General Office of the State Council, clearly identified the need to study and formulate relevant policy documents; guidance, management, assessment methods; and regulations on medical and health care within 1 year, in order to implement the Healthy China strategy and further reform the medical and health system. Therefore, in-depth analysis of the content of the medical service policy document is of great practical significance to the improvement of the medical service and the promotion of the \u201chealth of all people.\u201d At present, there are many problems to be solved in China's medical service . The assPolicy instruments , which aRothwell and Zegveld's policy instrument classification gave relatively little importance to plays down their mandatory characteristics and strengthens the role of government as environmental architect in the process of promoting policy projects, rather than only as an interventionist and controller , which iThe strength of a policy depends on the administrative level of the relevant government agencies: the higher the administrative level of a government agency, the greater its authority. This phenomenon reflects the government's priority on medical development. The weaker policy was promulgated by the lower-level government agencies, which also reflected the importance attached by the lower-level government to the development of medical care. At present, research on policy strength mainly focuses on quantitative research. Cheng and Qian  cited PeMost existing policy content analysis frameworks select two or more of the dimensions of policy instruments, policy subjects, policy strength, and so on. However, medical service policy is characterized by multi-type activities, therefore this feature is introduced here into the policy analysis framework. The types of activity related to medical service can generally be divided into three categories: medicine-related activities, medical activities, and medical insurance activities . In thisThis paper constructs a three-dimensional framework for analyzing medical policy based on the elements of policy instruments, policy strength, and medical service activities, as shown in The research method adopted is content analysis, which enables systematic and objective analysis of the policy text, both quantitatively and qualitatively . This haRoumell and Salajan  conducteThe sample policy documents used in this article were obtained from the official website of the People's Government of Sichuan Province, the Health Committee of Sichuan Province, the Sichuan Provincial Healthcare Security Administration, the Sichuan Drug Administration, and the Sichuan Traditional Chinese Medicine Administration. These government documents were selected according to the following principles: (1) the issuing unit is the Sichuan Provincial Government and its relevant departments; (2) the selected policy document is directly related to the medical policy; and (3) the policy document is issued in the comprehensive medical reform stage. Based on the feasibility of the policy document acquisition, a total of 221 valid samples of policy issued during the period 2010\u20132018 were collected; some of these are shown in The word network association diagram obtained using ROST software reflects the overall situation of medical service policy in Sichuan Province from 2010 to 2018; however, it is impossible to analyze the text content in detail. Therefore, this paper continues to use Nvivo 11 software to further mine and explore the policy text to ensure the integrity of the research results. The main method used is line-by-line coding of the research samples, to determine the research dimensions and keywords according to the relevant data and industry characteristics; this selects \u201csupply-side policy instruments,\u201d \u201cenvironmental policy instruments,\u201d \u201cdemand-side policy instruments,\u201d \u201cpolicy strength,\u201d and \u201cmedical service activities\u201d as tree nodes, constructing sub-nodes under each of these. Nvivo 11 software is used to code the reference points of each node according to the selection of nodes and reference points. If the total amount of text is consistent, the more reference points there are, the more adequate the disclosure of information. The reference points are the reflection of the absolute number of nodes in the policy text.The classification results for policy instruments are obtained from the coding analysis of medical service policy texts. As shown in The frequent use of environmental policy instruments reflects the importance attached in Sichuan Province to medical service policy and aims to create a favorable environment for their development through macro policy. Specifically, among the sub-policy environmental policy instruments, regulation and supervision is the most widely used, accounting for 36.96% of reference points. The malpractice in medical service systems and mechanisms in Sichuan Province has not yet been completely removed. In the 13th Five-Year Plan for the Development of Health and Family Planning in Sichuan Province, it is clearly pointed out that the existing costs of medical services is unreasonable, that the reform of a medical insurance payment system is overdue, and the price of drugs and consumables is high. Therefore, the long-term application of a regulatory and supervisory instrument is the highest priority. The second priority is goal programming, accounting for 25.82% of reference points, improving comprehensive medical reform of all aspects of medical security, services, and the drug supply and regulatory system, the implementation of which needs to be carried out in stages, making it necessary to formulate corresponding specific target plans in each stage of reform. The application of strategic and preventive measures and guaranteed work is a high priority, accounting for 11.14, 11.14, and 11.68% of reference points, respectively. The Sichuan Provincial Government has the lowest use of regulation and supervision, and financial services, accounting for 2.17 and 1.09%, respectively. As the fundamental guarantee of the development of medical services, this has not received adequate attention from the government, which needs to encourage the medical development agencies and enterprises to make available innovative financing and investment mechanisms. Furthermore, relevant medical institutions and enterprises should be given assistance in the form of financial subsidies and tax allowances.Supply-side policy instruments are also used frequently in Sichuan Province. In the sub-policy instruments, the proportion of infrastructure, human resources, and scientific and technological support on the supply-side is 24.61, 24.92, and 20.50% of reference points, respectively. Infrastructure is a basic prerequisite for ensuring the rapid development of the medical service; human resources cannot directly promote the development of the medical industry alone, however, they contribute to improving the utilization and allocation efficiency of other input factors. Scientific and technological support directly promotes the improvement in quality of medical services, and under the remit of the \u201ctalent plan\u201d and the current situation, the government should establish a long-term and comprehensive human resource development plan, with specific implementation measures to achieve the strategic objective of developing the provincial medical service. This will accelerate scientific and technological innovation to construct the medical science and technology innovation platform, promote medical scientific research, and to transform and promote medical scientific and technological achievements. Information services account for 15.46% of the total reference points, and in order to effectively promote the development of the three medical institutions, the Sichuan Provincial Government needs to establish a medical service information platform for the province, city, and county, that consists of information services; a management information system of all medical and health institutions; and make full use of available online knowledge and big data to promote the development of medical information. Financial support is 14.51% of reference points; this sub-policy tool has the lowest utilization rate of supply-side policy instruments, and the government should provide more financial support to strengthen the capacity of medical services such as medical institutions , this paper shows the amount of policy publications related to these different activities in Sichuan Province. Some medical policy documents involve more than one medical service activity. The results of the coding analysis show that there are 84 policy texts related to medicine-related activities, 166 related to medical activities, and 27 to medical insurance activities. The volume of publications for different types of policies shows that medical service activities accounts for the largest proportion of medical activities in Sichuan Province. Medical care has always been an important guarantee of the health of all people in a region. Also, the province attaches great importance to the development of the pharmaceutical industry or production and supply of medicines. In addition to the drug procurement mechanism and innovative drug research and development, the highlight in the field of medicine in Sichuan Province is the development of traditional Chinese medicine. The Province plans to include the traditional Chinese medicine health service industry in the important strategic arrangements for its \u201c5+1\u201d trillion-level modern industrial system.In this paper, the difference between the policy instruments used in different medical service activities is analyzed by using the matrix query method of Nvivo 11. Firstly, the situation of the first-level policy instruments is analyzed, and the statistical results of the reference point account ratios are shown in In order to understand more clearly the strengths and weaknesses of policy instruments used by each medical service activity and the differences in their use, this paper provides in-depth analysis of the specific use of the sub-policy instruments in the policy documents of the three types of medical service activities; the statistical results of the proportions of reference points are shown in Table 5Two-dimensional analysis of reference points between medical service activities and secondary policy instruments.A total of 188 secondary policy instruments were used in the policy paper on medicine activities. The frequency of regulation and supervision in environmental policy instruments is the highest, accounting for 26.06% of reference points; the use of secondary policy instruments has a frequency of <5% for financial support and information services in the supply-side policy instruments, preventive measures, financial services, and fiscal levy in the environmental policy instruments; and for all demand-side policy instruments, the government purchase of policy instruments has been at zero. A total of 540 secondary policy instruments were used in the policy paper on medical activities, with the highest frequency of regulation and supervision use in environmental policy instruments, accounting for 14.63% of reference points, and the use of secondary policy instruments with a frequency of <5% being financial services, strategic measures, and fiscal levy in environmental policy instruments, as well as all demand-side policy instruments; a total of 22 secondary policy instruments for policy documents on medical insurance activities, with the highest frequency for regulation and supervision in environmental policy instruments, accounting for 27.27%. The use of secondary policy instruments with a frequency of <5% has human resources, science and technology support in the supply-side policy instruments, preventive measures, financial services, strategic measures, and fiscal levy in environmental policy instruments, as well as all demand-side policy instruments; of these, only the utilization of a fiscal levy was not zero and the use of other secondary policy instruments with a utilization rate of <5% was zero.The above data show that in the use of secondary policy instruments, the structure of policy instruments for each medical activity is different; the difference is most obvious between medical insurance activities and the others. No demand-side policy instruments are used in the policy text of medical insurance activities, and the use of secondary policy instruments in environmental policy instruments and supply-side policy instruments is also very different. The particularity of medical insurance activities does not involve developmental policy instruments such as human resources, scientific and technological support, financial services and strategic measures, and policy instruments such as information services, goal programming, and guarantee work are preferred. However, the most frequently used secondary policy instruments in the policy documents of medicine activities, medical activities, and medical insurance activities are regulation and supervision, indicating their importance in the development of medical services.Through the application of content analysis and text mining and using Sichuan Province as an example, medical service policy documents published since the implementation of the new medical reforms are selected and frequency analysis of various policy instruments, policy strength, and medical service activities are applied to draw the following conclusions: The overall composition of policy instruments is uneven, with a high proportion of environmental and supply-side policy instruments, and a serious shortage of demand-side policy instruments. This demonstrates the government's attempts to optimize the environment of medical services, to vigorously improve the supply of related elements of medical development, and to promote the long-term development of medical services: however, the level of attention received by the medical service market is low. The distribution of secondary policy instruments is also uneven. Among the various environmental policy instruments, the Sichuan Provincial Government is more likely to ensure the stable and controllable development of medical services through strong regulation and supervision by the government; this emphasizes the importance of the development of medical services in accordance with the rules and regulations, which is conducive to the improvement of medical service capacity and the protection of the people's basic rights and interests relating to health. However, the proportion of financial services and fiscal levy is very low, which, to some extent, will affect the implementation of target planning in policy documents. In the supply-side policy instruments, there is no significant disparity in the use of secondary policy instruments (human resources and infrastructure). In the demand-side policy instruments, foreign exchange, and service outsourcing policy instruments are low, with the shortage of government purchases warranting the most concern. As can be seen in the structural distribution of policy instruments, the government has focused on regulation, supervision, and goal programming; however, the supporting factors of financial services, in terms of fiscal levies, government purchases, and overseas communication are weak, which limits the pace of development of the medical service market.In terms of policy strength, 42% of the policy documents are relevant circulars and announcements issued by the Sichuan Provincial People's Government and its committees, bureaus, and offices, while 38% of the policy documents are temporary regulations, implementation plans, decisions, opinions, methods, and standards. The government's policy efforts mainly focus on the goals, operational principles, and clear tasks related to medical services. Secondly, the medical industry mainly abides by the relevant laws and regulations formulated by the state, and the local laws and regulations formulated by the government are secondary. From 2009 to 2018, the overall policy strength of Sichuan Province has changed substantially, but it has been stable in 2016\u20132018 the past 3 years, and the number of policy issues has also shown an increasing trend, indicating that the government attaches growing importance to the development of the medical industry.In terms of the types of medical service activities, there are great differences in the number of policy issues between medicine, medical, and medical insurance activities: 60% of the medical service policies are related to medical activities; in contrast, the number of policy documents issued in relation to medical insurance activities is the lowest, at 10%. The policy texts of the three kinds of medical service activities prefer the use of environmental policy instruments, and the frequency in the use of demand-side policy instruments is the lowest, which indicates that the government attaches great importance to the environment of these three medical service activities and constantly optimizes the environmental factors in order to provide a better service environment. The utilization rate of secondary policy instruments in each medical service activity is very different, especially when comparing medical insurance activities with the former two. No demand-side policy instrument is used in medical insurance activities, and the use of secondary policy instruments in environmental and supply-side policy instruments is also very different. There is a serious lack of policy instruments, such as human resources, scientific and technological support, preventive measures, financial services, and strategic measures.The improvement of the national level of health is essential for the improvement of national productivity, sustainable economic development, and social harmony. The government undertakes the role of the basic demand guarantor, the system supplier, and the market regulator in the medical service through the formulation and implementation of medical service policy in order to safeguard national health. Using the analysis of medical service policy in Sichuan Province as an example, this paper offers policy suggestions on the development of medical service from the following three angles.From the point of view of policy instruments, the government needs to optimize the their overall structure and the structure of internal secondary policy instruments in order to appropriately reduce the use of environmental policy instruments, increase the application of demand-side policy instruments, and enhance the interaction between secondary policy instruments. In particular, this increases the frequency of use of supportive policy instruments such as government purchases, financial services and fiscal levies, as well as market shaping, overseas communication, and strategic measures, and encourages medical development institutions and enterprises to carry out innovative financing through investment and other measures, while providing support to relevant medical institutions and enterprises in terms of financial subsidies and tax incentives. The government needs to consider the coordinated use of various policy instruments, enhance continuity and stickiness among secondary policy instruments, and focus on strengthening policy synergies in order to enhance the policy effect and improve the sustainability of health care policies.From the point of view of policy strength, the government must continue to strengthen the policy and accelerate the establishment of basic medical service systems for urban and rural residents. To improve the attitudes toward implementation and make these more conducive to the development of medical services, government policy should be implemented as soon as possible to enable universal access to essential medical services.From the point of view of medical service activities, the linked development of three kinds of medical service activities should be accelerated. Medicine activities need to focus on improving drug supervision mechanisms, drug supply shortage guarantee mechanisms, and drug purchase mechanisms. Medical activities must aim to strengthen overseas communication and meet the requirements of financial services and fiscal levies, directly provide more support to the service capacity of medical service subjects such as medical institutions in relation to funding, promote the formation of new medical service models such as intelligent medical services, and improve their overall standard. There are still some problems in medical insurance activities, such as weak supervision of medical insurance funds and misappropriation of insurance. It is necessary to strengthen supervision and preventative measures, continue to implement reform of the system, improve the payment mechanism for medical insurance, solve the problems of accessing medical care in various locations, and mitigate commercial risks as soon as possible in order to improve the level of basic medical insurance.All datasets generated for this study are included in the article/supplementary material.HZ: project administration, supervision, and writing\u2014review & editing. LZ: data curation, methodology, software, and writing\u2014original draft. CZ: data curation and methodology. XC: methodology, supervision and writing\u2014review & editing. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "Dear EditorOne of the current worldwide challenges is struggling with the emerging disease of COVID-19. Following the announcement of the outbreak of the disease by the World Health Organization (WHO), numerous measures have been taken in the field of education, treatment and research at the national, regional and international levels by governmental and non-governmental organizations (NGOs).1Immediate and necessary decisions and measures such as closing schools and universities were taken and implemented by this headquarter. The initial instructions about the COVID-19 were published by official websites, including the Ministry of Health and Medical Education (MoHME) and the Universities of Medical Sciences included information on disease symptoms, methods of the prevention, diagnosis, and treatment of COVID-19. Iran, like other countries in the world, has taken extensive measures in this regard. On Feb. 25, 2020, the National Headquarter for Combating Corona (NHCC) was formed. 2Another concern about public health was mental and psychological health. Unknown and unpredictable future in the COVID-19 pandemic, along with misinformation and myths, has led to misunderstandings of health messages in the community. Restrictions on travel and quarantine at domestic and international airports in the spring, when most flights take place, have also raised concerns. 4Therefore, following the activities of the NHCC and MoHME, booklets on stress management and coping with anxiety were published. In this regard, a phone line for psychological counseling has been opened in the Ministry of Health and universities of medical sciences. Meanwhile, children are exposed to a lot of news about the disease epidemic. Therefore, publishing some booklets for children was another measure taken by MoHME to reduce their stress and anxiety.On the other hand, as previous studies have shown, fear of infectious diseases with high prevalence and mortality rate is associated with other psychological challenges such as stigma, discrimination, loss, feelings of fear of getting sick or dying, and helplessness. Another activity that took place in the first weeks of the illness and after the closure of schools and universities in Iran was teaching the students by distant education using virtual content and software. This kind of education ensured the students and their family and made them calm because they did not need to attend schools, universities or dormitories. In addition to government agencies, NGOs and charity organizations have taken steps to address the physical, economic, social and psychological harms of the disease. For example, some of these groups provided the equipment and supplies needed for patients and even members of the medical team, such as masks, gloves, and gown. These charity groups have also provided financial support to people suffering from financial problems during the closure of their businesses.5Despite all the measures taken in various areas at the national and provincial levels by government and non-government agencies, there are still some shortages. Because Iran is under numerous sanctions, especially in the field of health, and due to the lack of resources and equipment for healthcare services, an increase in the morbidity and mortality rate might happen in the long time. Although some efforts were made regarding the stress and anxiety of the public health, especially children and youth, there are some other measures which could be applied. Through online counseling, psychologists can provide training on how to deal with health issues caused by domestic conflicts, tensions between children and parents, and anxiety about illness. It is important to note that financial worries, sanctions, pressures, and deficiencies resulting from them could be associated with physical and mental disorders for people in Iranian society, especially for vulnerable, high risk groups such as low-income individuals and their families. Therefore, the support of international community and WHO, at least in lifesaving medical supplies, is essential. These kinds of lifting sanctions could decrease the tragedy and contribute to preventing the second wave of spreading the disease."}
{"text": "Computers and Education, American Journal of Pharmaceutical Education, and Theory into Practice. The author with most articles is Reddy, from Rutgers University. The most productive institution is the University of Virginia. The United States is the country with most academic publications, citations and with most international collaborations in its works. Worldwide research has followed an increasing trend, with optimum publication levels in latest years.The university learning classroom, in addition to a space for activities and architectural object, has a direct impact on the academic motivation, well-being and social relationships of the students. Thus, the link between the university classroom and the management of the socio-educational well-being of the student, in accordance with the principles of well-being theory, is a challenge that the current university must manage. The progress of worldwide research on this topic has been studied during the period 2004\u20132018. For this aim, a bibliometric study of 1982 articles has been applied. The results provide data of the scientific productivity of the journals, authors, institutions and countries that contribute to this research. The evidence reveals growing interest, especially in the last six years. The main category is Social Sciences. The most productive journals are  In recent decades, the progress reached in educational theories and paradigms, in addition to the development of information and communication technologies (ICT), have led to the need to transform the organization of learning spaces in higher education institutions (HEIs) ,2. This Nowadays, the classroom remains the physical framework that symbolizes educational pedagogy. It is the main element on which school buildings are projected ,5. ThereIn this context, learning spaces are not understood as a simple volumetric container of activities, but their concept goes beyond a mere architectural object. Appropriate for students and teachers, it manages to influence academic motivation, well-being and social relationships ,11. SincIn this same order, the link of the university classroom with the management of the socio-educational well-being of the student must be established according to the principles of the well-being theory, as one of the challenges to be met by the current university. The interest in the well-being and quality of life of students focuses on fully developing their capabilities and potentials. Indicators such as happiness, health and sociability allow you to focus on a healthy and sustainable university ,16.The revised literature has found the terminology around the main concept of research. In this sense, the concept of the classroom refers to the basic cell that is part of learning, where individuals are related according to certain physical, human, cultural and social circumstances and situations. In the classroom, diverse and meaningful learning modes are generated. The classroom therefore does not exist without the network of relationships between students, teachers, objects and facts ,18. At tLikewise, the term socio-educational well-being refers both to the psychological experience of happiness of the university student, due to the control and perception of their physical and mental conditions in relation to the act of teaching and learning ,20. As fThe purpose of this study is to analyze the research trends on the impact of the university educational space on the well-being, motivation and social interaction of the student, considering the physical-environmental, socio-perceptual and motivational attributes.In relation to the review of the literature carried out, and the work found that addresses this topic, the research problem concerns whether the design of the university educational learning and teaching space influences the socio-educational well-being of the student.As regards the main limitation found in this research is to discern whether, among other variables, the number of publications relates to a certain regulatory regulation, is due to the requirements of interest groups, or, on the contrary, to the needs demanded by the education system itself.Therefore, the principal objective of this research is to evaluate research trends on the impact of university classroom design on the socio-educational well-being of students globally during the period 2004\u20132018, considering the physical-environmental, socio-perceptual and motivational attributes.To get responses to research issues, a sample of 1982 articles from a selection of scientific journals from the Scopus database has been evaluated. This review applies the bibliometric method to synthesize the knowledge base on the impact of the university classroom on managing the socio-educational well-being of the student. The results revealed contributions in this field of research, so that it has made it possible to identify the main drivers, their potential trends, and reveal gaps in critical knowledge. Thus, it can be assumed that, at present, university learning spaces require a transformation that positively links the socio-educational well-being of the university student with the classroom where the teaching act is practiced and learning.Finally, it should be noted that among the lines of research currently being established in relation to the topic of the study, these relate, inter alia, to comparing the effect of the intrinsic characteristics of the university classroom on stress both in public and private universities, and in different countries; in addition to different studies that analyze the outcome in terms of inclusion and diversity.The study of the impact of the university classroom on managing of the socio-educational well-being of the student is supported by the analysis of the main theory that together with the basic concepts define the framework of reference in this issue of research. In this way, explanatory theory defines how a set of phenomena behave, in order to generalize and perform a separate generalization of cases.The literature review has allowed the detection and analysis of empirical, theoretical, critical, analytical or methodological scientific documents on the subject of research. The objective of this review was to obtain the research problem and the purpose of the study, in addition to generating a framework. Therefore, the literature analysis has offered publications that respond to the empirical study in the university classroom worldwide and has determined the impact factors of the classroom on the motivation and socio-educational well-being of the university student. The main publications in relation to the purpose of this study have made it possible to define in a concise and balanced way the definitions, concepts and theory on the impact of the university classroom in the management of the socio-educational well-being of the students.Otherwise, the revised literature provides definitions for the basic concepts of this research topic. Hence, it includes some reflections on the terms and concepts used in the context of this research.The link of the university classroom with the management of the socio-educational well-being of the student must be established according to the axioms of the well-being theory or the PERMA model  of Seligman, in 2011 . It is aThe well-being theory, in line with positive psychology, relates to the state of flow, referring to an intense concentration, the flexibility to react to new problems, the maximum performance of the capacity of the individual, and the feeling of pleasure and happiness, derived from the activity performed ,32.In order to define the concept of socio-educational well-being in the context of research, the term of well-being, as an abstract concept, refers both to the psychological experience of pleasure and happiness, as well as to the state of satisfaction and tranquility that individual submits because of their good physical and mental conditions ,34,35.Likewise, well-being focuses on capacity development and personal growth, as indicators of positive functioning. In other words, well-being encompasses a series of sensations that allow an individual to judge her/his life globally ,37. OtheThis concept transferred to the educational context has a special relevance. Thus, well-being in the environment is related to improving the teaching and learning process, increasing the capacity for attention and concentration, and promoting creative and holistic thinking ,39. In pNotwithstanding the above, social welfare includes the factors that participate in the quality of life of the individual, so that they allow their tranquility and satisfaction. It is an unobservable condition directly, which is understood and can be compared between different spaces from reflections. Thereby, the term socio-educational adds the goal of education to the concept. In this way, the concept of socio-educational well-being of student is a key factor in achieving better levels of care, success and motivation. While, historically, academic classrooms have not considered the parameters of comfort and well-being, it is now an analyzed factor, which links the learning space with student behavior ,41.The concept of personal space, studied by Hall in 1966, refers to the interpersonal distance that helps and allows the individual to interact with peacefulness and this is influenced by culture . In 1975Personal space is understood as a mechanism that regulates the boundaries between people and as a resource of alert to the invasion of space by another individual. Hence, it fulfills two fundamental roles, of self-protection and as a regulator of privacy ,38,47.Thereby, the concept of the university classroom refers to the educational space where the discents live, coexist, knowledge is transferred and, therefore, they are formed as citizens, with critical capacity, values and as protagonists of society. Nowadays, learning spaces are not understood as a simple volumetric container of activities, but their concept goes beyond a mere architectural object. This, being appropriated by students and teachers, manages to influence academic motivation, behavior and social relationships ,38,43,48The revised literature recognizes certain design factors involved in the classroom and their level of impact, both on the motivation ,43,49,50In 1995, G\u00f6ttler expressed the influence of the physical and environmental characteristics of the educational environment on the social interactions and other psychosocial aspects of the student. Since then, numerous authors have continued with the approach to the issue from a psychological and physical approach ,40,48,51In recent decades, this research topic has become particularly relevant with the publication of a large number of papers worldwide ,28,36,40The design, quality and adequacy of learning spaces encourage students to maintain positive emotions, feel integrated and, thereby, to experience more favorable academic results ,49,52,53The literature shows evidence of the link between student satisfaction with the environment and the academic results obtained. Consequently, if the student experiences personal well-being and attachment to where she/he spends much of her/his daily life, this results in a positive impact on the attention, motivation, learning and sociability ,54.On the other hand, the impact of design on learning spaces, considering that the space intervenes in the social connection of students, thus encouraging collaboration, reflection, exchange and interaction. Conversely, if the design is insufficient, it can promote the development of childhood disorders, such as tacit muteness and lack of social interaction ,50.The influence of learning environments on children\u2019s cognitive development and early literacy is undeniable. In such away, the primary cognitive development of human beings occurs through the relationships we maintain with our environment and the sociocultural stimuli perceived as external information. Hence, the study of the relationship between physical space and its impact on human behavioral processes is not novel . LearninLiterature indicates that the physical attributes of the environment and the configuration of the learning space act on the perception of students. In this dialogue where the level of well-being and the functional possibilities offered by space are related, the impact on the learning process of those who inhabit it can be positive if the conditions are ,38,40,55Learning is a multi-causal process that requires the integration of physical and environmental conditions to generate an enabling climate, allowing students\u2019 behaviors to be more assertive and school environments to be healthy and rewarding ,50. The Thus, there is a relationship between the environmental variables of the built space and its effect on teaching and learning processes, such as lighting, temperature, thermal comfort, color, materials, noise level, indoor air quality ,52,53,56In this way, spatial variables defined by the physical characteristics of the classroom act as a scenario. It underpins the social and motivational actions that the student requires, maintaining a reciprocal and complementary relationship ,45,57. DIn this sense, the morphology of the building, the size, the enclosures, the floors and ceilings and internal divisions of the classrooms must offer a visual continuity, supported by methodologies that favor participatory, active, collective and collaborative. Thus, students better perceive group cohesion, commitment to tasks and cooperation when the organization of seats is in small groups and allows the visibility of the rest ,47. ThisThe socio-perceptual dimension considers the subject as an active protagonist that inhabits the school space, and the impact on her/his behavior. The analysis focuses on human action and interaction in spaces, an aspect that addresses Environmental Psychology ,38,45. AIn this sense, the location within the classroom is decisive in the perception of the student, while the preference of the company with friends generates positive differences in motivation and social relationships ,58. On tIn 1978, Canter, a precursor to the psychological perception of the classroom and the degree of satisfaction provided by a school space in the subject, noted that \u201cby inhabiting the classroom, the individual is involved in the physical experimentation of his architectural space, all of this, taking into account the responses to certain variables\u201d ,56. In tFrom this perspective, the classroom is not only a space where the students live, but it is also the place that represents the family, the activities, customs and culture to which the person belongs ,44, and Finally, the motivational dimension emerges from other variables misused in research, such as academic performance. This dimension serves cognitive and attitudinal factors that influence student efficiency ,37,55. IMotivation influences learning, so the design of the university classroom must improve motivation in learning environments. For example, Keller\u2019s ARCS model  explains its relationship to learning processes ,62, in rDigital technologies applied to training and education also enhance motivation in teaching and learning processes and offer new opportunities for learning . The resIn order to achieve the objective proposed in this study, bibliographic data has been analyzed using two methods. A systematic  and a bibliomeric (quantitative) analysis of the data has been carried out.Scientometric is recognized as the scientific study of science and its results and is based primarily on the works of Solla Price and Garfield. In practice, there is a significant connection between scientometric and other scientific disciplines: bibliometric, information system, information science and scientific policy .Likewise, bibliometric is a component of the scientometric that utilizes mathematical and statistical processes to the scientific production and the authors that generate it, with the purpose of researching scientific activity. The instruments applied to measure aspects of scientific activity are bibliometric indicators; these are measures that offer evidence on the results of scientific activity ,66. It wThe purpose of this study is to recognize, organize and analyze research trends in the impact of the university classroom on managing of the socio-educational well-being of students, considering the physical-environmental, socio-perceptual and motivational attributes. To accomplish the proposed purpose, a quantitative analysis has been implemented, using bibliometric. In latest decades, it has provided to the review of scientific knowledge, and has been used productively in various scientific disciplines: health, engineering, economics, administration, education or ecology ,68,69.The methodology has been developed to analyze the scientific communities associated with this theme. The relationships between authors, institutions and countries, interpreted through the co-authorship of each document, have been analyzed, as well as analyzing the relationships between the keywords of all articles based on co-occurrence .The co-citation analysis allows the observation of documents with citations and references cited, which can show the intellectual basis and trends in a particular field of research. Thus, the authors, institutions and countries are determined based on the co-citations of the rest, which represent relevance in this discipline, so that these generators of scientific production can be substitutes for the ideas they represent.In this line, the co-occurrence analysis is used in order to provide a graphic visualization of the interconnection of the key terms within the documents analyzed. Generally, co-occurrence networks are used in order to facilitate a graphic visualization of potential relationships between authors, institutions, countries or terms in a text. Thus, the proximity relationship of two or more terms in a text unit can be observed, so that, if the terms co-occur in a sentence, there is a probability of their semantic relationship .In short, the co-occurrence criteria allow revealing and grouping strongly related concepts within the set of documents or records. This procedure examines documents in order to look for two or more concepts that tend to be presented together.The indicators of the collaboration structure, which measure the links between the authors, institutions and countries, have been analyzed through the processing tools and network maps due to their reliability and suitability in the bibliometric analysis .Through this methodology, the interest in the subject matter of our study has evolved, by modifying the most relevant authors, countries, journals and keywords in recent years. Several databases of scientific papers related to the subject that have been studied have been consulted.The two large scientific databases, Web of Science and Scopus, raise the main problem of the comparison and consistency of statistics derived from different data sources. It has been shown that Scopus has more indexed journals than Web of Science, in addition to minimizing the risk of losing documents during the search. Among its advantages, it stands out that it is easily accessible and offers some tools for viewing and analyzing data, as well as the option to download content in different formats, and that it provides a variety of data for each selected publication, its analysis and the comparison between them .The Google Scholar database has not been taken into account, as it has some limitations. In this sense, it includes a greater amount of non-relevant variables, so that the cleaning of the data is more laborious, the processing and classification of the results require more effort, and includes a large number of articles not reviewed by peers, that is, it contemplates publications with a low quality level.For these reasons, the information received from the Scopus database of Elsevier has been selected, as it is the largest repository of scientific articles and with a greater number of journals and authors, with peer review, compared to the rest of the databases . In addiThe method used was to carry out a complete search on the Scopus database, applying a search string, applying Boolean operators to the terms that combine this research: \u201chigher education\u201d, \u201cuniversity\u201d, \u201cclassroom\u201d, \u201cwell-being\u201d, \u201cintegration\u201d, \u201csocioeducational\u201d and \u201cmanagement\u201d.A descending search has been carried out in order to study the topic of research. With this type of search, first a sample of data from a broad general topic is selected and, sequentially, more restricted searches of the initial sample are performed, in order to define the data of a specific topic. Moreover, data abstraction consists in reducing a particular set of data to a simplified representation, that is, it refers to the process of removing characteristics from a research field to reduce it to a set of particular characteristics.Accordingly, in a first search, the key concepts extracted from the review of the literature were included, including the entire time horizon, that is, from the publication of the first document on thematic study until the last full year, that is, from 1944 to 2018. In addition, all types of sources were included, according to the Scopus database . This search yielded a total of 4379 documents. Subsequently, the time horizon was limited to the last fifteen years (2004\u20132018), a period where the study presents relevance, including all types of sources. This second search yielded a total of 2389 documents. Finally, in the third search, only the articles were selected. The decision is based on the fact that the articles are the only documents submitted to a peer review process, which guarantees the scientific quality of the works. This last search yielded 1982 documents.In such manner, the purpose was to analyze the subfields of the title, abstract and keywords over a period of 15 years (2004 to 2018), as reflected in other bibliometric works ,76. The VOSviewer  is a software tool for keyword processing and grouping analysis used for map visualization, which allows grouping by co-authorship and co-occurrence. Additionally, using the VOSviewer tool, the collaborative structure indicators, which measure the links between authors and countries, have been studied through network mapping and processing instruments due to their reliability and suitability in the bibliometric analysis, as well as for the identification of research trends based on the use of keywords ,78,79. TIn the same way as with the articles, the total number of authors has also increased for the period analyzed. In the last triennium, 2016\u20132018, 37.30% of the total authors of the 15-year period are concentrated. It is noted that the number of authors who published in this topic of research between 2004 and 2006 was 289, amounting to 1986 authors in the triennium 2016\u20132018. This is a larger increase than experienced in the number of articles published, because the average number of authors by article has also increased. Thus, in 2004\u20132008 the average number of authors by article stood at 2.1 authors by article, while in the last period (2016\u20132018) it increased to 2.8 authors by article, with a maximum of 3.1 in the fourth period (2013\u20132015).On the other hand, the number of countries involved in the publication of articles on this topic of research has increased from 43 in the 2001\u20132003 triennium to 179 of the last period analyzed. Throughout the period analyzed, the total number of countries that have contributed to the publication of articles on the impact of the university classroom on managing of the socio-educational well-being of students amounts to 134.In addition, the number of citations increased from the first period (2004\u20132006) with 3,011 to the third triennium analyzed (2010\u20132012) with 4972. Since this trienium, the total number of citations of the total articles has been decreasing, with 3705 in the following period (2013\u20132015), and with 1257 in the last period (2016\u20132018). This circumstance is due to the fact that the published articles, that is, those corresponding to the last 6 years, will receive a greater number of citations in the coming years, for their recent publication and impact, in addition to their distribution in open-access , and thiThe number of journals that published articles on the subject of study increased from 127 in the first period, 2004\u20132006, to 535, in the last triennium analyzed, 2016\u22122018. Likewise, the number of institutions increased from 215 in the 2004\u20132006 period, to 1296 in 2016\u20132018.Finally, the number of references increased from the first period (2004\u20132006) with 3547 to the last three-year period analyzed with 24,899. This assumes that the average has been increasing from 25.61 in the first triennium (2004\u20132006) to 35.67 in the last period (2016\u20132018).In this regard, During the time horizon analyzed, 2004\u22122018, there are several categories where work related to the impact of the university classroom on managing of the socio-educational well-being of students has been found. Thus, according to the Scopus classification, there are a total of 27 thematic areas in which the 1982 articles analyzed are classified. It is necessary to clarify that the same article can be classified in more than one category, depending on the interest of the author and the publisher.The association of publications in this field of study, mainly, to the Social Sciences category makes sense, since the sustainability factors of higher education relate to learning opportunities in the classroom university , or the By country, among the 20 most important journals are those of European origin: United Kingdom (7), Germany (1) and Ireland (1), which are also the journals that have a better position in the SJR 2018 ranking, and those of American origin, United States (6) and Canada (1).The journals that have published most articles on this field of research have been Computers and Education (31), Teachers College Record (27) and Asia Pacific Education Researcher (22), so these journals represent 4.04% of the total articles published since 2004\u20132018. Computers and Education stands out because it concentrates a great interest in the scientific community, as evidenced by the high number of citations that concentrate its work, 976, and for the average number of citations by published articles, with 31.48 citations by article. Additionally, it is also the journal that presents the largest H index for published articles on this topic of research, 19, although it is quite far from the overall H index of the journal, for all subjects, which stands at 149. It is also the journal with the highest SJR impact factor: 2.323 (Q1), followed by Journal of School Psychology, with 1.751 (Q1), and Teaching and Teacher Education, with 1.512 (Q1).The importance attached to the relationship of the university classroom with socio-educational well-being for the most productive thematic areas. Thus, Social Sciences includes journals such as Teachers College Record, Asia Pacific Education Researcher, Theory into Practice or Australian Journal of Teacher Education; while the area of Computer Science, contains Computers and Education, International Journal of Emerging Technologies in Learning, Australasian Journal of Educational Technology or International Journal of Engineering Education. These findings are linked to the factors or variables described in the literature review. The journals contained in the thematic area of Computer Science assess the physical variables of the classroom ,60; whilThe author who has published the most articles on the subject of research is the American, Reddy, from Rutgers University, with five documents, followed by a group of authors with four documents each: the Americans Bradshaw, Dudek, Vazou and Webster, Chai (Hong Kong), and Hudson . However, the author with the highest number of citations on the research study is the American Bradshaw, with a total of 125. Furthermore, he is the author with the highest average number of citations by article, with 31.25, followed by Chai (Hong Kong), with 76 citations and an average of 19 citations by article. Of the 10 most prolific authors in this field of research, six\u2014Reddy, Bradshaw, Chai, Dudek, Vazou and Webster\u2014have the highest H index, with 4.It is noteworthy that the 10 most prolific authors in the publication of articles on this subject of research have American origin (6), followed by Hong Kong, Australia, Spain and Greece, with one each one. In addition, four authors published a final paper in 2018, the last year analyzed in this study, and three authors in 2017, indicating the importance and interest of the research topic.These results are in line with cooperative learning in university classes, as well as communication of teaching experiences and expectations in educational policies and classroom practices ,98.The impact and influence of the United States on the subject of study is well defined by both its scientific production and the cooperation in its publications. The United States, despite having the most powerful and influential HEIs at the international level, is a country that records a very high gap between the results obtained by those who did not finish secondary school and who have at least two years of university courses . In addiThe terms \u201cHuman\u201d, in 437 documents, and \u201cTeaching\u201d, in 346, occupy the first two positions throughout the period analyzed. They are followed by the term \u201cEducation\u201d, in 332 publications, and \u201cStudents\u201d, in 2031. On the other hand, the composition \u201cOrganization and Management\u201d, is in fifth position, with 213 articles. For its part, the terms \u201cUniversity\u201d, with 211 articles, and \u201cHigher Education\u201d, with 154, occupy the sixth and eighth positions, respectively. Also noteworthy are the terms \u201cWell-being\u201d, \u201cClassroom\u201d and \u201cIntegration\u201d, among the 20 keywords in the period analyzed (2016\u20132018).These lines of research bring together all the concepts related to the topic of research, since it includes aspects related to the sustainability of institutions education in a globalized and connected world , and witAs an additional advantage, it is noted that research on this topic continues to advance at the global level, with other concepts and strategies, such as \u201cKnowledge Management\u201d, \u201cEducation for Sustainability\u201d or \u201cManaging Behaviour\u201d ,106,107.Organizations are also making an effort in line with education for sustainable development, since it is understood that, as UNESCO points out, education, in all its forms and all its levels, is one of the most effective tools for inducing necessary changes in order to achieve sustainable development and optimal management of socio-educational well-being ,110,111.The evolution of the keywords and their association in clusters is related to the dimensions or factors of the study theme indicated in Other relevant terms have also been grouped around the line of educational management  students\u201d, \u201cmanagement of innovation and change\u201d, \u201cmanagement development\u201d, \u201cmanagement and regulation of education\u201d). On the other hand, the research is linked to the different thematic areas of Scopus, generating a map highlighting the terms \u201cEducation\u201d, \u201cUniversity\u201d, \u201cStudents\u201d, \u201cHigher Education\u201d and \u201cOrganization and Management\u201d.The aim of this study was to study research trends on the impact of the university classroom on managing the socio-educational well-being worldwide over the previous 15 years, considering the physical-environmental, socio-perceptual and motivational attributes.A bibliometric study of 1982 articles achieved from the Scopus database has been developed. Thematic areas, journals, authors, institutions and most productive countries have been recognized in publications on this field of research.The number of scientific papers by year during the period 2004\u20132018 has increased, mainly in the last six years, where 1207 articles have been published, representing 60.90% of contributions on this research topic.The Social Sciences thematic area is the most relevant, grouping 45% of the articles, and it is followed by Computer Science and Medicine, with 8% and 7%, respectively.The most prolific journals have been Computers and Education, American Journal of Pharmaceutical Education, and Theory into Practice, with 4.04% of all articles published each one (34) in the analysis period. It should be noted that 40% of the journals that contribute to this topic are positioned in Scopus\u2019 first quartile. Journal of School Psychology is the journal with the highest number of citations (420), which presents the highest H index for published articles on this subject area (8) and presents the best average number of citations by article, with 46.67.The authors who have published the most about the field of research are the American Reddy from Rutgers University, with five articles, followed by a group of American authors , Chai (Hong Kong), and Hudson , with four publications each one. Bradshaw, from the University of Virginia, is the author with the highest number of citations (125) and the highest average of citation by article (31.25).The most prolific institutions in this area of research are the American ones Iowa State University, University of Texas at Austin and University of Virginia, and The University of Hong Kong (Hong Kong), and the University of Queensland , with 12 publications each one. The University of Virginia (United States) has the highest number of citations (466) and the highest average citations by article (38.83). In the group of the top 10 institutions with the most contributions to the subject of study, by country, the United States stands out with 7.The main countries that have made an effort is this field of research, in order of importance are the United States, the United Kingdom, Australia, Spain and Turkey. Thus, the United States presents the largest number of published articles (787) and citations (9496). In relation to the countries that have made the greatest international collaboration in their articles, the United States, the United Kingdom and Australia stand out.Nevertheless, this research has some limitations, which could be the basis for future research. Mainly, these come from the intrinsic characteristics of the quantitative analysis of the bibliometric method. One of these restrictions is that some authors publish few articles with high influence in a certain field of research. Furthermore, this method could be extended with other databases or quantitative or qualitative instruments, which would simplify a distinct perspective of the research. Alternatively, other types of documents, additionally to scientific articles, could also be incorporated in the study.In the context of the limitations of this research, these refer to the breadth of the focus of the purpose of the study for university students, since their location, grade, course, gender, race or other defining characteristics have not been specified. In addition, another limitation refers to the use of a sample with quantitative data and not having considered the advantages of qualitative data. It is also noteworthy that the study addresses the possible metabias, particularly as parameters for study samples demographics were not delineated.Future lines of research on this topic will focus on how neuroarchitecture analyses the impact that educational space has on learning activities, through holistic measurements and interpretations. Alternatively, other contributions should also study the impact of the interrelationship of the different natures of which the learning space is composed , in order to observe how their level of relationship may benefit or impede the notion of identity and the sense of belonging of the students. In addition, it should be explored how the transition between the intermediate level and higher education requires students to adapt to different processes and situations that require the implementation of various personal resources and assume participation in the new roles. This involves describing academic stress from the cognitive and affective processes that the student perceives of the impact of academic stressors.In this regard, it is necessary that future research be directed, not so much to the description of the factors that impact the well-being of the student, since they are very developed, and to investigate in a practical way how specific modifications, for example physical space, have impacts on the motivation and well-being of university students. In line with the findings of this study, they can be referred to practical applications, such as visual thinking, flipped classroom and active cooperative learning methodologies that influence students\u2019 communication and interpersonal relationships.Finally, it should be noted that it has been noted that trends in research on the impact of the university classroom on managing of the socio-educational well-being of students worldwide have followed an upward trend and stabilized in optimal publication rates in recent years."}
{"text": "Cannabis has been widely used as a medicinal plant for millennia; however, studies related to its main components were first conducted in 1960. Subsequently, laboratories have produced new components and structures related to its active biological properties. Countries that have approved the medicinal use of cannabis impose regulations that govern its clinical and scientific use. One means of administering medicinal cannabis is via a magistral preparation that must have a medical prescription and be prepared in an establishment that meets quality standards to ensure the quantities of its main components, such as tetrahydrocannabinol (THC) and cannabidiol (CBD). Furthermore, suppliers must have a clear indication of its use in the patient before prescription. This review shows the published evidence regarding the clinical use of medicinal cannabis magistral preparations in the management of post-chemotherapy nausea and vomiting, neuropathic pain in multiple sclerosis, and anorexia and cachexia in patients with HIV. The history of cannabis dates back to the year 4000 BC, with its first remains found in China. The first records of the use of cannabis are also found in a Chinese treaty, according to which, marijuana tea was used for the treatment of gout, rheumatism, malaria, and memory loss. However, the treaty warns of the main adverse effects, such as hallucinations and a feeling of \u201clight body\u201d . SubsequThis situation changed with the stigmatization of use at the end of the 19th century, when the epidemic of opioid abuse arose and legislation was introduced that regulated chemical substances related to psychoactive components, mainly as a control measure to address addiction. Therefore, in 1937, the Marijuana Tax Law was approved in the US, which made the non-medicinal use of cannabis illegal. In 1939, the Colombian government prohibited the cultivation of the plant and ordered the destruction of existing plantations .Documents and evidence related to the use of medicinal cannabis in a clinical context are scarce. According to a review of the research, the National Academy of Sciences, Engineering, and Medicine concludes that there is conclusive or substantial evidence of the effect of cannabis on chronic pain, chemotherapy-induced nausea and vomiting, multiple sclerosis-associated spasticities, and refractory epilepsy. Moderate or low evidence indicates an effect on sleep disturbances  ,4,5, HunOne means of administering medical cannabis is via compounding formulas. According to the technical definitions of the US Pharmacopoeia, chapter 795 , and theIn the context of medicinal cannabis in Colombia, under the regulations of Decree 613 of 2017 , these mDispensing of these magistral preparations must include : common The regulations in Colombia regarding the magistral formulation relate to the following: (i) The norms for the control, monitoring, and surveillance of the import, export, processing, synthesis, manufacture, distribution, dispensing, purchase, sale, destruction, and use of substances subjected to control, medicines, or any other product other than cannabis, its resin, extracts, and tinctures on the yellow list of narcotic drugs, and THC on the green list of psychotropic substances . (ii) ReTo understand the importance of the key characteristics of medical cannabis, its pharmacokinetics and pharmacodynamics are described in \u00ae), synthetic THC (Dronabinol), and pure CBD extract (Epidolex). The above ligands can act on CB1 or CB2 receptors and are designed to create cannabis-like properties and reduce undesirable side effects [Concerning the pharmacodynamics of medicinal cannabis, the endocannabinoid system is responsible for maintaining body homeostasis by regulating temperature, sugar, pH, and the elimination of metabolites. Its activation can be conducted by endocannabinoids (anandamide and 2-arachidonylglycerol (2-AG)), by phytocannabinoids  and synthetic cannabinoids , THC/CBD extracts  management of nausea and vomiting post-chemotherapy, (ii) neuropathic pain in multiple sclerosis, and (iii) anorexia and cachexia in HIV. We also aim to show the main regulations related to these master products in Colombia.To increase consistency between the results, the three reviewers reviewed the 735 articles selected for the indication of anorexia and cachexia in HIV, 742 articles for the indication of post-chemotherapy nausea and vomiting, and 763 articles for the indication of neuropathic pain in multiple sclerosis. A free web application, Rayyan, was used as an aid in conducting systematic reviews, in which the analysis of the searches and elimination of duplicates was carried out according to each indication. Disagreements in the selection of the studies, and the extraction of the data by consensus and discussion with the other reviewers, if necessary, was documented in PRISMA format for panoramic reviews ,34,35.Data were extracted based on the characteristics of the article . The studies were grouped and summarized for each of the proposed clinical indications and the type of population and study design, in addition to key measures of interest to our search. After selecting the included articles for each indication, the studies described in The results obtained from the search of the literature, in general, draw attention to the small number of studies that met the inclusion criteria and the scant evidence of the use of these magistral preparations based on medicinal cannabis. Regarding the selected indications and the use of magistral preparations: anorexia and cachexia in HIV have one published article; post-chemotherapy nausea and vomiting have three articles; and for neuropathic pain in multiple sclerosis, no related article was found.In the studies that met the selection and inclusion criteria for the indication of post-chemotherapy nausea and vomiting, it is observed that the evidence corresponds to publications over 30 years. This indicates that there is no new evidence related to the use of these magistral preparations. Furthermore, according to the chronological order of the studies in the case of the indication of post-chemotherapy nausea and vomiting, it is observed that in the first study, by Frytak et al. in 1979, the doses of the magistral preparations based on THC were high compared to those in other studies. No maximum dose of THC was applied, and the study therefore showed a greater number of adverse events and treatment discontinuations .The articles identified during the panoramic review of the characteristics of the cannabis-based magistral preparations for the two indications of anorexia and cachexia in HIV and post-chemotherapy nausea and vomiting agree with the finding in the literature that the main component of these formulas must be THC. However, it has been shown that the use of formulas rich in THC can predispose patients to an increase in psychoactive adverse events, which could be reduced with doses of CBD, given its properties of control over THC-induced psychoactive effects .Regarding the excipient, only one of the magistral preparations contains sesame oil, which influences the pharmacokinetics of medicinal cannabis because it allows optimization of its absorption and bioavailability. Most of the magistral preparations based on cannabis have poor bioavailability . The litHowever, one of the limitations described in the studies is that these medicinal cannabis-based drugs are not front-line for the treatment of established indications, but must be considered in indications that are refractory to conventional treatment, and additionally, they are not exempt from the presentation of adverse events.Regarding the risk management of cannabis-based magistral preparations, adverse events have been recorded in relation to the use of formulas rich in THC, such as psychoactive symptoms, sedation, and alterations in mood. These are observed in greater quantity with high doses of THC compared with few adverse events associated with the comparators used (prochlorperazine and placebo), consistent with the effect being mediated by dose-dependent THC . CurrentIn the case of drug interactions, in the indication of post-chemotherapy nausea and vomiting, Orr et al. in 1981 observed that cannabis may be more effective in controlling vomiting associated with some types of chemotherapy, such as cyclophosphamide, 5-fluorouracil, and doxorubicin, and less effective for nitrogen mustards and nitrosurea . InteracThe panoramic review had a number of limitations. Some of the obtained studies did not describe the specific characteristics of the magistral preparations used, which precludes a more in-depth analysis of these magistral preparations and their clinical use in relation to the outcomes or adverse events. In addition, since the initial study found in the literature, a lack of previous studies or reports of the use of these medicinal cannabis magistral preparations has been documented, which may result in little knowledge of these magistral preparations.The following aspects are recommended for the evaluation and management of patients who could benefit from the use of cannabis-based magistral preparations ,42. The The study protocol was performed using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 statement, in addition to the panoramic review recommendations of Levac et al. and The Johanna Briggs Institute, which have been reviewed in detail ,35,43,44To be included in the review, the articles had to be original articles, literature reviews, narrative reviews, systematic reviews, or meta-analyzes that examined the use of magistral preparations of medicinal cannabis for the management of post-chemotherapy nausea and vomiting, neuropathic pain in multiple sclerosis, and anorexia and cachexia in patients with HIV, in a population of men and women over 18 years of age. No restrictions on publication time or language were applied. Each indication was searched for separately. The articles were excluded if they did not fit with the conceptual framework of the study or focus on the use of the magistral preparations in the three previously established indications. Letters to the editor and editorial comments were also excluded.Published articles (published until April 2020) that reported the use of magistral preparations were identified using computerized literature searches in Pubmed, Medline, EMBASE, Google Scholar, Cochrane, LILACS, and OpenGrey . The seaMagistral preparations based on medical cannabis are specific preparations for a patient who is undergoing optimal treatment, or in the case of refractory conditions, because there is not enough evidence to indicate the efficacy of these preparations as a front-line treatment. These preparations require a prescription from a doctor who determines the potential benefit of their use. Although it is known that cannabis-based drugs have a favorable safety profile compared to other drugs, there is not enough conclusive evidence in this regard. This research provides key tools to understand the importance of individualizing prescriptions for these types of formulas, monitoring them in the context of efficacy and safety, and monitoring the therapeutic levels for their use in the examined indications."}
{"text": "Social isolation is currently identified as the best way to prevent theinfection by the new coronavirus. However, for some social groups, such aschildren and adolescents, this measure carries a contradiction: the home,which should be the safest place for them, is also a frequent environment ofa sad aggravation: domestic violence. This study aims to evaluate thenotifications of interpersonal/self-inflicted violence available in theInformation System for Notifiable Diseases in the State of Santa Catarina(southern Brazil), for the juvenile age group, before and during the newcoronavirus pandemics. Cross-sectional, descriptive study of violence against children andadolescents (from 0 to 19 years) notified by health professionals bycompleting and entering the occurrence in the Information System forNotifiable Diseases of the State of Santa Catarina in 11 weeks in which thesocial isolation measure was instituted as mandatory, comparing with thesame period before this measure. During the study period, 136 municipalities in Santa Catarina made 1,851notifications. There was a decrease of 55.3% of them in the isolationperiod, and the difficulties encountered in seeking protection andassistance institutions were listed. The society needs to be aware of possible cases of violence in the childrenand adolescent population. It is important to provide accessible, effective,and safe ways for complaints and notifications, as well as a quick responseto the cases, aiming at protecting victims and minimizing damages to preventthe perpetuation of the violence. On March 11, 2020, the World Health Organization (WHO) recognized that COVID-19disease, caused by the new coronavirus (SARS-CoV-2), has taken pandemicproportions.Since the first cases identified in Brazil, the population has turned its attentionto the devastating numbers of contaminated people and deaths, the adequacy with theways to avoid contagion and the sanitary obligation of social isolation. As aresult, daily activities of children and adolescents outside their home wereprohibited, such as attending classes, circulating in public environments, and evenhanging out with friends, restricting the social space of individuals to the homeenvironment.Despite laws and advances in the development of assistance and care strategies, thenumbers on violence in pre-pandemic Brazil were already worrying.Data from the Informatics Department of the Unified Health System (DATASUS) revealthat in 2017 there were 126,230 cases of violence against children and adolescentsup to the age of 19 .The record of 21,559 deaths from external causes, accidents, and violence up to theage of 19 shows that many did not resist the abuse. Of these cases, a quarter diedbefore the age of 10, and more than 10%  were up to 4 yearsold.In 2019, the Dial Human Rights , a telephone tool provided by the Braziliangovernment to receive, analyze, and forward complaints of human rights violations,including cases of violence, revealed 159,063 complaints of maltreatment - anincrease of 15% compared to 2018. Of these complaints, 86,837 were violence againstchildren and adolescents (55%), distributed as follows: 38% linked to negligence,23% to psychological violence, 21% to physical violence, 11% to sexual violence, 3%to exploitation/child labor, and 3% associated with other violent injuries. The mostfrequent place of occurrences was the victim's home.In the state of Santa Catarina, from 2015 to 2019, 65,672 notifications wereregistered in the Information System for Notifiable Diseases (SINAN). Of these,38.4% occurred in the age group of children and adolescents.Intrafamily violence is difficult to unravel, as it occurs in the private sphere, inthe domestic environment, within homes and is protected by the law of silence, bythe fear, and impunity of its agents - people who should support and protectchildren and adolescents. This violence covers five types: physical, sexual,psychological, neglect, and specific forms, which are expressed in the forms ofM\u00fcnchhausen syndrome, chemical violence, and filicide.This study aimed to present data on compulsory notifications on cases of violenceagainst children and adolescents in the state of Santa Catarina, in the months afterthe emergence of the new coronavirus, and how the establishment of sanitary measuresof social isolation influenced the increase in domestic violence against childrenand adolescents when comparing this information to that of the pre-pandemic, toalert health professionals, public institutions, and society to the need toreinforce actions to prevent injuries, protection, and adequate care forvictims.This is a cross-sectional, descriptive, and analytical study of violence againstchildren and adolescents (aged 0 to 19 years old) notified by health professionals,by filling out and inserting into the SINAN the Notification Forms for IndividualInvestigation of Interpersonal/Self-inflicted Violence,2.According to the Brazilian Institute of Geography and Statistics (IBGE), in 2012,the Brazilian state was the 11th in size of the population, with 6,248,436inhabitants. The estimated population in 2019 was 7,164,788 inhabitants, with971,034 being the population of children and adolescents. Santa Catarina has 295 municipalities, distributed over 95,730,921kmThe study analyzed the data using descriptive statistics.From January 1 to May 31, 2020, 136 of the 295 municipalities in Santa Catarina made1,851 notifications in SINAN of suspected or confirmed cases of interpersonal orself-inflicted violence in the 0 to 19 age group. These events were characterizedas: neglect or abandonment, physical, psychological, sexual, and other violence, andchild labor .10At the time of data collection for this study, only 46% of the municipalities hadincluded cases of violence in SINAN. The data request was sent to all municipalhealth departments in the state of Santa Catarina. The response of less than half ofthem may be due to the need for restructuring health facilities and adapting theirfacilities to the service demands of the pandemic.For 30 years, the Child and Adolescent Statute (ECA), under Law No. 8,069/90, madechildren and adolescents \u201csubjects of law\u201d in Brazil. It delegates to society theduties to protect and care for these developing Brazilian citizens and emphasizesthe obligation to ensure full compliance with the rights necessary to promote theirfull potential, removing any form of oppression or discrimination. In its Article13, ECA determines the obligation to report all cases of suspected or confirmedphysical punishment, cruel or degrading treatment, and maltreatment of children tothe local child protection councils, without damage to other legal measures.In 2001, the notification of suspected or confirmed cases of abuse against childrenbecame mandatory and directed to municipal epidemiological surveillance and thechild protection council.Data from social organizations and non-governmental institutions published in themedia report an increase in violence against children and adolescents in thepandemic, such as the 7.4% increase in the Federal District,The state of Santa Catarina has provided data on the number of cases of domesticviolence against children and adolescents since the emergence of the COVID-19pandemic.Based on SINAN notifications from 136 municipalities in Santa Catarina that releaseddata  for 2020, there was a progressive decrease in the totalnumber of notifications since the beginning of social isolation, the absolutenumbers in January, February, March, April, and May are, respectively, 469, 506,434, 273, and 169 .10 WheDoes this data mean that violence has decreased? We believe it has not. Severalfactors can justify the significant reduction in notifications. The need forrestructuring and adapting health services to the pandemic reality, directingemployees and health units for the exclusive care of cases of acute respiratorysyndromes, and overload of the teams of health workers due to the increased demandfor care may have made it difficult for users to access services usually availableto the population. Added to this, we have the interruption of public transportservices, which imposed difficulties in traveling and accessing health services. Thefear of contamination, the social isolation imposed, the limitations for leavinghome, added to the financial difficulties resulting from the pandemic, may haveconstituted barriers to reporting violence and seeking assistance and the consequentdecrease in notifications.For many women, the health measures adopted to cope with the new coronavirus demandedmore domestic work, greater care for children, away from daycare centers andschools, besides greater assistance to the elderly and sick family members. It isinferred that movement restrictions, financial limitations, and generalizedinsecurity encourage abusers, giving them a greater sense of power and control.Confinement also brings different changes in the routine of family members, leadingto stress, which, if not well conducted, can lead to consequences for the entirefamily dynamics. These consequences can affect the physical and mental health ofchildren and adolescents, especially young children, who do not have the necessarytools to adjust to stress or to overcome it, which can make it especiallyharmful.Family stress is closely associated with uncertainty/insecurity in the near future,the possibility of falling ill and experiencing the illness of a family member/lovedone, fear of not getting adequate access to health, not promising news in the media,economic problems related to job loss and/or reduction of monthly family income.Added to these facts is the increased time spent with children and adolescents, nowalmost 24 hours, both due to the need for social isolation and the closing ofschools, parks, and leisure areas in the condominiums.Stress is also associated with the absence of other components of the family supportnetwork, such as the interaction with grandparents, uncles, neighbors, domesticworkers, and even institutions such as churches and social projects. This tensionexperienced and expressed by parents is reflected in children and adolescents, whostart to adopt the same behavior: tension, demotivation, and aggression, which canbe intensified by the excessive time on screen.This whole range of factors favors a violent domestic environment, which, associatedwith the distance from the protection agencies, the fear of losing the only providerof the family, of not being able to leave the house, for example, to stay at theirparents' house (grandparents of the children), even because of the fear of rupturingthe relationship, thus enabling the maintenance of the pact of silence inside thehouse, making everyone vulnerable to suffering violence.Family violence has a strong historical-cultural connotation: parents who wereeducated in a violent manner reproduce this form of education, resorting to physicaland psychological violence, manifested by beatings, hair pulling, spanking,shouting, and the most diverse threats as a way to impose discipline to theirchildren.The protective role of the school is recognized as paramount, identifying in theteacher often the confidant, the professional with a watchful eye on the studentsunder their care, the one who can be the trigger for the protection and care networkand guarantee the rights of children and adolescents. However, according to theUnited Nations Educational, Scientific and Cultural Organization (Unesco), about 1.5billion children and adolescents worldwide are out of school because of the closureof educational institutions as an initiative to contain cases of COVID-19.Still, much of the state's child protection structure, such as child protectioncouncils and police stations, is providing virtual assistance only. Additionally,public transport is absent in many regions and greater consumption of alcohol andother drugs, as well as psychoactive medications.A recent publication was assertive when it was titled \u201cThe pandemic paradox\u201d, as thispandemic creates a paradox concerning security at home: a place where we should beprotected and safe is where violence occurs for the most vulnerable groups. Theauthors emphasize that we must all pay attention to this issue: \u201cGovernments aroundthe world have asked all of us to participate in the fight against COVID-19 bystaying at home, but it is also important to pay critical attention to what thismeans for many women and children\u201d.Given this, specific and regional regulations were developed, initiatives to bethought and reproduced by states and municipalities, such as the National Councilfor the Rights of Children and Adolescents, dictating recommendations for the fullprotection of children and adolescents during the COVID-19 pandemic,On June 10, the National Council of Justice and the Association of BrazilianMagistrates launched the Red Flag Against Domestic Violence campaign. The initiativefocuses on helping women in situations of violence to ask for help in pharmacies inthe country, offering a silent channel of communication and assistance: with a red Xin the palm of the hand, which can be done with a pen or even lipstick, the victimindicates she is in a situation of violence. With the woman's name and address inhand, pharmacies and drugstore attendants who join the campaign should immediatelycall 190 and report the situation. At the time of its launch, the project had apartnership with 10,000 pharmacies and drugstores across the country.In the same direction, the Military Police of Santa Catarina and the National Councilof General Commanders of the Military Police and the Military Fire Brigade joinedforces, dispatched and disseminated, through the internal network, normativeinstruction with the addition of standard operating procedures for the specifichandling of incidents involving domestic violence against women.In the same state, Technical Note 012/2020, from the State Department of Health,dated May 19, 2020, deals with measures to combat domestic violence in the contextof the COVID-19 pandemic. It warns of the importance of notifying suspected orconfirmed cases and referring them as soon as possible to protection agencies andmultiprofessional care as recommended in the care protocols. The note also listssuggestions for protective actions for victims and informs contact phones ofentities in the protection network.Law no. 14.022 was recently published in the Federal Official Gazette of Brazil, which ensures the full functioning, during theCOVID-19 pandemic, of entities assisting women, children, adolescents, the elderly,and citizens with disabilities who are victims of domestic or family violence.According to the law, assistance to victims is considered an essential service andcannot be interrupted while the state of public calamity caused by the newcoronavirus lasts.We chose to study data on domestic violence in children and adolescents underCOVID-19, considering the current concern of society for the risk of itsintensification during home confinement imposed by the pandemic. The small number ofmunicipalities that provided the notification data and the short period analyzed canbe mentioned as limitations of this study. Nonetheless, we understand that theselimitations are minimized by the relevance and urgency of the topic.It is possible to conclude that the reduction in the number of complaints of violenceagainst children and adolescents does not encourage, nor does it seem to reflect adecrease in the incidence of this condition. On the contrary, it can demonstratedifficulties that people may be facing in making the complaints and using existingsocial resources to care for the victims. Initiatives, although specific, areunderstood as beneficial, which warn of the need for attention to the problem. Inthis pandemic moment, with the confinement of children in potentially violent homesand spaces, it is essential that their surroundings and the whole society be alertto the suspicion and evidence of cases of violence and that accessible, effective,and safe ways are provided so that complaints, notification, and prompt response tocases occur, aiming at protecting victims, minimizing damage and, thus, preventingthe perpetuation of violence."}
{"text": "Currently, in the field of dentistry literature, one of most active research topics is clearly related to implants, bone materials, and regenerative strategies for the reconstruction of different oral tissues. Biomaterials and related technologies used with these purposes could only be derived from the integration of the knowledge of different disciplines, which together are skilled in generating innovation and research development, with extensive support of basic sciences and intense international cooperation. The combination of these resources, associated with the greater need for increasingly comprehensive and predictable therapeutic protocols, brings a substantial change in the treatment of oral rehabilitations. The development of biotechnologies and related new biomaterials is a major field of research and clinical innovation in all modern dentistry divisions, but especially so in oral surgery. In the current era of tissue engineering with the evolution of the properties, safety and efficiency of tissue regeneration and implantable materials, biomaterial research has contributed largely to the improvement in treatments strategy and to the suggestion of new therapeutic approaches in oral rehabilitation ,2,3.However, currently the most important research topic is clearly related to dental implants, bone materials, and regenerative medicine strategies for the reconstruction of oral tissues  These biThe interdisciplinary field of implant-supported oral rehabilitation alone is generating considerable literature, probably the largest literature from all dental-related topics today ,7. This This interdisciplinary collaboration also extends far outside the limited dental field to most medical disciplines as biomaterials often have multiple potential applications in the human body. Dental implants, bone substitutes, surgical adjuvants, and other instruments and the way to combine them all into a successful therapeutic strategy, particularly represent a new frontier in regenerative medicine with numerous applications in orthopedic, plastic surgery, and other related medical disciplines ,13.Today, the field of dental implants and related biomaterials is also the heart of translational research in dentistry. All of the new biomaterials are thoroughly designed and tested by material scientists, before they are finally tested in vitro, in vivo, in animal models, and finally in clinical settings. The translational research movement is always in both directions: basic to clinical sciences and vice versa ,15,16,17The international cooperation is an important step to develop and spread new ideas and projects, promote debate, contradiction, and sometimes consensus, and finally grow a shared literature with less misunderstandings, confusion, and bias .One final aspect of this field is related to the social sciences and appeared quite recently with the considerable development of this scientific field: the internationalization of higher education and research in this domain, its importance, and its consequences. With the growth of the scientific field and its industrial development, implant dentistry step by step became a major discipline worldwide in oral and maxillofacial sciences, leading to the constitution of various national leaderships and centers of research and education ,14,15.In this special issue on new materials in oral surgery and implant dentistry, we continued our task to gather a meaningful corpus of relevant articles. More than before, a better control of the specialized literature is due. We particularly describe the strengths, weaknesses, opportunities, and threats of these disciplines and how research in implantable materials, especially dental implants (new implant design and surfaces), bone materials, or surgical adjuvants, is affected by not only scientific bias and misunderstandings, but also industrial and financial interferences, creating many inaccuracies in the literature. Despite the incredible potential and revolution that these disciplines are supporting for patients and the clinical approach to oral rehabilitation, there is also a major threat to the credibility of this field ,20.We selected a series of articles with new data on a wide range of topics in biomaterials and regenerative research in periodontology, oral surgery, and aesthetic and implant dentistry, and we highlight how these interconnected fields of research are both transversal (multidisciplinary) and translational . In the following articles, most of the major current aspects of biomaterials in oral surgery are introduced.Several articles have focused on the molecular, cellular, and pharmaceutical aspects of the biomaterials used for bone grafting. More specific aspects have been investigated by other authors such as the biological mechanisms of dental implants, insisting in particular on the impact of implant surface topography on peri-implant tissues.Therefore, the articles gathered for this Special Issue highlight only a selection of key aspects of the current dental biomaterial sciences, which are both founding knowledge and innovative perspectives for the future of the field."}
{"text": "The Zika virus outbreak has triggered a set of local and global actions for a rapid, effective, and timely public health response. A World Health Organization (WHO) initiative, supported by the Department of Chronic Condition Diseases and Sexually Transmitted Infections (DCCI) of the Health Surveillance Secretariat (SVS), Brazil Ministry of Health (MoH) and other public health funders, resulted in the start of the \u201cStudy on the persistence of Zika virus in body fluids of patients with ZIKV infection in Brazil \u2013 ZIKABRA study\u201d. The ZIKABRA study was designed to increase understanding of how long ZIKV persists in bodily fluids and informing best measures to prevent its transmission. Data collection began in July 2017 and the last follow up visit occurred in 06/26/2020.A framework for the ZIKABRA Cooperation initiative is provided through a description and analysis of the mechanisms, strategies and the ethos that have guided the models of international governance and technical cooperation in health for scientific exchange in the context of a public health emergency. Among the methodological strategies, we included a review of the legal documents that supported the ZIKABRA Cooperation; weekly documents produced in the meetings and working sessions; technical reports; memorandum of understanding and the research protocol.We highlight the importance of working in cooperation between different institutional actors to achieve more significant results than that obtained by each group working in isolation. In addition, we point out the advantages of training activities, ongoing supervision, the construction of local installed research capacity, training academic and non-academic human resources, improvement of laboratory equipment, knowledge transfer and the availability of the ZIKABRA study protocol for development of similar studies, favoring the collective construction of knowledge to provide public health emergency responses. Strategy harmonization; human resources and health services; timing and recruiting particularities and processing institutional clearance in the different sites can be mentioned as challenges in this type of initiative. Aedes aegypti and microcephaly [Strategic Response Framework (SRF) [Aedes mosquito, the development of safe and effective therapies and vaccines and the identification of funding sources to support this extensive research and development agenda.The sudden emergence of the Zika virus (ZIKV) in Brazil, the wide geographical range of the mosquito vector of the virus and the link to microcephaly and other important disorders, triggered a call for a global response. On November 11, 2015, the Brazilian Ministry of Health (MoH) declared the ZIKV epidemic as a Public Health Emergency of National Importance . Consideocephaly . In turnThe \u201cStudy on the persistence of Zika virus (ZIKV) in body fluids of patients with ZIKV infection in Brazil \u2013 ZIKABRA Study\u201d was conducted to address one of the research gaps identified by the WHO Research Agenda which comprises the characterization of the ZIKV infection . The aimThe ZIKABRA study brought together the expertise of a multi-disciplinary group of scientists to meet the requirements of designing a research protocol with complex clinical, epidemiological, biomedical, virological, laboratory and public policy features. The national epidemiological situation and research capacity dictated the selection of the study sites, notably in three major capitals in the northern (Manaus), northeastern (Recife) and southeastern (Rio de Janeiro) regions of the country, with its reference laboratories at the Tropical Medicine Foundation Dr. Heitor Vieira Dourado (FMT-HVD), Oswaldo Cruz Foundation, in Rio de Janeiro (Fiocruz-RJ) and Brazil Oswaldo Cruz Foundation-Institute Aggeu Magalh\u00e3es, Recife (CPqAM \u2013 Fiocruz - PE). On the international side, the United States Department of Defense laboratory, and the Walter Reed Army Institute of Research (WRAIR) provided technical, material and immunologic assay support.This paper provides a framework for the ZIKABRA initiative through a description and analysis of the mechanisms, strategies and the ethos that have guided the models of international cooperation and scientific exchange between Brazil and international organizations in the context of a public health emergency.The project was jointly funded by the MoH/SVS/DCCI ; WHO ; WRAIR - (0130602D16) - Cooperation Agreement (W81XWH-18-2-0040) between Henry M. Jackson Foundation for the Advancement of Military Medicine and US Department of the Army; Wellcome Trust (WT) (grant 206522/Z/17/Z); and National Institutes of Health (NIH) (Award Number R21AI139777), thus completing the ZIKABRA international cooperation.This is a descriptive and documentary analytical study, based on primary data, produced by the ZIKABRA Cooperation. The documents produced by the research study group and technical reports were reviewed. Basically, the weekly meetings fed the information about the management and governance information, once all the representatives of the participant institutions attend these calls.Data underlying the study cannot be made publicly available due to ethical concerns, as data contain several personally identifiable information. Data are available from Oswaldo Cruz Foundation for researchers who meet the criteria for access to confidential data. To contact information, please report the Declarations section of the Manuscript, Availability data and materials.The study design was developed in partnership by a team of scientists from WHO, Fiocruz-RJ, CPqAM - Fiocruz-PE, FMT-HVD, WRAIR and DCCI and marked the beginning of the formation of the network of collaborators from MoH, PAHO, WHO, WRAIR, Fiocruz, WT and NIH, which is named ZIKABRA Cooperation.In 2016, at the time of the ZIKABRA study development, 216,207 probable ZIKV cases were reported in Brazil . From 20The laboratory component of the ZIKABRA study is a key part of the protocol, whose performance complexity requires mature operational and logistic support, essential to meet the requirements of all steps of the study, which included: recruitment; collection and transport of biological samples and specimens for laboratory testing at partner institutions in Brazil and WRAIR; follow-up of participants; data management and analysis; and production and progressive dissemination of knowledge generated within the scope of the project, , 10\u201312. Aedes aegypti and Microcephaly [The research agenda integrated into the Brazilian Plan for Fighting ocephaly  guided tocephaly , coverinocephaly . It was The WHO provided the initial funding, concept and planning for the investigation of ZIKV persistence in body fluids, and was responsible for bringing together funding partners, (WRAIR and WT), and providing the research protocol using the \u201cEbola RNA Persistence in Semen of Ebola Virus Disease Survivors\u201d  as a refPAHO/WHO in Brazil has had a central role in the technical conduct of the public health emergency by ZIKV, contributing to the MoH in the national response to this epidemic in Brazil and in the countries of the region, with the direct participation of its specialized teams in the field, mainly in the infection hotspots, supporting interventions in the areas of surveillance, epidemiological analysis and purchase of laboratory supplies. PAHO has facilitated the dialogue among several health managers in Latin America and contributed to the production of knowledge about ZIKV infection, both in Brazil and in the region. It has also played an important role in the management of funds earmarked for the development of strategic research activities .Fiocruz-RJ was responsible for coordinating the study and managing funds from international sources: Wellcome Trust, WHO and WRAIR. Additionally, it is in charge of carrying out laboratory tests together with FMT-HVD and Institute Aggeu Magalh\u00e3es (CPqAM), in Fiocruz-PE, coordinating the laboratory management interface of the study with CGLAB/SVS. Fiocruz is a federal agency whose mission is to produce, disseminate and share knowledge and technologies aimed at contributing to the promotion of health and quality of life for the Brazilian population. Besides generating knowledge, Fiocruz is also responsible for the production of medicines, immunobiologicals and diagnostic tests , and worFMT-HVD was the center responsible for the management of the national funding of the study. Patients from the city of Manaus, made up almost the entire sample of the study and the researchers were essential for the recruitment and follow-up of volunteer participants, laboratory analyses and transport of samples to the other sites in the national territory. As a national and world reference center for the treatment of tropical diseases, FMT-HVD plays an important role in clinical research and diagnosis and treatment of tropical diseases in the Amazon.The Wellcome Trust supports major projects in partnership with WHO and other institutions around the world to respond quickly to the global health threat caused by the ZIKV, including ZIKABRA. Its funding schemes offer grants across biomedical sciences, population health, medical innovation, humanities and social sciences, and public engagement .The NIH, more specifically the National Institute of Allergy and Infectious Diseases (NIAID), has partially funded the study through a grant, obtained via a bid notice. It promoted the research in areas such as the natural history of the disease, basic research on ZIKV, pathogenesis, rapid diagnostic tests, as well as treatments and vaccines .In this cooperation, WRAIR added its experience by providing scientific resources as a center of excellence for immunology and the development of vaccines and medicines for diseases such as dengue, Zika, Ebola, coronaviruses, malaria, HIV/AIDS and others. WRAIR\u2019s contributions to the ZIKABRA study included co-funding, protocol review, laboratory testing, technology transfer, laboratory capacity building and production and dissemination of results.The systematization and governance of the ZIKABRA Cooperation was based on the formalization of a memorandum of understanding (MoU) between the Ministry of Health, Fiocruz-RJ, WHO and WRAIR, which established the technical criteria for the cooperation, the allocation of responsibilities among the partners, the sharing of technical and scientific information and the commitment to national and international ethical and regulatory requirements . In addiWithin the scope of the ZIKABRA Cooperation governance, a weekly dialogue routine was established since the study protocol development phase, as proposed by WHO, through the use of virtual platforms, in order to enable the participation of those involved, with transparency and integration of the study management as the ethos that characterizes its governance. In these meetings, events that occurred at each site, advances in recruitment, logistical problems faced, and the solutions found, doubts, decentralized monitoring of the protocol follow-up and other topics are reviewed. Each of these meetings is documented by WHO in minutes that record the topics covered, the decisions and courses of action and are circulated to those involved on a weekly basis. This routine helped everyone in the process of following up the work on different areas and sites.In short, the programmatic instruments supporting the study are analyzed in this locus, namely: the MoU ; the resIn Brazil, the National Commission for Research Ethics (CONEP) regulates research involving human beings and coordinates the institutions\u2019 Research Ethics Committee (CEP) network, forming the CEP/CONEP System. The current regulatory framework is the CNS/MoH Resolution 466/2012 . After tIt is noteworthy that, in the ZIKV emergency context in Brazil, the CEP/CONEP System needed to adapt quickly to this reality  in orderThe ZIKABRA study strictly followed the current regulations for the transportation, processing and use of human biological material, for the purpose of creating biorepositories and sending biological samples outside the country in accordance with national rules , 26. ForThe ZIKABRA Cooperation Fig.\u00a0, is baseThis cooperation can be thought of as an example of global health governance, a process that makes up the type of collaboration between countries that work with common goals and interests. It can have a wide and flexible range of formal and informal joint activities that may include funding and coordination in health matters . It can The ZIKABRA Cooperation had a direct benefit for Brazil, but it also has potential applicability to other settings. The evidence generated by this cooperation could be used more broadly to address efforts regarding vulnerable and most at-risk population, such as those in countries with active transmission of the ZIKV or other emergent pathogens. It is, also, expected that the scientific information produced can support national and international guidelines for body fluid testing and contribute to the future health technology innovations .However, we point out that one of the main barriers to researching in health emergency scenarios is the bureaucratic mechanisms and the slow chain procedures in conducting the rational use of financial resources in the implementation of the study. For instance, the delay in building the MoU, hiring qualified personnel, procurement and importing supplies, standardizing laboratory tests, transfer of funds to local sites, excessive delay in adjusting the work plan and to reach international quality standards.It should be noted that the team of collaborators and supporters from the institutional partners played a leading role in the implementation of the ZIKABRA Study. The existence of this joint team of collaborators and supporters was key to overcome the barriers that came up during the throughout the execution of the study.Working in cooperation in fact contributes to achieving more significant results than each group working in isolation. For this reason, careful structuring, relevant distribution of functions, well-coordinated collaboration and cooperation are pivotal. Cooperation also enables to provide consultation and coordination mechanisms so that this synergy takes place effectively .Brazilian practices of international cooperation in health have shown fruitful results in tackling public health problems with the consolidation of research and development actions. Other studies have been produced showing the importance of international collaborations for responding to the ZIKV public health emergency, including innovation, joint publications, and research networks .Another Zika research consortia were installed by the European Commission, for instance the Zika Preparedness Latin American Network (ZikaPLAN)  to addreIt\u2019s important to highlight the research protocols coordinated by WHO like the ZIKV Individual Participant Data (IPD) Consortium, that aims the development of systematic review to describe and gather data to IPD from longitudinal studies of pregnant women with ZIKV infection during pregnancy and fetal, infant or child outcomes, in the absence of a ZIKV vaccine or prophylactics , 34.Another network initiative is supported by the European Commission (EC) Horizon 2020, was structured as a Consortium that comprises 53 partners organized in eight scientific and one management work packages (WPs), as well as three cross-cutting WPs, it\u2019s the ZIKAlliance Consortium. This is a multicentre research that covers Latin America and the Caribbean region. Among the goals is to describe the dynamic course of the ZIKV epidemic in pregnant women (PW), children (CH) and natural history (NH) cohorts. This Consortium also collaborates with the EC H2020-funded consortia: ZikaPlan and ZikAction. It works as a spin-off for newly emerging infectious diseases, as now seen for COVID-19 .It is relevant to highlight that for all rare disease outcomes in ZIKV infection, networking has been a concrete response to share action regarding side events such as Guillain Barre Syndrome and other neurological complications, early postnatal symptomatic ZIKV infections and other rare events such as thrombocytopenia. Even more frequent events such as attack rates and sexual transmission  can be bWe understand that organizational , administrative and regulatory processes must be sufficiently agile to meet the demands of scientific research in favor of the benefits that science can bring to public health , withoutIn ZIKABRA study, groundwork was done in the health units of the selected sites, which involved the participation of health service coordinators, doctors, nurses and social workers, through prospecting visits and meetings with the presence of the researchers in charge and members of WHO, PAHO, WRAIR and MoH. During these visits, technical training on the protocol, good research practices, ethical respect for volunteer participants, structuring of services to avoid interruption in the routine care to regular patients, professionalization of non-academic professionals, among other activities, were promoted. The results were particularly enriching due to the experience shared between the site health teams and the ZIKABRA team, favoring the engagement of all actors involved for the good execution of the study.One of the main bottlenecks in the operationalization of the ZIKABRA study was the change in ZIKV epidemiology, making it impossible to recruit participants in Rio de Janeiro, and very few participants in Recife. Additionally, there was a mismatch between the finalization of the ZIKABRA protocol, including all its regulatory and financial aspects completed in January 2017, and the end of the Rapid Action Strategy by SVS/MoH, on October 31, 2016, as well as the PHEIC closure by WHO, on November 18, 2016 . This deOn the other hand, the ZIKABRA Cooperation structure, with clearly defined roles in the operational instruments, has overcome the difficulties encountered, reaching the proposed goals, greater efficiency in fund management and strengthening research autonomy. The ZIKABRA study leaves as a legacy the interaction among the actors experienced in an arena of weekly discussions where decisions were made in full respect for the cooperative ethos among peers, the intertwining of institutional visions, in order to support the team of collaborators, aiming at the common interest and achieving excellence in results.Based on this cooperation, it is suggested that there is greater flexibility and autonomy in the mechanisms of disbursement of funds and execution of the work plan, ease in hiring qualified human resources and in the purchase and import of laboratory supplies, standardization of diagnostic tests, among others. Table\u00a0The legacy of the ZIKABRA Cooperation includes the construction of installed research capacity in the site, with improvement of laboratory equipment, laboratory and clinical data management platforms, training of academic and non-academic human resources, dissemination of generated knowledge, advancement of knowledge about the studied theme, knowledge transfer, availability of the ZIKABRA study protocol for development of similar studies, thus favoring the collective construction of knowledge to provide public health emergency responses. Additionally, the benefits arising from the study contribute to the strengthening of new partnerships with national and international researchers of recognized excellence in sciences, supported by public and government institutions in political, economic and technical terms .We highlight some steps towards the potential continuity of the ZIKABRA Cooperation initiative, such as the idea of WHO as a global health hub mobilizing experts and putting its tradition, prestige and knowledge to the services of technical responses achieving health goals and sharing understanding and capabilities about the actions, norms and procedures adopted by the set of participating institutions.Another relevant lesson learned is the horizontal cooperation among Brazilian researchers and institutions all over the country. The ZIKABRA project provided  technicaIt would also be important to bear in mind the role of interaction among government bodies of the participating institutions that takes place in the joint follow-up of the sites and project performance. Field supervision of all stakeholders during the implementation of the project occurred periodically. This helped to share the level of knowledge of the site settings by all participants and to avoid institutional constraints."}
{"text": "The Internet of Things (IoT) is of continuously growing interest for research and industry. IoT technologies are reaching maturity, as demonstrated by the increasing number of IoT applications in several markets ranging from smart homes to smart factories and Industry 4.0, with the so-called Industrial Internet of Things (IIoT).However, some issues remain despite this success. Amongst them, the main issue that may slow down the adoption of IoT relates to security. The heterogeneity in terms of protocols, operating systems, and devices, combined with poor adoption of standard solutions, create insecure designs, architectures, and deployments. Furthermore, IoT applications are often associated with sensitive data, core infrastructures, and assets, thus making them attractive in terms of vulnerability, data breaches, and denial of service attacks.Unfortunately, conventional security approaches tend to be inapplicable in the IoT due to the limitations of the resources of IoT devices and the decentralized nature of IoT architectures.Blockchain is a technology that is currently receiving great attention and may help in providing security in IoT scenarios. The decentralized architecture of blockchains, together with the ability to provide data immutability and non-repudiation services, seem to make blockchain a promising technique for securing IoT and protecting user/data privacy.The Special Issue \u201cBlockchain Security and Privacy for the Internet of Things\u201d seeks to explore the innovative developments, technologies, and challenges related to blockchain, security, and privacy for the IoT coming from both the latest research activities and ongoing projects. The presented topic is characterized by many open challenges that need to be solved or improved, and for this purpose, while several manuscripts have been received, only 15 original and high-quality manuscripts were selected for this Special Issue. Each manuscript was reviewed by several reviewers and went through multiple rounds of the peer-review process.We had two interesting review papers ,2 presenThe authors of  present In , the autIn the context of Smart City application and use cases,  presentsThe authors of  propose In , an archIn the challenging ecosystem of intelligent mobility and transportation systems, the authors in  present In , the autIn , a decenPaper  investigAn IoT security transmission and storage solution regarding sensing images for blockchain is proposed by the authors in . The proIn the Smart Grid application scenario, the authors of  introducThe authors in  propose Paper  presentsFinally, we would like to thank all authors and reviewers contributing to this Special Issue, the former for their original solutions and the latter for improvement suggestions. Their excellent work has allowed us to present novel and interesting contributions in the field IoT and blockchain technologies."}
{"text": "To the Editor\u2014The pandemic caused by a novel coronavirus disease, known as COVID-19, carried millions of people around the world to a state of unprecedented panic. The World Health Organization (WHO) stated that more than one-third of the world is currently under some social distancing pattern, which is the oldest and probably one of the most effective methods for controlling infectious disease outbreaks. However, governments of many countries have difficulty implementing social distancing, particularly in developing countries such as Brazil, where income inequality is high and the national economy is fragile. In a recent study, Taghrir et al investigated the efficacy of mass quarantine during the pandemic and found good-quality evidence for the social distancing strategies to have been highly effective in controlling the spread of the disease. Complementing this analysis, other researchers analyzed data of 8 countries extremely affected by COVID-19: China, Italy, Iran, Germany, France, Spain, South Korea, and Japan. They concluded that the rapidly increasing COVID-19 case numbers in European countries occurs due to late contention measures. Therefore, social distancing is currently the most effective way to slow the spread of COVID-19.Several studies in the literature, both in developed and developing countries, have demonstrated the effectiveness of social distancing in slowing the spread of COVID-19. Social distancing measures included the closing of schools, universities, and almost all shops, except food stores and pharmacies. In addition, cafes, restaurants, clubs, gyms, museums, and other institutions across the country have closed. Public gatherings, religious services, and social and sporting events have been cancelled. Nonetheless, the number of cases for COVID-19 has continued to grow exponentially due to difficulties in establishing true and effective social distancing. In the real Brazilian context, a large number of informal workers are still working normally and there is a lack of access to information for a large part of the population regarding minimum infection prevention and control measures, including hand washing and respiratory etiquette.In Brazil, the Ministry of Health recommended measures of social distancing, respiratory etiquette, and hand hygiene.Although handwashing and social distancing are still the best measures to protect against the virus, the flattening the COVID-19 curve will require additional measures in developing countries, where the spreading factor of the virus are different and more complex. In Brazil, it is essential to better understand the true prevalence of COVID-19, but the lack of mass testing is one of the main problems that make it difficult to implement measures to ensure that infected individuals are in an appropriate quarantine. Here, the physical distancing between infected and people is crucial in the high-risk group, such as the elderly and those with respiratory or chronic illnesses, to reduce the lethal effect of the pandemic. Cowling et al demonstrated that the implementation of social distancing measures and changes in population behaviors, including use of facial masks, were associated with reduced transmission of SARS-CoV-2 in Hong Kong. In Brazil, the adoption of this equipment can be difficult due to the low adhesion or the lack of access to facial masks by the Brazilian population. Thus, the correct use of facial masks is fundamental to the effectiveness of the measure and can be encouraged and improved through education campaigns.According to the WHO, wearing a surgical mask, in combination with hand hygiene and other preventative measures, is one of the prevention measures to limit the spread of SARS-CoV-2 in affected areas.In Brazil, coronavirus is advancing exponentially. Although the disease has spread rapidly in large capitals, where the incidence of cases is high, COVID-19 cases are increasing in smaller cities and poorer communities as well. More than three-quarters of the confirmed cases are in southern and southeastern regions of Brazil, which are more densely populated, including many elderly, and with tropical and subtropical climates. In addition, the economic burden that sustained distancing can impose is potentially catastrophic in Brazil and other developing countries. Furthermore, if social distancing is not effective and/or is not sustained for long enough, the healthcare system may collapse, contributing to a greater tragedy."}
{"text": "Maritime safety is a significant topic in the maritime industry since the numerous dangers at sea could lead to loss of property, environmental pollution, and even casualties. Existing research illustrates that human factors are the primary reasons of maritime accidents. Indeed, numerous maritime accidents can be classified into different types of human factors. In this context, the Human Factors Analysis and Classification System for Maritime Accidents (HFACS-MA) model is introduced in this paper. The HFACS-MA framework consists of five levels, complying with the core concepts of HFACS and the guiding principles of the International Maritime Organization (IMO). Based on the five levels of the framework, this research explores the underlying causes of Chinese Eastern Star, Korean Sewol, and Thai Phoenix accidents, and a comparative analysis is conducted. The analysis demonstrates the utility of applying the HFACS-MA model to the maritime industry, and the results emphasize the importance of the following categories: legislation gaps, organizational process, inadequate supervision, communication (ships and VTS), decision errors, and so on. Consequently, the research enables increased support for HFACS-MA and its application and provides valuable information for safety management and policy development in the maritime industry at different levels. The maritime industry is the global economic lifeblood, transporting about 90% of global trade, so maritime safety is a vital factor for the sustainable development of international economics and trade . The marThe International Maritime Organization (IMO), whose intention it is to create a fair and effective regulatory framework for the maritime industry in order to decrease human errors, has issued a number of maritime conventions. The four main maritime regulatory conventions are International Convention for the Prevention of Marine Pollution from Ships (MARPOL), Convention on the International Regulations for Preventing Collisions at Sea (COLREG), International Convention on Standards of Training, Certification and Watchkeeping for Seafarers (STCW), and International Convention for Safety of Life at Sea (SOLAS) . In partThis paper takes three catastrophic maritime accidents as examples to identify different kinds of human and organizational factors in the maritime industry: the Chinese Eastern Star, the Korean Sewol, and the Thai Phoenix accidents. There are several reasons for selecting the three accidents. Firstly, all the three maritime accidents happened in recent years and resulted in loss of property and heavy casualties. Secondly, the three accidents occurred in China, Korea, and Thailand, respectively, and they are all located in the Asian region with similar social contexts. After the capsizing of Eastern Star and Sewol, several scholars conducted detailed analysis on the accident causes ,19,20,21On 1 June 2015 (Beijing time), the Eastern Star, which is owned by the CESC, departed from Nanjing City and was sailing to Chongqing City. At 21:30, the Eastern Star encountered a squall line system accompanied by strong convective weather, tornadoes, as well as torrential rain. Influenced by strong storms, the Eastern Star capsized in a short time when the ship navigated in the Jianli waters affiliated to the Yangtze River of China. The Eastern Star is a large-scale travel ship that was initially built by the Chuandong shipyard in 1994 and renovated in 1997, 2008, and 2015, respectively. The passengers on board were mostly old people from a travel agency named Sunset Red and most of them were sleeping when the accident happened. The accident caused 442 deaths and was deemed to be the most serious maritime accident since 1949 [At 08:58 on 16 April 2014, the Sewol with 476 persons capsized on the way from Incheon port to Jeju Island, and 325 out of the 476 passengers were high school students who were going on a school trip. As an 18-year-old Japanese ship, the Sewol was purchased by the Cheonghaejin Marine Company in 2012. Subsequently, the Cheonghaejin made a series of modifications in a Korean yard to boost capacity in 2013, resulting in the Sewol\u2019s instability . When leOn 5 July 2018, the Phoenix went to sea illegally in spite of the weather warning. At 17:45, the ship encountered a severe storm on the way back to Phuket and capsized near Coral Island, resulting in 47 deaths . The sevThe overview of the three maritime accidents is presented in It is significant to choose an accident model because the choice of the model determines the methods of data collection, and the conclusions and the preventive measures could be different. In other words, \u2018what-you-look-for\u2019 determines \u2018what-you-find\u2019, and \u2018what-you-look-for\u2019 depends on the selected method or model employed in accident analysis ,26. TherHFACS, which is recognized as an epidemiological model, enables one to analyze the visible and underlying causes . In 1997With respect to the HFACS-MA framework, some changes have been made by comparing it with the original HFACS model. Firstly, the level of external factors is added into the HFACS-MA framework to capture the contributing factors that go beyond the scope of the organizational level, the additional level follows the application of HFACS model in the mining industry and railroad industry ,41, and In this section, the utility of applying the HFACS-MA model to the three maritime accidents is demonstrated. In order to extract the causation factors accurately, four safety experts are invited to analyze the three maritime accidents based on the HFACS-MA framework. Each safety expert needs to extract the causation factors independently according to the accident investigation report and some news articles, and an in-depth discussion about the causation factors is conducted among the four safety experts. When the causation factors are determined, they are classified into the appropriate level based on experts\u2019 experience, and a comparative analysis is carried out. Practical implications and limitations are discussed.In terms of the Chinese Eastern Star accident, 19 accident causation factors are identified according to experts\u2019 experience, and the accident causation factors are listed in With respect to the Sewol accident in South Korea, the disaster is the result of neglecting safety by government, supervising authorities, Chonghaejin, and the crew members . Based oRegarding the Phoenix ferry accident, 17 causation factors are identified based on the five levels of the HFACS-MA framework. Based on the cause analysis of the three accidents using the HFACS-MA framework, comparative analysis about the causes of three accidents is conducted, and the analysis results are presented in the form of an adapted fishbone diagram, which is shown in Regarding the level of external factors, legislation gaps are the primary category associated with the three accidents, especially in the Eastern Star accident and Sewol accident, as seen in At the level of organizational influences, As for the level of unsafe supervision, the most frequent categories involved in the three accidents are inadequate supervision and violations in supervision. The efficiency of organizational supervision is one of the influencing factors for the system safety and performance . Figure With respect to the level of precondition for unsafe acts, it was the most vulnerable level since the faults in the ship\u2019s hardware could be inspected at a glance. As the Swiss Cheese Model (SCM) suggests, the defects in the external factors, organizational influences, unsafe supervision, and precondition for unsafe acts result in unsafe acts . TherefoThis research explores the underlying causes of three maritime accidents by employing the HFACS-MA model, and the results indicate that the HFACS-MA model is applicative in analyzing the maritime accidents. In addition, we conducted a comparative analysis on the accident causes, attempting to explore the similarities and differences about the accident causes under the similar social context. Furthermore, the demographic of the causation factors were computed, and the key categories associated with the three accidents were identified.Regarding the three accidents, the main focus concentrated on establishing the corresponding legislations, policies, regulations, and safety culture within the maritime industry. Firstly, the legislations that related to maritime safety should be established and improved, which attempts to provide guidelines for maritime safety. Secondly, the standard procedures should be established and improved, including safety management system and rescue communications, and the in-depth risk assessment should be conducted routinely. Thirdly, the crew members on board should receive regular safety training to improve their safety knowledge and safety awareness and finally reduce unsafe acts. In addition, the rescue workers should be properly trained to improve the rescue operations level. Fourthly, it is significant to improve the meteorological warning capability and establish the information distributing platform of meteorological warning. Consequently, this research contributes to safety management and policy development in the maritime industry at different levels.Some materials of this research come from news articles, and one of the limitations is the inadequate data due to the translation obstacle of local language in Korea and Thailand when collecting evidence, which limits the depth of conclusions that we can draw. Furthermore, there are still many unresolved questions associated with the three accidents, such as the path of each accident and the risk assessment of human factors. In addition, this research is limited to accidents caused by Cruise ship and Ro-Ro passenger vessel only. Therefore, if the scope of research is expanded to multiple types of vessels, it is possible to establish effective maritime safety measures for maritime safety. Finally, HFACS was the only method used in this research. While this research was practical, it might be helpful to compare different analytical methods such as 2\u20134 Model , AcciMapIn this paper, the HFACS-MA model is introduced to explore the underlying causes of Chinese Eastern Star, Korean Sewol, and Thai Phoenix ferry accidents, indicating that the HFACS-MA model is applicable for maritime accident analysis. A comparative analysis on the accident causes of the three accidents was conducted, and the demographic of the causation factors were computed, and additionally the key categories were identified. Consequently, the research can increase support for HFACS-MA and its application, and provide valuable information for safety management and policy development in the maritime industry at different levels.At the level of external factors, it is important to improve the legislation in the maritime industry, especially in the Eastern Star accident and Sewol accident. At the level of organizational influences, the defects in the organizational process are the key contributing factors for the three accidents, and additionally the Eastern Star accident and Sewol accident emphasize the defects in the asset management. At the level of unsafe supervision, the inadequate supervision and violations in supervision are the primary reasons for the three accidents, and it highlights the importance of adequate safety training for maritime safety. Regarding the precondition for unsafe acts, the physical environment factors featured remarkably in the three accidents, and meanwhile communication (ships and VTS) play an important part in coordination and accident rescue. At the level of unsafe acts, it emphasizes the importance of the following factors: the decision errors and violations. Efforts to reduce unsafe acts should concentrate some critical HFACS categories at the lower levels.Although this research analyzes the causes of three accidents in detail, there are still many unresolved questions associated with the three accidents, such as the path of each accident and risk assessment of human factors. At the same time, this research provides some new insights to encourage further research to establish effective measures for national and international maritime safety."}
{"text": "Of Italian origin but Brazilian by adoption, Luigi Bogliolo was born on April 18, 1908, on the island of Sardinia, in Sassari, the main commune of the province of the same name. He died in Belo Horizonte on September 6, 1981. The firstborn child of Enrico Bogliolo, a railroad worker, and Maria Ruju, he graduated with a medical degree from the University of Sassari in 1930 as the best student in his class. At Medical School, he was a teaching assistant in Pathological Anatomy under the guidance of Prof. Enrico Emilio Franco, who was a source of inspiration for him throughout his life. In the 1931-1932 biennium, he was a volunteer assistant at the Institute of Pathological Anatomy and Histology of the University of Sassari, directed by Franco. At the end of 1932, he moved, along with his mentor, to the Royal Adriatic University Benito Mussolini, based in Bari, where he became a staff assistant in the Pathological Anatomy Department. In December 1936, following the footsteps of Franco once more, he moved to the University of Pisa, where he remained, until March 1939, as a deputy director of the Institute of Pathological Anatomy and Histology.Salomone Enrico Franco) was born in Trieste on November 22, 1881, and graduated with a degree in medicine from the Royal University of Padua in 1906. He was very demanding as a teacher, and apparently his students feared him with the same intensity with which they admired him; nonetheless, in the case of Bogliolo, he created all the conditions for the emergence of the \u201cmaster\u201d that his disciple, perhaps unsuspectingly, held in the core of his own being. His classes on the cadaver in the autopsy room were belissime, as Prof. Giuseppe Sangiorgi stated in the lecture (posthumous eulogy) that he delivered in Bari on November 18, 1950, to the members of the Italian Society for Experimental Biology. On that topic, his manual atlas of autopsy techniques, originally published in 1926, is an indisputable testimony of the seriousness and mastery with which he performed cadaveric examinations, which he considered a thorough investigation and not a hasty exercise in organ extraction.An Italian of Jewish origin, Enrico Emilio Franco , not only because of their high intellectual stature but also because they descended from a glorious scientific lineage, which is summarized below.While they were working in Pisa, Bogliolo and Franco bonded affectionately and professionally with the regent of the Chair of General Pathology, Cesare Sacerdotti, a disciple of Camillo Golgi and Giulio Bizzozero, whom they respectfully referred to as De sedibus et causis morborum per anatomen indagatis \u2013 a systematic confrontation between autopsy findings and clinical records, published in 1761. Therefore, one can consider Enrico E. Franco a legitimate descendant of the \u201cFather of Pathological Anatomy\u201d, from whom he was distanced by a few generations.As mentioned, Luigi Bogliolo (1908-1981) was a direct disciple of Enrico E. Franco (1881-1950) who, as a medical graduate from the University of Padua in 1906, was linked to the School of Giovanni Battista Morgagni (1682-1771), a distinguished professor of that old university and the author of the masterpiece Giovanni Battista Morgagni was a disciple of the anatomist and surgeon Antonio Maria Valsalva (1666-1723), a professor at the University of Bologna who dedicated himself to the study of the anatomy, physiology and pathology of the human ear. Valsalva was a disciple of Marcello Malpighi (1628-1694), founder of microscopic anatomy and author of notable contributions such as the first observation of capillary circulation, which was previously inferred by William Harvey; the first description of the vesicular structure of the human lung, which formed the basis for the formulation of a theory of respiration; the description of the lymphatic follicles of the spleen; the pioneering description of renal glomeruli; a detailed description of the structure and metamorphosis of the silkworm and of plant morphology; the description of the prickle cell layer of the skin; and the establishment of the foundations of a new discipline, Embryology. Marcello Malpighi was, in turn, both a mentor and a disciple of the physicist and mathematician Giovanni A. Borelli (1608-1679), the founder of Iatromechanics (the application of mechanics to medicine). Finally, Borelli was a disciple of the physicist and mathematician Galileo Galilei (1564-1642), a pioneer of scientific thought.Helicobacter pylori in the human stomach. Giulio Bizzozero studied in Germany with Rudolf Virchow (1821-1902), author of the magnum opus Die Cellularpathologie (1858) and of the famous aphorism Omnis cellula e cellula, which is why he is nicknamed the \u201cFather of Cellular Pathology.\u201d In addition, Camillo Golgi himself was a disciple of Giulio Bizzozero.The connections between Bogliolo and Franco with Cesare Sacerdotti allow the exploration of a second branch of what could be called the scientific lineage of Bogliolo. Sacerdotti was a direct disciple of Camillo Golgi (1843/44-1926), who, along with Santiago Ram\u00f3n y Cajal, won, in 1906, the Nobel Prize in Physiology or Medicine for his brilliant studies on the fine structure of the nervous system; he was also a disciple and collaborator of Giulio Bizzozero (1846-1901), the discoverer of platelets (and of their role in hemostasis) and of spiral bacteria in the stomach of dogs, the first step towards the identification of the species Mus musculus, var. alba) and the rat (Mus norvegicus).The publications of Bogliolo during his academic life in Italy deal with various topics, with an emphasis on those related to leishmaniasis and, in particular, to the experimental production of sarcomas through injections of Thorotrast in the mouse (thorotrastomas) due to exposure to alpha radiation .Thorotrast  was introduced for clinical use in 1928 and was used initially for retrograde pyelography and intravenous hepatolienography. As expected, almost all of the injected thorium dioxide was retained in the body, with 70% deposited in the liver, 20% in the spleen and the remainder in the reticuloendothelial system of the bone marrow and in the periportal lymph nodes. In 1931, Thorotrast began to be used by the Portuguese neurosurgeon Egas Moniz to examine the intracranial vessels, replacing the iodinated contrast that had been used until then for the same purpose. with successive injections of Thorotrast subcutaneously into the posterior half of the abdomen. In a second study, published in 1938, the injection of the contrast in the rat (Mus norvegicus) was able to induce the appearance of malignant blastomas in all 23 animals in the experiment, including 20 cases of fasciculated spindle cell sarcoma and three cases of pleomorphic sarcoma with areas of cartilaginous metaplasia  in hundreds of patients who had received the radiological contrast for diagnostic purposes, sometimes as much as 40 years previously. Nonetheless, the use of Thorotrast continued until the mid-1950s at highly prestigious institutions such as the Massachusetts General Hospital, the Lahey Clinic and the University of Michigan Hospital, in one of the most embarrassing episodes in the history of medicine.In Pisa, Bogliolo obtained the title of full professor in a public examination held in 1938; that same year, he married Geula Bennoun, a medical student of Jewish origin born in Jaffa, a twin city of Tel Aviv. In January 1939, Franco was dismissed from the University of Pisa amid the wave of anti-Semitism that ravaged his homeland and was forced into exile in Jerusalem, where he died on September 20, 1950, from diabetic nephropathy. In March 1939, Bogliolo was dismissed from the same University for his antifascist position, aggravated by his close relationship with Professor Franco and with Geula Bennoun, and was forced to leave his native country as well. After spending a few months in Belgium, he traveled with his wife to Brazil, arriving in Rio de Janeiro on January 5, 1940. In exile, until Franco's death, master and disciple never ceased to correspond, despite the difficulties imposed by World War II, which began on September 1, 1939, and the Arab-Jewish conflict, which experienced its most dramatic moments in 1947-1948. In January 1949, Bogliolo and Franco met, for the last time, in Jerusalem.At the beginning of his life in Rio de Janeiro, Luigi Bogliolo and his wife lived in a second-class guest house near the pier; and to survive, they tanned alligator skins in the bedroom. It is known that ancient Jews knew the method of tanning hides and skins with oak bark, an art that they must have learned as captives in Egypt; however, in the case of the young couple newly arrived from Italy, the place \u2013 a small bedroom in a guest house \u2013 was not the most suitable for the exercise of that ancient practice. It did not take long for problems to arise: annoyed by the strong smell from the tanning process, the owner of the guest house used to pound the door of the bedroom asking for explanations and threatening to evict the two afflicted artisans who, in an attempt to hide their wrongdoing, quickly threw the skins under the bed.post mortem findings with those observed intra vitam.In January 1941, under the recommendation of Prof. Eduardo MacClure, Bogliolo took on the Pathological Anatomy Service of the 5th Chair of Internal Medicine of the National Faculty of Medicine (now Faculty of Medicine of UFRJ), led by the great clinician Heitor Annes Dias (1884-1943), nicknamed \u201cthe Brazilian Jim\u00e9nez D\u00edaz\u201d. In perfect harmony with Annes Dias, Bogliolo boosted the Clinicopathological Conferences at that institution. Inspired by the unforgettable lessons of Franco, he conducted the autopsies of the cases that were presented in those meetings. Thus, after the clinical features had been explored, the diagnostic hypotheses had been formulated, and the possible reasons for the death of the patient had been considered, he was in charge of the autopsy report. Furthermore, at the end of the conferences, he used to perform the great synthesis \u2013 the epicrisis \u2013 correlating the post mortem examination, live in the clouds of a vain illusion. Forty-two years after Bogliolo\u2019s retirement, the Clinicopathological Conferences continue to take place at the Faculty of Medicine of UFMG. Regarding the invaluable pedagogical value of this academic activity, which I have coordinated since 1995, I published a book in 2010With the premature death of Annes Dias in 1943, Bogliolo was invited by his compatriot Alfredo Balena, director of the Faculty of Medicine of Belo Horizonte (now Faculty of Medicine of UFMG), to head the Chair of Pathological Anatomy of the institution Balena had helped to found in 1911. Starting in 1944, Bogliolo continued to perform autopsies and to favor Clinicopathological Conferences in his new home until his compulsory retirement in 1978. Certainly, he heeded Morgagni\u2019s wise warning that the physicians who have done or seen many autopsies have learned at least to mistrust their diagnoses, while those who do not confront themselves with the often discouraging findings of Taceant colloquia. Effugiat risus. Hic locus est ubi mors gaudet succurr\u011bre vitae \u2013 according to which, in the place where death delights to help the living, there should be no talking or laughing. To describe the Bogliolo\u2019s austere demeanor during the performance of an autopsy, it is worth reproducing the testimony of the late psychiatrist Joaquim Affonso Moretzsohn, who graduated in 1946:In the autopsy room, which he considered a kind of \u201csacred temple\u201d, Bogliolo demanded absolute respect for the corpse, as if he incorporated the message contained in an ancient Latin maxim \u2013 I met Prof. Bogliolo. He debuted with my class in the 4th year of Medical School, in 1944. \u2018What? Do you want to smell roses?\u2019 he exclaimed with a heavy peninsular accent when he realized that I took a handkerchief to my nose in the autopsy room.curriculum vitae, a written exam, a practical exam, a didactic exam and a thesis defense, he achieved the Cathedra.As mentioned, in 1944, Luigi Bogliolo became the head of the Chair of Pathological Anatomy at the Faculty of Medicine of Belo Horizonte. In the capital of Minas Gerais State, three of his children  were born, whereas Alexandre, his only son, had already been born in Rio de Janeiro in 1942. Both Alexandre and Ada would tragically die very young, victims of accidents, respectively in 1965 and 1967. Because he was a foreigner, Bogliolo was forced to revalidate his diploma; to accomplish this goal, between 1953 and 1957, he underwent practical, written and oral exams for all subjects of the last three years of the medical program. Therefore, it was not until 1958 that he completed his doctorate, defending a thesis on the pathology of acute toxemic form of schistosomiasis mansoni. In 1959, after a brilliant examination that consisted of an analysis of his Patologia, with the participation of his assistants and renowned professors throughout Brazil and Italy. In 2016, the ninth edition of the book, with 1,542 pages, was printed under the supervision of Prof. Geraldo Brasileiro Filho. In 1978, also through the Editora Guanabara Koogan, Bogliolo published the book Patologia Geral B\u00e1sica; in 2018, also under the supervision of Prof. Geraldo Brasileiro Filho, the sixth edition of the book was printed.In 1972, through the Editora Guanabara Koogan, Bogliolo published the first edition of the book Working at the Faculty of Medicine of UFMG until 1978, the year of his compulsory retirement, Bogliolo created a School of Pathological Anatomy that through its high level of regard would impose itself onto the scientific environment of his adoptive country. His first assistant professors included Paulo Roberto Ferreira Borges, Nello de Moura Rangel, Iracema Baccarini, Jo\u00e3o Henriques de Freitas Filho, Edmundo Chapadeiro, Washington Luiz Tafuri and Pedro Raso. The contributions of his School cover various topics in the field of Pathology, with an emphasis on tropical diseases, such as schistosomiasis mansoni and Chagas disease. The contributions of Bogliolo himself to the knowledge of the pathology of the different anatomoclinical forms of schistosomiasis mansoni deserve special attention, and include the following:\u2022 the accurate characterization of the morphological findings of the liver in the hepatosplenic form, especially in the case of Symmers fibrosis, which, according to some authors, should be called \u201cSymmers-Bogliolo fibrosis\u201d;\u2022 the clarification of the concepts of fibrosis and cirrhosis as they apply to fibrosing liver diseases, thus distinguishing the anatomical picture of the liver in the hepatosplenic form of schistosomiasis and in visceral leishmaniasis from that of liver cirrhosis;\u2022 the first description, in patients with the hepatosplenic form undergoing splenoportography, of the peculiar changes in the hepatogram, characterized by the presence, next to the clearer and denser image of the dichotomous portal branches, of a less dense and less defined shadow attributed to the newly formed vascular network around the dichotomous branches (\u201cBogliolo\u2019s sign\u201d);\u2022 the detailed description of the anatomical picture of the acute toxemic form, which was the focus of his doctoral thesis.The post-graduation, so valued today, was, in a way, already being carried out by Bogliolo in the 1950s; in fact, it consisted of a \u201cpost-graduation in spirit\u201d, because it lacked regulation and recognition by the relevant authorities. It was only in 1972 that the Teaching and Research Coordination Office of UFMG approved the creation of the Post-Graduate Program in Pathology, with three areas of concentration: General Pathology, Special Medical Pathology and Special Dental Pathology.Luigi Bogliolo was one of the founders of the Brazilian Society of Pathologists and served in virtually all positions therein, including the presidency (biennium 1960-1962). His remarkable presence, his verve, his critical spirit and his unmistakable style were felt in the conferences promoted by that society. He was also a member of the Minas Gerais Academy of Medicine, occupying chair 46, whose patron is Jos\u00e9 Aroeira Neves, a disciple of Ezequiel Dias. In 1978, shortly after his compulsory retirement, he received the title of Professor Emeritus of the Faculty of Medicine of UFMG.Although he was extremely strict and demanding, to the point \u2013 like Prof. E. E. Franco \u2013 of stoking undisguised fear in many of those who interacted with him, Bogliolo left an indelible mark on his disciples and collaborators. After all, one of his great passions was the unlocking of young people\u2019s potential, encouraging them to exercise reasoning, ask relevant questions, develop critical awareness and cultivate curiosity. Thus, he certainly endorsed the words of the ancient Greek philosopher Plutarch:For the mind does not require filling like a bottle, but rather, like a wood, it only requires kindling to create in it an impulse to think independently and an ardent desire for the truth.In 1992, I published a book about the fascinating trajectory of the late master."}
{"text": "Twenty years ago, the International Labour Organization (ILO) launched a new strategy, the Decent Work Agenda, to ensure human-oriented development in the globalization of working life and to provide an effective response to the challenges of globalization. We searched for and analysed the origin of the Decent Work concept and identified the key principles in ILO policy documents, survey reports, and relevant United Nations\u2019 (UN) documents. We also analysed the implementation of the Decent Work Country Programmes (DWCPs) and examined the available external evaluation reports. Finally, we examined the objectives of the ILO Decent Work Agenda and the Decent Work targets in the UN 2030 Agenda for Sustainable Development in view of occupational health. In two thirds of the ILO\u2019s Member States, the Decent Work Agenda has been successfully introduced and so far fully or partly implemented in their DWCPs. The sustainability of the Decent Work approach was ensured through the UN 2030 Agenda, the ILO Global Commission Report on the Future of Work, and the ILO Centenary Declaration. However, objectives in line with the ILO Convention No. 161 on Occupational Health Services were not found in the DWCPs. Although successful in numerous aspects in terms of the achievement of the Decent Work objectives and the UN Sustainable Development Goals (SDGs), the Decent Work Agenda and the Decent Work Country Programmes need further development and inclusion of the necessary strategies, objectives, and actions for occupational health services, particularly in view of the high burden of work-related diseases and, for example, the present global pandemic. In many countries, national capabilities for participation and implementation of Decent Work Country Programmes need strengthening. A total of 3.5 billion people\u201463% of the world\u2019s population\u2014belong to the global workforce. They spend more than one third of their adult life at work and produce a total world gross domestic product (GDP) of US$ 88 trillion , maintaiThere is evidence of the positive impact of globalization on the global economic growth of the world as a whole, particularly on the growth of world trade and the improved distribution of wealth also to the developing world, for example by halving the global poverty rates in the past 20 years. A similar positive impact is seen in the distribution of new technologies and the Internet throughout the continents and enhancement of global connectivity.th International Labour Conference: \u201cGlobalization has brought prosperity and inequalities, which are testing the limits of collective social responsibility\u201d [The social impact of globalization, and on occupational health in particular, is, however, not universally positive. The transfer of basic and manufacturing industries to low-wage countries has generated many positive impacts there, but left behind major employment and social problems in the former host countries and communities. Still, most of the two billion workers of the developing world, of whom over 50% are informal, have not benefited from globalization; sometimes quite the opposite. In particular, agricultural and rural populations, family farmers, fishers, and forestry workers, domestic workers, and small and microenterprises in developing countries have been losers in globalization. Several vulnerable groups in both the industrialized and developing countries are also recognized as potential victims. Mr. Juan Somavia, Director General of the ILO, stated before the 87ibility\u201d ,3,4,5.The ILO Decent Work Agenda is a unique global-scale response to the challenges of globalization, employment, economic, social protection policies, and social dialogue. This article describes the origin of the Decent Work concept and analyses its implementation at the national level, and particularly the role of occupational health as a part of the social protection pillar of the Decent Work Agenda .This explorative literature review was drawn up by studying the origin of the Decent Work concept and its key principles in selected and relevant ILO policy documents, survey reports, and relevant UN documents . The selIn the 1980s, the pace of globalization was accelerated by several geopolitical changes  and the increasing wide-scale implementation of new information and communication technologies. Working conditions changed radically; enterprise structures were reorganized ; and working contracts became fragmented .Freedom of association and right to collective bargaining;Elimination of forced or compulsory labour;Abolition of child labour;Elimination of discrimination in employment and occupation.In 1998, a year before launching the Decent Work Country Programme (DWCP) approach, the 86th International Labour Conference (ILC) launched the Declaration on Fundamental Principles and Rights at Work , which wThe eight ILO Fundamental Conventions concern the freedom of association, the effective recognition of the right to collective bargaining, forced labour, the abolition of forced labour, the effective abolition of child labour, the minimum age convention, equal remuneration, and the elimination of discrimination with respect to employment.By ratifying, the countries commit themselves to regulation and implementation in line with the Conventions. This commitment is supported by the ILO Follow-up procedure. The Member States that have not ratified one or more of the ILO Fundamental Conventions are asked each year to report on the status of the relevant rights and principles within their borders and to note any impediments to ratification and areas in which they may require assistance. These reports are reviewed by the Committee of Experts on the Application of Conventions and Recommendations (CEACR). Their observations in turn are considered by the ILO\u2019s Governing Body.As a response to globalization, the ILO developed the Decent Work approach to provide a social dimension to globalization and to initiate an intensive human-oriented approach to the challenges posed by the globalization of working life. In February 1999, the Secretary General of the UN, Mr. Kofi Annan, in introducing the new UN concept of the Global Compact before the World Economic Forum , emphasito promote and implement the standards and fundamental principles and rights at work;to enhance opportunities for men and women to obtain decent employment and wages;to expand the scope and heighten the effectiveness of social protection for all;to strengthen tripartism and social dialogue.The ILO\u2019s Decent Work Agenda promotes a development strategy that recognizes the central role of work in everyone\u2032s life. The Organization provides support in the form of integrated Decent Work programmes developed at the country level with ILO\u2032s constituents. These programmes set priorities and targets within national development frameworks and aim to tackle major Decent Work shortcomings through effective programmes that also meet each of ILO\u2032s four strategic objectives:In addition, Mr. Somavia in his address to the 87th ILC recalled the issues inherent in the concept of Decent Work and outlined the future role of ILO: \u201cThe ILO is concerned with Decent Work. The goal is not just the creation of jobs, but the creation of jobs of acceptable quality. The quantity of employment cannot be divorced from its quality. All societies have a notion of Decent Work, but the quality of employment can mean many things. It could relate to different forms of work, and also to different conditions of work, as well as feelings of value and satisfaction. The need today is to devise social and economic systems which ensure basic security and employment while remaining capable of adaptation to rapidly changing circumstances in a highly competitive global market\u201d .Later in 2008, the 97th Session of the ILC adopted the ILO Declaration on Social Justice for a Fair Globalization , which iSince 1999, the ILO has initiated large numbers of DWCPs, which have also been evaluated. The ILO Secretariat regularly reports on the development and implementation of the Decent Work programmes to the ILO Governing Body and the ILC, at which Member States of the ILO meet in June every year in Geneva, Switzerland. This ensures regular follow-up by the highest governance levels of the Organization.In the course of the globalization process, the relevance of and the need for the Decent Work Agenda have become even more important amid the widespread uncertainty in the world of work, from the financial turmoil and economic downturn of the last two decades to growing unemployment, informal employment, insufficient social protection, and labour migration. These have challenged governments and social partners\u2014workers\u2019 and employers\u2019 organizations\u2014to adopt the Declaration on Social Justice  to strengthen the ILO\u2019s capacity to promote its Decent Work Agenda and forge an effective response to the growing challenges of globalization.Both the Decent Work Agenda and its implementation and, at the time, the UN Global Strategy with its Millennium Development Goals (MDGs) aim to eradicate extreme poverty and hunger through achieving full and productive employment and Decent Work for all, including women and young people (MDG Target 1b). This target highlights the fact that, despite progress, almost half of the world\u2019s employed people are still working in vulnerable conditions, especially in Sub-Saharan Africa and Southern Asia. The MDGs succeeded in halving absolute poverty in the target period . In spitIn 2015, the UN launched the new Global Strategy, Transforming our world: the 2030 Agenda for Sustainable Development, which contains 17 Sustainable Development Goals (SDGs) with hundreds of targets and actions addressing people, planet, prosperity, peace, and partnership .The SDG strategy contains several goals, targets, and actions relevant to workers\u2019 health and safety, particularly SDG No. 1 on the Elimination of poverty, SDG No. 3 on Health, and SDG No. 8 on the Promotion of inclusive and sustainable economic growth, full and productive employment and decent work for all. The ILO has been appointed the custodian of 13 different SDG indicators . The UN,The ILO launched the Decent Work concept in 1999, and the first DWCPs were begun in 2000 in the Philippines and the Ukraine. The DWCPs were intended to be well coordinated at the national level with other ILO and UN programmes on the development of working life, in order to make as effective use of scarce resources as possible. The DWCPs aimed at the distinct ILO contribution to UN country programmes and constituting one main instrument to better integrate regular budget and extra-budgetary technical cooperation . The ILOThere has been long-term, logical continuity in the drafting and development of the DWCPs and the coordination, implementation, and independent evaluation of the accomplishments of the programmes. In order to facilitate the preparation of the DWCPs, in 2015, the ILO published a guideline for country-level actors\u2019 support . This guThe country diagnostics provide an overall national development framework with demographics and data related to education, health and human development, the structure and performance of the economy, aspects related to inequality, vulnerability, and poverty in the country, employment and the labour market, the labour force, fundamental principles and rights at work, the implementation of international labour standards, decent working conditions and occupational safety and health (OSH), equal opportunities and treatment in employment, and questions related to social protection and social dialogue, to help identify and recognize the main Decent Work challenges ahead.The logic of the DWCP process of the ILO is described in On the basis of the diagnostics of the country situation, the national stakeholders, in collaboration with ILO experts, will draft a DWCP document to be discussed and agreed on in the tripartite process of the country. The process also serves as a learning cycle for the development of Decent Work. Examples of the main contents of the DWCPs are poverty reduction through the creation of Decent Work opportunities with a focus on young men and women, the reduction of child labour and elimination of its worst forms, or more and better employment for vulnerable groups, and responding to HIV and AIDS challenges in the world of work. The selected priorities depend on the deficits recognized in the Decent Work diagnosis of the country .The DWCP process since the beginning of the DWCP implementation from 2000 to September 2019 is summarized by region in The actual situation in September 2019 shows that Africa has the highest number of ongoing DWCPs, followed by Asia. Africa\u2019s activities are even more prominent if the number of countries and the size of the workforce are considered . A totalThe independent evaluations of the national DWCPs have been carried out at the sub-national, national, and regional levels, and the ILO has published the lessons learned to facilitate the further planning of new programmes. Evaluations have been carried out of both the individual country programmes and the regional programmes, such as those of the Arab Region , North Africa, the Caribbean, the Western Balkans, and Mekong Sub-region. These evaluations have identified success factors and needs for development and provided guidance for further actions .One of the fundamental principles of the ILO Constitution is the \u201cprotection of the worker against sickness, disease and injury arising out of his employment\u201d . In adopIn 2003, the 91st ILC adopted the Conclusions of the Global Strategy on Occupational Safety and Health. These Conclusions confirmed OSH as key principles of Decent Work: \u201cDecent Work must be safe work\u201d . The ConIn addition to the DW policy principles, the ILO has also produced legal instruments for the implementation of Decent Work in occupational health practice. Already before the 87th ILC (and Convention No. 161), Recommendation No. 112 (R112) on Occupational Health Services from 1959 guided the Member States in the organization of occupational health services (OHS) for their workers. In 1985, the ILC adopted the Occupational Health Services Convention No. 161 (C161)  and the ILO\u2019s Convention No. 187 on the Promotional Framework for Occupational Safety and Health  emphasizRecently, new evidence on the growing need for occupational health and OHS has accumulated. Globally, occupational diseases, occupational injuries, and work-related diseases (WRDs) are estimated to cause 2.8 million fatalities a year and over 300 million cases of non-fatal health outcomes that affect the health and work ability of workers, leading to a 4% loss of GDPs on average. Occupational injuries lead to 380,500 fatalities annually, whereas the mortality from WRDs is estimated at 2.41 million a year . The cosThe trend of WRDs is expected to grow as working populations are ageing and numerous vulnerable groups such as migrant and refugee workers, several types of workers with vulnerabilities, and workers with partial work ability are recruited into the workforce and the number of informal workers grows. For example, half of the one billion World Health Organization (WHO) Western Pacific Region\u2019s (WPRO) workers are informal. The informal status of workers is the key determinant of the absence of health, safety, and workers\u2019 rights at work. The informal workers work in high-risk jobs, are exposed to high numbers of chemical, physical, biological, and social hazards, and are most vulnerable, for example, to infectious epidemics ,28,29,30The SDGs aim among other things to eliminate poverty. In the long term, the only sustainable way out of poverty for countries, communities, families, and individuals is the gainful employment of working-age people. Successful employment needs job opportunities at the systems level and good employability at the individual level. A prerequisite for individual employability is good work ability , decent working conditions, and safety and health at work. The SDGs cannot be achieved without good health and work ability in working populations, as all the resources available for societies are derived from productive work. Some countries have included or are in the process of including the objectives of the development of occupational health, work ability, and OHS in their National Health 2030 strategies, thus harnessing occupational health for achieving the SDGs.Some countries have achieved reasonably good working conditions and work environments, as well as occupational health, although the majority of countries still face great challenges in meeting the international standards set out in the Occupational Health Services Convention, C161. All countries need to exert a great deal of effort to achieve the UN\u2019s SDGs in the field of health, safety, and work ability of workers. The greatest challenges lie in the improvement of the occupational health and work ability of workers in micro- and small-scale enterprises, the self-employed, and workers in the informal sector, who comprise the majority of the world\u2019s workforce. Today, the majority of the workers of the world are still severely underserved and vulnerable. The gradual extension of the coverage and content of comprehensive OHS, including prevention, protection, promotion of health and work ability, care, rehabilitation, compensation in cases of injuries, and services for return to work is needed for all workers. Workers not yet covered, such as those in agriculture, the informal sector, and the self-employed, have the most urgent need for these services ,27,30.(a)the reduction of economic loss by preventing the loss of work ability through accidents, diseases, presenteeism, disability, and sickness absenteeism and(b)increased productivity derived from better work ability, better motivation, and smoother flow of production .All occupational health and safety hazards can be prevented. Economics researchers have found the control of occupational accidents and diseases and the improvement of working conditions and occupational safety and health to be financially productive and profitable mainly through:The high coverage, comprehensive content, and good functioning of OHS have been positively associated with the human development index (HDI) of the United Nations Development Programme (UNDP), the competitiveness index (World Economic Forum) and GDP per capita of countries, and the success and sustainability of enterprises .Work does not produce only economic and material assets; participation in working life enables important social contacts, support from the work community, opportunities for vocational and professional development, and gives the individual a place and status in working organizations, institutions, living communities, and society at large.Work itself is an important determinant of workers\u2019 health, providing potential enhancement of health and work ability in good jobs and adverse effects in poor working conditions. Workers\u2019 health and work ability also have a crucial impact on the health of families. In many societies, labour participation is the prerequisite for registration in social security schemes, which for their part reduce the risk of poverty. Still today, job opportunities and employment conditions vary greatly between and within countries and between different groups of workers and have great inequities among working people ,32,33.th session in Geneva in June 2019, stated \u201cSafe and healthy working conditions are fundamental to decent work\u201d [OSH has been a central issue for the ILO ever since its creation in 1919 and continues to be a fundamental requirement for achieving the objectives of the Decent Work Agenda. In reaffirming this, the ILO Centenary Declaration for the Future of Work, adopted by the ILO Conference at its 108nt work\u201d .Examination of the DWCPs have revealed that the contributions of occupational health and OHS have not been sufficiently utilized in national programmes. Even the total coverage of OHS in the world has remained low (18.5%). There may be several reasons for this, but the governance model of OHS is likely not the cause, as 73.5% of the respondent countries in International Commission on Occupational Health, ICOH\u2019s OHS survey were governed by the ministry of labour alone or jointly by the ministry of labour and ministry of health .Globally, the majority of work-related loss of DALYs is estimated on the basis of WRDs and only about 11% on the basis of occupational injuries . The manIncluding the development of OHS in the DWCPs would provide a strong substantive and practical contribution to the implementation of the DWCPs and make OHS available for underserved sectors as shown in the needs and provisions analysis in The WHO Global Strategy on Occupational Health for All (1995) called for universal OHS  . The UniThe WHO Regional Office for the Western Pacific has supported the provision of UOHC in the Western Pacific Region ,40. The As stated by the ILO: \u201cDecent Work is safe work\u201d . WorkersThe globalization process has continued over centuries, but during the last 30 years, it has developed and modified working life more intensively and faster than ever before. It is characterized by growing global trade and the movement of capital, materials, services, and people .Globalization exposes all countries and enterprises to challenges and changes. Production structures will be radically modified; some branches of the economy will disappear; and new ones will appear. There will be changes in enterprise structures, their production methods, working practices, and work environments. Enterprises will need to adjust to several new trends; new work organizations, management systems, working contracts, working hours, OSH, and OHS. All of these mean that working life is expected to undergo major changes in terms of employment opportunities and requirements for competence, skills, and work ability ,44,45,46In spite of progress in OSH in developed economies, the global situation is still unsatisfactory, with 2.8 million fatalities from occupational accidents and diseases a year and a manifold number of non-fatal injuries and diseases (see above). Many of the negative impacts of globalization hit the low-income and low and middle-income countries the worst, but they also affect advanced economies. Digital disruption affects enterprise and institutional structures. Some sectors of traditional economies are dying out, and their workers and professionals are at risk of exclusion from working life. Many traditional jobs are disappearing, and new challenging ones being generated; labour markets are being polarized; and in spite of improving averages, the inequities and gaps between the richest and the poorest are at risk of growing even further. New competence demands require new types of training, and numerous jobs are disappearing virtually overnight in large geographical areas, requiring movement of working populations to seek new job opportunities . Downsizing, outsourcing, and offshoring in industries and services are leading to a new division of work between different countries and continents, which may affect the health and lives of working populations ,48,49. IWith the help of new information and communication technologies, international interactions are being facilitated through ever-growing global connectivity and communication, including social media. Many other technological advancements, the introduction of new substances and materials including nanotechnologies and new e-technologies, digitalization, automation, and robotization in particular, and the use of artificial intelligence and big data are becoming effectively distributed throughout the global world of work. Automation and robotization are expected to eliminate 30\u201350% of current jobs, but new jobs are also being generated with different competence demands. Earlier, only physical and manual human power was replaced by automation, but the new trend is also partially replacing human intelligence by artificial intelligence: for example, speech recognition, problem-solving, learning, and planning.The national and international division of work has changed due to technology transfer and the outsourcing, downsizing, and offshoring of industries and services. Global giant multinationals will dominate economic activities, exceeding the influence of national governments. Changes in production and in consumer markets will lead to a new division of work; some countries may become primarily producers of materials and producers of goods, others dealers of products only, and others only consumers with no large-scale production. This may result in occupational structures becoming one-sided and even more vulnerable to changes in global markets. National markets will mainly be transformed into global markets.Due to robotization and artificial intelligence, the human role in production has become more one of planning, designing, quality control and services, transport and commercial, and marketing activities. The production of goods and materials will become assigned to automatic systems and robots. Some new branches of the economy will be generated, such as environmental and green economies, new energy economies, and knowledge economies. All these will have an impact on job contents, competences, and work ability profiles. ,50,51,52Major changes have been observed in the demographic structures of the global workforce. Four of these macro trends are ,54,55:The ageing of the workforce in most countries: In both the developing and industrialized countries, this is a dominant trend. Both developing and advanced economies show a comparatively rapid increase in the average age of working populations, known as the global ageing epidemic. This raises numerous challenges: the maintenance of decent employment for ageing individuals, the maintenance and promotion of their competence and work ability, the provision of employment opportunities, social protection, and the prevention of age discrimination. Better use of the competences and experience of ageing workers is warranted.Youth: Some developing and emerging economies are facing challenges in the employment of younger age cohorts, which, particularly in Africa, has led to both internal  and international migration, particularly to Europe, but also elsewhere. The working conditions, OSH, training and education, fair remuneration, social protection, and overall life situation of young migrant workers is a huge international challenge.The feminization of the workforce: In various parts of the world, this is progressing, providing many advantages for female workers, formal jobs, legal and social protection, better income, and more independence. Simultaneously, several jobs may have health hazards, long working hours, several psychosocial risks, reproductive hazards, balance of work and family life, and lack of gender equality and sexual harassment, calling for special protection of female workers at work.Migrants, the handicapped, workers with partial work ability, and informal and domestic workers: These form a vulnerable group of workers and together constitute the majority of the global workforce. Their labour markets and social situation in global working life have not necessarily improved during the era of globalization, often in fact the opposite. International organizations, particularly the ILO, and non-governmental organizations (NGOs) have put great effort into the special protection of vulnerable groups of workers and made it a key element in Decent Work programmes.Global economies are characterized by increased uncertainty of work contracts and employment; sudden changes in employment opportunities due to outsourcing and transfers of industries to new areas; quick, high peaks of employment, which may then dramatically drop; casual and temporary working contracts; and in general, higher risks of unemployment and insecure jobs. Such insecurity together with associated high job demands ,56,57 anGood work ability and psychological and physical functional capacity are key prerequisites for successful and productive employment. In the wider sense of the term, the concept of work ability is multidimensional and complex and includes workers\u2019 personal health, psychological, cognitive, and physical capacity, knowledge, skills, and competence, attitudes and motivation to work, and personal social networks (particularly family). However, good work ability and functional capacity also require a healthy and safe work environment, a conducive working community, a secure labour contract, and social protection. Just and fair management supports work ability, as does the availability of OHS with service modules for work ability ,61.In the course of the development of working life, the challenges related to the occupational health and work ability of workers are gaining more importance. This is due to the growing psycho-social demands of work, the need to address the work ability problems of ageing workers, support and protection of the health of vulnerable groups, and consideration of the numerous health needs of migrant workers and other vulnerable groups. Maintaining and promoting the work ability of all working people requires decent working conditions, a safe and healthy work environment, physiologically and psychologically sound working time schedules, and limits of maximum working hours. This all requires well-functioning OHS for all working people in all types of jobs and enterprises and all modes of working contracts and employment models, i.e., UOHC.The SDGs, particularly SDG 8, Decent Work for All, constitute a global response to the challenges of globalization by all sectors of societies and all regions of the world ,20,46.OSH and labour inspection  have been relatively well introduced as elements of Decent Work and are even further emphasized by Goal No. 8 of the UN Strategy on Sustainable Development, the ILO Global Commission, and the ILO Centenary Declaration . In spitEach year, the ILO\u2019s Evaluation Office holds consultations with senior management, the Evaluation Advisory Committee, and constituents to select topics for future high-level evaluations. The selected topics are then presented to the Governing Body (GB) for approval .A total of 53 programmes of 121 DWCPs have so far been evaluated by external evaluators, as either regional or subregional or individual country evaluations using pre-set criteria ,63,64,65Relevance to the ILO DW agenda, DW/CPO, and country needsDesign, coherence, and validityEffectivenessEfficiencyImpactSustainabilityThe following parameters were standardized for all DWCP evaluations:Data from national DWCP reports were used in regional and sub-regional analyses. Evaluation projects during the period 2006\u20132018 are presented in The Caribbean region, with twenty countries of diverse sizes, varying from 5900 to three million citizens, is home for a total of approximately 60 million people. It has a young population structure (60% below 30) and is multi-ethnic and multi-lingual, mainly English-, French-, and Dutch-speaking, and its population is highly literate and well-educated.The Caribbean economies are mainly based on agriculture, sugar, and spices and related rum distillation, but are complemented to a growing extent by light industries, electronics, textiles, handicrafts, and tourism. Some countries also have a notable mining industry. Half of the countries belong to the UNEP high human development group and the other half to the medium group. Informal employment is common, making workers vulnerable because of their lack of legal and social protection. The region shows high unemployment rates among youth and women. Increasing migration of female workers and highly educated people in particular to Northern America and partly to Europe is a growing concern. Common natural disasters, tropical storms, floods, earthquakes, and volcanic eruptions are also a major concern.On the basis of high-level political commitments by ministers of labour and other high-level government representatives, and employers\u2019 and workers\u2019 organizations of the English- and Dutch-speaking Caribbean, the DWCPs were launched for 2010\u20132015 in their respective countries. In collaboration with the ILO, DWCPs have been developed in the Bahamas, Barbados, Belize, Guyana, Suriname, and the member countries of the Organization of Eastern Caribbean States (OECS), comprising the Leeward Islands: Antigua and Barbuda, St. Kitts and Nevis, Montserrat, Anguilla, and the British Virgin Islands, and the Windward Islands: Dominica, St. Lucia, St. Vincent, the Grenadines and Grenada, Martinique, and Guadeloupe. The ILO has also provided technical support to Jamaica and Trinidad and Tobago, where no formalized DWCPs have been launched.The DWCPs were designed to enhance the ratification and reporting of ILO Conventions in order to strengthen tripartism and social dialogue, upgrade legislation, advance OSH policies, tackle discrimination on the basis of HIV/AIDS patients, and eliminate child labour. Through the programmes, measures for equalizing working conditions and formalizing the status of informal workers were developed, as well as for integrating workers with disabilities. Administrative capacities in public sector agencies and judicial capacity in the legal system were strengthened. Other inputs were the promotion of vocational training and education and the enhancement of productivity, competitiveness, employment, and trade.According to the high-level evaluation, the sub-regional and national DW programmes were relevant, particularly in addressing youth employment, child labour, OSH, and HIV/AIDS. The evaluation team rated the overall performance of ILO\u2019s DWCPs, strategies, and actions by triangulating the information and data gathered through desk reviews, surveys, and interviews of staff and constituents, as shown in the overall assessment graph in As a part of the ILO Asia Region, the subregion of the Lower Mekong countries, Cambodia, the Lao People\u2019s Democratic Republic, Thailand, Viet Nam, and Myanmar, constitutes a relatively homogenous and closely collaborating area and one of the most rapidly developing areas in the world. The total population of the sub-region is 241 million and the workforce 130 million. Four of the Lower Mekong sub-region countries were subjected to external high-level DWCP evaluation. Myanmar has not been evaluated yet, due to the short history of DWP in the country. According to ILO reports, the countries are simultaneously experiencing several new challenges due to globalization, climate change, environmental disasters, and several traditional working life problems such as occupational injuries and diseases, hazardous physical, chemical and biological exposures, long working hours, inequalities, and psychological stress. To facilitate the positive development of working life, the ILO initiated and obtained the Lower Mekong countries\u2019 commitment to the Decent Work Decade 2006\u20132015, focusing on five priority objectives: (a) sustainable productivity, (b) the youth employment challenge, (c) protecting migrant workers, (d) labour market governance, and e) local development for Decent Work. As in all DWCP evaluations, ILO-guided parameters were standardized and used in the evaluation .The overall assessment on the basis of the regional evaluation is presented in In the second decade of the new millennium, working life in the Western Balkan countries of Albania, Bosnia Herzegovina, Croatia, Montenegro, North Macedonia (previously the Former Yugoslav Republic of Macedonia (FYROM)), and Serbia was exposed to several simultaneous pressures: continuing policy and structural adjustment after the socio-economic transition to market economies, the post transition economic recession followed by the 2008 global financial and economic crisis, preparation for the European Union (EU) accession, and the universal pressures of globalization. Despite the efforts of the ILO and others, the post-crisis recovery in the sub-region was considered weak due to three main problems that continued to exist after the transition and the financial crises: persistently weak economic growth, high unemployment, and weak social dialogue. In spite of these challenges, today, all the Western Balkan countries are considered upper middle-income countries according to the World Bank ranking .The Western Balkan countries committed themselves to the DWCP process at different paces: Albania and Bosnia and Herzegovina developed the first generation of DWCPs between 2006 and 2007. The second generation of DWCPs was implemented between 2008 and 2011 in Albania, Bosnia and Herzegovina, Serbia, and at that time, FYROM. From 2012 onward, the third generation of DWCPs was developed in Albania and Bosnia and Herzegovina. Within the framework of the DWCPs, all five countries continued to ratify ILO conventions, which further contributed to improvements of labour or labour-related national legislation.(1)Rights at work: e.g., training and education in the protection of workers\u2019 fundamental rights, introduction of models for peaceful settlements of labour disputes, promotion of gender equality at work.(2)Employment creation and enterprise development: e.g., introduction of models for employment policies and their implementation, development of employment services, local employment development, enhancement of vocational training, promotion of entrepreneurship and SMEs, and the development of labour markets, including markets for vulnerable groups.(3)Social protection: e.g., support of national OSH systems and policies and capacity building of national labour inspections, OSH training of labour inspectors and even doctors, assistance in ratification, implementation of international labour standards, advice on the development of social security, social security, and pension reforms, and capacity building.(4)Social dialogue: e.g., legal advice on and technical assistance for national social dialogue mechanisms and capacity building of social partners.Taking into consideration the whole subregion, the inputs of the DWCPs were directed, in addition to the objectives of the ILO DWCP guidebook, also to recognized national needs. As a whole, the Western Balkans\u2019 sub-regional activities covered all the four pillars of the Decent Work Agenda well, but the programme contents differed between the countries, reflecting their specific needs. Examples of activities of the different Decent Work Pillars were:The overall performance assessment results of the evaluation are shown in The Southern African Development Community (SADC) is well endowed with human and natural resources. Given its economic potential, the SADC is one of the most promising developing regions of the world. The economies of the SADC Member States are at different stages of development, and as a result, the state of industry varies widely throughout the region. In many Member States, agriculture plays a major role in the economy, employing almost half of the total population of the region. Mining employs just 5% of the population, but contributes 60% to the foreign exchange earnings and 10% of gross domestic product for the SADC region. Tourism is growing rapidly, employing about 11% of the workforce and contributing over 12% to GDP.The countries of the region are diverse in their degree of development and living and working conditions. In spite of positive perspectives, the region still faces several challenges, including high levels of poverty (majority of people) and inequality, high unemployment (ranging from 4.5% to 80%) and underemployment, labour migration, and neglect of the application of law and international standards. Other challenges are low productivity and the low coverage of social security among the majority of men and women, youth, and children. For example, in South Africa, HIV/AIDS among the working-age population is high, at 12.5%.The four countries selected for evaluation had different economic and human development indicators: Lesotho and South Africa both have middle-income status in the World Bank ranking, and HDIs of 0.518 (low) and 0.705 (medium), respectively. Madagascar and Tanzania still belong to the low-income group with low HDIs of 0.521 and 0.528, respectively .The regional DWP had the following objectives and expected outcomes:Priority 1. Regional and technical work: The priority areas had the following objectives: (a) harmonization and strengthening of functional SADC labour market information systems (LMIS), (b) development of labour migration system, and (c) elimination of human traffickingPriority 2. Promotional work: (a) Ratification, domestication, and compliance of and compliance with International labour standards, (b) promotion of youth employment strategy, (c) compliance with SADC codes , and (d) promotion of Decent Work in the informal economy in SADC Member States.Priority 3. Information sharing: (a) improving knowledge of best practices in employment and labour policies, legislation, programmes, and social protection floors among Member States and (b) harmonization and development of skills development policies.The inputs of the DWCPs in the four countries varied widely.Lesotho: (a) employment creation for poverty reduction, (b) improvement of social protection coverage, and (c) development of tripartism and social dialogue.Madagascar: The DWCP set out two priorities: (a) to promote access of vulnerable groups to employment by enhancing their employability and boosting employment generating sectors; and (b) to improve labour productivity by promoting social dialogue, fundamental principles and rights at work, as well as social protection.Tanzania: (a) extension of social protection coverage for all; (b) promotion of the creation of productive employment; (c) improvement of compliance with labour standards and rights at work; (d) strengthening of social dialogue mechanisms at national and sectoral levels.South Africa: (a) strengthening of fundamental principles and rights at work; (b) promotion of employment creation; (c) strengthening and broadening of social protection coverage to include vulnerable workers operating in the informal economy and informal employment; (d) strengthening of tripartism and social dialogue.The overall assessment results of the SADC countries\u2019 evaluation are presented in The DWCP content, implementation, and actions varied between the countries, due to differences in the diagnosed country needs, national and regional circumstances, and available resources. Large numbers of region-, country-, and substance-specific conclusions and recommendations for the future development of the DWCPs were made. Some overall conclusions can also be drawn from the evaluation reports by using the ILO DWCP evaluation criteria.The relevance of the Regional and National DWCPs was found to be high, due to the national needs identification diagnosis and participatory principle applied with all constituents\u2019 partners. The ability of the national stakeholders to participate, however, varied widely depending on the national circumstances and resources. The DWCPs were also well synchronized with the other programmes of the UN (MDGs and SDGs) and the programmes of NGOs working for related objectives.The programme design and coherence were ensured through effective and skilful guidance provided by the ILO, based on the ILO Decent Work Agenda, DWCP Guidebook, and guidelines and diagnostic methods prepared for regional and country levels.Where critical conditions for full participation were met, the effectiveness and efficiency were good. In countries with lower interest or capacities for participation, capacities of institutions, national ownership of programmes, and availability of human and financial resources, the need for further development and strengthening of these resources was identified.The impact of DWCPs in most countries was good, due to enhanced awareness of Decent Work and transfer of the DWCP objectives to national strategies.The implementation was critically dependent on national circumstances, on political support, participation culture by stakeholders, on institutional capacities, and on human and financial resources, which in many countries need strengthening.The 2019 ILO Report, Time to Act for SDG 8, urges policy-makers around the world to help speed up progress towards SDG 8 and the implementation of the 2030 Agenda as a whole . AccordiOn the basis of experiences gained and the independent external evaluations performed so far, the following conclusions can be drawn:Globalization shows both positive and negative impacts on the occupational health of working people. These are not distributed equally between the countries with different degrees of development.Workers\u2019 health and work ability and healthy and safe workplaces are factors in productive employment, sustainable economies, and overall socioeconomic development. Globalization challenges all these aspects and calls for proactive occupational health policies and actions.The global analysis of health, safety, and economic burden of occupational and work-related diseases and injuries has been estimated to be at a level of 2.8 million fatalities. The majority (about 89%) of the total burden is attributed to WRDs, and about eleven percent to occupational injuries. The economic loss from such hazards amounts to 4% of GDPs on average. Recently, ILO has predicted a global loss of 25 million jobs by the COVID-19 pandemic.International surveys have shown low coverage of occupational health services (OHS) in the world . OHS are the key partner for the prevention and management of hazards for health and work ability at work and for the promotion of health and work ability. ILO C161 on Occupational Health Services aims to provide OHS for all workers.The COVID-19 pandemic has changed dramatically the perspectives for Decent Work and simultaneously demonstrated the critical value of health and safety, as well as of universal occupational health coverage in the management of the global crisis.The Decent Work Agenda of the ILO was established to equalize the impact of globalization on employment, workers\u2019 rights, conditions of work, OSH, social protection, and social dialogue.In 2000\u20132019, the ILO launched a total of 121 DWCPs, i.e., in two-thirds of the 187 ILO Member States. So far, 53 DWCPs have been subjected to external evaluation, either as individual country evaluations or as a part of regional evaluations, and were deemed well guided, well documented, and well implemented.The contents of the DWCPs have been drawn up on the basis of the ILO Decent Work Agenda and the diagnosis of countries\u2019 Decent Work needs and deficits, identified with the help of the Decent Work indicators. Thus, the programmes may differ between countries or the weight of the different Decent Work Pillars may vary between the DWCPs.The rapid changes in working life and working conditions and the parallel major demographic trends  mean that OHS must be given more emphasis. For this, the promotion, ratification, and implementation of ILO C161 on Occupational Health Services should be enhanced, aiming for universal occupational health coverage of all workers. The Basic Occupational Health Service approach (BOHS) can serve as an instrument for the implementation of UOHC.In the DWCPs, accidents and safety have been well addressed, but the health dimension and the work-related diseases, WRDs, except for HIV-AIDS at the workplace, are almost non-existent. There is a need to more firmly address the prevention and management of WRDs in DWCPs and ILO policies in general.The Decent Work concept has been deemed timely and feasible at the country level and has been widely adopted by the countries. The DWCPs are effectively guided by the ILO and designed to respond to countries\u2019 needs . They are implemented through national authorities and actors, with technical support from the ILO. The external evaluations collected data on the implementation and country experiences and provided guidance for the further development of the DWCPs.Although effective legal and technical tools, methodologies, and measures to prevent occupational accidents and diseases exist, there is a need for increased general awareness of the importance of OSH and OHS. High-level political commitment is needed for the development of national OSH systems and their effective implementation, including the development of OHS in particular.The ILO Decent Work concept has been adopted as the key content of SDG 8 of the UN 2030 Strategy. The ILO has been assigned as a custodian of 13 SDG 8 targets in the UN Strategy. Thus, the Decent Work Agenda contributes substantially to the implementation of the UN 2030 Strategy, but needs to strengthen the implementation and particularly occupational health dimension. Through the UN SDGs and the Global Commission on the Future of Work Report, the ILO Decent Work Agenda will have a bright future at least up to 2030 and possibly beyond. This brightness is seriously shadowed by the current COVID-19 pandemic. One of the key 2030 objectives should be the UOHC of all working people of the world. This need is even more emphasized by the rapid spread of the COVID-19 pandemic, which demonstrates the unmeasurable value of occupational health and work ability of workers as a critical factor for the maintenance of the whole social fabric, health of the population, national and global economies, employment, and the overall functioning of the national, international, and global systems.Decent Work is a unique social innovation with global coverage. The ILO has promoted and implemented it with its constituents for two decades, respecting the consistency and continuity of the ILO Decent Work Agenda. Over 120 countries have joined the ILO for implementation of the DWCPs and succeeded in integrating the DWCPs into national economic, employment, and social policies and programmes. Occupational safety and health have been included in part of, but not in all DWCPs. The external evaluations found the implementation of DWCPs on average good, but variation was wide. The external evaluation results have been used for continuous learning and improvement by all stakeholders. This has generated opportunities to achieve system-wide impact on the work life of the countries.The sustainability of the ILO Decent Work policy was ensured through the UN 2030 Agenda, the ILO Global Commission Report on the Future of Work, and the ILO Centenary Declaration. The priority given to occupational safety and health in the DWCPs needs, however, enhancement, and the position of occupational health services needs it even more. In view of the evidence on the global burden of work-related diseases the strengthening of the occupational health approach and expansion of the coverage of occupational health services are justified according to the lines of the UN Resolution on Universal Health Coverage, including the call for Universal Occupational Health Coverage (UOHC) and the provisions of the ILO Convention No. 161. The recent pandemic emergencies further emphasize the important role of occupational health."}
{"text": "This research aims at exploring and recognizing the effectiveness of implementing a community-based safety plan on reducing the occurrence of road accidents in the city of Zarand.The research method is descriptive method with analytical approach. To analyze the obtained statistical data, descriptive and inferential statistics were used. For field surveys, a questionnaire was used and for analyzing the data obtained from the questionnaire, the inferential statistics such as Friedman and Measurement tests were used. A paired T-test was used to test the significance of the hypotheses.The research showed the positive effect of the implementation of safe community plan on the reduction of accidents. The main cause of the accidents was human factors, including unauthorized speed and overtaking, left-leaning and rushing. After that, the quality and technical issues of the road have been identified, and according to the interviewees, the main cause of accidents is identified as hazardous route bends, especially in rural areas, poor quality paths and inappropriate signs. The technical and qualitative factors of the car are in the third place and, finally, the environmental and natural factors are the fourth. Also, hypotheses related to the role of the implementation of the safe community plan in reducing mortality, car accidents and pedestrian accidents were confirmed. It was also found that the role of human factors was reduced by implementing strategies such as training and changing the behavior of people, the quality of roads and technical issues. Safe society, Accidents, Human factors, Environmental factors, Road factors, Zarand City"}
{"text": "The GSA COVID-19 Task Force developed multiple materials to assist older adults, those who care for them, and policy makers in understanding a variety of topics, including aging and immunity, ageism, the process of developing a vaccine, and how to social distance. Members of the group also undertook development of a decision aid on whether to engage in activities outside the home. The process of developing the decision aid according to Ottawa Research Institute guidelines will be explained."}
{"text": "The present study aimed to propose a model for the national hemovigilance information system with a database approach, considering the importance and necessity of developing an information system for such a network.This is an applied, descriptive, and cross-sectional study, which was conducted in 2018. The research population comprised hemovigilance information systems in advanced countries, including the USA, UK, Australia, and France. Data were collected from library sources and the Internet from 2000 to 2018. The proposed model for the national hemovigilance information system was introduced using comparative tables and based on the similarities and differences of systems in the studied countries. The proposed model was then validated using the two-step Delphi technique through a researcher-made questionnaire whose validity was confirmed, and reliability was approved by a Cronbach\u2019s alpha of 94%.The final model of the national hemovigilance information system comprised five main components: goals, organizations involved in the blood transfusion process, databases of blood transfusion organizations, data transfer flow between the databases of blood transfusion organizations, and transferable datasets, and hemovigilance-related committees. This model was approved by experts with an >85% agreement coefficient.The national hemovigilance information system with a database approach can improve blood transfusion health by providing access to reliable sources on blood transfusion complications to everyone, especially the medical community. Thus, it is essential to implement this standard accurately and precisely control the practical methods of this process based on international guidelines. Blood transfusion is the primary concern for medicine. The advancement in the knowledge and awareness on this topic paves the way for the prevention of diseases and the improvement of the treatment process . In the The process of blood transfusion comprises various clinical and laboratory services; therefore, all the steps in this process must be followed with precision, efficiency, and reliability in order to prevent unwanted complications . Blood tA hemovigilance system is a tool for quality improvement in the blood transfusion process, mainly focusing on safety ,7. This The World Health Organization published in 2007 the standards on the blood transfusion process. Based on this report, the global database on blood safety, 42 countries have implemented national hemovigilance systems under different titles, e.g., the Haemovigilance Advisory Committee (HAC) in Australia in 2008 , the FreAs Iran is a member of the International Haemovigilance Network, due to the importance of designing such an information system for this network, and since no comprehensive study has been conducted  on a natThe present applied, descriptive, and cross-sectional study was conducted in the following three steps:1.Review of the literatureIn this step, the required data were collected based on a review of the literature on a hemovigilance information system and its main components in different countries, including the US, UK, Australia, and France, in Ovid, Scopus, PubMed, ScienceDirect, and Google Scholar databases from 2000 to 2018 using the following keywords: National Hemovigillance System, Hemovigilance System, Hemovigilance Network, Hemovigilance Information System, and Transfusion blood system.2.Developing a model for hemovigilance information system in IranIn this step, organizations in charge of blood transfusion and hemovigilance system in Iran were identified, and their work process was examined. Afterward, based on the results of the literature review and the organization and structure of the Iranian Blood Transfusion Organization (IBTO), a model for the national hemovigilance information system was developed.3.Model validationValidation was performed using the Delphi technique in two steps. First, a researcher-made questionnaire, including the demographic information of system users and the model of axes, was developed. The questionnaire was given to six experts , and their opinions were sought to check the validity. Moreover, Cronbach\u2019s alpha was calculated to determine the reliability of the questionnaire, which equaled 94%. As the value was above 0.7, the questionnaire was found to have high reliability. Then, the final model was given to 13 hematology experts at medical universities in Tehran, as well as the IBTO. Expert opinions on the main components of this model were collected, and the agreement coefficient of 75% was set as the criterion for model acceptance. Next, expert opinions were applied to the proposed model. In the second step of the Delphi technique, an expert panel with six hematology and health information management experts was formed in order to finalize the proposed model. Descriptive statistics were used to analyze the data on the final model confirmation.The review of the literature revealed that the goal shared by all countries with hemovigilance networks or systems included monitoring transfusion-related complications and reactions and enhancing quality and patient safety by improving the reporting system. Accordingly, the most important components of the hemovigilance information system were determined to be the definition and specifications of organizations involving in the hemovigilance system, databases, and data transfer flow in each database of the noted organizations.The proposed model for the national hemovigilance information system with a database approach in Iran comprised five main components:1.Goals of the national hemovigilance information system2.Organizations involved in the blood transfusion process3.Databases of blood transfusion organizations4.Data transfer flow and transferable datasets5.Hemovigilance-related committeesMajor organizations involved in the blood transfusion process included blood donation and transfusion centers, blood transfusion organizations in provinces, the IBTO, and the Ministry of Health and Medical Education (MoHME).Data transfer in the process of blood transfusion has been planned at the city, province, and national levels. There are centers for donating and receiving blood at the city level, including blood transfusion organizations at the province level, blood donation centers, and mobile centers for blood donation. The data transfer process was designed as follows: after blood donation, in case of any complications in the donor, this event is immediately reported to the hemovigilance committees at the province level in the blood transfusion organization. Centers receiving blood donation include hospitals and clinics for special diseases  in which blood is transfused. In hospitals, complications are immediately reported to the hemovigilance chief physician. Using the national hemovigilance information system, a set of data elements  is recorMoreover, a hemovigilance committee is formed in hospitals. If the complication turns out to be related to the transfusion process, this problem is reported to the hemovigilance committee at the province level.Based on organizations and activities related to the blood transfusion process, hemovigilance committees are formed at different levels consist of hospital, provenance, and national level committees.Findings of model validation indicated that all major axes were completely accepted by experts. However, there were some disagreements on several sub-criteria of the major axes. In cases where the agreement coefficient was <75%, those criteria were removed. Furthermore, some sub-criteria were suggested for addition. These suggestions were discussed by experts in the second step of the Delphi technique. The results are presented below.The suggested goals for the national hemovigilance information system, including policy-making and better allocation of financial resources, health planning for blood donors and recipients, evidence-based care planning, monitoring of blood and blood product supply chain, preparing statistical reports on transfusion-related unwanted events, blood processing and transfusion, and measures for preventing complications were agreed upon by all experts (100%).The formation of hemovigilance committees at the city, province, and national level was agreed by all experts. Also, all experts agreed with sending the data online .Findings in this table show that the IBTO, Health Vice-Chancellorship of the MoHME, hospitals, blood and blood product research centers, Iranian Society of Medical Oncology and Hematology, Iranian Scientific Association of Pediatric Hematology & Oncology, Iranian Blood Transfusion Association, and Iranian Laboratory Hematology Association were approved by experts (100%). Nevertheless, the Food and Drug Vice-Chancellorship of the MoHME, Iranian Society of Pathology, Iranian Pediatric Hematology & Oncology Society, and Iranian Scientific Association of Clinical Laboratory were eliminated as they scored below 75% .It is evident that that, except for the head of the information management unit, the operating room supervisor, and a representative from the financial affairs unit, the other members were approved by experts (<92%). Therefore, the remaining sub-criteria were eliminated from the final model. It was also suggested that the following be added to the hospital committee: educational supervisor, head of quality improvement unit, patient safety contact, hemovigilance nurse, treatment deputy, and legal medicine expert.Also, findings show that all members were approved by scores of >84%. It was also suggested that the following should be added to province-level committees: patient safety intermediary, hemovigilance chief nurse, a representative of the province-level laboratory affairs unit, and medical associations  .Based on In the second step of the Delphi technique, the proposed model was finalized, and all experts completely agreed (100%) with the suggestions added to the model .The goal shared by all countries with hemovigilance networks or systems is monitoring transfusion-related complications and reactions and enhancing the quality and patient safety by improving the reporting system. Accordingly, the proposed model for the national hemovigilance information system with a database approach in Iran comprised the five components of goals, organizations involved in the blood transfusion process and their databases, data transfer flow, transferable datasets, and hemovigilance-related committees. Organizations participating in this system included the IBTO, Health Vice-Chancellorship of the MoHME, hospitals, blood and blood product research centers, Iranian Society of Medical Oncology and Hematology, Iranian Scientific Association of Pediatric Hematology & Oncology, Iranian Blood Transfusion Association, and Iranian Laboratory Hematology Association. Similarly, the Australian National Blood Authority cooperates with organizations and committees such as the Peripheral blood mononuclear-stem cell (PBMSC) monitoring committee, the National Immunoglobulin Governance Advisory Committee (NIGAC) and the Australian Haemophilia Centre Directors\u2019 Organisation (AHCDO). Associations cooperating with this system include the Australian Association of Pathology Practices (AAPP), Australia and New Zealand Society of Blood Transfusion (ANZSBT), and Australian Private Hospitals Associations (APHA). It is noteworthy that the Food and Drug Administration (FDA) in the US  and the In the study conducted by Ganz and Wu , the 201In the present study, the following data elements were included: patients\u2019 demographic characteristics, healthcare events and side-events, the intensity of outcome, blood transfusion measures, the examination of results, type of product, transfused volume and time interval since the onset of transfusion until the event, patient\u2019s clinical condition at the onset of transfusion and during the event, ability to trace each part of the transfusion process, examining whether complications are due to transfusion, and the responsibilities of the hemovigilance chief physician.Similarly, the study by Hillis et al.  confirmeMoreover, in the present study, reports are daily and electronically sent, and the method of reporting is based on pre-determined reporting formats  at different levels  based on the information needs of stakeholders. Similarly, in the study by Sandid et al.  and LianInformation is distributed and published using websites, software programs, fax, and automation in the proposed model for the hemovigilance information system in the present study. Consistent with the study by Vanagas et al. , the infThe national hemovigilance information system with a database approach can improve blood transfusion health by providing access to reliable sources on blood transfusion complications to everyone, especially the medical community. Thus, it is essential to accurately implement this standard and precisely control the practical methods of this process based on international guidelines.The authors declare that there is no conflict of interest."}
{"text": "The mission of the majority of dental colleges around the world is to provide the high level of education and facilities to learn about the upstream factors that affect the health outcomes, such as personal behaviors, health care quality and access, social, cultural, economic factors, and to graduate dentists with the ability and desire to improve the health of all people by alleviating suffering and eliminating healthcare disparities through their leadership in patient care, research, education, health care administration, and the community , 2.To achieve these missions appropriately, such authorities as to the ministry of health, ministry of higher education, accreditation bodies, etc. which are responsible for supervision and accreditation of dental colleges must have strict rules and regulations for establishment of the new colleges.Unfortunately, in most developing countries such as Iraq, many conflicts of interest exist . These cThe tremendous increase in establishing new private colleges in the same province in Iraq threaten the quality of education mainly due to severe shortage in teaching staff. This, in turn, leads to graduation of unqualified dentists and low-quality oral health care services , 6. Thus"}
{"text": "The objective was to identify the presence of the capacity for reflexive-critical thinking or similar, in Nursing Curricula in Iberian America.Strategies to develop reflective and critical thinking in nursing students:Iberian America situation. To achieve this, a descriptive and exploratory research was conducted with qualitative approach. An instrument created for this project was used, along with some guiding questions to focus the information..The article gathers the results of one of the objectives of the macro-project developed by the Iberian American Network on Nursing Education Research, titled Eight countries participated , which contributed information from 189 curricular plans. The R&CT was found in the majority of the curricula, although with diverse denominations. The principal learning strategies used were problem-based learning, group dynamics, reflective reading, clinical practice, and simulation laboratories. The evaluation methods used are the knowledge test, case analysis, and practical exam.Significant stress exists in the discourse and curricular organization. Incongruences were found and a clear inclination toward the formation of professionals with broad technical skills under a traditional, memory, banking and knowledge accumulation education. Currently, the nursing professional\u2019s formation must respond in efficient, integral, timely, assertive, and humanistic manner to the demands required by caring for life and maintenance and reestablishment of human health. This is not an easy task, given that the formal care provided by this professional implies the dynamic of growing changes in the designs and current university methodologies, claim with it the implementation of an integrating vision and transversal of the contents, to deploy effectively the elements necessary to manage to strengthen the skills needed by a graduate from a professional nursing program.., recommend que las higher education institutions (HEI) in Iberian America que offer higher education in Nursing (undergraduate and graduate), form and contribute an interpretative vision in nursing professionals, through an academic curriculum that goes beyond teaching the diverse functions -granting, education, investigation, management, and administration, among others - that will take place around formal or professional nursing care, developing innovative skills. One of t.,3Thinking reflectively and critically permits knowing and discriminating one action from another, in function of priorities established to care for the person, interacting with them in emancipatory manner, where forms or bridges of union must be sought between the most artistic part of nursing and those elements more associated with the field of science, thus, achieving higher quality when providing care. The deveThe critical thinking capacity describes an integral or holistic behavior and it is expected that its promotion and development be cross-sectional, that is, that during each period and in each assignment or unit of learning it is taught by the professor and learnt by the students, as an individual skill, with interpersonal connotations, related with other skills, like analysis and synthesis capacity, critical and self-critical capacity, management of information, decision making, and problem resolution.Since the 1990s, in different national and international institutional documents, the need was established to develop the capacity for R&CT of the nursing staff during their formation and during exercise of their work practice. The scientific literature related with this study object also confirms the importance of developing said capacity.,8 Nevertrd Network Meeting in September 2011, in Coimbra, Portugal, within the framework of the 11th Iberian American Conference on Nursing Education, organized by the ALADEFE. This article describes the presence of the R&CT capacity in curricula of higher level or degree in nursing of educational institutions in Iberian America, as well as the educational approaches, teaching, learning, and evaluation strategies registered in each academic program analyzed.The Iberian American Network on Nursing Education Research  identified as one of its research priorities the \u201cDevelopment of Reflective and Critical Thinking in Nursing Students\u201d, a preference backed by the participation of over 80 nurses from Iberian American countries who attended the 3More frequently, the characteristics that distinguish nursing professionals are cognitive abilities over psychomotor skills that, historically, have been over-dimensioned in the academic curriculum. Reflection and reflective practice are very familiar terms, currently, within the setting of the nursing practice. These are meanings that can generate a broad spectrum of sensations and reactions: from more enthusiastic adhesion to ambiguity and skepticism. In recent decades, ideas related with reflection and the reflective practice have been incorporated in initial and continuous formation programs in the context in which is conducted the research study by the RIIEE.The evolution of nursing degree curricula has crossed continental borders and has homogenized the objectives and las philosophical lines that inspire different curricula aimed, in these moments, at formation through skills, among which are highlighted as vertebral axis of the formation the capacity for critical thinking. This has permitted, saving the cultural, economic, and socioeconomic diversity of the different regions, to undertake an interuniversity and international study of the educational dimensions presented by this research. Given thThis research has considered the paradigmatic visions or positioning of the authors already mentioned, from which was constructed the integrating notion of R&CT by the RIIEE, which alludes to a \u201cProcess of complex, systematic, dialogical and deliberate, self-directed and action-oriented reasoning, whose primary purpose is to choose, based on intellectual and affective processes , the best response options that favor nursing problem solving in well-defined contexts and according with the ethical postulates of the profession\u201d. This conThe objective of this study was to identify the R&CT presence or similar , in the different Nursing curricula of higher education institutions in Iberian America.study universe, these were nursing curricula of Iberian America and the study population the nursing curricula from universities that offer the career in Nursing in the regions comprising the RIIEE, independent of their being public or private. A population was chosen through convenience, taking into account the complexity and diversity that exists in a study of these dimensions and areas of influence, as shown in This research was carried out with the participation from research groups from Bolivia, Brazil, Colombia, Ecuador, Spain, Peru, Mexico, and Venezuela. It is an exploratory, descriptive study with mixed approach. This article privileges the presentation of qualitative results. Although the project has a common methodological framework, consensual adaptations have been made, in function of the context in which it has been applied, according to the exploratory methodology adopted, to obtain results more in keeping with the reality in each region and assuming the characteristics and limitations of each context. Regarding the The inclusion criteria were the curricula that had in their academic plan some assignments that included the R&CT capacity or similar words considered synonymous for this study, such as critical thinking, reflexive thinking, analysis and synthesis, critical and self-critical capacity, information management, decision making, problem resolution, among others; the curricula had to of public access or that when required from the respective academic instances, such would be provided.The study categories or nuclei were: (i) presence of the R&CT capacity or similar in the curriculum; (ii) teaching and learning methodologies and strategies suggested in the curricula to develop and promote the R&CT capacity or similar; (iii) forms of evaluations suggested in the nursing curricula linked to achieving the R&CT capacity; and (iv) coherence between the R&CT capacity and the educational methodology used in teaching, learning, and assessment processes. Upon identifying the R&CT presence in the curricula, the study proceeded to review the areas of knowledge or areas of development of the academic offer, which were classified into biomed, public health, nursing, research, and electives.To collect the data, a document was constructed, which in the first instance permitted identifying the type of institution, dependence, and country; thereafter, it was possible to gather elements to characterize R&CT within the curricula, through data related with the presence and denomination of this capacity, where, through consideration of the research team, terms were accepted, like analysis and synthesis, problem resolution, decision making, information management, or critical and self-critical capacity, given that they are all related with this type of thinking. Data was also gathered about the assignments, areas of knowledge, teaching-learning methodologies, and evaluation activities, with these elements being necessary to complement the characterization of the development and positioning of R&CT within the curricula. Lastly, to guide filling out the document, 10 guiding questions were elaborated, which permitted obtaining information on the educational approaches and the curricular theory that support the development of R&CT in nursing education institutions in Iberian America that participated in the research.The empirical or field phase filled out 189 data-collection documents. The results were first grouped into the four regions that participated in the research: Andean, Brazil, Mexico, and Europe, resulting from it a regional analysis to, finally, elaborate a final report that permitted knowing the differences and similarities in the nursing degree academic programs in eight countries and 189 curricular plans; organized based on the four categories or thematic nuclei of study already indicated, deriving from the results some conclusions, reflections, and recommendations, taking as axis the objectives proposed in this research.This project adhered to the Helsinki Declaration and to legislation in effect in each region and country of Iberian America for the regulation of confidentiality and protection of data obtained in the research.formation purpose proposes achieving a professional with integral, reflexive, critical formation, capable of adapting and transforming reality, with critical conscience, entrepreneurial leader, free, critical, and universal. The methodological strategy develops and implements pedagogical methods that promote reasoning and creative critical thought, curricular design through skills, analysis of lectures, group dynamics, individual and group practices, integrates theory-practice and integrates teaching-research and extension, with respect to conducting research, which can transcend at interdisciplinary and transdisciplinary levels. As result: the individual can solve problems, promote critical thinking, generate knowledge, critical analysis, capable of anticipating and visioning the future, and construct viable alternatives to problems.The total of the curricula reviewed, although with different emphasis, contemplate the development of R&CT as priority for all graduates from educational institutions. It was identified that this type of thinking was found in three complementary stages: as formation purpose, as methodological strategy, and as result. The Referring to the curricular theory used in the construction and conduction of the curricula, the study identified diversity of approaches, although in most cases alluding to constructivism, centered on learning (independent learning or self-learning), through skills, flexible or semi-flexible; aimed in inter and/or multidisciplinary manner, favoring, in some cases, accent lines: community, clinical, entrepreneurial, educational and/or research, although it is worth mentioning that, mostly, the skill focuses only on the critical capacity and skill, leaving aside the reflective element. The explicit and implicit R&CT presence was found in all the elements that make up the curriculum, such as mission, vision, objectives, foundation of the academic program, graduation profile, curricular guidelines and evaluation, among others. Although it may be said that great diversity exists of terms that, based on the sense in which they are employed within the curricula, these may be considered synonyms of R&CT. Thus, the following can be stated: critical knowledge, reflexive thinking, analysis and synthesis, clinical practice, problem solving capacity, critical and self-critical capacity, critical and/or reflective attitude, critical and/or reflective skill, critical and/or reflective capacity, clinical judgment or clinical method, critical spirit, problem resolution, information management and decision making; all imply a self-directed, complex, systematic, and deliberate reasoning process aimed at action.Social-humanist, which included assignments, like sociology, values, ethics, among others, many of them of elective nature; in contrast to those of greater curricular weight, like that of disciplinary-medical-technical knowledge - integrated by assignments, like anatomy, physiology, genetics, pharmacology, and nursing . Other assignments in which the capacity appears are Communication skills, Foreign languages, Research, Information management, Workshops, Informatics and Technology. In Spain (European region), this capacity is specified predominantly in areas of disciplinary knowledge, like Nursing models and theories, Nursing process, Practicum, Anthropology of Health, and Epistemology of Nursing.Within the Latin American RIIEE setting , R&CT presence is mostly consigned to areas of lower curricular weight, like the st century, making broad specifications on the Being, Knowing and Doing of the nursing professional. An example of this is the following manifestation: \u201cthe Nursing degree graduate will be able to \u2026solve problems, followed by decision-making professionals, with critical thinking, creative, participant, enterprising, productive, reflective and self-critical, capable of making clinical judgments, researcher, capable of business creation and engaging in independent practice, with autonomy, creativity, and self-realization, competent for intersectoral, multidisciplinary work, with effective communication and oral and written expression. Capable of providing integral care, conducting continuous and permanent learning, according to personal and professional needs\u2026\u201d (C-32).It was common to find in the graduation profile of the Nursing Curricula, belonging to the different institutions studied, the following statements: \u201ctrain higher-level professionals committed with the population\u2019s health, development of their discipline, with capacity to construct from their own knowledge, take initiative and solve problems; competitive and with aptitude for team work, assuming responsibly the risks involved in disciplinary and interdisciplinary professional practice, capable of applying knowledge based on scientific evidence to care for human health, with humanistic and bioethics sense\u201d; additionally, attributes are expressed on knowledge, skills, attitudes, and values to meet the needs, demands, and conditions of the nursing labor market for the 21formal or written curriculum, which may not necessarily be congruent between the real and the hidden curriculum, an aspect that in this study exceeds those comparisons. Hence, this section only accounts for what was found in most of the curricula reviewed. In all the regions studied, the academic programs make explicit the teaching-learning strategies and evaluation of the capacity for critical thinking, supported by the literature. Nevertheless, the lack of linearity in the application of these strategies is also common. These are not enunciated in the curricula or in the teaching plans, at least with sufficient clarity to determine that, effectively, the teaching activity is being guided toward acquiring the R&CT capacity. The principal teaching and learning strategies made explicit in the curricula were: Portfolio of evidence, analysis of lectures, group dynamics, individual and group practices, research, problem-based learning (PBL), brainstorming, analysis and synthesis, conceptual maps, analogies, case studies, experiential workshops, nursing process, panel, forums, seminars, reflective diary, critical incident, essays, fieldwork, socio-drama, debate, dialogue, summaries, simulation laboratories, supervised clinical practice, among others.Each curriculum analyzed consigns onto the \u201cteaching and learning activities\u201d section a range of actions the curricular program suggests, but it should be mentioned that this is only the so-called etc., which is not congruent with the didactic-pedagogic techniques of transmitting knowledge, generally evaluated to pass a course and promote students to the next academic level.The evaluation activities identified in the curricula reviewed were: portfolio of evidence, field diaries or logbooks, knowledge test, practical exam, elaboration of research work, essays, as well as case studies, elaboration of the nursing process, clinical case, written exam, oral exam, and self-evaluation. Regarding the evaluation, it was found that know-how is mainly evaluated. There is a message/discourse on constructivism, capacities, flexibility, self-learning, The teaching and learning strategies enunciated in the curricula reviewed are diverse. It is common to denominate active, creative, reflective, and critical or innovative methodologies. Most of the teaching plans gather the emerging tendencies having to do with learning and evaluation activities, although full coherence is not observed in them among the learning results expected, the teaching-learning activities developed and those activities to be evaluated by said results. Most of the curricula reviewed in this study do not make explicit the linearity between skill and the teaching-learning-assessment activities (T-L-E).The R&CT capacity is currently a necessary capacity highlighted, explicitly and narratively, in all the Nursing Curricula reviewed in this research; although it must be specified that they must be expressed through diverse nominations, which permits concluding that the term can be seen as multi-voiced. LikewiseIt is interesting to find in the graduation profile of the curricula analyzed statements that describe the formation of nursing professionals committed with the health of the population, development of their discipline, with capacity to construct their own knowledge, take initiative, and solve problems; this implies collecting, interpreting, evaluating, and selecting information for the purpose of making timely decisions  on the fThe social, cultural, health, and educational needs, to mention some, of the person, family, and society together are based on all the curricula reviewed, an aspect not reflected in the internal congruency of the study plan; particularly, in the profession\u2019s object of study, its objectives, and the graduate\u2019s profile, still privileging a biological, ahistorical, and individual education, although enunciating an integral or holistic formation of the graduate. We belieMoreover, the gap is often observed between the curricular theory and the pedagogical practice consigned in the majority of the curricula studied. Adaptation of the traditional nursing curriculum to a skills-based curriculum has assumed an important advance for the nursing formation. In the first place, it has mean tan effort of reflection shared by the faculty to become conscious of the new approaches the nursing career must assume, in order to reduce the gap between theory and practice. Integration of contents, coordination among faculty staff, and transversality, as well the orientation toward the professional practice, have been elements present in the reflection carried out. Change is evident in the elaboration of the curriculum, above all in that referring to the orientation by skills and to more creative and innovative teacher methodologies. However, these changes are only evident at explicit curriculum level. When delving into the study of the curriculum, many questions remain unsolved, especially regarding the implicit or hidden curriculum. This poses the question of whether the nursing teachers in the study field are actually carrying out the pedagogical and didactic practices that the new curricular approach suggests in the academic program.st century, formation of nursing professionals must respond in efficient, integral, timely, assertive, and humanistic manner to the demands required by caring for life and maintenance and reestablishment of human health. This is not an easy task, given that the formal care provided by this professional implies the dynamic of growing changes in current university designs and methodologies claim with it implementation of an integrating version and transversal of the contents to deploy effectively the necessary elements to achieve strengthening the skills a nursing degree graduate must have.With respect to the teaching, learning, and evaluation strategies, it may be said that these are not only multiple and diverse, but that they do not present full congruence, such is the case, for example, of the \u201cteaching and learning strategy\u201d used by the evidence portfolio and where the \u201cevaluation\u201d section specifies that the activity and the assignment will be graded through a written test of knowledge. We deem it important to reiterate that, during the second decade of the 21Although it is true that the curriculum orientation is perceived inserted onto the constructivist current, prevalence is still noted in the curricula of technical-instrumental formation characteristic of the positivist biomedical paradigm, known for high percentages of contents with disease-focused biologic clinical character in detriment of contents oriented at health and social critique. The paradigm of the transformation in which we are immersed and which promotes the emancipation of the professionals, is scarcely supported on the formation of new professionals, which proceed and continue to form in a context marked by the repetitive and anachronistic practice of the traditional health culture, where medical paternalism continues expressing the power they maintain in healthcare structures. Nevertheless, it is necessary to highlight the effort by nursing education institutions to adjust the curricula to this new transforming paradigm, in spite of the cultural barriers instituted and which, in many cases is maintained by the care professionals themselves.knowing, know-how, and knowing-being, as general consideration of the curriculum, and knowing to coexist for nursing.(objectification only of knowledge, many times of memory type, where we believe that the principal results are limitation of the students\u2019 creativity, autonomy, and self-criticism to measure and assess their academic performance and achievement.It is prudent to remember and recognize that the evaluation should be diagnostic, formative and summative or final, which seeks to use instruments that enable feedback from the educational process, preserving respect for the academic freedom of teachers, by these being autonomous institutions, through traditional evaluation techniques or assignment of research work, essays, case study, elaboration of the nursing process, clinical case, oral exam, self-evaluation, among other forms and strategies, which will grade the domain of  nursing. In spiteDevelopment and promotion of reflective and critical thinking in nursing professionals is currently essential, given that the epistemological and sociological growth of the nursing profession require professionals with permanent discernment, supported on scientific, ethical, aesthetic, and personal knowledge. Reflection and critique, as learning tools, must be incorporated into the formation of nursing professionals. If learning based on life experiences is so important in nursing, reflection is vital to avoid repeating practices that hinder professional development and affect the quality of service provided by the nursing staff. This type of multi-referred thinking must be one of the essential axes that transform the professional formation and practice and with it the quality of care to users, family, and society, besides achieving higher professional status in nursing.The results previously indicated permit stating that it is fitting to review and reorient institutional development plans, programs and academic plans, or study plans, fundamentally in what refers to the curricular contents, to develop and promote in the students and future graduates the practice of R&CT, diminishing existing gaps among theoretical formation, professional practice, and care requirements, reestablishing and maintaining health, favoring individual and collective wellbeing indices, especially if the aspiration of public and private universities that offer the nursing degree in Iberian America, consists in forming and contributing an interpretive vision to nursing professionals, through an academic curriculum that goes beyond teaching the diverse functions -granting, education, research, management, and administration, among others, which will take place around formal or professional nursing care, developing innovative skills. One of the cross-sectional-type curricular axes that must be considered, based on our point of view, is development, implementation, and promotion of R&CT in academic programs and their respective assignments or learning units, which provide nursing professionals the theoretical-practical tools necessary to use this type of thinking in any setting of the labor market they enter, which will enhance their vision, leadership, decision making, autonomy, and social and professional recognition.The principal limitation noted in a multicenter research of this nature was the collection of information in the different participating countries, to the extent in which, although a document was constructed to obtain data, the interpretations made difficult some aspects of analysis and construction of analysis categories."}
{"text": "A considerable number of qualitative studies have been published in recent years on the issues that the quantitative studies have limitations on. This study aimed at performing a meta-synthesis on qualitative studies on Road Traffic Injuries (RTIs) with a scoping review approach.This meta-synthesis study was conducted as a scoping review in 2019. The Arkesy and O\u2019Malley framework was applied which has six steps of identifying the research question, identifying the relevant studies, selecting the studies, charting the data, data analysis and reporting the results, and consultation exercise. The required data were gathered by searching the relevant keywords in databases of PubMed, web of knowledge, Scopus, Cochrane Library, Science Direct, Google scholar, Sid, IranMedex. Extracted data were analyzed by the Content-Analysis method.Finally, 30 studies were included. Extracted data summarized in five main themes and 17 sub-themes. The main themes were: consequences , the needs of survivors , risk factors , barriers of prevention , and prevention solutions  of RTIs.This study combined the methods of the scoping review and the meta-synthesis to mapping all qualitative studies on the RTIs, with this approach, this study provides extensive and practical information for policy-makers, managers, practitioners, and researchers in the field of RTIs. Also, by applying this approach, the gaps in the existing knowledge and areas in need of further research are identified.The online version contains supplementary material available at 10.1186/s13690-020-00493-0. Road Traffic Injuries (RTIs) are the main cause of morbidity and mortality in the world nowadays . The bigQuantitative studies have been published on various aspects of the RTIs. Although the quantitative studies were brilliant in this area and have helped the prevention of the RTIs, they are faced with some limitations in some aspects. So the researchers used the qualitative methods besides the quantitative ones . The quaConsidering the characteristics of the qualitative studies, in recent years a significant number of these studies have been performed on some aspects of the RTIs that the quantitative studies were faced with serious limitations on those aspects , 11. SumStep one: Identification of the research questionThis was a meta-synthesis study performed as a scoping review in 2019 with the aim of the analysis of published qualitative studies on RTIs. The framework by Arkesy and O\u2019Malley was used which is the first methodological framework to manage the scoping review studies. The framework is published in 2005 and includes six steps: identification of the research question, identification of the relevant studies, selection of the studies, data charting, data analysis and reporting the results, and consultation exercise .Step onWhat are the main approaches of the qualitative studies on RTIs?What are the main methods of data collection in qualitative studies on RTIs?What are the most important aspects of RTIs studied in qualitative studies and what are the results?The research question was what are the characteristics and results of the qualitative studies on RTIs. The question is specifically divided into the following:Step two: Identification of the relevant studiesInclusion and exclusion criteria: All qualitative studies on the RTIs from January 2000 to March 2019 were eligible to include in the analysis. The language was limited to English and Persian. Those studies on injuries of accidents other than road traffic accidents , those studies that assessed the RTIs and other injuries at the same time, short communications, and conference abstracts were excluded.Step three: Study selection/screeningThe required data were gathered by searching the keywords of road traffic injury, road traffic accidents, road traffic crashes, motorcycle accident, motorcycle crash, motorcycle injury, motor vehicle injury, motor vehicle crash, motor vehicle accident, qualitative, interview, phenomenology, focus group discussion, grounded theory at the databases of PubMed, web of knowledge, Scopus, Cochrane Library, Science Direct, Google scholar, Sid, IranMedex  flow diagram  was usedStep four: Categorization of the dataAfter screening, the reporting quality of the studies was assessed by two researchers using the Critical Appraisal Skills Program (CASP) checklist. The checklist includes 10 items. The first two items are screening questions. The appraisal of the study would continue only if the answer to at least one of these two questions was yes. For the next eight questions the three options of Yes, Can\u2019t tell, No were marked for which the scores of three, two, one were assigned respectively . So the Step five: Conclusion, summarization, and reporting the resultsTo extract the data, the data extraction form was developed in MS Word 2010. Data for three papers were extracted as a pilot. Then the form was revised. The intended data included: author(s), year, country, study purpose, participants, the approach of the study, data collection method, study findings (themes and sub-themes).Step six: Providing practical recommendationsThe gathered data were analyzed by the content analysis method. Content-Analysis is a widespread method for the analysis of qualitative data through the identification, analysis, and reporting of the patterns (themes) within a text \u201318. CodiAfter extracting and reporting the study results, based on the study findings and the opinions of the research team, practical recommendations were made in terms of research methodology and also for the policymakers and managers.Of the 4623 retrieved records, 1825 were duplicates. At the title and abstract screening, 2752 records were removed. The full-text review also resulted in the removal of 16 papers so finally, 30 papers were included in the synthesis , change in roles of the family members such as the breadwinner role of the mother of children due to injury of the father), and cut or reduction of family income.One main social consequence of the RTIs that was highly mentioned was the limitations of the social relations of the injured people. Moreover, the accidents due to the low safety of the vehicles and roads can result in distrust of the people in government actions.One of the most obvious consequences of RTIs is financial consequences. It includes damages to the vehicle, damages to road facilities, treatment and care costs of the injured people, costs of losing the productivity of the people in the society, paying the blood money, and other costs.Every RTIs due to the mentioned consequences creates some needs in the injured individual and his/her family. One of these needs is the social needs of the injured people which include social support by the government, charities, family, and friends in terms of financial, mental, spiritual, and legal supports. Another need after an RTI is the need for healthcare which includes emergency care right after the accident, specialist and quality care at the hospital, rehabilitation care, and mental care.The other main theme was the risk factors of the RTIs which had three sub-themes of general risk factors (five items), risk factors for motorcyclists (five items), risk factors for children and adolescents (four items). Table\u00a0The barriers to the prevention of the RTIs were in three categories of general barriers (five main and 13 sub-main), pre-hospital barriers (three main and 10 sub-main), emergency, and hospital barriers (two main and five sub-main). Table\u00a0Solutions for prevention of the RTIs and reduction of their consequences were categorized in five dimensions including increasing safety (three items), rules and regulations (four items), education (two items), increasing equipment (five items), and scientific solutions (two items). Table\u00a0Results of the quality appraisal of the included qualitative studies showed that the average quality score of them was 21.6 in the 8\u201324 range. One issue that did not receive sufficient attention in the studies was the ethical issues , needs , risk factors of the RTIs , barriers of prevention of the RTIs , and solutions of prevention of the RTIs .The RTIs not only cause physical and financial problems, but also cause some mental problems due to losing family members, feeling guilty, feeling ashamed, being an encumbrance, and fear of the future. The physical problems usually get better by healthcare or the person becomes adapted to the problems. But the mental problems such as long-term depressions bring more suffering for the person and have more severe consequences . A meta-Another consequence of RTIs is financial issues. The high social and economic costs of the RTIs have challenged the policymakers of the countries , 58. TheOne of the main needs of the victims of the RTIs is the need for social support because they cause the victims to be socially isolated , 68. NumOne of the most important categories of the risk factors identified in this study is the risk factors of the motorcyclists. According to the National Highway Traffic Safety Administration (NHTSA), the risk of death of the motorcyclists is 34 times more than other vehicles. This number is eight times for severe injuries . Most ofAs it is mentioned, the risk factors identified from qualitative papers in this study were general risk factors, specifically for motorcyclists and children and adolescents. Yet quantitative studies have identified specific risk factors for other groups of people such as the elderly, pedestrians, and bike riders. The literature shows that these groups are also vulnerable to RTIs \u201396 and sThe study by Khorasani Zavareh et al. (2009) showed that there are several barriers to the prevention of the RTIs in Iran. The main theme of the study was the lack of a systemic approach to the prevention of the RTIs and the sub-themes were human resources, transportation systems, and organizational coordination . A reporThe existence of a leading organization with sufficient authority and tools is one of the most important solutions for the prevention of the RTIs. Several organizations are involved in RTIs and their prevention, of which the main ones are the ministry of transportation, ministry of industry, ministry of health, traffic Police, forensic medicine organization, Central insurance organization, ministry of Justice, ministry of interior, the red crescent organization, and the EMS. At the countries that are successful in reducing the burden of the RTIs, usually, there is a leading organization that has the stewardship of the activities around the RTIs , 102. FoAnother important solution that was emphasized in several studies is establishing an on-time and effective registration and reporting system. The experiences of the countries indicate that the health sector can play an effective role in designing and implementing the recording and reporting system of the RTIs \u2013108. In Although with the best of our knowledge this is the first study of scoping review and meta-synthesis on qualitative studies on the RTIs, it has some limitations. The main limitation of this study was limiting the search of the literature to English and Persian languages because there might be some good studies in other languages that are not included in the synthesis. Subjective interpretation of the findings is another limitation of this study. Petticrew et al. (2013) noted that the results of meta-synthesis should be more interpreted by policy-makers and users . But in This study combined the methods of the scoping review and the meta-synthesis to mapping all qualitative studies on the RTIs to summarize the vast literature into five main themes and 17 sub-themes. The main themes found in this study were: consequences of the RTIs, needs, risk factors, barriers of prevention, and solutions for the prevention of the RTIs. With this approach, this study provides extensive and practical information for policy-makers, managers, practitioners, and researchers in the field of RTIs. Also, by applying this approach, the gaps in the existing knowledge and areas in need of further research are identified. However, this method is a new method and more studies are needed to become more mature with this method.\u27a2 Psychological and social effects of traffic accidents.\u27a2 Policy-making, management, and organizational tasks of RTIs prevention.\u27a2 Qualitative studies to investigate RTIs prevention issues in high-risk and vulnerable groups .\u27a2 Qualitative studies to further investigate the provision of high-quality health care services to traffic accident victims\u27a2 Carrying out qualitative studies on experiences, high-risk behaviors, and prevention of traffic accidents with the participation of drivers of public and heavy vehicles\u27a2 A qualitative study with policy-makers and senior managers on macro-level issues of traffic accident prevention .\u27a2 Application of qualitative studies in designing, implementing, and evaluating RTIs prevention interventions and policies.Based on the results of this study, the following topics are recommended for future qualitative studies:Additional file 1. Complete search strategy in PubMed databases for identifying the qualitative studies on Road Traffic Injuries (RTIs) published between2000 to 2019.Additional file 2. Results of the quality appraisal of qualitative studies on Road Traffic Injuries (RTIs) published between2000 to 2019."}
{"text": "Indoor Air Quality (IAQ) is one of main topics of Public Health on which international institutions and countries are taking action. With regards to healing architectures, several studies have reported data analysis and case studies to improve users\u2019 health , but there are not enough regarding volatile organic compounds (VOCs). Regarding chemical pollution of indoor air, the Scientific Community has highlighted that there are several factors that affect the IAQ, in particular the design and management, and energetic efficiency, of inpatient wards. Several stakeholders, from the designers to the managers, are responsible for the indoor air in healing environments. Supported by analysis of the State of the Art and the main factors that influence the heterogeneous scenario of inpatient wards, the paper presents three check-lists, designed for supporting the stakeholders during the design phase, or for the daily procedures and maintenance activities, for pre-assessment of factors that affect chemical pollution, and for the definition of strategies to be applied. In fact, in such environments IAQ assumes a particular meaning and importance, both for the vulnerability of the patients and for the long time spent by the sanitary staff. The multidisciplinary approach emphasizes the continuous need for interdisciplinary knowledge and skills aimed at finding solutions able to protect users\u2019 health status , especially in the field of the indoor air issue. Several stakeholders are responsible for health promotion in indoor environments, starting with the decision makers and the designers during the design process, to the managers and the users who will manage, work, use and live in the spaces .Referring to the factors that affect the Indoor Environmental Quality (IEQ), the Indoor Air Quality (IAQ) is an issue already discussed in the 1980s ,3,4,5, aAmong the indoor environments, IAQ in \u201cArchitectures for Health\u201d requires great attention for guaranteeing healthy indoor air and well-being, in particular for protecting patients and staff against Hospital Acquired Infections (HAIs) and occupational diseases ,8. In faTherefore, during the design process of hospital settings and their management, it is necessary to guarantee healthy spaces, starting with (a) the support of managers, medical and non-medical staff, maintainers and service providers, and (b) the design of hospital planners in relation to the layouts, the material selection, the rooms\u2019 dimension, the engineering plants, etc., which can highly affect the performances of the facility and its processes ,11. In fIn general, the IAQ within hospitals is a complex and dynamic system, in which physical factors, and biological and chemical contaminants generated in indoor environments, as well as those in the outdoor air that come into the building via natural ventilation  and, primarily, mechanical ventilation  play a role. The quality of the management and maintenance of engineering plants , the cleRegarding the chemical composition of indoor spaces, there may be threats to the air quality from a range of indoor and outdoor sources ,26,27,28Currently in the European Legislation, VOC concentrations and IAQ for generic indoor environments are limited via acts and norms in some countries, as Settimo and D\u2019Alessandro  investigNowadays, for assessing chemical pollution, it is necessary to monitor activity, but this is not always possible to set it up immediately, and data analysis requires a long time. Therefore, the aim of the paper is to give rise to three check-lists for reducing chemical pollution in inpatient wards, for supporting designers, hospital planners, medical directors and managers, to be applied during the design phase, and for the application of daily procedures and maintenance activities in the defining of strategies for healthy performances. The focuses of the check-lists are related, referring to the current trends in hospital design, and to facilities with mechanical ventilation and/or mixed systems .The inpatient ward is a low\u2013medium care environment, with the presence of hospital staff and users with weak health conditions. Typically, a traditional inpatient ward has about 28\u201332 beds with support services for medical activities and hospital staff, such as a nursing station, the head nurse office, several storages, a medical room, doctors\u2019 offices, a kitchenette, a workers\u2019 dining room and users\u2019 restrooms .In this functional area, one of the most important pathogen sources is related to the respiration of a potentially infectious user and related medical activities; most of the inpatients spend a lot of their time in beds, while medical staff spend a lot of their time in a ward, depending on the activities to be carried out ,33,34,35In general, they may be exposed to a wide range of chemical pollutants emitted from several products, such as finishing materials, furniture and disinfectants, and regular control plans, etc. .The configuration of the inpatient room, as well as the design and health-related trends, is affected by: (a) environmental factors, dimensional space and design features; (b) managerial factors, related to medical procedures, training and health education, maintenance and cleaning activities, etc.; (c) social factors, guaranteeing hospitable spaces for users . With reSince of the scientific literature reports give very different outputs and results, and the resulting work from the analysis conducted by Gola ,42 is diOutdoor and indoor microclimatic factors, which refer to the outdoor air, the solar exposure and indoor microclimatic parameters, such as temperature, relative humidity, air velocity, air change, etc. Although these factors can vary, they have a great influence on the IAQ and the performances of materials in the room and air fluxes.Management activities, which refer to the management and maintenance activities, ventilation systems, cleaning and disinfectant activities, control plan, etc., carried out in the room and in the functional units and/or in the entire facility. They can highly affect IAQ, but their emissions can be controlled through the applications of strategies, and at the same time they can be changed if their actions are dangerous for users.Design factors, which refer to all the components that characterize the inpatient room . In general, their emissions are constant, although in relation to their life, the emissions may decrease over the time.Human presence, which refers to the presence of users, their health status, and the medical activities carried out in the inpatient room. Their presence and application can vary, and therefore they can affect the indoor air in different modes.Starting from an analysis already conducted by Gola et al. , it is pAs emerges from an analysis of the several factors, to overcome the criticisms related to the design of healing environments, interdisciplinary knowledge needs to be taken into account, including: the needs of users  related to their activities and therapies; nosocomial infections; applications of the technologies and ventilation systems (HVAC) needed to carry out the ordinary and specialist healthcare disciplines; risk analysis techniques for several functional units, including events caused by incorrect application of procedures; acceptable residual risk values and related sharing and management procedures .In addition, designers, in collaboration with healthcare professionals, should design the healthcare settings according to the different uses, support the healthcare organization in identifying the most optimal solutions , and elExposure of hospital users to chemical pollutions is related to several aspects, related to product formulations, how and where the products are applied, the methods of use, the degree of aging of the various components, the type of maintenance activity, etc. . As someStarting from the application of several case studies and the evidence given by a detailed analysis of the scientific literature , IAQ is As the World Health Organization (WHO) and several Institutions have already highlighted, for understanding the real performances and the IAQ, it is proper to do several monitoring activities for an adequate data analysis, and for the investigating of the factors that affect this issue ,52. AlthFor this reason, for supporting designers and medical directors, the research team produces check-lists for the pre-assessment of chemical pollution in inpatient rooms, during the design phase, daily procedures and maintenance activities.These check-lists aim to be useful tools for the pre-assessment and prior verification of strategies and decisions to be applied, and, when these cannot be verified, to have an awareness and take action for avoiding possible risks for the hospital users regarding chemical pollution. They become a preliminary tool to define a future and broad protocol for supporting the healthcare organizations in the strategies to be applied.These lists refer to several criteria, considered as factors that affect IAQ  the State of the Art, several research projects and investigations, and the systematic reviews by scientific international researchers, supported by reports promoted by the research group Study for the Indoor Air Pollution of Istituto Superiore di Sanit\u00e0  in Italy . The lisThe aim of this check-list is to investigate and verify the design features of the room , its configuration and its installations. The check-list is particularly useful for designers and hospital planners during the design process.The general scope of this list is to highlight possible deficiencies in the design phase, and to implement the project of the room through design strategies. This check-list is strongly related to the design of new healthcare facilities, or the renovation of an existing hospital. In this phase, the decision makers have a great responsibility, because it is possible to already define the management strategies, supported by the healthcare organization, for obtaining the best performances of the rooms, as well as of the cleaning and maintenance activities.Starting from the answers, and in particular the negative ones, it will be possible to define strategies and solutions for improving the use and performances of the environmental unit for the medical activities.In general, the check-list focuses on healthcare facilities with mechanical systems, responding to the current trends in hospital design.As The check-list aims to highlight some criticisms, related mainly to negative answers, for identifying strategies and solutions to be applied, where possible, because each hospital project is different.The following list  suggestsThe check-list has the aim of investigating and verifying the daily procedures, the room occupancy and its performances. The aim of this list is to highlight possible deficiencies in medical and human activities, and to implement the procedures through management strategies.Although design strategies require hard interventions, the check-list permits one to consider several factors and plan alternative actions related to the ventilation system (HVAC) and its efficiency, cleaning activities and detergents, a series of more specific activities of sanitation and disinfection, medical activities, and procedural adoption of prudential and adequate behavior.Starting from the answers, and in particular the negative ones, it will be possible to define strategies and solutions for improving the use and performances of the environmental unit for the medical activities.In general, the check-list focuses on healthcare facilities with mechanical systems.As The check-list aims to highlight some criticisms, related mainly to negative answers, for identifying strategies and solutions to be applied, where possible, because each healthcare project is different.The following list  suggestsThe check-list has the aim of investigating and verifying the condition of the room after the maintenance activity and/or intervention.The aim of this list is to highlight possible deficiencies of the room and procedures before occupation of the room by users, and to apply management strategies.The type of interventions can be different , i.e., hard or soft interventions in the room. In relation to complexity, the strategies may concern natural ventilation or HVAC systems and efficiency, medical activities and management procedures, the planning of cleaning and disinfection, activities\u2019 assessment, and actions related to air monitoring for both chemical and biological agents.Starting from the answers, and in particular the negative ones, it will be possible to define strategies and solutions for improving the use and performances of the environmental unit for medical activities.In general, the check-list focuses on healthcare facilities with mechanical systems.As The check-list aims to highlight some criticisms, related mainly to negative answers, for identifying strategies and solutions to be applied, where possible, because each activity requires different attentions.The following list  suggestsIt is clear that IAQ is a very broad topic, in which any variable can affect the performance of air in indoor environments. In fact, design and management strategies which may be adequate in relation to different procedures can decrease or increase the quality performances of the inpatient room, and the comfort of users ,84.Although current monitoring activities and data analyses are more reliable, the check-lists become useful tools for a pre-assessment and prior verification of strategies and decisions to be applied, and when they cannot be verified, they help one to have awareness and take action for avoiding possible risks to the users.The multidisciplinary approach, supported by design, chemical and healthcare issues, demonstrates the need for interdisciplinary of knowledges and skills aimed at finding solutions able to protect the health status of users . It is cThe hospital system should be rethought, giving attention to the pollutant emissions, and providing buildings that, from the design phase up to the building\u2019s realization and functioning, can maintain the safe conditions of the indoor environment ,69,90. IThe paper aims at the elaboration of strategies for health promotion in hospital wards, from the chemical pollution point of view. In any case, it is possible to consider improvements, all the time, to the contents of the check-lists, thanks to the support of several research groups, the data analysis and monitoring activities supported by scientific methodologies, such as those of Gola et al. and \u015amie\u0142owska et al. ,76, whicThese activities help the healthcare organization and hospital staff, with a view to preventions and the planning of interventions into the activities and the use of sanitizing or disinfectant substances related to medical activities, and also helping them to be ready in the case of epidemics , particularly regarding the activity of disinfection .Among the future perspectives, the new challenge is to investigate the correlations between the chemical and biological pollutants, and their effects on IAQ and the quality of the healthcare facility."}
{"text": "Sensors. The authors contacted the publisher regarding the robustness of the results. The selection of weight parameters was not sufficiently rigorous, resulting in doubts concerning the scientific validity of the theoretical models and simulation results.The journal retracts the article , cited aSensors. The extent of the error is significant and, therefore, in accordance with the journal\u2019s procedural requirements, this article is retracted.Adhering to our procedures, an investigation was conducted by the Editor-in-Chief with the editorial office of The authors agreed to this retraction and apologize for any inconvenience caused."}
{"text": "The article presents data on a new scheme of complex treatment and rehabilitation of emigrants with psychogenic, endogenous and organic depressive disorders, as well as the results of comparative analysis of the effectiveness of this scheme, compared to the traditional one.The use of the proposed treatment scheme also allowed to reduce the severity of anxiety, indicators of the severity of psychopathological symptoms, improve the quality of life among emigrants suffering from depressive disorders of different genesis.The received results allow us to recommend the scheme we have developed for implementation in the complex treatment of emigrants suffering from depressive disorders of psychogenic, endogenous, and organic genesis. The problem of emigration in Ukraine is one of the most pressing state and social problems. Emigration is one of the most massive social processes in the world, which has shown a pronounced tendency to increase in recent years. Based on the information from Ukrainian embassies abroad, the Ministry of Foreign Affairs reports that up to 2.5 million citizens are employed outside the country. The data of the Ministry of Social Policy of Ukraine obtained based on the analysis of the labor market, made it possible to determine the volume of labor migration, which is approximately 3 million persons . AccordiIn recent years, due to Russian aggression towards the East of Ukraine, there has been a tendency for a rapid increase in the number of Ukrainian migrants. If the intention to emigrate was present in 12.3% of the respondents in 2005, the percentage was already 65.0% in 2015 .Migration is seen as an important factor in influencing a person\u2019s mental health. Some authors believe that emigration provokes manifestation or exacerbation of endogenous mental illness. At the same time, the issues related to the peculiarities of the depressive disorders in emigrants have not been studied sufficiently. In particular, the manifestations of depression concerning the emigration factor have not been investigated, which significantly complicates the development of targeted therapeutic approaches to the treatment and prevention of depressive disorders in this population category. This study was based on the research and analysis of clinical-psychopathological phenomenology of depression to develop the system of measures for treating depressive disorders in emigrants.Migration is accompanied by the transformation of the whole system of socio-psychological relationships, including interpersonal, family, parental, labor, and leads to significant tension of psychological mechanisms, which finally can lead to depressive and anxiety disorders, somatization, and post-traumatic stress disorder. The process of adaptation of migrants in a recipient country can be challenging and require a fundamental psychological and sociocultural restructuring, defined by the term \u201cstress of acculturation\u201d , 9.N.V. Kondrashova believes that the interdisciplinary nature of the migration problem necessitates the use of a set of research methods based on the implementation of ethno-sociological and cultural approaches, which ensures obtaining the results that objectively reflect the current state of the problem, makes it possible to predict the development of this process and to give scientifically substantiated recommendations .According to N.S. Palagina, the problem of adaptation of forced migrants has a complex interdisciplinary nature, while the socio-psychological aspect of the adaptation of migrants is not enough investigated. In the process of social and psychological adaptation of migrants, there are significant changes in the personal plan manifested in decreased self-esteem and level of aspirations, deformation of value orientations, and social attitudes. The author highlights that most of the forced migrants are non-adapted, which is manifested in the hypothymia type of response, the chaotic nature of the activity, in trend to take a protective position, externality and escapism, a decreased emotional state, emotional tension, and a tendency to groundless concern about minor issues, irritability, and anxiety. The situation of forced migration can be characterized as a crisis and even extreme, the one that poses a threat to health and life. At the same time, the success of the socio-psychological adaptation of migrants is determined by psychological and non-psychological conditions, in particular, socio-demographic affiliation, personal characteristics, life experience, degree of similarity, and differences between cultures, the communicative potential of the subject, creativity, and others. In the process of socio-psychological adaptation of migrants, there are clearly revealed phases (stages) that characterize the dynamics of adaptation processes and the success of adaptation in general. A comprehensive program of assistance, which includes a system of social, psychological, and educational measures, can optimize socio-psychological adaptation by main indicators, such as adaptation to the sociocultural environment, emotional stability, social frustration, and mental state .L.A. Shaygerova emphasizes that the complex process of adaptation in the situation of migration leads to changes in the identity of the migrant\u2019s personality that reach a crisis level. The crisis of identity among migrants manifests itself in the different profound transformations of its contents, occurring on the personal and group levels. So, the overcoming of the identity crisis is an essential condition for the successful adaptation of the individual in the situation of forced migration. However, it often reaches such depth and strength that personal resources are not enough and the person requires psychological help for overcoming it. Such help is the correction of violations of the motivational and necessity sphere, restoring of positive identity, integrity, and integration, development of constructive strategies for overcoming, building up and integrating into the content of the personality\u2019s identity of the values and elements of the host culture .It is evident that the nature of emigration \u2013 forced or voluntary \u2013 is extremely important for the negative impact on the psyche of an individual. R. Rice and D. Bhurra et al. emphasize that the problem of forced migration, which has a powerful negative impact on the state of migrants\u2019 mental health, has recently become a result of political instability, poverty, terrorism, and other negative social factors . From thZ.H. Lepshokova notes that the characteristics of the ethnic identity of the migrants are related to certain acculturation strategies: the expressiveness of the national identity of the migrants is positively related to the separation strategy, the expressiveness of the civic identity \u2013 with the strategy of assimilation. At the same time, the integration strategy is positively associated with all components of the psychological well-being of the individual and with a high level of sociocultural adaptation of migrants. Assimilation, separation, and marginalization strategies have a predominantly negative relationship with the components of mental well-being and mental health (anxiety and depression) .Emigration is considered as a factor provoking a manifestation or exacerbation of endogenous mental illness -19. EmotNumerous studies have found that the situation of migration determines the high dissatisfaction of the individual with life changes and leads to the development of depression, psychosis, paranoid and schizoid disorders.C.A. Zaiontz et al. note that migration is a factor that provokes, exacerbates and participates in the formation of a psychopathological picture of some severe mental disorders, especially affective disorders; the authors consider it necessary to study the level of sociocultural integration and psychological support of migrants in recipient countries .B.L. Zhong et al. report significant psychoemotional stress experienced by migrants, especially difficulties of adaptation in the new social environment, intense work, farness from the family, and financial difficulties .R.A. Yaskevich et al. emphasize the peculiarities of older migrants\u2019 adaptation severity; in addition to the exacerbation of somatic diseases, in the period of adaptation, depressive symptoms can be seen in most individuals. The women have depressive symptoms 1.8 times more often and anxiety disorders 3.2 times more often than men. The authors recommend the use of a special rehabilitation psychotherapeutic program for such migrants .M. Shen et al. note that the presence of depressive and anxiety disorders in migrant parents affects the normal functioning of the whole family and causes behavioral disorders in children .N.S. Mahajan et al. emphasize that emigration is a risk factor for psychosis. The most common diseases are mood disorders - women have a greater prevalence of a major depressive episode with melancholic symptoms, while manic episodes are more frequent in men. In this case, mental disorders are especially prevalent among the second generation of emigrants, which is associated with the effects of migration stress, discrimination, and acculturation in the early years of life .B.L. Zhong et al. report a greater risk of a major depressive disorder during the life of labor migrants . SimilarM.E. Beutel et al. point out that, despite the actuality of the problem of emigration in Germany, the studies of the migrant\u2019s mental health are extremely insufficient. Based on large-scale research , the authors found a high prevalence of depressive disorders, anxiety disorders, and suicide among first-generation migrants, while the mental health of the second generation of migrants did not differ from ethnic Germans; their socio-economic status was also high .M. Schouler-Ocak indicates that migrants suffer from specific psychiatric disorders , and the prevalence of mental disorders in this population is greatly increased .D. Bhugra et al. showed that migrants are more prone to mental illness, a fact that should be taken into account in public health and social policy programs.The mental health of migrants has become a key problem in current healthcare issues in EU member states. H.J. Salize et al. indicate that mental health services in the recipient countries are not able to provide adequate psychiatric care to migrants because of a growing stream of mental illnesses, limited health resources, the reduced number of trained professionals, and new legal requirements. Several studies substantiate the need to involve a variety of state and community structures that provide language, cultural and social adaptation of migrants with free access to mental health services in the system of psychiatric help.The experience, gained by migrants in combat zones, crisis regions, and during escapes, increases the risk of primary and secondary traumatism with further psychiatric disorders. In addition to post-traumatic stress disorder, major depressive disorders, anxiety disorders, and psychosis are more likely to occur in migrants than in the general population. Recent studies have shown that around half of forced migrants suffer from mental illnesses such as depression, post-traumatic stress disorder, and anxiety disorders. In Germany, about 5 thousand sessions of psychotherapy are held annually, which is only 4% of the need.Treatment and rehabilitation approaches for depressive disorders of migrants are currently in the stage of active formation. Understanding the importance of correction of depressive symptoms among migrants has motivated scientists from different countries to find new methods of treatment and prevention of depressive disorders in this category of patients.Looking at the life-threatening clinical manifestations, complications and the presence of high suicidal danger, it is clear to see that severe depression belongs to the category of urgent pathologies. The leading deontological requirement for the provision of medical care to patients with depression is the most rapid possible achievement of the therapeutic effect with the appointment of individually adequate intensive care. It requires a comprehensive multivariate assessment of the patient\u2019s condition, including the operative diagnosis of depression and comorbid states, clinical- psychopathological and syndromal evaluation of depression, characteristics of its course, comorbidity and pathogenesis. The authors highlight the need for complex treatment using different medication groups, non-drug therapy with subsequent supportive treatment for reducing the symptoms of the current episode and preventing exacerbations, as well as a prophylactic treatment to avoid relapses.It is evident that migrants need special therapeutic approaches to the treatment of depressive disorders, taking into account the socio-psychological characteristics of this contingent of patients. However, analyzing the modern scientific literature on pharmacological therapy of depressive disorders in emigrants (remigrants), it should be noted that this problem remains practically not resolved. Somewhat more studied are measures for psychosocial therapy of affective disorders in emigrants and remigrants.Specialists of the European Psychiatric Association have formulated recommendations for reducing the risk of migrants\u2019 mental disorders.In the public sphere, a clear policy that takes into account employment, provision of housing, the satisfaction of the physical and intellectual needs of migrants, with appropriate resources that has to be freely available to migrants, provision of the system of social-psychological support of migrants by skilled personnel, adequate information policy, collection and analysis of the necessary information have been implemented.In the field of mental health, the availability to physicians for necessary information, cultural awareness, and training should become an obligatory part of professional competence; it should be the part of training plans for medical staff that provide psychiatric and psychological help to migrants and the range of medical (psychiatric) services should be sufficient and cover all main areas, being provided with all necessary resources. Much attention is paid to the importance of psycho-educational activities, which include giving practical advice to migrants all the necessary knowledge about illnesses. Such information should be problem-oriented.The psychological assistance to emigrants for effective psychological adaptation is determined by the following directions: changes in the living conditions of the emigrant according to his educational and professional level, the change in the hierarchy of needs and in the system of meaningful goals, as well as the increase of intrapsychic adaptation in the process of psychological correction.Cognitive-behavioral therapy (CBT) is one of the most promising psychotherapeutic directions in the treatment of depressive disorders. CBT refers to a group of interventions that are among the best-known empirically-supported treatments for depression. CBT is based on the premise that inaccurate beliefs and maladaptive information processing (forming the bases for repetitive negative thinking) have a causal role in the etiology and maintenance of depression. This \u2018cognitive model\u2019 posits that when maladaptive thinking is corrected, both acute distress and the risk for subsequent symptom return will be reduced . At the Thus, the analysis of modern scientific literature devoted to the problem of depressive disorders in emigrants and remigrants shows that its development is not enough. The contradictory nature of the scientific data of the influence of factors of emigration and remigration on the emergence and the course of depressive disorders, the lack of programs of complex pharmacological and psychosocial correction, causes the relevance of further research of the clinical, psychopathological and psychiatric aspects of this problem, as well as the development of modern approaches to integrated treatment and rehabilitation of emigrants and remigrants with depressive disorders.Based on this research, the scheme of integrated treatment and rehabilitation of emigrants with psychogenic, endogenous, and organic depressive disorders was developed and implemented in the health care practice. A comparative analysis of the effectiveness of this scheme and the traditional one was conducted.The proposed treatment and rehabilitation schemes are based on the principles of integrated, individualized, and differentiated approaches to ensuring the phases and continuity of treatment and rehabilitation measures. Its goals are to stop, as quickly as possible, the manifestations of depressive disorders  and ensure maximal restoration of the ability to work, social functioning of the patient, prevention of relapses of depressive disorders, providing early socialization and social adaptation, taking into account specific features identified at emigrants and reemmigrants, with the involvement of family and public organizations. Targets of therapy are clinical manifestations of depressive disorders , social maladaptation and disorders of microsocial communications, pathological behavior patterns associated with the presence of depressive disorders, as well as factors of emigration and remigration.A comparative assessment of the effectiveness of the proposed treatment and rehabilitation scheme relative to the traditional one was done by comparing clinical and psychological and psychometric data, as well as indicators of quality of life.The proposed scheme is implemented in four stages related to the continuity of treatment and diagnostic measures.\u2022The first stage \u2013 diagnosis. It includes clinical and psychopathological evaluation of the existing psycho-emotional disorders in the patient, analysis of anamnestic data, clinical symptoms, dynamics and prognosis of the disease, the relationship of clinical and socio-psychological factors.\u2022The second stage \u2013 complex treatment. Includes a complex of biological therapy and psychotherapy aimed at reducing depression, normalization of the psycho-emotional state, social adaptation and rehabilitation. Differentiated psychotherapeutic correction of emigrants includes the use of rational psychotherapy, cognitive-behavioral therapy and group psychotherapy. In emigrants with psychogenic depressive disorders, psycho-educational therapy could also be used. The criterion of the effectiveness of therapy is a stable (at least two weeks) normalization of the psycho-emotional state, the absence of clinical signs of depressive disorder, the development of an adequate emotional response to real-life circumstances, including emigration, giving up destructive patterns and developing constructive patterns of behavior.\u2022The third rehabilitation stage is aimed at the formation of a stable adequate emotional and behavioral pattern, maximum adaptation and rehabilitation of the patient, prevention of relapses of the depressive disorder. The drug therapy is similar to the one used in the treatment stage, with the correction of doses of medications, depending on the current state of the patient. Differentiated psychotherapeutic work includes the use of cognitive-behavioral psychotherapy in emigrants and a combination of cognitive-behavioral therapy, family psychotherapy and autogenous training in remigrants. At this stage, there are also measures for social rehabilitation and the readaptation of the patient.\u2022The fourth stage - prophylactic - is aimed at maintaining the normal psycho-emotional state, effective resistance to stress, and prevention of relapse of depressive disorder. Medication therapy includes the treatment of the main disease in depressive disorders of the organic genesis and the seasonal prevention of endogenous depressions. Psychotherapy, the use of techniques of self- regulation, and measures for social adaptation could be used as well.In groups of emigrants that suffer from depressive disorders, the proposed scheme of dynamics therapy showed a higher efficiency, compared with the traditional scheme in terms of recovery and improvement of the general condition, reduction of psychopathological symptoms, and increased quality of life.The obtained results allow us to recommend the scheme we have developed for implementation in the complex treatment of emigrants suffering from depressive disorders of psychogenic, endogenous and organic genesis.The authors declare that there is no conflict of interest."}
{"text": "Urban shrinkage is currently spreading at global level. At the same time, the scale of urban shrinkage is not limited to urban agglomerations, metropolitan areas, or big cities, but begins to expand to a vast number of small towns. Over the years, the characteristics, models, and mechanisms of shrinkage in large cities have attracted the attention of scholars; however, the problem of shrinkage in small towns has not been fully discussed. In China, small towns are located at the margins of cities and are the first part of the countryside; hence, they are the link and the bridge between urban and rural areas, and a space carrier to solve the diseases of big cities and for rural rejuvenation as a whole. However, in the process of rapid urbanization, some small towns have experienced urban shrinkage, mainly through a decline in township enterprises and the deterioration of the living environment, which has restricted their role in coordinating the spatial support of urban and rural development. Therefore, a correct understanding of the shrinkage of small towns has considerable theoretical and practical guiding significance. We focused on the towns of the Jilin Province as the research unit, and combined township population, economy, land use, and employment indices to establish an urban shrinkage index, identifying the status, spatial distribution, and influencing factors of small towns shrinkage in the Jilin Province. Moreover, we analyzed the similarities and differences of small towns shrinkage between the Jilin Province and developed countries. The results show that small towns shrinkage in the Jilin Province shares similar characteristics with developed countries, as well as important differences in aspects such as population migration, low-level industrial structure, and administrative division adjustments. Since there was no negative index in the original data, we adopted the calculation method of the positive index. The specific formula used is as follows:ij is the original index, which represents the value of index j of year i of a small town; and max(jX) and min(jX) are the maximum and minimum values of the index j across all years, respectively.Where Then, we used the entropy method to calculate the weight of the evaluation index and the urban shrinkage index. The specific formulas used are as follows:m is the number of research units; n is the number of indices; jW is the weight of the index j  and slightly shrinking towns (-0.069836 - -0.000402) by applying the natural breaks using ArcGIS.Where  index j ; Sij is r value, which reflects the degree of linear correlation between two variables. The value of r is between , and the higher the absolute value of r, the higher the correlation. The Pearson correlation coefficient was calculated as follows:Small towns shrinkage is a complex process, influenced by several factors, and caused by factors such as population, economy, location, and nature. In order to measure the relationship between small towns shrinkage and these factors, following existing research , we intrN is the number of shrinking towns; X is the selected index; and S is the urban shrinkage index of shrinking towns.Where Small towns in the Jilin Province are facing an extensive shrinking trend. From 2003 to 2017, 284 of the 414 towns in the Jilin Province, accounting for about 68.60% of the total, had a growth trend, while 130 towns, accounting for about 31.4% of the total, were facing a shrinkage trend. Among these, the slightly shrinking towns accounted for 27.29% of the total, and the significantly shrinking towns accounted for 4.11% of the total. The geographical location of the significantly shrinking towns was relatively remote and far away from the main traffic arteries, core urban areas, and county towns, so they were relatively less attractive to the population. In the Jilin Province, the slightly shrinking towns were mainly agricultural and resource-based towns. The agricultural towns dominated by agricultural production drove the lack of urban economy and employment capacity, and led to the loss of population in townships. Resource-based towns are towns with mineral, forest, and other natural resources exploitation and processing as the leading industry. Due to the implementation of natural forest protection policies and the decline of recoverable mineral resources such as coal and oil, the economy of resource-based towns was in recession, unemployment and poverty were increasing, and towns were shrinking. Hence, it may be concluded that, from 2003 to 2017, about 3/10 of the towns in the Jilin Province experienced different degrees of urban shrinkage, and the majority of these towns had a slightly shrinking trend. Shrinking towns generally faced population loss, economic recession, and lack of industrial support.The concentration of shrinking space in small towns in the Jilin Province was relatively evident . From thThe spatial distribution of small towns shrinkage in the Jilin Province was significantly affected by the agglomeration and diffusion effect of central cities. Changchun was in the primary stage of diffusion, and traditional industries, information, and innovation began to move to the periphery. Under the influence of function diffusion in the central urban area, the shrinkage degree of small towns in the inner suburbs of Changchun decreased. At first, the urban function diffusion of Changchun did not affect the outer suburbs, which made the shrinkage of small towns in the outer suburbs more severe than that in the inner suburbs. However, the development of other central cities in the Jilin Province was in the agglomeration stage, attracting the industries, population, and talents of small towns in the inner suburbs to the central cities, and forming a typical \"siphon effect\", depriving the development opportunities of small towns, and resulting in the fact that shrinking towns were mainly distributed in the inner suburbs of the central cities. The agglomeration and diffusion effect of central cities would continue to act on small towns in the Jilin Province for a period of time in the future. The current spatial pattern of shrinking towns would continue for a long time.Small towns shrinkage was the result of the comprehensive influence of all factors investigated. Considering the possibility to collect and quantify data, as well as the comparability between towns, we focused on 6 aspects  and 14 influencing factors of small towns shrinkage in the Jilin Province . The PeaSmall towns shrinkage in the Jilin Province was generally small in scale; this is consistent with the characteristics of small towns shrinkage in developed countries \u201343. By tSmall towns in the peripheral regions of the Jilin Province were seriously shrinking, as well as small towns located in the periphery of large cities and in backward areas of the Jilin Province. Compared with small towns in the periphery of large cities, small towns in geographically peripheral regions were more vulnerable to economic and social recession, in a similar way as for shrinking towns in Germany and France. The peripheral small towns in Germany shrank significantly. Location had a clear influence on the development of these towns: the more peripheral the towns, the higher the population decrease , 44, 45.The mining resources-based small towns in the Jilin Province had a strong shrinkage, in line with the shrinkage of resource-based small towns in developed countries. The initial development of mining towns in the Jilin Province relied mainly on the mining industry, and the development of the town's economy was highly dependent on these resources. In recent years, the exploitable resources of these towns in the Jilin Province have been facing exhaustion, and replacement industries have not been formed. The primary sector in resource-based towns had a small scale, while the secondary and tertiary sectors were insufficient, and their ability to absorb employment was poor. In 2010, the mining industry employed only 4,576 people in the townships of the Jilin Province, indicating a significant shrinkage of small towns. When mines were closed or reduced in size, due to changes in the resource industry and the depletion of recoverable resources, Australia's resource-based mining towns also failed to find suitable alternative industries. As a result, the economy shrank and population loss intensified , 48, 49.The public facilities in the shrinking small towns of the Jilin Province were gradually aging, in a similar way as for shrinking towns in Europe , 50. DueThe following six main differences between small towns shrinkage in the Jilin Province and in developed countries have been identified:The function types of shrinking towns in the Jilin Province were more diverse, while those in developed countries were relatively uniform. The economy of the shrinking towns in the Jilin Province was mainly based on agricultural product processing, industrial and mining resources, trade, and forestry. The functional comprehensive towns, as well as the tourism-based towns and the port towns at the border with other countries, also showed a certain shrinkage. The economy of the shrinking towns in developed countries was mainly based on the agricultural, mining, and manufacturing sectors. In the United States, the towns with strong agricultural and mining sectors recorded the fastest population outflow . In JapaThe shrinkage of small towns in the Jilin Province was mainly affected by population migration, and was less affected by population age structure, as happened in developed countries. The shrinking towns in the Jilin Province were less attractive to population, and emigration rate was increasing, especially among young and educated people, who pursued a higher quality of life. The outflow of population from the province was mainly directed towards Beijing, Tianjin, Shanghai, and Shandong . The popThe shrinking towns in the Jilin Province were characterized by a low-level industrial structure, while these in developed countries were mainly affected by deindustrialization under the background of globalization. The low-level industrial structure of small towns in the Jilin Province was mainly composed of resource-based industry and agricultural product processing industry. Resource-based industries were characterized by a high dependence on mineral resources, the lack of deep processing of resources, a short industrial chain, the lack of technological advantages, the lack of technology and product correlation among industries, and by a poor industrial development flexibility. Once entering into resource exhaustion, and market and technology competition, the industrial system of small towns would be \"paralyzed\". The production capacity of the enterprises processing agricultural products was low, resulting in low agricultural economic benefits and low added value of agricultural products. In developed countries, due mainly to economic globalization and deindustrialization, traditional industries such as textiles, metal manufacturing, and shipbuilding gradually lost their competitiveness in the global economy. A large number of traditional manufacturing industries were constantly shifting to overseas developing countries. Some towns, especially in the United States and Japan, lost their leading industries , 47, 56.The development of shrinking towns in the Jilin Province was affected by the overall decline in the development of Northeast China, while some shrinking towns in developed countries were subject to post-socialist transformation. Small towns in the Jilin Province were an important component of the old industrial base in Northeast China. In recent years, the economy of Northeast China has gradually been overtaken by the rapid economic development of the Pearl River Delta, the Yangtze River Delta, and the Beijing-Tianjin-Hebei region. The economic and industrial focus of China has been moving southward, and the regional functions in Northeast China and their competitiveness have gradually declined. As a result, shrinking towns have lost their appeal to businesses and population, and the prospect of economic development gradually declined. On the contrary, the shrinkage of small towns in Central and Eastern Europe in the 1990s was mainly due to the post-socialist transformation. The socialist system was generally concentrated in the larger cities and established a relatively stable economic base in the small towns in the periphery, which became regional administrative and manufacturing centers. The socialist transformation had a serious impact on the economy and society of these countries, especially on small towns, which lost relatively more development opportunities and economic prospects than big cities .The main strategy of shrinking towns in the Jilin Province was still focused on attracting investment and economic growth, while the development direction of shrinking towns in developed countries shifted towards adopting a strategy of smart decline, consisting in pursuing fewer people, fewer buildings, and less land use , 58. In The adjustment of administrative divisions in the Jilin Province was the most important and characteristic cause of urban shrinkage. With the rapid development of urbanization, the administrative divisions of the Jilin Province have been adjusted frequently, including turning counties (cities) into districts or into cities, merging villages and towns, and including the combination of administrative districts and boundary adjustments. In China, the spatial definition of urban population is also directly linked to the administrative division system. When two towns are merged, although the urban population in the two towns increase, the per capita economic level does not significantly improve \u201361. SincUnder the background of resources depletion in the old industrial bases and the decline of traditional industries in Northeast China, small towns in the Jilin Province have experienced urban shrinkage through population outflow, the decline of township enterprises, and the deterioration of the living environment. The development of most small towns is in a \u201cmaintenance\u201d state, and shrinkage has become a prominent feature of the development of small towns, especially resource-based towns, which show a distinct \u201cabsolute shrinkage\u201d feature. The spatial distribution of shrinking towns in the Jilin Province was highly concentrated along the northeast-southwest axis and followed a core-edge structure. The average population size of shrinking townships in the Jilin Province was considerably lower than that of growing townships. Population migration, industrial development, employment level, and adjustment of the administrative division were the key factors restricting the development of towns.There are several similarities between the shrinkage of towns in the Jilin Province and that in developed countries, related to aspects such as population loss, the decay of the town\u2019s material space, the decline of the economy and social culture, and the exhaustion of resources in resource-based towns. There are also significant differences between the Jilin Province and developed countries. In the Jilin Province, the phenomenon of town shrinkage was shorter in time; moreover, it involved a large number of different types of shrinking towns, which were widely geographically distributed and held significant spatial differences. The shrinkage of small towns in the Jilin Province was mainly due to population migration, low-level industrial structure, and administrative division adjustments. Small towns in developed countries were more likely to shrink because of the industrial restructuring caused by deindustrialization and globalization, as well as because of an aging population and a decline in fertility rate (in Japan and in Europe), poverty and isolation under the background of suburbanization (in the United States), climate change , and post-socialist transformation (in Europe).The formation of urban shrinkage in the Jilin Province cannot be separated from its special development background. First, as one of China's traditional old industrial bases, Jilin Province's traditional industries are mainly resource-based industries. There are many resource-based cities and towns, which are widely distributed in the Jilin Province. The land area, population, and local GDP of resource-based cities and towns account for 70%, 50.6%, and 49%, respectively, of that of the Jilin Province . The JilThere are significant differences in the historical background and political system of small towns shrinkage between China and developed countries, and the shrinkage of small towns in developed countries provides a good basis for the study of the shrinkage of small towns in China. Urban shrinkage is not necessarily a bad thing, and not all shrinking towns will go into decline. Shrinking towns can enjoy economic prosperity , and theThis research used the entropy method and the Pearson correlation coefficient to identify shrinking towns by using multi-dimension indices, to quantitatively explain the factors influencing shrinking towns in the Jilin Province, thereby providing a new perspective for the quantitative study of urban shrinkage. However, this research has the following limitations: 1) The research object of this research is the township, which is similar to the concept of small town in developed countries. However, the concept of small town in China does not entail a clear population limit, therefore the number of identified shrinking towns may be higher than that in developed countries. 2) This research is limited by the urban statistical data. The temporal coverage of the yearbook data on townships is limited, and it is difficult to obtain multi-dimensional data of unified indicators for several years; therefore, it is necessary to further mine the available data on small towns in the future. 3) Due to limitations in urban statistics, this research did not analyze the utilization efficiency of public facilities in shrinking towns, which will be the focus of future research.S1 Table(XLSX)Click here for additional data file.S2 Table(XLSX)Click here for additional data file."}
{"text": "The mediation category underlay theanalysis.an integrative review, which included theoretical and methodological studiespublished in the following databases: COCHRANE Library, EVIPNet, HealthSystems Evidence, LILACS, PDQ-Evidence, PubMed, Rx for Change, and SciELO,in addition to mediation category indicated the need forthese theories not to be restricted to the micro-context, but to incorporatethe elements of the social macro-structure to which they are connected.19 references were included, published between 1997 and 2018. It is aninnovative proposal to direct the process of evaluating health programs,interventions, and/or policies, with the democratic participation of theparties involved, such as users, workers, managers and researchers; itproposes to elaborate theories about what works, for whom, in what context,and how. The It is indicated that the realist evaluation is to be conducted in 21 stages.It takes into account qualitative and procedural methods, which makes itpowerful for understanding human and social relationships in the contextanalyzed. Theories that come from evaluating the functioning of the programsanalyzed have greater explanatory chances if they are built by reference tothe social totality. On the other hand, it is knownthat assumptions about the success of this type of intervention must be betterunderstood through evaluation processes, since they occur concretely within thescope of social relationships, allowing to ascertain the plausibility of theintervention and assist the evaluators in deciding what should beprioritized..Procedural monitoring, with access by the team of evaluators to intermediateoutcomes, is considered essential in the evaluation of complex healthprograms..The evaluations indicated for complex interventions involve stages that range fromthe identification of health needs to the design and implementation of the programsand policies. In addition, it is necessary that the evaluation process takes intoaccount the discussion of the political priorities and considers collecting data atdiverse moments, to capture changes over time..The traditional models for assessing public programs and policies do not have suchattributes. Coming from predominantly positivist frameworks, they focus on theinterests of the organizations and institutions, the logic of human resources, andthe cost-benefit ratio. In this perspective, the structure is vertical, with theevaluator playing a central role and being generally external to the context of theevaluation.. The realistic review, which shares the same theoretical perspectivewith the realist evaluation, argues that the best evidence must come from atheoretically oriented and locally situated process.The realist evaluation aims to overcome this traditional approach. In this sense, itinvolves qualitative and quantitative components, based on theory, to promote theimplementation of policies and programs in specific contexts. The re process..A literature review mapped the concepts of the realist evaluation as applied tohealth systems research, based on primary studies that used this evaluationmethodology. The authors recommend greater clarity regarding the definitions ofmechanisms and context, two elements considered structural in the realistevaluation, in addition to the outcome.Thus, this review aims at identifying and analyzing the concepts of the realistevaluation and the recommended methodology for its implementation in the healtharea.The question in this review is the following: What are the concepts and stages of therealist evaluation used in the health area? It was formulated using the PICostrategy , with theelements delimited as follows: P - Without delimiting the population; I - Conceptsand stages of the realist evaluation; Co: Health area., thus stimulating the exposure and understanding of theoretical andmethodological frameworks about certain phenomena of reality. The development stagescan be systematized in eight steps, according to the literature in the area: (1)Creating a group to conduct the IR; (2) Preparing the introduction; (3) Formulatingthe question and the objective; (4) Describing the methodology; (5) Analyzing andinterpreting data; (6) Presenting outcomes; (7) Interpreting and discussingoutcomes; and (8) Disclosing outcomes.The integrative review (IR) was chosen because it constitutes an appropriatemethodology to contribute to the synthesis of the review of theories andmethodologies, thus soutcomes.In this sense, once the first phases that demanded meetings of the responsible groupwere overcome, in stage 4 only theoretical and methodological studies, bothpublished and of the gray literature, were included, which analyzed and/or proposedtheories and/or methodologies of the realist evaluation. The search was carried outin August 2019 and included references published in Portuguese, English, andSpanish, in any year, and indexed in the databases until July 2019.Teses-CAPES and Google Scholar. Theexpression \u201cRealist evaluation\u201d was chosen as it was the most sensitive searchstrategy, enabling the mapping of the largest number of potential references on thetheme. On the other hand, it guaranteed sufficient specificity. This expression isnot a MeSH term, as it is a relatively new term. Manual searches and among thereferences of the references included were also carried out.To search for scientific and gray literature, the expression \u201cRealist evaluation\u201d inEnglish or Portuguese was used in the following databases: COCHRANE Library,EVIPNet, Health Systems Evidence, LILACS, PDQ-Evidence, PubMed, Rx for change, andSciELO, in addition to After identifying the studies, the references were selected by title and abstract,full reading, inclusion/exclusion, and data extraction by the team of fourreviewers, with at least two of them working independently. Data extraction wasperformed using an instrument composed of the following items: (1) Title; (2) Year;(3) Authors; (4) Country of origin of the lead author; (5) Area of knowledge of thefirst author; (6) Objective of the study; (7) Definition and purposes of the realistevaluation; (8) Theoretical reference framework; (9) Stages of development of therealistic review; and (10) Summary of the text selected.The evaluation of the methodological quality of the studies included was not carriedout, as the object of study was of the theoretical type, and there was no inclusionof empirical studies., with the essential conceptual elements of the realist evaluation beinganalyzed according to the mediation category.From the point of view of collective health, the theoretical approach of historicaland dialectical materialism was adopted in this study, with tThe authors of this article declare that they have no conflict of interest.428 references were identified from data sources, manual searches, and references ofthe references, as shown in After excluding duplicate and unavailable publications and selection by title andabstract, 47 references were analyzed in full. In total, 19 references wereincluded, as shown in It should be noted that the studies were published between 1997 and 2018, with nine(47%) starting from 2011. The studies were published by authors from the UnitedKingdom, Australia, Canada, Sweden, United States, and Singapore, in the followingareas of knowledge of the first author: Primary Care, evaluation, Education,Nursing, Philosophy, Business, Rehabilitation, Technology Development, Sociology andSocial Policy, and Social Research. The figure below presents the integrativesynthesis of the definitions and purposes of the realist evaluation:.It was identified that the concepts presented by the different authors are congruentwith each other. The realist evaluation is a methodology structured according to thephilosophical assumptions of realism, which aims to address the complexity of thehealth interventions, considering the influence of the social relationships andorganizational structures. It is a theory-oriented approach that focuses theevaluation on obtaining answers about what works, for whom, in which context, andhow,,,-30.. The mechanisms are the way the subjects interpret and act regardingthe intervention and are not always explicit, whereas the context is represented bythe characteristics of the conditions in which the interventions were introduced.Finally, the outcomes are the consequences of activating different mechanisms indifferent contexts, which produce clear theories or structured theoretical models, toexplain how interventions promote the expected outcomes.The realist evaluation considers the Context-Mechanisms-Outcomes (CMO) articulationto understand the underlying dispositions that make up the studiedsituation,15. Tcontexts,17, woutcomes., assuming that different contexts produce different outcomes, eitherbetter or worse(-). The CMO configuration has the potential to introduce a broad and complete picture ofwhat is happening, in order to elucidate the essential elements that enabled theuse, or not, of interventions, programs, and/or public policies, assumior worse-16. .Another innovative aspect is the purpose of understanding the configuration ofoutcome patterns obtained by implementing the interventions. The realist evaluationstudies aimed to present the changes resulting from the implementation ofinterventions and how such measures were produced and introduced to modify thecontext and balance of the underlying mechanisms,20.. In this sense, programs/interventions/policies are evaluated based onthe changes produced in the individuals, subgroups, and contexts involved, inaddition to identifying the social and cultural resources that are necessary tosustain the changes. For the realist evaluation, it is necessary to: (1) formulate a theoryabout the program, interventions, and/or policies assessed; (2) formulate andprioritize evaluation questions around the theory; (3) plan, design, and conduct theevaluation based on the theory; (4) identify the constructs postulated in thetheory; (5) determine the efficacy or effectiveness of the program, interventions,and/or policies assessed, and explain cause and effect associations between thetheoretical constructs and the factors that affected the outcome pattern. Theseprinciples are situational and do not constitute strict criteria, since theirapplication depends on the nature of the program assessed, the objective of theevaluation and the individuals who will use it.In order to understand the investigated reality, the realist evaluation must beginwith theories, which will be tested and refined in a cyclical and iterative way,being structured in the form of proposals about how the mechanisms occurred incontexts to produce outcomes,-,,27. I changes. For thl use it.. The choice of the data collection methods must be guided by thetheory, in order to test the assumptions/theories and to unveil the patterns andregularities of the program, through observations, data collection, data analysis,among others. In complex programs, random sampling, randomized clinical trials orquasi-experimental projects may not be able to identify elements that interfere withthe participation of those involved in the program, because the intervention hasunexpected processes that cannot be predicted in advance for statistical purposesand do not capture outcomes and contextual elements.In this way, the evaluation allows for a circuit that can be guided by differentstrategies for understanding the reality under study,,,21. Tg others,27. Ielements,27.. This process should follow an emancipatory perspective, which requiresthe participation of other stakeholders in the evaluation, in the identification oflocal history, and in the transformative actions in which the practiceoccurs. Emancipation is in this sense understood by the author as a process inwhich those involved identify needs for changes in the practices, reflect on suchpractices, and seek to promote cultural changes, based on the needs identified inthat context. Analyses and changes are related to the local cultural dimension ofthe social relationships. The political and economic dimensions are not considered in theauthor\u2019s perspective.In this sense, it is necessary to include the evaluator in the process, who has thetask of understanding and testing the theory studied,19. Teoccurs. Emanciionships. The po.The emerging realist evaluation is one of the evaluation categories found and isdescribed as the one that aims at social improvement by implementing programs andpolicies. The evaluator engages in the process of creating knowledge with theparticipants, believing that public discussion informs society for making sociallyresponsible decisions. Therefore, the evaluation is not a condition for deciding onthe merit of a social policy, but it supports democratic decision-makingprocesses,25..The critical realist evaluation derives from critical realism, an approach that isadvocated for implementing evidence-based innovation in health. In this perspective,it is highlighted that the evaluation is inherent to the implementation process andnot something out of place to measure outcomes. The critical realist evaluationemerges more explicitly to show that it is part of the broader implementationprocess considering the conditions that promoted or hindered the changes..In short, the realist evaluation has the potential to support decision-making and thecreation of public policies, as the outcomes are presented according to thedifferent contextual realities of pre-existing social structures, to generate achange that includes structures, culture, and social relationships,,26.The integration of the stages was possible without the need to overcomecontradictions, since all the papers found are based on the same epistemological andtheoretical-methodological frameworks, with some non-conflicting variations, as isthe case with the emerging and critical realist evaluation. Thus, from the CMOconfiguration, the stages for conducting the realist evaluation were integrated andshown in Using the studies included and the analysis category, the specific guidelines foreach stage were described, considering that the stages can occur in an overlappingand iterative way.1. Definition of the theory and of the evaluation questions:Formulate theories about the program . The understanding of the theory allows for the development ofexperimental configurations of mechanisms and contexts. Consider that theexplanation of reality by the theory will occur in all the stages of theevaluation;context). The unaluation;2. Title: Identify the document as a realistic synthesis orevaluation;aluation;3. Abstract: Include brief details about: the policy, program orinitiative under evaluation; program configuration; purpose of the evaluation;evaluation question(s) and/or objective(s); strategy; data collection,documentation, and analysis methods; main findings and conclusions;clusions;Introduction:4. Presentation of the study theme: Explain the purpose of theevaluation with secondary data;ary data;5. Theory of the program: Describe the initial program theory (ortheories) that underpin the program, policy, or initiative;itiative;6. Evaluation questions, objectives, and focus: Indicate thequestion(s) and specify the objectives for the evaluation. Describe whether and howthe program theory was used to define the scope and focus of theevaluation;aluation;Methods:7. Justification for using the realist evaluation: Explain why arealist evaluation approach was chosen and (if relevant) adapted; adapted;8. Description of the program policy, initiative or productassessed: Provide relevant details about the program, policy orinitiative assessed;assessed;9. Evaluation locus: Describe and justify the reason for choosingthe place where the evaluation took place;ok place;10. Description and justification of the evaluation design: Adescription and justification of the evaluation design  must be included, at least briefly or as an appendix, inthe document that presents the main conclusions. If this does not happen, theomission must be justified and a reference or link to the design must be provided.It can also be useful to publish or avail for free  any document or original evaluation design document, if any;, if any;11. Data collection method: Provide details and justificationsabout the method choices, which can be quantitative or qualitative: which ones wereused, why, and how they contributed to develop, support, refute or refine theprogram theory. Quantitative methods are mostly used regarding the context, forexample, group comparison; Qualitative methods contribute to the exploration ofhypotheses and to the identification of unforeseen elements of the context andoutcome. The semi-structured qualitative interview is the most common and availablemethod of data collection, either alone or in combination with other methods. Itusually contains exploratory questions based on the program assessed and acting asinstruments to extract the proposals of the general investigation;tion,,-28;12. Definition of the participants: Describe how the participantsin the evaluation were defined, invited and engaged, and how they contributed to thedevelopment, support, refutation or refinement of the program theory. The stakeholders are considered the main data sources, as they haveexperience in specific phases and processes within the program assessed;m theory. The stassessed;13. Data analysis: Describe and justify which method of analysiswas used, how the program theory was developed, supported, refuted and refined, andwhether the analysis changed during the evaluation. There is not just one suitable analytical method, as it depends on thetheories proposed and on the availability of data. In the realistic program theory, different outcome patterns areexpected to exist for different groups or contexts within the program, and theanalysis tests these theories;aluation. There  of data. In thetheories;14. Ethical approval: Indicate whether the realist evaluationrequired and obtained ethical approval from the relevant authorities, providingdetails as appropriate. Explain the reason if it is not necessary to conduct theevaluation.aluation.Results:15. Details of the participants: Report (if applicable) whoparticipated in the evaluation, details of the data they provided, and how the datawas used to develop, support, refute or refine the program theory;m theory;16. Main results: Present the main results, linking them to thecontexts, mechanisms, and configurations of outcomes. Show how they were used todevelop, test, or refine the program theory;m theory;Discussion and final considerations:17. Theory test: Review and understand the possible CMO patternconfigurations to refine the theory and promote knowledge;18. Summary of the outcomes: Summarize the main outcomes withattention to the evaluation questions, purpose, the program theory, and thestakeholders;eholders;19. Strengths, limitations, and future directions: Discuss thestrengths of the evaluation and its limitations, including considerations of all thestages in the evaluation processes. In many evaluations, there will be anexpectation of providing guidance on future directions for the program, policy orinitiative, its implementation and/or project. The particular implications of therealistic nature of the outcomes must be reflected in these discussions. Considerthat future directions support public policies, being important politicalinstruments for social research;research;20. Discussion and main conclusions: Compare the outcomes withexisting literature and list the main conclusions that are justified by the dataanalysis. If appropriate, offer recommendations consistent with a realisticapproach;approach;21. Funding and conflict of interests: Indicate the source offunding (if any) for the evaluation, the role played by the funder (if any), and anyconflicts of interest of the evaluators.aluators..The aforementioned stages, integrated from the studies gathered in this review, allowguiding the development, as well as the preparation, of the final report of arealist evaluation,,28.It was assumed in this work that the potential of the realist evaluation lies in itsability to capture the interactions inherent to the CMO complex..This type of evaluation highlights that the outcomes found in a given evaluationprocess are not linearly transferable to other realities, as they depend on theinteraction of particular social processes..The interactions, as analyzed by the mediation category in this work, represent thearticulation between the parts of a complex totality and, at the same time, themovement between the singularity and the totality, formed by socio-historicalstructures, constituted by interactions with dynamic and contradictory movements,and not only by the Cartesian sum of the parts..The mediation category carries both an ontological and a reflective dimension sinceit exists independently of the social subject, and can support individuals\u2019reflection processes about a certain reality, captured by its essence and not onlyin the appearance realm.. In the realist evaluation, part of the underlying mechanisms, whichcan interfere with the outcomes of a given project, depends on the reflection ofthis social being on the proposed intervention and on the reality in which it isinserted.Mediation constitutes the ontology of the social being that is based on the ownmovement of the categories of reality, and not on logical ideal concepts, beingpresent in the sociability of the social being. Therefore, it is sustained in theperspective of the relationship between man and nature and, in this way, thetransformation of nature by man (work) is a condition of human existence. In the.This field of mediations takes shape in the particularity in which the dialecticbetween the universal and the singular occurs. It is in this mediation field thatthe singular facts are related to the laws of universality, which is configured fromthe reality of the singular. The individual, being the smallest unit of the socialtotality, has infinite variations and, therefore, has great complexity andparticularities.. In the realist evaluation, the context is located in the particulardimension since, depending on its conditions, there will be or there will not be theactivation of underlying mechanisms, which may influence the outcomes of theintervention proposed by a given program, policy or service.The particular represents the expression of the categories of mediation between thesingular individuals and society. In the. Thus, the mediation category helps to apprehend the movement of thehidden social being in individuals and, therefore, supports the understanding of theunderlying mechanisms addressed in the realist evaluation.It starts with the understanding that the social being and its dynamic complexesexpress themselves in a particular way. In the sphere of universality, there are thegreat determinations and tendency laws of a given social complex. Laws anddeterminations that, in the sphere of singularity, are hidden by the dynamics offacts. Thus, .In this perspective, mediations are instrumental categories by which the action isimplemented, they are a way of objectifying the practice. The mediations areexpressed by the set of instruments, resources, techniques, and strategies that thesubject becomes aware of in order to penetrate the plots of reality as a possibilityto transform it..Regarding the limitations, realist evaluations of property demarcation and educationprograms in penitentiaries, initially described by the creators of the realistevaluation, were not based on theoretical frameworks or totalizing theories thatexplained what the root is of the problems that lead to the creation of theseprograms. Nor was it discussed, for example, how society is organized and the modeof capitalist production, which are generators of social inequalities. Thus, in itsorigin, the realist evaluation showed certain pragmatism when looking for cause andeffect relationships..Other limitations concern the philosophical dimension of critical realism, whichemphasizes that the production of several authors who follow the critical realistictheory is restricted to non-historical abstraction by not using any tools that makeit possible to understand how objective social structures can be transformed and howto carry out the transformation. Thus, it states that critical theorists do notalways make assumptions about the object of investigation when analyzing socialrelationships, which makes the starting point of investigation arbitrary. In thisperspective, the causal mechanisms are self-referenced and the structures only existas a result of human behavior and that the causal powers would thus berelational.. It has been argued that the use of dialectic alters the researchstrategy for critical realism in several ways. First, it demonstrates the need toabstract causal powers through dialectical connections and contradictions that areinherent to diverse interconnected totalities. Second, historical analysis becomes akey moment in this dialectical procedure in order to overcome a common dualism incritical realistic thinking between structures in closed systems and contingentmechanisms in contingent historical events. Society is seen as an interconnectedhistorical totality, so that concrete events are themselves moments of thattotality. Thus, the mechanisms are considered moments of dialectical connections intotalities and moments of specific dialectical contradictions. It is verified thatthe dialectic reshapes the debates about the relationship between the parts and thewhole.Such limitations are still under discussion, even by one of the main theorists ofcritical realism - Roy Baskar - who has sought to add the dimensions of historicityand totality, and the dialectic, considering the contradictions ofreality. It hasThis IR made it possible to map the scientific production of the health area on theconcepts, purposes, and stages of the realist evaluation. The studies included didnot present theoretical discrepancies, allowing for the epistemologicalreconciliation of the concepts and methodology of this approach. The integration ofdata enabled the presentation of 21 stages for the development of the realistevaluation of complex health contexts.Thus, it can be said that, by analyzing the outcomes of a given intervention, basedon the understanding of the interactions that occur in the reality of socialrelationships, the realist evaluation ends up identifying its potential fortransformation and the elements that interfere in the outcome of theinterventions.From the milestones of the mediation category, however, there is a need for thesetheories to be elaborated incorporating the elements of the social macrostructure towhich the mechanisms are connected.For collective health, this has essential implications for research and healthpolicies because taking social totality as a reference expands the explanation aboutreality and, consequently, the possibilities for transformation."}
{"text": "Between electric gloom,angels and demons dressed in plastic bluehave dragged me through the darkness,to the infinite black stone,where the origin and the end of time are lost.There, in the immense dark solitude,and in the imposed silence of word and thought,She, in my breath, gazed at mewith her eyes of fire,frosty and timeless,without any mercy,without any mercy."}
{"text": "Human Genome Variation (HGV), the second official journal of the Japan Society of Human Genetics, and worked diligently to increase its profile. For the last 6 years, the editorial committee has been successfully managed under his strong leadership. This open-access journal, launched in 2014, has attained a unique position in the human genetics/genomics research community. On behalf of the Editorial Board of the HGV, its authors and readers, I sincerely want to thank Professor Tokunaga for all his contributions to the journal.It is with great pleasure that, from 1 January 2020, I have taken over the role of Editor-in-Chief from Professor Katsushi Tokunaga, who founded HGV as a member of the Editorial Board, I have seen and experienced the success of this unique open-access, online-only journal. An innovative feature of the journal is a curated database of the underlying data from Data Reports, which is growing into an important resource for the human genetics/genomics community. The rapidly changing field of genomic technologies, especially next-generation sequencing and genome editing, are revealing more and more genetic variants responsible for or associated with various human diseases and traits. HGV aims to provide a coherent link between a published paper and the underlying data deposited in an accompanying database. This open-access database of variations and variability can be searched, filtered and variously used to further the progress of genomics research. Articles published in this journal are also fully open access, allowing for the widest dissemination, visibility, and impact of authors\u2019 research. The intended audience for this journal is researchers, scientists, clinicians, genetic counsellors and those interested in human genetics/genomics, from all sectors and from around the world. We warmly welcome submissions from the scientific community. We assure authors submitting to the journal of efficient and respectful handling of their manuscripts and, in particular, of a shorter submission to decision time.During the years that I have been associated with HGV, and also very proud to be working with an outstanding internationally diverse team of Associate Editors, members of the Editorial Board, reviewers, and the supporting staff in Springer Nature. As the new Editor-in-Chief, I will strive to continue to improve and enhance the quality and reputation of HGV. I welcome suggestions, discussions and thoughts from the readers, authors, reviewers, and editors to help me to understand and rectify any problems with the journal.I am truly honored to assume the responsibility of the Editor-in-Chief of I am enthusiastic about this opportunity and look forward to working with you over the coming years."}
{"text": "This study analyzes the productive structure of Portugal in the period 2013\u20132017, using indicators of localization and specialization applied to 308 Portuguese local authorities. From an empirical approach using a threshold model, the following indicators are used: (i) localization quotient; (ii) specialization coefficient; (iii) Theil entropy index; (iv) rate of industrialization; and (v) the density of establishments by business size. The selected period 2013\u20132017 is due to the available data concerning firms located per local authority, and the choice of threshold model is justified through the possibility of assessing the non-linear effects of specialization and diversification on productivity, considering, in simultaneous terms, different regimes per business size. Estimation of the threshold model identified a positive, statistically significant relation between industrialization and productivity. Similarly, the terms of interaction between exports and diversification, and between the former and higher education institutions, shows a catalyzing effect of productivity. In addition, the most specialized micro-firms affect productivity significantly and positively, while the least specialized have the opposite effect. Small, less specialized companies have a significant and negative effect on productivity, contrasting with less specialized, medium-sized companies, which affect productivity positively. For large firms, the impact on productivity is negative for both high and low levels of specialization, reinforcing the need to fill existing gaps in strategic diversification, as well as the vertical and horizontal integration of the activities of production chains with high value added. The relation between spatial concentration and sector specialization, which began to be studied in the field of regional science, in recent years has emerged in the field of entrepreneurship and innovation, with it being a well-established fact that business undertakings are susceptible to geographical concentration ,2,3, togIn the literature on this topic, the concept of industrial district formulated by Marshall  and BecaIndustrialization greatly improved productivity , which hAiming to advance knowledge about the relation between industrialization and productivity, using the Sales Index database, this study uses indicators of localization and specialization applied to all 308 local authorities in Portugal, intending to make a generic analysis of the dynamics of their production structure in the period 2013\u20132017. More specifically, a threshold model is estimated, in order to test the effect of industrialization on productivity as well as other research hypotheses arising from the literature review.In this vein, the current study uses a concept of entropy operationalized through the Theil Index, developing an economics approach focused on the analysis of both spatial and sectoral determinants of productivity. This approach aims to assess the non-linear effects of specialization and diversification on productivity, considering, in simultaneous terms, different regimes per business size. Toward this empirical application, we contribute to advancing the existent knowledge on determinants of productivity, using an Entropy index and also unveiling distinct signals and significances of the determinants studied in different specialization regimes.To achieve the objectives proposed, the following sections present firstly a literature review, originating in industrial districts and moving toward the cluster approach, and resulting in the research hypotheses. This is followed by the empirical approach, namely the methodology, and presentation, analysis, and discussion of the results. The study ends with the conclusion, limitations, and implications.Principles of Economics by Marshall  see .p value of 0.003, indicating that H0: single threshold model; H1: double threshold model) is highly significant with a bootstrap p value of 0.000  and 0.023 (Th-22)  see .The results of the fixed effects regression and threshold effect are presented in The F statistic of 3.06, for a level of significance of 5% with the null hypothesis of all The parameters displayed in It is worth pointing out that the rate of industrialization , which can contribute to reinforcing productivity and competitiveness, following a sustainable logic of strategic diversification of sectors of economic activity and considering the spatial heterogeneity of the European regional chessboard."}
{"text": "December, 2019, marked the third re-emergence in the 21st century of the zoonotic coronavirus (CoV), named severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), crossing species to infect humans. The outbreak of the 2019 novel coronavirus disease (COVID-19), which started in China in the city of Wuhan likely from a wet market of live animals, has caused a rapid increase in the number of infections and deaths across Chinese borders, and has become a serious public and global health threat.The emergence and re-emergence of zoonotic diseases is not new, and over the past three decades the onset of outbreaks of infectious diseases emerging from animal reservoirs to infect humans has increased. For example, Ebola virus, highly pathogenic avian influenza (HPAI) viruses, and the coronaviruses severe acute respiratory syndrome (SARS) coronavirus and Middle East respiratory syndrome (MERS) coronavirus.Vet Res in 2005, show that at least 75% of emerging infectious diseases are zoonotic and originate from wildlife. Prevention activities are difficult to implement because events causing the emerge or re-emerge of zoonoses are complex and affected by multiple factors, such as genetic evolution, demographic changes, environmental conditions, or climate changes affecting the ecosystem.The size of the issue is significant, as epidemiological data by Blancou and colleagues from the University of Athens Medical School , reported in The unforeseeable onset and rapid dissemination of zoonotic outbreaks means public health systems need to be able to quickly identify early signs of such threats and react promptly. The fact that the beginning of the nCoV-2019 outbreak was observed by at least one physician, as reported by The Guardian on February 2, but not perceived as an urgent threat at the level of decision makers, demonstrates the essential need to identify what could be done better\u2014before new diseases emerge\u2014therefore preventing future outbreaks or, at least, reducing their impact.To reach this aim, the following steps are crucial: first, the understanding of the causes of disease emergence, the ecology of the agents involved, and their animal hosts; second, the creation of a network able to merge the contributions of different expertise, and work together holistically. At present, the main players of the network are in place , but they act separately; for example, veterinarians are not connected with occupational physicians, and in turn they are not in contact with general practitioners who are at the frontline of the disease. Therefore, in the current system, a cohesive network able to receive and act on early warnings at different levels is missing.The One Health approach is an example of how separate efforts can be aligned to work together effectively. The concept of One Health recognises the interdependence of human health, animal health, and environmental health, and aims to achieve better public health outcomes through the understanding and prevention of risks that originate at the interface between humans, animals, and their environments. Such approach implies a multidisciplinary effort in the implementation of programmes, policies, and research, where multiple sectors communicate and work together, with the common goal of helping disease prediction, prevention, and preparedness.Three major international organisations, WHO, the UN Food and Agriculture Organization (FAO), and the World Organisation for Animal Health (OIE), have started to put this vision into practice by consolidating a formal partnership to combat human-animal-environment health risks, strengthening their joint action in May, 2018. A year later, as a result of this partnership, they released a\u00a0guide  that provides principles and best practices to assist countries in achieving sustainable and functional collaboration at the human-animal-environment interface.This effort should be repeated both at the academic and public health level. Rare examples are the University of Washington's Center for One Health Research  or the Global Health department at Harvard University , which has recently promoted the cross-education of its practitioners by collaborations with veterinaries. In public health, interestingly, the US Centers for Disease Control and Prevention is following One Heath strategies against some zoonoses. An example is the response to the Rift Valley Fever (RVF) Virus outbreak in East Africa in 1997. Most of the human infections resulted from direct or indirect contact with the blood or organs of infected animals. To break the chain of transmission, CDC researchers developed a vaccine to vaccinate animals against RVF, therefore preventing its transmission to humans.The Lancet in January. Those occupational categories deserve attention as groups at particular risk of zoonotic exposure. In public health departments the collaboration between hygienists, occupational physicians, general practitioners, and veterinarians could provide a push to implement monitoring activities, where the health of workers, animals, and the general population are jointly monitored.Another key area where the One Health approach is needed is monitoring and surveillance. Some professions have greater exposure to zoonotic risks than others\u2014eg, farmers or butchers. Nearly half of the first patients affected by COVID-19 were working at the wet market where the virus originated, according to the first clinical characterisation provided by Chen and colleagues from The University of Hong Kong\u2013Shenzhen Hospital , and published by The recent outbreak of the coronavirus infection is a particularly severe example of how close interactions between the health of humans, animals, and the environment can lead to a deadly epidemic. Now it is time to embrace One Health as a framework for public health action against zoonoses, as suggested by the tripartite  zoonotic guide. Governments must prioritise strategies to introduce the One Health approach in education and training programmes and in their public health systems, both at the national and international level. The timely recognition of the interconnection between humans, animals, and environment, intrinsic in the One Health approach, is a key prerequisite for understanding and managing the future of global health threats.EClinicalMedicine"}
{"text": "The data were collected between March and April2020, using a form structured into: background, scope, challenges andpotentials of health/nursing professionals and recommendations for thefuture.the challenges and the need for investments in the health and nursingworkforce to achieve the Sustainable Development Goals were evidenced. Thereport of the High Level Commission on health Employment and Economic Growthpresents important recommendations, also introduced in the Triple ImpactReport and in the Strategic Directions for Nursing and Midwifery, convergingto the goals of the Nursing Now campaign, stimulating a profile of nurseswith technical, political and leadership skills, engaged in healthpolicy-making, and the effectiveness of their practice is clear to theentire society.Nursing Now campaign may be a condition forachieving its goals. This reality reveals evidence that global health willnot be ensured without strengthening Nursing first.knowledge about the dynamics of the factors that converged to the developmentof the  Contradictorily, despite this numerical relevance, the estimatedglobal shortage of nurses is about nine million by 2030.In 2020, Nursing, with approximately 27.9 million professionals, represents 59% ofall health professionals worldwide, constituting the majority group in the healtharea. Contranurses is used in this article to designate all members of thenursing team, in accordance with the documents of the World Health Organization(WHO) analyzed in this study. The use of the term Nursing, in turn,designates both the profession and the academic discipline.It should be highlighted that, for the sake of standardization, the termnd World Health Assembly, which recognized 2020 as theInternational Year of Nurses and Midwives, not only to honor the 200thanniversary of the birth of Florence Nightingale, but to reaffirm and grantvisibility to the daily contribution of Nursing to the health and well-being ofpeople. Therefore, WHO underlines that nurses are fundamental to achieving thegoal of leaving no one behind, in a global context of seeking toimplement the Sustainable Development Goals (SDG) by 2030. Among the strategies toachieve the SDG, universal health coverage and access, so that everyone is entitledto health services(-), requires not only the strengthening and qualification of nursingeducation, as investments for the continuation of these workers in professionalpractice.As a historical milestone, it is important, initially, to highlight WHO\u2019s72fpeople. Therefrvices-, requir.Thus, the vital contribution of Nursing to the achievement of global and Braziliangoals related to the priorities on the global health agenda is recognized, includinguniversal access, mental health and non-communicable diseases, emergencypreparedness and response and patient safety, always focusing on people-centeredcare,5.(-), as occurs in the context of COVID-19.Despite its representativeness and the acknowledged relevance of its work, however,Nursing is still invisible and undervalued in many aspects, especially in healthpolicy-making. Hence, in addition to the recognition and valuation of its numericalimportance, it is essential to value high-quality Nursing for leadership, policy anddecision-making, participation in decision-making processes, and action ranging fromplanning to care provided to specific population groups, including the fight againstpandemics-8, asNursing Nowcampaign was launched, implemented in collaboration between the InternationalCouncil of nurses (ICN) and WHO, with the support of the Burdett Trust for Nursing,a coalition of nurses and other health advocates.In this perspective, it is imperative to invest in the qualification of nurses toprepare them to cope with health problems worldwide, so that their contributions andpotentials are properly understood. Among the manifestations of the recognition ofNursing as a key profession for health and for the achievement of universal healthcoverage and access, on February 27, 2018, the global dvocates., Triple Impact Report and Global Strategic Directions for Nursing and Midwifery(2016-2020).The global campaign was based on evidence from key documents that demonstrate therelevance of Nursing to global health: Report of the High-Level Commission on HealthEmployment and Economic Growth-working for Health and Growth, Triplet Report and Glo16-2020).NursingNow campaign, to be met between 2018 and 2020, are: 1) Increaseinvestments in the improvement of teaching, professional development, standards,regulations, and the terms and employment conditions of nurses; (2) Increase andimprove the dissemination of effective and innovative approaches in the field ofnursing; 3) Intensify the influence of nurses and midwives in global and Brazilianhealth policies, as part of broader efforts to ensure that human resources forhealth are more engaged in decision-making processes; (4) Enhance leadershippositions occupied by nurses, and multiply opportunities for development at alllevels; and (5) Provide an expanded evidence base for the decision-makers andpolicy-makers about where Nursing can have the greatest impact, what prevents nursesfrom reaching their full potential, and how to deal with these obstacles.In this context, it is worth noting that the goals of the Nursing Now campaign sets relevant and challengingobjectives, emphasizing the fundamental importance of Nursing leadership for theachievement of local, Brazilian and global health targets. It is based on theassumption that health agendas will not be successful without nurses in leadershippositions, in the different spaces for health policy-making and decision-making, andwho perform their functions with greater effectiveness. Thus, at least 75% ofcountries should have a Chief Nursing Officer as part of their most qualified teamsin health management and policies. Therefore, greater investments in the training ofnurses with political and \u201cpolicy\u201d skills is fundamental.Therefore, the Nursing Now campaign also seeks to demonstratethe individual and collective value of Nursing, supporting research that documentsthe visibility and socioeconomic impact of Nursing on the healthcare quality andcosts. It aims to reset the boundaries of practice, valuing the philosophicalassumptions of the nursing discipline and the social mission of theprofession. Thus, the campaign has been implemented in 123 countries, withdecentralized goals, but which align with the global objectives of the campaign ineach nation involved.In this context, the ofession. Thus, involved.NursingNow campaign, the objective in this article is to identify the guidingaxes of the documents that grounded the Nursing Now campaign and relate therecommendations in those documents with the campaign goals.This being a unique moment for global Nursing and in view of the importance ofunderstanding the creation and implementation context of the , based on the analysis of documents that encouraged the creation andimplementation of the Nursing Now campaign. The identification ofthe documents was based on the reading of the seminal document that officialized thelaunch of the global campaign.Descriptive and documentary research, based Nursing Nowcampaign, aiming at an in-depth understanding of its contributions and importancefor the creation and implementation of the campaign.In this process, it was essential to recover historical materials that referred tothe political and health scenario, at the time of the preparation of the documentsthat motivated the planning and development of the Nursing Nowcampaign constituted the scope of analysis, namely: Report of the High-LevelCommission on health Employment and Economic Growth-working for Health andGrowth; Triple Impact: How developing nursing will improve health, promotegender equality and support economic growth; Strategic Directions for Nursing and Midwifery - 2016-2020.Therefore, three official reports that promoted the dGrowth; Triplec growth; Strate016-2020.These historical documents were accessed from the official websites of the UN, WHOand ICN. Together, these documents establish the campaign, justifying the need for aspecific movement to value Nursing as a means of effective investment instrengthening health systems and improving the health conditions of the population,around the globe.Three independent researchers repeatedly read these reports and individuallycompleted a data collection script they had prepared in advance. In case ofdisagreement between the analyses, the material could be analyzed by a fourthresearcher. That was not necessary though. The script consisted of the topics:background, scope, challenges and potential of health/nursing professionals\u2019 work,as well as recommendations for the future.Nursing Nowcampaign. After completing each topic in the script, for each analyzed report, thecomparative analysis of the data started. Thus, for example, a synthesis of thetopic \u201crecommendations for the future\u201d could be elaborated among the documents(reports). In the next step, the recommendations of the reports that structured thecampaign (guiding axes) were identified, relating them to each of theNursing Now campaign goals. The data collection script made it easier to synthesize in order to describe the dataand identify the guiding axes that promoted the The research data were collected between March and April 2020. Being officialdocuments in the public domain, collected through online access, registration orapproval of the research by an Ethics Committee for Research involving human beingswas deemed unnecessary.(-) that grounded and motivated the Nursing Now campaign, have beendetailed below.The information collected in the analysis process, based on the documents-12 thIn In In Therefore, the data support that each goal of the Nursing Now campaign is based oncomplementary evidence in the seminal documents analyzed for the overallstrengthening of nursing. and, specifically, targets for the advancement of globalhealth(-). Thus, the Report of the High Level Commission on Health Employment andEconomic Growth presents a global diagnosis of the health workforce conditions. Withthe participation of an ICN representative in the Commission, this document presentsimportant recommendations that were also introduced in the Triple ImpactReport and in the Strategic Directions for Nursing and Midwifery.The three documents analyzed in this article emphasize the challenge imposed on theinternational community to invest in the health and Nursing workforce as a conditionfor achieving different SDG and, splhealth-12. Tc Growth presenttReport and in , understanding Nursing not as a cost to institutions, but as aninvestment. This necessary demonstration implies, however, facing the challenge ofopposing arguments that support the thesis of this investment, knowing beforehandthat two priorities of health managers are always at the top of the list: costreduction without changing the quality of care and improvement of patient outcomeswhile maintaining reasonable costs. In this negotiation, the assertiveness of nurse leaders\u2019 argumentsneeds to be based on the best evidence on the effectiveness of Nursing work, throughevidence deriving from comparative analyses between similar conditions ofperformance, with and without nurses, proving the added value of this workforce inthe health indicators of the patients under their care.It should be taken into account that the objectives of the Nursing Now campaign andthe recommendations evidenced in the documents studied, are interconnected, whichalso mobilizes and enables their analysis and discussion in an interrelated way. Thefundamental issue of achieving universal health access and coverage by 2030, in viewof the implementation of the SDG, demonstrates and implies the need to make visibleand disseminate the relevance of Nursing, demonstrating its socioeconomicvalue, undersvestment,15. Tle costs. In thi(-).In addition, the defense will be convincing if the nurse leader demonstrates to thehealth manager the value of Nursing in achieving health outcomes in economic terms.In the same perspective of budget containment, nurses who ensure the patient\u2019s safereturn of the patient successfully develop the alternative of a shorter hospitalstay-19.In this perspective, it should be emphasized that nurses need to be attentive tocapitalize in favor of Nursing on all these initiatives and successfulinterventions, ensuring that these records, in economic value, are computed in thoseorganizations as cost savings resulting from nursing work, without loss of qualityand ensuring care continuity at the primary level, preventing readmissions andensuring the return of the health system user to society and work..The first goal of the Nursing Now campaign recommends investments in the improvementof teaching, professional development, standards, regulations and employmentconditions of nurses. It is directly related to Recommendations 1, 2, 3, 4, 5, 6, 7,8 and 9 of the Report of the High Level Commission on Health Employment and EconomicGrowth as well as Recommendation 4 of the Triple Impact Report and Thematic Area 1of the Strategic Directions for Nursing and Midwifery. Therefore, mostrecommendations of the High Level Commission on Health Employment and EconomicGrowth were related to this campaign goal. In this sense, for the sake ofinvestments in professional development and employment conditions, it is essentialto invest in job creation, in the provision and organization of health services. Inthe meantime, it is paramount to invest in the Nursing workforce, fundamentally inhigh-quality, modern, dynamic and relevant teaching, which is attractive to futurenurses, avoiding, as early as in the education process, possible drop-outmovements., with prepared and sufficient teachers who acknowledge Nursingeducation as a challenge, with relevant curricula and sufficientclinical and management experiences and training. An education that guaranteesBrazilian and international recognition of its competence and quality, ensuringrights in possible immigration processes, with preparation focused on the healthneeds of the populations, the most vulnerable groups and areas, centered on people,but also with skills to act in situations of humanitarian crises, particularlyconsidering the workers\u2019 rights and requirements of protection and security. It isimportant for this education to present the students, future nurses, with how theyshould act as leaders, providing role models, broadening horizons and opportunities,as well as the prestige of Nursing, in such a way that future generations will beable to advocate for improvements in services, policies, and opportunities forconstant training as a pre-condition for self-confidence, quality improvements,security, and stimulus to action, as well as the creation and implementation ofpositive changes in the outcomes of the population\u2019s health and well-being.Thus, the goal is teaching based on evidence of the best and most modern practicesfor learning, with pIn addition, plans should be supported to increase the number of trained and employednurses around the world, ensuring the appropriate training and motivation of thisworkforce for work at all health levels and services. Among the recommendations, theunique importance of Nursing work in situations of humanitarian crises and thechallenge that is imposed on countries in cases of international migration of nursesare highlighted. Still within the scope of this first goals, for the advancement ofnursing education, it is relevant to value quality and continued educationthroughout working life, exploring the power of information and communicationtechnologies, based on the recognition of gender equality rights and aiming tomaximize women\u2019s economic participation in the job market.. Despite different possible problems, Nursing practice at the regional,Brazilian and international level may share the competencies of its workers,requiring continuing development, which implies the recognition and valuation ofnursing with lifelong experience and the strengthening of clinical leaders,highlighting that good leaders create other leaders. Achieving this objective will only be possible when enhancing fundingand fiscal resources, as well as through local, regional and internationalintersectoral collaboration and partnerships.In this sense and strongly articulated to the necessary investment in high-qualityeducation, motivating and mobilizing future nurses, health systems need to beresponsive, with the necessary perspective of attractive jobs, not only to welcomeyoung newly qualified nursing workers, but to ensure their permanence and motivationfor the practice of the profession. Therefore, jobs and openings need to createdthat are recognized as decent, with salaries that permit fulfilling nurses\u2019 basicneeds, whose work organization is also decent, fair, appropriate, and compatible interms of sufficiency, quality and value of human resources, and materials andequipment essential for their performance. Despit leaders. Achievincrease and improve the dissemination of effectiveand innovative practices in nursing and is related to Recommendation 10of the Report of the High Level Commission on Health Employment and Economic Growth,with Recommendations 5 and 6 of the Triple Impact Report and with Thematic Area 4 ofthe Strategic Directions. In this perspective, the documents highlight the relevanceof research development with robust evidence that underpins the dissemination ofeffective and innovative Nursing practices. Therefore, research on the impact ofNursing on health service access, quality and costs is suggested, as well as toincrease the gender equality and improve the countries\u2019 economic conditions.Expanded efforts are needed to disseminate the evidence in formats that better reachthe service professionals, as well as the policy makers.Campaign goal 2 aims to The traditional mode of responsibility the researcher complies with by merelypublishing results in journals is outdated, given its insufficiency due to lack ofcapillarity and the characteristics of the postmodern society in the digital age:direct methods need to be explored to increase the quality and speed of scientificdissemination and translation of knowledge.. They also focus on the importance of Nursing and its work throughinterprofessional collaborations, as well as investment in search of scientificevidence that strengthens the development of the Nursing workforce. For this,\u201cbreaking silences\u201d is needed, rupturing walls that sometimes Nursing itself has built in a siegeprocess, conquering other health professionals, politicians, legislators and healthleaders as allies for the work of nurses, so that they are allowed to freely usetheir full potential and competence, not only in a technical, but essentially in apolitical perspective.The third goal advocates nurses and midwives\u2019 greater influence in global andBrazilian health policies, as part of broader efforts to ensure that human healthresources are involved in decision-making processes and is related to Recommendation1 of the Triple Impact Report and thematic areas 3 and 4 of the Strategic Directionsfor Nursing and Midwifery. The recommendations reinforce the need to strengthen theprofile of Nursing, making it central to health policies. They as needed, ruptur. If, for various reasons, investments in leadership are needed, at alllevels and modalities of nursing education, ranging from undergraduate topostgraduate education, in addition to continuing education courses on specifictopics, the aging of the nursing workforce and the imminent vacancies in leadershipneed to be considered, which need to be filled by prepared young talents.Goal 4 reinforces the need for more nurses in leadership positions and moredevelopment opportunities at all levels and relates to Recommendations 1 and 3 ofthe Triple Impact Report and thematic area 2 of the Strategic Directions for Nursingand Midwifery. Leadership is central in the discussions about the contributions ofNursing to more effective health policies that meet the health needs of individualsand communities: leadership of the professional team, leadership in defense ofgender equality with equal wages and opportunities, leadership to exercise the fullpotential of nursing, leadership for active participation in the processes ofestablishing health policies and health decision-making. Thus, the goal is thestrengthening of nursing leadership, enabling more efficient and effectivemanagement and governance environments. Nursing leaders should devote time andeffort to improve the social capital of the workplace in favor of their team, aimingat positive deployments of this investment. If, fo. Nevertheless, training and empowerment initiatives for leaders at thefront line of services are needed, as well as many other forms of development of leadership and themeanings of engagement, empowerment and job satisfaction(-). Goal 4 drives nurses to appropriate the right and duty to emphasizetheir participation in leadership positions and to create opportunities to ensurethe development of professionals and the profession at all levels.Efforts are urgently needed to enhance the prospection of candidates for leadershipposts and concern with other determining factors, such as that generation Y nursesconsider or reject leadership roles. Neverte needed, as welsfaction-25. Gper day, sevendays per week, it is responsible for pointing out feasible routesand strategies to solve problems and achieve the goals the team that outlined,representing the profession with her participation and vision. In this context, thisobjective synthesizes much of the other four objectives, reinforcing the need forreliable evidence to strengthen the political mobilization of Nursing, culminatingin better indicators of health, economic development and gender equality.Finally, goal 5 seeks to provide an expanded evidence base for decision makers andpolicy makers on how and when nursing can have the greatest impact and what preventsnurses from reaching their potential to manage these obstacles. It is directlyrelated to Recommendations 2 and 3 of the High Level Commission on Health Employmentand Economic Growth, Recommendation 5 of the Triple Impact Report and thematic area4 of the Strategic Directions for Nursing and Midwifery. That explains the relevanceof seeking evidence as to how and when the purposes of political activity aresuccessful, ensuring greater and better participation of nursing leaderships inhealth policy-making, health planning and interventions, as well as in situations offrustration and failure, knowing what obstacles remain to be overcome in order toensure this intended and necessary political activity; as the most presentprofession in the entire health system, 24 hours The analysis of these interrelations reveals that the objectives of the campaignidealize a nurse profile with technical and political skills to make the differencein any work environment, with leadership and health policy-making competencies,scientific evidence of the effectiveness of its practice being disseminated to theentire society.The limitations of this research are related to the ability of abstraction themethodology used can grant to the research problem because, being a documentary,descriptive research, other analyses of how the narrative about the topics in thedata analysis process may complement and deepen possibilities to better understandthe possible impact of the Nursing Now campaign, based on its connections with thefactors signaled in the documents that fostered its existence and development.Furthermore, the incipient nature of research on the theme results in limitedexplorations of contextual factors that may be involved in the development of thecampaign goals.At this unique moment for global Nursing, this article was able to demonstrate theaspects embodied in the documents that converged to the planning, launch anddevelopment of the Nursing Now campaign, thus revealing the foundations thatvalidate the campaign goals. Therefore, this study points to a complex process,based on evidence published by respected organizations, that the challenges forglobal health and its socioeconomic implications require that Nursing isacknowledged, equipped and valued to meet the current and future health demands ofhumanity, in different contexts.It should be emphasized, however, that this research did not aim to analyze theimplications of the terminologies international entities use concerning universalhealth coverage or access. Therefore, other theoretical and methodologicalapproaches are due for this purpose.In addition, the investments made now, advocating for changes and actions expectedand explained in the Nursing Now campaign goals, will revert, of course, indeployments of the campaign with short, medium and long-term results. To achievethis success Nursing, Health Systems and the society that receives health caredeserve, it is necessary that each of us, who practice nursing today, arecontinuously mobilized in favor of this cause and that we are all collaborators toachieve the objectives of the Nursing Now campaign."}
{"text": "In 2020, ~1.8 million Americans are expected to be newly diagnosed with cancer, with approximately 70% of cases diagnosed over the age of 65. Cancer can have a ripple effect, impacting not just patients themselves, but their family caregivers. This presentation will provide an overview of the estimates of the number of family caregivers caring for individuals with cancer in the US, focusing on older patients, from several population-based data sources: Caregiving in the US 2020, the Health Information National Trends Survey , the Behavioral Risk Factors Surveillance System , and the National Health and Aging Trends (NHATS) Survey. The presentation will compare features of the data sources to give a comprehensive picture of the state of cancer caregiving. In addition, the presentation will highlight what is known about the experiences of cancer caregivers, including caregiving characteristics, burden, unmet needs, and ideas for improving support for family caregivers."}
{"text": "The prevalence of leprosy has been declining steadily throughout the world since the 1980s as a result of multidrug therapy.Characteristically, leprosy evolves in a chronic, indolent form, with polymorphous lesions and in an oligosymptomatic form. Virchowian forms are even more indolent and diffuse infiltration can make diagnosis difficult. Lepromas, although asymptomatic, are often the reason for seeking medical care, and may generate diagnostic confusion with other papulonodular dermatoses such as granuloma annulare, dermatofibroma and sarcoidosis, among others.As Virchowians are the most bacilliferous, all strategies for identification and early treatments are valuable. In this manuscript, the dermoscopic findings of the lepromas are described.Male, 54 years old, brown, with asymptomatic nodular lesions throughout the integument one year ago. At examination, multiple normochromic papules of fibromatous consistency were found, associated with diffuse infiltration of the skin and diffuse loss of hair on the body . These nM. leprae, with consequent multiplication and bacillary spread through the haematogenic pathway.Individuals that evolve to the virchowian pole, such as this case, present humoral immune response, with high production of antibodies against the PGL-1 antigen, but these antibodies are ineffective in the elimination of Dermoscopy, in addition to being of great importance in the diagnosis of cutaneous tumors, is currently used in the detection and diagnosis of other non-tumoral skin diseases, such as inflammatory and infectious dermatoses, in order to reinforce clinical suspicion and differential diagnosis.The dermoscopic description of the lesions of some clinical forms of leprosy can be found in the literature, such as the histoid and tuberculoid forms.Its yellowing color in the dermoscopic examination is due to the intense xanthomization of the lepromes (Virchow cells), which is less evident in other lesions such as granuloma annular, sarcoidosis and xanthogranuloma,In anatomopathological examination of the leproma, there is an epidermal rectification, probably due to the accumulation of macrophages grouped in the superficial and deep dermis, with clear cytoplasm and vacuolated aspect. These vacuoles, in the coloration of fite-Faraco, contain a large quantity of bacilli; forming globes.The diagnosis of leprosy, however, is clinical, so that dermatoscopic aspects, as well as laboratory tests, anatomopathological and specific staining help in cases of greater clinical difficulty. Treatment with the diagnosis should be done promptly, as well as investigation of communicators, in order to reduce the transmission of the bacillus and controlling the incidence of new cases of the disease in the country.None declared.Anna Carolina Miola: Approval of the final version of the manuscript; elaboration and writing of the manuscript; obtaining, analysis, and interpretation of the data; critical review of the literature; critical review of the manuscript.Natalia Parenti Bicudo: Approval of the final version of the manuscript; obtaining, analysis, and interpretation of the data; critical review of the manuscript.Giuliane Minami Tsutsui: Approval of the final version of the manuscript; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases, critical review of the manuscript.Helio Amante Miot: Approval of the final version of the manuscript; elaboration and writing of the manuscript; critical review of the literature; critical review of the manuscript.None declared."}
{"text": "Violence against women in the Republic of North Macedonia is the most common form of human rights violation, and women's safety is thus a high-priority public health problem. There have been significant achievements in the area of policy development: legislation harmonization for human rights protection, prevention of violence against women, protocols for the treatment and support of female victims, especially those with disabilities, and further collaboration and coordination between different sectors. In practice, there is still a need to establish a system of institutions for effective prevention, protection, gathering of evidence, and support of women victims of gender-based violence in addition to the prosecution of perpetrators. Policies for the improvement of women's safety should be considered as a priority and undertaken at an individual, relationship, community, and society level. Women's safety is a global public health problem , and \u201cGlViolence has a negative effect on women's physical, mental, sexual, and reproductive health . EvidencViolence against women in the Republic of North Macedonia (further in the text Macedonia) is the most common form of human rights violation against women, and it has a negative impact on health, causing injuries, death, as well as psychological trauma . Women'sPublic health and human rights approaches have been applied to analyze the magnitude, burden, and risk factors of violence against women in Macedonia and to give actionable recommendations for policy interventions for the purpose of prevention. The public health approach is a science-based, multi-disciplinary approach for understanding and preventing violence, with coordinated action to be undertaken by different sectors .In Macedonia, due to inappropriate evidence of violence and a lack of systematic follow-up of the victims of violence, within health, social, educational, and other institutions in the country, it is not possible to give an objective assessment of the burden of violence against women .The official data from the police showed that, in 2004, there were 2,434 complaints of domestic violence of which 1,000 victims were wives, 460 parents, and 175 were children and other family members  in big families with members spanning several generations. In most of the cases, violence was linked to alcohol abuse. Centers for social work have provided services to 409 victims of family violence in 2004 and 2005, and 85 victims of violence were accommodated in the four shelter centers in Skopje, Kochani, Bitola, and Strumica  in 2000 showed that 61.5% of the interviewed women reported psychological violence, 23.9% physical violence, and 5% sexual violence .An intimate partner was identified by women as the most frequent perpetrator in 43.9% of reported violence against women in the community injury survey conducted on a sample of 1,000 households in Macedonia in 2008 .The Global School-Based Student Health Survey has shown that \u201coverall 10.0% of students aged 13\u201315 years had been bullied on 1 and more days during the past 30 days, while 8.6% of students seriously considered attempting suicide during the past 12 months; male students (6.8%) were less likely than female students (10.5%) to seriously consider attempting suicide\u201d  is 59.4%, whereby psychological violence is most common (58.2%) followed by physical violence (23.7). Almost every second woman in Bosnia and Herzegovina (47.2%) has experienced at least one form of violence since age of 15, mostly psychological (41.9%) and physical (24.3). Data obtained from a study conducted in Serbia in 2010 show that the overall prevalence of violence against women is 54.2%, with psychological violence at 48.7% and physical violence at 21.6% .The official number of violent deaths in females in Macedonia has decreased; homicides have gone down from 12 in 2007 to 9 in 2017 and suicides from 45 in 2007 to 32 in 2017, and this is almost three times lower than in males . Twenty-Evidence suggests that certain characteristics in women, such as sexual orientation, disability status, or ethnicity, and some contextual factors, such as humanitarian crises, including conflict and post-conflict situations, may increase women's vulnerability to violence  and may The main risk factors for violence against women in Macedonia, as stated by the perpetrators, are poor economic status of perpetrator, low education, unemployment, exposure to domestic violence against their mothers, harmful use of alcohol (every fourth perpetrator), unequal gender norms, including attitudes accepting violence, and a sense of entitlement over women . The vioThe main risk factors for victims of intimate partner violence as reported by the women are low levels of education, lack of employment for the woman, exposure to mothers being abused by a partner, experienced child abuse, and attitudes accepting violence, male privilege, and women's subordinate status , 18.The State response in addressing the problem of violence against women was in line with the resolution WHA67.15 from May 2014  and the The Government has been undertaking evidence-based policy interventions that are in line with WHO key recommendations , 22 at aThe Republic of North Macedonia is a signatory of the international acts from the United Nations (UN), the Council of Europe (CoE), and the European Union (EU) for the protection of human rights and prevention of discrimination, torture, and maltreatment, which are incorporated in the national legislation . The mosThe existing national legislative provisions are, to a great extent, in compliance with the principle of gender equality and the international instruments on the protection of women's human rights. Macedonia ratified the CEDAW Convention on January 18th, 1994, and the Optional Protocol to the same Convention and made no reservations .The Constitution  stipulatCitizens shall be equal in the Constitution and the laws: Criminal Code ; Law on In 2003 and 2004, the State made amendments on the actual Family Law  and Law The Annual Report of the Helsinki Committee for 2012 shows that there were serious violations to the freedoms and rights of citizens as well as drastic violations to the principle of rule of law and the legal state; this was not only in the form of systemic problems in the functioning of the bodies and institutions but also in the form of the abuse of their competencies .Violence prevention was set as priority in the collaboration between the Ministry of Health and the World Health Organization (WHO) since 2004 in Biennial collaborative agreements. The WHO National focal point for violence and injury control and prevention was appointed by the Minister of Health in 2003, thus starting the collaboration with the WHO organizing the national conference against violence against women on November 25th, 2003.The Department for Violence and Injury Control and Prevention was established within the Institute of Public Health in 2004 as a lead agency for violence prevention in the health sector, and it was later in 2012 inaugurated as the Safe Community Affiliate Support Center.The first shelter center was opened in 2004 in Skopje for the protection of victims of domestic violence. The process was followed by the opening of five more centers in the country and a national SOS line financed by the Government. Training of social workers and health professionals was also conducted .In the institutional framework, the sector for equal opportunities was established within the Ministry of Labor and Social Policy for the improvement of the status of women. There is also the national commission on equal opportunities for women and men, which was established in 2006 as a regular parliamentary commission .The Governmental National Coordination Body for Domestic Violence Prevention was established with Government approval in 2009, and it includes representatives from the Ministries of Health, Labor and Social Policy, the Interior, Education, Justice, the Institute of Public Health, as well as other non-governmental organizations, WHO and other stakeholders responsible for the implementation of the National Strategy for protection against domestic violence 2008\u20132011 .The Joint UN Program \u201cStrengthening National Capacities to Prevent Domestic Violence\u201d started in December 2008 and finished in August 2012, and it provided technical and financial assistance to the National Coordination Body in the implementation of the National Strategy for protection from domestic violence. UN agencies UNDP, UNFPA, WHO, UNICEF, and UNIFEM have worked together with the national partners: Ministries of Labor and Social Policy, the Interior, Justice, Health, Education, and Science, providing funding of 2,458,000 US dollars from the Government of the Netherlands, 958,000 US dollars from the UN Trust Fund, and a further 43,000 US dollars from UN agencies. A total of 70,000 US dollars in kind have also been provided by Government of the Republic of Macedonia .Specific national policies for domestic violence prevention have been developed to address violence against women, and annual action plans have also been prepared for implementation: a National Strategy for Protection Against Domestic Violence 2008\u20132011  was implProtocols against child abuse and neglect, sexual abuse, and pedophilia have been prepared as well . The JoiIn the context of the recent ratification of the European Council Istanbul Convention, the Government opened three multi-sectoral sexual assault referral centers in the hospitals in Tetovo, Kumanovo, and the University Obstetrics and Gynecology Clinic in Skopje for psychosocial and legal support as well as for the safety and security of the victims of sexual violence, applying a standard operating procedure. In the next 5 years, the Government will open seven more centers .The First Family Center established in 2013 in Skopje as a specialized counseling center for support and prevention against domestic violence is an example of good cooperation between the civil sector, local government, and business sector, providing free, confidential, and high-quality counseling and psychotherapy services for victims and perpetrators of domestic violence .The WHO Training Education Advancing Collaboration in Health Violence and Injury Prevention modular training curriculum on violence prevention and control has been completed by 2,390 health professionals and 60 university professors within the period 2009\u20132012. Training was financially supported by WHO within the UN Joint Program mentioned above. Two hundred twenty doctors were trained in 1 day workshops for evidence of violence and web register in Skopje in 2012 .Guidelines for referral mechanisms for professionals were prepared in 2010 and 2-day capacity-building workshops for the implementation of the Joint Protocol for domestic violence prevention were organized in eight municipalities in the period 2011\u20132012, and these were supported by the UN Joint Program. A total of 200 professionals from different sectors were trained: health workers, social workers, policemen, teachers, municipal staff, etc.Three 1-day capacity-building workshops for the protocol for intersectoral collaboration for domestic violence prevention were organized in 2015, and 90 doctors, nurses, social workers, and other workers were trained.In 2016, the Ministry of Health, in cooperation with NGO HERA, UNFPA, the Center for Family Medicine, and the Institute for Public Health, accredited a training package for gender-based violence with nine modules for 2-day training for health professionals. Over 200 medical professionals have completed this training, while 40 primary health care physicians completed a 2-day training program for gender-based violence in persons with disabilities in 2019.Despite the progress made in violence control and prevention and safety promotion, further efforts and a more strategic approach are needed in the years ahead , especiaThe future key challenges in the prevention of violence against women in Macedonia in the near future will be to implement the legislation for the prevention of domestic violence as well as the recommendations of the WHO World Report on Violence and Health  through Advocacy and empowerment counseling interventions, education, and home visitation are promising in the prevention or reduction of intimate partner violence against women .A multisectoral integrated approach is required for gender-based violence reduction at both the legislative and community level, dealing with common risk factors as well as the cultural and societal influences behind perpetrator behavior and victim response.Overall strengthening of the main functions, and especially the development of violence-prevention policies and legislation and establishing strong monitoring, will add significant value to the integrated system for the prevention of violence against women while including health in all policies.There are achievements in policy development for the prevention of violence against women as well as capacity-building and multisectoral collaboration between governmental, civil society, and international organizations with legislative and institutional changes. But there is still a need for the Government to provide resources and undertake measures and activities to respond to cultural change in social systems and to improve efficiency and effectiveness of legal mechanisms for the protection of women. Policies for the improvement of women's safety should be considered as a priority and should be undertaken at the individual, relationship, community, and society level.The author confirms being the sole contributor of this work and has approved it for publication.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "Painful conditions, particularly due to head pain, spinal disease, and neuropathic pain, are highly prevalent in modern society, resulting in a significant impact on the individual due to the disability of the condition and the direct cost of associated treatments. Additionally, indirect costs to society result from the loss of work productivity of the individual due to pain. For musculoskeletal pain alone, the related costs in the USA are estimated at $215 billion, of which 41% are from direct medical care, and the remaining are indirect costs associated with the condition [In this Special Issue of Brain Sciences, the included manuscripts have explored several causes of pain and disability, their diagnosis, and treatment. Cantone et al. evaluated the disability that can result from mucopolysaccharidosis related cervical myelopathy . The aut"}
{"text": "Despite good intentions, training programs targeting hospital managers are only effective if grounded on the best practices. These training programs must be sustainable and continuously be monitored and updated.4Hospital managers and administrators are the key motivators for the success of each inpatient healthcare institution.IJHPM entitled \u201cCapacity Building to Improve Hospital Managers\u2019 Performance in West Asia. \u201d5 This letter outlines the training and development program, targeting public hospital managers in Iran, initiated in 2016 by the Iranian Ministry of Health and Medical Education (MoHME) in collaboration with the World Health Organization (WHO). The purpose of this program is to empower public hospital managers, and to build capacity for improving their performance and productivity. Despite its efforts, the letter did not provide a comprehensive historical overview of the program. The letter also did not adequately acknowledge the intellectual property right of the project owners. There was no reference to the project owners responsible for delivering these training programs. Further, the title of the letter did not represent its content, which mainly covered Iran\u2019s experience not the West Asia region.The present letter is a critique and a response to a letter recently published at the The history of health managers\u2019 professional development initiatives in Iran dates back to nearly two decades ago, in 1999, when some health managers participated in international training courses. 6 and WHO confirmed the proper implementation of this program.7 The tailored course entailed 28 days of training in 7 modules over a period of 8 months. This course was implemented in 7 management training centers in Iran. This successful experience in Iran, motivated the WHO to implement this course for health managers in Iraq and Afghanistan, which was held in the National Public Health Management Center in Tabriz, Iran. The WHO has supported the capacity building program since the starting point of the program, and in addition, involved in monitoring and evaluation of the training courses. In Iran, as a developing country, it will be important to continue conducting health management training, and also to justify the large investments in training programs, through rigorous assessment of their contribution to the capacity development of individuals, organizations, and health systems. To accomplish this important objective, the Health Managers Development and Training Supreme Institute, affiliated with the MoHME, was established in 2017, to organize and lead the professionalism, managers training, and management development in national and international health systems.Notwithstanding these academic events, with the beginning of the Health Transformation Plan in Iran in 2014, the need for managerial skills improvement in hospital managers was deeply felt. In 2015, a training assessment for hospital managers was done to identify their needs for inclusion in the planning, implementation, and evaluation of educational courses. Based on this assessment results, approximately 75% of the participants obtained low scores, and the qualitative analysis demonstrated their training needs. Consequently, the Hospital Managers Development Program was designed, and then started by the Hospital Management and Clinical Services Excellency Office in collaboration with Management Development and Administration Reform Center of MoHME, WHO country office of Iran, International Federation of Hospitals, and Iran University of Medical Sciences, Tehran, Iran. Also, International Relation Department of MoHME supported and facilitated the Hospital Managers Development Program initiative. In less than two years, all of the 600 public hospitals managers were trained in leadership and management skills,Not applicable.Authors declare that they have no competing interests.All authors developed this letter and agreed upon the final manuscript.1Department of Health Policy, Economics and Management, School of Management and Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2Advisor to Secretariat of High Council for Health and Food Security, Ministry of Health and Medical Education, Tehran, Iran. 3Secretariat of the High Council for Health and Food Security, Ministry of Health and Medical Education, Tehran, Iran. 4School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran. 5Health Managers Development Institute, Ministry of Health and Medical Education, Tehran, Iran. 6Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran."}
{"text": "COPHELA , a collaborative project between the European Union (EU) and Latin America, will produce on-line courses for the master degree in pharmacy. The program runs from 2019 through 2021. It is funded by the Erasmus+ program of the Education, Audio-visual and Culture Executive Agency (EACEA) of the European Commission. The partners are EU and Latin American universities. These are accompanied by associated partners from EU and Latin American universities, as well as from governmental and non-governmental organizations, such as pharmacy chambers and educational associations. The project is coordinated by the University of Granada, Spain (first author of this paper). It will produce distance learning master degree courses in a dozen fields of specialized pharmaceutical science education and practice, ranging from patient care to industrial pharmacy. This paper describes the design of the project and is intended to evoke constructive comments. It also represents a call for the recruitment of additional associated partners.  In light of the evolving situation in pharmacy specialization in Latin America, the COPHELA project proposes to produce distant learning tools for master degrees in pharmacy specialization. These will be published in Spanish, Portuguese and/or English, and will be available primarily for the Latin American market but also in the EU.PHARMINE (Pharmacy Education in Europe) ,2, and tPHAR-QA  ,4, andPHAR-IN  ,6.This COPHELA project is a follow-on to three previous EU-funded projects: The competences for fundamental and specialized pharmacy practice The education and training tools necessary to produce the competences cited previously in (1) above, andThe harmonization of competences, and the education and training tools necessary, in the EU member states.All three projects centered on:The purpose of the three previous projects was to adapt pharmacy education in the EU to the on-going evolution in practice. For example, community and hospital pharmacies are moving towards patient care activities, such as therapeutic monitoring, intervention in public health campaigns (vaccination and other), medicinal treatment of long-term ailments, and interpretation of clinical biological results, etc. There is also a substantial transformation in industrial pharmacy in research and development, production, etc. This accompanies the shift in therapeutics from small chemical drug molecules to large protein biosimilars. The development of the generic drug market with the consequential changes in marketing, regulatory affairs, etc., is another example of the evolution in practice. COPHELA looks at the paradigms and technology required to extend to Latin America the principles behind the three EU PHARMINE projects. It aims at creating master degree courses in specialized pharmaceutical sciences to meet the challenges of the changing face of pharmacy. Below, we examine the characteristics of pharmacy practice in the EU and Latin America, and how specialized education and training can provide possibilities for adaptation in the changing world.Workplace. A hospital pharmacist can be defined as a pharmacist working in a hospital pharmacy -and this independently of the education and training s/he has followed. An industrial pharmacist can be defined as a pharmacist working for a drug company. In both cases \u2013hospital and industrial \u2013 this attribute is independent of the following three attributes.Specific pharmaceutical activities. This concerns the definitions of the practice of community and hospital pharmacy . Such definitions involve pharmaceutical acts like formulation of specific forms of drugs or deliverance of specific drug treatments. The practitioners\u2019 perceptions of such acts have been described in detail [n detail ,8,9.Laws and directives. The definition of attribute 2 \u2013pharmacy practice \u2013is established through laws and directives from national associations and/or chambers, and, in the case of the EU, by directives drafted by the European Commission and approved by the European Parliament. It should be noted that a directive is an act that requires a given country to achieve a result without dictating the means of achieving that result. Thus hospital pharmacy in Spain and Portugal are governed by associations and chambers [chambers ,11, and chambers ,13. At tchambers  defines chambers ,16,17,18chambers ,20. The Education and training. This attribute concerns the education and training for fundamental practice and for specialized practice in hospital and industrial pharmacy. As an example, in Spain and Portugal, hospital pharmacy practice is taught in specific hospital pharmacy specialization courses [ courses ,22. Conc courses .The attributes of pharmacy practice, with examples from the EU and Latin America, are:Below, are the paradigms and methodology to achieve these aims. Evidence of collaboration between the EU and Latin America in the form of student and/or staff exchange, joint projects in education and training and/or research, etc.Present and future development of specialization in pharmacy practice in the fields of patient care, research in pharmaceutical science and/or education, etc.Development of IT capacity in teaching.Interaction with national and international governmental departments , pharmacy chambers and associations, etc.The first stage in the elaboration of the COPHELA project was to constitute a core team of 10 partners (authors of this paper) who replied to the following criteria:EACEA/EU projects are separated into \u201cworkpackages\u201d (WPs) that group the activities of the project. WPs function independently but rely on the results of other WPs. The target group and the ultimate beneficiaries of the COPHELA project are the populations of the Latin American countries. Benefit will come in various forms. Firstly, there will be an improvement in the healthcare of the Latin American population, following the amelioration of pharmaceutical care, based on the upgrade of pharmaceutical specialization in community and hospital pharmacies. Secondly, the Latin American pharmaceutical industry will benefit by providing employees with the tools required for future changes in the industry, such as the change from a chemistry-based industry producing small molecules to a biotechnology-based industry producing large therapeutic proteins.There are several potential issues. Firstly, they involve shortcomings in the performance of the partners and their capacity to produce, evaluate and accredit satisfactory courses. in the time given. Appropriate expedient measures to counter such deficiencies are based on the capacity of the auditing to detect and suggest solutions, and a satisfactory interaction with EACEA and project partners.Secondly, problems could arise in the accreditation of courses by bodies external to the project such as government health and education authorities, and thus, in the long-term use of COPHELA material post-2021, the official date of the closure of the project. The main purpose of COPHELA accreditation is recognition. The project in its present form has 44 partners and associated partners in the EU and Latin America. The fact that all the COPHELA universities and other institutions have contacts with the accreditation authorities in their different countries should ensure that such problems can be resolved. Thirdly, in parallel to accreditation, problems could arise concerning intellectual property and ownership of the material produced given that in the EU and in Latin America the economics of the education and training of pharmacists vary greatly. This ranges from the situation in state-owned universities where such education and training are without charge, to that in private universities with a fee system. Here, solutions will be found on the basis of interactions between the project partners and associated partners, and the relevant partners in the healthcare system of the country concerned. Ownership will be guaranteed by the commitments and conventions on a joint project. Intellectual property rights will be ensured through Creative Commons Licenses .COPHELA is a collaborative project between the EU and Latin America aimed at improving specialization education in pharmacy. Its ambition is to improve not only the competences of target groups, such as university staff and students, and pharmaceutical professionals, but also the wellbeing and prosperity of the general public through better patient care, and better drugs, with a modernized pharmaceutical industry capable of providing the latter. The purpose of this manuscript is to request comments on project design and recruit potential research partners."}
{"text": "Late life depression (LLD), a common mental disorder, has become an increasingly acute public health concern with a quickly expanding geriatric population worldwide. To our knowledge, however, the incidence of LLD in northern cities in China has not been empirically investigated, and many elderly people with depressive moods and mild depressive symptoms have not been given sufficient attention.This is a multi-stage and prospective study. The first stage is a cross-sectional study, investigating the epidemiological characteristics of LLD in northern China and exploring the biological, psychological, and social risk factors for developing LLD based on a set of questionnaires from 6,800 community-residing elderly adults. The second stage involves statistical analysis, by constructing a risk factor model for LLD and analyzing their direct and indirect functional routes on the basis of structural equation modeling. The third stage is an experimental study a total of 60 elderly patients with LLD and their principle caregivers will be randomly assigned to control and trial groups. The trial group patients and caregivers will undergo supportive psychosocial, drug treatment, and health education (PDH) intervention, whereas the control group patients and caregivers will be treated routinely . At the end of the intervention, depressive symptoms, quality of life, and the social and cognitive functioning of the patients in the two groups will be respectively assessed at a baseline and after 6, 9, and 12 months post-intervention by employing scales and questionnaires to analyze the effectiveness of the supportive PDH intervention measures in comparison with TAR. Ultimately, a supportive PDH intervention and health management model will be obtained by combining PDH intervention with mental health institutions, community health services, and aging families as the main line.This study will provide strong and suitable evidence for enhancing the integrated supportive PDH intervention and health management model of LLD patients among community-dwelling residents.This study has been approved by the Ethics and Research Committee of the First Affiliated Hospital of China Medical University . Late life depression (LLD) is complex, burdensome, and difficult to treat. Specifically, it refers to elderly people who, for the first time in their lives, meet criteria for major depressive disorder (MDD) or display clinically significant depressive symptoms such as functional disability, cognitive decline, increased risk of medical comorbidity , and even suicide in severe cases \u20134. MeanwEvidence shows that successful antidepressant treatment is one of the most effective ways of reducing disability, preventing morbidity, and improving quality of life (QOL) in older patients . HoweverIn Western countries in the 1970s, health management, an important topic in the field of healthcare, developed rapidly and was successfully implemented for chronic conditions such as hypertension, diabetes mellitus, and chronic obstructive pulmonary disease \u201322. By cAccording to literature review and analysis, we found that there are four main deficiencies of the existing research. First, due to a large elderly population base, rapid aging growth, uneven distribution of mental health resources, and insufficient public attention to the mental health of the elderly, under-recognition and under-treatment of depression appears to be severe in Liaoning which ranked first among 19 provinces and cities in terms of the proportion of the elderly population aged 65 and above in 2016. Second, research on interventions for LLD is limited. Previous studies have been mostly based on pharmacotherapy, psychosocial intervention, health education, or a combination of any two of these, but none, to our knowledge, have been conducted combining all aspects together. Third, research on the risk factors of LLD has been limited, and the methods used have not been sufficiently systematic. Previous studies were limited to investigating risk factors \u201326, but This study is designed to comprehensively assess the overall community mental health resources available to LLD patients, along with the prevalence, risk factors, and prevention and treatment status of LLD in Liaoning. By exploring and constructing the integration of psychosocial interventions, medical care, and health education with psychiatric hospitals, community health services (CHS), and aging families, this study can provide a reference for the practice of supportive intervention and health management, as well as guidance for formulating health policies in Liaoning. The aims of this study are as follows:Analyze the epidemiological characteristics of LLD in Liaoning province.Construct a risk factor model for LLD in Liaoning.Conduct supportive psychosocial, drug treatment, and health education (PDH) interventions alongside treatment as routine (TAR) in a trial group and control group, respectively, to compare their effectiveness with regard to patients and their caregivers.Establish a supportive PDH intervention and health management (SIHM) model for elderly patients with depression according to the local economic level, mental health resources, and demographics of Liaoning.Team members of the preliminary investigation will consist of six graduate students studying psychiatry, two clinical psychiatrists with experience in the fields of mental health, geriatrics, and medical psychology, and five CHS staff members from Liaoning province. Before implementing the questionnaire survey, graduate students and CHS staff will undergo unified training, to explain the specific purpose, content, significance, procedures, and principles of the investigation. Further, the team members will learn the definitions and scoring criteria of each item in the questionnaires and scales, communication skills for interacting with elderly patients and their caregivers, and possible problems and solutions that might be encountered. After sampling according to inclusion and exclusion criteria, the psychiatrists, accompanied by other team members, will enter selected communities, ask permission from community leaders, and complete the investigation in public activity areas or at elderly residences accompanied by the arranged community staff.In addition, team members of the intervention will comprise graduate students in psychiatry, one clinical psychiatrist, and one psychologist employed to supervise and guide the intervention process. After team members work out a detailed intervention plan according to the purpose of the project and the characteristics of the research objects, the research team will organize experts in psychiatry, psychotherapeutics, social medicine, and geriatrics to review and approve the plan. Afterwards, the plan will be revised and improved based on expert advice before implementation. Then, in the course of carrying out the plan, the intervention team members will record any problems with the intervention process and immediately report back to the project leader for revisions before further implementation. The goal of such cycles is to ensure the effectiveness of the intervention.In order to ensure the quality of the preliminary investigation of this project, we formulated the following measures. First, there will be unified training for researchers before data collection to reduce bias caused by differences among researchers. Second, when carrying out the questionnaire, the environment will be as quiet as possible, so as to facilitate the emotional stability of the research subjects and avoid adverse effects from the internal and external environment. Third, when collecting the questionnaires after completion, missing items will be promptly identified (without violating the principle of voluntariness) to ensure the accuracy and integrity of the survey data. Finally, data obtained from the survey will be input into statistical software for analysis by two investigators working together. At the same time, before statistical processing, SPSS descriptive statistics will be used to verify the recorded data, and errors will be corrected.Similarly, the following three measures were developed to ensure the quality of the intervention. First, members of the intervention team will regularly report the concrete content of the intervention measures and the implementation process to the project leader and clinical psychiatrists. Second, a clinical psychiatrist will be invited to evaluate, guide, and correct the accuracy of the intervention measures and methods, along with any problems with the intervention and suitable solutions. Third, contingency plans will be developed and imparted to researchers in case of any emergencies while executing intervention measures.This is a multi-stage and prospective study. It includes the following three stages:The first stage is a cross-sectional study, based on the baseline information from 6,800 community-dwelling elderly adults collected through a set of questionnaires. The aim of the first stage is to investigate the epidemiological characteristics of LLD in northern China, and to explore the biological, psychological, and social risk factors for developing LLD.The second stage involves statistical analysis, with the aim of constructing a risk factor model for LLD and analyzing direct and indirect functional routes on the basis of structural equation modeling (SEM).The third stage is an experimental study, comprising a 6-month supportive intervention period and a 6-month follow-up period. In order to ensure the participation of the subjects in this study and improve the effectiveness of the interventions, a total of 60 elderly patients with depression and their principle caregivers will be randomly and equally assigned to trial and control groups.Trial group patients and caregivers will undergo supportive PDH interventions, and control group patients and caregivers will receive TAR. Subsequently, depressive symptoms, QOL, and the social and cognitive functioning of the patients in the two groups will be respectively assessed at a baseline and after 6, 9, and 12 months post-intervention by using scales and questionnaires to analyze the effectiveness of the supportive PDH intervention measures. Ultimately, an SIHM model will be constructed by combining PDH intervention with mental health institutions, CHS, and aging families as the main line.We plan to enroll the participants between December 2019 and December 2022. The goal is to recruit 6,800 community-residing elderly adults to complete the baseline investigation. Then, 60 LLD patients who meet more strict criteria, along with their principle caregivers, will receive 6 months of supportive PDH intervention followed by a 6-month follow-up period. The inclusion and exclusion criteria for all the respondents, patients with LLD, and caregivers are listed in The 6800 community-residing elderly adults will be screened and enrolled by the investigators according to the inclusion and exclusion criteria. To ensure the balance and representativeness of sample sources, we intend to adopt a multi-stage sampling method. At the first stage, four cites will be randomly selected in Liaoning province by randomized sortition. At the second stage, one district and one township will be randomly selected from each selected city. At the third stage, one urban community and one village community will be randomly selected from each selected district/township. At the fourth stage, elderly residents will be selected from each selected urban community and village community with a convenient sampling method.The 60 community-residing elderly adults with LLD and their principle caregivers will be allocated to trial and control groups. In addition, we will ensure that there are no statistical differences between the two groups in term of the degree of depression, drug treatment programs, knowledge of mental health, geographic distribution, and other aspects before carrying out the interventions. The trial group of 30 elderly patients and their principle caregivers will receive the same content and frequency of individualized and group intervention for 6 months. By contrast, the 30 elderly patients in the control group and their principle caregivers will receive TAR, which are suitable for all MDD patients as routine. During this period, except for any additional treatment for comorbid physical diseases or short-lasting benzodiazepines for severe insomnia, other antipsychotic medications, systematic psychotherapy, and long-lasting benzodiazepines will not be allowed. The detailed content, forms, and methods of the supportive PDH intervention are listed in Considering that Shenyang, the capital of Liaoning, has the second-largest elderly population in the province, a multi-stage sampling method will be applied during this phase as well. At the first stage, one district and one township will be randomly selected by randomized sortition in Shenyang. At the second stage, one urban community and one village community will be randomly selected from each selected district/township. At the third stage, with the help of local community health workers, 60 elderly patients with LLD who meet the inclusion criteria will be selected from each selected urban community and village community with a convenient sampling method.In addition, the 60 elderly patients in the trial and control groups will receive clinical visits at the baseline and after 6, 9, and 12 months post-intervention using scales and questionnaires. The primary treatment and intervention outcome evaluation index shows the change in the total Geriatric Depression Scale (GDS) score. A secondary index includes the change in the total Older People Quality Of Life (OPQOL) score, the 36-item short-form (SF-36) from the Medical Outcomes Study (MOS), the Social Disability Screening Schedule (SDSS), the Family APGAR Scale, the Montreal Cognitive Assessment (MoCA), the Knowledge-Attitude-Practice (KAP) for LLD, the General Self-Efficacy Scale (GSES), and the Irritational Beliefs Scale (IBS). That is, the effectiveness of the supportive PDH intervention will be comprehensively evaluated in terms of depressive symptoms, QOL, and social, family, and cognitive functioning. See At screening, the trained investigators will examine, gather, and record participant eligibility. The Chinese version of MINI  will be Finally, to evaluate the effectiveness of supportive PDH intervention, follow-up data regarding improvements in depressive symptoms, QOL, and social, family, and cognitive functioning will be assessed and acquired using other standardized Chinese scales and questionnaires, respectively \u201331.The primary goals of this study are to analyze the epidemiological characteristics and construct a risk model for LLD in Liaoning. The study design for this part is a cross-sectional study. Wang et al. reported the prevalence of MDD in elderly Chinese at 2.8%, where the ratio of urban to rural was 1.4:1 . That isGiven that 10% of the data are missing, a total of 6,800 elderly residents  should be included.The secondary goals of this study are to conduct and evaluate integrated supportive PDH interventions and TAR for the objects in the trial group and control group, respectively. The study design for this part is an experimental study, and the sample size can be determined by the change in the value of the mean and standard deviation of the depression score of elderly patients before and after intervention in a previous study . That isGiven that 20% of the data are missing, each group should have a sample size of 30 LLD patients. Meanwhile, to facilitate the compliance of patients in the later intervention stages, and to ensure the effectiveness of the intervention, each patient\u2019s primary caregiver will be required to accompany the participant. In the later stages, we will further revise the sample size according to the preliminary experimental results from the intervention study.The participants, method, assessment time, and data collection administrators are listed in The statistical analyses will be performed by employing the SPSS statistical package, version 20.0 , and all evaluations of significance will be determined based on two-sided tests using the 0.05 level of statistical significance. In addition, missing values will be replaced by the column mean/median in this study. The details of the analytic approach are as follows.Demographic and clinical characteristics, lifestyle patterns, medical history, history of alcohol and drug abuse or dependence, family history of mental illness, self-knowledge and treatment attitude, and the self-efficacy levels and depressive symptoms of the subjects will be described by frequency distribution, percentage, arithmetic mean, and standard deviation.t-test, Mann\u2013Whitney U-test, and the chi-squared test, as appropriate.Comparison of the above variables between patients with or without LLD will be made using the independent-sample Correlation analysis, logistic regression (for binary variables), and multiple linear regression (ANCOVA for continuous variables) will be used to determine whether the variables can enter SEM, and to test the direct and indirect pathways among these hypothesized determinants.Amos version 22.0 statistical software will be used for SEM of the risk factors for LLD.GDS, SDSS, SF-36, OPQOL, Family APGAR, GSES, IBS, MoCA, and the related KAP for LLD in the elderly will be used as evaluation indices, and analysis of variance (ANOVA) will be applied to compare the results of the control and the trial groups before and after intervention.Regression analysis will be used to analyze the influence of various factors on the effectiveness of the supportive PDH intervention.This study [approval no. (2019) 2019-312-2] was approved by the Ethics and Research Committee of the First Affiliated Hospital of China Medical University, which verified that the study will be performed in accordance with all ethical standards set forth by the committee.Participants will be assured of the confidential nature of the study, and written informed consent will be obtained. All data collection will be anonymous and in accordance with the provision of Chinese law regulating patient autonomy, rights, and responsibilities in the field of clinical information and documentation.Based on an analysis of the current clinical report results, there are many basic studies and investigations of the pathogenic factors of LLD. Investigations mainly focus on three groups of variables. First, researchers study the correlation between the characteristics , 35 bio, 37 per\u201340  and a grant from the Major Project of the Science and Technology Ministry in China (2017YFC0820200).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "The 11th International Retroviral Nucleocapsid and Assembly Symposium was held August 15\u201317, 2019, on the campus of Northeastern University. The meeting consisted of 40 oral presentations and a poster session while providing a stimulating environment to advance our understanding of retroviral assembly and replication and promoting interactions between young scientists and prominent researchers. The presentations covered a range of topics related to retroviral replication and assembly, including biophysical and structural studies, the roles of Gag, NC, RNA, and membranes in retroviral replication and assembly, interactions with cellular factors, virus assembly and budding, and therapeutic strategies. As an outcome of the meeting, this Special Issue was organized. Due to the pandemic, deadlines for the Special Issue were extended, and the issue was completed in October 2020.The eleven manuscripts published as part of this Special Issue reflect the breadth of topics covered by the symposium, ranging from fundamental biophysical studies of the molecular interactions involved in retroviral replication and assembly to the characterization of complex cellular interactions involved in these processes. Studies of molecular biophysics and biochemistry included a study of the dimerization of the Rous Sarcoma Virus genomic RNA , compari"}
{"text": "Citation analysis is one of the most commonly used methods in academic assessments. Up to now, most of academic assessments are based on English literature, ignoring the fact that the role of Chinese papers in academic assessments has become increasingly indispensable. Therefore, to give full play to the role of Chinese literature in academic assessments is an urgent task of current academic circle. Based on Chinese academic data from ScholarSpace, i.e., 82826 Chinese computer science journal papers, we conduct a comprehensive assessment of academic influence from the perspectives of fields, journals and institutions, in order to achieve a better understanding of the development of Chinese computer literature in the past 60 years. We find that Chinese scholars tend to cite papers in English, discover evolution trend of fields, journals and institutions, and call on journals, institutions, and scholars to strengthen their cooperation. The progress of scientific research is closely related to academic inheritance. Only by standing on the shoulders of predecessors can the younger generation see further. Citation is a form of academic inheritance. Through citation analysis, scholars can understand the development of academic fields and draw lessons from classical research ideas, thus gaining new academic achievements. Therefore, citation analysis is one of the most commonly used methods in academic assessments.Up to now, most of academic assessments are based on databases that mainly consist of English literature, such as DBLPHowever, this assessment method is not entirely suitable for Chinese scholars, since a considerable number of them writes in their native language, and there are many excellent works in Chinese papers [According to  papers have fewer than h citations each  literature.ScholarSpaceChinese Journal of Computers(CJC), Journal of Computer Research and Development(JCRD), Scientia Sinica (Informationis)(SS-I), Journal of Software(JS), Journal of Computer-Aided Design & Computer Graphics(JCAD&CG), Acta Electronica Sinica(AES), Journal of Chinese Information Processing(JCIP), Journal of Frontiers of Computer Science and Technology(JFCST), Journal of Chinese Computer Systems(JCCS), Journal of Image and Graphics(JIG), as well as Computer Science(CS), including the 10 sub-fields of computer science defined by CCF (China Computer Federation), i.e., Computer Network and Communication(Network), Information Security and Privacy Protection(Security), Chinese Information Processing and Information Retrieval(Info), Computer Theory(Theory), Graphics and Human-Computer Interaction(Graphics & HCI), Software Engineering/System Software/Program Designing(Software), Database System and Data Mining(Database), Architecture and High Performance Computing(Architecture), Artificial Intelligence and Robotics(AI), as well as Intersection and Synthesis(Intersection).As a subsystem of ScholarSpace, our dataset, ScholarCitation has obtained 71,221 citation relationships of 82,826 journal papers from top 11 Chinese computer science journals, i.e., The ontology of our dataset is shown in target papers in the following analysis. We define a series of evaluation indicators for three types of entities: fields, journals, and academic institutions, including the number of papers, the number of self-citations, the number of other-citations, the number of other-references, the number of citations, the number of references, self-citation rate, citation rate, and reference rate. The definitions of these indicators are shown in For ease of explanation, the 82,826 journal papers collected by ScholarCitation will be referred to as Further explanation of these indicators is provided below.P means the total number of target papers published by entity E in a period T. For example, assuming that Chinese Academy of Sciences(CAS) published 1000 papers between 2009 and 2018, then P is 1000.First, the number of papers CS\u2212S means the total number of times that entity E cited its own published target papers in a period T, and the meaning of self-citation rate CRS\u2212S is the number of self-citations of entity E per paper in a period T. For example, assuming that CAS published 4000 papers and cited itself 2000 times between 2009 and 2018, then CS\u2212S is 2000, and CRS\u2212S is the ratio of 2000 to 4000, i.e., 0.5.Second, the number of self-citations CO\u2212S means the total number of times that the target papers published by entity E were cited by other entities in a period T. For example, assuming that CAS was cited by other institutions 3000 times between 2009 and 2018, then CO\u2212S is 3000.Third, the number of other-citations Ced means the total number of times that the target papers published by entity E were cited by all entities (itself and other entities) in a period T, and the meaning of citation rate CedR is the number of citations of entity E per paper in a period T. For example, if CS\u2212S is 2,000 and CO\u2212S is 3,000, then Ced is the sum of 2,000 and 3,000, i.e., 5,000. At the same time, if P is 1,000, then CedR is the ratio of 5,000 to 1,000, i.e., 5.Fourth, the number of citations CS\u2212O means the total number of times that the entity E cited target papers published by other entities in a period T. For example, assuming that CAS cited other institutions 4,000 times between 2009 and 2018, then CS\u2212O is 4,000.Fifth, the number of other-references C means the total number of times that the entity E cited target papers published by all entities (itself and other entities) in a period T, and the meaning of reference rate CR is the number of references of entity E per paper in time T. For example, if CS\u2212O is 4,000 and CS\u2212S is 2,000, then C is the sum of 4,000 and 2,000, i.e., 6,000. At the same time, if P is 1,000, then CR is the ratio of 6,000 to 1,000, i.e., 6.Sixth, the number of references CS for entities of institutions. The meaning of CS is the sum of citation scores of entity E in a period T. The calculation method of this indicator is based on the CSRankingsIn addition, we define citation score This section will first give an overview of our citation analysis in section overview of citation analysis, then conduct the citation analysis based on fields, journals and institutions in section fields-based citation analysis, section journals-based citation analysis, and section journals-based citation analysis respectively. In section cross citation analysis, we will finish cross citation analysis.By 2018, ScholarCitation has collected 71,221 self-citation relationships of 82,826 target papers. Therefore, the self-citation rate of ScholarCitation is 0.86. However, from the official website of Scimagojrmerely considering self-citation, Chinese scholars prefer to cite English papers.By comparison, in the field of computer science, the self-citation rate of Chinese and English journal papers published by Chinese scholars is much higher than that of Chinese journal papers. Therefore, P, C and CR, and found out the temporal changes of the three indicators. The publication and citation of target papers in the last 10 years are shown in Horizontally speaking, Chinese scholars prefer to cite English papers. What about the longitudinal situation? We sampled target papers from ScholarCitation from 2009 to 2018, calculated Chinese papers in the field of computer science show a development trend of \u201chigh quality in small amount.\u201d However, although citation rate is on the rise, there is still a gap between it and self-citation rate (2.60) of the above-mentioned Chinese and English journal papers. This situation is not only aroused by the quality of target papers, but also by Chinese scholars' preference to cite English papers.In terms of the number of papers, it increased first and then decreased from 2009 to 2018. However, the overall fluctuation is modest in that the gap between the maximum and the minimum is within 1,000. In terms of the number of citations, it shows an overall growing trend and reached the maximum in 2015. However, similar to the number of papers, the fluctuation of the number of citations, which remains at around 5,000, is slight. As the result of the calculation of the number of papers and citations, citation rate is a more comprehensive indicator. As is seen in the figure, citation rate shows an overall upward trend and reached a maximum of 1.56 in 2015. This is because the number of papers in each year differs little, but in 2015 the number of citations reached a maximum. Therefore, as a whole, P), the number of self-citations ), the number of other-citations ), the number of other-references , and citation rate ). The publication and citation of papers in 10 sub-fields of computer are shown in In order to understand the development of different sub-fields of computers, we extracted citation data collected by ScholarCitation from 1960 to 2018 to calculate 5 indicators for each field: the number of papers published , so the rate of citation in each field, that is, the ratio of the number of citations to the number of papers, fluctuates little (standard deviation is 0.17).Second, there are differences in the composition of citations among different fields. In terms of the composition of citations, the fields where the number of self-citations is significantly higher than that of other-citations are Info, Graphics & HCI, as well as Network. On the other hand, the fields where the number of other-citations is significantly higher than that of self-citations are Architecture, Theory, and Intersection. Therefore, the degree of interdependence among different fields differs.Third, there are differences in citation preference among different fields. In terms of citation preference, the fields of Graphics & HCI, and Network prefer to cite papers in their own fields, while the fields of Theory, Architecture, and Security prefer to cite papers in other fields. This conclusion and the second point above can mutually confirm, indicating that the degree of interdependence among different fields is different.Cumulative citation of the target field in a period T is the sum of citations of target papers in this field in T, which is denoted as Ced. In order to compare the differences of citations in different fields, we introduce the concept of proportion. The proportion of cumulative citation in a target field refers to the ratio of cumulative citation of the target field to that of all fields. Next, we will further analyze the historical development of fields according to the proportion of cumulative citation in different fields. First, the development of Architecture is slowing down. The field of Architecture (HPC) has been the hotspot from 1982 to 2000. But since the twenty-first century, its ranking has been gradually declining: In 2001, it was surpassed by Network, as well as Graphics & HCI, falling to the third place. In 2003, the fields of Theory, Software developed rapidly, rendering a decline in the ranking of HPC to the 5th place. In 2006, 2008 and 2012, the fields of AI, Info, and database and data mining surpassed HPC, respectively, so it ended at the 8th place.Second, Graphics & HCI, as well as Network have become hot fields. The fields of Graphics & HCI, and Network ranked the same for the first time in 1982. After they reached their peaks in 1983 and 1986, respectively, their rankings began to decline slowly. And they got the same rankings again in the 1990s, when they were in their troughs. However, since 1995, the two have grown rapidly and succeeded in occupying the top two places in the twenty-first century.Third, Software and Theory are neck and neck. Although their starting points are sharply different, since 1983, the proportion of cumulative number of citations in Software and Theory has been very close to each other. The former performed slightly worse than the latter from 1983 to 1989, while from 1989 to 2003, the latter was overtaken by the former, but the gap was not huge. The field of Theory gained a weak leading edge again from 2003 to 2006. And from 2006 to 2018, the field of Software was slightly better.P), the number of self-citations ), the number of other-citations ), the number of other-references ), and citation rate ). The publication and citation of papers in eleven most representative journals of computer are shown in In order to understand the development of different computer journals, we extracted the citation data of ScholarCitation from 1960 to 2018 to calculate 5 indicators for each journal: the number of published papers , CJC (founded in 1978) and JCIP (founded in 1986). The lowest are SS-I (founded in 1950), JCCS (founded in 1980), CS (founded in 1974) and JFCST (founded in 2007). It can be seen that the citation rate of a journal has little relation with its starting time.Second, there are differences in the composition of citations among different journals. In terms of the composition of citations, the journals with more self-citations than other-citations include JCAD&CG, AES, JCIP, JCCS, and CS. On the contrary, the journals with more other-citations than self-citations include CJC, JCRD, and JS. From the analysis above, the significance of the three most representative Chinese journals  of computer science can be inferred.Third, there are differences in citation preference among different journals. In terms of citation preference, JCAD&CG, AES, and JCIP prefer to cite their own papers, while JFCST, JCCS, and CS prefer to cite papers from other journals.Cumulative citation of a target journal J in a period T is the sum of citations of target papers published by J in T, which is denoted as Ced. In order to compare the differences of citations of different journals, we introduce the concept of proportion. Proportion of cumulative citation of a target journal refers to the ratio of cumulative citation of the target journal to that of all journals. In order to further analyze the historical development of each journal, we use the indicator of the proportion of cumulative citation of different journals. Chinese Journal of Computers, AES, JS, JCRD, and JCAD&CG. These five outstanding journals fall into two categories: stably developing veterans and rapidly rising stars.As is shown in The first is the stably developing veterans. From the perspective of rankings, the performance of journals established for a long time are relatively stable. Except being overtaken by JS in 2009-2012 and 2016-2017, CJC (founded in 1978) and AES (founded in 1962), have consistently ranked in the top two. As for JCRD, founded in 1982, it held the third place till it was overtaken by JS in 2006, and has ranked the fourth since then. However, it is worthy to mention that according to the numeric value of proportion of cumulative citation, CJC and AES show a downward trend.Then there are the rapidly rising stars. After 10 years' hard work, JCAD&CG (founded in 1989) and JS (founded in 1990), both developed rapidly in the twenty-first century. The former has been in the top five since 2003, and the latter has been in the top three since 2006. JS even surpassed AES, obtaining the second place.Cumulative citation score of a target institution I in a period T is the sum of the citation scores of target papers published by the corresponding institution in T, which is denoted as CS. To compare differences between cumulative citation scores of various institutions, we introduce cumulative citation score proportion, which refers to the ratio of cumulative citation scores of the target institution to that of all institutions. + or A on Computer Science and Technology in the 4th round of subject evaluation conducted by Ministry of Education of China.As is the case in citation analysis based on fields and journals, in order to analyze the historical development of each institution, the proportion of the cumulative citation score of each institution will be analyzed below. CAS tops the list. From 1979 to 2018, cumulative citation score of CAS has always been the highest one, leaving institutions in the second place far behind. However, in terms of numerical value, cumulative citation score proportion of CAS fluctuated, descending from 1979 to 2002, increasing from 2002 and 2008 and achieving stability at around 36% from 2008 to 2018. High ranks of CAS mainly attributes to its sheer size. As a whole, ranks of institutions have remained stable since the twenty-first century, especially in the last decade.It can be inferred from +, A, A\u2212, B+, B, C+ are 4, 7, 12, 24, 24, 26, respectively. An institution is accurate-evaluated if it receives an A+ in the assessment conducted by Ministry of Education, and ranks No.1~No.4 after our calculation. We calculated the accuracy of each rating according to the definition above.For each institution, we calculated its ranking of average citation score in the last 10 years and compared the rankings with the assessment in the 4th round of subject evaluation conducted by Ministry of Education of China on Computer Science and Technologyare consistent with the evaluation results of Ministry of Education of China.SS-I, target journals are all included in Cross citation analysis is based on journal-field. Generally speaking, in terms of the subject of computer science, papers collected by English journals are focused on a certain field, while Chinese journals tend to be more comprehensive. That is to say, a journal may include target papers from multiple fields simultaneously. Similarly, target papers in a particular field may be distributed among different journals. most representative Chinese journals of computer science present a situation of tripartite confrontation and are typical comprehensive journals. As a consensus, three most representative Chinese journals of computer science are CJC, JS, and JCRD. They show strong performance, occupying at least two of the top three positions in all fields except Graphics & HCI. Secondly, journals oriented to specific fields to some extent represent the authority of their own fields and are typical characteristic journals. For instance, JIG and JCAD&CG win the top two in the field of Graphics & HCI, while JCIP is the leader in the field of Info.From the analysis of Based on citation relationships collected in ScholarCitation system, we conduct a citation analysis of Chinese journals in the field of computer science with a time span of 60 years. As a whole, Chinese papers in the field of computer science shows a trend of \u201chigh quality in small amount.\u201d The number of papers increased and then decreased in the last decade. However, the number of citations showed an overall growing trend. Merely considering self-citation, Chinese scholars tend to cite papers in English.Three most representative Chinese journals of computer science present a situation of tripartite confrontation and are typical comprehensive journals. They show high coincidence of cooperative institutions and cooperate closely with multi-cooperation institutions. As for characteristic journals, they to some extent represent the authority of their own fields and pay more attention to the dominant institutions in their own fields.Development trends of different fields and institutions differ. The development of Architecture slowed, while Graphics & HCI, and Network developed into hot fields. In terms of institutions, ranks of institutions have remained stable since the twenty-first century, especially in the last decade.Journals, institutions and scholars should strengthen their cooperation, working to improve the quality of papers together. More analysis should also be conducted on literature in non-English languages to boost diversity.The datasets generated for this study are available on request to the corresponding author.All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "Replication and cross-validation of research findings across independent longitudinal studies is essential for a cumulative science. However, the interplay between harmonization, replication, and generalizability of results across interdisciplinary longitudinal studies can present remarkable challenges. Careful interpretation of multistudy results must include consideration of the age, birth cohort, health, and education of individuals in the sample, measurements, the number and spacing of assessments, and rates of response and attrition. Placed in a broader historical (or future) context, we must consider the representativeness of population sampling, historical period, and analytic method in understanding the replicability and generalizability of findings. In a multistudy context, harmonization can be considered at levels of research question, statistical models, and measurements and can minimize some sources of cross-study variability. I will discuss the challenges and benefits of harmonization and the coordinated analysis approach used by the IALSA research network to achieve results from multi-study integrative research."}
{"text": "The involvement of psychological factors in the etiology of chronic diseases is rousing the interest of the scientific community (Conversano, Psychodynamic research has highlighted the role of personality in the development and progression of psychopathological and organic diseases (Price et al., One aspect of personality commonly studied in patients with chronic diseases is alexithymia, which is defined as the inability to distinguish between emotions, thoughts, and physiological responses to stimuli. Alexithymia has been found to be associated with several medical conditions (Lumley et al., per se and its influence on individual psychological well-being has been widely documented (Alonzo, Among other factors which contribute both to the onset and to the course of chronic illness, stressful life events are involved in the pathogenesis of both psychological and organic diseases (McFarlane,  Alonzo, . Researc Alonzo, . Accordi Alonzo, , confirm Alonzo,  as well  Alonzo, .the opportunities provided by bioscience and computational psychiatry to creatively explore and assess the value of protocol-directed combinations of specific treatment components to address the key problems of individual patients\u201d (Fonagy, Taking these findings together, we assume that psychological and organic issues are intercorrelated and a comprehensive understanding of chronic medical conditions should consider all aspects of the illness (Yoo and Ryff,  Fonagy, .CC and MD contributed in equal part to the development, conceptualization, literature review, and writing of the manuscript. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "Dear Editor,The presence of recurrent skin lesion outbreaks in intertriginous areas and lower extremities, during years of evolution, may be a presenting form of necrolytic migratory erythema (NME), which is a paraneoplastic skin disease that is associated with malignant glucagonoma in 90% of cases.This report presents the case of a 59-year-old woman with a history of keratoconjunctivitis, asthenia, and constipation. She was referred to evaluate recurrent skin lesions with four years of evolution. She was affected by erythematous, scaly plaques and hyperpigmentation in the legs, gluteal area, groin area, thighs, and elbows, with no associated systemic symptoms . She proWith the suspicion of NME and high levels of glucagon, an abdominal CT scan was made showing a 4\u202fcm mass in the pancreas, and the presence of a malignant glucagonoma was confirmed by pathological anatomy. The skin lesions completely resolved after tumor resection. However, one year later she developed liver metastasis with no recurrence of skin lesions.etc., NME may be the first and only glucagonoma symptom.Although malignant glucagonoma may be accompanied by systemic symptoms such as diarrhea, weight loss, newly developed diabetes, normocytic anemia, zinc deficiency, or fatty acid or amino acid deficiency, None declared.In\u00e9s Gracia Darder: Approval of the final version of the manuscript; conception and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; participation in study design; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.Daniel Ramos: Approval of the final version of the manuscript; conception and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; participation in study design; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.Juli\u00e1n Boix Vilanova: Approval of the final version of the manuscript; conception and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; participation in study design; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.Ana Francisca Bauz\u00e1 Alonso: Approval of the final version of the manuscript; conception and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; participation in study design; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.None declared."}
{"text": "The article presents, in a clear, concise manner, the main concepts, such as digital imaging, segmentation, extraction/selection of relevant features, artificial intelligence (AI), machine learning, deep learning, neural network, computer-aided diagnosis, content-based image retrieval, radiomics, and radiogenomics, introducing the reader to these new \u201c-omics\u201d that we will have to deal with on a daily basis in the near future.The article \u201cArtificial intelligence, machine learning, computer-aided diagnosis, and radiomics: advances in imaging towards to precision medicine\u201d by Koenigkam-Santos et al.In recent decades, the field of radiology and diagnostic imaging has been influenced by new technologies that have led to changes in the way radiologists practice their specialty. Notable among such technologies are digital imaging and picture archiving and communication systems (PACS), which have completely modified the reporting of imaging examinations and have allowed large numbers of images to be stored. This large amount of qualitative (imaging) and quantitative data is what constitutes the \u201cBig Data\u201d of medical imaging.,3. In addition, online database sharing and competitions such as those organized by Kaggle have facilitated the development and testing of new algorithms, accelerating their enhancement.In recent years, the development of AI, the increased access to powerful computers, and the large accumulation of data have resulted in great advances in the field of radiology and diagnostic imaging. Many of those advances, such as cell phone use, have enabled social progress and changes in quality of life. In AI, the advance of machine learning algorithms, especially deep learning and neural networks, has allowed the development of powerful computer science tools. Some emblematic examples were victories by the \u201cmachines\u201d over champions in games like chess and Go-10. In the field of dermatology, a cell phone application has been developed to differentiate melanomas from other skin lesions and has been shown to have the same accuracy as that of a group of dermatologists. In the field of pathology, algorithms such as those developed by Liu et al. have been shown to have greater sensitivity for detecting tumor cells in histopathological specimens than do human pathologists. In the field of ophthalmology, studies on the detection and classification of diabetic retinopathy have demonstrated the clinical application of AI in the diagnosis of retinal lesions.The evolution of deep learning involving neural networks has been followed with great interest, and deep learning has changed many aspects of our daily lives; it is sure to revolutionize health care as well. The idea that its impact will be pronounced, likely transforming daily clinical practice in fields such as radiology, pathology, ophthalmology, and diagnostic ophthalmology, has been supported by the results of a number of scientific articles, demonstrate the desire on the part of radiology societies to participate in the development of AI instruments for imaging diagnosis. In the field of imaging, there are several potential applications for AI, such as in patient flow algorithms, in the definition of image protocols, in the generation of synthetic images, in quality control, in radiation dose control, in computer-aided diagnosis, in automated lesion detection, in automated interpretation of findings, in radiomics, and in radiogenomics, which could result in great changes in radiology practice.In the field of radiology, competitions involving the use of AI at annual meetings of the Radiological Society of North America-for bone age definition in 2017 and for the diagnosis of pneumonia in 2018-as well as the launch of a journal focusing specifically on AI in radiology introduce concepts that promote a deeper understanding of this new era.Change is coming, and we radiologists, who have always had our activities closely linked to evolving technologies, should all be aware of AI, which could allow us to put into practice the concepts of precision medicine and personalized medicine. Review articles like the one authored by Koenigkam-Santos et al."}
{"text": "With the incidence and prevalence of COVID-19 disease, health, social, and economic considerations need to be reviewed and redefined. Since this pandemic, even more severe and pervasive than the First and Second World Wars, has disrupted the world\u2019s social systems and economic structures, many well-known concepts and disciplines in the social health sciences need to be adapted. Changes in many professions, industries and economic resources have undoubtedly made new demands on social health.Adherence to the principles of individual ethics, professional ethics, and social ethics, attention to social media , sustainable development, social justice, prevention of violence , vigilance and active management of international institutions  in preventing wars between governments, equitable distribution of food resources, preventing the increase of non-communicable diseases  are among the urgencies of government and global management.Here it is necessary to mention a group of disciplines discussed in social health ."}
{"text": "Walter Everaerd, former President of the International Academy of Sex Research, World Association for Sexual Health (WAS) gold medalist, and internationally acclaimed sex researcher, died on October 4, 2019, at the age of 82. Walter had been suffering from bladder cancer for several years. He is survived by his wife Bets, his three children, and eight grandchildren.Walter was a pioneer in experimental sexology in the Netherlands. At the age of 21, after two years of military service, Walter began his studies at Utrecht University, where he specialized in the new and promising fields of experimental clinical psychology and psychotherapy. In an academic environment that was at the time mainly oriented toward psychoanalysis and introspection as scientific methods, Walter approached clinical problems as an experimental psychologist and behavioral therapist. He became a full professor in Psychology at the age of 37 at Utrecht University, and he moved to the University of Amsterdam 12\u00a0years later. Over the years, with his students and collaborators, he received numerous grants in fields as diverse as symptom perception, interoception, vaginismus, sexual arousal, stress and health, cancer, asthma, and traumatic memory. Walter\u2019s contributions to the field of sexology, both theoretically and experimentally, have significantly changed and advanced how we define sexuality and treat sexual problems. Influenced by Walter\u2019s work, the field of sexuality has now moved away from drive and libido as the main explanatory constructs for sexual response and sexual expression toward information processing models of sexual response. Walter was the first scholar to propose that sexual arousal should be considered an emotion. Also, current views and knowledge of sexual desire and sexual arousal problems, as reflected by the DSM-5, have, in more direct and indirect ways, been informed and inspired by Walter\u2019s theoretical and experimental work.Walter was a modest and kind man who took his task as an academic mentor as seriously as his scientific endeavors. He mentored almost 60 Ph.D. students, many of whom became full professors. It is probably no exaggeration to say that he raised several generations of Dutch sexologists. His former Ph.D. students include Stephanie Both, Peggy Cohen-Kettenis, Joost Dekker, Jos Frenken, Luk Gijs, Erick Janssen, Bram Kuiper, Ellen Laan, Anne Oldenhave, Theo Sandfort, Mark Spiering, Arno Toorians, Adriaan Tuiten, Daan van Beek, Janneke van der Velde, and Jacques van Lankveld. Walter was honorary member, scientific program chair, and host and president of several national and international psychological and sexological societies, including the International Academy of Sex Research. He also served as department chair and as a board member and chair of various university bodies and national organizations, such as the Dutch Association for Gay and Lesbian Studies and the Dutch Health Council. He was the recipient of many awards, including the Heymans Award of the Dutch Psychological Association, the Sexologist of the Year Award of the Polish Academy of Sexology, the van Emde Boas\u2013van Ussel Award of the Dutch Society of Sexology, and the WAS Gold Medal.We are grateful for Walter\u2019s many contributions, and we will miss him dearly."}
{"text": "Safe community is based on four principles: safety belief, knowledge of the proper use of safety devices, access to safety requirements and respect for the rules, and safe driving is one of its axes. According to the World Health Organization s annual report for 2015, more than 1.25 million People die because of traffic accidents worldwide, and the eighth cause of death in the world is the leading cause of death in the age group of 15-15 years. This study was carried out to promote the safe community based on traffic accident analysis in the age group under 19 years old in Iran.This study was conducted through document review, reassessment of documents, data from the World Health Organization, Death and Immortality of Iran, and the Forensic Medicine Organization.According to the statistics, in 2016, there was a change in the pattern of injuries in adolescence, and the first three priorities were changed to traffic accidents (32%), fall (16%), poisoning and violence (5%). Is. The study of the 10-year trend of traffic accidents in three types of pedestrians, motorcyclists and motorcycles shows that the age group of 15-19 years old males in all three levels is in the number of injuries. In the traffic accident cases, the pattern of injuries has changed. Despite the fact that 34.5% of the victims of the incident belonged to the age group of 19 to 15 years old, it was ranked second in the age group of 19-15 years old. The major causes of driving accidents in the age group of 19-15 years were not having a driving license, mental and emotional state, non-use of seat-belts, imagine the ability to control a car or engine, dramatic movements during driving and Lack of attention to driving directions which could be prevented.All organizations involved in traffic safety and the safe community should focus on providing cultural, educational, and empowering age groups with the explanation of the areas of technical, scientific, educational and research services and the design of safety promotion interventions. Preventive strategies should be employed at three primary, secondary and tertiary levels.Safe community, Traffic Accidents, Prevention, Child and Adolescent"}
{"text": "Drs Kahleova, Alwarith, and Rembert, as employees of Physicians Committee for Responsible Medicine, were involved in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The research team of the Physicians Committee for Responsible Medicine had full autonomy in all aspects of the study.\u201d This article has been corrected.In the Original Investigation titled \u201cEffect of a Low-Fat Vegan Diet on Body Weight, Insulin Sensitivity, Postprandial Metabolism, and Intramyocellular and Hepatocellular Lipid Levels in Overweight Adults: A Randomized Clinical Trial,\u201d"}
{"text": "The levels of obesity in the general population are reaching epidemic proportions. Over the last 40\u2009years, the prevalence of obesity in the United States has tripled, and the World Health Organization estimates that 650 million individuals worldwide older than 18 years are obese. Although it has long been recognized that obesity is a key risk factor in the etiology of type 2 diabetes and cardiovascular disease, emerging evidence indicates that obesity is an adverse factor in the development and severity of many human cancers, including those of the breast and colon  was associated with reduced risk of obesity-related cancers, particularly endometrial cancer . LikewisThe current study by Meyerhardt and colleagues is a rare example of a trial that has examined the combination of metformin with an exercise intervention in the context of cancer. Although limited by the small sample size and relatively low compliance to metformin, the results conclusively demonstrate that the combination was most effective at reducing insulin, body weight, HOMA, and leptin in breast and colorectal cancer survivors, highlighting the potential utility of metformin and exercise in patient management and care in oncology. Of particular interest, in exploratory analyses there were greater effects of metformin, exercise, and especially the combination of the two on insulin, glucose, HOMA, and body mass index (BMI) in patients with higher baseline values for each of these variables. This implies that patients with the highest BMI, or those with the most severe metabolic dysfunction, may experience the greatest benefit of metformin and exercise and raises the possibility that stratification strategies based on those parameters may become instrumental in predicting response in future cancer trials of metabolic medications, weight loss, or exercise regimens. These findings emphasize the importance of incorporating standard patient characteristics, such as body weight, BMI, and blood insulin, in the design and execution of future clinical trials.It is estimated that by the year 2030, 50% of Americans will be considered formally obese . Given tAffiliations of authors: Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada ; Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada .The authors have no conflicts of interest to disclose."}
{"text": "To generate high-quality evidence, contextually relevant outcome measurement instruments are required. Quality of life evaluation among polio survivors typically involves the use of generic instruments, which are developed and validated among a different groups of people. There is no clear evidence whether these instruments are appropriate for the measurement of quality of life among polio survivors in northwest Nigeria. The purpose of this review is to identify and select a pre-existing instrument that is best suited for the measurement of quality of life among polio survivors in northwest Nigeria.Using the findings of a previous scoping review of the literature and qualitative descriptive study, we screened 11 quality of life instruments that are used in polio literature. We identified and selected the most appropriate instrument, which reflected the perspectives of polio survivors in northwest Nigeria and at the same time exhibited good measurement properties.The Quality of Life Index, World Health Organization Quality of Life Brief, and Comprehensive Quality of Life Scale are consistent with the perspectives of polio survivors in northwest Nigeria and have satisfactory measurement properties. Among these instruments, the Quality of Life Index satisfied most of the screening criteria we employed and is suitable for cross-cultural adaptation in northwest Nigeria.Most instruments that are employed to evaluate the quality of life of polio survivors were not primarily designed as a measure of quality of life. To select the appropriate instrument, there is a need to consider and reflect the perspectives of the individuals, to improve the validity of the measurement. Paralytic polio is a neuromuscular disorder, which is characterized by acute flaccid paralysis, especially in the upper and lower limb muscles, resulting from the destruction of motor neurons in the brainstem and spinal cord by poliovirus , 10. EviStudies have shown that in comparison with the general population, polio survivors frequently report poor health and quality of life (QoL) , 51, 64.QoL is an important outcome that can be employed to evaluate the unmet social and healthcare needs of individuals and also determine the success of various interventions , 48, 52.Development and validation of a new QoL instrument is exceptionally laborious. Hence, researchers suggest cross-cultural adaptation and validation of pre-existing instruments . One of In our previous review, we identified 11 instruments that have been employed to measure the QoL of polio survivors globally . Table\u00a01We conducted this integrative review using the findings of our previous studies: a scoping review of QoL assessment instruments among polio survivors  and a quThe screening of the instruments was done by two authors (SS and BK) to minimize bias and improve validity. We evaluated the characteristics of the instruments using the guidelines proposed by Bentzen and colleagues , and wheThe intent of the instrument refers to the aim of the instrument, which addresses the question: for what purpose was the instrument developed? It reflects the appropriateness of the instrument and the construct that the instrument purports to measure , 24, 32.Content suitability denotes the extent to which the instrument reflects the perspectives of the target individuals. For this review, we looked for reflection of the perspectives of polio survivors. Content suitability mirrors some aspects of validity since it capitalizes on the representation of the construct based on the individuals\u2019 perceptions , 24. We Psychometric analysis refers to the evaluation of the measurement properties of the instruments, based on evidence of reliability , validity , and responsiveness . We asseFeasibility refers to the burden, time, and resources required to administer, score, analyze, and interpret the instrument. It includes aspects such as comprehensibility, interpretability, cost of the instrument, completion time, mode of administration, etc. . We asseConsiderations in adapting the instrument for cross-cultural use deals with the core aspects of translation and adaptation of the instrument into other cultures . To admiTable\u00a0Of the 11 instruments we screened, only 5 instruments were solely designed for measuring QoL. These include the Quality of Life Index (QLI), Kaasa\u2019s Questionnaire (KQ), Quality of Life Profile (QP), World Health Organization Quality of Life Questionnaire- Brief (WHOQOLBREF), and Comprehensive Quality of Life Scale (CQS). For the remaining six instruments, five were designed to measure health status: Short-Form\u00a036 (SF-36), Nottingham Health Profile (NHP), European Quality of Life Instrument-Five Dimensions (EQ5D), Swedish Health-related Quality of Life Questionnaire (SWED-QUAL), and the Short-Form 12 (SF-12). While the last instrument, the Satisfaction with Life Scale (SWLS), was designed to assess global satisfaction with life.In terms of content suitability, only the QLI has items that reflect all the perspectives of the polio survivors, satisfaction of needs , happiness, spirituality, and self-perception . This is followed by the QP, WHOQOLBREF, and CQS respectively. The QP has items reflecting most aspects of satisfaction of needs  and happiness, and two aspects of self-perception, self-value and feeling independent. The items of the WHOQOLBREF reflect happiness and most aspects of satisfaction of needs and self-perception. The CQS has items reflecting the satisfaction of needs and happiness; however, the scale has no item that represents self-perception. The remaining instruments have at least one item reflecting happiness and some aspects of satisfaction of needs and self-perception. Surprisingly, none of the 11 instruments has any item that reflects spirituality except the QLI. Thus, only the QLI satisfies all the requirements of this feature.In terms of psychometric properties, the SF-36 has good evidence of six measurement properties , followed by the QLI , EQ5D , and WHOQOLBREF  each with five measurement properties. The NHP  and SF-12  have four adequate psychometric properties. The remaining instruments have at least three good measurement properties, except the QP, which has only evidence of adequate content validity. None of the instruments has evidence of measurement error  or cross-cultural validity . Thus, with the exception of QP, all the instruments have satisfactory evidence of good measurement properties.All the instruments are user-comprehensive. However, in terms of interpretability, only the SF-36, NHP, QLI, and SF-12 have both meaningful profile and indices scores. While the remaining instruments have either profile score or indices score. Most of the instruments can be self-administered, except the CQS, which requires administration by an interviewer. Besides, most of the instruments are available in the public domain; however, users require written permission for non-commercial use of the instruments. Most of the instruments take approximately 10 min to complete, except CQS which takes about 45\u2009min to complete. Thus, in terms of feasibility, all the instruments are feasible for application in northwest Nigeria.The QLI, KQ, QP, WHOQOLBREF, and CQS have more items that are relevant in the Hausa language compared to the remaining instruments because they are more consistent with the perspectives of polio survivors in northwest Nigeria. All the instruments have contents with semantic relevance in the Hausa language; however, some of the items of the instruments would require adaptation. Moreover, except for the WHOQOLBREF, none of the instruments have been adapted to the Hausa culture. However, the authors that translated the WHOQOLBREF did not provide information about how equivalence was established . Based oAs stated earlier, our goal was to identify and select the most appropriate QoL instrument for cross-cultural adaptation in northwest Nigeria. Specifically, we intended to select the instrument with the following features: primarily designed as a measure of QoL, consistent with the perspectives of polio survivors in northwest Nigeria, good measurement properties, feasible, and amenable to cross-cultural adaptation in northwest Nigeria. Subsequently, we identified and selected only instruments that have all or most of these characteristics. Based on the screening performance of the instruments Table , the QLIThe Quality of Life Index (QLI) was developed by Ferrans and Powers  to measuConversely, the World Health Organization Quality of Life Questionnaire-Brief (WHOQOLBREF) is an abbreviated version of the WHOQOL-100, which was developed cross-culturally by the World Health Organization Quality of life Group . The WHOOn the other hand, the Comprehensive Quality of life Scale (CQS) assesses QoL on both subjective and objective axes across seven domains, which include material well-being, health, productivity, intimacy, safety, place in the community, and emotional well-being . The CQSThis review aims to identify and select a pre-existing QoL instrument that is consistent with the perspectives of polio survivors in northwest Nigeria and at the same time exhibits good psychometric properties. The findings of this review show that the Quality of Life Index (QLI), World Health Organization Quality of Life\u00a0Questionnaire- Brief (WHOQOLBREF), and Comprehensive Quality of Life Scale (CQS) are consistent with the perspectives of polio survivors in northwest Nigeria and have satisfactory measurement properties , 56. TheThe QLI, WHOQOLBREF, and CQS were primarily designed for the measurement of QoL and have well-established evidence of good psychometric properties . In contTo apply the QLI, WHOQOLBREF, and CQS in the measurement of QoL of polio survivors in northwest Nigeria, there is a need to cross-culturally adapt and validate the instruments in the northwestern Nigerian context . GeneralOn the other hand, the item equivalence refers to the acceptability of the items of the instruments in the target culture . Here, tCross-cultural adaptation of outcome measurement instruments has many advantages over the development of a new tool. Cross-cultural adaptation is economically cheaper, less time consuming, and can produce equivalent instruments in various cultures for comparison , 9, 18. Finally, when applying the QoL instrument for cross-cultural adaptation, psychometric validation, or routine QoL evaluation, users should take response shift into consideration, in order to avoid paradoxical scores of QoL measurement. As pointed out earlier in the introduction, response shift can occur as a result of redefinition of the construct, when the individual readjust their priorities as a result of a life-changing event, environmental influences, and newly acquired coping strategies. Moreover, response shift could also ensue when the individual reprioritizes their values or change their internal standards of measurement through recalibration . VariousWe could not identify any study in the literature that integrates individuals\u2019 perspectives to select a QoL instrument that is similar to our process. Our approach to the selection of QoL instrument is based on rigorous recommendations and the perspectives of polio survivors (in northwest Nigeria), to select the most appropriate instrument available. Moreover, we considered critical aspects for cross-cultural adaptation and feasibility of the instrument in addition to psychometric properties. However, despite our effort to ensure rigor, this review has some limitations. For example, we did not assess client comprehensibility of the instruments, which could compromise possible self-administration of the instrument. Moreover, because our study was based on a previous scoping review, we may have not included other relevant QoL assessment instruments in our screening.Most instruments that are used to assess the QoL of polio survivors were not primarily designed for the measurement of QoL. Thus, it is pertinent to employ instruments that are specifically designed for QoL evaluation. To select a contextually relevant instrument, there is a need to consider and integrate the perspectives of the individuals. Our findings show that the QLI, WHOQOLBREF, and CQS are consistent with the perspectives of polio survivors in northwest Nigeria. Hence, these instruments could be used to evaluate the QoL of polio survivors in northwestern Nigeria and similar contexts. Although the instruments have demonstrated good measurement properties, we recommend the validation of the instruments among Nigerian polio survivors. Drawing upon the screening performance of the instruments, the QLI exhibits the following characteristic features: primarily designed as a measure of QoL, more consistent with the perspectives of polio survivors in northwest Nigeria, more evidence of good measurement properties, feasible, and amenable to cross-cultural adaptation in northwest Nigeria. Hence, we recommend the translation, cross-cultural adaptation, and psychometric validation of the QLI among polio survivors in northwest Nigeria. A rigorous protocol of cross-cultural adaptation such as the International Society for Pharmacoeconomics and Outcomes Research principles of good practice can be considered. Measurement of QoL among polio survivors in northwest Nigeria could provide the impetus needed to draw the attention of stakeholders toward addressing the unmet needs of the individuals. Therefore, to generate high-quality evidence about the QoL of the polio survivors, a culturally relevant and valid instrument is necessary; which researchers can produce using cross-cultural adaptation and psychometric validation techniques."}
{"text": "On the hundredth day since days since the WHO was notified of the first cases of \u201cpneumonia with unknown cause\u201d in China, the COVID-19 pandemic, caused by SARS-CoV-2, has spread throughout the world to 195 countries with over 1.5 million cases and more than 85\u2009000 deaths [The Government of the Republic of Croatia has established the National Civil Defense Headquarters in order to raise the level of preparedness of all the competent authorities, protect the health of Croatian citizens and coordinate all the services in the battle against SARS-CoV-2 in Croatia. The Deputy Prime Minister and Minister of the Interior was chosen to lead the headquarters, whose members are the Director of the Croatian Institute of Public Health, the Director of the Croatian Institute of Emergency Medicine, and the Director of the Dr Fran Mihaljevi\u0107 University Hospital for Infectious Diseases (UHID), who is also the President of the Croatian Society for Biosafety and Biosecurity. After the daily meetings, the headquarters issues press releases.Together with other public services, all the health care institutions were quickly mobilized in preparation for the battle against the COVID-19 epidemic, with the UHID taking the leading role, from the establishment of quarantine to being declared the National Hospital for COVID-19. The Minister of Health issued the decision to proclaim the threat of a COVID-19 epidemic as an administrative measure, which does not indicate the degree of the threat but permits the Minister to mobilize all the resources in the health care system, redeploying ID physicians, other health care workers (HCWs) and equipment, in order to improve the administration of the health care system.Unfortunately, what few had thought possible has come to pass. An infectious disease has transformed social and economic relations, as well as humanity as a whole, entering and altering every pore of society. Colleges and schools have closed their doors, students are attending classes from home, via television and computers, the majority of the public sector employees are working from home, while some, regrettably, have lost their jobs. The churches have also closed their doors.am by an earthquake of 5.5 magnitude on the Richter scale, followed in the next 24 hours by 57 aftershocks. Due to extensive property damage, several hospitals had to be evacuated, including the UHID, where there were 86 patients at the moment, including 22 COVID-19 patients, 15 of whom were in the ICU. This additional misfortune has jeopardized the safety of us all, especially the most vulnerable members of our society: children, the elderly and the sick. A total of 27 persons were injured during the earthquake, of whom one, sadly a 15-year-old girl, died of her injuries.At the end of the fourth week of the epidemic in Croatia, a total of 206 cases had been confirmed, with 49 newly diagnosed on 21 March 2020. When we thought that nothing worse could happen, on 22 March 2020, the citizens of Zagreb, the capital of Croatia, home to a quarter of the total Croatian population, were awakened at 6:24 We as HCWs were expected to remain clear-headed, gather all our strength, knowledge and skills, and provide our patients with the best of what was possible, and sometimes even the impossible. But we also remember the scene around our hospital buildings, where the old and young, staff and patients, corona-positive and negative, were scattered on the grass and the parking lot, shivering from the cold and fear.Nevertheless, we survived that, too, and we will continue to survive, even when faced with greater challenges. We have demonstrated and proven that we cannot do without one another: physicians without nurses, patients without HCWs, HCWs without non-medical and support staff, parents without children, and children without parents.In addition to property damage, we were quite apprehensive that the earthquake would accelerate the spread of the COVID-19 epidemic in Croatia since the earthquake, which left many homeless and fearful of earthquakes to come, triggered migrations to other parts of the country. However, six weeks since the first COVID-19 case and three weeks after the earthquake, only 1650 cases have been registered in Croatia  are major threats to humanity. Nevertheless, no one expected that a second misfortune, the earthquake, would occur during this pandemic in our little country.The subtitle of the previously cited article by \u010civljak et al. , What's All HCWs, including physicians, nurses, technicians, laboratory personnel, caregivers and other staff who come into contact with patients, are being directly or indirectly exposed to the infected and sick, which places them at risk. At the UHID, among 691 employees, only two have acquired SARC-CoV-2 infection in the post-earthquake period: one nurse and one ancillary worker. On the national level, no increase in the incidence of COVID-19 was experienced in the post-earthquake period, as shown in Moreover, owing to the chronic shortage of medical personnel throughout the entire health care system, particularly now when the demands are increasing, we are being expected to make great sacrifices in order to provide the best possible care to all citizens. An additional burden is that 216 HCWs in Croatia have COVID-19, while another 562 are in self-isolation at the moment. All of them are currently unable to perform their regular professional duties and the number may soon increase. The Minister of Health has stated that the health care system is not in jeopardy for now and the ministry is redeploying HCWs in order to fill the most crucial positions.Salmonella, chickenpox, or other infectious diseases in general [This third coronavirus epidemic underscores the need for the ongoing surveillance of infectious disease trends throughout the world. However, in combination with a natural disaster, such as earthquake, the risk for increasing the number of the infected, as well as outbreaks of other infectious diseases, is higher. As shown in the systematic review by Suk et al., cascading effects of post-disaster outbreaks are possible after earthquakes, such as outbreaks of  general .By now, due to a well-organized public health system and coordinated outbreak response, Croatia has overcome the current challenges, including extensive damage to hospitals, shortage of hospital personnel, and disruption of supply chains. We hope that everything done so far will provide the basis for stopping this epidemic in Croatia and mitigating the damage done from the COVID-19 epidemic and the recent earthquake."}
{"text": "We focused on medical informatics journal publications rather than on conference proceedings by comparing and analyzing the data from journals and conferences from a broader perspective. The aim is to summarize the unique contributions of China to medical digitization and foster more multilevel international cooperation.  In February 2019, publications from 2008 to 2018 in three major English-language medical informatics journals were retrieved through Scopus, including the journals, namely, International Journal of Medical Informatics , JAMIA (United States), and Methods of Information in Medicine . Three major Chinese-language journals, namely, China Digital Medicine (CDM), Chinese Journal of Health Informatics and Management (CJHIM), and Chinese Journal of Medical Library and Information Science (CJMLIS), were searched within the major three Chinese literature databases. The datasets were preprocessed using the NLP package on Python, and a smart local moving algorithm was used as a clustering method for identifying the aforementioned journals.  Between 2008 and 2018, the total number of published papers and H-index of the three English-language journals was 1371 and 67 (IJMI), 1752 and 86 (JAMIA), and 637 and 35 (MIM), respectively. In the same period, the total number of published papers and H-index in the three Chinese-language journals was 6668 and 23 (CDM), 1668 and 22 (CJHIM), and 2557 and 25 (CJMLIS), respectively. IJMI, JAMIA, and MIM received submissions from 82, 59, and 62 countries/regions, respectively. By contrast, the three Chinese journals only received submissions from seven foreign countries. The proportions of authors from institutional affiliations were similar between the three English-language journals  and CJMLIS because the majority of the authors were from universities , followed by medical institutions  or research institutes . Furthermore, the proportions of the authors from enterprises were low  for all journals. However, the authors in CDM and CJHIM were mainly from medical institutions (50% and 40%), followed by universities (33% and 32%) and research institutes (3% and 4%). In addition, the proportions of enterprises were only 3% and 2%, respectively. Among the top five authors in three English-language journals (ranked in terms of the number of published papers), 100% had doctoral or master's degrees, compared with only 60% in the Chinese journals. Additionally, 28204 different keywords were extracted from the aforementioned papers, covering 275 specific high-frequency key terms. Based on these key terms, four clusters were found in the English literature\u2014\u201cHealth and Clinical Information Systems,\u201d \u201cInternet and Telemedicine,\u201d \u201cMedical Data Statistical Analysis,\u201d and \u201cEHRs and Information Management\u201d\u2014and three clusters were found in the Chinese literature: \u201cHospital Information Systems and EMR,\u201d \u201cLibrary Science and Bibliometrics Analysis,\u201d and \u201cMedical Reform Policy and Health Digitization.\u201d Only two clusters are similar, and Chinese-language journals focus more on health information in technology and industrial applications than in medical informatics basic research.  This study provides important insights into the development of medical informatics (MI) in China and Western countries showing that the medical informatics journals of China, the United States, and Europe have distinct characteristics. Specifically, first, compared with the Western journals, the number of papers published in the journals of professional associations in the field of MI in China is large and the application value is high, but the academic influence and academic value are relatively low; second, most of the authors of the Chinese papers are from hospitals, and most of the counterparts in the Western countries are from universities. The proportion of master's or doctoral degrees in the former is also lower than that of the latter; furthermore, regarding paper themes, on the one hand, China MI has no theoretical and basic research on medical data statistics and consumer health based on the Internet and telemedicine; on the other hand, after nearly 10 years of hospital digital development, China has fully used the latecomer and application advantages in hospitals and, through extensive international cooperation, has made significant advancements in and contributions to the development of medical information. Medical informatics (MI) can be defined as the acquiring, storing, retrieving, and using of healthcare information to foster better collaboration among a patient's various healthcare providers , which oJournal of the American Association (JAMIA), is also included in the SCI.The establishment and development of a discipline rely on the foundation and support of a system, including relevant institutions and associations, mainstream auxiliary journals, and publications , for whiDifferent from MI in Western countries that developed from computer applications to medicine, MI in China evolved from medical library information science in the early 1980s. Along with the development of hospital digitization in China, this discipline did not become independent until 2010. To date, only a few educational institutions in China have established an MI institute or graduate courses , and the majority of participants are undergraduates . FurtherTo efficiently, accurately, and timely understand the research hot spots and developing trends of medical informatics, researchers have adopted bibliometrics to study the frontiers of MI from three aspects: academies, conferences, and journals. As for academies, V. Maojo et al. in 2012 reviewed the members attending three mainstream academies of MI, including Medical Informatics Europe (MIE) 2005\u20132008, MedInfo 2004, 2007, and 2010, and AMIA 2005\u20132009, and thought that the influence of these academies outside this discipline was very low . As for Under the framework of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) , We seleFirst, the English-language papers were searched on Scopus, which provided comprehensive preprocessed data from academic publications and has been accepted as one of the best databases for literature analysis . The seaMetadata of journals, including the names of journals, organization of the sponsors, organization of the publication, time of publication, period of publication, place of publication, and database of inclusionMetadata and contents of periodical papers, including the title; keywords; abstract; year of publication; citations of papers; and authors' names and education level, affiliations, and countryBecause all the databases had standard functions for data analysis and abstraction, we selected and imported the following information:Next, to maximize the effectiveness and accuracy of co-word analysis and data visualization, we preprocessed the target datasets. First, the titles and keywords of the included articles were standardized into lowercase, and the morphology and abbreviations were reproduced in Python 2.7\u2009+\u2009NLTK NLP . Second,The basic characteristics of the papers were analyzed with the built-in functions of Scopus, CQVIP, CNKI, and WanFang Data. The author affiliations were clustered using self-developed tool based on Python 2.7. The tool clusters the authors' affiliations into six categories: medical institutions, universities, manufacturers, research institutions, and others. The H-index was designed as a measure of scientific research impact , which iPapers published in MI journals between 2008 and 2018, including the three Chinese MI journals  and the three English MI journals , were analyzed both quantitatively and qualitatively. The basic information of each journal is listed in Supplementary Materials From the three mainstream Chinese-language databases, 6668, 1668, and 2557 articles between 2008 and 2018 were identified from CDM, CJHIM, and CJMLIS, respectively, with a total of 10893 and an annual rate of 990 articles. Using Scopus, 1371, 637, and 1752 articles were identified from IJMI, MIM, and JAMIA, respectively, with a total of 3760 and an annual rate of 341 articles. The number of Chinese-language papers was 2.89 times that of English-language papers, and the number of papers in CDM was 1.77 times that of the total number of English-language papers . The proThe academic influence of the professional MI journals is significantly different. JAMIA and IJMI are top-ranked journals, followed by MIM; however, the Chinese MI journals  are ranked much lower. JAMIA published 1752 papers between 2008 and 2018, which were cited 44051 times, with an average of 25.1 times per paper and an H-index of 86 . IJMI puWe compared similar statistics from the three Chinese MI journals, and the results suggest that the total citations of the three Chinese MI journals are slightly lower than that of IJMI (23184 vs. 26900) but far lower than that of JAMIA (44051), even though the total number of papers published by the three Chinese journals was 16.9 and 13.2 times those in IJMI and JAMIA, respectively.Similar to the country distribution of authors in the MI conference proceedings, the regional MI journals, including JAMIA  and MIM , and Chinese MI journals  were dominated by local authors, whereas the international journals such as IJMI  represented authors from various regions. Between 2008 and 2018, JAMIA published submissions from authors of 58 countries or regions, and the number of countries or regions with >10 manuscripts was 15; however, the majority of authors were from the United States (approximately 69%), followed by Europe (\u223c10%). By contrast, the proportion of the authors from China  was only 4%. MIM published submissions of the authors from 62 countries or regions, and the number of countries or regions with >10 manuscripts were 21. However, most authors were from Europe (approximately 63%), followed by the United States (about 16%), and the proportion of authors from China  was only 2.4%. IJMI published submissions from the authors of 81 countries or regions; the number of countries or regions with >10 manuscripts was 28; and approximately 27%, 40%, and 6% of authors were from the United States, Europe, and China , respectively. The Chinese MI journals  were less internationalized because publications by foreign authors were only from Japan, Canada, the United States, South Korea, the United Kingdom, Netherlands, and Germany. The affiliations and academic backgrounds of the authors were largely different among journals. The proportions of different affiliations were similar between the English-language journals  and the Chinese journal CJMLIS because the majority (>50%) of authors were from universities , followed by medical institutions  or research institutes . Furthermore, the proportions of enterprises were low  across all journals. However, the authors in CDM and CJHIM were mainly from medical institutions , followed by universities  and research institutes , and the proportions of enterprises were only 3% and 2%, respectively . These dWe further assessed the top five authors in each journal and analyzed their affiliations and academic and knowledge backgrounds  and Chinese MI academic journals  because the majority of authors had no background in clinical medicine. Of the top five authors in IJMI, one had an MD, four had doctoral degrees, and all were from universities. Among the top five authors in CDM, one had a master's and doctoral degree, three had doctoral degrees, and two had master's degrees. Furthermore, two were from medical institutions and three were from institutes.We also observed some differences because the top five authors from IJMI, MIM, and JAMIA all received professional academic training in MI; however, the top five authors in the Chinese MI academic journals mostly did not receive this training; usually were from the computer, public health, statistics, library science, or informatics fields; and only became involved in MI after employment.The purpose of the keyword selection and analysis is to identify the focal points of research that have been confirmed as a major step in monitoring the development and trend of a discipline . Here, tg-index [The frequency distributions of the keywords were largely different between the Chinese- and English-language MI journals, which led to differences in the high-frequency word selection methods. To simplify the selection and analytical process and to decrease unnecessary interference from low-frequency words, we selected high-frequency words. However, no unified method is available to determine the critical levels of high-frequency words, and the available methods include the subjective empirical method, 80/20 rule , Price'sg-index , and higN1 is the number of keywords with one word frequency and T is the frequency threshold of high-frequency words.To select the appropriate frequency threshold, we first observed the frequency distributions of keywords in the six MI journals and found that the repeated rates of keywords were low in papers from Chinese MI journals compared with those in the international high-quality and mainstream MI journals . Namely, many keywords occurred once, and the rate of these words was 20% higher than those in the English-language papers, which limited the applicability of the high/low-frequency word isolation method based on Zipf's law. Specifically, the threshold value was slightly larger, and too few high-frequency words were intercepted. After multiple trials, we adopted different high-frequency word threshold computation methods according to the characteristics of English-language and Chinese-language papers and used Donohue's method  based onFor the Chinese papers, according to the 80/20 rule , high-frAnalysis of keywords can indirectly reveal the hotspots and changing trends in research topics, which is critical for understanding the development of this field . Next, wThe results showed the keywords from the English-language MI journals were reorganized into four clusters, which we named (1) \u201cInternet and Telemedicine\u201d (yellow), (2) \u201cHealth and Clinical Information Systems\u201d (blue), (3) \u201cMedical Data Statistical Analysis\u201d (green), and (4) \u201cEHRs and Information Management\u201d (red). Notably, our clustering results were supported by Kim et al., who mined the abstracts and texts from the articles published in 23 English-language MI journals within 12 years . Only thThe results of the clustering are presented in Figures We previously analyzed the MI conference proceedings in China, the United States, Europe, and IMIA and found that MI research in China was largely different and lagged behind other developed regions in terms of academic evaluation, multisource cooperation, talent pool and quality, focal points, trends, and research investment . In thisMI as an emerging interdisciplinary field has not been set within a specific category in the WOS but has a similar category\u2014Medical Informatics\u2014involving 25 journals. JAMIA (the 2017 impact factor: 4.27), IJMI (the 2017 impact factor: 2.95), and MIM (the 2017 impact factor: 1.53) rank as 3, 6, and 17, respectively. In particular, JAMIA has been highly approved by the Academic Committee of China Computer Society, listed by the China Computer Society as a key recommendation, is a well-known and highly reputed journal in the cross-disciplinary/comprehensive/emerging field, and encourages submissions from Chinese counterparts .However, China has no authorized MI journal or any MI journal included in SCI, EI, or Medline. We believe that this may be related to the academic levels of these journals. Of the three authorized MI professional journals, the H-indices of CDM, CJHIM, and CJMLIS are 23, 22, and 25, respectively, which are less than half that of IJMI and are 70% that of MIM. However, they are slightly higher than that of MEI and the MedInfo proceedings (H-index of both: 19) and lower than that of the AMIA Annual Symposium (H-index: 32) . FurtherIJMI, MIM, and JAMIA, as authorized academic journals in MI, have attracted submissions from academic researchers and industrial workers worldwide; however, the Chinese MI journals  have received submissions from only seven foreign countries. However, in the IJMI, MIM, and JAMIA journals, the proportion of Chinese authors  did not exceed 6%, which implies gaps in MI development in China.China has an insufficient talent pool for MI and has no continued support from existing educational institutions for the advancement of industrial development, which is stated as \u201ccold in academic research, (and) incorporate(s) hot in industrial application\u201d . The autSuch a difference in author characteristics between the Chinese journals and journals from other regions is because of the distinguished developmental environment for MI in China. In 2009 in China, HIT was considered one of the \u201c four beams and eight pillars\u201d of the new healthcare reform , and MI EMR Function Grade Specification issued by the National Health Commission of China in 2015, telemedicine was already included in EMR [EN-Cluster 1 (\u201cInternet and Telemedicine\u201d): this cluster results from the introduction of the Internet into the medicine field and is based on extensive research on diabetes and family care through the Internet, telemedicine, and other techniques and through questionnaires. Surprisingly, telemedicine in Europe and the United States has formed an independent system, but in China telemedicine belongs to the cluster \u201cHospital Information Systems and EMR\u201d and is an important part of hospital information systems (HIS) and a supplement to out-hospital continuity of medical services to patients. We posit that this situation may be related to the \u201cdigital hospital\u201d policies in China. On the one hand, in the d in EMR ; on the d in EMR .EN-Cluster 2  and CN-Cluster 1 (\u201cHIS and EMR\u201d): clinical informatics , especiaEN-Cluster 3 : this cluster is exclusive to the English-language MI journals and involves abundant content related to theoretical models, including the topics associated with medical information methodology, artificial intelligence, natural semantic processing, and data mining software and systems.EN-Cluster 4 (EHRs and Information Management): this cluster is also exclusive to the English-language MI journals and describes an important aspect of MI. We posit that this also means that EHRs have gradually become a widely approved and accepted concept. The European and US researchers are focusing on technical issues of EHRs. Notably, EHRs are not present in the high-frequency keyword list in China; nevertheless, its in-hospital version\u2014EMR \u2014is the cCN-Cluster 2 : this cluster is exclusive to the Chinese-language MI journals, and its research and application are concentrated in medical information research; medical information resources construction, retrieval, and services; and other health information management and evaluations. We posit that this occurs because the development of MI in China originated from library science in the mid-1980s, and this narrow sense of MI continues to account for a large proportion in China.CN-Cluster 3 : this cluster is exclusive to China and involves the propaganda, interpretation, analysis, and comments of HIT policies issued by healthcare reforms and government functional departments.In Figures As an independent discipline, MI has been widely accepted in Europe and the United States. To date, greater than 80 US-based academic institutions offer on-site or distance MI training programs . AdditioThis study provides notable contributions to theory and practice.From the theoretical perspective, first, this study further enriches and improves the knowledge of global MI literature research; in particular, for the first time, this study adds the analysis of Chinese MI journal literature. On this basis, our comparison of bibliometrics between three representative official English journals of the international MI societies and three Chinese journals of the national MI societies overcomes the limitation that some bibliometrics research in the field of MI has mainly focused on English-language literature , 42, 48.Second, we explore the differences in authors between those in China and Western countries in their organizations and academic degrees. We find that on the one hand, most of the authors of Chinese papers are from medical institutions, and most of their counterparts in Western countries are from universities. The proportion of doctoral or master's degrees in the former is lower than that in the latter. By contrast, China's MI is mainly based on the traditional medical literature system, and the trainees are mainly undergraduates. Therefore, the education level and faculty's strength are far behind their counterparts in Europe and the United States. Thus, we suggest that China's MI field should establish and improve the education system of medical informatics, strengthen the training of faculty by sending teachers and researchers to study abroad, introduce advanced educational concepts of medical informatics, and employ teachers from different professional backgrounds to participate in the teaching, to improve the teaching environment and curriculum selection for students. Furthermore, for the first time, we explore the differences in the themes of the papers published in the mainstream Chinese and English MI journals during the past 11 years. On the one hand, China has fully used the latecomer advantage and application advantage in hospitals, especially the extensive implementation and application of EMR ; on the Third, this study has extended our previous research about the academic proceedings published by main academies of MI , 5, 8 anBecause discipline evaluation is a complicated task, we assess papers published in journals. Moreover, we use data from representative professional journals on MI in both China and Western countries but exclude all MI journals, use a limited number of searching tools to find other professional publications, and exclude achievements of patents or other forms. Furthermore, many achievements in MI may have been published in non-MI journals, but we have no perfect method or mechanism to include these papers; however, we intend to analyze these papers in subsequent studies.We used bibliometrics to analyze Chinese- and English-language MI papers published in six representative MI journals between 2008 and 2018 in China, the United States, and Europe. The results of this study provide important insights for the development of MI in China and Western countries. First, compared with the Western counterparts, the number of papers published in the journals of professional associations in the field of MI in China is large and the application value is high, but the academic influence and academic value are relatively low; second, most of the authors of the Chinese papers are from hospitals, and most of the counterparts in the Western countries are from universities. The proportion of master's or doctoral degrees in the former is also lower than that of the latter; further, regarding paper themes, on the one hand, China MI has no theoretical and basic research on medical data statistics and consumer health based on the Internet and telemedicine; on the other hand, after nearly 10 years of hospital digital development, China has fully used the latecomer and application advances in hospitals and, through extensive international cooperation, has made significant advancements in and contributions to the development of medical information."}
{"text": "Real-time cell analysis (RTCA) is a technique based on impedance and microsensor electrodes. RTCA system allows label-free, real-time, and continuous monitoring of cell adhesion, morphology, and rate of cell proliferation. The system offers a wide range of applications, mainly in toxicological studies, new drug screening, and microbiology. Here, we describe the usefulness of the system in different applications and compare this technology with conventional endpoint assays based on tetrazolium salts. We present advantages and disadvantages of the system and endpoint methods and their limitations in cytotoxicity investigations. Thus, the CI is a reflection of overall cell number, adhesion quality, and cell morphology, which can change as a function of time .,94.42,94Determination of cell numbers is a crucial step in studies focused especially on cytokinetics and cell toxicity . The conThe application of RTCA system in cytotoxicity tests should also be considered when drugs containing additives such as: sorbitol, lactate, and sodium hydroxide are studied . These cDespite the disadvantages of the endpoint assays and RTCA system, both methods are reliable and suitable in cytotoxicity investigations, and they generate mostly comparable results. Braicu and Gherman investigated the effect of epigallocatechin gallate in triple-negative breast cancer cells (Hs578 T). The dynamic real-time monitoring of the cells treated with the compound confirmed the antiproliferative effects obtained by MTT test . VistejnIn spite of more and more use of the RTCA technology, the main limitation of this system is the cost of experiments. E-plates are expensive, single use, and disposable. However, some authors indicate that E-plates can be regenerated and reused several times without significantly affecting experimental results ,. Other The characteristics of the RTCA technology and endpoint assays are presented in 4in vitro studies, especially in the need to confirm the RTCA results.The real-time cell analysis system is a modern and useful technique applied in many areas of research. Despite high costs of experiments and some limitations, the system provides a high throughput and quantitative method for continuous and real-time monitoring of cell proliferation and cellular morphological changes. The system is used in pharmacological, toxicological, and microbiological studies, mainly to evaluate cytotoxicity of new drugs and improve the effects of different therapies. However, it is worth emphasizing that classical endpoint assays, due to low cost and simplicity, will still be widely applied as basic methods in many The authors declare that there is no conflict of interest regarding the publication of this paper."}
{"text": "The countries of Central Asia and the Caucasus are linked by travel and trade, which is promoted by visa-free mobility across borders. Unfortunately, this migrant mobility has given rise to the transmission of various infections within this region. Overlaps in culture, tradition, and behavior among these countries provide opportunities to share experiences that have proven effective in controlling transmission. Here we present a review of hepatitis B virus (HBV) prevalence, prevention and treatment across Central Asia and the Caucasus. Overall, owing to effective measures, while HBV prevalence has been steadily declining in the region, certain gaps still exist regarding the generation and availability of HBV infection data. Following the collapse of the Soviet Union in 1991, 15 countries gained independence: Armenia, Azerbaijan, Belarus, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Moldova, Russia, Tajikistan, Turkmenistan, Ukraine, and Uzbekistan  Figure . CountriIn this article, we provide an overview of the prevalence, control, and treatment of hepatitis B virus (HBV) infection among the nine countries of Central Asia and the Caucasus. We review the policies implemented by the governments for the prevention and treatment of HBV, and highlight areas that have worked in certain countries and may be adapted by others.The prevalence of hepatitis B infection in Armenia significantly increased from <2% to 8% between 2000 and 2007 ,7. This As a bloodborne pathogen, HBV transmits readily through injection needles and blood transfusions. The safety of donated blood and its products is ensured by implementation of rigorous screening protocols by the blood banks . AccordiIn Armenia, the HBV vaccine was introduced in 1999, and the birth dose was instituted the same year . The vacWith the exception of Georgia and Turkmenistan, for all the countries of Central Asia and the Caucasus, clinical guidelines for the treatment of HBV infection are either available online or in the report of the Alliance for Public Health  Table 4Table 4. Overall, in Central Asia and the Caucasus, the prevalence of HBV and associated co-infections has been declining, owing to rigorous implementation of vaccination, treatment, and blood donor screening protocols. Thorough and large-scale surveys are key to recording evolving trends in the prevalence and transmission of infections. While regular surveys are being carried out by countries such as Armenia, Azerbaijan, Georgia, and Kazakhstan, certain exceptions still exist. Another area of focus is to enhance public accessibility of the information related to data, as well as policies regarding HBV infection and its control. For the prevalence of HBV single and co-infection, information was readily available from Azerbaijan, Georgia, and Kyrgyzstan, while from the rest of the countries this information was either partially available or unavailable. Additionally commendable is the full disclosure of information regarding blood-screening protocols by Kazakhstan, Kyrgyzstan, the Russian Federation, and Tajikistan. It appears, therefore, that in certain countries the information, while it may exist, is not readily available for review or scrutiny, compromising the transparency of the process."}
{"text": "Social isolation and loneliness have profound implications for quality of life and health and welfare budgets, but interventions to reduce loneliness are limited effective. The aim of this study is to examine the often-ignored impact of macro-level drivers of loneliness, in addition to micro-level drivers by adopting a cross-national perspective. We use longitudinal data from 2013 and 2015 from the Survey of Health, Aging, and Retirement in Europe (SHARE), combined with macro-level data from additional sources. Our study confirms that key micro-level drivers of loneliness are gender, health and partnership status, frequency of contact with children and changes therein. Macro level drivers are level of safety in the neighbourhood, and poverty and social deprivation of a society. In order to understand and reduce loneliness we require not just a focus on individual risk factors, behaviours and expectations, but also on macro-level factors that are associated with exclusion from social relations."}
{"text": "In the original published version of this article, the article listed the order of the authors in the incorrect order: Christian Ventura, Cody Gibson, George Donald Collier. This has now been corrected to: Cody Gibson, Christian Ventura, George Donald Collier. The publisher apologizes for this mistake. Both the HTML and PDF versions of the article have been updated to correct this error."}
{"text": "Coinciding with the 2020 presidential election, the 75th anniversary of the Gerontological Society of America arrives amid the contentious creation of a new future for politics and aging. Increasing inequality, spreading disinformation, and mounting despotism are escalating threats to constitutional democracy, but at the same time other social changes are promoting the development of a more thoroughly caring, intergenerationally just, and robustly democratic society. At the crux of this societal transformation, relentless political inertia on core aging issues, like the role of government in the care and support of older adults, continues to inhibit meaningful change in federal policy, dampening the potential for older Americans to achieve desired future states, like living well despite advanced age or disability. This session examines major contemporary trends at the intersection of politics and aging in the United States. Papers address the economics and demographics of aging, drawing attention to increasing federal spending on older adults, decreasing availability of caregivers, and geographic clustering of older people; changes in the age of the electorate, intergenerational political values, and the growing politically polarization of American society; the tendency for federal initiatives to fail to support caregivers, for reasons of policy history, policy traits, and mass public features, like the political isolation of informal caregivers; and the role of linguistic and metaphorical practices in shaping our experiences and views of aging. Discussion addresses opportunities for the country to become more age-friendly while also sustaining democratic institutions and national unity."}
{"text": "The recent Covid-19 pandemic has had significant psychological and social effects on the population. Research has highlighted the impact on psychological well-being of the most exposed groups, including children, college students, and health workers, who are more likely to develop post-traumatic stress disorder, anxiety, depression, and other symptoms of distress. The social distance and the security measures have affected the relationship among people and their perception of empathy toward others. From this perspective, telepsychology and technological devices assume important roles to decrease the negative effects of the pandemic. These tools present benefits that could improve psychological treatment of patients online, such as the possibility to meet from home or from the workplace, saving money and time and maintaining the relationship between therapists and patients. The aim of this paper is to show empirical data from recent studies on the effect of the pandemic and reflect on possible interventions based on technological tools. The Covid-19 pandemic led to a prolonged exposure to stress. As a consequence, researchers showed an increased interest in measuring social and community uneasiness in order to psychologically support the population. This increased attention might help in managing the current situation and other possible epidemics and pandemics. The security measures adopted in managing the pandemic had different consequences on individuals, according to the social role invested. Some segments of the population seem to be more exposed to the risk of anxious, depressive, and post-traumatic symptoms because they are more sensitive to stress.The following article has two focuses of interest: (1) the evaluation of the psychological and social effects of the pandemic on the population, mostly children, college students, and health professionals; and (2) the identification of new perspectives of intervention based on digital devices and in line with the social security measures and mental health promotion. Telepsychology, for instance, is a valid tool, effective in taking charge of the psychological suffering caused by the pandemic and in preventing the chronicity of the disease. The prolonged stress could involve anxiety, depression, and the inability to manage traumatic and negative emotions. Furthermore, the constant fear of contagion affects daily life and leads to social isolation, modifying human relations.Studies of pandemics faced over time, such as SARS, Ebola, H1N1, Equine Flu, and the current COVID-19, show that the psychological effects of contagion and quarantine is not limited on the fear of contracting the virus . There aAs reported in a recent survey administered during the Covid-19 pandemic, children and young adults are particularly at risk of developing anxious symptoms . The resHealth-care workers (HCWs) are another segment of population particularly affected by stress . HCWs arAs a consequence of the pandemic, the health professionals who were overworked suffered high level of psychophysical stress . Health As emerged by the recent literature, the promotion of psychological interventions on the specific population who is more likely to develop pathologies and suffering is needed. The Lancet Global Mental Health Commission\u2019s observation  reportedIn order to reduce anxiety and depression symptoms widespread among the population, the At the same time, as a consequence of the emerging issues, psychotherapists provided psychological support online, addressing the technological challenge ; Liu et via webcam  in order to use them in relation to the specific purposes identified by the professional. For example, the Italian Service of Online Psychology conducted a study based on a service of helpdesk on Facebook. This service guided people in asking for psychological help, working on their personal motivation. At the same time, another helpdesk on Skype provided some psychological sessions a webcam . In thisa webcam .One of the future goals of public and private psychological organizations should be the promotion of specific training for psychologists and psychotherapists, with the following aims: (1) developing the basic skills in managing the effects of a pandemic and of emergency situations; and (2) sensitizing patients to online therapeutic relationship, providing the main rules and benefits of the process . On thisOnline psychological services provide several advantages, especially in the current situation of pandemic. First of all, online services help people in a short period of time, reducing the risk of contagion and the strong feeling of anxiety in both psychotherapists and patients, who feel uncomfortable in doing traditional psychotherapy due to the pandemic . Furtheronline disinhibition effect demonstrating how the web, unlike the real life, leads to the failure of the hierarchical relationship based on dominant-dominated among individuals; this aspect, according to the author, allows a greater sense of freedom in expressing oneself and less concern related to judgment (ibid.). Other researchers  social context and historical period of the individual, (b) neurological mechanisms, and (c) psychological and behavioral responses to feelings of others. The neuro-sociological perspective analyzes the mechanisms involved in the empathic process, focusing on human communication and interpersonal relationships . SpecifiAccording to the abovementioned considerations, our suggestion consists in:Primary prevention. Studying the impact of the pandemic toward an at-risk population to reduce symptoms related to stress and providing specific online psychological counseling based on the target .Secondary prevention. Overcoming the limitations of the human interaction based on digital devices: (1) developing new spaces of inter- and intrasocial communication and new tools of support and psychological treatment, reproducing the multisensory experienced during the face-to-face interaction ; (2) training the next generation of psychotherapists in managing online devices and in implementing their adaptive and personal skills; and (3) sensitizing the general population on telepsychology and its advantages.Research according to the neurosociological perspective. Studying human interaction mediated by new technologies and the role of empathy, associating neuroscience, sociology, and psychology.VS, DA, and VA conceptualized the contribution. VS wrote the paper, reviewed the manuscript, and provided the critical revision processes as PI. All authors approved the submission of the manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "Responsible higher education institutions have an impact on society and economic, environmental, and social development. These effects define the axes of the socially responsible management of the universities. The concept of university social responsibility (USR) manages these relationships to produce a positive impact on society through higher education, research, and the transfer of knowledge and technology, as well as education for sustainability. For this study, worldwide research into this subject was studied for the period 1970\u20132019. A bibliometric analysis of 870 articles was made, obtaining results for the scientific productivity of the journals, authors, institutions, and countries contributing to this research. The main category is business, management, and accounting. The most productive journal is the Business and Society Review, while the California Management Review is the most cited. The authors with the most articles are Stavnezer, Luo, and Lanero. The most productive institution is Wuhan University. The United States is the country with the most publications and citations, and the same country, together with the United Kingdom, make the most international contributions. Evidence shows growing worldwide interest in the economic and environmental impacts of USR. Future research should focus on analysing the links between the responsible and sustainable consumption of universities and their short-term financial, economic, and sustainable impacts. In recent decades, the impact of global changes, both economic and political, social, environmental, and technological, has led to a shift in the role of higher education institutions (HEIs) in contemporary society ,2. In thCurrently, the survival of universities is related to the social and environmental implications of their actions. In this sense, the transfer of knowledge, associated with economic growth and social development, has a place in public and economic policy ,2,3.Thereby, the social responsibility of universities includes education, organization, cognition, equity, and socialization, to create more sustainable societies . AmongstSince the classical definition of the university as a community of learning and teaching, knowledge has become one of the main instruments for the development of societies ,7. For tTo the initial missions of universities, which were teaching and research, a third has been added related to community commitment. This \u201cthird mission\u201d has drawn attention to university institutions on the part of international agencies and political leaders , promotiThe concept of university social responsibility (USR) is based on the statements of the stakeholder\u2019s theory, in order to unify the commitment that it acquires to fulfil the expectations of the different groups in their economic, social, and environmental functions.In this context, the revised literature points to terminological inaccuracy concerning the main concept of research. USR is a concept that derives and connects with the terms Social responsibility, corporate social responsibility (CSR), sustainable development, corporate environmental responsibility (CER) and education for sustainability, and not with terms related to philanthropy ,11.Thereby, with some generality, USR is a commitment of the university institution to develop initiatives that promote its relationship with the different social groups of society. Similarly, it is considered university management policy to promote actions that improve this relationship between the university and society, to balance the impact at both academic and organizational level . TherefoAs regards putting USR into practice, it can be considered within the regulatory framework of quality management in relation to the commitment of universities to meet the demands of knowledge transfer and research results . In partA quality education is the basis for improving people\u2032s lives, as well as for sustainable development. Great progress has been made in access to education at all levels and, similarly, in enrolment rates at universities, particularly for girls and women. Although basic literacy has increased markedly, greater efforts are needed to achieve the goals of universal education and achieve equality for women in the university and their insertion in technical careers.In this sense, the quality management of HE is linked to sustainability and the development of a peaceful and equal society. These aspects, in turn, influence the generation of a higher quality of life and a greater positive impact on the environment, on the welfare state and on the economy in general ,10.Likewise, in the last decades, universities have gone from being dependent on centrals governments, elitist, small, closed and with little scientific production, to reverse this situation and be autonomous, decentralized, internationalized and more active in research, in general lines. This evolution has also meant that the institution participates in the environment in which it is located and cares about the social, economic, and environmental aspects in a productive way, generating innovation and added value ,12,14.The review of the literature, on the other hand, has found different studies that discuss whether universities, as institutions committed to sustainable development, use the USR as an instrument to favourably manage their reputation in their financial statements  or, on tIn addition, there is the controversy of equating the CSR with the USR, since the former was formed as a concept of market requirements for business organization, while from a university perspective, it emerged in response to the social needs linking its development with knowledge transfer from HEIs ,21.This has justified the interest to develop this research. Hence, the motivation of this study is to document the evolution of the knowledge base of the economic and environmental impacts of USR, with the intention of contributing to educational institutions to the approach of sustainable consumption, in relation to minimizing the environmental impact and satisfying consumer needs, both for present and future generations.From the reviewed literature, the research questions have been identified, which refer to determining what is the structure of knowledge about the economic and environmental impacts of USR; which are the most productive authors, institutions and countries; and what are the thematic axes that this research topic develops and towards which they are evolving.One of the main limitations of this study is to discern whether, among other variables, the number of publications related to a particular community is due to the demands of given interest groups, or on the contrary, to the needs of society.Accordingly, the main objective of this study is to analyse research trends on the economic and environmental impacts of USR globally over the period 1970\u20132019, i.e., over the last fifty years. This period ranges from the first article published on this topic (1970) to the last full year (2019). The study is consequent in admitting that the extensive period analysed covers numerous global socials, economic and political changes, which have involved different approaches in the management of university campuses. Furthermore, the appearance of new concepts has modified the analysis in scientific research on this topic.To answers these research questions, a sample of 870 selected scientific journal articles from the Elsevier Scopus database was analysed. The bibliometric method was followed to synthesize the knowledge base on the implications of USR in a global context.Finally, it should be noted that the research lines currently being developed on the subject include, among other things, the relation between the effect of implementing social responsibility policies in public and private universities in different countries with different political and economic systems. In addition, different studies are being related that analyse the outcome of social responsibility of HEIs with policies of inclusion and diversity.The study of USR is based on the theoretical principles of interest groups analysis, which, together with the basic concepts, define the reference framework in this field of research. Hence, these explanatory principles define how a set of phenomena behaves, to systematise and generalize individual cases. Consequently, with the study carried out, In 1930, Ortega y Gasset, in his work \u201cMission of the University\u201d, and E. Allen Gaw, in his publication \u201cSocial Education\u201d, discussed of the roles that university institutions needed to play in order to participate in the process of modernising society, and proposed, in a debate still valid today, that higher education (HE) should be reformed for the benefit of society ,23,24.In 2003, at the World Conference on Higher Education, UNESCO stressed the importance of the well-being of nations and the quality and scope of HEIs. Since then, arguments and definitions have flowed that make it possible to distinguish the practices and policies of social responsibility related with universities from those that mainly relate to companies.In particular, among the purposes pursued by HEIs, are, in politics, the development of democracy and conflict resolution ; in the Universities today have a complex end goal, whereby they must respond to confusing questions of strategy. These strategies and alternatives should be aimed, amongst other things, at analysing the causes of the expansion of HE , to seekIn this sense, the triple helix model is a valid framework for describing interactions and relationships between universities, industries, and governments, with a view to capitalizing on knowledge ,33. TherThe literature review has made it possible to analyse documents that are what have allowed us to define the bases of this research. This subsection examined the theoretical principles used to conceptually argue the link between social responsibility, sustainable consumption, corporate sustainability, and HEIs ,51,52. TThe concept of USR must be established according to the axioms of stakeholder theory to unify its commitment to meeting the expectations of the different stakeholders in their health, economic, social, and environmental functions ,54.First, the theoretical approach of stakeholders, enunciated in 1984 by Freeman , is estaOn the other hand, recent decades have seen a growth in the influence of stakeholders on organizations, but to successfully implement and manage social responsibility, there is a need to know and identify their needs and expectations. The implementation of stakeholder theory in HEIs in order to create knowledge-based societies led to the need to promote university policies in social responsibility based on participatory methods, and thus contribute to the liaison between academic and research functions, and social needs and problems ,61.For all these reasons, in recent decades, universities have gone from being dependent on central governments, elitist, small, closed and with little scientific production, to reverse this situation and be autonomous, decentralized, internationalized and more active in research, in lines general. This evolution has also meant that the institution participates in the environment in which it is located and cares about the social, economic, and environmental aspects in a productive way, generating innovation and added value ,60.The revised literature provides definitions for the basics of this research topic. Some reflections are included on the terms and concepts used in the context of this research, which have helped model the term university social responsibility (USR) from the idea of corporate social responsibility (CSR). Hence, Likewise, although the official definitions of CSR refer mainly to companies, the general consensus is that the foundations of CSR affect all types of organizations, be they companies, public administrations, labour unions, or NGOs among others. Furthermore, it is a voluntary initiative of management and good governance, which, integrated from the decision-making of an organization, takes into account its stakeholders, and economic, social, and environmental variables. For these reasons, the USR is the answer that the university must train responsible citizens with their environment, creators of creative ideas and committed to help solve social, economic, and environmental issues.Since its initial definition, the concept of the CSR has not undergone major changes, although its role in company strategy has evolved, as has the effect that socially responsible actions had on sustainable development. The term emerged as a response of companies to growing social and corporative concerns with issues that included social, environmental and consumer interests.Since its inception, CSR has been extensively studied and researched ,63,64,65As regards social responsibility, institutions should treat laws and regulations as opportunities for improvement, insisting on ethical behaviour in their interactions with stakeholders . In thisFor its part, the concept of sustainability formally appeared for the first time in the Brundtland Report in 1987 , relatedFurthermore, just as companies and other organisations have recognised the demand for greater social and environmental sustainability, universities have responded with new pedagogical approaches. Hence, arose the concept of education for sustainable development (EDS), a term that refers to the various forms of learning and teaching associated with the sustainable development of societies . In thisIn relation to the basis of sustainable development and the Sustainable Development Goals (SDGs) by 2030, education allows for self-reliance, fosters economic growth by improving skills and improving people\u2032s lives. Thus, the USR and stakeholders require better access and quality to the university, eliminating, among others, gender inequalities, food insecurity and armed conflicts .In addition, by bringing together these concepts that address social responsibility from different perspectives, it is noted that, from their origin, universities have been the basis of education and, to some extent, of social sustainability. In this context, universities are obliged to implement a series of ethical principles and values in the fields of management, teaching, and research, so that they declare their intentions, in this sense, in their vision and mission ,79,80.Hence, in the knowledge society, USR refers to managing the strategic model in the context of a socially responsible HEI. For this reason, the implementation of the USR entails self-criticism from the institution itself, responsibly assessing the impact of its actions on society ,82. ThatAs mentioned by A. Parsons  of the UThis social concept reviews the actions of universities in a knowledge society to determine the applicability of CSR in these educational institutions. At the same time, USR encompasses the operational variables that a university must manage if it is to be socially responsible in terms of support for inclusion, community education, and respect for and conservation of the environment or natural resources ,13.As regards the USR regulatory framework, the international standard ISO 9001, which deals with the quality of management systems and accreditation, certifies universities in terms of optimal processes of organization and planning of activities. ISO 26,000 establishes the management and focus of social responsibility in universities from a managerial perspective to achieve a sustainable society ,86.The Bologna Process (1999), the basis of the subsequent European Higher Education Area (EHEA), which is organized on the principles of quality, mobility, diversity and competitiveness, was initially directed towards increasing employment in the European Union and the transformation of the European higher education system into an instrument for attracting students and teachers on a global scale. Thereby, the incorporation of the social dimension of HEIs was not initially considered. Subsequently, the following statements have examined the influence that universities have on the development of European society ,87,88. ITherefore, in 2015, with the support of the European Union\u2032s Lifelong Learning Programme, the Comparative Research Project on University Social Responsibility in Europe and the Development of a Community Reference Framework (EU-USR) were initiated. On the initiative of certain leading European Union universities regarded as leaders in social responsibility, the objective of this common European model was to optimise the USR of all universities. Initially, it was formed in response to the European Commission\u2032s political priority on the need for a common social responsibility strategy for all European universities. Today, many European universities understand their social dimension, promoting policies and practices, albeit without a frame of reference .Likewise, both the Millennium Development Goals, in 2000, and the SDGs, in 2015, mainly in SDG 4, have promoted, in relation to the USR, an inclusive, equitable and quality education that promotes learning opportunities during all life for all. In this way, these resolutions establish the bases for the achievement of a quality education as a foundation to improve people\u2032s lives and sustainable development.In this sense, the European Commission managed the INHERIT project  to stimulate effective policies, practices and innovations in relation to key environmental stressors and the underlying causes of inequity in health. Likewise, the objective of this Horizon 2020 research project, for the period 2016\u20132019, was to promote the change of sedentary lifestyles and those outside the circular economy, and thus formulate scenarios to create a more sustainable future. In other words, this project sought to design and implement intersectoral initiatives to achieve healthier social change .Scientometrics is the science that studies and measures scientific production. It is also known as the scientific and empirical study of science and its results. In practice, there is a significant overlap between scientometrics and other scientific fields: bibliometric, information system, information science and scientific policy . It is bBibliometric, on the other hand, applies mathematical and statistical methods to the literature of a scientific nature and the authors that produce it, with the aim of studying and analysing scientific activity. The instruments used to measure aspects of scientific activity are bibliometric indicators, which are measures that provide information on the results of scientific activity in any of its manifestations . It was The objective of this study is to provide an insight into the overall dynamics of research and the state of the issue regarding the economic-environmental impacts of the USR in a global context. To achieve the proposed objective, a quantitative analysis was carried out, using bibliometric, to identify, organize and analyse trends in the research topic. In recent decades, it has contributed to the review of scientific knowledge, and has been successfully used in various scientific fields ,94.According to the reviewed literature of the study topic, mainly the one detailed in The choice of the Scopus database is due to the fact that, when performing the initial search in the Web of Science (WoS) and Scopus databases, it showed a significant difference in the volume of articles in the analyzed period 1970\u20132019, since 559 articles were extracted from WoS, and 870 articles from Scopus.Additionally, Scopus has greater advantages over other databases, such as WoS or Google Scholar, among which are: (i) it is considered the largest repository of peer-reviewed literature; (ii) it minimizes the risk of losing documents during the search; (iii) it is easily accessible and offers some tools for data visualization and analysis, in addition to presenting the option of downloading content in different formats; and, (iv) it presents a variety of data.The process followed in the selection of the sample of documents conforms to the flowchart of Thereby, in phase 1 (identification), 249,478 records were identified from the Scopus database, considering all fields for each of the key search terms , all types of documents, and all years in the data range .In phase 2 (screening), the option of \u201carticle title, abstract and keywords\u201d was chosen in the field of each term, so that 248,123 records were excluded, so 1355 records were identified.Subsequently, in phase 3 (eligibility), only the articles were selected as the type of document, to guarantee the quality derived from the peer review process. In this phase, 420 documents were excluded, so it had 935 records.As for the time horizon of analysis, this is between 1970 and 2019, both included, that is, from the publication of the first article on this topic (1970), to the last full year (2019). For this reason, in the last phase (included), 65 documents are excluded, so the final sample included 870 articles.In short, the search selected records of subfields of title, abstract and keywords, in the period that contains the last 50 years, from 1970 to 2019, in the same way that it has been successfully applied in other studies that have used the bibliometric methodology ,97,98. TTherefore, the final sample included a total of 870 articles, both open access and non-open access. The variables analysed were year of publication, thematic area, journal, author, author\u2019s country of affiliation, institution to which the author is affiliated, and keywords that define the publication.In this study, the indicators of scientific production analysed were the distribution by years of published articles, the productivity of authors, countries, and institutions . As for In addition, collaborative structure indicators, which measure the links between authors and countries, were analysed through network mapping and processing tools due to their reliability and suitability in the bibliometric analysis.VOSviewer software  was applied for the analysis of collaboration structure and relationship indicators, by co-authorship and co-occurrence analysis, which provides data on interactions and the evaluation of subject-matters, to measure the activities of research networks. In other words, this tool allows analysis for the purpose of displaying relationship maps and network links between authors, institutions, countries, and keywords. Subsequently, this software tool allows you to recognize research trends based on the use of keywords in research articles. In this sense, network mapping refers to the process of seeing the connection and structure of the network in order to map the dynamics of science, in this case, of a certain research field, and which seeks to explore the structure underlying similarities and interrelationships between documents ,101.Likewise, the clustering algorithm of VOSviewer allows communities to be detected in a network that considers modularity, that is, a measure that assesses the quality of community structures. Thereby, modularity-based clustering of VOSviewer provides networks where nodes are densely connected internally within groups, but without external connection between different groups. In this way, it unifies the mapping and grouping approaches, in addition to dividing the research carried out into documents . The resThis section presents and discusses the results of scientific production concerning the economic-environmental impacts of USR in a global context, as well as the distribution of publications by subject area and journal, and the scientific production of authors, institutions, and countries. The results obtained from the analysis of the keywords associated with this field of research are also discussed.As with the number of articles, the total number of authors also increased during the period analysed. In the last decade (2010\u20132019), 85.70% of the total number of authors for the whole 50-year period published at least one article. While only 11 authors published in this field of research in the first decade (1970\u20131979) a total of 2001 authors were active in the period 2010\u20132019. The average number of authors in the third and fourth decades was 2.8 authors per article, while in the last period studied it was 2.7 authors per article.The number of countries involved in the publication of articles on this research subject increased from 2 in the first decade, 1970\u20131979, to 86 in the last period analysed, representing 95.56%. During the whole period analysed, 90 countries contributed to the publication of articles on the scope of USR.In addition, the number of citations grew exponentially, from the first period (2001\u20132003), increasing from 813 to 5737 in the last period analysed (2010\u20132019). It should be noted that the articles corresponding to the most recent decades will receive a greater number of citations in coming years, both because of their recent publication and impact, and for their distribution in open-access . This isFinally, the number of journals where USR articles were published increased from 2 in the first period, 1970\u20131979, to 397, in the last decade analysed, 2010\u20132019, which also accounts for 88.03% of the total number of journals examined in the 50-year period.Scientific production on the research topic, influenced by the link with the concepts of corporate social responsibility and the HEI at a global level, was developed in line with the technological advance that brought about the appearance of the Internet globally, leading to greater ease in the use of data and international academic and research cooperation ,91,98.In addition, articles published in the English language account for 92% of the total, as the main language of science. Here, English is followed by Chinese (4%) and Spanish (2%). The remaining languages do not add up to 1%.During the period analysed, 1970\u20132019, there are several categories in which works related to the economic and environmental impacts of USR can be found. In this way, according to the Scopus classification, there are a total of 26 thematic areas into which the 870 articles analysed are classified. It must be borne in mind here that the same article can be classified in more than one category, depending on the interest of the author and the publisher.The association of publications in this field of research, mainly the categories of Business, Management and Accounting, and Social Sciences, arises from the conceptual and practical link of the dialogue between the USR and the stakeholders, about the economic, social, and environmental factors ,51.Moreover, as can be seen in The important changes that have taken place in these five decades, both socially, economically, politically, culturally and environmentally, have obviously motivated scientific production to evolve, since the researcher and academic seek and need to find answers to these changes. Along these lines, the Millennium Development Goals, in 2000, and the SDGs, in 2015, mainly in SDG 4, stand out mainly in the promotion of quality education ,51,70.By country, among the 20 most important journals in the USR publication are those of European origin: United Kingdom (7), Netherlands (3), Lithuania (2), Switzerland (1), Poland (1), Czech Republic (1), Romania (1), and those of American origin (4).The journal that has published most articles on the economic and environmental impacts of USR globally is Business and Society Review, with 50 articles, which represents 5.75% of the total number of articles published from 1970 to 2019.The California Management Review is the journal that has occupied the first position in the ranking for more decades, two of the five periods analysed . It also stands out because it attracts great interest from the scientific community, as seen by the high number of citations that it received (2098), and for the average number of citations per article (87.42). It is also the journal that has the highest H index for published articles on USR, with 15, which is far from the journal\u2019s overall H index for all subjects, which stands at 118. The journal Nucleic Acids Research has the highest impact factor SJR, 8.636 (Q1), followed by the Journal of Experimental Medicine, with 7.941 (Q1), and the California Management Review, with 2.658 (Q1).It is important to mention how the journal Sustainability, with 13 articles published on the subject since 2015, has become the journal that has ascended most in terms of ranking, standing seventh throughout the period analysed (1970\u20132019) and fourth for 2010\u20132019.The authors who have published the most articles on the subject are Stavnezer , Luo , and Lanero , with four articles each.The author with the highest number of USR citations is the Australian, Brammer, with a total of 387, which also places him as the author with the highest average number of citations per article, with 129, followed by the Americans, Stavnezer, with 302 citations and an average of 75.50 citations per article, and then Schrader, with 258 and 86, respectively. In addition, Stavnezer has the highest h-index, 4.Of the 10 most prolific authors in the publication of articles on this research subject, four are of Spanish origin, from the University of Granada , and three American .The lack of international co-authorship of Spanish institutions is interesting. By contrast, 50% and 83.3%, respectively, of the articles on the economic and environmental impacts of USR from the Chinese Academy of Sciences and York University are internationally co-authored, with the same number of articles as the Spanish, University of Cadiz (6). In addition, York University shows its international credentials with the highest average number of citations per article published with international collaboration (141.60). It is also of note that the Loyola University of Chicago, despite international collaboration in 20% of their articles, have no citations in these publications.In this sense, efforts being made by HEIs in recent years in relation to educational activity for sustainable development, are relevant, because, as UNESCO points out, education is one of the most effective tools to stimulate the changes necessary to achieve sustainable development ,105. ForThe above data refer to the ranking of the most productive countries in the publication of articles on USR for the whole the period analysed, underlining its research potential, with 171 articles in the last period alone (2010\u20132019). During this last decade, China has moved into second place, with 82 articles published, replacing the United Kingdom, which held this position in the previous two decades . These countries , together with Spain and Canada, are the main promoters of USR research globally, since, they have been responsible for publishing 54.94% of the world total.The remaining five countries  have published fewer articles. Of this group, Germany, with the fourth largest number of citations (987) in 27 published articles, presents the third best h-index (15) in articles on USR, and has held eighth position for the last two decades studied.In seven of the countries in Thereby, cluster 1, the largest, includes 7 countries: India, Indonesia, Iran, Lithuania, Malaysia, Pakistan, and United Arab Emirates. Group 2 consists of Croatia, Czech Republic, Poland, Russian Federation, Slovakia, and Ukraine. Cluster 3 is led by Japan, and includes France, Hungary, Romania, Sweden, and Turkey. Cluster 4 is headed by the United States and includes China, Hong Kong, Lebanon, and South Korea. The fifth cluster, led by the United Kingdom, includes Brazil, Italy, Portugal, and Spain. Cluster 6 consists of Belgium, Finland, Netherlands, and Saudi Arabia. Group 7 consists of Australia, South Africa, and Thailand. Cluster 8 consists of Denmark, Switzerland, and Taiwan. Cluster 9 consists of Austria and Germany. Cluster 10 is made up of Canada and Algeria. Finally, cluster 11 contains Norway and Singapore.The five most common keywords used during the period analysed (1970\u20132019) are sustainability (in 66 articles), priority journal (45), sustainable development (43), controlled study (36), and corporate strategy (28). As regards the first term, Sustainability, in the last period (2010\u20132019), co-occurrence is in 92.4% of the published articles on USR. Moreover, the literature review of the term Sustainability suggests that word is used as a synonym, or an equivalent term, of Sustainable Development ,110.Of the top 20 keywords, six have started to be associated with this field of research during the last period examined (2010\u20132019). These are stakeholders (position 9), students (12), financial performance (15), innovation (18), management (19), and perception (20).These lines group all terms related to the economic and environmental impacts of USR globally. Hence, the \u201csustainability\u201d line includes aspects related to sustainable development in a global context of HEIs . The \u201cgoThe development and evolution of this field involves new concepts and study arguments at a global level, such as \u201ccorporate citizenship and higher education behavior\u201d, \u201cgreen university\u201d, \u201cgreen campus\u201d, \u201csustainable university\u201d, \u201cgreen corridors\u201d, \u201ccircular community\u201d, \u201creducing private car use\u201d, \u201cnetworked governance\u201d, \u201cinclusive university\u201d, \u201cresponsibility for health\u201d, \u201cwork-life balance\u201d, \u201cphysical space\u201d, \u201chealthy lifestyle\u201d, \u201chealthy campus\u201d, \u201ceco inclusion\u201d, or \u201cinclusive education management\u201d.For all these reasons, obtaining a quality education is the basis for improving people\u2032s lives, as well as contributing positively to sustainable development. In this sense, progress has been made in terms of access to education at all levels and in enrolment rates in universities, mainly for women and girls. On the other hand, basic literacy has increased substantially, although greater efforts are needed to achieve the goals of universal education and achieve equality for women in the University and their insertion in technical careers.Hence, the quality management of HEIs are aligned with sustainability and with the development of an egalitarian society, with the purpose of SDG 4 guaranteeing inclusive, equitable and quality education, and promoting lifelong learning opportunities ,82.In recent years, HEIs are undergoing changes at a global level, albeit in a heterogeneous way. It is key to admit that there is a disparity in performance, but also in the resources, capacities, and scope in which these institutions carry out their activity. The modernization of the universities has meant that their focus is turned from the academic and research perspective, and pay attention to the stakeholders, with special reference to the characteristics of their immediate geographical context that marks the environment of competition and the available potential markets. The organizational heterogeneity of the different HEIs has a direct impact on the implications in the decisions that are related to the economic, social, and environmental aspects.The evolution of research on this topic encourages the appearance of different projects at the international level, with the aim of considering a positive environmental impact, a sustainable and responsible consumption, to offer a more sustainable future in relation to the SDGs.In the context of both corporate sustainability, SDGs and responsible consumption, initiatives emerge, such as, the EuroHealthNet research platform promotes evidence-based approaches to health, equity and well-being, through collaboration between decision makers and researchers and their results. In this regard, it provides an evidence base for policies and practices that address health inequalities and environmental threats to health . LikewisThese initiatives promote sustainable consumption to improve sustainable performance, in addition to meeting the needs of consumers, and increasing the quality of life of citizens. It is about improving, through public or private initiatives, both the efficiency of resources, as well as increasing the use of renewable energy, reducing carbon emissions, and minimizing waste ,123,124.Future studies on this topic should focus on new research lines that will determine, among others, whether the ethical code of a given university reflects its commitment to sustainable development; or, also, to evaluate, as a sustainability challenge, the participation of HE in business ethics.Furthermore, on the other hand, the research must identify what actions are necessary for a more responsible future, related to the economy, demography, sustainability, health, well-being, social inequalities, equity, and the environment.Even, it should be analysed how the promotion of educational practices on social responsibility and focused on the development of the consciousness of millennial students, will have a positive effect on responsible consumption. Green marketing, from both educational institutions and their providers, must be extensively studied to highlight these fraudulent practices, which undermine the image of HEIs.It would also be necessary, on the other hand, to develop academic and scientific contributions that establish the dimensions that contribute to the strengthening of the USR from the social, economic, healthy, welfare and sustainable points of view.These new thematic axes should also create models that measure the satisfaction of interested parties with the practical aspects of the USR, institutionalize the link between USR and learning services; evaluate the impact of strategies that develop partnerships between HEIs and other institutions or organizations with respect to achieving the objective of sustainable development, and analyse the links between the responsible and sustainable consumption of universities and their short-term financial, economic, and sustainable impacts.In short, research at the global level, both from the initiative of the individual researcher and from joint projects, should develop studies that extol the sustainable consumption of HEIs in their USR actions, from the consumption of products and services that minimize the environmental impact, maximize the economic impact, and satisfy the needs of the societies to which they are linked, for both present and future generations.The objective of this study was to analyse the scientific production of the economic and environmental impacts of USR in the last 50 years through a bibliometric analysis of 870 articles obtained from the Scopus database. The findings made it possible to identify the main drivers, potential tendencies, and certain gaps in critical knowledge. It is concluded that the USR, as a mechanism that allows the dissemination of HEI values and so ensures their economic, environmental, and social sustainability, is committed to the demands of its various interest groups. Thereby, the thematic areas, journals, authors, institutions, and countries involved USR publications have been identified.The number of scientific papers published per year during the period 1970\u20132019 has increased, especially in the last decade, when 743 articles were published, representing 85.70% of total contributions to this research topic.The thematic area of business, management, and accounting is the most common, since it groups 27% of the articles, followed by Social Sciences with 25%, and Environmental Science with 14%. Furthermore, regulatory developments have influenced the development of articles related to the business, management, and accounting and social sciences subject areas.The most productive journal on the scope of USR worldwide has been the British journal, Business and Society Review, with 50 publications, representing 5.75% of the total number of articles published in the study period. Of the journals that contribute to this topic, 45% are positioned in the first quartile of the Scopus database. The American journal, California Management Review has the highest number of citations , the highest average number of citations per article (87.82) and the highest h-index for published articles in this subject area (15).The authors who have published the most on the subject are Stavnezer (USA), Luo (China), and Lanero (Spain), with four articles each. Brammer, an Australian from Macquarie University, is the author with the highest number of citations (387), and the best average citations per article (129). Stavnezer is also the author with the highest h-index for contributions on USR (4).The most productive institution in this research area is Wuhan University, China, with 10 articles. The Canadian York University has the highest number of citations (709), the best average citations per article (118.17), and it is the institution with the most international collaborations in its work on the USR (83.3%). Among the institutions that have contributed the most to the subject but with no international collaboration in their articles during the period studied are Cadiz University and Jaume I University (Spain) and Loyola University of Chicago (USA).The main countries that have contributed to this area of research, in terms of the number of articles and international collaboration, during the period 1970\u20132019, are, in order, the United States, the United Kingdom, China, Spain, and Canada. The United States presents the largest number of published articles (212) and citations (4550), in addition to the highest h-index, with 34.Future research lines on this topic will focus on (i) determining whether the ethical codes of a given university reflect its commitment to sustainable development, (ii) assessing the involvement of HE in business ethics like a challenge of sustainability, (iii) identifying what actions are needed for a healthier future, related to the economy, demography, sustainability, health, wellbeing, social inequalities, equity, and the environment, and (iv) promoting educational practices focused on the development of millennial students\u2032 awareness of social responsibility and investment.Among the main future research lines to be pursued are, principally, those that must (i) determine whether the ethical code of a given university reflects its commitment to sustainable development; (ii) evaluate the participation of HE in business ethics; (iii) identify the actions necessary for a more responsible future, (iv) analyse how the promotion of educational practices on social responsibility and focused on the development of the consciousness of millennial students will have a positive effect on responsible consumption; (v) study green marketing, both from educational institutions and from their suppliers; or (vi) analyse the links between the responsible and sustainable consumption of universities and their short-term financial, economic, and sustainable impacts.This study supposes an analysis of the scientific production and the actors that stimulate the investigation of the socio-economic and environmental dimensions on University Social Responsibility during the period 1970\u20132019, as well as the identification of the lines of investigation and their evolution and transformation. Innovation in this research field has been identified based on the morphology of the groups of authors, institutions, countries, and keywords, and the intensity of the relationships that develop in them. The results obtained are a complement to the knowledge of the evolution of the socio-economic and environmental dimensions on USR and allow to establish the relationship between science and technology, and to inform the decision-making process.Likewise, this research is of interest since it makes known the importance of USR in training responsible citizens with their environment, generators of creative ideas and committed to help solve social and environmental problems. This study contributes to disseminating the need for universities to make available to students, not only knowledge but also the possibility of developing competencies and skills, which give them the opportunity to transform their participation in social action initiatives.With a triple-pronged approach, the USR allows the implementation of progress policies and actions that lead towards sustainability. In this way, the research we carry out fosters a greater knowledge of the tools for more sustainable progress in our society. In this sense, the investigation and dissemination of these terms allows the promotion of initiatives that promote the ethical conduct of the citizen towards herself/himself and with her/his environment, and goes far beyond compliance with legal obligations, but seeks to raise awareness and respond to forge responsible students with their environment and with humanity.Finally, it should be noted that research on the economic and environmental impacts of USR worldwide has followed an upward trend of exponential growth, especially in the last decade studied, namely 2010\u20132019."}
{"text": "War is a stressful factor for children and families. During war, there are two categories of children including those who are directly attacked and all of their amenities such as school, house, and social structure are influenced and destroyed. Another category includes children who are indirectly observing these disasters through social media and the first group, in addition to psychological aspects, suffers from nutritional and physical health problems. In this study, the researcher aims to find out if there is any solution to provide psychological safety and nutritional and physical health for children involved in war.In this study, articles published in English and Persian languages in scientific sites, journals and conferences of Medical Sciences of Iran and Red Crescent, SID, PubMed and Scopus, and humanities were searched by keywords such as psychological health safety, violence against children, vulnerability of children during war, nutritional and physical health of children, and solutions to provide supplies and health during war.The results show that during war, it is necessary to gather information from the study area exposed to danger. Costs estimation, maintenance and storage of food supplies, supplying kitchens, warehouses and mobile refrigerators, providing food and shelter, establishment of hospitals and schools, education to cope with crisis for families and people working with children, and separating the consumer groups to maintain nutritional health of children are necessary. But the most important element is psychological health of children and it is necessary to train people before the accident and send them to the area. These people should know that children are more sensitive and understand the situations.To solve psychological problems of children, parents and authorities should prepare a comprehensive plan to reduce psychological injuries. For children who may need tranquilizers for psychological disorders, the presence of psychologist and psychiatrist is necessary. For health and nutrition of children, correct planning and prediction and management can reduce losses caused by the crisis.Children, War, Psychological problems, Food supply, Health"}
{"text": "Continuously evolving technologies make dentistry one of the most advanced sectors in the field of medicine. The digital improvements in recent years have brought many advantages to clinicians and patients, including reduced working times, lower costs and increased efficiency of performance. Some of the most important digital technologies introduced in the dental filed are cone beam computer tomography (CBCT) scan, Computer Aided Design/Computer Aided Manufacturing (CAD-CAM) systems, and intraoral scanners. All of these allow faster and more accurate rehabilitations, with the opportunity of pre-simulation of the final treatment. The evolution of computer science has brought significant advantages in the medical and dental fields, making the diagnosis and execution of even complex treatments, such as implantology and bone reconstruction, possible. The digital world is trying to supplant the traditional analog workflow, and over time, with the further advance of technologies, it should tend to be the treatment of choice of our patients. Digital Health, is an innovative approach to medicine. The broad scope of digital health includes the computerization of healthcare processes, digitization of medical documents, computerization of medical records, creation of electronic files, and electronic prescriptions ,2. ExampThe digitalization of medical records allows the clinician to share and update the patients\u2019 informations in real time, and archive the documents more easily, with full respect for the general data protection and privacy requirements, also using cloud technologies. Instead, analog medical records are usually stored in \"physical\" environments such as archives or warehouses, which everyone can access. Digital documents contain sensitive data, hence it is of importance that the digitized medical records can be examined only by operators, based on an approved workflow, which was previously established. There may be many attempts to hack digital information (data breach), so it is necessary to protect them with certified procedures, starting from the software houses and ranging to the person authorized to treat them.An example of lifesaving technological solution is geolocation, which can be used to quickly locate an emergency situation that requires the intervention of rescuers. Some emergency interventions would not be possible without the availability of satellite tracking systems and the app map-based running on smartphones ,4. OtherThe digitization of the medical profession, in all sectors, advances inexorably and offers advantages that combine analog workflows with new technologies. Digital technologies can support clinicians to make accurate diagnostic-based decisions, as well as supporting patients to make better-informed consent about their own treatment. Moreover, new options for facilitating the prevention or early diagnosis of life-threatening diseases, and management of chronic conditions outside of traditional care settings, can be provided using an innovative digital health approach. In the dental field, there are several specialities that have undergone evident changes in all the steps of the protocols and materials, including but not limiting to orthodontics, implantology, prostheses, and all the dental laboratory procedures. This allows for accurate prosthetically/functional-driven planning, proper aesthetic/functional pre-evaluation of the proposed therapy, computer-assisted execution of the treatment, as well as continuous follow-up of the patients. The main revolution was the Computer-Aided Design/Computer-Aided Manufacturing (CAD-CAM) technology, initially proposed to increase the performance of the restorations, reduce the costs and the fabrication times, and improve patient satisfaction/aesthetics. The CAD-CAM technologies make both the project and the execution faster, consisting of a three-dimensional design (planning/project) of the virtual treatment through the use of a computer, that than results in computer-assisted production of the same by the use of milling or printing machines. This technology offers several advantages, such as the accuracy of a computer-based planning/project, the rapidity of digital impression, the quality of digital-made products and its reproducibility at any time. Another very important advantage is a three-dimensional pre-visualization (simulation) that allows the final object/execution to be shown on the screen, so that the clinician can evaluate it from every viewpoint, increasing diagnostic capabilities and the accuracy of the treatments. All of this also allows for rapid communication between clinicians, other collaborators, and patients ,7.Some of the last considerable innovations in digital medicine are the digital impressions, optically detected by intraoral scanners (IOS), the introduction of the Cone-Beam Computerized Tomography (CBCT) scan, and the combination of both, thanks to which diagnosis and planning are faster, predictable and safe. There are various types of IOS and CBCT on the market that depend on the acquisition technology, the possibility of processing the files and the type of file generated.Intraoral scanners use structured light scanning, which consists of projecting a grid onto the surface of the tooth, where a series of high-resolution cameras reads its distortion. The detected distortion is processed by a microprocessor which transforms this data into a dimensionally perfect object, visible directly in the acquisition software. The intraoral scanner is the perfect completion for all CAD-CAM productions; the main benefit is the possibility of immediately checking the level of accuracy of the impression with the patient still in the chair. Another great advantage is the possibility of analyzing the occlusal relationships between arches, so as to define whether the occlusal distance is suitable for the creation of CAD-CAM restorations with specific materials. Last but not least is the possibility to send impressions by email, avoiding a waste of time for delivery.1)Night guards;2)Dental aligners;3)Fixed dental prosthesis;4)Guide for dental surgery.Some of the major applications in the dental field are: Its increasing use is also linked to implantology, in which scan bodies are used instead of conventional transfers. Implants are then repositioned in this precise position due to CAD software that matches the specific geometric shape of the scan body, with its dedicate library, allowing the design of individual abutments, frameworks and crowns. It has been demonstrate that the system is precise and accurate, since it does not suffer from distortions due to the traditional impression of the transfers. Moreover, the greater precision in the digital impression techniques has allowed its use, in combination with Digital Imaging and COmmunications in Medicine (DICOM) data derived from CBCT, for even more accurate diagnosis and virtual implant planning, including the production of surgical guides ,9. For tIn orthodontics, the introduction of intraoral and facial scanners, 3D printing machines, and, before that, digital radiology, including a CBTC scan, have improved both the diagnosis and execution of the orthodontic treatment. Digital studio models offer a viable alternative to traditional plaster models. Their advantages in orthodontic diagnosis and treatment planning include the easier and quicker transfer of electronic data, immediate consultation, and reduced space for storage . DigitalAesthetics is another application that benefits from intraoral scanners and digital workflow, consisting of smile design and simulation, prototype mock-ups, and veneer manufacturing. This is possible by the acquisition of digital impressions, a series of photos of the face and the patient\u2019s smile, and through a smile design software that allows to shape the entire appearance of the smile area. In this way, clinicians have the opportunity to discuss with the patient and to decide with him/her the aesthetics of the restoration before the treatment starts ,17,18. TEven complete or partial prostheses, on both natural teeth and implants, could be made through a fully digital workflow, that allows clinicians and dental technicians to fabricate the restoration in all of its aspects, potentially reducing production times, and therefore the overall waiting times for both clinicians and patients, and, not least, the costs ,20,21,22Every treatment starts with the acquisition of the dental impressions which can be quickly detected using an intraoral scanner . The digital models are processed with dedicated CAD software. Through this digital workflow, there is no need to physically deliver the impressions to the dental technicians, and this also allows the process to be safer from a biological point of view ,24,25. DEven if working in a fully digital work-flow, simple and complex treatments could be performed. As in the clinic, patient\u2019s aesthetic and virtual jaw\u2019s movements can be simulated before the treatment, allowing both clinicians and dental technicians to better evaluate the proposed treatment plan, and to evaluate in advance the overall cost and time required for the treatment ,33,34,35In conclusion, it is true that these technologies will need to be further improved, and strong scientific evidence presented, before replacing the analog procedures. There are different aspects that need to be evaluated, therefore, both by the clinicians and patients, and in this way they could decide how to face the necessary treatments and feel more relaxed."}
{"text": "JMA Journal, a new official English medical journal.The Japan Medical Association (JMA) and the Japanese Association of Medical Sciences (JAMS) have launched the Asian Medical Journal in 1958 (renamed JMAJ in 2001), the JMA has been publishing Japanese medical studies and its activities in English.Since the inception of the JMA Journal, a peer-reviewed publication, is issued with the cooperation of the JAMS as a new global platform for information dissemination, in place of the traditional JMAJ but continuing its traditions.With due consideration of the environment of global health and medical information provisions, the JMA Journal covers all aspects of medicine and medical care, and includes contributions from medical researchers and healthcare professionals in Japan and elsewhere, on a wide range of areas, including original work, health policy, global health, and other commentary.The JMA Journal will promote international medical science and contribute to the improvement of the quality of health care by being read and cited by many people.The publication of this type of comprehensive medical journal is the first challenge in Japan. We sincerely hope that the Yoshitake Yokokura, MD, PhDPresident, Japan Medical AssociationPresident, World Medical Association"}
{"text": "Nutritional deficiencies  developing as a side effect of radiotherapy (RT) currently represents a significant but still inaccurately studied clinical problem in cancer patients. The incidence of malnutrition observed in head and neck cancer (HNC) patients in oncological radiology departments can reach 80%. The presence of malnutrition, sarcopenia, and cachexia is associated with an unfavorable prognosis of the disease, higher mortality, and deterioration of the quality of life. Therefore, it is necessary to identify patients with a high risk of both metabolic syndromes. However, the number of studies investigating potential predictive markers for the mentioned purposes is still significantly limited. This literature review summarizes the incidence of nutritional deficiencies in HNC patients prior to therapy and after the commencement of RT, and presents recent perspectives for the prediction of unfavorable nutritional changes developing as a result of applied RT. Head and neck cancer (HNC) consists of a group of malignant neoplasms, mainly squamous-cell carcinomas (approx. 90% of tumors), that are heterogeneous with regard to their anatomical location, etiology, and clinical presentation, occurring in the mouth, throat, larynx, salivary glands, paranasal sinuses, and ear ,2. HNC fHNC is characterized by an unfavorable prognosis and the percentage of 5-year survival in this group of patients, regardless of the stage of cancer progression, which also depends on the anatomical location of the tumor, its degree of differentiation, the treatment used, and the clinical-demographic characteristics of the patient, does not usually exceed 30\u201340% ,8. In adThe choice of the HNC treatment method depends on the anatomical location, clinical stage, and histological differentiation of the tumor, as well as the clinical and demographic features of the patient, including age, fitness, the presence of comorbidities, and the nutritional status. In addition to surgical treatment, radiotherapy (RT) constitutes essential and routine HNC treatment, and in advanced stages of the disease, it is often supplemented with chemotherapy (CRT). If radical RT is used as the sole method of treatment or in combination with chemotherapy, conventional radiation doses are used /day for 5 days a week in a treatment regimen lasting 5\u20137 weeks ). This allows the achievement of therapeutic effects comparable to surgical treatment and permits the organ affected by cancer to be saved. Currently, in order to reduce RT complications, save healthy tissue, and precisely adjust the radiation dose delivered to the tumor tissue, Intensity Modulated Radiation Therapy (IMRT) is used ,15,16,17Regardless of the applied RT scheme and the obtained treatment results, RT is associated with a high risk of developing early or late radiation reactions. These adverse effects can be more fatal in the case of CRT. Moreover, various degrees of toxicity are observed in all patients who have completed the full course of treatment. Serious physical symptoms and functional disorders and losses caused by the disease and its treatment using RT have negative clinical, psychological, and social effects ,19. The Currently, the definition of malnutrition, cachexia, and sarcopenia is the subject of lively discussions among researchers of various specialties. A multifactorial background leading to the development of the two metabolic disorders, including abnormalities in the functioning of biochemical, molecular, and immunological pathways, effectively prevents the achievement of the desired consensus ,22. AccoFollowing the initiation of the neoplastic process and its further progression, the key function of the body, which is nutrition, becomes impaired. In the physiological state, nutrition is precisely controlled by mechanisms regulating hunger, satiety, and molecular and biochemical pathways responsible for the supply of substances that provide energy to tissues and then their use for the needs of intracellular metabolism. The proper functioning of the above mechanisms allows the body to maintain a dynamic balance between the processes of energy-providing substance consumption and their use for cellular metabolism, as well as the storage of their surplus  ,31. The The result of the above-described metabolic disorders developing under the influence of the ongoing cancer process is disruption of the body\u2019s caloric balance, the development of inflammation, a loss of cell mass, and a change in the body composition that can lead to the development of malnutrition or wasting of the body ,40.For decades, the presence of cancer cachexia was considered an obvious consequence of the ongoing neoplastic process in the body. Over the years, however, significant differences have been observed in the response to treatment and the survival of patients suffering from cancer cachexia compared to patients with a normal nutritional status, despite similar clinical-demographic characteristics. Unlike cachexia, sarcopenia was previously matched with an older age. Nevertheless, 22.5% of cancer patients present a risk for sarcopenia. Alarmingly, the prevalence of sarcopenia in HNC patients has been demonstrated to be high, although there is considerable between-study variation (16\u201371%). We now know that malnutrition, sarcopenia, and cachexia in cancer patients constitute an unfavorable clinical factor associated with deterioration in the quality of life and a worse response to the applied therapy, as well as a shorter survival time . MalnutrHNC patients are at a very high risk of developing malnutrition, and about 60,000\u201390,000 patients die from cancer cachexia every year. The high rate of malnutrition in this group of patients is affected by the anatomical location of the tumor, the degree of its infiltration of the structures responsible for providing food to the body, and the toxicity of the applied therapy ,44. ApprMalnutrition, cachexia, and sarcopenia developing as a side effect of cancer treatment is currently a significant but still inaccurately studied clinical problem in cancer patients. RT or CRT, which are characterized by a high aggressiveness in the destruction of tumor tissue, unfortunately also damage healthy tissues, which results in either the development of malnutrition or intensification of the already existing malnutrition, leading to cachexia ,62. The Assessment of the risk of cancer malnutrition, sarcopenia or cachexia at the stage of RT planning in HNC patients seems to be crucial for determining the patient\u2019s further prognosis, the success of the applied therapy, and the risk of early and long-term effects of its toxicity . The curp < 0.001) or have a worse performance status (according to ECOG-WHO), and they were less likely to have a tumor located in the larynx, stage I or II disease, or p16-positive oropharyngeal cancer [Elevations in inflammatory cytokines and impairments in leptin/ghrelin functioning are associated with symptoms of cancer cachexia. Moreover, leptin level can decrease after the commencement of RT . In anotl cancer . Clinical cancer ,112. TheThere are limited data concerning the predictive value of nutritional support in RT-treated HNC patients, because most studies have focused on the treatment methods of post-RT nutritional deficits. However, according to nutritional management guidelines, nutritional intervention should be part of the management of RT-treated HNC patients. Nutritional intervention should be tailored to meet the needs of the patient and be realistic for the patient to achieve. Individualized nutritional intervention either during planning or for early stage RT may be beneficial in terms of decreasing the impact of its side effects, as follows: Decreasing unintended weight loss; improving dietary intake and quality of life; reducing acute toxicities and treatment interruptions; and positively affecting the survival. It is recommended that nutritional intervention takes place before RT is started and continued during and after treatment ,114. ForMalnutrition, cachexia, sarcopenia, and body composition changes are some of the major issues in RT-treated HNC patients. Unfortunately, there are a lack of established clinical guidelines allowing the successful management of HNC patients undergoing RT intervention. Data from oncology departments of European hospitals prove that only 30\u201360% of cancer patients at risk of malnutrition receive nutritional support in the form of oral supplementation, as well as parenteral or enteral nutrition . By sele"}
{"text": "Since 2016, Brazil has been in the midst of its largest sylvatic yellow fever epidemic ever, found predominantly outside the Amazon region. Cases originating from Brazil have been reported in France, the Netherlands, Romania, Switzerland, Argentina, and Chile. The epidemic began in the Central-West region of Brazil in 2014, spreading into the Southern region, with significant non-human primate transmission continuing towards Paraguay and Argentina. This report is an integrative review of Pan American Health Organization cooperation during a sylvatic yellow fever epidemic.  The Pan American Health Organization has played a central role in handling the yellow fever emergency, collaborating with the Ministry of Health and various research groups in supporting interventions of different response areas. The Pan American Health Organization's technical cooperation included: training and workshops to exchange experiences, carrying out technical cooperation in patient management and epidemiological, entomological, laboratory, and epizootic surveillance, organizing the assistance network, and acquiring strategic inputs. The Pan American Health Organization\u2019s technical cooperation supported the Ministry of Health\u2019s decision to adopt a single-dose vaccine and use fractional doses to support the vaccination needs of more than 39,000,000 people. The coronavirus disease 2019 pandemic contributed to the failure of reaching the yellow fever vaccination goals and made it difficult to integrate the yellow fever vaccine into recommended areas. Given the ongoing coronavirus disease 2019 pandemic, it is necessary to strengthen measures for the surveillance, prevention, and control of yellow fever with multilateral cooperation between countries. Brazil is currently experiencing its greatest sylvatic yellow fever (YF) epidemic ever, reaching a record number of cases  between 2016 and 2018. The epidemic is centered predominantly outside the Amazon region , and has reached more than 4 times the number of all cases over the previous 20 years. As YF is typically a multimodal epidemic, we consider the period from 2016-2018, after the epidemic began in the Central-West region of Brazil in 2014 and spread into the Southern region, to be part of the two or more waves marking the peak of an epidemicThis particular epidemic was marked by the persistent transmission of the virus in non-human primates (NHP), even in periods of low seasonality, which has subsequently affected areas previously considered to be without risk, such as the states of Rio de Janeiro and Esp\u00edrito Santo, and the eastern portions of Bahia and S\u00e3o Paulo. This increase in the territory affected by the virus, along with an associated increase in the recommendation of anti-yellow fever vaccination, has increased vaccine demand by 30,000,000 doses. Currently, vaccination is being expanded to include the whole country. YF transmission has been so intense that there have been reports of cases originating in Brazil documented in France, the Netherlands, Romania, Switzerland, Argentina, and ChileAedes albopictus mosquitoes captured in the state of Minas Gerais. It is widely known that these insects are capable of bridging the gap between sylvatic and urban transmission, increasing the risk of YF re-urbanization,In addition to the known epidemic described above, the Evandro Chagas Institute of the Health Surveillance Secretariat of the Brazilian Ministry of Health detected the YF virus in In regards to the overlap of this YF epidemic with the ongoing coronavirus disease 2019 (COVID-19) pandemic, the present report aimed to present the strategies adopted by the Pan American Health Organization (PAHO) in order to improve the understanding of various types of international technical cooperation in health care. The present report entails an integrative review of the cooperative actions carried out by PAHO in coping with the YF epidemic from 2016 to 2020.The Ministry of Health (MoH), in compliance with the International Health Regulations (IHR), notified PAHO of known YF cases in January 2017. PAHO then issued an epidemiologic alert for all American countries, in accordance with the IHR, which has been found to be an effective instrument with which to start response activities in the event of a disease outbreak.in situ and providing of supportive interventions in different response areas, PAHO facilitated the dialogue of several health institutions, and contributed to the knowledge regarding YF transmission, as described in the post-event evaluation and control actions of YF in the state of Minas GeraisIn Brazil, PAHO has played a central role in the technical handling of the current YF emergency, collaborating with the MoH and MoH-partnered research groups in regards to the national response and preparation of other countries within the Americas that may be affected by this YF epidemic. Through the direct participation of their specialized teams The response to the ongoing YF epidemic has brought together the expertise of scientists from different disciplinary fields, involving clinical, epidemiological, virological, laboratory, and public policy aspects, forming a multidisciplinary and multi-institutional team. It is worth mentioning that the established research capacity in Brazil was decisive in ensuring a fast and accurate response. The participation of the Evandro Chagas Institute and the Oswaldo Cruz Foundation (Fiocruz), which are federal institutes whose missions are to produce, disseminate, and share knowledge and technology that contributes to bettering the health and the quality of life of the Brazilian population, was very important to the YF response. In addition to generating knowledge, Fiocruz is also responsible for producing immunobiological and diagnostic tests.Aedes aegypti in 1942. Historically, technical cooperation in the fight against YF was began with the inception of PAHO, which has addressed the disease since its creation in 1902, as the International Sanitary Bureau of the American Republics. The program was institutionalized at the first International Sanitary Convention of the American Republics in 1902, during which the vector-borne transmission of YF, a historically neglected theme, was discussed. PAHO is proud to have achieved the elimination of urban YF with the eradication of Honoring its mission \u201cto promote equity in health, to combat disease, and to improve the quality of, and lengthen the lives of the peoples of the Americas\u201d, PAHO has spared no efforts to tackle this epidemic, which has been supported by the Global Outbreak Alert and Response Network (GOARN).PAHO's technical cooperation occurred in several ways: training and workshops to exchange experiences; carrying out technical cooperation in the areas of patient management and epidemiological, entomological, laboratory, and epizootic disease surveillance; and organization of an assistance network. Equally important was the dissemination of knowledge with support for the creation of distance education courses, the publication of handbooks, the hiring of personnel for laboratory and field epidemiology activities, and the acquisition of strategic items, including dry ice, syringes, software licenses, vaccines, and supplies for molecular and histopathological diagnosis.PAHO also organized, for the first time on the American continent, a meeting for the Eliminate Yellow Fever Epidemics (EYE) strategy, including the World Health Organization (WHO), United Nations International Children\u2019s Emergency Fund (UNICEF), and Global Alliance for Vaccines and Immunization (GAVI), with more than 130 partners. PAHO\u2019s technical cooperation supported the decision of the MoH to adopt a single-dose vaccine, which had been recommended by the organization since 2013, and the use of fractional doses to support the vaccination needs of more than 39,000,000 people. The 7,648,772 fractional doses used provided savings of more than 6,000,000 doses. ,Professionals hired by PAHO, who then transferred to Brazilian National Laboratories, had significant findings of the YF virus in monkeys of the Callitrichidae family. Managerial support for decisions to expand the recommended vaccination area, adjust the vaccination schedule (adoption of a single dose), and adopt a campaign for fractional doses are also among the cooperative activities carried out by PAHO in Brazil during the current YF epidemic,It is worth emphasizing PAHO's participation in the genomic surveillance of YF, a decisive measure to direct Brazil\u2019s response and reaction to national and international concerns about transmission dynamics, including the type of transmission cycle (sylvatic or urban), virus travel speed and origin, and level of introduction of the virus , etc. In this regard, it is also necessary to mention PAHO's support of the studies that culminated in the publications \u201cGenomic and epidemiological monitoring of yellow fever virus transmission potential\u201d and \u201cYellow fever virus reemergence and spread in Southeast Brazil, 2016-2019\u201dThe present technical report is necessary due to the weakening role of the World Health Organization (WHO) in the coordination of efforts against COVID-19, and the non-compliance of various nations to the IHR. These factors, along with the reduction of funding to WHO by powerful nations, have diminished both the spirit of solidarity between nations and the multilateral approach needed to respond adequately to the pandemicThe ongoing YF epidemic in Brazil continues to show a significant rate of transmission in the Central-West and Southern regions of Brazil, continuing towards Paraguay and Argentina. The COVID-19 pandemic has contributed to the failure of Brazil to meet the YF vaccination coverage goals, and has made it difficult to implement the YF vaccine in recommended areas. During the ongoing COVID-19 pandemic, it is necessary to strengthen measures for the surveillance, prevention, and control of YF, and multilateral cooperation between countries."}
{"text": "Autophagy is an evolutionarily conserved process that occurs in yeast, plants, and animals. Despite many years of research, some aspects of autophagy are still not fully explained. This mostly concerns the final stages of autophagy, which have not received as much interest from the scientific community as the initial stages of this process. The final stages of autophagy that we take into consideration in this review include the formation and degradation of the autophagic bodies as well as the efflux of metabolites from the vacuole to the cytoplasm. The autophagic bodies are formed through the fusion of an autophagosome and vacuole during macroautophagy and by vacuolar membrane invagination or protrusion during microautophagy. Then they are rapidly degraded by vacuolar lytic enzymes, and products of the degradation are reused. In this paper, we summarize the available information on the trafficking of the autophagosome towards the vacuole, the fusion of the autophagosome with the vacuole, the formation and decomposition of autophagic bodies inside the vacuole, and the efflux of metabolites to the cytoplasm. Special attention is given to the formation and degradation of autophagic bodies and metabolite salvage in plant cells. Autophagy, which literally means \u201cself-eating\u201d, plays a crucial role in the degradation of useless or damaged cell components such as macromolecules, protein complexes, and organelles. Autophagy also plays a role in the degradation of foreign elements for cells, such as bacteria, viruses or sperm residues after egg cell fertilization. It is a conserved process that occurs in a similar way in fungal, animal and plant cells. This process was first observed in the 1960s, and for decades it was thought to involve non-selective degradation of cellular elements ,3. HowevSome stages of autophagy are currently subject to intensive study, and our knowledge is gradually increasing. Areas of strong research interest include the initiation of autophagy, formation and elongation of the phagophore, and identification of the receptors and scaffold proteins involved in selective kinds of autophagy. However, despite many years of research, some aspects of autophagy are still not fully understood. Our knowledge about some stages of autophagy is poor, even fragmentary, and in addition, these stages are currently not of interest to many scientists. These include the final stages of autophagy, in particular, the degradation of autophagic bodies and the recovery of metabolites constituting the final products of autophagy. We specifically focus on the formation and degradation of autophagic bodies and metabolite salvage in plant cells and we compare this knowledge to data related to yeast.Macroautophagy is by far the best-studied and described type of autophagy. The first visible symptom of macroautophagy is the appearance in the cytoplasm of a cup-shaped structure, called the phagophore . The phaComponents of the cytoskeleton play an important role in the cytoplasmic transport of autophagosomes . It is aMagnaporthe oryzae, Pichia pastoris, Saccharomyces cerevisiae, and Schizosaccharomyces pombe [During the fusion of the autophagosome with the vacuole in yeast, the outer membrane of the autophagosome is connected and incarnated to the tonoplast, while the inner membrane together with the content becomes the autophagic body inside the vacuole  24,25,55,56. In es pombe ,63,64,65es pombe , syntaxies pombe , syntaxies pombe ,69,70, aes pombe ,71,72,73Arabidopsis mutants with T-DNA VTI12 insertion, growing in rich-nutrient conditions, presented a normal phenotype, whereas under nutrient-poor conditions accelerated aging was observed, confirming that VTI12 is involved in autophagy in plants [Arabidopsis and Populus and it participates in, among other processes, the formation of the wood conductive elements when programmed cell death occurs [In plants, the fusion of autophagosome and vacuole and the mechanisms regulating this process are poorly understood. So far, only the involvement of protein VTI12 has been confirmed in the fusion of autophagosome and vacuole in plants , Table 1n plants ,75,76,77n plants  or intran plants , VTI12 ih occurs ,81. The h occurs ,82. Moreh occurs . NeverthPichia pastoris and degradation of anthocyanin aggregates in Arabidopsis thaliana [The amount of data in the literature that describes the process of microautophagy in fungi, animals and plants, including its course, regulation mechanisms, and importance for the cell, is much smaller than the information on macroautophagy. During microautophagy, an autophagosome is not formed, but the tonoplast creates an invagination into which the cargo moves. The invagination of the tonoplast increases and the cargo is engulfed into the vacuole forming an autophagic body  83,84,8,884,85. thaliana ,87. Howethaliana   and proteinase B (Prb1) , Table 3Arabidopsis thaliana is likely to act similarly to yeast Pep4 by activating cascades of other hydrolases that are responsible for the hydrolysis of various structures found inside vacuoles, including the autophagic body  embryo axes during seed germination [The regulation of the whole autophagy process is an extensive topic, which has been intensively studied for several decades. In short, autophagy under normal conditions occurs at a low intensity; however, this process is clearly enhanced as a result of various types of abiotic and biotic stresses ,130,131.mination . Enhancemination ,138,139.mination , caused mination .Research on autophagy is currently being carried out in many research centers around the world and is the focus of interest for many research teams. The research on autophagy has two faces. On one hand, the initial stages of autophagy, selective types of autophagy and its significance in the etiology, course, and prevention of diseases is being studied intensively, while on the other hand, there are still many aspects of autophagy that are not popular among the scientific community. The events occurring in the final stages of autophagy have been explored only marginally and require a lot of research to be fully understood. Knowledge regarding the formation and, in particular, degradation of the autophagic body is sparse. Also, the efflux of metabolites from the vacuole to the cytoplasm is poorly investigated and understood. These stages of autophagy have not been intensively studied, indeed, they have been analyzed somewhat incidentally and are often written about using generalities and conjecture. Nevertheless, these latter stages are very important stages, because they complete the entire process of autophagy. Although autophagy has been known since the 1960s, and in the last two or three decades our knowledge on autophagy has increased dramatically, there are still many unanswered questions. For example, is the autophagic body degraded by nonspecific vacuolar lytic enzymes, or is the autophagic body degraded by some specific autophagy-related enzymes? Or do both of these enzymes participate in the degradation of the autophagic body? Another poorly understood stage of autophagy in plants is the transport of metabolites from the vacuole to the cytoplasm after autophagic body degradation. Also, in this case, there are other unanswered questions such as whether the constitutive vacuolar membrane transporters are involved in the transport of metabolites to the cytoplasm or whether some autophagy-related transporters are necessary for the metabolite salvage at the end of autophagy. It is also unknown whether, and how the spectrum and level of vacuolar lytic enzymes and membrane transporters change during enhanced autophagy occurring under different stresses, for example, during carbon or nitrogen starvation. In summary, so far, we have only discovered the tip of the iceberg and there remains much to be explored on the way to a full understanding of the whole process of autophagy."}
{"text": "Sensors. The context of the special issue theme is first briefly described. This is then followed by an outline of each paper that provides information on the problem addressed; the proposed solution/approach; and, where relevant, the results of the evaluation of the proposed solution.This editorial gives an overview of the papers included in the Special Issue on \u201cSecurity, Privacy, and Trustworthiness of Sensor Networks and Internet of Things\u201d of  The rapid developments in hardware, software, and communication technologies have facilitated the spread of interconnected sensors, actuators and heterogeneous devices. An example is single board computers, which collect and exchange a large amount of data for offering a new class of advanced services characterized by being available anywhere, at any time and for anyone. This ecosystem is widely referred to as the Internet of Things (IoT). In the past years, the number of deployments both for Sensor Networks (SN) and the IoT grew significantly. This continuous and exponential growth is facilitated by investments and research activities originating from industry, academia and governments, while the penetration of these technologies is also driven by the high technology acceptance rates of both consumers and technologists across disciplines. Such networks collect, store, and exchange a large volume of heterogeneous data. Nevertheless, their rapid and widespread deployment, along with their participation in the provisioning of potentially critical services , raise numerous issues related to the security, privacy, and trustworthiness of the performed operations and provided services. Accordingly, research into the security and privacy of the IoT and sensor networks is attracting increasing attention from both industry and academia. In line with these efforts, the central theme of this Special Issue is to investigate novel methodologies, theories, technologies, techniques, and solutions for IoT/SN security, trust and privacy. In particular, this Special Issue aims at addressing these topics across multiple abstraction levels, ranging from architectural models, the provisioning of services, protocols and interfaces, as well as specific implementation approaches.Fifteen papers have been published in this special issue. Brief presentations of these are given in the next section.In the first paper of the special issue , entitleIn , entitleIn , entitleIn , entitleIn , entitleIn , entitlePaper , entitlePaper , entitlePaper , entitlePaper , entitlePaper , entitlePaper , entitlePaper , entitlePaper , entitleThe last paper in the special issue , entitle"}
{"text": "Childhood malnutrition of every form, including undernutrition , micronutrient deficiencies, as well as overweight and obesity, consists a triple burden of disease, especially for low- and middle-income countries, and is one of the leading causes of poor health and a major impediment to personal development and achievement of full human potential worldwide . GloballMalnutrition is a global public health problem that is associated with high health care cost, and increased morbidity and mortality . ApproxiWhile there has been some progress concerning the reduction of undernourished population from over one billion people in the 1990s to 793 million in 2015 , around At the same time, both in high-income and low- and middle-income countries, rates of childhood overweight and obesity are rising . In the The risk of morbidity and mortality in adult life increases among persons who are overweight or obese as children or adolescents ,26,27,30This Special Issue comprises of both research and review articles, which focus on diverse components of malnutrition among healthy and non-healthy population groups spanning high income and low- and middle-income contexts. Each of the papers provides the readers with a chance to examine a different aspect of childhood malnutrition and highlights the urgent need for design and implementation of the necessary actions and policies for its prevention and control.Readers are encouraged to explore these articles and consider the role of malnutrition as a risk factor in their own context. Every country in the world and every population group is affected by one or more forms of malnutrition ,4,29. Co"}
{"text": "Wiktor Stein is considered one of the founders of Polish neurology after World War II Fig.\u00a0. He creaWiktor Stein was born on November 28, 1899 in Lviv. His father, Maurycy Stein, was a doctor and a representative of the Jewish intelligentsia in Rohatyn (70\u00a0km from Lviv\u2014south-eastern Poland before World War II), where during the second half of the nineteenth century the Jewish community comprised approximately 48% of the city\u2019s total population [After returning to Poland and the nostrification of his medical diploma, he was again promoted, at the Jagiellonian University in Krakow on February 4, 1926. The same year he started working at the Lviv State Hospital. In the period between January 1, 1927 and March 31, 1938, he worked at the Department of Nervous Diseases of the Lviv Hospital. In 1935 he completed an internship at the Neurological Clinic in Paris, headed by Georges Charles Guillain (1876\u20131961). Also in that year he became the head of the Lviv Polyclinic, where he worked until the outbreak of World War II.In the years 1928\u20131936 he was the secretary of the Neurological and Psychiatric Society in Lviv, in the works of which he took an active part. During the Second World War he was in exile in Romania, where, as an outstanding violinist, he was a concertmaster in the Craiova Philharmonic Orchestra. After repatriation in 1946, he worked in Wroclaw as an assistant in the psychiatric clinic of the local University and as the head of the Neurological Department of the Provincial Hospital of Nervous Diseases. Two years later, he moved to Lublin, where he was entrusted with the management of the UMCS Neurological Clinic. He was nominated an associate professor in 1950 and a full professor in 1957. He held the position of head of the clinic until his retirement in 1970. In 1965 he became an honorary member of the French Neurological Society. His scientific achievements include over 40 works devoted to clinical matters. Wiktor Stein died on April 11, 1979.Stein was conducting research on neurological diseases before World War II. Working at the neurological clinic in Lviv, together with Goldschlag, he published works on Swift\u2019s disease (dermato-polyneuritis)  and aftePublications from the 1950s and 1960s concerned research on changes in the cerebrospinal fluid in the course of tuberculous meningitis. Both pulmonary and non-pulmonary tuberculosis were huge epidemiological and clinical problems in post-war Poland. In his works, Stein used modern immunological methods; he studied the presence of specific antituberculin antibodies in the cerebrospinal fluid and considered the diagnostic value of these observations . His ownNumerous original papers included those devoted to circulatory disorders in the spinal cord, carotid insufficiency, and rehabilitation of patients with sciatica. The Iron Curtain dividing Europe from the late 1940s made it difficult to exchange scientific ideas between East and West. However, archives of the Medical University of Lublin contain numerous traces of correspondence between Stein and scientists from the USA, France, Israel, Spain, Belgium, Netherlands and Germany asking him for his publications which were unavailable in full version in the West. Such requests were directed to Stein by, among others, Alfred J. Crowle of the Colorado Foundation for Research on Tuberculosis and Julio H. Garcia of the Medical College of Virginia. These archival documents are proof of a vivid exchange of scientific thought between Stein and many Western research centers.Wiktor Stein was first and foremost a clinical neurologist, an excellent diagnostician, precise in clinical thinking. He was admired by colleagues and valued by patients. He combined the best traditions of Lviv neurological school, with a deep understanding of the need for rapid progress in neurology. The expression of the last was his constant and firm support for the development of neurosurgery. The ability of perspective vision and the correctness of assessing new phenomena was the result of the Professor's comprehensive, natural, humanistic and artistic mind."}
{"text": "The English Longitudinal Study of Ageing (ELSA) is a unique and rich resource of information on the health, social, wellbeing and economic circumstances of the English population aged 50 and older. The current sample contains data from up to nine waves of data collection covering a period of seventeen years (2002-2019). The multidisciplinary and longitudinal nature of the data allows the examination of complex relationships and causal processes. The survey data are designed to investigate a broad set of topics to help understand the ageing process. These include predictors of well-being, health trajectories, disability and healthy life expectancy, the determinants of economic position in older age, the links between socioeconomic status, physical health and functioning, cognition and mental health, the nature and timing of retirement and post-retirement labor market activity, household and family structure, social networks and social supports; patterns, determinants and consequences of social, civic and cultural participation."}
{"text": "An author name was incorrectly spelled as Mohammad Mirhakkak. The correct spelling is Mohammad Hassan Mirhakkak.Thomas Wolf was not included as an author in the published article. The corrected Author Contributions Statement appears below.TD and KT contributed to the conception and design of the work, data acquisition, data analysis, interpretation of the data, and drafting and revising the manuscript critically for intellectual content. M-LY and K-YY contributed to the conception and design of the work, data analysis, interpretation of the data, and revising the manuscript critically for intellectual content. GP contributed to the design of the work, data analysis, interpretation of the data, and revising the manuscript critically for intellectual content. SS, MM, W-LW, AN, CY, AL, TW, and K-HC contributed to the data analysis and interpretation of data, and revising the manuscript critically for intellectual content. All authors contributed to the article and approved the submitted version.The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated."}
{"text": "The Global Burden of Disease (GBD) project provides a long-term, comprehensive, and comparable picture of what disables and kills people across countries, time, age, and sex . The GBDThe main goal of the GBD project is to provide comprehensive data on disease burden to support evidence-based decision-making and policies at local, regional, national, and global levels. Insights at the national and sub-national levels can be gained from the GBD estimates if provided with sufficient detail. For Brazil, considering the plurality of the society and its diversity across the regions of the country, obtaining sufficiently fine-grained burden estimates is challenging but needed.Recognizing this challenge, the GBD Brazil Network was created in 2014 as a collaboration among the Brazilian Ministry of Health, a network of Universities, Research Institutes and Health Departments, led by the Universidade Federal de Minas Gerais (UFMG), and the Institute for Health Metrics and Evaluation (IHME) of the University of Washington, which leads the global project [The GBD Brazil Network conducted several initiatives, both in academia and in health services, to discuss Brazilian health issues and to disseminate tools and metrics developed by the GBD project. These capacity-building and dissemination activities involved face-to-face training and postgraduate courses, lectures, media releases, scientific workshops, and regular meetings of a scientific committee, with participation of researchers from several different Brazilian Institutions and ad hoc participation of researchers from the IHME. A web course in the Portuguese language on GBD methods is being developed to be launched later in 2020.Brazilian Journal of Epidemiology [Population Health Metrics aims to further discuss and disseminate findings on the burden of disease in Brazil to the international academic and scientific community.Regarding the scientific production using GBD estimates, the GBD Brazil Network produced analysis that have resulted in the publication of two capstone papers , 4. In 2In the current supplement, we used the GBD tools and metrics developed by to explore different health conditions and specific populations in Brazil and its federative units, from 1990 to 2017. These studies describe patterns and trends, as well as knowledge gaps and point to possibilities for improving the models and estimates used by the GBD study.The publication covers the life cycle of the Brazilian population, including an evaluation of inequalities in infant mortality and the burden of disease among older people. An emphasis was given to studies on chronic noncommunicable diseases, considering the recent epidemiological transition and including analyses on overall mortality from chronic diseases, and the disease burden of diabetes, hypertension, and breast cancer. Given the triple burden of disease, which continues to challenge the Brazilian health system, communicable diseases were not forgotten, with articles on tuberculosis and malaria. Violence by firearms, one of the main causes of death in the country, is also covered. There is also a comprehensive discussion on the impact of an integrated approach to risk factors for chronic noncommunicable diseases .The GBD Brazil network is continuously discussing with IHME, researchers, and analysts the accuracy and reliability of the estimates, and it also monitors data quality in the country. An article on vital statistics data and another on the quality of death certificate completion calls attention to the advances and challenges concerning vital statistics in Brazil. Finally, the article on health-related \u201cSustainable Development Goals (SDGs)\u201d analyzes the indicators and trends of 41 health-related SDG indicators in Brazil and its States and covers regional inequalities, aiming to leave no one behind.Sistema \u00danico de Sa\u00fade) and its expansion in the last three decades has allowed Brazil to rapidly address the changing population health needs, with dramatic upscaling of health service coverage. However, the situation has deteriorated in the last 4 years of economic crisis and political instability, especially due to the reduction of investments and expenditures in health. Indeed, fiscal policies implemented in 2016 ushered in austerity measures that, alongside the new environmental, educational, and health policies of the Brazilian government, could reverse the hard-earned achievements of the SUS and threaten its sustainability and ability to fulfil its constitutional mandate of providing health care for all [Inequality and inequity have been hallmarks of Brazilian society; access to health care and basic sanitary services varies according to the socio-economical position, race/skin color, and region. The creation, 30 years ago, of the Brazilian Unified Health System (SUS\u2014from Portuguese  for all . At presMaintaining and expanding the GBD Brazil Network will assure that the impact of these changes is estimated and the burden estimates remain available for Brazil to guide decisions and health policies in the future. The GBD Brazil Network intends to use GBD data to provide decision-makers at the local, regional, and national levels with the best and most up-to-date evidence on trends and drivers of population health to support decisions and health policy. Providing sound scientific evidence for local managers is challenging due to data gaps, high variability, and the low quality of data from small municipalities. The importance of using models and assumptions for small numbers must be considered as well.Independent groups of researchers are vital in the analysis of country data, reflecting on current and future challenges, tracing trends, and analyzing the living and health conditions of the Brazilian population, from different perspectives. We are aware of the heterogeneity of the quantity and quality of secondary data among the different health conditions we address. Further research is needed, and we advocate for more resources, in Brazil, not only for health care, but also for research. Knowing the health status pattern and its trends in the last decades allows us to take a critical look at progress and what limits it in addressing disease burden. Improved health policies and a strengthened SUS are needed to build a fairer and more equitable society."}
{"text": "Dear Editor,Necrobiosis lipoidica (NL) is a chronic idiopathic disease, of a granulomatous nature, which affects the dermis. The lesions are characterized by brownish-yellow plaques, and the most common location is the pre-tibial region. It more often affects females 3:1) and appears, in general, from the third decade of life onwards. There is an association with diabetes mellitus (DM), and microangiopathy is considered an etiopathogenic factor for the condition. Ulceration is a common complication, while reports of the onset of squamous cell carcinoma (SCC) in NL lesions are rare. and appe5A 62-year-old female patient presented an ulcerated, hyperkeratotic lesion in the NL area, on the right leg, about three months prior, with no history of local trauma. She had been diagnosed with NL in the pre-tibial region of both legs ten years before, with no history of recurrent ulceration. The patient had controlled systemic arterial hypertension and type 2 DM. She used oral hypoglycemic agents, with good control in the last years, and did not present retinopathy or diabetic nephropathy. At the physical examination, the patient presented atrophic bilateral plaques on the pre-tibial region and, on her right leg, a small hyperkeratotic ulcerated plaque over a NL lesion . The anaNL is a chronic degenerative disease of the dermal connective tissue characterized clinically by yellowish plaques with a narrow granulomatous border, central atrophy, and a tendency to ulceration, most commonly affecting the pre-tibial region of the lower limbs. It is more frequently observed in diabetic patients and, unlike in the reported, most patients also present microvascular complications related to DM, such as nephropathy and retinopathy.The etiology and pathogenesis of NL are uncertain; it is believed that external trauma, primary vascular disorders, and microangiopathy can contribute to its development, regardless of the presence of DM.The onset of SCC in areas of ulceration and scarring is well documented in a variety of skin diseases. Ulceration is the main complication of NL, observed in a quarter of patients with this disease. However, despite presenting a chronic course and a tendency to ulceration, the onset of SCC in NL lesions has been seldom reported. It is not clear whether the transformation to SCC is the result of chronic ulceration or of long-standing changes in NL. Risk factors that may be involved in malignant transformation include loss of melanin, which facilitates the lesion, chronic inflammation, and hypoxia.5th case reported in the international literature.5Metastases have been described in the literature, and may be related to delayed diagnosis .The onset of SCC on a NL lesion is very rare. This possibility should be considered in patients with NL with chronic ulcers, as well as in new lesions in patients with NL. Early detection and treatment of SCC associated with NL is of fundamental importance to allow conservative surgical treatment and the best possible clinical outcome.None declared.Maria Em\u00edlia Vieira de Souza: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; critical review of the literature; critical review of the manuscript.Julia Kanaan Recuero: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; obtaining, analyzing, and interpreting the data; intellectual participation in propaedeutic and/or therapeutic conduct of studied cases; critical review of the literature; critical review of the manuscript.Manoella Freitas Santos: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; critical review of the literature; critical review of the manuscript.Renan Rangel Bonamigo: Approval of the final version of the manuscript, conception and planning of the study, elaboration and writing of the manuscript; obtaining, analyzing, and interpreting the data; effective participation in research orientation; intellectual participation in propaedeutic and/or therapeutic conduct of studied cases; critical review of the literature; critical review of the manuscript.None declared."}
{"text": "Background and Objective: Currently, climate change represents an existential, physical, and psychological threat. Therefore, mitigation and adaptation actions and measures have become increasingly necessary to preserve individual and collective well-being. The psychological distance is one of the main psychological constructs that explains the most concrete or abstract perception of the objects and events surrounding people. The psychological distance is a multidimensional construct, and in accordance with the construal level theory (CLT), temporal, hypothetical, spatial, and social distance are considered the most critical dimensions. This systematic review aims to provide an update of the literature on the role of psychological distance in the commitment to engagement mitigation and adaptation attitudes toward climate change.Method: The review was carried out following PRISMA guidelines and a systematic search was performed on PubMed, Psycinfo, Web of Science, Cochrane, and Scopus databases.Results: Nineteen articles have been identified as being eligible for the final synthesis. Results showed, in general, that individuals have a higher propensity to perform pro-environmental and resilient behaviors against climate change when it is perceived as more proximal and concrete within the construct of psychological distance. However, not all studies show this result. Some studies showed that, despite people considering climate changes as real and tangible, they do not perform mitigation and adaptation behaviors. Other studies showed that people implement these behaviors despite perceiving climate changes as distal and abstract.Conclusions: The current literature shows the existence of a relation among psychological distance and pro-environmental and resilient behaviors applied to climate change. For a deeper understanding of the conflicting results that emerged, more studies are necessary to explore the possible presence of further psychological variables involved in the relation within psychological distance, mitigation, and adaptation in environmental contexts. The theory of the Construal Level explains that there is a relation among the psychological distance and response of people to a specific event , personal capabilities , contextual factors , and habit and routine Stern, . HoweverThe psychological distance can explain the commitment to engage pro-environmental and resilient behaviors and, consequently, a more significant engagement of mitigation and adaptation attitudes toward climate change. Perception, from a personal stance is essential because individuals are more probable to behave in favor of the environment, and/or respond resiliently to changes in the surrounding environment, when they perceive the problem of climate change as a difficulty that can have direct consequences for themselves   and adaptation behaviors to a low psychological distance . For example, the study of Chen  reportedFurthermore, as shown in the analysis of the collected articles, there are several differences in the methodologies used for examining the role of psychological distance and pro-environmental and resilient behaviors. In fact, in the selected studies, different tools and measures were used for both psychological distance dimensions and mitigation and adaptation behaviors. This could explain the conflicting results. Additionally, only a few dimensions of psychological distance were observed in most of the selected studies. Specifically, in 12 studies, only one or two dimensions of psychological distance were measured, as already done in previous studies given the simplest manipulation and the best control of the observed variables  were related to pro-environmental and resilient behaviors. A previous study, which already investigated the constructive level linked to the will to act on climate change  and measured them in relation to psychological distance and pro-environmental and resilient behaviors (Sacchi et al., In conclusion, psychological distance and all its dimensions contributed to the commitment to adopt pro-environmental and resilient behaviors of mitigation and adaptation, respectively. Although, it is an important topic for the psychological and physical well-being of individuals and the well-being of the whole planet, the studies conducted are still limited. This is because the research field has only recently become interested in this topic. The aim of this systematic review is to offer a good scientific starting point for future studies aimed at exploring and deepening the link among psychological distance and mitigation and adaptation behaviors in the hope of encouraging them more and more.All datasets generated for this study are included in the article.DM, RP, LC, ADD, and MV contributed to the conception and project of this review. RM, PL, EP, and ADC conducted the literature search and wrote the first draft of the manuscript. RP, LC, DM, ADD, and MV revised the first draft of the manuscript. All authors participated to the subsequent drafting and rewriting of the manuscript and approved the final version of the manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "In the everyday life, a large number of pre-hospital emergency missions are including the injurers caused by traumatic events. Meanwhile, the immediate response to the injurers of the mass casualties is of particular importance due to their large number and also the distance to the medical centers. Using of a proper triage scale has a major role in prioritizing the injuries resulted from mass casualty events in order to treat and transfer them to health centers and also in the management of the scene and improving the quality of care of traumatic injuries. Therefore, the purpose of this study is to describe the various methods of triage in the scene, so that we can present a suitable triage scale for prioritizing injuries in mass casualty for pre-hospital emergency.This study is an overview one and is performed by using of databases and library resources and words including triage, pre-hospital emergency, mass casualty, crisis and emergency medical technician.Based on the surveys, a variety of triage methods in the scene were found including Simple triage and rapid treatment (START), Jump start, triage sieve or Major Incident Medical Management and Support (MIMMS), Pediatric Triage Tape (PTT), Move, Assess, Sort, and Send (MASS), Care Flight, Sort, Assess, Lifesaving interventions, and Treatment and/or Transport (SALT), Revised Trauma Score (RTS), Pediatric Trauma score (PTS).In the literature, the use of different triage scales has been recommended in the crisis, the scene of the accident and trauma. By considering the context, structure and dispersion of mass casualty in the country, it isn\u2019t known yet which one of these scales is operational and applicable. Therefore, for the patients in mass casualty, it is suggested that an appropriate and applicable triage scale should be designed for pre-hospital emergency operations.Triage in the scene, Pre-hospital emergency, Mass casualty"}
{"text": "The COVID-19 pandemic has significantly affected the elderly and particularly individuals with Alzheimer\u2019s disease and related disorders (ADRD). Behavioral and psychological symptoms of dementia (BPSD) are heterogeneous and common in individuals with ADRD and are associated with more severe illness. However, unlike the cognitive symptoms of ADRD that are usually progressive, BPSD may be treatable. Individuals with BPSD are facing unique challenges during the pandemic due to the inherent nature of the illness and the biological and psychosocial impacts of COVID-19. These challenges include a higher risk of severe COVID-19 infection in individuals with BPSD due to their frailty and medical vulnerability, difficulty participating in screening or testing, and adhering to infection control measures such as physical distancing. Further, biological effects of COVID-19 on the brain and its psychosocial impact such as isolation and disruption in mental health care are likely to worsen BPSD. In this paper, we discuss these challenges and strategies to manage the impact of COVID-19 and to effectively care for individuals with BPSD in community, long-term care, or hospital settings during the pandemic. Despite the ongoing uncertainty associated with this pandemic, we can reduce its impact on individuals with BPSD with a proactive approach. The COVID-19 pandemic has affected the elderly including those with Alzheimer\u2019s disease and related disorders (ADRD), creating numerous challenges to their mental health . BehavioOlder age, medical comorbidities, and other risk factors, such as APOE4 , which aThe recommended treatment approach to BPSD depends on the presenting symptom or the nature of the underlying disorder. However, individualized non-pharmacologic interventions are typically first line, followed by carefully considered pharmacological interventions , 23. FurIn a 4-year retrospective case-control study of an Alzheimer\u2019s Special Care Unit, a higher inherent risk of respiratory infections relative to other units was found . PreviouThere is a need to understand the impact of the current pandemic on individuals with BPSD across various settings from community living to hospital units. Further, there is an urgent need to implement preventive interventions to protect individuals with ADRD from the COVID-19 infection while effectively managing BPSD. In this paper, we discuss unique challenges faced by individuals with BPSD and their caregivers during the COVID-19 pandemic and provide recommendations on how to address these challenges. Our aim is to address these challenges in individuals experiencing significant BPSD across the spectrum of cognitive decline ranging from pre-clinical to dementia, and across different neurodegenerative disorders.i.e. weight loss, exhaustion, weakness, and inactivity) and functional decline and dysregulation of immune and inflammatory mechanisms  in long-term care homes and inpatient units. Caregivers and HCW need to assess for both typical (upper respiratory symptoms and fever) and atypical presentations of COVID-19, including gastrointestinal and neurological symptoms , 45. An e.g. sedative medications in an emergency situation to reduce movement), as well as seclusion, or physical restraints as a last resort. However, these situations require careful examination of ethical, legal, and institutional factors, due to the potential for serious harm   . The comcontact) , 53, 54.contact) . Severalcontact) , 57. Thecontact) , 58. Thecontact) .via neuro-inflammatory mechanisms or vascular mechanisms such as hyper-coagulation   . These fousness)  with neuousness)  and MRI ousness) . In seveousness) , 65 and ousness) , 67. Indousness) . Increasousness) . Howeverousness) .Some individuals who experience worsening of BPSD due to COVID-19 may require additional pharmacological interventions. Many of these individuals are already prescribed multiple psychiatric medications and are likely to experience adverse effects related to polypharmacy , 70. ThiWe expect an increase in all domains of BPSD Figure 1In home environments, family or external caregivers provide support for activities of daily living and management of BPSD. Appointments with physicians and other clinicians may have to be conducted virtually . Thus, fLTCH have been a major focus during this pandemic, given the high morbidity and mortality in these settings , 79. ManAt any given time, a significant number of patients affected by dementia and BPSD are admitted to specialized behavioral units or geriatric inpatient units , 85. TheConsistent staffing is critical to provide effective care to individuals with BPSD because the work demands a high degree of familiarity with the individual. The psychological impact of working in LTCH, hospital, or other institutional settings during a pandemic should be recognized and addressed proactively . There aThe COVID-19 pandemic is disproportionately impacting the elderly including those with BPSD. Individuals with BPSD and their family or professional caregivers are facing unique challenges due to the inherent nature of the illness and superimposed biological and psychosocial factors related to the COVID-19 pandemic. Certain BPSD may lead to a higher risk of infection, a more severe course of illness, and higher mortality rates. These challenges can be addressed with a proactive approach. It is important to implement infection control strategies for individuals with BPSD across settings such as proactive screening and testing, maintaining a high degree of suspicion for atypical presentations of COVID-19, and instituting timely interventions. Individuals with BPSD and COVID-19 should also be monitored for long term biological and psychosocial effects of COVID-19. BPSD need to be managed during the pandemic using evidence-based structured psychosocial and biological interventions through innovative means such as virtual and individualized care, use of structured and algorithmic models of care, and appropriate use of psychosocial interventions across healthcare settings. Individuals with BPSD and their substitute decision makers should be invited to discuss and make decisions regarding goals of care and end of life care. Efforts should be made to address the psychological health of the frontline HCW and informal caregivers as they are paramount to success in caring for BPSD.The original contributions presented in the study are included in the article/supplementary material; further inquiries can be directed to the corresponding author.AK: Substantial contributions to the conception or design of the work and the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. EB: Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; and final approval of the version to be published. AR: Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; and final approval of the version to be published. TR: Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; and final approval of the version to be published. BP: Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; and final approval of the version to be published. BM: Substantial contributions to the conception or design of the work; interpretation of data for the work; revising it critically for important intellectual content; and final approval of the version to be published. SK: Substantial contributions to the conception or design of the work and the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All\u00a0authors contributed to the article and approved the submitted version.TR: research support from Brain Canada, Brain and Behavior Research Foundation, BrightFocus Foundation, Canada Foundation for Innovation, Canada Research Chair, Canadian Institutes of Health Research, Centre for Aging and Brain Health Innovation, National Institutes of Health, Ontario Ministry of Health and Long-Term Care, Ontario Ministry of Research and Innovation, and the Weston Brain Institute. He also received in-kind equipment support for an investigator-initiated study from Magstim, and in-kind research accounts from Scientific Brain Training Pro. BP: research support from the Peter & Shelagh Godsoe Endowed Chair in Late-Life Mental Health, CAMH Foundation and Discovery Fund, National Institute of Aging, Brain Canada, the Canadian Institutes of Health Research, the Alzheimer\u2019s Drug Discovery Foundation, the Ontario Brain Institute, the Centre for Aging and Brain Health Innovation, the Bright Focus Foundation, the Alzheimer\u2019s Society of Canada, the W. Garfield Weston Foundation, the Weston Brain Institute, the Canadian Consortium on Neurodegeneration in Aging and Genome Canada. Honoraria from the American Geriatrics Society. He holds United States Provisional Patent No.62/466,651 for a cell-based assay and kits for assessing serum anticholinergic activity. BM: research financial support from Brain Canada, CAMH Foundation, Canadian Institutes for Health Research, and US National Institutes of Health; nonfinancial support from Pfizer , Eli Lilly , Capital Solution Design LLC , and HAPPYneuron . He directly owns shares of General Electric . SK: research support from Brain and Behavior Foundation, National institute on Ageing, BrightFocus Foundation, Brain Canada, Canadian Institute of Health Research, Centre for Ageing and Brain Health Innovation, Centre for Addiction and Mental Health, University of Toronto. He also receives equipment support from Soterix Medical.The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "This study shows that Berlin and London are likely candidates for future world record attempts, whilst such a performance is unlikely in New York or Boston.The main goal of this study was to analyse the pacing strategies displayed by the winners of the six World Marathon Majors in order to determine which race offers the greatest potential for future world record attempts. For data analysis, the total distance of the marathon was divided into eight sections of 5 km and a final section of 2.195 km, and time needed to complete each section was calculated in seconds. When we analyzed the mean winning time in the last 13 editions of each of the World Marathon Majors, we observed differences between New York and London (ES = 1.46, moderate effect,  The pacing strategy adopted during competition is crucial in determining marathon running performance  succeeded in lowering the previous record by 1 min and 18 s. This performance has increased speculation regarding the possibility of a sub 2 h performance  providing the winners of the official World Marathon Majors for men between 2006 and 2018, which resulted in a sum of 76 winners. Each set of information included at least: the position, category, official final time, half-marathon time, and time data every 5 km.The total distance of the marathon was divided into eight sections of 5 km and one section of 2.195 km, and time needed to complete each section was calculated in seconds. Full marathon average speed and the average speed of each section were calculated individually. The relative speed of each section for every runner was then calculated and presented as a percentage of the average speed for the full race.The athletes were divided into six groups: (A) group of marathon Berlin (winners between 2006 and 2018), (B) group of marathon Boston (winners between 2006 and 2018), (C) group of marathon Chicago (winners between 2006 and 2018), (D) group of marathon London (winners between 2006 and 2018), (E) group of marathon New York , (F) group of marathon Tokyo .The course information were retrieved through the official internet website for each city marathon, on marathon archive websites and from various media outlets.post-hoc comparisons. The magnitude of the differences or effect sizes (ES) were calculated according to Cohen's d  was used to analyze the data. Each data set was screened for normality of distribution and homogeneity of variances using a Shapiro-Wilk normality test and a Levene test, respectively. One-way analysis of variance (ANOVA) was used to compare the mean winning time in the last 13 editions of each of the World Marathon Majors. Two-way analysis of variance (ANOVA) with repeated measures for time was used to compare the pacing strategies between the winners of the six world marathons majors. When differences were found, a Tukey's range test was used for d Cohen,  and inted Cohen, . SignifiWe acknowledge that such a statistical approach has been criticized as it may induce a greater risk of type I error Sainani,  and may p = 0.0030), New York and Berlin , London and Boston , Boston and Berlin , Boston and Chicago , Berlin and Tokyo , Berlin and Chicago .Mean winning time in the last 13 editions of each of the World Marathon Majors are presented in p = 0.0001), London , Tokyo , Boston , and Chicago . On the other hand, London was faster than Chicago .When individual 5 km segments were analyzed, differences were found in running speed relative to the whole race average . In the p = 0.0133), London , Chicago , Boston , and Tokyo .In section 6, New York again differed from other races, as it was faster than Berlin  and Boston , London was slower than New York , and Boston  and New York was faster than Tokyo .In section 8, we found the following differences: Berlin was slower than New York , London , Boston , and Tokyo .In the final 2.2 km section, New York was faster than Berlin .All datasets generated for this study are included in the article/supplementary material.JD participated in the study design, collected all the data and participated in data analysis, statistical analysis, interpretation of the data, and manuscript editing. AR participated in the study design, participated in data analysis, statistical analysis, interpretation of the data, and manuscript editing. EF-O participated in the conception and design of the study and revised/reviewed the manuscript. MT designed and carried out these experiments, participated in data analysis, and statistical analysis. JS-C participated in the coordination of our study participated in data analysis, statistical analysis, interpretation of the data, and helped to polish the manuscript. All authors have read and approved the final version of the manuscript and agreed with the order of presentation of the authors.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "Dear Editor,The first case of the novel coronavirus was reported in Wuhan, Hubei Province, China in December 2019. The disease caused by the virus is called Coronavirus Disease 2019 (COVID-19). Since it is highly contagious and has widely spread throughout the world, the World Health Organization (WHO) declared the pandemic state on 11 March 2020 . In addAfter the pandemic declaration, most of the countries implemented different types of mitigation strategies, such as self-isolation, social distancing, mass quarantine, and city lockdown. During these conditions, infected individuals as well as healthy ones have been exposed to short- and long-term psychological consequences. Death of a COVID-19 patient in quarantine conditions and burial by special equipment deprives the family members of their traditional grief and leads to complicated grief syndrome. Quarantine conditions also impose stress, anxiety, irritability, and sleep disorders on the general public . Due toDissemination of misinformation, misconceptions of people, and the use of negative words are the causes of the social stigma in patients with COVID-19. Individuals who have died, those who have recovered from the disease, and those who have been quarantined as well as their families are exposed to stigma and rejection by the society. The reluctance of friends and relatives to visit the home of a person with COVID-19 due to the fear of spreading the disease to visitors can exacerbate the feelings of isolation, loneliness, and complex emotions. Families and relatives of patients may also experience the feelings of guilt and self-blame due to isolation conditions and inability to care for the sufferers during the pandemic, which can eventually lead to disruption of their daily activities. The mentioned conditions necessitate exceptional psychosocial support for this group of individuals. The adverse psychological effects could be reduced through increasing the general awareness, educating the people about the characteristics of these patients, and having appropriate interaction and empathy among people.The following solutions can also be useful in reducing the adverse psychological effects: providing the possibility of transferring the deceased to the city of residence, selection of the burial place by the family, and creating an opportunity for the patient\u2019s relatives to see the body and face of the deceased person in a safe manner, using clear bags to transport the corpus of the dead one, letting a family member be present during the transfer by ambulance to the burial site, and sharing his or her latest pictures with family members , conducting telephone and internet-based consultations in the form of telemedicine for psychological screening, developing educational startups and applications in this regard, paying attention to and respecting the local and cultural customs of different societies, providing spiritual supports in hospitals and health centers, holding modified debriefing and hot wash sessions using social media for patients and healthy people in quarantine, providing mental preparedness and adequate explanations about the necessary safety measures for post-quarantine conditions, strengthening and respecting religious beliefs and supporting them, holding virtual funerals and ceremonies through the social media, supporting disadvantaged and vulnerable groups both economically and socially, providing an agreement to impose unavoidable restrictions on patients and their families, using relaxation and yoga techniques, and avoiding following the news.The following measures can be used to prevent the social stigma: increasing the general population\u2019s knowledge and awareness of the disease, respecting the personality and self-esteem of the infected patients, not using negative words by healthcare providers, people, and the community, producing scientific and educational contents by celebrities, bloggers, social media influencers, and religious leaders, strengthening the cohesion of social ties, sharing the experiences and narratives of COVID-19 patients with others, putting false information and beliefs aside, strengthening the society members\u2019 sense of social responsibility towards each other, and establishing public and multi-organizational information networks to deal with false news about the disease and patients. Given that there is no consistent and scientifically validated data on COVID-19, it is common to see the disease as a dangerous and frightening event, which can have adverse psychological effects on people. Challenging the feelings of guilt, processing painful emotions, encouraging grieving people to take care of themselves, and strengthening resilience and the ability to adapt with the consequences of bereavement through psychological support in the form of counseling, psychotherapy, and being in touch with other quarantined families in a safe manner can contribute to people's mental health. The large number of deaths and the need for patients and survivors to receive psychosocial support reflect the necessity of counseling services on a large scale. Hence, reduction of the long-term consequences for families and the society is recommended to be addressed by policymakers and health planners both globally and regionally.Ahmad Soltani and Mahmoudreza Peyravi equally contributed as first authors.The authors would like to thank Ms. A. Keivanshekouh at the Research Improvement Center of Shiraz University of Medical Sciences for improving the use of English in the manuscript.The authors have no conflict of interest to declare.Nil."}
{"text": "Synopsis of the Golden Chamber by Zhang Zhongjing. It is a disease of heart and lung internal heat by Yin deficiency, which belongs to the category of emotion disease in Chinese medicine. In recent years, researchers believe that lily disease and depression syndrome of Yin deficiency and internal heat have many similarities in etiology, pathogenesis, and clinical manifestations. This review summarizes the clinical symptoms, etiology, pathogenesis, and therapeutic medication of lily disease and modern Yin-deficient internal heat depression and discusses the relationship between them. Furthermore, the relationship between coronavirus disease 2019 (COVID-19) and lily disease was discussed from the etiology, pathogenesis, and treatment. It provides new ideas for the treatment of COVID-19 and the treatment of psychological problems after recovery.Lily disease was first recorded in  Major depression disorder (MDD) is a mood disorder characterized by sentimentality, despair, anhedonia, and sensitivity for social rejection . These sEmerging evidences from human postmortem and animal studies point out depressive disorders may instigate from human body system imbalance affected by genetic and environmental factors . HoweverAs a critical component of complementary and alternative medicine, traditional Chinese medicine (TCM) is a multicomponent, multitarget, and multipathway therapy, which can achieve its unique therapeutic effect by adjusting the biological network of the human body system , 7. TCM Most of Yin deficiency and internal heat of depression is the deficiency syndrome, and its main clinical manifestations are anxiety, depression, tension, suspicion, irritated fever, night sweat and zygomatic red, palpitation and insomnia, red tongue with little moss, and thready and rapid pulse .Synopsis of the Golden Chamber by Zhang Zhongjing. It is a disease of heart and lung internal heat by Yin deficiency, which belongs to the category of emotion disease in Chinese medicine [Lily disease was first seen in medicine . In receBased on the TCM theory, many disease occurrences are related to personal physical and emotional injury . It willSynopsis of the Golden Chamber: Lily Disease, Huhuo and Yin Yang Toxin: Pulses, Syndromes and Treatment. The manifestations of \u201clily disease\u201d patients are marked by unclear consciousness, fluctuated appetite, frequent silence, restlessness, confused cold and heat body sensation, bitterness in the mouth and dark urine, red tongue body and less tongue coating, and weak and thready pulse. These characteristics are similar to the manifestations of depressive disorders [The \u201clily disease\u201d is initially reported in isorders . Based oisorders .Emerging evidences from the ancient Chinese medical text suggest that the etiology factor of lily disease is mainly internal and external injury . The intWith regard to pathogenesis, there are many TCM hypothesis mechanisms underlying internal and external factors inducing lily disease . The mosPlain questions said that \u201call eleven dirty depends on the gallbladder.\u201d Therefore, if the gallbladder has heat, all veins are affected by Yin deficiency. The gallbladder controls the decision, so the deficiency of gallbladder Qi showed the symptoms of trance. The third view is the theory of liver. Some scholars believe that the location of this disease is the liver and that the failure of sentiment leads to liver Qi stagnation, endogenous heat deficiency, and Yin injury [Golden Chamber described, TCM experts considered that its pathogenesis lies in the damage of coke due to irregular diet [The second view is the theory of gallbladder. For example, Liang et al. believe that \u201cbitterness in the mouth\u201d is a syndrome of Shaoyang gallbladder meridian disease . Plain qn injury . The foular diet .In summary, the cause of lily disease is the damage of viscera by external or internal injury, leading to Yin deficiency of viscera and disorder of Qi and blood; then, the veins will lose nourishment, and hence, it will lead to the symptoms of mental disorder. The Yin deficiency of viscera will lead to the virtual heat coming from the inside of the body, as well as bitterness in the mouth, red-colored urine, and other symptoms.According to the TCM theory, depression can be divided into positive syndromes and deficiency syndromes, including Qi stagnation, fire stagnation, phlegm stagnation, blood stagnation, heart and spirit loss nourish, deficiency of both heart and spleen, and hyperactivity of fire due to Yin deficiency. Most of the Yin deficiency internal heat depression is menopausal depression or depression in old age, and its etiology is plant nerve dysfunction and endocrine dysfunction .Contemporary scholars believe that depression belongs to the category of \u201cno disease\u201d in TCM. Most patients have no obvious organic lesions. The pathogenesis is the imbalance of Qi, blood, Yin, Yang, and the dysfunction of viscera, which makes the body in a state of excessive Yin and Yang or partial decline. Disorders of Qi and blood in the viscera will lead to abnormal mind, and changes in mind will also affect Qi and blood in the five viscera .TCM experts generally considered that depression is closely related to Qi and blood blockage and liver unreel distributing , 26. AllThe intrinsic mechanism of Yin deficiency and internal heat of depression is the imbalance of the kidney, lung, and spleen and other viscera. The clinical manifestation of Yin deficiency and internal heat of depression is a mixture of deficiency and excess syndromes . Vital QBased on the TCM theory, lily disease is a kind of emotional disease, which is closely related to emotional and psychological factors. Lily disease occurs because of the disorder of seven emotions, which will hurt viscera and lead to the imbalance of Qi, blood, Yin, and Yang. In addition, it may be the sequela of exogenous fever or other diseases . With reFrom the pathogenesis, the basic pathogenesis of lily disease is internal heat due to Yin deficiency, and its pathogenesis is the result of the interaction of various pathogenic factors . From thRehmannia root is naturally sweet with bitter flavor, and mostly shows its curative effects in the kidney, liver, and heart. It has effect on promoting body fluid production, nourishing Yin, and controlling heat [Zhang Zhongjing believed that the treatment of emotional diseases should first improve the physical symptoms combined with Chinese herb treatment based on syndrome differentiation . The maiing heat . When twAnemarrhena) is bitter and sweet in properties, and it is also associated to the lung, stomach, and kidney meridian. It has the effect of clearing away heat, eliminating annoyance, draining the lungs, and nourishing the kidneys. Because \u201cblood and sweat are homologous\u201d and \u201csweat and fluid are homologous,\u201d excessive sweating will lead to more deficiency of body fluid, Qi and blood, and obvious symptoms of dry thirst [Lily Zhimu Decoction (BZD) was another traditional Chinese formula for treatment of lily disease . Zhimu  was used to treat lily disease mistreated with purgative. Talc tastes sweet and is cold in nature. It was used to treat vexation, hot, and thirsty. Hematite tastes bitter and is flat in nature, into Stomach Channel of Foot-Yang Ming. It can reduce stomach gas to stop hiccups, relieve cough, and clear heat and have the characteristic of inducing astringency without hurting vital energy. After the wrong purgation, stomach Qi and body fluid were injured, and internal heat increased. Because the main disease has not changed, lily is still the monarch medicine. Talc is used as minister medicine to diuretic and purgation heat, and hematite is used as adjuvant drug to induce astringency and astringing Yin .Lily disease mistreated with the vomiting method should be treated with Lily Yolk Decoction (LYD) underlying syndrome differentiation . Yolk taLily disease patients with lasting for one month without alleviation can use lily to wash the body. If thirst is severe, it should be treated with Gualou oyster powder (GOP) . TrichosTCM believes that the pathogenesis of depression is related to the deficiency of Qi and Yin in several viscera. Therefore, the main principles for treating Yin deficiency and internal heat of depression are nourishing Yin to clear heat in five viscera . Howeverthe Canon of Internal Medicine, people's spiritual consciousness and thinking activities are coordinated by the five viscera. The heart is the master of all the viscera recorded in Lingjiu. It means that the heart has a controlling effect on the five viscera, and the malfunction of the heart can also lead to the malfunction of other viscera. The treatment of Yin deficiency and internal heat of depression from the heart mainly adopts the method of replenishing Qi and nourishing the heart. Major Heart Supplementing Decoction was clinically used to treat heart Qi deficiency-type depression [Inula japonica acts on Qi, and the two drugs used mutual promotion can benefit heart Qi and enhance heart function. Bamboo leaves can clear the mind and purge fire to remove irritation. Pulp of Cornus can ease the emergency of the heart and prevent dredge too much, leading to the consumption of Qi. Ginseng and dried ginger can benefit heart Qi to enhance heart function. This prescription has the effect of supplementing heart Qi. It is an effective prescription for treating depression due to heart Qi deficiency.Heart Qi deficiency can lead to poor blood flow and blockage of heart vessel. According to pression . Cortex Rehmannia can nourish the heart and Yin, as well as cool blood to clear heat, and the two drugs can nourish the heart and lung and clear heat to calm nerves when they are used together.Yin deficiency and hot of the lung can lead to the failure of the lung to disperse and descend. The treatment of Yin deficiency and internal heat of depression from the lung is mainly based on the method of invigorating Qi and nourishing Yin. Zhang et al. considered that LBRD has a good therapeutic effect in clinical practice . In thisAngelica sinensis, Astragalus, and Arillus Longan have the effect of invigorating Qi, activating blood, and calming spirits. Lanceolata can nourish Qi and enhance the function of the spleen and lungs. Atractylodes, Poria cocos, and spine date seed have the function of calming the mind and eliminating dampness to strengthening the spleen. This prescription has the function of strengthening the spleen and blood to calm the spirit, and it is an effective prescription for the treatment of depression due to spleen deficiency.Lack of body fluid in the spleen makes it become hot and dry and leads to Yin deficiency, which will cause the maladjustment of transport and transformation of the spleen. The spleen is the most negative viscera in the human body. And spleen Yin deficiency will affect the lung, liver, and kidney functions and result in the dry heat performance of the body . TherefoAstragalus is commonly used in clinical practice to replenish liver Qi. For example, Wang et al. [Astragalus can replenish Qi. Salvia can activate and nourish blood. Pinellia ternata tastes spicy and can resuscitate and dissipate the lump, and it is an adjuvant drug to inhibit the disadvantage of a large amount of Astragalus. The combination of these three drugs can invigorate Qi and activate blood circulation and has the advantage of supplementing without stagnation.Liver Qi stagnation will make the liver hot and then damage the liver Yin. If the dredge function of the liver is abnormal, the operation of Qi in the viscera and meridians will be obstructed, which will lead to the damage of liver Yin and the appearance of internal heat. The treatment of Yin deficiency and internal heat of depression from the liver is mainly based on the methods of invigorating liver Qi and nourishing Yin of the liver. Common formulations include Ease Powder, Bupleurum Decoction, and so on . In addig et al.  treat deSchisandra chinensis has many functions, including tonifying the lung to collect Qi, nourishing the heart to remove annoyance and tranquility, strengthening the spleen and consolidating the base, regulating the rise and fall, softening the liver to relieve depression, and invigorating Qi to stabilize kidney essence [The kidney essence exhausted will make the kidney dry and hot and lead to the injury of kidney Yin. The kidney is the origin of congenital constitution and holds essence, and the essence of the kidney is the material basis of kidney Yin. It shows that the reason of kidney Yin deficiency is the insufficieny of kidney essence. The treatment of Yin deficiency and internal heat depression from the kidney is mainly based on the method of reinforcing the kidney . Epicedi essence . These tCoronavirus disease 2019 (COVID-19) has the characteristics of fast transmission, wide transmission, strong infection, general population susceptibility, and no specific therapeutic agents . It is aTCM experts believe that COVID-19 was classified as \u201cepidemic disease,\u201d with the lung and spleen as the main disease sites , 49. Qi,The pathogenesis of COVID-19 varies from mild to severe, from surface to entrant, and from solid to deficiency , 52. TheA recent study indicates that exogenous febrile disease and pulmonary diseases are related to the occurrence of lily disease . From thGlycyrrhiza, Pogostemon cablin, bitter almond, honeysuckle, Poria cocos, weeping forsythia, tangerine peel, and Coix seed [TCM has been widely recognized and widely applied in the treatment of COVID-19 during the epidemic. COVID-19 prevention and treatment program and clinical prescription data in various regions of China suggested that the common high-frequency drugs of the prevention and treatment plan and clinical medical records included oix seed . Currentoix seed , fragranWe believe that the treatment prescription of lily disease can be considered as a supplementary treatment for pneumonia in the middle and later stages, to clearing away heat and nourishing Yin, strengthening spleen and benefiting vital Qi, and regulating the function of viscera, Qi, and blood, which is beneficial for novel coronavirus pneumonia rehabilitation.COVID-19 patient medical therapy should be paid not only to the treatment of pneumonia itself but also to the psychological state of patients. The patients' mood changes will affect the treatment and prognosis of the disease. So, it is necessary to carry out psychological intervention and drug therapy for emotional diseases. In addition, COVID-19 patients will still have different psychological problems after recovery and discharge from hospital, and follow-up and psychological intervention after discharge is still an urgent task.We systematically summarize the research status of lily disease and Yin deficiency and internal heat of depression and came to the conclusion that the cause of lily disease is the damage of viscera by external or internal injury, which will lead to Yin deficiency of viscera, and the disorder of Qi and blood; then, the veins will lose nourishment, and hence, it will lead to the symptoms of mental disorder. The Yin deficiency of viscera will lead to the virtual heat coming from the inside of the body, as well as bitterness in the mouth, red-colored urine, and other symptoms.From the clinical symptoms, lily disease showed trance, sleep, anxiety, insomnia, and other symptoms similar to the clinical diagnostic standard of modern depression. And bitterness in the mouth, red-colored urine, and rapid and thready pulse are the typical symptoms of internal heat due to Yin deficiency. Therefore, we can infer that internal heat depression due to Yin deficiency is a major syndrome of lily disease from etiology and pathogenesis.For COVID-19 patients, lung damage can cause spread and decline malfunction, and deficiency of Qi and Yin in the lungs will make it hot and dry. If the residual heat in the late period of febrile disease has not been solved, it will consume Yin-Jin and result in lily disease. Therefore, the treatment of lily disease can also be referenced when treating COVID-19 patients."}
{"text": "The study provides insights into the aspects of creativity, the structure of psychometric intelligence, and personal adaptation resources of senior preschool children. Creativity and intelligence are presented as general adaptation resources. Existing studies of creative ability and creativity as integral individual characteristics in the context of adaptation are analyzed. The aim is to identify varied sets of creativity and personal adaptation resource markers that differentiate groups of children in order to determine possible strategies for adaptation, preservation, and development of their creative abilities at the beginning of lyceum schooling. It embraces the use of the E. Torrance Test of Creative Thinking (TTCT) , the Wechsler Intelligence Scale for Children (WISC), and the G. Rorschach Test. A sample of the study consisted of 122 children, aged 6\u20137 and enrolled in a school. The average IQ score among the children was above 115 . The entire sample was divided into four groups by the originality-elaboration ratio according to the TTCT. The correctness of the children\u2019s division into the groups according to the markers of creativity and personal adaptation resources is confirmed by the discriminant analysis. We have identified the factor structure of creativity, intelligence, and personal adaptation resources in the entire sample of children and in each of the groups. In the group of preschoolers with high originality and elaboration, the resulting structure integrated the components of creativity with personal adaptation resources and intelligence scores. In the group of children with a low level of originality and elaboration, the markers of creativity, intelligence, and personal adaptation resources are not interlinked. The growing frequency and cultural diversity of contemporary creativity studies are connected with the increase in their importance for social progress ,2. TodayThis paper focuses on the personal adaptation resources of children with high intelligence scores and various markers of creativity prior to their enrollment in a lyceum school.The period of schooling is decisive in terms of building creative abilities and adaptation resources in individuals. Schooling nurtures socio-cultural standards of activity and communication. Thus, a conflict is possible between a creative potential and initiative and the need to comply with standards . The speAdaptability in this study is understood as a structural feature of the target future action of subjects and includes personal components that determine its development: Impulse and reflection of forces, desire and anticipation, aspirations and self-confidence, perseverance and performance, forecast of one\u2019s own capabilities and the capabilities of the environment, and situation .Aim: To identify varied sets of creativity and personal adaptation resource markers that differentiate groups of children in order to determine possible strategies for adaptation, preservation, and development of their creative abilities at the beginning of lyceum schooling.To study \u201ccreativity in the context of adaptation\u201d, it is imperative to identify the differentiating grounds according to creativity metrics, identify options for combining them with the adaptation resources of preschoolers, and choose activities with a high level of uncertainty so that a child can independently demonstrate various forms of creativity and adaptability.The adaptation processes are explored in the context of intelligence and its development in ontogenesis ,10. HencThe ratio of intelligence and adaptation is complex and variable due to diverse markers of personal adaptation to the world. The adaptation markers include study progress and professional achievements\u2014\u201csubject-symbolic adaptation\u201d, adaptation to the social environment\u2014\u201csocial adaptation\u201d, and coping behavior as harmonization of the inner world\u2014\u201cpersonal adaptation\u201d . It is rFor the study of \u201ccreativity in the context of adaptation\u201d, the findings of researching the creativity-intelligence ratio as an adaptation resource are crucial. Some studies identify the creativity-intelligence ratio ,14; otheJ.-H. Guignard et al. found that high verbal ability children showed significantly higher scores on verbal creative potential . The comE. Torrance\u2019s studies revealed that the creativity-intelligence interrelationship does not exist in all samples of subjects. According to the intellectual threshold theory, when IQ is below 115\u2013120, intelligence and creativity form a single factor, with IQ above 120 they are independent factors . B. Shi\u2019Let us review the concepts and approaches to insights into creativity, which identify its key features, which are significant for the differentiation of subject groups.The core approach to the study of the structure of creative abilities is the psychometric approach developed by J. Guilford and E. Torrance ,18,20,21Creativity is measured using the widely popular E. Torrance Test of Creative Thinking (TTCT). Ample studies have confirmed the good psychometrics of the test\u2014high validity and reliability ,18,25. TAccording to E. Torrance, the key criteria differentiating subjects by creativity are scores of originality as the ability to create new things and elaboration as the ability to detail and deepen initial ideas, which increases their complexity and improves presentation. It has been revealed that children with a high level of originality excel in curiosity and independence, and are prone to take risks, while children with a high level of elaboration are distinguished by the desire to have the upper hand and are emotionally insensitive . The studies of the factor structure of creativity by the TTCT revealed sets of variables featuring the innovation and adaptation potentials of subjects, the relationship of creativity with such personal qualities as openness to new things, curiosity, tolerance for uncertainty, and risk acceptance ,29.In addition, studies revealed two-factor structure of variables  in the context of the Adaption-Innovation Theory ,31.To summarize, aforementioned analysis allows us to differentiate our samples by two variables: originality and elaboration. Those two variables, representing both the potential to create new and adaptational potential, are abilities that are required to bring something new into being.Another approach to the study of creativity is integrative: creativity is cited as a systemic feature, including intelligence, knowledge, mindset, individual traits, motivation, and environment . M. CsikIn the studies of creativity as systemic quality, personal components were identified\u2014intrinsic motivation , intelleIn different age samples, the personal properties that manifest themselves in a situation of uncertainty (according to the G. Rorschach Test) were investigated; properties aimed at changing and creativity, and properties aimed at stabilizing and maintaining standards. The first group of properties includes intellectual initiative, flexibility, composite thinking, originality, and perception, while second one includes intellectual control, emotional reactivity, anxiety, and realistic perception ,39.Based on the theoretical analysis, creativity markers were chosen as grounds for differentiating groups of children\u2014originality and elaboration taking into account intelligence scores (according to E. Torrance). For the study of children\u2019s personal adaptation resources, opposite personality traits were selected, including types of experiences (the ratio of introversion and extratension), emotional reactivity, intellectual initiative and intellectual control, composite thinking, realistic perception, and originality, providing both the creativity and adaptability in situations of uncertainty (according to G. Rorschach).Hypothesis: Children with high intelligence scores who have different levels of manifested creative abilities\u2014originality and elaboration\u2014feature specific sets of personal adaptation resources.The empirical study consisted of the psychological diagnostic of children using three methodics: The Wechsler Intelligence Scale for Children (WISC), the E. Torrance Test of Creative Thinking, and the G. Rorschach Test.For the study of creativity, intelligence, and personal adaptation resources, discriminant and factor analysis of captured psychological screening results were applied. The analysis as a whole covered the entire sample and groups of children with different creativity scores . All calculations were performed using the IBM SPSS Statistics package.All subjects gave their informed consent for inclusion before they participated in the study. The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Local Ethics Committee of the Higher Biomedical School South Ural State University of 307/20 of 5 December 2019.The study involved 122 children aged 6\u20137, 65 boys and 57 girls, enrolled in a school in Chelyabinsk. The sample consisted of children who belonged to the same ethnic group\u2014Russians who live in Chelyabinsk city. Later, all these children were accepted in different classes of the same school.The IQ average scores among the children was above 115 . The sample was divided into four groups by originality  and elaboration ratio . The first group was 25 children with above average originality and elaboration scores. The second group was 22 children with above average originality and below average elaboration. The third group was 25 children with below average originality and above average elaboration. The fourth group was 50 children with below average originality and elaboration.For the psychological assessment of creativity and its key markers, we have used the TTCT; the figural version adapted by E.E. Tunik ,23. The For the psychological screening of intellectual levels, we used the Wechsler Intelligence Scale for Children (WISC) with five verbal subtests  and five non-verbal subtests . In this study, we used the markers of verbal (VIQ) and non-verbal (PIQ) intelligence and a general IQ score.Average results of intelligence, creativity, and adaptive personal resources in groups are shown in For the psychological screening of creative and adaptive resources, the G. Rorschach Test was applied ,41,42. TThe validity of the Rorschach Test results and their combinations were confirmed in multiple scientific studies ,43,44,45The differentiation of children according to the originality-elaboration ratio was tested using discriminant analysis. The captured findings of assessing the correctness of classification and assignment of subjects into groups, the analysis of the contributions of creativity, and personal adaptation resources to the core discriminant function are shown in The greatest contribution to the core discriminant function, which is a linear equation for classifying children with different creativity scores, is made by the variables: Originality, elaboration, and overall creativity (the TTCT), and compositional thinking (the G. Rorschach Test).The structure of children\u2019s creativity, intelligence, and personal adaptation resources was assessed on the basis of the factor analysis of captured psychological screening findings .The factor structure of creativity, intelligence, and personal resources throughout the sample forms five factors (77.62% of explainable variance), in which variables of methods are not included in common factors, while personal resources are represented by two factors (with 18.8% and 16.9% variance). Creativity is represented by two factors (with 17.4% and 11.2% variance) and intelligence by one factor (13.3% variance) in general; in a sample of children with IQ scores above the norm, the factor structure of creativity, intelligence, and personal resources is represented by orthogonal factors, which indicates the unrelated nature of these phenomena.In Group 2, children with above average originality and below average elaboration, the first set of variables is a bipolar factor formed by several features of personal resources  and IQ at one pole and originality according to the TTCT at the other pole. The second set of variables includes only the markers of personal adaptation resources\u2014indicators of intellectual control, \u201crealistic\u201d perception, and psychophysical activity. The third set of variables embraces such features of creativity as fluency and flexibility, as well as indicators of intelligence: total IQ and verbal intelligence (VIQ). The fifth set of variables includes flexibility, total IQ, and non-verbal intelligence (PIQ). The fourth set of variables is represented by overall creativity and elaboration and personal resources; intellectual initiative and compositional thinking . Thus, cIn Group 3, children below average originality and above average elaboration, the first set of variables is a bipolar factor formed by several features of personal resources. At one pole of the factor, there are the amounts of experience, emotional reactivity, compositional thinking, and originality of perception, and at the other pole\u2014standard, realistic perception. The second set of variables also represents the bipolar factor: One pole includes features of creativity\u2014overall creativity, flexibility, and originality, and the other pole embraces the indicators of personal adaptation resources\u2014intellectual initiative, psychophysical activity, and realistic perception. The third set of variables covers all IQs: Total IQ score, VIQ, and PIQ, and fluency as a metric of creativity. The fourth set of variables includes overall creativity and elaboration as well as intellectual control and originality of perception . Thus, fIn Group 4, children demonstrating below average originality and elaboration, the markers of creativity, intelligence, and personal adaptation resources are independent and form four orthogonal factors. The first set of variables is formed only by the metrics of personal resources . The second set of variables is formed only by creativity markers. The third set of variables includes the markers of intelligence and its components. Only the fourth set of variables embraces two features of creativity; the overall creativity and elaboration, and the indicator of personal adaptation resources\u2014intellectual control. Thus, as in the whole sample of children with below average originality and elaboration, the markers of creativity, intelligence, and personal adaptation resources are independent.Children with high levels of intellectual abilities differentiated by key characteristics of creativity\u2014originality and elaboration\u2014differ, in general, by characteristics of creativity and personal adaptation resources . The maximum contribution to the proposed classification is made by the indicators of originality, elaboration, overall creativity, and compositional thinking in a situation of uncertainty.In general, in a sample of children with a high level of intellectual abilities, the factor structure of the characteristics of creativity, intelligence, and personal resources is represented by orthogonal factors, showing the unrelated nature of these phenomena. This helps to confirm the \u201cthreshold theory\u201d regarding intelligence proposed by E. Torrance. However, in the group of children with high levels of originality and elaboration, and in the group of children with high level of originality, sets of variables were captured, including both characteristics of intelligence and creativity.The factor structure of creativity, intelligence, and personal adaptation resources in each of the four groups of children demonstrating various levels of originality and elaboration has been determined. In the group of preschoolers with a high level of intellectual abilities, originality, and elaboration, the resulting structure is as integrated as possible; creativity is simultaneously linked to personal adaptation resources, and to overall intelligence and its components . Creativity, intelligence, and adaptation resources in the group of children with a high level of intellectual abilities and low levels of originality and elaboration are not connected at all. The most problematic from the point of view of personal adaptation resources are two groups of children. This is the group of children with a high level of intellectual abilities and a high level of originality characterized by interrelations of creativity and intelligence, as well as creativity and those personal resources that support both intellectual activity and creativity\u2014intellectual initiative and complexity of interpretations. It is this complexity of properties that is decisive in the effective strategy of school adaptation, aimed at supporting \u201cinnovative creativity\u201d ,47. AnotIn general, the study revealed the possible foundations for a differentiated approach to the adaptation of children with high intellectual and creative abilities prior to the start of schooling.The first limitation is the sample that is shifted by intelligence scores: The mean IQ is 133.7. The second limitation of the sample is that the children included in this study were preparing for the enrolment in a lyceum school with high levels of development. The third limitation is the use of the TTCT to screen the characteristics of creativity. The research findings could be improved through the simultaneous combination of several metrics of creativity and real creative achievements."}
{"text": "Medicina. Particular attention was paid to nephrotoxic, hepatotoxic, cardiotoxic, immunotoxic, neurotoxic, and behavioral effects of pyrethroids on human and animal bodies. It could be added that pyrethroids generate oxidative stress, which modifies DNA, RNA, protein, lipid and carbohydrate molecules. However, public awareness of the possible negative effects of the use of insecticides is still low. Further research should be carried out to clarify the molecular basis of the pathomechanism of pyrethroid detrimental action. Proper dissemination of the results seems to be of first importance for public health.Pyrethroids are pesticides commonly used in crop protection; in the forestry, wood, and textile industries; as well as in medicine and veterinary medicine to treat parasitic crustacean infestations. They have been found to be relatively safe for humans and animals. Pyrethroids are recommended for personal protection against malaria and virus Zika by the World Health Organization. Pyrethroids act on voltage-gated sodium channels, which cause an influx of sodium ions into the nerve cells and permanent depolarization. They also influence activities of enzymes, especially in nerve and liver cells. Contact of pyrethroids with the skin, digestive tract, and respiratory tract results in their penetration into the body. Due to the importance of the subject, a summary of the current state of knowledge on the toxic effects of pyrethroids was presented in the comprehensive review by Chrustek et al, published in journal  The interest in protecting humans and animals against insects and diseases transmitted by insects, as well as crops against pests, has been around for nearly 200 years. Undoubtedly, due to the growing population of people, farm animals, and growing agricultural areas, the use of pesticides is constantly increasing ,2,3,4. ATanacetum cinerariaefolium (former name Chrysanthemum cinerariaefolium) [Historically, pyrethroids are a group of compounds of natural origin isolated from the flowers of the plant efolium) ,3,4,5. Nefolium)  (WHO perefolium)  (WHO delefolium)  (WHO cypefolium) .Pyrethroids act on voltage-gated sodium channels ,4. BindiPyrethroids are lipid soluble, so any contact with the skin, digestive tract, and respiratory tract results in their penetration into the body ,18,19,20Children and pregnant women are at risk of faster pyrethroid penetration into the body ,22,23,24Pyrethroids were divided into two groups, depending on the type of intoxication symptoms that appeared in a vertebral organism after their administration . Type I Particularly noteworthy is the fact that it has been proven that the level of pyrethroids in the body, as well as the severity of symptoms of poisoning, depends on the type of diet ,2,3. HigStudies concerning the negative effects of pyrethroids on humans and animals have been conducted for years. The review \u201cCurrent Research on the Safety of Pyrethroids Used as Insecticides\u201d published in Medicina Lithuania in 2018 , cardiotCurrent knowledge about the site of action of pyrethroids, toxic doses, and induced tissue and organ effects were presented . What deThe article  did not Nevertheless, public awareness of the possible negative effects of the use of insecticides is still low and further research should be carried out to clarify the molecular basis of the pathomechanisms of the pyrethroid detrimental action. The results of these studies should be widely disseminated. The review  presents"}
{"text": "Ethanol precipitation is a purification process widely used in the purification of Chinese medicine concentrates. This article reviews the research progress on the process mechanism of ethanol precipitation, ethanol precipitation process application for bioactive component purification, ethanol precipitation and traditional Chinese medicine quality, ethanol precipitation equipment, critical parameters, parameter research methods, process modeling and calculation methods, and process monitoring technology. This review proposes that ethanol precipitation technology should be further developed in terms of five aspects, namely, an in-depth study of the mechanism, further study of the effects on traditional Chinese medicine quality, improvement of the quality control of concentrates, development of new process detection methods, and development of a complete intelligent set of equipment. In the 1950s, a batch of modern dosage forms of traditional Chinese medicine (TCM) appeared in the climax of national dosage form reform, such as tablets, capsules, injections, granules, and mixtures. To meet the higher refining requirements of these dosage forms for the TCM systems, water extraction and ethanol precipitation (EP) technologies have been widely used in the production of TCM. The ethanol precipitation process (EPP) has many advantages, such as simple operation, easy amplification, and solvent safety. The EPP can effectively remove highly polar molecules such as sugars, salts, and proteins, and it is beneficial to reduce the dosage . In the EP is often the first refining process or even the only refining process after the extraction of TCMs. The quality of the EPP has a significant impact on the difficulty of follow-up preparations and the quality of the final drug. In recent years, with the continuous improvement of Chinese medicine standards, the EPP has attracted much attention from academic and industrial circles. This article mainly reviews the research progress on the process mechanism of EPP, EPP application for bioactive component purification, EP and TCM quality, EP equipment, critical parameters, parameter research methods, process modeling and calculation methods, and process monitoring technology and proposes future development directions.d-glucose, d-fructose, sucrose, maltose, raffinose, trehalose, and cyclodextrin has been reported . Th. Th58]. Table\u00a0The frequency of each critical factor in Table\u00a0According to the researches shown in Table\u00a0Many studies have considered the density, water content, and solid content of the concentrate. However, the differences between different batches of concentrate are mainly reflected in the content of each component in the total solid and other physical and chemical properties except density. There are few studies on these factors. Zhang et al.  screenedThere are many process parameters or concentrate properties that may affect EP results. However, the parameters of EPP are usually limited in narrow ranges in industry. Therefore, the quality control of concentrates is very important to keep batch-to-batch consistency of supernatants. By improving the quality control of decoction pieces and upstream processes of EPP, the quality of concentrate can be controlled within a proper range to promote the quality of the EPP.\u03d5) of ethanol in the supernatant solvent is defined in Eq.\u00a0, which is defined in Eq.\u00a0 ofentclass1pt{minimapKa value, the solubility of the organic acid salt (SA), the pH of the supernatant, the total concentration (CA) of the organic acid and organic acid salts in the supernatant is shown in Eq.\u00a0 . The parYan et al. established a mathematical model between the contents of active components in concentrates, the process parameters, and the properties of supernatant by adopting a feedforward control strategy. Then, according to the contents of active components in the concentrate, the parameters of the EPP of Danhong injection were adjusted. This method can improve the consistency of the active component contents in the supernatant . The autOperating process parameters with design space, varying process parameters according to the change of concentrate quality, or adjusting controllable parameters to lower the effects of noise parameters can all improve the batch-to-batch consistency of supernatant quality after EPP.In the production of TCM, an ethanol meter is widely used to detect the apparent ethanol content of the supernatants on the spot. This method is simple and practical, but only the density information of the liquid can be obtained.2, squared prediction error, and principal component score) is set up, and the process trajectory diagram is drawn. The multivariate statistical process control model can monitor the EPP in real-time and sensitively judge the normal operation state of the process. The establishment of a multivariate statistical process control model is helpful further to implement the feedback control of the EPP.The monitoring technology and indicators of EPP in the literature are listed in Table\u00a0In general, spectrum of EP system is rich in information. The process monitoring method based on spectrum can not only judge the process state, but also quantify the concentrations of specific components in combination with chemometrics.Based on the extensive review, great progress has been made in the study of process parameters, optimization methods, and process monitoring methods of EP of TCM. Problems still exist in industrial EP, including the loss of active components, the long time necessary for refrigeration, the quality difference between batches of EP supernatants, etc. In the future, EP technology research can be carried out from the following directions:The difference in concentrates between batches is mainly reflected in the fluctuation of the content of the components. At present, there have been reports about the influence of ethanol content in the supernatant on the solubility of Chinese herbal medicinal components. Nevertheless, there is no study on the influence of the content of Chinese herbal medicinal components on the solubility of other components. Therefore, it is not yet possible to describe the effect of the composition change of concentrate on the effect of EP. It is also difficult to accurately predict the material transfer and drug delivery rule of EPP.EPP is widely used in TCM industry from the last century. However, the quantitative effects of EPP on TCM quality are still unclear. The relationship between TCM substances and its quality is generally nonlinear. Therefore, some newly developed artificial intelligence technology can probably be used for the investigation of EPP and TCM quality. For example, as a typical algorithm of deep learning, convolutional neural network (CNN) can be a useful tool to deal with nonlinear quantitative problems , 154.At present, the concentrate quality in the industry is mostly controlled by density or volume. However, less attention has been paid to the chemical composition of the concentrate. It is recommended that the concentrate be used as one of the critical intermediates, and the quality standard of its composition should be set. Yan et al. used the quantitative model of process parameters, raw material properties, and EP evaluation index to back-calculate the quality standard of a concentrate . This woNIR combined with multivariate statistical analysis is used to detect indicators/major components or to detect process trajectories. NIR has many advantages, but the equipment cost is high, and the renewal and maintenance of the multivariate statistical model require professionals. In addition, there is still no means to detect the amount of encapsulation loss. Therefore, it is still necessary to develop simpler and easier-to-use detection technology.At present, the structure of EP equipment is simple, and process control relies heavily on manual work. The energy and material consumption are still high. Therefore, a complete set of intelligent EP equipment should be developed based on multidisciplinary technology. This equipment should be able to improve the efficiency of heat and mass transfer, quickly collect and analyze process data, and realize the automatic control of EPP."}
{"text": "Due to the high pathogenicity and mortality, the COVID-19 disaster caused global panic and anxiety. At present, diagnosis and treatment are of great concern. As time progresses, however, the sequelae caused by many other organ system complications and treatments will become increasingly obvious, and psychosomatic symptoms are one of these changes with great potential impact. Studies have shown that symptoms like poor sleep quality, anxiety and even delirium are not uncommon in patients during isolation. By summarizing the follow-up study on mental and psychological health of SARS in the past 10 years, and combining the characteristics of the existing cases of COVID-19, we will provide suggestions for the prevention and treatment of psychological diseases in clinical practice. Nearly 8\u2009months have passed since the first confirmed case of Corona Virus Disease-2019 (COVID-19) was found in Wuhan, China, in December 2019, and now the world is threatened by this highly infectious and devastating viral pneumonia. As of 26th August 2020, around 23,965,059 people in the world have been infected with the virus, and this number is still surging every day in Europe and America, the case fatality rate even exceeded 5%. In China, the earliest outbreak point, although the infection has been basically controlled, a large number of discharged patients are facing the burden brought by the complications of various organ systems and the mental pressure from the change of social roles and environment. As for the 187 countries where the outbreak is still raging, effective mental health interventions are needed to respond to the treatment pain of a large number of isolated patients, the depression of severe patients and the psychological pressure of medical staff under overload work.In view of the strong homology between the COVID-19 genome sequence and Severe Acute Respiratory Syndrome (SARS) , and menCurrently, we know little about the long-term impact of mental health of COVID-19 patients, so the importance of detection and treatment of comorbidity is self-evident, and mental health services can play an important role in rehabilitation. By summarizing the potential impact of major emergent events on mental health and behavioral symptoms such as anxiety, stress, fear, violence, progressive neurological dysfunction and cognitive impairment of survivors, and combining previous research and data characteristics of mental disorders caused by infectious diseases such as SARS, this paper concluded the mental and psychological symptoms that may appear on a large scale in the prognosis of patients with COVID-19 a highly dangerous disease spreading globally today, the risk factors and possible effective intervention programs. Then, it can further provide a comprehensive reference for the researchers in the field of global mental health and front-line workers, such as improving the medication plan in the treatment period, conducting certain psychological counseling as early as possible, and focusing on high-risk groups in the follow-up period of prognosis, moreover, regularly carrying out psychological assessment and psychological intervention treatment and giving certain drugs to control the further development of mental and psychological problems and the progressive damage of other organs for patients with severe emotional stress.Excluding acute lung, heart, kidney and other organic damage, psychological damage may have a wide and long-term impact. The outbreak of SARS in 2003 can be regarded as a mental health disaster. PTSD is the most common chronic psychosis, followed by depression. The problem of mental illness after the epidemic is extremely serious, and its influence covers all fields and is closely related to everyone. In one follow-up study of 195 adult SARS patients, 10 to 18% reported PTSD 1 month after discharge, and the severity of symptoms was related to higher perceived life threat and lower emotional support . AnotherSARS survivors also showed worrisome depression, anxiety and post-traumatic symptoms, with an alarming proportion (64%) of those who had reached the diagnostic criteria for psychosis . More stNotably, the mental health of survivors in terms of stress, anxiety, depression and post-traumatic symptoms did not improve over time, but gradually deteriorated . The stuIt is reported that neuroendocrine, neural structure and neuroimmune disorders play an important role in depression and PTSD. On the one hand, coronavirus can guide the immune damage mechanism in the body and induce a large number of inflammatory reactions. In the blood and Cerebrospinal fluid (CSF) of patients with coronavirus pneumonia, Interleukin-6(IL-6), C-reactive protein (CRP), Interleukin-1(IL-1), Tumor Necrosis Factor (TNF) and other proinflammatory factors are all increased to varying degrees , among wSecondly, in PSTD, the increase of corticotropin releasing factor (CRF) induced by traumatic stress may play an important role in the process of enhancing activated macrophage releasing facto , and theThe long-term prognosis of COVID-19 patients with mental disorders after rehabilitation is similar to that of SARS and other major epidemics , and itsIn previous retrospective studies, the occurrence of psychosocial diseases is often strongly associated with specific population or special environmental factors. For example, although the stress level of medical staff among SARS survivors during the outbreak was similar to that of non-medical staff, a year later, the pressure level of medical staff was significantly higher, with higher levels of depression, anxiety, post-traumatic symptoms and scores. After controlling factors such as age, gender and education, health care workers are six times more likely to score above the General Health Questionnaire-12 (GHQ-12) threshold due to the dual pressure of being patients and medical staff , so the The infection of virus is not only the battle of patients and medical staff, but also the battle of the whole country and people, as it is closely related to everyone and no one can stay out of the business. Studies have showed that the residents in the areas with high prevalence of SARS, regardless of age, continued to develop more serious post-traumatic interference than those in the areas with low prevalence of SARS. In addition, the prevalence of PTSD was significantly higher in the elderly and residents in SARS epidemic areas . The mosWe found that the high-risk factors for the prognosis of patients with COVID-19 are not only related to the specific population, but also highly related to the treatment drugs in the acute phase. For example, the use of a large number of interferon in the treatment of coronavirus will lead to emotional depression, anxiety, short-term memory disorders of sleep disorders through the impact on endocrine and changes in neurotransmitter and immune system changes ; meanwhiFrom the current situation of transmission, we are concerned about the mental state of people around the world. With regard to SARS, whose outbreak was brought under control in a few months mainly due to the two characteristics of SARS coronavirus: First, coronavirus is a large virus and is not easy to mutate; second, the infected people show obvious symptoms when they are likely to spread the disease, so they can be identified and isolated in time . HoweverPsychological intervention is very necessary for patients, health care workers and the general public. We should pay attention to the high-risk groups prone to disease, and at the same time eliminate the stimulation factors that induce PTSD and depression as much as possible, and timely and early intervention is beneficial to reduce the incidence of PTSD . We shouIt should be noted that stigmatization of disease may have a longer-term impact than disease itself. Two thousand three SARS virus, HIV and Spanish influenza, which was mistakenly associated with Spanish people, all of them have caused huge psychological and economic losses to specific groups and regions. The stigmatization of diseases, especially of certain ethnic groups, can lead to adverse social emotions and promote racism. In 2006, don C. des jarlais PhD proposed a positive and effective strategy for the United States to remove the stigma of Acquired Immune Deficiency Syndrome (AIDS) and protect people suffering from AIDS, such as the President of the United States posing with AIDS patients, and the promulgation of the Americans with Disabilities Act . It is tGenerally speaking, it is of great significance to carry out active and effective mental health education for the whole people, popularize relevant mental education assistance work as soon as possible, and provide timely psychological support with self-coping strategies to enhance their resilience and reduce their fear, anxiety and pressure. At the same time, it is more important to ensure the psychological status of specific occupations and high-risk groups, and the possibility of long-term subjective pain and occupational difficulties for medical workers infected with COVID-19 could be included in the data model, which will provide a better basis for future prevention and treatment . EffectiThe mental and psychological impact of major public health events may be long-term and even far outweigh the initial threat to life. The psychological symptoms of COVID-19 patients and cured survivors include poor sleep quality, low mood, anxiety, inattention, and two of the most common and severe long-term mental illnesses-depression and PSTD, which will cause great burden and threat to society in the long run. Age, gender, incidence rate and risk factors of acute phase are highly correlated with psychological morbidity, thereby providing a reliable basis for early identification and psychological support. At the same time, medical staff, as a special group fighting against epidemics and susceptible to infection, are facing multiple and complex pressures and are more prone to mental and psychological diseases, especially in the infected medical staff. Inflammatory response and other organ system prognosis sequelae are the possible mechanism for the generation and continuous progression of depression and PSTD. Therefore, it will exert a significant effect by reducing the dosage of corticosteroids in the treatment period, actively treating the psychiatric or psychological complications in the rehabilitation period with psychological counseling and treating severe cases of depression with chronic antidepressant medication. In addition, the government should provide public policy support to survivors, de-stigmatize the disease, and develop follow-up research programs to strengthen the evaluation of COVID-19 for long-term mental illness."}
{"text": "The purpose of this study was to carry out a literature review on the effectiveness of the validation method (VM) in job satisfaction and motivation of care professionals working with older people in nursing homes. The review was carried out in specialised databases: Scopus, PsychINFO, PubMed, Web of Science (WOS), Google Scholar, Scielo, and Cochrane Database of Systematic Reviews. 9046 results were obtained, out of which a total of 14 studies met the inclusion criteria: five quantitative, four qualitative, one single case series, two quasi-experimental and two mixed methods studies. The results of the analysed studies report that the VM can be an effective tool that facilitates communication and interaction in care, reducing levels of stress and job dissatisfaction among care professionals. The VM facilitates communication between professionals and older people with dementia, and improves the management of complex situations that may arise in care, directly influencing a reduction in work stress and increasing job satisfaction. The increase in life expectancy and the higher prevalence of neurocognitive disorders means there is a need to improve and innovate non-pharmacological strategies in order to ensure the quality of life and well-being of older people and their caregivers ,2,3. As Care for people with dementia can cause difficulties for care professionals, increasing their levels of stress, discomfort and job dissatisfaction ,9,10,11.This methodology is linked to the need found in many residential centers to promote the development of professionals\u2019 relational and socioemotional skills in order to improve positive and reciprocal relationships between them and the older people, which is a core aspect of care models like the well-known person-centred care model ,18,19,20In this regard, this review is necessary given the increase in interest to improve the quality of care, giving priority to humanisation and the implementation of the person-centred care model ,18,33,34A literature review was performed by peers of articles that included the effectiveness of VM in nursing home care professionals. The following databases were used for the review: Scopus, PsychINFO, PubMed, Web of Science (WOS), Google Scholar, Scielo and Cochrane Database of Systematic Reviews. The terms validation therapy, validation method, validation training, nursing, care, institutionalised, satisfaction, motivation and burnout were used. The search strategy used in the databases was: \u201c and (therapy OR method OR training) AND  AND (satisfaction OR motivation OR burnout)\u201d. In the Google Scholar database the following search was used: \u201c and (therapy OR method OR training) AND  AND (satisfaction OR motivation) and (Feil)\u201d.The bibliographic references of the selected articles were analysed manually, in order to find other studies that could potentially be included for the review. In addition, documents from grey literature were included, as well as scientific articles, systematic reviews (SR), metanalyses and book chapters that met the inclusion criteria .The initial selection and subsequent screening were carried out by the principal researcher based on the title and results summary. Subsequently, the final selection was carried out by peers in a team six reviewers: five experts accredited by the Validation Training Institute in VM , and oneFor the evaluation of each article, the following were taken into consideration: the year and country of the study, the type of study design , outcome measures, intervention group , type of intervention, evaluation of intervention and main effects on results in healthcare professionals.Initially, 9046 results were obtained, out of which a total of 14 studies met the inclusion criteria .With regards to the characteristics of older people that some studies included ,28,36,37In contrast, the characteristics of the professional participants in age, gender, sample size and professional profile in the studies are heterogeneous . Most ofRegarding professional profile, 12 studies (86%) included nursing staff, made up mostly of nurses and auxiliary nurses, in the training of the VM and/or in its implementation ,36,37,38These studies used different designs ranging from quantitative designs 5) ,33,36,37 ,33,36,3The trial structure of the included studies that did training in the VM or analysed the effect on its implementation was, in two studies (14%), a single-arm trial where training in the VM was carried out ,30; in fAlthough all the interventions were carried out in nursing homes, the duration and time of intervention varied. Most lasted between five and seven months ,26,27,30Regarding the variables of the professional studied, first, in the studies with quantitative measures, six studies 43%) quantified as outcome measures the effect of VM in three major areas ,33,36,37% quantifSecond, in the studies with qualitative measures, five studies (36%) quantified as an outcome measure the satisfaction with the relationship and communication between the professional and the residents and between the latter and their families which was assessed through observations of the interactions between the professional, the residents and their families or with Hecht\u2019s Interpersonal Communication Satisfaction Inventory (ICSI) , the DemThird, two quasi-experimental studies (14%) and one case series study (7%), quantified as an outcome result the effect of VM on satisfaction with communication between the professional and the residents and between the latter and their families, its use in the positive management of problem behaviours and increasing understanding of the behaviours of the disoriented person with dementia evaluated through Hecht\u2019s Interpersonal Communication Satisfaction Inventory (ICSI) , the DemFinally, despite the heterogeneity in the sample composition and in the structure and duration of the training and implementation, all the studies included in the review agree that training positively influences satisfaction, motivation, competence and self-efficacy of the care professional, improving their productivity and commitment to the organisation. Although there are only two randomised studies, the evidence suggests that training in and/or implementing VM can have a positive effect on healthcare professionals on a personal/professional, interpersonal and organisational level.In the professional sphere there is a reduction in stress levels ,33,36,37Regarding the interpersonal sphere, there is an improvement in communication skills between the professionals and the disoriented person, which facilitate the relationship and care ,27,30,38Finally, in the organisational sphere, there is a positive increase in the work climate ,37 and aThe purpose of this study was to analyse evidence on the efficacy of the VM on the job satisfaction and motivation of nursing home care professionals. Despite the limitations and methodological heterogeneity of the studies, most of the studies indicate that the VM provides benefits to care professionals, concluding that training and the correct use of the communication techniques that the VM provides are useful tools for relating and communicating with disoriented seniors, reducing burnout and negative work climate, and increasing their productivity and satisfaction, motivation and happiness at work ,29,30,33In the studies analysed, the variables most analysed in the professionals are burnout, job satisfaction, competence in the positive management of problematic situations that arise in care, as well as improvement of the relationship and communication between the professional and resident. Implementing and/or training in VM may have positive work effects that can be related to job satisfaction and motivation. Therefore, the communication tools, relationship, and theoretical framework provided by the VM is highlighted in this type of intervention since it provides tools for developing relational competencies, facilitating the relationship and communication between the disoriented senior and the care professional. As a result, it is necessary to extend research on non-pharmaceutical strategies that provide care professionals with tools, as well as the use of VM with other pharmaceutical interventions, as is being done, for example, with the Emotion-Oriented Care Model ,26,27,53The VM, which is in some ways congruent with the good practices that the person-centred care fosters, promotes a change in the culture of care where the abilities of the older person with dementia are valued and empowered, and where the professional moves from a role of being caregiver of a patient to being a caregiver of an expert in his/her own care ,34,54,55Finally, this review has a number of limitations: One is that there may exist a publication selection bias, since the initial screening of articles was not done by peers. Furthermore, the heterogeneity, lack of information on the sample composition or the type of intervention, samples under thirty participants in some studies, as well as methodological limitations, means that the results need to be taken with caution. In addition, there may be a general publication bias in the evidence analysed and a bias on the \u201cnegative\u201d effects of the use of and/or training in VM. The authors of the review have found this publication bias difficult to control. With regard to its strengths, it should be noted that an extensive search on the VM was conducted, where any type of study that dealt with the effectiveness of VM on nursing home care professionals was included, both in terms of implementation of, and training in, the method.Training in and/or implementing VM provides professionals with techniques of relationship and communication with disoriented older people that enables and helps them to manage their care, improving their quality of life and acting as tools that protect them against burnout, given that stress and overwork are reduced. In addition, it leads to greater empathy and provides professionals with a greater understanding of the meaning of the residents\u2019 behaviour, promoting good treatment focused on the real needs of the older person with dementia (or disoriented).More exploration of this method\u2019s techniques is required, since it offers a field of communication and relationship that should not be underestimated and that, as the scientific evidence shows, generates positive effects on the satisfaction and motivation of care professionals. To do this, it is necessary to generate studies with standardised instruments, appropriate samples, and also include mixed methodology to complement the qualitative nuances that are generated in the relationship and communication between the professional and the person with dementia (or disoriented) with the quantitative data."}
{"text": "Dear Editor,Diffuse Normolipemic Plane Xanthoma (DNPX) is a rare acquired dermatosis, clinically characterized by patches and/or yellow-orange plaques symmetrically distributed. It is an uncommon type of non-Langerhans histiocytosis that occurs due to the deposition of lipids in the skin and, in almost half of cases, occur in the absence of hypercholesterolemia.A 61 year-old man with a history of onset of asymptomatic yellowish spots, 2 years ago, initially on the eyelids. In one year, the lesions also appeared in the armpits, in the inguinal, genital and gluteal regions. He had a recent diagnosis of Hepatitis C (HCV), without treatment. He denied other comorbidities and use of medications. On examination he had yellowish plaques with a symmetrical distribution in the periorbital region bilaterally , and plaDNPX is a rare type of non-Langerhans histiocytosis that usually appears initially with a palpebral xanthelasma, as is the case, with later appearance flesions usually in the neck, trunk, upper dorsum, cubital fossae, and extremities. These distribution of xanthomatous lesions in DNPX is unique, although it varies among cases.Hepatitis C is a systemic disease that can cause manifestations in various organs and systems. It is estimated that approximately 74% of patients experience at least one extra hepatic manifestation of the disease during their lifetime, with 17% of them having dermatological manifestations. The most commonly associated dermatoses are cryoglobulinemia, lichen planus, porphyria cutanea tarda and acral necrolytic erythema. It is believed that most of these diseases present as path physiology the formation and deposition of immune complexes in the tissues, although the mechanism of these diseases is not completely understood. Other dermatological diseases also have been shown to be associated with hepatitis C, but with less consistency, such as cutaneous B-cell lymphoma, erythema multiforme, leukocytoclastic vasculitis and urticaria.XPDN has been associated with hematologic disorders, particularly multiple myeloma and monoclonal gammopathy; however, leukemia, lymphoma and Castleman's disease have also been associated with the disease.None declared.Maria Carolina Casa Souza: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; obtaining, analysis, and interpretation of the data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; review of the literature; critical review of the manuscript.Paulo Henrique Teixeira Martins: Statistic analysis; approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; obtaining, analysis, and interpretation of the data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; review of the literature; critical review of the manuscript.Anal\u00fa Vivian: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; review of the literature; critical review of the manuscript.Laura Luzzatto: Obtaining, analysis, and interpretation of the data; effective participation in research orientation.None declared."}
{"text": "Case Report. Patient E.M.S, 25 years old, male, leucoderma, referred to the Emergency Room of our institute. He reported being a victim of physical aggression, occlusal alteration, limitation of mouth opening, sensibility loss in the mentalis region, right infraorbital, and denied visual alteration. On physical examination, during the inspection and palpation, the crackling was observed in the right mandibular region and apical displacement of the maxillary alveolar process, corresponding to elements 13, 14, and 15.  This report aims at demonstrating the treatment of complex mandibular fracture functional reimplantation of the maxillary alveolar fragment (FRAF), denoting the possibility and feasibility of this reduction with an excellent prognosis.  The rigid fixation of the complex jaw fracture and alveolar maxilla process, through functional reduction, indicated satisfactory applicability, and favorable prognosis. The bones of the face are part of the complex stomatognathic apparatus, of which the mandible occupies the second position among the most affected in craniofacial traumas . Such prThe etiology of mandibular fractures is concentrated in cases of physical aggression and automobile accidents, although sports accidents and pathological or mechanical fractures are present as predisposing factors, either in the involvement of neoplasms or during the extraction of lower third molars , 2. CommFor diagnosis, a thorough clinical and radiographic examination should be performed, taking into account factors such as impact energy, direction, and location, as well as the resilience of the structures involved . The objPatient E.M.S, 25 years old, male, leucoderma, was referred to the Emergency Room of our institute. During a medical-dental questionnaire, the patient mentioned having been a victim of physical aggression, reporting occlusal alteration, limitation of the amplitude of buccal opening, and loss of sensibility in the mental and infraorbital region. He denied visual and respiratory changes, although there were signs of subconjunctival ecchymosis and epistaxis. On physical examination, during the inspection and palpation, crepitation was observed in the body region and right mandibular angle and apical displacement of the bone fragment in the premaxilla, corresponding to elements 13, 14, and 15, with an evident sign of alveolar tooth fracture . In all After systemic stabilization, the patient was taken to the Buccomaxillofacial Surgery and Traumatology Service, after 10 days of the first care. In the surgical center, in HDD, under general anesthesia, antisepsis was started with topical PVP-i and placement of the sterile fields, followed by subperiosteal infiltrative terminal anesthesia in the right maxilla region, aiming at facilitating the detachment of the muco-suspicious flap and promoting hemostasis; through the Newman Modified incision, the detachment of the flap continued, evidencing the dentoalveolar fracture. In order to eliminate the granulation tissue at the interface of the fragment and maxilla, which would certainly prevent good bone repair, the fragment was removed Figures \u20134. HowevIn the next step, through the Risdon incision in the mandible, the subcutaneous planes were approached, location and protection of the facial nerve and artery, and incision of the pterygomassetric band and detachment. With the separation of the fragments and evaluation of the lingual space, the reconstruction and anatomical repositioning of the fragments with transfixing screws and plates and screws of the 2.0 system Figures  and 8 weThe suture of the deep planes of the mandibular approach and oral cavity was performed with Vicryl 4.0 wire and on the skin was used Nylon 6.0.The patient was preoperatively treated with Dexamethasone 8\u2009mg, Cephalotin 1\u2009g, and intravenous dipyrone 500\u2009mg. All medications were maintained in trans and postoperative and were adapted for use in tablets. Postoperatively, N-acetylcysteine 500\u2009mg was added to the bucosinusal communication.The patient followed postoperative follow-up for 7, 14, 21, 35, and 64 days, presenting evolution within the norms of normality and cicatricial process compatible with the surgical procedure performed. There was an absence of secondary infections, occlusal restoration, and consolidation of the fragment in the maxilla. In respect to the regeneration of the nervous tissue, although it is known, by the literature, that the regeneration of the proximal stump occurs, in this specific case, it comes to an avulsion of fragment with involved teeth, which made the reasoning of this case to devolve in the same conditions and treatment of avulsioned teeth, that is, endodontic treatment after 14 days of the trauma. The patient was referred to the endodontic treatment of the elements 13 and 14, making it possible to maintain them in the oral cavity. A radiographic examination of the control was performed, in which titanium plates and screws were positioned, indicating a satisfactory reduction of the bone fragments Figures  and 11.Facial fractures generate discussions among students ever since Hippocrates was alive, especially regarding the origin of the trauma, diagnosis, and treatment. In agreement with the findings found in the literature, this report presents a patient who suffered physical aggression of high intensity, generating maxillomandibular trauma. Such an etiology ranks first among the most common causes attended in emergency services , 4.Among the anatomical subdivisions of the mandible, the body region corresponds to a significant percentage of the fractures, and the immediate reduction of the stumps is a determinant factor to obtain adequate occlusion , 5. In tThe treatment choice was based on the analysis of complete clinical and radiographic examination, considering the possible sequels, both aesthetic and functional, that could be caused. According to most of the cases found in the literature, even in the other mandibular regions, the functional reduction was obtained through occlusal adjustment and rigid internal fixation, considering the complexity and biases of the reduction of complex fractures or maxillo-mandibular fractures , 5\u20137. WhAccording to a study carried out by Melo and Oleveira (2013), dentoalveolar trauma resulting from physical aggression accounts for about 35.8% of the cases, a study carried out on 1459 patients showed that in only 1% of the cases there was an association of dentoalveolar trauma with mandible fracture [It is important to observe that the removal of the fragment for removal of granulation tissue was indispensable; its nutrition was safeguarded by the periosteum itself carefully detached in the step of dieresis . From itThe nonrigid attachment of the dental elements involved should be indicated, when necessary, to stabilize them \u201316. HoweWith the evolution of the case, we can conclude that the proposed treatment proved to be effective, reestablishing the patient functionally. The FRAF technique process and primary stabilization of the anterior mandibular complex fracture and reconstruction plate are feasible and demonstrate a favorable prognosis when correctly indicated, following the basic principles of reduction, stabilization, and fixation even if mediated."}
{"text": "The Lancet HIV, Oliver Ratmann and colleaguesPopulation mobility is an intrinsic human condition. People have always moved over space and time, and always will. Yet mobility can be hard to define and measure, and thus it is challenging to understand the effects of mobility on the spread of HIV. In As countries move toward the UNAIDS 90-90-90 treatment goals and beyond, we will need more studies like that of Ratmann and colleagues to identify and predict whether and how population mobility will influence (positively or negatively) HIV intervention effectiveness. Strategies to end the HIV epidemic, especially those that target geographical hotspots, will increasingly need to account for population mobility with special attention to time.Human mobility directly and indirectly affects HIV transmission dynamics over time, but the temporal scale has received less attention. For example, the importance of population mobility on intervention effectiveness in a community depends on the relative timing of the intervention and mobility in the population.Migrant populations are heterogeneous, and the relative importance of different types of mobile populations on HIV depends on the stage of the epidemic. At the start of the HIV epidemic in sub-Saharan Africa, the spread of HIV was closely tied to migrant flows,Migration can have non-linear and long-lasting effects on transmission dynamics, depending on the epidemic's stage, the frequency and context of migration, the relative timing of interventions, life-stage, and the sexual behaviour of migrants."}
{"text": "WHO statistics shows that drowning is one of the most important research areas in the world. Despite the extensive research on drowning in the past, scientometric approaches have not been used yet to evaluate these studies.In this descriptive cross-sectional study, which is based on scientometric method, the analysis was done using the words in the title, abstract and keywords. In addition to visualization of the universal cooperation between universities and researchers, the bibliographic and citation data of articles have been retrieved from Web of science, PubMed and Scopus in the period of 2007-2017. These documents were analyzed using HistCite12, 03, 1 and VOS viewer 6, 5, 1 software.2314 articles in Web of science, 4024 articles in Scopus and 98 articles in PubMed published in the past 10 years were found. The number of articles published by Iranian researchers in Web of Science, Scopus and PubMed were 19, 45 and 10, respectively. The findings showed that the number of articles about this topic had increased in Web of Science and Scopus over the last 10 years. According to the results of this study, important research areas were visualized in the three databases by extracting repeated words. The frequency pattern of words showed that the focus of the research has been on cardiovascular diseases, age-groups, resuscitation problems, forensic medicine, and suicide, among others. The language of more than 80% of the documents was English. American and English Universities, journals and researchers had the most contribution in this field. The result of this study will help researchers to develop, plan and increase the qualitative and quantitative levels of their research on drowning. Similar to developed countries, developing research can help improve the culture and general education to prevent drowning in developing countries.Drowning, Scientometrics, Scientific Productions, Article"}
{"text": "Life cycle assessment (LCA) is conducive to the change in the wind power industry management model and is beneficial to the green design of products. Nowadays, none of the LCA systems are for wind turbines and the concept of Internet of Things (IoT) in LCA is quite a new idea. In this paper, a four-layer LCA platform of wind turbines based on IoT architecture is designed and discussed. In the data transmission layer, intelligent sensing of wind turbines can be achieved and their status and location can be monitored. In the data transmission layer, the LCA platform can be effectively integrated with enterprise information systems through the object name service (ONS) and directory service (DS). In the platform layer, a model based on IMPACT 2002+ is developed, and four management modules are designed. In the application layer, different from other systems, energy payback time (EPBT) is selected as an important evaluation index for wind turbines. Compared with the existing LCA systems, the proposed system is specifically for wind turbines and can collect data in real-time, leading to improved accuracy and response time. Wind energy is a type of important clean and renewable energy with abundant reserves. As a green and environmental protection power generation technology, wind turbines can effectively reduce environmental pollution. In recent years, due to the gradual maturity of wind power technology and the continuous decline in the cost of wind power generation, wind turbines have been widely used in the world. According to \u201cBP Statistical Review of World Energy June 2019\u201d, the annual growth rate of global wind farms in 2018 is 12.6%, and the power generation capacity is 1170.0 TWH. Additionally, the rated power of wind turbines has developed from dozens of kilowatts to megawatts . In the As a technology to evaluate the environmental factors related to products and their potential impacts, life cycle assessment (LCA) has been developed as an important tool to evaluate the energy and environmental performance of products in their life cycle. The LCA of wind turbines can not only help enterprises carry out green design or improvement of the key energy consumption parts but also help the wind power industry change from the terminal-oriented management mode to the full life cycle management mode. In order to minimize energy consumption and environmental emissions, it is necessary to optimize energy management and carry out green design through accurate LCA of wind turbines. Moreover, the resource and environmental costs and energy conservation and emission reduction potential can be obtained through quantifying energy consumption and pollutant emissions. On this basis, suggestions for green and low-carbon management strategies of the wind power industry can be put forward.The accuracy of LCA mainly depends on the accuracy of the life cycle inventory and the rationality of the environmental analysis process. In the current research, the inventory data come from investigation, literature, or the existing database, which are universal to a certain extent and can be used in different products. However, due to the effectiveness and regionality of inventory data, the input and output data of the same material will vary greatly in different regions with different process levels. Consequently, the difficulty mainly lies in the acquisition and accuracy of data, because of the polymorphism, time variability, and sensitivity of LCA data.The existing life cycle assessment process mainly relies on software system databases, which are from the average data of various industries, or manually collecting from literature or on site. The real time, dynamic, and accuracy of evaluation data are far from satisfactory. Therefore, the results of LCA are not accurate enough.The existing LCA software are commercial, and they are for many products. As a result, the process is not specifically for wind turbines.The existing LCA methods mainly include problem-oriented midpoint methods and damage-oriented endpoint methods, having their limitations.The existing LCA systems and enterprise information systems (EIS) are independent of each other and cannot be effectively integrated together, and the data of enterprise information systems cannot be effectively utilized.The existing problems in the life cycle assessment of wind turbines are as follows:As a new and rapidly developing technology, the Internet of Things (IoT) holds great promise in handling the abovementioned issues. IoT is a pervasive presence around us of a variety of things or objects (such as radio-frequency identification (RFID) tags, sensors, actuators, mobile phones, etc.), which can interact with each other and cooperate with their neighbors through unique addressing schemes ,5. IoT iThe IoT technology is applied to achieve the real-time, intelligent collection of energy consumption and environmental impact data in the entire life cycle of wind turbines. Therefore, the databases of the platform have the function of updating and expanding, which ensures the objectivity and accuracy of the assessment results. Additionally, the status and location of wind turbines and their components can be monitored with the support of IoT technology.A novel LCA architecture based on IoT is proposed, which achieves the energy consumption assessment and environmental impact assessment of wind turbine from parts to products, including the stages of design, raw material acquisition, production and manufacturing, transportation and installation, operation and maintenance, and recovery and disposal.An LCA model for wind turbines is proposed based on IMPACT 2002+ , which cBased on ONS and DS of IoT technology, the effective integration method between the proposed platform and the existing EIS is innovated, thereby constructing an open and extensible platform for life cycle assessment.In order to solve the above problems, based on IoT, this paper proposed a new LCA platform for wind turbines. Additionally, the main innovations are as follows:The remainder of the paper is organized as follows. Life cycle assessment (LCA) has made remarkable progress, since the first life-cycle-oriented methods were proposed in the 1960s. Currently, LCA is defined as a tool that assesses the potential environmental impacts and resource consumption in a product\u2019s life cycle, i.e., from raw material acquisition, via production and use stages, to waste management ,11. It iCurrently, the research on LCA mainly focuses on the evaluation of the new energy system, product resource consumption, and environmental emission. Additionally, LCA has been widely used in various fields, including materials, energy sources, transportation and construction, etc. Boyden et al. compared the environmental impact of three management strategies for lithium-ion batteries in Australia ehydro-metallurgy, pyro-metallurgy, and landfill through LCA . Geng etThe methods of LCA mainly include problem-oriented midpoint methods and damage-oriented endpoint methods . AdditioIn recent years, in view of the continuous expansion and complexity of evaluation objects, LCA methods are also developed in new forms. Additionally, the combination of LCA methodology with other methods has become a common practice. Suhariyanto et al. proposed a multi-life cycle assessment perspective for assessing the environmental impacts on the multiple life cycle product system . Bai et LCA needs a large amount of data as the basis and a variety of models as tools. In order to improve the research efficiency, the software developed includes Simapro, Gabi, LCAiT, eBalance, PEMS, and so on.Simapro is developed by the University of Leiden, the Netherlands. It provides abundant databases and a variety of evaluation methods. The database in the manufacturing phase is the most detailed. It is also the most popular LCA software in the world.GaBi is developed by Institut fur Kunststoffprufung und Kunst\u2014stoffkunde from Stuttgart, Germany. It has the latest wide-range comprehensive database and provides sensitivity analysis.LCAiT (LCA Inventory Tool) is developed by Chalmers Industrieknik in G\u00f6teborg, Sweden. Although it has fewer own databases, it can connect with external databases. It is suitable for people who understand the flow of material and energy.eBalance is developed by IKE Environmental Technology Co. Ltd. from Chengdu, China. It includes three databases: Chinese Life Cycle Database, European Reference Life Cycle Database, and Ecoinvent Database. It supports China\u2019s localized evaluation of energy conservation and emission reduction.Pira Environmental Management System (PEMS) is developed by Pira International, UK. The parameters in the database are from Europe, which cannot be modified or edited.2, CO, SO2, Nox, COD, etc.) in each stage can be calculated.Based on the system boundary, the main input of the above software includes the consumption of various resources  and different types of energy . Based on the establishment of process flow and the database in the software, the energy consumption and environmental emissions  For enterprises, the improvement schemes are proposed for the stages or parts with large energy consumption/environmental impact, and improvement measures of green design of wind turbine will be provided. (2) For the government, the reference standard of the research object will be established through the LCA results of each stage, and the energy consumption and environmental emission standards of each stage will be established. (3) For the third-party testing and certification department, it is to carry out green certification for the wind turbine by comparing the evaluation results with the defined green index value of the wind turbine.The related research objects are mainly divided into three types: wind farm, wind turbine, and its main components. Wind farm refers to the place where wind energy is captured, converted into electric energy, and sent to the power grid through transmission lines, including wind turbines, power collection lines, substations, and roads. A wind turbine is mainly composed of a rotor, an engine room, a tower, and a foundation. For the main components, the rotor is mainly composed of blade, hub, nose cone, and bolt; the engine room is usually integrated by engine room frame, which covers generator, gearbox, transformer, electrical, and mechanical equipment; tower supports engine room and rotor, mainly made of steel, aluminum, copper, and plastic; foundation provides ground support for all the above parts, which is composed of concrete, steel, and iron.Usually, for enterprises, the research object is mainly wind turbine or its main parts; for the third-party testing and certification department, the research object is wind farm or wind turbine or its main components; for the government, the research object is usually wind farm or wind turbine. The complexity of LCA decreases in the order of wind farm, wind turbine, and its main components.The system boundary is determined according to the research objectives. The wider the research scope is, the more the relative workload will be. Nowadays, the system boundary of LCA pays more attention to evaluation efficiency instead of breadth and depth, which is excluding the stage not related to the research objectives from the system boundary after comprehensively considering the accuracy of the evaluation results and the complexity of the evaluation work, and determining the most efficient system boundary according to the needs of research objectives. For example, when enterprises intend to improve the green design of wind turbines, they only need to study the stages of raw material acquisition, manufacturing, recycling, and scrapping, while the transportation, on-site installation, operation, and maintenance stages have little impact on the research objectives can be ignored.For different users, the objectives, and scope of LCA of wind turbines are shown in The evaluation of the wind turbine is the most common in practical applications. Therefore, this system is mainly designed for wind turbines. Taking wind turbine as an example, the system boundary of LCA for wind turbines is shown in Through the analysis of the objectives and scope of LCA of wind turbines, the architecture of the LCA platform based on IoT technology is constructed. The data acquisition layer, data transmission layer, platform layer, and application layer are included. The architecture of the LCA platform for wind turbines is shown in Each layer of the platform is introduced as follows.In the data acquisition layer, intelligent identification, positioning, tracking, monitoring, and management can be achieved with the help of RFID devices, barcode identification equipment, global positioning systems, laser scanners, and other information sensing equipment. Consequently, all the input and output data involved in the life cycle of wind turbines will be obtained and preprocessed. There are three ways for collecting data: (1) By using RFID, wireless, mobile, and sensor equipment, real-time and intelligent collection of energy consumption and environmental emission data can be generated from different material units and manufacturing processes of wind turbines. (2) Bill of Materials can be acquired from the information management systems of enterprises. (3) For the data that cannot be collected through sensors or obtained by EIS, they can be collected by manual input, such as enterprise fundamental information, some parameters and specifications of wind turbines, etc. In the process of manual entry, it is necessary to ensure the authenticity and effectiveness of data and make sure there is evidence to follow for data output in the later stage.The data acquiring methods in each stage of wind turbines are as follows. In the design stage, the wind turbine and its main components are designed, and the three-dimensional models of them are established, and the structure is tested and analyzed. Because the design tools such as computers and other electronic equipment are mainly used in this stage, the energy consumption and environmental emission data are not generated directly. Therefore, the energy consumption is measured by smart meters, and other data can be obtained through EIS. All the design schemes have a great impact on the final results.Raw materials include parts, components, semi-manufactures, etc. Raw materials can be obtained in two ways: production in the factory and purchased from other factories. For the raw materials produced in the factory, which usually including internal and external blades and baffles of wind turbines, relief valve, brake, transmission shaft, rod, bearing, clutch, flying pendulum, cover, and so on, the relevant data can be obtained by integrating with EIS. For the purchased raw materials, which usually including tire coupling, permanent magnet synchronous generator, standard parts, etc., the relevant data are collected by reading barcodes or RFID tags attached to them.The elementary raw materials in the wind turbine include concrete, steel, iron, copper, glass fiber, epoxy resin, etc., as shown in In the production and manufacturing stage, the energy consumption data of water, electricity, and gas are collected by embedded systems and sensing equipment installed on manufacturing equipment, and environmental emission data can be obtained from intelligent sensors and environmental monitoring systems. At the same time, in order to improve the reliability of the data, the measurement calibration certificates of relevant monitoring equipment should be upload simultaneously to the enterprise information database in the platform layer. According to the material composition of each component and the energy consumption and environmental emissions of various main raw materials, the total energy consumption and environmental emissions of wind turbines can be calculated in this stage.In the transportation stage, the fuel consumption, weight of product transported, and transportation distance are collected by sensors on vehicles, and the total energy consumption and pollutant emission of the transportation process can be calculated based on the fuel consumption per kilometer. In the installation stage, which includes the installation of foundation construction, tower hoisting, and engine room, the data related to mechanical equipment can be obtained by sensors, and other data can be manually entered.In the operation stage, the environmental information  and its operation data  can be collected through sensors. In addition, equipment calibration records  need to be uploaded in time. Based on IoT technology, the wind turbine status can be continuously monitored, and detection automation can be achieved. In the maintenance stage, energy consumption is mainly generated by using various maintenance tools or component replacement. Additionally, its data can be collected by reading RFID tags or manually entering.This stage is the process of wind turbine disassembly, renovation, recycling, reuse, reassembly, or disposal. Recovery methods include direct recovery and recovery after solvent extraction. Scrapping methods of the wind turbine include open stacking, landfill, and incineration. Eighty-five to ninety percent of the foundation, tower, and engine room components of the wind turbine can be recycled. However, it is difficult to recover the blades, because the thermosetting materials cannot be degraded and the cost of recovering fiber materials is very high . NowadayThe data transmission layer can also be called the network layer, which transfers the data captured in the data acquisition to the servers in the platform layer through networking technologies including WSN, WIFI, Ethernet, and so on. In addition, this paper proposes to achieve effective integration with EIS through object name service (ONS) and directory service (DS). As the infrastructure of the network layer, the ONS and DS provide external services.The ONS is defined by GS1 EPCglobal, and it is the core technology of the Internet . In 2013The ONS mainly completes the network resource analysis pointing request of all kinds of IoT identification and can map the Code identification to the resource entrance. The ONS can be called by the applications that need to conduct the name service. The DS is mainly deployed to offer the index access to EIS, which is at the data acquisition layer. Each enterprise submits event indexes automatically to their representative DS server. Before adopting this integration scheme, enterprises need to register and maintain their domain names in the enterprise information database in the Database Management Module in advance.The process of integration with enterprise information systems is shown in As shown in The platform layer mainly carries out an inventory analysis of the life cycle of wind turbines. Inventory analysis is the process of collecting and objectifying the basic data of all relevant processes of wind turbines, which mainly includes the analysis of raw material consumption, production and manufacturing energy consumption, material and product transportation energy consumption, operation and maintenance energy consumption, and scrapping treatment environmental emissions. The integrity and accuracy of the data obtained by inventory analysis affect the accuracy of LCA results directly. The platform layer includes four modules: Unit Process Management Module, Flow Management Module, Database Management Module, and Inventory Data Processing Module.Unit process refers to the most basic unit in life cycle assessment. In this module, the decomposition of the research object and the identification of the process flow are completed. In the meantime, in order to quantitatively determine the input and output corresponding data, users need to input the unit process attribute data of the research object in this module, and manage all the unit processes on this basis.The structure of wind turbines is complex, and there are many kinds of components and materials. Decomposing the wind turbine and classifying the materials and its components play a crucial role in the process of inventory analysis, which will affect the accuracy of the evaluation results. In our system, the analytic hierarchy process (AHP)  is used An example of wind turbine decomposition is shown in LCA focuses on the full life cycle and goes deep into each process to analyze the input and output data. For this reason, it is also necessary to identify the key influencing factors of each stage of the process flow. On this basis, the data of each basic unit are input and output, and the data of each stage are classified and summarized. The main LCA influencing factors of wind turbines in each stage are shown in Material flow management and energy flow management are included in this module. Material flow and energy flow data are a vital link and are used to record the material/energy interaction between different unit processes. In this module, the material flow and energy flow information of each unit can be added, modified, deleted, and viewed by users, which provides support for inventory data processing of the wind turbine. The Database Management Module is an important module to support the completion of the life cycle assessment of wind turbines. It mainly includes the functions of data addition, data storage, and data calls. For users, the required data can be obtained from the database conveniently, timely, and accurately.LCA basic database: the existing mature database, including Ecoinvent, European Reference Life Cycle Database (ELCD), Chinese Life Cycle Database (CLCD), GaBi Databases, NREL-USLCI Database, etc. The resource consumption and environmental emission of unit mass materials in the raw material acquisition stage, unit power consumption in the production and manufacturing stage, unit oil consumption in the transportation stage, and materials with different disposal methods in the scrapping stage can be obtained from these databases.Material list database: mostly utilizing the name and unit of the International Reference Life Cycle Data System (ILCD), and adding the material list according to the characteristics of the wind turbine.Enterprise information database: storing the enterprise information involved in the life cycle of the wind turbine, including enterprise name, organization code, enterprise identification, identification rules, enterprise address, legal person information, responsible person information, enterprise website, and other fundamental data of the enterprise. The information of the database is obtained through enterprise registration and filing mainly.Product information database: storing the fundamental data, operation and maintenance data, and environmental emissions and energy consumption data in the life cycle of wind turbines. The fundamental data contain the structural information of all kinds of wind turbines and defines the structural relationship between the wind turbine and its components and between the components. In this database, the fundamental data are mainly obtained through integration with EIS, and the operation and maintenance data and environmental emissions and energy consumption data are obtained by real-time monitoring of IoT technology. Based on the database, the usability and real-time performance of LCA can be significantly improved.Four databases are included in this module, which are as follows:LCIA index management: it mainly stores the types of evaluation indicators, conversion coefficients between different types of indicators, and environmental impact assessment standards of relevant industries or regions. It supports the calculation of LCIA characteristic indicators, normalized indicators, and weighted comprehensive indicators. Consequently, it is an important module for data normalization and environmental impact factor unification.Online modeling: Based on linking all types of life cycle inventory results via 14 midpoint categories to four damage categories, a feasible approach combining midpoint and damage is proposed, which is the IMPACT2002+ methodology . Based oThe Inventory Data Processing Module is the core module of the LCA platform. Based on the data support of material flow, energy flow, unit process, and database module, the module can quantify and analyze the data between input and output of resources and environment in each stage through online modeling and the corresponding algorithm. In this module, life cycle impact assessment (LCIA) index management and online modeling are included, which are as follows:As shown in Since the previous data collection is aimed at each unit process, in order to ensure the accuracy and integrity of the evaluation results, it is necessary to determine a measurement reference of data before data processing, which is the function unit. In the raw material acquisition stage, the functional unit of the weight of various raw materials is kg. In the manufacturing stage, the functional unit of electrical energy consumption is kWh. In the transportation stage, the functional unit of the transportation distance and energy consumption are km and L separately. In the recovery and disposal stage, the functional unit of the weight of recycled or scrapped materials is kg.The main influencing factors and functional units of each resource and environment index are shown in After the inventory analysis, in order to evaluate the accuracy of the inventory data, the relative error can be obtained by comparing the total mass of the wind turbine with the summing of the material quality of all components.To sum up, the data processing of the proposed platform is shown in Based on the Unit Process Management Module, the decomposition of the wind turbine is completed. The quantity of various resource and energy consumption can be obtained from the Flow Management Module. Additionally, the total energy consumption and environmental emissions can be calculated, and all kinds of indicators can be characterized in the Inventory Data Processing Module, which is based on the parameters from the Database Management Module.LCIA is a process of quantitative or qualitative evaluation to obtain the performance of energy consumption and environmental emission after inventory analysis, and the inventory information will be translated into environmental impact scores. In terms of resource consumption of wind turbines, it mainly includes the evaluation of mineral energy consumption in the raw material acquisition stage, electric energy consumption in the production and manufacturing stage, and oil consumption in the transportation stage. For wind turbines, energy payback time (EPBT) is one of the key factors of evaluation, because it is one of the important indexes in the evaluation system of wind turbines generating capacity . iE is the total energy input of the wind turbine in its entire life cycle, and 0E is the annual power generation of the wind turbine, which is calculated byp(v) is the expression of wind turbines output power characteristic curve, and f(v) is the wind speed frequency distribution curve expression of wind turbines installation site.EPBT is the ratio of the total energy input of the wind turbine in the entire life cycle to the annual power generation during its operation , as show0E will be calculated. At the same time, Ei is obtained according to the Inventory Data Processing Module. Thus, the EPBT of the wind turbine will be calculated. On this basis, according to the design life of the wind turbine, the power generation without emission in its life cycle can be calculated.In this study, the real-time wind speed and the actual output power of the wind turbine are collected through IoT technology. After obtaining the power characteristic curve of wind turbines and the wind speed frequency distribution of the installation site, Besides, when the wind turbine parameters  and installation address are known, the EPBT can be estimated in advance. On this basis, it can be predicted whether the installation site of wind turbines is appropriate, to avoid the loss caused by the improper installation scheme.Improvement analysis is to analyze the results of the impact assessment, form a report, and provide practical improvement plans for different users. Enterprise users, government users, and third-party users are included in this system.For enterprise users, according to the LCA results, the stage, or the key components with large resource consumption, energy consumption and environmental emission of wind turbines will be identified. Consequently, better raw materials can be selected. Additionally, design optimization, production process optimization, transportation route and vehicle optimization, operation and maintenance optimization, and recycling optimization can be carried out. For example, energy consumption in peak hours or idle time can be reduced.For government users, through the results of impact assessment, the entire process of recycling can be monitored, the recovery rate of product components or materials can be improved, and the potential harm to the environment in the recycling can be reduced. Additionally, the suppliers of materials and components with the highest proportion of environmental emission can be list as the major concerns. Based on the evaluation results, relevant standards can be established, the corresponding evaluation mechanism can be improved, and the industrial structure will be optimized finally.For the third-party users, the green certification will be accomplished by comparing the evaluation results with the defined green index value of the wind turbine.Based on the proposed architecture, an LCA prototype system of the wind turbine has been developed. In this system, various users have different authority to manage data.The main process of the life cycle assessment by using this system is illustrated as follows:The enterprise registers in the system and inputs the information of name, identification, address, website, responsible person information, relevant qualifications, etc.The decomposition of the wind turbine studied is determined, and the process flow is identified through the Unit Process Management Module. Additionally, then, the relevant parameters and the main information of key components for life cycle assessment will be input. Then, the material flow and energy flow information of each unit can be added, modified, deleted, and viewed through the Flow Management Module.Based on the installation of various sensors, the relevant energy consumption and environmental emission data will be collected. Meanwhile, the operation data will be monitored, including wind speed, vibration, noise, engine speed, pitch angle, etc. According to these data, the output power characteristic curve is formed, which can be used to calculate the annual power generation of the wind turbine. Moreover, the real-time fault data and the fault rate curve of wind turbines are collected and formed. On this basis, the residual life prediction of the main components of wind turbines is carried out.In addition to the real-time monitoring data, the Bill of Materials is acquired by integrating with the information systems of enterprises. Additionally, other data are obtained by the Database Management Module in the system.Based on the online modeling and LCIA index management, the inventory data will be processed through the Inventory Data Processing Module. Based on inventory data, the energy consumption and environmental emission data at all stages of wind turbines are calculated systematically, and the evaluation results are analyzed visually. On this basis, the life cycle assessment report of wind turbines is formed.The workload of using LCA software include goal definition and scoping, data preprocessing, inventory analysis, and impact assessment. Compared with the existing software, the workload of data collection is greatly reduced, and most of the scoping of wind turbines has been established in detail in the proposed system.To compare the LCA workload between the proposed system and the existing software, we suppose the total workload of data preprocessing, goal definition and scoping, inventory analysis, and impact assessment of the existing software are all 100%, and the weights of them on the LCA workload are 30, 20, 40, and 10%, respectively. The comparison results are shown in As shown in At present, the data collected by existing systems are often intertwined and need to be distributed among multiple parts, which is greatly affected by subjective factors. Therefore, the accuracy of the inventory data is not high. The proposed system can increase the data accuracy through IoT technology and improve the integrity of the data processing model through the integration with EIS.6 \u00d7 100% = 134%As previously mentioned, the system boundary of LCA for wind turbines mainly includes six stages. In order to estimate the accuracy of the results, we assume that the accuracy of inventory analysis in each stage is increased by 5% on average. Consequently, the accuracy of the results is improved by (1 + 5%)The characteristics of the IoT-based life cycle assessment platform of wind turbines are summarized as follows:The platform is designed for wind turbines. In the process of the platform design, the corresponding system modules are established according to the life cycle process of the wind turbine. At the same time, according to the characteristics of the wind turbine, the LCA model based on the IMPACT2002+ is established. Additionally, the EPBT of wind turbines can be calculated accurately.To solve the lacking of information in the process of life cycle assessment, it can effectively integrate with the existing enterprise information systems through the ONS and DS based on IoT. Furthermore, the platform provides a standard application program interface and supports all kinds of users to develop and integrate various business applications on the platform. Therefore, it has the feature of extensibility. Based on the Internet of Things technology, real-time and dynamic data in the life cycle of wind turbines can be collected in the platform. Therefore, the databases of the platform have the function of updating and expanding, which ensures the objectivity and accuracy of the assessment results. Based on the big data technology, the platform can analyze the real-time data collected by sensors and obtained from EIS and has functions of intelligent monitoring, analysis, and prediction. Finally, it can serve the design and manufacturing enterprises of wind turbines, wind farm construction enterprises, and operation and maintenance enterprises, which include modeling service, evaluation service, simulation service, analysis service, and optimization service, etc. In the meantime, an open platform with controllable permissions can be provided through the construction of application components, so that the third party can participate in the application development and create business value.The platform supports centralized user management, unified authentication and authorization, and business collaborative processing. Additionally, it is designed on B/S architecture, which is more convenient to operate and easier to maintain.To sum up, the comparison between the proposed platform and several existing LCA systems is shown in In this paper, based on IoT technology, an LCA platform architecture for wind turbines is proposed. Additionally, object name service and directory service are used to provide external services in the network layer. In the meantime, an LCA model of wind turbines is established based on IMPACT 2002+. Therefore, the platform is wind-turbines-oriented and has good scalability and credibility.The application of this platform can achieve effective integration and sharing with the existing enterprise information system and accomplish the real-time, intelligent collection of the energy consumption and environmental emission data generated in some stages. Given that the inventory data can be updated, the objectivity and accuracy of the assessment results can be ensured. It is of great significance for the sustainable development of the wind power industry.In our future work, it is very important to deploy the LCA platform in more application scenarios. Additionally, combining the platform with blockchain technology to ensure the authenticity and credibility of data is also a key research direction. Besides, further research and exploration are needed to make the analysis results comparable with the existing systems."}
{"text": "The affiliation for the last author is incorrect. The correct affiliation for Morteza Naderi is Arak University.An additional affiliation is missing for the last author. Morteza Naderi is also affiliated with the Department of Molecular Biology and Genetics, Faculty of Sciences, Koc University, Istanbul, Turkey."}
{"text": "Thismakes infections more difficult to treat and increases the risk of pathogensspreading, leading to higher mortality. Although the term antimicrobial refers toantibiotics, antivirals, antifungals, and antiparasitics, this article focuses onissues related to the use of antibiotics in the Brazilian context.Acquired antimicrobial resistance (AMR) occurs when bacteria, viruses, fungi, andparasites change over time and cease to respond to drugs to which they werepreviously \u00adsusceptibleAMR is a threat to global health and its worsening is observed in the current contextof the SARS-CoV-2 pandemic. Added to the challenges of infection control and theprevalence of morbidity and mortality in the pandemic, viral and bacterialresistance are a global health emergency. In this regard, AMR becomes intrinsicallyrelated to the current health context, which may imply accelerated AMR patterns andgreater incidence in health services.These challenges, with health and political implications on a global scale, areespecially difficult in countries with medium and low economic income, as is thecase of Latin America. In this scenario, responses to AMR require coordinated and\u00admultisectoral efforts involving clinical-biological, socio\u00adeconomic, and political\u00adperspectives at the global, national, and local levels.,3.In response to the global agenda for tackling AMR, the World Health Organization(WHO) proposes \u201ca collaborative, multisectoral, and transdisciplinary approach \u2013working at local, regional, and national levels \u2013 with the goal of achieving optimalhealth and well-being outcomes, recognizing the interconnection between people,animals, plants, and their shared environment\u201d, designated One HealthThis article considers the potential ramifications of the One Health approach to AMRresearch. It adopts a theoretical-methodological perspective that articulates theOne Health approach and the social production of the AMR phenomenon, in three axes.The first refers to the practices of prescribing and dispensing antibiotics byprofessionals. The second one concerns the analysis of antibiotic use from the pointof view of health services users. The third one proposes a reflection on the processof construction of a political agenda to fight AMR in Brazil. This contributionpresents an analysis and appreciation of the diversity of practices, knowledge, andindividual perspectives of Primary Health Care (PHC) users, health professionals,and policy makers that aim to fill research and knowledge gaps in the Braziliancontext. Moreover, it aims to advance the global action agenda in Brazil, whilecontributing with reflections that can serve as a reference for the Latin Americanregion..Furthermore, the functioning of health services, the communication betweendifferent levels of health care, and the influence, or lack of clinicalrecommendations and evidence-based clinical protocols, particularly in PHC, posechallenges for the implementation of appropriate interventions at this level ofhealth care. Antibiotic prescription has been the subject of increasing monitoring in hospitalsettings in the last decade, even though great part of the problem relies onPHC. Studies point to several factors associated with the prescription ofantimicrobials: knowledge about AMR, critical clinical situations, riskperceptions and patients\u2019 expectations, as well as professionals\u2019 behaviors,values, and ideologies.Antibiotic prescription has been widely used as a preventive strategy inveterinary medicine and zootechnics. Antibiotics are offered on a large scale topromote the growth and development of animals for human food consumption,although little attention is paid to the impacts these practices have on thedevelopment of AMR. Thus,AMR tends to be analyzed, above all, in relation to human health or thedoctor-patient relationship, despite the fact that AMR extends into the web ofinteractions among humans, animals, and the environment, including the healthsystems themselves and the provision of networks of basic sanitation,7. There is little scientific production on the\u00adrelationships among humans, animals, and food consumption, especially in theBrazilian context.However, the purchase, sale, handling and disposal of antibiotics in pharmaciesand pet supply stores continue to be addressed only superficially addressed andin a fragmented waykit-Covid, an arrangement of drugs considered\u201cprophylactic\u201d, the use of which was encouraged by the Federal Government to beprescribed and used with the slogan of \u201cearly treatment\u201d. As a result,azithromycin, an antibiotic already used in health services, had greaterprescription rates and sales throughout 2020 in the country as one of thecomponents of the kit-Covid. Communication and negotiation between antibiotic \u00adprescribers and users, as wellas the challenges and facilities that professionals find in their clinicalpractices, cooperate to make the intrinsic dynamics of antibiotic prescriptioneven more complex. For instance, in Brazil, antibiotics were included in theso-called In Brazil, the analysis of access conditions to the services of the BrazilianPublic Health System (SUS), especially through the teams of the Family HealthStrategy (FHS), contributes to the knowledge of housing spaces and theunderstanding of the factors conditioning demand and the use of antibiotics. Italso reveals how the interactions between users and health professionals areimportant to guide informed attitudes towards the consumption of thesemedications. The family unit, the community, the relationships between humansand animals, and the sanitary conditions in which they live are aspects forunderstanding the problem. isidentified. The impact of disposing of antibiotics in household waste, sinks,and toilets, as well as its influence on the selective pressure of resistantagents, is not completely known, indicating the relevance of investigating theconditions of use, storage, and disposal of antibiotics among health systemusers. All these aspects are an urgent issue in the Brazilian context, given thehigh rate of prescription and consumption of these drugs since the beginning ofthe COVID-19 pandemic in the country.Thus, the centrality of the individual inserted in the environment in which theylive is strategic, with a focus on \u00admapping attitudes and knowledge regardingthe use of antibiotics and AMR. Characteristics such as gender, generation,income, and housing are understood as prevalent factors for the different formsof antibiotic use. The individuals\u2019 lack of knowledge about the complicationscaused by the use of these medications without a medical prescription andthrough self-medicationSuch elements demand a comprehensive understanding of the environment, as thecontext in which individuals and groups are inserted, with the notion of theenvironment being that of a shared space where networks encompassing individualsand groups, as well as the relationships they establish among themselves, arebuilt. In this regard, the integrated approach to the environment and health,both human and animal, advocated by the One Health, is pertinent. Therefore,dimensions of \u00adcohabitation and interaction between owners and animals arevisible, as both domestic animals and humans can develop and transmit multidrugresistant microorganisms. Consequently, veterinary care practices for domesticanimals, such as prescribing antibiotics, also affect the development ofAMR.. The PAN-BR was coordinated bythe Ministry of Health and included the participation of the Brazilian HealthRegulatory Agency (Anvisa), the Ministry of Agriculture, Livestock, and Supply(Mapa), and the Ministry of the Environment (MMA), among others. The PAN-BR bothmeets an internal need to build a more integrated and intersectoral politicalagenda, as well as responds to a call from the multilateral agenda to recognizethe problem of AMR as a priority issue. This initiative was led by the WHO inpartnership with the Food and Agriculture Organization of the United Nations(FAO) and the World Organization for Animal Health (OIE).Although specific AMR-related actions have been developed in previous years, theformalization of a national agenda was only materialized in 2018, with thepublication of the National Action Plan for the Prevention and Control ofAntimicrobial Resistance in the Scope of One Health (PAN-BR). The creation of mechanisms that allowdialogue between health and epidemiological surveillance, with data sharing, toallow the search for causal links related to AMR from the perspective of OneHealth is required. The formulation of the PAN-BR represents a step forward in recognizing the needfor a multidisciplinary and multisectoral approach to AMR. Its implementationdemands articulated relationships among different levels of governance, publicand private agencies, industries, as well as the society in general. Thisimplies different priorities and possible conflicting \u00adinterests. Among the mainchallenges for its implementation, the following are highlighted: theinstitution of a sustainable policy; the decentralized execution of control,prevention, and \u00admonitoring activities; and investment in research, development,and innovation for the production of antimicrobials, diagnostic methods, andvaccines through universal and equitable accessThe context of the global SARS-CoV-2 pandemic highlighted important elements forthe AMR agenda, including the urgency of investment in infection prevention andcontrol programs, and the need for comprehensive risk communication strategies,as well as the dangers arising from technological dependence on health suppliesfor the guarantee of medicines, including antibiotics. The lessons learned canserve as a reference for planning AMR-related interventions in the post-pandemicscenario and for preventing future crisis.Research on the political agenda of AMR in Brazil implies understanding theframeworks in which AMR is inserted, as well as how the underlying processes ofdispute, negotiation, consensus and dissent are constructed based on theperspectives of the main interested actors. Understanding the extent to whichpolicy responses such as the PAN-BR incorporate views and demands from healthservice users and professionals who work in the prescription and dispensing ofantibiotics is essential to promote adequate and sustainable interventions.Danida \u2013 Ministry of Foreign Affairs of Denmark."}
{"text": "PLOS Pathogens strives to advance community-rooted adoption of practices that enable transparency, rapid communication, reproducibility, and trust in research, and help to transform research globally. A key vision of PLOS Pathogens is to facilitate widespread adoption of Open Science to accelerate and improve research that is rigorous and trustworthy and to ensure its meaningful impact on lives.The pathogens research community has driven, and benefited from, Open Science. As a leader in the field, Open Science\u2014the public, unrestricted sharing of all components of research\u2014can improve science in many ways and has benefits for a wide range of stakeholders. Some elements of Open Science, such as Open Access to publications, advance equity to ensure research findings can be accessed by everyone with a vested interest in the science. Other elements, such as resource and data sharing, enable researchers to reuse and build on existing science. What all elements have in common is the ability to increase trust, reproducibility, and transparency in science . These aPLOS Pathogens was founded with a philosophy based on open, high-quality, rigorous science, initially focusing on Open Access publication and diversifying the ways scientists communicate with the community and public  and morple, see . We haveple, see  and, oveple, see ,6). PLOSs Plan S  and the s Plan S , that wiPLOS Pathogens, we have recently seen the critical importance of Open Science practices including the sharing of preprints and the genomic sequencing data of SARS-CoV-2 to drive rapid innovation in research during the global response to the COVID-19 pandemic , an, anPLOS nity see \u2014to incluPLOS Pathogens, and we hope the journal can continue to work with the community to advance Open Science for years to come.Open, high-quality, peer-reviewed science is, and has always been, core to the mission of"}
{"text": "To evaluate the effectiveness of a collective intervention to encourage the consumption of fruits and vegetables on the nutrients intake for the prevention of chronic non-communicable diseases (NCDs), a randomized controlled community trial was conducted with a representative sample from the Health Academy Program. While the individuals in the control group (CG) participated in regular physical exercise, those in the intervention group (IG) also participated in a collective intervention. After 12 months, IG and CG showed a reduction in energy, omega 3 and sodium intake and an increase in the consumption of carbohydrates, fiber, vitamins, and minerals. Individuals from the CG showed an increase in phosphorus consumption and, in the IG, a reduction in the consumption of total, saturated, and polyunsaturated fats as well as an increase in the consumption of monounsaturated fats was seen. In both groups, there was an increase in the prevalence of adequate nutrients. Participation in the nutritional intervention was associated with lower consumption of energy and protein in the diet. The results pointed to the importance of individuals\u2019 participation in the program, which, associated with nutritional intervention, promoted an improvement in the nutrient profile of the diet and the prevention and control of NCDs. Chronic non-communicable diseases (NCDs) are an important public health problem, accounting for more than 70% of all deaths worldwide . A healtIn view of this, different nations, including Brazil, have sought to encourage their populations to adopt adequate and healthy diets, in addition to other healthy lifestyle factors ,4,5,6. IThe PAS is a Brazilian primary health care (PHC) service which aims to contribute to the promotion and production of health care and healthy lifestyles for the population . It inclDespite the positive results presented by the nutritional interventions developed within the scope of the PAS, it is not known whether actions to encourage the consumption of FV can also bring positive changes in the nutrient profile of the diet, especially for those nutrients aimed at the prevention and control of NCDs . A systeTherefore, the objective of this study was to evaluate the effectiveness of a collective intervention to encourage the consumption of FV on the nutrients intake, especially the ones focused on the prevention and control of NCDs, in those who attend the Brazilian PHC health promotion service.This is a randomized controlled community trial, carried out between 2013 and 2015, with the objective of evaluating the impact of an intervention to encourage the consumption of FV in PAS users in the city of Belo Horizonte, Minas Gerais, Brazil . This muAccess to the PAS in Belo Horizonte occurs by spontaneous demand or by referral from a health professional . The proThe selection of PAS units participating in the community trial was based on simple cluster sampling, stratified by the nine administrative regions of the municipality. At the time of the sampling process 2012), there were 50 PAS units in operation, 42 of which were eligible because they operate in the morning and are located in areas with medium and high/very high IVS; they have the predominant characteristics of the health service in the municipality, and have not participated in a nutritional intervention study in the last two years , the weight was obtained via a single measurement on a Marte\u00ae brand digital scale, model PP 180, with a capacity of 180 kg and precision of 100 g. Height was also verified via a single measurement using a portable stadiometer, brand Alturexata\u00ae, with a capacity of 220 cm and accuracy of 0.5 cm. Individuals with a BMI \u2265 30 kg/m2 were classified as having obesity  and protein [RR: 0.978 ] . Analysis of the adequacy of the consumption of nutrients aiming at the prevention and control of NCDs showed that participants of both groups, after 12 months, reported an increase in the prevalence of adequacy of the consumption of total fat, saturated fats, fiber, and sodium, and reduced trans fats. Additionally, IG individuals showed an increase in the prevalence of adequacy of potassium intake. However, participation in the collective intervention to encourage the consumption of FV, after adjustment for possible confounding factors, was not associated with adequacy of nutrient intake for the prevention and control of NCDs . 1, B2, B3, B6, B12, C, D, and E, folate, calcium, magnesium, potassium, selenium, manganese, zinc, and iron. IG individuals also showed a reduction in the consumption of proteins, and total, saturated and polyunsaturated fats; and an increase in monounsaturated fats consumption; while those in the CG reported an increase in phosphorus consumption. Regarding the evolution of the adequacy of the consumption of nutrients for the prevention and control of NCDs, improvements were observed for total fat, saturated, fiber, and sodium in both groups, and in potassium for IG; trans fats in worsened in both groups, with no differences related to participation in the nutritional intervention. The collective intervention to encourage the consumption of FV was effective in reducing the consumption of energy and protein in the diet. In addition, after 12 months of follow-up, regardless of participation in the nutritional intervention, PAS participants showed a reduction in energy, omega 3, and sodium consumption, and an increase in the consumption of carbohydrates, fiber, vitamins A, BNutritional interventions are important tools to motivate and encourage healthy food choices, amplifying health service results. Systematic reviews that investigated the effect of nutritional interventions on the eating behavior of PHC users identified beneficial effects of interventions, such as increased consumption of FV and whole grains and reduced consumption of fatty foods, in addition to improving the nutrient profile of the diet ,38. HoweOne of the eating behaviors that should be the target of nutritional interventions developed in PHC is the high consumption of energy and total fat, as it is related to excessive weight gain and the development and aggravation of NCDs . This stRegarding protein consumption, the median values of protein consumption at baseline remained above the recommendations for the prevention and control of NCDs  . After 1It is essential to design and strengthen food and nutrition education actions within the scope of health services, such as the PAS, given its characteristics of health promotion and care. In addition, interventions aimed at improving the food environment around these health services are also necessary in order to support their clients in making healthier food choices. Actions developed in the health promotion services are strategic to promote adequate and healthy food choices. For example, longer participation in the PAS seems to be effective in improving the profile of food and nutrient consumption of its clients, as evidenced by a cross-sectional study that identified an increase in the consumption of home-prepared food and a reduction in UPF, as well as lower energy and fat consumption, and higher levels of carbohydrates, vitamin C, and calcium among those with longer time as participation in the health service . A previUnderstanding the role and importance of balanced consumption of nutrients for a healthy diet, and the prevention and control of NCDs, some parameters guide adequate nutrient consumption. It is noteworthy that our result which stated that a significant increase in fiber consumption and adequacy was observed for both groups (CG and IG) over the course of the study, is in line with the recommendation .As for nutrients, the preference for unsaturated fats over saturated and trans fats  and limiRegarding sodium, a consumption of less than 2 g per day is recommended, since its increased intake is associated with insufficient potassium consumption contributing to the development of arterial hypertension and increased risk of heart and cerebrovascular diseases . In thisThis study makes important contributions by demonstrating that health promotion service users tend to show improvement in the adequacy of nutrient consumption over time and that the collective intervention to encourage the consumption of FV, based on theories, potentiated these beneficial effects, further reducing total energy and protein consumption. It also showed greater adequacy in the consumption of nutrients, including those aimed at the prevention and control of NCDs, regardless of participation in the nutritional intervention, revealing the potential of the PAS to promote adequate and healthy eating. However, it is also vital that government strengthen public actions and policies that promote a healthy food environment consistent with the health recommendations offered by PAS. Among the limitations of this study is the possible information bias on food consumption, inherent to food surveys. To minimize their possible effects, the instruments were applied by a data collection team trained every six months and a home-measurement kit was used to help identify the portions of food consumed. Another limitation relates to the quality of the nutritional composition tables that contain restricted data in relation to the foods consumed by the population. To reduce this limitation, tables of the nutritional composition of foods commonly consumed in Brazil were used, developed from the Family Budget Surveys; food label information and/or recipe standardizations were added, when necessary. Additionally, not having investigated the intake of vitamin supplements and the fact that some study participants already had arterial hypertension or diabetes were some other limitations of the study, but adjustments were made to minimize this effect as well. The external validity of this study is limited, considering that the participants come from health promotion services, and may differ from the general population, including the motivation to make changes in health-related behaviors. However, its data are relevant for the Brazilian PHC and for the adequacy of public policies and educational actions developed within the scope of PAS, which includes, among its objectives, the prevention and control of NCDs. Finally, there was a loss of follow-up during the study; however, data imputation was performed to minimize possible interference from this loss. The strengths of this study are the sample size and the study design with a high level of scientific evidence, which allowed us to obtain reliable data on the effectiveness of nutritional intervention on the nutrient profile, including those aimed at the prevention and control of NCDs, gaps existing in the literature and identified by systematic reviews ,38. FurtResults of this study pointed to the practical importance of health promotion services for the positive development of the nutrient consumption profile, including those associated with the prevention and control of NCDs. Thus, this study has practical importance, which can guide the expansion of actions carried out within the scope of PAS, including in its routine actions to promote adequate and healthy food."}
{"text": "Therefore, more and more reflections on the impacts and applicability of studies have permeated the center of discussions at a global level, especially considering the growing increase in knowledge production. In this scenario, research translation (RT) has a notable importance insofar as the social commitment of research establishes that the knowledge arising from investigations must reverberate in fruitful and beneficial results for society, configuring a core premise of research. However, the weaknesses regarding transfer and application of knowledge from research in health services\u2019 practice are still notoriousRT tunes in and correlates with the translation of knowledge, evoking, for its understanding, an imaginative variation that expresses a dynamic, interactive, multidirectional and participatory movement that involves several nuances related to health demands and characteristics of research designs, institutional actors, starting points and intersections. From this perspective, RT aims to use evidence and knowledge to close gaps and leverage transformations ethically, responsibly and effectively in health care practice., given that, often, the knowledge unveiled is not transferred and concretely implemented in health practices and in health management and training policies. In this regard, the incipient understanding and implication of RT presents itself as a complex challenge, especially considering the plurality of concepts and terminologies that touch RT as well as the gaps regarding the forms of implementation.Therefore, it is crucial to understand the tenuous distinction between knowledge translation and evidenceTherefore, RT presents itself as an area still under development and covered in complexity. This is due to the pressing need to overcome obstacles, such as the inclusion of a translational perspective in research planning, weaknesses in the researcher\u2019s training path, resulting in unpreparedness and inexperience for RT, lack of dialogue between researchers and services, inaccessibility of evidence for services, managers and potential users of knowledge, restriction of knowledge to the academy, lack of resources and investments, in addition to the historical devaluation of qualitative research results..On the other hand, from the identification of challenges, perspectives and initiatives to overcome them are outlined, highlighting the recovery of research\u2019s social commitment, development of networks for dissemination and transfer of the results obtained, use of methodologies and rigorous, reproducible, and transparent research designs that include translation, reflection on the understandability of findings, increased investments, and communication strategies. Such actions favor accessibility to research and encourage a break with traditional and conservative models that tend to perpetuate unidirectional and limited patterns, which do not guarantee the realization of the public utility of the study and the strengthening of health and research systemsThus, considering the aforementioned considerations as well as the spreading of knowledge disassociated from the effective incorporation of evidence in places where care is provided, which would have repercussions in advances in health care, the following reflections emerged: is there understanding, support and preparation for RT in Brazil? What paths and bridges do we need to build to ensure the effective implementation of research results? What is the future of RP? Where are we going?The discussions raised here converge to the pressing need to (re)think research, its applications and purposes, with the intention of orchestrating them under the aegis of knowledge translation and social commitment, making RT a priority issue and intending to build paths and perspectives that value reflexivity, dissemination of knowledge and collaborative work, promoting powerful, safe and assertive transformations in health care practice for the population.In summary, this editorial is expected to promote new reflections on the subject, contributing to re-signification of RT by reducing the distance between theory and practice, in addition to boosting engagement and concentration of efforts by researchers, research centers and services to improve transfer and use of knowledge obtained, with the aim of remodeling practices and providing subsidies to guide the decision-making process safely and reasonably, whether in clinical practice or in health policies."}
{"text": "The growth in our knowledge of the diversity of the herpetofauna of Mexico has occurred over the period of approximately 445 years from the work of Francisco Hern\u00e1ndez to that of a broad multinational array of present-day herpetologists. The work of this huge group of people has established Mexico as one of the most significant centers of herpetofaunal biodiversity in the world. This status is the result of a complex orography, in addition to diverse habitats and environments and the biogeographic history of Mexico. The current herpetofauna consists of 1,421 native and introduced species, allocated to 220 genera, and 61 families. This figure is comprised of 1,405 native species and 16 non-native species (as of April 2023). The non-native species include two anurans, 13 squamates, and one turtle. The level of endemism is very high, presently lying at 63%, with this level expected to increase with time. Species richness varies among the 32 federal entities in the country, from a low of 50 in Tlaxcala to a high of 492 in Oaxaca. Amphibian species richness by state-level can be envisioned as comprising three levels of low, medium, and high, with the lowest levels occurring in the Peninsula of Baja California, a group of seven states in north-central and central Mexico, and a group of three states in the Yucatan Peninsula, with the highest levels occupying the southern states of Guerrero, Puebla, Veracruz, Oaxaca, and Chiapas, and the medium level in the remaining states of the country. Reptile species richness also can be allocated to three categories, with the lowest level occupying Baja California Sur, a group of central states, and the states of the Yucatan Peninsula, and the highest level found in a cluster of the states of Veracruz, Guerrero, Oaxaca, and Chiapas. Knowledge of the Mexican herpetofauna will continue to grow with additional studies on systematics, conservation, and the construction of checklists at various levels. Historically, our knowledge of the diversity of different biological groups in Mexico has increased through the accumulation of local, regional, state, and/or country level studies mammals: . In studThe contributions of Finally, between 1990 and 2000, a strong interest in biodiversity led to an assessment of the herpetofauna of Mexico at both the regional and state levels , b. SubsChiropterotritonaureus or C.nubilus  compiled by the authors, which were searched from 1940 to date;records obtained in specialized journals, such as Mesoamerican Herpetology, ZooKeys, Zootaxa, Revista Mexicana de Biodiversidad, Herpetological Review, and Amphibian & Reptile Conservation, as well as publications of newly described species for the country (until 30 April 2023);https://www.gob.mx/conabio); anddatabases generated from projects undertaken by the Comisi\u00f3n Nacional para el Conocimiento y Uso de la Biodiversidad (https://www.gbif.org/), and authenticated by geographic distribution records from previously published literature.records of amphibians and reptiles from Mexico obtained from the Global Biodiversity Information Facility (https://www.amnh.org), and for reptiles, based on the Reptile Database website (http://www.reptile-database.org/).All taxonomic changes and the identification of the species were based on the most recent taxonomic revisions . The sciOur results show that the current native herpetofauna of Mexico is comprised as follows: amphibians = 16 families, 58 genera, and 430 species  and 14 reptiles .Currently, 16 species of non-native or exotic amphibians and reptiles have been reported from Mexico , includiThe percentage of species endemism of the Mexican herpetofauna is very high at 63.1%  maintain the highest richness levels  to that of Chihuahua , of which the latter is 165.5 times larger than the former  are found in the two states of the Peninsula of Baja California, a north-central swath of states that include Coahuila, Nuevo Le\u00f3n, Zacatecas, Aguascalientes, and Guanajuato, two small states in central Mexico, Ciudad de M\u00e9xico, and Tlaxcala, and the Yucatan Peninsula states, Campeche, Yucat\u00e1n, and Quintana Roo Fig. . The nexAccording to the number of species of reptiles by state the resulting categories are somewhat different than those for the amphibians, since the lowest rank (32\u2013120) is occupied by the states of Baja California Sur, a smaller central Mexican swath that includes Zacatecas, Aguascalientes, Guanajuato, Quer\u00e9taro, Estado de M\u00e9xico, Ciudad de M\u00e9xico, Tlaxcala, and Morelos, the state of Colima, and the states of the Yucatan Peninsula  Fig. . The medThe richness of amphibian and reptile species in Mexico has been the subject of study for several decades, generating various works listing the herpetofauna at the country level. In this study, we update the list of species to 1,421, of which 1,405 are native species, and 16 are non-native. The number of native species we record in this study is higher compared to that of recent works by The high species richness and endemism of both groups stands out compared to that of other groups of vertebrates in Mexico , since Jth century, the principal impulse that led to our current knowledge of the Mexican herpetofauna did not occur until the second half of the 19th century and was made possible through the contributions of th century the number of species in the country was ca. 219, but by the end of 20th century it had increased to 995 species (Fig. st century, the increased herpetofaunal species richness resulted from new state records (The brief historical review shown in the introduction of this work highlights the continuous study of the herpetofauna to date, since it began with the acknowledgement of the amphibian and reptile fauna by the Aztecs, which later increased with the Spanish conquest of the Americas . Althougies Fig.  and Ameries Fig. . At the  records  and the  records . All theBased on this number, the herpetofauna of Mexico has been analyzed by authors in other related fields, including conservation  and biogThe states in southeastern Mexico, including Oaxaca, Chiapas, and Veracruz, have shown the highest amount of species richness Figs , and theFuture studies on systematics , regiona"}
{"text": "Emancipation andHealth: Decoloniality, Reparation, and Critical Reconstruction, the eventproposed a dialogue with previous editions and absorbed the discussions in the area,expressed in the Master Plan of the Commission of Social and Human Sciences in Healthdeveloped from 2020 to 2022. As it took place in a post-pandemic context, wheredemocratic institutions were being re-established and public policy investment cyclesstrengthened, the debates focused on diversity, the decolonial purpose, and the demandfor social reparation as guiding principles for both the production of public actionsand the production and sharing of knowledge.Another page in the history of Brazilian Public Health Association (Abrasco) was writtenfrom October 30 to November 3, 2023, during the 9th Brazilian Congress of Social andHuman Sciences in Health Decoloniality of Can-be-know-do: Challenges and Contributions ofSocial and Human Sciences in Health; Repairing HistoricalInjustices in the Field of Health: Ethos, Knowledge, Politics, and SocialAction; and Challenges for the Critical Reconstruction of Brazil:the Place and Contributions of Social and Human Sciences in Health. Threepanels were also held, guided by the preparatory discussions of the Congress, whichsought to address central themes in the area, such as The Distribution ofCapital and the Question of Visibility in the Field of Public Health;The Critical Vanguard of Human Sciences in Health and their Potential in theField of Public Health; and Training in (Public) Health in theExperience of Social and Human Sciences in Health.The dialogues and debates revolved around three major debates and 34 panel discussions ontopics such as The significant participation of the Social and Human Sciences in Health community wasevident and powerful, with almost 200 organizers and more than 2,300 participants at theCongress, 2,353 articles submitted and 1,770 presented in the 35 thematic meetings. Weinnovated methodologically by including representatives of the social movements on thescientific committee, who designed the activities with us and evaluated the articlessubmitted, and by holding meetings between generations of researchers and students and exchanges among researchers, students, andrepresentatives of the social movements (inter-knowledge snacks).The Congress brought many reflections on the role of Social and Human Sciences in Healthin the paradigmatic renewal movements in the field, on the protagonism and diversity ofepistemic subjects in a turn that affirms the plurality of rights, identities, andstruggles. It also points to the urgent need to review parameters for the inclusion"}
{"text": "Scientific mapping using bibliometric data network analysis was applied to analyze research works related to lipases and their industrial applications, evaluating the current state of research, challenges, and opportunities in the use of these biocatalysts, based on the evaluation of a large number of publications on the topic, allowing a comprehensive systematic data analysis, which had not yet been conducted in relation to studies specifically covering lipases and their industrial applications. Thus, studies involving lipase enzymes published from 2018 to 2022 were accessed from the Web of Science database. The extracted records result in the analysis of terms of bibliographic compatibility among the articles, co-occurrence of keywords, and co-citation of journals using the VOSviewer algorithm in the construction of bibliometric maps. This systematic review analysis of 357 documents, including original and review articles, revealed studies inspired by lipase enzymes in the research period, showing that the development of research, together with different areas of knowledge, presents good results related to the applications of lipases, due to information synchronization. Furthermore, this review showed the main challenges in lipase applications regarding increased production and operational stability; establishing well-defined evaluation criteria, such as cultivation conditions, activity, biocatalyst stability, type of support and reactor; thermodynamic studies; reuse cycles; and it can assist in defining goals for the development of successful large-scale applications, showing several points for improvement of future studies on lipase enzymes. Enzymes can act as natural catalysts on specific or non-selective substrates, usually under mild temperature, pressure, and pH conditions, and achieve high conversion rates . In thisLipases demonstrate several interesting properties, such as their ability to act at the interface between aqueous and non-aqueous phases, their ability to process all types of glycerides and free fatty acids in transesterification, specificity, high catalytic activity under milder reaction conditions, stability in organic solvents, and activity without cofactors. These properties of lipases demonstrate their good performance when applied in biocatalysis in the most diverse processes . For exaDue to the diversity of catalytic processes involving lipases, a large number of studies have been published proposing improvements in the characteristics and mechanisms of action of these biocatalysts, such as improved stability ,14, immoBibliometric analysis is a quantitative method that uses mathematical and statistical tools to measure the interrelationships and impacts of publications within a given area of research, resulting in a macroscopic view of a large number of academic works. VOSviewer is a program designed to build and visualize bibliometric maps based on network data, considering the strength of the connection between items .The emergence of scientific databases, such as Scopus and Web of Science, made it relatively easy to acquire large volumes of bibliometric data. This phenomenon associated with bibliometric software enables extensive data analysis, motivating academic interest in bibliometric analysis . TherefoThe present study highlights the relationship of study networks involving lipase enzymes, based on a search of the literature in English in the Web of Science (WS) database from 2018 to 2022 to highlight, through scientific mapping, the most researched topics involving lipases. With this, it was possible to identify the challenges related to the scale-up of the process catalyzed by lipases and to show perspectives for future research that seek to increase the production and operational stability of processes enzymatic.Bibliometric analysis is a quantitative method that uses mathematical and statistical tools to measure the interrelationships and impacts of publications within a given area of research, resulting in a macroscopic view of a large number of academic literature works .The data collected for this research was based on WS. The search expressions form the terms \u201clipase\u201d and \u201cindustrial applications\u201d for the topics in this field, which performs word searches in titles, abstracts, and keywords. According to Gon\u00e7alves et al. ,25,26, tAccording to Uman , systemaBibliographic coupling measures the proximity between two articles by comparing their references. Therefore, the greater the number of references they share, the greater the similarity between them, which can be theoretical, methodological, or another shared particularity . Figure The articles are indicated by a label and, by default, a circle. Thus, the more citations the document has, the larger the circle in the bibliographic coupling will be. The articles by the authors Chapman et al. , Basso aIn the bibliographic coupling chart, the strength of a link indicates the number of cited references that two publications have in common . Table 1Chandra et al.  and MahfIn this context, from the connection network established among the articles, it is possible to observe the similarity of the research topics developed by these authors, evidenced by the total link strength value shown in bibliographic coupling.Keyword co-occurrence analysis assumes that words often appear together and have a thematic relationship . VOSviewIn order to identify possible topics researched in the last five years, a network was built for the co-occurrence of keywords. From the information extracted from the WS, the minimum number of five occurrences for a keyword was established, resulting in a total of 140 keywords identified for constructing the network graph in VOSviewer, as presented in With the grouping of terms, it was possible to identify the existing relationships among topics in the field of research of enzyme immobilization, studies on enzymatic catalysis, its characteristics, and studies on enzymes from microbial sources . In cluster 2 (in green), the search terms were enzymes, cold-adapted lipases, enzyme identification, and classification. Cluster 3 (dark blue) presented a search set involving nanoparticle stability, in vitro antioxidant stability, transesterification, esterification, and biodiesel. The terms in cluster 4 (in yellow) are related to research on biotechnology, directed evolution of enzymes, stability, and enzyme stability. In cluster 5 (in purple), the researched topics were directed to the production and application of lipases, in which the terms industrial application, biochemical characterization, extracellular lipase, production of lipases, solid-state fermentation, and microbial lipases appear. Cluster 6 (in light blue) contains search terms related to enzyme production, optimization, hydrolysis, fermentation, substrate, purification, alkaline lipases, and microbial lipases.Co-occurrence links present the strength of the relationship between items (link strength), represented by a positive numerical value. Journal of Molecular Catalysis B: Enzymatic; International Journal of Biological Macromolecules; Bioresource Technology; Process Biochemistry; Enzyme and Microbial Technology; Applied Microbiology and Biotechnology; Biotechnology and Applied Biochemistry; and Biotechnology Advances have very dense and highlighted areas on the map, showing a more significant number of citations in these journals in the investigated period. In addition, it is possible to observe on the map that these journals are located close to each other, indicating closely related research fields. The journal co-citation map shows the structure of the researched scientific areas. For the construction of the map, journals with a minimum of ten citations were selected, totaling 429 journals used to construct the co-citation map. Journal of Molecular Catalysis B: Enzymatic; Process Biochemistry, and Enzyme and Microbial Technology hold great relevance for research mainly related to enzyme immobilization. Therefore, it was possible to obtain an overview of the structure of the co-citation map of the journals, to observe the intellectual links among journals, and the impact of this network through the visualization of the density map , which is one of the few liquid lipase formulations for industrial application. A genetically-modified lipase, derived from the lipase of the fungus Thermomyces lanuginosus [In general, soluble enzymes do not present characteristics that allow their application in large-scale continuous processes. With their sensitivity to process conditions, low stability, and difficult reuse at an industrial scale, studies focus on immobilization techniques to improve this performance . When weuginosus ,78, withuginosus ,80. Curruginosus ,82,83.The main goal of immobilization techniques is the protection of enzymes under extreme environmental conditions, including the influence of temperature, pH, and organic solvents during the application processes, allowing enzymatic activity to be maintained even under various reaction conditions since the main function of the support is to stabilize the enzyme structures and, consequently, to preserve enzyme efficacy and storage. Immobilized enzymes are more robust, show higher stability, and are easier to handle compared to their soluble forms. They are also easily recovered/recycled after use ,86,87,88Enzyme immobilization methods include physical adsorption, ionic and covalent bonds, and various techniques such as binding, entrapment, encapsulation, and reticulation. Various organic and inorganic materials or carriers can be used to apply enzyme immobilization techniques ,89. ImmoIn the food industry, for example, studies show that immobilized enzymes are applied in different stages of food and beverage processing, in brewing, meat tenderization, baking, and protein hydrolysis, offering numerous advantages such as stabilization and reuse, which enable cost reduction ,78,91,92Lipase immobilization techniques have been the subject of several studies developed over the years ,96,97,98In the graph generated by the program VOSviewer , it is oGoing deeper into these details, the authors address the relevance of recombinant technology studies with protein engineering, which act in the structural modification of this enzyme ,18, mainModeling and optimization by statistical experimental planning stand out in most of the works with lipase ,31. NoneAmong the observed works, when talking about the bioreactor, there is a range of studies that need to be considered for the effective dynamics of the reaction system, which should be considered for scale-up. Thus, the large amount of biocatalyst is mentioned, in relation to the efficiency of the reaction and the enzymatic activity, as well as the impregnation of the material on the reactor wall in continuous processes or for long periods, the adequate heat and mass transfer, the effective operational control, the combination of the reaction medium with the characteristic of the enzyme, the kinetic model of the reaction, and the amount of water in the medium ,32,47.The works with significant numbers of citations found in the search focus on lipase immobilization processes for application in industrial processes.Within this niche, the application is focused on the biotechnology and bioprocess sectors, which include food, cosmetics, biofuels, and environmental areas, which show the versatility of this enzyme.When observing the topics that comprise the optimization of lipases, studies are found evaluating both the supports for immobilization, fermentative processes of enzyme production, enzymatic purification, biochemical characterization, and the application in reactions in both an organic and inorganic media, reinforcing the breadth of use of this biocatalyst.It is verified that in the case of lipase immobilization techniques, the tests comprise the configuration of support materials, operational stability, and reuse.Kinetic studies are fundamental in this process of transition from laboratory scale to industrial scale. Allied with the computational modeling of these reactions, it allows us to determine and optimize operational parameters, in addition to enabling monitoring of the bioprocess and planning the structure necessary for implementation.Other factors that contribute to the previous topic are the genetic studies at the structural level of lipases, which allows the improvement of their characteristics regarding activity, productivity, thermal stability, reuse, and enantioselectivity.Compatibility studies considering the synergy of free or immobilized enzyme, reactor type, reaction medium, and product are fundamental to performing a combination that allows an efficient process, with high yields, and continuous operation processes.Lipases stand out in different industrial sectors with wide applicability; consequently, the number of research works involving this enzyme covers multiple areas of knowledge. Therefore, the systematic review presented aimed to map the potentiality of this biocatalyst aiming at its industrial application, where the following topics can be highlighted:Thus, the approach of enzyme technology focused on lipases is broad, requiring the combination of knowledge in protein engineering, immobilization, process engineering, and life cycle analysis to both understand the mechanisms that involve this biocatalyst and enable the use on an industrial scale with the least efficiency loss in the processes."}
{"text": "Mixed Methods Appraisal Tool (MMAT), STrengthening the Reporting of OBservational studies in Epidemiology (STROBE), and Standards for Reporting Qualitative Research (SRQR). The qualitative and quantitative findings were grouped into a four-level hierarchical matrix. The epidemiological profile of malaria morbidity, from traditional epidemiology, has been sustained by environmental problems, armed conflict, individual risk behaviors, and low adherence to recommendations from health institutions. However, the qualitative component reveals deeper causes that are less studied, of greater theoretical complexity, and that reflect challenges to design and implement health interventions, such as socioeconomic and political crises, poverty, and the neoliberal orientation in the malaria control policy; the latter reflected in the change in the role of the State, the fragmentation of control actions, the predominance of insurance over social assistance, the privatization of the provision of health services, the individualistic and economistic predominance of health, and low connection with popular tradition and community initiatives. The above confirms the importance of expanding mixed studies as a source of evidence to improve malaria research and control models in Colombia, and to identify the underlying causes of the epidemiological profile.Mixed methods are essential in public health research and malaria control, because they allow grasping part of the complexity and diversity of the factors that determine health-disease. This study analyzes the mixed studies on malaria in Colombia, 1980\u20132022, through a systematic review in 15 databases and institutional repositories. The methodological quality was assessed with The online version contains supplementary material available at 10.1186/s12889-023-16098-5. Plasmodium vivax and P. falciparum represent about 98% of all Colombian cases, and problems of plasmodial resistance to antimalarials or anophelines to insecticides do not explain their endemicity ) AND ) AND (Colombia), in Scielo with (ab: (mixed methods)) AND ) AND (Colombia) and ScienceDirect with Colombia Title, abstract, keywords: (mixed methods) AND malaria, do not generate results.Specifically in malaria, there are studies with mixed methods that have evaluated strategies for case reporting , health National Strategic Plan for Malaria 2019\u20132022 from Colombia. In connection with these purposes, the objective of this research was to analyze the mixed studies on malaria in Colombia published in the world scientific literature between 1980\u20132022, through a broad approach of Cochrane, which one summarize the scientific production in an area, update a field of knowledge, summarize the available evidence, identify the main research topics or gaps in research, define future lines of work, among other aspects [For all the above, it is important to carry out a systematic review in this field in order to synthesize the available evidence in the country and determine its methodological quality; know the main topics addressed; identify ways to articulate quantitative and qualitative evidence on malaria; identify issues with consistent evidence to guide public policy actions; generate hypotheses on aspects not yet explored or explained in qualitative or quantitative research; broaden the understanding of the processes underlying the epidemiological profile of malaria in Colombia; and ultimately, to generate evidence that allows us to complement the actions of  aspects .A systematic review following PRISMA guideline . The revin Spanish Descriptores en Ciencias de la salud) and MeSH , the following search terms were identified: i) for the disease: malaria, Plasmodium, and Paludism; ii) for the method: mixed methods, qualitative, hermeneutic, ethnographies, ethnography, grounded theory, community-based participatory research, community-based research, participatory research, participatory action research, cultural anthropology, ethnopsychology. With these terms, nine search strategies were established and applied in the PubMed, OVID EMCare, Scielo, Science-Direct, Jstor, Web of Science, Campbell Collaboration / Cochrane Library, EMBASE, and HAPI databases . They were complemented with searches for other publications in Google Scholar, Redalyc, and the system of libraries and institutional repositories of the main Colombian universities with research on malaria . It is important to note that the systematic review was limited to Colombia, since the findings of other studies in countries with a similar parasitological situation such as Venezuela, Peru or Brazil, are not comparable in key aspects of this review such as the following: type of system of health, type of disease control program, characteristics of the territory , political and social situation , among other characteristics that may offer disparate results or that they are not applicable to the reality of Colombia. To manage references and eliminate duplicates we use Zotero.We apply four inclusion criteria: include search terms in title, abstract, or keywords ; be a study on malaria as the central outcome; developed in a Colombian population; and that it was original research. In this review we only applied two exclusion criteria: studies executed without a design based on mixed methods , and studies with incomplete information or without data from the two components  of a mixed study on malaria. Two researchers conducted this phase independently and discrepancies were resolved by consensus.Data extraction from the selected manuscript was carried out by extracting the following variables: title, authors, year of publication, study location, number and central characteristics of the study subjects, type of mixed study, data collection instruments, central theme or objective, central results of the quantitative component, categories of the qualitative component and conclusions. Then, qualitative synthesis was conducted. Two researchers also conducted this phase independently and discrepancies were resolved by consensus.Mixed Methods Appraisal Tool (MMAT)\" [STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines were applied for the quantitative component [Standards for Reporting Qualitative Research (SRQR) guidelines were applied for the qualitative component [Two researchers independently guaranteed the reproducibility of the studies' methodological quality assessment . The methodological rigor of the studies was evaluated based on the criteria of the guide \" (MMAT)\" . Given tomponent , becauseomponent . The supCollected search results, screening, and data extraction process, were made in Excel. The percentage of studies that met each of the methodological quality criteria was determined, and for each study, the percentage of quality criteria met was determined. Because, in the quantitative component, the studies evaluated different units of analysis  and studied heterogeneous subjects, it was not possible to carry out a quantitative synthesis , but rather a qualitative one of the main variables, proportions, and temporal trends in malaria. In the qualitative component, the main categories reported from the studies were analyzed, and for each one, its properties (characteristics of a category that give it meaning) and dimensions  were identified.Once the synthesis of the findings of each component was made, its articulation was carried out through a matrix in which the results were grouped in four levels:The most investigated , called the epidemiological profile of malaria, includes aspects of morbidity, mortality, outbreaks, and knowledge surveys.The second grouped the characteristics of the malaria control program after of the reform to the health system (Law 100 of 1993), giving an account of the impacts of this change on the operation and achievements of the program.In the most profound or structural aspects, the changes in the Colombian health system in the 1990s appear.The base of the hierarchy includes structural and permanent problems from Colombia in the last four decades, such as poverty; economic, social and political crises, and the neoliberal turn in the Colombian economic system.Some approaches of the critical realism were taken to define these levels. Critical realism is an epistemological stance that allows overcoming the limitations of positivism and hermeneutics by making explicit the importance of investigating the simultaneity, interrelation, and superposition of the dimensions of reality : the empirical (observer's perceptions), historical, and transfactual  .n\u2009=\u200991), Redalyc (n\u2009=\u200952), and the system of libraries and institutional repositories of the main Colombian universities (n\u2009=\u200944). Only 491 articles with search terms in title, abstract, or keywords were screened. Of the 153 eligible texts, 94 epidemiological studies (quantitative), ten entomological studies, 9 in vivo or in vitro models, 11 qualitative, and 20 corresponding to other typologies  were excluded. Therefore, only nine investigations that applied mixed methods were included , allowed the identification of 127,679 records, of which 187 were identified in the manual search in Google Scholar . In this sense, most studies did not correctly describe the quality criteria applied in their quantitative component, being bias control the least applied. In the qualitative component, the least applied items were the specification of the type of study and the guarantee of reflexivity Fig.\u00a0.Fig. 2AsHousing: important characteristics are reported, such as poor material conditions of the floor, ceiling, and walls, as well as the absence of sanitary infrastructure in most of the cases analyzed (greater than 70%) [han 70%) .Families: in this unit stands out the high proportion of poverty , the high risk of greater impoverishment due to the disease, and due to the type of economic activity of its members (primarily people who are paid for each workday), absence of protection mechanisms against malaria  and overcrowding [crowding . The extcrowding .Subjects exposed to malaria: the largest proportion does not attend hospitals because they are far from their homes, the long waiting times, the poor-quality care (friendliness), and delay in diagnosis [iagnosis . There aiagnosis .Malaria control program at the municipal, departmental or national level: the following findings are highlighted: i) the national trends evaluated since 1960 show that mortality has decreased and morbidity has increased, with an underestimation of cases between 15\u201325%, and with the presence of outbreaks in some years [ii) in the decade 1991\u20132000, the highest incidence occurred in the Department of Antioquia (one of those that reports the highest proportion of cases in the country), the highest peaks occurred between 1992 and 1995 with 17 municipalities concentrating 75% of all the Department's cases [iii) Antioquia, like the national average, shows a decrease in mortality from 1946 to 2003 [me years ; ii) in 's cases , 35; iii to 2003 , 39, alt to 2003 . After 1 to 2003 .Information related to units of analysis such as housing and families in endemic areas, exposed subjects, and control programs were obtained:However, morbidity trends should be analyzed with caution due to the following problems in data availability: decrease and lack of knowledge over several years of the number of blood samples examined ; underreAdded to the above is a recent study showing a low diagnostic and epidemiological surveillance capacity in some areas. For example, the Rond\u00f3n study with 25 diagnostic sites in southern Colombia indicates that less than 30% had microscopy stations; approximately half of them performed the diagnosis for malaria, and the rest only took the sample and sent it to a reference laboratory; the Secretariat of Health of the Amazon (Colombia) does not carry out monitoring visits, and only 60% of the diagnostic points participate in quality assurance programs . HoweverIn this component, issues related to the concept of health were found in some exposed subjects from rural areas, socioeconomic characterization of some studied regions, the role of the State, and impacts of the change in Colombia's general health social security system in 1993.Regarding the conceptions of health of some endemic areas' residents, it was mentioned that health is related to biological, psychological, social, and environmental factors. At the same time, the disease is explained in terms of socioeconomic problems reflected in the absence of sewerage, little supply of water and food, among others. Also, nosological systems that group diseases into infectious , behaviors that affect health , pests , and environmental problems  were found , 36.In describing the socioeconomic context, some authors found that migration to urban areas to seek better education and income generates problems of food insecurity . This isIn some testimonies, the importance of having a strong State was also highlighted, even though the reality of the residents of some endemic areas of the Department of Antioquia, mainly in the rural area, shows the low presence of the State, the failure to comply with its responsibilities in security, its inability to control armed groups, low coverage of basic health-care services, problems (and in some cases absence) of road infrastructure, few incentives for agricultural production and low inclusion of social organizations in activities related to managing their health .Finally, various categories were found that account for the negative effects of changes in the Colombian general health social security system at the end of the 1980s and the beginning of the 1990s, from the perspective of key actors such as experts from the Pan American Organization of Health, the National Institute of Health, the departmental and local health secretariats, as well as operational personnel and community leaders. In this sense, it is indicated that since 1993 there have been radical changes in the structure and organization of public health programs and in the functions or responsibilities of territorial entities, which resulted in fewer investments in core public health issues, and loss of the capacity and experience gained in previous decades. Also, significant territorial gaps in planning, allocation of resources, personnel, training, disease monitoring, and intersectoral coordination are outlined .Although the most significant impacts have been recorded since 1993, several authors highlight that the significant changes related to the competencies of territorial entities, particularly the decentralization  that affected public health programs, had been a constant and long-term process in Colombia since 1986, modeled by Laws 12 of 1986, 10 of 1990, 60 of 1993, 715 of 2001, being a milestone Law 100 of 1993 that completely reformed the health system , 38. In Malaria was classified as one of the most critical health problems among the subjects studied. The main symptoms of malaria, the causative agent, the vector, and the prevention methods  are identified. The subjects know that the vector lives and reproduces in stagnant waters, that transmission occurs by mosquito bites, that the tropical climate partly explains the disease's presence, and that the mosquito is found in bushes, near garbage, stagnant water swamps and latrines. Knowledge is often not directly related to practice; many people start self-medicating since no prescription is required in pharmacies , 36.People living in endemic areas go to health services  or traditional healers. They make the initial (symptomatic) diagnosis at home and manage it with medicinal plants, although as the fever progresses, they visit the health center for pharmacological treatment . Most suIn addition to cultural practices and beliefs, the primary socio-ecological dynamics related to malaria include mining, migration, armed conflict, and climatic variations . In addii.Loss of progress made since the Malariology Campaign from 1943 and the Malaria Eradication Service (in Spanish SEM) from 1956, in terms of community education and training, active case detection , operatiii.An economic emphasis of the program , with a prevalence of privatization in disease care and an individualistic view of health .iii.Disarticulation and fragmentation of responsibilities and preventive actions, low integration with local health plans, and little participation of the community and local authorities in control activities .iv.Since 1991, a deterioration in malaria control has been observed, associated with decentralization and the subjection of health policy to market principles, with progressive weakening of State responsibilities, dismantling of installed capacity, loss of know-how and experience acquired, fragmentation of control actions, and the collapse of the information system .v.Reduction of economic resources allocated to the program, subordination of health care to insurance contracts, delayed payments for health service providers, and little clarity on the allocation and administration of resources , 39, 40.vi.Organizational problems since the health secretariats are subject to political influence, with little participation of the personnel and an unstable relationship with institutions of training. Additionally, there is personnel without sufficient technical skills, low salary, corruption in hiring, little horizontal and vertical articulation with other vector control programs, and delays in providing drugs, mosquito nets, and insecticides .Finally, in this component it is highlighted the testimonies of key actors and the documentary research on the negative impacts that the changes in the General Health Social Security System had on the malaria control program in Colombia, highlighting the following events:i.clinical-epidemiological profile of malaria. This level includes the findings of the quantitative component of the studies that show increasing trends in morbidity, the presence of outbreaks, groups with a higher prevalence of the event, and high levels of knowledge about the causes, symptoms, transmission, treatment and prevention of malaria.The first would correspond to the most visible part or to the proximal processes, closest to the clinical-epidemiological outcome, which materialize in the ii.characteristics of the malaria control program after the changes introduced with the health reforms that began in the late 1980s, highlighting the reduction in the program's budget, problems with information systems and surveillance, fragmentation of malaria control actions, among others.The second level shows the iii.The previous characteristics are based on the changes derived from implementing the new social security health law (Law 100 of 1993), whose axes were the economic vision of health, decentralization, privatization, the reduction of social spending, among other neoliberal policies.iv.Finally, all the previous characteristics underlie problems related to the neoliberal economic system, the change in the role of the State, poverty, and the social, economic and political crises that the country has experienced Fig.\u00a0.The previous results account for proximal, intermediate, and structural processes associated with malaria in Colombia. Using some postulates of critical realism Fig.\u00a0, the eviFigure\u00a0It confirms that in malaria research in Colombia, the biomedical studies focused on the parasite, the vector and clinical-epidemiological aspects predominate ;It coincides with previous systematic reviews that demonstrate the low academic-scientific production in qualitative studies and social processes that underlie malaria , 45;This predominance of approaches of traditional epidemiology will not allow progress in the intervention of the malaria in Colombia since its conception of health is limited in theoretical and practical terms .Through 9 search strategies applied in 15 sources, the study found nine mixed studies on malaria in Colombia published between 1986 and 2018 in various topics and units of analysis. This low number of studies accounts for several important aspects:Regarding the last aspect, it is worth noting that, in health philosophy and social epidemiology, this phenomenon has been called the \"paradigm in crisis\" of classical epidemiology. This phenomenon occurs because their reasoning and methods do not address all levels of reality ; they assume the population only as the sum of individuals , favoring the measurement of biological factors, behavioral factors or external environmental exposures; they do not allow addressing social, historical and cultural aspects of the health-disease process; they generate partial public policy recommendations given the limitations of their ontological, epistemological and methodological foundations; and they have low explanatory power for key outcomes such as morbidity or mortality .The above highlights the importance of articulating the quantitative tradition with qualitative findings that make it possible to overcome some of the limitations mentioned above. In this sense, this systematic review shows the advantages of mixed studies by revealing social, economic, political, cultural, and historical causes, generally not revealed in the hegemonic research on malaria in Colombia. Thus, the advantages of mixed methods materialize, such as capturing part of the complexity and diversity of the factors that determine health disease; enriching the results of traditional epidemiological studies ; improviIn the quantitative and qualitative findings, it was common the reference to homes, families, and socioeconomic context characterized by poverty and its related problems such as migration , food insecurity, barriers to access to health services and the increased risk of becoming ill. This complexity of the social and economic contexts in which the disease occurs has been widely documented for general issues that relate to poverty, malnutrition, and infectious diseases . These aIn this regard, it is essential to clarify that the studies in this review that refer to poverty are not exhaustive or precise in the use of this concept. In this sense, it is important to note that in the study of poverty, there are multiple visions , approaches , definitions , methods , and measurement typologies (univariate or multivariate) demonstrating that this field of study is complex. In the case of malaria in Colombia, it is a subject that has not been rigorously investigated, which should be corrected in subsequent studies .i) social representations, meanings, perceptions, wisdom, experiences, and practices about the health-disease process; ii) nosology, knowledge, beliefs and therapeutic itineraries of the traditional health system; and iii) the meanings of the health-disease process as a material, cultural and spiritual reality [On the other hand, it is essential to note that the social and practical representations that subjects and communities have regarding malaria are part of a broader sociocultural system referred to social constructions on health and its value, and they determine the initial actions against health, disease care, hospital consultation and the type of treatment accessed. The finding from the systematized studies in this research coincides with a previous review on the qualitative studies of malaria in Colombia, in which it is established that, from the perspective of social actors, their conception of the health system revolves around the following categories:  reality . These aIn this regard, it was also found that the knowledge, attitudes, and practices about the causality, transmission, treatment, and prevention of malaria are satisfactory. This finding indirectly reflects the effect of the education, communication, and health information campaigns that different institutions and community groups have carried out on the disease as part of the objectives of control programs since 1957, which has resulted in the incorporation of a part of biomedical knowledge in the communities , 38. TheIn the structural aspects that determine the profile of malaria, multiple testimonies captured in the qualitative component highlight two interrelated factors, the low presence of the State  and the armed conflict derived from this, findings that coincide with that reported in a systematic review of qualitative studies carried out in Colombia . The nexThe results of this research also show that the establishment of neoliberal policies in Colombia, at the end of the 1980s and during the 1990s, negatively affected public health in general and malaria control in particular, because it implied the reduction of the budget, fragmentation of the information system, disarticulation of control actions, reduction of active surveillance of cases, reduction of the diagnostic effort, among other effects derived from the change from a healthcare model to an insurance model, adjusted to the logic of private markets and decentralization. These findings coincide with previous publications that have documented multiple characteristics of neoliberalism in health, highlighting the positioning of the private sector for health care or \"privatization of individual health\"; the lack of financing of the public sector and the dissemination of the idea of its inefficiency to justify the participation of private health companies; assume the provision of health services as an axis of capitalist accumulation; promote the use of generally expensive technologies that result in the need to accept private capital; outsource hospital processes; give technocratic management to the health system; prioritize economic efficiency mainly by reducing costs and medical personnel; and not addressing issues of health inequities as a priority \u201357.Despite the fact that some narratives of the qualitative component relate the changes in the health system with the economic model , the evidence on this relationship is not solid or consistent, which requires further investigation. In general, the structural or deep determinants of the epidemiological profile of malaria in Colombia were only captured in the qualitative component, which has limitations in its inference; For this reason, more quantitative and mixed studies are required to analyze these findings in greater detail.This research shows that health education and communication efforts have effectively generated a significant amount of knowledge about the etiology, symptoms, treatment, and prevention of the disease. It also shows that malaria morbidity has not been effectively impacted in the last decades. The epidemiological profile of malaria morbidity, from traditional epidemiology, has been sustained by environmental problems, armed conflict, individual risk behaviors, and low adherence to recommendations from health institutions. However, the qualitative component of the mixed studies reveals deeper causes that are less studied, of greater theoretical complexity, and that reflect greater challenges to design and implement health interventions, such as socioeconomic and political crises, poverty, and the neoliberal orientation in the policy of malaria control; The latter reflected in the change in the role of the State, the fragmentation of control actions, the predominance of insurance over social assistance, the privatization of the provision of health services, an individualistic and economistic predominance of health, low connection with the popular heritage and the social and community initiatives, among others. These characteristics show the importance of expanding mixed studies as a source of evidence to improve malaria research and control models in Colombia and identify the underlying causes of the epidemiological profile. The intervention of the underlying causes is not being included in current control policies, plans, and projects.Additional file 1."}
{"text": "The Science of Nature grants the Arnold Berliner Award to the lead author of an article which represents excellent, original, and\u2014especially\u2014interdisciplinary research. As such, the winning articles clearly reflect the vision of Arnold Berliner (Autrum As every year, r Autrum . Springer Autrum , a 2-yeaI am very proud that, this year, the Editorial Board of our journal has decided to award Cynthia Tedore Fig.  for the On behalf of the Editorial Board, I congratulate Cynthia Tedore, the two co-first authors Mateusz Glenszyk and David Outomuro, and the rest of the team on the award."}
{"text": "Chung Un Lee,  was a pioneer of tropical medicine research in China, serving as the president of Guiyang Medical College, the dean of Peking Union Medical College, the vice president of the Chinese Medical Association, a member of the British Medical Association, and the Far Eastern Tropical Medical Association  Lu, 199. Chung UChung Un Lee, a native of Changzhou, Jiangsu Province, was born in 1894. His father was influenced by the Reform thoughts when he was the magistrate of Shandong and established the first local new-style primary school, where Chung Un Lee studied . In 1908In 1913, Chung Un Lee entered the medical school of the University of Glasgow in the UK . The schIn 1923, Chung Un Lee published the article \u201cA Filarial Survey in British Guiana, 1921\u201d in the Journal of Helminthology, which included a survey visit to the local domicile, and covered ~50% of the Chinese in Georgetown. According to the census returns for 1921, there were 2,722 Chinese in British Guiana, mostly native-born, and the local Chinese were mostly spared from filariasis or elephantiasis. He found through blood tests and a survey of lifestyle habits that the lower incidence of filariasis among the Chinese was attributable to their attention to personal hygiene, with most falling asleep soon after dark and almost all sleeping under mosquito nets, a traditional habit that allowed them to avoid infection. This finding suggested that filariasis is dangerous regardless of race and that there is no racial immunity .In June 1923, Chung Un Lee returned to his homeland and took up an assistant professorship in the Department of Internal Medicine at Peking Union Medical College, from which he started a new medical career. Chung Un Lee pioneered the research of tropical diseases in China and established tropical disease observatories in the epidemic areas in the south. Many scientific studies from the 1920s and 1930s were focused on parasitic diseases, especially filariasis, malaria, schistosomiasis, and kala-azar.Microthrix parvicella infection was high, whereby lymphatic disease is also evident. His study of paraffin sections of a series of mosquitoes collected from Tsing Kiang Pu revealed that a significant proportion of C. pipiens were negative for different stages of pathogen development, and although no larva was found in the rostrum, larvae at different stages of development were found in the pectoral muscles, which provides strong evidence that both C. pipiens and Culex fatigans can serve as effective intermediate hosts for Filaria bancrofti in China. This led to the conclusion that filariasis is carried by human-associated mosquitoes such as Culex spp., and is mainly caused by indoor infection (At the beginning of the 20th century, there was high incidence of filariasis in China, which is typical in southern regions. In 1926, Chung Un Lee started his research on filariasis in China, and in response to the occurrence of filariasis and elephantiasis in the population north of the Yangtze River, Chung Un Lee examined 363 people for microfilament disease, finding that the rate of microfilament disease in people with signs of filarial infection was much higher than in those who were free from filarial disease . He alsonfection . ThroughAnopheles, the vector of malaria, and proposing countermeasures for the epidemic and clinical treatment of malaria. In the Peking Union Medical College Hospital, Chung Un Lee\u2019s team conducted >3,700 experiments in the decade from 1925 to 1935. In 1936, he proposed that two infections, malaria, and relapsing fever, occur after blood transfusion. Based on a study of the occurrence of 54 cases, he found that malaria in most people is the result of direct blood transmission from transfusion donors, thus proposing that blood transfusion is a route for transmitting the pathogen. Accidental transmission of benign tertian malaria or relapsing fever to a person whose health is already compromised by some existing disease is a risk factor for complications, and in malaria-endemic areas, the effects can even be catastrophic, so that the most stringent measures must be used to minimize the incidence of accidental transmission through blood transfusion (Chung Un Lee conducted extensive research on malaria, studying the identification, habits, and control of nsfusion .Plasmodium falciparum or crescents from the blood. Quinine\u2019s strong bitter taste and induction of intoxication symptoms, especially in susceptible individuals, also greatly reduce its value as an antimalarial agent. In addition, the cultivation of quinine-derived cinchona trees is limited to certain regions of the world, and quinine production was monopolized by private companies, which further contributed to unreasonably high drug prices. It is out of these considerations that Chung Un Lee introduced plasmochin, a new synthetic product invented by the Elberfield Pharmaceutical Laboratory in 1925. It belongs to the same class of drugs as quinine, and treatment with a combination of quinine and plasmochin is more effective. In some cases of malaria, in which a decision needs to be made quickly, Chung Un Lee advocated the use of spleen puncture as a diagnostic tool. Even though some so-called irritant measures were applied in some cases, repeated blood examination failed to detect parasites, while after spleen puncture, there was a febrile reaction and parasites were found in peripheral blood (In the 1920s, Chung Un Lee confirmed the value of plasmochin as an antimalarial drug through the treatment history of 8 cases of malaria, 6 cases of benign malaria, and 2 cases of aestivo-autumnal malaria in Beijing. Although the value of quinine and its associated alkaloids is undeniable, in many respects they are not ideal specific drugs. Quinine is more specific for aestivo-autumnal malaria and has little effect on clearing al blood .in vitro could be extended up to two and a half months if the medium was changed frequently. This could be achieved using the small tissue culture method, which prevented bacterial contamination and desiccation of the media. Later, he studied the lethal action of four antimony compounds on schistosomes in vitro: chemically pure, sodium antimony tartrate, Fouadin, and antimony III-pyrocatechin-disulphonate of sodium (Schistosomiasis is also a tropical disease with a high incidence in China, mostly in the Yangtze River basin, which is the hardest hit. Chung Un Lee devised a simple technical method that keeps adult schistosomes alive without difficulty in artificial media for several weeks, or even months if necessary. The viability of the worms varies in different media, which may depend more on the inherent vitality of the parasite than on the nature of the medium . Chung Uf sodium .In the 1930s, kala-azar was widely prevalent in China in the region north of the Yangtze River, with hundreds of thousands of patients. Chung Un Lee proposed that sandflies might be the vector of kala-azar. He used an artificial feeding device  to squeeChung Un Lee\u2019s research confirmed the infection of dogs with kala-azar and that patients could be infected by dogs. He conducted studies on the association of kala-azar in humans with sandflies and dogs, and identified the key factor of dogs in the epidemic of kala-azar. He and Dr Huei-Lan Chung confirmed that humans can be infected by dogs with kala-azar, and pointed out that the infection rate of dogs is much higher than that of humans after the bites of sandflies, thus concluding that dogs are the most important hosts of kala-azar . Based oIn a study of clinical manifestations and therapeutic drugs for kala-azar, Chung Un Lee conducted a clinical study of 394 cases of pathogenically confirmed kala-azar admitted to Peking Union Medical College Hospital, 51 of which were in the early stages. The results of the study showed that children are relatively susceptible to kala-azar, and the superficial lymph glands of children are significantly enlarged in the early stages of the disease. Severe complications may occur in the early stages of kala-azar, with two cases of acute agranulocytosis. Early diagnosis can be difficult since splenomegaly, leucopenia, and globulin precipitation are absent or negative. Early kala-azar must be differentiated from tuberculosis, malaria, typhoid fever, or undulant fever, and the possibility of pathogenesis can be considered when accompanied by a definite, progressive leucopenia-induced fever . In his In 1934, Chung Un Lee compared the efficacy of urea-stibamine and neostibosan in the treatment of kala-azar and suggested that urea-stibamine is more effective, but its toxicity is also more severe . In the In November 1937, Chung Un Lee left Beijing to attend the National Medical College of Guiyang, which was planned by the Ministry of Education to receive medical students affected by the war. On March 1 of the following year, the National Guiyang Medical College was established, and Chung Un Lee was officially appointed its president. Chung Un Lee\u2019s nine years at Guiyang Medical College were also nine significant years for medical education in China .In 1947, Chung Un Lee was appointed president of the Peking Union Medical College, the first Chinese president in its history . He firmChung Un Lee spent his life fighting for the eradication of tropical diseases in China, blazing the trail for research on kala-azar, filariasis, malaria, and schistosomiasis. He made various breakthrough achievements in tropical medicine and laid the foundation for related research in China. Chung Un Lee devoted himself to medical education, serving as the first president of the National Guiyang Medical College, where he proposed the motto of \u201cSincerity in oneself, loyalty to the group, and respect for the past and the future,\u201d sending a large number of medical experts to China during the war. He served as the president of Peking Union Medical College, was elected as the first academician of Academia Sinica, was a member of the first national committee of the Chinese People\u2019s Political Consultative Conference, and the chairman of the European and American Association. Chung Un Lee was a man who cared about the fate of the motherland and the suffering of the people, always adhering to the spirit of science and the principle of academic primacy, which made him a trailblazer in the research of tropical diseases in China."}
{"text": "Since the beginning of the pandemic in 2019, SARS-CoV-2 virus has undergone numerous mutations and several variants of concern (VOCs) have emerged. Here, we investigated the transmission of SARS-CoV-2 based on the virus sequencing data from the world, USA, and the local area . We examined the changes in prevalence of the WHO designated VOCs Alpha, Delta, and Omicron variants in the world, USA, and Temple, TX for past three years. In addition, the time interval until the emergence of these VOCs in 20 major cities of USA and the local area were compared.The metadata for weekly sequenced cases of VOCs Alpha, Delta, and Omicron for the world and USA were downloaded from GISAID. The local data consisted of 8154 SARS-CoV-2 samples collected from patients of Central Texas VA hospital located in Temple, TX from March 2020 to April 2023. Our local catchment includes rural and urban area. All SARS-CoV-2 positive samples were sequenced regardless of their Cycle Threshold (CT) values. The penetration of VOCs in the USA was determined by the days from the first detection of each variant anywhere in the world until the first date that each variant appeared in each city.The prevalence changes of VOCs were similar across all three of our comparison areas . While Alpha and Delta showed gradual increase, Omicron showed a sharp increase. The fold increase of cases between Alpha to Delta, Delta to Omicron, and Alpha to Omicron were much bigger for Temple, TX than the US or across the world . The penetration of VOCs differed by region and by variants . Overall, the penetration of Alpha and Delta was much slower than Omicron. The penetration of Alpha to major cities took 41 to 419 days, and Delta penetration took 0 to 441 days. However, Omicron was penetrated to all major cities in only 12 to 42 days .Penetration of the VOCs in the USAFigure 1The changes in prevalence of the VOC variants Alpha, Delta, and Omicron in the world, USA and local catchment area and its impact. A. The number of VOCs in the world, USA and Temple, TX region. The number is compounded weekly from the week of March 15, 2020, to April 2, 2023. For the World and USA, data analysis is based on the samples sequenced and uploaded to GISAID database. Arrows indicate first detection date of each variant. B. The total number of sequenced cases for each VOCs in each region. C. The fold increase of the number of variants in the transition between Alpha to Delta, Delta to Omicron, and Alpha to Omicron in three regions.By analyzing regional penetration, our study demonstrates the diverse transmission characteristics of Alpha, Delta, and Omicron variants. While the penetration of new VOCs such as Alpha and Delta was slower during the early years of the pandemic, Omicron spread was much more rapid. Understanding these transmission patterns of SARS-CoV-2 can help public health entities and the federal government better plan initiatives that help protect their citizens.Figure 2Penetration of the VOC variants to major cities in USA. Days were calculated from the first detection date of each variant in the world till its appearance in the city. The red gradients indicate early emergence while blue gradients indicate late arrival. Background map shows 2018 population of the areas.All Authors: No reported disclosures"}
{"text": "The intention of the present Special Issue is to focus on the latest research in the musculoskeletal system, with an emphasis on the molecular mechanisms underlying its pathophysiology, as well as innovative diagnostic tools and therapeutic perspectives. The musculoskeletal system is the biggest human organ system, comprising bones, providing support, articular cartilage, allowing joints to slide, ligaments and tendons, connecting all the bones together and muscles, with associated nerves and blood vessels, permitting them to contract and allowing the movement of the human body, which, in turn, underlies the basis of life. The mechanobiology of the musculoskeletal system is based on the strong interconnection between the mechanical forces and the biological cues of molecules, cells, and tissues which are connected in the kinetic chain in which one site alterations affect all the tissues and organs. It means that, when the tendon or ligament is damaged, the released metabolites, cytokines, extracellular vesicles, and other mediators affect the cartilage and bone locally, as well as the surrounding muscles, and even distant tissues due to the instauration of a systemic inflammatory response triggering a chain reaction throughout the body. The management of the pathological processes established at the molecular level requires a multidisciplinary approach based on a holistic view of the entire system in terms of prevention, early diagnosis, and innovative therapeutic approaches. The holistic view of the musculoskeletal system as an interdependent organ system has been highlighted by the authors contributing to the present special issue. For instance, Eldjoudi and co-authors , in theiThe muscle atrophy, fibrosis, and inflammation are the main causes of muscle weakness but also of the surrounding tissue impairment . There aAging represents another leading risk factor for musculoskeletal disorders, considering also the metabolic alterations that occur with aging, that may lead to undernutrition, dysbiosis, and other digestive system-related disorders, which, in turn, can worsen age-related variations, as in a vicious circle ,19. The Furthermore, skeletal muscle is considered the main site for insulin-stimulated glucose uptake and therefore, a primary target for insulin resistance in the human body. In a study by Grunwald et al. , the locRecently, in the perspective of the management of articular cartilage degenerative disorders, a multidisciplinary approach based on the construction of \u201csmart\u201d biomaterials for tissue engineering, able to interact both with the damaged and surrounding tissues, raised increasing attention among the scientific community ,23,24,25Finally, we wish to highlight the contributions to the present SI, focusing on the innovations in the examination and diagnostic tools used in the musculoskeletal disorder evaluation and treatment. For instance, the study by Kamp et al.  evaluateWe express thanks to all the authors who contributed to this Special Issue, who added, through their researches, a small brick to this extensive wall of knowledge regarding the musculoskeletal disorder physiopathology, diagnosis, and therapeutic perspectives, providing new molecular-level insights and inviting the scientific community to further deepen research into the treated aspects."}
{"text": "To map the inclusion of affirmative policies in Postgraduate Nursing courses in Brazil.This is a descriptive, document-based study, carried out with information collected on the Sucupira Platform, via the Coordination for the Improvement of Higher Education Personnel, linked to the Ministry of Education. After data collection, carried out between October 2021 and March 2022, each public notice was read in full, in order to extract the following elements: name of the program; program code; name of the Higher Education Institution; acronym; Federative unit; and number of vacancies for master\u2019s courses.79 institutions in the country were identified, with a final sample of 67 evaluated programs, which were classified into nine types, based on the use of affirmative policy principles in academic and professional master\u2019s degrees.Postgraduate Nursing courses present an imbalance regarding the implementation of affirmative policies in their offers of regular vacancies, as well as in issues of equity in regional access and diversity in the social groups contemplated. During this period, the demand for plurality in public spaces and the discrimination of this part of the population gave rise to discussions on public policies for equal opportunities and on reorientations in the educational system,4.Through historical perception, it was observed that the conservative way of maintaining the privileged classes in the field of educational, social and media resources, recurrent for generations, provided the practice of discriminatory processes in multiple scenarios. Thus, it was understood that discriminatory actions were not composed of isolated factors and events, but composed structured and complex networks of specific conditions that preceded them, such as intersectionality.Based on the requirements of the National Education Plan, which lasts for ten years, and in a constitutional manner, considering art. 214 of the Federal Constitution and Law #13,005/2014, there was the promotion of goals for overcoming educational inequalities and the elaboration of policies for all educational levels, from basic to higher education, which led to a significant expansion of offers vacancies in Federal Institutions of Higher and Technological Education, in addition to enabling forms of integration and democratization of access to public education in the country for subjects conditioned by the harmful conformations already described,6.This was solidified with the enactment of Law n.\u00ba 12,711/2012, which promoted the reservation of vacancies in higher education courses at federal institutions, linked to the Ministry of Education (MEC), complemented by Law n.\u00ba 13,409/2016, which facilitated the retention of vacancies for low-income students, black, brown, indigenous and people with disabilities, who are part of the Federation Unit where the educational institution is located, according to the records of the Brazilian Institute of Geography and Statistics (IBGE),8.Although the Brazilian population is made up of 47.7% whites and 50.7% blacks, a 2015 study identified that the profile of postgraduate students was composed of 70.86% whites and 27.08% black. With the observation of this inequality, in 2016, Normative Ordinance MEC #13, supported by the Statute of Racial Equality and Law #12.711, designated the expansion of the ethnic and cultural diversities of postgraduate students, from the adoption of AP, giving autonomy to each institution to adhere or not to inclusion of proposals,10, but postgraduate studies present a lack of information in this regard. Therefore, it is pertinent that mechanisms for distributing vacancies aimed at social integration be evidenced, in order to collaborate with the discussion on equity in postgraduate studies, especially in what is in line with the objects of the four-year evaluation report of the Coordination for the Improvement of Higher Education Personnel (CAPES).In reference to the area of Nursing, there are several and diverse studies on the inclusion and follow-up of quota students in undergraduate coursesThus, the present study aims to map the use of affirmative action policies in postgraduate Nursing courses in Brazil.This is a descriptive study, based on documents, with a quantitative approach, carried out with the data obtained from CAPES, linked to MEC..The data set was extracted from the Sucupira platform, a tool designed to collect information on stricto sensu postgraduate programs  nationwide. Annually, the program coordinators are responsible for updating the information on the platform, in order to feed the databases on topics related to postgraduate studies, which serve as a reference for the four-year evaluation and academic transparency. The Sucupira platform is an important tool of the National Postgraduate System (SNPG), which handles the monitoring and evaluation of said programsData selection was carried out between November 2021 and March 2022 on the Sucupira platform, based on information provided by graduate programs in Nursing about academic and professional master\u2019s courses (PM) on the platform, in the year 2021. The collection was guided by a research instrument validated by the authors, composed of the items: adhesion of the Higher Education Institution (HEI) to the affirmative action policy; number of vacancies destined to affirmative actions; and types of affirmative action implemented in graduate programs.Thus, the data was downloaded directly from the Sucupira platform, from which a table was generated, with the following variables: name of the program; program code; HEI name; HEI acronym; Federative unit; and quantitative number of vacancies in the institution\u2019s master\u2019s courses.From the collected data, the mapping, quantification and identification of registered programs in the country were carried out. Then, the information was exported to the Microsoft Excel software, being evaluated by descriptive statistics and presented in graphs and tables, considering, in the presentation of the classifications, the groups benefited by the AP, which are generally qualified, based on on characteristics such as race or ethnicity, gender, social class and disability.The rationale for the discussion on the collected texts included articles indexed in the SciELO, LILACS and BDENF databases, using the descriptors: \u201cpublic policy\u201d; \u201cEthnic groups\u201d; \u201cgraduate nursing education\u201d; \u201cteaching\u201d; and \u201csocial inclusion\u201d.Because it is a descriptive study, supported by secondary data in the public domain, there was no need to file ethical questions by the Research Ethics Committee with Human Beings, however the analysis was carried out with scientific rigor, in view of the production of truthful and meaningful results.A total of 79 institutions were found that offer academic and professional master\u2019s (PM) courses at the postgraduate level in Nursing in Brazil, considering the research outlines. However, one program was excluded for having only a doctoral level record and another 11 for not adhering to AP. Thirty-one programs were identified that did not offer doctoral vacancies, only academic and professional master\u2019s degrees, but offered AP vacancies in their selections, while 36 programs had the same number of vacancies for PM courses and doctoral degrees, but their public notices did not define the number of vacancies offered for AP by academic degree.In this scenario, in order to avoid non-scientific biases, the present work only considered evaluations at the PM level, so the final sample had 67 evaluated programs, allocated in the North, Northeast, Midwest, Southeast and South regions of Brazil.In the study, it was observed that the Southeast Region had the highest number of programs (24), considering the important factors of demographic density and the number of public universities that offer graduate programs in Nursing, followed by the Northeast, with 18 programs, South, with 15, Midwest, with six, and North, with four programs .In view of the specific vacancies for AP made available by graduate programs in Nursing in Brazil, the Southeast Region has the highest number (55 vacancies), followed by the Northeast (49), South (41), Central-West (14) and North (seven vacancies) which shows the lowest number of vacancies, as illustrated in In the same evaluation, graduate programs were separated into nine classes, considering the types of AP available in their PM courses: quilombolas; trans people; deaf; gypsies; migrants and refugees; traditional populations; indigenous; black or brown; and people with disabilities .The highest distribution index observed was AP for blacks (blacks and browns), with a percentage of 28.2%, representing a quantitative of 29 programs, while the second highest percentage found was for people with disabilities (25.2%), as 26 programs adhere to this type of AP, followed by 24.3% of AF for indigenous people, arranged in 25 programs, and 10.7% of AP for quilombolas, present in 11 programs .The lowest rates of offers of AP vacancies were observed for trans people, with 4.9%, distributed in five programs, for representatives of traditional populations (2.9% \u2014 three programs), for migrants and refugees (1.9% \u2014 two programs) and for deaf and gypsies (1% \u2014 one program each) .Considering the regional distribution of the analyzed programs, it was verified that, among the seven states that make up the North Region, only Amazonas and Par\u00e1 provide seven vacancies for AP in postgraduate courses in Nursing, exclusively for blacks (blacks and browns), for indigenous people and for people with disabilities (PwD) .In the Northeast Region, made up of nine states, eight programs were found  that offer AP vacancies for blacks (blacks and browns), indigenous people and PwD; four  that end offers of AP vacancies for quilombolas and/or for traditional peoples and communities; two  that offer vacancies in AP for transgender people; and one  who joined the AP vacancies for gypsy women .Of the four states in the Midwest Region, three ensure offers of AP vacancies in five postgraduate programs in Nursing , which are aimed at blacks (blacks and browns) and indigenous people, followed by reservations for people with disabilities (made in two states \u2014 33.3% of programs) and for quilombolas (made in one state \u2014 16.7% of programs). Only one of the states in the region, which has a graduate program in the area, does not have vacancies for affirmative action and one of the programs does not describe the number of PA opportunities offered .In the Southeast, comprising four states, 24 graduate programs in Nursing were found. Of the PA vacancies available in the region, the offers cover blacks, indigenous peoples and PwD, granted in the states of S\u00e3o Paulo, Minas Gerais and Rio de Janeiro (in 75% of the programs), and there are vacancies for traditional peoples and communities, for trans people and for refugees in one state (Minas Gerais \u2014 25% of programs). It is important to emphasize that, in the state of S\u00e3o Paulo, which has thirteen postgraduate programs in Nursing, only one provided the full number of vacancies for the PA policy, as shown in In the South Region, the three states offer AP vacancies in their programs, considering black, indigenous and quilombola groups . For trans people, vacancies are offered in two states (Santa Catarina and Rio Grande do Sul \u2014 29.9%) and, for deaf people and PwD, there is access in only one state (Rio Grande do Sul \u2014 9%).,12.The participation of students benefiting from quota policies in academic community spaces has created and revealed stigmas in the social and university environments, since there are narratives about stereotypes of inferiority of those involved, however, in fact, such AP are instruments of historical reparation, resulting from initiatives to suspend methods of social exclusion. Such a negative perception also contributes to the individual identification of the subject, producing barriers to the execution of AP in institutions and the monitoring of admissions to universities.Within the scope of postgraduate studies, APs arise from recent and unique discussions, since each program defines its guidelines and criteria for engagement, including because quota policies are flexible, which does not occur at the undergraduate level. For the most part, the programs promote the admission of candidates, based on regular stages, described in a unified public notice and ordered steps, thus the modalities of admission of wide competition and/or use of the AP are declared in each course. However, these actors are important to reduce access inequalities at the higher level,15.The insertion policies, which have, as an initial conception, the identification of the subjects to be admitted, define the characteristics of those who have integration needs, with the objective of aligning the premises of organization of the inclusion and exclusion practices. Such a determination places men, rich, white and heterosexual individuals as habitual and normal and defines black, poor, PwD, women and gay individuals as unequal and distinct, accustomed to the need for integration. Precisely, valuing movements contrary to these characteristics is important in postgraduate studies, as it can bring many benefits to those involved and to society in general,13,16.With this understanding, it is noted that meritocracy, as opposed to equity, points to a generational debate, based on social beliefs, which emphasize the logic of a Eurocentric educational system, demonstrating organizational differences, which strengthen characteristics that have already been deconstructed at different levels of education,16. Indeed, nursing has a significant representation of self-declared brown and black professionals, which, together, constitute 53.0% of the total number of workers in the area, in addition to indigenous professionals. This data is relevant, as it demonstrates the contingent of students who can potentially seek postgraduate studies through offers of AP vacancies.Currently, there is a promising scenario in Nursing, with regard to racial diversity, which is occasionally beneficial to society. Thus, the fact that a large percentage of nursing professionals identify themselves as brown or black may represent important trends in the diversification and enrichment of postgraduate programs in the area. Thus, postgraduate studies, in addition to being a step forward in the academic and professional training of these individuals, can significantly benefit from the variety of experiences and perspectives they bring,13.These points and the issues of integration and diversity in the academic environment translate into fundamental aspects in the production of relevant and contextualized knowledge, whether it be those who identify as non-binary or other gender identities, which can also bring broader perspectives and approaches to patient care.When analyzing the theme of gender identity in Nursing, it can be seen that this area has traditionally been and mostly female. This predominance can be attributed to several sociocultural factors, including the perception that care and empathy are characteristics often associated with being feminine. However, it is crucial to emphasize the importance of gender diversity in the profession, whether male, since multiplicity, in all its manifestations, enriches the profession, making it more representative of the entire population and allowing for a more open and inclusive exchange of ideas,13,16.Furthermore, it is also essential to recognize and value the contribution of indigenous professionals of different age groups, who can help shape a more balanced workforce. Therefore, as we try to demonstrate here, encouraging gender, ethnicity and age diversity in nursing graduate programs is decisive,18.Considering these facts, it is noted that there is already a plurality in the national distribution of vacancies in the Nursing area, considering the heterogeneity of peoples, communities and groups in situations of social vulnerability, of which blacks, traditional communities, indigenous and PwD are the ones that stand out the most, evidenced by the greater visibility of these segments in postgraduate admission processes, which is in line with notes on representativeness, as signaled in other studies.In Nursing, the training of graduate professionals has shown great relevance in promoting fundamental debates for the construction of Science, in addition to allowing the qualification of professionals and composing a new perception of the autonomy of the nursing worker. In this way, the literature also highlights the social vulnerability in the implementation of postgraduate programs in Brazil, considering that the North and Midwest regions have the lowest concentration of courses, in contrast to the Southeast and Northeast, which have the highest concentration, with graduate studies concentrating the main producers of scientific research,20,21, has minimal rates of AP use when students enter their postgraduate courses, despite the fact that a large portion of the northern population is made up of indigenous populations and traditional communities, which benefit from the Quota Law at universities and in local degree courses.Although there are gaps in the literature on aspects of insertion of AP in postgraduate programs in Nursing in Brazil, from the scenario described in this work, it was possible to identify that the North Region, despite being in a moment of ascension in the field of search.The data also clarified that the Midwest region, which has only four states in its composition, has the second largest territorial extension in Brazil and is the political division with the smallest population, has a small scope of use of AP in its postgraduate courses. -graduation. In turn, the Southeast Region, with four states, has the highest population concentration index in the country \u2014 with emphasis on the state of S\u00e3o Paulo, which has the most preponderant economic production in South America and is home to the only mega-metropolis in Brazil: the city of S\u00e3o Paulo \u2014, is a predominantly urban region, with great ethnic, cultural and economic diversity and presents relevant methods of insertion in undergraduate courses, such as the Social Inclusion Program of the University of S\u00e3o Paulo (Inclusp), which reveals the use of measures to expand the access of people in vulnerable situations to the university,22,23,24.The South Region, characterized by having the smallest territorial extension at the national level, for having an influential economy and for being the second most populous division in the country, has three states in its composition, which offer AP vacancies in their programs. In the region, measures for the integration of vulnerable students have been discussed, since graduation, through the guarantee of permanence of these students in courses and the strong presence of interculturality in university spaces,22. This fact was reflected in the last specific public notices, increasing the distance between the regions, in terms of qualification of postgraduate programs. In this sense, it is necessary to consider the importance of such regions becoming protagonists in research on their peculiarities, an important point to raise their grades in national evaluation mechanisms.Historically, the South and Southeast regions have shown the best performances in CAPES assessments, with the North and Northeast regions being marginalized, including in terms of the implementation of public policies, especially at the graduate level,22,25. The expansion of the Quota Law in postgraduate courses in Nursing constitutes important instruments for the insertion and qualification of indigenous professionals, quilombolas, PwD and other actors studied here, improving the debate and increasing the level of research development in each region of the country, according to your specifics.It should be noted that the inclusion processes are relevant to the inclusion of ethnic and multicultural groups in postgraduate spaces, as these initiatives enrich dialogue, as well as reduce inequalities in educationThis study was limited to addressing the master\u2019s programs in Brazil, based on the records of the Sucupira platform and the information provided by the graduate programs themselves, not covering the doctoral level, however. Although these postgraduate levels are stricto sensu, the master\u2019s and doctoral programs differ in terms of objectives, requirements, expected results and duration, so it is opportune to evaluate the academic progress of the AP, depending on the integration and permanence of students in a state of vulnerability, in order to identify the connection between the levels and the barriers demonstrated, related to aspects of access, progression and effective technical and scientific training of students coming from the public in focus in this article, as well as with regard to the organization of programs in monitoring these students.To mitigate these limitations in future studies, it would be useful to expand the research scope, seeking to include doctoral programs and additional sources of information, in addition to the Sucupira platform, to ensure more comprehensive and more accurate views of postgraduate studies in Brazil. Certainly, there is no attempt to generalize graduate programs since the characteristics and requirements of master\u2019s programs may not represent the universe of graduate programs with the necessary accuracy.As for the area of Nursing, this study makes it possible to visualize the result of some systems of entry of groups in a situation of social vulnerability in postgraduate studies \u2014 in master\u2019s courses, particularly \u2014, presenting subsidies for making new and better decisions, referring to the methods selection and vacancies. This fact adds value to the discussions on actions of social scope, an item observed by CAPES in the quadrennial evaluation procedures of the PM, being opportune in the constitution of reports on the current condition of the postgraduate programs analyzed here and in their future planning.Additionally, this text points out the importance of discussing the meanings of integration and its processes, aiming, in addition to access, the qualification of programs and the alignment of the mentioned policies. Likewise, problematic situations already identified in graduation are highlighted, such as the question of the permanence of students enrolled in AP, which must be better managed, aiming at obtaining satisfactory results, which is far ahead of the theme of offer of inclusive vacancies that can be the subject of studies, regarding the permanence and continuity of the qualifications of these individuals.When addressing the issue of affirmative action vacancies among the 67 institutions studied here, nine significant classifications were identified, demonstrating that there is a movement towards the implementation of affirmative action policies in academic and professional master\u2019s courses in the country, proving a dynamic with the potential to reduce  the historical limits and barriers experienced by certain minority groups. When investigating the findings on postgraduate courses in Nursing, observing them as specialized spaces to produce knowledge, aimed at health promotion and prevention, and on the constitution of essential and unique epistemological foundations for each region, it was verified the practical difficulties in the implementation of educational policies in Brazil.In this sense, the North and Midwest regions stood out, demonstrating the absence of initiatives to aggregate ethnicities and cultures to the profile of local nursing students, based on exchanges of knowledge and experiences with blacks, browns and indigenous peoples On the other hand, the execution of these actions in the South and Southeast is significant, confirming the logic, in which regions considered peripheral repeat the colonialist movement, regarding the production of knowledge and postgraduate training, therefore the maintenance of the Eurocentric profile is also evident among graduate students, as well as the standardization, already underway, which regulates admission by quotas to undergraduate courses.This mapping also makes it possible, in principle, to identify and discuss possible challenges and obstacles in graduate programs in Nursing, throughout the national territory, highlighting the disparities between regions, as well as the distribution and plurality of types of eligible affirmative actions, which makes it possible to review selection processes and opportunities for advancement, in terms of equitable training and the production of information representative of regional groups, especially those with the protagonism of communities and individuals from each part of Brazil.Moreover, the demand to produce data about and with historically excluded groups and, beyond that, about multiple public policies, which cover different human spaces, contributes to the constitution of an intercultural scientific knowledge, capable of strengthening society, which can be made possible by the insertion and recognition of the role of affirmative action policies in the practice of a more equitable education."}
{"text": "Policy analysis provides multiple methods and tools for generating and transforming policy-relevant information and supporting policy evolution to address emerging social problems. In this study, a bibliometric analysis of a large number of studies on historical policy analysis was performed to provide a comprehensive understanding of the distribution and evolution of policy problems in different fields among countries. The analysis indicates that policy analysis has been a great concern for scholars in recent two decades, and is involved in multiple disciplines, among which the dominant ones are medicine, environment, energy and economy. The major concerns of policy analysts and scholars are human health needs, environmental pressures, energy consumption caused by economic growth and urbanization, and the resulting demand for sustainable development. The multidisciplinary dialog implies the complicated real-world social problems that calls for more endeavors to develop a harmonious society. A global profiling for policy analysis demonstrates that the central policy problems and the corresponding options align with national development, for example, developing countries represented by China are faced with greater environmental pressures after experiencing extensive economic growth, while developed countries such as the USA and the UK pay more attention to the social issues of health and economic transformation. Exploring the differences in policy priorities among countries can provide a new inspiration for further dialog and cooperation on the development of the international community in the future. Social problems are evolving with the rapid development of economy, and the problems mankind is facing and options they choose reflect the developmental demand. Policy is a political action with specific subjects, targets, and strategies in a certain period of time, which primarily aims to create a healthy environment for the development of society Porter, . As for Accordingly, regarding the typology of policy analysis, three categories can be established based on ontology and epistemology Fig.  Bacchi,: (1) PosThe profoundly complex and diversified realistic demands such as equity and sustainability  What core concerns are reflected in the policy analysis and how does these core concerns reflect real-world social problems? (2) How do these core concerns change over time? (3) What are the differences in core concerns among countries and what drives those differences? From an evolutionary perspective, this paper aims to uncover the past and present policy problems of concern and the relevant possible options, thus providing a clue for future policy analysis. The analysis of the evolution and differences in policy problems among countries may provide a view of the development context of different countries and put forward new inspiration and hope for further dialog and cooperation on the development of the international community in the future. Furthermore, another possible key sustainability implication with respect to the core concerns of policy analysis is to provide a reference for exploring the gaps between academic research and policy agenda.www.vosviewer.com)  Core Collection database was used for data retrieval \u201d. For further discipline analysis, the most cited articles were selected with the quick filtering toolbar of WOS. Consequently, 1287 most cited papers of policy analysis were included in dataset 1. Then co-citation analysis of journals was performed to provide clues for discipline research , followed by medicine-related journals , the journals of energy science , the journals of economy , and then several multidisciplinary journals .For network construction, 1287 most cited papers were screened. The collaboration network of countries was visualized and illustrated, showing that 112 countries have published the most cited policy analysis articles. As for the co-authorship of countries and organizations, 2286 universities were identified, and 193 of them from 59 countries met the criteria of network analysis, among which the universities from the USA , the UK  and China (University of Chinese Academy of Sciences) had the largest number of links and the strongest willingness to cooperate with other organizations ; the red cluster centering policy, such as policy framework, policy systems, and policy implementation; and the yellow cluster mainly concerned with energy  Fig. . SimultaPolicy analysis-related articles mainly involved the fields of medicine, environment, energy, economy and multidiscipline. The publication information in different fields was investigated. First, the volume growth trend over time was traced. Generally, a growing number of articles were published annually. The most obvious growth was found in policy analysis in environment, followed by medicine and energy, and the growth in economy and multidiscipline was relatively stable Fig. . SpecifiA total of 8381 organizations from 177 countries contributed to medical policy analysis. Further investigation showed that universities from the UK , the USA , Canada  and Australia  contributed the most to medical policy analysis with the greatest willingness to collaborate both domestically and internationally. By contrast, Chinese universities, such as Peking University, University of Chinese Academy of Sciences and Zhejiang University, were more prone to domestic collaboration Fig. .Fig. 6PrCo-occurrence analysis of keywords showed that of the 16,719 keywords identified from 7963 retrieved items, 1778 keywords met the threshold. In addition to the three core topics \u201cmedicine\u201d, \u201cpolicy\u201d and \u201chealth\u201d , the mortality, prevalence, risk factors as well as prevention of diseases have been the key focus of medical policies. Additionally, the issues of children and adolescents, such as physical activity, overweight and childhood obesity, have also attracted medical scientists and policy analysts. Figure Co-authorship analysis showed that 9060 organizations from 160 countries contributed to environmental policy analysis, among which universities from China played a key role, especially University of Chinese Academy of Sciences, Tsinghua University, Beijing Normal University, North China Electric Power University and Beijing Institute of Technology Fig. . Of the The collaboration network showed that 3668 organizations from 117 countries performed policy analysis in energy. The top five organizations were Tsinghua University, University of Chinese Academy of Sciences, Xiamen University, North China Electric Power University and Beijing Institute of Technology, all of which showed strong willingness to collaborate both domestically and internationally. The network showed that there was complex knowledge interaction and flow in the citation of energy policy analysis Fig. . Of the 1144 organizations from 67 countries were found to contribute almost the same to policy analysis in economy. Hong Kong Polytechnic University, Delft University of Technology, University of Leeds, Rensselaer Polytechnic Institute and University of Sydney had the largest number of publications. Hong Kong Polytechnic University, Delft University of Technology, University of British Columbia, University of Sydney and Rensselaer Polytechnic Institute had the highest collaboration Fig. . Of the In the co-authorship network, universities such as Stanford University, University of Chinese Academy of Sciences, University of Maryland, University of California, Berkeley and University of Cambridge had the most publications and a high collaboration. University of California Irvine had fewer publications but relatively higher link, showing that this university was strongly willing to cooperate with other organizations Fig. . Of the Policy analysis aims to understand what is the governments\u2019 focal point, investigate why and how governments issue policies, evaluate the effects of certain policies  resulting in climate change and environmental degradation remains to be the most threatening and urgent issue, and has attracted attention of governments and the society  hypothesis demonstrates the relationship between environmental quality and economic output, which has been proved by empirical studies  Policy analysis has been a great concern of scholars for many years and has attracted increasing attention year by year, which reflects the value of and actual needs for policy analysis. (2) The world is facing common problems, which requires attention and efforts of the whole world, and a more harmonious social development such as the management of epidemics and complex disease, environmental-friendly development, green energy production and transformation from resource and energy usage-driven economic expansion to sustainable development is on the way. (3) Global profiling for policy analysis demonstrates that the central policy problems align with national development, which inspires further dialog and cooperation on the development of the international community in the future.This study has limitations. First, keywords cannot fully reflect the essential intent of an article although they are the key points of a study. Therefore, using keywords as an element for bibliometric analysis is far from enough. Second, this paper deals with academic research of policy analysis, but whether it is fully consistent with the policy agenda is unexplored. Moreover, we have shown the correlations between different phenomena, but the underlying mechanism remains indefinable.Supplementary information"}
{"text": "Considering the development of this study, we selected cases where art therapy played a central role in the educational/therapeutic process. Studied 130-150 cases per year on average, for 25 years (1996-2021), including children and adolescents aged between 2 and 18 years of both sexes, different social backgrounds in terms of housing, culture, and education: education/ clinical art therapy  and non-clinical education/art-therapy.The activities also have components of artistic creation, research, and teaching with students, within the disciplines \u201cArt therapy in institutional contexts\u201d and \u201cArtistic play and experiment in group dynamics\u201d, within the University of Art and Design section Pedagogy of Plastic and Decorative Arts from Cluj-Napoca Romania. The results are published at the international and world congresses to which we were invited together with the practitioners under supervision.The aims of occupational therapy, which include art therapy and play therapy, are to facilitate the use of creative process and symbolic communication, associated with narrative and imitation, to develop new ways of communication, self-expression and seeing things.The making of art or the production of other crafts resembles a situation testThe analysis of the products allows the beneficiaries to attain a certain level of introspection and to \u201cwork through\u201d their problems in constructive mannerThe execution of an operation requires sensory, cognitive, and affective intervention;Psychological dimensions, which include the individual\u2019s intrinsic need for self-improvement, for obtaining competence and self-knowledge;The socio-cultural and symbolic dimension of the act;The spiritual dimension, related to the meaning of the occupation for the individual;The temporal dimensions of the occupation (referring to the time or period of time required for recovery).We use materials and techniques that are specific to visual arts , but also traditional ones, specific to tridimensional arts, such as pottery wheels and sculptural modeling. Activities are structured according to the following dimensions:By interacting with these factors, the individual gets to know his own potential and limits, but also those of the environment in which he lives.Image:Image 2:An equidistant trialogue and circular relations between art, religion and science, without any specific supremacy, is created, which can offer from the start the possibility of lasting harmonizations, of informational transfers and professional enhancements that support developments, ennobling the human being through positive reorientations and beneficial recoveries.None Declared"}
{"text": "There are errors in the Funding statement. The correct Funding statement is as follows: This work is supported by Fundamental Research Grant Scheme , Ministry of Higher Education of Malaysia , and Faculty Research Grant Scheme (GPF018A-2018), Universiti Malaya . The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."}
{"text": "Processing of Chinese Materia Medica (PCMM) is the concentrated embodiment, which is the core of Chinese unique traditional pharmaceutical technology. The processing includes the preparation steps such as cleansing, cutting and stir-frying, to make certain impacts on the quality and efficacy of Chinese botanical drugs. The rapid development of new computer digital technologies, such as big data analysis, Internet of Things (IoT), blockchain and cloud computing artificial intelligence, has promoted the rapid development of traditional pharmaceutical manufacturing industry with digitalization and intellectualization. In this review, the application of digital intelligence technology in the PCMM was analyzed and discussed, which hopefully promoted the standardization of the process and secured the quality of botanical drugs decoction pieces. Through the intellectualization and the digitization of production, safety and effectiveness of clinical use of traditional Chinese medicine (TCM) decoction pieces were ensured. This review also provided a theoretical basis for further technical upgrading and high-quality development of TCM industry. So the corresponding changes of drug processing will improve the efficacy and indications, reduce the toxicity, enhance the clinical efficacy, and increase the clinical use. The theory of processing medicine and the theory of differential usage of the raw and cooked medicine were reported  DC.  was made into Rehmanniae radix praeparata by multiple steaming and drying with yellow rice wine, its property changed from cold to warm, and its efficacy changed from clearing to tonifying. The steaming and drying repeats created the medicinal components with antioxidant activity of rehmannia radix (Reynoutria multiflora (Thunb.) Moldenke  was changed from diarrhea to tonifying  W.T.Wang ex Z.Y.Su and C.Y.Wu  (Processing of Chinese Materia Medica (PCMM) refers to the processing Chinese botanical drugs by roasting, firing, frying, washing, soaking, bleaching, steaming, boiling and other methods. The purpose of processing is to eliminate or reduce the toxicity of the drug, to enhance the efficacy, to facilitate medicine preparation and storage, and to purify the botanical drugs. Under the guidance of the traditional Chinese medicine (TCM) theory, the proper processing is designed along the therapeutic nature of the drug and eliminates or balances the bias and toxicity, the effects of ascending, descending, floating and sinking, and the meridian tropism of drug, reported . For exaredients . After tia radix . After sonifying . The anarhizoma] . These aHowever, the processing traditional Chinese decoction is generally empirical, and there are obvious problems in the PCMM decoction pieces, such as backward or old equipment, low efficiency, no or very few digitalization and intelligence, and insufficient standardization . The devIn this review, the application of digital intelligence technology in the PCMM was reviewed on three major aspects: overview of process of PCMM, application of digital-intellectualization technology in PCMM, and digital-intellectualization industrial transformation of PCMM. The shortcomings of traditional methods in the processing of PCMM and the application significance of digital intelligence technology are shown in PCMM is a key factor affecting the quality and efficacy of decoction pieces. Usually, the botanical drugs are processed by fire after cleansing and cutting, so they are also called stir-frying. The commonly used stir-frying methods include stir-baking, steaming, boiling, and calcining. At present, in the general rules of the appendix of the 2020 edition of Pharmacopoeia of the People\u2019s Republic of China (ChP), the processing methods are systematically, completely and scientifically classified as cleansing processing, cutting processing, stir-frying and other processing . The proCleansing, also known as pure selection, is the first step in the processing PCMM. Generally, the purpose of removing impurities, size grading, removing non-medicinal parts and separating medicinal portions is achieved by selecting, screening, selection in wind (separating impurities from drugs by wind according to different specific gravity of drugs and impurities) and magnetic separation  to ensure the accuracy of each medicinal amount in the prescription.Cutting processing refers to the processing softening the purified medicinal materials with cutting them into slices, filaments, segments, blocks or other shapes with appropriate cutting tools. After cutting, it is easier to crush process, extract the effective components, and facilitate the preparation of decoctions and other preparations. In addition to fresh and dry cutting, the cutting methods may soften the medicinal materials. Generally, according to the characteristics of medicinal materials and the conditions of season and temperature, different methods such as leaching, washing, soaking, bleaching, and moistening are adopted to soften dry medicinal materials by absorbing a certain amount of moisture. The soften degree is checked by the bending method, finger pinch method, puncture method, and others in order to have a better cutting. However, at present, it is difficult to control the processing parameters during soaking and moistening. Long-term soaking may cause a significant loss of effective components. If the moistening is not appropriate, successful cutting may not be achieved .The cut medicinal materials contain more water and must be dried in time to maintain the quality for decoction pieces. During the drying process, temperature, time, and drying methods affect the degree of drying, and sometimes lead to changes in metabolites or content, and biological activity . The sizStir-frying generally refers to a processing method of Chinese botanical drugs by fire. The heat, temperature, time, acid and alkali environment, varieties or amount of excipients, applied in the stir-frying processing affect the efficacy of processed products. It is necessary to standardize the processing, so that the effective components and botanical drugs of medicinal materials are fully retained, for ensuring the effectiveness of medicinal materials. The heat may be different with the mild fire, medium fire and martial fire. The commonly used heating methods are stir-baking, steaming, boiling and calcining. Adding different varieties or amount of excipients, the stir-frying processing may change the \u201cfour properties and five flavors\u201d  in the drug, thus may alter the therapeutic effect. Obtaining a variety of processed products of a drug may be appropriate for specific clinical treatment. Excipients are mainly divided into liquid excipients and solid excipients. The input of excipients may have an effect on the contents of botanical drugs of drugs, so as to achieve the purpose of reducing toxicity and increasing efficiency .Pinellia ternata (Thunb.) Makino , Arisaema erubescens  Schott , Sauromatum giganteum (Engl.) Cusimano and Hett.  and other Araceae botanical drugs are often processed by duplication method.Other methods include duplication, making frost-like powder, levigating, sprouting and fermentation . Pinellietc., and the fermentation processing must be completed in one processing step without interruption. The temperature and humidity, pH value and medium substrate should be checked and monitored in real time to avoid unwanted bacterial growing, mildew and rancidity caused by environmental factors. In addition, making frost-like powder, levigating and dry distillation are also the characteristics of PCMM. In these processing methods, firepower, temperature, time, water addition and excipients may also affect the quality of decoction pieces to a certain degree.Fermentation method requires controlled environment of temperature, humidity, moisture, etc. The quality of Chinese medicine decoction piece is still difficult to quantify, to evaluate, to control, and to maintain efficiency, through the extensive processing steps. These difficulties become the key scientific limitation restricting the development of Chinese botanical drugs industry.The processing is a key factor to ensure the safety and effectiveness of Chinese botanical drugs. At present, the PCMM has a good science and technology foundation and careful scale measurement. There are, however, still some difficulties, such as the characteristic processing technology on the verge of being lost, the lack of innovation, the lack of brand quality, and the lack of precise clinical application, the combination of digital intelligence and intelligent digitalization. At present, the main branches of artificial intelligence applications include machine learning (ML), machine vision, Internet of Things (IoT), artificial neural network (ANN), robotics and expert system, etc.  has powerful visual information on processing capabilities and may achieve efficient hierarchical feature expression of data. CNN plays an important role in applications such as image classification and detection in processing control . TherefoIn the process of softening, many water-soluble active ingredients may be lost or destroyed to varying degrees. As for cutting, different kinds of medicinal materials may be discussed separately. Combining advanced computer vision technology with deep learning architecture, the image data sets of different kinds of plant medicinal materials are constructed. The mathematical model of rhizome cutting specification is established; and the cutting of different specifications and tablets is designed by intelligent conversion of blade position . The cirIn the PCMM, heat refers to the size and duration of fire when the drug is heated, which is a key factor affecting the quality of decoction pieces. Studies have shown that with the change of fire degree, the content of volatile components, amino acids and reduced sugars in drugs have changed significantly . TherefoThe contents of chemical components and biological activity of drugs may be changed by steaming, boiling, and frying under different air pressures . MaillarDue to the particularity of Chinese medicine decoction pieces, it is not only necessary to control the process of PCMM but also to test the quality of the final pieces to ensure the safety and effectiveness of the drug. At present, many scholars have achieved stable and rapid qualitative and quantitative analysis through new technical methods such as electronic sensors, Fourier transform near-infrared technology , DesorptLonicera japonica Thunb.  and the steaming processing of Gastrodia elata Blume  by NIR spectroscopy as a processing analysis tool combined with real-time release sensor and chemometrics. Thus, the quality of drugs and therapeutic effect were significantly improved. Salvia miltiorrhiza Bunge  using metabolomic data, which was helpful to select the best processing technology of Salviae miltiorrhizae radix et rhizoma according to the actual needs. Therefore, a combination of NIR spectroscopy, metabolomics, Gas Chromatography-ion Migration Spectrometry (GC-IMS) ((GC-IMS) , online (GC-IMS)  and othe(GC-IMS) . For som(GC-IMS) . DNA bar(GC-IMS) . In addi(GC-IMS) .Through data mining (DM), the database of raw and processed products of traditional Chinese medicinal materials was established; the internal relationship between raw and processed products of traditional Chinese medicine and processing steps was analyzed; the related model of processing and quality of decoction pieces was constructed; and the conditions and regulation of processing steps were established . Based oThe research on the technology in producing PCMM is an important link to realize the standardization of the traditional Chinese medicine processing. ML is the core of artificial intelligence, which may predict new and invisible data based on previous observed results and data, so that the computer may automatically learn without manual intervention, to adjust the operation accordingly, and to make decisions automatically. It is often divided into three categories: supervised learning, unsupervised learning and reinforcement learning . The labWith the advent of the fourth industrial revolution, the future factory will be highly digital and intelligent to meet the needs of real-time, flexible, personalized and automated monitoring of traditional Chinese medicine processing, and will realize the intelligent production of \u2018Internet + manufacturing\u2019 . The onlHardware equipment is the infrastructure of the industrial production. With the acceleration of the modernization of TCM, the processing equipment needs to be constantly innovated. The standardization of traditional Chinese medicine processing equipment is the premise of the standardization of processing parameters. The development of digital intelligent processing equipment is helpful to solve the modernization problem of TCM decoction piece industry.The sensor can objectively show the shape, color and taste of the drug through the digital form of the sensitive element, which is the first link to realize automatic detection and control. New sensors are added to the processing equipment, and the corresponding mathematical model is established. The artificial intelligence system is used for automatic control, and the technological innovation is achieved to promote the new equipment creation. The traditional processing technologies such as levigating, dry distillation, duplication, and roasting are combined with modern microwave technology, cyclone and foam separation, mass transfer and heat transfer, and biotransformation to develop new processing equipment.The stir-frying equipment is the most characteristic pharmaceutical equipment of traditional Chinese medicine. Taking the stir-baking equipment as an example, the stir-frying machine is transformed into a fuel gas heat source supply and automatic temperature control system, which may not only achieve rapid heating, but also use the real-time, continuous and non-contact measurement of the temperature in the pot by a temperature sensor. It is truly the digital monitored and managed PCMM processing . Non-conBased on the application of the above-mentioned digital intelligent technology in the processing and the digital intelligent processing equipment, an efficient digital intelligent production line of Chinese medicine decoction pieces may be designed . By autoAconite lateralis radix praeparata), an important medicine for restoring \u201cYang\u201d and rescuing patient from collapse, as an example . Numeral intelligent processing makes all traditional experience objective and information, production processing and quality control, into digital and intelligent controlled processing. New technology aims to improve the problems of distinguishing, evaluating and controlling the quality of traditional Chinese medicine decoction pieces through extensive processing with low efficiency. Through the multi-dimensional holographic processing property characterization, the electronic rapid identification of the shape and taste quality of decoction pieces, and the intelligent control of fire temperature and other technologies, the traditional processing technology may be thoroughly innovated and improved. The scientific content of TCM may be improved. The modern development needs may be met. The clinical application of characteristic decoction pieces may be expanded. The high-quality industrial benefits may be achieved. The intelligent manufacturing of a number of traditional Chinese medicine decoction pieces may be achieved. This paper reviewed the application of digital intellectualization technology in the processing of TCM, which promoted the standardization of the processing, the standardization of the quality of decoction pieces, the digitalization and intellectualization of production, and the safety and effectiveness of clinical use of TCM decoction pieces. At the same time, this review also provided a theoretical basis for the technical progress and high-quality development of TCM industry in the future."}
{"text": "Sir,Leishmaniasis is a parasitic infection caused by the Leishmania parasite, which is transmitted to humans through the bite of infected sand flies. The disease can cause a variety of symptoms, including disfiguring skin lesions and scars that may leave permanent psychosocial effects, such as declining mental health, social exclusion, and stigma . Moreover, infected individuals are at a higher risk of suffering from lower quality of life, depression, anxiety, low body image, and loss of social status. There are several barriers to effective diagnosis and treatment of leishmaniasis, including poor health literacy, poverty, and limited access to healthcare in some regions. These factors can make it difficult for individuals to seek timely and appropriate care for the disease, which can lead to further complications and negative health outcomes .Community-based interventions are an important strategy for the prevention and treatment of leishmaniasis. These interventions typically focus on reducing contact between humans and the sand fly vectors that transmit the disease, as well as controlling vector populations through the use of insecticides and other measures.Protective management strategies, such as bed nets, can also be effective in reducing the risk of infection. In addition, efforts to reduce the reservoir host populations can help to limit the number of infected individuals.Community participation is crucial in the success of these interventions, as it can help to increase compliance with preventive measures and promote awareness about the importance of seeking treatment. Education and training for health professionals, volunteers, and community members on screening and treatment methods can also play an important role in improving outcomes for individuals with leishmaniasis .Community-based interventions can take many different forms, and may vary in terms of their content, design, and intended outcomes. These interventions are generally aimed at improving the health status and understanding of health issues among community residents, particularly those living in areas where leishmaniasis is endemic.Ultimately, the effectiveness of community-based interventions will depend on a variety of factors, including the specific context in which they are implemented, the resources available, and the level of community engagement and participation. However, when designed and implemented effectively, these interventions can play an important role in reducing the burden of leishmaniasis and improving the health outcomes of affected individuals and communities . Community-based interventions can take place in a variety of settings, including neighborhoods, workplaces, schools, religious institutions, charitable organizations, and government agencies. These interventions may be focused on mobilizing the public through a range of strategies, such as financial incentives, health education programs, information campaigns, and supportive groups.In addition, efforts to improve access to health services and eliminate financial barriers can also play an important role in reducing the morbidity and mortality of leishmaniasis. Training and education activities can help to build the capacity of health professionals and community members to effectively diagnose and treat the disease, while also promoting preventive behaviors and early detection .In conclusion, community-based interventions can be a critical component of efforts to prevent and treat leishmaniasis, particularly given the complex and multifaceted nature of the disease. Addressing the physical and psychosocial complications of leishmaniasis, such as scars, financial barriers, and healthcare accessibility, is essential for improving health outcomes and reducing the burden of the disease.To be effective, community-based interventions must be designed with a holistic and comprehensive approach that takes into account the individual behaviors and social relationships within communities, as well as the broader political and economic context. This may involve working with local governments and other stakeholders to develop policies and strategies that promote effective prevention and treatment of leishmaniasis, as well as engaging with community members directly to promote awareness and education about the disease.Ultimately, the success of community-based interventions will depend on a range of factors, including the level of community engagement and participation, the availability of resources and infrastructure, and the effectiveness of implementation strategies. However, when designed and implemented effectively, these interventions can play a critical role in improving health outcomes and reducing the burden of leishmaniasis in affected communities.The authors declare that they have no competing interests."}
{"text": "To describe the construction process of an intercultural care program for international migrants in northwestern Mexico.Report of professional experiences, according to what was suggested by Daltro and Faria.The development and evolution of care for international migrants has favored the elaboration of a community-like Social Service Program for students of a public university in northwestern Mexico, so that intercultural health and health care for this population become part of the curricular training of the new generations of nursing graduates, in a context in which international migration is a topic of great social and cultural relevance.Salud-Migrante program will enhance compliance with international recommendations on universal health for migrants, promoting respect for identity and cultural diversity in their actions.The construction and application of the  Among these, not having access to health services, violence in the migratory process, socioeconomic barriers, illiteracy, language differences, and even the development of risk behaviors, driven by the epidemiological conditions of the countries through which they transit, can be considered,3,4.Recent estimates indicate that 3.6% of the global population are international migrants, the equivalent of 281 million people. Under these settings and characteristics, one can state that this population is at risk of developing and acquiring communicable and non-communicable diseases, accidents, addiction and mental health problems, among others. This has led nursing, as a care science, to generate theoretical-methodological contributions that seek to understand, study, and address these social problems in a culturally sensitive way,7,8.On this basis, it should be considered that the presence of migrants in a particular context implies the existence of cultural diversity, since there are many nationalities, languages, habits, beliefs, and practices that move with them. Under this premise, the concepts of dialogue and negotiation are elementary, establishing that between two figures in which a relationship is established, in this case nursing professional and patient, there are inequalities and inequities. Thus, interculturality is considered one of the most sensitive trends to the needs for interaction, development, and growth of a culturally diverse population group that joins another that is culturally different.Regarding the existing relationship between migrants and new contexts, it becomes necessary to consider the term of interculturality, which is defined as, \u201ca communication and interaction tool that focuses on creating the conditions for dialogue, conflict management, and negotiation between individuals in diverse societies\u201dSalud Intercultural, SI), which is an action recommended by various international organizations,11,12. Intercultural health can be defined as \u201cthe interaction between cultures in a respectful, horizontal, and synergistic way, where the idea is that no cultural group is above the other, favoring at all times the integration and coexistence of both parties\u201d. It is inferred that those policies, programs, strategies, and actions that are developed under this concept shall consider the knowledge and practices in health, based on the individual or collective experience. It should be noted that it not only focuses on the interaction among people, but also on the need for integration and synergistic work of existing health systems, thus vindicating the historical evolution of populations that have been minimized or invisibilitized.A contribution that has been highlighted for the improvement of health care for migrants is Intercultural Health  and the Cultural Competence Model in caring for the person.Initially, the Transcultural Nursing can be defined as:. This contribution has gained strength over time thanks to the modification of socio-cultural spaces worldwide. Transcultural Nursing stands out for its generalization, because it recognizes culture as a global element of the human being, starting from the need to discover care and the individuals\u2019 cultural behaviors, as a way of influencing their health, thus consolidating a consistent, safe, and responsible care activity.\u201cA formal area of humanistic and scientific knowledge and practice focused on the phenomena and competencies of holistic cultural care to help individuals or groups to maintain or regain their health (or well-being) and to cope with disabilities, death, or other human conditions, in a culturally coherent and beneficial way. For the use of this theory, an understanding of concepts is required, as follows: Cultural Care Diversity: the differences in meanings, models, values, ways of life and symbols of care between societies or communities that are directly related to the application of care activities to the person .\u2013 Universality of cultural care: the similarity or uniformity in the meanings, models, values, ways of life, and symbols of care manifested among many cultures and that reflect care as an element of universal humanity.\u2013 Moreover, every society develops forms of care specifically associated with its culture, for example, traditional Chinese medicine, or traditional Mexican medicine; however, if the person is not in their environment  their thoughts and forms of care are different, and barriers may arise, interfering with prevention, diagnosis, treatment, and recovery processes. Some barriers from the receiving systems are the lack of knowledge of the migrant\u2019s language, the lack of knowledge about historical-cultural factors and intercultural health,18\u201d. For this, the nursing staff should consider the application of one of these actions: Cultural care conservation: Actions and professional decisions of assistance, support, facilitation, and training that help people of a culture to recover or preserve significant care values, for their well-being, to recover from illnesses or to know how to face physical or mental impediments.\u2013 Adaptation of cultural care: Those actions that allow the person to adapt or reach an agreement with other cultures, to obtain beneficial and satisfactory results.\u2013 Reorientation of cultural care: They are actions that allow people to reorganize, change their life models (ways of caring) to obtain different and beneficial results.\u2013 This way, the theory states that in the relationship with the person, nursing staff shall provide culturally appropriate care, which can be considered as the \u201cexplicit use of care and culture-based health knowledge, in a sensitive, creative and meaningful way, that adapts to lifestyles and general needs of individuals or groups for well-being, and beneficial and satisfactory health or to cope with illness, disability or death. This way, seeking a real approach to the person becomes fundamental, inviting us to understand the work methodologies to have an in-depth comprehension of the elements of life that are around health issues. Thus, the Cultural Competence in care emerges as a proposal to strengthen the contributions of the Transcultural Nursing theory.They promote decision-making awareness of cultural needs, which reduces conflicts arising from health care due to cultural differences, which lead to distance between the health staff and the population, and prevents discrimination and the imposition of ethnocentric thinkingMCC). This model, provided by nursing, establishes the need to understand and know the influence of the culture of individuals, families, and communities in various aspects of daily life\u201322, particularly in scenarios where health personnel, and especially nursing professionals, acquire an ethical and professional responsibility, in which understanding, knowing, and recognizing the value of people from their cultural contexts is vital within the process of care, which directly interferes with the nursing professional/person relationship,23.On the other hand, one of the models that has stood out in the literature is the Cultural Competence Model , in the city of Mexicali, in the state of Baja California (BC) in Mexico, where efforts were made in 2018 and 2019 to provide prevention care. These activities were carried out in key community settings, such as points where migrants found temporary and low-paid jobs or near the border wall, also called \u201cThe Line\u201d or \u201cTrump\u2019s Wall.\u201dThe data described is presented chronologically, in such a way that the progress and evolution of the actions carried out with the community of national and international migrants are demonstrated. As recommended, the narrative was made clearly considering the theoretical references and the positions for the development of reflections.The presentation of this experience is not considered a research activity, therefore it was not submitted to the Research Ethics Committee of the academic entity. However, during the approaches to migrant communities, the bioethical principles and human rights of the people with whom interactions were established were followed.This contribution is contextualized within the northwest border landmark of Mexico-United States, in the city of Mexicali, Baja California (BC), Mexico, which is a point where people of different nationalities arrive through land or air and it is also a regular and irregular point of entry to the State of California in the United States.. A large part of this population of migrants is subject to the regulations of the immigration policy of both Mexico and the United States, since many are in the Mexican territory, waiting to receive a response to their asylum claim according to the United States guidelines and policies.From January to December 2022, the migration statistics of the Government of Mexico, regarding people in an irregular situation in BC, refers to the presence of 44.411 people, of which 9.097 were located in this border city. In this scenario, international migrants in a regular situation with temporary (299) and permanent (649 people) visas, as well as those who have requested a stay for humanitarian reasons (251), must also be considered. This situation implies the presence of people from different contexts and socio-cultural needs which proposes a structure that allows migrants to access medical care, health surveillance, and public health services, responding to the wide range of health problems. Initially, health promotion was carried out on topics such as prevention of hypertension, diet, prevention of addictions and sexually transmitted infections, in addition to anthropometric measurements (weight and height).When relating this situation to health care, the fact that Mexico is a country that establishes universality in health, which grants every person who is in the Mexican territory the right to access its protection, is highlighted, and that is why the Mexican government developed the Comprehensive Health Care Plan for the Migrant PopulationPIASPM) of the Mexican government. However, at various times when professors and researchers sought the collaboration of public health institutions that provided care to vulnerable populations, it was highlighted that the efforts made by them were not structured according to the PIASPM and only responded to emerging social and health needs.In these approaches, which included health brigades, humanitarian aid campaigns for clothing and food, and research projects on community intervention, work was done with migrants from Honduras, El Salvador, Guatemala, and Haiti, as well as those from the south of Mexico. These actions were considered to contribute to those established in the Comprehensive Health Care Plan for the Migrant Population ; within the most representative populations, migrants of Central American origin and Haitians who resided in vulnerable areas of the city are highlighted.The cultural differences became evident with the Haitian population (mainly language) and established the need to address disease prevention from an intercultural approach, a situation with which actions and studies were developed to strengthen cultural competence in what regards access to health services during their transit through the northwestern region of Mexico and on the topic of STI prevention. This situation led to meetings with social and spiritual leaders (barbershops and churches) of the community and later to coexistence and routine interaction.In the process of knowledge of cultural constructs, the Cultural Competence model was used, where through meetings, interviews, and interaction with the various communities, there was a progression to stage number three (consciously competent), which allowed understanding the functioning and representation of health in its migration context. In view of this, maintaining health status becomes critical to allow people to go on moving, while accidents and injuries hinder continuing on the road. The perceived difficulties in accessing health services due to the language were also marked, where the effort of local personnel was focused on explaining with signs and from Spanish, the actions to be carried out. The perception of discrimination based on skin color is also taken up again, a situation associated with long waits in health institutions.\u201ckapot\u201d (Haitian Creole word for condom) is out of step with religious beliefs. As a result of these interactions, significant and sensitive learning was obtained in terms of education for condom use and from which qualitative articles were published that allowed increasing cultural competence,29, leading to the comprehension of the importance of religious beliefs in protected sexual relations and the perception of access to health services during transit to northern Mexico.The increase in the demand of care services for Haitian women\u2019s pregnancy, childbirth, and puerperium, as well as the strengthening of relations between Haitian men and Mexican women, were elements of great interest generated from the observation in the field work. In this regard, and from the perspective of the population addressed, the use of As a result of all this, in the year 2021, the cultural adaptation of an intervention was carried out to increase the use of condoms by Haitian migrant men, in which beliefs, language, habits, and even social and labor dynamics were considered in the Mexican context. Two courses of three sessions each were given, with a total population of 34 migrant men. The activities addressed topics about STIs and HIV, myths and realities, training for the use of the external condom and considerations regarding sexual health during the migration process. This way, a close relationship with the Haitian migrant community was consolidated, which allowed continuing with health activities, as well as volunteer service.The experience regarding the approach of the diverse populations over the years led a member of the group of FEM-UABC\u2019s professors to pursue specialization studies on international migration during the year 2022, in which he proposed, as a final project, the evaluation of the Mexican program established for the migrants health care. For this, meetings were held with those responsible for shelters and public humanitarian support centers to understand the scope of the public health system, as well as their real needs, a situation that led to meetings with OIM representatives and efforts to donate food and winter clothing, and the development of health brigades to shelters in vulnerable areas of the city of Mexicali.Salud Migrante\u201d , was designed and created, the objective of which was to develop activities for disease prevention and health promotion with an intercultural approach, in shelters, refuges, and temporary camps in the city of Mexicali Baja California, Mexico.With all the experience acquired over the years and with the increase in cultural competence regarding health needs and the phenomenon of international migration, the processes began to consolidate a proposal that would allow an approach by organized groups of university students, for which a Community Social Service Project called Health Program for Migrants, with an Intercultural Approach \u201cThe structure of this project implies that students are trained in international migration, current migratory flows in the region of the Americas, intercultural health, and cultural competence. Thus, the proposal is to develop, in each institution, nine sessions of approximately one hour with educational strategies focused on the community, under the following thematic axes: tuberculosis, diabetes mellitus, arterial hypertension, gastrointestinal infections, oral health problems, addiction prevention, prevention of gender and/or sexual violence, cancer prevention in women and men, prevention of HIV and other STIs, and promotion of maternal and child health.Salud Migrante project during 2023 aims to generate a social impact, to promote access to disease prevention and health promotion services for national and international migrant populations, at risk of developing or acquiring communicable and noncommunicable diseases, alterations caused by environmental and animal factors, injuries due to violence and accidents, in the context of the northwest border of Mexico.The application of the Salud Migrante program has been selected and approved by internal calls of this university and is registered as active in the Comprehensive System of Social Service of the UABC. It receives financial resources for student scholarships, with students from all areas of knowledge, particularly from the area of health, being invited to contribute with actions or strategies from their disciplines to improve the health of the international migrant population. In the long term, the creation of groups of nursing students for the migrants\u2019 health is expected, in the Mexican cities through which they transit to the United States.To date, the The construction of health-related proposals, based on the work with migrant populations, is an issue that allows demonstrating the need to incorporate intercultural health and cultural competence in nursing care, which strengthens the provision of congruent cultural care. A globalized world that favors migratory movements requires a great commitment from public and private health services. Health professionals have acquired the responsibility of providing quality care based on scientific and humanistic knowledge, developing community-type projects, promoting quality care, and adding efforts to international recommendations for health universality, a situation in which the migrant population, at least in the context of Latin America and the Caribbean, has greater opportunities to achieve the migratory objectives of better health conditions.The challenge of applying this knowledge in structured programs is vast, since it implies, to a great extent, personal dedication and large economic financing to effectively influence the complex scenarios in which migrants find themselves. Moreover, the permanent link with State agencies becomes evident, for the coordination of efforts and jointly to be able to comply with the application of national and international laws, treaties and agreements.The northwest border of Mexico has been characterized by the reception of people from China, Haiti, Venezuela, Honduras, Guatemala, Brazil, Cuba, etc., and even, and derived from the current geopolitical situation, from Ukraine and African countries; all these people have unique elements that make them stand out from the rest; therefore, nursing staff must consider the cultural factors that constitute them in a holistic approach, promoting a science of care that is more sensitive to the needs of people.The experience in the process of caring for migrant populations has witnessed the need to strengthen actions from intercultural health, something that implies the development of cultural competencies by the nurses who are in contact with this population. The use of cultural care theories and models promotes a more sensitive approach to the needs of international migrants. Care actions can be extended during the various points of transit, which implies coordination between nursing personnel from health institutions in various countries, as well as from higher-level academic institutions, to help these people maintain an optimal health status before and during the journey to the destination country."}
{"text": "Community-based nursing in recent years has received much attention from nursing schools in different countries as a suitable solution in response to existing and future problems and challenges, but there is yet no comprehensive and correct understanding of this concept and considering its importance, the present study was conducted to the aim of analyzing the concept of community-based nursing.Concept analysis was done using Walker and Avant's 8-step approach. Nursing dictionary, Persian dictionary, research articles, journals and conferences articles, dissertations, thesis, books, and other sources related to the concept of research were investigated through search engines and available databases using the keywords of nursing, community-based, concept analysis and Walker and Avant from 1990 to 2023. Finally, 54 articles related to the concept were reviewed and analyzed.The results showed that community-based nursing has attributes such as individual-oriented/ family-oriented/ community-oriented, social partnership with the communities and stakeholders, social justice, and group and interprofessional cooperation, the community as the main activity setting, providing services based on cultural diversity, providing services according to the context, conditions and community needs, caring for individuals and families with health problems throughout life, responding to the community needs, community-based experiences and facing real-life issues in the context of community, using a problem-based and service-based approach, providing context-based care and considering factors affecting health. In this regard, borderline and related cases  were also presented to clarify the concept. Antecedents of community-based nursing included: determining the position of community-based nursing, making infrastructure and structure, the partnership between university, hospital and community, identifying all settings, the presence of educators proficient in education, survey of community needs, having knowledge, communication and community-based skills, expanding the role of the nurse, stakeholders' attitude towards community-oriented nursing and management and financial support. Consequences of community-based nursing included: competence development in nurses, solving community-based nursing challenges, meeting the health needs of individuals, families and communities, social justice, and increasing access to health care services.The results of this study can provide an objective and understandable image of the use of community-based nurses and their education in practice. Conducting more quantitative and qualitative studies about community-based nursing is also recommended.The online version contains supplementary material available at 10.1186/s12909-023-04749-5. The term community-based has different meanings, but the common and main point of all of them is the community, which is the focus of service delivery and where community participation is very important . ChangesCommunity-based nursing provides nursing care to individuals, families, and groups wherever they are, such as where they live and work . CommuniDue to the extensive changes, including the increase in urbanization and the increase in the elderly population, changes in the geographical epidemiology of diseases, and the inability to control them by the health team has been highlighted the need to pay attention to community-based nursing as a suitable solution in response to the problems and challenges ahead. In Iran, a study showed that community-based nursing provides direct access to health and treatment services through home visits and home care and accurate identification of the patients\u2019 needs .Community-based nursing as a new field in education and a new role of nurses in the community has attracted the attention of many nursing schools in different countries in recent years. Still, due to the attention to this concept in recent years, there is no comprehensive and correct understanding. Many people have confused this concept with community-oriented nursing, community health nursing, population-based nursing, and public health nursing, or use these concepts interchangeably. In contrast, these concepts have different meanings and applications, and there is a limited understanding of this concept , 8, 9. AAlso, considering that every community has different context and characteristics, therefore specifying the definition, features, and constituent elements of this concept by examining the concept in other communities helps us in developing knowledge and a comprehensive understanding of the concept .\u201cIn fact, without a clear understanding of the concept of community-based nursing, one cannot reasonably anticipate its effective execution and appropriate training. A comprehensive grasp of the concept and its constituent elements is essential for the proper implementation of community-based nursing care, enabling nurses to embody the role of a community-based nurse. Furthermore, such comprehension serves to garner increased attention from policymakers and raise public awareness.\u201c , 3.In the field of \u201ccommunity-based nursing education\u201d conceptualization has been done by Mtshali , 11, butConcept analysis has been widely considered and supported as a fundamental research approach to expanding and developing nursing knowledge. Concept analysis is a process of examining the main elements of the concept that the researcher wants to better understand the concept by reviewing its components. It\u2019s a way to deconstruct a term to understand it better and create a correct definition that provides the possibility of measuring the concept and a great insight into the phenomenon of interest . The purThis study is a systematic analytical approach; it aims to clarify the concept of community-based nursing and determine its dimensions using the approach of Walker and Avant (2019). To find meanings related to the concept, an extensive search of the literature of 1990\u20132023 in search engines and available databases such as Iran Doc, Google Scholar, SID, OVID, CINAHL, Scopus, PubMed, Magiran with keywords of Community-based, nursing, Walker & Avant, concept analysis was done.In the current research, based on the approach of Walker and Avant (2019), the following steps were carried out, including selecting the concept, determining the aims of the analysis, identifying the uses of the analyzed concept, determining the defined attributes of the concept, identifying a model case, identifying borderline and related issues, identification of the antecedents and consequences of the concept and defining the empirical referents .In this way, in the beginning, a search was conducted to find what existed under the title of community-based nursing in related articles and sources. Then the articles were included in the study based on the inclusion criteria . The exclusion criteria included the focus of the study on hospital nursing. The procedure for selecting studies using PRISMA diagrams is shown in Fig.\u00a0In this analysis, the concept of \u201ccommunity-based nursing\u201d is considered the main concept of the present research due to its wide application in response to the challenges and health problems of the community, the ever-increasing changes in the way of providing services and the health care system and its importance in education. This concept has received a lot of attention due to its importance in promoting the health of society in the healthcare system. Still, this concept has no proper understanding and clarity, and the boundaries that separate it from other concepts have not been defined. Therefore, it seems that the clarification of this concept can help to understand the performance of community-based nursing and how to train nurses in this field , 15, 16.Considering that the concept of community-based nursing is one of the concepts that is confused with many other concepts and is sometimes used instead of other concepts, while these concepts are different from each other  and it iTo identify the characteristics of community-based nursing, a wide range of old to new literature (1995\u20132023) was reviewed, and the characteristics of community-based nursing were determined as follows:(1) Individual-oriented/family-oriented/ community-oriented, (2) Social partnership with the communities and stakeholders, (3) Social justice, (4) Group and interprofessional cooperation, (5) The community as the main activity setting, (6) Providing services based on cultural diversity, (7) Providing services according to the context, conditions and community needs, (8) Caring for individuals and families with health problems throughout life, (9) Responding to the community needs, (10) Community-based experiences and facing the fundamental issues of life in the context of community, 11. Using a problem-based and service-based approach, 12. Providing context-based care and considering factors affecting health .The concept of colowing cases: (1) Managing acute and chronic conditions and providing acute or chronic care in health care centers, homes, schools, primary care clinics, outpatient services, and community centers , 3, 2)  2, 3], . First, the nurse evaluates the condition of the patient\u2019s family in terms of economic, cultural, social, physical and psychological aspects  and realizes that their children are all married and they live alone and economically, they are at an average level, as a result, to the patient\u2019s consent, the nurse prepares and uses a suitable dressing for his leg wound , and then the nurse teaches the father of the family how to take care of the dressing and the leg wound  and meanwhile, the nurse asks about his diet, the client does not like some foods and on the contrary eats some foods that are not suitable for him and says that he cannot have a regular meal plan (using a problem-based and service-based approach), also, he does not use some foods at all due to the prohibition in their culture and religion . Based on this, the nurse prepares the best meal plan in consultation with the treatment team and nutrition consultant and then implements it with the approval of the specialist doctor and other members of the treatment team, as well as with the client\u2019s consent . The nurse also teaches his wife about diet and asks her to cooperate with her husband to implement this plan. While talking to the mother of the family, the nurse notices her respiratory distress, asks her questions, examines the mother, and realizes that she has asthma and does not use her respiratory aid sprays properly. As a result, the nurse helps her to use the spray correctly and teaches her. The mother of the family states that she is depressed due to her difficult situation, the nurse talked to the mental health consultant of the care team about this issue, and an appointment was made to examine the mother of the family and help her . In the end, the nurse explained the risk factors of diabetes and asked them that if their children have these attributes, they must be evaluated and referred to the health care center of their region . Finally, the nurse determines the time of the next visit, advises on social services that can help the family, and ensures that the patient and his family have received all the needed care .In this study, borderline and related cases of community-based nursing based on the literature review included the following:Community health nursing: In community-based nursing, the nurse may meet an acute need, but the goal is to strengthen the capacity of the individual and family to take care of themselves. The main goal of community health nursing is to maintain the community\u2019s health, and its secondary goal is to promote self-care among individuals and families. It also provides care, especially for high-risk people and those with infectious diseases. Community-based nursing care is family-oriented, even if it is for an individual. Community health nursing combines nursing theory and public health sciences. It assigns the priorities of prevention, protection, and health promotion, and its responsibility goes beyond the client, individual and family. In community-based nursing, the nurse cares for individuals and families who have health problems, while in community health nursing, the nurse works with people who are generally well and have no symptoms. The roles of community-based nurses and community health nurses are both client-centered and service-centered. They include providing care, education, counseling, client advocacy and support, and case management, which are similar. Still, the main difference between the two is in the group-oriented roles. In community health nursing, the nurse has more group roles, such as the community advocate, who knows what the community wants and needs and solves it with the available resources. In community-based nursing, nurses spend most of their time (85%) in case management, patient education, individual and family counseling, and interdisciplinary practice, while in community health nursing, nurses spend most of their time in finding case and patient education, while both emphasize cultural sensitivity , 19.Community-oriented nursing: Many attributes of community-based nursing are shared with community-oriented nursing, but they are different. The purpose of community-oriented nursing is to prevent illness and disability, maintain and promote health, focus on health care for individuals, families and groups in the community, provide medical services to improve the quality of life, provide community diagnosis, health monitoring and assessment and school nursing, while the goal of community-based nursing is to manage acute and chronic conditions, focus on caring for the illness of individuals and families throughout life, determining special care in the community where they are located, home care, disease prevention, and health promotion .Population-based nursing: Population-based nursing is a systems approach to a problem for a specific population, but in community-based nursing, the target population may be located anywhere. In population-focused nursing evaluation, the target population and the environment in which the population is located should be examined. These assessments focus on epidemiological, environmental, psychological, cultural, spiritual, technological factors and the availability of community support systems , 20.Public health nursing: Public health nurses serve poor people instead of working with the whole people, and this is under cover of community health nursing, which occurs in every field. Public health nursing aims to prevent disease and disability and support the community, with a broad focus on community health and investigating the impact of the health status of the community (resources) on the health of individuals, families, and groups .Antecedents of community-based nursing based on extensive literature review included the following: (1) Determining the position of community-based nursing, its duties and organizational level in the Ministry of Health and achieving the position of the nurse at all levels of health from prevention to rehabilitation  and creaBased on an extensive literature review, community-based nursing consequences included: 1. Competence development in nurses, such as improving professional, practical, communication skills, critical thinking, teamwork, experience, and deep knowledge about health and social issues in the community ,2. Solving community-based nursing challenges such as hospital-oriented and treatment-oriented in the health system, defects in the position and role of community-based nurses, flaws in community-based education infrastructure, deficiencies in trust, awareness, and acceptance of nurses in the community by the people , 38, 39,According to the extensive literature review, community-based nursing is a vital approach that delivers essential care across the lifespan with a central focus on enhancing overall health, primary care, and rehabilitation. This approach thrives on interdisciplinary collaboration to cater to diverse client groups within their natural environments. It is firmly rooted in the principle that healthcare decision-making primarily rests with the individual, their family, and the community. The nurse plays a pivotal role in devising nursing interventions for the client, their family, and the healthcare team, aligning these interventions with the values held by the client, their family, and the broader community. Community-based nursing places a strong emphasis on prevention, striving to avert the onset of diseases, promptly identify health issues, and provide early intervention and rehabilitation following illness or injury .In the present study, the concept of community-based nursing was analyzed using Walker and Avant\u2019s approach. Since the concept analysis causes objectification of a specific concept and its operationalization , it seemCommunity-based nursing is characterized by individual-centered, family-centered, and community-centered orientation. It provides nursing care for individuals, families, and groups wherever they are, including their place of residence, workplace, school, etc. Many studies have considered this attribute important in community-based nursing , 16, 18.Social participation is defined as a person\u2019s participation in activities that interact with others in community, also, this concept is defined as groups that work with common goals, responsibilities and power for the betterment of community and it includes the participation of community members, governmental and non-governmental organizations, universities, health center staff and other stakeholders and pays attention to the populations it is supposed to serve, many studies have mentioned social participation as an essential characteristic of community-based nursing , 45\u201349 aThe meaning of social justice is the fair and equitable benefit of the people of a community from health care based on need, which is at the heart of community-based health promotion measures to achieve health equality and is another essential attribute of community-based nursing . Community-based nursing requires group and interprofessional cooperation, and the nurse collaborates with different teams, including doctors, pharmacists, specialists, and assistants. Interdisciplinary collaboration is an essential element in the role of community-based nurses because nurses cannot achieve patient support goals without collaboration with other healthcare team members. Nurses provide the necessary care throughout the patient\u2019s life, focusing on improving health and primary rehabilitation care through interdisciplinary cooperation for different community Sects. , 10. In The community is considered the main setting for the activity of community-based nurses. It is used to such an extent that the percentage of community-based experiences is higher than other clinical experiences. Most studies have emphasized this issue , 16, 23.Another essential attribute of community-based nursing is attention to cultural diversity. Cultural diversity exists within and between countries, and nurses are morally committed to providing care appropriate to the culture. To provide adequate care to a client with a different culture or ethnic background, the nurse tries to understand the other person\u2019s point of view regarding their cultural framework. When the nurses are not successful in this field, the consequence will be inequality in care; considering ethnic diversity in Iran, understanding the beliefs of clients, patients, and families, and paying attention to their needs deepens the relationship between nurses and clients . The nurProviding nursing care considering the background, conditions, and community needs is one of the attributes of community-based nursing since the community is the primary activity setting, taking into account the local, regional, and global community conditions, demographic and epidemiological developments, the prevalence of mental diseases, severe changes and the burden of diseases and developing a care plan based on that importance has many and different studies have emphasized this issue , 41, 49.The philosophy of community-based nursing is to guide nursing care for individuals, families with health problems, and other groups throughout life, wherever they are, including where they live, work and go to school, etc. According to this definition, community-based nursing is not a specialty but a philosophy that guides all nursing care  and haveCommunity-based nurses are responsible for the health needs of the community. They must be able to provide the necessary care for individuals and families and investigate, plan, intervene, and evaluate the community\u2019s needs. Since nursing services are mainly offered in hospitals in Iran, the activities of nurses do not meet the community\u2019s needs, and it is one of the essential things mentioned in many studies , 55, 56.Community-based experiences and facing real-life problems in the context of the community are integral parts of community-based nursing. Nurses need a wide range of experiences to provide care to individuals, families, and communities, from preventive care to acute care and rehabilitation. This means that they need direct access to population groups to work with and communicate with over time and help improve their health status, and many studies have emphasized this issue , 42, 58.Using a problem-based and service-based approach to solve problems is one of the attributes of community-based nursing. Solving problems and dealing with real-life issues requires using such an approach, and by focusing on the situation, nurses look for different solutions. With critical thinking and using evidence, they provide the best available resolution to meet the needs of the client and the family , 16, 49 Due to being exposed to the conditions and realities of the lives of individuals and families, nurses need to be aware of the target community\u2019s values. This issue makes them aware of social and cultural issues, injustices, and other factors affecting health .Proper care of individuals and families in social environments requires careful attention to social risks such as poverty, mental illness, unsafe housing, history or current injury, malnutrition, transportation problems, low literacy, etc. The nursing care team should comprehensively assess these areas and cooperate with social partners and colleagues  to deal with them and follow the needs of the individual, family, and community over time. In community-based nursing, nurses are exposed to social, economic, political, cultural and other factors affecting the health of individuals, families, and communities. It is believed that such exposure facilitates a better understanding of social issues and equips nurses with the skills to deal with them. More importantly, it provides a comprehensive and complete view of health and disease because when the nurse encounters the patient only in the hospital setting, such opportunities are lost , 30, 37.To ensure the continued provision of essential services, community-based nurses must hold a well-defined position within the healthcare infrastructure , 39, 59.Being in different situations and solving problems in community increases the competence of nurses . The posConcept analysis of community-based nursing focused only on theoretical analysis without empirical verification from the nurse educators; this indicates the limitation of the study. Verification of the concept from the nurse educators could have helped the researcher obtain additional data to expand further or clarify the concept.Proper care of individuals and families in social environments requires careful attention to social risks such as poverty, mental illness, unsafe housing, history or current injury, malnutrition, transportation problems, low literacy, etc. The nursing care team should comprehensively assess these areas and cooperate with social partners and colleagues  to deal with them and follow the needs of the individual, family, and community over time. In community-based nursing, nurses are exposed to social, economic, political, cultural and other factors affecting the health of individuals, families, and communities. It is believed that such exposure facilitates a better understanding of social issues and equips nurses with the skills to deal with them. More importantly, it provides a comprehensive and complete view of health and disease because when the nurse encounters the patient only in the hospital setting, such opportunities are lost. Based on the literature review, it can be said that community-based nursing, in facing the fundamental problems of life, using a problem-oriented and service-oriented approach, provides the necessary health care for individuals and families to the health problems during life and based on the context and community needs  provides from the first level of the prevention to the third level and it does this through group and interdisciplinary cooperation and taking into account cultural diversity, factors affecting health and social justice for different strata of community in the natural environment of life and places in the community and it is based on the principle that community-based nursing is a collaborative work, the individual, family, and community have primary responsibility for health care decisions and the nurse mainly determines the nursing interventions with the client, the family and the health care team based on the values of the client, the family and the community and tries to respond to the community needs. The main goal of community-based nursing is to strengthen the capacity of the individual and family to take care of themselves and improve the community\u2019s health. To achieve such a goal, it is necessary to provide infrastructure and structures such as the position of a community-based nurse, essential resources, and facilities and conditions for the nurse to enter the community. In line with the present study, it is proposed to investigate the challenges of community-based nursing education in Iran and introduce a solution to improve it.Additional file 1: Supplementary file. Overview of all included studies in concept analysis"}
{"text": "Medicine and oral health are constantly progressing through a series of small advancements that, together, lead to significant discoveries and breakthroughs. These achievements enable the management of an increasing number of diseases and improve the quality of care and rehabilitation in the field of dentistry. In the present text, the content of this Special Issue, titled \u201cSecond Edition of Innovative Solutions for Oral Healthcare\u201d, is summarized, which comprises a variety of studies, clinical cases, and reviews aimed at providing new knowledge in the field of oral health and its related topics. The articles cover subjects such as early diagnosis, technological innovation, student education, the use of new therapies, and the impact of the environment on oral health. The objective is to continue promoting research and innovation in the field of dentistry.In the first volume of this Special Issue, oral health was linked to physiological alterations, aging, early diagnosis, environmental pollution, student education, digital dentistry, and the application of new technologies. Ikebuchi et al.  identifiAn important aspect of the published research was evaluating the quality of training for students and recent graduates, both in terms of their ability to diagnose benign tumors, malignant tumors, and premalignant lesions through a cross-sectional study , and in New drugs are constantly being proposed, influencing the management of patients undergoing oral surgery. In the case of patients taking direct oral anticoagulants, a peri-operative management protocol has been proposed based on an analysis of the existing literature .In the current Special Issue, many other important topics have been addressed. Moga et al.  exploredImplant-prosthetic rehabilitation is at a turning point compared to in the past: from traditional techniques based on the manual fabrication of prostheses, it is now possible to accurately predict and plan the rehabilitation, which will then be executed with the highest precision and predictability. This is made possible by the ever-increasing diagnostic possibilities , extremely advanced CAD/CAM technologies, and innovative materials . In this Special Issue, two studies address this topic.Todaro et al.  presenteAzpiazu-Flores et al.  presenteBased on the considerations mentioned above, the Guest Editor of the present Special Issue would like to thank all clinicians and researchers who contributed their relevant manuscripts."}
{"text": "The release of organic waste annually amounts to millions of tons of substances. Waste is used as a raw material for fertilizers and microbiological technologies. Anthropogenic pressure increases the volume of waste, which is important for large cities. The release of sewage sludge is expressed in millions of tons. It is disposed of in landfills. Waste is generated as a result of the use of natural resources; it serves as a source of raw materials and secondary raw materials. Waste from the food and processing industries can be recycled. Protein raw materials are used to produce supplements, dietetic treatments, and growing mediums. Microorganisms can decompose organic matter. Ecobiotechnologies use this ability for microbiological synthesis. The main methods of environmentally friendly waste processing are composting and vermicomposting, methane digestion, and aerobic stabilization. Composting is of low cost. Vermicomposting allows obtaining biohumus, which is technologically advanced in use. Liquid fractions of manure, droppings, and manure containing urea are dangerous for the environment. The pollution of nature is a catalyst for ecological catastrophe. Thus, a comprehensive analysis of environmental pollution is needed.Microorganisms and their enzymes destruct organics, which makes it possible to obtain biofertilizers with a high agronomic effect . CompostTraditionally, wastes are recycled naturally, with the participation of relevant microorganisms . WastewaGreen plants are also used in wastewater, soil, and atmospheric air purification (phytoremediation method), which is one of the directions of bioremediation. Anthropogenic pressure on ecosystems is growing, but sustainability has limits; the current problem is to develop biological methods for cleaning the environment. These methods are based on natural mechanisms. One of these methods is phytoremediation - the purification of the environment from pollutants with the help of living plants that can absorb heavy metals and their toxic compounds . PhytoexThe main directions of biotechnological waste processing are based on the degradation of toxic waste; the return of carbon, nitrogen, phosphorus, and sulfur into the cycle of substances; as well as obtaining organic fuel . The aimThe research novelty lies in the fact that we propose a system of a comprehensive analysis of the state of the environment, which provides for obtaining objective data on the sources of environmental pollution, the nature of the impact of pollutants on the natural environment, people, and animal and vegetal life, identifying the mechanism of the response of natural objects to the impact of harmful substances on the animal world and nature. It is possible to identify critical links in the biosphere, normalize anthropogenic impact, and environmental-economic regulation of the natural environment using the proposed method.Global environmental problems require significant efforts of the entire international community. Humankind has destroyed and continues to destroy up to 70% of natural ecosystems on the planet in the 20th century, which are capable of retransforming waste products. The permissible anthropogenic impact on the biosphere has now been exceeded several times. Thousands of tons of substances of various nature are thrown into the natural environment, which are not amenable to natural processing. The most urgent environmental problem is protection from pollution, which includes the protection of the atmosphere, hydrosphere, and lithosphere. Microorganisms can decompose organic substances and transform polymers. Ecobiotechnologies use this ability during microbiological synthesis in waste processing. The main methods of deep, environmentally friendly waste processing are composting and vermicomposting , methaneOnly a small part of cattle manure and bird droppings is used as fertilizer. The rest of the agricultural production waste accumulates and negatively affects the environment. Liquid fractions of manure, droppings, and manure sewage contain urea, phenols, pathogens, drugs, and other environmentally harmful substances . Most of2 into acetate , which produce carbon dioxide, water vapor, nitrogen and sulfur oxides, carbon monoxide, dioxins. Pyrolysis is used to produce activated carbon from wood. The main negative factor of thermal utilization is the release of dioxins into the environment . Organic acetate .Land waters have atmospheric nutrition, and their composition depends on the state of the atmosphere. The polluted atmosphere is characterized by acid precipitation, which leaches macro- and microelements, humus from the soil, disrupts plant photosynthesis, slows down their growth, and causes the death of plants sensitive to pollution. All these factors lead to a decline in soil fertility and, as a result, to the disappearance of forests .Aerobic wastewater treatment is the most extensive use of microorganisms in biotechnology. It is promising for the economical production of gaseous fuels at moderate temperatures (30\u00b0C\u201335\u00a0\u00b0C). Different countries use different types of waste to produce energy and by-products. Brazil, Australia, and New Zealand use specialty crops for fuel. Similar projects are being discussed in Finland, Sweden, and Ireland. In England, work on energy bioconversion is carried out under the Solar Energy Program, and biological energy projects are heavily financed there.The 20th and early 21st centuries show an increase in environmental accidents and catastrophes . PollutiChemical and biochemical enterprises are carriers of the potential danger of accidental releases of toxic substances into the atmosphere and microbes that can cause epidemics among people and animals. The ecological situation on the planet is unfavorable due to the insufficient use of the potential of nature by scientific and technological progress and the irrational exploitation of natural resources, increasing the rate of pollution of the biosphere. Humanity has novel methods and approaches to normalize the current situation by processing industrial organic waste. Normalization provides for reducing the degree of pollution of the natural environment; rationalization of exploitation of natural resources; reactivation of non-renewable resources; use of environmentally friendly biotechnologies. Environmentally friendly biotechnologies are the main and promising way to combat pollution of the natural environment, atmosphere and hydrosphere, and the fertile soil layer. A comprehensive analysis of the state of the natural environment is much needed in scholarship and practice, considering promising ways of using biotechnology. The analysis provides a reliable idea of the sources of environmental pollution, the nature of the impact of non-decontaminated waste on the environment and wildlife, the establishment of a mechanism for the reaction of natural subjects to anthropogenic substances and energy fields."}
{"text": "Dear Editor,In the last decades, facial pigmentation techniques for aesthetic purposes have become common. Among them is eyebrow tattooing or micropigmentation. Unlike traditional tattoos, in which the pigment is deposited in the deeper layers of the dermis, in micropigmentation, the semi-permanent pigment is deposited in the upper layer of the dermis. Adverse reactions to this technique include infection, contact dermatitis, granulomatous reactions, and Koebner phenomenon.A 30-year-old female patient, with a history of previous bariatric surgery, without other comorbidities, complained of raised eyebrows for three months. She had repeatedly undergone micropigmentation of the region over the past four years, the last being 14 months before. She denied any systemic symptoms. On examination, she had raised plaques on the topography of the eyebrows, especially on the right, in addition to areas of alopecia A. At derHistopathology showed non-caseating chronic granulomatous dermatitis with a sarcoid pattern ; acid-faMicropigmentation is normally performed with a portable tattoo pen, which is smaller than the traditional tattoo device. Ready-made paints are available on the market, but some professionals make their own mixtures. Pigment washout may occur during the first few days of healing, then the remaining pigment particles are stored in dermal macrophages and fibroblasts.3Sarcoid granulomas can develop in areas of tattooing or permanent makeup as isolated reactions or as part of systemic sarcoidosis. The time between the tattoing and the reaction onset is variable, and there may be a long latency period, justifying the investigation of systemic sarcoidosis.2Topical and intralesional corticosteroids are the first line of treatment.While numerous cases of sarcoid granulomas have been reported in body tattoos, few have been related to eyebrow micropigmentation. With the greater prevalence of this cosmetic technique, it is important to recognize the possible adverse reactions, as well as the adequate management. Moreover, it is crucial to remember the importance of investigating systemic sarcoidosis in these patients.None declared.Tamires Ferri Macedo: Approval of the final version of the manuscript; drafting and editing of the manuscript; collection, analysis, and interpretation of data; critical review of the literature.Simone Perazzoli: approval of the final version of the manuscript; drafting and editing of the manuscript; collection, analysis, and interpretation of data; critical review of the literature.Renan Rangel Bonamigo: Approval of the final version of the manuscript; design and planning of the study; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the manuscript.Renata Heck: Approval of the final version of the manuscript; design and planning of the study; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the manuscript.None declared."}
{"text": "There are errors in the Funding statement. The correct Funding statement is as follows: This work was supported by Institute of Research and Consulting Studies, King Khalid University, Saudi Arabia. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."}
{"text": "In the Funding section, the role of the funder is incorrect. The correct Funding statement is: This study was funded by Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA. The funder provided support in the form of salaries or consulting fees for CB, SS, TL, CSL, and MP, and had input in the study design, data collection and analysis, decision to publish, and preparation of the manuscript.The authors requested this update prior to the article\u2019s publication, but due to an internal error the updated statement was not incorporated into the article before its publication date. The publisher apologizes for the error."}
{"text": "The advancements of civilization are based on our ability to pass on the events and knowledge of the past so that the next generations can start from an ever-higher level of expertise. The memory of the past can be kept alive by preserving historical and artistic assets, the cultural heritage of every nation.In light of the above, this Special Issue (S.I.) aimed to collect studies that describe interesting/relevant problems in analyzing cultural heritage samples and suggest analytical strategies to solve/manage them. A total of 19 manuscripts were published . The submitted papers cover different aspects of cultural and archeological heritage protection, conservation, and restoration.The sample matrix complexity belonging to cultural heritage, including archeological samples, generally requires a multi-analytical approach. The integrated use of different analytical techniques, with the preference for noninvasive or micro-invasive ones, allows an in-depth understanding of the original materials and their degradation processes and helps obtain innovative solutions for the restoration and conservation of artworks.The paper by Cotte et al.  shows thRecently, enormous advances have been seen in analytical strategies for studying bioarcheological materials, particularly through mass spectrometry. The work of Barberis et al.  offers aThe synergistic action of air pollution, climatic conditions, and biological contamination can harm the preservation of historical and artistic heritage. In particular, prehistoric artworks, including paintings and engravings, are particularly fragile as they are exposed to different environmental impacts. With the use of nondestructive elemental and molecular spectroscopies, it is possible to choose the most appropriate conservation and restoration strategy for prehistoric artworks and better understand their evolution over time.In work from Costantini et al. , micro-eThe degradation of stone materials with the formation of unsightly and chromatic stains may be related to the biological activity of specific microorganisms and promoted by environmental factors such as temperature, humidity, and illumination. The work by Cardellicchio et al.  investigAmong the various forms of degradation affecting stone artifacts, colored stains that form on surfaces in contact with metals or alloys are of particular concern. In the work of Reale et al. , the mecStudies of Fe speciation in archeological ceramics may be critical to gain insights into the various types of clay used and the different techniques and temperatures of clay firing. The study by Kozak et al.  reports Among the most beautiful expressions of ancient art is the Roman mosaic. The preliminary study by Colantonio et al.  suggestsAnother topic addressed in this S.I. is the study and evaluation of the authenticity of precious stones belonging to cultural heritage. The work of Aceto et al.  suggestsTwo papers, by Serafini et al.  and BosiThe work from Bosi et al.  highlighNoninvasive cross-sectional analysis of pictorial stratigraphy in paintings, essential for adopting the most appropriate cleaning strategies or assessing adhesion and compactness between layers, is a major challenge in cultural heritage science. To date, no technique can noninvasively and uniquely measure the thickness of pictorial layers, as these are generally composed of heterogeneous and optically opaque materials. In the work of Dal Fovo et al. , the posIn the paper by Aguilar-Rodr\u00edguez et al. , the comStudying paints and their components, such as binders, dyes, or pigments, may allow us to acquire useful information to differentiate original from non-original materials and date objects and artifacts. In the work of Macchia et al. , the comThe study and preservation of objects, infrastructures, and works belonging to the industrial archeological heritage is a relatively new area of research that emerged in the 1970s. Costantini et al.  aimed toContemporary art is affected by a globally influenced, culturally diverse, and technologically advanced world in which it is increasingly easy to communicate and exchange information. Because of this, contemporary artworks are a dynamic combination of materials, methods, concepts, and subjects. The conservation of contemporary artworks has become a new and exciting field of study, which needs continuous research because of the ever-changing and more recent materials. The work of Alp et al.  providesThe work of Longoni et al.  confirmsThe review by Creydt and Fischer  discusseTwo reviews concern lipid residues and their degradation products, such as fatty acids and metal soaps, which are of great importance for the study of archeological objects and oil paintings ,19. OrgaThe review by Irto et al.  reports"}
{"text": "The publisher apologizes for the errors. There is an error in affiliations 2 and 3 for authors, Sachiko Kuroda and Hideo Owan. The correct affiliation 2 is: Faculty of Education and Integrated Arts and Sciences, Waseda University, Japan; and the correct affiliation 3 is: The Research Institute of Economy, Trade and Industry, Tokyo, Japan.i from the baseline (t = 0) and follow-up (t = 1) surveys, and nT and nC are the number of workers in the treatment group and in the control group, respectively.In the Analysis of covariance (ANCOVA) subsection of the Estimation strategy, there is an error in the first equation. The correct"}
{"text": "Public health emergencies are extraordinary events of disease spread, with health, economic, and social consequences, which require coordinated actions by governments and society. This work aims to analyze scopes, application possibilities, challenges, and gaps of decision support frameworks in PHE management, using the components of the Health Emergency and Disaster Risk Management Framework (H-EDRM) and the Preparedness, Prevention, Response and Recovery Model (PPRR Model), providing guidelines for the development of new models. A systematic literature review was carried out using the Web of Science, Scopus, and Pubmed knowledge databases on studies published between 2016 and 2023, and thirty-six articles were selected. The outcomes show a concentration of frameworks on short-term emergency response operations, with a limited emphasis on the political and strategic components that drive actors and responsibilities. Management prioritizes monitoring, evaluation, and information management frameworks. However, the models need to overcome the challenges of multisectoral and interdisciplinary action, different levels of decisions and actors, data sharing, and development of common platforms of evidence for decisions fitted to the various emergencies. In March 2020, the World Health Organization (WHO) declared the COVID-19 pandemic a Public Health Emergency (PHE) of International Concern affecting the lives of millions of people on a global scale until May 2023, when the slowing of transmission of the coronavirus (SARS-CoV-2) was achieved, but with attention to its consequences. Health emergencies, especially pandemics, epidemics, and disasters, are extraordinary events of disease spread, with health, social, economic, and political consequences, which require coordinated actions by states and affect, especially, the most vulnerable populations [In emergency situations, the manager makes decisions under dynamic and chaotic conditions, when interpreting the context under pressure from ethical and political constraints , seekingConsidering this complexity, the WHO increased its perspective on response, prevention, recovery, prediction, and preparedness mechanisms to achieve an intelligence hub, with multidisciplinary collaboration, multisectoral decision making, global data sharing architectures, and expanded health context analysis capabilities to support health manager decision making .In public health emergencies, such as the COVID-19 pandemic, each country has the challenge of making decisions tailored to the limitations of its health systems and related subsystems, guided by global guidelines such as the WHO standards, the Sustainable Development Goals (SDGs), the Sendai Framework for Disaster Risk Reduction 2015\u20132030, and the International Health Regulations ,7.In this sense, frameworks serve as the interface between the decision maker and the problem to be solved, in various formats such as conceptual models, application of multicriteria methods, and systematic literature review. However, governments can adopt their frameworks without regard for system interoperability and information sharing . In furtThe bounded rationality of decision makers and the behavior of their heuristics and biases in contexts with variables of uncertainty pose a challenge to framework models , requiriCountry planning for an emergency is comprehensive and must begin before the health event, with the challenges of information analysis, expert decision-making approaches and priority setting, choices of methods and models, budget programming, the establishment of a data infrastructure, and evidence production, which condition alert, preparedness, assessment, and crisis control actions, posing a challenge to managers and government structures ; therefoThe examined works present the challenges of decision frameworks in emergencies, focusing on a gap between model type, actor expectation, and context constraints, which this article seeks to mitigate by describing the characteristics and requirement constraints to support country governments in developing frameworks for emergencies using a more adaptive approach incorporating the system dynamics of  and the In this sense, this work aims to analyze the scopes, application possibilities, challenges, and gaps of decision support frameworks in PHE management using components of the Health Emergency and Disaster Risk Management Framework (H-EDRM)  and the In recent decades, the global population has been confronted with recurrent health issues that undermine the ability of governments to respond , establiThe WHO guidelines for a public health information center emphasize a predictive perspective to produce better data, better analyses, and better decisions as part of an adaptive, comprehensive, and contextualized approach. Interpreting the context depends on prioritizing risk dynamics rather than managing isolated events, proactive action rather than reactive action, considering the dangers, uncertainties, and vulnerabilities and capacities of each context, as well as involving society and sharing responsibilities. The challenge is directly related to the capacity for resilience in the face of the entropy of the entire health system in an EPS, generated by a scarcity of resources, disputes over political narratives, and indeterminacies between science and common sense ,5.As an illustration, the Brazilian government issued an ESPIN in January 2023 due to a lack of assistance to the Yanomami indigenous population, which is characterized by a crisis that requires the mobilization of national strategies in the health, environmental, management, and regulatory dimensions of the territory, in response to the dangers posed by the presence of illegal mining in the Amazon Region . At the The International Health Regulations, the central instrument for actions to protect countries against the international spread of disease, define public health risk as \u201cthe probability that an event will adversely affect the health of human populations, with an emphasis on those that can spread internationally or pose a grave and direct threat\u201d . More thA PHE is a surprising event generating uncertainty, dealing with turbulent problems, and challenging states\u2019 forecasting and protection strategies. There are resilience challenges to restore the previous equilibrium of a situation, which is not always possible or even enough. These are complex decision-making contexts for managers, requiring collaborative relationships and the strengthening of partnerships at all levels, adoption of innovative solutions, and effective communication about risks to achieve a new reality .Decision making in PHEs requires a complexity calculation as close to reality as possible, considering the information available in the time interval of the decision, considering the scientific, technological, political, and managerial data, when the use of frameworks can mitigate the bounded rationality of the decision makers . This huA framework, based on Design Science Research (DSR), is an \u201cartefact\u201d in the form of constructs with conceptual aspects, models that attempt to describe reality, its variables, and their interactions. In the DSR approach, the method relates steps for the execution of actions and analysis and may adopt heuristics and algorithms; instantiation verifies the application of one or more artifacts in the environment, to know the technical feasibility and effectiveness, according to the characteristics of the context . This coOne of WHO\u2019s mechanisms for preparing countries for a PHE is the Health Emergency and Disaster Risk Management Framework (H-EDRM), an expert-developed management framework that reinforces the paradigm of an integrated approach to deal with health emergencies and disaster risks , guidingThe prevention measures reduce the impact of hazards and risk events on health, especially in the more vulnerable population. Recovery is a slow process that promotes actions to restore community life, such as physical, social, or psychological rehabilitation. The response measures include urgent life-saving support, such as the deployment of workforce, infrastructure, logistics, and communication systems. Preparedness increases PHE readiness by strengthening the capacity of governments, institutions, and society through proper legislation, resource planning, and community empowerment ,22.The H-EDRM Policies, Strategies, and Legislation (H-EDRM-PSL) outline organizational structures, roles, and duties. Planning and Coordination (H-EDRM-P&C) emphasize the integration of health planning at all levels. The Monitoring and Evaluation (H-EDRM-M&E) component tracks risks and the implementation of strategies, programs, and activities. The Information and Knowledge Management (H-EDRM-I&KM) integrates health surveillance, early warning, and evidence-based technical guidance. Health Infrastructure and Logistics (H-EDRM-HI&L) address safe and sustainable health facilities. Human Resources (H-EDRM-HR) build capacity and establish human competencies to address PHEs. The Health and Related Services (H-EDRM-H&RS) component guides actions such as prevention, basic care, rehabilitation, and immunization programs. The Risk Communication (H-EDRM-RC) component reports communication strategies to society, and the Community Health Capacities (H-EDRM-CHC) component assesses community risk prevention, population engagement, and territory planning. Finally, the Financial Resources (H-EDRM-FR) mobilize program budgets, contingency funds, and financial arrangements .As shown in Effective decision making in public health emergencies integrates institutions, public policy, science, and society; integrates multidisciplinary and multisectoral collaboration platforms; bridges knowledge generation and action; overcomes fragmentation; and strengthens the sharing of comprehensive and contextualized data, thereby empowering decision makers to understand and manage health risks. Reliable decisions adopt analytical methods and tools, access collective knowledge, and include cognitive characteristics of the decision maker . The comA PHE is a complex process guided by the interdependence of political, social, economic, and health issues, which involves local, regional, and global components . In thisThis systematic literature review is a qualitative approach, which allows the identification of key issues in the field . Our stuhttps://osf.io/u6xfb (accessed on 15 June 2023). The strategy resulting from this validation process is described in the following sections.This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, which aims to \u201chelp systematic reviewers transparently report why the review was done, what the authors did, and what they found\u201d . This reStudies on decision making in PHEs are recent, and a bibliometric analysis indicates an increase since 2014, associated with the intensification of health events, with 73.27% of the publications identified in the last 5 years, with an indication of growth in the coming years. The results indicate that there is little coordination between countries, institutions, and authors about decision making in PHEs, which raises the possibility of interdisciplinary analysis from a multicultural perspective which is more interpretative of the context of problems that affect the management dimension, especially in countries with populations in situations of economic, social, and environmental vulnerability that intensify in a PHE . In anotThis article reports on the general aspects of frameworks. It considers complexity through the interface of individuals and organizations, dependent on the connectivity of systems and the ambiguities and uncertainties of contexts . The intIn this sense, our article covers the last 7 years in a systematic literature review on aspects and configurations of decision support frameworks in PHEs, which interprets the interface of management problems through the components of the H-EDRM  and the Planning defines the scientific knowledge bases that will be investigated in the research  as folloIn defining the scope, guiding questions were formulated to be addressed to achieve the objective of this study. The text is organized by the H-EDRM and the PPRR model, which address specific topics. The questions guide the analysis of the frameworks studied. These are the following: Q1: How are management decision support frameworks characterized in PHE contexts? Q2: What type of intervention are the frameworks geared towards in a PHE? Q3: What are the challenges and gaps to be overcome by frameworks for strengthening decision making in PHE contexts?Considering the importance of an integrated view and the boundaries between PPRR measures and the H-EDRM components in PHEs, the identification of the theme should be in more than one H-EDRM, which could accommodate an interdisciplinary approach. However, we tried to locate the article studied in the H-EDRM with the greatest intensity, without prejudice to bringing them closer together in the composition of the texts and analyses.In the literature search step, following the questions presented in the scoping, a string is used to query the databases . In theshttps://decs.bvsalud.org/sobre-o-decs/ accessed on 16 June 2023) to find words and synonyms, resulting in the following string composition:  OR  OR  AND (\u201chumanitarian\u201d) OR (emergenc*) OR (\u201cemergency management\u201d) OR (\u201cdisaster\u201d) OR (\u201coutbreak\u201d) AND  OR (\u201cassessment\u201d) OR  AND (framework*) OR (\u201cstructure\u201d) OR (\u201cmethod\u201d) OR (\u201cmodel\u201d) OR (\u201ctool\u201d) OR (\u201cmechanism\u201d) OR (\u201ctechnique\u201d) AND (\u201cdecision-making\u201d) OR (\u201cDecision Support Techniques\u201d) NOT . The search eliminates medical research that has no relation to the areas of management and administration.The definition of the search string in the knowledge bases analyzed bibliographies linked to the topic and accessed the Health Sciences Descriptors (DeCS) base , with 1.0 being the global average . Notablyhttps://bit.ly/3QZ6DUA (accessed on 15 June 2023). The results are organized by the H-EDRM and answer the presented questions. Q1 addresses the characterization of the frameworks: contexts, identification of the H-EDRM and the PPRR model, scope, and method or model of analyses. Q2 identifies the type of intervention by H-EDRM components and PPRR model measures and the interface between them. Q3 analyzes the gaps and challenges in an interdisciplinary approach. The dynamics observed in our framework study are those located between the causes of a health emergency with its ambiguities and uncertainties and the limits of health systems, whose contexts present challenges for management, based on which we seek to identify their dynamics and sense of intervention, scopes, and relationship of variables and tendencies.This section presents the analysis of the selected frameworks, according to the appendix available at The frameworks are presented in several formats, adopting conceptual structures ,16,17,20The dimensions of information and monitoring and evaluation of the results of managers\u2019 responses deal with the evolution of risk dynamics that need to be managed in emergencies ,52,55,59The provision of structures and resources focuses on hospitals that are under immediate pressure in PHE situations. The focus is on the agility of adapting physical infrastructure  and leveA PHE requires the attention of different areas according to the ambiguities and uncertainties of a context, considering a multidisciplinary approach that includes economic, social, psychological, and health impacts , which cIdentifying frameworks using H-EDRM and PPRR Models implies observing permeable borders on their components to look at management dynamics in the context of a PHE. In this sense, Due to the magnitude that the COVID-19 pandemic has reached since 2020, response efforts predominate, followed by preparedness, prevention, and a recovery measure, suggesting a focus on the system\u2019s reaction; however, the strengthening of preparedness activities affects the evolution of all health systems during a crisis, resulting in a more effective response and capacity for resilience to recovery of the health system.Future research must investigate the conditionality relationship between these actions to determine the extent to which having more preparedness actions can produce more assertive responses and require less time to recover structures and the relationship between measure types and management components, as depicted in Framework development incorporates decision support concepts, theories, and multicriteria methods, which address the \u201cmultidimensional representation of problems with identification of critical information, comparisons of alternatives, and preference structures\u201d . AlthougThe H-EDRM-PSL component presents The Analytical Framework of China\u2019s Governance Responses to COVID-19 (response), with centralized governance for effective coordination of implemented measures, in a framework that integrates institutional, administrative, coordination, and governance configurations, with rational behavior of the actors, which generate a dynamic to reduce positive entropy in management that compromised government responses during the pandemic . DecisioHowever, as the frameworks established by nations reflect the opinions and circumstances of their authors, the exchange of models between different country realities is not automatic, and it is vital to expand PHE research into the operational and ethical dimensions of models that address the dynamic complexity of management in a context . It is aWhat must be investigated is the suitability of frameworks in diverse PHE situations, with models that include characteristics of the nations\u2019 governance style in accordance with the degree of centralization of activities. The absence of command and the perception of a PHE as a political game compromises the responses of governments, as in the United States during the COVID-19 pandemic; however, the Chinese experience of more effective control of the pandemic is not easily adopted by other nations because their decision-making contexts differ .H-EDRM-P&C addresses mechanisms for planning intervention in an epidemic. The definition of action plans is presented in a framework to support the integration of priority setting in the preparedness, alert, control, and evaluation stages of a disease pandemic, using documentary analysis and incorporating the experiences of health professionals, in an outbreak of the Ebola virus in Uganda . In thisThe countermeasure strategies present a multicriteria decision support system for choosing strategies to mitigate (prevention) the effects of COVID-19 using Bayesian networks to addresses uncertainty in dynamic environments, in the transition from short term to long term. Despite the improvement in multicriteria decision support methods for health emergencies, the scoring adjustment of the attributes of analysis may be harmed in contexts of uncertainty, for dealing with strategies not previously tested and for more uncertain attributes that receive less weight in the analyses, compromising a broad view of the problem .(recovery) to a state of normality [In terms of resilience, managing COVID-19 presented a hybrid approach that identifies causal factors, security barriers, and key lessons using bowtie modelling. Modelling societal resilience in health emergencies integrating causation, barriers, and lessons learned relies on hypothetical scenarios rather than probabilities and immediate problem-solving that is not always possible. Few studies have focused on frameworks for dynamically addressing the context of uncertainty, able to integrate accumulated management experiences from previous health crises to understand how contexts returned ormality . The resormality .Ethics, as a component of the planning and coordination measures in a PHE, also depends on developing ethically robust policies for community protection. The framework of ethical values for planning, policy enactment, and action on disasters, based on a decision guide, includes benefit and harm, effectiveness, precautionary principles, harm from intervention, respect, equity, and trust. The framework is a decision tree that provides guidance on the potential of the crisis, the establishment of recommendations, communications for intervention, and the verification of results, but the achievement of an adequate level of protection (prevention) for the population in public health emergencies, based on evidence, still lacks models that integrate the scientific, ethical, and management dimensions, with social, infrastructure, and logistical factors, for interventions that are appropriate to the context, especially for the least favored populations .In problem analysis, planning for a PHE is a complicated system with interdependent variables . Thus, MH-EDRM-HR components are strategic resources to face pandemics because they reinforce guidelines for personnel planning, occupational health, personnel safety, and capacity building in technical, epidemiological, diagnostic, service, and communication areas, in all cycles of the PPRR model and even for the H-EDRM components, at all levels . Despiteresponse to a PHE to straighten the decision-making process in complex emergency contexts, guided by the domains of decision theory, ethical principles, and the individual and group emotions of decision makers. The tool was based on the OODA loop , which incorporates intuition and deliberative process in choosing alternatives. Chaos and unpredictability condition decision making in emergencies, establishing a gap between the intuitions, heuristics, and biases of the decision maker. What is missing is a structured analysis of the variables of the context of uncertainty to achieve a more rational and deliberative process. It is a challenge to be studied to guide the training processes of health authorities in this context. Human resources can also be understood in the face of a PHE by the integration of agents participating in the decision-making process [The framework for training public health practitioners in crisis decision making was also identified as a necessity for the  process .The alignment of different agents in PHE decision making requires overcoming collective risk framing positioning, nonlinear preferences, dependence on source conditions, and estimation of gains and losses of each actor or group of actors. Additionally, cognitive and complex linguistic information capture presents a challenge. The gaps point to the development of consensus models which integrate psychological factors, information quality, and decision speed. Thus, decision-maker hesitation and perception demand weights and ranking of alternatives in structured analysis to mitigate their bounded rationality ,13 and aIn H-EDRM-M&E, the analysis of risk dynamics in contexts of uncertainty requires the development of decision support frameworks with the application of advanced hybrid dynamic methodologies to overcome the shortcomings of conventional probabilistic static models. The framework evaluates risk dynamics in time-dependent contexts and the dynamic variation of process variables, using a dynamic risk analysis (DRA) for mapping, managing, and identifying risk dynamics , with thGovernments strategies are subject to evaluating factors to respond to the COVID-19 pandemic, taking care to apply the guidance factors established by the WHO for countries. The framework uses Decision-Making Trial and Evaluation Laboratory (dematel) and Fuzzy Rule-Based Techniques and identifies causal relationships between factors and critical elements impacting Covid-19 virus infection, like social media sharing, mass crowding control, people movement control, international travel restrictions, distance learning, and economic stimulus measures. However, the study calls attention to the challenge of linking multicriteria decision support methods to the Dematel method to analyze complementary components (factors) influencing the spread of COVID-19, including different statistical techniques with larger sample sizes . The evaThe adjusting government strategies to contain SARS-CoV-2 transmission by analyzing the interactions and behaviors of agents integrates geographical factors, climatic factors, displacements, and contacts between agents in public spaces, called residents in quarantine or confirmed cases, the transportation agents, or even the government agent which establishes policies to address the emergency. The model relates the agents, their attributes, and interactions, based on data for simulation in the time and space of the analysis, in multi-agent modeling, which uses the tool Repast Simphony 2.8.1 , developed in the Eclipse Platform and using the Java language. It analyzes the spatial dynamics and produces, from scientific evidence, dynamic feedback about the interactions in time, allowing the government to analyze scenarios and adjust prevention and control actions, adopting effective intervention measures according to the context. The restrictive measures for the population are incorporated according to the behavior of the agents and the dynamics of the contexts, without the prevalence of a one-size-fits-all approach. However, this creates a challenge for governments in knowing the impacts of different measures in space and time, given by the economic and social development of a region .Particularly regarding the humanitarian response in PHE contexts, the identification and assessment of factors facilitating agility capacity in the aid network, the framework includes the timeliness of delivery of products and services, health risk management, long-term needs, health information and donor organization, and government and non-governmental organization policies to face the challenge of overcoming the gaps in verifying the effectiveness of action plans (response). It is an application of a hybrid evaluation approach that combines fuzzy decision trial evaluation laboratory (DEMATEL) and the analytic network process (ANP) to deal with ambiguities, uncertainties, and inaccuracies inherent in the evaluation process. The methods assess interactions between elements and establish reliability ratings .Monitoring and evaluating disaster actions within the scope of the health department (responses) is a framework that generates records for learning and preparing future responses to address emergencies. It is a conceptual framework developed based on a literature review on quality improvement, and it can be applied to enhance the disaster monitoring and evaluation cycle, including stages of documentation, evaluation, dissemination, and implementation of measures, looking at context settings and response mechanisms, focusing on the studies that explain ways of intervention and operation in different contexts .Monitoring and evaluating risk dynamics ,52, goveIt is known that the performance of health systems in a PHE allows for an adaptive response for epidemics, which addresses the analysis of context, intervention, process, performance, and impact, and a route to performance analysis and optimization of interventions, but the studies show models focused on specific contexts, with low capacity to reformulate the intervention, frameworks with limited structures for reapplication in different contexts and an iterative approach, missing settings of evaluation of the full cycle of an intervention .www.gradeworkinggroup.org\u2014accessed on 15 June 2023), that checks and makes recommendations on the quality of evidence to support decision making, applied in the context of public health emergencies [The H-EDRM-I&KM brings together frameworks to support better evidence for decision making, first on an application by the Emergency Operational Committee (EOC) of the Saskatchewan Health Authority, Canada, to identify COVID-19 policy priorities, providing rapid reviews and evidence reporting, in a web-based data dashboard. The COVID-19 evidence support team produce and sustain the best available evidence on COVID-19 to facilitate the decision making of policymakers, researchers, and clinical practitioners and foster the context-based learning cycle in health, which depends on information sharing; however, an aspect still to be overcome is the performance of experts in isolated silos of their own characteristics, which compromises the integration of knowledge from multiple actors and the generation of quality evidence in the emergency . AnotherA disaster impacts the environment and public health, and it is understood that it requires going through different phases of risk mitigation . However, risk assessment frameworks need to advance the identification of evidence in the early stages of the emergency (response) with the involvement of experts and specialized and multidisciplinary technical contributions. In this way, a methodology was developed to strengthen decision making, communication, planning, and action management to assess risks, an on-line tool that integrates the European Union Civil Protection Mechanism . In anotThe decision-making process to response and prevention plans to the COVID-19 pandemic, according to the studies, requires the application of multicriteria methods for decision support, integrating the expression of uncertainty by decision makers, setting criteria weights for choosing an optimal solution , and ranThe decision-making process asks for a system of emergency intelligence with the capability to deal with a context full of uncertainty and complexity. In this way, studies have been carried out about interagency decision support systems for sharing critical information in cross-border situations, which addresses the emergency management life cycle, integrating preparedness measures with stages of planning, simulations, and training; response measures using a decision support system and real-time monitoring; and recovery measures for vulnerable groups, highlighting the interoperability of existing systems and end-user-oriented solutions . In anotH-EDRM-HI&L presents framework studies on safety risk factors in the hospital environment during COVID-19 in India, using a Fuzzy Delphi Method (FDM). The weights of categories and their respective factors are calculated and ranked based on their criticality using the Fuzzy Analytic Hierarchy Process (FAHP), and the ranking of Indian hospitals is conducted by the Fuzzy Technique for Order of Preference by Similarity to Ideal Solution (FTOPSIS). The preparation of health services for the response to a pandemic integrates guidelines from reference bodies such as the WHO and can adopt multicriteria decision support methods to analyze risk factors. However, the exact definition of the criteria and the attribution of values for analysis of services is a challenge to be overcome due to the dynamics of contexts, ambiguities of expert opinions, and scarcity of resources that affect hospitals mainly during the PHE .A literature review on health care agility to classify hospitals in Tehran, Iran, in the context of disaster and the application of the Flowsort method with IT2FSs  build a framework to classify hospitals by level of agility, based on management capacity to deal with disasters in contexts of uncertainty. It verifies the relationships between agility factors and the actions to prepare, mitigate, rebuild, and respond to a disaster situation, including organizational structure, hospital chain management, clinical governance, technological upgrading, market awareness, and trained staff. Hospital agility is a structuring component of health service responses in situations of natural or man-made disasters in terms of how effectively facilities respond to the emergency, with competence, flexibility, and speed . A pandeCOVID-19 exposed the weaknesses of supply chain systems by the sudden increase in global demand for health supplies, which challenged the limits of production and logistics and increased the need for studies on frameworks for assessing optimal stock levels in preparedness measures for health emergency contexts. In this way, a decision model about stock levels of health systems in emergency scenarios was developed, using multicriteria spherical fuzzy regret. It represents the level of hesitation or adherence of decision makers to listed alternatives, considering the availability of local production and proximity to production centers, necessary quantity of product or equipment, supply costs, the criticality of use, inventory, and stock maintenance .The spread and speed of cases of a severe acute respiratory syndrome may increase the need for equipment and inputs such as mechanical ventilators and oxygen. A conceptual framework for determining the need for and allocation of ventilators during a PHE was developed (response), capable of planning actions and adequate logistics of equipment, supplies, and qualified personnel in intensive care, analyzing patient demand and the need for adequacy and increase in resources in hospitals, strengthening provisions at federal, state, and local levels. Despite the definition of strategies for technology allocation, frameworks for the situation analysis of the health system need to contemplate the capacity of structures, qualified personnel, and especially ethical principles to serve different population groups .H-EDRM-H&RS listed only one study in decision support methods for managers on improvements for the reduction in overcrowding in emergency rooms in Paran\u00e1, Brazil, which addresses feedback relationships, interdependence, and influences among criteria, with emphasis on resource utilization, layout efficiency, productivity and technology, in a composition of Decision-Making Trial and Evaluation Laboratory\u2014DEMATEL\u2014and Preference Ranking Organization\u2014PROMETHEE II. The management of the health emergency room to avoid overcrowding deals with problems that are difficult to identify and with patient management factors that cannot be changed quickly; however, according to the complexity of the context, there is a need for the association of multicriteria decision support methods to prioritize alternatives, such as assigning weights, establishing causal relationships between criteria, identifying improvement, and ordering the choices in time .To the best of our knowledge, the studies did not present a specific financial resources framework (H-EDRM-FR); however, it is a strategic resource to provide financing expeditiously and maintain all the programs and measures in different stages of a PHE. The lack of studies also applies to risk communication (H-EDRM-RC), which plays a special role in positioning society in complex contexts of contradictory information that compromises risk mitigation strategies and the protection of citizens, especially vulnerable populations. Communication is closely related to the level of response according to a society\u2019s community capacities (H-EDRM-CHC), which includes health professionals and civil society in shared crisis planning with the community , but no Governments and societies face challenges for assertive decision making in contexts of health emergencies, where the complexity of management lies between the health event\u2019s behavior and the health system\u2019s limit, implying a multidisciplinary and interdisciplinary, multisectoral, and contextualized approach. In this sense, the framework is at the interface between the decision maker and the problem, which in a context of uncertainty takes on nonlinear and counterintuitive proportions.The analysis of the frameworks using H-EDRM recorded the prevalence of components in the areas of information and knowledge, monitoring and evaluation, planning and coordination, and infrastructure and logistics; however, policies, strategies and legislation, human resources and services, risk communication, and the community capacity were of a lower priority. In the analysis, response measures predominate, followed by preparedness, prevention, and recovery. This conclusion presents a question for future research, which is the conditionality relationship between measure types and management priorities in a PHE, to verify to what extent strengthening the preparedness action can generate more assertive responses and a shorter recovery time of health structures.This article does not exhaust the analysis of the gaps in multicriteria methods, as synergistic relationships must be strengthened between multicriteria analysis, cognitive psychology, decision-maker behavior, and decision support systems  for a moAdapt the development of frameworks to the country\u2019s governance model, according to its organizational forms, vulnerabilities, and capacities, to mitigate the introduction of models that are disconnected from reality.Prioritize ethical aspects in the planning of PHEs in all actions , with special attention to the most vulnerable populations, incorporating historical data to know the behavior of society in previous events and strengthen the resilience capacity for future emergencies.Strengthen policies, strategies, and legislation to prepare the states, prioritizing planning and scenario projection as a conditioning step for response time, improving the effectiveness of interventions and the recovery of health systems.Integrate the expectations and hesitations of decision makers at all levels, individual and collective, with frameworks that best interface heuristics and bias and the rationale of context in the face of variables of uncertainty.Develop within the framework functions that incorporate community capacity into PHE decision making to produce appropriate responses at all levels and increase the social resilience through collective action to strengthen the capacity of the society to deal with the effects of positive entropy in complex and dynamic PHE contexts.Apply methods capable of incorporating the linguistic expressions of the agents, feedback relations, and interdependence among criteria in framework development, making hypotheses and behaviors explicit in the context analysis, due to the uncertainties that compromise the accuracy of predictions.Improve evidence sharing and analysis frameworks, with quality analysis and guidance on levels of certainty, to define local strategies aligned to global challenges in PHEs. In this regard, the interoperability of information systems needs to be strengthened.Forecast complexity scenarios in all phases of a PHE, continuously confronting the behavior of the health event and the limits of the health services and the supply chain, production, and logistics to develop strategies for allocating strategic inputs to health, including human, cognitive, financial, and technological resources.Expand the capacity of the communication frameworks with society, as a strategic action to avoid misinformation and to strengthen sensemaking in society about the interventions.In conclusion and based on the analysis of aspects regarding context constraints, the historical perspective of emergency behavior and future impacts, the limits of provision of technologies and infrastructure, governance styles, and decision maker cognition factors, this article presents the following guidelines for the development of decision support frameworks in PHEs:The studies have shown that the main challenge for the development of frameworks is supporting an adaptive outlook by the manager regarding the complexity of PHE contexts, with tools and mechanisms suited to different circumstances, models of government, and society, since the intervention takes place in a part of a larger reality."}
{"text": "Aging is an inevitable process that leads to changes in various dimensions of older adult life, including physical, psychological, and social aspects. Unfortunately, older adults are more susceptible to health problems caused by adverse experiences such as the Corona outbreak.The current study examines the lived experience of older adults in facing the conditions of the Corona epidemic to see how green spaces at various scales can influence the physical and mental health of this group.Relevant articles published, from 2019 to February 17, 2023, were searched using in the Scopus and Web of Science databases. Eligible studies published in English and all studies passed a quality evaluation.In the final search, 40 articles were selected and analyzed. The majority of studies conducted during the pandemic categorized the impact of green spaces on the health of older adults into three main categories: Place-based attribute, Process, and Function.The findings of this study demonstrated that people were using private green spaces , small local green public spaces, sitting and gathering spaces in the neighborhood, nearby open spaces, and urban green-blue spaces throughout the epidemic era. They visited green spaces outside the city and urban areas, including urban gardens, agricultural areas, forestlands, and pastures. In this research, we investigated the characteristics of these spaces and classified them into four physical categories: urban landscape, land use, activity, movement, and accessibility. The results showed that exposure to nature or green space improved physical and mental health and increased attention and decision-making quality in older people. We have proposed design implications recommendations for crises to improve safety, security, and social capital by increasing the safe access of older adults to diverse and high-quality green spaces on different scales, which will ultimately enhance the physical and mental health of people in different age groups. The health issues caused by the COVID-19 pandemic have had severe repercussions for urban areas, including detrimental impacts on urban health, society, and the economy ]. As a rAccess to urban green spaces improves people's quality of life in cities as it allows for the creation of jobs and food, the promotion of biodiversity, urban heat mitigation, and the creation of health advantages . IncreasThe COVID-19 crisis has highlighted the vulnerability of the older adult population, particularly in terms of their physical  and mentPrior to COVID-19, research consistently shows nature exposure improves mental health and wellbeing. Urban green spaces, water bodies, private gardens, and visual experiences are linked to these benefits. Nature connections also reduce the risk of psychiatric disorders , and thThe sense of isolation among older adults can also be attributed to individual factors. Research has shown that age greatly impacts access to services and amenities, as well as participation in cultural and leisure activities. Additionally, factors such as retirement and marital status may contribute to feelings of loneliness and isolation . DespiteIn the various reviews, some policies need to be established to create friendly communities for older adults. In this context, places far from the community should be examined, people far from social activities should be studied, and policies at the neighborhood scale to increase social participation should be considered ; Table 1Table 1 sNumerous studies have demonstrated that exposure to natural environments offers extensive physical and psychological benefits . These eDuring lockdown, it is possible to enhance the mental and behavioral health of older adults by considering their personality traits, such as higher intelligence, emotional stability, and extroversion, while also promoting public communication . AccessIn a study by Bartalucci et al. , the comThe emphasis on green space in previous reviews has been consistent. However, other forms of nature, such as blue space , green In 40 selected articles, the focus was on factors such as the density of commercial facilities, the density of schools, access to public transportation, the density of roads, and access to green spaces, along with the environmental characteristics of built space, such as urban density and mixed language use, the health impacts of urban residents' land use, and long-term active travel behaviors.Older adults, as a vulnerable group of people to epidemic diseases, rarely use green space due to the dread of infection . They arThis narrative review study shows that some socio- demographic factors  , and actDuring the COVID-19 pandemic, the requirements to observe social distancing highlight to what extent the quality of life (QOL) is related to social and physical activity in middle and old age. They also show the necessity for more mobility in the living space. During lockdown, the amount of activity and mobility of middle-aged people at home or in private outdoor spaces decreased . A studyUrban green spaces are mainly used for various activities, such as running, walking, and outdoor sports, which depend on many interconnected variables and the type of city texture, including the construction and population density of the neighborhood, the amount of green space available, and the safety and security of traffic and crime . With reThe study by Noszczyk et al. , in whicSeveral studies have indicated that the physical and spatial characteristics of a neighborhood can influence the attendance of older adult individuals during the COVID-19 pandemic. Factors such as the physical attributes of housing, urban landscapes, land use, and activity levels have been found to impact the quality of attendance for this population . NotablyThe characteristics of the local environment in the neighborhood level play a vital role in promoting adaptive behaviors and enhancing the health and wellbeing of older adults. For instance, a study conducted in New York demonstrated that individuals living in disadvantaged neighborhoods, who faced challenges in leaving their homes due to physical disabilities, encountered similar difficulties . Those wHowever, the presence of greenspace alone does not guarantee access. Barriers such as inadequate transportation, connectivity infrastructure, provisions for disability, and socio-cultural issues, including harassment and violence against women, continue to persist . In summNeglecting the quality of design in green spaces, both in terms of their qualitative and quantitative aspects, can have detrimental effects on social interactions, civic participation, community involvement, and the health of older adults . The WoTo highlight the benefits of green spaces in older adults' lives in this narrative review, worth noting is that, during the pandemic, living in greener neighborhoods with more public green spaces can increase older people's willingness to engage in physical activities such as walking and cycling  as well Having more benefits of green space during the pandemic depends on reducing transmission by design based on three crucial factors: the density of development and construction, the level of connectivity and design of green infrastructure, and the availability of urban green-blue spaces . To miniFurthermore, Poh et al.  have fouResearchers have extensively confirmed the impact of \u201cplace-oriented\u201d factors on health outcomes . The plNumerous social and economic factors, including age, gender, education, income, race, female-to-male population ratio, employment status, and occupation type, can influence the risk of COVID-19 . IndividFurthermore, there is a significant relationship between education level, engagement in sports, and recreational activities in urban green spaces during the epidemic. Individuals with higher education tend to recognize the importance of utilizing green spaces and improving their mental wellbeing while staying at home . OccupatNotably, Van Tilburg et al.  found thBesides, some research indicates that older individuals in disadvantaged neighborhoods face higher social exclusion levels than in other neighborhoods. This discrepancy arises from neighborhood deprivation in areas such as access to services and amenities, social relations and civic participation, and cultural and recreational activities, as well as green spaces . The COVMoreover, the rate of COVID-19 infections is directly related to the percentage of the black population, non-native immigrants, households without access to a vehicle, and the population over 65 years old . The panThe studies related to older adult activity show that throughout the pandemic, individuals attended parks for various activities, including sightseeing, strolling, exercising, and jogging. The purpose of such activity was to enhance their mental wellbeing, and the presence of greenery was a crucial component in attracting older adults. The landscape of parks, particularly the plants, played a significant role in this regard, as evidenced by the popularity of cherry blossoms in Olympic Forest Park, lotus flowers, and red leaves in Xishan National Forest Park . IncorpoThe desirability of a neighborhood for older adults is influenced by the distribution, quality, and accessibility of green spaces . The proYe and Qiu  discoverA study proposed the \u201cUrban Meteoropathy\u201d planning tool for high-density cities like Macau Peninsula, suggesting the implementation of multiple layers of greening on the ground, walls, and rooftops of buildings to address the lack of green spaces . To enhFinally, urban planners and designers can enhance the green space experience, especially during the pandemic, by creating green walls, small parks, and gardens  66), an, an66), Our goal was to investigate the impact of green spaces on older adults' wellbeing during the COVID19 pandemic. In the next studies, these benefits and effects can be examined in different socio-economic and cultural conditions. It is also possible to check how the policies of different countries have responded to the needs of older people during the pandemic.This study draws upon available studies to identify the individual characteristics of older adults and their living environment to see the effects of the pandemic on the health of the older adult. Moreover, this study examines the qualities of green spaces, the benefits of using green spaces, the types of spaces used by older adults, and the desirable activities of the older adult in the green space during the COVID pandemic. This narrative review study highlights the substantial and enduring impact of the coronavirus on the physical and mental wellbeing of older adults. It also reveals that there is a strong relationship between the surrounding green environment and the incidence of physical problems, anxiety, and depression symptoms among the older population. In addition, in the lived experience of older adults, there was a positive encounter with the condition of the disease, which included sub-themes such as facing the crisis of acceptance and inflexibility in difficult conditions, which made the older adult adapt to the conditions related to the spread of Corona.According to the findings, there are several stakeholders and experts, including urban planners, health professionals, local communities, and lawmakers, who may collaborate to develop successful strategies to improve people's quality of life. Officials, designers, and urban planners should consider the following measures to help reduce crises:Enabling access to and promoting the use of green and open spaces in various dimensions to alleviate overcrowding,Enhancing the quality of green spaces by improving biodiversity and tree diversity in urban areas,Strengthening pedestrian and bicycle paths to enhance mobility, reduce inequality, promote physical activity, and facilitate access to urban and green areas,Developing public and semi-public spaces to foster social interactions and cohesion within neighborhoods,Establishing private or shared green spaces, such as terraces and patios, to encourage activity and communication and improve the physical and mental health of the older adult,Enhancing neighborhood safety and security while simultaneously strengthening social capital,Utilizing mass media to disseminate relevant information,Prioritizing health measures and providing access to medical consultations, andFocusing on public transportation networks and their ability to minimize risks and injuries, especially for the older adult.As the global population continues to age, there is an urgent need for further research in the field of the physical and mental health of older adults. This is particularly crucial in the context of urban environments, where the majority of the population resides, and where environmental factors can significantly impact health outcomes. To effectively address the challenges facing the older adult population, it is critical to understand the influence of various environmental variables on their physical and mental health.All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication."}
{"text": "In the published article, there was an error in the author list, and author [Yasser Abdelazim Abdelmawgoud Samak] was erroneously [excluded]. The corrected authors list and affiliations are appears below.1*, Huda Aseem1, Amira Alzain1 and Yasser Abdelazim Abdelmawgoud Samak2Mogeda El Sayed El Keshky1Department of Psychology, Faculty of Arts and Humanities, King Abdulaziz University, Jeddah, Saudi Arabia2Department of Geography and GIS, Faculty of Arts, Assiut University, Assiut, Egypt.In the published article, there was an error in the Author contributions. The statement was incorrectly written as \u201cMK contributed to the definition of research objectives, model and hypotheses, data analysis plan, writing \u2013 original draft, funding acquisition, and reviewing and approval of the final manuscript. HA and AA contributed to the provision of materials , participated in data collection. All authors contributed to the article and approved the submitted version.\u201dThe corrected statement is:ME contributed to the definition of research objectives, model and hypotheses and funding acquisition. ME and YS participated in data analysis plan, writing\u2014original draft, and approval of the final manuscript. ME, HA, AA, and YS contributed to the provision of materials , participated in data collection, review and editing. All authors have read and approved the final version of the manuscript.The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated."}
{"text": "To identify the scientific evidence on the impacts caused by the use of screens during the COVID-19 pandemic in children and adolescents, raising reflections for future interventions with this public.This is an integrative literature review, conducted in the databases Medical Literature Analysis and Retrieval System Online (MEDLINE), Literatura Latino-Americana e do Caribe em Ci\u00eancias da Sa\u00fade (LILACS), Cumulative Index to Nursing and Allied Health Literature (CINAHL), United States National Library of Medicine (PubMed), Scopus, Web of Science, and Embase, published from March 2020 to January 2022, in Portuguese, English and Spanish.The search strategies allowed retrieving 418 articles, of which 218 were duplicates. The analysis of titles and abstracts resulted in the maintenance of 62 studies. Of these, 31 were excluded from the reading of the full text, since they did not clearly present the phenomenon investigated. Thirty-one were eligible, resulting in five categories: eye consequences; increased sedentary behavior and weight; change in eating habits; implications for sleep quality and impacts on mental health.The excessive use of screens during the pandemic led to numerous consequences for children and adolescents, with a higher incidence of visual damage, sedentary lifestyle, inadequate eating habit and increased weight gain, in addition to impaired sleep quality and mental health. This study provides subsidy for health professionals to carry out continuing education focused on this theme, and elaborate effective interventions for this public in this transition to the post-pandemic period. In childhood, heavy use of these devices may increase the risk of cardiovascular diseases and psychological disorders, in addition to favoring exposure to inadequate content. Some authors associate prolonged screen exposure to delays in linguistic domains and fine motor skills. In adolescence, it significantly influences social and family interactions and mood, with a greater risk of developing depression, self-extermination attempts, low self-esteem, as well as other behavioral problems.Technologies evolve rapidly, and are inserted in the daily lives of children and adolescents through pocket, mobile and portable devices, having consequences for healthy development. The trajectory of screen use was analyzed at 24, 36 and 60 months of age in Canadian children, and heavy use showed poorer child development and sub-optimal learning outcomes. In addition, intense use of screens contributes to weight gain that can trigger obesity, sedentarism, and accelerate or accentuate possible physical and mental disorders.Children's early access to technologies and the inappropriate use of these tools can compromise their social, cognitive, and affective development. In these media, they are exposed to advertisements that rely on persuasive and appealing techniques to reach mainly children, exercising intense control over their behavior.Use of screens, including television sets, video games, and computers, is a practice that works as a source of leisure and entertainment for adolescents, replacing outdoor activities. The impact of this habit results in consumption of unhealthy foods and physical inactivity, increasing the prevalence of overweight and obesity in this age group. In addition, excessive use of these technologies can have negative consequences on vision development, as well as on sleep quality and psychological health. that required necessary global preventive measures, such as social distancing to break the disease's transmission chain. Currently, the impacts of these restrictions on the population's health, communication, interpersonal, family, social and economic relationships can be observed.Such a reality and its problems have been intensified with the advent of COVID-19. In March 2020, the World Health Organization declared the Coronavirus Disease 2019 (COVID-19) pandemic \u2014 an acute, potentially serious respiratory infection with high transmissibility There was an absence of school space and decreased outdoor leisure activities, increasing the use of screens and affecting quality of life. This new reality presents short, medium and long-term effects directly linked to the development of comorbidities, in addition to physical, psychological and behavioral complications that may arise.Initially, with the interruption of school activities, children and adolescents witnessed abrupt changes in their daily routines, were physically more distant from friends, remained in home confinement, and were more exposed to alarming information about the pandemic, increasing feelings of anxiety, stress and sadness. With the advancement of vaccination and its benefits, there was a decrease in restrictive measures, including the return to school. However, studies show that even after going back to school children have low levels of physical activity and increased screen time and sedentary activities.In January 2021 the vaccination campaign against COVID-19 began in Brazil, in a gradual progress, and in 2022 the vaccine was made available to children.This study is justified by the need to investigate the impacts caused by screen use during the pandemic in children and adolescents, grouping information essential for the performance of health professionals given the repercussions of the COVID-19 pandemic. Thus, it aimed to identify scientific evidence of the impacts of screen use during the COVID-19 pandemic in children and adolescents, raising reflections for future interventions with this public.This is a study that used the integrative review, broad method, which combines experimental and non-experimental research to achieve a more didactic understanding of a phenomenon of interest, presenting the state of science and applicability in health practice.For the elaboration of this integrative review, the following steps were performed: identification of the problem (clear definition of the review purpose), search of the literature , evaluation and data analysis.To guide the integrative review, the following question was formulated: What are the impacts caused by the use of screens during the COVID-19 pandemic on children and adolescents?The following electronic databases were used: Medical Literature Analysis and Retrieval System Online (MEDLINE), Latin American and Caribbean Literature in Health Sciences (LILACS), Cumulative Index to Nursing and Allied Health Literature (CINAHL), National Library of Medicine and National Institutes of Health (PubMed), Scopus, Web of Science, and Embase. The search was conducted by the authors independently in order to ensure the legitimacy of the study, recovering scientific articles published from March 2020, after the beginning of the pandemic and the consequent establishment of prevention measures. Articles that did not include the guiding question, review, abstracts and conference proceedings, editorials, experience reports, theoretical essays, single case study and duplicate studies were excluded from the selection.The inclusion criteria of the articles were: original, complete studies, published in English, Portuguese and Spanish, with full texts, available online in the selected databases, addressing the impacts of the use of screens on children and adolescents during the COVID-19 pandemic in the period from March 2020 to January 2022. This is the period between the recognition by the World Health Organization of COVID-19 as a pandemic and the date of the search for articles in the databases.The search was conducted during the month of January 2022, using combinations between the keywords, which are descriptors in Descriptors in Health Sciences (DeCS), Medical Subject Headings (MeSH) and Embase subject headings (Emtree): Screen Time/Tempo de Tela/Tiempo de Pantalla and Child/Crian\u00e7a/Ni\u00f1o and Adolescent/Adolescente/Adolescente, combined with the term COVID-19 in all three languages.The studies retrieved by searching the databases were exported to the Rayyan QCRI Program. Subsequently, duplicate studies were removed, and titles and abstracts were read by three reviewers  using the double-blind method in order to identify potentially eligible studies. Those studies that presented doubts and/or divergences between the reviewers regarding the inclusion or exclusion were solved by a fourth author with expertise in child and adolescent health (ECRG).For the compilation of results, a table was built with the main characteristics of the studies, such as: title, authors and year of publication, journal, language, country of origin, objective, methodological approach, population, main results, conclusions, and bibliographic references.There was no need for approval by the Research Ethics Committee because this is a bibliographic study. Ethical aspects and copyright were respected, and the studies referenced.The articles included in this study were selected, evaluated, and classified hierarchically according to their level of evidence. This practice contributes to the decision-making of health professionals. In this study, the proposal of Melnyk and Fineout-Overholt was adopted, which is shown in The search strategies allowed retrieving 418 articles, of which 218 were duplicates. The analysis of titles and abstracts resulted in 62 studies being included. Of these, 31 were excluded from reading of the full text, since they did not clearly present the phenomenon investigated, and 31 were included in the review, as shown in the flowchart .Of the 31 papers analyzed, all were quantitative articles, except one. As for year of publication, the highest incidence was 2021 (27 articles), 2020 (2 articles) and 2022 (2 articles). Seven were developed in China, four in Canada, two in Italy, India, France and Turkey, and one in the Netherlands, Spain, Japan, Brazil, Saudi Arabia, Iran, the United States of America (USA), Hungary, Jordan, Indonesia, Poland and Egypt. All studies were published in English. The table shows the studies\u2019 main characteristics .2,5,6,1All the papers examined addressed the theme of the impacts of screen use during the COVID-19 pandemic on children and adolescents. Five categories emerged from these findings: eye consequences; increased sedentary behavior and weight; altered eating habits; implications for sleep quality and impacts on mental health.The studies analyzed revealed the association between high use of screens and higher risks of myopia, as well as other eye problems in children and adolescents during the COVID-19 pandemic. The researchers also claim, that the use of computers and smartphones has a higher probability of facilitating the progression of myopia compared to the use of television for remote education.Chinese researchers carried out a large-scale survey, finding that the use of screens in this period increased due to school closures, as well as myopia was more prevalent among respondents who were in high school and fundamentally, screen time was associated with greater risks of symptomatic myopia progression and the study population used more computers and smartphones. An association was also found between excessive exposure to electronics eyestrain, blurred vision or dry eyes.Similar results were found in other studies regarding the progression and incidence of myopia associated with restrictive measures to contain the spread of Covid-19, in addition to axial stretching. Furthermore, there was an increase in children's weight and body mass index (BMI) due to longer time watching television and using computers.The studies revealed greater use of screens during the period of restrictive measures to control COVID-19, providing increased sedentary activities, decreased physical exercise and less time outdoors, compared to the year before the pandemic. Electronic devices, whether televisions, computers, laptops or tablets, when located in bedrooms, present a greater risk of being used for long periods.With the restrictions imposed, the increased use of screens was inevitable, since they became educational tools and a form of leisure, especially for those with restricted access to external areas. Therefore, ending the COVID-19 restriction measures alone will not by itself promote new habits in children and adolescents.The alarming fact is that, even after relaxation of the restriction measures, children still reported performing fewer physical activities than in the previous year, showing that the reopening of schools did not fully restore these activities. This indicates that there may be a lasting impact related to screen use time in that such behavior has been normalized. This is related to higher fat intake and consumption of advertised products, such as sugary cereals, sweets, drinks and snacks. Such behavior was more observed as of the start of distance education during the pandemic, compared to the previous year. The use of screens can indirectly increase food consumption and the intake of unhealthy foods, reduce physical activity and energy expenditure, increasing the risk of obesity.Another issue analyzed in the studies was the diet associated with the use of electronics, where a common habit of eating while watching TV was found. Scientific evidence suggests that the change in diet and lifestyle caused by the pandemic has led to excessive body weight gain in children and adolescents, and this can have serious health consequences.Investigating the relationship between screen time and changes in the diet of children and adolescents showed that increased use of mobile phones, television, laptop and video games was associated with increased appetite, increased consumption of sweets and unhealthy foods, snacks and frequent snacks between meals, as well as with children who were indifferent to eating fruits and vegetables. This can be explained due to changes in the biological clock, which plays an important role in the good performance of restorative sleep. Night exposure to intense light can stimulate the wakefulness system, making individuals more alert and causing them to sleep later.The excessive use of electronics, according to the studies analyzed, has consequences on hygiene and sleep quality, especially when these devices are used at night. bringing physical and psychological consequences to children and adolescentes.Poor sleep quality may be related to the exacerbated use of screens, changes in routines and schedules, little exposure to light during the day and a lot of exposure to light at night, changes that may be related to the restriction measures imposed during the pandemic, This new reality implies less time for performing outdoor activities and lack of socialization with peers, consequently fostering the use of electronic devices both for education and as a form of leisure.The changes caused by social isolation had a great impact on the mental health of the pediatric and adolescent population. In contrast, although education implies spending several hours in front of a screen, learning can act as a form of protection, since it allows the reduction of stressors caused by confinement.Children who use screens for long periods have higher levels of depressive and anxiety symptoms. Therefore, it is necessary to adopt measures aimed at minimizing damage, using other devices in a moderate way and with limited time.The use of smartphones at younger ages may be a risk factor for mental health in the context of the COVID-19 pandemic. In addition, longer screen time is associated with more conflicts with parents, since this habit can lead to a negative mood in adolescents.Studies show that more time on TV or digital media causes high levels of inattention and hyperactivity, and the excessive use of video games provoke irritability, inattention and hyperactivity. Although in developed countries access to electronic devices is easier compared to developing countries, among the studies analyzed, the largest amount of research was conducted in emerging countries (n=17), showing that the impacts of screen use have been a global concern, also confirmed by the diversity of countries developing research on the subject.With globalization, the use of technologies has become commonplace, and this reality has both positive and negative aspects; in the pandemic period experienced in recent years, this scenario has become more evident. In 2019, Brazilians were ranked third in relation to daily hours online, Brazilian teenagers in particular ranked second in internet connection time outside of school hours. However, only one of the studies analyzed here was developed in Brazil, showing the need to develop more research on the subject, especially after the pandemic.The more frequent access of children and adolescents to the web is not a recent concern, but has intensified in several countries including Brazil, since the problematic use of these devices can cause mental, visual and auditory disorders.As addressed in category one, although myopia is considered a benign alteration, its prevalence has become increasingly common. This pathology can lead to severe visual complications, including macular degeneration, posterior staphyloma, cataract, glaucoma, and retinal detachment, becoming a public health concern. This should be taken into account and given due importance, since school activities through virtual tools during the pandemic significantly increased screen time, which contributed to symptomatic myopia incidence.Myopia is related to individual characteristics, but it is also caused by environmental factors and lifestyle, thus prolonged screen use is an important factor in its development. These effects are more frequently observed in children and adolescents, since optical development is not fully completed.The size of the screen, as pointed out by the studies, can also influence the progression of myopia, devices that have larger screens provide viewing at a more acceptable distance, minimizing the use of close vision, which reduces stimulation of hypermetropic blur, while with smaller screens the distance is shorter, which can lead to increased eye impairment.Based on these findings, it is necessary to disseminate information, especially to parents and guardians, to warn them of the recommendations regarding the necessary distance when looking at a screen, so they can prioritize those that appear to be less harmful and limit use time, since the risks of developing myopia increase every hour that a child is exposed to a digital device.The change in the lifestyle of the investigated population during the pandemic, with the consequent exacerbated use and the consequent sedentary lifestyle are associated with several health risks, including hypertension, metabolic syndrome and obesity, which presented worrying indicators even before the pandemic.According to data from the Brazilian Society of Bariatric and Metabolic Surgery, the COVID-19 pandemic has had a major impact on the childhood obesity picture in several countries, including Brazil, due to changing lifestyle habits and increased screen time. The Brazilian Institute of Geography and Statistics (IBGE) points out that, in a group of three children from five to nine years old, one is overweight in the country. The context of obesity in Brazil was already worrisome and worsened during the pandemic. Such reality implies morbidities that can cause various damage to health. On the other hand, the pandemic showed regional disparities in Brazil, as there were groups of children and adolescents with malnutrition caused by the worsening of the economic crisis, compromising the growth and development of children and youth.This corroborates the Brazilian study developed in 2022, which sought to investigate the consequences of social isolation in relation to weight gain in children, analyzing the nutritional diagnosis of children in the five Brazilian regions, between the years 2019 and 2021, through reports of the Food and Nutrition Surveillance System (SISVAN) of the Ministry of Health, which observed an increase in weight in children during the pandemic in all Brazilian regions, reflecting changes in lifestyle during this period.Understanding that these long-term habits can have numerous consequences for this population, it is necessary to develop strategies to reduce screen time and stimulate physical activity by retrieving games that stimulate physical abilities and encouraging sports.In addition to the increase in sedentary lifestyle, another concern related to the use of screens is poor diet. As well as the implications found in studies for the consumption of foods with low nutritional content and excess calories associated with technologies, other complications arise, which can be justified by the economic crisis faced during this period, the worsening in family income, the increase in food prices, providing food insecurity and malnutrition. Such reality is faced by Brazilian children and adolescents who suffer from neuropsychomotor impairments, that have a greater likelihood of developing chronic diseases such as diabetes, hypertension, and overweight.The Brazilian Society of Pediatrics points out that during the pandemic families started to overeat foods with high sugar content that provide a sense of pleasure. Despite this, family meals can be a nutritional protection mechanism, by favoring the consumption of complete meals, with appropriate intervals, which can ensure an adequate intake of macronutrients, minerals, antioxidants, and vitamins, thus ensuring adequate nutrition.Guidelines on food in the school environment or offered by the family members are necessary so that this public is encouraged to create healthier habits in the current transition to the post-pandemic period, an important factor for a good nutritional status, favoring the adequate development of children and adolescents. During childhood and adolescence, it gains even more importance by acting in the physiological processes of growth, maturation and health, in addition to having an important role in strengthening the immune system.Sleep is essential for the proper functioning of the human body, since it contributes to physical and mental homeostasis. In addition, short sleep and early awakening can lead to depressive or stress symptoms. Thus, it is essential to guide this public about creating routines, having regular and appropriate schedules for sleep, adapting exposure to light, and limiting the use of screens at night.As shown by the investigated studies, the exposure to light-emitting diodes (LED) with a short wavelength (blue range) at night also blocks the secretion of hormones that are important for sleep regulation, such as melatonin, thus morning awakening is later. There is a need to identify the threats to the mental health of this population and to carry out prevention and intervention strategies to minimize the damage caused by confinement as a result of the COVID-19 pandemic.Thus the importance of stimulating outdoor activities to reduce risks to mental health. Although the quality of mental health is related to numerous factors, controlling exposure to screens is essential.Among the study's limitations is the fact that analysis of the impacts of screen use during the COVID-19 pandemic was restricted to the month of January 2022, not allowing these impacts to be evaluated up to the present moment. Another limiting factor is the publication of studies in different countries, with only one Brazilian study being retrieved, which shows regional disparities in publications on the subject and makes it impossible to generalize the data. Regarding the levels of evidence, a prevalence of cohort studies, case-control and systematic reviews of qualitative studies was noted. It is believed that the randomized clinical studies not found could clarify the most severe consequences of the use of screens in children and adolescents.The findings reveal that excessive use of screens during the pandemic has led to numerous consequences for children and adolescents, with a higher incidence of visual impairments, sedentary lifestyle, inadequate eating habits, in addition to weight gain, impaired sleep quality and losses in mental health. The changes in habits due to the restrictive measures presented a contrast between the increase in the consumption of foods with low nutritional content and the excess of calories associated with technology, which points to the problem of overweight and malnutrition that compromises the development of children and adolescents, something that is no longer restricted to developed countries. Thus, this study provides subsidy for health professionals to carry out continuing education focused on this theme, warning parents and guardians of the implications of the use of screens, as well as developing interventions that are effective for children in the prevention and promotion of health in the transition to the post-pandemic period."}
{"text": "Vocational education helps students develop or enhance their knowledge, skills and abilities for a particular occupation. As a result, vocational education plays an important role in the economic and social development of countries (and regions) around the world. It has also made an important contribution to educational equity. The development of quality and sustainable vocational education has become an issue of concern for governments, educational institutions, educators and researchers. In the past, many experts have been thinking about how to develop policies to help promote vocational education. However, in addition to national goals, industry needs and expert opinions, the education policy system also needs to take into account the views and opinions of the stakeholders in order to implement the policy effectively.The psychology of vocational education is broad in scope, because it encompasses stages of vocational probation, vocational preparation and continuing vocational education, from K-12 education to higher education and to lifelong education. Consequently, the issue of how to improve the quality and learning outcomes of vocational education has become an important topic in education. From the theoretical perspective of educational psychology, psychological and cognitive factors can be used to facilitate students' learning performance or to enhance teachers' teaching effectiveness. It can also help teachers in vocational schools better understand and develop students' vocational literacy in a more in-depth way, so that they can better respond to the challenges of their work.The psychology of vocational education can be based on a cross-disciplinary theoretical approach to facilitate educational policy implementation, educational management, curriculum development, instructional design, apprenticeship, workplace learning, career counselling, skills training, career preparation, workplace learning, and so forth. The importance of the psychology of vocational education is therefore self-evident.Liu Y.-B. et al.; Peng et al.), career adaptation , career exploration , creativity , critical thinking , discrimination perception , education climate , employability , entrepreneurship education , learning engagement , learning methods , learning motivation , learning readiness , online learning , postgraduate education , professional literacy , prosocial behavior , self-efficacy , skills training , social support , and teaching methods . As can be seen from the above, there is a wide range of research issues in the psychology of vocational education.The study of the psychology of vocational education contributes to the development of vocational and technical personnel and the understanding of individual differences. It is more helpful to identify the effects or problems from the perspectives of the persons involved and to understand the reality of the situation. There is a wide range of specific Research Topics in the psychology of vocational education. Examples include: academic achievement (e.g., In addition, the dramatic impact of the COVID-19 pandemic on education systems around the world has given us insights into the impact of context in educational research. From the perspective of the psychology of vocational education, we have also gained a better understanding of the learning difficulties encountered by vocational education students and the teaching constraints of teachers when learning online. While it is important to understand successful stories, the reasons why they fail or succeed also need to be explored in order for us to understand the reasons. The results of these analyses can also help us understand how to effectively improve the design of online teaching and learning. In the post-epidemic era, vocational education is entering a new phase. Researchers, teachers and government agencies will be considering how to compensate for the impact of the COVID-19 epidemic on vocational education. This highlights the need for more research on teaching and learning to inform us of how up-to-date vocational education is.Furthermore, because of the COVID-19 epidemic, positive psychology has gained more attention in vocational education. Therefore, future research could be conducted on the role of helping people understand positive and negative emotions, career choices and career adaptation in the process of career development and construction, within the framework of occupational emotion theory. We can also use more positive psychology-related theories and variables to help us understand the psychology of vocational education.It is clear from the above that, given the specificity and importance of the psychology of vocational education, interdisciplinary research methods, theoretical foundations and statistical models are needed to help us understand it more comprehensively. As time changes, new variables and localized variables need to be proposed to explain more current situations. In addition, the development of research on the psychology of vocational education needs to take into account the characteristics of the localization, global trends and educational policy directions, as well as to extend the scope of the psychology of vocational education to different cultures, groups and contexts. It is also possible to expand the psychology of vocational education in different cultural groups and contextual contexts. The need for education encompasses many dimensions, from the Macrocosm, to the mesocosm, to the microcosm\u2014all need to be considered.Of course, the research themes in the psychology of vocational education are not limited to those mentioned above. We are also looking forward to a wider range of Research Topics to help us understand the situation of vocational education. Although the formal system of vocational education is only a few hundred years old, the concept of skill training has been around since the creation of civilization. The development of vocational talent has also been around for thousands of years. Therefore, it needs to be paid with more attention and importance.J-HY and M-YC: concept, design, and drafting of the manuscript. J-HY and Y-WH: critical revision of the manuscript. All authors contributed to the article and approved the submitted version."}
{"text": "Our aim was to analyze the strength of the family\u2019s influence on the internalization of the ideal of an athletic figure and, consequently, on the multifactorial image of the body, from the perspective of intercultural differencesA total of 488 healthy women aged 19\u201326; of Polish (154), Ukrainian (228), and Italian (106) took part in the study. The Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ-4) and the Multidimensional Body-Self Relations Questionnaire (MBSRQ 69) were used to measure athletic ideal internalization and family pressure. The body image of Ukrainian, Polish, and Italian women depends both on the degree of internalization the ideal of an athletic figure and influence of the familyThe research also suggests significant differences between the three populations, which may suggest cultural differences between young women living in Eastern, Central, and South European countries. The search for scientific evidence confirming the existence of sociocultural and family predictors explaining the specificity of the pursuit of the perfect body appearance and its musculature is a subject that increasingly inspires contemporary psychological research in nonclinical and clinical populations . The athThe image of an ideal female body, strongly promoted in the media in Europe  and the Research on the subject of the standards of an ideal fit and muscular body was more often conducted on male populations in various European countries \u201317 or thFewer studies have been conducted on women, who are traditionally tested for the pursuit of thinness rather than athleticism. Although there are few studies, their results seem to be consistent. On the one hand, internalizing the ideal of an athletic body can be as harmful as internalizing the ideal of a lean body and may be associated with effects such as eating disorders , 23, excThe literature review suggests the inconsistency of models describing the influence of sociocultural factors on the internalization of the athletic figure ideal. While peer pressure and family and media pressure are often seen as key variables in internalizing the slim ideal, causing body dissatisfaction and, consequently, eating disorders \u2014from Poland, Ukraine, and Italy. The intention of the sample selection was, among others, to examine the differences but also similarities in terms of the specificity of family influences on body image in young women brought up in families living in the Eastern (Ukraine), Central (Poland), and Western  European countries. On the one hand, striving to achieve the ideal of an athletic body and its internalization may be an expression of the implementation of pro-health behaviors of physical activity, but also, when applied excessively and restrictively, it may lead to the consolidation of bigorectic tendencies (behaviors).The study undertaken by the authors of this article aims to analyze the strength of the family\u2019s influence on the internalization of the ideal of an athletic figure and, consequently, on the multifactorial image of the body. The study of the family role seems to be particularly important in the analysis of the cultural specificity of the studied populations. The selection of women brought up in families and living in Ukraine, Poland and Italy reflects the potential degree of intensity of the influence of Western culture: Italy, the Western European country that has undergone \u201cwesternization\u201d for the longest time ; UkraineEven though these countries are at different stages of political and social transformation, all three seem to be influenced by Western culture today. However, what is particularly important, in all three countries, is that the family plays a large role in shaping the identity of young people, their system of values, and the transmission of attitudes and beliefs  tha tha46)] An important factor that could influence the obtained results is the period of data collection. The study was conducted during the COVID-19 pandemic, which could have influenced many of the factors considered in the study. Some studies suggest that during a pandemic, women may experience increasing difficulties in eating regulation, preoccupation with food, and deteriorating body image . TherefoDespite these limitations, however, the project appears to be a valuable contribution to the study of the body image of young women. The study is all the more valuable, as it indicates significant intercultural differences in the level of intensity of phenomena traditionally associated with nutritional psychopathology. This, in turn, suggests that research on risk factors and predictors of recovery disorders is insufficiently versatile and that there is a need to conduct research on these issues while considering sociocultural background.The research may be of application significance because the results may be used in the creation of educational programs. Evidence-based prevention programs may be more positively accepted by parents. Due to the comparisons of three cultural perspectives and family factors: Italy, Poland, and Ukraine in relation to the ideal of an athletic female figure and different ways of perceiving one\u2019s own body image, the results may be useful in building European programs for use in health prevention and working with young people on their image. Body and stimulating proper health behavior toward the body in the trend of \u201cbody positivity.\u201dThe raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by the Ethics Board for Research Projects at the Institute of Psychology, University of Gdansk, Poland (decision no. 33/2020). The patients/participants provided their written informed consent to participate in this study.BI, BB-K, and ML: conceptualization. SL and ML: methodology. BI and SL: formal analysis. BI, TY, NB, RO, ML, US-R, and BMR: investigation. BI, BB-K, and SL: data curation. BI, KG, BB-K, TY, NB, RO, SL, KS-W, US-R, BMR, and ML: writing\u2014original draft preparation. BI, BB-K, TY, NB, SL, KS-W, US-R, BMR, and ML: writing\u2014review and editing. BI, BB-K, KS-W, and ML: supervision. BI and ML: project administration and funding acquisition. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "In the published article, there was an error regarding the affiliations for Gianfranco Parati and Martino F. Pengo. They both have the following affiliations:Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy and Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy.The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated."}
{"text": "Access to and choices of food are doubtless beyond the realms of biological and nutritional needs. This does not mean that limitations to individuals\u2019 access to the social, cultural, economic, and psychological aspects should also be overlooked. Access to safe, nutritious, pleasant, sustainable, and healthy food for all individuals should be the focus of food producers, industries, services and policymakers ,2,3,4. IConsidering these premises and the continuous demand for, interest in, and topicality of the subject, as demonstrated in the Special Issue first edition , we promHealthy and sustainable food systems are essential in the efforts to meet increasing food security, nutrition and health demands . DespiteThere is great concern about animal products consumption and the impact of the practice on health and the environment. In this sense, the food industry and consumers are searching for alternatives to reduce animal product consumption globally. However, the use of plant-based foods as substitutes for animal products is challenging from technological, sensory, nutritional, consumer acceptance and sustainable points of view ,11. Furt"}
{"text": "Healthcare access and consequences of COVID-19 were assessed based on comparisons with months before its onset or an identical season in previous years. A general reduction of healthcare delivery, associated with the decline of care quality, and closure of many specialty services were reported. The impact was heterogeneous in space and time, with an increase in urban areas at the beginning of the pandemic (March-June 2020). The return to normalcy was gradual from the 3rd quarter of 2020 until the end of 2021. The impact of COVID-19 on the health system and its use was attributed to (a) conjunctural factors resulting from government actions to mitigate the spread of the epidemic ; (b) structural factors related to the disruption of public and private facilities and institutions, in particular, the health system; and (c) individual factors linked to the increase in costs, impoverishment of the population, and fear of contamination or stigmatization, which discouraged patients from going to health centers. They have caused considerable socio-economic damage. Several studies emphasized some adaptability of the healthcare offer and resilience of the healthcare system, despite its unpreparedness, which explained a return to normal activities as early as 2022 while the COVID-19 epidemic persisted. There appears to be a strong disproportion between the moderate incidence and severity of COVID-19 in sub-Saharan Africa, and the dramatic impact on healthcare access. Several articles make recommendations for lowering the socioeconomic consequences of future epidemics to ensure better management of health issues.This overview aimed to describe the situation of healthcare access in sub-Saharan Africa, excluding South Africa, during the COVID-19 pandemic. A PubMed The numbers of COVID-19 cases and deaths in sub-Saharan Africa (SSA), excluding South Africa which accounts for nearly half of the reported COVID-19 cases in SSA, have been lower than in other continents for reasons that remain unclear . HoweverAccording to the COVID-19 dashboard edited and updated daily by the WHO Africa Regional Office, the first cases of COVID-19 were detected in Nigeria on February 28, 2020, and in Senegal on March 2, 2020, in travelers .Access to healthcare requires that five specific dimensions be met: (a) availability, which reflects the adequacy between supply and demand, (b) accessibility, which implies geographical and logistical proximity between the patient and the health center, (c) accommodation, i.e. good quality services adapted to the needs of the public, (d) affordability for the population concerned, and (e) acceptability of the healthcare offered by people and health personnel .A review of the literature during the COVID-19 pandemic period provided an overview of the situation of healthcare access and use of the healthcare system by the population in SSA countries excluding South Africa. This study aimed to identify the main impacts of reduced access to care by mentioning the causes identified by practitioners and researchers involved in the pandemic.\u00ae was searched using the keywords \"COVID, Africa, Public health, Impact\" targeting publications published from March 31, 2020, to August 15, 2022. Articles were selected in two steps, without language restriction  , 101-103Across the SSA, there has been a decline in access to sexual and reproductive health services, institutional delivery, antenatal care, family planning, and HIV care. An increase in teenage pregnancies has been reported . In MozaChildhood vaccinations  have fallen sharply, leading to a worrying reduction in immunization coverage, raising fears of a resurgence of these diseases , 89, 108In specialty services, including cardiology, urology, rheumatology, radiology, oncology, ophthalmology, and dentistry, visits have declined by more than 50% or even stopped in some places , 117.People with chronic diseases had great difficulty accessing essential medicines during the COVID-19 lockdown, leading to deteriorating health conditions for most of them , 94, 113The decline in blood donation began as soon as COVID-19 was announced, leading first to an interruption in mobile blood drive campaigns and then to the closure of blood donation centers in most countries . In NigeThe impact of COVID-19 on health services was very heterogeneous across localities - generally higher in urban than in rural areas - and over time, with a strong increase in the first months of the pandemic, and then according to the epidemic waves, which were not synchronous in different countries , 112. A Vulnerable populations, including transgender people, sex workers, and drug users, were turned away from medical services, especially sexual and reproductive health services , 93.However, several studies noted a gradual improvement between epidemic waves and a certain capacity to adapt the healthcare supply , 112, anAccess to healthcare was directly affected by the governmental measures taken to contain COVID-19 , 108. ThInadequate health system preparedness was reported. It was due to (A) low availability of the health service, (B) inadequate resources and equipment, and (C) lack of appropriate testing, and therapeutic response for COVID-19 . The redA large proportion of the population refused to visit health centers for fear of contamination and stigma , 119.Many healthcare workers refused to care for patients for fear of contracting the virus themselves , 94, 99.The exacerbation of pre-existing barriers  has been highlighted by vulnerable populations to explain their reluctance to visit health centers , 118.Finally, all the specific dimensions necessary to maintain healthcare access - as described by Penchansky and Thomas  were hamNearly all studies showed a sharp decline in healthcare activity and access during the early months of the pandemic, followed by a gradual return to normal starting in the third quarter of 2020 and continuing through the end of 2021 . The hetIn any case, the authors are unanimous in describing the socioeconomic disorganization caused by the government measures, making them unacceptable to the population to the point that they were quickly relaxed. Three types of factors explained the decline in healthcare access: conjunctural, linked to government measures for the mitigation of transmission; structural, resulting from the dysfunction of the health system; and individual, involving the reactions of health personnel and the population.The Public Health and Social Measures Severity (PHSM) index can be applied to the governmental response to the epidemic  to assess its impact on the epidemic . A high Government restrictions have been responsible for the loss of huge numbers of jobs, especially in the informal sector, and resources that have led to a dramatic decline in purchasing power and prevented patients from accessing basic healthcare, which is their sole responsibility in most SSA countries , 57, 61.Finally, rumors (infodemia) from all sources, and misconceptions or misinformation about diseases and healthcare, contributed to discouraging people from attending health centers, but also to school dropout and a range of psychosocial consequences such as mental health disorders, domestic violence, and prostitution , 120.The overall unpreparedness of the health system  was obvious and greatly accentuated the disorganization of the health system caused by conjunctural factors , 118. AdThe health information system and mandatory reporting were severely disrupted, preventing surveillance and the implementation of targeted interventions . This maThe delay or reduction of many healthcares, interruption of services, mitigation of transmission risk strategies or recommendations, difficulties in the supply of drugs and health products, high cost of the latter, and the shortage of essential medicines discouraged people who suspended their seek for healthcare , 84, 94.Many factors have been put forward to explain the population's reluctance to travel, including visiting a health center. In addition to personal reasons, primarily the fear of contamination and resulting stigmatization, as well as the drop in income that limits many activities, conjunctural factors  and structural factors  explain the refusal to consult and the lack of access to healthcare. Fear of contamination, for themselves or their relatives, also concerned most health workers, especially those who had never experienced a major epidemic , 83, 118Several studies have successfully tested strategies to address the observed deficiencies. Improved service delivery relies on technological innovations and adaptations, such as the use of self-tests, telemedicine through telephone or videoconferencing for diagnosis or prescription of drugs, and the use of drones for the distribution of health products 37, 71. Patient flows and supply of health products, including personal protective equipment, need to be regulated , 46, 84.Training of health workers in patient intake and management, and improvement of alternative diagnostic and therapeutic techniques, such as appropriate drug dispensing  would help to anticipate difficulties that are bound to arise in accessing healthcare, in the supply of drugs, or health facility access , 119.The role of community health workers in the management of patients with conditions other than COVID-19, particularly in the most vulnerable slums and rural areas, requires stronger support and recognition , 85, 119Misinformation and rumors should be controlled by appropriate information strategies with clear and simple messages, targeting community and opinion leaders, including religious ones, artists, and trusted individuals , 38, 63.Finally, legislation on domestic violence and the maintenance of constant surveillance, including in times of restricted movement and social disorganization, should be adjusted , 76.This study was not intended to be exhaustive or to detail changes in healthcare access, but to identify the main impacts of COVID-19 on the organization and use of the health system in SSA. The outcomes of a literature review, such as this one, depend largely on the quality of the studies, i.e., their representativeness, the validity of the samples selected, and the relevance of the analyses performed. The procedures used to select the samples, the decision criteria, the presentation of the results and their discussion were not of the same quality according to the study, even if all the articles came from indexed peer-reviewed journals. In addition, health centers were not randomly selected, and some sample sizes were small. However, despite these limitations, the convergence of the raw data supported the validity of the results. The decline in healthcare access appeared in all studies with similar levels and kinetics over time, giving them credibility.The causes of the impact of COVID-19 on access to healthcare are multifactorial. However, restrictive government measures limiting travel, transport, supply, and the opening of public places, including shops and places of entertainment or worship, have blocked all social and economic activities with considerable deleterious consequences. The disorganization affected the whole of society, including the health system which was not prepared for it. In addition, at the individual level, the fear of contamination, reduction in income, economic and social disorder, in particular the loss of confidence in the health system, and stress increased by the infodemia explained the population's reluctance to healthcare access , 120. ThFortunately, although healthcare access was severely hampered , the retThis epidemic, coming after many others, such as the one due to the Ebola virus , will be"}
{"text": "Magnetic nanoparticles (MNPs) have been widely used for their potential applications, mainly for the diagnosis and/or therapy (theranostic) of several diseases in the field of nanomedicine, as passive contrast agents, through the opsonization process, or active contrast agents, after their functionalization and the subsequent capture of the signal using various techniques such as magnetic resonance imaging (MRI), optical imaging, nuclear imaging, and ultrasound. MNPs are also used as carriers for the delivery of drugs, which can be guided or accumulated through the action of a magnetic field, as well as magnetic biosensors in molecular imaging, magnetic separation, or therapeutic applications, such as the technique magnetic hyperthermia (MHT). These nanoparticles, when functionalized using different therapeutic agents, such as radionuclides, nucleic acids, and antibodies, can be used in combined therapies.The various configurations of MNPs in the design of structures, chemical compositions, and surfaces enhance their properties, giving the character of multifunctional nanoparticles and thus permitting their simultaneous use in several molecular imaging techniques in a non-invasive way, providing morphofunctional information in different moments, characterization and quantification of biological processes at the cellular and molecular levels, and accurate and timely diagnosis and individualized treatment of diseases . Technological innovations and the development of new tracers and intelligent probes have further promoted these multimodal imaging techniques, providing better contrast and functional, structural, and morphological information.This Special Issue of Pharmaceutics highlights advances in the development of MNPs and their applications in the field of diagnosis and therapy in various diseases in in vitro, in vivo, and ex vivo studies.Of the papers presented in this Special Issue, five papers studied therapies ,2,3,4,5,One of the therapeutic applications of MNPs is their use in the MHT technique, where, due to the MNP heating process, apoptosis of tumor cells is produced when an alternating magnetic field is applied. Therefore, in the publication by Andrade et al. , calciumThe publication by Abbas et al.  developeReferring to studies using MNPs for diagnosis, the work by Nucci et al.  determinIn the work of Li et al.  and HuanThe reviews by Gomez et al.  and AhmaIn general, in this Special Issue, original articles and literature reviews are published that allow for understanding the importance of MNPs and potentiate their functionalization aiming at theranostic processes, giving future perspectives to this type of nanomaterial."}
{"text": "The National School for Training in Mental Health Rehabilitation and Recovery at the Ono academic college operates under the auspices of, and is funded by, the Division for Mental Health Rehabilitation of the Israeli Ministry of Health. Intended to hone the quality of services provided, it offers numerous training courses, that target various populations associated with and working in the field of mental health recovery, among them clients and their family members, as well rehabilitation professionals and support personnel. The novel course of trauma and posttraumatic growth (PTG) was developed and aimed at supporting recovery, coping strategies and ultimately PTG through the lenses of both recovery and trauma informed care for psychiatric and support personnel, professionals with lived experience, and family members. It is built of eleven six hours long sessions with lectures, in-vivo assignments, and group supervision.Portray the development, implementation, and outcomes of the course from psycho-educational, clinical, social, and personal perspectives of students as well as the course\u2019s developers.A case study of the course that will be portrayed through qualitative anonymous testimonials from students\u2019 surveys and assignments, as well as the analyses of processes that the course underwent through the years.The course has several dimensions that allow the integration between trauma, recovery, and PTG in psychiatric rehabilitation: the integration between academia and research-based knowledge with experiential knowledge; integration between the perspectives of PTG and recovery; and, integration between social and cultural perspectives and person-centred care. In addition, the course promotes trauma-informed models in psychiatric rehabilitation; offers new perspective and implantation to psychiatric recovery-oriented tools so as to promote PTG; and enhances social support and cohesion within mental health services and personnel.The current case study portrays the unique processes of knowledge development, implementation, and training in psychiatric rehabilitation personnel, supported staff and people with lived experience. The course brings a focus on PTG as a promising addition to the trauma-informed approach in psychiatric rehabilitation, which is only scarcely linked to recovery.None Declared"}
{"text": "The occurrence of African swine fever has restricted the sustainable and healthy development of the hog industry and its ability to enhance the supply of pork, thus negatively impacting China\u2019s economic and social development. During 2018\u20132021, the resilience of China\u2019s hog industry improved due to the adjustments to the prevention and control mechanisms in African swine fever policy and the subsequent recovery of hog breeding and pork production. There are differences among the key factors influencing the resilience of the hog industry across different provinces and periods. These factors include the slaughter rate, carcass weight, mortality rate, culling rate, economic level, industrial structure, per capita consumption, scale level, resource carrying, etc. The aim of this study is to provide guidance for better prevention and mitigation of epidemic risks, thus promoting the high-quality development of the hog industry and meeting the nutritional needs of residents.African swine fever has damaged the foundation of China\u2019s hog industry, caused a serious decline in hog production, highlighted the contradiction between supply and demand in the pork market, and led to major economic and social impacts. The industrial resilience of 31 Chinese provinces to African swine fever shock and its spatial and temporal differentiation characteristics from 2018 to 2021 were measured in this study from the two dimensions of resistance and recoverability. Using Geodetector, the key factors influencing the resilience of China\u2019s hog industry were explored. The results showed that 2018\u20132019 and 2020\u20132021 represented the resistance and recovery periods of the hog industry under African swine fever shock, respectively, with poor resilience characterizing the resistance period and improved resilience characterizing the recovery period. At the early stages of the African swine fever outbreak, the hog industries in Tianjin, Shanxi, Guangxi, and Yunnan had robust resistance due to the slaughter rate, economic level, mortality rate, carcass weight, and culling rate in those areas. At the most severe stage of the outbreak, resistance was generally poor in all provinces due to the slaughter rate, per capita consumption, and scale level at the time. During the period of rapid recovery in hog production, the recoverability of each province was very strong due to the industrial structure, culling rate, economic level, and resource carrying capacity at that time. During the reasonable adjustment period of hog production capacity, the recoverability based on the breeding sow inventory in 13 provinces, including Henan, Shandong, and other large hog-breeding provinces, was negative due to the scale level, slaughter rate, per capita consumption, and resource carrying at that time. Taking measures to enhance the resilience of the hog industry, strengthen the prevention and control of hog epidemics, improve the monitoring and early warning mechanisms, and enhance the ability of the hog industry to cope with major animal epidemics is recommended. According to a traditional Chinese saying, \u201chogs and grain can stabilize the nation\u201d. The hog industry occupies a key strategic position in China\u2019s national economic and social development. Since the reform and opening up, the development of China\u2019s hog industry has achieved remarkable results, but it still faces many outstanding problems and practical challenges. In particular, the outbreak of African swine fever in 2018 had a significant negative impact on both the hog industry and the pork market, severely challenging the foundation of the industry, leading to a severe decline in hog production, exacerbating the contradiction between supply and demand in the pork market, and pushing up the prices of livestock products across the board. In 2019, the number of hogs slaughtered began to fall, declining by 21.6% year on year, and pork production fell by 21.3%. In addition to the impact of cyclical factors, the effect of the African swine fever shock on hog price fluctuations that began in the second half of 2019 was exceptionally obvious, with prices surging and becoming an important factor driving up China\u2019s consumer price index (CPI). At the same time, African swine fever caused major problems, such as a shortage of breeding sows, the retention of ternary sows, and the low productivity of sows in general, which severely impaired the sustainable development of the hog industry. Compared to the hog epidemic and avian influenza of previous years, the impact of African swine fever was much greater and deeper and had more obvious and negative effects on China\u2019s national economic development, as well as on the production and lives of the Chinese people.To cope with the negative impact of African swine fever and accelerate the recovery of hog production, the Chinese government has intensively launched a series of policy initiatives, including infrastructure, agricultural machinery purchase, manure resource utilization, standardization demonstration, resumption of production support, epidemic prevention and control, finance and insurance, etc., which have entailed breakthroughs in terms of land use, prohibition, and breeding restriction policies. In 2022, China\u2019s hog inventory reached 452.56 million heads, which was up 0.7% from the previous year, when the breeding sow inventory reached 43.90 million heads, representing an equivalent increase of 1.4%; hog slaughter reached 699.95 million heads, increasing by 4.3%; pork production reached 55.41 million tons, increasing by 4.6%; and hog production capacity was set within a reasonable range. According to another traditional Chinese saying, \u201cFamily money with animals does not count\u201d, referring to the major risk of animal disease incurred in livestock breeding. At present, China still faces challenges, including a wide range of diseases, considerable capacity issues with respect to total hog breeding capacity, weak epidemic prevention and control, and a large risk of the introduction of foreign animal epidemics into the country. The future prevention and control of major animal epidemics cannot be ignored. In this context, to accelerate the improvement of hog industry resilience, building a safe and effective pork market \u201cdefense system\u201d is of great practical importance.There are currently no domestic or foreign studies on the resilience of China\u2019s hog industry and its influencing factors, and the related literature has placed a greater focus on exploring the relevant impact mechanisms. Studies have concluded that epidemics exert a high negative impact, can cause severe economic losses, and pose a major threat to the livelihoods of farming households in developing countries ,2,3. EpiEpidemics have a major impact on price fluctuations in the hog market, and \u201cbehind every round of large swings in hog prices, there is a lingering shadow of epidemic disease\u201d ,16,17. UThus far, the literature on resilience has focused on the agricultural and macroeconomic fields, and its research paradigm and research methods have important reference value for this study. From the perspective of agricultural resilience, factor analysis, coupling coordination degree, and other methods have been used in the literature to study the characteristics, laws, and synergistic strength of agricultural economic resilience and high-quality agricultural development ; the entConsidering that the resilience of China\u2019s hog industry has not been systematically measured in the literature, and that the relevant influencing factors have yet to be explored, examining resilience is of great practical importance for promoting the stable and orderly development of the hog industry and ensuring the safe and effective supply of the pork market. Therefore, two core variables, namely, the inventories of hogs and breeding sows, were selected for this study, and the industrial resilience and spatial and temporal characteristics of 31 provinces that faced the impact of African swine fever in 2018\u20132021 were systematically measured. In the study, the two dimensions of resistance and recoverability are used, the influencing mechanism of the resilience of China\u2019s hog industry is investigated through Geodetector, and relevant countermeasures and recommendations for policy and production decisions are finally proposed.Based on the theory of regional economic resilience, two indicators were selected\u2014namely, the inventory of hogs, and that of breeding sows\u2014as the core variables of this study, used to measure the resilience of the hog industry to the impact of African swine fever by measuring its resistance and recoverability. Resistance focuses on the ability of the hog industry to avoid the decline caused by the impact of African swine fever, while recoverability focuses on the ability of the hog industry to adapt and recover through its own vitality, external thrust, and other factors. Under the impact of African swine fever, this study focuses on the resistance of the hog industry to falling from its normal level and the recoverability of the hog industry from such a fall back to its normal level.rResistance denotes the resistance of the hog industry, iresV denotes the inventory of hogs or breeding sows in province r in year i during the resistance period, and i\u2212V1res denotes the inventory of hogs or breeding sows in province r in year i \u2212 1 during the resistance period.The formula for calculating resistance is as follows:rRecoverability denotes the recoverability of the hog industry, irecV denotes the inventory of hogs or breeding sows in province r in year i during the recovery period, and i\u2212V1rec denotes the inventory of hogs or breeding sows in province r in year i \u2212 1 during the recovery period.The formula for calculating recoverability is as follows:q denotes the driving force explanatory factor, which has a value range of 0\u20131. A larger value indicates that the influencing factor has a higher degree of explanation regarding the resilience of the regional hog industry; h = 1,2 \u2026; L is the number of classifications; hN and N denote the number of sample units in stratum h and in the whole region, respectively; and h\u03c32 and \u03c32 denote the variance in stratum h and in the whole region, respectively.In this study, Geodetector was used to detect the relationships between various factors and the resilience of the hog industry in each province of China, and to search for the factors with the most explanatory power. Geodetector is a statistical method used to detect spatial heterogeneity and reveal the driving force(s) behind it, including factor detection, interaction detection, risk area detection, and ecological detection . The speTo explore the key factors that affect the resilience of the hog industry, regional economic theory, the actual development of the hog industry, and the existing research foundation were combined for this study, and the four dimensions of the development foundation, scientific and technological support, basic security, and epidemic shock were analyzed. Regarding the development foundation, four main indicators were considered: economic level, industrial structure, market share, and per capita pork consumption. Regarding scientific and technological support, four main indicators were considered: hog slaughter rate, carcass weight, scale breeding degree, and labor productivity. Regarding basic security, three main indicators were considered: the comparative efficiency of hog breeding, resource carrying capacity, and technical service level. Finally, regarding the epidemic shock, three main indicators were considered: the number of cases, mortality, and the culling rate of African swine fever. In general, the better the development foundation of the hog industry, the higher the level of scientific and technological support and basic security, and the more robust the resilience of the hog industry. Furthermore, the more intense the impact of African swine fever, the weaker the resilience of the hog industry. The relevant influencing factors and the methods for calculating the resilience of China\u2019s hog industry are shown in China Statistical Yearbook, the China Animal Husbandry and Veterinary Yearbook, the National Compilation of Cost and Benefit Information of Agricultural Products, and the Official Veterinary Bulletin of the Ministry of Agriculture and Rural Affairs of the People\u2019s Republic of China. Some of the data were specifically treated in the following ways: (1) Tibet lacks market prices for hogs and corn, so they were replaced in this study with the corresponding average prices across the country. (2) Labor productivity in hog breeding is measured by the ratio of total output value per head to the average number of laborers on large, medium, and small farms; however, there is a lack of data for the small farms in Beijing, Shanghai, and Tibet. For medium farms, there is a lack of data for Shanghai and Tibet. Finally, for large farms, there are data gaps for Tibet and Ningxia. Therefore, national average data were utilized to fill these gaps in this study.The period of 2018\u20132021 was chosen as the research period because the African swine fever outbreak began in 2018, while by 2021 the epidemic was better controlled and hog production had recovered to its previous normal levels. The study unit consisted of 31 provinces in China, excluding Hong Kong, Macau, and Taiwan. The basic data for this study were obtained from the Before examining the resilience of the hog industry and its influencing factors, it was necessary to identify the resistance and recovery periods for the hog industry. After the African swine fever outbreak was first diagnosed in China\u2019s Liaoning Province in August 2018, it spread rapidly across the country in just eight months. The inventories of hogs and breeding sows decreased by 3.04% and 4.71% in 2018 compared to the previous year, respectively, and by 27.50% and 27.70% in 2019 compared to the previous year, respectively. At the end of 2019, the Chinese government formulated and implemented the Three-Year Action Program for Accelerating the Resumption of the Development of Hog Production to promote the accelerated recovery of hog production to its normal levels in previous years. In 2020, the inventories of hogs and breeding sows increased by 30.96% and 35.09%, respectively, compared to the previous year, and the production capacity of hogs effectively recovered to a normal level in 2021, increasing by 10.51% and 4.02%, respectively, compared to the previous year . TherefoBased on this, and considering the hog industry resilience measurement method and basic data, the resilience of the hog industry and its spatial and temporal characteristics were calculated. In terms of resistance, in the early stages of the African swine fever outbreak, i.e., 2018, Tianjin, Shanxi, Guangxi, and Yunnan all had positive resistance, and the positive resistance of Shanxi and Xinjiang was based on the inventory of breeding sows, indicating that the hog industry in these provinces was not negatively affected by African swine fever and maintained a relatively normal development trend. The five provinces with the worst resistance were Beijing, Shanghai, Fujian, Ningxia, and Tibet, which are all areas with relatively weak hog breeding bases; Liaoning Province, where African swine fever was first diagnosed, was also hit relatively hard. The main reason for this was the outbreak of African swine fever that occurred in the second half of 2018, which spread quickly and widely in a relatively short period. During that period, however, the epidemic had not yet spread to all parts of the country, and there were still some areas that had not been affected or were less affected by the epidemic.In 2019, when African swine fever was at its most severe state, aside from the positive resistance level of the hog industry in Ningxia based on the inventory of breeding sows, the resistance of other provinces as based on hog or breeding sow inventories was negative, indicating that the resistance of the hog industry was generally poor during the most severe period of the epidemic. The main reason for this was that African swine fever had appeared in China for the first time, and neither government departments nor hog farmers had mature knowledge or experience in epidemic prevention and control. This fact, coupled with irrational epidemic prevention and control policies and a poor level of epidemic awareness, caused a more serious market panic and artificially deepened the impact of African swine fever. The five provinces with the worst resistance based on hog inventories were Beijing, Jiangsu, Hainan, Qinghai, and Shanghai, and the five provinces with the worst resistance based on breeding sow inventories were Beijing, Hainan, Qinghai, Jiangsu, and Guangdong. From the point of view of large hog-farming provinces, Hunan, Sichuan, and Yunnan Provinces were affected by the impact of African swine fever to varying degrees, but the resistance was high, and the impact was contained to a relatively moderate level.In terms of recoverability, when the recovery of hog production accelerated, in 2020, the recoverability of the hog industry in 31 provinces was positive based on the inventories of hogs or breeding sows, indicating that the hog industry nationwide had been showing continuous accelerated recovery and had strong recoverability. The top five provinces in terms of recoverability based on their hog inventories were Beijing, Jiangsu, Qinghai, Shanghai, and Tibet, and the provinces at the bottom of this ranking were Shaanxi, Jilin, Guangxi, Guizhou, and Heilongjiang; the top five provinces in terms of recoverability based on the breeding sow inventory were Qinghai, Jiangsu, Beijing, Shanghai, and Hainan, and the provinces at the bottom of this ranking were Tibet, Shaanxi, Guangxi, Jilin, and Yunnan. The reason for the generally strong resilience of the hog industry in 2020 was mainly that the government had implemented a series of policies to prevent and control African swine fever and had vigorously promoted and supported hog farming, which included the issuance and implementation of policy documents such as the Three-Year Action Program for Accelerating the Resumption of the Development of Hog Production, which resulted in a very high level of activism among local governments and large-scale farms, aimed at resuming and expanding hog farming. During the piglet shortage period, for the rearing and expansion of the purchase of hogs, ternary sows or backcross sows bred as binary sows, crossbred sows bred as purebred hogs, and other phenomena became more frequent among many farm households; moreover, the birth of foreign piglets was pursued by domestic hog farms.In 2021, two provinces showed negative recoverability based on their inventory of hogs, namely, Ningxia and Shanghai, while the recoverability based on the inventory of breeding sows was relatively more negative, spanning 13 provinces, including Henan, Shandong, and other large hog-breeding provinces. The main reason for this is that, in 2020, the year of accelerated recovery of hog production, many farm households blindly and disorderedly expanded the healthy development of the hog industry, which caused potentially severe problems. It has also been factually demonstrated that due to the unregulated expansion of hog farming, hog market prices in 2021 appeared to fall off a cliff and experienced the strongest \u201chard landing\u201d, which resulted in many farms experiencing the \u201cepidemic impact loss\u2013high price profits\u2013price plunge loss\u201d \u201croller coaster\u201d of the \u201csecond blow\u201d. To ensure the orderly development of the hog industry, the Ministry of Agriculture and Rural Affairs of the People\u2019s Republic of China issued and implemented the Hog Production Capacity Control Implementation Plan  in 2021, which clearly proposed stabilizing the hog production capacity within a reasonable range. The 14th Five-Year Plan period had the effect of stabilizing the normal retention of breeding sows at approximately 41 million, with a minimum retention of no less than 37 million, causing many provinces to reduce the numbers of breeding sows.In this study, the resistance and recoverability of the hog industry in each province was taken as the dependent variable, and 14 indicators in four dimensions, i.e., development foundation, scientific and technological support, basic security, and epidemic shock, were taken as independent variables. After the data of the independent variables were discretized by using the natural breakpoint method of ArcGIS, we applied the factor detection and interaction detection of Geodetector to analyze the resistance and recoverability of the hog industry in China. The spatial differentiation of the factors affecting the resistance and recoverability of China\u2019s hog industry was also analyzed. Regarding the factors that influence resistance in the hog industry, in the early stages of the African swine fever outbreak in 2018, the five indicators with the highest explanatory power regarding resistance based on the inventory of hogs were the slaughter rate, economic level, mortality rate, carcass weight, and culling rate, while the five indicators with the highest explanatory power regarding resistance based on the inventory of breeding sows were the slaughter rate, economic level, carcass weight, mortality rate, and culling rate. Contrasting these two sets of factors, one can see that they appear to be the same indicators, revealing that the scientific and technological support capacity, the economic development level, and the epidemic shock had a large impact on the resistance of the hog industry in the early stages of the African swine fever outbreak. The higher the level of economic development, the more fundamental advantages the development of the hog industry has, and the stronger its resistance. The more severe the African swine fever shock, the greater the impact on the hog industry and the weaker its resistance. In general, the slaughter rate and carcass weight reflect the level of scientific and technological development, and these factors show a positive relationship with the resilience of the hog industry, i.e., the higher the slaughter rate and the carcass weight, the stronger the resilience of the hog industry. However, the extent of the impacts in the early stages of the African swine fever outbreak cannot be solely based on the general situation, as this extent is affected by information asymmetry and many other factors. Many farmers who were experiencing market panic and other influences accelerated their slaughter activities, which resulted in a substantial increase in the hog slaughter rate and a sharp decrease in carcass weight. The slaughter rate and the carcass weight at that time both demonstrated that simply increasing the level of industry resilience is not sufficient.In 2019, when the African swine fever outbreak was at its worst, the five indicators with the highest explanatory power for resistance based on the hog inventory were the slaughter rate, per capita consumption, scale level, economic level, and the number of cases, while the five indicators with the highest explanatory power for resistance based on the breeding sow inventory were the per capita consumption, slaughter rate, technical service, labor productivity, and scale level. When contrasting these two sets of indicators, it can be seen that the indicators for both resistance bases were the slaughter rate, per capita consumption, and scale level. As mentioned above, when an outbreak of African swine fever occurs, many hog farmers accelerate their slaughter efforts, resulting in a different slaughter rate from that of normal years, and the abnormal slaughter level of hog farming is directly related to a lack of resilience. During the period of African swine fever\u2019s most serious impact, large-scale farms had a better foundation and stronger advantages than small-scale farms and free-range farmers, and their resistance to the impact of African swine fever was greater. This is because the higher the scale level, the greater the resistance and resilience of the hog industry. The epidemic impact also caused a decline in hog production capacity that led to pork supply shortages, and residents\u2019 consumption and other demand-side factors became important factors affecting the resistance of the hog industry.Regarding the factors influencing the recoverability of the hog industry, in 2020, which was the year of rapid recovery in hog production, the five indicators with the highest explanatory power for recoverability based on the inventory of hogs were industrial structure, slaughter rate, culling rate, economic level, and resource carrying capacity, while the five indicators with the highest explanatory power for recoverability based on the inventory of breeding sows were resource carrying capacity, labor productivity, culling rate, economic level, and industrial structure. The shared indicators were the industrial structure, culling rate, economic level, and resource carrying capacity. The industrial structure reflects the advantages of the hog industry. The higher the industrial structure, i.e., the higher the proportion of the output value of the hog industry in the total agricultural output value is, the more dominant the hog industry is in the region, the better the foundation for its development, and the more robust its recovery and resilience. The culling rate reflects the severity of the impact of African swine fever; hence, the higher the culling rate, the more severe the epidemic and the greater the threat to the resilience of the hog industry. In addition, hogs are grain-fed livestock. Thus, the better the resource base is, the stronger the carrying capacity, the more secure the feed grain for the development of the hog industry, and the stronger its recoverability and resilience. The mechanism of influence of the economic level on the resilience of the hog industry is the same as that noted above.In 2021, when hog production capacity was reasonably adjusted, the five indicators with the highest explanatory power for recoverability based on the hog inventory were the scale level, slaughter rate, resource carrying, per capita consumption, and economic level, while the five indicators with the highest explanatory power for recoverability based on the breeding sow inventory were the scale level, slaughter rate, per capita consumption, labor productivity, and resource carrying. Contrasting these two sets of indicators, the indicators that apply to both are the scale level, slaughter rate, per capita consumption, and resource carrying capacity. The degree of scale and the slaughter rate reveal the level of scientific and technological support during the reasonable adjustment period of hog production capacity. Scale is the inevitable requirement for the high-quality development of the hog industry, and the slaughter rate reflects the scientific and technological level under normal circumstances. Both had a positive impact on the recoverability and resilience of the hog industry in the adjustment period of hog production capacity. The influence mechanism of per capita consumption and resource carrying capacity is consistent with the above.Regarding the results of the interaction detection for resistance and recoverability in the hog industry, it can be seen that the effect of any two factors interacting on the resistance and recoverability divergence pattern of the hog industry is greater than the effect of any one factor alone on the spatial divergence pattern of resistance and recoverability, indicating that the relevant effects of the resilience of the hog industry are all integrated effects. In addition, the resistance based on the inventory of hogs underwent a two-factor enhancement of 27 in 2018, and the corresponding number of two-factor enhancements for resistance and recoverability in the period 2019\u20132021 was 16\u201317; resistance based on the inventory of breeding sows was a two-factor enhancement of 26 in 2018 and of only 3 in 2019, and the corresponding two-factor enhancements for recoverability in 2020\u20132021 were all 11; all remaining factor interactions were nonlinear enhancements. For example, the scientific and technological support factor and the epidemic shock factor together affected the resilience of the hog industry. Epidemic shock will inevitably affect the scientific and technological support factor, and when African swine fever occurs, indicators such as the hog slaughter rate will be affected to varying degrees. In 2018\u20132019, China\u2019s hog slaughter rate was significantly higher than the normal annual level, at 162.04% and 175.32%, respectively.In this study, we applied two core variables, namely, the inventory of hogs and that of breeding sows. We measured the industrial resilience and its spatial and temporal characteristics in 31 provinces of China that were faced with the impact of African swine fever, from the perspectives of both resistance and recoverability. We then explored the influence mechanism of the resilience of China\u2019s hog industry using Geodetector, and we obtained the following research conclusions:First, the periods of 2018\u20132019 and 2020\u20132021 represent the resistance and recovery periods of the hog industry under the impact of African swine fever, respectively, with the industry showing poor resilience in the resistance period and good resilience in the recovery period. The increase in the resilience of China\u2019s pork industry was mainly due to the adjustment of the policy for the prevention and control of African swine fever, as well as the implementation of the policy for the recovery of hog breeding and pork production.Second, there were differences in the resistance and recoverability of the hog industry across different provinces and periods under the impact of African swine fever. In the early stages of the African swine fever outbreak, Tianjin, Shanxi, Guangxi, and Yunnan had strong levels of resistance. In the most severe stage of the African swine fever outbreak, the resistance of the hog industry in all provinces was generally poor. In the period of rapid recovery in hog production, the recoverability of all provinces was very strong. In the reasonable adjustment period of hog production capacity, the recoverability of the 13 provinces, including Henan, Shandong, and other large hog-breeding provinces, was negative based on their inventories of breeding sows, which resulted from active policy regulation.Third, there were differences in the key factors that influenced the resilience of the hog industry across different provinces and different periods. In the early stages of the African swine fever outbreak, the slaughter rate, economic level, mortality rate, carcass weight, and culling rate had the highest explanatory power for the resistance of the hog industry; in the most severe period of the African swine fever outbreak, the slaughter rate, per capita consumption, and scale level had the highest explanatory power for the resistance of the hog industry. In the period of rapid recovery in hog production, the industrial structure, culling rate, economic level, and resource carrying had the highest explanatory power for the recoverability of the hog industry. Finally, in the reasonable adjustment period of hog production capacity, the scale level, culling rate, per capita consumption, and resource carrying had the highest explanatory power regarding the recoverability of the hog industry.Based on the above research conclusions, the following countermeasures are suggested: First, the level of resilience of the hog industry should be improved. It is necessary to accelerate the construction of the modern hog industry system, production system, and business system, to promote the modernization of breeding, processing, circulation, sales, and other high-quality development factors of the entire industry chain, and to further enhance the resilience of the industry chain, supply chain, and security level. We need to continuously cultivate new industries, new forms, and new modes, focus on improving the levels of industrial integration and development, further extend the industrial chain, improve the value chain, stabilize the supply chain, and enhance the resilience of the hog industry by internalizing risks. We should strengthen disaster prevention, mitigation, and relief capacity building, support the hog breeding insurance system (particularly regarding the prevention and control of major epidemics), and further consolidate the risk prevention foundation of the hog industry, as well as its risk transfer capacity.Second, the prevention and control of hog epidemics should be strengthened. The initiative, foresight, and precision of epidemic prevention and control policies should be enhanced, and short-term emergency response, long-term effective response, and market shock regulation and control should be improved. The construction of a hog disease prevention and control system should be promoted by comprehensively covering both the industrial chain and the supply chain, including breeding, slaughtering, processing, circulation, and sales. We need to strengthen the establishment of grassroots animal disease prevention and control teams and enhance the level of technical training. We should optimize biosecurity, culling, vaccination, and other means of prevention and control, and improve epidemic reporting, culling subsidies, and other systems. We should strengthen the integration and demonstration of technologies for the prevention and control of major animal diseases, including African swine fever, and widely promote effective models for epidemic prevention and control. We must accelerate the promotion of innovation in key core technologies for the prevention and control of major animal diseases, and promote scientific research on African swine fever vaccines.Third, the monitoring and early warning mechanisms should be improved, as should the mechanisms underlying hog epidemic risk identification, market monitoring and early warning, and the regular release of information, reports, and plans. We should concentrate professional talents in the fields of agricultural economics and information technology, rely on big data, cloud computing, and other intelligent technologies, scientifically collect international and domestic information, conduct real-time simulations, and make response plans. Based on one national standard and one set of data, the uniformity and authority of information should be improved. We need to abandon the \u201cinternal reference\u201d and other old concepts and old ways, so that the data and information are open and transparent to the whole society, and every producer, consumer, researcher, and policymaker can access the relevant information to avoid market panic and confusion."}
{"text": "Colomesus, we conducted a survey the parasite fauna of Colomesus tocantinensis collected from the Tocantins River, Brazil. We first recorded the presence of the ectoparasites Ergasilus colomesus and Lernaea sp. where 96.77% of the fish were parasitized.Considering the lack of studies on freshwater fishes of the genus  The Tocantins River is composed of the Tocantins-Araguaia basin and is located in the Legal Amazon. It originates in the state of Goi\u00e1s and runs northward for 2500 km, passing through the states of Tocantins, Maranh\u00e3o, and Par\u00e1 . The TocColomesus comprises only three fish species, two of which are freshwater: Colomesus asellus  and C. tocantinensis Amaral et al., 2013, both endemic to South America and distributed throughout the Amazon and Tocantins-Araguaia basins, respectively  in 2018. The procedures for necropsy of the hosts and collection, preservation, and preparation of parasites were performed according to the methods reported by Thirty-one individuals of Lernaea sp.  are freeborn, and after actively infecting the host, they undergo metamorphosis until they reach the adult stage and reproduce , and aposematism  , which cividuals , it is uC. tocantinensis, analyzing for the first time the record of two species of ectoparasites (Lernaea sp. and E. colomesus) for this host. We emphasize the need for further study, as existing studies on the biology and ecology of this species are limited.Our study provides new insights on the parasitic fauna of"}
{"text": "The authors would like to clarify the affiliation list of the published article to correctly show where the work was conducted. In the original article, the affiliation at the time of publication of one author (Ramzi Dhahri) was listed as Laboratory of Physics of Materials and Nanomaterials Applied to the Environment, Faculty of Sciences of Gabes, University of Gabes, Erriadh, 6079, Gabes, Tunisia. However, this author also had a second affiliation which was regretfully omitted: Department of Physics, Faculty of Sciences and Arts, Najran University, P.O. Box 1988, Najran, 11001, Saudi Arabia. The corrected list of affiliations at the time of publication of the original article is presented here.The Royal Society of Chemistry apologises for these errors and any consequent inconvenience to authors and readers."}
{"text": "It is with deep sorrow that we mourn the passing of the virologist Professor Jianguo Wu. He devoted his life to the research of viruses, and was still working until the end of his life. His death is a great loss to the international virology community. Here, we summarize his significant contributions to the development of virology, the construction of scientific research platforms, and social services in epidemic prevention and control. Through commemorating our beloved virologist, we are inspired to continue to work hard in his spirit of persistent struggle against viruses.Professor Jianguo Wu was born in Jishui County, Ji\u2019an, Jiangxi Province, China. From 1978 to 1985, he studied at Wuhan University and engaged in virology research. He went to the United States in 1989 and obtained his Ph.D. in biochemistry from the University of Idaho in 1992. From 1993 to 1996, he engaged in postdoctoral research in molecular biology at Princeton University, and he worked here as a research fellow for another 3 years. In 1999, he resolutely gave up the preferential treatment in the United States and went back to his motherland, China. He worked diligently at Wuhan University for more than 20 years. After retiring, he continued to engage in teaching and research at Jinan University, and also made remarkable achievements there. As soon as the COVID-19 pandemic broke out, he devoted himself to work on SARS-CoV-2 testing and research until the end of his life.Professor Wu conducted virology research with an emphasis on elucidating the molecular mechanisms of infection, immunity, and the pathogenesis of important human viruses, and the molecular epidemiology of newly emerging viruses. He was devoted to the study of the pathogenesis of human hepatitis B virus (HBV) and hepatitis C virus (HCV). He revealed several important functions of hepatitis B virus x protein (HBx), like its roles in cell apoptosis, transformation, and tumorigenesis ,2,3. TheThe influenza virus has been endangering the life and health of human beings for a long time. Professor Wu was also committed to investigating the epidemiological characteristics of influenza viruses , exploriEnteroviruses, particularly Enterovirus 71 viruses, always attracted Prof. Wu\u2019s research interest. He made great achievements in studies about the epidemiological characteristics ,38 and mAfter retiring from Wuhan University, Professor Wu\u2019s focus shifted to the Pearl River Delta area in China, where Zika and Dengue, of flavivirus, are the more prevalent viruses in the region. He reported the molecular epidemiology and molecular mechanisms of the pathogenesis of Dengue virus , and revThe outbreak of SARS and COVID-19 brought great harm to society, and Prof. Wu conducted in-depth and systematic research on SARS-CoV and SARS-CoV-2 ,55. TheiIn addition to the studies on the viruses mentioned above, Wu\u2019s team also explored the molecular pathogenesis of viruses including Epstein\u2013Barr virus (EBV) , HIV-1 , mumps vAs a national high-level talent introduction, Professor Wu\u2019s scientific research career was supported by governments at all levels. He presided over more than 30 scientific research projects, including major national science and technology projects, 973 national program projects, and key projects of the National Natural Science Foundation of China. When returning to China and taking up his post at Wuhan University, he devoted himself to the establishment of the State Key Laboratory of Virology (SKLV), played an extremely important role in the establishment of the SKLV, and worked as its director from 2006 to 2016. After retiring, Prof. Wu continued to shine in the virology field. He worked as the president of the Institute of Medical Microbiology at Jinan University . He and Under the leadership of Prof. Wu, these research platforms have produced good scientific output, served local education and scientific research, and contributed to local economic development.Throughout his career, Prof. Wu made outstanding achievements. He published over 230 papers in scientific journals, and he was selected as one of the most cited Chinese Researchers in 2021 by Elsevier. He was also granted 32 authorized national invention patents. During the COVID-19 pandemic, Professor Wu\u2019s company  donated free disinfection and sterilization products to the community, which solved the problem of supply shortage. This selfless dedication received praise from the local government . In recognition of his outstanding contribution, he received 30 awards in the last 25 years. They included the first prize for Natural Science in Hubei Province, the second prize for Natural Science in Yunnan Province, the second prize for life chemistry research in Yaoming Kant, the first prize for outstanding team in the implementation of national science and technology plan, and the first prize for excellent academic papers in Natural Science in Hubei Province. His honors also include a special allowance provided by the government of the State Council, Excellent Foreign Experts of the People\u2019s Government of Hubei Province, Top Ten Young and Middle-Aged Experts with Outstanding Contributions in Hubei Province, Advanced Individuals of New Overseas Chinese Entrepreneurship in Hubei Province, etc. In short, Prof. Wu made indelible contributions to education, virology research, and the welfare of society. He achieved many great things in his short life. We pay tribute to our beloved teacher with this article to express our deep thoughts for him."}
{"text": "The German immigration to the state of Rio Grande do Sul (RS), Brazil, began in the 1920s. Between 1824 and 1922, 142 German colonies were created in Rio Grande do Sul, and it is estimated that, in this period, about 50 thousand Germans arrived in the state..In this group of immigrants, Augusto Heinrich Rohde, Luiz Rohde's great-grandfather, arrived in 1857. On January 14, 1936, Luiz Rohde was born, the youngest son of Augusto Em\u00edlio and Erna Rohde, fruit of a union that generated eight children, in the locality of Para\u00edso do Sul, in the municipality of Cachoeira do Sul, 200 km from Porto Alegre (RS), in the central region of the stateAfter an initial school education in his region, in Cachoeira do Sul, Luiz completed the high school and soon the inclination to study medicine arose. Since then, it could be noted in the young Luiz Rohde marks that would be perennial in his character and in the example he would set for all those who were his students in the future: discipline, rectitude, education, and concern for the well-being of all with whom he had the opportunity to know and relate to.He studied medicine at Universidade Federal de Santa Maria, where he joined in 1955 and concluded in 1961, having been chosen valedictorian of the class. At the same institution, another characteristic of Rohde was already evident: in the graduation speech, he drew attention to the need for creating a local university hospital to improve the training of doctors. Therefore, very early on he had the vision of what would be most important for the education of medical students. After completing the medical course, he was accepted, by a public tender at the University of S\u00e3o Paulo (USP), in the state of S\u00e3o Paulo (SP), in the residency in General Surgery, from 1962 to 1964.It was also in 1964 that Luiz Rohde married Vera Guedes Paim, newly graduated from the dermatology residency at the Federal University of Rio Grande do Sul (UFRGS). They had two children: Luis Augusto and Luis Eduardo. They also chose to study medicine and pursue teaching like their father, and are currently full professors at UFRGS, respectively, in psychiatry and cardiology. The example of the medical parents stimulated the development of their careers, being nowadays two of the most outstanding professors at the university with worldwide relevance in their fields. In addition, they gave Luiz Rohde some of his greatest joys: his grandchildren Catarina and Pedro, and the latter is also studying medicine to take forward the third family generation in the profession chosen by Luiz Rohde.Funda\u00e7\u00e3o Faculdade Cat\u00f3lica de Medicina de Porto Alegre \u2013 FFCMPA) , working at this institution for 22 years.In 1965, after returning to Porto Alegre, Rohde took over as an assistant professor at the Catholic College of Medicine of Porto Alegre , in 1975.There were hundreds of students and over a hundred residents in General and Digestive Surgery who had the privilege of being trained by Professor Luiz Rohde over the years. He was chosen as an honoree or class sponsor of the medical classes of 1967, 1968, 1969, 1972, 1973, 1974, 1980, 1981, 1983, and 1984. At FFCMPA, he developed his full potential as a teacher, surgeon, and researcher. He defended his Titular Professor thesis entitled While working at the Santa Casa de Miseric\u00f3rdia de Porto Alegre, a teaching hospital of that institution, he was head of the surgical wards number 30, 40 and 36, the latter known throughout the state since then as the \u201cInfirmary of Professor Rohde,\u201d where most of the graduates who opted for surgery longed to intern.Hospital de Cl\u00ednicas de Porto Alegre \u2013 HCPA) was just beginning its activities, he worked in the infirmary of Santa Casa, under the coordination of UFRGS, thus being able to develop activities in both schools at the same hospital.Rohde also dedicated himself to the Federal University of Rio Grande do Sul. Hired as a professor in 1978, by public tender, at a time when the General Hospital of Porto Alegre , and Bariatric Surgery Group. He has repeatedly advocated the importance of sub-specialization as a source of improvement in specialized medical care for patients and teaching and research in the Department of Surgery and in HCPA in the area of digestive surgery. Subsequently, he was elected head of the General Surgery Service of HCPA in 2005/2006.During the period in which he was head of the Department of Surgery, he strongly acted on the teaching of General Surgery to students and residents, creating the subareas and groups of surgical activity in the digestive tract: Esophageal and Stomach Surgery Group, Liver Group, Pancreas and Bile Duct GroupFaculdade de Medicina \u2013 FAMED) of UFRGS. Driven by the occasion of the centenary of UFRGS, in 1998, Rohde led a bold project to build the new FAMED building, bringing it to the HCPA, forming the current Health campus with other related schools. Thus, the visionary and pioneering side of Luiz Rohde appeared in a way that left an enduring legacy, gathering FAMED students in his teaching hospital in a definitive way.In 1993, he was elected director of the School of Medicine , alongside his friend Henrique W. Pinotti and other colleagues, gathering prominent specialists in the field of Digestive Surgery from all over Brazil.st Brazilian Week of Digestive System, held in Porto Alegre, which was the seed that allowed us to be, in 2023, in the XXII Brazilian Week of Digestive System.In 1994, he was elected president of the 1He was elected president of the Brazilian College of Digestive Surgery, term of office 1995 and 1996, and, following his predecessors, he greatly contributed to disseminating and valuing digestive surgery throughout the country.Furthermore, he was a member of other national and international medical societies and an emeritus member of the Brazilian College of Surgeons, the Brazilian Medical Association, the Brazilian Society for the Development and Research in Surgery, the American College of Surgeons, the World Association of Hepato-Pancreato Biliary Surgery, and president of the Academy of Medicine of Rio Grande do Sul (2009-2010). He made numerous study trips inside and outside the country. In Brazil, he participated in congresses, courses, and medical journeys in most states, with about 350 lectures given, visiting its main medical and university centers, where he learned about issues related to medical care, scientific research, and medical education, and contributed to their solution.Rotina em Cirurgia Digestiva (\u201cRoutine in Digestive Surgery\u201d), which is already in its 5th edition, being a reference for many students and residents in the field of Digestive Surgery.He had almost a hundred scientific articles published in national and international journals. In 2005, he published the book In 2006, he founded the Digestive Surgery Service at HCPA, unanimously approved by the institution's specialties. Henceforth, over 50 residents have been trained in digestive tract surgery. During all these years, he was responsible for the surgical and academic training of numerous masters and doctors, some of them who are currently physicians and professors at FAMED and other educational institutions. In 2008, the renowned Council of UFRGS granted him the title of Professor Emeritus of the University.In 2018, he was honored with the nomination of the Service, which, from then on, was called the Prof. Luiz Rohde Digestive Surgery Service.We and so many others who know and relate to Professor Luiz Rohde have in him the example of leadership marked by education, rectitude of his conduct, and complete devotion to the art of operating and teaching. His time in the academy, in two Schools of Medicine, was enormously fruitful and continues to be up to now.. Perhaps, with it, we can capture some of the essence of this master in the art of operating and teaching:Better than talking more about Professor Luiz Rohde is to transcribe an excerpt from one of his many speeches\u201cI understand medical education as an integrated whole and not as a simple sum of contents of medical disciplines and specialties. In teaching, in graduate programs and in residency, practice is the great motivator of learning. Problem-based learning. The end result should be the surgeon with deep knowledge, technical competence, ethical humanitarian training, and socially responsible performance. Physicians, especially surgeons, when making their decisions based on evidence, use science; and when they apply these decisions, they put art into practice. Science and art applied with competence, dedication, respect, and compassion are the characteristics that the best surgeons should have.\u201dTeaching is done by words and example. Dear Master Rohde, your example lives on in all of us."}
{"text": "This year, 2023, the Brazilian National Immunization Program  is 50 years old. Established on September 18, 1973 by the Ministry of Health, the PNI became officially recognized in 1975, the year in which Law No. 6,259, dated October 30, 1975 came into force. The law),. Currently, there are more than 20 vaccines, capable of safely preventing various diseases, available for each stage of life according to the National Vaccination Schedules - children, adolescents, pregnant women, adults, the elderly and special populations .During this period, the commitment of SUS workers, such as the valuable collaboration of experts, researchers, health professionals, managers, partner institutions and the entire Brazilian society, has helped Brazil to achieve high vaccination coverage. Over the years, Brazil achieved control and elimination of several vaccine-preventable diseases, such as measles, poliomyelitis, rubella, congenital rubella syndrome and neonatal tetanus, and the PNI became recognized, nationally and internationally, as a public health success story.A set of factors has contributed significantly to the progress and relevance of the PNI over these 50 years: vaccination campaigns, such as National Vaccination Day, D-Day against Polio, with a strong communication plan led by the Z\u00e9 Gotinha character and the support of celebrity immunization ambassadors; strengthening surveillance and diagnosis actions for vaccine-preventable diseases; implementation of pharmacovigilance to monitor vaccine safety; the valuing and expansion of Primary Health Care, as a fundamental SUS strategy for health promotion, disease prevention and control; SUS management decentralization to municipal level; and tripartite administrative management, between the federal administration and the state and municipal health departments.However, the success of the PNI has been threatened by the recent decline in vaccination coverage, particularly during the COVID-19 pandemic, increasing the risk of reintroduction and spread of vaccine-preventable diseases eliminated in Brazil, such as measles and poliomyelitis.The PNI offers conditions for Brazil to commit to meeting IA 2030, particularly in an integrated manner with Primary Health Care, through the country\u2019s universal health system, the SUS, and through the national capacity for vaccine production, research and technological innovation. However, the success of IA 2030 in Brazil will depend on political commitment and effective measures, aiming to recover the high vaccination rates achieved over half a century of PNI activities.At the beginning of 2023 when the current government took office, important changes were implemented in the regulatory structure of the Ministry of Health, including the reformulation and expansion of the Program, whereby its status changed from General Coordination to Department and four new General Coordinations were set up in its current organization chart.Microplanning enables the planning and implementation of high-quality immunization activities.In its new configuration, the PNI has strengthened ties with various institutions, governmental and non-governmental bodies, and society in general, with the aim of promoting the National Vaccination Movement. This movement, one of the federal government\u2019s priorities in conjunction with state and municipal governments, has the main objective of strengthening the SUS and the country\u2019s vaccination culture.The PNI\u2019s structure and tradition allow it to commit to IA 2030. Its relevance as an exemplary public health policy worldwide enables the Program to reaffirm its original commitment to reducing the transmission of vaccine-preventable diseases through integrated health surveillance and vaccine pharmacovigilance actions, and health innovation, promotion, prevention and protection actions.th anniversary of the PNI, which continues to be, and will be even more so, a source of pride for Brazil, hope for the future of our health and expression of the desire of Brazilian men and women to live in a country free from vaccine-preventable diseases.Everyone is invited to celebrate, with just pride, the 50"}
{"text": "In recent years, China\u2019s sub-healthy and aging populations have increased dramatically, giving rise to a series of health and wellness needs. People prefer health and wellness tourism activities instead of sightseeing tourism activities because of the increasing emphasis on safety and experience. Health and wellness tourism resources are a prerequisite for the development of health and wellness tourism. To critically reflect on China\u2019s official tourism resource evaluation criteria, expert consultation was carried out by applying the Delphi method, and index weights were determined using the analytic hierarchy process. Through three rounds of expert consultation, a value evaluation system for health and wellness tourism resources was established and improved in three aspects: construction of an index system, selection of evaluation subjects, and grade discourse description, thus enhancing the feasibility and application value of the evaluation system. The system developed in this study not only enables a reflection on China\u2019s official tourism resource evaluation criteria, but also presents a new approach in the value evaluation research of health and wellness tourism resources. Accordingly, the China National Tourism Administration encouraged all regions to develop their health industry and actively develop health and wellness tourism resources. After the promulgation of China\u2019s national standard named National Health and Wellness Tourism Demonstration Base, the construction of health and wellness tourism destinations was launched nationwide, promoting the overall development of health and wellness tourism in China.China is the most populous country in the world and is also home to the world\u2019s largest elderly population. In the 19th century, population aging began to increase in China, raising the demand for health, medical care, and elderly care. However, there is a shortage of elderly care professionals, and the quantity and high-quality supply of medical facilities and elderly care service institutions are extremely mismatched with existing social demands [Huang Di Nei Jing, the earliest Chinese medical book, recorded ancient people\u2019s understanding and experience of health and wellness. Over time, the understanding of \u2018health and wellness\u2019 (Kang Yang in Chinese) has become multi-faceted. First, from the Chinese literal understanding, with \u2018Kang\u2019 for health and \u2018Yang\u2019 for nourishing of life, \u2018Kang Yang\u2019 means health and wellness. Secondly, from the perspective of industrial development, the word \u2018Yang\u2019 means pension, and \u2018Kang Yang\u2019 is defined as health and elderly care. In addition, China\u2019s Office for Aging and The Blue Book of Health and Wellness are more inclined to define \u2018Kang Yang\u2019 as health, regimen, and elderly care. In The Blue Book of Health and Wellness published in 2017, health and wellness (Kang Yang in Chinese) is defined as activities that combine with the external environment to improve people\u2019s body and mind, so that they can attain an optimal health condition. The concept of health and wellness tourism is clarified in the National Health and Wellness Tourism Demonstration Base (LB/T051-2016), which states that health and wellness tourism should include forms and functions such as longevity, healthy diet, and self-cultivation, with the aim of optimizing the physical and mental state of tourists [The Blue Book of Health and Wellness (2016) subdivides health and wellness tourism resources into five types: forest, climate, ocean, hot spring, and Chinese medicine. According to the business patterns, Li Weijie divides health and wellness tourism resources into four categories: migratory bird type, healing type, rural type, and comprehensive type [tourists . The Bluive type . Thus, tth century, China began to explore how to scientifically survey existing tourism resources and prepared a trial draft of relevant census specifications. In 1997, the Revised Plan of Tourism Resources Grading and Classification Program was formulated, and a simple fuzzy quantitative evaluation method of expert scoring was designed. On this basis, the national standard of Tourism Resources Classification, Survey and Evaluation was first promulgated in 2003 [Classification, Investigation and Evaluation of Tourism Resources (GB/T 18972\u20132017) was proposed in 2017 [At the end of the 19 in 2003 . The dev in 2017 . Tourismes GB/T 1972\u20132017 The sharp increase in the demand for health and old-age care ushered in health dividends, and the health and wellness tourism industry also ushered in a good development opportunity . Health Existing research on health and wellness tourism on the Web of Science and CNKI databases is largely foreign and focuses on medical health and wellness tourism, hot spring health and wellness tourism, and rural health and wellness tourism. However, Chinese research focuses more on forest health tourism, the health and wellness industry, rural health and wellness tourism, and the construction of health and wellness tourism destinations. As an example of the latter, in the 19th century, forest bathing tours started to emerge in Germany. By the 20th century, the forest bathing base in Bad W\u00f6rishofen in Germany was regarded to be the earliest forest health and wellness tourism destination. As a natural oxygen bar, the forest is a tourism resource integrating rest, exercise, and wellness. It provides hiking, sunbathing, aerobic walking, and other special tourism projects . ScholarFrom the perspective of demand and supply, Kaung Hwa proposed eight customer service elements of health and wellness tourism, including personnel service, environment, healthy diet, leisure, rehabilitation, unique travel experience, social activities, and physical and mental cultivation, and analyzed the health and wellness tourism preferences of elderly tourists . NikipelThe industrial revolution has promoted the rapid development of the healthcare industry, and modern medical technology has made the globalization of medical care possible. The problems of ethics and service quality supervision in the medical care system have hindered the rapid development of medical health and wellness tourism, which has thus attracted scholars\u2019 attention and discussion. Karadayi-Usta and Serdar Asan propose a medical tourism service supply chain (MTSSC) model, which supplements the theoretical basis of medical health and wellness tourism service management . The COVThe relationship between supply and demand of health and wellness tourism, especially the demand side of tourists, such as psychological needs, physical needs, and the relationship between their motivations and behaviors, needs to be further discussed . For exaThe value evaluation research of tourism resources began in the middle of the 20th century, and the evaluation method was mainly qualitative. China\u2019s tourism resource value evaluation started relatively late as compared to foreign research whereby tourism resource value evaluation research started in the 1970s. At the end of the 20th century, with the development of qualitative and quantitative evaluation methods, more subdivided research on the value evaluation of tourism resources appeared, and value evaluation of tourism resources showed a trend of refinement and diversification. Earlier qualitative evaluation can be traced back to the end of the 20th century, when Huang Minsheng assessed tourism resources in terms of resource value, development conditions, and benefits . Most scBased on tourism planning and the tourism value theory, Murtini et al. evaluated the tourism value of Ria Kenjeran beach from four aspects: attraction, infrastructure, suitability, and development strategy . VelascoThe Delphi method was created by RAND Corporation in 1946 and is widely used in comprehensive evaluation and scientific prediction studies in various disciplines . This meIn the late 20th century, American scholar T. L. Satty proposed the analytic hierarchy process (AHP) . AHP comRosenberg and Fishbein put forward the model of behavior and attitude measurement and evaluation in the same basic form . This evi is the weight of the ith factor, and Pi is the evaluation score of the ith factor. This study tries to improve the evaluation model by introducing the evaluation opinions of experts, administrators, and tourists, and assigning different weights to make it more suitable for the value evaluation of health and wellness tourism resources.Where E is the comprehensive evaluation value, n is the total number of factors, QClassification, Investigation and Evaluation of Tourism Resources (GB/T 18972\u20132017), that is, resource elements\u2019 value, environmental value, and development and construction value are selected as the three first-level indicators. When selecting the second-level index, on the basis of China\u2019s relevant evaluation criteria and domestic and foreign studies, the index is modified and added according to the characteristics of health and wellness tourism resources. Nine second-level indexes are selected, including tourism health value, cultural value, resource dependency, resource added value, environment quality, diversity, stability, location characteristics, and construction conditions. In the selection of the three-level index, starting from the three main characteristics of health, regimen, and elderly care, and referring to the index system constructed by domestic and foreign scholars, a total of 36 indicators are determined.The traditional three-level system is adopted to construct the evaluation index system of health and wellness tourism resources. The selection of the first-level index is mainly based on the first-level categories in the Biomedical Research Ethics Committee. Participant experts provided consent via email and telephone communication, thus the experts involved throughout the consultation process voluntarily agreed to participate in the study.Adhering to the principle of objectivity and comprehensive evaluation, the information of experts studying health and wellness tourism was randomly searched on the literature platform. Scholars were invited to participate in the expert consultation by e-mail and telephone, and 35 interviewed experts who voluntarily participated in the whole consultation were identified. The interviewed expert group was composed of experts in tourism geography, ecology, Chinese Traditional Medicine and other research fields, among which 28 were engaged in tourism research, accounting for 80%. This study was approved by The expert consultation questionnaire included three parts: the judgment of the importance of primary indexes, rationality of index system, and suggestions of index correction. Based on the increasing order of importance of indexes, they were divided into five dimensions, and assigned as 1, 3, 5, 7 and 9 points in turn. The first round of expert consultation was conducted from August 17, 2021, to August 29, 2021. A total of 35 expert consultation forms were sent out by email and all of them were collected. After analyzing the first round of expert consultation, the index system was modified, and a second round of questionnaires was formed. The second round of expert consultation took place from December 1, 2021, to December 8, 2021, with no change in the list of experts. A total of 35 expert consultation forms were distributed and all of them were collected. All the consultation questionnaires were completed and valid, and the effective recovery rates of the first and second rounds were 100%.The final index system was determined through the first two rounds of expert consultation, and the pairwise importance comparison matrix of three levels was constructed respectively to form the relative importance assignment matrix table. The relative importance of the pairwise index was compared by using the 1\u22129 fractional scale method, and the third round of expert consultation was continued. Experts participating in the first two rounds were invited to fill in the relative importance assignment matrix table between January 5, 2022, and January 12, 2022. A total of 35 consultation questionnaires were sent out and all of them were collected. All the consultation questionnaires were completed and valid. The effective recovery rate of the third round of expert consultation questionnaires was 100%.Concentration degree (M) can reflect the importance of indicators. The larger the concentration degree, the more important the indicators that need to be retained. Usually, if M is between 7 and 9, the corresponding indicators can be retained. If M is between 5 and 7, the two indexes of dispersion and coordination should be combined, or the choice should be made according to experts\u2019 opinions and characteristics of health and wellness tourism resources. If M is less than 5, it is recommended to delete the indicator directly. Dispersion degree (S) is used to describe the dispersion of the evaluation of various indicators by experts. Generally, the second round of expert consultation can only be entered when S is higher than 0.63. Coordination degree (V) is used to measure the coordination of experts\u2019 opinions. When V is between 0 and 0.33, the coordination degree is high, and the opinions among experts are more unified, so relevant indicators can be retained. The calculation formulas of the concentration, dispersion, and coordination degrees are as follows.k is the value of the kth expert on the indicator.Where n is the total number of experts interviewed, k is the expert serial number, and QIn the results of the first round of expert consultation, the mean concentration degree of evaluation indicators was 6.82, the maximum was 8.26, and the minimum was 5.23. The mean dispersion degree was 1.57, the maximum was 2.08, and the minimum was 0.99. The mean coordination degree was 0.24, the maximum was 0.35, and the minimum was 0.12 . In the In the results of second round of expert consultation , the meaCoordination degrees of \u2018combination degree of resources\u2019 and \u2018distance from main source of visitors\u2019 were greater than 0.33, and the importance and coordination of these two indicators were lacking, therefore these were deleted. The data analysis results of the other indicators were good and retained. After the second round of expert consultation, a revised and confirmed value evaluation system of health and wellness tourism resources was constructed .After a consistency test, the consistency ratio (CR) of levels 1\u22123 was less than 0.1, therefore the model passed the consistency test. Then, index weights of each level were calculated . In the Because health and wellness tourism activities involved related research experts, administrators, and tourists, it is segmentary to evaluate a place\u2019s health and wellness tourism resources only from one perspective. Based on the above reasons, the Fishbein-Rosenberg evaluation model is innovatively improved when the evaluation opinions of experts, administrators, and tourists are given different weights. Thus, the value evaluation model of health and wellness tourism resources is established. The improved model is as follows.i is the evaluation score of respondents; Qi is the weight value of evaluation factors; and m, n, and s represent the total number of surveyed experts, administrators, and tourists respectively.Where E is the total evaluation score; PIn tourism activities, administrators represent the supply side and tourists represent the demand side. Both supply and demand are equal, so administrators and tourists are given the same weight. However, experts who study health and wellness tourism are often able to evaluate from a more scientific and comprehensive perspective, so the evaluation weight of experts is slightly higher than that of administrators and tourists in this model. Finally, the weights of this model are determined: the weights of experts, administrators, and tourists are 40%, 30%, and 30%, respectively.In China\u2019s official tourism resource evaluation criteria, the scoring and classification of individual tourism resource evaluation is explained in detail , but theThe value score of health and wellness tourism resources is greater than or equal to 90 points, rated as fifth grade, and classified as super level.The value score of health and wellness tourism resources is between 75 to 89 points, rated as fourth grade, and classified as excellent level.The value score of health and wellness tourism resources is between 60 to 74 points, rated as third grade, and classified as good level.The value score of health and wellness tourism resources is between 45 to 59 points, rated as second grade, and classified as ordinary level.The value score of health and wellness tourism resources is between 30 to 44 points, rated as first grade, and classified as poor level.Classification, Survey and Evaluation of Tourism Resources (2017). Although some problems that appeared in previous tourism evaluation have been amended, China\u2019s official tourism resource evaluation criteria is still characterized by the traditional understanding of tourism resources. First, the value evaluation index system is rough and blunt, which is not conducive to the in-depth value exploration of tourism resources. Second, in the evaluation of tourism resources, China\u2019s official criteria adopts the direct scoring method of survey team to calculate evaluation level, which appears to be subjective and fails to take into account different opinions of stakeholders. Third, there is redundancy in its classification. For example, fifth-grade tourism resources are classified as special grade and excellent grade together with fourth grade and third grade ones.Between 1997 and 2017, China continuously explored and improved the evaluation standards of tourism resources, forming the latest official criteria of Therefore, on the basis of critical reflection on China\u2019s official tourism resource evaluation criteria, a value evaluation model of health and wellness tourism resources that is different from the official criteria is constructed, which is specifically reflected in the following three aspects. First, the characteristic elements of health and wellness tourism resources and public health incident plan are added in the evaluation system. Second, the opinions\u2019 weight of administrators and tourists is included in score calculation. Third, the grade description discourse is improved.In the evaluation process of health and wellness tourism resources, objective and subjective indicators should not be confused. The evaluation of objective indicators should be based on the real and objective analysis of ecological and environmental data and socio-economic data. As for the evaluation of subjective indicators, this study advocates for the design of a special questionnaire or interview outline to comprehensively consider the real experience of experts, administrators, and tourists for investigation, so that evaluation can be more objective.Health and wellness tourism has been in dynamic development. With the evolution and upgrading of tourism and major public events, the value evaluation index will also change. Differing from existing studies, the index system constructed in this study adds the elements of health, wellness, and public health incident plan. The value evaluation research of health and wellness tourism resources should focus on long-term and dynamic analysis and make timely adjustments to the selection and modification of evaluation indicators based on national, social, and people\u2019s conditions, so as to improve the scientific accuracy of the value evaluation on health and wellness tourism resources. In follow-up research, several different types of health and wellness tourism destinations can be selected for empirical and comparative study. It can also subdivide the types of tourists, further adjust the evaluation model through in-depth research, and enhance the universality and applicability of the evaluation system.Based on critical reflections of China\u2019s official tourism resource evaluation criteria, this study establishes and improves the value evaluation system of health and wellness tourism resources from three aspects: construction of index system, selection of evaluation subjects, and grade discourse description.In the aspect of index system construction, through two rounds of expert consultation, the health and wellness tourism resource evaluation system\u2014including three first levels, seven second levels, and twenty-eight third levels\u2014was finally established. The first layer covers three main value evaluation categories of health and wellness tourism resources. In the second layer, it not only absorbs standard elements of general tourism resources, but also adds the characteristic elements of health and wellness tourism resources. In the third layer, a number of indicators such as health value, culture, environment, location, and public health incident plans are taken into account. Stability of ecological environment, rehabilitation and convalescence value, and health preservation value are three key indicators to measure the values of health and wellness tourism resources. Tourism health value, environment quality, and construction conditions are the three key conditions to evaluate the values of health and wellness tourism resources.In terms of evaluation subject selection, this study attaches importance to the different evaluation basis of multiple stakeholders and improves the Fishbein-Rosenberg evaluation model through the comprehensive perspective of experts, administrators, and tourists. It is applied to the value evaluation of health and wellness tourism resources to improve accuracy.In terms of grade discourse description, the classification discourse of grade is modified into the following levels: super, excellent, good, ordinary, and poor. This description eliminates the redundancy of China\u2019s official tourism resource evaluation criteria in the description of grade types, which is not only a rethinking of existing national criteria, but also a new attempt to research the value evaluation theory of health and wellness tourism resources.In addition to the above contributions, this paper had some limitations in case application, because the evaluation index system has not been utilised in the field. Thus, future research should focus on the constant updating and application of the value evaluation index system of health and wellness tourism resources. Reasonable evaluation of health and wellness tourism resources can help correctly understand the characteristics of health and wellness tourism resources and promote related industries to carry out utilization work on this basis. The ultimate goal is to better meet the tourism needs of the elderly and sub-healthy people and respond to the national strategy. At the same time, it is the obligation of every scholar to reflect on the existing evaluation criteria used in China. Based on the inheritance and reflection, it is expected to promote the exchange of different views on tourism resources evaluation, stimulate the innovation of theories, and further improve the national criteria."}
{"text": "Mycotoxin Research may have already recognized, there was a recent change in the position of the editor in chief (EiC). Prof. Dr. Hans-Ulrich Humpf from the University of M\u00fcnster has taken over this position, effective January 1, 2023, from Prof. Dr. Ewald Usleber, who served as EiC for the last 15\u00a0years. Mycotoxin Research, the official journal of the Society for Mycotoxin Research (https://www.mycotoxin.de), has continuously developed very well over the years and is now one of the leading journals in the field of research in all aspects of mycotoxins. This is reflected by a current impact factor  of 4.082. Mycotoxin Research is covered by all major scientific databases worldwide, and online access is guaranteed by our publisher, Springer/Nature. The change in the position of the EiC was already announced by the Society for Mycotoxin Research during the 43rd Mycotoxin Workshop 2022 in Toulouse, France , the journal covers all aspects of mycotoxin research: ecology and genetics of mycotoxin formation; mode of action of mycotoxins; metabolism and toxicology; agricultural production and mycotoxins; human and animal health aspects, including exposure studies and risk assessment; food and feed safety, including occurrence, prevention, regulatory aspects, and control; environmental safety and technology-related aspects of mycotoxins; and chemistry, synthesis, and analysis of mycotoxins.Saying this, the incoming EiC Hans-Ulrich Humpf follows in big footsteps left by Ewald Usleber. Hans-Ulrich Humpf will take up the challenge to continue the success story of Mycotoxin Research will introduce associate editors in the near future, to cover specific topics with their expertise. Furthermore, as authors more and more demand short notification and publication time, we will significantly shorten the time from submission to first decision.In order to cover all mentioned aspects, Mycotoxin Research. We also thank the publisher Springer/Nature with all involved coworkers for their support in all administrative questions and the fruitful and helpful collaboration.We would like to thank the authors, members of the editorial board, and the reviewers for their substantial contribution to ensure the high scientific quality and the great success of Society for Mycotoxin Research. Further information will be available on the workshop website (https://www.mycotoxin-workshop.eu/).Mark the date: we are looking forward to meeting you at the 44th Mycotoxin-Workshop, which will be held in Celle (near Hanover), Germany, from 5 to 7th of June, 2023. This year\u2019s Workshop will be organized by the group of Madeleine Pl\u00f6tz from the University of Veterinary Medicine, Hanover, in cooperation with the"}
{"text": "To map and describe studies available in the literature about mobile applications to support parents in newborn care and data from applications accessible in online stores.ndroid and iOS, in October and December 2021, and applications with content to support parents of newborns were selected.This is a scoping review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. The searches were carried out in theses and dissertations databases and portals, in September 2021, and articles, theses, and dissertations were included. An independent search was performed in online stores of applications for operating systems AA total of 5,238 studies and 757 applications were found, and of these, 16 and 150, respectively, composed the sample. The topics discussed in the studies were: care, breastfeeding, fever, identification of neonatal diseases, child growth and development. In the applications, the themes found were care, breastfeeding, growth, immunization, development, sleep, tips, and guidelines.Applications are important support tools for parents, as they are an innovative means and accessible to a large part of the population. Main representative of the evolution of mobile telephony, the smartphone has as its main operating systems the Android and the Iphone Operating System (iOS).The use of mobile applications (Apps), among parents, to receive information and education about their children\u2019s health, is more and more popular, and the use of computer technology is being increasingly accepted and used by society, can be used to optimize results and reduce health risks in educational programs,4,5, as well as to understand the determinants that promote newborns\u2019 (NB) health.Such a scenario collaborates for the construction of a new modality of health care, and the literature shows that Apps, including the information generated from them,6.Currently, the almost universal use of smartphones has presented a transformative potential for health care, as it allows users instant access to information through Apps, which have great potential to support health, facilitating access to information and communication between professionals and patients has been gaining prominence, due to the possibility of interventions and behavior change, through health promotion, self-management of diseases or conditions, data monitoring, and provision of information and communication,7.Mobile health  as a medical and public health practice supported by mobile devices. As an ally, mobile technology should be used for training users, as a source of information for parents, and for continuity of care, considering the large number of births, including premature births, and the importance of providing health care and home care.App-based interventions available for smartphones have become an increasingly valuable resource for disease prevention. Thus, knowledge of the already available Apps to support parents of newborns is required, as well as the studies conducted in this field, to encourage professional practice and guide parents on this topic.Nursing is present in the care of newborns and their families at all levels of care and the experience of these professionals in the development of mobile Apps contributes to safe care and care practice and the increasing inclusion of health professionals in the construction and validation is apparent. There is a variety of purposes in the development and use of the App and health researchers have focused on this theme, bringing to light its benefits, presenting results such as theses and dissertations linked to graduate programs in nursing in Brazil and in the world.In this context, the growing number of smartphone Apps availableAiming at contributing to the consolidation of knowledge regarding the development and availability of mobile Apps as a support strategy for parents of newborns, the objective of this research was to map and describe available studies in the literature about mobile applications to support parents in caring for the newborn and app data accessible in online stores. and registered in Open Science Framework (OSF), available at https://osf.io/vtyce/, and conducted with methodological rigor, recommended by the Joanna Briggs Institute (JBI), following the recommendations of the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. Scoping reviews are not intended to assess the quality of available evidence but aim to map the main concepts that support a research area, involving a systematic procedure.This is a scoping review whose protocol was publishedAndroid and iOS, to identify the Apps that addressed the theme to support NB parents.The structure of this review took place in two phases, the first being a search in databases and the second applied in online mobile devices stores. The first phase was subdivided into six stages: 1) identification of the question and study objective; 2) identification of relevant studies that would allow the extent and comprehensiveness of the review\u2019s purposes; 3) selection of studies, according to predefined criteria; 4) data mapping; 5) summarization of results, through a qualitative analysis in relation to the objective and question; 6) presentation of results. For the second phase, an independent search was carried out in the mobile App virtual stores, through smartphones, with operating system Android and iOS?The elaboration of the guiding question was based on the mnemonic structure PCC  proposed by the JBI, with Population (P) being newborn, parents and family; Concept (C), studies addressing mobile applications in the field of neonatology; Context (C), care for newborns. Following this organization, the research question was elaborated: Which mobile applications, developed to support parents in newborn care, exist in the literature or are available in online smartphone stores with the operating systems To ensure the reliability of the process, the searches and selection of scientific productions and applications were carried out by two independent investigators, who standardized the sequence of procedures and, after completing the sample recruitment, compared their findings to check for discrepancies in the sample obtained. A third investigator was called in cases of non-agreement.PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Scopus, Latin American and Caribbean Literature on Health Sciences (LILACS), Excerpta Medica dataBASE (Embase), Cochrane Library, Google Scholar, Scielo, Portal of the Virtual Health Library (VHL) were used, as well as those in the gray literature (dissertations and theses), through the Portal of Theses and Dissertations from Latin America and the Catalog of Theses and Dissertations of the Coordination for the Improvement of Higher Education Personnel (CAPES).Studies available in an electronic publication in the databases Medical Subject Headings (MeSH), and CINAHL Headings, using the Boolean operators \u201cAND\u201d and \u201cOR\u201d were consulted.The databases were searched through the CAPES plat\u00adform on the Federated Academic Community (CAFe) portal on September 16, 2021, using the \u201cadvanced search\u201d feature. Controlled and uncontrolled descriptors in Health Sciences (DeCS), The strategy integrated descriptors crossed with each other in Portuguese and English, as well as uncontrolled descriptors .Original scientific articles and reviews, either descriptive or analytical, quantitative, or qualitative, theses and dissertations electronically available in full, which dealt with the theme and without time or language limitations, were chosen. Findings addressing NB, premature infants and children, parents and professionals were also included, as well as studies bringing other support tools besides the App. Scientific productions in editorial format, letter to the editor, opinion articles and advertisements were excluded; gamified apps, for the exclusive use of professionals, with an exclusive child theme, and duplicate documents were computed only once. requirements and adapted for the present review, comprising: author, year, methodological design, main results, parent support theme and usability area, and description of the App\u2019s content.The fourth stage consisted of reading the title and abstract, to identify whether they answered the research question. After this reading, the pre-selected studies were read in full to confirm inclusion in the final sample and made up the fifth stage, which consisted of completing and evaluating the data collection instrument. The instrument was based on the JBIAndroid, on October 28, and iOS, on December 26, 2021, according to the protocol. Thus, the Apps available in those stores were also the results of this review, which had as an inclusion criterion addressing support content for parents of newborns. The apps covering newborns, infants, and information for parents and professionals were also included. The exclusion criteria adopted were: not being available for download in free or paid forms, gamified App, unrelated to the theme, exclusive for professionals and product sales. The Apps found twice, during the search with different terms and stores, were counted only once.In the second phase, independently of the search in the databases, searches were carried out in online mobile app stores for smartphones with operating systems Android and 272 in the system iOS. This stage of the research was also carried out by two independent investigators, simultaneously, to avoid selection bias. A total of 150 Apps with themes related to support to newborns\u2019 parents were chosen.In each virtual store, the searches took place using the term \u201cnewborn\u201d. Then, a second search was performed with the term \u201cpremature\u201d individually. This choice was due to the specificity of meeting the search criteria in online stores. All Apps found were downloaded, 485 of which being found in the operating system For data collection, an instrument consisting of ten variables about the App was used: operating system; country/state in which it was produced; language; year of update in the virtual store; parent support theme; indicative rating of the content; entity licensed to use the application; type of access (open or paid); accessibility for people with disabilities; number of downloads. It should be noted that such variables were used because they are information about the App that can be obtained and are available in the App itself and/or in the online store.Then, in the sixth stage, the data from the studies and applications were interpreted separately, with the studies being compared and based on theoretical knowledge and data extracted from mobile applications entered a spreadsheet and then exported to the R program, version x64 4.0.0. For this analysis, descriptive statistics were used, expressed by absolute and relative frequencies.There was no need for ethical appreciation, as the study analyzed secondary and already publicly available data. It should be noted that the copyright of the cited studies was respected.Preferred Reporting Items for Systematic Review and Meta-Analyses (Prism) was used, which was adapted for this study \u201325, fever,27, child development, growth, and identification of neonatal diseases. In addition, 11 scientific productions were presented in the form of articles and 5 dissertations and were published between 2017 and 2021.The narrative synthesis of the 16 studies selected points to the main theme addressed: support for the parents of NBs, care of NBs-21,25,27, United States of America.26, United Kingdom, Netherlands, Singapore, Australia, Thailand, Iran, Uganda, New Zealand, and Spain , were mapped, described, and elected. Of these, 91.33% are rated as containing no restrictions for use, 31.32% are available and can be accessed in Portuguese, 54% had the last update in the year 2021, 10.66% have more than 1,000,000 downloads, and only 6.66% have charged content access.It should be noted that, in neonatology, childcare, in a way, generates uncertainty,18,21 and domestic care,17,19\u201321, and breastfeeding,23,25 are highlighted, findings that converge with Apps available in online stores (23.99% and 18% respectively). Most of the Apps analyzed, related to baby care, refer to daily care, for personal records and tasks such as bathing, changing diapers, feeding, among others. Fever.27, child development, growth, and identification of neonatal diseases were also support themes identified in the studies.Among the themes identified, care for the NB in different contexts, involving hospital and quality care in the family context is essential for the NB\u2019s healthy growth and development. Scientific evidence indicates that preventive practices can significantly reduce neonatal morbidity and mortality, including basic care such as providing warmth, hygiene, and exclusive breastfeeding.Information about daily care is a useful tool for the parents\u2019 effective participation, being useful to optimize knowledge and take care of their child after hospital discharge,17,20. During the NB\u2019s hospitalization, the parents also state that the use of the App, together with a bundle of care, helps to gain knowledge and significant confidence to enable them to care for their babies in the NICU and, consequently, antedate hospital discharge.Many parents say the App facilitates the quick and reliable retrieval of essential information\u201321 to greater interaction, such as monitoring growth and development and identifying neonatal diseases remotely, care with nutrition, sleep and hygiene, vaccination and growth curve. Parental participation in care, guided by the use of an App, based on scientific evidence, can help reduce the hospitalization rate and improve the quality of care.The literature shows that some Apps are also being developed to support parents of preterm infants, who need specific care after hospital discharge, ranging from App guidance on care,25,34,35.In their turn, BF apps provide specific instructions on breastfeeding, as well as important information involving the family and self-management tools for breastfeeding mothers, and 92% of mothers had complications in breastfeeding, including difficulty, pain, and concern about the amount of milk. Thus, information and support for breastfeeding mothers is vital to encourage breastfeeding.The main factors indicative of initial difficulties with the breastfeeding technique are inadequate latching (25.0%), the baby\u2019s response to contact with the breast (26.1%), and problems with the breast (28.3%),38.The practice of breastfeeding can also be influenced by the participation and knowledge of fathers, and the greater the knowledge about the benefits of breastfeeding, associated with support and involvement, the better the practice of women who provide breast milk to their children, as a well-informed father/mother becomes a key element in the maintenance and success of breastfeeding about time, duration of feeding, and a reminder of breastfeeding time,24, observations about child behavior and baby care, location of milk collection points, lactation rooms, and public spaces favorable to breastfeeding\u201335. Advances in the testing of Apps are still required, in what regards breastfeeding, especially related to content, acceptability, effectiveness, usability, clarity regarding standardization in operational development, validation by women, and all these based on scientific evidence,34.Apps related to breastfeeding, in general, aim to provide support information to the woman and allow the creation of a profile with a diary of personal records,27 and identification of neonatal diseases were developed to provide simple language, focusing on the integration of parents in care and decision-making,27, highlighting the importance of Patient- and Family-Centered Care\u201328,30. It is known that developing a support and information App for parents, with themes that can cause stress and without exacerbating their fear or anxiety is a challenge.The mobile Apps that offer support to parents regarding care in case of fever,30; however, in the App available in online stores, selected in this study, only 4% had these resources. Although some health professionals have suggested making videos of NB procedures available, many parents have stated that watching such material would be disturbing or alarming. It should be noted that some Apps allow parents to interact with health professionals and this leads to a sense of safety in the postnatal period and brings greater satisfaction to users,16,30.The audiovisual resources in the App are important tools,22\u201325 with the participation of users and validated by them, had good acceptance of use,24,26,30.The Apps that were built by health professionals, based on scientific evidence,. In addition to this discussion, it is necessary to evaluate Apps as a support tool for parents that can be used in the long term, since monitoring the child\u2019s growth and development is an important indicator of quality of life and child health. Therefore, in Apps with an area for home use, those related to child growth (10%) and development are highlighted (21.99%).The studies focus on the feasibility and acceptability of mobile Apps, although it is necessary to advance in the evaluation of their effectivenessBased on the mapped evidence, it is possible to state that health professionals are increasingly engaged in the development of health-related Apps and, considering the number of downloads, parents are increasingly accessing this technology. Sharing this health information strengthens the practice of \u00adevidence-based care for newborns.The scoping review method was adopted for allowing the selection of different types of studies, enriching the findings and highlighting the applications developed to support the parents of newborns. It is clarified that the review has limitations regarding searches in online stores. Therefore, there are App differences from a smartphone to another, in what regards the operating system and the update of these mobile devices.The present study allowed mapping and describing the mobile Apps available to support NB parents. These are important support tools, as they are an innovative means and a method capable of generating interest, besides being accessible to most of the population, due to the widespread use of mobile devices connected to the Internet.Knowledge of the technology of Apps available to parents of NBs by nursing professionals can significantly contribute to engagement and guidance on the use of these Apps in NB care, expanding the quality of nursing care in the maternal and child area.It should also be highlighted that it is important and necessary that new Apps developed by health professionals are based on scientific evidence and validated by peers in what regards content, semantics, functionality and usability, and viewing their potential to be integrated into professional practice, even allowing optimization of communication between nurses and parents of newborns from the perspective of care."}
{"text": "Dear colleagues and friends,It is with great joy that we celebrate the 65th anniversary of the founding of Acta Biochimica et Biophysica Sinica (ABBS). Looking back at the development of ABBS, we are filled with immense pride and gratitude.ABBS is a professional academic journal supervised by the Chinese Academy of Sciences (CAS) and sponsored by the Center of Excellence in Molecular Cell Science , which has evolved in the last 65\u2005years from a Chinese vernacular journal to an English journal with international impact. The Journal was founded as Acta Biochimica Sinica in 1958 by Professor Yinglai Wang, who served as the first Editor-in-Chief. In 1961, the Journal was renamed as Acta Biochimica et Biophysica Sinica (ABBS), with the aim of developing into an authoritative journal in the research field of biochemistry and biophysics in China. In the early years of its establishment, the Journal published a number of important scientific achievements, such as the preliminary research results on synthetic crystalline bovine insulin between 1961 and 1964, and a series of research papers on \u201cKinetics of irreversible modification of enzyme activity\u201d by Professor Chen-Lu Tsou in 1965. These scholarships witnessed the beginning and development of biochemistry in China and promoted the progress of biochemistry and biophysics in China.In 1998, as one of the most influential academic journals in China, ABBS became one of the first Chinese vernacular journals to be indexed in Medline database and SCIE database, which was an important milestone for the journal. To adapt to the rapid progress of scientific research in China and to enhance further international exchange, ABBS was converted to a monthly English journal in 2004. This change significantly promoted the international dissemination of Chinese scientific research works. In 2005, ABBS established a partnership with Blackwell Publishing Asia Ltd, which opened the mode of global publication and distribution for the journal, and took the lead in starting the online version of the journal. ABBS became one of the first few journals in China to explore international cooperation in publishing and marketing. In 2009, ABBS set up a cooperative relationship with Oxford University Press and published the journal simultaneously in both print and electronic versions. In doing so, the subscribers of ABBS have covered most of the developed countries and regions including Europe, the United States, and Japan, as well as more than 30 developing countries. Through these international collaborations, ABBS has achieved tremendous development and accelerated the international dissemination of Chinese research works.The Open Access (OA) publishing model has brought new opportunities for the prosperity of academic journals, and also provided a possibility for Chinese scientific and technological journals to explore the way to grow and develop independently. In 2022, ABBS, as the first academic journal, started the journey of returning back to China to publish independently. With the SciEngine, a full-process digital publishing platform provided by Science Press, ABBS started OA publishing and distribution by itself. The Journal has accomplished the localization of the whole publishing process covering content production, publication, distribution, and data storage, and kept the trend of stable development. This paved a new path for the development of Chinese scientific journals.Over the past 65\u2005years, ABBS has been adhering to the missions of serving the scientific community and providing a professional, friendly and high-quality publication platform for scientific researchers to publicize and disseminate their works. At present, ABBS has grown into a professional academic journal with international influence. In the last 5\u2005years, the Journal has published more than 940 scientific papers with nearly 4000 authors from more than 600 research institutions in 25 countries and regions worldwide; furthermore, the research content of the papers has covered hot research areas such as protein science, RNA regulation, epigenetics, DNA damage repair, tumor metabolism and immunity, enzyme structure and function regulation, cell signaling pathways, and cell death and apoptosis, and much more. The Journal has reached over 300,000 views and downloads per year, and 60% of the readers are international researchers.To meet the new opportunities and challenges in the future, ABBS will continue to commit to the original missions of the journal: to actively promote the publication and dissemination of cutting-edge research works in biochemistry and biophysics, and to provide a high-level, high-quality professional publication platform with better services and supports to the scientific community.On the occasion of the 65th anniversary of ABBS, as the current Editor-in-Chief of ABBS, I would like to express my sincere gratitude to CAS and CEMCS for their full supports, and to the former Editor-in-Chiefs, the members of the past and current Editorial Boards, all the reviewers, and all the researchers who have supported and cared about the development of ABBS for their selfless dedication, tireless efforts, and valuable contributions. Only because of you, ABBS has flourished over the past 65\u2005years. I sincerely hope that ABBS will continue to receive your fondness and support, and I look forward to working together to further promote the development of biochemistry and biophysics in China.To celebrate ABBS\u2019 65th anniversary, ABBS has organized and published two special issues: the current issue focusing on cancer biology and the next issue focusing on liquid-liquid separation. These review articles cover the main research hotspots in these fields, summarizing the research progresses in recent years and providing the authors\u2019 perspectives on future developmental directions. We hope that readers will benefit from these two special issues in their future research work."}
{"text": "For decades, researchers of different areas, ranging from artificial intelligence to computer vision, have intensively investigated human-centered data, i.e., data in which the human plays a significant role, acquired through a non-invasive approach, such as cameras. This interest has been largely supported by the highly informative nature of this kind of data, which provides a variety of information with which it is possible to understand many aspects including, for instance, the human body or the outward appearance. Some of the main tasks related to human analysis are focused on the body , the hands , the head , or the face . Additional tasks are based on non-corporal elements, such as motion  and clothes . Unfortunately, privacy issues severely limit the usage and the diffusion of this kind of data, making the exploitation of learning approaches challenging. In particular, privacy issues behind the acquisition and the use of human-centered data must be addressed by public and private institutions and companies.Thirteen high-quality papers have been published in this Special Issue and are summarized in the following: four of them are focused on the human face , two on eye image analysis (eye status classification and 3D gaze estimation), five on the body , and two on the outward appearance (transferring clothing styles and fashion-oriented image captioning). These numbers confirm the high interest in human-centered data and, in particular, the variety of real-world applications that it is possible to develop.Transportation Security Administration Passenger Screening Dataset (TSA-PSD). The task of 3D human pose estimation is addressed in [The human body represents one of the most investigated elements in the literature and in our Special Issue. In , the autessed in , where aessed in , the autAnother topic investigated in this Special Issue is human face analysis. In particular, the published papers address different topics, including the problem of machine interaction using voice commands and facial movements , 3D faceFinally, two papers focus on the problem of outward appearance and fashion. In particular, Fontanini et al.  propose The main goal of this Special Issue is to improve the communication between companies and researchers belonging to both private and public institutions regarding the opportunities (and limitations) of the use of human-centered data in the development of future artificial intelligence applications. The above-mentioned papers contribute to stimulating new ideas, motivations, and methodologies that can shape the future of this area, also outlining potential future industrial applications and prospective trends. Again, we remark on the importance of the proper use of data concerning humans, which must be compliant with privacy and ethical regulations."}
{"text": "Five national urban agglomerations are selected according to the Fourteenth Five-Year Plan, namely the Yangtze River Delta, the Pearl River Delta, Beijing-Tianjin-Hebei, the Middle reaches of the Yangtze River, and Chengdu-Chongqing. The study on synergistic effects of such national strategic planning urban agglomerations, defined as coordinated degrees, and their time-series trends from 2016 to 2021 is significant for the practice of the national \"double carbon\" goal. Spatial differentiation of coordinated degree in five agglomerations is analyzed based on the Theil Index, along with regional linkage strength of coordinated degree under the gravity model. Conclusions include: (1) a downward trend is shown from 2016 to 2021 for the coordinated degree, along with the Pearl River Delta is the best among the five agglomerations; (2) the Middle reaches of the Yangtze River is the highest, followed by the Pearl River Delta and the Yangtze River Delta of coordinated degree in 2021; (3) the main cause of downwards in coordinated degree combined by a stable decline in carbon emissions and fluctuating increase in pollutants; (4) intra-regional differences in the Yangtze River Delta and the Middle reaches of the Yangtze River are relatively large, compared with the smallest in the Pearl River Delta measured by Theil Index; (5) coefficients of variation are relatively higher in the Middle reaches of the Yangtze River and the Yangtze River Delta, followed by the Beijing-Tianjin-Hebei, the Pearl River Delta and Sichuan-Chongqing urban. Consequently, countermeasures are proposed from the perspective of government, including technology and regional cooperation, policy innovation by overall coordination, synergy promotion by technological innovation, and regional synergy by win-win cooperation. The CPC Central Committee and The State Council issued Opinions of The State Council on the Complete, Accurate, and Comprehensive Implementation of the new Development Concepts and the Work of Achieving Peak Carbon Neutrality on September 22, 2021 :T:TTB=1Rab represents the regional linkage strength of the Coordinated Degree of Pollution and Carbon Reduction between urban agglomerations a and b; Sda and Sdb represent the Coordinated Degree of Pollution and Carbon Reduction in urban agglomerations a and b; Tab represents the distance between urban agglomeration (unit: km); K is the gravitational constant, usually 1.The spatial linkage gravity model ,18,19 isThe results obtained by Eqs  to 9) a a9) are The Thiel index of the Coordinated Degree of the two urban agglomerations in the Yangtze River Delta and the Middle reaches of the Yangtze River is above 0.5, indicating that the regional differences in carbon reduction synergy are large. This may be due to the reason that the urban agglomerations in the Yangtze River Delta and the Middle reaches of the Yangtze River contain more provinces and cities, including 26 and 31 cities respectively, and the inter-provincial connection is not close enough, making integration and coordination tough. Therefore, the discrepancy between the Coordinated Degree of Pollution and Carbon Reduction is significantly greater than that of the other three urban agglomerations. The Yangtze River Delta and the Middle reaches of the Yangtze River have relatively fast economic development. In particular, the Yangtze River Delta urban agglomeration plays a demonstration role in regional economic innovation and multi-industrial integration and strengthens its ties through inter-regional economic cooperation, trade exchanges, and preferential policies. Consequently, the difference in Coordinated Degree between urban agglomerations and other urban agglomerations is smaller than that between different prefecture-level cities within urban agglomerations.The Theil Indexes of Coordinated Degree of Pollution and Carbon Reduction in Beijing-Tianjin-Hebei, Pearl River Delta, and Chengdu-Chongqing urban groups are all less than 0.33, indicating that there is little difference in the collaborative governance of Pollution and Carbon Reduction within the region, which is speculated to be due to the relatively small number of cities covered by them, the small geographical distance within the urban groups, the similar regional culture, the similar development path, the sharing of regional resources, and the frequent inter-regional connections, so the differences in the collaborative governance of Pollution and Carbon Reduction are small. Among them, the Theil Index of Coordinated Degree of Pollution and Carbon Reduction in the Pearl River Delta is the smallest, which is between 0.168\u20130.180. This may be because the Pearl River Delta urban agglomeration only includes nine cities: Guangzhou, Foshan, Zhaoqing, Shenzhen, Dongguan, Huizhou, Zhuhai, Zhongshan, and Jiangmen, and it has the smallest regional coverage area, with well-developed transportation networks such as roads and railways and convenient coordination. That\u2019s why it is the most closely connected. As an urban agglomeration highly open to the outside world and under the jurisdiction of one province, the Pearl River Delta is superior to the Yangtze River Delta and Beijing-Tianjin-Hebei region in terms of resource integration and coordination. The latter region is under the jurisdiction of multiple provinces and cities, and the operation of integration and coordination is more complicated. This factor enables the Pearl River Delta to better conduct collaborative governance of Pollution and Carbon Reduction under unified planning and arrangement, give play to the merits of diverse cities, cooperate, and promote the virtuous cycle of urban agglomeration.From the longitudinal analysis, the Theil Index of the Coordinated Degree of Pollution and Carbon Reduction in the Yangtze River Delta, the Middle reaches of the Yangtze River, the Pearl River Delta, and the Sichuan-Chongqing urban agglomerations show a trend of first rising and then declining in the past 6 years, indicating that the differences of the Coordinated Degree of Pollution and Carbon Reduction in these urban agglomerations show a trend of decreasing gradually, while the variation trend of the Theil Index of the Coordinated Degree of Pollution and Carbon Reduction in the Beijing-Tianjin-Hebei urban agglomerations is opposite, and the discrepancies of regional governance increase. On the whole, the contribution rate of intra-regional differences is about 83%, much higher than the contribution rate of inter-regional differences. Consequently, the difference in the Coordinated Degree of urban agglomerations in Pollution and Carbon Reduction is mainly caused by intra-regional differences.Eq  is used The spatial linkage gravity model is applied to calculate the regional linkage degree of the collaborative governance of Pollution and Carbon Reduction within the five national urban agglomerations, and the results are shown in From the analysis of In this paper, based on the definition of the synergy of Pollution and Carbon Reduction, as well as the accounting model of the Coordinated Degree of Pollution and Carbon Reduction constructed and the statistical data from 2016 to 2021, the Coordinated Degree of Pollution and Carbon Reduction of five national urban agglomerations is calculated, and its dynamic trend and spatial distribution are analyzed. Furthermore, the spatial differentiation of Pollution and Carbon Reduction degree in five urban agglomerations is analyzed, and the regional linkage strength of the Coordinated Degree of Pollution and Carbon Reduction among five urban agglomerations is deduced. The findings include:First, on the whole, compared with the Coordinated Degree of the five urban agglomerations from 2016 to 2020, the average annual fluctuation range of the Coordinated Degree of the five national urban agglomerations in 2021 is smaller, falling between 17.71% to 21.31%. Additionally, the urban agglomeration of the Middle reaches of the Yangtze River has the highest degree of Pollution and Carbon Reduction in 2021, followed by the Pearl River Delta and the Yangtze River Delta.Second, from the perspective of time series analysis, the Coordinated Degree of Pollution and Carbon Reduction in the five urban agglomerations show a downward trend on the whole. From 2016 to 2018, it showed a fluctuation trend of first decreasing and then increasing, and from 2019 to 2021, it presented a steady decline. From the horizontal comparison of the five urban agglomerations, compared with other urban agglomerations, which maintained a stable trend and then declined, the Pearl River Delta urban agglomerations had a peak of 1.662 in 2018, reflecting the high coordination of this economic development region.Third, by further analyzing the internal composition of the coordination degree of Pollution and Carbon Reduction of the five urban agglomerations, namely the variation trend of the total amount of pollutants and carbon emissions, it can be concluded that when the coordination degree of Pollution and Carbon Reduction of the five major national urban agglomerations decreases overall, which is mainly caused by the comprehensive effect of steady decreases of the total amount of carbon emissions and the increases of the total amount of pollutants. Besides, although the total amount of pollutant emissions increase due to industry expansion and other reasons these years, the government has put forward documents to reduce pollutants to guarantee environmental sustainability. Therefore, the technology of garbage disposal should be improved to whittle down the coordinated degree.Fourth, the analysis of the intra-regional differences in the coordination degree of Pollution and Carbon Reduction in the five national urban agglomerations shows that there are large intra-regional differences in the Yangtze River Delta and the Middle reaches of the Yangtze River. The Theil index is above 0.5, which may be because the Yangtze River Delta and the Middle reaches of the Yangtze River contain more provinces and cities, including 26 and 31 cities respectively, and the inter-provincial connection is not close enough. Therefore, it is tough to integrate and coordinate. The Theil indexes of the other three urban agglomerations are less than 0.33, with subtle differences within the region. Among them, the Theil index of the Pearl River Delta urban agglomeration is the smallest, ranging from 0.168 to 0.180 in the five years from 2016 to 2021, which may be due to the small number of prefecture-level cities and the smallest regional coverage area, as well as the developed and convenient coordination of road, railway, and other transportation networks.Fifth, the Middle reaches of the Yangtze River and the Yangtze River Delta urban agglomerations have a higher level of coefficient of variation, which may be caused by the wide regional coverage area, large differences in transportation network systems, and large differences in resource allocation. The coefficient of variation of Coordinated Degree in Beijing-Tianjin-Hebei urban agglomeration is the second, and the Pearl River Delta and Sichuan-Chongqing urban agglomeration have low levels of variation, which may be related to the fact that the number of cities in the Pearl River Delta and Sichuan-Chongqing urban agglomeration is only 9 and 16, convenient for integration and coordination.The results of the above study show that: the Coordinated Degree of the five national urban agglomerations is low, there is a great discrepancy in the Coordinated Degree within urban agglomerations, and a deeper mechanism of action has yet to emerge. The collaborative governance of Pollution and Carbon Reduction should be made in the direction of policy, science, technology, etc., and promote the improvement of environmental quality and high-level economic quality.Pollution and Carbon Reduction have the same target, and target synergy is the key to deciding the policy system of collaborative governance. Given the low coordination degree caused by the independent and different modes of collaborative governance systems for Pollution and Carbon Reduction in urban agglomerations, it is essential to effectively implement the national \" Carbon peak, Carbon neutrality\" goals, improve the system and mechanism for environmental pollution control and addressing climate change, and innovate the coordinated policy system for Pollution and Carbon Reduction targets in urban agglomerations. The Beijing-Tianjin-Hebei city cluster should give full play to the guiding role of government policies, strengthen the reduction of carbon emissions and realize the green transformation of economic and social development. The Yangtze River Delta urban agglomerations should improve climate change investment and financing policies, and strengthen the spatial linkages within urban agglomerations. The Pearl River Delta urban agglomeration should further improve its environmental management mechanism, and innovate coordinated incentive policies for Pollution and Carbon Reduction.Encourage foreign investment to invest in low-carbon green high-tech enterprises, introduce, learn, and absorb foreign advanced manufacturing technologies. In terms of environmental pollution control, set up a special research and development fund for the collaborative treatment of Pollution and Carbon Reduction technologies, carry out research and development of key technologies, and improve the scientific and technological innovation mechanism for the collaborative treatment of Pollution and Carbon Reduction in urban agglomerations, to provide a strong scientific and technological guarantee for realizing the synergy between Pollution and Carbon Reduction. In terms of resource utilization, promote the application of existing successful experiences and technologies in reducing pollution and carbon, strengthen the research and development and application of collaborative regulation technologies, optimize the selection of technological routes for Pollution and Carbon Reduction, and improve resource utilization efficiency.Since greenhouse gases and pollutant emissions are of the same root, same origin, and all industries and fields within urban agglomerations are responsible for environmental pollution and greenhouse gases, all urban agglomerations should, based on their regional advantages and the concept of coordinated development, adopt coordinated governance strategies for Pollution and Carbon Reduction based on local conditions, and jointly promote the high-quality integrated development of the regional economy.Specifically, the Beijing-Tianjin-Hebei urban agglomeration should promote green manufacturing in the industrial field, accelerate the green transformation of steel, petrochemical, building materials, and other industries, and strictly control the construction of projects with high energy consumption and high emissions. The Yangtze River Delta urban agglomeration should optimize the allocation of regional human capital, strengthen cooperation among cities, and promote the continuous improvement of ecological environment quality. The Pearl River Delta urban agglomeration should continuously strengthen cooperation in industrial restructuring, industrial transfer, energy conservation, clean energy replacement, and technological upgrading. The Chengdu-Chongqing urban agglomeration should advocate the green, high-end, and intelligent development of traditional industries such as steel, machinery, chemical industry, and building materials, and concentrate on ecological protection, green economy, and resource recycling as an innovation ecosystem. The Middle reaches of the Yangtze River urban agglomeration should inherit the advantages of industrial gradient transfer. Concerted efforts ought to be made to bring in scientific and technological innovation factors and to stimulate high-end and high-quality enterprises to go global.S1 Appendix(XLS)Click here for additional data file."}
{"text": "Numerous interrelationships are known in the literature that have the final effect of unmasking or influencing various pathologies. Among these, the present article aims to discuss the connection between systemic lupus erythematosus (SLE) and the human microbiome. The main purpose of this work is to popularize information about the impact of dysbiosis on the pathogenesis and evolutionary course of pediatric patients with SLE. Added to this is the interest in knowledge and awareness of adjunctive therapeutic means that has the ultimate goal of increasing the quality of life. The means by which this can be achieved can be briefly divided into prophylactic or curative, depending on the phase of the condition in which the patient is. We thus reiterate the importance of the clinician acquiring an overview of SLE and the human microbiome, doubled by in-depth knowledge of the physio-pathogenic interactions between the two , with the target objective being that of obtaining individualized, multimodal and efficient management for each individual patient. Being defined as a multisystemic inflammatory disease, juvenile systemic lupus erythematosus (SLE) presents a peak incidence during puberty 12.6 years) and an increased activity compared to the adult form. The evaluation of the activity of the disease is mainly done by measuring the specific antibodies represented by anti-nuclear (ANA) and, respectively, anti-double-stranded DNA (anti-ds-DNA) antibodies. Therefore, pediatric SLE (pSLE) needs a more aggressive therapeutic with the aim of preventing or limiting damage. These characteristics proved to be much more pronounced in the age groups under 5\u20137 years, where the low frequency of ANA stands out, which is doubled by the low titer of anti-ds-DNA and an increased rate of neuropsychiatric symptoms in contrast to renal and musculoskeletal damage. Regarding the determining factors of the condition, single genetic mutations (identified in >7% of the subjective), but also the combination of genetic predisposition and disturbing environmental factors (\u201caggressors\u201d), can be incriminated in the development of SLE 2.6 years. PharmacThe microbiome\u2013host inter-relationship is in continuous evolution parallel to that of the human body since the intrauterine period and until the age of senescence, an aspect that validates the involvement of the former in various physio-pathological processes . The main ways in which the microbiota exerts effects on the body in all stages of life are represented by influencing the metabolic balance, modulating the synthesis and absorption of vitamins (by this means regulating functions such as coagulation) or imprinting the balance of T helper lymphocytes 1/2/17) and regulatory T cells. To these, the ability to influence intestinal maturation and the diversity of food digestion products such as short-chain fatty acids  is added. The latter exert their functions on the integrity of the intestinal barrier (being an important source of energy), the inflammatory balance, as well as body weight. Unlike the components of the external environment that must cross certain barriers  to interact with the internal environment, the endogenous microbiota can facilitate homeostasis imbalances much more easily, dictated by an inversion of the ratio (\u201cdysbiosis\u201d) beneficial bacteria/ harmful bacteria . Thus, t and reguWe performed a narrative review of the specialized literature using the PubMed, ScienceDirect and Oxford Academic databases to identify relevant articles related to how dysbiosis can influence the emergence and evolution of autoimmunity among pediatric patients with SLE. Searches focused on keywords and phrases frequently used to describe SLE, dysbiosis and the main directions to follow in their support and modulation , as well as terms useful in directing to information about the pathogenesis of SLE and pathophysiological mechanisms behind the microbiome\u2013immune system interaction . Thus, we brought together in the same review current topics intensively studied in medical research that include the human microbiome and ways of modulating it with the aim of maintaining the balance of harmful bacteria/beneficial bacteria. We have chosen to practically exemplify this presentation of information by making a correlation between dysbiosis and organic diseases, with an emphasis on the description of the implications in the potentiation and management of autoimmunity (respectively of SLE). Broadly speaking, the inclusion criteria concerned study groups made up of children (0\u201318 years); although, where clinical exploration was limited, we chose to include results obtained on adult groups or murine models, with the aim of covering the informational bias. The present work is therefore a crossroad of the current information regarding the pathogenesis, diagnosis and management of SLE described from the perspective of a less exploited causal relationship with dysbiosis, especially in pediatric practice.With a high mortality rate, both in comparison with the general population and with the adult form of the pathology, juvenile SLE represents approximately 15\u201320% of all lupus cases, with an incidence of 0.36\u20132.5 and a prevalence of 1.89\u201334.1 per 100,000 children [Regarding the complications of SLE, especially lupus nephritis, Hiraki LT. et al. objectify an increased proportion of positive cases in the research group , with a distribution dependent on the patient\u2019s age, gender and demographic location. Thus, a 4.5 times higher prevalence is reported in girls compared to boys . SimilarThe factors that increase the risk of developing complications are not yet fully defined, but it is unanimously accepted that they are part of the large family of genetic and environmental factors. This hypothesis complicates the work of research professionals because research in the field of the human microbiome has similarities with that of molecular epidemiology or the genome, but the results are much more variable in time and space , individual architecture, component genes and diet-dependent drugs, such as antibiotics, infections or foreign substances, all of which lead to imprinting the health of the subject by influencing the metabolism ,11,12.The physio-pathological cascade encountered in SLE is a multivalent one, the homeostasis of the internal environment being disturbed on various levels, among which we note the impact of genetic factors such as mutations , polymorphisms or aneuploidy that can determine family aggregates prone to certain diseases. While monogenic SLE  is caused by disruption of the genes involved in the complement pathway , nucleic acid metabolism, apoptosis and immune tolerance reflected on the activity of B and T lymphocytes, the majority of SLE cases meet a coexistence of the involvement of genetics and additional factors in shaping the etiology. The genetic component can partly explain the division of the risk of the disease depending on sex, with current research emphasizing the pivotal role of the X chromosome in the pathogenesis, an aspect certified by the escalation of up to 14 times the cases of SLE in the male population diagnosed with Klinefelter syndrome compared to boys that have a normal karyotype . The genetic factors are doubled by the epigenetic component, the understanding of which is useful in order to elucidate the discrepancy between SLE incidents in homozygous twins, represented by DNA methylation, post-translational histone modification and the presence of non-coding micro-RNA sequences ,14,15.In the pathogenesis of SLE, both innate and adaptive immunity are disrupted, resulting in the production of antigen\u2013antibody complexes, activation of dendritic cells, abnormalities of phagocytes, overexpression of interferon (IFN) type 1, cytokines such as interleukin (IL)-1, IL -2, IL-4, IL-6, IL-8, IL-10, IL-17, IL-18, IL-21, IL-23 and activation of T-helper cells ,17. The In this study, the diagnostic lines follow two entities concurrently, namely SLE and systemic microbiota confined to various sites in the body. For an easier understanding, we will present in the following  the mainThe human microbiota, as we stated previously, is divided according to the sites of interest, the disruption of its homeostasis mainly in response to changes in environmental factors, diet or antibiotic therapy, with the effect of increasing the risk of atopy, autoimmunity, heart diseases or malignancy ,27. EverStreptococcus, Staphylococcus, Propionibacteria, lactic bacteria and Bifidobacterium) proved to be an important prebiotic, probiotic and vector of vertical bacterial transmission, modulating Bifidobacterium/Firmicutes balance, with the cessation of breastfeeding leading to the maturation of the intestinal microbiota with the inversion of the ratio of the two, in detriment of Bifidobacterium. Antepartum, intrapartum or postnatal antibiotic therapy, as well as antifungal therapy, also lead to the reduction of Bifidobacterium, Bacteroides and Actinobacteria species, promoting the dominance of Enterococcus, Clostridium, Proteobacteria and Firmicutes. A benefit of natural food is the objective of a reduced rate of colonization with Escherichia coli, Clostridium difficile, Bacteroides and lactobacilli. Last but not least, the type of birth and the gestational age seem to influence dysbiosis in the same way as previously described, being thus preferable to natural birth that promotes fetal insemination with vaginal bacteria, to the detriment of cesarean surgery, considered a trigger factor for imbalance [Taking the intestinal microbiota  whose relationship with the maternal component is intensively studied as a model, Kim H. et al. have brought to attention, in addition to the impact played by living in the vicinity of pets, the influence of the prenatal and perinatal period in shaping the predisposition towards certain pathologies. In this sense, in addition to its role in nutrition and the maternal\u2013fetal emotional bond, breast milk . From the point of view of the identified microorganisms, a discrepancy was objectified between the regions affected by SLE and the unaffected skin areas, which was characterized by the increase of the genus vibacter .Staphylococcus, Corynebacterium, Dolosigranulum, Moraxella, Haemophilus, Neisseria) of the upper and lower respiratory tract, which was considered a sterile structure until recently [Having a diminished immune defense during childhood, especially at the level of the mucous membranes, objectified by the increased incidence of various pathologies in the respiratory sphere, maintaining the balance of microorganisms that usually or occasionally colonize the respiratory tract  represents a topic of interest in current pediatric practice by proving its involvement both in its maturation and in the regulation of immunity. And at this level, the type of birth, nutrition and antibiotic therapy, in addition to seasonal influences, vaccination, history of respiratory tract infections, living together with siblings, frequenting collectives and exposure to smoke have been shown to have a dynamic imprint on the microbial balance  during the evolutionary course of children with recurrent respiratory diseases [Being the well-known connection between the intestine and the lungs, the current specialized literature recommends the maintenance of balance and the modulation of the former . Microorganisms present at this level are Lactobacillus, Bifidobacteriaceae, Gardnerella vaginalis, Actinobacteria, Prevotella, Enterobacter, Streptococcus, Proteobacteria and Bacteroides, whose fragile balance is incriminated in the pathogenesis of bacterial vaginitis, pelvic inflammatory disease, hysteromyoma, endometriosis, adenomyosis, transmission infection sexual or those with the human papillomavirus, which can evolve into cervical dysplasia [Bacteroides, Escherichia and Shigella) [Lactobacillus, Bifidobacterium, Faecalibacterium, pathogenic microorganisms characteristic of sexually transmitted diseases, Enterobacteriaceae, Escherichia coli, Ureoplasma, Prevotella, Corynebacterium, Enterococcus and Staphylococcus aureus, microorganisms whose balance imprints the development of inflammatory conditions, male fertility and even the risk of malignancy in the prostate [The genitourinary tract is made up of the urinary system  in close connection with the genital organs  and the digestive tract, especially at the level of the external openings. Thus, the microbiota of the three systems, although individual for each one, can show similarities, potentiating each other. In the female sex, the main organs whose bacteriological study is easy are the vagina and the uterus, which have structures that show variable colonization through a retrograde mechanism, hematogenous transmission or the seminal fluid, which, after the onset of puberty, is dependent on the phases of the menstrual cycle and the presence/absence of possible pregnancies, and which are separated from each other by the cervical mucus plug that acts as a barrier to the ascent of pathogens  . In boysprostate .While the colonization of the urethra mostly respects the bacterial species identified at the level of the genital system, we emphasize here the need to know the variations of the bladder microbiome and urinary pH, depending on age and pathogen, respectively. A good diagnosis of these leads to the prophylaxis and optimal treatment of renal lithiasis or urinary tract infections, thus eliminating the risk of long-term complications such as the chronicity of the condition, renal scars or resistance to antibiotics ,57,58,59Streptococcus, Staphylococcus, Fusobacterium, Veillonella, Haemophilus, Escherichia coli, Pseudomonas and Lactobacillus), viruses  and fungi  [Starting from the upper orifice, the microbial components that populate the oral cavity of children are in constant evolution, the key moments of which are birth , with the dental eruption and the finalization of the dentition, being, however, also influenced by diet, type of birth, environmental factors, ethnic or geographic belonging, genetic determinants and horizontal transmission from the people with whom they interact ,60. Thusococcus) .Streptococcus , Lactobacillus, Bacteroidetes, Vaillonella, Candida albicans, Prevotella, Limnohabitans, Rothia, Neisseria, Pasteurella stomatis, Spirochaets or Campylobacter, doubled by a decrease in the abundance of Actinomyces, Corynebacterium, Haemophilus, Eikenella, Ramlibacter, Mucilaginibacter, Proteobacteria, Pseudomonas, Moraxellaceae, Fusobacterium and Firmicutes, which are currently intensively studied components, the variety of which proves to be different even in comparison with first-degree relatives and is the basis of the development of new biomarkers used in microbiota research, but also of the current principles of its modulation, through food means or substitution  [The main diseases in which the microbiome of the oral cavity plays an essential role are certified to be dental caries that appeared during early childhood, inflammatory bowel diseases , post-infectious irritable bowel syndrome, celiac disease, diabetes, autism, Henoch\u2013Schonlein purpura, Wiskott\u2013Aldrich , appendicitis and sleep apnea syndrome. In their production, the main microorganisms incriminated are  matter) ,64,65,66 matter) .Helicobacter pylori (H. pylori) infection, but also in chronic gastritis, duodenal ulcer or carcinogenesis, conditions in which the microbiota has been shown to have an altered diversity compared to the batches of control subjects, with part of its components showing causal relationships with the incriminated pathologies  [H. pylori and gastric dysbiosis among duodenal ulcer patients, Zheng W. et al. postulated that in this situation, the character of infected/uninfected has the potential to modulate the community of genotoxic bacteria present at the level of the microbiota [H. pylori, possibly through the interaction with the metabolism of bile acids  [H. pylori, doubled by the negative impact of the infection and the development of antibiotic resistance, it is necessary to know alternative therapies such as probiotics based on Limosilactobacillus reuteri, a Gram-positive bacterium resistant to gastric and bile juice, which maintains homeostasis in the environment by inhibiting the development of pathogenic species, while at the same time increasing adherence and therapeutic efficiency by improving digestive symptoms [With reference to the stomach, the main lines of research regarding bacterial colonization include its modification in  marker) ,69,70. Acrobiota . A role ic acid) . Due to symptoms .Dysbiosis at the intestinal level has been shown to be involved in multiple pathologies, starting from local ones , osteoarticular (osteoarthritis), skin , vascular (atherosclerosis or thrombosis), chronic renal, hepatic, pulmonary  and metabolic  and culminating with those in the neuropsychiatric sphere  or neoplastic , with all these processes being under the empire of the main axes formed by intestine and lung, brain, heart or skin ,74,75,76Firmicutes/Bacteroidetes, overwhelmed by the escalation of species such as Rhodococcus, Eggerthella, Klebsiella, Prevotella, Eubacterium and Flavonifractor and the reduction Lactobacillaceae, which is a dysbiosis that leads to the potentiation of the chronic inflammatory response and the decrease of immune tolerance, with the increase of anti-double-stranded DNA antibodies and possible imprinting of renal function [Clostridium ATCC BAA-442, Atopobium rimae, Shuttleworthia satelles, Actinomyces massiliensis, Bacteroides fragilis and Clostridium leptum in samples collected from patients positive for SLE, compared to healthy subjects, with their levels decreasing after treatment [Sphingomonas), which interferes with the digestion and absorption of proteins, the data regarding the model of change in diversity between positive subjects for SLE and healthy controls is contradictory to other studies with similar themes in the literature, which is possibly due to the influence of age and gender differences between the groups. Research in the gastrointestinal field associates the disturbance of the balance of amino acids and fatty acids with symptoms such as abdominal distension, pain, nausea, vomiting and anorexia, which were found in the clinical picture of SLE. The biological profile reveals an increased prevalence of lipid metabolism disturbances, with bile acids  being strongly correlated with the SLEDAI score, an aspect doubled by the discordance identified between the metabolites present in the serum and those detected in the feces [Taking the microbiome\u2013SLE relationship as a model, a first change objectified by current studies is the inversion of the relationship function ,80. Chenreatment . The maihe feces ,88,89,90Lactobacillus, Bifidobacterium, Akkermansia faecal and Ruminococcus) and the degree of activity of the disease or the modulation of the constituents of the immune response by being involved in maintaining the homeostasis of the intestinal barriers and optimizing regulatory T cells [Although it targeted a group of subjects over 18 years old, we consider it appropriate to discuss the results of the work done by Liu F. et al.  with ref T cells . The lin T cells ,91.Regarding the clinical picture of subjects with SLE, Visitaci\u00f3n N. et al. postulate, through the study of changes in the cardiovascular system in relation to the intestinal microbiota in murine models, the link between this and the development of endothelial dysfunction, vascular inflammation and hypertension . Lupus nRuminococcus gnavus strain from subjects with lupus to produce alteration of intestinal permeability through the action on zonulin, at the same time documenting the reversal of the process upon initiation of treatment with larazotide acetate (zonulin antagonist) [Another direction worthy of consideration is represented by the effects of the anti-rheumatic medication used in the treatment of SLE on the intestinal microbiota, but also by the impact of vitamin D deficiency on the composition of the microbiome, the viability of the intestinal epithelial barriers and autoimmunity  ,95. Alsoagonist) ,97.In addition to the standard therapy used in SLE and adapted to pediatric criteria, which includes glucocorticoids, antimalarials, nonsteroidal anti-inflammatory substances, immunosuppressants and biological agents directed against B cells, modern medicine also brings to the fore new approaches such as the impact played by dietary principles and supplementation with probiotics/prebiotics or symbiotics, but also the role of fecal matter transplantation from a healthy donor in the regulation of intestinal homeostasis or future directions that still require certification through human studies ,99.Firmicutes/Bacteroidetes ratio, just as vitamin A promotes the development of lactobacilli, and starch interacts with pathogens, improving mortality and de-escalating inflammation [Lactobacillus in the probiotic treatment of SLE and also underline the strong correlation between it and the dietary components [The basic characteristic necessary for any microenvironment to survive is its ability to reach the level of symbiosis that can confer some resistance to colonization due in part to the efficient use of nutrients, thus impoverishing the resources needed by pathogens . Occupyiammation ,100. Conammation . Wang X.mponents .Lactobacillus strains on renal function and mortality reduction in lupus nephritis, but also in the reversal of the IL-10/IL-6 ratio, which is a marker of inflammation, the results being objective in a discordant, gender-dependent manner [Bacteroides fragilis, where the range of action also includes effects on the expression of CD1d, CD86 and the balance between helper T lymphocytes 17 and regulatory T lymphocytes [Mu Q. et al. have demonstrated, in murine models, the benefit brought by supplementation with t manner . Similarphocytes . Adminisphocytes .Lactobacillus and Bifidobacteria [Lactobacillus helveticus, Bifidobacterium infantis and Bifidobacterium bifidum, for 60 days, which is a finding doubled by the increase in the Firmicutes/Bacteroidetes ratio (insignificant difference compared to placebo) and the reduction of a number of 13 operational taxonomic units incriminated as possibly pathogenic [Thus, summarizing the specialized literature of Esmaeili SA. et al. concludes that the main bacteria intended to restore immunological tolerance by acting on the pro-inflammatory\u2013anti-inflammatory balance, competitive exclusion and antibacterial action are strains of bacteria . In a sithogenic .Clostridium difficile infection, is gaining more and more interest regarding its use in the management of autoimmune diseases  and intestinal dysbiosis. Although still lagging behind in terms of research, benefiting so far from little interest, an aspect highlighted by the limited presence of human studies in contrast to those on animal models, it is important to know the advantages of its use, but also the interactions with pharmacological substances, such as antibiotics or laxatives, which can disrupt success rates [Transplantation of large feces, introduced into clinical practice for the purpose of treating ss rates ,109,110.ss rates . Modern ss rates ,112.In conclusion, both the study of SLE and that of the internal microenvironment represent two vast research subjects, both found at the pediatric age. The challenge in this stage is represented by the escalation of the pathogenic process of lupus, objectified by more aggressive clinical manifestations and increased mortality in contrast to the adult population. At the other pole of interest, we find the microbiome, a structure of a complexity comparable to that of the human genome, which is in continuous development starting from the intrauterine period until the age of senescence. Numerous studies in the recent literature link the microbial balance to the pathogenesis of SLE, an aspect intensively researched but still incompletely certified. Therefore, given the fragility and increased variability of the microbiota that can be modulated by various exogenous or endogenous factors, but also the connection between it and SLE, we consider it necessary for the clinician to acquire an \u201coverall view\u201d in order to reduce the burden induced by the disease in especially on the child, whose existence is under the sign of continuous discovery and change that must, as much as possible, take place in a natural course. The present work is considered by the authors to be a point of intersection of research on the stated themes, being centered on the succinct description of the main defining aspects regarding the two entities, diagnostic criteria and principles of locating and optimal collection of evidence, and the way in which they can influence each other and the potential impact of adjunctive therapeutic means to pharmacological ones in the evolutionary course of SLE, an aspect that will open new horizons in future research, also emphasizing the vast involvement of microbial disturbances in multiple systemic diseases."}
{"text": "Dear Editor,,On using spirometry, El-Moatasem and AbbassThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.The authors have no conflict of interest to declare.Not applicable.The author constructed the manuscript, reviewed the literature, wrote and approved the final draft, and is responsible for the content and similarity index of the manuscript."}
{"text": "Art therapy entails a therapeutic relationship that allows the expression and exploration of mental and spiritual needs through art Bell, . It inteArt therapy can contribute to the knowledge, recognition and appropriation of one's own spirituality. This is a necessary part of the discovery process for those on the path of transcendence, leading the individual to (re)discover a broader meaning for existence , using resources such as imagination, symbolism, and metaphors. This context facilitates communication, reorganization of internal contents, meaningful emotional expression, and deepening of internal knowledge, freeing the ability to think and creativity , intrapersonally (toward self-acceptance and meaning), interpersonally (by connecting with others and one's environment), and transpersonally , inner emptiness and anxiety are some of the constraints that prevent individuals, children and adults of all ages from expressing themselves creatively Cocco, . CreativSpirituality provides meaning to our lives by enhancing our consciousness of the most personal elements of our existence, material body, environment, and the divine Bell, . CreatinThe meaning-making process and the self-affirmation of personal and societal values and ideas can help us understand spirituality. This domain of human experience can be explored through artistic representation, enabling people to direct their interest to the spiritual side of the creative experience. An integrative person-centered approach is a foundation for giving spirituality the same care and attention as other physical and psychological realities. It is acknowledged to have a large and decisive influence on recovery, healing, growth, and positive therapeutic outcomes. Art-based spiritual care, therefore, lends legitimacy to the care of the most vulnerable people and contributes to a caring culture focused on spiritual development. Additional research in a broader set of cultures and populations is needed to better understand the effectiveness of art therapy interventions in spiritual growth. Furthermore, conceptual clarity and consensus on terminology will be important in art-based spiritual care both in clinical and community settings.All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication."}
{"text": "Following the significant changes in healthcare systems over the last century, the role of pre-hospital emergency medical services (EMS) has been drawn against numerous challenges. In view of this, the present study aims to reflect on the trend of change in the role of pre-hospital EMS to meet new situations and needs, thereby providing a clear picture of this process.Respecting the intricate concept of development and the major changes in Iran\u2019s healthcare system, this study was fulfilled using situational analysis (SA), developed by Clarke (2018), in Iran within 2022\u20132023. For this purpose, the data were collected through semi-structured, in-depth individual interviews with four faculty members, two managers involved in EMS, and six highly skilled EMS personnel in various positions. Moreover, the relevant articles published from 1950 to 2023 were reviewed. The data analysis was then performed via SA in the form of open coding as well as simultaneous analysis through three types of maps, viz., situational, social worlds/arenas, and positional maps, along with constant comparative analysis.Pre-hospital EMS in Iran has thus far had two turning points from 1970 to 2023, wherein academic components, need for equipment and resources, in conjunction with basic needs in the modern society, have been the main propellers. As well, the complexity of care for non-communicable diseases (NCDs), demand for managed care, and technological advancement has gradually resulted in further development in EMS. This trend describes the EMS situation in Iran from 1973 to 2023, as well as the EMS emergence stages, quantitative growth and infrastructure, and clinical education development in 2002\u20132023, indicating the lack of funding and inadequate scientific infrastructure in proportion to the population receiving such services.Considering the trend of change in the approaches adopted by healthcare systems across the world, and given the breakthroughs in nursing and medicine, along the education of professionals during the last thirty years, the descriptions of duties and performance in EMS have moved from primary care and patient transfer to specialized services and outpatient care. In addition, the cultural context specific to Iran, the challenges of women working in EMS centers, the disconnection of service providers, namely, the Iranian Red Crescent Society (IRCS) Relief and Rescue Organization (R&RO), Iran\u2019s National Police Force (INPF), and Iran\u2019s National Medical Emergency Organization (INMEO), as well as lack of resources and equipment, and the geographical distribution of human resources (HRs) based on population dispersion, are thus among the significant issues facing pre-hospital EMS in this country. Pre-hospital emergency medical services (EMS) are known as the key element in healthcare systems around the world, since they play a vital role in medical teams , 2. The Notably, EMS emerged in developed countries in the 1970s. With the trend of change in the role of EMS from 1973 to 2023 worldwide, it has accordingly moved from primary care and patient transfer to specialized services and outpatient care . In 1973Having a population of about 88\u00a0million in southwestern Asia, Iran is a member of the World Health Organization (WHO) in the Eastern Mediterranean region \u201314. CurrThis study utilized grounded theory (GT) as a qualitative method with reference to situational analysis (SA), developed by Clarke 2018). Originating from GT, SA could thus make it possible to identify and describe the situational and positional complexities of social worlds and arenas through mapping . As heal8. OriginThis SA was conducted in Iran with the participation of pre-hospital EMS personnel in the related centers, the Medical Emergency and Accident Management Center (MEAMC) at the universities of medical sciences, the specialty boards , the Iranian EMS Association (IEMSA), and teachers at the schools of nursing and paramedical sciences, including the personal experiences and archives of Javad Malekzadeh, as one of the influential people in the last six decades of nursing in Iran, who has been working on policymaking, management, education, and research in this field from 1951 to 2019 (before and after the Islamic Revolution), and five key people of his era. Inclusion criteria included: willingness to participate in the study and having at least 10 years of work experience in various fields of pre-hospital emergency. Exclusion criteria: unwillingness to participate in the study or withdrawal from the study during the interview.In total, 12 participants, varying in terms of gender, age, and academic degrees, were recruited , and the National Library and Archives of Iran (NLAI), including available statistics, government documents, international reports and historical information, the articles related to INMEO and the Iranian Nursing Organization (INO), and the studies about the role of EMS published from 1950 to 2023 in the databases of Web of Science, Scopus, and ScienceDirect, as well as the memos on the role of EMS.Upon answering each question, some follow-ups such as, The analysis and initial coding of the data retrieved from each interview were performed before the next one. With regard to the qualitative data obtained from the interviews and the existing documents, the memos were thus analyzed after the data conversion. Data analysis was performed by the first author. In this case, like GT, simultaneous data analysis was done together with data collection, coding, and classification as a constant comparative process, and memoing. Although SA, developed by Clarke (2018), was similar to the Straussian approach for open and axial coding, it lacked selective coding and an axial variable to explain the theory. Along with the axial coding, the analysis was fulfilled via a triple approach of data mapping, using situational, social worlds/arenas, and positional maps. According to these data, theoretical elements, including situational maps , social worlds/arenas maps , and positional maps  were obtained.To establish the robustness of the study findings, the four stringent evaluative criteria , proposed by Lincoln and Guba (1985) were implemented. With regard to the credibility of the findings, all codes extracted from each interview were shared and checked with the interviewees and then modified if necessary. Besides, over one year was devoted to data collection and analysis. To enhance the confirmability of the findings, the transcribed interviews together with the codes and categories extracted were reviewed, and then approved by the second and third authors as well as a faculty member outside the research team. For the dependability of the findings, the research stages and processes were recorded and reported as precisely as possible step by step. There were also attempts to observe maximum diversity in the participants in terms of service delivery location, EMS role, work experience, and job position, which helped augment the credibility and then the transferability of the findings. To check the accuracy of the documents, the historical data obtained from the primary sources were compared, and supplementary interviews were further conducted with informants. Considering the external criticism of the documents, library documents as the secondary sources and their details were compared with other sources (such as interviews and other documents) and analyzed. Regarding the internal criticism of such documents and the authenticity and validity of their content, given that the primary sources were still available, historical informants were also recruited.In this study, the trend of change in the role of EMS in Iran over the last century was described by SA, using situational, social worlds/arenas, and positional maps. The description of the situation of the role of EMS in Iran from 1973 to 2023 included the following steps, viz., EMS emergence, quantitative growth and infrastructure, and clinical education development in Iran in 2002\u20132023, indicating the lack of funding and inadequate scientific infrastructure in proportion to the population receiving EMS.To better understand the situation, the frequency distribution plot of EMS according to the last-twenty-year trend was exploited Fig.\u00a0. Here, tBefore 1973, there was no formal education program for EMS in Iran. According to the available documents, the collapse of the roof of the main hall of the MIA terminal building, where 16 people lost their lives and 11 individuals were injured, was the stimulus to establish EMS in Iran. After that, a team of Iranian physicians were sent to the United States to study EMS, who then returned after six months with two highly skilled EMS educators, Jim Patterson and Max. Following a public call for people having a high school diploma and holding an entrance exam, they selected the best and employed them as EMS technicians, completing an intensive six-month training course. Therefore, EMS officially started in 1975 under the title, Emergency Information Center (EIC) . As high\u2026at that point in time, you could simply take part in such courses with all types of high school diplomas. My hometown had three centers for the whole province, and there were three ambulances. As I remember, another support was a rescue worker who was also an ambulance driver\u2026Based on the interviews and the existing documents, the EMS equipment and infrastructure, particularly the physical settings, developed at three time periods as follows:Starting new political relations with other countries, including those in the Point Four Program (as the United States policy announced by President Harry S. Truman in 1949) and the Central Treaty Organization (CENTO), between 1948 and 1978, as well as membership in the WHO, overshadowed Iran\u2019s situation with the urgency of change. In this global situation, corresponding to the Second, Third, and Fourth Economic Development Plans (EDPs), Iranian oil exports instigated economic growth. Such political and economic changes in the government accordingly pave the ground for the establishment of EMS infrastructure , 27, so The EMS resources and equipment have been thus exploited in Iran for about thirty years (1975\u20132002). As well, higher public awareness and the prevalence of NCDs  gradually raised the need for specialized personnel for primary care and patient transfer, which demanded a platform for the scientific development of pre-hospital EMS.At this period, due to the severe shortage of personnel across Iran, the healthcare system focused on supplying EMS personnel to provide the required services. Currently, after about half a century, more than 20000 EMS personnel and experts, with Associate\u2019s and Bachelor\u2019s degrees, are working in INMEO, but this is far from the standard indicators in proportion to the growing population, the fleet of ambulances, and EMS centers .In this sense, Participant No. 9 stated that:\u201c\u2026. There were only three emergency center and five American ambulances in Mashhad, which were used less due to high fuel consumption\u2026 \u201cWith the onset of making EMS a subject of academic study in Iran (2002), medical equipment was improved and the fleet of ambulances was renewed. In 1999, the first Air medical emergency center launched in Tehran. As well, the Communication and Operation Command Center (COCC)  was organized in a more specialized manner . During From the start of the EMS in Iran, receiving the missions was in a traditional (wireless), analog form. Following technological advancement and the digitalization of Iran\u2019s healthcare system, the algorithm of telephone triage, ambulance management, and patient information documentation changed due to the use of a software program, called ASAYAR, but the previous system was maintained for further support  Fig.\u00a03)3).In this sense, Participant No. 6 stated that:\u2026 \u201cWe had heard that there were light helicopters in the emergency that were used in very rare cases \u2026.\u201dWith the merger of the universities of medical sciences and their affiliated hospital in Iran, the former Ministry of Health (MOH) was formed under the name, Ministry of Health, Treatment, and Medical Education (MOHTME) in 1986 . AccordiIn this sense, Participant No. 6 stated that:\u201c\u2026 From 1995 onwards, the type of activities became more and more advanced and there was a lot of focus on learning intubation in the system, and in the way that there are currently protocols and instructions and sometimes the right to prescribe medicine, it was not like that at that time. The type of activities moved towards becoming more professional, and in general, our dealings with clients have become more professional and ethical \u2026\u201dUpon the graduation of the pre-hospital EMS personnel, holding academic degrees, the healthcare and clinical services became gradually more scientific and specialized. The activities of the EMS personnel accordingly moved from simple and basic tasks, such as primary care and patient transfer to more advanced scientific and specialized ones, i.e., primitive and advanced CPR, working with equipment such as an electroshock and an automated external defibrillator (AED), telemedicine, coding patients with heart attacks and strokes, etc. . This le\u2026we were in charge of transferring the patients at that time. We thus went to Jorjani School for taking a short six-month course, and then entered the emergency department due to a severe shortage of personnel. These days, those who are coming here have university education and academic degrees. Some equipment such as AED is available in our base, and we have learned to work with them\u2026In these maps, the actions of people both as individuals and as members of social worlds could be examined in the current discourses. To plot it, the collective entities or social worlds in the arenas could be thus addressed, so that the collective agents and arenas of commitment and discourse could be further analyzed in a situation . The hisThe influential people of these organizations in the government system accordingly have bureaucratic and supervisory power to develop programs and perform roles in the healthcare field. Currently, MOHTME is the heart of funding EMS education, which is more important than that for other organizations.Another key issue in the related organizational groups is the close and direct relationship between the Fire Department, IRCS R&RO, and Iran\u2019s National Police Force (INPF) and the pre-hospital EMS personnel. In such a way, the Fire Department puts out the fire, releases the injured inside the city, and IRCS R&RO helps in natural disasters to rescue the injured on the road . This bePositional maps illustrate a deep understanding of the data in the adopted and unadopted positions, which are organized based on the differences, conflicts, and concerns about various issues . The keyA.Prevalence of NCDs, indicating the high demand for EMS in the societyB.Specialization of pre-hospital EMSC.Lack of equipment and resources There is also a shortage of EMS personnel with academic degrees in Iran, so that the national standard is one urban base with one active ambulance for every 20000 people and one road base with one operating ambulance in each city with a population of less than 20000. Besides, the number of standard personnel in each base is 9 people. The official statistics released by INMEO have also filed 1300 urban centers for 63\u00a0million urban population and 1700 road centers. This shows the lack of 3150 urban centers and 3300 road centers for the current position of Iran to be close to the national standards . TherefoThe above positional map displays that the healthcare system policymakers working on service provision, particularly in the pre-hospital field, need to make operational decisions to improve the quality of care to clients by categorizing different levels of pre-hospital care and changing the standards, to be compatible with the complexities of current expected care and the new economy of systems.It is clear that the role of EMS in Iran and the world has undergone significant changes over the years due to various factors, including political relations, establishment of laws and regulations, crises, education development, technological advancement, and infrastructure improvements , 37.The emergence of EMS in Iran was initially due to the collapse of the roof of the main hall of MIA terminal building in 1973. However, for about thirty years, there were no significant changes in EMS education or medical equipment, and no academic education was established for pre-hospital EMS. After the Islamic Revolution and the Iran-Iraq War, there was a small growth in the number of rescue workers, and the dire need for more advanced nursing and healthcare services during the war paved the ground for pre-hospital EMS .However, it was not until after 2002 that Iran began to create a more suitable situation for changes in the role of EMS by developing pre-hospital EMS education and renovating the fleet of ambulances and medical equipment , 39.One significant factor affecting the role of EMS was the development of EMS education, which led to the graduation of pre-hospital EMS personnel with academic degrees, making clinical care more scientific , 40\u201342. It is worth noting that the structure and composition of Iran's pre-hospital EMS are different from that of other countries, with two people present in the role of EMS personnel and a physician providing aids via phone calls and consultations, while in other countries, pre-hospital EMS is met by a team of physicians, EMS personnel, and nurses. This distinction can have a significant effect on the expected EMS type and performance , 46, 47.Like in many other countries, pre-hospital EMS personnel in Iran face a range of challenges. Some of these challenges include: Lack of resources: Despite recent improvements in the fleet of ambulances and medical equipment, there is still a lack of resources in some areas, especially in rural and remote regions , 36, 48.Like other countries in the world, the role of EMS in Iran became vital due to the prevalence of NCDs, trauma triage in accidents, crises, and the high demands in the society; however, the roots of inadequate EMS and the related reasons in Iran have their own similarities and differences with those in the world.Considering the trend of change in the approaches adopted by healthcare systems across the world, and given the breakthroughs in nursing and medicine, along with the education of professionals during the last thirty years, the descriptions of duties and performance in EMS has moved from primary care and patient transfer to outpatient care and specialized services. However, sufficient EMS infrastructure has not been developed in terms of postgraduate education. In addition, the cultural context specific to Iran, the challenges of women working in EMS centers, the disconnection of service providers, namely, IRCS R&RO, INPF, and INMEO, lack of resources and equipment, and the geographical distribution of human resources based on population dispersion, are thus among the significant issues facing pre-hospital EMS in this country.To make more progress and reach a balanced development in the role of EMS, there is a need for a scientific review of the high-level courses of pre-hospital EMS, in parallel with the clarity of the role and the position of the Associate\u2019s and Bachelor\u2019s degrees as an urgency of change, which should be established by analyzing all situational maps. Given the economic pressure and the lack of EMS, continuously affecting Iran\u2019s healthcare system, nursing managers and policymakers should attempt to strengthen the legal structures, executive regulations, and the standards appropriate to Iran\u2019s situation as soon as possible to develop the role of EMS. Furthermore, there is a need to keep thinking about pre-hospital EMS teams in new situations.Getting permissions to interview the top-level managers in Iran\u2019s healthcare system was not possible in this study, so they were not recruited. Additionally, some archives and library documents could not be reviewed due to their historical age."}
{"text": "Active euthanasia is currently permitted in Netherlands, Belgium, Colombia, Luxembourg, Canada, Australia and India. Assisted suicide is allowed in Switzerland, Germany, South Korea, Japan, as well as in the states of Washington, Oregon, Colorado, Hawaii, Vermont, Montana, California of the USA.The right to die is considered to be a basic human right. In 2018, 2,357 euthanasia procedures were carried out in Belgium, most of them for the elderly. Factors that contribute to the decision to euthanize older people are: existential crisis; loss of autonomy, dignity and control; worry about future loss of autonomy, dignity, and control; lack of understanding of the processes of dying; concerns about medical intervention and treatment at the end of life; increasing disunity between generations; decline of people\u2019s spiritual culture and religious faith. In the Netherlands, euthanasia is allowed from the age of 12, sometimes for infants up to two years old. Some countries allow assisted suicide of the mentally ill.The possibility of suicide for people \u00abwho are tired of life\u00bb is discussed.Investigation of the ethical aspects of the role of a psychiatrist in the commission of assisted suicideIn order to study ethical aspects of the role of a psychiatrist in assisted suicide, the materials of the Department of bioethics of UNESCO and the positions of the legislation of a number of countries were studied.The decision about euthanasia is taken by a commission of 3 doctors, one of whom is a psychiatrist.According to psychiatrists, the desire to die in a patient with a mental disorder should be considered the same as the desire of a patient with cancer.The role of psychiatrists in euthanasia and assisted suicide is reversed. These are: the study of assisted suicides, assistance in their implementation and popularization, determination of legal capacity to permit suicide, creation of a psychotherapeutic space and providing psychological assistance to patients in the process of dying, writing of a prescription for a lethal drug, consulting patients and their families.The role of psychiatrists in Russia is to prevent suicides and treat patients with suicidal tendencies. Assistance by a psychiatrist in the suicide is a critical problem in psychiatry.None Declared"}
{"text": "The National School of Rehabilitation, Integration and Recovery in Mental Health was established in 2011 at Ono Academic College. Its operation is supervised and funded by the Department of Rehabilitation in the Mental Health Division of the Israel Ministry of Health. The School offers courses for a broad variety of mental health professionals and others involved in the mental health field (service users and family members) to promote professional competencies, social cohesion, learning from experience, and to advance mental health rehabilitation. In recent years, the School has become increasingly involved in multiculturalism, providing special courses and workshops for both the Palestinian-Arab and ultra-Orthodox Jewish sectors in Israel. The School is based on the belief in the ability of service users to recover, integrate, and live meaningful lives in the community. This belief is consistent with values of the recovery approach . The School is constantly in dialogue with the community, and provides training for interventions that promote recovery, as well as social cohesion in the field of psychiatric rehabilitation.To describe the process of foundation, implementation, and outcomes of the unique model of the School; to discuss the multicultural and social opportunities and challenges; to portray major elements of the school methodology and practice.Work model presentation through qualitative analyses of social and academical processes, alongside quantitative descriptive data.Every year, 700 students from various helping professions in the field of psychiatric rehabilitation study at the School, as well as service users. The school operates as a bridge between academy and the field and encourages learner and staff diversity, joint learning, and discourse. Over 30 courses are conducted annually including evidence-based intervention courses such as IMR, and training courses such as knowledge by experience, supervision, rehabilitation coordinators, etc. In addition, unique courses are given, such as eating disorders, DBT, and social cognitive intervention training with multicultural adaptations. Lastly, the school offers consultation in implementing interventions within services.The working model of the School operates under the framework and values of recovery, social integration and cohesion, and multiculturalism. To this day, the School offers courses, symposiums, conferences, and professional publications, to educate for values of recovery and community inclusion, alongside improving the quality of services.None Declared"}
{"text": "Dear Editor,Leishmania transmitted by the bite of a female sandfly of the genus Lutzomyia.L.(V.) braziliensis, L.(V.) guyanensis, and L.(L.) amazonensis.American tegumentary leishmaniasis (ATL) is an infectious disease caused by protozoa of the genus Leishmania guyanensis. The bacteriological culture of the fragment from the dorsum of the hand was positive for the Gram-negative bacillus Pseudomonas aeruginosa. The radiological examination showed bone sequestration and destruction of the cortex of the distal and middle phalanges of the third finger, suggestive of chronic osteomyelitis (+5/day intravenously for 30 days and cefepime, according to the sensitivity identified in the antibiogram, at a dose of 1\u00a0g 2\u00d7/day for 10 days, resulted in significant improvement in the skin lesions (This case report describes a 49-year-old male patient, a farmer, without comorbidities, from Mau\u00e9s, state of Amazonas, Brazil. He sought medical care at a Dermatology service complaining of a condition which had started three years before, with a papule on the proximal phalanx of the third finger, progressing to an ulcer that extended to the dorsum of the right hand. Considering the clinical picture, nine direct tests were performed to search for amastigotes, all with negative results. Different types of treatments with antibiotics and corticoids were prescribed without improvement, and with worsening and progression of the lesions for the last six months. On examination, an ulcer was observed on the dorsum of the right hand, covered by yellowish crusts, with clear and erythematous borders, which extended to the phalanges, resulting in anatomical deformity of the third finger. There were also nodules following an ascending lymphatic path, in the right forearm, some of which showed painless ulceration, with raised erythematous borders, measuring approximately 2\u00a0cm A and 1 Bmyelitis . The com lesions . The patATL can be classified into localized cutaneous, disseminated, diffuse, and mucocutaneous leishmaniasis.Among the atypical forms of ATL, the verrucous, lupoid, eczematous, zosteriform, tumor, acneiform, and sporotrichoid forms have been reported.The diagnosis should be based on epidemiology, lesion characteristics, direct examination, and culture. In atypical cases, histopathological examination and PCR are fundamental tools.5Direct examination is the most frequently used method for diagnosis because it is simple, inexpensive and easy to perform. However, the probability of finding the parasite is inversely proportional to the time of evolution of the skin lesions, being rare after one year.On histopathology, intense granulomatous inflammatory infiltrate is observed, and histiocytes, epithelioid and giant cells, lymphocytes, plasma cells, some eosinophils, and depending on the time of evolution, macrophages containing amastigotes can be seen.Leishmania guyanensis was crucial for the correct diagnosis and starting treatment.PCR, a method based on parasite DNA amplification, has a sensitivity and specificity of 100% in the typical forms and a sensitivity of 94% in atypical presentations.Pseudomonas aeruginosa, as well as the radiological alterations suggestive of persistent chronic osteomyelitis in the radiological control, suggest that the bone lesions observed in the present case were caused by contiguity from the secondary infection.The rare bone involvement reported in cases of ATL and proven infection by Despite its wide distribution in Brazil, atypical presentations of ATL can make the diagnosis difficult. Therefore, the relevance of epidemiology and PCR in atypical lesions is highlighted, as well as the importance of an early diagnosis, so that sequelae or mutilations can be prevented.None declared.Dina Fabr\u00edcio da Silva: Approval of the final version of the manuscript; drafting and editing of the manuscript; collection, analysis, and interpretation of data; intellectual participation in the propaedeutic and/or therapeutic conduct of the case; critical review of the literature; critical review of the manuscript.Sidharta Quercia Gadelha: Approval of the final version of the manuscript; drafting and editing of the manuscript; collection, analysis, and interpretation of data; intellectual participation in the propaedeutic and/or therapeutic conduct of the case; critical review of the literature; critical review of the manuscript.Andr\u00e9a de Souza Cavalcante: Approval of the final version of the manuscript; design and planning of the study; intellectual participation in the propaedeutic and/or therapeutic conduct of the case; critical review of the literature; critical review of the manuscript.Rosilene Viana de Andrade: Approval of the final version of the manuscript; design and planning of the study; participation in the writing of the histopathological report; critical review of the literature; critical review of the manuscript.Jorge Augusto de Oliveira Guerra: Approval of the final version of the manuscript; design and planning of the study; intellectual participation in the propaedeutic and/or therapeutic conduct of the case; critical review of the literature; critical review of the manuscript.Alcidarta dos Reis Gadelha: Approval of the final version of the manuscript; design and planning of the study; intellectual participation in the propaedeutic and/or therapeutic conduct of the case; critical review of the literature; critical review of the manuscript.None declared."}
{"text": "Background and Objectives: The purpose of this study is to enhance the quality of life in elderly patients with lung cancer by understanding relations of uncertainty, appraisal of uncertainty, self-efficacy, and quality of life targeting elderly patients with lung cancer receiving anticancer therapy, and also analyzing the factors affecting the quality of life based on Mishel\u2019s theory. Materials and Methods: The subjects were a total of 112 lung cancer patients aged 65 or older receiving anticancer therapy. The data was collected by using self-report questionnaires targeting patients in hemato-oncology at Chungbuk National University Hospital. The data were analyzed using descriptive statistics, a t-test, an analysis of variance, Pearson\u2019s correlational coefficients, and hierarchical regression analysis. Results: In stage 1, anticancer therapy (chemotherapy) , economic condition (low) , the number of anticancer therapies (three times or more) , and education (graduation from high school or higher)  were influencing factors . In stage 2, self-efficacy , appraisal of uncertainty: danger , appraisal of uncertainty: opportunity , the number of anticancer therapies (three times or more) , and anticancer therapy (chemotherapy)  were influencing factors, which showed 74.2% explanatory power . Conclusions: In order to improve the quality of life of subjects, it would be necessary to develop interventions for raising their self-efficacy by considering their degree of education, economic condition, the types and numbers of anticancer therapies, and understanding of the appraisal of uncertainty about the disease is assessed as an opportunity factor or a danger factor. In Republic of Korea, the elderly population aged 65 or older was 14.9% in 2019 [Meanwhile, thanks to the recent expansion of medical examinations and the development of treatment methods, the five-year relative survival rate of lung cancer patients has also improved . This meIn fact, recent studies have revealed that quality of life is a strong predictive factor of survival, highlighting its growing importance ,7. For iMoreover, the symptoms that lung cancer patients experience can have a negative impact on their physical, psychological, social, and spiritual well-being . InadequThe quality of life is a state of well-being that is subjectively appraised based on the general and overall situation or life experience in multidimensional areas such as physical, psychological, social, and functional . For canUncertainty refers to a lack of understanding of one\u2019s disease, related treatments, post-treatment prognosis, and the inability to judge disease-related situations. If uncertainty persists throughout the course of the disease\u2019s progression, it can be considered threatening as it delays the formation of cognitive structures and limits the ability to properly assess an individual\u2019s situation . AccordiSince uncertainty in the early stages of disease becomes a changeable and destructive element, a patient appraises it as a \u2018danger\u2019. Once the uncertainty is continued, a certain order is built, and the uncertainty is appraised positively. In this case, it could be regarded as an \u2018opportunity\u2019 in life , so the In addition, self-efficacy is a dynamic process of appraising one\u2019s own ability to perform actions necessary for coping with and adjusting to a potentially-threatening event . Due to This study is a descriptive survey research study for understanding the relations between uncertainty, appraisal of uncertainty, self-efficacy, and quality of life targeting elderly patients with lung cancer and also analyzing the factors affecting the quality of life. The research subjects were 112 elderly patients with lung cancer receiving anticancer therapy from a tertiary hospital in Chungbuk. The criteria for selection are as follows: (1) male and female senior citizens 65 or older; (2) people who received chemotherapy once or more after getting diagnosed with primary lung cancer; (3) people who have insight into the disease and an ability to communicate; and (4) people who understand the purpose of this study and have submitted written consent to participate in this study. The criteria for exclusion are people who were diagnosed with a cognitive disorder or mental illness, which was verified in their medical records. The researcher directly distributed 114 questionnaires and then conducted a face-to-face survey. After excluding two improper questionnaires, 112 people were finally included as research subjects.This study verified sex, age, marital status, main caregiver, degree of education, breadwinner, and economic condition as the sociodemographic characteristics and also researched diagnosis, clinical stage of lung cancer, types of anticancer therapy, and the number of anticancer therapies as the disease-related characteristics.In order to measure uncertainty, this study used the instrument translated into Korean by Chung et al.  in 2005 For the appraisal of uncertainty, this study used the instrument translated and verified for validity by Kang  based onIn the research by Mishel and Sorenson , the relSelf-efficacy was measured using the Korean-version instrument   of the cThe quality of life was measured through the Korean-version functional assessment of cancer therapy scale-lung (FACT-L), version 4 , developThe data were collected from 12 October 2022 to 27 January 2023 after obtaining approval from the institutional review board of Chungbuk National University Hospital. The research subjects were elderly patients with lung cancer suitable for the criteria of selection among outpatients and hospitalized patients in hemato-oncology. I met the subjects in the outpatient counseling room of the Department of Hematology at Chungbuk National University Hospital and collected data. The researcher fully explained the purpose and methods of this study, the confidentiality related to participation in this study, and the possibility of withdrawing their participation at any time with no damage to the subjects. After that, the patients voluntarily signed the written consent for their participation. The subjects filled out the self-report questionnaires for themselves. For the patients who found it difficult to fill out the questionnaire, the researcher directly read the content of the questionnaire and took down their responses. It took an average of 20\u201330 min to complete the survey. The collected data was kept in a cabinet with locks. A password was set up for the PC, including the research data, so no one else but the researcher could read the data.\u00ae Statistics 27.0 software made by IBM Corporation, Armonk, NY, USA, the general characteristics and disease-related characteristics of subjects were calculated through descriptive statistics such as real numbers, percentages, mean, and standard deviation. This study conducted the t-test and ANOVA for comparing the quality of life according to the general characteristics and disease-related characteristics of subjects and used the Scheffe test for the post-analysis. This study used the mean and standard deviation for the degree of uncertainty, appraisal of uncertainty: opportunity, appraisal of uncertainty: danger, self-efficacy, and quality of life of subjects, used Pearson\u2019s correlational coefficients for relations of uncertainty, appraisal of uncertainty: opportunity, appraisal of uncertainty: danger, self-efficacy, and quality of life of subjects, and conducted hierarchical regression analysis for the factors affecting the quality of life of subjects.Using the SPSS\u00b1 5.65 years, and the range of age was 65~87 years. The most responses were obtained in married couples  for marital status, spouses  for main caregivers, and oneself or pensioners  for breadwinners. In terms of disease-related characteristics, most responses were obtained in non-small cell lung cancer  for diagnosis and stage III or IV  for the clinical stage. The types of anticancer therapy included immunotherapy , targeted therapy , chemotherapy , and radiotherapy and chemotherapy . In terms of the number of people receiving anticancer therapy, 73 people (65.2%) received it once.The general characteristics and disease-related characteristics of subjects are listed in p = 0.015), economic condition , types of anticancer therapy , and number of anticancer therapies  of subjects. In other words, people who graduated from high school or higher showed a higher quality of life than people who graduated from middle school or lower. The people who responded to economic conditions as middle showed a higher quality of life than the people who responded as low. In terms of the types of anticancer therapy, people who received immunotherapy or targeted therapy showed a higher quality of life than people who received chemotherapy. In the number of receiving anticancer therapy, the people with the first or second time showed higher quality of life than people with three times or more. There were no differences in the quality of life according to other general characteristics or disease-related characteristics.The comparison of the quality of life according to the general characteristics and disease-related characteristics of subjects is shown in The degree of uncertainty, appraisal of uncertainty: danger, appraisal of uncertainty: opportunity, self-efficacy, quality of life, and sub-areas of quality of life are shown in p < 0.001), appraisal of uncertainty: danger , appraisal of uncertainty: opportunity , and self-efficacy . In other words, the higher the degree of uncertainty and the higher the appraisal of uncertainty as a danger, the lower the quality of life of the participants. In addition, the higher the degree of self-efficacy and the higher the appraisal of uncertainty as an opportunity, the higher the quality of life of the participants.The relations of uncertainty, appraisal of uncertainty: danger, appraisal of uncertainty: opportunity, self-efficacy, and quality of life of subjects are shown in The analysis on the factors affecting the quality of life of subjects are presented in p < 0.001), economic condition (low) , the number of anticancer therapies (three times or more) , and graduation from high school or higher  showed statistically significant results, and those variables explained 36.5% of the quality of life of subjects . In the results of analyzing by adding uncertainty, appraisal of uncertainty: danger, appraisal of uncertainty: opportunity, and self-efficacy to the general characteristics and disease-related characteristics in step 2, self-efficacy , appraisal of uncertainty: danger , appraisal of uncertainty: opportunity , the number of anticancer therapy (three times or more) , anticancer therapy (chemotherapy)  were significant variables explaining the quality of life. As the explanatory power was increased by 37.7% compared to step 1, it totaled 74.2%, which was statistically significant .In the results of conducting the hierarchical regression analysis, in step 1, the degree of education, economic condition, types of anticancer therapy, and the number of anticancer therapies that showed significant differences among the general characteristics and disease-related characteristics were input. As a result, the variables such as anticancer therapies (chemotherapy) , or when receiving chemotherapy three or more times. Their variables explained 36.5% of the subject\u2019s quality of life. In the second stage, the subject\u2019s quality of life decreased when receiving anticancer therapy (chemotherapy) or more than three times of anticancer therapy. Additionally, the quality-of-life score increased by 0.1 points every time the subject\u2019s score perceived uncertainty evaluation as an opportunity increased by 1 point, and the quality of life decreased by 0.18 points every time the score perceived as a danger increased by 1 point. In addition, each time the self-efficacy score increased by 1 point, the quality of life increased by 0.16 points. Their variables explained 74.2% of the subject\u2019s quality of life. In the first stage, among the general characteristics that affect the quality of life and disease-related characteristics, chemotherapy was found to have the highest influence. Symptoms such as fatigue, nausea, vomiting, loss of appetite, and weight loss resulting from chemotherapy make it difficult for patients to have confidence in their future . As a reThe study also revealed that the quality of life tends to decrease as the number of chemotherapy cycles increases. These findings are consistent with a recent study by Hyun and Kim , which sThe most significant influencing factor in the second stage was self-efficacy, which affects quality of life. The study confirmed that higher self-efficacy is associated with a higher quality of life, which is consistent with other studies demonstrating the significant impact of self-efficacy on cancer patients\u2019 quality of life ,51. AccoNext, the factors that were identified as affecting the quality of life were the appraisal of uncertainty as danger and the appraisal of uncertainty as opportunity. The appraisal of uncertainty has also been observed in studies of prostate cancer patients  and breaMeanwhile, in this study, it was confirmed that uncertainty does not affect quality of life. There was a difference from Kim\u2019s  study, wThis study is significant in the aspect of understanding the degree of uncertainty, appraisal of uncertainty, self-efficacy, and quality of life of elderly patients with lung cancer receiving anticancer therapy and also verifying the factors affecting the improvement of the quality of life of elderly patients with lung cancer. However, since this study included elderly patients with lung cancer from a single university hospital for convenience and did not include a sufficient number of subjects, generalizing the results of this study to elderly patients with lung cancer is limited. Furthermore, it needs to be careful when interpreting the results of this study, as there could be influences according to the treatment stage and symptoms following the types of anticancer drugs. As a result of influencing factors that affect the quality of life of elderly patients with lung cancer, self-efficacy, appraisal of uncertainty: danger, appraisal of uncertainty: opportunity, the number of anticancer therapy (three times or more), anticancer therapy (chemotherapy), economic condition (low), and education (graduation from high school or over) were significant influencing factors. Accordingly, in order to improve the quality of life of elderly patients with lung cancer, we analyze the degree to which uncertainty is evaluated as an opportunity or danger, reduce what is recognized as a danger, help them recognize it as an opportunity, and increase self-efficacy. In addition, intervention is needed in consideration of education, economic conditions, the type of anticancer therapy, and the number of anticancer therapy.First, there should be expert interventions for improving the quality of life of elderly patients with lung cancer receiving anticancer therapy. It is highly possible for elderly patients with lung cancer to experience uncertainty and declining quality of life in the process of treating their cancer. Thus, to raise the quality of life of elderly patients with lung cancer, it is urgent to develop intervention programs for establishing effective management measures by considering the degree of education, economic condition, and types and several anticancer therapies. In particular, the type of treatment and the number of treatments require active expert intervention. Explanations to the patients and mutual cooperation between experts and patients will improve the quality of life.In addition, there should be consideration of the appraisal of uncertainty: danger, opportunity, and self-efficacy. Furthermore, there should be research on the quality of life of cancer patients using Mishel\u2019s theory of uncertainty."}
{"text": "As the only blood vessels that can directly be seen in the whole body, pathological changes in retinal vessels are related to the metabolic state of the whole body and many systems, which seriously affect the vision and quality of life of patients. Timely diagnosis and treatment are key to improving vision prognosis. In recent years, with the rapid development of artificial intelligence, the application of artificial intelligence in ophthalmology has become increasingly extensive and in-depth, especially in the field of retinal vascular diseases. Research study results based on artificial intelligence and fundus images are remarkable and provides a great possibility for early diagnosis and treatment. This paper reviews the recent research progress on artificial intelligence in retinal vascular diseases . The limitations and challenges of the research process are also discussed. In 1956, artificial intelligence (AI) was first proposed. As a branch of computer science, the purpose of AI is to develop and study computer methods to simulate and expand human intelligence and perform complex tasks . MachineWith the rapid development of computer science in recent years, AI has made significant progress. AI has been applied in the field of medicine, especially in ophthalmology, and the clinical application of AI is particularly extensive. AI has been used to develop AI models for automatic diagnosis, screening, classification and treatment, especially in ophthalmic diseases such as ocular surface diseases , anterioRetinal vascular disease (RVD) is a major retinal disease. The vascular system of the retina is one of the components of the systemic circulatory system. There are many causes of retinal vascular diseases, including the effects of local eye diseases and systemic diseases on retinal vessels, which can be divided into the following categories: 1) retinal vascular obstructive diseases, such as retinal vein occlusion; 2) the effects of systemic diseases on retinal vessels, such as diabetes and hypertension; 3) retinal vascular inflammatory immune diseases, such as retinal periphlebitis; and 4) retinal vascular abnormalities and developmental abnormalities, such as retinopathy of prematurity. Retinal vascular disease can cause irreversible damage to retinal cells and can seriously affect the vision of patients. If patients are not treated in time, they will experience serious vision loss or blindness. Therefore, for patients with retinal vascular disease, early detection, diagnosis, and treatment are particularly important, but relatively insufficient resources for ophthalmic diagnosis and treatment greatly limit the early diagnosis and treatment of retinal vascular diseases. In recent years, AI has become increasingly used in ophthalmology, especially in image recognition and processing of retinal vascular diseases, which provides a new possibility for early diagnosis and treatment. This review summarizes the research achievements of AI for the diagnosis of retinal vascular diseases in recent years and discusses the limitations and challenges of the research.Using the AI model by Diabetes is a common metabolic disease that causes extensive damage to many tissues and organs in the body. Diabetic retinopathy (DR) is one of the most serious microvascular complications of diabetes and a common cause of blindness . The incBy analyzing the fundus examination images of DR patients, AI can complete the automatic diagnosis of DR, which is of great significance in improving the diagnostic and work efficiency of doctors. To build an AI model that can automatically detect DR, Hypertensive retinopathy (HR) is a common retinal vascular disease caused by long-term hypertension . Fundus In many studies, AI has been used to screen and diagnose HR, and the AI model constructed in this study showed good screening and diagnostic performance and has the potential for clinical application. AI is also used in the classification and grading of HR, which is expected to be used clinically to reduce the pressure on doctors. Retinal vein occlusion (RVO) is one of most common retinal vascular disease, second only to diabetic retinopathy, and more common in older patients . The patAs an important clinical assistant tool, AI has been widely used in the early screening of retinal vein occlusion, and especially in areas where lacking medical resources, AI can play an important role. To assist in screening for retinal vein occlusion, In addition, AI can help clinicians diagnose RVO by identifying and segmenting the characteristic lesions in the images of patients with RVO, thus reducing the workload of clinicians. Retinopathy of prematurity (ROP), also called retrolental fibroplasia, is a proliferative retinopathy of immature or low birth weight infants . Most ofTo automatically diagnose ROP, In recent years, AI model has made a lot of research achievements in assisting the clinical staging and grading diagnosis of ROP. In order to assist in the grading and staging of ROP, To detect the blood vessels in areas I, II, and III of children with ROP and to assist in assessing the severity of ROP, Age-related macular degeneration (AMD), also known as senile macular degeneration, is common in Europe, the United States, and other developed countries and is the main cause of blindness in the elderly in developed countries. Its incidence increases with age . At presTo assist clinicians in diagnosing age-related macular degeneration and distinguishing its different types, AI has carried out a lot of research in this area, with remarkable results. In addition to extensive research on the diagnosis and classification of AMD, AI has been used to predict the severity, disease progression, and therapeutic effect in patients with age-related macular degeneration. Based on the referenced studies, AI is widely used in retinal vascular diseases, especially in image recognition and data analysis. Although AI model shows superior performance in assisting the diagnosis, identification, screening, staging and grading of retinal vascular diseases, AI model also faces many limitations and challenges in the research process, which will seriously affect the further research of artificial intelligence in retinal vascular diseases and hinder its clinical application. Below, we list the main limitations and challenges of AI in research on retinal vascular diseases. 1) Image quality in the dataset : The imaAt present, the use of AI technology to assist clinicians in the study of ophthalmic images and other ophthalmic examinations is a current major focus. The combination of AI and ophthalmology will greatly improve the diagnosis of ophthalmic diseases, especially retinal vascular diseases based on the analysis of fundus images. The diagnosis model based on AI will be beneficial for the early detection, diagnosis, and treatment of retinal vascular diseases. Although the application of artificial intelligence in the field of ophthalmology has made a lot of research results, but from the overall situation, it is only the beginning. With further developments in computer science and technology, the application of AI in the field of ophthalmology will be more and more widely used in the field of ophthalmology. In addition, with the deepening of research, in addition to image processing and recognition, other artificial intelligence technologies will also carry out related research in the field of ophthalmology, so as to promote the continuous development of ophthalmology."}
{"text": "Currently, there is an active introduction of modern types of psychosocial treatment (PST). At the same time, an important direction is the evaluation of the effectiveness of PST, the identification of factors affecting it, which determines the urgency of research in this area.To evaluate the effectiveness of psychosocial treatment of patients with schizophrenia at different stages of psychiatric care; to build regression models to identify factors that influence the effectiveness of psychosocial treatment.Clinical and psychopathological, statistical, as well as a battery of tests: PANSS, CGI; Drug Attitude Inventory ; Insight Scale for Psychosis ; \u00abSF-36 Health Status Survey\u00bb ; URICA ; The Social Adjustment Scale-Self ; PSP  and a number of other scales. 90 patients with schizophrenia in the community, inpatient department of psychiatric hospital, day hospital participated in the basic PST program, which included psychoeducation, motivational training, social and cognitive skills training. At each stage, PST was received by 30 patients who did not differ significantly in age and other socio-demographic characteristics, but were characterized by different quality of remission, the duration of the PST program was 3 months. The assessment of the patients\u2019 condition was carried out before and after the rehabilitation program.A significant improvement in the indicators on the PANSS scale was found in patients of all three groups, as evidenced by a reduction of more than 10 points in the total score of the scale. As a result of the PST program, patients of all three groups have improved to varying degrees their awareness of the disease understanding of the need for drug treatment, increased motivation, and have shown a tendency to improve a number of cognitive functions. The participants of the program demonstrated an increase in the level of activity and purposefulness of activity, as well as the ability to master new social skills and implement them. Correlation and regression analysis, during which more than 100 factors were studied, allowed us to identify the most significant factors that positively or negatively affected the effectiveness of PST: severity of the condition, duration of illness, age of onset of the disease, age of referral to the service, number of hospitalizations, type of remission, observation group, level of education, marital status, family support, family relationships, having friends, having income.The effectiveness of the basic PST program has been shown. However, the work on evaluating the effectiveness of the PST should be continued, especially for the development of information criteria and a tool for its evaluation.None Declared"}
{"text": "To analyze the concept of Health Advocacy from the methodological framework of the Evolutionary Model.The concept of interest was evaluated from the perspective of published studies identified in the databases: Web of Science, CINAHL, EMBASE, SCOPUS, MEDLINE and articles of interest. The attributes were determined from 19 scientific productions. Data were analyzed using thematic analysis, proposed by Bardin.The following operational definition was obtained: Health Advocacy is an intentional action, implemented jointly and in favor of individuals and communities, especially for those who suffer from health inequalities, with the aim of preserving and improving health, well-being and empowerment for health promotion.Thus, a broader concept of Health Advocacy was abstracted, from the micro to the macro, which contemplates the development of the patient\u2019s autonomy; includes individuals and groups in care plans and involves them in political activities as possibilities to provide assistance and correct health inequalities. Among these assumptions, one can mention the guidance for health promotion. This, as a practice, involves empowerment to increase control over the factors that influence and impact health.In this perspective, the Galway Consensus, agreed in June 2008, subsidizes the implementation of health promotion actions through the standardization of fundamental competences to promote health, divided into nine domains: Favoring change, Health Advocacy, Partnership, Communication, Leadership, Diagnosis, Planning, Implementation and Evaluation and research. The document also emphasizes that the values and principles of health promotion are based on health determinants, equity, social justice and respect for diversity.Among the nine domains of competences, there is the concept of Health Advocacy, which is defined in the document Core Competencies in Health Promotion (CompHp), endorsed by the European Union, as: Claiming with and in favor of individuals, communities and organizations to improve health, well-being and capacity building for action in health promotion.It is understood that concepts are built throughout history, bringing significant contributions to the construction of knowledge. They are formed by identifying features common to a class of objects or phenomena. They are dynamic and strongly influenced by public socialization and interaction, and their development varies according to the social context,5. These concepts can be applied to advocacy exercised by a professional and directed at different individuals or groups and understood at macro and micro levels. Thus, the authors did not identify a study that would clarify this distinction, leading the concepts to be often used interchangeably.The concept of Health Advocacy, although defined in the literature, has gaps in terms of establishing well-defined limits and differentiating it from other similar concepts, such as Patient Advocacy, Environmental Advocacy, Self-advocacy and Nursing Advocacy,7.Additionally, there is a need to expand the investigation of the concept of Health Advocacy specifically in the field of Nursing (the CompHP definition has a multidisciplinary character), since the Health Advocacy exercised expressly by nurses has particular characteristics. However, exploring this concept can make the discussion about its applicability in nursing practice scenarios visible, expanding the understanding of the term and highlighting its relevance.The study aims to analyze the concept of Health Advocacy based on the methodological framework of the Evolutionary Model in order to make it possible to clarify the term and its distinction from similar ones, establishing a theoretical basis to guide practice and future studies.Concept analysis study, built from the methodological framework of the Evolutionary Model. According to the model, concepts are ideas, being better defined based on their use and the description of their set of attributes. It is a continuous process, subject to change, depending on the context, time and situation. The analysis of a concept must follow an inductive method, in which a consensus on the term is identified, its historical aspects are evaluated and elements of agreement and disagreement are determined in different areas.The concept analysis comprises six activities: 1. Identification of the concept of interest and associated expressions, in order to select the most appropriate terminology; 2. Choice of scenario and sample. In a literature-based analysis, setting refers to the period and areas or type of literature to be included; the sample is best available described in the relevant or pertinent literature; 3. Data collection and management to: highlight the attributes of the concept; and its contextual bases, antecedents, consequences and sociocultural and temporal variations, in order to understand the situations in which the concept can be used; 4. Data analysis, in general, through thematic analysis; 5. Identification of an example, when applicable, in order to clarify the application of the concept of interest; 6. Interpretation of results, with determination of implications, hypotheses and contributions to the future or continued development of the concept.In this study, the concept of interest in Health Advocacy was defined from the perspective of published and indexed studies in scientific databases: Web of Science, CINAHL, EMBASE, SCOPUS, MEDLINE/PUBMED and references to articles related to the concept. These databases were chosen due to the availability of productions with complex and detailed discussions on the topic. The CINAHL base was specifically chosen for its focus on Nursing and the others, given the efficiency of its coverageThe following inclusion criteria were used: original studies, reflective or reviews studies related to the theme of Health Advocacy; published in Portuguese, English or Spanish. Opinion articles, letters to the editor, previous notes were excluded; duplicate studies; research protocols; studies that did not describe the concept of Health Advocacy; and studies unavailable digitally or physically in full. The term Health Advocacy was used to search, and 4,001 results were identified. Excluding duplicates, 1,561 studies remained, which were read title and abstract, using a total of 19 articles that met the aforementioned criteria in this study.. The research protocol consists of nine data collection indicators: reference; year of publication; country of origin; concept; attributes; background; consequences; substitute terms; related concepts; use of the concept and application over time.For the follow-up of the study, a research protocol was adopted, which allowed its systematization, inductive reflective-critical reading and conceptual analysis. This protocol was chosen because it had already been used in another similar study, which also followed the activities described in the Evolutionary Model.The characterization of each of the elements proposed by Rodgers for concept analysis was used, as follows: Background - Aspects, situations and phenomena that contributed to the construction of the concept; Consequences - Refer to characteristics or phenomena generated after the construction of the concept; Substitute terms - Terms or expressions used that have the same meaning in articles; Related concepts - Concepts that contribute to the constitution of the evaluated concept; Attributes - Terms or expressions that characterize the concept. To clarify the application of the concept, the examples were demonstrated through the list of publications revealing the practical application of the concept, called empirical references and interpreted by contrasting the interdisciplinary findings.Data were analyzed using the thematic content analysis proposed by Bardin to carry out the analyzes and followed three phases: pre-analysis; exploration of the material and; treatment of results, inference and interpretation. The concepts extracted from each study were listed and the coding units were systematically identified in each text. Subsequently, these units were grouped into categories, called attributes. Finally, a single concept emerges from themes present in each category, listed considering the frequency and relevance of the inferred meaning of the coding units. To clarify the application of the concept, the examples were demonstrated through the list of publications revealing the practical application of the concept, called empirical referents and illustrated concomitantly with the antecedents and consequences. The results were displayed in tables and figures and interpreted by contrasting the interdisciplinary findings.Data were analyzed using content analysis, proposed by Bardin to carry out the analyzes and followed three phases: pre-analysis; exploration of the material and; treatment of results, inference and interpretationThe attributes of the Health Advocacy concept were grouped into four parts: starting point of the concept, who implements it, who benefits from it and what it achieves (objective), as shown in .Most authors describe Health Advocacy as an action and some qualify or attribute some requirements to it, such as: intentionality; planning; not biomedical, necessarily; and that goes beyond the regular demands. In addition, another author emphasizes Health Advocacy as a job, since it is configured as any practice that involves intention, time and effort. However, since Health Advocacy is characterized as an action, it is understood that its existence is configured in a field of practice. It is understood that the stimulus for initiating the Health Advocacy action will depend on basic conditions, such as individual beliefs.There is reference to Health Advocacy as a mindset and skill,28. An example of this occurs in the digital context, of social media, where a variety of topics are superficially discussed, without, however, presenting the potential to cause change.With regard to the characteristics of the action of Health Advocacy, it is a deliberate act. In this way, he must carry within himself the will to transform a reality, to intercede. Although it is understood that advocacy can manifest itself at macro and micro levels, there is a range of activities that should not be considered Health Advocacy,11. Thus, two important components of the concept of Health Advocacy emerge, the participation and empowerment of those who have a place to speak on the subject.The second group of attributes refers to the person responsible for implementing Health Advocacy. Different actors are reported in the literature, including individuals, groups, health professionals, organizations, communities and society. Therefore, it is understood that any individual or group can practice Health Advocacy. Authors emphasize that the action must be carried out jointly with the beneficiary. Corroborating this is the emphasis on the need to include training on Health Advocacy in the nursing curriculum. Furthermore, the search using the terms \u201cHealth Advocacy\u201d and \u201cNursing\u201d showed that publications specifically using the terminology Health Advocacy in this area are rare.Health advocacy implemented by nurses has particular characteristics, since it requires specific skills and actions from them, in addition to presenting facilities and barriers inherent in the area of nursing. However, this type of advocacy, while necessary, has little potential for long-term change. It is noteworthy that there are more vocal types of Health Advocacy and others that are more silent, so that health professionals tend to exercise the type that best suits their practices and lives.Among the studies on Health Advocacy in the context of nursing, those focusing on actions at the micro level, directed at individual patients and with an emphasis on barriers related to interprofessional relationships and institutional conflicts of interest, stand out.An example of Health Advocacy at the macro level would be actions to increase funding sources or change protocols for accessing gender-affirmative treatments by transgender people; and for micro advocacy it would be to help an individual patient who does not meet all the requirements present in a given protocol to gain access to gender reassignment treatment. They can be inspired to face contemporary and future challenges, reflecting on the work of nursing personalities, such as Lillian Wald, Dorothea Dix and Florence Nightingale. These historic leaders embraced and shaped the delivery of population-based health care and advocacy and policy making.When nurses practice advocacy, their own power, professional status, and job satisfaction are enhancedThis is followed by the division of attributes with the detailing of the beneficiaries of the Health Advocacy action. The terms individuals and collectivities, likewise, broadly cover all beneficiaries, even in cases where the action will be in favor of cases and causes. By way of clarification, cases such as advocacy exercised at micro levels are understood, in general, advocacy directed at a patient; causes, on the other hand, is configured in advocacy exercised at the macro level, with objectives that will benefit collectivities.Attributes two and three may be responsible for the variability of concepts related to Health Advocacy. It was observed that, in the context of health, there is a tendency to name the type of advocacy based on who performs it or benefits from it. The use of the term patient advocacy is frequently observed, for example, when the action is directed at a sick person; or the term advocacy in nursing when the action is implemented by nurses. These different usages result in confusion in the understanding and application of the terminologies.,5. However, it is commonly used interchangeably with Health Advocacy, even though Health Advocacy is not restricted to the benefit of patients. Therefore, the existence of a conceptual hierarchy is assumed.The concept of patient advocacy has been discussed previously. Other authors describe health advocacy as a combination of individual and social actions aimed at obtaining political commitment, social acceptance, policies and support systems. It is observed that in both examples they cite mechanisms and omit the actual purpose of the activity.Finally, the attributes related to the objectives to be achieved were grouped together. When it comes to the desired result, it is observed that some authors do not distinguish between recommendations for how to reach the intended objective itself. For example, authors state that health advocacy is an intentional action by health professionals to address health determinants that negatively impact individuals or the communityIn any case, a variety of different objectives were identified, which included: (a) structural changes, such as obtaining political commitment, social acceptance, policies and support systems, influencing authorities and individuals, addressing systemic problems, promoting social changes, economic, educational, and political, address health determinants, mobilize resources, influence health policy, create system change, reduce health threats, and address unhealthy systems; (b) curative perspectives, aiming to alleviate suffering, achieve health, guarantee access to care and the health system, implement the right to health and meet a health need; and (c) preventive perspective and health promotion, to achieve health promotion objectives, with a view to developing health promotion actions; and improve health and well-being.. In Brazil, equity is one of the principles of the health system and should be taken into account in the management of health actions and resources.Knowing that health is socially determined, for example by economic conditions, housing, food; actions to result in real impact on health require structural changes. At the same time, considering the range of demands, it is important that the strategies consider the need for health equityHealth Advocacy is based on the values of health promotion. Thus, a broader concept of health is assumed, contemplating individual perspectives and empowerment to maintain health. For example, when there is a movement to implement culture, leisure and sports activities in the community for the elderly population, there is a demand for health, instead of exclusively curative.Therefore, from the determination of the most relevant attributes, the operational definition was arrived at: Health Advocacy is configured as an intentional action, implemented jointly and in favor of individuals and collectivities, especially for those who suffer from inequities in health, with the aim of preserving or improving health, well-being and empowering for health promotion.,30.Although the terminology Health Advocacy appears in studies published from 1974 to 1993, the publications referred to the term without proceeding with its previous definition or continuing with the concept of advocacy only. Some researchers have tried to construct a clear definition or framework for understanding Health Advocacy; however, these efforts met with limited success. As a result, there remained a divergence of understandings and wide variability in the enactment of Health Advocacy. It is observed that the concept emphasizes examples of mechanisms through which Health Advocacy manifests itself but fails to highlight elements of empowerment and detailing the characteristics of the objectives to be achieved.The World Health Organization in the Glossary of Health Promotion defines Health Advocacy as the combination of individual and social actions to acquire political engagement, policy support, social acceptance and support of systems or programs to achieve goals.In the Brazilian context, the Health Reform can be considered a Health Advocacy action, as it sought to reduce social inequalities and structural changes in the health care model. However, even so, the greatest challenge for the realization of the right to health in Brazil is to develop health democracy, related to the effective participation of society in strategic decision-making that result in the realization of the universal, equal and integral right to health. However, a model is lacking to explain the term. Some important elements can be added to the concept, such as the deliberate character of the action, the emphasis on health inequities, the objectives, in addition to aspects related to the maintenance of well-being or health. Additionally, the term collectivities, or groups, better encompasses other aggregations of individuals, such as health professionals.The document Core Competencies in Health Promotion (CompHp), endorsed by the European Union, published in 2012, defines Health Advocacy as: Advocating with and on behalf of individuals, communities and organizations to improve health and well-being and to develop capacity for health promotion actionsFinally, the virtual era adds a new scenario, or even a new element to the concept of Health Advocacy: the location. While, in general, Health Advocacy actions are taking place at the level of institutions, especially those of direct health care, in recent decades, with the use of the internet and social networks, the digital context has gained preponderance. Characteristics such as democratization and the expansion of the reach of information offer this technology enormous potential to generate changes.The study brings a broader concept of Health Advocacy, from the micro to the macro, in which it contemplates the development of the patient\u2019s autonomy; includes individuals and groups in care plans and involves them in political activities as possibilities to provide assistance and correct health inequalities. In this way, understanding the concept of Health Advocacy makes nurses more empowered in terms of practice, defending patients and families, as well as favoring health reforms.It is expected to contribute to a more consistent use of the concept of Health Advocacy, for its use prior to its operationalization in practice, since health advocacy encompasses a wide range of activities such as: encouraging patients to engage in healthy behaviors , helping patients navigate health care , and engaging in systems and policy-level activism  to provide assistance and correct health inequalities."}
{"text": "Objectives: The central sterile services department (CSSD) offers a variety of procedures, including collecting contaminated medical equipment from various agencies through a process of washing, cleaning, packing, and sterilization, followed by storage and distribution to internal and external departments. Plans to expand and open service to the Center of Excellence continue, which will result in a rapid increase in the processing of specialized medical devices. The Center of Excellence is a source of education, learning, teaching, and practice in the cleaning, disposal, and sterile treatment of medical devices. We sought to improve the quality of sterile medical equipment to satisfy international standards of safety. Methods: We implemented a 7-stage process in the CSSD and we developed a checklist with 8 categories of environmental development based on APSIC guidelines. We provided knowledge to CSSD employees, developed their skills, and promoted attitudes in various areas, including sterile work standards, the use of sterilization machines, and infection prevention and control both inside and outside the facility. Results: We established inventory control systems, storage guidelines, and disbursement of medical supplies and equipment in the CSSD. To improve machine use in sterilization treatment or disposal, we educated staff and provided practice of machine skills according to instructions for use. Information technology (IT) was used for the distribution process, medical device identification, recording sterilization, and statistical logging of sterilization and sterile services. Conclusions: Overall, we improved the quality of CSSD services and knowledge and practice of CSSD staff, and we achieved compliance with international standards. These measures ensure the safety of service providers and patients and build trust in the quality of CSSD services and output."}
{"text": "Entropy, entitled Information and Divergence Measures, covers various aspects and applications in the general area of Information and Divergence Measures.The present Special Issue of Measures of information appear everywhere in probability and statistics. They play a fundamental role in communication theory. They have a long history dating back to the papers of Fisher, Shannon, and Kullback. There are many measures each claiming to capture the concept of information or simply being measures of divergence or distance between two probability distributions. Numerous generalizations of such measures also exist. The concept of distance is important in establishing the degree of similarity and/or closeness between functions, populations, and distributions. The intense engagement of many authors with entropy and divergence measures demonstrates the significant role they are playing in the sciences. Indeed, distances and entropies are related to inferential statistics, including both estimation and hypothesis testing problems ,3,4,5,6,All the articles included in this Special Issue were reviewed and accepted for publication because they have been found to contribute research works of the highest quality and at the same time, they highlight the diversity of the topics in this scientific area. The issue presents twelve original contributions that span a wide range of topics. In , the aut"}
{"text": "To further promote the effective governance of rural human settlements in China, it is necessary to summarize and organize the research on rural human settlements that has been undertaken in the last decade. This paper analyzes the current status of rural human settlements research from the perspectives of Chinese literature and English literature. It takes the core documents included in WOS (Web of Science) and CNKI  as samples, and produces a visual analysis of the authors, institutions, disciplines, and research hotspots for rural human settlements research with the help of CiteSpace V and other measurement software, focus on identifying the similarities and differences between CNKI and WOS in the study of rural human settlements. The results show that the number of papers is increasing; cooperation between Chinese researchers and institutions needs to be further strengthened; the existing research has achieved interdisciplinary integration; the research hotspots are converging, but China pays more attention to the study of the hard environment, such as the macro level of rural human settlements and the natural ecological environments of residence, and lacks insight into the soft environment, such as the main body of residences, social relations, and individual needs in the urban fringe. This study is conducive to promoting the integrated development of urban and rural areas in China, promoting the revitalization and development of rural areas in China, and achieving social equity. The rural human settlement environment refers to the places that rural residents rely on for production, life, and residence. With the implementation of the rural revitalization strategy, rural human settlements have attracted much attention and become an important part of rural revitalization. The report of the 19th National Congress of the Communist Party of China officially proposed action to be carried out for the rectification of rural human settlement environments. Since then, the study of rural human settlement environments has gained the attention of domestic scholars. In February 2018, the General Offices of the CPC Central Committee and the State Council issued the Three-year Action Plan for the Improvement of Rural Human Settlements (2018\u20132020). In 2021, the General Offices of the CPC Central Committee and the State Council issued the five-year Action Plan for the improvement of Rural Human Settlements (2021\u20132025). The improvement of rural human settlements has entered a new stage [In order to fully reflect the reliability and comprehensiveness of the data, the Chinese and English documents in this paper are from the CNKI platform and WOS platform, respectively, which represent one of the most authoritative databases in Chinese and English.Chinese studies were screened through the CNKI platform, and data sources were selected from Peking University Core, EI, and CSSCI. The search conditions were as follows: the subject was rural human settlements OR village human settlements; the document type is academic journal; the language is Chinese; the matching method was selected as accurate; the time span is 1 January 2013\u20138 June 2022. Due to the requirements of the research tools, the title information was exported in the form of Refworks, EndNote, and NoteExpress text, and imported into NoteExpress software for data cleaning and manual cleaning. In order to prevent the contents of master\u2019s and doctoral theses and conferences from duplicating the contents of journals, some documents, such as master\u2019s and doctoral theses and conference theses, as well as book reviews, conferences, solicitations, news articles, etc., which were not relevant to the research topic, were eliminated, and 292 effective documents were finally obtained. For English literature screening through WOS, the following search conditions were entered for the basic search: the database is a core collection of Web of Science; the theme is rural residential environment or rural living environment; the document types are article and review; the language is English; the time span is 1 January 2013\u20138 June 2022. A total of 2991 documents were searched. After the duplications were processed in the same way as that described for the Chinese documents, a total of 2990 valid documents were retained.http://www.sationline.cn/#!/, Tianjin, China), Note Express , and CiteSpace V , a literature measurement software used around the world. SATI is a document catalog information analysis tool, which converts text data such as CNKI, WANFANG DATA, and the China Science and Technology Journal Database, and extracts and counts data including keywords, authors, and institutions for the construction of a common word matrix and the conversion of different matrices [The research tools used were SATI4.0  was used to analyze the literature data, and 1407 keywords were found from 2013 to 2022, among which 895 were independent keywords, with an average of 4.82 keywords per article. SATI software  algorithm was used to obtain the rural human settlements keyword clustering diagram . There aThe smaller the number in the clustering label, the more keywords it contains. Taking the first three significant clusters as an example , the cluAccording to the above graphic analysis, the research themes and trends related to rural human settlements in CNKI can be divided into the following areas.The first point relates to rural revitalization and rural human settlement environment research. At present, most Chinese research on rural human settlements is related to the development of rural revitalization. Based on the background of rural revitalization, Liu Chunxia\u2019s paper analyzes the current status of rural residential environment improvement in Henan Province, and puts forward countermeasures, such as developing rural industries, unified village planning, and the intensive use of public funds . Li BohuThe second point pertains to research on the residential environment. Residential environment research is the focus of this area of rural residential environment research, and mainly considers water and sanitation improvement, garbage treatment, sewage treatment, and the construction of public service facilities. It advocates the construction of a new countryside and a livable countryside. However, domestic research on the living environment focuses more on the improvement of the natural environment, and less on the study of the human and cultural environment in relation to the rural living environment. Zhou Chuanbin designed an ecological engineering model for a rural courtyard, with \u201cplanting\u2014breeding\u2014toilet\u2014cleaning\u2014water cellar\u201d as the main line, demonstrating a micro-ecological cycle, with the production and life integration of a compound ecological courtyard . Ma JunqThe third area pertains to residential space research. China is a vast country. Due to the varying climate, terrain, and other natural environmental features, as well as traditional national culture and social and economic conditions, there are regional differences in residential spaces. Lin Chuanhong analyzes the spatial patterns of rural human settlements in Anhui Province from three perspectives: production space, living space, and ecological space . From thAs shown above, a knowledge graph analysis was undertaken for the research of rural human settlements in CNKI. Then, statistics and trend analysis were conducted for the research of rural human settlements with the data of literature included in WOS, so as to understand the overall and directional nature of international research in this field. This aspect of the study aimed to generate follow-up research on rural human settlements.As can be seen from In terms of the countries that have published papers on rural human settlements, this paper selects the top 10 countries according to the number of published papers . It can According to the analysis of the network of cooperative institutions that was conducted using CiteSpace V software see , there aThe top 10 disciplines of English research on rural human settlements were selected see , and theAccording to the SATI analysis, the number of total authors and independent authors in the study of rural human settlements in the past decade is 15,290 and 13,662, respectively, with an average of 5.12 authors per article. Through an analysis of the author cooperation network, conducted using CiteSpace, Introduction to land use and rural sustainability in China, Liu Y.S. offered an examination of the impact of shifts in human socio-economic activities on changes in land use and related policy making from both Chinese and global perspectives [The type of reference nodes in the literature data was analyzed using CiteSpace V, and the time slice was set as one year with a time span of 2013\u20132022. Other settings were set to the default. pectives . Conceptpectives . Thus, tA total of 11,635 keywords and 6968 independent keywords were retrieved through WOS, with an average of 3.89 keywords per article. According to the word frequency list of CiteSpace V, the top 20 high-frequency keywords were selected see . Among tThe WOS bibliographic information was imported into CiteSpace V software, the type of Keyword node was analyzed, the time slice was set to one year, and the keyword clustering view was obtained after running the software . There wThe keyword clustering was converted into a time graph , showingAccording to the above chart analysis, the themes and trends in rural human settlements research in WOS can be summarized as follows.The first area pertains to residential environment research. English literature mainly discusses the impact of living environments on human health, in relation to asthma, depression, obesity, and other diseases, as well as the relationship between mental health and neighborhood relations. Studies have shown that the degree of exposure to natural environments affects mental health. Beyer, K.\u2019s article examining the relationship between green spaces and mental health and the role of green space in non-urban settings suggests that \u201cgreening\u201d may be a potential strategy for improving populations\u2019 mental health in the United States . EngemanThe study of residential subjects is another key area. In WOS, scholars have carried out classification research on the main part of residence when studying the rural residential environment, especially the elderly, women, children, and young people. The most important active groups in rural human settlements are the elderly, women, children, and other vulnerable groups. According to Burholt, V., the rural environment intensifies the difficulty of social participation and access to social resources, and it enhances the loneliness of the elderly in their later years . In addiBased on the literature analysis conducted using SATI4.0, Note Express, and CiteSpace V, this paper drew a knowledge map of rural human settlements research from 2013 to 2022. We summarized and compared the number of papers, authors, research institutions, subject areas, research hotspots and trends, as well as important literature on rural human settlements in CNKI and WOS. The main conclusions are as follows:In terms of the number of published papers, both CNKI and WOS have shown a rising trend in the number of papers published on rural human settlements research. Both of them attach great importance to rural human settlements research, and their research prospects are broad.In terms of research authors and institutions, compared with WOS, CNKI lacks communication and cooperation between research authors and research institutions, and has not yet formed a complete and close cooperation network. However, Chinese research authors and research institutions have close cooperation with other countries\u2019 research authors and research institutions internationally, and they play an important role in these networks. The core group of authors and cooperating institutions in international research on rural human settlement environment has formed a relatively complete cooperative network.In this study, we can find that the study of rural human settlements in WOS integrates geography, environmental science, planning, ecology, economics, management, history, pathology, and other disciplines, realizing interdisciplinary research. The research on rural human settlements in CNKI has also achieved interdisciplinary research, but the degree of interdisciplinary integration is not as high as that in WOS.The research hotspots in CNKI are rural revitalization, living environment, and living space, and more of them are based on rural revitalization to promote rural revitalization and development. It focuses on the transformation of the living environment, including the transformation of water and toilets, garbage disposal, and sewage treatment, and the construction of public service facilities. The living spaces of different regions are mainly studied from the perspectives of production, life, ecology, and \u201cliving space\u201d, especially in relation to changes in traditional settlements in China. Because China has a long history and culture, the change in settlements reflects the different choices living subjects make regarding their living environments in different periods . GeneralIt can be seen from the above studies that the research on rural human settlements has broad prospects. In future research, Chinese scholars should connect with the hotspots of international rural human settlements research, set out the national conditions, combine the actual situations of different regions and types of rural areas in China, and establish a system theory and policy suitable for the development of rural human settlements in China. Scholars should aim to strengthen the research on the subject of rural human settlements, social relations, individual needs, and the impact of urbanization on rural human settlements from a micro perspective and continue to conduct in-depth research on the human environment, housing structures, infrastructure, and urban\u2013rural integration. We will continue to learn from countries with valuable practical experience and provide a meaningful reference for effectively promoting the integrated development of urban and rural areas in China, promoting rural revitalization and development and social equity."}
{"text": "During recent years, remarkable progress has been made in the development of new materials. Advanced structured materials, including smart and nano materials, have opened up new engineering possibilities because of their specific properties  that are not found in nature, and can be significantly changed by a user in a controlled manner to make them appropriate for certain applications. Due to their unique properties, smart and nano materials have been of interest in countless areas of technical application, in various systems and structures, including intelligent and adaptive sensing or actuation, as well as active control. An understanding of the relationships between their structures and properties is of crucial importance for the practical utilization of these materials.Over the past several years, a series of approaches for progress in structural control and healthy monitoring have left paramount impacts on our everyday lives. This has shaped the framework of many engineering fields. Given the current state of quantitative and principled methodologies, nowadays, it is possible to rapidly and consistently evaluate the structural safety of mechanical systems, industrial machines, and modern concrete buildings, etc., to test their capability for serving their intended purpose. However, unsolved, problematic, and new challenges exist. Unmolded nonlinearities, ineffective sensor placement, and the effects of confounding influences due to operational and environmental variabilities still harm the effectiveness of the state of structural control and healthy monitoring systems. A typical integrating structural control and health monitoring system is shown in The aim of this Special Issue is to gain new, unique knowledge about the relationships between the structures and physico-mechanical and chemical properties of new materials, including finding ways to structure the control and development of new methods for structural healthy monitoring. Another goal is to gather the main contributions of academics and practitioners in mechanical, aerospace, and civil engineering to provide a common ground for improvements to these approaches to structural control and healthy monitoring, by using the unique properties of smart and nano materials. Studies concerning sensor technologies, vibration-based techniques, artificial-intelligence-based methods, and related fields are all welcome, in both numerical and experimental form.Structural health monitoring;Structural control;Smart materials and structures;Nanomaterials and nanocomposites;Sensors and actuators;Energy harvesting;Artificial intelligence;Damage detection;System identification;Machine learning;Sensor placement;Intelligent structure systems.The keywords of this Special Issue are:Evidently, the articles accepted for publication will cover all the topics and it is expected that the manuscripts published here are of interest to researchers working in improving the materials utilized in structural control and health monitoring.The manuscripts of this Special Issue can be classified according the topics provided in Considering the knowledge of the guest editors of this Special Issue, the preservation of the structural integrity of the damaged parts is distinguished by a control and repair procedure through establishing the smart and nanomaterials effect, in which local moment and force are induced in these materials by applying the converse effect of the structure, in order to break the increase in stress and strain levels due to the external load, thus decreasing the criticality of the damage. Additionally, entering structural health monitoring (SHM) and artificial intelligence (AI) techniques into the procedure of controlling and repairing the damage to structures will definitely highly affect the avoidance of a premature collapse of mechanical and civil structures such as pipelines, houses, bridges, aerospace, and offshore platforms. In this Special Issue, we underwent efforts to collect contributions from active researchers in the fields of structural control and health monitoring, and also mechanical, structural, electrical, material, and other engineering fields. It will act as a platform for sharing. Furthermore, researchers may provide transparent views and indices for their research areas through challenges and opportunities. In short, this sharing can help researchers to develop new ideas, particularly in the early stages of this research field."}
{"text": "In order to effectively protect rare and endangered plants, 27 provincial-level administrative regions in North Asia (the Asian part of Russia) have compiled and published local Red Data Books. In this study, the names (with synonyms) of vascular plants in the 27 provincial Red Books were digitalized and merged into a database of rare and endangered vascular plants in North Asia. The purpose is to reflect the species composition, geographic distribution pattern, and protection level of these plants and their inclusion in the national Russian Red Data Book and the IUCN Red List, and provide a reference for formulating conservation strategies. The dataset has a total of 2079 species, 160 subspecies, and 53 varieties belonging to 667 genera and 143 families. It contains data on 2292 taxa, including family name, genus name, species name and synonyms, protection level, and other information. We also analyzed the main influencing factors, existing problems of rare and endangered vascular plant species, and suggestions for addressing them. We conclude that, to date, the IUCN criteria have not been applied consistently in all regions, leading to an excessive number of species being recorded in the Red Data Books of Asian Russia; specifically, one-third of all floral species are in the regional Red Data Books. Based on this list, scientific and practical measures for protection, reproduction, and rational use are formulated. Since 1963, the International Union for Conservation of Nature and Natural Resources (IUCN) has maintained the list, also known as the Red List of Threatened Species   containeDuring the development of the government decree in 1996, Red Data Books were officially established in all regions of Russia. The first official regional Red Books began to appear in the Altai Territory and the Novosibirsk region in 1998 ,8. The mThis article provides a comprehensive analysis of the rare and endangered vascular plants included in all 27 Red Data Books at the provincial level in the Asian part of Russia , and all of them are listed in a database that has been created.2, or approximately 77% of Russia\u2019s territory. In the west, the border runs mainly along the middle of the Ural Mountains, separating the European and Asian parts of the Russian Federation. The northern and eastern boundaries are bounded by the Arctic and Pacific Oceans. Along the southern border, the region shares borders with Kazakhstan, Mongolia, the People\u2019s Republic of China, and North Korea. North Asia includes the Ural Federal District, the Siberian Federal District, and the Far Eastern Federal District, with a total of 27 provincial administrative regions  extends from southwest to northeast. In North Asia, there are four major rivers: the Ob, the Lena, the Yenisei, and the Amur Rivers. The climatic characteristics of North Asia vary from coastal oceanic to strongly continental in inland Siberia . There aAlthough the 27 provincial-level regions in North Asia have compiled and published lists of rare and endangered vascular plants, the information is scattered in certain regions, with a degree of dispersion and locality. There are still some species for which the accepted name is not generally accepted internationally, and there is the issue of synonyms. The purpose of this paper is to integrate the Red Book species lists of 27 provincial distribution areas in Asian Russia and form a distribution map of rare and endangered vascular plants in North Asia, and to reveal the status of threatened vascular plants and the influencing factors. We attempted to compile an integrated checklist of Red Book vascular plants of North Asia in order to contribute to the protection and rational use of these species.We collated 143 families, 667 genera, 2079 species, 160 subspecies, and 53 varieties  from the checklists of rare and endangered vascular plant species in 27 regional Red Data Books in North Asia .Oxytropis, Astragalus (both in Fabaceae), and Carex (Cyperaceae) ranked in the top three  indicate that in terms of family classification, Fabaceae, Asteraceae, and Ranunculaceae ranked in the top three . In termop three .Among North Asia\u2019s 27 provincial distribution regions, rare and endangered vascular plant species (including subspecies and varieties) are unevenly distributed across different areas. This includes the Yamal-Nenets Autonomous Area, located in the Arctic region of the Western Siberian Plain, which has the lowest number at only 61 taxa. Krasnoyarsk Territory has the highest number with 328 taxa, and the regions with the second-highest numbers are the Republic of Sakha (Yakutia) and Khabarovsk Territory, with 265 taxa a.Among the 27 provincial-level regions in North Asia, the proportion of rare and endangered vascular plants to the total number of vascular plants is between 6% (Republic of Tuva) and 18% (Kurgan Region) b. The Red Data Book of the Russian Federation  includesThe comparative analysis results indicate that among all 2292 species (subspecies and varieties) of rare and endangered vascular plants in the 27 provincial regions of North Asia, 65 families, 115 genera, and 190 species (subspecies and varieties) were on the IUCN\u2019s Red List of vascular plants , represeWe analyzed the similarities and differences in the assessment criteria of threat levels in the three sets of data in this paper. The results show that the evaluation criteria of the Russian national and local red lists conform to the basic framework of the IUCN evaluation criteria, with supplements added and improvements made at the same time see . The IUCBased on the relationship between the assessment standards of the IUCN and Russia, we determined the endangered level of 2292 threatened taxa in North Asia . Among tBased on the descriptions in the Red Book, we conducted incomplete statistics on the influencing factors of the 2292 threatened species, which mainly include 12 types: residential and commercial development, agriculture and aquaculture, energy production and mining, transportation and service corridors, biological resource use, human intrusion and disturbance, natural system modifications, plant diseases and insect pests, geological events, climate change and severe weather, and low ability of species to reproduce and spread, with narrow distribution. We counted a total of 6679 items of risk factor data, and their proportions are shown in The local Red Data Book for North Asia\u2019s 27 provincial administrative regions includes 143 families, 667 genera, and 2292 species (subspecies and varieties) , with 69Based on the three sets of data in this paper, these numbers basically reflect the geographical distribution pattern of rare and endangered vascular plants in North Asia a. It canStipa pulcherrima K. Koch has decreased due to pasture cultivation, and the species may be endangered or disappear [Eutrema cordifolium Turcz. ex Ledeb. [Micranthes brachypetala  Tkach [Based on the statistical results of the influencing factors of threatened species, it is evident that the most important factors are human economic activity, livestock farming and ranching, tourism and recreation, gathering of terrestrial plants, logging and wood harvesting, mining and quarrying, roads and railroads, climate change and severe weather, and fire and fire suppression. For example, in the Trans-Urals, the abundance of isappear ,33,35. Ix Ledeb. ,21,22 anv) Tkach ,17,18 isAt the level of the 27 regions in North Asia, the number of Red Book species (subspecies and varieties) accounts for 6% (Tuva Republic) to 18% (Kurgan Region) of all vascular plants in the region b. HoweveCeratophyllum demersum L. and Potamogeton pectinatus L. (Stuckenia pectinata (L.) B\u00f6rner), and the Red Book of the Irkutsk region includes Hydrocharis morsus-ranae L. and Sagittaria sagittifolia L., which are on the edge of their range. Of the total 224 vascular plants in the Amur region Red Book, 81 are on the edge of the distribution area or ecological distribution area, accounting for 36% of the total.The vast territory of Asian Russia, from both west to east and north to south, includes the limits of distribution of many species. The populations of many plant species that are on the edge of their range are often less resilient than those in the center of the range. It was shown for aquatic species that growing at the limits of their global range was the most frequent reason for their inclusion in regional Red Data Books of Asian Russia, and 61 species represent 64% of the list . Thus, tTriglochin maritima L. and Spirodela polyrhiza (L.) Schleid. are included in the Red Data Book of Kamchatka Territory [Potamogeton perfoliatus L. in the Red Data Book of Chukotka Autonomous Area [Elatine, Coleanthus subtilis (Tratt.) Seidel ex Roem. et Schult., and Ranunculus reptans L. are often included in Red Data Books, although they are often not threatened, as they are widespread. These species, as a rule, have no commercial value and are not collected by local people. In this case, conservation management decisions will hardly affect the abundance of the taxon in nature. In the case of a threatened taxon, as a rule, we are looking at the action of anthropogenic factors, which can be weakened or removed by making managerial decisions.A large number of taxa are listed in the regional books of the Asian part of Russia because some of our colleagues confuse the concepts of \u201crare\u201d species and \u201cendangered\u201d species. Regarding the former, the rarity of a taxon is often associated with natural causes or their ecological and biological features. erritory , and Potous Area . Some plIt was shown that most of the aquatic plants in the regions of Asian Russia are not considered to be threatened; approximately one-half have stable populations, there are no data for one-third of the species, and one-fifth of the species are increasing, while most of the protected species in the region listed in the Red Data Book of Russia are declining (94%) . Most ofHydrilla verticillata (L. f.) Royle, which is commonly found in neighboring plain regions, is among the rare species in the Red Book. Some species have a wide distribution, but are rare because of their association with cold oligotrophic lakes .Some Red Books list species whose distribution is regulated by purely natural factors . As an example, in the Republic of Altai , with a A notable effect of climate change is the northward range expansion of both widespread native species and non-native species, which has already been recorded for some aquatic plants and many southern species now occurring north of their conventional ranges . It is iIt is also inappropriate to include such species in the regional Red Data Books . UsuallyAs of 2020, six regions of Asian Russia did not have up-to-date floristic reports; in 11 regions, these reports were presented by key manuals in which the keys for identifying plants take up a lot of space, and only 10 had full-fledged reports (flora or synopsis of flora) . HoweverAfter combining the vascular plant lists in the Red Books of 27 provincial distribution areas and removing duplicate data, a total of 2440 records were obtained. When these records are matched against the Catalogue of Life, which includes 495 taxa synonyms, it can be seen that the proportion of synonyms in the data is as high as 22.0%. This shows that the problem of synonyms is widespread.Among the 27 provincial distribution areas in North Asia, the years of publication are different, as well as the standards for division. In most regions, the Red Books are compiled according to the requirements of the \u201cMethodological recommendations for maintaining the Red Data Book of a constituent entity of the Russian Federation\u201d. The assessment of taxa protection levels basically refers to the relevant assessment standards of the International Union for Conservation of Nature (IUCN) and the Red Data Book of the Russian Federation . AccordiFirst, descriptions should indicate the conservation status of the taxon in all neighboring regions. In this case, if an author uses other categories (including those recommended by IUCN), the data for the region become incomparable with the data for neighboring regions. And since the Red Books in neighboring regions are usually published in different years, we do not know how this contradiction could be resolved.Second, as we pointed out above, the flora of many regions of Russia is still poorly studied. Not all regions of the country have a sufficient number of qualified botanists. As shown by a seminar on the use of IUCN criteria in the Russian Federation at the regional level held in Moscow in the early 2000s, the floristic information available for most regions of the country does not allow a qualitative determination of the categories of protection for many plant taxa. There are Russian studies on the current situation with rarity categories and recommendations for changing it ,45,46,47Today, we can state that the prepared and approved letter of the Ministry of Natural Resources of the Russian Federation No. 02-12-53/5987 dated 27 July 2006, \u201cMethodological recommendations for maintaining the Red Book of a constituent entity of the Russian Federation\u201d .Thus, we summarized the information about compiling red lists in the vast territory of Asian Russia, which surpasses Canada, China, and all of Europe in size. Russia has a long way to go, starting from understanding the importance of and providing state support for the branch of knowledge known as conservation biology in order to study population dynamics and threats. It is necessary to rebuild the entire system of compiling red lists of species in need of protection. Undoubtedly, it is necessary to adopt the vast global experience gained by the IUCN in compiling the Red Lists ). We collected and digitalized the vascular plant data in the Red Data Book of the Russian Federation (514 species (subspecies and varieties) altogether) [https://www.iucnredlist.org/search (accessed on 28 January 2023)).We followed the administrative divisions of the Asian part of Russia comprising 27 first-level regions: 12 regions (oblasts), six territories (krais), five republics, three autonomous areas (autonomous okrugs), and one autonomous region (autonomous oblast) . The namogether)  and the ogether) ,37,38,39This dataset includes the rare and endangered vascular plants listed in 27 provincial-level Red Books in North Asia (published or released), with a data volume of 2292 items see . The dathttp://www.sp2000.org.cn/names_match_services (accessed on 2 November 2022)). The spelling of names and authors in the Catalogue of Life was accepted as well. A few names that were missing in this global index of species were nevertheless included in the checklist. In this dataset, the classification is based on PPGI [To harmonize the taxonomy and nomenclature applied in different data sources, we followed the taxonomy of the 2019 Annual Checklist of the Catalogue of Life ( on PPGI  for lyco on PPGI , and APG on PPGI  for angiBased on the Red List of vascular plants in 27 regions of North Asia, we calculated the numbers and distribution patterns from the Red Data Book of the Russian Federation and the IUCN Red List. We analyzed the similarities and differences in the assessment criteria for threat levels in the three sets of data in this paper, and selected a unified IUCN standard for merging and other comparative analyses. We also attempted to summarize and analyze the factors influencing these threatened species.Our research shows a huge disproportion, with one-third of North Asia\u2019s vascular plants being included under different classes of protection in the regional Red Data Books of Asian Russia. One of the common shortcomings of a significant number of regional Red Data Books is the inclusion of many species that are not actually threatened by extinction and do not need special protection measures.The most significant problems of the regional Red Books of Asian Russia, according to the authors, are confusion between the concepts of \u201crare\u201d species and \u201cendangered\u201d species, the frequent inclusion of species at the borders of ranges, the inclusion of species under the control of natural factors, the inclusion of species characteristic of individual stages of restorative succession, insufficient knowledge of the territory and a lack of data on population dynamics, and organizational problems associated with maintaining the books.It is necessary to change the situation, and a more critical approach is needed for the selection of species to include in Red Data Books. The main criteria for including taxa in Red Books should be that their existence is threatened as a result of human activities and that we have the ability to influence their process of extinction."}
{"text": "After the outbreak of COVID-19, the international community has been faced with various problems it has brought to cities. A large number of research projects and corresponding management measures were launched globally, trying to reduce the impact of COVID-19 on society. Among them, exploring how to maintain the health of residents by managing and updating the design of urban streets is one of the important issues regarding urban sustainability in the post-epidemic era.This study uses bibliometric analysis techniques to obtain an overview of the knowledge structure of 898 Chinese urban streets and residents' health relationship studies from the China National Knowledge Infrastructure (CNKI) database for two periods (1999\u20132019 and 2020\u20132022). Five aspects were analyzed in terms of the keyword domain co-occurrence network, topic evolution path, emergent terms, hierarchical clustering, and confusion matrix.The findings revealed that studies focused on six broad themes: community residents, health surveys, health education, COVID-19, healthy city, and public health. Based on these findings, the paper compares and discusses research priorities before and after the outbreak and highlights areas for further research and attention. Historically, cities have been at the center of pandemics, and public health crises have played a significant role in the evolution of urban planning and design concepts and technologies . As contIn the urban spatial structure, the street is the most important public space in the city, which spreads like a human vascular vein . The manThere is no doubt that the relationship between urban streets and residents' health in China will emerge in the research of different professional disciplines. The street, as an administrative and statistical unit, can be used in the research of health management, disease investigation, and analysis, especially during the epidemic period; it will be considered as the \u201cfirst line of defense for epidemic prevention and control\u201d . At the In this context, this study aims to review research on the relationship between urban streets and residents' health in China from 1999\u20132019 to 2020\u20132022. Specific objectives were to identify key topic areas, discuss how they have changed over time, and generate references that highlight influential literature. Through comparison, this study also emphasizes lessons to be learned from the epidemic and makes recommendations for areas that are relatively underdeveloped and require further research. This study provides a detailed systematic review of specific issues, emphasizing the relevance of various topics. The research findings can be used to understand better the current knowledge structure related to the subject, provide critical resources for reference and obtain more information for interested researchers and decision-makers, and then identify potential research differences.The bibliometric analysis summarizes large quantities of bibliometric data to present the state of the intellectual structure and emerging trends of a research topic or field. The analytical process is a combination of quantitative and qualitative assessment and interpretation \u201315. ThisTo make the analyzed data more comprehensive and reliable, the China National Knowledge Infrastructure (CNKI) databases was used as the data retrieval source. The database is listed as the main journal articles access database in Oxford LibGuides and Harvard Library's Chinese Studies, and CNKI is also the largest digital library in China, which includes most Chinese academic publications \u201321. The In this study, the Dissimilarity Matrix was constructed as follows . FirstlyAccording to the above, the paper sorts out the literature focus and research fields in these two periods, then discuss the research trend, the main topic areas of research, and the results of the analysis of the evolution path of the research topic.As seen in The study of the relationship between urban streets and residents' health in China, as a cross-cutting research theme, mainly involves the following disciplines during 1999\u20132019: public health and preventive medicine, clinical medicine, society, politics, urban and rural planning and municipalities, urban economy, and environment (in order of the percentage of literature by discipline); during 2020\u20132022, it mainly involves public health and preventive medicine, the urban and rural planning and municipality, urban economy, society, politics, etc. There is a clear shift on the proportion of literature by various disciplines and particularly with a significant increase in urban and rural planning and municipalities, and urban economy between 2020 and 2022.Valid keywords were extracted from 688 articles, and a total of 1,575 keywords were obtained. Valid keywords were extracted from 210 papers, and a total of 677 keywords were obtained. In this study, a time-zone diagram of the theme evolution was analyzed by COOC, and Burst Detection was performed by CiteSpace, which is based on the temporal dimension to determine (grasp) the research evolution paths, evolution characteristics, and frontier research trends of the research theme over different periods. During 1999\u20132009, the emergent terms with high salience and centrality were humanization, urban public space, and urban community sports. The emergent terms in this period indicate that research on the relationship between urban streets and residents' health in China has focused on the humanization of spaces, the development of community sports, and the education and management of residents' health. Residents' daily hygienic behavior is the critical normative content of health education through the production and distribution of promotional materials , explaining to residents about the prevention and treatment of chronic diseases, and guiding them to look at hygiene bulletin boards, hygiene wall posters, etc., and regularly carrying out thematic hygiene knowledge competitions and health consultation activities . Along wDuring 2010\u20132015, urban streets, community construction, population aging, and landscape design were the emergent terms with high emergence and centrality. Based on the SD method, Gou and Wang  evaluateDuring 2016\u20132019, only the words of social organization, elderly service facilities, urban design, community governance, accessibility, built environment, and optimization strategy emerged. Luo and Fu , based oThe context of the study theme at this time is the emergence of new types of research evidence as cities enter a phase of stock renewal and a new phase of centralized data generation for all types of urban data. Big data and open data constitute the new urban data environment, making the research results more scientific and overcoming the limitations of static, scale, and granularity trade-offs in traditional methods. However, numerous researchers are at the stage of analyzing the data and exploring the relationship between variables, and the evaluation of how to make the research results serve in the actual street space update and the effects after use is relatively weak. On the other hand, the equity of the study also needs to be concerned, as most of the studies focus on first-tier cities with good economic environments and infrastructure, and more levels of cities are needed as research subjects.The thematic evolution trends of this research area in the period of 2020\u20132022 are shown in The clustering tree diagram  and confThe second subcategory contains only township (street) and women of reproductive age. The third subcategory is from survey analysis to health status. In these two categories, streets appear as administrative services and statistical units. The research focuses on the reproductive health and health knowledge of married women of childbearing age , 40, as Integrating and analyzing the results of these three categories mentioned above, it was obtained that the literature is dominated by studies focusing on community residents, health surveys, and health education. In other words, research questions related to urban public health are relatively under-explored. An important issue that can be noted from this analysis is the diversity of groups targeted for study in health survey research , which brings insight into public health research from an urban planning and urban design perspective (there is a homogeneity of research groups). The change in the content of health education requires a diversification of the means of communication and the timeliness of acceptance by residents throughout the process.The clustering tree diagram  and the The second subcategory contained only psychological health and COVID-19, and He et al.  concludeIn the third and fourth subcategories, from street space to older people health, Yu et al.  proposedOn the other hand, Yu et al.  discusseIn the fifth subcategory, from landscape to street design, Li and Yang  propose During this period, research related to COVID-19, healthy city, and public health topics were more prominent. Among them, the healthy street is a new model for street development and a new direction for street design in the context of healthy city and stock planning, and it provides physical, psychological, and social dimensions of health services for residents. During a pandemic, the combination of administrative and geospatial attributes of streets is more evident, and the epidemic policies at different stages influence when and where residents go out and have a subtle impact on their daily life behaviors, for example, online food delivery services , communiOn the other hand, for this topic, searches in two databases, web of science and ScienceDirect, found that travel restrictions imposed during the pandemic increased the risk of alienation and associated stress and anxiety issues. At a time when most residents want to maintain their physical and mental health by accessing parks and street green spaces \u201364, it iAnother important issue reflected by the pandemic is the vulnerability of cities to supply chain disruptions, especially those related to the food supply, mainly due to restrictions on movement in pandemic prevention policies that block the food transportation chain from farms to markets and to residents' homes, which is undoubtedly a huge blow to low-income groups and the unemployed . Lal 7272 and LaFrom before to after COVID-19, the theme extended from the focus on the health of community residents and the sustainable development of healthy streets to re-examine the allocation of street space and refined management, focusing on women and vulnerable groups , this has accumulated more experiences and rich research directions for exploring the relationship between street space and residents' health such as building more humane streets and improving spatial compatibility; adhering to the orientation of healthy street planning and design, and refining the design of street facilities; using flexible thinking to manage street space in multiple dimensions and pluralistic participation in governance (civil society groups); continuing to pay more attention to women and disadvantaged groups; applying urban multi-source data to improve the information and technology of street governance, etc. The impact of COVID-19 has left cities operating in an environment with extreme uncertainty. Such a result is a challenge to the socio-economic, public health, and social stability, leaving governments with difficult trade-offs. City managers and researchers have explored different perspectives on how to control the spread of pandemics in urban spaces to safeguard sustainable urban development and health equity for residents; among them, the street is the most basic research unit. Although human society has been affected by COVID-19, the relationship between street space and residents' health should also follow the objective laws of urban, economic, and social development. A paradigm shift in governance from planning concepts and design tools to the policy of management is needed, rather than relying on a temporary and campaign approach to deal with the relationship between the two when a public health event occurs, and such shift must become a regular and continuous spatial governance effort.The purpose of this study is to provide an overview of existing research on the relationship between street and resident health in urban China before and after the onset of COVID-19, to identify major topic areas, and to highlight under-researched areas. In an analysis of 688 papers published from 1999 to 2019, it was found that research relating to this topic can be summarized into three major themes: community residents, health surveys, and health education. And from 2020 to 2022, themes of COVID-19, healthy city, and public health were dominated, and the research relating to this topic is enriching and growing.COVID-19 once again reveals how pandemics change the spatial structure of cities and social relations in space, reshaping space and social relations during the pandemic, which also created new spatial inequalities. Hence, executable policy of health is depending on political will and state budgeting . When stOverall, the pandemic has had a subtle impact on the relationship between streets and the health of China's residents. Now that 3 years have passed since the pandemic, it is the appropriate time to take stock of the lessons learned in order to improve the ability of cities to cope with the pandemic and to maintain sustainable and healthy urban development. First, because the streets have different orientations in the research of different disciplines, but they are interrelated, so the theoretical framework, research methods and research paradigms of the research are diverse. Second, at different times, the integration of urban streets and residents' health is different, and the correlation between the resources of each element within this complex system has not been sufficiently studied. Third, the shift of the study from relevance exploration to the causality of the research content, makes the findings more convincing. Fourth, there have been researchers who have conducted quantitative research through experimental methods, using technical equipment and virtual experiments, but the complex diversity of the city itself makes the research results remain some uncertainties.The research on the relationship between urban streets and residents' health is influenced by multiple factors such as urban economy, politics, society, science and technology, public health, etc. The research should be based on the actual situation of urban development, with more links to administrative management, public health, pathology, and other disciplines to strengthen the relationship, distinguish the problem under study and discern its characteristics. In the process of problem analysis, it is important to avoid the reduction of interdisciplinary cross-research opportunities due to the lack of knowledge on related research contents in different disciplines, which is one of the reasons why it is difficult to implement research and obtain appropriate results. Moreover, some research results, because it takes a certain period of time to execute on the ground, are less effective, and it is an issue worthy of attention on how to promote the implementation of research results. Therefore, when conducting research on the relationship between urban streets and residents' health, it is necessary to integrate the interrelationship between research elements, go beyond the traditional research from the perspective of the research object itself, and break the research paradigm of \u201ccurrent situation - problem - countermeasure\u201d.However, this study has its limitations. Evidently, bibliometric analysis is a valid method to provide an overview of the research field, identify major subject areas, and explore the evolution of themes and concepts. Yet, this study only provides a systematic review of the literature in China, and relevant research literature from other countries should be examined to better understand the impact of pandemics in providing more specific policy recommendations. In addition, most of the articles that this study analyzed are peer-reviewed. Evidence reported in the gray literature should also be considered in future studies to ensure better coverage of real-world impacts and policy-focused reporting, which will improve the coverage and breadth of study results where limitations can be reduced and reflect the needs of the real world.The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found in the article/supplementary material.LM and K-HW: conceptualization, methodology, and writing\u2014review and editing. LM: writing\u2014original draft, software, formal analysis, data curation, and visualization. Both authors have read and agreed to the published version of the manuscript."}
{"text": "The main objective of this paper is to analyze the Brazilian Ministry of Health (MoH) efforts in the management of medical equipment, with a specific approach for lung ventilators in the pandemic scenario of COVID-19.The methodology included a review of the normative framework and literature on technological management and research on the database of the Ministry of Health.As a promoter for acquiring medical equipment, the MoH role is highlighted and added to this competence; its function as the coordinator of the National Policy on Health Technology Management (PNGTS). According to the PNGTS the MoH has to support health managers in the implementing, monitoring, and maintaining health technologies. The scenario of lung ventilators in the pandemic was discussed, with research to verify demands, offers, installed capacity, and investments. In less than one year, the Ministry of Health acquired several pulmonary ventilators, 8.55 times greater than the annual averages of equipment acquired from 2016 to 2019. So far, there is still no maintenance plans or strategy of management for that equipment, especially in a post-pandemic scenario. Conclusion: It is possible to conclude that the Ministry of Health needs to improve health technology management systems. On the scale of the Policy, it is necessary to commit to permanent and long-term actions to ensure sustainability and reduce the technological vulnerabilities of the SUS. The Brazilian Ministry of Health (MoH) has historically made efforts to adapt its installed infrastructures through investments based on Programs to Strengthen the Unified Health System (SUS). One of the MoH financial efforts is \"Action 8535\u2014Structuring of Specialized Health Care Units\" , which iThrough these investments to public and private non-profit institutions, linked to SUS, the MoH substantially fosters the market for medical-hospital equipment with more than US$ 140 million per year, intended exclusively to purchase medical-hospital equipment and materials permanents . In 2018The MoH's first formal initiative on medical-hospital equipment management was in1990. The MoH created the Dental-Medical-Hospital Equipment Program (PROEQUIPO). This program aimed to contribute so that the health system had, at all levels , dental-medical-hospital equipment addressed to international technical standards regarding safety and quality and qualified human resources to manage this entire installed park.This initiative hoped to avoid operators' and patients' risks, wasted financial resources, and early scrapping of equipment .i)the creation of a specialization course in the area of management and maintenance of medical equipment for professionals of different levels of education ;ii)the development and internalization of international technical standards for the certification and improvement of the quality of the manufacture of electromedical equipment;iii)the creation of electromedical equipment testing laboratories for certification procedures;iv)the reformulation of the standard on hospital construction , which later originated the Ministerial Order MoH n\u00ba 1884/1994;v)the development of technical manuals to guide health professionals in the areas of safety, planning, and dimensioning of hospital environments;vi)the development of standards and ordinances by the Ministry of Health to improve the quality and safety of medical equipment;vii)and the mandatory registration of medical equipment and articles sold in the country .Between 1992 and 1996, the Program allowed:In January 1997, the MoH published the operative manual for the SUS Reorganization and Reinforcement Project (REFORSUS). The World Bank\u2014WB financed the Project to recover the country's health network infrastructure by purchasing medical equipment, renovation, expansion, and conclusion of health institutions infrastructure, and actions to improve the management of services. These initiatives resulted in a considerable increase in the value of the technological park of SUS healthcare establishments, which in 2015 arrived at the level of 63,626 institutions involving around 17.5 million dollars in investments .Within the scope of REFORSUS, MoH carried out several actions and initiatives to prepare SUS technical staff in the management of health technologies. In 2002 the MoH made a public call to finance a distance learning project related to the training of national human resources on medical and hospital equipment management. This action was named the Medical- Hospital Equipment Maintenance Management (GEMA).In mid-2001, the Brazilian National Health Surveillance Agency (Anvisa) instituted the Sentinela Network intending to be an active observatory of the performance and safety of regularly used health products: medicines, IVD, orthoses, prostheses, equipment, and medical- hospital materials, sanitizing, blood and its components. Among its specific objectives, the following stand out: i) obtain quality information on adverse events and technical complaints related to products under surveillance in the post-use / post-marketing period\u2014VIGIPOS, to support decision-making by the National Surveillance System Sanitary (SNVS); ii) contribute to the improvement of risk management in health services; iii) develop and support studies of interests to the Brazilian Public Health System . The intIn 2007, the Support System for the Elaboration of Health Investment Projects (SOMASUS) was created, which is a computerized system with free access, developed by the Executive Secretariat of the MoH, to assist states, municipalities, and institutions of the SUS in the elaboration of infrastructure investment projects in a more qualified way. The information provided by SOMASUS includes layouts of the environments of health establishments, their respective technical characteristics, and comprehensive content to support dimensioning, acquisition, installation, and operation of medical assistance equipment. The development of SOMASUS was based on the premise that establishing standards is essential for planning health investments. Therefore, the available content is based on the parameters from SUS care coverage, ministerial ordinances, technical standards, and Anvisa collegiate directive resolutions .In early 2008, Ordinance n\u00ba 375/GM/MS was published, which instituted the National Program for Qualification, Production, and Innovation in Equipment and Materials for Use in Health at the Industrial Health Complex. The General Coordination of Equipment and Materials in Health (CGMES) within the structure of the Department of the Industrial Health Complex(DECIIS) of the Secretariat of Science, Technology and Strategic Inputs (SCTIE) .In May 2019, through Decree n\u00ba 9,795, DECIIS and, consequently, CGEMS were extinguished . In thisAlready in 2010, the National Health Technology Management Policy (PNGTS) was published, which is the guiding instrument for the actors involved in the management of the assessment, incorporation, dissemination, management of the use and withdrawal of technologies in the Unified Health System. PNGTS establishes that it is up to the MoH to support managers in the implementation of technologies and in their monitoring and maintenance after incorporation .In 2011, the MoH instituted the Health Network Quality Improvement and Training Project , with an intervention proposal to support the organization of regionalized health care networks in Brazil. It was a cooperation between the World Bank and the Ministry of Health, which aims to add to the ongoing efforts to consolidate SUS. There has been a quantitative and qualitative leap in providing health technologies to the population in recent years. This new reality has demanded from health managers an increasing effort to train professionals to manage medical-assistance equipment to optimize the use of public resources and expand the population's access to this equipment .Also, in 2011, Law 12,401 was published, and it provides rules for therapeutic assistance and the incorporation of health technology within the scope of SUS. Decree n\u00ba 7,646 provides for the National Commission for the Incorporation of Technologies in the Unified Health System (CONITEC) and the administrative process for incorporating exclusion and altering health technologies SUS .In 2013, through Ordinance GM/MS n\u00ba 3134, the National List of Equipment and Permanent Materials financed by SUS (RENEM) was created to manage the financeable items for SUS and standardize their nomenclatures, allowing their effective management. RENEM items are made available to register project proposals according to the type of Health Care Establishment and their respective environments, organized by the Equipment and Materials Information and Management System (SIGEM) .At the end of 2014, Ordinance n\u00ba 2,531/GM/MS was published, which redefined the guidelines and criteria for defining the list of strategic products for SUS and the establishment of Partnerships for Productive Development (PDP) .We carried out a literature search for normative account and survey of descriptive and exploratory data on the management of medical and hospital equipment within the scope of the MoH: i) National Register of Health Establishments (CNES) of the Department of Informatics of SUS (DATASUS), ii) and the System of Management of Equipment and Permanent Financeable Materials for SUS (SIGEM) of the National Health Fund (FNS). CNES provides information on the registration of Health Establishments regarding the physical area, human resources, equipment, and outpatient and hospital services. SIGEM, on the other hand, is the system that makes the information on financial equipment available to SUS. Data search was also carried out in the Federal Government's Integrated Financial Administration System (SIAFI), an accounting system to carry out all the processing, control, and financial, patrimonial, and accounting executions of the Brazilian federal government. Finally, we consulted the database on the ANVISA website to obtain information on the health records of lung ventilators.https://covid.saude.gov.br/, containing information on the pandemic's Brazilian response. The original search was carried out between March 2020 and December 2020.We also made consultations in the MoH website database dedicated to coronavirus data, In addition to research of an applied nature with a qualitative and quantitative approach, it is considered the authors' practical experiences in managing medical-hospital equipment and the health industrial complex.The lung ventilator is a device used in cases of respiratory failure, with the function of pumping oxygen-enriched air into the lungs. In the SIGEM there is the item with the nomenclature Pressometric and Volumetric Lung Ventilator with a suggested value: US$ 11.440,7749 .In consultation with SIGEM, in March 2020, approvals for decentralized purchases of lung ventilators in the last four years were verified, Table Checking the approval data in the last year, 2019, we can see that 76% of the approved items have specification and value  suggested by the Ministry of Health, which indicates that the settings definitions are mostly standardized.In consultation with the National Register of Health Establishments (CNES-DATASUS)  in MarchIn a consultation carried out March 2020), 60 records of volumetric lung ventilators were found on the Anvisa website [20, 60 reIn the paper entitled \"Study of Medical-Assistance Equipment, Orthotics, Prosthetics, and Special Materials in the Unified Health System (SUS) in Brazil,\" published in March 2019, the authors intended to consolidate the strategic and priority products in a single list through the analyses of computerized databases, publications, and consultations with the technical and final areas of the Ministry of Health. In addition to crossing the information with the previous publications on the list of strategic products, assistance demands, incidences and ABC curve, judicialization, and recent incorporation in SUS. The study considered all the criteria with the same relevance and without weighting. The lung ventilator appeared in four out of five possible criteria, showing its relevance to the services and the health system . The lunWith the establishment of a pandemic of international importance due to the new human coronavirus, MoH took measures to deal with the public health emergency, mainly to provide the historical care demand for lung ventilators.Interministerial efforts through a workgroup coordinated by the Special Secretariat for Productivity and Employment of the Ministry of Economic (MoE), with broad support and participations from the business community, the productive sector, and financial agents gathered energy to supply the necessary demand of SUS in lung ventilators. Highlighting that this happened almost a year after the extinction of CGEMS and DECIIS within the MoH, remembering that one of its competencies was coordinating activities for qualification, productions, and innovation in medical and hospital equipment.In addition to the extinction of DECIIS, the MoH extinguished the Executive Group for the Industrial Health Complex\u2014GECIS. This Forum, coordinated by the MoH, was a formal representation of fourteen bodies or entities of the Federal Public Administration, involving the decision-making nucleus of national development policy , national development and regulation agencies and ST&I institutions. With this Forum, the SUS National Directorate began to coordinate, in an unprecedented way, a priority policy for industrial, technological, and innovation development, placing itself as an instance of articulation of the economic, industrial, and technological area to meet the imperatives of SUS .Productive escalation: First, MoH specified the demand and criteria for ventilatory therapy for patients affected by COVID-19. Then, the MoH stimulated partnerships for large-scale product developments, arrangements for the production of critical components, and all the logistics necessary for the national companies that produce lung ventilators to make an exponential leap in their production to supply the centralized acquisition of MoH. Table a) More Maintenance Initiative Lung Ventilators: The Initiative\u2009+\u2009maintenance was carried out through a voluntary network to maintain unused lung ventilators, estimated at 3,000 lungs ventilators. The voluntary network was formed by the National Service for Industrial Learning (SENAI), ArcelorMittal, BMW Group, Fiat Chrysler Autom\u00f3veis (FCA), Globo Comunica\u00e7\u00e3o e Participa\u00e7\u00f5es, Ford, Oswaldo Cruz Foundation, General Motors, Honda, Hyundai Motor Brazil, Votorantim Institute, Technological Research Institute (IPT) and POLI-USP, Jaguar Land Rover, Mercedes-Benz do Brazil, Moto Honda, Petrobras, Renault, Scania, Todos pela Sa\u00fade (Ita\u00fa), Toyota, Troller, Usiminas, Vale, Volkswagen do Brazil and Volvo do Brazil. Supported by the Ministry of Health, the Ministry of Economy, the Brazilian Agency for Industrial Development (ABDI), and the Brazilian Association of Clinical Engineering (ABEClin). It had 40 points to receive the equipment. It involved more than 500 engineers and trained technical volunteers. More than 2,500 lung ventilators were recovered [b) ecovered , 24.Among the actions carried out by the interministerial group to supply the care demand for lung ventilators, the following stand out:Regarding the national lung ventilator manufacturers, it is essential to register the investments and government subsidies that allowed the country to have the productive capacity to respond to the health emergency. Among those manufacturers, we highlight the history of KTK Takaoka, specifically the young medical student Kentaro Takaoka, who, with subsidies from USP's Institute of Technological Research (IPT). He set up a plant in the building of the Clinical Hospital of the Faculty of Medicine. He developed reduced dimensions equipment capable of performing controlled artificial ventilation, winning in 2005 Finep (Brazilian Innovation Agency) Inventor Innovator trophy .Also, there was support for the Magnamed company, founded in 2005. This company was one of the first companies invested by the Center for Innovation, Entrepreneurship, and Technology (Criatec), in 2014 it received from BNDES, through PSI\u2014Innovation (Investment Support Program), credit for a new lung ventilator development project and in 2015 support from FINEP\u2014Innovation and Research.As Marcelo Miterhof, an economist at BNDES, points out, \u201cif today we have a company capable of manufacturing high-tech equipment in Brazil, it is not luck or chance. It is a collective effort of Brazilian society. That started with the Technological Institute of Aeronautics (ITA), passed through USP's laboratories, received funding from FAPESP research, gained scale with investment funds from BNDES and FINEP, obtained subsidized credit from BNDES-PSI, and now it will help Brazil to face the pandemic, strengthening the SUS\u201d .It is worth mentioning Anvisa's actions and efforts with the issuance of instruments and transitory flexibility applicable to the confrontation of COVID-19. Specific resolutions have been published to address lung ventilators. Such efforts have contributed to expanding the availability of lung ventilators with accurate health records. In June 2020, 70 records of pressure and volume lung ventilators were located.In consultation with CNES, in December 2020, the installed capacity of lung ventilators in SUS also increased considerably, from 43,758 units in USE in SUS to 60,089, Table The pandemic of the new coronavirus highlighted the weaknesses in the databases for managing health technologies in the Ministry of Health. As demonstrated, there have historically been efforts for management systems for technology investments, appropriately for the decentralization of resources with a view of the institution's acquisitions. However, there are still no tools to assist the management of these post-acquisition technologies. CNES data, at the beginning of the pandemic, suggested that about 3,000 lung ventilators were out of use, and it is not possible to identify the reasons for this equipment not being in use. It should be noted that the MoH systems do not have standardization of item nomenclature; they are not interoperable and connected, which makes data collection and management difficult.The management of technologies involves, in addition to other system and infrastructure resources, trained human resources in operation and maintenance of this equipment in health establishments. The annual demand in recent years, through the approval of investment proposals from the Ministry of Health, averaged 1,800 lung ventilators per year. Given the massive centralized purchases, about 15,000 lung ventilators, efforts to adapt the management of these technologies in health services are imperative.The analysis of the technical specifications of the lung ventilators approved in 2019, about 76% with the same specification, indicates opportunities for using government purchasing powers through possible centralized purchases with the possibility of more significant advantage and economy, especially to establish maintenance clauses and post-investment data.In less than a year, the Ministry of Health acquired several lung ventilators, 8.55 times greater than the annual average of equipment acquired from 2016 to 2019. It should be noted that, to date, there has been no maintenance or management plan or strategy for this equipment, especially in a post-pandemic scenario. It should be noted that according to PNGTS, it is up to the MoH to support managers in the implementation of technologies and in their monitoring and maintenances after incorporation.Technology management lacks interoperable data and systems for its implementation. Data fragmentation, absence of technology databases compromises public policies and weakens the performance of health services.Furthermore, the articulation of public policies that combine efforts to ensure the population's access to the SUS is crucial. The interruption of the activities of the Industrial Health Complex, especially of the GECIS meetings, in the year preceding the pandemic, demonstrates the fragility of the continuity of government efforts in the medium and long term for national productive development, with a reduction in the dependencies of the international market.Therefore, based on the themes discussed here, it is possible to conclude that the Ministry of Health needs to improve health technology management systems. On the scale of the Policy, it is necessary to commit to permanent and long-term actions to ensure sustainability and reduce the technological vulnerabilities of the SUS."}
{"text": "In this sense, despite the relevance of the growth of female participation in the medical career, little is discussed about the distribution between genders of the main surgical medical specialties in the country.  discuss the process of feminization in surgical specialties in Brazil over the last few years, tracing a distribution profile of these specialties.  this is a retrospective and cross-sectional study with secondary data from the Censuses of Medical Demography in Brazil in the years 2011, 2013, 2015, 2018, 2020 and 2023, including the surgical specialties: Urology, Orthopedics and Traumatology, Thoracic Surgery, Neurosurgery, Digestive System Surgery, Cardiovascular Surgery, Hand Surgery, General Surgery, Head and Neck Surgery, Vascular Surgery, Plastic Surgery, Ophthalmology, Coloproctology, Otorhinolaryngology, Pediatric Surgery, and Gynecology and Obstetrics. males prevails in numbers, among the surgical specialties, however, with a lower growth rate compared to females. Specialties such as urology, orthopedics and traumatology and neurosurgery are mostly male, while gynecology and obstetrics are female.  it is evident that female participation in the surgical medical field has increased significantly over the last few years.  The same effect is seen in Latin America, where during the years 1960 to 1990, the number of economically active women tripled, growing from 18 to 57 million,,,A large part of this female workforce is concentrated in some sectors of activity, including domestic, administrative, teaching, and health. When it comes specifically to Brazilian medicine, despite men still comprising the majority of the active medical class, female participation has seen a slow and gradual increase over the last few decades, marked by the increase in the number of university graduates,,-,-This change marks a process of feminization of medicine in the country, especially when analyzing younger age groups at the base of the doctors\u2019 population pyramidIn this sense, despite the relevance of the topic on female participation in the medical career, no current research was found in the literature that debated the distribution between sexes of the main surgical medical specialties in the country. Therefore, the objective of this work is to discuss the feminization process in surgical specialties in Brazil over the last few years, outlining a distribution profile of these specialties.We conducted a retrospective, cross-sectional study with secondary data, which includes evaluating sociodemographic characteristics of doctors in Brazil according to the number of professional records, gender, and distribution in medical and surgical specialties.The secondary data used correspond to the Medical Demography Censuses in Brazil from the years 2011, 2013, 2015, 2018, 2020, and 2023.We considered the number of specialists the most suitable variable for mapping population characteristics, such as sex and age, as it disregards secondary medical records, that is, those registered with more than one Regional Council of Medicine (CRM) for practicing in more than one Federation Unit. We obtained specialist data from the Medical Demography Censuses, by crossing information from medical specialty societies, the National Medical Residency Commission (CNRM) of the Ministry of Health, and the Regional Medical Councils, as there is no unified database in the countryWe included the following medical specialties: Urology, Orthopedics and Traumatology, Thoracic Surgery, Neurosurgery, Digestive System Surgery, Cardiovascular Surgery, Hand Surgery, General Surgery, Head and Neck Surgery, Vascular Surgery, Plastic Surgery, Ophthalmology, Coloproctology, Otorhinolaryngology, Pediatric Surgery, and Gynecology and Obstetrics.We present the data in raw numbers, percentages, and by the male-female ratio (MFR), which constitutes descriptive statistics, calculated from the number of males divided by the number of females in the same surgical specialty. Values less than 1 indicate a predominance of females in relation to males, while values greater than 1 indicate male predominance. In turn, a ratio equal to 1 indicates equality between the groups. We tabulated and organized the obtained data in Microsoft Office Word and Microsoft Office Excel, both in the 2016 version.To demonstrate the temporal distribution of the percentage of male and female specialists, we created maps with pie charts using the QGIS 3.22 software. The country\u2019s demographic and cartographic data were obtained from the Brazilian Institute of Geography and Statistics (IBGE), comprising data available in the Medical Demography Censuses in Brazil for the years 2011, 2013, 2015, 2018, 2020, and 2023.Since we extracted the data from public domain documents, submission to the Ethics in Research Committee was not necessary.Regarding the total number of specialist doctors, males remain with significant numbers, totaling, in 2023, 96,836 doctors, as opposed to 45,921 female physicians. At the same time, the growth rate in the number of female specialists increased by 114%, in contrast to the 77% growth for male doctors .Certain specialties remain predominantly male, such as urology, followed by orthopedics and traumatology and neurosurgery . On the The biggest drop in the MFR was in the urology sector, falling from 84.61 (2011) to 33.04 (2023), followed by thoracic surgery, from 14.34 to 7.02, and orthopedics and traumatology, varying from 19.2 to 12.47 .--As occurred in other professional classes, Brazilian medicine is undergoing a change in the distribution between the sexes, the effect of a movement in favor of equal rights and a reduction in inequalities and discrimination in the work environmentth century that the first female medical students graduated in Brazil,th century, men made up 77.7% of the medical profession. This male expressiveness lasted until the 60s, when it reached 87%. Following the opening of more medical schools and the significant fight for rights, female participation increased from 15.8% in 1970 to 48.6% in 2022,,It was only at the end of the 19-,,Despite the reduction in sex discrepancy over recent years, surgical specialties are still predominantly male. This same scenario is found in the United Kingdom and the United States, as men represent 73% and 61% of practicing surgeons, respectively. Among the surgical specialties studied, urology and orthopedics and traumatology were the specialties marked by the numerical superiority of men, despite the significant reduction in the discrepancy between sexes. Studies indicate that these surgical areas are, historically, demarcated by gender discrimination and psychological harassment, which, although often unrecognized, prevent women from entering them,,--When asked about the reasons, among other factors listed, the precarious maternity policy and work relations in educational institutions and hospitals, as well as the restricted guidance and mentoring on the part of teaching superiors and the salary difference are important causes of dissatisfaction and low adherence of women in surgical and academic careers-,,Another critical point strictly related to sex discrimination refers to female surgeons being repeatedly questioned about their professional and social skills, which is reflected in the limited number of women taking on leadership and coordination positions in surgical areas-,,,,Conversely, surgical specialties focused on women\u2019s health or that simultaneously have an associated clinical career, such as gynecology and obstetrics, otorhinolaryngology, and pediatric surgery, have a greater female participation and, therefore, display the lowest MFR rates. This is due to more valued and respected maternity policies, more flexible work routines and hours, in addition to more harmonious and balanced working relationships with superiors-,,-,,In fact, when analyzing the years studied, there was a significant increase in women in surgical specialties, especially due to the fight for labor rights and the deconstruction of cultural paradigms and social stereotypesAs limitations of the study, it is worth mentioning that a single data source - the Medical Demographic Census - can contribute to a smaller sample number of data and, therefore, mischaracterize the numerical reality of the proportion between men and women in surgical specialties in Brazil. Furthermore, it is not possible to know what is the main dedication or composition of the journey of doctors who have degrees in more than one specialty, which may not reflect reality.Female participation in the medical and surgical field has increased significantly over recent years, with a greater proportion of growth and participation in certain specialties. Although this great advance has been demonstrated, educational measures related to coexistence in the workplace and labor rights are still necessary, in search of a greater increase in the surgical training of women, aiming at equal participation between men and women in this field."}
{"text": "Although gender inequities in surgery are well recognized in the international literature, the panel portrayed how distant we are from the desired equity in our country. In addition, the session emphasized the need to broaden the debate and identify the mechanisms for greater inclusion and maintenance of women in the surgical career. In this editorial, we provide a historical overview of gender disparities in the Brazilian surgical ecosystem, highlight the contributing factors to a reduced number of female surgeons, and how the structure of medical societies may influence the rise of women to leadership positions. Accordingly, we discuss the benefits of gender diversity for surgeons, patients, and institutions. Furthermore, we analyze the representation of women in the Brazilian College of Surgeons since its foundation and in the scientific sessions at the conference, demonstrating that more initiatives are required to encourage female representation in the college. Finally, we propose a series of recommendations to foster engagement and contribute to the prosperity of women surgeons in Brazil.In September 2021, the 34 The panel was moderated by Dr. Maria Cristina Araujo Maya, professor of general surgery at the State University of Rio de Janeiro, and featured three speakers from different generations: Dr. Elizabeth Gomes dos Santos, general secretary and president of the Commission of Women Surgeons and of the Residency Committee of the Brazilian College of Surgeons (Col\u00e9gio Brasileiro de Cirurgi\u00f5es - CBC); Dr. Fernanda Lage Lima Dantas, professor at the Federal University of Acre, member of the Commission of Women Surgeons and full member of the CBC; and Dr. Flavia Yung Ju, plastic surgeon, full member of the CBC and preceptor of the Brazilian Institute of Plastic Surgery. On the panel, the three speakers addressed the low representation of women in the surgical area, the challenges they face, and the factors that contribute to maintaining the status quo. Although the existence of gender inequities in surgery is recognized in the international literature, this panel portrayed how far we are from the desired equity in our country. In addition, it was clear the need to broaden the discussion, identifying means for greater inclusion and retention of women in the surgical careers. Finally, it is still necessary to fight prejudice and to reaffirm the benefits of diversity for surgeons of both genders and for patients, as well as to find ways for medical societies to contribute to the prosperity of female surgeons in Brazil.In September 2021, the 34Women who choose a surgical career have faced historical challenges for generations. Until 1879, women were not accepted in medical schools in Brazil, a paradigm broken by Dr. Rita Lobato Freitas, the first physician in the country to graduate from the Bahia Faculty of Medicine, in 1887. Gradually, the percentage of women studying medicine increased, reaching 50% of the total number of medical students in 1993, and becoming the majority in 2009,Several factors contribute to a reduced number of women opting for a surgical career. Among the reasons mentioned by the conference speakers, two were recognized by a study carried out with Brazilian female doctors as the main challenges: the balance between personal and professional life and the workloadDuring the panel, the guests also discussed how the structure of medical societies influences the rise of women to leadership positions,,8.12.  Men and women differ in their experiences and values, which influence both interests and prioritiesth Brazilian Congress of Surgery, only 21% (95/455) of the speakers were women  through mandatory institutional courses on diversity, equity, and inclusion for medical students, resident physicians, and practicing physicians, as well as other health professionals; Strengthen institutional notification and response mechanisms in cases of gender discrimination and moral and sexual harassment; Promote equal mentoring and career planning programs with counseling, guidance, and emotional and professional support;Implement family planning initiatives during graduation and residency, providing information on contraceptive methods, fertility, and assisted reproduction, as well as compatible maternity and paternity leave, flexible hours, and day care in workplaces, with adequate facilities for breastfeeding, among others; Promote gender diversity when selecting speakers, moderators, and members of congress organizing committees, to achieve greater equity during the event, including also other genders and ethnic minorities; Develop a diverse and inclusive organizational culture in the context of medical societies in different areas of expertise.th congress, the CBC was innovative by enabling protagonism to women surgeons and diversity with the \u201cPanel discussion: Women in Surgery\u201d. More measures like these will be needed to allow the Congress and the College to become more inclusive environments. Incorporating diversity and equity as institutional values enable the inclusion of different perspectives and leadership styles that benefit patients, surgeons, and organizations. Thus, medical societies can and should be spokespersons for these changes, as well as agents that promote women\u2019s prosperity in surgery.  The Brazilian Congress of Surgery is one of the main spaces to promote scientific discoveries, generate debates, and communicate discoveries in the surgical area. Therefore, the event selects which people and ideas are considered relevant to medical-scientific development. In its 34"}
{"text": "Water quality criteria (WQC) for the protection of aquatic organisms mainly focus on the maximum threshold values of the pollutants that do not have harmful effects on aquatic organisms. The WQC value is the result obtained based on scientific experiments in the laboratory and data fitting extrapolation and is the limit of the threshold value of pollutants or other harmful factors in the water environment. Until now, many studies have been carried out on WQC for the protection of aquatic organisms internationally, and several countries have also issued their own relevant technical guidelines. Thus, the WQC method for the protection of aquatic organisms has been basically formed, with species sensitivity distribution (SSD) as the main method and the assessment factor (AF) as the auxiliary method. In addition, in terms of the case studies on WQC, many scholars have conducted relevant case studies on various pollutants. At the national level, several countries have also released WQC values for typical pollutants. This study systematically discusses the general situation, theoretical methodology and research progress of WQC for the protection of aquatic organisms, and deeply analyzes the key scientific issues that need to be considered in the research of WQC. Furthermore, combined with the specific characteristics of the emerging pollutants, some new ideas and directions for future WQC research for the protection of aquatic organisms are also proposed. Water quality criteria (WQC) refers to the maximum concentration or level at which pollutants or environmental factors in water environments do not have harmful effects on human health or water ecosystems ,2,3. WQCCurrently, the two mainstream WQC research systems internationally are based on those of the United States and the European Union (EU). The United States puts forward the toxicity percentage ranking method, which is a two-value criteria system . It poinVarious relevant factors are comprehensively considered in the derivation process of WQC, and the determination of criteria values is influenced by many water environmental factors, such as water hardness, temperature, pH and dissolved organic matter, and so on ,15,16,17Based on the mentioned above, the main purpose of the present study is to systematically summarize and integrate the current technical methods of WQC, deeply analyze the key issues and technical systems of WQC research methods and summarize the current case studies of WQC. Finally, some new ideas of the derivation method of WQC for emerging pollutants are also explored and prospected.The pioneering study on WQC began in the early 20th century. The United States was the earliest country to conduct WQC research. The development process of water quality standards is presented in the form of a series of WQC papers, reports, and monographs. Additionally, the United States finally issued its national water quality guideline for the protection of aquatic organisms in 1985. In addition, the European Union, the Netherlands, Canada, Australia and New Zealand, Japan, China, and other countries have also formulated their own relevant technical guidelines for WQC and established their own WQC and ecological risk assessment research systems. With the deepening of WQC research, many countries have revised, improved, and updated their guidelines in recent years .For example, the technical guidance of the United States was issued in 1985 [Technical Guidance Document for Risk Assessment\u201d (TGD) in 2003 [The European Union promulgated the Water Framework Directive (WFD) in 2000, which played an important role in developing and promoting the setting of water environmental quality standards. The WFD is a legal framework designed to protect freshwater and marine ecosystems from the adverse effects of pollutants and to protect human health. The European Union (EU) uses environmental risk assessment technology to derive the predicted no-effect concentration (PNEC) of pollutants as water quality protective objectives for environmental management and issued the \u201c in 2003 . In 2004 in 2003 . This isGuidance Document for Aquatic Effects Assessment in 1995 to evaluate the hazardous effect of pollutants on water environments [A protocol for the derivation of water quality guidelines for the protection of aquatic life\u201d [Australian and New Zealand guidelines for fresh and marine water quality\u201d in 2000 [the Guidance document on deriving environmental risk limits in 2001 [Environmental Quality Standards for Water Pollution in 1971 [In addition to the two mainstream countries of the United States and the European Union, some other countries and organizations have also conducted relevant research on WQC. For example, the Organization for Economic Cooperation and Development (OECD) issued the ronments . In 1999ic life\u201d , which wic life\u201d . The Aus in 2000 , which w in 2000 . The Nat in 2001 , which w in 2001 . The Min in 1971 , which w in 1971 .Technical guideline for deriving WQC for freshwater organisms\u201d, which was first released by the Ministry of Ecology and Environment in 2017 [The research on WQC in China started relatively late, dating back to the 1980s. The initial research was only the collection and collation of relative references and data and integrated the research methods of WQC in different countries and organizations. Subsequently, on the basis of a large number of theoretical explorations and WQC case studies, some monographs and books related to WQC were published one after another ,5,39. Th in 2017 . It is a in 2017 , which iThere are many key steps involved in the extrapolation of WQC for the protection of aquatic organisms. In general, the factors affecting WQC mainly include the reliability of basic data, standardization of toxicity data and the scientificity of statistical analysis methods. All these elements play a very important role in the study of WQC.Firstly, in terms of species selection, the selection of regional native species is crucial for WQC. Many studies have shown that, for the same pollutant, biota differences will lead to the ultimate difference in the WQC value of the pollutant, which further highlights the importance of site-specific or native species ,42,43. T5, which is the concentration at which 5% of species are at risk [Secondly, in terms of WQC derivation methods, the derivation system based on the SSD method and supplemented by the assessment factor (AF) method has been basically formed in the world at present. The main steps of WQC derivation mainly include data collection, data screening and evaluation, and WQC derivation . The bas at risk ,45,46. I at risk  only use at risk , the SSDThe SSD method is an international mainstream method used to establish ecological environment criteria. Model selection is the core and key of this method. When building SSD models, the commonly used derivation methods according to the amount of toxicity data include the normal distribution model, logistic distribution model, etc., and the mainstream trend is to use the best-fit curve to derive the final WQC value ,48,49. SThirdly, in terms of the description and value of the WQC for specific pollutants, the double-value criteria system is mainly used internationally at present. The United States, Canada, China, and other countries adopt double-value criteria. Double-value criteria generally refer to long-term criteria and short-term criteria (or chronic criteria and acute criteria). Long-term criteria (chronic criteria) are designed to protect aquatic life  from the negative effects caused by the indefinite long-term effects of pollutants. In contrast, short-term criteria are designed to protect aquatic organisms from serious negative effects (such as death) caused by short-term effects. Some countries and organizations also use single-value criteria such as the European Union . There aIn recent years, great progress has been made in international research focusing on WQC. Many scholars have carried out a large number of WQC case studies of typical pollutants and published a series of research papers, monographs, etc. These studies not only summarized and explored the theoretical methodology of WQC for the protection of aquatic organisms but also provided case studies on WQC, including conventional pollutants, some physical and chemical parameters of water bodies, and new emerging pollutants ,39,45,52At the same time, the countries and organizations studying WQC were screened, and it was found that China and the United States were significantly ahead of other countries in terms of the number of publications on WQC, with 284 and 134 publications . In China, the Chinese research academy of environmental sciences published the most articles, and its secondary institution, the state key laboratory of environmental criteria and risk assessment, contributed more than 118 articles. The top five countries in terms of the number of articles issued were China, the United States, Canada, the United Kingdom, and Italy. Additionally, the number of WQC articles issued by these five countries accounted for 60% of all the published articles .In terms of the WQC values of toxic substances published at the national level, some countries have also published WQC for the protection of aquatic organisms for some toxic substances at the national level. For example, since the release of the guidelines for WQC in the United States, a number of WQC for toxic substances have been published, and the WQC are updated almost every 2\u20133 years in combination with the latest research. EPA\u2019s compilation of nationally recommended WQC is presented as a summary table containing recommended WQC for the protection of aquatic life and human health in surface waters. These criteria are published pursuant to the Clean Water Act and provide guidance for states and tribes to use to establish water quality standards and ultimately provide a basis for controlling discharges or releases of pollutants. At present, the latest WQC published by the US EPA contains 186 indicators ,22, inclIn addition to the United States, Australia and New Zealand , Canada The acquisition of toxicity data is the key issue of WQC research. Different types of pollutants have different influencing factors in the study of WQC. For example, the toxic effect of organic matter on organisms is relatively complex, so the endpoint of the toxic effect of organic pollutants on organisms should be clarified in the WQC study, and then the criteria are deduced. The toxic effects of heavy metals are greatly influenced by environmental factors. Another problem encountered in WQC studies is the lack of data on the toxicity of the selected pollutants. The toxicity data could not meet the requirements of fitting the SSD curve, nor could they meet the requirements of the AF method. However, when environmental management is in urgent need, it is necessary to predict the toxicity data of pollutants by means of model prediction. Model prediction includes the following levels. First, how to use laboratory experiments to predict actual toxicity effects in the field? The Biotic Ligand Models (BLM) approach can be used. The BLM is a mechanistic approach that greatly improves our ability to generate site-specific ambient water quality criteria for metals in the natural environment . Water eEmerging pollutants refer to the pollutants produced in production, construction or other activities, which are caused by human activities, that clearly exist but have not been regulated by laws, regulations and standards and harm the living and ecological environment. With the continuous detection of emerging pollutants in the environment, they are gradually receiving widespread attention ,73,74. TCompared with conventional pollutants, emerging pollutants have the following differences. Taking EDC as an example, first, the dose\u2013response relationship of conventional pollutants generally follows the principle of \u201clow dose, low toxicity\u201d, and its toxicity value has a certain threshold. While for EDCs, it is also toxic at low doses, with the characteristics of \u201clow dose, high toxicity\u201d. In addition, EDCs may exhibit certain biological effects, including delayed and multigenerational effects, and may exhibit non-monotonic dose\u2013response relationships ,76. SecoFurthermore, in terms of WQC values, when deriving WQC for conventional pollutants, double criteria values, such as short-term criteria values and long-term criteria values, are generally formulated. Nonetheless, EDCs in a short time exposure generally will not cause serious toxicity on aquatic organisms, while, under trace concentrations, will have irreversible toxicity effects on aquatic organisms. The acute-to-chronic ratio of EDCs is generally large; the largest may reach 10,000 or 100,000 times. Therefore, it is recommended to use single-value criteria when deriving WQC for EDCs, and only the values obtained from chronic toxicity are used to derive the long-term criteria value. In addition, it is also important to establish an effective correlation between toxic effects and endpoints . Many efIn addition, a non-monotonic dose\u2013effect relationship may appear in both in vitro and short-term in vivo studies of the EDCs, but it might not be able to widely predict the toxicity endpoint in long-term in vivo studies. In the absence of the toxicity threshold of EDCs, probabilistic methods should be used to predict the threshold, which is also a new idea for the future study of WQC of emerging pollutants."}
{"text": "Pregnancy, childbirth, and the postpartum period are phases commonly associated with joy and hope. Even though it may be an unplanned event for many women, pregnancy usually develops without complications most of the times: mother and newborn child start together\u2014and well\u2014a new phase of their lives. This does not mean that the good outcome was achieved without a significant number of women experiencing discomfort, stress, anxiety, fear, or even some sadness. These are conditions that, although not desirable, tend to be present during pregnancy, childbirth, and the postpartum period. However, for some women, this is a period of great anguish, suffering, and risk. Risk of intimate partner violence, of mistreatment in health facilities, of developing physical or psychological sequelae, and risk of dying.A maternal death is an individual, family, and social tragedy. Because it is preventable in the absolute majority of times it occurs, there is no male equivalent, and it disproportionately affects certain groups of women, maternal mortality exceeds the boundaries of clinical obstetrics and reflects broader societal issues.Homo sapiens, lies the biological basis of pregnancy and childbirth. This includes, for instance, the shape of the pelvis and the complex endocrinology of parturition. The innate characteristics and potential of the species favored the development, over time, of the current human culture and society. Culture and society are the origin of the guiding principles of social organization, the legal and political structure, and the mode of production of the economy. In this context, human interaction with the planet has produced environmental degradation, with consequences that include the increasing concentration of particulate matter in the atmosphere and the acceleration of global warming. The latter, besides being responsible for the melting of ice glaciers and the rise of the sea level, is associated with a greater frequency and intensity of extreme climate events, including heat waves or drought or severe storms and heavy rain. These events affect maternal health and have been associated with an increased maternal and perinatal morbidity and mortality.Considered as causes of complications of pregnancy, intrinsic or extrinsic etiological agents  do not act in isolation on women to produce complications. The etiological agents act under the influence of several other factors, in a complex and multifactorial process known as the health-disease process . Over thH. sapiens, their culture and society, and the environment are super determinants of the whole health-disease process, thus originating the so-called primary determinants of health. Education, income, ethnicity and gender issues affect the risk of a woman dying during pregnancy, childbirth, and postpartum/postabortion period. Women of color, those living on the outskirts of large cities or in rural areas, those with little access to education or income, are the women experiencing the highest maternal mortality.Together, the innate characteristics of Given the broad determinants of maternal mortality and the complex health-disease process, maternal mortality has long ceased to be \u201cjust\u201d a health indicator and became a social development indicator. Hence its inclusion as a progress indicator of two successive global initiatives, the Millennium Development Goals (2000\u20132015) and the Sustainable Development Goals (2016\u20132030). Both initiatives, promoted by the United Nations (UN), seek to encourage the governments of the signatory countries to implement programs to promote social development and eliminate extreme poverty.The World Health Organization (WHO) estimates that in the early 1990s there were \u223c 500,000 maternal deaths per year worldwide. According to the UN health agency, the annual number of maternal deaths around the world would be just over 450,000 deaths in 2000 and 295,000 in 2017. The global maternal mortality ratio in 2000 and 2017 was estimated at 342 and 211 maternal deaths per 100,000 live births, respectively. In Brazil, the maternal mortality ratio in 2000 was estimated by the WHO at 69 deaths per 100,000 live births, and, in 2017, 60 deaths per 100,000 live births. The WHO estimated for 2017 a total of 1,700 maternal deaths in Brazil, with the lifetime risk of 1 maternal death for 940 women.Considering the evolution of the maternal mortality ratio in Brazil since 1990, the most substantial reduction took place in the last decade of the 20th century. This reduction of maternal mortality has been partially and ecologically attributed to a greater access to primary health care during pregnancy , greater coordination between the different levels of the health system, and improvements in emergency services. These advances occurred in the context of greater economic stability and the implementation of the Unified Health System (SUS) in Brazil, which occurred in the beginning of the 1990s. In the 2000s, the rate of reduction in the maternal mortality ratio decreased and started to tend to stability, suggesting the need for more intense social transformations as well as greater gains in efficiency and quality in the health system.Although there is no shortcut to reduce maternal mortality\u2014social development is necessary for substantial and sustainable gains\u2014the health sector cannot be exempted from its central role in tackling maternal mortality. The reduction in maternal mortality occurs over a long journey, which can be divided into stages. According to the theory of obstetric transition , Brazil Maternal mortality is a difficult puzzle to solve. However, progress made in the last few decades is encouraging. In Brazil, the major obstacle is to advance the quest for social justice, particularly from an ethnic and gender perspective, expanding women's access to education and income, with special emphasis on women of color. In addition, it is essential to make a leap in the quality and effectiveness in public health services. The provision of women-centered, timely, appropriate and respectful quality care guided by the best scientific evidence should be the major goal of all maternity and women's health services. For this, the state needs to strengthen the public sector health system, and the society needs to exercise its primary role of defense and social control of the public health system."}
{"text": "The year 2022 has been a year of significant advancements in disaster and emergency medicine. The global community, in the previous years, has faced numerous challenges, from the COVID-19 pandemic to an increase in natural disasters  protocols in Munich, Germany, reveals that the location of out-of-hospital cardiac arrest (OHCA) does not significantly affect the return of spontaneous circulation incidence, although patients in public spaces have a higher chance of being admitted to the hospital with spontaneous circulation. The study also highlights the overall low levels of bystander CPR and bystander use of automated external defibrillators, emphasizing the importance of public education and training to improve the chain of survival.Another significant aspect of disaster and emergency medicine is the management of patients in challenging environments. Two articles in this Research Topic address the intricacies of providing medical care during transportation. Wang et al. present a national retrospective study on trauma treatment and incidence, providing valuable data to inform healthcare prevention and management strategies in the country. By analyzing over 4.5 million trauma patients from two national-level databases, the authors offer insights into the demographic characteristics, trauma causes, injury degrees, disease burden, and mortality rates. This valuable information can serve as a foundation for informed decision-making, resource allocation, trauma prevention, and trauma management.The Research Topic also delves into the epidemiology of trauma in China. Lamberti-Castronuovo et al. discuss the key role of health diplomacy in overcoming the crisis, demonstrating the importance of intersectoral cooperation and collaboration between different areas of expertise. By conducting a retrospective observational case study with qualitative methodology, the authors analyze the changes made to human resources, health service delivery, and logistics in response to the pandemic. Their findings underscore the importance of intersectoral collaboration in overcoming pandemic-related challenges and preparing for future disasters.The interconnectedness and multidisciplinary nature of disaster and emergency medicine are further emphasized through the articles exploring the challenges posed by the COVID-19 pandemic. This Research Topic showcases the breadth and depth of disaster and emergency medicine research in 2022, demonstrating the crucial role of intersectoral collaboration, adaptation to changing environments, and effective resource allocation. As we continue to face complex challenges in public health, military medicine, trauma care, and cardiac arrest management, it is essential to draw upon the valuable insights provided by these studies to advance our understanding and enhance our response capabilities.Robinson et al., climate change is having and will continue to have a significant impact on public health, particularly in the context of emergency medicine. The increasing frequency and severity of extreme weather events call for the development of adaptive strategies. These strategies should focus on enhancing our capacity to respond to emergencies, especially in resource-limited countries where the consequences of extreme weather events are more severe, and response capabilities are often constrained (The diverse range of issues addressed in this Research Topic highlights the interconnectedness and multidisciplinary nature of disaster and emergency medicine. As underscored by strained .Lamberti-Castronuovo et al., the COVID-19 pandemic showcased the importance of intersectoral cooperation in overcoming the challenges posed by a global health crisis. However, such collaboration cannot be improvised in the wake of an emergency. Instead, it requires an ongoing relationship between the actors potentially involved in the response, fostering a culture of preparedness and resilience.Public health, by definition, is multidisciplinary and multisectoral. The contributing articles in this Research Topic demonstrate the indispensable nature of collaboration between different sectors and areas of expertise in emergency disaster response. As highlighted by In conclusion, this Research Topic underlines the ever-evolving nature of disaster and emergency medicine and the need for collaboration, innovation, and preparedness to address the emerging challenges. The findings and insights from these contributions will undoubtedly contribute to the ongoing efforts to improve the practice of disaster and emergency medicine and enhance our capacity to respond to the pressing issues of our time. As researchers, practitioners, and policymakers continue to work together in this multidisciplinary field, we can expect further advancements that will ultimately benefit the health and wellbeing of communities worldwide.SO conceptualized the Research Topic, drafted the manuscript, ensuring that it adhered to the journal guidelines and provided a comprehensive overview of the Research Topic, revised the manuscript based on feedback, ensuring its clarity and coherence, and solely responsible for the content of this editorial and approves its submission to the journal."}
{"text": "Stroke is a major health concern globally, ranking as the second-leading cause of death and the third-leading cause of death and disability combined. The economic impact of stroke is also significant, with an estimated global cost exceeding US$721 billion, equivalent to 0.66% of the global GDP . These fThis opinion article presents an analysis of the current state of stroke research in China, focusing on the four major clinical medicine journals, namely the New England Journal of Medicine (NEJM), The Lancet, the Journal of the American Medical Association (JAMA), and the British Medical Journal (BMJ). In addition, Frontiers in Neurology was also used as a reference. We also examine the factors driving progress in stroke research in China and discuss possible future directions for stroke research in the country.China has made significant progress in stroke prevention, treatment, and rehabilitation in recent years , 6. The As the population of China continues to age and risk factors for stroke, such as diabetes and hypertension, remain poorly controlled and on the rise, the incidence of stroke is reaching a period of high prevalence , 14. ThiIt is important to note that stroke research in China has predominantly focused on ischemic stroke, with particular emphasis on acute-phase rescue and treatment during hospitalization. Societal organizations such as the Chinese Stroke Association and the National Health Commission Stroke Prevention and Control Committee have made significant efforts toward stroke prevention, post-discharge rehabilitation, and secondary prevention for the past decade , 15, 16.Our study focused on stroke-related research published between 2020 and 2021 in the Science Citation Index Expanded (SCIE) database. A total of 9,113 articles and review articles were identified using the search terms \u201cstroke\u201d. Of these, Chinese scholars contributed 2,351 publications, accounting for 25.8% of the total, and ranking second globally after the United States . Capital Medical University ranked first among research institutions worldwide with 428 publications. However, the average number of citations per article by Chinese scholars was only 90% of the global average (6.18/6.93), suggesting the need for further improvement in the quality of stroke-related research conducted by Chinese scholars.As an example, Frontiers in Neurology published a total of 4,220 papers, including articles and reviews, between 2021 and 2022, according to the SCIE database. Of these, 673 (15.9%) were related to stroke research, with China contributing to nearly one-third of these papers (31.6%). Four highly representative articles (most cited articles in SCIE database) from these stroke-related studies include a review by Li et al. , which aIn conclusion, China has made significant strides in the field of stroke research, driven primarily by its economic growth, talent development, and demographic advantages. While there has been a notable increase in the number of studies published in top journals, the overall quality of research still falls behind that of developed countries. Moving forward, the government must invest more resources in stroke-related research, particularly in the areas of hemorrhagic stroke and rehabilitation. By doing so, Chinese scholars can make further contributions to the field of stroke research and improve the overall health of the global population.W-JT had full access to all the data in the study and took responsibility for the integrity of the data and the data analysis accuracy, study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, and study supervision."}
{"text": "Wood is a widely used building material. It is characterized by a high strength-to-weight ratio, predictable fire behavior, good performance in seismic zones, and it is easy to use in the construction of prefabricated buildings. In addition, wood reduces energy consumption during construction and reduces a building\u2019s overall environmental impact, has lower embedded energy compared to steel and concrete, and has a positive effect on a building\u2019s carbon footprint . The useFor multi-story floors, glulam-concrete composite beams (GCC) have been used for years, in which bending tensile forces are mainly carried by laminated wood, and compressive forces by concrete. Compared to typical glulam beams, GCC beams are characterized by, among other things, better load-bearing capacity, flexural strength and stiffness, better sound insulation, and greater thermal mass . Du et aThe permanent preservation of the form and safety of wooden constructions is ensured not only by the structural elements with adequate load-bearing capacity and strength but also by the properties of connectors and connections of individual components. Among the most common connectors in wooden constructions are dowel-type fasteners, which include screws, dowels, and bolts. According to Johanides et al. ,6, in orAn important aspect of current research is numerical modeling, which is an excellent tool for understanding the behavior of joints in wood constructions ,6. The nAn innovative solution for connecting light timber-framed roof elements has been proposed by Islam et al. . The apeThe safety of wood construction relies on proper construction technique, the quality of the engineered wood, and fire resistance. The fire safety of the structure is one of the basic requirements to be met when designing, constructing, and using a wooden house. For this reason, flame retardants are used for wood and wood-based materials, which are designed to, among other things, reduce the spread of fire, weight loss, and the rate of heat release. However, the use of flame retardants affects the mechanical properties of the wood. Grze\u015bkowiak et al.  determinOne of the research directions presented in this Special Issue is the possibility of using wood by-products from primary wood processing in the production of wood-based and insulation materials for the wider construction industry. In the sawmill industry, during the primary processing of wood raw material, in addition to losses due to desorption changes, material losses of up to 50% of the wood raw material originally intended for production are also generated . These l2. The decrease in the bond quality of plywood glued with resin with the addition of different bark species is due to its chemical composition, which can affect the resin curing process and lower the pH of the adhesive mixture. The consequence of this can be the occurrence of resin pre-curing and a decrease in the strength of the adhesive bond. In addition, spruce bark causes a decrease in the elastic modulus of plywood and its bending strength, especially in the perpendicular direction. However, the presence of lignin as well as tannins in the bark contributed to a favorable reduction in formaldehyde emissions, which was clearly observed for birch, beech, maple, and pine bark. Only in the case of spruce bark was a deterioration in the hygienic quality of the plywood produced.The bark has a unique chemical composition and contains numerous organic compounds such as tannins, lignin, cellulose, catechins, gallocatechins, flavonoids, and proanthocyanidins ,13,14. FBy-products from the wood industry have also become a source of fillers that can be used in the production of polymer-based composites. Dukarska et al.  showed tThe current technological and social trends require the construction sector to implement the principles of sustainable development. An important element of this concept is the principle of wooden construction based mainly on wood and wood-based materials, which counteracts climate change by storing carbon dioxide in wood and reducing the consumption of high-emission materials such as concrete and steel. The introduction of new and innovative solutions improves the energy efficiency of buildings, their functionality, and reduces their negative impact on the natural environment. The works presented in this Special Issue exemplify the current directions of research in modern wooden construction in accordance with the concept of sustainable development."}
{"text": "A negative impact on mental health of Ukrainian people who will survive the war is very likely.Those who leave are exposed to the trauma of leaving behind home, relatives, friends, job, habits, i.e., most of what they had built in their life, and to the unpleasant feeling of knowing nothing of what they will go through.Mutual support and nurture problem-solving strategies, including favoring family reunion, restoring people dignity and control over the environment, help children recover a more positive social reality, are major protective factors in buffering the impact of war, displacement and related trauma.By November 2022, Italy had hosted more than 170.000 Ukrainian refugees. The National Service intervention, coordinated by the Civil Protection Department, has developed a Plan for the reception and assistance of the population from Ukraine to uniform the response to the emergency on the national territory. The plan has focused on two aspects: humanitarian assistance and reception. The network for reception is composed of the CAS - Extraordinary Reception Centers and the SAI - Integration Reception System. The Plan also provides measures related to health care and education to ensure mandatory vaccination requirements and the access to the school system for unaccompanied foreign minors. As to plans aimed to address mental health issues, the right to care is guaranteed, but several issues can be identified that limit the impact of the national policies on the needs of this population.None Declared"}
{"text": "The Fourth Industrial Revolution profoundly changed social institutions, industries, individuals, and ultimately the current society. The potential to improve the quality of life and generate economic benefits is one of the major promises of the Fourth Industrial Revolution, and some of the most significant opportunities can be found in nanotechnology, quantum technology, and artificial intelligence (AI). At the same time, the development and deployment of technology raise a range of ethical and social issues globally. These include (1) potential labor market disruptions, (2) biases inherent in the technology itself, (2) the emergence of new moral dilemmas, (3) societies torn apart by falling trust, (4) growing inequality due to the digital divide, and (5) growing threats to data privacy, security, and reliability , the efficiency of economic systems and competitiveness countries in general.Therefore, one of the factors for effective digital modernization of society, as well as any process of change, can be the stimulation of skills of current workforce. In this regard, the issue of human development in the context of labor productivity growth during digitalization is very relevant and in high demand for scholarship and practice. Currently, companies are facing a number of problems related to human capital and its efficiency  shows that the productivity of almost 60% of children will be half of what they could achieve; at the same time, there are many positive examples of human resource transformation, for example, in Singapore, the Republic of Korea, and Ireland : (1) management and organization theory, (2) institutional economics, (3) market and firm theory, (4) behavioral dogmas of the organization, (5) various applied methodologies and methodologies for measuring and systematizing HCR, (6) business process human resources, and (7) strategic and collective human capital. When using the polyparadigm nature of the study of management research, it is important to consider the many paradigms of management research. The proposed study analyzes the polyparadigm of strategies .LDGOS\u2013is the level of development of the government's online service, rated in points (1\u2013100) and calculated by WIPO; data from some countries for 2020 and 2022 were not taken into account due to lack of data (no data). The highest score in 2021 was occupied by the USA (94.7), and the lowest\u2013by Germany (73.5). One can assume that the digitalization of government's online services actively influences the development of human capital and strategies for its management.PI\u2013is the prosperity index, rated in points (1\u2013100) and calculated by the Legatum Institute Foundation; data is contained in The Legatum Prosperity Index\u2122 2019: Creating the Pathways from Poverty to Prosperity Report and reflects the achievements of the countries of the world in terms of their wellbeing and prosperity. PI practically did not change for the considered countries in 2020\u20132021. This index can also be taken into account in modern personnel strategies for managing human capital.IEF\u2013is the index of economic freedom, rated in points (1\u2013100) and calculated by the Heritage Foundation; data is contained in Country Rankings of Economic Freedom 2020 and reflects the rule of law, the degree of bureaucratization of public administration, the effectiveness of regulation, and the openness of markets. In 2022, Germany had the highest IEF (76.1), and Russia\u2013the lowest (56.1). IEF can also be considered in new personnel management strategies.HIC\u2013is the human inequality coefficient calculated by the United Nations (UNDP); data is contained in the Human Development Report 2019. It reflects the degree of social justice in education, employment, career development, performance, and pay (in %). In 2021, the USA had the highest HIC (10.6), and Germany\u2013the lowest (6.2). The index can be integrated into modern strategies.phw-is the productivity per capita (GDP per hour worked) per hour (USD). It is calculated by the OECD and shows the cost of goods produced by one worker per 1 h of work. This index can be taken into account in digital HR management strategies. Unfortunately, there is no information about GDPphw in Russia today; in the USA, the index is 71.1 USD.GDPThe novelty of the proposed research is characterized, first, by the specification of the conceptual dogmas of human capital administration in the context of digitalization and, second, by the assumption of the interdisciplinarity of the digitalization phenomenon. We tested the skills of current workforce methodology, which is based on the calculations of the World Economic Forum  and reflects the level of education and training, labor force qualifications, and digital skills of the population.Strategic management originated in the early 80s of the 20th century at the enterprises of Western Europe. Strategic management of skills of current workforce involves managing the formation of competitive labor potential, taking into account current and future transformations of the external and internal environment, which allows the organization to survive, develop, and achieve short-term and long-term goals. The reorganization of the labor supply market and the development of digital platforms are transforming employment mechanisms; in this connection, further, we will highlight the main current personnel strategies.phw; PI) are related to the behavioral dogmas of the organization and methodologies for measuring and systematizing HCR. For example, when calculating the profitability of a business and the cost of an hour using modeling methods for 50 production employees who directly provide services to customers , the full salary per hour will be 330 rubles, and the profitability of the business will be 59%. In the considered strategy, recruitment is carried out according to strict criteria; wages are calculated depending on the length of service.The main strategy is the concept of profitability of human capital management in the context of digitalization of economic systems Hamburg, . This stThe advantage of the strategy of profitability of human resource management in the context of the digitalization of national economic systems is the focus on flexible management of personnel training. The classical methods of managing human potential based on the development of skills no longer meet the requirements of the modern labor market, according to the concept developed by I. Hamburg . The demIn addition, corporate learning extends beyond a single company, with massive open online courses and social learning becoming especially popular. These trends are producing new types of corporate training and co-working spaces.phw; IEF) converge on a multidimensional typology of HCR resources: management and organization theory, behavioral dogmas of the organization, HCR systematization, and strategic and collective human capital. For example, when transferring employees to a remote work format, eliminating rental fees, and introducing automation everywhere, business profits can increase up to 10%. Financial rewards in an organization using a liquidation strategy are gradually increased based on merit, and staff skills are constantly improved as needed. The liquidation strategy in the context of the digitalization of economies in the field of human capital management includes the automation of the functions of the personnel department, which is an important advantage of the concept. Automation includes, on the one hand, the introduction of digital workplaces and, on the other hand, technologies that change the methods of work and interaction between employees  converge on the management, the theory of behavioral dogmas of the organization, and strategic and collective human capital. At present, one can state the formation of an innovative direction in management based on the management of human potential, a dynamic network organizational structure focused on the cultivation and management of self-managed working groups. The spread of remote work contributes to the acquisition of skills for online management of virtual departments and well-coordinated work in a multicultural environment, which also implements an entrepreneurial strategy. The advantage of this strategy is that it is implemented in conditions of a high degree of financial risk and limited resources and involves mobile decision-making. Personnel awards that meet personal needs are awarded on a competitive basis, with an emphasis on entrepreneurial strategy and teamwork. In contrast to the liquidation strategy, the entrepreneurial concept is focused on the use of digital platforms that allow economic activity to be regulated in such a way that most of the duties performed by full-time employees can be transferred to a private company.The next relevant concept of human resources management in the context of the digitalization of national economic systems is an entrepreneurial strategy (Malik and Sanders, The anti-crisis strategy for the transformation of human resources management in the context of the digitalization of national economies is aimed at preventing the bankruptcy of an organization Mendy, . The polIn the human resource management system, the concept in the context of the digitization of national economies is focused on low risks and sustainable growth, and long-term planning is the dynamic growth strategy of Knice et al. . PolyparAny strategy for the development and control of human potential accumulates the conditions and safety of work, methodological aspects of conflict resolution, methods for assessing and adapting personnel, a code of corporate ethics, a personnel reserve, a system of incentives and remuneration, as well as a development concept. The modernization of human potential in the context of the digitalization of the economy should be based on a competency-based approach while taking into account the new conditions; digital competencies will be a priority.As a result, we provide a detailed outlook on the cumulative challenges associated with intra-entrepreneurship, the sustainability of HRM management, and the digital transformation facing modern organizations. The researchers considered a sustainable approach to personnel management, which focuses on the synthesis of internal and external factors in the context of achieving positive results not only for a particular institution but also for the socio-economic segment and the environment. There is a strong necessity to examine cases related to the role of HRM in creating a corporate image and optimal development of institutions, as well as in increasing employee engagement, satisfaction, productivity, and wellbeing. The study discusses the new opportunities provided by digitalization and mobile communications in the field of intellectual capital, which make employees the focus of an organization to create sustainable, highly competitive advantages, which is the practical significance of the study.Research design: LK. Research: VK, PK, and LB. Literature review: PK and LB. Writing: LK and VK. All authors contributed to the article and approved the submitted version."}
{"text": "Infection science is a discipline of healthcare which includes clinical microbiology, public health microbiology, mechanisms of microbial disease, and antimicrobial countermeasures. The importance of infection science has become more apparent in recent years during the SARS-CoV-2 (COVID-19) pandemic and subsequent highlighting of critical operational domains within infection science including the hospital, clinical laboratory, and public health environments to prevent, manage, and treat infectious diseases. However, as the global community transitions beyond the pandemic, the importance of infection science remains, with emerging infectious diseases, bloodstream infections, sepsis, and antimicrobial resistance becoming increasingly significant contributions to the burden of global disease. Machine learning (ML) is frequently applied in healthcare and medical domains, with growing interest in the application of ML techniques to problems in infection science. This has the potential to address several key aspects including improving patient outcomes, optimising workflows in the clinical laboratory, and supporting the management of public health. However, despite promising results, the implementation of ML into clinical practice and workflows is limited. Enabling the migration of ML models from the research to real world environment requires the development of trustworthy ML systems that support the requirements of users, stakeholders, and regulatory agencies. This paper will provide readers with a brief introduction to infection science, outline the principles of trustworthy ML systems, provide examples of the application of these principles in infection science, and propose future directions for moving towards the development of trustworthy ML systems in infection science. Particularly, the use of ML continues to increase in high-stake environments where data is being used to support humans in decision-making scenarios and in some cases, completely removing human involvement. In healthcare, data driven processes are becoming more prominent along with the application of ML. This is evident by the growing application of ML in many areas of healthcare including radiology, cardiology, neurology, and general hospital use . This is2.ML is a type of artificial intelligence (AI), described as a set of methods/algorithms that learn patterns from data, utilising these patterns to produce predictions . ML tech3.Recently, the principles associated with trustworthy AI have become more of a focus in the research community as ML becomes increasingly applied in high-stakes environments such as finance, defence, and healthcare. This includes identifying the requirements for the development of trustworthy ML systems, and establish pathways to adoption for ML systems in practice.\u2022Human agency and oversight\u2022Technical robustness and safety\u2022Privacy and data governance\u2022Transparency\u2022Diversity, non-discrimination and fairness\u2022Societal and environmental well-being\u2022AccountabilityThe implementation, relevance, and specific interpretations of the trustworthy AI requirements ultimately depends on the specific domain and context in which the ML system is being developed and deployed , established by the European Commission . They crdeployed . The guideployed , and do  purpose .In healthcare, it is the responsibility of the stakeholders in each of the unique domains to develop their own specific set of best practices that are appropriate for their own context. When developing ML systems worthy of trust, it is important to consider the entire lifecycle of the ML system. This involves data collection and processing, ML model development, and subsequent deployment and monitoring of the model. ML model development involves training, testing, and validation of the model, and deployment requires taking the model from the research, to the real world environment. This is often achieved by providing an interface to enable users to interact with the ML system, through a client-side application such as a web or mobile application, or through the use of an application programming interface (API) deployed through the use of cloud computing resources or on premise infrastructure. The principles of trustworthy ML systems need to be integrated at each of the stages in this ML system development and deployment lifecycle. This has been previously identified by Li et al. , where tThe recent attempts at establishing the principles, and guidelines for trustworthy AI systems has also prompted the requirement for methods to assess the overall trustworthiness of a system. An assessment of the trustworthiness of a ML system is necessary to deploy these systems into real world environments. Z-Inspection, introduced by Zicari et al. , is one 4.As previously identified, there have been a number of reviews highlighting the application of ML to problems in IS. However, far fewer ML applications implement the principles for developing ML systems that are worthy of trust. The google scholar database was searched to identify research articles that explore and implement the principles and practices of trustworthy machine learning systems for IS. Exact searches for \u201ctrustworthy machine learning for infection\u201d did not produce any articles. Articles containing \u201ctrustworthy machine learning infection\u201d and \u201cmachine learning infection\u201d were searched for. Articles were then manually examined. Examples of studies which have implemented some of these principles based on this search have been included in this section and shown in 5.ML based approaches have been producing promising results in IS, providing insight into the utility of ML applications for addressing problems relating to patient management, clinical laboratory workflows, and surveillance and monitoring of public health. The increasing interest in the application of ML in the IS context presents additional opportunities to address the regulatory and system stakeholder concerns regarding the trustworthiness of ML based approaches in practice. The importance of implementing trustworthy ML principles along the entire ML lifecycle, from collection of data through to the deployment, monitoring, and continuous improvement of ML systems is critical to ensuring the success and adoption of these systems in practice. Whilst there has been a significant increase in the number of ML applications in IS, this is not reflected in the real world integration of the models into practice. A significant amount of the work regarding the development of ML systems in healthcare has been directed towards a small number of domains, which is evident by the number of approved AI based systems/devices in the United States of America (US) and Europe (EU). Between 2015 and 2020, 222 and 240 AI/ML devices have been approved in the US and EU respectively . These f6.There has been an increased focus on IS as a result of the COVID-19 pandemic and the significant impact on the global community. As the world moves beyond the pandemic, IS and the problems within the domain remain significant, with the growing threat of emerging infectious diseases, the global burden of sepsis, and the continual rise of AMR. The recent growth in the development of ML applications in the different areas of IS including the hospital, clinical laboratory, and public health setting has shown promising results. These applications have targeted a wide range of problems including the treatment and management of patients, the improvement of laboratory workflows, and predicting infection trends. However, there is a significant gap between the number of ML applications in research, and the effective implementation of ML systems. This paper has provided readers with an introduction to infection science, outlined the principles of trustworthy ML systems, presented an overview of the ML applications in IS that implement some of the principles of trustworthy AI, and identified the need for a change in focus towards implementing the practices of trustworthy ML systems to promote adoption of these systems in practice. Further work is required to ensure a more systematic view of trustworthiness is integrated into ML approaches in IS. In the future, we encourage researchers, engineers, and ML practitioners to address all areas of the ML system lifecycle, moving beyond model training and testing, and take a focused, end-to-end view of implementing trustworthy ML system principles in the IS domain to promote adherence to the regulatory requirements, stakeholder acceptance, and adoption of ML systems in practice within IS."}
{"text": "Stress Biology. Stress Biology was launched this year as an open access journal published by Springer Nature\u00a0in partnership with Northwest A&F University of China. We plan to have the journal indexed by SCIE in 2024 and aim to obtain its first impact factor of no less than 5.0 in 2024.We are pleased to invite you to join us in celebrating the birth of a new life sciences academic journal, Stress Biology journal is to promote stress biology research for the sake of agricultural sustainability and human well-being.All organisms in nature, including plants, animals and microbes, have to struggle with a variety of biotic (pathogens and pests) and abiotic  stresses in order to survive and propagate. During the long history of evolution, these organisms have developed various strategies and mechanisms to cope with environmental stresses. Nevertheless, severe stresses are still the main challenges limiting the growth, health and productivity of plants and animals. Plants, animals, and microbes and their interactions are the vital parts of the ecology we depend on, and some of them such as crop plants, livestock and poultry provide the food, fiber and shelter for us. Global climate change brings with it more frequent extreme weathers, leading to outbreaks of diseases and pests, and severe drought and floods, heat waves and bitter cold, and causing great threats to agricultural production and food security. Therefore, understanding the mechanisms of stress resistance and developing technologies for improving the stress resistance of plants, animals and useful microbes is critical for sustainable agriculture. The mission of the Stress Biology aims to be a leading international journal that is vigorously peer-reviewed and publishes important results of stress biology research. The journal publishes original, high quality research of all aspects of stress biology, including but not limited to work that (1) provides fundamental insights into the understanding of responses of plants, microorganisms and animals to abiotic and biotic stresses; (2) elucidates the mechanisms underlying the adaptation and resistance of plants, microorganisms and animals to biotic and abiotic stresses; and (3) uses biotechnological and other strategies to improve the resistance of plants, microorganisms and animals to abiotic and biotic stresses. Topics covered by the journal include: physiology, molecular biology, cell biology, microbiology, pathology, ecology, genomics, epigenetics, gene editing, stress resistance breeding, biotechnology, and so on. Article types include: original paper, short communications, reviews, highlights, letters to the editor, editorials.Stress Biology will have all the good characteristics of a Springer Nature journal, including straightforward initial submission, fast and fair review with constructive comments, rapid online publishing prior to copyediting and typesetting, high-quality production, etc. Furthermore, as an open access journal, all contents will be freely available to researchers worldwide through the Springer Nature platform. The journal will cover article processing charge for authors during the period from 2021 to 2023.Stress Biology cover a wide range of research topics in the field of stress biology and showcase the goals and scope of our journal: a high-quality open access journal with a broad scope for communicating various discoveries in stress biology that contribute to the development of sustainable agriculture worldwide.The high-quality reviews and research articles published in this inaugural issue of Stress Biology!We sincerely thank all of the authors who have contributed papers to this inaugural issue. We also would like to thank all of our editorial board members and the reviewers, as well as members of our editorial and production teams, for their support. Our joint efforts have now culminated in the successful launch of this new journal of our own research community! We look forward to working together with you all to grow this promising journal so that your important research discovery can have the great impact and benefits to society it deserves. Come and publish in Editors-in-ChiefZhen-Sheng Kang: Academician of the Chinese Academy of Engineering, and Director of the State Key\u00a0Laboratory of Crop Stress Biology for Arid Areas\u00a0of ChinaJian-Kang Zhu: Member of the US National Academy of Sciences, and Director of the Shanghai Center for Plant Stress Biology, Chinese Academy of SciencesAssociate EditorsJin-Rong Xu: Professor of Purdue University, USAHuazhong Shi: Associate professor of Texas Tech University, USAExecutive editorQiao-Chun Wang: Professor of Northwest A&F University,\u00a0China"}
{"text": "First experience of the sub-national process of certification of elimination of mother-to-child transmission (MTCT) of HIV and/or syphilis at a global level. In 2022, 43 municipalities \u2265 100,000 inhabitants were certified, covering 24.6 million inhabitants.The experience of sub-national certification of the EMTCT was important in mobilizing the municipalities that engaged in its initiatives, worked to improve the quality of care and surveillance and emerging as the main proponents in the process.Through this ongoing and dynamic initiative, there is an anticipation of over 100 municipalities and states joining in 2023. Sub-national certification aims to enhance comprehensive care for pregnant women, in order to achieve national certification of EMTCT.  to describe the subnational implementation process of the certification for elimination of mother-to-child transmission of HIV and/or syphilis, its main barriers, challenges and opportunities. in 2022, indicators from the last full year for impact targets and the last two full years for process targets, available in national information systems, were evaluated; descriptive reports were analyzed and actions were acknowledged within four thematic axes, according to PAHO/WHO recommendations. 43 municipalities \u2265 100,000 inhabitants were certified, covering 24.6 million inhabitants; one municipality achieved dual elimination (HIV-syphilis), 28 municipalities achieved elimination of HIV and 10 received silver tiers; regarding syphilis, one elimination was observed, along with 4 gold tiers, 13 silver tiers and 4 bronze tiers; a higher number of certifications was identified in the Southeast and South regions. barriers and challenges of the process were overcome through tripartite collaboration; the experience provided better integration of surveillance with care and improved actions aimed at preventing mother-to-child transmission. Several recommendations and guidelines have been published, and a plan has been proposed for the Member States to promote the elimination of mother-to-child transmission (EMTCT) of HIV and syphilis in the Americas, with targets set to be met by 2015.Following PAHO\u2019s initiative, the World Health Organization (WHO), in 2014, released the Global guidance on the criteria and processes for certification: EMTCT of HIV and/or syphilis. These criteria were expanded in 2017, when it was established the possibility for countries with a high prevalence of HIV and/or syphilis to be certified for the bronze, silver or gold tiers in \u201cthe path to elimination\u201d, encouraging gradual reduction in MTCT rates.), and dual certification, in addition to providing for certification for gold, silver and bronze tiers on the Path to Elimination of MTCT of HIV and/or syphilis, in order to encompass places that have not achieved the elimination targets but show indicators that are closer to .8 Nati),,,,1,(1), The years evaluated were 2019 and 2020.The certification process of EMTCT of HIV and/or syphilis occurred in municipalities with \u2265100,000 inhabitants during 2022, as a partnership strategy involving the Ministry of Health, states and municipalities, aiming to improve actions for reducing MTCT of HIV and syphilis, infections still considered a public health problem in the country.The steps for implementing the certification were as follows: (i) the establishment of the National Validation Committee for MTCT; (ii) definition of criteria and process and impact indicators; (iii) development of a list of cities with \u2265 100,000 inhabitants and eligible states, meeting the recommended indicators; (iv) proposal presentation to states and municipalities; (v) standardized development process of the certification report, based on the supplement to the Guide for Certification of Elimination of Mother-to-child Transmission of HIV and/or Syphilis, by the candidate municipality or state; (vi) analysis of municipal reports by the Ministry of Health; (vii) establishment and training of the National Validation Team (NVT), comprised of experts from each thematic axis; (viii) development of the field manual for the NVT; (ix) planning and performance of on-site visits by the NVT, based on the supplement to the Guide;In the Guide for Certification of Elimination of Mother-to-child Transmission of HIV and/or Syphilis, the subnational certification strategy acknowledges the development of actions distributed in four thematic axes, according to PAHO/WHO recommendations:a) programs and services;b)epidemiological surveillance and data quality;c) diagnostic capacity and test quality; andd)human rights, gender equality and community participation.These four axes were structured to induce organization and improvement of care based on the best evidence, according to the logistical and technological resources available.This spans from early prenatal care with timely access to testing and appropriate treatment, to surveillance, through case monitoring and control.The requirements and minimum criteria for municipality certification included (i) prior achievement of impact and process indicators, established in the Guide for Certification of EMTCT , (ii) thOf the total of 326 Brazilian municipalities with \u2265 100 thousand inhabitants, 85 were initially considered eligible based on the analysis of impact and process indicators and targets available in the national information systems; with the exception of testing, whose source is local. State administrators, contacted by the Ministry of Health via e-mail and phone calls, were asked to participate in the certification process by crafting strategies to support municipal administrators and health professionals of the network, aiming at epidemiological analysis of the data and development of the descriptive report.The main stage of the process was the on-site visit to the municipalities, carried out by the NVT, whose members should come from different states than those of the municipalities visited. The purpose of these visits was to validate and enhance the information provided in the report submitted by the municipality. This activity was divided into two segments: first, a technical and political meeting with state and municipal administrators, health professionals and local non-governmental organizations (NGOs) involved in the process; and secondly, the visit to the health services that comprise the maternal and child health care network . The primary care centers visited should preferably be located in regions of higher social vulnerability.In order to standardize the visits, (i) a list of evaluation points was developed for each type of request , according to the four axes previously described, and (ii) a structured framework was developed for generating reports during technical visits, including the evaluated points and observations.Conselho Nacional de Secret\u00e1rios de Sa\u00fade - CONASS), the National Council of Municipal Health Secretaries , professional councils , scientific societies, PAHO, UNICEF, UNAIDS and the National Regulatory Agency for Private Health Insurance and Plans . The visit report was also sent to the municipalities, as part of an ongoing process of improvement and qualification.A report was drafted for each visit in order to support the National Validation Committee in making the final judgment on the granting of certification. This Committee is comprised of representatives of the Ministry of Health, the National Council of Health Secretaries , followed by the Northeast region (n = 64). These regions encompass 71.5% of the Brazilian population living in municipalities of this size .In total, 45 certification requests were received from municipalities, across the country\u2019s five macro-regions, and 43 received certification and/or tiers of progress toward elimination. The process involved visits to 337 health services within the maternal and child health care network. Services located in areas of greater social and individual vulnerability, as well as maternity hospitals and specialized care services (SCS) were given priority. Local specificities and schedule compliance represented challenges experienced by the NVT.At the end of the process, in 2022, of the 43 certifications awarded, 38 were for HIV and 22 for syphilis. One municipality achieved dual elimination of both HIV and syphilis. The highest number of certifications occurred in the Southeast and South regions of the country. The total number of municipalities that were certified encompassed 24.6 million inhabitants. Regarding the categories, 28 municipalities achieved elimination of HIV, while 10 received silver tiers. As for syphilis, there was one elimination, 4 gold, 13 silver and 4 bronze tiers A and 3B.The subnational certification process of EMTCT of HIV and/or syphilis in Brazil was the first experience in this regard, and can serve as a model for other countries. Implemented in 2022 for both health conditions, the initiative showed the importance of collaborating with states and municipalities in organizing service networks and surveillance of these infections.Some barriers and challenges emerged during the process, but the joint work involving the three levels of government enabled the identification of solutions and adaptations within the outlined dynamics. The primary required adjustment was the use of the guidance for certification proposed by the WHO,One barrier found in the experience was the challenge of measuring the indicator of coverage for pregnant women who underwent at least one HIV and/or syphilis test during prenatal care, given that there is no single national data source for its verification. It could be seen that adherence to the Ministry of Health\u2019s electronic medical record system, which allows this information to be recorded, is heterogeneous across the country. It was also noted that a significant number of the candidate municipalities performed rapid testing, but did not systematically record this procedure. In addition, there was a gap in collecting this data within the private healthcare network. Therefore, the alternative found was to allow the systematic analysis of medical records, based on a representative random sample of live birth population in the years evaluated, namely: the medical records from the last full year for impact targets; and the last two full years for process targets. This measure was important and further motivated the municipalities to participate in the certification process for the elimination of MTCT of HIV and/or syphilis.),,,17,,(An opportunity in conducting this process was the face-to-face visits to the municipalities, which provided the exchange of experiences and knowledge, mobilization of local teams, identification of strengths and weaknesses in the processes developed in the locations, as well as encouraging the use of national information systems and the electronic medical record in primary health care. The certification process is a strategy for mobilization and continuous education. The indicators are monitored across the three levels of management annually, encouraging empowerment through recognition of the joint effort made. The stages of the process have strengthened the integration between surveillance and health care, intersectoral collaboration, intergovernmental management and social control in tackling EMTCT. All of these elements contribute to a continuous learning methodology and local improvement, operating as a potent mechanism for inducing the achievement of process and impact targets, towards the EMTCT of HIV and syphilis.By including the axis of \u201chuman rights, gender equality and community participation\u201d, the certification process has promoted the recognition of municipal experiences in prevention, diagnosis and treatment, in the context of populations facing vulnerability and inequity in access to these services. Furthermore, it highlighted the need to promote community participation in instances of social control, such as health councils and ombudsman offices.The experience with the certification process of EMTCT of HIV and/or syphilis in 2022 was important in mobilizing the municipalities that engaged in its initiatives, worked to improve the quality of care and emerging as the principal proponents in the process. The participation of the three levels of government - federal, state and municipal - civil society and the scientific community showed the strength of tripartite governance, especially in a country with continental dimensions such as Brazil. For 2023, the whole process is being repeated with the anticipation of over 100 municipalities joining. The experience of the subnational certification of the elimination of MTCT of HIV and/or syphilis showed that, beyond the outcomes achieved, the methodologies employed were of paramount significance, providing change in service routines and better integration of surveillance with health care."}
{"text": "The process of ovulation involves multiple and iterrelated genetic, biochemical, and morphological events: cessation of the proliferation of granulosa cells, resumption of oocyte meiosis, expansion of cumulus cell-oocyte complexes, digestion of the follicle wall, and extrusion of the metaphase-II oocyte. The present narrative review examines these interrelated steps in detail. The combined or isolated roles of the follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are highlighted. Genes indiced by the FSH genes are relevant in the cumulus expansion, and LH-induced genes are critical for the resumption of meiosis and digestion of the follicle wall. A non-human model for follicle-wall digestion and oocyte release was provided. Ovulation is the term used to define the ovarian release of the female mature gamete that is ready to be fertilized. The process of ovulation includes a series of morphological and biochemical events within the preovulatory follicle. Several genes are activated in the ovarian environment, leading to enzymatic and structural transformations under the influence of gonadotropins and sex steroids that are modulated by several growth factors. All of these events ensure that the oocyte becomes likely to be fertilized and extruded on the ovarian surface to form the corpus luteum.menstrual cycle,menstrual cycle physiology,folliculogenesis,theca cells,granulosa cells,oocyte,oocyte-cumulus complex,follicular wall digestion,cumulus-oocyte-complex expansion,oocyte maturation,gene expression,FSH,LH, andprogesterone receptor. We expanded the search to the references of the retrieved articles.We searched for articles published in English in the PubMed and Google Scholar databases. The keywords were as follows:The more advanced stages of follicle development are characterized by the appearance of intercellular space filled by antral fluid. At this stage, the granulosa cells are differentiated into two distinct populations: cumulus cells, which are those closely linked to the oocyte, and wall or mural granulosa cells, which internally line the follicular wall. Although these two cell types share a common origin, there are differences in the production of transcribers and proteins.Folliculogenesis begins with the formation of the primordial follicle, and ends with the preovulatory follicle.The ovulation process occurs in a coordinated and interrelated way in five complex steps: interruption of granulosa cell proliferation, resumption of meiosis, expansion of the cumulus with oocyte release inside the antrum, lysis of the follicular wall, and oocyte extrusion at the metaphase II (MII) stage. In mammals, oocytes are stationed in meiosis I at prophase I. The resumption of meiosis I occurs during puberty as a result of the gonadotropic stimulus in follicles in the preovulatory stage, culminating in the rupture of the germ vesicle.Periovulatory gene expression induced by the FSH in cumulus cells plays a minor but necessary role in the mediation of ovulation . The ocThe role the LH in the ovulation process is complex and fundamental for the resumption of meiosis, loosening of the cumulus cells, and rupture of the follicle.The genetic and biochemical events responsible for cumulus mucification are summarized inThe oocyte maturation process aims to empower the female gamete and ensure its subsequent development until the activation of the embryonic genome occurs. Therefore, chromatin condensation is relevant in the continuity of meiosis, redistribution of organelles in the cytoplasm, and alterations in the cytoskeleton; all of these modifications are precisely regulated and coordinated .28ForThe functions of the OSFs include growth stimulation, prevention of apoptosis, inhibition of luteinization, regulation of energy metabolism, cholesterol biosynthesis, and regulation of cumulus expansion.In general, the properties of lacunar junctions enable the direct and bidirectional transport of small molecules between the oocyte and the granulosa cells. High intraoocyte levels of cAMP maintain the oocyte in the stage of germ vesicle, through suppression of the activity of the maturation-proimoting factor (MPF).In a recent studyThe meiotic spindles are responsible for the continuity of the meiotic division and extrusion of the two polar corpuscles. Initially, the mitochondrial groups are in a central position in the oocyte. As the maturation progresses, they migrate to the edges of the oocyte, close to the extruding regions of the polar body.Morphological and biochemical changes that result in rupture of the follicular wall and oocyte extrusion occur basically by the action of the LH, because it induces the synthesis and secretion of various enzymes . The roCAATenhancer-binding protein \u03b2 (C/EBP\u03b2), PR, and other activator protein-1 family members , all involved in the functional activity of the granulosa cells of the ovulating follicle.The ADAMTS 16, present in luteinized granulosa cells, responds to FSH stimulation and actively participates in the process of structural follicle remodeling at the time of ovulation. The role of the LH on PR is mimicked by cAMP-inducing agonists . Targets of PR appear to control the rupture of the follicle, mainly ADAMTS-1  and cathepsin L. Among the proteases involved, thrombospondins 1 and 4 (ADAMTS1/4) promote the breakdown of the proteoglycan family structures, such as versican, through granulosa activation by PRs,The proteoglycan  components of the ECM induced by the LH peak, on either granulosa or theca cells, serve as substrates preferably for ADAMTS 1, culminating in follicular rupture.After the rupture of the follicular wall, there is tissue reorganization by the activation of promatrix factors, which, in an organized and vascularized way, causes granulosa cell differentiation into luteal cells, thereby originating the corpus luteum. The corpus luteum is composed of functional cells for the synthesis of progesterone, the main regulator of the pituitary secretion of gonadotropins, the principal factors involved in the maintenance of the corpus luteum until initial gestation."}
{"text": "The \u201cOne Health\u201d concept considers that human and animal health, and ecosystems are closely related and aims to make a link between ecology and human and veterinary medicine. Due to the explosion in population growth along with the geographic and climatic conditions , Africa is becoming a major hotspot for various socio-health issues associated with infectious diseases, including arboviruses. The incontestable advantages of a One Health approach in Africa lie in the fight against pathogens, such as arboviruses, and in the preservation of environmental, animal, and human health to ensure that the increasing high needs of this population are met as well as their protection against potential epidemics. The One Health strategy gives us a glimpse of the difficulties and challenges that the African continent faces. The importance of this approach in Africa is to establish guidelines and strategies for effective solutions and changes in behavior and harmful activities. Overall, the establishment of high-quality global health policies in the framework of the global health standards program would provide healthy and sustainable human\u2013animal\u2013environmental interactions for the welfare of all. The changes in our environment, mainly caused by human activities and the evolution of interactions between humans and animals, are, and will undoubtedly be, responsible for sanitary crises ,2,3. TheThe risk of the emergence and/or re-emergence of infectious diseases with active human-to-human transmission increases the risk of rapid and direct development of the diseases, leading to an epidemic and in some cases a pandemic. Likewise, the increase in interactions between wildlife, domestic animals, vectors for human and animal pathogens, and humans inevitably increases the risk of transmission and dissemination of zoonoses within the human population, leading to increased risk of epidemics. In addition to the challenges from the epidemics of Dengue in Burkina Faso, Ivory Coast, Nigeria, Ghana, Mali, Democratic Republic of Congo (DRC), Angola, Gabon, Sudan, and Ethiopia and the current management of the COVID-19 pandemic, there are the issues of antimicrobial resistance and environmental sanitation policies in Africa ,12,13. MAmong these emerging diseases, the term arbovirus refers to a group of viral diseases transmitted by arthropods, such as mosquitoes, ticks, and sandflies. Vector-borne diseases are a growing burden according to the World Health Organization (WHO), sometimes causing epidemic outbreaks in various tropical regions . These dThe impact of arboviral diseases in Africa is significant, particularly in low-resource settings where access to healthcare is limited ,30. The Arbovirosis in Africa is a complex problem that is influenced by a variety of factors, including the high prevalence of mosquito vectors that are the primary vectors. Many parts of the continent have a warm and humid climate that provides an ideal breeding ground for mosquitoes. Additionally, deforestation and urbanization create new habitats for disease-carrying mosquitoes, leading to an increase in their population ,31. The Overall, the combination of these factors makes arboviral diseases a significant economic burden to African countries, particularly in terms of healthcare costs, lost productivity, and reduced tourism revenue. Arboviruses are, unfortunately, not a priority for research and surveillance in Africa due to other health, security, and political issues. Thus, they are among the neglected diseases in many African countries, even though there is a great risk of emergence of new variants and/or re-emergence of existing variants. Many people in Africa are unaware of the risks associated with arboviral diseases and the measures they can take to protect themselves. This can lead to a lack of preparedness and a delay in seeking medical attention, which can exacerbate the impact of these diseases. The burden of these diseases is expected to increase in the future due to population growth, urbanization, and climate change, making it a major public health challenge for Africa.The One Health approach is of great importance in the management of current and future emerging and re-emerging diseases in Africa. Tight collaboration between various actors from different disciplines is very important in the prevention, surveillance, diagnosis, and discovery of therapeutic solutions necessary for the control and/or eradication of infectious diseases. Indeed, integrated surveillance lies in the surveillance, control, and diagnosis of infectious diseases , in the research for molecules of therapeutic interest, in the training of health professionals, in connecting actors from different fields, and in establishing policies to fight against endemic and neglected zoonoses. Human behaviors and activities also show the need for this strategy. For example, deforestation by humans forces changes in wild-animal behaviors. Indeed, the animals affected have to adapt to their new environments, for example, by changing their feeding grounds and settling increasingly close to livestock breeding areas ,31. In tArboviruses are, unfortunately, not often a research or surveillance priority in Africa. In this sense, they are among the neglected diseases, although they represent an increasing risk of epidemics and the appearance of new more virulent or contagious strains. Arboviruses are a major health risk in Africa because of its climate, and the different interactions between humans, animals, and vectors. African countries must therefore adopt comprehensive policies for surveillance of and research into arboviruses.Different methods can be used to better characterize the risk associated with arboviruses and understand their biological basis in order to better guide public health interventions. These methods include studies of biology at the environmental, vector, animal, and human level, with a trans/interdisciplinary interaction. In general, the transmission of arboviruses is influenced by a large number of factors related to the biology of hosts, vectors, and viruses, which are inter-related within dynamic natural environments and influenced by abiotic factors, such as climate or hydrography . A comprConsequently, the need to understand the emergence of a disease in humans through an approach that integrates a large number of environmental parameters, described as global, has been reinforced ,34. HencTight collaboration between animal, environmental, and human health institutions is important to find solutions and effective control approaches at both local and international levels. These efforts must include Africa, especially given its climate, rapid population growth, and slow economic growth, making Africa at risk for the emergence and/or re-emergence of epidemics. For the moment, no African country has taken the lead for the continent, but instead, individual countries are organizing themselves for carrying out studies with a One Health aim, sometimes with local funds and very often with foreign funds. This is particularly the case today for common North\u2013South diseases  ,37. The The effectiveness of the One Health approach has been demonstrated with zoonoses responsible for emerging and/or re-emerging diseases linked to epidemics in certain regions of Africa  ,40,42,43We analyzed several reports on the One Health concept and highlight the relevance of using this approach in the control of arboviruses in Africa, while at the same time addressing the challenges and difficulties related to its implementation. A systematic literature search related to the topic was first performed in electronic databases . We also searched data on the WHO and the Institute of Research for Development (IRD) websites. All collected data were then used to discuss: (1) the relevance of the One Health concept in the control of arboviruses in Africa and (2) the challenges and difficulties of implementing this concept on the African continent. The search included research articles (in English and French) and news articles published between January 2009 and April 2023 (that last 14 years). A total of 863 articles were reviewed and all articles identified as irrelevant were excluded. Exclusion criteria included type of study, language of publication, nature of the pathogens addressed, and incomplete technical and/or clinical data. The articles were analyzed first on the basis of the title, then the abstract, and then, finally, the full text. A total of 71 articles were included for study. We combined the following search terms: \u201cOne Health and Africa\u201d and \u201chuman health\u201d or \u201cenvironmental health\u201d or \u201canimal health\u201d or \u201carbovirus and emerging diseases\u201d or \u201cre-emerging diseases\u201d and \u201cAfrica climate\u201d. Figure 2 was generated using the online software Datawrapper and Figures 1, 3\u20135 were generated using PowerPoint 2019 software.In regard of various epidemics in Africa , the health authorities of certain countries have thought of a multidisciplinary strategy to fight against these epidemics ,48,49,50The relationship between a pathogen , and its host is rather dynamic and the environment plays also an important role in the nature and dynamics of an epidemic . This maPhlebovirus of the Phenuiviridae family. RVF is endemic in Africa and affects domestic ruminants, such as cattle, sheep, goats, and camels [Aedes-type mosquitoes that transmit the virus during blood meals both in animals (domestic or wild) and humans, with contact between infected animals also allowing for virus spread ) and annual rainfall totals over 150 mm ,47. ThesNairoviridae, genus Orthonairovirus. It is a zoonosis that also has a high rate of human-to-human transmission and produces epidemic outbreaks in humans [CCHF is a viral hemorrhagic fever caused by a virus from the family n humans ,55,56. Tn humans . The morn humans . The modn humans . Farmersn humans .Considered the second most common arbovirus in the world due to its geographical distribution, CCHFV is endemic in several African countries, such as DRC, Nigeria, Namibia, Mali, Burkina Faso, Central Africa Republic, Senegal, Uganda, South Soudan, Ethiopia, Tanzania, Madagascar, Mauritania, South Africa, Kenya, and Senegal, as well as in Asia , South-Eastern Europe, and the Middle East  ,60,61,62Due to this very complex cycle, in which hosts and vectors are themselves strongly influenced by environmental parameters, a One Health approach is required for the prevention and control of this disease . The intIn Africa, improvement in technical platforms for the detection of CCHF is required. Indeed, the 451 antigenic cross-reactivities with nairoviruses prevents serological analyses due to the high rate of false positives. In this sense the One Health approach will make it possible to pool funds and direct funding towards the most appropriate strategies for all, and an appropriate screening strategy . AlthougThe One Health approach to CCHF surveillance also involves promoting awareness and education about the disease, particularly in areas where CCHFV is endemic. This includes educating communities about the importance of tick control, proper animal husbandry, and safe food-handling practices.Flaviviridae family, genus Flavivirus. There are four serotypes of DENV: DENV-1, DENV-2, DENV-3, and DENV-4 [Aedes. Like all arboviruses, transmission is either sylvatic, where the virus circulates between wild animals, such as Simian species , and mosquitoes  without human contact; or urban, where the virus circulates between mosquitoes  and humans through constant contact with the bite occurring preferentially during the day  helps in the early detection of cases and outbreaks, and facilitates a rapid response to control the spread of the disease. In addition, early detection of circulating DENV serotypes could identify potential new emerging strains. Then, by integrating data from human, animal, and environmental sources, public health officials may identify potential outbreaks early and take proactive measures to prevent their spread. This approach can lead to the development of more effective and sustainable strategies for disease prevention and control, as well as contribute to the overall health and well-being of communities.Prevention and control efforts are crucial to reduce the impact of the disease on humans. The interest in DEN surveillance by the One Health approach lies in its ability to provide a more comprehensive understanding of the disease and its transmission dynamics. Dengue involves multiple hosts and vectors, including humans, mosquitoes, and non-human primates, although dengue epidemics are currently linked to an urban transmission cycle. A One Health approach to DEN surveillance can provide a comprehensive understanding of the disease and help in developing effective prevention and control strategies. Surveillance of DENV circulation in mosquitoes . Most African countries are poor and located in areas at high risk of disease emergence due to their climate, proximity to risk areas, and human activities. Therefore, the pooling of funds and One-Health-type policies would be very useful, both in the reduction of unnecessary expenditure and in the establishment of priority policies related to the surveillance and control of emerging or re-emerging diseases . The chaAnalysis of the flaws in the management of the COVID-19 crisis has shown that the One Health strategy is indeed rarely used in many countries . The strAn integrated health strategy has indeed operational consequences that disrupt the existing methods of study, surveillance, prevention, and action\u2014giving rise to resistance to implementation. Implementation of One Health requires a change in the understanding of risks and practices . The varThe centralization of data is important for an overall quality analysis based on the economic and geographical networks in place. It is also important to establish shared regulations between the different sectors involved, standardized operating protocols, effective control instruments, the creation of health structures for rapid treatment, and laboratories sufficiently equipped to maintain health and surveillance systems during crises. It is also important to improve staff training in One Health strategies by introducing the importance of this notion into the training paths of students from the various disciplines concerned.The recent outbreaks of arboviruses , and the COVID-19 pandemic have demonstrated the need for an integrated health strategy and have encouraged us to plan for the prevention and management of future crises. Africa is particularly exposed to the risks of the emergence of new pathogens given its environment of high demographic growth with a favorable climate to emerging/re-emerging diseases. A special effort must be made in Africa to ensure a trans/interdisciplinary approach for safer health and more effective management of future epidemics. This management involves coordinated multi-sector actions at different scales, from local to international. The One Health concept should be considered as an approach that goes far beyond the prevention of health crises; it is indeed a holistic vision of health that considers the close links between health, environment, climate, food, and agriculture. Implementing the One Health concept requires political commitment and adherence to a number of core principles, including socio-political and multi-cultural parity, inclusion, and community involvement, defined by the One Health high-level interdisciplinary expert group."}
{"text": "Cameroon has two main educational systems: English and French, which have a colonial heritage. The controversy is that each educational sub-system has its own curriculum. In the French-speaking part of the country, sports and physical education are mandatory for obtaining the CEPE, Baccalaureate, and any other public examination. In the English-speaking part, sports and physical education are yet to be included in the curriculum. The goal of this policy paper is to change the narrative of the curriculum of public examinations in Cameroon's anglophone educational sub-system by following the example of the country's French part. This policy paper targets curriculum developers, the General Certificate of Education Board, and the Ministries of Education. What will be innovative is that students from English-speaking Cameroon will also be included in sports activities at an early age.Development: We used the Health-Enhancing Physical Activity Policy Audit Tool (HEPA PAT) to collect data at the ministries of education, the Ministry of Sports and Physical Education, 197 public schools, and 204 health care facilities. Content analysis, ethnographic studies, and Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis are used to assess why average French-speaking Cameroonians have a longer life span, are physically active, and participate in more high-level sports than their English-speaking counterparts.The Cameroon Government Certificate (GCE) of Education Board is in charge of putting this project into action. Sports and physical education should be required courses for both the ordinary and advanced levels of the GCE.We will implement the process and conduct an impact assessment. With the process evaluation, we will monitor if the program is meeting the intended goals. The impact evaluation will give a broader view of the outcome of the program.When this policy is put into place, the English-speaking part of Cameroon will have HEPA and be pushed to be as healthy and fit as the French-speaking part."}
{"text": "Dear Editor,Tegumentary leishmaniasis (TL) in Brazil is the New World tegumentary leishmaniasis (NWTL), with distinct protozoan species, vectors, reservoirs and presentation when compared to the Old World tegumentary leishmaniasis (OWTL), which occurs in European, African and Middle Eastern countries. The authors report the fourth case of TL in Brazil caused by an Old World species, which is not native to Latin America, and discuss the introduction of this species in the country.L. amazonensis and L. major through the anatomopathological analysis, although the literature reports differences in the size of the parasitophorous vacuoles of these species .Leishmania spp. This genetic target was chosen due to the presence of multiple copies per cell and due to the size of the DNA fragment amplified from the employed primers ,Leishmania major species complex .L. major infection.In the Middle East, the most often reported etiological agents are In 1991 the cases decreased in Syria, where this disease is endemic, due to the fight against mosquitoes. However, in the late 1990s, an increase was observed, which was attributed to intense rural-urban migration and the deterioration of services, such as garbage collection and basic sanitation.The refugees were settled in border towns, mainly in Turkey, without medical care and living in an environment favorable for the spreading of epidemics. New cases of TL were observed in refugee camps. In Lebanon, there was an increase from six cases between 2000\u20122012 to 1,033 cases in 2013 alone, 97% of which were Syrian refugees.In Brazil, Syrians constitute the predominant group of refugees.Leishmania. In Turkey, non-endemic strains have been detected, even in a patient with no history of travelling, suggesting the introduction of this species.Anopheles sergentii as a vector was verified,L. majorL. major-like strains, possibly L. major,Hence, it is possible to discuss the autochthonous transmission of new species of The authors emphasize the importance of this diagnosis in patients from endemic areas, considering the potential for deformities. Moreover, they emphasize the relevance of this report for the epidemiological investigation of the possibility of autochthonous transmission of Old World species in our country.None declared.Cindy Tiemi Matsumoto: Data collection, or analysis and interpretation of data; writing of the manuscript or critical review of important intellectual content; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; approval of the final version of the manuscript.Milvia Maria Sim\u00f5es and Silva Enokihara: Intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature.Mar\u00edlia Marufuji Ogawa: Data collection, or analysis and interpretation of data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; approval of the final version of the manuscript.Samira Yarak: Data collection, or analysis and interpretation of data; writing of the manuscript or critical review of important intellectual content; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; approval of the final version of the manuscript.None declared."}
{"text": "The WHO emphasizes lifelong management of hearing diseases such as hearing loss and advocates for prevention. The Ear and Hearing Care Situation Analysis (EHCSA) tool was designed by the WHO for assessment and quality improvement of state-led management of hearing loss prevention and management programs. The purpose of this study was to use the EHCSA to assess the ear and hearing management program in Korea and to establish goals consistent with best practices for improving policies and services related to ear and hearing care.The EHCSA was used as a need assessment of the ear and hearing management services in the country. The EHCSA consists of two sections. Section 1 consists of 41 questions to evaluate health policies and support services. Section 2 consists of 203 questions to evaluate human resources and services of the ear and hearing management sector.There are an estimated 800,000 people with hearing loss in Korea. Policies such as hearing aid support are in place, and outreach services such as free hearing tests are also being actively conducted. In all medical institutions, ear and hearing management treatment and medication prescriptions could be received without barriers. Workers in the fields of ear and hearing management, such as audiologists, language therapists, special education teachers, and sign language interpreters, are specialized and have well-established guidelines for training.Overall, the domestic ear and hearing management sector has confirmed that policies and services are well-prepared in comparison with advanced countries such as the United States, Iran, and China. The use of the EHCSA was functional in collecting data on the current state of domestic ear and hearing management policies and services in Korea, can be used for continuous quality improvement and expansion of medical services, and can be used as a reporting mechanism to the WHO. Hearing is one of the five senses and refers to a mechanical sense that detects the frequency and intensity of sound waves transmitted through a medium, such as air or water. The ear is a sensory organ that causes brain activity, which leads to thoughts and emotions, and it has a proportion equivalent to vision in perceiving the surrounding environment . By 2050Accordingly, since 2005, China has been implementing a national project called the Hearing the Future-China National Hearing Care Program, which includes the early diagnosis, prevention, treatment, and rehabilitation of hearing loss. India has also continued to implement a state-led policy called NPPCD since 2008, and Australia is operating a government-led program to manage and supervise hearing screening, diagnosis, hearing loss prevention, and rehabilitation services from newborns to the older adult. The United States is striving to reduce the occurrence of social problems caused by hearing loss through the national \u201cHealthy People 2020\u201d  is a method for situation analysis developed by the WHO and includes the conditions of situation analysis . SituatiThe \u201cWHO EHCSA\u201d was distributed to collect, evaluate, and report on ear and hearing management policies, services, and human resources and for the assessment of national health systems in the context of ear and hearing management. This can help to understand the dynamics of hearing loss and the systems and policies that support ear and hearing management, including available personnel, infrastructure, and services, and to establish an improved healthcare system that can help with hearing management. The tool has a total of two sections: Section 1 and Section 2 with a total of 41 and 203 questions, respectively. Section 1 provides information on overall health policies and services, such as total population, age distribution, gender distribution, illiteracy rate, Internet penetration rate, life expectancy, fertility rate, vaccination status, deaf patient distribution, infant health policy, youth health policy, and disease management protocol. Section 2 provides detailed information on human resources, such as departments and representatives dealing with ear and hearing care issues in the Ministry of Health and Welfare, ear and hearing care-related institutions, policies, and programs. Questionnaires for assessment are also available .The emphasis was on collecting indicators in line with the context of the questions in the WHO ear and hearing care situation analysis tool. Information, such as country profiles and holidays, was collected using documents from national institutions, such as WHO statistics, the Ministry of Health and Welfare, and the National Statistical Office. First, the indicators of the National Statistical Portal (KOSIS) serviced by the National Statistical Office were confirmed. In addition, to confirm the specific information, documents, such as project reports and academic publications of national institutions that calculated the indicators, were checked. Finally, if the index was not secured through the search, consultations were conducted with experts.To answer the questions, open materials distributed by the state and materials from the conference were used. Data from the National Statistical Office, 2021 population and housing census, 2021 future population estimation, 2020 death cause statistics, and 2017 and 2021 birth statistics press releases were used. In the data from the Korea Centers for Disease Control and Prevention, the 2021 tuberculosis patient report status, 2020 HIV/AIDS report status year, and tuberculosis treatment guidelines were used. In the data from the Ministry of Health and Welfare, clinical guidelines for screening genetic testing for newborns, criteria for determining the grade of disablement, disaster crisis management measures for infectious diseases, and the classification of medical institutions were used. In addition, the World Population Review's literacy rate by the country in 2022, the Ministry of Science and ICTs 2021 wireless communication service subscriber statistics, the 2021 Internet usage survey, the Ministry of Education's school health inspection guidelines and integrated education guidebook, the National Health Insurance Service and Health Insurance Review and Assessment Service's health insurance statistics year, and hospital inquiry services were included. To use data from National Health Insurance, approval of the institutional review board is required. This study was approved by the Institutional Review Board of Yonsei University Wonju Severance Christian Hospital  (CR323326). The National Statistical Portal (KOSIS) provided by the National Statistical Office, Population and Housing Survey, and Disability Statistical Yearbook published by the Korea Disabled Development Institute were mainly used.The Korean Statistical Information Service (KOSIS) is a statistical service provided by the National Statistical Office for users to find the statistics they want at once by collecting major domestic and international statistics. Currently, it contains more than 1,000 types of state-approved statistics on the economy, society, and environment prepared by more than 300 institutions and provides the latest statistics on international finance, the IMF, the World Bank, and the OECD. Most national distribution data, such as the population and housing census and disability statistical yearbook, are uploaded on the portal .The population and housing general survey is a basic national statistical survey conducted by the National Statistical Office to understand the size and characteristics of all people and houses in Korea and is released annually. It is a national basic statistical survey conducted on people and residences in the national territory at a certain time and period and is used as basic data in various fields, including policymaking, planning, research, and evaluation by national institutions, private companies, academic organizations, and the public. It is used to prepare secondary processing statistics, such as the Ministry of Employment and Labor's labor supply plan, the Ministry of Health and Welfare's premium rate and national pension fiscal estimate, the low birth rate and aging index, and the Ministry of Land, Infrastructure, and Transport's housing supply rate . The disThe main priority was whether the criteria for determining the data were calculated by national ministries. As most of the data produced by national ministries are targeted at the entire nation and collected at the national level, it can be inferred that these data have been verified in terms of representation and reliability. If there were no data, the data of the academic society or association in the field were used; if there were no data in the institution, the engineer or expert was consulted. The year of the data to be used was set as 2021, as the data from the major national ministries for the year 2022 would be distributed the following year, and the most recent data were used if there were no data for the year 2021.The results of the population profile are shown in The results of the sociopolitical profile are shown in The results of the health status indicators are shown in The results of the hearing loss are shown in The results of the healthcare strategies are shown in The results of the EHC policies implemented by the Ministry of Health and Welfare and other institutions are shown in The results of the existence of primary medical care and the presence or absence of EHC are shown in The results of the overall state of the primary medical institutions are shown in The results of the overall state of the secondary medical institutions are shown in The results of the overall state of the tertiary medical institutions are shown in Section 2.3 concerns people employed in the EHC field. The results of the overall state of ENT specialists are shown in The results of the overall state of audiologists are shown in The results of the overall state of speech and audio-verbal therapists are shown in The results of the overall state of hearing aid and earmold technicians are shown in The results of the overall state of teachers of the deaf are shown in The results of the overall state of sign language interpreters are shown in The results of the overall state of general physicians are shown in Health workers, excluding medical personnel  specified in the Medical Act, include emergency medical technicians, caregivers, health education specialists, and practical nurses.The results of the overall state of emergency medical technicians are shown in The results of the overall state of health education specialists are shown in The results of the overall state of caregivers are shown in The results of the overall state of practical nurses are shown in The results of the overall state of hearing aids are shown in Cochlear implants are available in both public health systems and the private sector, similar to hearing aids. This was confirmed in the hospital inquiry service of the Health Insurance Review and Assessment Service, and the guidelines are publicly distributed by Snail of Love, a non-profit organization .The results of the overall state of other assistive devices are shown in The results of the overall state of medicines are shown in The results of the overall state of enactment of the hearing care service are shown in The results of the overall state of health insurance are shown in The results of the overall state of health-related data are shown in The results of the overall state of EHC research are shown in This study aimed to identify the current status of EHC in Korea using EHCSA distributed by the WHO in 2015, compare it with other countries, and establish and improve policies related to medical services and hearing diseases. To this end, we would like to examine various areas, such as domestic health policies, the status of patients with hearing-impairment, and the status of medical personnel, and report to WHO on the state of EHC in Korea.In Iran, a situation analysis was conducted on the domestic ear and hearing care program based on the EHCSA. Through this, inadequate health literacy, weak intra-sectoral and intersectoral cooperation, inadequacy of policy responses, non-integration of the EHC in the primary healthcare system, poor standard processes and resources of EHC, and lack of an EHC surveillance system were identified as major problems . In BangIn contrast, Russia supplemented its nationwide implant and hearing aid programs by introducing a cochlear implant in 1991. Therefore, infants born with hearing impairments could receive hearing aids or cochlear implants and rehabilitation services as needed, and up to 1,100 infants receive cochlear implants each year. In addition, people of all ages can receive hearing tests and hearing aid fitting services at audiological centers, which are paid through the national budget . In the Comparing policies and workforce status in other countries, data, such as Korea's EHC program and workforce status, are at the level of advanced countries. The Ministry of Health and Welfare publishes a health and welfare white paper every year to understand major policies and achievements in the health and welfare sector and to help the government achieve new national goals and tasks. The policies implemented by the Ministry of Health and Welfare, the current status of projects, and plans for implementing new policies are specified. There are child welfare policies, older adult welfare policies, low birth rate measures, disability welfare policies, oral health policies, mental health policies, and herbal medicine policies; however, EHC policies are not implemented or planned, except for innate hearing tests and hearing aid support policies .The Korea Health Industry Promotion Agency's \u201cHearing Aid Market Analysis\u201d published in 2015 reported that the average growth rate of hearing aids worldwide is 6.9%. Looking at the ranking, Korea showed the fourth-highest growth rate of 8.5% after 18.3% in China, 10.3% in Germany, and 9.1% in France . There aA survey was conducted to investigate the current status of the domestic hearing aid market, and 61.6 and 71.7% of the respondents said they needed an obscure certificate to sell hearing aids in the category of factors that hinder the development of the domestic hearing aid market and need education as a hearing expert, respectively .The above data are not updated continuously, so it is difficult to state that it represents the current situation because it is not the latest data and the survey was conducted with a limited number of people. Therefore, this study is meaningful, and the information on the latest status of the EHC programs was collected. Overall, both the Health workforce and EHC programs are well-prepared, but incidences of hearing diseases, such as hearing loss, are continuously increasing, so various support measures need to be prepared to convert hearing aid-related certificates into national certificates or rehabilitation and support. In addition, domestic health policy improvements and medical service expansion should be achieved through the continuous collection of data on EHC.The original contributions presented in the study are included in the article/The studies involving humans were approved by the Institutional Review Board of Yonsei University Wonju Severance Christian Hospital (CR323326). The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation was not required from the participants or the participants' legal guardians/next of kin in accordance with the national legislation and institutional requirements.Conceptualization: YS. Data curation: JuhL and JunL. Formal analysis, methodology, and visualization: CY and JuhL. Project administration, writing\u2014reviewing, and editing: CY, YS, SO, and TK. Writing\u2014original draft: JuhL. All authors contributed to the article and approved the submitted version."}
{"text": "In order for the results to be tangible and have an impact, it is essential to be attentive and agile in attracting resources.Knowing one\u2019s own budget and that of other entities that may become a source of resources, understanding the ecosystem that surrounds it is extremely timely for the search for better investments.Although there is no regulation for the profession of fundraiser, being created according to the needs of the entities, it is important to notice that the search for complementary resources is a method of identifying opportunities and partners to explore and test new business initiatives, enabling the best use, optimizing efforts, and obtaining better results.fundraising points exclusively to the financial understanding, the concept is much broader and also covers those resources related to technical, technological, material, immaterial, and human capacity, both for creation and implementation,Although the term Actions involving these activities can be applied to collaborate specifically with an institution (whether public or private), municipalities, states and/or priority projects and programs,The scarcity of capital directly affects entities, generating the most diverse limitations, from the provision of basic services, infrastructure, updates, and the implementation of continuous improvements through research and academic studiesAn example is the current crisis caused by the coronavirus, which has required a large volume of investments in health in a short period of time. In order to reduce the health crisis, public resources were redirected to the Brazilian Unified Health System (SUS) in the three spheres of government. Although the private sector has supported the SUS, it has not received the same opportunities and benefits.The private sector suddenly had to cope with an increase in demand for COVID-19 care, a rise in the price of supplies, and the suspension of elective surgeries and examinations, sharply reducing the revenues of private hospitals.,In the third sector, the pandemic has affected the budget of entities. According to Luis Donadio, coordinator of Fundraising Office of Funda\u00e7\u00e3o Oswaldo Cruz (Fiocruz), with the COVID-19 pandemic, it was found that of the R$ 7 billion received by Fiocruz during the pandemic, from the various entities of society, 80% had been operated by public institutions,The pandemic itself was one of the main recent factors that demonstrated how fragile and limited the budgets of institutions and governments are, sensitizing them on the importance of structuring areas and sectors focused on fundraising activitiesOther challenges that make resources more constrained are the economic, legal, and political scenarios in Brazil.However, it is not enough just to raise funds, with the structuring of areas and sectors focused on these actions. It is essential to qualify the human resources involved, training the teams to prepare plans based on priorities and feasibility of implementation, considering all the perspectives that the project requires, monitoring the technical and financial execution until completion, aiming at efficient and effective management.When drafting, the adequacy of real targets, objective and up-to-date value estimates, the assessment of deadlines and their follow-up forms help to implement feasible projects.Setting feasible targets, acapacity building, monitoring indicators, investing in institutional relationships, and monitoring project implementation are essential for achieving favorable results.Aware of the competing demands on their own resources, external fundraising alternatives are sought.,There are several formats of resource transfers from public entities to other spheres, widely served in other areas as essential as health, briefly explained here only to add knowledge to the reader, since the focus of this work is the health areaConstitutional transfers: the portions of resources collected by the Union and transferred according to the Federal Constitution;Legal transfers: regulated by representative laws that determine the qualification, application, and accountability. They may or may not be linked to a specific purpose. They are presented in automatic transfers, which consist of financial transfers without the use of covenants, adjustments, agreements, or contracts, occurring through deposit in a specific account of the beneficiary, used for the decentralization of resources in certain programs in the area of education;Direct transfer to citizen: provides monthly financial benefits to the target audience of the program;Voluntary transfers: for costing or investment, as cooperation, aid or financial assistance not related to constitutional or legal determinations.The main financial provider for health care, public resources can be obtained by governmental and non-governmental (non-profit) entities.Constitutional Amendment No. 29 of 2000 ensures the financing of public health actions and services, proposing that the three spheres of government annually contribute minimum resources from percentages of revenues. Expenses for public health actions and services are considered to be those with active personnel and other costing and capital expenses, related to finalistic and support programs, including administrative ones, which are aimed at actions and services of universal, equal and free access and which are in accordance with the objectives and goals of the health plans of each federative entity,Ordinance GM/MS No. 204 of January 29, 2007, regulates the financing and transfer of resources for health actions and services, monitoring and controllingCurrently, the distribution of public resources, mainly from the Union, is guided by the Federative Pact, established by the Federal Constitution of 1988. This pact determines the financial obligations, laws, collection of resources, fields of action and the definition of the competencies of each entity of the federation\u2013Union, states, and municipalities.The Constitution provides that each sphere of government must apply a minimum share of tax revenues to health, with 12% of revenues for states and 15% for municipalities.,,The National Health Fund, established by Decree No. 64,867 of 1969, acts at the federal level as the financial manager of SUS resources, financing capital and current expenses, in accordance with the policies and programs managed by the final secretariats of the Ministry of Health, in addition to managing the transfers of these resources to states, municipalities and the Federal DistrictThe budget allocations that make up the general budget of the Union, intended for the transfer of resources, are:Program Resources: programs previously listed by the grantor, available for public and private entities to register project proposals;Parliamentary Amendment Resources: these are resources granted to parliamentarians of the Legislative Branch, inserted in the General Budget of the Union, with a view to participating and influencing the distribution of the proposals of the Executive Branch. The distribution by the ministry occurs through current legislation and adapting to the technical character of execution,After the publication of Ordinance No. 3,992/2017, federal funds for public health actions and services began to be transferred in the fund-to-fund modality, through two blocksPublic Health Actions and Services Costing Block: resources intended for public health actions and services already implemented and the functioning of the responsible bodies and establishments.Investment Block in the Public Health Services Network: resources for the structuring and expansion of public health actions and services.,The Investment classification (GND 4) is used for budget expenses with the execution of expansion works and new constructions or with the acquisition and installation of equipment and permanent material. The transfer occurs via fund to fund, agreement or transfer contract, taking into account the structuring of specialized health care units or the structuring of the primary health care services networkIt is noteworthy that only the acquisition of equipment and permanent materials that are part of the National List of Equipment and Permanent Materials that can be financed for SUS is allowedThe classification of Other Current Expenses (GND 3) is used for budget expenses for the acquisition of consumables, renovations, training, in addition to other current expenses of the other nature groups. The transfer occurs via fund to fund, considering the temporary increment of the medium and high complexity ceiling or the temporary increment to the costing of primary health care servicesBefore sending the resource, it is recommended to consult the primary health care services and medium and high complexity ceilings of each state, the Federal District, and each municipality to be indicated as beneficiary. If the ceiling is already exceeded, it is not possible to receive new resources within the current year.\u2013No counterpart is required from states, municipalities or the Federal District for transfers of resources to SUS, as well as for private non-profit entities that work in health and comply with art. 76 of Law No. 13,242/2015The instruments for the transfer of resources from the Ministry of Health to the states and municipalities are carried out by:Fund-to-fund transfers;Agreements;Onlending contracts;Decentralized execution term;Public consortia, created by Law No. 11.107/2005, establish the joining of two or more federation entities with legal personality to establish cooperation relations and the achievement of common objectives. Art. 9 of Interministerial Ordinance No. 127/2008 determines that public consortia have preference to voluntary transfers from bodies and entities of the federal public administration.These transfers of resources from the Union to the other spheres of public administration or to private non-profit entities are carried out through the conclusion of instruments between the parties, for the execution of activities of reciprocal interest, highlighted in the general budget of the Union in budget appropriations for specific purposes.Prioritizing the capture of public resources in health, according to the classifications already mentioned, the following describes in detail the transfer instruments.Fund-to-fund transfers decentralize resources by dispensing with the formalization of agreements. Guided by Law No. 8,142/1990 and regulated by Decree No. 1,232/1994, they are transfers that are developed within the scope of the Brazilian SUS, through the National Health Fund, under the management of the Basic Operational Standard of the Brazilian SUS 01/1996Intended to cover health actions and services that are implemented by the states, Federal District, and municipalities, these actions and services correspond to investments in the service network, outpatient and hospital coverage and other health actions.The decentralization process was improved by the Ministry of Health in 2006, with the release of the Health Pact (Ordinance No. 399/2006). Thus, the transfers became part of six resource blocks: basic care (primary care), medium and high complexity care, health surveillance, pharmaceutical assistance, SUS management, and unregulated blockTransfers occur directly from the National Health Fund to state, Federal District, and municipal health funds. The application must be carried out as provided for in the health plan of the respective government sphere. It should reflect, at the end of each year:The link with the purpose of each work program of the general budget of the Union that gave rise to the transfer;The established in the health plan and in the annual health programming of each federative entity;The object and commitment agreed in the normative acts of the SUS.When directing resources to municipalities, according to Law No. 8,142/1990, the municipality must meet the minimum criteria, which include the existence of a health fund, health council, health plan, management report, counterpart of resources in the respective budgets, and a commission for the elaboration of the career, positions and salaries plan, with a two-year deadline for its implementation. Failure to comply with these criteria will result in the State being responsible for administering the funds,With regard to accountability, Consolidation Ordinance No. 1/GM/MS of 2017 regulates the management report by consolidating the rules on the rights and duties of health users, the organization and functioning of the Brazilian SUSThis management report must be sent to the Ministry of Health annually and submitted to the respective health council for approval, proving the conformity in the application of the transferred resources (adequacy with the purpose of the budget action), and compliance with the agreed object.,Interministerial Ordinance 424, of December 30, 2016, establishes: Agreement is an instrument that regulates the transfer of financial resources from bodies or entities of the Federal Public Administration, direct or indirect, to bodies or entities of the State, District or Municipal Public Administration, direct or indirect, public consortia, or private non-profit entities, for the purpose of executing a project or activity of reciprocal interest and in mutual cooperation,Decree No. 6,170, of July 25, 2007, establishes that the on-lending contract is the administrative instrument in which the transfer of financial resources is carried out through a federal public financial institution or agent, as agent of the UnionThe rules apply to agreements and, when applicable, to transfer contracts.The decentralized execution term is the decentralization of credit between bodies and / or entities that are part of the Union\u2019s fiscal and social security budgets, to carry out actions of interest to the decentralizing budget unit and the object provided for in the work program, faithfully respecting the functional programmatic classification.The health sector in Brazil has faced numerous difficulties, which has required an urgency on the part of institutions and organizations in diversifying to contribute resources to their projects. The professionalization of project management has become increasingly necessary and resolutive in view of the prospects and projections for the economic scenario in the country.In order to finance investments, alternatives are emerging in the private sector that can help to complement public resources, which are currently insufficient for health maintenance.,Although the search for resources in the private sector provides a wider range of options, these follow fiscal obligations are disciplined by legislation and in particular by the fiscal responsibility law\u2013Complementary Law No. 101,Interestingly, before Complementary Law No. 101, there was no legislation that guided public indebtedness, spending limits and contracting of credit operations, which provided a real chaos in the budgets of government entities, causing the accumulation of immense, poorly planned debts that went from mandate to mandateThe absence of legislation such as this one was and has been up to nowadays the biggest cause of the existence of unfinished works and indebted public entities.The fiscal responsibility law came to establish parameters related to the public spending of each federative entity. The implementation of budget restrictions proposes the fiscal preservation of entities, in accordance with their annual balance sheets, ensuring the financial health of states and municipalitiesThe main source of private funding, financing is the most common alternative for supplementing budgets and making major investments.In Brazil, the main financiers are the development banks, which are used for both public and private projects of long term and high value.Briefly, development banks are financial institutions, usually set up by governments, and provide adequate supply of medium and long-term financing for economic and social development programs and projects.,Currently, the main lenders, which account for 50% of the Brazilian banking system, are Caixa Econ\u00f4mica Federal, Banco do Brasil and Banco Nacional de Desenvolvimento Econ\u00f4mico e Social. In addition to these, some national banks also act as capital providers for long-term financingFor the most part, financing is desired to expand and/or modernize the physical structures of health institutions, to improve and increase the capacity of care and the provision of health services, but it still meets demands for modernization of management, governance, operational efficiency, and certification, aiming at economic and financial sustainability.Inserted in the national scenario by Federal Law No. 11,079/2003, public private partnerships are commonly presented as the union of a group of actors with a common goal of improving health, with mutually agreed roles and principlesAt least one private non-profit organization and one for-profit organization;Sharing of efforts and benefits;Creating social values to improve health.Subject to the rules imposed by government regulators, they can come up with breakthroughs and innovative solutions to provide additional resources for public health research.The expression of interest procedure allows individuals or legal entities to present feasibility studies for a specific project, subsidizing with information suitable for the opening of a concession or public private partnership process.The winning study that will be used for the implementation of the project will have the reimbursement of the expenses of the elaboration of the project, while the other ones do not have any valid reimbursement.Expression of interest procedure can be applied in public private partnership projects, concession, permission and lease of services and public goods, concession of real right of use, privatization of companies and partnership contracts.Public notices are public calls opened by legal entities, which, through the proposed criteria, select normative Manager procedures to receive resources or awards provided for in the notice.It is a very important source of fundraising, being recommended for all types of organization, as in 2019 the number of calls for proposals moved more than R$ 3 billionThey are extremely democratic and are made available throughout the year, for the most diverse causes, for the most diverse stakeholders, and at flexible values adaptable to demands and projects.The competition is broad and requires that the projects are well prepared and planned, meeting the proposed needs, and the criteria required in the notices. Upon approval, the resource must be used exclusively for the purpose for which it was registered and estimated in the work planFinally, fundraising, regardless of whether it is public or private, is an important step and should be discussed by the researchers involved. It is important that this fundraising is strategic, structured, with clear objectives and that it considers all the financial needs involved, such as administrative expenses, human resources, and maintenance of the physical structure."}
{"text": "Medical education is an important and ever-changing profession that determines the future of healthcare and public health in any nation. It is also a complicated and difficult process that needs ongoing adaptation and innovation in order to satisfy the changing demands and expectations of health systems and communities. However, several challenges and limits impede the growth and quality of medical education in the Arab world, preventing it from reaching its full potential. In this article, we\u00a0will highlight some of the major difficulties affecting medical education in the Arab world from our\u00a0own experience as a medical student\u00a0in one of the Arab nations. The puzzle and the answerThe Educational SubjectsIn the Arab world, there is a misalignment between the curriculum and the demands of local health systems and communities. Many medical schools in the area confront this difficulty, since they frequently follow outmoded or imported curricula that do not represent the epidemiological, cultural, and socioeconomic realities of the region . This crThis gap is caused by a number of factors, including the rapid changes in the health landscape caused by the increasing burden of chronic diseases, aging, and environmental issues, the limited involvement of stakeholders in the design and evaluation of curricula, such as health professionals, policymakers, patients, and communities, the lack of integration of scientific research skills and evidence-based practice into curricula, and the insufficient use of innovative teaching methods .Despite the challenges, the Arab world has seen some achievements and opportunities for improvement, such as the establishment of prestigious and reputable universities that provide medical education in accordance with the most recent and advanced educational curricula, the attraction of international partnerships and collaborations that enhance the exchange of expertise and resources, and the adoption of continuing medical education as a principle ,3.Faculty MembersOne of the primary issues that medical education faces in the Arab world is a lack of skilled and competent faculty members and mentors who can provide\u00a0high-quality education and training to medical students. This scarcity has an adverse effect on the quality and outcomes of medical education, as well as on the healthcare system and society as a whole. There are several reasons for this shortage, including the low attractiveness and retention of medical faculty members, a lack of incentives and recognition for teaching excellence and innovation among faculty members, a lack of training and development opportunities for faculty members to improve their teaching skills and knowledge in line with current advances and standards in their fields, and the high workload and stress that faculty members face in their academic and clinical roles, which often leads to burnout and dissatisfaction .There are various viable remedies that might be applied by medical schools, hospitals, and policymakers throughout the Arab world to solve this dilemma. Some of these solutions include: increasing faculty recruitment and retention in the medical field by offering competitive salaries, benefits, and career opportunities that match their qualifications and competencies, rewarding and recognizing faculty members who demonstrate teaching excellence and innovation in their fields through awards, grants, promotions, and other forms of recognition, providing regular and effective training and development , and lowLimited Opportunities for Scientific Research and InnovationScientific research and innovation are critical in every civilization for expanding knowledge and improving health outcomes. However, the Arab world's medical education confronts several problems that hinder its ability to conduct high-quality research and create an innovative culture. Lack of finance, inadequate infrastructure, insufficient human resources, low academic standards, poor cooperation, and restricted dissemination of research findings are some of the obstacles .Despite these obstacles, there are some possibilities and initiatives throughout the Arab world to improve research and innovation in medical education. Some institutions, for example, have developed centers for entrepreneurial studies, social innovation, and technology transfer to encourage faculty and student innovation and entrepreneurship . To suppInfrastructure and ResourcesMedical education in the Arab world is suffering from a significant lack of facilities and teaching and learning tools. The physical buildings, equipment, technology, and communication systems that enable the delivery of medical education are referred to as infrastructure. The human, financial, and material inputs that enable the execution of medical education programs are referred to as resources. According to a recent assessment, many Arab medical schools lack enough facilities and resources to achieve quality and accrediting criteria .In the Arab world, limited facilities and resources have a detrimental influence on the quality and results of medical education. Inadequate infrastructure, for example, may limit the availability and accessibility of clinical training facilities, simulation labs, libraries, and research institutes . InadequSeveral solutions have been suggested and executed by various parties to solve the Arab world's poor infrastructure and resources for medical education. Increased governmental and corporate investments in medical schools, hospitals, clinics, labs, libraries, and research institutes are among them. Enhancing collaboration and coordination among medical education institutions, health authorities, professional groups, and international organizations to exchange best practices, standards, curriculum, professors, and students is another approach ,10. A thConclusionMedical education in the Arab world has several problems, particularly in light of social, political, and economic developments. The coronavirus disease 2019 (COVID-19) epidemic has highlighted both the region's strengths and inadequacies in medical education. As a medical student in the Arab world, I wanted to express some of my thoughts on the present situation and potential solutions.Despite these challenges, there are several possibilities and strengths that may be used to improve medical education in the Arab world. One of them is the availability of technology and digital platforms that may help with information access, communication, cooperation, and creativity. The COVID-19 pandemic has hastened the adoption of online learning and telemedicine, which have the potential to improve the quality and efficiency of medical education and practice. However, it is critical to guarantee that these technologies are used correctly, ethically, and successfully.Medical education in the Arab world is facing a critical era of development that will need collaborative efforts from every group involved to solve problems and capitalize on possibilities. As a regional medical student, I hope that this article has thrown some light on some of the challenges that impact our education and future professions. I also hope that it has sparked some conversation and action among educators, politicians, practitioners, and students in our region to enhance medical education."}
{"text": "The Younger Researchers of the Brazilian Chemical Society committee supports early career researchers promoting communication, collaboration, education, networking, representation, and career development. The establishment of national and international scientific networks has been progressively encouraged by scientific and governmental entities worldwide. This movement aims to strengthen science and technology sectors, given the advantageous intersection of ideas, promotion of interdisciplinary projects, and stimulation for creating multilateral opportunities in research and innovation. We live in a constantly changing world, and we must be prepared to handle local and worldwide challenges that emerge from the social, economic, and health fields. In this regard, strategic decisions and sustainable actions depend largely on the exchange of knowledge, flexibility to deal with adversities, and the ability to manage complex situations.1 Undoubtedly, the creation and maintenance of networks composed and directed to young researchers are highly beneficial for both the younger and senior scientists. Whereas experienced researchers provide valuable training, mentoring, and professional advice that contribute to the younger researcher\u2019s career advancement, early career researchers provide up-to-date information about new and upcoming technologies in an era of rapid digitalization, for example. Besides, they can also offer their undeniable enthusiasm and fresh ideas.2Scientific societies play an essential role in this process by aggregating experts in their areas. However, it is a challenge for their knowledge to be further fructified into the preparation of future leaders and training them as new decision-makers. Indeed, there is a common sense that the active participation of younger generations of researchers in scientific societies is vital for the dissemination of the knowledge acquired by experienced scientists who have been building those societies.3 which started in 2018. Its first activities included the alignment with the demands of the Brazilian Chemical Society (SBQ) board and divisions, the search for institutional support, writing bylaws, and defining the initial activities for its consolidation. The committee would have its existence centered on the organization of a workshop during the SBQ annual meetings and on the representation in national and international meetings and initiatives. However, after the first months of its launch, the committee took on other roles, both within the Brazilian Chemical Society itself and in the broader scientific community. These activities highlighted the enormous demand already existing in the scientific environment, and the potential of young researchers as agents of transformation, renewal of ideas, and workforce. After this initial structuring, the official launch occurred in 2019 during the 42nd Annual Meeting of the Brazilian Chemical Society . Since then, the committee has been promoting the representation of Brazilian, young and early-career researchers, in the national and international scientific community. Among several activities and objectives, the committee aims to organize and support the community of younger scientists, fostering communication, collaboration, education, networking, exchange, and career development in an inclusive and effective way. Both in the national and international scenario, the core activities include: (1) full support of several actions headed by the Brazilian Chemical Society; (2) governance; (3) public outreach; (4) social media management; (5) assistance, coordination and transmission of web-based courses, seminars and podcasts; (6) organization of events during the SBQ annual meetings; (7) representation and participation in external conferences; (8) organization of journal themed issues dedicated to young researchers; (9) structuring and launching recognition awards.Bringing the discussion to the Latin American scenario, this can be illustrated by the creation of the committee of Younger Researchers of the Brazilian Chemical Society (JP-SBQ),The principles of equality, inclusion, freedom of ideas, and a range of views are also fundamental premises of the committee. It supports people from all ethnicities, sexual orientations, gender identities, socioeconomic status, disabilities, and other individualities. The result is the creation of an environment where all young researchers feel represented and comfortable in a safe, respectful, harassment-free, accessible, and welcoming space.To promote professional collaboration and interaction between young researchers from different chemistry fields from companies or universities, the network includes representatives from most Brazilian regions. However, in a continental country such as Brazil, promoting the development of a network that reaches towards underrepresented regions is not an easy task. Overcoming this bottleneck by increasing diversity, exchange of ideas, and, finally knowledge advancement, is the aim.4 The committee advocates for urgent revision of the governmental policies, turning them into enduring state policies for investments in science, technology, and innovation. This agenda could also be promoted by the mobilization of society, industrial, and academic bodies to put Brazil on a path to becoming a developed and self-sufficient country and not an exporter of the young science talent. By these means, proper investment in highly skilled early-career scientists will contribute to building a modern and sustainable economy based on human capital, technology, and innovation, rather than mainly on the exploitation of natural resources.5Another key aspect of the committee\u2019s activities involves career development in a country threatened by unstable funding for science, inadequate financial support, and PhD salaries based on monthly scholarships without any professional register, such as retirement or payroll taxes contribution.6Implementing a committee composed of young researchers in the Brazilian Chemical Society was only possible due to the support of senior and well-established researchers, as well as the support of university bodies, research, and funding institutions. In common, those bodies are aware that investments in young leadership are essential to address national and global challenges.Prof. Dr Shirley Nakagaki, current president of SBQ, says:SBQ is the largest scientific society for Chemistry in Brazil. It has a long history of representing chemists in all instances where such representation is necessary, whether in academia, research funding agencies or committees involved in formulating and making decisions about current scientific and technological policies in the country. For us, the board of the Brazilian Chemical Society, it has always been a challenge to involve our young researchers in the society\u2019s activities, as we understand that without active young researchers and decision-makers, no scientific society has a future. Investing in our young scientists, equipping them with the skills they deem important, is key to building a sustainable society. Guiding them along the scientific path, igniting their interest in science, particularly in the field of chemistry, begins in academia, research laboratories, and the development of scientific work that, in most cases, is destined for success. We, as educators and researchers, are trained for this. However, showing them the path involved in making the right decisions regarding their involvement with universities and representation committees that guide research policies, is a fundamental role in establishing a solid and fruitful scientific community in our country. In scientific organizations like SBQ, we have groups of individuals with this expertise, and the creation of committees like JP-SBQ serves as an open and efficient channel to provide our young researchers with the necessary information and training to achieve this learning in an appropriate, ethical, and scientific environment. As the current president of SBQ, and undoubtedly speaking on behalf of my predecessors, I have been striving to accommodate the demands and ideas of our young researchers in order to make SBQ a facilitating environment for their lifelong scientific learning. However, within the society, we certainly possess the expertise to facilitate this knowledge acquisition. Our goal, from the perspective of JP-SBQ, is to have our young researchers become national and international scientific leaders, trusted educators, influencers, and decision-makers who will help shape Brazilian scientific policies.\u201d\u201c"}
{"text": "Regarding the mode choice of farmland transfer, the existing literature have more examined the choices between market-based transfer (spontaneous transfer) and government or village committee-led transfer, and between formal contract and informal contract. However, the question that how the two parties choose among various specific transfer modes has not attracted extensive attention of scholars. Based on contract theory and transaction cost economics, this paper uses the public samples of the third national agricultural census data to investigate how large-scale households choose among the specific transfer modes when transferring into farmland, like the transfer of the contracted management right (TCMR), lease and shareholding. The findings of this paper are as follows. Firstly, with the increase in the transfer-in area and the education level of the household head, the probability of choosing lease and shareholding increases relatively, but the latter rises faster. Secondly, compared with large-scale farmers whose aim is to plant crop, the probability of those who transfer into farmland for gardening and forestry operation choosing shareholding has increased significantly. Thirdly, the age of the household head and the number of household laborers have an interactive effect on the mode choice of transferring into farmland. In addition, the mode choice of large-scale households\u2019 transferring into farmland is also significantly affected by environmental factors such as local topography, irrigation, traffic conditions, industrial structure, and social security development. Therefore, adhering to the parties to choose the mode of farmland transfer independently is crucial. The government and rural grassroots organizations should help the parties to understand the characteristics, adaptability and supply and demand of different modes, and help the parties to explore the most economical mode. The contribution of this paper is that it expands the study of the transfer of rural land rights to the choices of specific transfer modes, and partially reveals the rule of choices, which provides a reference for the parties to choose the most efficient transfer mode under different conditions and for the government and rural grassroots organizations to play a role. Farmland transfer plays an important role in the revitalization of rural industry, agricultural modernization, and rational utilization of land, scale management, as well as the improvement of land output rate, labor productivity and resource utilization rate [Since the implementation of the household contractual system in rural China in the 1980s, farmland transfer and moderate scale management have occurred and become popular, and diversified transfer modes like the exchange of contracted land, the transfer of contractual management rights (TCMR), substituting farming, subcontracting, lease, \u201cReverse Renting and Subcontracting\u201d, shareholding and land trust have also emerged. This is due to the change of family population and labor force and the difference of farming ability; especially with the development of industrialization, urbanization and modern agriculture, a large number of rural labor force enter the industry and commerce, and thus new agricultural management entities such as, family farms, farmers\u2019 cooperatives and agricultural enterprises have emerged in large numbers. By 2020, the areas of transfer of contracted farmland had reached nearly 37.64 million hectares, accounting for 36.15% of the contracted  and government or village committee-led transfer, and between formal contract and informal contract. Some studies explore that there are more spontaneous transfer among farmers in land transfer in non-suburban rural areas; however, in suburban rural areas, the government or village committee-led circulations occur more frequently . Driven Farmland property rights and its supporting system, the relationship between the parties to the transaction and the participation of government or village collective, land use and so forth have an important effect on the choice of the contract form of land transfer . The signing of formal contracts are significantly promoted by the confirmation of contracted land rights, the establishment of land transfer dispute mediation institutions , the conBesides, some studies examine the choice of price of land transfer and contract flexibility. For instance, the land rights  and its Some researchers have explored how farmers choose among specific land transfer modes. They show that those choices are mainly affected by farmers\u2019 age, education level, risk preference, land endowment, as well as non-agricultural employment, family income and its stability. For instance, Wang and Gu  examinesMoreover, some scholars analyze the choice and change of fixed rent contract and shared tenancy contract. Barzel  argues tAs mentioned above, regarding the mode choice of farmland circulation, the previous literature have mainly examined the selection between market-based transfer (spontaneous transfer) and government or village committee-led transfer, as well as between formal contract and informal contract. However, the problem that how the transferor and transferee in farmland market choose specific circulation modes such as TCMR, lease, and shareholding, namely the circumstance that the circulation subjects with different characteristics may choose which specific modes under what conditions has not yet attracted extensive attention of the existing literature.Based on contract theory and transaction cost economics, this paper adopts the public samples of the Third National Agricultural Census, and takes the case that large-scale households transfer into cultivated land to analyze how they select among three basic circulation modes of TCMR, lease and shareholding, focusing on the impacts of circulation areas, uses and family characteristics on the mode choices of circulation.As mentioned above, in China, there are various circulation modes in cultivated land transfer, such as exchanging contracted land, the transfer of contractual management rights (TCMR), substituting farming, subcontracting, lease, \u201cReverse Renting and Subcontracting\u201d, shareholding, land trust, auction and sale of land management rights during realizing mortgage of that rights. But from the perspective of land transfer-in and expanding management scale, only TCMR, lease and shareholding (namely absorbing others to share with the land management rights) are three basic circulation modes . Meanwhile, TCMR will make the transferor lose the contractual rights and the security function of land, thus, only a few households are willing to choose TCMR to transfer out of land . AccordiIn addition, circulation areas may also affect the mode choice of farmland transfer-in through capital demand. The greater the areas of transfer-in , the greater the capital demand, and the more likely the transferee is to choose the contractual form which can reduce capital demand. Under the contracts of TCMR and the fixed rent contract, the transferee or lessee needs to pay the price of TCMR or rent, while it is not required to pay that price or rent under the shareholding contract. Therefore, ceteris paribus, in order to reduce the demand for funds, the probability of large-scale households\u2019 choosing shareholding may increase faster than that of choosing lease with the increase of the areas of transfer-in.The uses of farmland transfer-in include crop cultivation, garden and forestry management, breeding, etc. Different uses have different production cycles. The longer the cycle, the greater the uncertainty , and the higher the operational risks may be . TherefoThe characteristics of human capital of large-scale households include the ability to search for trading partners and information, organizational ability, and the specificity of human capital. Firstly, when large-scale households transfer into farmland, the costs and scope of searching for trading partners are affected by search capability. The stronger the search ability, the more likely they are to lease land or absorb others to share with land management rights beyond the collective, so the probability of choosing lease and shareholding may rise relatively. Secondly, from the perspective of management decision-making, the transferee or the lessee enjoys the exclusive management decision-making rights under the contracts of TCMR and lease. While, under the contract of shareholding, the costs of decision-making are more higher as shareholders collectively execute their decision-making rights , 62. In The environment of cultivated land includes topography, traffic, irrigation water and so forth, which may have multiple effects on the mode choice of farmland transfer-in. First, ceteris paribus, the contractors\u2019 willingness to transfer out of the contractual management rights may be relatively lower in areas with better environmental conditions, such as plains, traffic-developed areas and water-sourced areas. That is, for the transferee, the number of potential counterparties choosing TCMR is relatively smaller, and the costs of searching and waiting for transaction are relatively higher. Thus, subject to this, the probability of large-scale households\u2019 choosing TCMR to transfer into farmland may be reduced relatively. However, there may also be an opposite forces, that is, for land with better environmental conditions, the transferee may relatively prefer to establish a stable and persistent contractual relationship. While as mentioned above, compared with lease and shareholding, TCMR is the most stable and lasting. Therefore, the probability of choosing TCMR may relatively increase. Subsequently, environmental conditions may affect the future value of cultivated land. Nevertheless, due to the complexity and uncertainty of environmental factors that affect the future value of land and the bounded rationality of human beings, it is fairly difficult to predict the future value of land, and the costs of finding transaction prices and bargaining may be quite high in TCMR and lease. In the shareholding, equity returns automatically reflect the change of land future value, thus saving the costs of predicting the change of land future value. As a result, ceteris paribus, the more complex and uncertain the environmental factors that affect the future value of land are, the more likely large-scale households are to choose shareholding when they transfer into farmland. Therefore, the influence of environment of cultivated land on the mode choice of transfer-in is uncertain and needs to be tested.As mentioned above, large-scale households\u2019 mode choices of transferring into cultivated land are subject to the number of potential counterparties with different modes in the market, namely households\u2019 mode choices of transferring out of cultivated land. The land security function  is The data used in this paper are from the public sample of the Third National Agricultural Census of the People\u2019s Republic of China . As shown in In this paper, the explained variable is the mode of large-scale households\u2019 farmland transfer-in: TCMR = 0, lease = 1, shareholding = 2. In the sample, 96.77% of large-scale households transfer into land by lease, with 1.73% by TCMR and 1.50% by shareholding.The explanatory variables include circulation areas, uses, and human capital of large-scale households.The average households\u2019 areas of transfer-in in the sample are about 7.25 hectares, with the minimum of 0.0067 hectares and the maximum of 866.67 hectares.The most majority of large-scale households transfer into cultivated land for crop cultivation, accounting for about 87.15 percent of the total sample, only 6.73 percent for breeding and 5.61 percent garden & forestry managements. In addition, few used for other business.This paper chooses gender, age, educational attainment of the household heads and the number of labor forces to reflect the characteristics of human capital of large-scale households. Among the samples, 92.52% household heads are male and 7.48% are female. The average age of the household heads is about 47 years old. The smallest is 1 year old, and the largest is 94 years old. Moreover, the education attainment of household heads is mainly junior high school, accounting for 60.53%, followed by primary school, and high school & above education accounting for 26.02% and 12.02% respectively. Additionally, few have not attended school and the average number of labor forces per household is about 2.7, with the minimum of 0 and the maximum of 12.Control variables include village topography , township traffic conditions , the main irrigation water source of the village , the ratio of pension insurance coverage , and the proportion of output value of the primary industry of the province (city) taking up in GDP . Among them, the first three variables reflect the environmental conditions of cultivated land, and the last two variables reflect the security function of local land.Owing to the database used in this paper have been desensitized, it is impossible to identify or infer which administrative village or township corresponds to the large-scale households in the sample, but it can identify whether they belong to the same prefecture-level city. Therefore, this paper uses the prefecture average level of topography, traffic, water and RPI among those control variables.mlogit regression. According to the above theoretical analysis, the mlogit model is established as follows:The explained variable contains three unordered categories , so this paper adopts ML indicates the logit predicted value or Log Odds of households choosing different modes of farmland transfer-in. ix represents each explanatory variable; iz represents each control variable; \u03bc is a random error item; \u03b20, i, \u03b4i\u03b2 are parameters to be estimated.In function (1), Since the circulation areas have abnormal observations, the logarithm of circulation areas is taken in the model.mlogit regression analysis is carried out on the data with the minimum value as reference and the results are shown in Using STATA for statistical analysis, age-mean)#(labor-mean), is introduced into Model 2. The impacts of these variables are discussed as follows.This paper also examines the interaction effect between explanatory variables. In order to avoid multicollinearity, a middle strategy is used for interaction items . The results show that there is a significant interaction effect only between the age of household heads and the number of labor forces. Therefore, the interaction term of age and labor, namely .One the other hand, the following is the effect of circulation uses on the mode choice. In contrast to large-scale households who transfer into cultivated land to operate crop cultivation, for those whose purposes are garden and forestry, the Log Odds of choosing lease of is relatively higher, but it is insignificant. Log Odds of choosing shareholding increases by 1.7166 at the 5% significance level (Model 1), that is, large-scale households prefer to choose shareholding. This may be mainly because that garden & forestry have longer business cycle, greater uncertainty and higher operational risks compared with crop cultivation, and large-scale households tend to choose shareholding contracts to decentralize risk when they transfer into cultivated land. In addition, compared with those whose purpose is crop cultivation, Log Odds of choosing lease decreases relatively when large-scale households\u2019 purpose is breeding, and Log Odds of choosing shareholding increases relatively, but they are insignificant.First, in contrast to large-scale households with female household heads, for those with male household heads, the probability of choosing lease and shareholding is relatively higher in transferring into cultivated land, but both are insignificant.Second, with the improvement of household heads\u2019 educational attainment, the probability of choosing lease and shareholding increases, but the latter increases faster. Compared with those uneducated, Log Odds of large-scale households whose household heads have primary school, junior high school, senior high school & above diplomas choosing to lease increases by 0.6877 at the 10% significance level, 0.7287 at the 10% significance level and 0.7406 at the 5% significance level, respectively. Log Odds of large-scale households\u2019 choosing to share increases by 2.7996, 2.8103 and 3.7307 (Model 1) at 1% significance level, respectively. It is probably because that cross-collective lease and shareholding require higher ability to search for trading partners and information, communicate, and negotiate, as well as supervise and execute contracts in contrast to the transfer of contractual management rights (TCMR) among members within the collective. Additionally, compared with TCMR and lease contracts, shareholding contracts have higher requirements on organization and control capability of the core subjects, whereas education significantly improves the ability of the educated in these aspects. Therefore, when households transfer into cultivated land, households\u2019 educational attainment has a significant positive impact on the selection of lease and shareholding, but the impact on shareholding is more greater.Ceteris paribus, with the increase of the age of household heads, the probability of large-scale households\u2019 choosing lease and shareholding when transferring into cultivated land decreases significantly, but the latter decreases faster. In other words, the probability of choosing TCMR increases relatively. The followings are two possible reasons for that. One reason is that older farmers have less opportunities for non-agricultural employment, but own stronger specificity of their human capital and more farming experience dedicated to agriculture than younger farmers. Consequently, they pay more attention to the stability of contracts when they transfer into cultivated land. As mentioned above, at present, the contracts of TCMR are more stable and durable than lease and shareholding contracts in China. Besides, for shareholding contracts, farming experience is not included in the surplus distribution, which further restricts older farmers with more farming experience to share with land management rights. Therefore, when large-scale households transfer into cultivated land, the negative impact of household heads\u2019 age on the selection of shareholding is greater than that on lease.According to the interaction term between the age of household heads and the number of family labor forces in Model 2, for large-scale households with different numbers of labor forces, the impact of household heads\u2019 age on the mode choice of transferring into cultivated land has significant differences. In terms of the average number of family labor forces (about 3), for one year increase in household heads\u2019 age, Log Odds of choosing lease and shareholding decrease by 0.0123 and by 0.0335 at the 5% significance level respectively. The coefficient of interaction term is positive, indicating that the increase in the number of family labor forces weakens the negative impact of household heads\u2019 age on the selection of lease and shareholding. In other words, the household heads\u2019 age has a negative impact on choosing lease and shareholding, but this negative impact is less for families with more labors than those with less labors.In the light of the choice of TCMR and lease, the number of family labor forces has a significant negative impact on the selection of lease. From the interaction term in Model 2, the impact of the number of family labor forces is significantly different for large-scale households with different household heads\u2019 age. At the average age of household heads about 47 years old, for each additional family labor forces, Log Odds of the selection of lease decreases by 0.1408 at the 5% significance level. In addition, the coefficient of interaction term is positive, indicating that the increase of household heads\u2019 age weakens the negative impact of the number of family labor forces on the selection of lease. In other words, the number of family laborers has a negative impact on choosing lease, but the negative impact on households with older household heads is less than those with younger household heads. From the perspective of the selection of TCMR and shareholding, the probability of choosing shareholding also shows a downward trend with the increase of the number of labor forces, but it is insignificant.5.2.4.1. Effects of topography. Log Odds of choosing lease decreases by an average of 0.4129 at the 1% significance level in accordance with the order of plains, hilly areas, and mountainous areas (model 1). On the contrary, the probability of choosing TCMR increases in turn in the same order. This may be because the worse the topography conditions, the higher the households\u2019 willingness to transfer out of contractual management rights, which brings about more suppliers of TCMR. That is, for the transferee, through TCMR, the costs of searching and waiting for in the transaction decrease relatively. Accordingly, when large-scale households transfer into cultivated land, the probability that they choose TCMR increases relatively. Additionally, there is also a decreasing trend to choose shareholding in accordance with the order of plains, hilly areas, and mountainous areas, but it is insignificant.5.2.4.2. Impacts of traffic conditions. In terms of the choice of TCMR, lease and shareholding, with the improvement of traffic conditions, the probability of choosing lease increases relatively, but it is insignificant and the probability of choosing shareholding increases significantly at the 5% significance level. Log Odds of choosing shareholding increases by 1.0665 on average as traffic conditions improve by per one level. It is probably due to the fact that the better the traffic conditions, the greater the space for the rise of land value. But it is difficult to predict the future value of land, and the costs of finding transaction price and bargaining in TCMR and lease may be high. However, from the perspective of shareholding, the return on equity of shareholders automatically reflects future changes in land value, saving the costs of predicting that changes.5.2.4.3. Impacts of water sources. Between the choice of TCMR and lease, compared with regions without water sources, Log Odds of lease in regions with water sources decreases by 3.5972 at the 1% level (Model 1). This may be because ceteris paribus, the costs of irrigation in regions with water sources are lower, which makes the transferee prefers to choose a more stable way to transfer into farmland with water sources. As mentioned above, in contrast to lease contracts, TCMR is more stable and persistent. Furthermore, Log Odds of choosing shareholding in regions with water sources also shows a downward trend compared with regions without water sources, but it is insignificant.5.2.4.4. Impacts of the ratio of pension insurance coverage. From the perspective of the choice of TCMR and lease, for every 1% increase in the ratio of pension insurance coverage, Log Odds of choosing lease decreases by 0.0254 when large-scale households transfer into cultivated land at the 1% significance level (Model 1). That is, with the increase in the ratio of pension insurance coverage, the probability of choosing TCMR increases relatively. It is probably because that ceteris paribus, the higher the ratio of pension insurance coverage, the smaller the security function of land, and thus the higher the probability for households to transfer out of the contracted land, the more the transferor. That is, for the transferee, the more potential counterparties to choose TCMR, the lower the costs of searching and waiting for the transaction. As a result, the probability of choosing TCMR is relatively higher when transferring into cultivated land. Between the choice of TCMR and shareholding, with the increase in the coverage rate of pension insurance, Log Odds of shareholding also decreases, but it is insignificant.5.2.4.5. Impacts of the proportion of primary industry. Between the choice of TCMR and lease, when the proportion of primary industry increases by per 1%, Log Odds of choosing lease increases 0.0756 at the 1% significance level (Model 1). That is, with the increase in the proportion of primary industry, the probability of choosing TCMR is reduced. This may be because the higher the proportion of primary industry, the more backward the secondary and tertiary industries, which brings about more stronger land security function. According to this, when the contractor transfers out of the cultivated land, the probability of choosing TCMR and lease relatively decreases and increases respectively. Namely, for the transferee, the potential counterparties of TCMR relatively reduce, and the cost of searching and waiting of TCMR relatively increases. When the transferee chooses lease, the potential counterparties increase and the cost of searching and waiting decreases relatively. Therefore, the probability of choosing lease is relatively higher when transferring into cultivated land. However, the influence of the proportion of the primary industry on the selection of TCMR and shareholding is insignificant.Considering that models may have endogenous problems and the results are not robust, in this paper, we carry out the robustness tests in model 3 and model 4. On the one hand, according to Lu & Wang\u2019s  practiceOn the other hand, in Model 4, the educational attainment of the heads of large-scale households is treated as a continuous variable. It is shown that among the choice of three circulation modes, the probability of choosing lease and shareholding increases significantly with the improvement of educational attainment, while the latter increases faster, which is consistent with the results of Model 1 and Model 2. In addition, the symbols of other variables also correspond to those of Model 1 and Model 2, and the coefficient and significance change little. Consequently, in this study, the estimation results are robust.Based on the contract theory and transaction cost economics, this paper adopts the public samples of the Third National Agricultural Census of People\u2019s Republic of China, and takes the case that large-scale households transfer into farmland to analyze the choice of three basic circulation modes which include the transfer of contractual management rights (TCMR), lease and shareholding. According to the contract theory and transaction cost economics, saving the transaction cost is the basic principle of contract choice. TCMR, leases and shareholding have different characteristics in terms of the scope of transaction, land security function, market supply, capital demands, transaction costs and risks; and thus have different transaction costs and risks under different conditions such as the area of transfer-in, the use, the human capital of the parties, the number of laborers, and farmland environment (see Part 3 for details). Therefore, under different conditions, the transfer subjects have different tendencies on the mode choice of land transfer namely contract form. The followings are the findings of our study.On the one hand, when large-scale households transfer into cultivated land, the areas and uses of circulation, the number of family labor forces and characteristics of household heads have important impacts on the selection of the mode of circulation. First, with the increase of circulation areas and improvement of educational attainment of household heads, the probability of choosing lease and shareholding increases relatively, but the latter increases faster. Subsequently, in contrast to large-scale households whose transfer purpose is crop cultivation, those whose transfer purpose is garden and forestry management are more likely to choose shareholding. Furthermore, there is an interaction effect between the age of household heads and the number of family labor forces on the mode choice of circulation. Specifically, the probability of choosing lease and shareholding shows a downward trend as household heads\u2019 age increases, but the latter decreases faster, and this trend weakens with the increase of the number of family labor forces. With the increase of the number of family labor forces, the probability of choosing lease also presents a downward trend which weakens gradually with household heads\u2019 age increasing.On the other hand, the mode choice of large-scale households\u2019 transferring into cultivated land is also significantly affected by local topography, irrigation, traffic conditions, industrial structure and social security development. First, from the perspective of topography, according to the order of plains, hilly areas and mountainous areas, the probability of choosing lease decreases significantly, and the probability of choosing TCMR increases in turn. Subsequently, in the light of irrigation conditions, large-scale households in areas with water sources prefer to choose TCMR, and the probability of choosing lease significantly reduces. Moreover, the probability of choosing shareholding shows a marked increase in areas with better traffic conditions. Additionally, as the proportion of primary industry rises, the probability of choosing lease increases significantly, and the probability of choosing TCMR is reduced relatively. Ultimately, as the ratio of pension insurance coverage increases, the probability of choosing lease decreases significantly, and the probability of choosing TCMR increases relatively.Based on the above research findings, five policy implications are put forward as follows. First, saving transaction costs is the basic principle of contract selection. Different circulation modes have different transaction costs under the conditions of different areas and uses of circulation, human capital and number of labor force. Generally speaking, both the transferor and transferee pretty understand that conditions. Therefore, the mode choice of farmland transfer must adhere to circulation parties\u2019 independent choice and negotiation to stimulate the initiative and creativity of them. In addition, mandatory orders and one-size-fits-all policy should be inhibited. Second, for the selection of circulation modes, the government and rural grassroots organizations should play a main role in educating, training, demonstrating and guiding farmers by providing them with necessary knowledge to choose circulation modes, such as the characteristics and adaptability of different circulation modes. Moreover, it is important for government and rural grassroots organizations to help farmers to obtain information, provide negotiation platform, analyze the characteristics of supply and demand of different circulation modes, and discuss the possible circulation modes from the ability to save transaction costs and then put forward suggestions. Meanwhile, the government should support the development of rural land rights value assessment institutions through fiscal, taxation and credit policies to reduce the costs of discovering transaction prices and bargaining in land rights transactions. Third, improve the quality of rural education and develop vocational education and skills training. Thus, that will enhance farmers\u2019 search capability for transaction partners and information, communication and negotiation, supervision and implementation of contracts to promote the circulation of land management rights. Fourth, support the development of rural transport and play a positive role of it in land lease and shareholding. Specifically, strengthen village road construction; improve the transportation network; increase the density of highway exits and entrances, railway stations and docks. Furthermore, it is extraordinarily possible to try to achieve a scene where there are entrances and exits for villages and towns along the expressway, docks for villages and towns along the waterway, and railway stations for villages and towns with a certain population along the railway. Fifth, it is necessary to reduce farmers\u2019 dependence on land. Specifically, improve the level of rural social security; increase the employment of farmers and then promote the transfer of rural labor force by developing the processing and circulation of agricultural products, rural leisure tourism, rural service industry and so on. Additionally, water conservancy construction of cultivated land should be strengthened to solve the problem of irrigation water source in water-free areas. Accordingly, these measures will play a positive role in TCMR.Regarding the study of rural land rights transfer or configuration modes, the contribution of this paper is mainly reflected in two aspects. First of all, it expands the research field of rural land transfer, turning the focus to the choice of specific transfer modes, like TCMR, lease and shareholding. Taking large-scale households\u2019 land transfer-in as an example, this paper investigates the effect of the area and use of transfer-in, labor resources and human capital of households, farmland environment and land security function on the mode choice of land transfer-in. Secondly, the different modes of land rights transfer are regarded as different forms of contracts, and the analysis paradigm of transaction cost economics is applied to the analysis of the mode choice of farmland transfer-in for large-scale households in this study. This study partly reveals the rule that the parties of rural land rights transfer choose the modes of transfer, and provides a reference for the parties with different characteristics under different conditions to choose the most efficient mode of transfer, and also for the government and rural grassroots organizations to play a role.However, this study has some limitations due to the restriction of data resource. First, some factors that may have an impact on the mode choice of farmland transfer-in are not included in the analysis, like the local agricultural insurance and the financing environment. Second, the classification about the uses of farmland transfer-in is relatively rough. Third, the indicators reflecting the security function of farmland and land environment are not accurate enough since this paper uses regional averages or provincial data.Therefore, this study can be further broadened from the following aspects. Firstly, a comprehensive analysis of the factors that affect the mode selection of farmland transfer-in could be considered in the future research. Secondly, environmental factors could be more accurate. In addition, future studies can focus on the mode choice of rural land rights transfer from the perspective of agricultural enterprises, farmers\u2019 cooperatives, and the party who transfers out of land."}
{"text": "The co-construction of conjugality is influenced by the interactions established in the family as a whole. It manifests itself, therefore, as a relational model in the expression of affectivity and the management of conflicts.In this clinical case report, the couple assumes relational difficulties focused on the significant reduction of time in individual leisure activities and, on the other hand, a 24-hour coexistence in the same space, in a period of compulsory confinement due to the COVID-19 pandemic.This study is exploratory-descriptive, using the case study as an empirical approach.The case described, reports to Couples Therapy, with the sessions taking place in 2022, in a total of seven. The couple, N, male, and J, female, have been married since 2020, shortly before the first confinement because of the COVID-19 pandemic. Regarding their marital relationship, they reported that it deteriorated due to the difficulty in expressing an adaptive reaction to the stressor confinement and the opposite position regarding their desire to become parents.Integrative strategies were developed, with different theoretical and operative references. The couple took control of their relationship due to a greater empathic awareness and the establishment of a healthy and balanced communication system.None Declared"}
{"text": "As health and care workers represent the backbone of health systems, addressing the challenges posed by the escalating demand for medical services has become imperative for central governing bodies, the scientific and medical community, and non-governmental organizations.A spectrum of global obstacles, including a growing elderly population, a surge in chronic illnesses, ecological threats due to shifting climates, unforeseen epidemics, and the heightened expectations of medical service users emphasize the need for immediate and targeted interventions.Across Europe, a healthcare crisis has materialized, underscored by medical personnel strikes driven by insufficient resources and unfavorable working conditions. These strikes have been observed in nations such as France, Germany, and the United Kingdom. Dr. Hans Henri P. Kluge, World Health Organisation (WHO) Regional Director for Europe, asserts that \u201cThe health workforce crisis in Europe is no longer a looming threat \u2013 it is here and now. Health providers and workers across our region are clamouring for help and support\u201d .Currently, all countries in the WHO European Region face severe challenges related to the health and care workforce, including staff shortages, migration, concerns about mental well-being, and gender-related disparities. The need for action is urgent, demanding not only efficient and impactful solutions, but also approaches tailored to the distinct needs of the population, taking into consideration the socio-economic disparities inherent to national and regional contexts.One issue, especially pertaining to Eastern Europe, is staff shortage due to migration or uneven distribution. The Romanian healthcare system experienced a substantial outflow of medical professionals migrating to OECD countries in the past. By the end of 2020, more than 21,500 Romanian doctors had relocated primarily to nations such as France, Germany, the United Kingdom, Israel, Hungary, Belgium, Sweden, and Ireland. However, this migration trend has been on a decline, primarily attributable to factors such as salary increases in the public sector implemented in 2017 and various government initiatives. Notably, the number of doctors who migrated between 2018 and 2020  is less than half of the trend observed between 2012 and 2014 . Moreover, Romania boasts a record of trained medical professionals. In 2020, 26.3 medical students graduated per 100,000 population, surpassing the ratios of all European Union (EU) nations and significantly exceeding the EU19 average of 17.7 in the same year ..1].Given the extent and impact of the issues approached, it is of great importance that the Bucharest Declaration is transposed into concrete political action, to address the needs of the medical system and, ultimately, ensure improved patient outcomes. Moreover, there is a need for a resolution coming from the World Health Organisation that aligns with the principles laid out in this declaration to commit towards addressing the health and care crisis.The Bucharest High-Level Regional Meeting on Health and Care Workforce in Europe took place in the capital of Romania between 22 and 23 March 2023, showcasing a view on the state of European healthcare .The opening ceremony was moderated by Natasha Azzopardi Muscat, Director at the Division of Health Systems and Public Policy from the WHO Regional Office for Europe, and featured Hans Kluge, the WHO Regional Director for Europe, and representatives of the Romanian Government. Medical practitioners and nurses then shared their accounts, highlighting the state of health and care.The event  featuredOver the course of the first day, the High-Level Regional Meeting delved into an array of critical topics, exploring the recruitment and retention challenges faced by health and care personnel in remote and rural settings, the domain of digital health, and innovative nursing methodologies. The topics extended to the examination of retention policies and the sharing of successful practices across various regions within the WHO framework. An essential aspect of the day's discourse was dedicated to the mental well-being of health and care workers. This segment was distinguished by spotlighting the experiences of Albania, Ukraine, Italy, and Ireland, thus underlining the significance of mental health support within the field.Transitioning to the second day, the event embarked on an exploration of healthcare planning and governance, enriched by valuable insights from Denmark, Spain, the Netherlands, and Georgia. Additionally, the imperative role of health data in facilitating well-informed policy decisions, particularly concerning human resources, was underscored. Further discussions revolved around the practical intricacies of health systems, encompassing forecasting methodologies and the seamless integration of scientific evidence into policy-making. At the heart of these deliberations was the endeavor to enhance the appeal of health and care professions, aligned with the overarching goal of advancing the quality and reach of healthcare services.In a broader context, the High-Level Regional Meeting also approached strategies to attract young and passionate talents to the realm of healthcare, as well as focused on addressing pressing matters such as workforce migration, promoting work-life balance, and mitigating gender-based pay disparities within the sphere of European health and care.The event conveyed a concise yet powerful message, while there is no single solution to the healthcare crisis, collaborative efforts are essential to achieve incremental and consistent progress that could lead to significant changes.We were honored to host this regional meeting tackling a subject of extreme importance to the sustainability of healthcare systems in WHO\u2019s European Region. \u201cTIME TO ACT\u201d is not only a slogan, but means assessment, coordinated planning, and, most importantly, implementation. Healthcare professionals are the beating heart of our healthcare systems, and we hope that the adoption of the Bucharest Declaration on Health and Care Workforce will emphasize the importance of taking more robust measures aimed at providing better training to healthcare professionals, better distribution of workforce, increasing the attractiveness of a healthcare career, as well as more effective planning and governance."}
{"text": "Journal of Functional Morphology and Kinesiology , which was first released in March 2016, saw significant developments in 2022. This journal provides an advanced forum for research studies on functional morphology and kinesiology and the regulatory functions of movement. JFMK meets the growing demand for high-quality, peer-reviewed international journals, offering easy access, high publicity via open access, the Digital Object Identifier (DOI), ORCID, and CrossRef to all researchers. We are indexed in Scopus (Elsevier\u2019s abstract and citation database), PubMed, PMC, DOAJ , Scilit , Google Scholar, World Health Organization Hinari, Food Science and Technology Abstracts (FSTA), IFIS, and Norwegian Register for Scientific Journals, Series and Publishers (NSD). Our full texts are archived in CLOCKSS , e-Helvetica , and J-Gate (Informatics India).The In 2022, JFMK was assessed by SCImago Journal Rank as having a 2.7 CiteScore and reached Q2-quartiles in the following research fields: Anatomy, and Physical Therapy, Sports Therapy and Rehabilitation.In 2023, the CiteScoreTracker result for our journal in Scopus is 3.6, which is higher than in the previous year, which demonstrates the citation growth of our journal. In October 2022, we applied to be indexed in the Web of Science.JFMK is a member of the Committee on Publication Ethics (COPE). To verify the originality of content submitted to our journals, we still use iThenticate to check submissions against previous publications. MDPI works with Publons to provide reviewers with credit for their work and with MDPI Scitations Alert to provide our authors information on new publications in their research field.Journal of Functional Morphology and Kinesiology has continued to grow on functional morphology and kinesiology research dealing with the analysis of structure, function, development, and evolution of cells and tissues of the musculoskeletal system and the whole body. It is my pleasure to confirm the progress recorded in recent years [https://www.mdpi.com/journal/jfmk/stats (accessed on 15 January 2023).The journal publishes articles focusing on molecular, cellular, tissue, system, and the whole-body response to a broad definition of physical activities. Furthermore, the journal provides an advanced forum for the analysis of the structure, function, development, and evolution of the cells and tissues of the musculoskeletal system and associated clinical disorders. We are proud to let you know that, thanks to your continuous support, the nt years ,2,3,4,5,Journal of Functional Morphology and Kinesiology receives more manuscripts than it is able to publish, and the decision as to which papers are accepted or rejected is a difficult one. The decision is based on several factors, including originality, experimental design, scientific quality, data interpretation, clarity, and the quality of the written English, in order to uphold the high standards we have set for our journal.Indeed, the number of published manuscripts has jumped from 98, in the 2021 volume, to 112, in the 2022 volume, and we rejected 35% of the contributions to maintain the high standards of our journal. The In 2022, different Special Issues were activated thanks to the huge support of our editors. They include the following: \u201cMotor Competence, Physical Activity and Health 2022\u201d, edited by Prof. Dr. V\u00edtor P. Lopes and Prof. Dr. Luis Paulo Rodrigues ; \u201cMotivaJournal of Functional Morphology and Kinesiology will be published in full open access in order to provide free access to readers, and to cover the costs of peer review, copyediting, typesetting, long-term archiving, and journal management, an article processing charge (APC) of 1600 CHF (Swiss Francs) will be applied to papers accepted after peer review.All articles published in the In 2022, we added new keywords related to our journal as follows: Exercise and Physical Health; Sports Psychology and Cognitive Functioning; Muscle Structure and Musculoskeletal Disorders; Anatomy and Kinesiology; Adapted Physical Activity for Health Promotion; Rehabilitation and Rheumatology; Sports Medicine, Injury Prevention and Treatment; Strength and Power; Nutrition and Body Composition; Physical Activity and Neurodegeneration; Postural Control and Balance; Resistance Training; Sport Physiology and Performance; Athlete Monitoring and Management; Team Sports and Technology.In 2023, we shall continue our efforts to improve the journal through further growth and increased visibility.Follow up the planned papers from editorial board members;Contact international conferences recommended by the Editor-in-Chief or by editorial board members and try to establish media partnerships with them to make JFMK increasingly well known among scholars;Communicate with editorial board members more frequently and seek their generous and valuable input and expertise for journal development;Post high-quality papers through social media  and increase online readership;Reduce the processing time of each submitted manuscript;Take steps to have publications indexed by the Emerging Sources Citation Index (Web of Science), by EMBASE (Elsevier) and by Web of Science\u2014Clarivate;Improve the Citescore in the SCImago Journal Rank in the kinesiology-related sections such as Anatomy, Histology, Orthopedics and Sports Medicine, Physical Therapy, Sports Therapy, and Rehabilitation;Achieve the First Impact Factor status, as released by Clarivate Analytics;Accomplish, for our authors, the JFMK Best Paper Award and the JFMK Travel Grant Award;Garner, for the sake of journal promotion, support from sponsors for our editors to participate in, and disseminate our journal to, international conferences.In order to achieve this target and lay a strong foundation for publications in 2023, and in our application for indexing, we have made the following plans:Since 2021, MDPI has included the accepting Academic Editor\u2019s name on published articles, where they have accepted that manuscript after full peer review. This supports greater transparency for the readership, demonstrates the care that our Academic Editors take in making decisions, and offers full acknowledgement of the effort put in when making expert judgements about the suitability of a manuscript for publication. We strongly believe that this will also support the rigorous and robust quality of our peer-review process.We hope that you share our enthusiasm for this journal, and we look forward to working with you to make JFMK a leader in its field. Your contributions are vital for the success of this new journal. We look forward to receiving your contributions , and proposals for Special Issues are always welcome.I have personally found this to be quite a challenge, one not helped by the COVID-19 pandemic, but one due in large part to the special position that JFMK is trying to navigate in the highly competitive publishing landscape. I wish you a healthy and prosperous new year and look forward to continuing to expand the reach and impact of the journal with your help next year.I take also this opportunity to warmly thank, for their confidence, the following: our authors, readers, and reviewers, as well as our editorial advisors, eminent scientists in these fields, who, with their experience and important suggestions, guide us in this great enterprise; our excellent editorial board members, whose depth of experience covers a very broad spectrum on different disciplines related to morphology and kinesiology arenas; the managing editor, Ms. Molly Lu, for her huge support, the publishing manager, Dr. Peter Ribar, and the other members of the Editorial office, who day after day, thanks to their valuable contributions, ensure the growth of this journal; and finally, all members of our teams in Basel, Barcelona, Beijing, Belgrade, Romania, Tokyo, and Wuhan, as well as our sponsors."}
{"text": "Journal of Personalized Medicine presents extended versions of selected contributions to pHealth 2021, the 18th International Conference on Wearable Micro and Nano Technologies for Personalized Health, held on 8\u201310 November 2021 in Genoa, Italy. The original papers have been published in the IOS Press Studies in Health Technology and Informatics 2021, volume 285  (URL accessed on 15 June 2023).This Special Issue of the JPM pHealth 2021 Special Issue before giving the green flag for formal submission. Mauro Giacomini, as Chair of the pHealth 2021 Local Organizing Committee, has managed the review process, performed by at least two independent international experts.The 2021 edition of pHealth emphasized the interrelated aspects of advanced pHealth, i.e., personalized, participative, preventive, predictive, precision medicine (5P medicine) in health and social services. In that context, mobile technologies, micro\u2013nano\u2013bio smart systems, artificial intelligence and robotics, data management and analytics, machine learning and deep learning for personalized health, the Health Internet of Things (HIoT), systems medicine, public health, and virtual care are of interest. Those new technologies create new potential risks for security, privacy, and safety, resulting in new challenges for meeting ethical and trustworthiness requirements of systems, partners, and processes. Bernd Blobel as the long-term Chair of the pHealth conferences\u2019 Scientific Program Committee as well as of the pHealth Steering Committee has checked and edited every paper invited for publication in the MDPI The book starts with an introduction into the ongoing transformation of health and social care including the related organizational, methodological, and technological paradigm changes. For designing and managing ethical and intelligent transformed health ecosystems, the comprehensive and correct formal representation complex, dynamic, interdisciplinary ecosystems with their knowledge spaces is inevitable. Regarding ethical, legal, security, and privacy aspects, the system\u2019s policy domain and their aforementioned subdomains must be especially addressed. Therefore, the paper specifically discusses the deployment of ontologies for representing ecosystems and their domains, hereby also considering newly standardized ontologies for representation and management of ethically driven robotics and automation systems. Thereafter, knowledge representation and management for semantic data integration is discussed in the context of practical solutions for biobanks. As the new technologies and methodologies are not just necessary for developing and running transformed health and social care ecosystems, but are also inevitable for properly including the current and potential actors, the introductory chapter of the book concludes with a paper on didactic concepts for digital learning in care settings.The second chapter presents two papers tackling the deployment of mobile technologies for pHealth. The first discusses and compares different approaches to learning systems for managing ambulant stress detection. The second one studies the deployment of mobile applications for improving care processes, especially the communication between care providers in pediatrics.The third chapter discusses the deployment of machine learning, artificial intelligence, and automation in transformed health and social care ecosystems with concrete solutions. The first paper focuses on Natural Language Processing, and the last one on unsupervised learning for automatically analyzing notes and electronic medical records. The second paper analyzes processes optimization with machine learning. The papers that follow investigate the deployment of Chatbots in the context of behavioral health, the deployment of machine learning to analyze the side effects of CVD interventions, the intelligent analysis of COVID-19 pneumonia cases using Hybrid Bayesian Networks, and, finally, the use of decision support systems.The last chapter addresses security, privacy, safety, and trust issues changing their characteristics as well as occurrence and importance in the context of the transformation of health and social care ecosystems. First, the implementation of standard-based security and privacy in genomic information systems is discussed at length. Thereafter, a new methodology is presented for assessing privacy and trust in eHealth. The penultimate paper of this volume addresses the importance of data democratization for the advancement of data sharing at a national and European level, as well as globally, while the last paper offers a risk prediction methodology in cardiac surgery.Journal of Personalized Medicine and its Editorial Office, and especially to Penny Su, for the valuable continuous support. Without all those efforts, this volume would not have been possible.The editors thank all authors and reviewers for their important contribution to the success of this volume. Furthermore, they are deeply indebted to the MDPI"}
{"text": "Malaria is a major public health threat worldwide, and it was also widely prevalent in the history in China, seriously endangering people's health and affecting socioeconomic development. China was certified malaria elimination in 2021 with unremitting efforts since the founding of the People's Republic of China in 1949. This great achievement has been another milestone in the fight against major infectious diseases following the elimination of smallpox, poliomyelitis, leprosy, filariasis, neonatal tetanus and blinding trachoma in China. This paper briefly introduces the malaria burden dynamics and the corresponding malaria transmission risk stratificantions, as well as systematically reviews the evolution of anti-malaria policies and measures from severe epidemic to elimination in China. Meanwhile, five key lessons in malaria control and elimination in China are also briefly summarized. All of the above provide evidences for promoting global malaria eradication and preventing reestablishment of malaria transmission, finally benefit all individuals still suffering from the scourge of malaria. Plasmodium parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. Plasmodium parasites that infect humans include Plasmodium falciparum, P. vivax, P. malariae, P. ovale  and P. knowlesi, of which P. falciparum is the most lethal, and P. vivax and P. ovale can relapse due to the presence of latent liver stages known as hypnozoites, which can activate weeks, months, or even years after the primary clinical infection  from 1950 to 2021 . FurtherIn order to actively response to the health-related Millennium Development Goals, and the ultimate global goal of malaria eradication, the Chinese government launched the national malaria elimination program (NMEP) in 2010, with the corresponding National Action Plan for Malaria Elimination in China (2010\u20132020) . As a reWith the launch of the NMEP in 2010 and the WHO certification of malaria-free in 2021 as milestones, three phases of the malaria control phase (1949\u20132009), the elimination phase (2010\u20132020) and the post-elimination phase (2021~) can be divided from the founding of the People's Republic of China. Furthermore, the control phase could be roughly divided into four different stages according to the characteristics of malaria transmission and the anti-malaria policies and measures in different periods, namely, the focal investigation and control stage (1949\u20131959), the control of severe epidemics stage (1960\u20131979), the incidence decline stage (1980\u20131999), and the achievement consolidation/pre-elimination stage (2000\u20132009)  Figure .Anopheles mosquitoes. It was recorded that four Plasmodium species  have been endemic in China, among which P. vivax and P. falciparum were the main species. Moreover, P. vivax was distributed nationwide, and P. falciparum was the dominant species in the hyperendemic area in southern China, which was the major cause of severe malaria and death. In addition, P. malariae was mainly scattered in southern China, and P. ovale was only found sporadically in some areas of southwest China and some counties in Hainan.In the early days of the founding of the People's Republic of China, it was estimated that there were 1,829 malaria-endemic counties nationwide, accounting for more than 70% of the total number of counties at that time . The claAnopheles anthropophagus and Anopheles minimus, and the northern edge of P. falciparum malaria transmission  were first divided in 1958 according to the disease survey data combined with topography, climate and other factors, then this stratification was updated with more characteristics in 1965  were stratified based on the national malaria reports from 2006 to 2008 in China , 39 Fig.In the post-elimination phase, risk stratification of the re-introduction was defined in the Technical Guideline for Prevention of Reestablishment of Malaria Transmission based on the border malaria status, the receptivity and vulnerability  Figure .P. ovale was reported in Pingba County in Guizhou Province  responsible for malaria investigation, personnel training and pilot prevention and control were began to be established in severely endemic areas. In 1953, the report on the National Health Administrative Conference and the second National Health Conference was approved by the Government Council, and the prevention and control against the most serious endemic diseases including malaria was required to be strengthened. By 1955, malaria transmission nationwide was basically clear, and more lessons on malaria control were summarized. At the same time, a variety of antimalarial drugs such as proguanil, cycloguanil, chloroquine, primaquine and pyrimethamine could be synthesized, with a capacity to provide batch supply of some antimalarial drugs such as proguanil and cycloguanil. In 1956, the Draft of National Program for Agricultural Development (1956\u20131967) was proposed, in which malaria was included as one of the most serious diseases affecting the population that could be virtually eliminated in all possible areas and within a limited period of time. In the same year, the first National Malaria Control Program was developed by the Ministry of Health, and malaria was classified as a notifiable disease for the first time. In 1958, Kaili County in Guizhou Province was selected as the first pilot county for malaria eradication by the Ministry of Health.As a result, remarkable progress such as the significant reductions of prevalence and incidence of malaria was achieved in the hyperendemic areas such as Simao County in Yunnan, Kaili County in Guizhou, and Hainan Island.P. vivax were occurred mainly in the Huanghuai Plain in the early 1960s and early 1970s.At this stage, China's malaria control unfortunately failed to achieve continuous results, and serious epidemics caused by Plasmoduim species and the transmission level were specified in the National Technical Plan for Malaria Prevention and Control issued in 1964  established in the early days of the founding of the People's Republic of China to carry out focal investigation and control, or the malaria surveillance network relying on three-level primary health network at the county, town and village levels, or the implementation of various control and elimination policies and measures, all of which are inseparable from a stable malaria control team. In addition to natural factors, the repeated recurrences of malaria transmission in China in the past were related with brain drain, team dispersion, and work stagnation. Meanwhile, the establishment of a real-time surveillance and response system with detailed case epidemiological information, the establishment of a nationwide malaria diagnostic reference laboratory network and quality management system, as well as the continuous implementation of various forms of training and assessment, have improved the level and quality from timely detection and standardized treatment of cases to rapid identification and effective response of epidemics, laying a solid foundation for malaria control and elimination.Plasmodium species, distribution and ecological habits of malaria vectors, etc. in China, thus different strategies and measures have been developed, tailored and implemented in various malaria transmission phases and settings, which made control and elimination feasible in different subregions of China. For instance, the technical specifications for malaria elimination around the core of 1-3-7 approach was carried out in the elimination phase, and the strategy for prevention of malaria re-establishment was updated in a timely manner from the elimination strategy focusing on each case/focus to the prevention of reestablishment focusing on timely identification of the source of infection in the post-elimination phase.Development and implementation of evidence-based strategies and policies across the whole country have been the key to China's successful response to the disease. There are great differences in various topography, climate, level of socioeconomic development, people's living habits, transmission characteristics of etc., have not only provided advanced concepts, technologies and financial support, but also strengthened timely information sharing and experience exchange, which facilitated the malaria elimination.Community involvement has played an important role in malaria control and elimination in China from the following three aspects at least: (1) extensive participation in health education and promotion organized by different sectors to improve public awareness and behavior of malaria prevention and control and to create a healthy and harmonious community; (2) extensive mobilization of community residents to protect environment and implement vector control in combination with new rural construction and China Patriotic Health Campaign; and (3) assistance and cooperation with local CDCs and township health centers in malaria case epidemiological investigation, foci investigation and disposal. Furthermore, inter- or multi-sectoral collaboration to develop and perform guidelines, policies, plans and measures for malaria elimination, intranational collaboration such as the joint prevention and control mechanism for malaria control in Jiangsu, Shandong, Henan, Anhui and Hubei, and the international cooperation such as the close collaboration and cooperation with the WHO, the Global Fund, and the cross-border cooperation under bilateral and multilateral mechanisms, Research in basic science and field applications has made great contributions to malaria elimination in China, not only in the control and elimination strategies, but also in key technologies, covering pathogen biology, vector biology, and interventions such as diagnostics, antimalarial drugs, insecticide-treated mosquito nets and radical treatment of vivax malaria, etc. . Among tMalaria is another major infectious disease eliminated in China after the elimination of smallpox, poliomyelitis, leprosy, filariasis, neonatal tetanus and blinding trachoma , which iZ-GX: conception or design of the work. J-HY and Z-GX: drafting the article. LZ and X-YF: critical revision of the manuscript. All authors final approval of the manuscript."}
{"text": "This study aimed to analyze coronavirus disease 2019 (COVID-19)vaccine policies and effectiveness in Korea, Japan, and Singapore, thereby providing empirical experience for vaccination and response to similar public health emergencies.The study systematically summarized the COVID-19 vaccine policies in Korea, Japan, and Singapore through public information from the Our World in Data website and the official websites of the Ministries of Health in these three countries.Total vaccinations, COVID-19 vaccination rates, rates of fully vaccinated, rates of boostervaccinated, and total confifirmed cases were selected for cross-sectional comparison of COVID-19 vaccination in these three countries. Combining the basic characteristics of these three countries, daily cases per million, daily deaths per million, and the effective reproduction rate were calculated to measure the effectiveness of COVID-19 vaccine policies implementation in each of these three countriesThe countermeasures against the COVID-19 in Korea, Japan, and Singapore, although seemingly different on the surface, have all taken an aggressive approach. There are large similarities in the timing of the start of COVID-19 vaccination, the type of vaccine, how vaccine appointments are made, and whether vaccination are free, and all had high vaccination rates. A systematic comparison of the anti-epidemic practices in the three East Asian countries revealed that all three countries experienced more than one outbreak spike due to the spread of new mutant strains after the start of mass vaccination with COVID-19 vaccination, but that vaccination played a positive role in reducing the number of deaths and stabilizing the effective reproduction rate.This study comparatively analyzed the COVID-19 vaccine policies and their effects in South Korea, Japan, and Singapore, and found that there is a common set of logical combinations behind the seemingly different strategies of these three countries. Therefore, in the process of combating COVID-19, countries can learn from the successful experience of combating the epidemic and continue to strengthen the implementation of vaccination programs, as well as adjusting public perceptions to reduce the level of vaccine hesitancy, enhance the motivation for vaccination, and improve the coverage of COVID-19 vaccine based on different cultural factors, which remains the direction for future development. The worldwide pandemic of coronavirus disease 2019 (COVID-19) is the most serious public health threat since the 1918 H1N1 influenza pandemic ; On MarcSince the COVID-19 pandemic, despite the various measures taken by countries to control the epidemic, the high transmission capacity of the virus, the rapid mutation rate, the general susceptibility of the population and the many asymptomatic infected persons have put enormous pressure on global public health, vaccination has become the most cost-effective means of controlling outbreaks . The devAlthough each country fights the epidemic differently, the external shocks and expectations to end the epidemic are the same for all countries. Therefore, we need to understand why the same effects occur in different countries, that is, what is the common logic behind the seemingly different strategies. The central question of this study is: Why did the three countries achieve similar results with different policy strategies? Thus, this article is a study in search of commonalities. Finding and refining the basic principles for fighting the epidemic can provide important guidance for future epidemic prevention and control . ConsideThe COVID-19 epidemiological data used in this study were obtained from publicly available information on the Our World in Data website and the official websites of the national health ministries of Korea, Japan, and Singapore. The data were selected for the period from the start of COVID-19 vaccination in each of the three countries to May 5, 2023. Total vaccinations, COVID-19 vaccination rates, rates of fully vaccinated, rates of booster-vaccinated, and total confifirmed cases were selected for cross-sectional comparison of COVID-19 vaccination in these three countries. Daily cases per million, daily deaths per million, and the effective reproduction rate (Rt) were calculated to measure the effectiveness of COVID-19 vaccine policies implementation in each of these three countries.Total vaccinations are the sum of the basic and booster doses of the COVID-19 vaccine and are the total number of doses of COVID-19 vaccine administered. COVID-19 vaccination rates are the proportion of the population that has received at least one dose of COVID-19 vaccine, including the proportion of the population that is fully vaccinated and the proportion of the population that is partially vaccinated. Daily cases per million is the number of new confifirmed cases per million population per day for each country. Daily deaths per million is the number of new deaths per million population per day for each country. The effective reproduction rate is an indicator of how many people are infected by one individual. If Rt\u2009=\u20092, this implies that each infected person transmits the virus to two others, resulting in an uncontrolled epidemic . Rt can The COVID-19 vaccine policies of Korea, Japan and Singapore are obtained from official WHO documents, survey reports, and official government websites and official documents of the three countries, such as Ministry of Health of Singapore, Japanese ministry of health, labor and welfare, Korean Ministry of Health and Welfare, etc. The COVID-19 vaccine policy extracted from this study includes the following aspects: basic vaccination program, vaccine procurement and supply, vaccine development, vaccine booster vaccination, vaccination of underage groups, mandatory vaccination, incentive vaccination, and vaccination support policies.Finally, we conducted a cross-sectional comparison of basic COVID-19 vaccination in Korea, Japan, and Singapore, summarized the COVID-19 vaccination policies in each of these three countries, plotted the epidemiological curves of each of these three countries, and labeled the major vaccination policies to assess the effectiveness of the COVID-19 vaccination policies adopted by each country and to examine their commonalities.Cross-country comparative studies need to be based on an understanding of the underlying country context, otherwise they tend to yield unrealistic policy recommendations . First, As seen by Fig.\u00a0Korea launched a large-scale COVID-19 vaccination on February 26, 2021, as can be seen by Table\u00a0The main goal of the Korean government was to achieve universal vaccination as soon as possible in order to control the epidemic and restore normal socio-economic activities. The government has actively promoted the vaccination program by providing free vaccines to the Korean public and ensuring the supply of vaccines to the public through a variety of means, including mass vaccination centers, local vaccination centers, and corporate vaccination. At the public perception level, the Korean public has been supportive of vaccination and widely recognizes the importance of vaccines in controlling the epidemic. The majority of the public actively participated in vaccination and cooperated with the government's vaccination program. At the same time, as Korea focuses on collective consciousness and social responsibility , this isWhile most countries around the world started vaccinating their populations in early 2021, the Japanese government's delay in doing so has been met with accusations from both inside and outside Japan. Starting with the first mass vaccination on February 17, 2021, the vaccination was carried out in the order of medical-related personnel, the elderly, and the general public, as can be seen by Table\u00a0The main objective of the Government of Japan was to achieve universal vaccination as soon as possible in order to control the epidemic and restore normal socio-economic activities. The government was actively promoting the vaccination program by providing free vaccines to the Japanese people and ensuring the supply of vaccines to the public by providing services such as appointments and vaccinations through multiple channels. In terms of public perception, Japan has some disagreements with Korea. Influenced by a long history of self-confidence in the strength of medical resources, science and technology, and health education, Japan is more cautious in accepting new things and viewing external information , for exaSingapore launched its National Vaccination Programme (NVP) on December 30, 2020, with the first vaccines being the Pfizer-BioTech/Comirnaty vaccine, jointly developed by Pfizer and Biotech, the first country in Asia to receive mass vaccination. As can be seen by Table\u00a0The Singapore Government's main objective was to achieve universal vaccination as soon as possible to contain the outbreak, to reduce transmission and to protect public health. The Government was actively pursuing the vaccination programme by providing free vaccines to Singaporeans and ensuring the availability of vaccines and vaccination services through the establishment of multiple vaccination centers and the provision of a booking system, among other things. The public in Singapore has been supportive of vaccination and generally recognizes the importance of vaccines in combating epidemics. The majority of the population was willing to be vaccinated and participated in the government's vaccination program. Vaccine-related information has been made widely available to the public, and decisions based on official guidance and expert advice. One of the cultural characteristics of Singapore is the emphasis on social responsibility and the collective good , and thiAs seen by Fig.\u00a0In terms of the number of deaths and mortality rates during the wave phase, this round was lower than the previous four waves in Japan, with only 2100 and 0.26%, and the rapid spread of the vaccine played a huge role in this round, as Japan began mass COVID-19 vaccination on February 17, 2021. Except for a small fluctuation in the low level of the epidemic in July and August 2021 due to the Tokyo Olympics, both daily cases per million and daily deaths per million remained at extremely low levels until the end of 2021, and the epidemic in Japan was nearly dissipated after the Delta epidemic. As seen by Fig.\u00a0Since the promotion of COVID-19 vaccination, the situation of daily new cases per million varies among countries, with a decrease in daily deaths per million, and the effect is more pronounced in countries with high coverage, but except for Singapore. Vaccination levels in Singapore were very high, with daily new cases per million starting to decline 40\u00a0days after vaccination initiation . With 72Through a comparative analysis of the vaccination policies of the three countries, it can be seen that the three countries share many similarities in their vaccination strategies. Korea, Japan and Singapore all attach great importance to vaccination as an important means of outbreak control, and have developed scientific and rational vaccination strategies and priorities. Based on specific target populations, a phased vaccination program has been formulated, and vaccination priority is determined based on risk assessment to ensure early vaccination of high-risk groups. In terms of vaccine supply and distribution, all three countries were committed to ensuring an adequate supply of vaccines, signing agreements with multiple vaccine manufacturers to ensure the stability of the vaccine supply, thus guaranteeing smooth vaccination, and distributing vaccines through the establishment of vaccination centers and appointment systems. In terms of improving vaccine coverage, Korea, Japan and Singapore have attached great importance to improving vaccination coverage by setting up multiple vaccination centers and providing convenient vaccination services in each region to ensure easy access to vaccinations and vaccinate as many residents as possible.At the same time, there are differences in vaccination policies. In terms of the challenges faced by the three countries in the early stages of vaccination, Japan faced delays in supply and distribution in the early stages of vaccination, while South Korea and Singapore moved forward with their vaccination programs relatively quickly. In terms of strategies for vaccination, Korea and Singapore adopted mass vaccination centers and appointment systems, while Japan focused more on establishing vaccination sites and strengthening promotion and publicity at the local level. In terms of the speed of vaccination, Korea achieved high nationwide coverage for a large part of the population in a relatively short period of time, while Japan and Singapore reached high coverage at a later stage.A comprehensive analysis of vaccination policies and epidemiological curves shows that in terms of vaccination coverage, Korea, Japan and Singapore have all actively promoted vaccination, and although there are some differences in vaccination speed and strategy, they have all achieved higher vaccination coverage earlier. In terms of outbreak control effects, although all three countries had more than one outbreak peak caused by new mutant strains, with the increase in vaccination coverage, all three countries achieved some outbreak control results, with decreases in daily cases per million, daily deaths per million, and Rt values. Korea's outbreak control after vaccination reached the expected goal and the situation improved significantly; Japan's outbreak control effect gradually appeared, but further efforts are still needed; Singapore successfully controlled the outbreak and reached a more controllable state. In terms of social life and economic recovery, with the advancement of vaccination, people can participate in more social activities, and various industries have begun to recover; in terms of the safety of vaccination, all three countries have implemented stringent vaccine safety testing and regulatory measures, and have rigorously evaluated the quality, safety and efficacy of vaccines, and the vaccines that have been put into use are in line with international standards and regulations, although all three countries Although there are reports of individual adverse reactions and side effects in all three countries, these countries have actively taken measures to detect and manage them, such as setting up reporting systems, strengthening testing and treatment, and other ancillary measures. In terms of ongoing prevention and control measures, the intensity of prevention and control and the degree of implementation varied by country based on the outbreak situation and the level of social compliance, but all three countries emphasized the ongoing implementation of prevention and control measures after vaccination, including non-pharmacological interventions such as social education distances and the use of face masks.The ostensibly different vaccination policies of Korea, Japan and Singapore selected for this study show great similarities in vaccination rates and vaccination levels. Therefore, by comparing the anti-vaccination practices of Korea, Japan and Singapore, this study reveals the common logic behind the seemingly very different anti-vaccination approaches and policy combinations of the three countries, i.e., positive willingness to vaccinate, multi-party collaboration, and protection from multiple perspectives are the main threads running through the three countries.In terms of vaccine policy objectives, although, due to the differences between countries in terms of epidemic situation, healthcare systems and economic conditions, different countries have chosen different policy instruments and focuses; for example, while accelerating the speed of vaccination, South Korea and Japan have taken measures such as restricting public gatherings in order to control the spread of the cases; while Singapore has adopted means such as retrospection and quarantine. However, in essence, the objective of all three countries is to safeguard public health and safety. First, the general principles of the anti-epidemic institutional arrangements in the three countries are very similar, with epidemic prevention and control planning, national leaders personally directing and taking the lead in vaccination, and all using the risk of infection and serious illness as the first criterion for vaccination consideration; second, in the medical and public health fields, the strength of the resource allocation in Singapore, South Korea, and Japan is at the forefront of the world, and they have played an important role in this epidemic, and during the epidemic, the Singaporean government During the epidemic, the Singaporean government took the initiative to follow up on its social security policies, South Korea had multiple appeals, and Japan vigorously strengthened its medical response system to bridge the infection prevention gap.It is worth mentioning that the public's willingness to vaccinate and vaccine hesitancy have always had an impact on the advancement of COVID-19 vaccination . On the In the practices of Korea, Japan and Singapore, the combination of these factors has contributed to increased vaccination coverage, which in turn has had a significant impact on controlling outbreaks. Therefore, the promotion of COVID-19 vaccination also requires adjusting public perceptions as much as possible based on different cultural factors to reduce the level of public vaccine hesitancy, adequately publicizing the safety and efficacy of vaccination, developing incentives to enhance the motivation of the population to vaccinate, and appropriately conducting mandatory vaccination to increase COVID-19 vaccine coverage.Non-pharmacological interventions (NPIs) are public health measures aimed at reducing virus transmission by reducing exposure rates, such as contact tracing, international travel controls, closure of public transportation, wearing of masks, closure of workplaces, and cancellation of public events . In thisThis study assessed the effectiveness and impact of different policies in promoting vaccination by examining non-pharmacological interventions during vaccination in three countries and analyzing the vaccination situation in the three countries comparatively, and then explored the impact of factors such as the social, cultural and economic contexts on the implementation and effectiveness of the policies, in order to contribute to a better understanding of the reasons for the differences in the policies between the different regions, as well as the factors behind the same results.The study found that, despite the different degrees of challenges in vaccine supply and public trust in vaccines in these three countries, they all adopted active vaccination policies, committed to achieving universal vaccination and thus controlling the outbreak, and formulated relevant policies based on the actual situation of the countries in a pragmatic and locally adapted manner, which ultimately led to significant results in controlling the outbreak and protecting public health in all of them. Thus, COVID-19 vaccination is a key public health strategy to reduce the overall burden of COVID-19 globally , and theAt the same time, we should also recognize that epidemic prevention and control is a multi-task, multi-link complex activity, and there is no need for countries to adopt a one-size-fits-all policy mix, but rather a need to follow a common goal, and it is entirely possible that different combinations of anti-epidemic policies can be formed according to their respective national conditions, which may lead to different paths to the same end. The great difference between East Asia and the rest of the world in this outbreak is that there is some consensus on the basic anti-epidemic goals and logical starting point, as epitomized by Korea, Japan and Singapore. In the global fight against COVID-19, countries can continue to strengthen the implementation of vaccination programmes, drawing on the successful experience of combating the epidemic. At the same time, based on different cultural factors, public perceptions should be adjusted as much as possible so as to reduce the level of public vaccine hesitancy. On this basis, fully promoting the safety and efficacy of vaccination, developing incentives to enhance the public's motivation to vaccinate, and appropriately carrying out mandatory vaccination to enhance COVID-19 vaccine coverage remain the direction for future development."}
{"text": "Polymer nanomaterials have emerged as a promising class of materials within the field of biomedicine, owing to their unique physical, chemical, and biological properties. These materials have been extensively investigated for a wide range of biomedical applications, including drug delivery, tissue engineering, and diagnostic imaging. In this editorial, we review recent research articles about the use of polymer nanomaterials in biomedicine. More specifically, we examine the development of new nanomedicines in combination therapy for cancer treatment, the use of thermosensitive liquid suppositories for drug delivery, and the development of nanoparticulate photoluminescent probes for bioimaging. These articles highlight the potential of polymer nanomaterials in addressing some of the key challenges in biomedicine, such as the improvement of drug delivery, the enhancement of therapeutic efficacy, and the development of new diagnostic and imaging tools. As the field of polymer nanomaterials continues to advance, it is important to consider their safety and long-term effects. With careful designs and tests, polymer nanomaterials have the potential to revolutionize the field of biomedicine and improve patient outcomes.Anna et al.  focused Kim et al.  developeMoreover, Maria et al.  developeMagdalena et al.  exploredLee et al.  studied The use of polymer nanomaterials in biomedicine is an exciting and rapidly growing field with a wide range of potential applications. The articles reviewed in this editorial highlight some of the latest developments and advancements within the field, including the development of new nanomedicines in combination therapy for cancer treatment, the use of thermosensitive liquid suppositories for drug delivery, and the development of nanoparticulate photoluminescent probes for bioimaging.Furthermore, these studies demonstrate the versatility and potential of polymer nanomaterials in addressing some of the key challenges in biomedicine, such as the improvement of drug delivery, the enhancement of therapeutic efficacy, and the development of new diagnostic and imaging tools. The use of these materials can lead to better outcomes for patients; that is, disease management can be improved and survival rates can be increased."}
{"text": "To report the experience of using the Project-Based Learning methodology, inemergency remote teaching, with undergraduate nursing students.The study was carried out in the course \u201cEducational Actions in NursingPractice\u201d, developed remotely in 2020, during the pandemic caused by the newcoronavirus, in the Bachelor\u2019s and Licanciate Degrees in Nursing at a publicuniversity in the state of S\u00e3o Paulo. The course used Project-Based Learningthrough the following phases: anchoring; driving question; investigation andresearch; creation and development; and presentation of the results as anactive learning methodology, with the formation of small groups of studentsand tutors and process evaluation.The students developed educational projects in health through a virtuallearning environment, platforms, and digital tools.The methodology adopted and the use of digital technologies allowed theachievement of the proposed objectives, the motivation and autonomy of thestudents throughout the remote teaching process, and the development ofcompetences for the elaboration of projects in health education for nursingtraining. The scopeof the spread of the virus around the world has made countries adopt contagionreduction strategies, includingsocial isolation, which directly affected education systems with the widespreadclosure of educational institutions such as schools, colleges, anduniversities,4.The World Health Organization (WHO), in March 2020, declared COVID-19, caused bySARS-CoV2, a pandemicERE).The suspension of in-person activities led Higher Education Institutions (IESs) toquickly adapt, in an improvised way, their teaching strategies and tools,characterizing Emergency Remote Teaching  is highlighted, whichallows students to confront real-world situations, issues, and problems, making themmeaningful, determining how they should be addressed, and acting cooperatively insearch of solutions. It is characterized as a methodology that encourages studentsto work collaboratively and in a team based way on the integration of differentknowledge, stimulating the development of critical thinking and the active role ofstudents, aiming to solve or propose the confrontation of a challenging issuestemming from the construction of a project. The PjBL methodology consists of thefollowing steps: anchoring; driving question; investigation and research; creationand development; and presentation of resultsThe objective of this study was to report the experience of using the Project-BasedLearning methodology in emergency remote teaching, with undergraduate nursingstudents.This is an experience report on the use of the PjBL in the course of educationalactions in nursing practice, developed remotely in 2020, during the pandemic causedby the new coronavirus, in the Bachelor\u2019s and Licanciate Degrees in Nursing at apublic university in the state of S\u00e3o Paulo.\u201ctounderstand and apply the necessary foundations for the development ofeducational actions in health inherent to the practice of nursing in differentsocial groups and learning scenarios\u201d. The objectives to be achievedby students are:The course has a workload of 90 hours, with a practical component of 60 hours, and isoffered in the second semester of the first year of nursing school. It lasts for asemester, with a weekly meeting. The general objective of the course is .\u201c1. To understand the concept of health education 2. To recognize the educationalprocess as inherent to nursing practice 3. To identify and apply presuppositions ofthe theoretical frameworks of the learner\u2019s adhesion and motivation in theeducational practice. 4. To recognize and implement educational practice atdifferent stages of life cycle. 5. Plan, build, develop, and evaluate educationalhealth projects\u201d.The course\u2019s learning program, before the pandemic, adopted dialogic expositoryclasses, case studies, workshops, discussions, and seminars as teaching strategies,with the support of a virtual learning environment, as well as practical activities. The established assessment method included selfand hetero-assessment, reporting, and activities developed in the field of practice.The approval criterion consisted of the final average above and/or equal to five anda frequency of at least 70%Google Meet\u00ae, through the corporate platform of the Google Workspaces forEducation\u00ae in which students and professors are logged in the educationalinstitution email. Asynchronous moments were supported by the institution\u2019s virtuallearning environment (VLE) Moodle\u00ae.The course plan remodeled from the PjBL methodology consisted of theoretical contentsadministered remotely in synchronous classes  through theuse of the software of video calls The instructional design of the course\u2019s VLE was structured following the contentscovered and the phases of the PjBL, aiming to be a collaborative space for learningand exchanging experiences. The environment presented tools for asynchronousinteraction between teacher and students; course guidelines and presentation;welcoming message from teachers to students; course schedule; notices and newsboard; course syllabus; division of tutoring groups; tasks, materials, andcomplementary bibliographies; assessment of classes and tutoring; as well as virtualclasses and the recording of synchronous classes.Google Forms\u00ae composed of global assessment questions available in the VLE. For eachproposition, the Likert scale was adopted, with four response intervals, rangingfrom one  to four , as well as a space for studentsto add justifications to their answers.The evaluation method remained self- and hetero-evaluative, replacing the report andactivities developed in the field of practices with the development and presentationof the educational project. At the end of the semester, students were invited toevaluate the course through a form on the platform .At PjBL, students play an active role, being co-responsible for the constructionof the project at all stages, seeking information, exchanging experiences,communicating and collaborating with their peers, in small groups, through themediation of professors who act as tutors in the processThe methodology assumes the development of five phases: anchoring; drivingquestion; investigation and research; creation and development; and presentationof results.anchoring, used to introduce the context of the project tostudents, can be presented in different ways, such as short narratives, data,and information from a certain context, as well as images, videos and/or news.The objective of this phase is to attract the students\u2019 attention and interest,presenting the context and the problem to be worked on.The phase driving question guides and identifies the focus of thecontext and of the problem that will be worked on in the project. It can beestablished in advance by the tutors or jointly identified by the studentsthemselves, based on reflection, discussion, and the definition of priorityquestions related to the context and problem presented.The phase investigation and research for a better understanding andin-depth investigation of the problem, providing the articulation of theory withreality. The greater the engagement around the anchoring and driving question,the greater the involvement of students at this stage.From the anchoring and driving question phases, students are encouraged to carryout the creation and development phase.After investigation and research, students are encouraged to think, together andstrategically, about the best way to create and develop forms of coping with theproblem, characterizing the results presentation, throughdiversified strategies, such as oral presentation, dialogue poster, video, amongothers. If the problem is related to a practical field activity, it can beshared with the subjects that make up the context worked on.Finally, the group of students has the possibility to socialize the developmentof the project systematicaly in the CNS),not requiring submission to the Human Research Ethics Committee.This experience report was built by the course professors and the creators of theproject. The students were active participants in the execution of thepedagogical proposal. This research is part of Resolution No. 510 of April 2016, of the National Health Council  provides the development of the teaching-learningprocess.Learning emphasizes the protagonist role of the student, due to his/her direct,participatory, and reflective involvement in all stages of the process,experimenting, designing, creating, with the teacher\u2019s guidance, the final product.Learning is developed in a flexible way through the sharing of space, time,activities, materials and technologies that make up the active process and projectdevelopmentERE was presented concomitantly with limitationsfor the use of ICT in terms of cognitive, epistemological, and structural obstacles.The insecurities of teachers in the use of technologies, as well as cultural beliefsthat students are more prepared for digital use, are pointed out as obstacles inadapting to the use of ICTs.For some authors, .In this context, there was a trend towards an increase in the number of hoursdedicated to the use of ICT in 2020, with the most used resources being digitallearning environments, followed by audio and video platforms. There were alsolimitations regarding the availability of equipment and the challenges of overcomingthe inequality of opportunities among students, such as technological infrastructureand high-speed internet.ICTs are tools that allow new interactions and the creation of favorable spaces forthe teaching-learning process, as they act as facilitators in the construction andexchange of knowledge, stimulating the exercise of autonomy of the subjectsinvolved,20,21.Several authors highlight successful experiences in the educational process with thepromotion of meaningful learning through PjBL, as learning is based on realproblems, in the context of life, and the proposals for solutions are based onmeeting these needs.In this regard, in the use of the PjBL methodology, the tutor\u2019s supervisory rolebecomes essential, involving students in the creation and execution of the project,respecting the learning objectives and recognizing the difficulty that students andteachers have in planning and executing this strategy, which emphasizes the need forweekly records and monitoring to enable the construction of projects. The use ofdigital tools helps in the planning and execution of the project, as it promotesintegration and agilityThe PjBL methodology was very close to the subject\u2019s learning object \u2013 related to thepractical component, which was greatly affected by the pandemic \u2013, allowing thestudent to develop an educational action in health. Based on the health needsidentified by the groups of students, the methodology contributes to theconstruction of educational projects based on the current situation and itsapplicability..In a study on pedagogical action in the light of PjBL, the path traced and theresults obtained demonstrated the methodology as an effective strategy regarding thecommitment to diversify the professor\u2019s methodological repertoire, especially in apost-pandemic context that led to the establishment of a parallel, virtual world andto a reality of abrupt changes in the ways of interacting, dialoguing, teaching, andlearning.At PjBL, students are protagonists and have a voice to make choices during theprocess. Thus, in this course, projects of educational actions were developed indifferent themes, supported by the theoretical methodological framework proposedduring the execution of all projectsMentimeter\u00ae was used, with the purpose and opportunity to re-signify the evaluationprocess with ICT as allies. The use of digital tools for the assessment process iseffective and, when directed to formative assessment, allows students and professorsto carry out agile, practical, remote, and synchronous feedbacks.As a form of evaluation, the The ICTs are part of the contemporary model of teaching in health and nursing andtend to be more incorporated as scientific and technological development advances.In the course presented, the use of ICT was essential for the maintenance of thestudents\u2019 academic schedule in the context of the pandemic, especially with regardto the practical component. However, the analysis and reflection on the limits andpossibilities of the use of technologies in health and nursing education arerequired.Offering the course with the use of PjBL, allied to technologies, proved to beeffective in achieving learning objectives, especially in the development of skillsto plan, build, develop, and evaluate educational health projects. The innovativecharacter of the experience in articulating the PjBL with the promotion of thedevelopment of technological competences applied to health education in the trainingof nurses is also highlighted.The tutoring meetings were fundamental for the growth and productivity of the groupof students, allowing autonomy and freedom of creation and learning in topicsrelated to health education, expressed by the satisfaction of students in the courseevaluation.Regarding the future challenges of the course\u2019s professors, the main ones will be:the implementation of the methodology in the return of classroom teaching to supportthe performance and construction of projects to be applied in practice scenarios;and the reflection on the limits and possibilities of technologies for thedevelopment of technological competences in the training of nurses, aiming at theirappropriate use in teaching, professional practice, and in the population\u2019s healtheducation."}
{"text": "This article was published with an error in the affiliation of Biljana Blazevska Stoilkovska. She is in fact affiliated with the Department of Psychology, Faculty of Philosophy, Ss. Cyril and Methodius University in Skopje, Skopje, Republic of North Macedonia."}
{"text": "To identify and map the types of analysis in nursing validation studies This is a scoping review with collection carried out in July 2020. The following data extraction indicators were considered: year of publication, country of origin, type of study, level of evidence, scientific references for validation and types of analyses. Data were collected in the following bases: U.S. National Library of Medicine, Cumulative Index to Nursing and Allied Health Literature, SCOPUS, COCHRANE, Web of Science, PSYCHINFO, Latin American and Caribbean Literature in Health Sciences, CAPES Theses and Dissertation Portal, Education Resources Information Center, The National Library of Australia's Trobe, Academic Archive Online, DART-Europe E-Theses Portal, Electronic Theses Online Service, Open Access Scientific Repository of Portugal, National ETD Portal, Theses Canada, Theses and dissertations from Latin America.  The sample consisted of 881 studies, with a predominance of articles , with a prevalence of publications in 2019 , of Brazilian origin , of the methodological study type . Polit and Beck stood out as the methodological reference  and Cronbach's Alpha  as the statistical test. Regarding the type of analysis, the exploratory factor analysis and the content validation index stood out.  The use of at least one method of analysis was evident in more than half of the studies, which implied the need to carry out several statistical tests in order to evaluate the validation of the instrument used and show its reliability. In the world scenario, there is a growing number of validation studies in the health field aimed at the production of technological resources with the purpose of supporting care in different contexts, both in the training and qualification of professionals, as well as in management and patient care. From thiFurthermore, numerous materials can be submitted to validation stages, such as research instruments, care protocols, educational booklets, standard operating procedures, virtual learning objects, algorithms and others. These maContent validation assesses whether the content produced is relevant, correct and adequate for what is proposed. TransculUse validation seeks to trace the degree of user satisfaction with the tool built. As for usability, the validation investigates the effectiveness, efficiency and relevance of the use of the technology in relation to the intended objective in a more broad manner.,7 TherefThus, the data analysis stage is important for validation studies, as it is considered essential to establish the relevance and quality of the constructed material. However, the reliability of the analysis process must be in line with the material and type of validation performed. Thus, itStudy design. This is a Scoping Review with a research protocol registered in the Open Science Framework (DOI:10.17605/OSF.IO/YH9UZ) based on the recommendations of the Joanna Briggs Institute (JBI) Reviewer's Manual, accordinStudy location and data collection period. A primary investigation was carried out by crossing Data analysis AND Validation study AND nurse research in the National Library of Medicine (PUBMED) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases to identify and survey the most common keywords frequently in surveys. Thus, the search strategy was obtained with the help of the Boolean operators AND and OR: Validation Study OR  AND Data Analysis OR  AND Nurse Research OR (Nursing Sciences). It should be noted that the search in each database was adapted to its specific search engines, but the compatibility of descriptor combinations was maintained. The capture of studies was performed in July 2020. The following platforms were used to search for articles: U.S. National Library of Medicine (PUBMED), Cumulative Index to Nursing and Allied Health Literature (CINAHL), SCOPUS, COCHRANE, Web of Science, PSYCHINFO, Latin American and Caribbean Literature in Health Sciences (LILACS). In view of the theses and dissertations that make up the gray literature, the following were explored: CAPES Thesis and Dissertation Portal, Education Resources Information Center (ERIC), The National Library of Australia's Trobe (Trove), Academic Archive Online (DIVA), DART- Europe E-Theses Portal, Electronic Theses Online Service (EThOS), Open Access Scientific Repository of Portugal (RCAAP), National ETD Portal, Theses Canada, Theses and dissertations from Latin America.Selection criteria. The following inclusion criteria were defined for the eligibility of the studies: research related to the types of analysis of validation studies in nursing, studies published in full and available electronically on the CAPES Periodicals Portal through the Federated Academic Community (CAFe). No restrictions were established regarding language and time of publication. Editorials, letters to the editor, opinion articles and reflection articles were excluded. In addition, duplicate materials were counted only once.Sample definition and Study variables. The study selection process took place in two stages, the first starting from reading the titles and abstracts, which were verified by peer reviewers. In the second stage, the studies were analyzed by reading the material in full and the indicators were extracted: year of publication, country of origin, type of study, level of evidence based on the JBI recommendations, which coData processing and analysis. The selected data were organized in a spreadsheet using the Microsoft Excel 2010\u00ae software, evaluated using simple descriptive statistics, and presented in graphs, tables and figures.From the search in the databases, 809,975 studies were initially identified, which were analyzed in stages that are described in The selected studies consist of articles , dissertations  and theses . With regard to the period of publications, the year 2019 stood out  .Regarding the origin of the studies, Brazil , the United States of America  and Turkey  stood out, as shown in Regarding the type of method, there was a prevalence of those classified as methodological , cross-sectional , validation studies , descriptive , observational , cohort and exploratory , quasi-experimental , accuracy, concept analysis, randomized clinical trial and action research  each, case control, sequential triangulation and systematic review  each. It is noteworthy that some studies  did not describe the method used. The levels of evidence of the studies were evaluated, in which there was a predominance of level five , followed by level four , level three , level two , and level one . In addition, the data collection indicators  were synthesized and presented in There were also variables such as the types of analysis of validation studies in nursing and the amount of analysis used in each research, which are described in Regarding the analysis of published studies, the predominance of articles was noticed. This finding is associated with the fact that this type of production is carried out in a shorter period of time compared to the others and, often, they consist of clippings from larger research, such as research reports, dissertations and theses. Regardinstricto sensu graduate courses in the health area, which foster the progress of science and technology, which require a careful evaluation before their implementation and, therefore, validation studies become essential as they attest to the quality of the tool developed. was found as one of the most important dimensions in the analysis of a material, since it allows the determination of the validation of the material based on statistical calculations defined according to the pre-established.,23,24 ThHowever, for Pasquali, this process is understood as Content Validation Coefficient (CVC) and differs in statistical calculations. In this case, each item and the instrument as a whole are validated according to previously established criteria and by means of an expert opinion, which provides the adequacy of the content and semantics of the material to make it understandable to the audience for which it is intended and compatible with the purpose for which it is available. Both verIt is evident that the presence of one more method of analysis in 50% of the studies implies the need for several tests to measure the validation of a material and prove its reliability. These results corroborate an integrative review by confiThe main types of analysis used in validation studies in nursing are the exploratory factorial and the content validation index. Regarding the methodological framework, Polit and Beck stood out, and as a statistical test, Cronbach's Alpha for structuring and evaluating the tool produced. All these processes allow the improvement of the technologies developed and ensure their quality, in addition to enabling their use in health services, since such materials guide and the routine of professionals and turn it dynamic by subsidizing their practical performance and strengthening the theoretical basis.Furthermore, as contributions from the research developed, the mapping of the analyzed information is elucidated, considering that from the results obtained, researchers will be able to base the analyses of their validation studies by understanding which types of analyses are most suitable for each type of approach according to the findings of this material, as well as statistical tests and calculations that can be associated and appropriate references and benchmarks"}
{"text": "The concept of One Health is not new; it can be traced back for at least two hundred years , firstlySilent Spring, reporting the tragedy of silenced birds due to biomagnification and exposure to the organochlorine insecticide dichlorodiphenyltrichloroethane (DDT) [Historically focused on zoonoses , the conne (DDT) . What isne (DDT) ,14. The n = 2458 inpatients).In the toxicology\u2013pharmacology areas, some recent findings published in the Journal of Clinical Medicine, with an intersection with other scientific areas, are worth mentioning. The everyday appearance of new psychoactive substances (NPS) and the consequent morbidity and mortality associated with their consumption is a highly recognized problem . PiperazAs highlighted before for several pharmacological drugs with abuse potential ,30,31,32Discussing toxicology in a unifying approach to balance and optimize the health of people, animals, and the environment is needed. By taking a One Health approach to toxicology, researchers can gain a more complete understanding of the impacts of toxic substances on the health of multiple species, as well as the ecological and societal implications of these impacts, and clues to reach a greener chemistry. This can help inform policy decisions concerning the regulation and management of toxic substances, with the goal of promoting the health and well-being of all living beings. Innovative research directly related to toxicology , but also at the interface of biomedical, biochemistry and environmental Sciences , with cross-cutting issues within the Sustainable Development Goals, is welcome. Real world data and evidence will further improve the translational impact, enabling the development of ecological and needs-oriented research, and to identify the specificities, risk, and resilience factors of the individuals to the toxic insults on health. Finally, multidisciplinary approaches involve the study of toxicological interactions and implications to One Health, biosorbents and environment, food microbiology, chemical compounds and therapeutic implications, drug repurposing, biomarkers, cancer studies, the development of analytical methodologies, and the analysis of real-world data and evidence for a better understanding of the diseases from a global picture point of view."}
{"text": "During the transport, storage, and consumption of edible vegetable oils, the color of some freshly refined oils is gradually darkened, which is known as the color reversion. The oil industry has been plagued by the issue for a long time because the dark color of the oil is related to its poor quality and low acceptability for consumers. Color reversion of refined vegetable oils is primarily related to the processing pigments, especially tocored, which is the oxidation product of \u03b3-tocopherol. However, the underlying molecular action mechanism of tocored is not yet fully understood due to the complex transformations of tocored in oil systems. This paper presents a brief description of oil color, followed by an overview of research progress on the mechanism of color reversion. In particular, the effect of minor components  on color reversion is highlighted in an attempt to explain the remaining mysteries of color reversion. Furthermore, the measures to restrain color reversion by quality control of the oilseeds, the adjustment of technical parameters of processing, and the storage conditions of refined oils are summarized to provide some references for the oil industry. Refined vegetable oils, after degumming, deacidification, bleaching, deodorization, and dewaxing, appear pale yellow or amber when they are freshly prepared. However, during transport, storage, and consumption, the color of some vegetable oils gradually darkens and turns deep yellow or light red. This phenomenon is known as the color reversion of oils . The colThe gradually deepening color of freshly prepared oils was due to oxidation. Meanwhile, the peroxide value of the oil, an indicator of the content of primary oxidation products, was significantly increased during the deepening process, which resulted in the poor quality of the oil . A similThe studies on the color reversion of refined vegetable oils can be divided into four stages . The firThe second stage was from 1960 to 1980, and the research was dominated by Japanese researchers. Tomita et al.  found thThe third stage was from 1980 to 2000, and the research was concentrated in Taiwan, China. A color reversion mechanism, which was significantly different from that of Japanese researchers, was proposed by Lai et al. . SubsequThe fourth stage was from 2000 to now. The correlative works were mostly concentrated in China, and the research field was divided into two parts: mechanism analysis and restraining measures. The color reversion of vegetable oils has been systematically studied by Dr. Zhang . The aut(I) The quality control of oilseeds. For example, the degree of color reversion of oils was influenced by the cultivar, the moisture content, and the maturity of the oilseeds.(II) The pretreatment of oilseeds. Steam pretreatment of raw soybeans has been proven to be an effective measure to restrain the color reversion of refined soybean oil .(III) The oil extraction process. The temperature during the process was very important for the color stability of the oil.(IV) The refining of crude oil. The five processes involved in vegetable oil refining are degumming, deacidification, bleaching, deodorization, and dewaxing. The color reversion of refined vegetable oils was influenced by the technical parameters of these processes (except dewaxing).(V) The storage of refined vegetable oils. The speed of color reversion of refined vegetable oils was determined by the addition of exogenous antioxidants as well as the temperature, light, and sealing conditions during storage.In this review, the color of vegetable oils and the research progress on the mechanism of color reversion were presented. To understand the reasons for color reversion, the effect of minor components was highlighted. In addition, the restraining measures were also summarized to provide some available references for subsequent research and the oil industry.The color of vegetable oils is mainly attributed to two types of pigment. One is the naturally existing lipid-soluble pigments, such as carotenoids and chlorophylls. The other is the pigments produced during oil processing, which are called the processing pigments, for example, the products of oxidative polymerization, and non-enzymatic browning reactions.Carotenoids and chlorophylls are the predominant natural pigments present in most vegetable oils . Caroten2+, and chlorophylls are responsible for the green color of vegetable oils. The main forms of chlorophyll in vegetable oils are chlorophyll a and chlorophyll b  The oxidative polymerization of acylglycerols ). The major portion of vegetable oil is TAG, which is comprised of one glycerol and three groups of fatty acids. Due to the presence of unsaturated double bonds in these fatty acids, TAGs are prone to oxidative polymerization at high temperatures, which results in the formation of polar components including the oxidized TAG monomers, TAG dimers, and TAG oligomers . Most of(II) The non-enzymatic browning or Maillard reaction. In previous studies, non-enzymatic browning products of phospholipids (pyrrolized phospholipids) were found to rapidly enhance the color intensity of oils ,28,29. T(III) The oxidation of non-TAG. The color of oils was changed with the oxidation of non-TAG components, such as tocopherols and phospholipids .(IV) The other reactions. Sono et al.  found thortho-quinones, and it tends to be yellow at low concentrations and red at high concentrations . Th. Th\u22121 toNatural antioxidants are good alternatives to synthetic antioxidants because consumers are concerned about the safety of synthetic compounds. However, natural antioxidants have some limitations and disadvantages, such as low thermal stability and expensive costs. Therefore, in order to achieve the commercial sustainability of natural antioxidants, more efficient and economical methods for the extraction of natural antioxidants from plant matrices should be developed ,97.The market for refined vegetable oils has been plagued by the phenomenon of color reversion. A comprehensive understanding of the mechanism of color reversion and the effective restraining of this phenomenon is of increasing interest. As discussed in many studies, the color reversion of oils is involved in a large and complex system. Although some studies have shown that \u03b3-tocopherol oxidation is the main reason for color reversion, the proposed mechanisms of color reversion are controversial. Consequently, the molecular action of the oxidized derivatives of \u03b3-tocopherol  in lipid systems is worth exploring, as this could provide new insights into the mechanism of color reversion. Moreover, further research should also focus on elucidating the mechanism of the effect of phospholipids and metal ions on color reversion. Despite the achievements, the issue has not been satisfactorily solved. An efficient and economical method to restrain color reversion is still needed to be developed."}
{"text": "The current Special Issue, entitled \u201cFriction, Corrosion and Protection of Material Surfaces\u201d, aims to discuss the state-of-the-art research progress regarding the friction and corrosion behaviors of new materials and advanced protective materials or technologies, with a special focus on the understanding of underlying friction and corrosion mechanisms and modification approaches of material surfaces against friction and corrosion in order to guide the design and preparation of materials with high performance for practical applications.Friction and corrosion, which exist widely in engineering instruments, marine equipment, aerospace settings, medical equipment and other advanced manufacturing fields, are the key factors that cause surface damage to material surfaces  and the failure of equipment. According to incomplete statistics, they cause billions in economic losses every year. Therefore, the friction, corrosion and protection of materials are hotspots in scientific research ,2.Friction and corrosion are phenomena of surface\u2013interface interactions that are closely related to the environmental conditions in which materials and components are used. The design of materials and components should take into consideration the specific operating environment, so as to reduce the energy dissipation and component damage caused by surface corrosion and interfacial friction between interacting materials . The reaThe research interest of this Special Issue thus includes, but is not limited to, friction and corrosion behaviors of new materials, advanced protective materials, and advanced protective technologies. Moreover, the experimental and theoretical studies of the friction and corrosion mechanisms and advances in the friction, corrosion and protection of material surfaces are the central topics of this Special Issue."}
{"text": "Women are at risk for a wide range of depressive and anxiety disorders and particularly for mood disorders associated with their menstrual cycle, with seasonality, and during the menopausal transition.To review the presentation of depression, the importance of timely and effective treatment, and some of the research surrounding increased prevalence of depression in women, and the times and conditions such as the perimenopausal transition, pregnancy, postpartum period, and comorbidities of this increased risk in women.Dynamic interactions of both biological and environmental factors contribute to the development of major depression. These include, but are not limited to, predisposing genetic influences, gender, environmental stressors, poor social support, childhood sexual abuse, other psychiatric illness, and trauma. Timely and effective treatment of each episode of depression to remission is critically important. Barriers to instituting collaborative care of depressive illness are numerous. The lack of adequate collaborative care along with the consequent failure to adequately diagnose and treat depression reflects some of the deficiencies in the current organization and delivery of health services.The prevalence of depression, its psychosocial and medical consequences, and the worsening course of depression without treatment highlight the public health importance of early detection and improved strategies for the treatment of depression in modern health care settings."}
{"text": "Engineering materials encompass a wide spectrum of structural\u2013functional products that are commonly used in the transportation , construction, machinery, and tooling industries. The final shapes and performances of such products are determined by a sequence of primary and secondary manufacturing processes. In many cases, the performances are intimately linked with and depend on a complex self-balanced (elastic) residual stress state which may enhance or weaken the expected performances of the products in relation to the target application .The quality and performance of engineering products are normally assessed at the end of the manufacturing route via standard testing methods, which are generally of a destructive type . However, these methods are not capable of discerning between residual stresses and the intrinsic properties of a material. X-ray diffraction techniques are used, although not so frequently, to measure the residual stresses over the surface of engineered products at the microscopic scale .The employment of a quick, viable, non-destructive assessment method, which can be used not only at the end of the manufacturing process but also at all the critical steps of such a process, would introduce considerable benefits to industry in terms of improving the processes, quality, and reliability of the final products.The aim of this Special Issue is to show how the instrumented indentation test (IIT) can introduce unprecedented benefits to research and industry because of its quick, non-destructive, and low-cost features. Moreover, unlike the tensile test, only relatively small probing samples are required. The current state of the art is presented in a number of selected illustrative case studies. Further, the possible limits and shortcomings have also been reported. The following major benefits of ITT have been identified in the vast sector of engineering materials and their manufacturing: (a) the rapid setting up of the manufacturing process, (b) the identification of the critical manufacturing stages, such as the replacement of worn tools, (c) in-line process control through the monitoring of any relevant indentation properties at the desired depth of a product, (d) in-service structural health monitoring, (e) the determination of the tensile-like properties of a product , and (f) the possibility of detecting subsurface biaxial residual stress induced by the manufacturing process. The current ISO 14577 standard, Part 1 to Part 4 ,3,4, refIIT is already successfully utilized in the industrial sector of coatings, thin films, and MEMS at the nanoscale  for final quality assessments , althougA number of scientists, users, developers, engineers, and technical experts from the academic, industrial, and research areas have contributed to this first volume of the Special Issue on The Instrumented Indentation Test: An Aiding Tool for Materials Science and Industry. The present state of the art on the subject indicates that, in spite of promising experiences which encourage the transfer of IIT from the laboratory to industry ,17,18,19The article by Schiavi et al.  is speciThe comprehensive review by Montanari and Varone  offers nThe paper by Scales et al.  presentsResidual stresses are ubiquitous in most manufactured products and components. As compressive and/or tensile residual stresses typically induce pile-up and sink-in phenomena respectively during IIT, accurate prior test calibrations and ad hoc corrections are needed. At present, the influence of residual stresses on IIT properties is not fully understood . The papers by Akatsu et al.  and Lee The study by Lee et al. is instead based on an experimental approach. They used the macro-instrumented indentation test (MIIT) to assess the performance of three arc-welded T-joints made of HY-grade (30 mm thick plate) vessel steels. The necessary free-stress region in the samples was associated with the electro-discharge machined regions that were liberated after the dissection operations of the joint samples. They measured the residual stress profiles along the fusion line on the top and the bottom of the plate surfaces using a method based on force difference measurements. The achieved MIIT-based residual stress profiles were successfully validated against the X-ray diffraction-measured counterparts at an appreciable level of confidence. The mechanical characterization of dissimilar welded joints is a complex problem of industrial and scientific relevance. The accurate inspection of the complex inter-phase mixture region, which develops when welding the two dissimilar materials in contact, determines the actual mechanical strength and toughness of a joint. The work by Maizza et al.  presentsThe fundamental study by Pero et al.  on the nThe research by Cabibbo  was drivThe proposed calibration mainly focuses on the indenter geometry (area function) and machine compliance; three reference indenters and three reference materials were considered. The results shown in this work attest a reduced spread of the mean values of the determined indentation hardness, hence permitting a more accurate characterization to be made of individual microstructure features, such as twins in copper, carbides in 100Cr6 steel, pearlite globules, and ferrite grains in gray cast iron. nIIT plays an important role in expanding the science of elastoplastic materials in various forms , due to the possibility of using very small loads with a point indenter. The demand for the determination of a more accurate indentation modulus and contact area during nIIT led Huen et al.  to develThis Special Issue also received contributions that are devoted to material science research.The work by Ohmura and Wakeda  involvesFinally, the possibility of efficiently automating nIIT has enabled developers to enhance the speed of indentation data acquisition and storage to a very high level. This has encouraged researchers to develop more efficient numerical methods to manage and post-process such data. For instance, Kossman and Bigerelle  took advAll of the articles submitted to this Special Issue deal with the latest key advance in the use of IIT in industry and research and pave the way toward a successful transfer of IIT to the vast industry of engineering materials and inherent manufacturing. The contributions have touched on various aspects of IIT, from a pedagogical basis to nanoplasticity science in metallic materials, while presenting important case studies of industrial applications with useful hints for new IIT developments and valuable suggestions for the revision of existing international codes. Indeed, the provision of improved international IIT codes is paramount to accurately and unambiguously assess the final quality, integrity, and performance of the large spectrum of manufactured products and engineering materials in an non-destructive manner. As the number of industrial activities and sectors involved in such an assessment process has been forecast to be quite large, the relative impact on the improved materials, products, processes, and systems and, in turn on our lives, safety, economy, environment, science, and technological progress is expected to be enormous and of great importance."}
{"text": "The spatial structure of minerals is a fundamental factor in determining the morphology, physical properties, and genesis of minerals ,2,3,4. TIn recent years, research activity on the interaction mechanism and environmental effects at the surface interface between minerals and environmental substances has been increasing ,11. In cThermal and kinetic studies on the spatial structure of minerals are also of great interest to the scientific community. Under high-pressure  conditions, corresponding patterns of change and intrinsic relationships in the chemical composition, internal structure, and physicochemical properties of minerals can be observed ,14,15. TThis Special Issue reflects the diversity of spatial structure studies related to minerals. We will provide a brief overview of the contents of this Special Issue in the following paragraphs. We would like to make it clear, however, that the purpose of this Editorial is not to elaborate extensively on each article, but to encourage readers to explore them.Kang et al. (Contribution 1)  treated Luo et al. (Contribution 2)  observedShi et al. (Contribution 3)  carried The article by Hua et al. (Contribution 4)  describeZhao et al. (Contribution 5)  utilizedThis Special Issue introduces the latest research on the physical and chemical properties and modification mechanisms of pyrite tailings, the intrinsic structure and geological genesis of thermally metamorphosed coal-based graphite, the mechanical properties and spatial structure of geopolymer-modified clays, the characterization and utilization of the mineral phases of iron ore tailings, and the spatial structure and mechanical properties of Pisha sandstones under wet and dry cycling. This compilation of articles on the spatial structure of minerals covers a diverse range of research directions, reflected, for example, in the variety of research methods , the flexibility of combining macro- and micro-applications, and the range of media studied, such as rocks, industrial raw materials, and solid wastes. In addition, the results presented in this Special Issue can serve as a reference for scholars working in this research area. We invite such scholars to continue conducting further research on the topics discussed."}
{"text": "A model of recovery and recovery-oriented practice has been developed based on three previously published meta-syntheses of experiences and processes of mental health and substance use recovery. The model integrates the findings of these three meta-syntheses into three components: experiences of recovery, processes of recovery-oriented practice, and social and material capital. The experiences of recovery involve being, doing, and accessing and are viewed as embedded in the processes of recovery. The processes of recovery-oriented practice aim to mobilize and apply various forms of capital to support the recovery journey. Social and material capital, in turn, constitute the context in which recovery occurs and requires mobilization for the individual and the service system. The model is grounded in the principles of well-being, person-centeredness, embedding, self-determination, and the interdependency of human living. The model is both descriptive and explanatory, as it depicts the experiential and processual aspects of recovery and recovery-oriented practice and their interrelationships. The model as a framework needs to be elaborated further through application in practice and research, especially for understanding how experiences, processes and practices interact over time, and how they are affected by access to material and social capital. In enhancing knowledge of mental health and substance use recovery and recovery-oriented services, the participation of individuals with lived experience is crucial. The World Health Organization (2022)  states tThis paper presents an experience-based model of recovery and recovery-oriented practice developed by integrating the findings from three meta-syntheses ,3,4. TheAlthough there are still controversial views regarding the concept of recovery and its application in the context of mental health and substance use (MHSU) care, specifically in terms of the dichotomies of clinical versus personal and process versus outcome, the definition of recovery in the MHSU context advanced by SAMHSA is generally accepted. It states that \u201crecovery is a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential\u201d  (p. 3). Recovery-oriented practice in MHSU care encompasses person-centered processes such as acceptance and insight, autonomy and control as the basis for the recovery process of self-actualization, transformation from a negative to a positive sense of self, and provider-oriented processes of support and resource mobilization to help people to pursue their subjective recovery processes and handle difficulties that may occur. During recent decades, many versions of recovery-oriented practice models have been developed and applied in clinical practice. Several systematic reviews focus on the nature and characteristics of recovery-oriented practice, beginning with the study by Le Boutillier and colleagues 2011) [ [11] witThe key principles and philosophies underlying various models of recovery-oriented practice include an emphasis on processes that foster (a) living a good life through promoting wellbeing, (b) an orientation towards the primacy of the person in determining priorities and aspirations, and (c) maintaining citizenship and social inclusion. For example, Slade  proposedIn embracing the prevailing ideas in the literature on recovery and recovery-oriented practice and integrating our orientation toward lived experience, we identified three general philosophical/conceptual ideas as the basis for an elaboration of our model of recovery and recovery-oriented practice. These include the principles of wellbeing, the principles of person-centeredness and self-determination, and the general orientation of human life as interdependent and social. Wellbeing has become a central focus of international health care policy, suggesting the need for a shift from a traditional deficit focus in mental health care to a focus on possibilities and the necessary conditions for living well . This foThe concept of wellbeing has also been extended in positive psychology, which focuses on factors that enable human flourishing at individual, community, and societal levels. Seligman  specifieThe notions of person-centeredness and self-determination have emerged strongly in the health care field in recent decades as a perspective in which the worthiness of individuals as autonomous, unique human beings is upheld as the foundation for a meaningful and fulfilling life. These notions are, therefore, viewed as the basis for wellbeing and health, and are founded upon the concept of personhood, which upholds the essential features of being human in terms of dignity, autonomy, and human singularity . Person-Beginning with the thoughts of the classical philosophers, the essential features of human life have been examined in relation to the social component, where politics was the major aspect in Plato and Aristotle. Sociologists in modern times, starting with Weber, Durkheim and Marx and continuing to the post-modernists of recent decades, have pointed out various systematic ways in which social systems and social factors determine and constrain human experiences and actions. In a fundamental way, human living is played out in social contexts in which other people and social institutions both promote and confine the ways in which life is lived. In our work, the work of Bourdieu on human practice and social capital provides a foundation to consider how social aspects of human life influence everyday living, i.e., human practice. In his conceptualization of human practice, Bourdieu posits the role of capital in various forms, including economic, cultural, social, and symbolic capital, as resources that yield power playing out in human practice . To BourThis model has been developed by integrating and consolidating the results of three meta-syntheses by this research team of the empirical publications published during the past 25 years. The major themes reported are presented in The five major themes describing recovery experiences are viewed as specifying recovery as the dynamics between the self and others and as the dynamics between the self and material contexts (one\u2019s environment) . RecoverFrom our perspective, the experiences of recovery are grounded in the recovery processes extracted in the second meta-synthesis. Three major themes extracted here  are then structured into three meta-concepts of being, doing, and accessing . RecoverWhile the concepts specified for the experiences and processes of recovery refer to the phenomena in persons in recovery, the major themes identified in our third meta-synthesis express the aspects of recovery-oriented practice considered as vital characteristics of such practice . These tThe model of recovery and recovery-oriented practice emerges from these three sets of recovery-related experiences as dynamically integrated, interrelated, and coalescing, because the locus of recovery-oriented practice is in the experiences of recovery coexisting with the processes of recovery. This is depicted in By integrating the results of our research, the model is founded in the philosophy of wellbeing and the good life as a human right, the principles of person-centeredness and self-determination as an ideal mode of living, and the philosophy of the interdependence of human living as the essential feature of the lives of humans as social and ecological beings. The concept of recovery is oriented towards the idea that one must strive to live as well as possible and must have access to and use of resources. This means that a person with MHSU problems may need relational and material/environmental support. Therefore, recovery-oriented MHSU services are viewed as supporting, facilitating, and coordinating the efforts of persons with MHSU problems in their recovery journey. The model as depicted in The model is constructed with the conceptual categories as the major components, rather than making direct use of the themes found in the meta-syntheses. This was to enable a high level of conceptualization derived from using the major themes as experientially critical categories. This is primarily a descriptive model that provides a comprehensive picture of various experiential phenomena that exist in persons in recovery in the context of recovery-oriented practice. The experiences of recovery are viewed as inherently embedded within the processes of recovery involved in the recovery journey, while recovery-oriented practice influences and interacts with the person\u2019s experiences and processes of recovery. These three components of experiences are interconnected in MHSU service provision at any given time and in long-term contact with services. A person begins a recovery journey with the realization of the MHSU problem and has experiences that reflect the dynamics of the self in relationships with others and with the environment through the ongoing processes of being, doing, and accessing. When the person receives MHSU services, he/she gains help, support, and coordination in a collaborative framework for accessing, mobilizing, coordinating, and using various forms of capital, through relationships with professional care providers. In an ideal situation, such practice processes will be tailored to individuals\u2019 specific needs and desires. Since the themes found in the meta-syntheses are experiential, they can be used as illustrative components in understanding and describing experiences of recovery and recovery-oriented practice. Furthermore, the model may also be used to illustrate and explore how experiences, processes and practices are interrelated and interdependent. It is also possible to use this model in an explanatory fashion, by examining individuals\u2019 recovery experiences in relation to the co-existing recovery processes and the use of MHSU care practices. Since it is an experientially based model, it is critical to examine how experiences in various dimensions exist for persons in recovery and in relation to practice processes either at a given time or over a longer period.The descriptive and explanatory model developed in this paper, based on our three previous meta-syntheses that compiled experiential knowledge from an extensive number of studies on recovery experiences, recovery processes and recovery-oriented services, demonstrates the complex and comprehensive nature of recovery. Personal experiences and processes are entangled with material issues, and, to enable recovery, having or developing access to a variety of resources is key. The model can be considered a useful tool in enhancing knowledge and understanding of how recovery at a personal level is entangled with relational and material issues, and how relational and material resources are also important at the level of service provision. Being sensitive to how social determinants affect possibilities for recovery is decisive in developing working relationships and adequate services. The model may be used to enhance understanding at an individual-oriented level, at a relational level and at a more structural level, and how these levels interact and mutually affect each other. Thus, the model unfolds recovery as multifaceted and complex, extending beyond the often referred to and criticized understandings of recovery as individual journeys ,19,34. According to the WHO , recoverWhile what is referred to as recovery capital involves a myriad of resources, Best and Laudet  argue thInternational human rights provide an important framework, obliging countries to respect, protect and fulfil fundamental rights and freedoms for all people, including the rights of people with mental health conditions and psychosocial disabilities. A rights-based approach to mental health involves a paradigm shift in what counts as knowledge, and hence also a shift in power balances, which aligns well with an understanding of recovery as also involving a paradigm shift . The UN Mahdanian et al.  suggest"}
{"text": "Previous anatomical studies of the urogenital fascia (UGF) have focused on males, and there is a lack of relevant anatomical studies on the distribution of the extraperitoneal UGF in females.In this investigation, guided by the embryonic development of the female urogenital system, the ventral pelvic fascia structure of 10 female cadavers was dissected, and the distribution and morphology of female extraperitoneal UGF were observed, recorded in text, photographs and video, and 3D modeling was performed.We find that in the female extraperitoneal space there is a migratory fascial structure, the UGF, which surrounds the urogenital system and extends from the perinephric region to the pelvis along with the development of the urogenital organs. The two layers of the UGF are composed of loose connective tissue rich in fat that surrounds the urogenital organs, their accessory vascular structures, and the nerves of the abdominopelvic cavity. In the pelvis, it participates in the formation of the ligamentous structures around the rectum and uterus. Finally, it surrounds the bladder and gradually moves into the loose connective tissue of the medial umbilical fold.Sorting out the distribution characteristics of UGF has some reference value for studying the metastasis of gynecological tumors, the biomechanical structure of the female pelvis, and the surgical methods of gynecology, colorectal surgery, and hernia surgery.The online version contains supplementary material available at 10.1186/s12893-023-02239-5. The combination of embryology, anatomy, and surgery has helped surgeons identify anatomical problems, analyze anatomical structures, and innovate surgical methods. With the widespread development of minimally invasive surgery and pursuit of safe and efficient operation plans, surgical membrane anatomy has made great progress. Surgeons from different specialties, such as colorectal surgery, obstetrics and gynecology, and urology, mark and name the fascial structures based on the characteristics of their respective specialties by separating their respective surgical areas, and this naming based on surgical practice lacks standardization and uniformity \u20133. This Ten formalin-treated female cadavers provided by the Department of Human Anatomy and Histoembryology, Health Science Center, Xi\u2019an Jiaotong University were dissected using a set of dissection equipment and a camera. The cadavers used in this study had intact retroperitoneal and pelvic cavities, the type of study was anatomical and surgical, and the cadavers were exposed only to formalin solution and no other fluids during the entire study. There was no pathological evaluation of cadaveric specimens in this investigation, and the entire study was conducted by two professors of human anatomy, two professors of general surgery, one professor of obstetrics and gynecology, and three postgraduate students, who were systematically trained and qualified for anatomical studies. The entire study was conducted in strict accordance with the protocol approved by the Biomedical Ethics Committee of Xi\u2019an Jiaotong University (Ethics License No. 2014\u2009\u2212\u20090303). For educational and scientific research purposes, written informed consent was obtained from the immediate family members of the deceased. The format of the informed consent form followed the guidelines of the China Organ Donation Management Center. The methods of this study follow the CACTUS guidelines, which provide guidance for anatomical studies and contribute to the quality of research methods .The peritoneum was incised longitudinally at the bilateral paracolic gutters, the colon was lifted to expose the retroperitoneal space, and the perirenal fascia was carefully dissected to observe its continuation into the pelvis. The specimen was dissected with a saw along the highest point of the iliac crest and the sagittal plane of the pelvis, respectively, and the UGF, internal iliac artery, pelvic splanchnic nerves, and pelvic plexus were carefully dissected, and the rectum, uterus, broad ligament, round ligament of uterus, upper vagina, fascial structures around the bladder, and preperitoneal fascia were dissected. The peritoneum of the hemipelvic specimen was completely and carefully peeled off, fully exposing the underlying UGF. Finally, the aforementioned fascial structures and the organs, blood vessels, and nerves within them were dissected from the cadaveric specimen along with the iliac blood vessels and flattened, taking care to preserve their integrity. Finally, their morphology was observed and documented through text, photographs, 3D modeling, and video.Our research has shown that outside of the peritoneum there is an intact migratory fascial structure that surrounds the urogenital system known as the UGF. The fascia extends anteriorly and posteriorly around and into the female pelvis with the development of the genitourinary organs. The two layers of the UGF are loose connective tissue rich in fat that surrounds the kidneys, ureters, fallopian tubes, ovaries, hypogastric nerves, uterus, bladder, and their accessory vascular structures. The side near the center of the body is called the visceral layer, and the other side is called the mural layer. At the upper pole of the kidney, the visceral and mural layers of the UGF surround the kidney, and they originate from the intermediate mesoderm like the kidney, and we can consider the anterior and posterior renal fascia as the starting segments of the visceral and mural layers of the UGF. In the midline, the visceral and mural layers of the UGF fuse in front of the aorta and inferior vena cava. Laterally, the UGF surrounds the ovarian vessels and is externally bordered by the laterocostal fascia. At the inferior pole of the kidney, the UGF continues to expand and encompasses the genitourinary vessels, ureters, and submental nerves as it migrates toward the pelvis Fig.\u00a0. Its vis.Embryology helps us to understand the continuity of membrane anatomy. The theories of mesenteric anatomy, fascial anatomy, and membrane anatomy reveal the structure and function of membranes from different perspectives , 15. FasHow the UGF migrates from the retroperitoneum to the pelvis can be understood from the embryonic development of the female genitourinary system. At 4\u20135 weeks of embryonic development, the mesonephric ducts formed from the intermediate mesoderm extend caudally into the cloaca. Immediately thereafter, the ureteric buds emerge from the end of the mesonephric duct and return to the intermediate mesoderm to induce differentiation into the kidney , 20. ThiThe fascial structures surrounding the uterus and the four pairs of ligaments in the parietal uterus play an important role in maintaining the position of the uterus , 23. GeoMalignant solid tumors are confined to regions of tissue of the same embryologic origin for a considerable period of time. The boundaries between tissues of different embryologic origins are boundaries for tumors that limit their spread and prevent them from invading adjacent tissues of different embryologic origins. From the point of view of the histo-embryological development of the organ, the key to complete resection of the organ is the precise dissection of the fascial gap between adjacent organs. Total mesometrial resection (TMMR) is a new embryology-based surgical technique for cervical cancer that removes tissue of M\u00fcllerian duct origin, removes tissue structures of the same origin in terms of embryonic developmental origins, achieves a very high degree of radicality, preserves the pelvic visceral nerve compared to conventional hysterectomy, and thus reduces the incidence of postoperative complications . HoweverThe limitations of this investigation are 1. the cadavers were performed on formalin-fixed cadavers, not fresh cadavers, and the findings can be affected by post-mortem degenerative changes.2. because of the limitations of the autopsy technique, it was not possible to remove the entire portion of the UGF in the retroperitoneal, pelvic, and the anterior preperitoneal space from the cadaver intact.3. lack of histologic validation. These deficiencies will be improved in future anatomical studies.As in males, the UGF in the extraperitoneal space in females migrates from the perirenal space to the pelvis as the genitourinary organs develop, forming a continuous, integral, and complete fascial structure around them that supports, protects, and nourishes the organs of the genitourinary system. Sorting out its distribution characteristics has some reference value for exploring the metastasis of gynecological tumors, the biomechanical structure of the female pelvis, and the surgical methods of gynecology, colorectal surgery, and hernia surgery.Below is the link to the electronic supplementary material.Supplementary Material 1"}
{"text": "Frontal ataxia, originally described by Bruns, is characterized by the presence of signs of frontal lobe dysfunction, such as perseveration, paratonia, frontal release signs, cognitive changes, and urinary difficulty, associated with imbalance, slow gait, broad-based, the presence of postural instability and falls, retropulsion, and bradykinesia in the lower limbs. The goal of the present study is to recall the historical aspects of this condition, to draw attention to the importance of this clinical finding for the differential diagnosis of ataxias and to review the main semiological differences between primary ataxias ."}
{"text": "National Neurology Forum (NNF), held on April 21-22, 2023, at the Palace of Parliament in Romania, served as a platform for exchanging ideas and presenting advancements in the field of neurology  as its central focus. Announced by Health Minister Prof. Dr. Alexandru Rafila in the autumn of 2022 and developed under the aegis of the Romanian authorities, the SNBCC is an initiative aligned with the 2023-2030 National Health Strategy and European level initiatives such as the Stroke Action Plan for Europe (SAP-E). Cardiovascular and cerebrovascular diseases are the leading cause of mortality and morbidity in the Romanian population, having a significant economic burden on the healthcare system. The SNBCC aims to implement a systematic reform plan for the management of healthcare practices at the national level to ultimately improve population health. The strategy will help policymakers to improve care for the Romanian population by implementing a comprehensive reform plan in the field of cardiovascular and cerebrovascular diseases, based on a detailed assessment of their impact on the Romanian population, which will inform initiatives focusing on prevention, investments in medical staff training, infrastructure, increasing access to neurorehabilitation, and consolidating the national network for acute stroke care.EFNR President), Prof. Dr. Cristina Tiu (President of the Romanian Neurology Society), and Prof. Dr. Bogdan O. Popescu (Vice Rector at the University of Medicine and Pharmacy Carol Davila Bucharest). Supported by the Foundation of the Society for the Study of Neuroprotection and Neuroplasticity (SSNN), the Ministry of Health, the Romanian Society of Neurology (SNR), Carol Davila University of Medicine and Pharmacy, Iuliu Hatieganu University of Medicine and Pharmacy, and George Emil Palade University of Medicine, Pharmacy, Science and Technology, the event featured an array of topics, such as neurology, neurosurgery, cardiology, diabetes and nutritional diseases, and physical and rehabilitation medicine. Officials from public authorities, universities of medicine and pharmacy, and national and international professional societies were present at the scientific proceedings.The forum was chaired by Prof. Dr. Dafin Muresanu  panel showcased perspectives on at-home care, the personal, clinical, and economic impact of the disease, and the objective evaluation regarding the burden of advanced PD. The session also highlighted patient and caregiver perspectives on the neurological degenerative condition and encompassed different approaches to the early identification of at-risk patients, improved access to care, and expanded education and medical and psychosocial care. Neurorehabilitation, as an integral part of PD patient care, was also discussed in terms of adequate neurological rehabilitation with multidisciplinary teams, the current state of medical infrastructure, and solutions to expand patient access to high-quality care.Intersectoral Global Action Plan (IGAP) on epilepsy and other neurological disorders and the Brain Health Strategy (EAN) to reduce the burden of neurological diseases and improve the quality of life for patients worldwide.The epilepsy panel approached the importance of prioritizing this disease within national action plans, highlighting the relevance of awareness campaigns and specialized services and emphasizing the scientific significance of recent progress in epilepsy research and innovation. Additionally, the panel provided perspectives on developing a national registry for epilepsy and pediatric neurological diseases and improving medical access in Romania's rural communities. The session aimed to promote the objectives of the The next panel centered around cognitive impairment and dementia, showcasing the importance of early identification and the emotional and social impact on patients and their families. Participants discussed emerging trends and progress in diagnosing and managing cognitive impairment, including innovative therapies and non-pharmacological interventions. The session highlighted the importance and benefits of multidisciplinary collaboration and partnerships among healthcare professionals, patients, and authorities to develop personalized strategies to improve patients' quality of life. Overall, the unique challenges of cognitive impairment and the need for innovative care strategies represented the central theme.The multiple sclerosis panel discussed the burden of the disease and its impact on the patient's quality of life, emphasizing the role of integrative approaches in managing the symptoms and the impact of early identification, monitoring, and access to personalized therapies. The debates tackled the perspective of healthcare actors and stakeholders and were directed toward identifying the main challenges and solutions for raising patient care standards through collaborative efforts among patients, professionals, and healthcare authorities.Focused discussions on peripheral neurological diseases followed, centered around the interdisciplinary approaches in the diagnosis and management of several disorders including Spinal Muscular Atrophy (SMA), Amyotrophic lateral sclerosis (ALS), progressive muscular dystrophy, Pompe disease, or amyloid neuropathy.The experts discussed the importance of early diagnosis and treatment in neuro-oncological affections, pinpointing the need for comprehensive multidisciplinary approaches from the perspective of oncology, radiotherapy, neurosurgery, psycho-oncology, and palliative care. The use of minimally invasive and modern neurosurgery techniques was debated, as well as the importance of comprehensive evaluation in cerebral metastasis, immunohistochemistry, and pathologic diagnosis. Lastly, the session addressed the determination of tumoral mutations and the use of NGS technology, as well as off-label therapies, clinical studies, and genetic counseling.The headache and migraine panel brought forward recent innovations in diagnosis and treatment and explored the international classification of headaches and migraines and their impact on patients\u2019 lives. The session aimed to identify the most efficient solutions for patients\u2019 treatment by offering a comprehensive approach to all the perspectives outlined.The Romanian healthcare system stands to benefit from integrative approaches, better access to medical care, and increased awareness and education regarding cardiovascular and cerebrovascular diseases. The future of neurology and general healthcare should be built upon the collaborative action of all actors involved and center around improving resource allocation, patient care, and medical personnel training. Considering the current disparities in access to care for the population, broadly accessible approaches are direly needed.To support and encourage reformative actions of the Romanian Healthcare System, the second edition of the National Neurology Forum will be organized next year, on 18-19 April 2024 . The fol"}
{"text": "Journal of Appalachian Health is committed to reviewing published media that relates to contemporary concepts affecting the health of Appalachia. This is a review of the text Appalachian Health: Culture, Challenges, and Capacity. This book is an ideal starting point for anyone interested in Appalachian history, public health, and health disparities research.The  Scutchfield FD, Wykoff RW, editors. Appalachian health: culture, challenges, and capacity. Lexington KY: University Press of Kentucky, 2022. ISBN-13: 978-0813155576; Cost: $40.50 e-Edition; $45.00 Hardcover.Danielle M. Davidov, PhD, is an associate professor in the Schools of Public Health and Medicine at West Virginia University. Her research employs qualitative and mixed methods to develop and evaluate complex interventions to address trauma and violence in community-based, academic, and clinical settings. Much of her work has focused on the intersection of trauma, substance abuse, and mental health among Appalachian populations. She has received grant funding from the National Institute of Minority Health and Health Disparities, Canadian Institutes of Health Research, and Patient-Centered Outcomes Research Institute to explore and address issues related to intimate partner violence and child maltreatment in Appalachia. She conducts research, teaching, service, and engagement activities that aim to enhance the health and well-being of women and underserved groups in her home state of West Virginia. Within the School of Public Health, she mentors undergraduate, master\u2019s-level, and doctoral students and teaches courses related to intervention design, qualitative methods, social determinants of health, and public health prevention.This book is comprised of 11 chapters written by scholars and researchers from public health disciplines  as well as experts in the field of Appalachian studies. Many of the authors are natives of Appalachia and currently live and work within the region.Editors include F. Douglas Scutchfield, MD, and Dr. Randy Wykoff, MD, MPH, TM. Dr. Scutchfield, a renowned public health expert and leader in the field of Appalachian health, passed away in May 2022. Dr. Scutchfield held appointments in the Honors College, College of Medicine, and College of Public Health at the University of Kentucky (UK). He founded the College of Community Health Science at the University of Alabama and the Graduate School of Public Health at San Diego State University. He additionally founded the School (now College) of Public Health at UK. In addition to extensive editing and publishing experience in the field of public health, he served as the founder and previous editor-in-chief of this journal.Journal of Appalachian Health and co-editor of the book under review. He is Founding Dean of the College of Public Health and Director of the Center for Rural Health Research, both at East Tennessee State University. He is board certified in Pediatrics and Preventive Medicine, with an additional certification in Tropical Medicine. Previously, he served as Senior Vice President for International Operations at Project HOPE, as the Deputy Assistant Secretary for Health  in the U.S. Department of Health and Human Services, and for 11 years with the Food and Drug Administration.Dr. Randy Wykoff is the current editor-in-chief of the Aunique region with a complicated social, political, and economic history, Appalachia often enters the public discourse as a place bound by geography and culture that is subjected to stereotypes and fraught with health challenges. Appalachia has long been mistaken as an area of abject poverty begging for outside intervention. Still, the region faces significant socioeconomic and health disparities that threaten the health and well-being of current and future generations. A critical first step in reducing these disparities is to document them, examine their causes, and propose evidence-based, multilevel solutions.This text uses a socio-ecological approach to provide an in-depth examination of the complex history and current reality of health in the U.S. Appalachian Region. It takes the reader on a fascinating journey that illustrates how the mountainous region, with one of the nation\u2019s strongest economies prior to the Civil War, and an abundance of natural resources, became home to some of the most distressed and disadvantaged places in the country within just over a century. The authors do an impressive job of describing the region and its inhabitants not as a monolith, but in a way that highlights challenges as well as bright spots using historical insights into the causes and context surrounding Appalachian health.This book is an ideal starting point for anyone interested in Appalachian history, public health, and health disparities research. More established scholars  and their students who focus on Appalachian health will appreciate the myriad comparisons between Appalachian and non-Appalachian counties on a variety of health indicators. Additionally, the inclusion of data demonstrating the geographic variation in health and economic status within Appalachian subregions can help planners, politicians, and researchers focus energy and resources on places most in need. Epidemiological data provided throughout the text reveal that even where improvements in Appalachian health and socioeconomic status have been made, this progress has happened at a much slower pace than in the rest of the U.S.To explain and provide context for these disparities, the authors expertly weave together consequential stories of the region\u2019s rich and complicated history, including hardships like environmental exploitation and mining disasters, as well as powerful success stories, such as the formation of the Frontier Nursing Service and Appalachian Regional Healthcare System. Importantly, this text emphasizes the complex interplay of place, identity, and cultural context, while underscoring the substantial power and influence that structural and political forces have had on Appalachia. Taken together, the chapters of this book provide \u201ca cautionary tale but inspiring fable\u201d of a region of paradox and tremendous promise. Alongside the epidemiological data are stories about local communities and champion changemakers that give us hope for the future with inspiration from the past.This book contains numerous tables, graphs, and figures illustrating comparisons of sociodemographic and health indicators between non-Appalachian counties, Appalachian counties, and in many cases between subregions of Appalachia . There are also tables showing Appalachian and non-Appalachian metrics of healthcare utilization and access as well as data on trends over time for numerous variables and indicators. Included maps show county-level health disparities and indicators throughout the Appalachian Region. To top these resources off, there are extensive endnotes and references at the end of every chapter.This book is an in-depth, nuanced exploration of health in Appalachia, with focus on disparities and health indicators described within relevant geographical, historical, socio-cultural, and structural contexts. While the reader is left with the stark reality that Appalachians unquestionably suffer poorer health and quality of life compared to their non-Appalachian counterparts, we are also reminded of the preventable, reversible, and thus changeable nature of many of the outlined health indicators. It provides us with reassurance that while we have a long way to go to make meaningful improvements in Appalachian health, with solution-oriented, structural, and environmental approaches, the issues are surmountable.Finally, the authors leave us with a charge: Appalachian problems are the world\u2019s problems. If we can learn from the complex lived experiences of Appalachian people to find equitable solutions to their health challenges, those same solutions can be applied globally and locally to improve health."}
{"text": "First, a scoping review was carried out to elaborate the content. In the second step, the content was validated with 46 nurse judges selected for convenience. The minimum criterion of agreement among judges was 80%. The third step consisted of content organization and layout.the guide content was elaborated from the Federal Nursing Council legislation, scientific articles and textbooks. Content was considered appropriate, relevant and organized by judges.the digital guide is an alternative that can contribute to the NP execution and implementation, supporting the planning and implementation of actions for quality of care. Moreover, the published literature on SNC brings a diversity of concepts, generating ideological conflicts in the understanding of nursing practice, in the teaching of nursing theories, the nursing process and care methods-3.The terms Systematization of Nursing Care (SNC) and Nursing Process (NP) are still treated as synonyms in several Brazilian publications, which contributes to the lack of consensus on these two fundamental concepts for nursing practice, with direct repercussions on the formation of professional identityConselho Federal de Enfermagem) Resolution 358/2009 points out that the SNC seems to be a broader concept and different from the NP. This resolution states that SNC \u201corganizes professional work in terms of method, staff and instruments, making the operationalization of the NP possible\u201d and defines NP as \u201ca methodological instrument that guides professional nursing care and the documentation of professional practice\u201d.On the other hand, the Federal Nursing Council .This research was carried out between 2020 and 2021, which followed three steps: 1) guide theoretical content elaboration; 2) content validity; and 3) guide layout. was carried out. Thus, the authors selected as questions for the review: what is SNC? What is NP? What strategies can be used to implement the NP?For content elaboration, a scoping reviewWe included scientific articles , textbooks and legislation on SNC and NP, nursing staff sizing, nursing theories, concepts and application of NP, nursing instruments and records, without restriction of modality or methodology, published from 2002 to 2021. The initial time frame of 2002 coincides with the publication of regulations that provided, for the first time, in Brazil, on the mandatory implementation and documentation of SNC: COFEn Resolution 272/2002.Base de Dados de Enfermagem (BDENF); Spanish Bibliographic Index of Health Sciences (IBECS); Medical Literature Analysis and Retrieval System Online (MEDLINE); Cumulative Index to Nursing and Allied (CINAHL); CAPES portal for theses and dissertations; and Cochrane and Scientific Electronic Library Online (SciELO). For electronic search, the tools of the aforementioned databases, libraries and portals were used. A search was also carried out through Google Scholar for material referring to gray literature.The sources consulted were the professional regulation websites, Federal and Regional Councils of Nursing in Brazil and Brazilian states, in addition to bibliographic databases: Latin American and Caribbean Literature in Health Sciences (LILACS); The selected Health Science Descriptors (DeCS) related to NP applicability, concept and teaching were: Nursing Process; Nursing Legislation; Nursing Education, Standardized Nursing Terminology; Nursing Theory; Nursing Diagnosis; Continuing Education, Nursing Records. For search strategy, the Boolean terms AND, OR and NOT were used to compose the search keys to be used for searches in the databases. To complement the search for attributes in the literature, the bibliographic references cited in the selected publications were also used.Two authors performed a critical reading of the publications, selected to identify and characterize distinctions between the concepts of SNC and NP, identify NP elements that can support its application in nursing practice and verify operational elements of NP and SNC essential to its implementation. This reading included judgment on argument consistency and content reliability of the publications, which were considered, for producing the guide, in line with the regulatory directives contained in COFEn Resolution 358/2009.Based on the scoping review, a pilot material was organized that was assessed and corrected by four nurses with expertise in NP. After adjustments, we proceed to the second step.In the second step for content validity, 147 nurses from care, management and teaching areas were selected for convenience. After nurse selection, an invitation letter was sent by e-mail with information about the objective, procedures and instruments to be completed.\u00ae, with a two-section instrument: 1) judge characterization; 2) preliminary version of the guide, still without final layout, for validity of the following items: ability to express the content; organization (order) of content; relevance to the theme; language adequacy; adequacy and clarification of images; organization, sequence and structure.Data collection was performed using Google Forms.The authors established as an adequacy criterion the achievement of at least 80% agreement between the judges, and situations where the agreement index was lower than 80% would be reformulated, following the suggestionsFor the diagramming step, a team of designers was hired, who worked together with the researchers.Based on literature search, the guide content on SNC and NP was prepared in accordance with COFEN legislation provisions on NP. Thus, 47 scientific articles were gathered in the databases, in addition to 24 textbooks on SNC and NP, staff sizing, nursing theories and classifications, concepts and application of NP, instruments for data collection and care documentation.\u00ae); NANDA International (NANDA-I); Nursing Outcomes Classification (NOC); and Nursing Interventions Classification (NIC); and the third addresses strategies for implementing the NP. In addition to the textual content, 32 illustrations were prepared, which seek to exemplify, reinforce and self-explain the pertinent content.The digital guide has 45 pages, being composed of three parts: Defining concepts; The Nursing Process; and Strategies for implementing the Nursing Process. The first part covers the topics: What SNC is; Classification methodology; Staff sizing and development; and instruments. The second deals with NP aspects: process steps, registration, use of classifications: International Classification for Nursing Practice  nurses from various states of Brazil, most of them from the South and the Southeast, with ages ranging from 27 (twenty-seven) to 69 (sixty-nine years old). Length of professional training varied between 1 (one) and 47 (forty-seven) years. Regarding the degree, 41.3% had a master\u2019s degree, 45.7% a specialization and 13% a doctoral degree.In the digital guide content validity, in relation to the ability to express the content, experts\u2019 agreement was 94.6%; in item content organization (order), it was 94.4%; in theme relevance, it was 94.6%; in language adequacy, it was 97.2%; in image adequacy and clarification, it was 93.8%; and in organization, sequence and structure, it was 95.8%. The overall agreement index was 95.06%.In the diagramming step, the written content and figures were reorganized on presentation pages and configured in the format of a digital guide so that it would also meet the needs of those who want to print the material.The cover and all header and footer layout were prepared by a designer. The insertion of content on the pages resorted to the use of tables that highlight some excerpts that summarize the central ideas of the topics covered. The figures were carefully arranged, highlighting their importance and function of composing the content. The screens were assessed and reformulated by the authors together with the diagrammer.Before starting the didactic content, the guide brings a brief presentation and summary, in which the reader can learn about the content covered and guide their search for a specific topic, as shown in In the first part, the guide presents the distinction between SNC and NP, highlighting the differentiating attributes of the concepts, since understanding the difference between them is an important knowledge for the nursing team, as it is not yet the domain of the entire professional category .Part 2 of the guide is entirely dedicated to the NP, addressing the constitutive definition of concept and emphasizing its operational steps. To facilitate understanding, in addition to the definition of each step, figures were also used that represent these dynamics and relationship of the steps, which do not occur in a linear way, but follow a whole reasoning that favors their effectiveness. The legal aspect and the importance of systematizing the nursing consultation were also addressed, bringing its main characteristics clearly and succinctly. The guide exemplifies and presents some of the most well-known and used nursing theories in Brazil .The guide deals with the importance and legal aspects of nursing records, presenting the conceptual distinction between notes and nursing evolution as well as the mandatory elements for registration. The guide then discusses the standardized nursing language systems used in each NP, addressing the structure and way of applying the NANDA-I, NOC, NIC and ICNP\u00ae classifications.Part 3 of the guide brings two reports on the experiences of hospitals in the SNC and NP implementation, showing some of the strategies and resources available, and then the references used are presented, as shown in .In the first part, the guide presents the distinction between SNC and NP, and it is common to find in practice and in publications that treat NP, care methodology and SNC as synonyms or with different definitions. There is a conceptual conflict that generates difficulty in understanding the professional practice of nursing.The correspondence of meanings attributed to SNC and NP contributes to the lack of consensus on the concept of these two fundamental components for nursing practice, and this has direct repercussions on the formation of professional identity.The second part of the guide addresses NP. The NP implementation showed that nurses recognize the importance of the scientific method to achieve a systematic and deliberate practice, although in practice they still maintain attitudes focused on care focused on the management of signs and symptoms of diseases, to the detriment of the real needs demonstrated by patients-7,15.Among the main difficulties in complying with what is recommended in the legislation in relation to NP, the lack of theoretical knowledge, practical exercise and resources, as well as the scarcity of time for its performance, stand out. Nurses\u2019 actions often make doing routine, without sufficient scientific support.The legal aspect and the importance of Nursing Consultation, at the outpatient level, were also addressed. Nursing consultation should be used as a technology for differentiated care and provided with scientific knowledge that provides understanding and reflection on their health work. It is important that nurses know the nursing theories, because their use supports nurses in defining their roles, adequacy and quality of professional performance. The guide exemplifies the theme by presenting some of the most known and used theories.NP and nursing consultation should be guided by a theoretical support-19.The theoretical support chosen guides data collection, diagnosis definition, action planning and assessment of the results achieved, influencing aspects of nursing record. Practice guided by nursing theory helps to improve quality of care as it allows nurses to articulate what they do for patients and why. Therefore, they should continue guiding their practice through the lens of nursing theory, in addition to assessing the effectiveness of this practice guided by it.When performed based on theoretical support and with the use of standardized language, nursing records favor a more effective communication between the health team allowing a continuity of patient care. However, incompleteness is still observed in clinical records compromising quality of care and patient safety,22-23. On the other hand, the quality of nursing records arouses the interest and need in other professionals to consult them, allowing a better definition of therapy, care and diagnosis, in addition to serving as a basis for assessment and efficiency of quality of care practices.The guide addresses nursing classifications and records. Standardized language systems are important tools for NP registration, as they qualify documentation and communication between professionals,8,25.The third part presents the report of two hospitals in the implementation of SNC and NP, showing strategies and resources. The NP implementation favors the strengthening and recognition of nursing through standardization of actions and their records-28.The digital guide is an educational technology that contributes to the NP execution and implementation in the different scenarios of nursing practice, enabling quick, simple, direct and qualified access to these tools in a more complete way. Technology can be understood with different meanings, such as technical, scientific knowledge, procedures, processes, products, materials and organizational, educational, information and support systems-34.Nursing technologies are being incorporated into the clinical learning environment as a way of dynamizing the teaching-learning process or in the care and management context, for the NP execution and documentation in order to optimize access to information, records and documentation or to assist decision-making regarding patient care. Technologies also help in the implementation of appropriate practices in the services, organize the work processes, support the execution of health procedures, and update team knowledge-32. In this regard, different methods can guide the process of elaboration, validity and application of technologies in teaching, care and management, and the method used in this research has the potential of reproducibility for developing other materials.The literature is extensive about the development of technologies in nursing. Researches point to the use of qualitative and quantitative approach methodologies, methodological, descriptive, applied technological development, quasi-experimental, cross-sectional, Convergent Care Research, participatory research, action research, integrative or systematic review, User-Centered Design studies, among others-34. We emphasized the importance of publicizing the construction/application of technological productions in order to contribute to the advancement of nursing science.Different formats of digital educational technologies are being developed and used in nursing education, such as applications, hypertext, games, videos, virtual environments, virtual learning objects and simulators with virtual reality. In terms of care and management, studies point to the development and use of technologies such as guides, manual/protocol, software/application, teaching material, non-patentable process/technology, diagrams, instructional material, courses, booklets, recommendations, among othersAs a limitation, the technology content validity step is identified, due to the invited judges\u2019 low compliance, pointing out the need for new research in order to expand the number and representativeness of different Brazilian states and practice scenarios of the evaluators.The digital guide provides nursing professionals with access to material on SNC and NP based on technical-scientific knowledge. In a practical way, themes present in daily work were presented and evidence of quality, efficient, effective and safe care for people. The guide allows access to fundamental knowledge, which will assist in professional practice with more security and legitimacy.The \u201cGuide on Systematization of Nursing Care and Nursing Process\u201d is a technological innovation in health, as it encompasses a broad content, based on national and international references on the concepts, implementation strategies and operationalization of SNC and NP. The guide can be important for the entire nursing category, in addition to serving as an instrument that can bring an understanding of NP to professionals from other professional categories, such as managers and multidisciplinary teams, who need to understand the nursing work process for their decision-making.The guide content was considered by experts as relevant, clear, objective, organized, with adequate and scientifically coherent language and images, and has coherent and relevant organization, sequence and structure. In the global assessment, the agreement rate was 95.06%.The digital guide is available as a motivating and satisfactory alternative to health education, capable of contributing to the NP execution and implementation, supporting health care planning and implementation of actions aimed at quality of care.The illustrations help the reader\u2019s understanding of SNC and NP, representing the definition and relationship between these two concepts, and follows a whole reasoning that favors understanding, allowing quick, simple, direct and qualified access to fundamental knowledge, which will help in professional practice based on scientific evidence.This digital guide is relevant for scientific and technological development, having the potential to generate impact and be applied at local, regional and national levels, as it is available online on the website and can be used in teaching-learning to support nurses and students and provide subsidies for advancing the NP/nursing consultation implementation."}
{"text": "In the published article, there was an error in the Funding statement:This work was partially supported by VetzPetz Asia Company and Chiang Mai University (CMU) , which provided the necessary budget through the Center of Excellence in Veterinary Biosciences, Faculty of Veterinary Medicine, Chiang Mai University, R000029941 (WP), and the Faculty of Veterinary Medicine, Chiang Mai University . The authors declare that this study received funding from VetzPetz Asia Company. The funder was not involved in the study design, collection, analysis, interpretation of data, the writing of this article or the decision to submit it for publication.The correct Funding statement appears below.This work was partially supported by Pharmalink International Limited and Chiang Mai University (CMU) , which provided the necessary budget through the Center of Excellence in Veterinary Biosciences, Faculty of Veterinary Medicine, Chiang Mai University, R000029941 (WP), and the Faculty of Veterinary Medicine, Chiang Mai University . The authors declare that this study received funding from Pharmalink International Limited. The funder was not involved in the study design, collection, analysis, interpretation of data, the writing of this article or the decision to submit it for publication.The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated."}
{"text": "BackgroundThe Preventive Health and Screening Outpatient Department (OPD) was started in Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India with the vision of promoting health , counseling, screening, early diagnosis, and treatment and referral services (secondary prevention). The objective of the study is to describe the process of establishing the Preventive Health and Screening OPD in a tertiary hospital in Delhi and illustrate the functioning of the newly established OPD.MethodologyThis study is based on observation of the day-to-day functioning of the OPD, record checking of registers, and reviewing the records of the hospital registration system. Here, we describe the functioning of the OPD from its initiation in October 2021 until December 2022.ResultsThe routine services provided at the OPD include health promotion and education, especially focusing on non-communicable diseases, screening, diagnosis, treatment, lifestyle counseling; general OPD services; growth monitoring and counseling; group discussion for harms of tobacco usage; counseling for tobacco cessation, hepatitis B, and dT vaccination; group counseling for antenatal women; and screening for breast cancer. A few events such as the breast cancer screening camp and the non-communicable disease screening camp were also conducted under the purview of the new OPD. Such OPDs are the need of the hour for the provision of comprehensive healthcare, including promotive and preventive healthcare, along with curative health services, at tertiary healthcare levels.ConclusionsHealthcare services are incomplete without the preventive, promotive, and screening components of healthcare. For mainstreaming health promotion and preventive healthcare, Preventive Health and Screening OPDs are essential at hospitals. The benefits of prevention extend beyond managing chronic diseases and longer lives. Three levels of prevention and five levels of preventive interventions, as promoted by Leavell and Clark, are taught in all healthcare institutions under the concept of health and disease . \u201cPrevenEvidence has proved that investment in public health is more efficient and effective than an emphasis on curative and rehabilitative services -9. The hThe objective of the study is to describe the process of establishing a unique outpatient department (OPD), the Preventive Health, and Screening Outpatient Department, in a tertiary hospital in Delhi, and illustrate the functioning of the newly established OPD. The Preventive Health and Screening OPD was started in Vardhman Mahavir Medical College and Safdarjung Hospital by the Department for Community Medicine for promoting health and preventive measures at the tertiary healthcare level.The present study is a descriptive account involving meticulous observation and review of hospital records. The initiation process of the OPD has been delineated through a comprehensive analysis of the proposal (for the establishment of the OPD) and minutes of the meeting register. Furthermore, data collection was conducted through daily observations of the OPD\u2019s operational functioning. In addition, hospital registration reports spanning a period of 15 months, from October 2021 to December 2022, were thoroughly reviewed for data analysis and reporting purposes.Establishment of the Preventive Health and Screening Outpatient DepartmentThe inception of the Preventive Health and Screening OPD at Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, was formulated with the vision of promoting health , screening, early diagnosis and treatment (secondary prevention), counseling, and referral services. The intention of establishing such an OPD was set in motion by the Department of Community Medicine. The proposal was discussed among the faculty of the department. Debates and discussions regarding the selection of services, functioning of the OPD, the utility of such an OPD, the demand of the OPD, and logistics requirements followed. The priority areas were marked, and the services list was finalized for the OPD. After repeated persuasion, with the support of the Medical Superintendent and the Ministry of Health and Family Welfare, Government of India, the OPD was started in the new OPD building of Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, in September 2021. The staff posted in the OPD is listed in Table The OPD has delivered health care to its beneficiaries for more than 15 months until December 2022. This has been mediated by conducting health education sessions, group and individual counseling of beneficiaries, screening of high-risk groups, and, per demand, diagnosis and treatment of common illnesses, non-pharmacological interventions, lifestyle counseling, adult vaccination, and referral to other departments. Citizen charters were put up at different locations in the hospital to inform about the new OPD and its services. Beneficiaries in the OPD were either walk-in patients, referred from other departments or from the field practice areas, and referred cases from peripheral clinics of the Department of Community Medicine. The flow of OPD services is illustrated in Figure Non-communicable disease screening, diagnosis, and treatment and lifestyle counselingOpportunistic screening for diabetes, hypertension, oral cancer, and breast cancer was conducted for all walk-in patients aged 30 and above. Under the purview of occupational health checkups, all security guards employed in the hospital were screened for diabetes, hypertension, and oral cancer. During the screening, a history of diet, medication, and addiction was also obtained. The guidelines followed for the screening and management of the beneficiaries were in accordance with the guidelines issued under the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke, Ministry of Health and Family Welfare, India. All beneficiaries with elevated blood pressure and blood glucose level were followed up and provided treatment and counseling for lifestyle modification. All patients were explained about diet, exercise, frequency of follow-up visits, the importance of treatment adherence, blood investigations, possible disease complications, and ways to prevent the complications. If required, patients were referred to other specialized departments.General outpatient services Patients with common illnesses were treated according to standard treatment protocols. For chronic non-communicable diseases such as diabetes, hypertension, and osteoarthritis, lifestyle modification was emphasized, along with pharmacological treatment. Patients were also explained the importance of treatment compliance and regular follow-up visits. Opportunistically, patients were educated about the dangers of antibiotic abuse and were discouraged from the use of over-the-counter antibiotics. For all patients, non-pharmacological interventions were equally highlighted as the pharmacological part of the treatment during the counseling.Group discussion for harms of tobacco usage and counseling for tobacco cessationAll security guards, sanitation workers, and nursing attendants in the hospital were provided health education on the harms of tobacco usage in group counseling sessions. All tobacco users, identified during non-communicable disease screening, were registered for tobacco cessation. All counseling sessions were conducted with the help of a validated flipchart. Patients were referred to the Department of Psychiatry if indicated.Adult vaccination centerA center was established for adult vaccination where hepatitis B and dT vaccinations were regularly provided at the OPD. First-degree relatives of hepatitis B patients were counseled about the ways of transmission and prevention of hepatitis B. All hospital staff was encouraged to get regular doses of hepatitis B and flu vaccines according to schedule.Health promotion and health educationResident doctors and interns posted at the OPD conducted regular health education sessions about relevant topics using flipcharts at the OPD premises and the waiting\u00a0areas of the hospital.Group counseling for antenatal womenGroup counseling sessions for antenatal women were conducted in the OPD, with the help of a PowerPoint presentation. The beneficiaries were explained about medication intake, diet, rest, contraindications during pregnancy, birth preparedness, breastfeeding, postnatal care, and family planning. At the end of the counseling, the queries of the beneficiaries were addressed. All antenatal women were screened for any anomaly of the nipple which might cause difficulty in breastfeeding.The well women clinicAll women above 30 years of age were screened for breast and cervical cancer. This service was conducted in coordination with the Department of Obstetrics and Gynaecology. The beneficiaries were also taught about self-breast examination. Beneficiaries who screened positive for breast lumps were referred to the Department of Surgery.Growth monitoring and counselingA total of 33 children were found to be malnourished after screening in 15 months. They were screened for anemia and other common illnesses. Along with treatment, their attendants were counseled on the diet and care of the children.After 15 months of functioning of the OPD, the total number of beneficiaries of different services is presented in Table The Preventive Health and Screening OPD aimed at achieving health in a holistic way. Hence, apart from the above-mentioned services, a few special events were conducted by the Department of Community Medicine, at the OPD premises.In November 2021, a blood sugar screening camp was conducted on the occasion of World Diabetes Day. A total of 214 people were tested. Among them, 32 individuals were found to be diabetic who were unaware of their status. In total, 29 people were found to have uncontrolled blood glucose levels. All diabetic patients were treated and informed about the dietary and lifestyle changes at the Preventive Health and Screening OPD.On the occasion of International Women\u2019s Day, the Department of Community Medicine and the Department of Obstetrics and Gynaecology, Vardhman Mahavir Medical College and Safdarjung Hospital, in collaboration with the Association of Obstetricians & Gynaecologists of Delhi conducted Women Cancer Screening Fortnight. A total of 70 women visiting the hospital were screened for cervical  and breast cancer . Moreover, their knowledge of cervical and breast cancer was assessed. They were educated on the risk factors, symptoms, preventive measures of cervical and breast cancer, and self-breast examination.On the occasion of International Day of Yoga 2022, the Central Council for Research in Yoga and Naturopathy, Ministry of AYUSH, Government of India along with the Department of Community Medicine, conducted an event with the theme \u201cYoga for Humanity\u201d at the Preventive Health and Screening OPD. The standard Yoga protocol was demonstrated. The program was attended by around 150 participants comprising MBBS interns, faculty employees, security staff, and nursing staff.A refresher training session about anti-rabies vaccination was held in the OPD. The participants included nurses, postgraduate trainees, junior residents, and interns. An interactive discussion about the vaccination schedule, indications, and challenges was conducted. Queries of the staff posted at the Rabies Vaccination Clinic were addressed at the end of the session.Safdarjung Hospital, a 1,531-bedded multi-specialty with an additional 500 emergency beds, is one of the largest tertiary care teaching hospitals in India. It is a Central Government Hospital under the Ministry of Health & Family Welfare, Government of India. The hospital has a monthly OPD attendance of approximately 200,000 which includes patients from all age groups, socioeconomic strata, and disease spectrum from all over India. Patients are mostly accompanied by one or more attendants. This heavy footfall provides an opportunity to cater promotive and preventive care to them within a tertiary care setup. With almost 10,000 patients per working day, there are time constraints faced by treating physicians as well as supporting paramedical staff to provide detailed health education and health promotion advice to patients.Health education regarding the prevention of diseases, lifestyle modification, and overall health promotion is an important component of disease management and holistic health improvement. Such advice should be given in a detailed manner and should be personalized to the patient\u2019s illness, risk factors, and level of understanding to ensure the proper transfer of information and improve compliance. Such advice assumes greater importance in the context of non-communicable diseases because these diseases are influenced by modifiable lifestyle factors to a great extent. Properly disseminated health information and health promotion advice has the potential to prevent non-communicable diseases, earlier detection, and/or reduce complications of such diseases. In addition, screening for non-communicable diseases is important in the Indian scenario because of the lack of awareness and regular screening. Such screening helps in the earlier detection of non-communicable diseases and ensures better treatment and control while reducing potential complications. Similarly, antenatal care also requires counseling for lifestyle modification apart from medicinal treatment. Growth monitoring of under-five children and advice for defaulters also require individual counseling and guidance.Preventive care services can promote healthier lifestyles, provide early detection of diseases, and reduce the need for inpatient care services among individuals . A similThe private healthcare sector is presently catering to the increasing demand for preventive healthcare -16. The Our study is not without limitations. Because our study is review and observation-based, it suffers from the inherent problem of incomplete and inconsistent existing data. The study elaborates on a period of the initial 15 months. It is limited by the timeframe of data collection, which may not capture changes or trends that occur outside of the study period.Healthcare services are incomplete without the preventive, promotive, and screening components of healthcare. The benefits of prevention extend beyond managing chronic diseases and longer lives. For mainstreaming health promotion and preventive healthcare, Preventive Health and Screening OPDs are essential at hospitals. Tertiary hospitals being the apex centers in our country should attend to their beneficiaries holistically beyond the narrow purview of curative medicinal practice. Research should be encouraged for assessing the feasibility of the implementation of such OPDs, exploring barriers, ways to awareness and demand among the community for the services, and improving the effectiveness of such OPDs."}
{"text": "The frequent occurrence of pig epidemics has restricted the sustainable and healthy development of the pig industry and its ability to enhance the supply of pork, negatively impacting China\u2019s economic and social development. In recent years, China has faced many pig epidemic risks and challenges, with one high-risk area and two medium\u2013high-risk areas. The epidemic risk was highest in Beijing, Hainan, Liaoning, Tibet and Zhejiang. This study will help to better prevent and mitigate epidemic risks, promote high-quality development of the pig industry, and meet the nutritional needs of residents.Strengthening the analysis and risk assessment of the pig epidemic will help to better prevent and mitigate epidemic risks and promote the high-quality development of the pig industry. Based on a systematic understanding of live pig epidemics, a risk assessment index system was constructed, and the spatial and temporal variation characteristics of pig epidemics in China were explored by the entropy method. In recent years, the overall trend in pig epidemics over time first increased and then decreased; in space, the acceleration of the spread of epidemics across the country weakened. China still faces challenges, including many types and a wide range of diseases, large total livestock breeding and weak epidemic prevention and control capacity, and a large risk of introduced foreign animal epidemics. The spatial and temporal variations in the pig epidemic risk were obvious; one high-risk area, two medium\u2013high-risk areas and 10 medium-risk areas have been found in recent years, during which time, the epidemic risk was highest in Beijing, Hainan, Liaoning, Tibet and Zhejiang. However, there were significant differences in the regional distribution of the risk level of pig epidemics in different years. To further build a secure \u201cdefense system\u201d for the high-quality development of the pig industry, it is recommended to improve the monitoring and early warning system of pig epidemic risk, perfect the pig epidemic prevention and control system, and strengthen the regional collaboration mechanism of epidemic prevention and control. Accelerating the high-quality development of the pig industry and ensuring the stable and orderly operation of the pork market is an important means of meeting the animal-based nutrition needs of residents and safeguarding national food security. This is a basic guarantee for enhancing the level of regional economic and social development, improving the ability of farmers to increase production and income and forging a realistic path for accelerating the construction of an agricultural powerhouse and realizing people\u2019s aspirations for a better life. In recent years, the frequent occurrences of African swine fever and other major animal epidemics have restricted the sustainable and healthy development of the pig industry and its ability to enhance the supply of pork, negatively impacting national economic and social development and the lives of urban and rural residents. Although, currently, incidences of African swine fever and other major animal epidemics have been alleviated, sporadic occurrences, as well as epidemic prevention and control, cannot be ignored. Data from the Ministry of Agriculture and Rural Affairs of the People\u2019s Republic of China showed that 15 new outbreaks of African swine fever occurred nationwide in 2021, and 4500 pigs were killed and disposed of. Since then, China\u2019s government has attached great importance to the construction of national biosafety risk prevention, control and management systems; it has become inevitable and necessary to carry out risk assessment and systematic research on major animal disease prevention and control as an important part of the national biosafety risk prevention and control system.The literature on animal disease risk is primarily focused on risk assessment, animal disease prevention and control, etc. . In termThe issues of domestic animal disease transmission risk and international trade disease transmission risk have also been explored in many studies ,16,17. SOther studies have suggested that to achieve the stable and orderly development of the pig industry, the important role of epidemic prevention and control must be given high priority in building a long-term mechanism ,28. FromIn general, with the current focus on African swine fever, the research that specifically analyzes this situation and risk assessments of pig epidemics needs further systematic and in-depth review. In particular, after African swine fever outbreaks, it is of great practical importance to review the circumstances of the pig epidemic, systematically explore the spatial and temporal variation characteristics associated with the risk level of the pig epidemic, and summarize the lessons learned to better improve the epidemic prevention and control system, prevent and resolve the epidemic risk, and promote the high-quality development of the pig industry in the future. Considering the shortcomings of existing studies, this study attempted to construct a pig epidemic risk assessment index system based on an understanding of pig epidemic circumstances starting in 2017; use the entropy method to assess the epidemic risk and understand the spatiotemporal characteristics; and, finally, propose corresponding countermeasure suggestions for reference.Animal epidemics are an important factor that restricts the smooth and orderly development of the pig industry; epidemics with greater impacts mainly include porcine reproductive and respiratory syndrome and African swine fever. Regarding the trend of pig epidemics in recent years, after 2018, affected by African swine fever, the number of cases, deaths, and cullings increased sharply. Afterward, as the epidemic prevention and control situation continued to improve, the pig epidemic gradually slowed down . In termBefore the African swine fever outbreaks, pig epidemics were mainly distributed in Jiangxi, Hubei, Chongqing and Guangxi provinces, while the number of cullings was generally at a relatively low level. After the outbreak of African swine fever, the regional distribution of the epidemic changed significantly, with concentrated outbreaks in various regions. In 2018, the top three provinces in terms of cases were Jiangxi, Yunnan and Sichuan, the top three provinces in terms of deaths were Liaoning, Yunnan and Chongqing, and the top three provinces in terms of cullings were Liaoning, Hunan and Fujian. In 2019, the regional distribution of the epidemic changed further, with the top three provinces in terms of cases and deaths being Guangxi, Sichuan and Heilongjiang, and the top three provinces in terms of cullings being Heilongjiang, Jiangsu and Guangxi. Since 2020, with the African swine fever epidemic under better control, the national pig epidemic situation has continued to improve, and only Gansu Province\u2019s pig epidemic has been relatively serious. Overall, the regional distribution of pig epidemics in recent years was mainly affected by African swine fever, and with the African swine fever epidemic under control, pig epidemics have rapidly slowed nationwide. Currently, pig epidemics occur only sporadically in some provinces .At present, although African swine fever and other major animal diseases are better controlled, the associated risks and challenges are still prominent. First, pig epidemics are diverse and widespread. According to the \u201cList A, B and C Diseases\u201d issued by the Ministry of Agriculture and Rural Affairs of the People\u2019s Republic of China in 2022, there are currently a wide variety of pig diseases in China, such as A diseases, including African swine fever, foot and mouth disease, and swine vesicular disease. At present, a large number of pig diseases occur sporadically, and complete elimination is still far off. In terms of the speed and scope of the spread, African swine fever, for example, was first diagnosed in Liaoning Province in August 2018, and then the epidemic spread rapidly across the country within a short period of time, tremendously and negatively impacting the pig industry and market as well as the economy and society. The pig slaughters in 2019 fell by 21.6% compared with the previous year, and pork production dropped by 21.3%.Second, the total amount of livestock breeding was large, and the epidemic prevention and control capacity was not strong. China is the world\u2019s largest producer and consumer of pigs, and since the outbreak of African swine fever in 2018, China\u2019s government has implemented a series of policy initiatives to accelerate the recovery of pig production to normal levels. The inventory of pigs reached 452.56 million heads in 2022, of which the inventory of breeding sows reached 43.90 million heads. Although the level of scale, intensification and modernization of pig breeding has improved, there is still a large gap between the expected goal of high-quality development and the levels of developed countries in terms of epidemic prevention and control capabilities. There are still more small and medium-sized farms, retail households and other business entities in which the awareness and ability regarding epidemic prevention and control are not strong, and the level of epidemic prevention and control of pig households needs further improvement. In addition, the current grassroots epidemic prevention and control system is not sound, the epidemic prevention team is relatively weak, and loopholes in quarantine supervision and other issues remain prominent. In China, where people prefer hot fresh meat, the long-distance transport and slaughter of live pigs also create uncertainty about the spread of pig epidemics.Moreover, the risk of introduction of foreign animal diseases is greater. At present, the global situation of pig epidemics is still not optimistic. Data from the World Organization for Animal Health (WOAH) showed that in 2022, there were 6026 new outbreaks of African swine fever worldwide, with 159.80 thousand newly confirmed cases, 199.90 thousand heads killed and disposed of, and 38.50 thousand deaths. Although China has been strictly controlling foreign animal epidemics for a long time, including with the development and implementation of the \u201cEmergency Response Plan for Major Animal Epidemics Inside and Outside China\u201d and \u201cInterim Measures for Veterinary Health Management of Animal Isolation and Quarantine Sites at Ports\u201d and other policy initiatives, it still failed to block the introduction of animal diseases such as African swine fever into China. It is necessary to pay great attention to the variety of global animal diseases, the complexity of the pathogens and the seriousness of these situations and other issues; to learn from the current round of African swine fever regarding domestic exposures; to accelerate sound domestic animal disease prevention and control systems; and to reduce the risk of foreign disease introduction to protect the high-quality development of the pig industry.To systematically assess the risk of pig epidemics and explore their spatial and temporal risk characteristics, this study constructed an evaluation index system and combined it with the entropy method. In defining the concept of risk assessment, the United Nations Office for Disaster Risk Reduction considers that risk consists of two parts: hazard and vulnerability . CombiniSpecifically, the morbidity rate was measured by the ratio of the number of cases caused by the epidemic to the number of pigs, the mortality rate was measured by the ratio of the number of pig deaths caused by the epidemic to the number of cases, and the culling rate was measured by the ratio of the number of pigs culled during the epidemic to the number of pigs. The higher the three indicators were, the more serious and dangerous the pig epidemic was. In particular, unlike morbidity and mortality rates, the culling rate was more indicative of the severity of the epidemic, such as the occurrence of African swine fever in recent years, which caused a higher culling rate, and although the realistic mortality rate was not high, a large number of pigs were culled due to factors such as the high lethality and rapid spread of African swine fever.Breeding density was measured by the ratio of pig inventory to grain cultivation area. Pigs are grain-fed livestock, and a higher breeding density indicates a higher local pig carrying capacity and a higher epidemic risk faced by pig breeding. Industrial structure was measured by the ratio of pig industry output value to total agricultural output value. The higher the proportion of pig industry output value is, the more likely the pig industry is the leading industry in the province, the higher the corresponding scale of standardization and modernization, and the lower the epidemic risk faced by pig breeding. The prevention and control foundation was measured by the ratio of pig inventory to the number of people on staff in township animal husbandry and veterinary stations. The higher the ratio of pig inventory to the number of staff in the township animal husbandry and veterinary station is, the more pigs a single animal husbandry and veterinary staff member has to manage and serve, the weaker the force of pig epidemic prevention and control, the lower the intensity of epidemic prevention and control, and the greater the risk of an epidemic affecting pig breeding.ijx is the value of hazard and vulnerability indicators after normalization, ija is the original value of each hazard and vulnerability indicator, and max{ija} and min{ija} are the maximum and minimum values of each hazard and vulnerability indicator, respectively.Considering the differences in different indices in terms of their outlines and positive and negative directions, this study first standardized the indices, then calculated the index weights at all levels by the entropy method, and finally combined the standardized index values and weights to calculate the pig epidemic risk index. It should be noted that the morbidity rate, mortality rate, culling rate, breeding density and prevention and control foundation were all positive indicators, while industry structure was a negative indicator. The standardized treatment formula is specified as follows:ith region under the jth indicator needs to be calculated as follows:ijp is the corresponding indicator weight. Then, the entropy value of the jth indicator is calculated:je is the entropy value of the corresponding indicator and satisfies je\u2265 0, k = 1/lnn. On this basis, the weights of each indicator are calculated as follows:jw is the corresponding indicator weight, jd is the information entropy redundancy of the jth indicator, and jd= 1 \u2212 je.Before calculating the weights of each indicator through the entropy method, the weight of the corresponding indicator of the The data for this study were obtained from the Official Veterinary Bulletin of the Ministry of Agriculture and Rural Affairs of the People\u2019s Republic of China, China Animal Husbandry and Veterinary Yearbook, and China Statistical Yearbook. Considering that the Official Veterinary Bulletin from the Ministry of Agriculture and Rural Affairs of the People\u2019s Republic of China was available only for October 2021 and earlier, the pig epidemic data for 2021 were only for January\u2013September. Therefore, the time interval examined in this study was set as 2017\u20132020, where 2017 was the normal year before the outbreak of African swine fever, 2018\u20132019 was the most serious period of African swine fever, and 2020 was the year when the epidemic was better controlled. Overall, the time interval selected in this study covered the current round of the pig epidemic, and the pig industry in each region and its impact could better reflect the corresponding epidemic risk prevention and control capacity and its problems.Combined with the basic data, the indices of pig morbidity, mortality and culling rates, breeding density, industrial structure, and prevention and control foundation from 2017 to 2020 were calculated, and the risk of a pig epidemic and its hazard and vulnerability indices were calculated after standardization. Specifically, the hazard and vulnerability weights calculated by the entropy method for 2017\u20132020 were 0.679 and 0.321, respectively; the hazard indicators were 0.243, 0.105 and 0.652 for morbidity, mortality and culling rates, respectively; and the vulnerability indicators were 0.393, 0.125 and 0.482 for breeding density, industrial structure and prevention and control foundation, respectively. The weights of each indicator reflected that the risk of a pig epidemic came more from hazards, the culling rate regarding hazard factors was more important, and the foundation of prevention and control of vulnerability factors was more important. Regarding the characteristics of the regional distribution of pig epidemic risk, the top five provinces were Beijing, Hainan, Liaoning, Tibet and Zhejiang, with risk indices of 0.682, 0.367, 0.337, 0.282 and 0.268, respectively. The bottom five provinces in terms of risk were Shandong, Hebei, Jilin, Ningxia and Inner Mongolia, with risk indices of 0.097, 0.104, 0.112, 0.118 and 0.125, respectively.In terms of hazards, the top five provinces were Beijing, Liaoning, Tibet, Qinghai and Jiangxi, with hazard indices of 0.799, 0.361, 0.329, 0.281 and 0.266, respectively. The bottom five provinces were Shandong, Guangdong, Henan, Hebei and Guizhou, with risk indices of 0.006, 0.017, 0.052, 0.052 and 0.07, respectively. Among them, the top provinces in terms of morbidity rates were Jiangxi, Chongqing, Qinghai, Tibet and Zhejiang, the top provinces in terms of mortality rates were Jilin, Qinghai, Inner Mongolia, Liaoning and Heilongjiang, and the top provinces in terms of culling rates were Beijing, Liaoning, Tibet, Tianjin and Xinjiang.In terms of vulnerability, the top five provinces were Hainan, Fujian, Guangdong, Guangxi and Zhejiang, with vulnerability indices of 0.962, 0.566, 0.460, 0.439 and 0.438, respectively. The bottom five provinces were Jilin, Inner Mongolia, Heilongjiang, Shanxi and Ningxia, with vulnerability indices of 0.118, 0.122, 0.147, 0.148 and 0.149, respectively. The top provinces in terms of breeding density were Hainan, Fujian, Beijing, Guangdong and Guangxi; the top provinces in terms of industrial structure were Hunan, Yunnan, Sichuan, Anhui and Chongqing; and the top provinces in terms of prevention and control foundations were Hainan, Henan, Zhejiang, Anhui and Fujian. In terms of the overall situation of the risk of pig epidemics in different areas in recent years, there was 1 high-risk area, 2 medium\u2013high-risk areas, 10 medium-risk areas, 17 medium\u2013low-risk areas and 1 low-risk area nationwide. The risk of pig epidemics and regional prevention and control should not be ignored.Regarding the trend in temporal changes in the risk of pig epidemics, the regional changes in the risk of pig epidemics in different years were obvious. Before the outbreak of African swine fever in 2017, the provinces with the highest risk of pig epidemics were Qinghai, Jiangxi and Chongqing; the risk was also relatively high in northwest, southwest and southeast China; and the risk was low in northeast and north China. There were three high-risk areas, no medium\u2013high-risk areas, and three medium-risk areas, and the others were medium\u2013low- and low-risk areas. In 2018, with the outbreak of African swine fever, the regional distribution of pig epidemic risk changed significantly, mainly concentrated in Beijing and Liaoning, with Zhejiang, Tianjin and Jiangxi also at relatively high levels, and the overall risk of pig epidemics shifted to the east. There was one high-risk and medium\u2013high-risk area and three medium-risk areas, and the remaining areas were low-risk and medium\u2013low-risk areas.The year 2019 was a more severe year for the occurrence of African swine fever, and the risk of pig epidemics spread faster across the whole country. The highest risk of epidemics shifted to Tibet and Jiangsu; the epidemic risks in Qinghai, Xinjiang and Heilongjiang were also relatively high. There were two high-risk areas, three medium\u2013high-risk areas, and two medium-risk areas, and the remaining areas were low- and medium\u2013low-risk areas. In 2020, with the African swine fever epidemic under better control, the risk of pig epidemics in China slowed. Gansu and Shanghai had the greatest epidemic risks and were high-risk and medium\u2013high-risk areas; the risks in other areas were relatively low, and there were 26 low-risk areas.In general, the spatial and temporal variation in pig epidemic risk was the result of multiple factors. This study focused on two aspects: the occurrence and spread of pig epidemics and the spatial and temporal variation in epidemic prevention and control. From the perspective of the occurrence and spread of pig epidemics, the higher the mortality rate was, the faster the spread, the more serious the situation, the greater the risk of pig epidemics, and the more obvious the risk spillover effect to other regions.Taking African swine fever as an example, the mortality and culling rates caused by the national pig epidemic in 2018\u20132019 were 41.97% and 0.49% and 40.95% and 0.19%, respectively, much higher than the respective 21.50% and 0.001% in 2017 before the African swine fever outbreak. Among them, the highest culling rate was 7.64% in Beijing in 2018 and 2.16% in Tibet in 2019, which was consistent with the regional distribution and annual changes in the risk of pig epidemics. In terms of spatial and temporal differences in pig epidemic prevention and control, factors such as breeding density, industrial structure, and prevention and control foundation were closely related to the risk of an epidemic; the greater the breeding density was, the more vulnerable the industrial structure, and the poorer the prevention and control foundation was, and the more serious the risk faced by pig breeding. In terms of breeding density, the highest was 10.73 heads/ha in Hainan, and the lowest was 0.72 heads/ha in Inner Mongolia. The risk of pig epidemics in Hainan was obviously higher than that in Inner Mongolia. In terms of industrial structure, the highest was 19.65% in Hunan, the lowest was 1.40% in Tibet, and the risk of pig epidemics in Tibet was higher than that in Hunan. In terms of prevention and control foundation, each township animal husbandry and veterinary station in Hainan Province needed to serve 21,086.40 pigs, while the corresponding indicator in Tibet was only 136.94 pigs. The pressure of prevention and control in Hainan was significantly greater than that in Tibet, so the corresponding risk of pig epidemics in Hainan was higher than that in Tibet.On the basis of understanding the situation of pig epidemics, the following research conclusions were obtained by constructing a pig epidemic risk assessment index system and combining it with the entropy method to explore the characteristics of spatial and temporal differentiation of pig epidemic risk in China.First, the overall trend in pig epidemics first increased and then decreased. African swine fever was the most serious epidemic in recent years, and swine erysipelas, swine pasteurellosis, porcine reproductive and respiratory syndrome, classical swine fever and other pig diseases were also more common. Pig epidemics showed a trend of accelerated spread nationwide after continued weakening and now have only sporadic occurrences in some areas. Although African swine fever and other pig diseases are better controlled, the risks and challenges, which include many types and a wide range of diseases, cannot be ignored. Livestock breeding and epidemic prevention and control capacity were not strong during the study period, and the risk of introduction of foreign animal diseases was greater.Second, the spatial and temporal variation in pig epidemic risk was obvious. In 2017\u20132020, there was 1 high-risk area, 2 medium\u2013high-risk areas, 10 medium-risk areas, 17 medium\u2013low-risk areas and 1 low-risk area. The top five provinces in terms of pig epidemic risk were Beijing, Hainan, Liaoning, Tibet and Zhejiang, and the bottom five provinces were Shandong, Hebei, Liaoning, Ningxia and Inner Mongolia. There were significant differences in the regional distribution of epidemic risk in different years, with the high-risk areas being Qinghai, Jiangxi and Chongqing in 2017, Beijing in 2018, Tibet and Jiangsu in 2019, and Gansu in 2020. The temporal and spatial variations in pig epidemics and risks were mainly the result of many reasons, such as the scale of pig breeding, transportation and circulation, epidemic prevention and control capacity in different provinces, and so on.Based on the above research findings, the following countermeasures are proposed for reference. First, sound monitoring and early warning systems for pig epidemic risk are needed. For domestic and foreign pig and other animal diseases, it is necessary to establish a risk monitoring and early warning system that covers the whole industry chain, including breeding, slaughtering, processing, circulation and sales, so that timely detection, timely reporting, and timely formation and release of epidemic prevention and control early warning plans can provide a reference for scientific decision making for the pig industry and market participants.Second, the pig epidemic prevention and control system should be improved to include innovations in vaccination and culling, biosecurity and other means of disease prevention and control and should strive for an effective combination of multiple programs and efficient prevention and control. Epidemic detection in the pig industry chain of breeding, transportation, slaughtering and processing should be strengthened. The feeding management system, such as closed feeding and all-in-all-out, should be implemented; the cleaning and disinfection facilities and equipment for epidemic prevention in pig farms should be improved; farm records should be established; and pig identification, such as ear tags with activity, temperature and sound sensors, should be strictly enforced. The strategic planning of animal disease prevention and control science and technology should be strengthened; the promotion of scientific and technological innovation, transformation of results and integrated demonstrations should be accelerated; and research and development of vaccines for African swine fever and other major diseases should be accelerated. The construction of a grassroots animal disease prevention and control system, an epidemic prevention team, and grassroots epidemic prevention capacity should also be strengthened and improved. The culling subsidy system should be improved, and the enthusiasm and initiative of farm households for prevention and control should be fully mobilized.Third, the regional collaboration mechanism for epidemic prevention and control should be strengthened. To jointly build a solid \u201cdefense system\u201d for the high-quality development of the pig industry, it is necessary to establish an overall responsibility-sharing mechanism for the prevention and control of swine diseases in production and marketing areas based on the \u201cnational chessboard\u201d; to streamline and consolidate the responsibilities and obligations of various areas; to implement zonal prevention and control and regionally differentiated prevention and control strategies; to compensate for shortcomings and weaknesses according to local conditions; and to strengthen regional cooperation in the prevention and control of the entire industrial chain of pig and product production, transportation and slaughtering."}
{"text": "Nature Biotechnology 10.1038/s41587-019-0360-3, published online 5 February 2020.Correction to: In the published version of this paper, the members of the Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium were listed in the Supplementary Information; however, these members should have been included in the main paper. The original Article has been corrected to include the members and affiliations of the PCAWG Consortium in the main paper; the corrections have been made to the HTML version of the Article but not the PDF version. Additional minor corrections to affiliations have been made to the PDF and HTML versions of the original Article for consistency of information between the PCAWG list and the main paper, and in the PCAWG Technical Working Group, the two affiliations for Miguel Vazquez have been changed from Massachusetts General Hospital, Boston, MA, USA and Instituci\u00f3 Catalana de Recerca i Estudis Avan\u00e7ats (ICREA), Barcelona, Spain to Barcelona Supercomputing Center, Barcelona, Spain and Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway."}
{"text": "Since the appearance of the first civilizations, various substances have been used to improve human health. Although nature is undoubtedly the source of many medicinal substances, since the early 19th century there has been an enormous development of pharmaceutical products aimed at treating or improving human health. Over time, the emergence of new generations of therapeutic agents has been observed, including not only small molecules, but also proteins and peptides, monoclonal antibodies, nucleic acids, and living cells. This progress has opened up new possibilities for the use of these therapeutic agents in the treatment of specific diseases, while at the same time causing enormous challenges in delivering them into the body while maintaining their therapeutic usefulness. For the effective action of these agents, it is necessary, among other things, for them to have proper solubility, stability, target location, off-target non-toxicity, controlled pharmacokinetics, possibility of bypassing biological barriers  or, in the case of cells, maintaining cell viability and phenotypes ,3.Polymers, along with metals and ceramics, constitute the most common platform used for DDSs ,5. They Over the past 70 years, DDS polymer materials and their designs have progressed from external devices and simple off-the-shelf macroscopic supplies through to microscopic particles and ultimately to complex and rationally designed nanocarriers. The application of DDSs has improved the clinical usefulness of many drugs and enabled new therapeutics, such as anti-cancer and siRNA therapies. However, there are still remaining challenges that drug delivery systems have to overcome to be clinically viable. The next generation of DDSs will need to be able to overcome the biological barriers which limit the delivery of complex therapeutic molecules, and utilize less invasive systems which secrete biomolecules into specific tissues, at specific times and concentrations, sometimes for a prolonged period of time. Therefore, the innovations in the field of polymer materials will be the driving force in overcoming existing boundaries, while the polymer DDSs will still be considered the most active field of biomedical research in pharmaceutical industries and academic laboratories.Polymers Special Issue dedicated to the memory of late Professor Andrzej Dworak https://www.mdpi.com/journal/polymers/special_issues/polym_carr_deliv_biomed_appli_mem_prof_Dworak (accessed on 23 February 2021)This book comprises articles concerning recent advances in natural and synthetic polymeric materials with the desired physical, chemical, biological, and biomechanical properties to match the various requirements of controlled delivery of various therapeutic agents. The book contains reviews and original articles of eminent scientists and friends of Professor Dworak, each of which was published previously as original contributions to the Prof. Dworak was an outstanding specialist with experience in the studies of the mechanisms of oxirane and cyclic imines polymerization and controlled radical polymerization of various types of monomers in order to obtain macromolecules with carefully planned structures and properties, including polymers sensitive to stimuli. In his research, he successfully translated knowledge in the field of polymer chemistry and polymer materials into their potential use in medicine and pharmacy. Prof. Dworak initiated many national and European projects in which he carried out studies in the field of basic research, including the preparation and therapeutic use of various types of nanoparticles and polymer nanocontainers carrying different types of active substances. He also managed projects related to the development of polymer supports for the culture and transfer of cell sheets, which significantly accelerated the healing process of burn wounds. The results of Prof. Dworak\u2019s research has been published in nearly 150 articles in international journals, and he was the co-author of several patents.On 17 March 2022, the Silesian Meeting on Polymer Materials Conference (Polymat 2022) was organized and dedicated to the memory of Prof. Andrzej Dworak . The conAccording to the conference program, Prof. Axel M\u00fcller , JohannePolymers, published by the Multidisciplinary Digital Publishing Institute. In the category of advanced synthesis and study of polymeric materials, Aneta Medaj, Jagiellonian University, Cracow, Poland, was awarded for her presentation entitled \u201cPolymer nanocapsules templated on liquid cores as model photoreactors\u201d. In the category of interdisciplinary and international studies, Erik Dimitrov of the Institute of Polymers, Bulgarian Academy of Sciences, Sofia, Sofia University, and the Centre of Polymer and Carbon Materials, Zabrze, Poland, was awarded for the presentation \u201cNucleolipid vesicles. Supramolecular structures resembling spherical nucleic acids\u201d. In the category of advanced biopolymer materials, Mattia Parati . The posters were available also on the Internet. Many of them were of high practical importance. The posters were evaluated by a special jury . The three best communications were selected and awarded prizes of EUR 450 each, funded by the Swiss journal a Parati , UniversPolymers, MDPI, and the Chemical Industry.The conference was held under the auspices of the European Federation of Polymers, the Committee of Chemistry of the Polish Academy of Sciences, and the Polish Chemical Society. The media patronage over the conference was taken by The conference was accompanied with a small exhibition of research instruments . The Scientific Committee, headed by Prof. Zbigniew Florja\u0144czyk, was responsible for the high scientific level of the presented papers, and the Organizing Committee, headed by Prof. Alicja Utrata-Weso\u0142ek, orchestrated the smooth running of the event. The conference was attended by about 170 scientists from Poland and abroad. After the closing remarks given by Prof. Barbara Trzebicka, chairwoman of the Conference, the participants proposed a farewell toast: to meet again at Zabrze in the near future! An extended report on the conference was also published in Polish ."}
{"text": "This article explores the first fifty years of the History of Medicine and Health Care Program in Calgary and considers the impact of interdisciplinary cooperation as well as the role of interprofessional undergraduate and clinical medical education. Through this exploration, I argue that medical history should be a central part of study curricula, that a historical understanding can provide a robust background for physicians in a fast-changing world in the clinic, and that through their disciplinary expertise, medical historians play a fruitful role in scholarly and teaching exchanges with medical students and clinicians in the modern medical humanities.Medical historians and educators have long lamented that the integration of the study of the history of medicine into the educational curricula of medical schools and clinic-based teaching has been protractedly troubled. Employing the development of the history of medicine program at the University of Calgary as a case study, this article emphasizes the importance of integrating medical history with teaching schedules to further students\u2019 insights into changing health care settings, the social contingency of disease concepts, and socio-economic dependences of medical decision-making. History of medicine programs can furnish plentiful opportunities for research training through summer projects, insight courses, and field  Karl Sudhoff\u2019s (1853\u20131938) institute for the history of medicine, which opened in 1906 at the University of Leipzig in Germany, has long been considered a gold standard for history of medicine programs affiliated with medical faculties.A statue of Hippocrates stands in the Health Sciences Centre (HSC) of the University of Calgary\u2019s (UofC\u2019s) Cumming School of Medicine (CSM). It is a legacy of Peter J. E.Cruse\u2019s (1927\u20132006) history of medicine courses and was a gift from the sizeable Greek-Canadian population to the UofC\u2019s new medical school.Founding faculty member Dr. Cruse pushed for the inclusion of medical history in the schedule of Calgary\u2019s new medical school (1970\u20131971), from which workshops emerged for residents in surgery and staff surgeons.The Calgary Associate Clinic\u2019s Historical Bulletin. The Bulletin, as it was previously called, was published between 1936 and 1958, focusing greatly on the history of medicine in Alberta, but also on the history of medicine in general, in 22 volumes comprising 88 issues.Canadian Bulletin of Medical History (CBMH) when it was created as the newsletter of the Canadian Society for the History of Medicine in 1979. Published twice a year for the Canadian Society for the History of Medicine, originally by Wilfrid Laurier University Press and now through the University of Toronto Press, the CBMH has prominently featured several research articles from faculty and trainees participating in Calgary\u2019s HOMHCP.Calgary\u2019s founding physician-historian Cruse was born in Stellenbosch, South Africa. His father, Henri P. Cruse (1894\u20131950) was a university professor specializing in the history of pedagogy at Stellenbosch University, while his mother Aletta (1897\u20131965?) worked as a schoolteacher.aficionado Bill Whitelaw, who headed the conference until 2007 , where they gave short history of medicine presentations to the assembly.2007 see .23Cambridge Scholars Publishing in Britain has emerged to document the conference proceedings and include the best peer-reviewed research papers given at the conferences. These publications combine the submitted and accepted papers regarding clinical medical history topics, as well as those topics in health care history by other interested undergraduate and graduate students from across Canada. It is also a welcome opportunity for medical residents to write and publish some of the first papers in their clinical careers. Of all the submitted conference papers, up to fifteen of the best papers are considered for publication in the conference proceedings, often making substantive contributions to our medical understanding and the existing historiography, including for example original work on the early ambulatory and mobile clinical stations in Atlantic Canada, the introduction of super glue into modern surgery, and assessments of the economy of material culture of menstruation products in public health and gynaecology to mention here only a few.Presentation topics at the HMDs have covered areas such as the classics , history of public health , nursing (including the interdisciplinary nature of modern medicine and the physician-nurse relationship), veterinary medicine , as well as neuroscience  see . Prizes,The review process and the selection of high-quality papers is made by a local committee, which receives further input from the board of advisors, as well as from external historians of medicine. These selection processes have engendered a significant academic appeal for the HMDs at the UofC.Medical school instructors have long pondered the challenges of incorporating history of medicine teaching in student and clinical education, seeking ways to furbish insights into the humanities, social contextualization, and create ethical awareness in the curricula.(1) To attract students and faculty from interdisciplinary backgrounds and cross-departmental affiliation to engage in and contribute to the Program\u2019s activities\u2026; (2) to develop and expand the profile and standing of the Program within medical and interdisciplinary communities engaging in historical research and teaching medicine and health care across Canada and abroad; (3) to relate to the university, the local community and the public at large explaining and interpreting topics from the history of medicine, the life sciences and neuroscience\u2026; (4) to conduct interdisciplinary teaching and research in the CSM and beyond by integrating views from the History and Philosophy of Science, Science and Technology Studies, Cultural and Media Studies.This directional statement emphasizes the importance of engaging with the social, cultural, political, and economic contexts of clinical training and medical knowledge. Today, the half-time validity of medical knowledge is getting increasingly shorter and 50% of medicine\u2019s knowledge basis is revised every 5 years.Building a wider understanding of the central task and function of history in current medical curricula remains attractive to students, since it provides a valuable foundation to them.practica offered, which make extensive use of the Dr. Cruse Collection and Mackie Collection for their research projects and presentations concerning medical history.Furthermore, a significant number of the history of medicine books from the former Calgary Associate Clinic were later donated to the UofC\u2019s Health Sciences Library. There, the collection was merged with the \u201cDr. Peter J. Cruse Collection\u201d and the \u201cMackie Family Collection in the History of Neuroscience.\u201dEnticing collaborations in research and education among physicians, medical scientists, historians, sociologists, and anthropologists has been, and continues to be, a foundational motivation for the UofC HOMHCP. To this end, meeting and exchange platforms, the history of medicine library collection, as well as interest groups and specialized colloquia, have been established to foster the interaction between the humanities and health sciences. Since 2012, the mutual interaction in the wider field of the medical humanities has also become institutionalized through the collaboration with other members of the CSM\u2019s Health Care Humanities Committee.In their previous article \u201cMaking the Case for History in Medical Education\u201d in this journal, David S. Jones et al. have argued that they see both chances as well as challenges with integrating medical history within the medical humanities, while making \u201cthe case for history as an essential component of medical knowledge, reasoning, and practice.\u201dclient\u00e8le as the Monday lectures, offer practical instruction and experience on various topics, ranging from skills for public presentation, academic discussion, history research methodology, to history of medical techniques with some hands-on experiential learning. The course offers thereby a good chance for medical students to establish informal relationships with faculty, who later serve as faculty preceptors in students\u2019 disciplines of interest for individual research projects and even as collaborators on mutual publications.The history of medicine courses are comprised of a series of lectures and seminars held on Mondays from 12:30 to 1:20 PM throughout the full academic year, which highlight particular themes, episodes, controversies, people, and events in the history of medicine. The types of history taught in these courses include the social history of medicine, the history of medical ideas, laboratory history, the relationship of the history of medicine with the history of science and the Science and Technology Studies (STS), elements from public health history, as well as the relationship between the history of medical technologies and modern media studies. These lectures and seminars, attended by medical students, residents, postdocs, and interested clinical faculty, provide an overview of history of medicine and are taught by both historians and medical faculty actively publishing in the history of pathology, pediatrics, geriatrics, public health, as well as complementary and alternative medicine.curriculum vitae as well as their electronic Canadian Resident Matching Service portfolios.Proceedings of the Annual History of Medicine Days.At the end of each academic year, the associate dean for undergraduate medical education receives a letter about each student\u2019s participation in the course and spin-off activities, including archival work, presentations, and publications, as these are always seen as valuable additions to a student\u2019s This content of the UofC\u2019s HOMHCP is hence fully aligned with most of the strategies for history at medical schools in the US and Canada as pointed out in \u201cMaking the Case for History in Medical Education.\u201d The concerns articulated in their article regarding resource competition between the medical humanities and history of medicine would not necessarily lead to antagonism but can also be overcome through mutual forms of collaboration and the emphasis of interdisciplinary strengths. Furthermore, Jones et al.\u2019s focus on reframing history of medicine as a field that is based in science studies and history of science, discussing questions of paradigms, biopolitics, discourses, and postmodernism, can also be widened to include valuable public health perspectives, areas of comparative and global history, along with important aspects of intersectionality and indigeneity regarding the history of medicine and health care.Students could also submit abstracts on medical topics to the Royal College of Family Physicians of Canada for their student prize competition.aper\u00e7u: \u201cart always outlasts science.\u201dAlthough the Calgary History of Medicine and Health Care course has changed in nature and scope since it was started by Peter Cruse, students remain committed to the experience of the program, which offers them insight from various faculty members into their specific areas of interest.Clio in the Clinic emphasizes. The current analysis of the local history of medicine program can offer useful insights into the proliferation of the program along with the available resources and history of medicine collections. Education studies have frequently examined history of medicine programs to elicit how medicine is perceived, understood, and taught with a critical perspective to its historical development and socio-cultural context. This article has examined the historical steps that led to the foundation of the UofC\u2019s HOMHCP and its context in the reform education initiatives at this younger medical school in Canada. The support of external funding agencies, the AMF and the Hannah Foundation (now the AMS), was instrumental in bringing a medical history perspective into the educational setting in Calgary. Rather being wedded to contingent local settings, the UofC has tried to reach out to other medical schools, nursing schools, and history of medicine programs, to stimulate active exchanges and place history of medicine in a wider communicative network.Comparatively few North American medical schools include medical historians and history of medicine courses. At the UofC\u2019s CSM, the muse of history is nevertheless seen as integrative to medical teaching, research, and collaboration, as this case study submitted to Further networking opportunities were woven into the fabric of many of the history of medicine courses, including exchanges with colleagues from clinical education, and interdisciplinary collaboration with other historians, philosophers, anthropologists, and ethicists, as well as inter-professional panels.This collaborative community is locally supported by the planning committees, the award committees, and a pool of volunteering judges and conference moderators. The program is presently supported by Melanie Stapleton, a gastroenterologist as first co-chair and Lesley Bolton, a classicist, as second co-chair; Stephen Pow, who arrived from the Central European University, Budapest, Hungary, as an AMS-funded postdoc; sessional history instructor Susan McMahon as a research associate; and Marcia Garcia as the course and conference coordinator; along with physician-historian Robert Lampard holding an adjunct position in the department of community health sciences. Previous postdocs have included Fedir Razumenko from Saskatoon, Saskatchewan; Aleksandra Loewenau from Oxford, UK; Will Pratt from Edmonton, Canada; and Matt Oram from Christchurch, New Zealand. The program is administratively located in the CSM and can be found on the third floor of the Cal Wenzel Precision Health Building, while the Science, Technology, Environment, and Medicine Studies laboratory is housed on the eighth floor of the Faculty of Arts, and the History of Medicine Room in the library being located on the first floor of the HSC. The following individuals or administrators serve on the advisory committee: the chair is the associate dean, research (CSM), Bill Whitelaw as former HOMHCP chair, the head of the department of community health sciences, the head of the department of history, the associate dean for undergraduate medical education (CSM), the director of the O\u2019Brien Institute for Public Health, the director of the Hotchkiss Brain Institute, classicist Peter Toohey, the dean of the Faculty of Arts, a student representative, and the CEO of AMS. The current state of the history of medicine curriculum at the UofC has further been exported to other schools, most visibly at the UofA\u2019s medical school in Edmonton, where the history of medicine interest program was restarted and revitalized by Jamil Kassam, a historian trained at the University of Chicago with see  a speciaReviewing the structure and function of the HOMHCP reveals similarities, differences, and cooperation features with other history of medicine programs that developed around the same time across Canada. Many students and trainees from these centres have attended the HMDs conferences in Calgary:Its program in the medical humanities is located in the faculty of medicine and was led for four decades by physician-historian Jock Murray, who had been the former dean of the faculty. The program is primarily addressed to undergraduate medical students. Staff members include medical humanities scholar Wendy Stewart, historian of medicine Ronald Stewart, Marc Gilbert as postdoc, and Ana Sardinha as administrator.The department of social studies of medicine was founded in 1966 by Donald G. Bates (1933\u20132001). It is situated in the medical faculty, but members are cross-appointed in the departments of their home discipline. A lecture on the history of medicine and seminar-style block courses are taught in the medical faculty, yet most of the undergraduate teaching occurs within the disciplinary departments. McGill\u2019s is a research-intensive department, staffed by architectural historian Annmarie Adams as chair, sociologist of science Alberto Cambrosio, bioethicist Jennifer Fishman, medical ethicist Phoebe Friesen, bioethicist Jonathan Kimmelman, medical ethicist Nicholas King, historian of medicine Thomas Schlich, anthropologist Margaret Lock, medical historian Andrea Tone, medievalist Faith Wallis, historian of medicine George Weisz, and anthropologist Todd Meyers.The Institute for the History and Philosophy of Science and Technology was created in 1967 as a graduate studies and research institute. As an autonomous unit, it remains outside the medical faculty, with close relations to other UofT faculties. Academic staff include philosopher of science Brian Baigrie, philosopher of science Hakob Barseghyan, philosopher of science Joseph Berkovitz, historian of medicine Lucia Dacome, religious studies scholar Yiftach Fehige, historian of mathematics Craig Fraser, historian of biology Nikolai Kremensov, philosopher of sociology Mark Solovey, medical anthropologist Wen-Ching Sung, historian of biology Marga Vicedo, philosopher of biology Denis Walsh, historian of technology Rebecca Woods, and historian of physics Chen-Pang Yeang.Furthermore, the other seven Hannah Chairs continue to send students and participate themselves regularly in the HMDs, as organized by the UofC\u2019s own Hannah Chair.A particular aim of many history of medicine programs is the reinterpretation of Western culture, medicine, and science in critical, epistemological, constructivist, and other perspectives through teaching and research in medicine.[The Introduction of the teaching of history of medicine] is unlikely to occur in a \u201ctop-down\u201d fashion\u2026, it is much more likely to occur in a \u201cground-up\u201d fashion, whereby energetic, committed, politically adroit historians will take advantage of local circumstances and opportunities at their own institutions, succeed in their work, and thereby facilitate the growth and spread of the effort.History of medicine programs actively further interdisciplinary collaboration between departments, faculties, and beyond \u2013 and, what is perhaps one of the greatest benefits of all, teaching faculty are available to meet with individual students to discuss their interests, provide feedback on history of medicine and career path questions, and offer research preceptorships for projects. Most medical schools, with their rather large budgets, could afford to finance medical history positions and would derive significant profit from them. The study of the history of medicine is central to the training of future doctors \u2013 from day one of their classes, while offering a space for insightful reflection of their work on the clinical wards and clerkship periods \u2013 through the medical humanities and within the (ever) ongoing reform activities in medical education."}
{"text": "Geopolymer (GP) is environmentally friendly, has good mechanical properties and long-term workability, and has broad application prospects. However, due to the poor tensile strength and toughness of GPs, they are sensitive to microcracks, which limits their application in engineering. Fiber can be added to GPs to limit the growth of cracks and enhance the toughness of the GP. Plant fiber (PF) is cheap, easy to obtain, and abundant in source, which can be added to GP to improve the properties of composites. This paper reviews recent studies on the early properties of plant fiber-reinforced geopolymers (PFRGs). In this manuscript, the properties of PFs commonly used for GP reinforcements are summarized. The early properties of PFRGs were reviewed, including the rheological properties of fresh GPs, the early strength of PFRGs, and the early shrinkage and deformation properties of PFRGs. At the same time, the action mechanism and influencing factors of PFRGs are also introduced. Based on the comprehensive analysis of the early properties of PFRGs, the adverse effects of PFs on the early properties of GPs and the solutions were summarized. At present, Geopolymers (GPs) are considered an environmentally friendly alternative to traditional building materials and an ecological material to replace traditional cement in recent years ,2,3. ComIn general, the synthesis of GPs consists of an active solid silicaluminate precursor and activator solution. The source of precursor material is very rich. For example, kaolin, silica fume, fly ash, slag, and other industrial wastes . The mos4 and Al-O4 tetrahedral units. GPs are an environmentally friendly cementing material with low energy consumption and less pollutant emission in the production process [As mentioned earlier, GPs are an emerging sustainable material that meets the goals of energy conservation and environmental protection and can reduce carbon dioxide emissions in the environment. GPs are inorganic polymer materials with a three-dimensional network structure composed of Si-O process ,10. Howe process ,12. Fibe process . Because process ,15.Plant fiber (PF) has the advantages of low density and a high length-diameter ratio. It is not only cheap and readily available, but also comes from abundant sources and can be repeatedly processed and biodegradable . At the In recent years, PFs have been gradually applied to the development of engineering materials to improve the brittleness and other properties of cementing materials ,19,20. AResearch in recent decades shows that PF is feasible to replace synthetic fiber in GP composites. The research on the early properties of plant fiber-reinforced geopolymers (PFRGs) in recent years is reviewed. In this paper, the characteristics of PFs commonly used in GPs and the properties of fiber-reinforced geopolymers are briefly reviewed. The research on the early properties of PFRGs is discussed, including the rheological properties of freshly mixed slurry, early strength of GPs, early shrinkage deformation and cracking of GPs, etc. The action mechanism and influencing factors of early properties of GPs were introduced. The microstructure of GP in the early reaction process was analyzed and discussed.PFs are abundant, widely distributed, and have many other advantages. They are not only low-cost but also have good mechanical properties and are biodegradable ,28. The As can be seen in However, compared with other types of fibers, PFs have unique properties that enable them to bond effectively to the substrate. 6H10O5)n. The chemical structure of the GPs is shown in Cement produces gels due to the hydration of mineral particles, but the reaction systems of GPs and cement-based materials are quite different. Cellulose is the most important component of PFs, and its chemical formula is (CSome researchers believe that the reaction process of GP mainly consists of dissolution, diffusion, polymerization, and solidification. First, when aluminum silicate raw materials are dissolved in an alkali activator solution, many silicon and aluminum monomers can be produced. The silicon and aluminum monomers gradually diffused from the surface to the inside and then condensed rapidly to form the oligomer gel phase of silicon and aluminum. Finally, the silica-alumina oligomer gel phase solidifies and hardens into GP concrete ,77. HoweWhen PF is added to the GP matrix, a series of changes will occur in fiber properties. The compatibility between PFs and GP matrix will affect the workabilities and mechanical properties of composites to a great extent. Tan et al.  studied The PF itself has an internal cavity structure ,30,31. B\u22123. Pimraksa et al. [Fiber can affect the density of composites as well as the water absorption. Liu et al.  studied a et al.  believeda et al.  studied a et al.  added siThe interface characteristics and adhesion of fibers and matrix are key factors in the interface control technology of composites ,80. The In fact, by adding kaolin and nanoclay, the porosity and pore size distribution of cement mortar is reduced ,93. On tGP is considered a green alternative to Portland cement. Previous studies on GPs have focused on their chemical and mechanical properties, microstructure, and potential applications, but few researchers have focused on their rheological behavior. In the fresh state, good workability of PFRGs is a prerequisite for better mechanical properties ,95. The Slump value is one of the important characteristics of the workability of fresh concrete. Slump tests can judge the workability and the freshness of the mixture. Compared with other fibers, steel fiber, and other conventional fibers are considered to be one the potential reinforcement fibers in GP composites. These fibers can enhance the flexural strength, tensile strength, ductility, and toughness of GP composites ,100. HowBashar et al.  conducteIn contrast to traditional inorganic fibers, the sugar in PF is easy to hydrolyze under the action of alkalinity in the matrix. Hydrolysate plays an anticoagulant role in the hardening of the composite. At the same time, the fluidity of the slurry will be significantly reduced, and the slump loss of the slurry will be accelerated.Wongsa et al.  found thAbbas et al.  studied Similar to the above studies, Su et al.  studied In summary, the workability loss of different types of fiber-reinforced GP mixtures is affected by their type, aspect ratio, and content in the mixture. The workability reduction of PF is higher than that of steel fiber and inorganic fiber with the same GP matrix. This is due to the high water absorption of PFs. Therefore, pre-wetting or pretreatment of PFs before the addition of GP mixtures can reduce the absorbent chemical composition of the fibers.From the perspective of low carbon and environmental protection, relevant personnel also carried out research on the related properties of waste PFRGs . Liu et Malkawi et al.  used palIn addition, the effect of setting time is also an important index to evaluate the rheological properties of GPs. Ferreira  et al. i2 and C-S-H will be produced in the hydration process of cement, which will increase the viscosity of the system and thus increase the slump loss of concrete. Adding admixtures to concrete is beneficial to maintaining the good fluidity of concrete. The surface of mineral admixtures is smooth and dense. When mixing concrete, they are dispersed among cement particles, and these dense particles act as dispersants.Many factors affect the rheological properties of GPs. Due to the high viscosity of sodium silicate solution, the rheology of GPs is quite different from that of ordinary concrete . When ceThe higher ratio of sodium silicate to sodium hydroxide in the GPs exacerbates the viscosity effect and further reduces the slurry flow ,119. SimIn addition, increasing the volume of the activator solution has been shown to improve rheology without significantly affecting the compressive strength of the mixture due to an increase in its liquid-solid ratio . Su et aThe addition of PFs will reduce the fluidity of the GP slurry and shorten the setting time of the slurry. The addition of some materials, such as rice husk ash, also affects the rheological properties of the GPs. Das et al. found that due to the absorption characteristics of rice husk ash particles, rice husk ash has a high water requirement, and insufficient water content will lead to faster hardening, thus reducing the processing capacity and setting time ,122.PFs affect the early strength of GPs, including compressive strength, flexural strength, and tensile strength. The results show that the PF can shorten the setting time of the matrix and improve the ductility and tensile strength of composites. Its influence on the composites is mainly manifested in the enhancement of toughness and the decrease of compressive strength ,124.The early strength of GPs is higher than that of cement concrete. Saranya et al.  found th2 to 21.25 N/mm2 when 0.5% coir fiber was added. Korniejenko et al. [Both traditional inorganic fiber and PF can affect the compressive strength of the GP matrix. Korniejenko et al.  analyzedo et al.  analyzedExcessive fiber addition and uneven distribution in the matrix have adverse effects on the compressive strength of GPs . LazorenAbbas et al.  studied The effect of waste fibers such as straw on the compressive strength of the GP matrix is similar to that of sisal and coir fibers. Workiye et al.  preparedThe mechanical properties of PFs can improve the flexural strength of GPs, which is due to the high tensile strength and elastic modulus of PFs. The tensile stress exerted on the composite matrix can be transferred to the fiber through the interfacial bonding between the fiber and the GP matrix. In GP composites, fiber types, and properties are more effective than matrix properties in improving fracture properties such as flexural strength. Fiber properties control the failure mechanism and fracture characteristics of composites.Lazorenko et al.  showed tThe flexural behavior of PFRGs is similar to the compressive behavior. Zhou et al.  studied Abbas et al.  investigKorniejenko et al.  found thSimilar to flax fiber, cotton fiber, sisal fiber, and coir fiber, related studies found that sawdust produced consistent results in the GP matrix . SawdustAs can be seen from Through microscopic analysis of the early reaction process of GPs, researchers have further understood the structure and formation mechanism of the early reaction of PFRGs, to better understand their early properties. With the further study and development of the chemical reaction and mechanism of GPs, other early characterization techniques have been gradually developed and applied.Wongsa et al.  conducteFrydrych et al.  showed bIn contrast to cement-based materials, water does not participate in hydration during polymerization. In this process, the purpose of adding water is to provide a workable mixture. Over time, this excess water will dissipate and cause significant shrinkage of the GPs . ShrinkaPF can reduce the shrinkage of the matrix . Some stAlthough the mechanical properties of GPs containing PFs have been studied extensively, the effects of these fibers on the drying and shrinkage properties have been significantly less reported. Su et al.  observedFibers can act as bridges in cement-based materials to prevent the spread of cracks. The morphology of the fibers has a great influence on their bonding properties with the cementitious matrix. The main function of fiber is not to improve the compressive strength of composites but to improve its toughness and control the further development of matrix cracks.Alomayri et al.  found thGPs are cost-effective, environmentally friendly, and consume relatively little energy. However, the early tensile strength of GPs is relatively poor, and the mechanical properties of GPs can be improved by adding PFs.There are many studies on the mechanical properties of PFRGs, including the durability and degradation of PFs in a matrix. In recent years, more and more types of fibers have been used as reinforcements in a GP matrix. The recent advances of PFRGs are mainly reflected in the following aspects:Various recycled reinforcements have been used to prepare PFRGs, such as wastepaper sludge, waste cotton stalk, bagasse, and straw particles;Due to the need for intelligent construction technology, good early performance of PFRGs, including flowability and buildability, is becoming increasingly important, such as the development and preparation of 3d printing PFRGs;As the admixture of composites, nanomaterials are added to the PFRGs to improve the physical and mechanical properties of the matrix, such as nanoclay and nanocellulose;A variety of PFs pretreatment methods are used to improve the characteristics of PFs, to enhance the performance of PFRGs.The early properties of PFRGs are studied, including the rheological properties of freshly mixed GP slurry, the early compressive strength and flexural strength of GP, and the early shrinkage deformation and cracking of GP.The addition of PFs greatly delays the setting time of cement-based composites. However, unlike cement, the addition of PFs shortens the setting time of GP due to the heat that may be generated during the degradation of PFs.The degree of workability loss of different types of fiber-reinforced GP mixtures is affected by fiber type, aspect ratio, and content in the mixture.PF can improve the early flexural strength of composites and has the function of toughening and strengthening composites. The higher the content of cellulose, the greater the toughening and strengthening function.Compared with traditional fibers, the influence of PFs on the early performance of GPs mainly has the following problems:In an alkaline environment, cellulose, hemicellulose, and lignin of PFs are easily hydrolyzed to produce carbohydrate substances. However, saccharides can hinder the solidification of GPs and inhibit the strength development and setting time of cementitious materials during the polymerization, which will have a negative effect on the early mechanical properties of GPs. The characteristics of PF cause its water absorption, variability, and cementitious material bonding to be poor. Because of the high water absorption, the effect of PF on the workability of the GP matrix is higher than that of steel fiber and inorganic fiber.Through this study, the application of PFs to GPs as reinforcing materials has an adverse effect on the early performance of composites, mainly on the fluidity of mixtures. To solve these problems, PFs can be pretreated with chemical modification to solve them."}
{"text": "Department of Respiratory, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.In the published article, there was an error regarding the affiliation for Shicong Zhu. Instead of having affiliation 1, they should have The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated."}
{"text": "Formerly Scientific Officer, Medical Research Council Social and Community Psychiatric Unit, Institute of Psychiatry, London, UKJohn Birtchnell, who died on 5 September 2022 at the age of 90, had a long and prolific career in psychiatric research. A common factor linking his areas of research interest was the definition and measurement of psychological dependence. It was out of this that he developed his general theory of relating, which he regarded as his most important contribution to knowledge.Throughout his career John balanced his pursuit of statistically valid data from populations with the in-depth knowledge of individuals, couples and families gained through his clinical work as a psychotherapist. In over 100 published papers, topics included early loss and separation experiences, social class and mental illness, marital quality and depression, the causes and management of attempted suicide and maladaptive forms of relating. In later years John drew on evolutionary theory to theorise on brain function and was fascinated by aspects of memory even as his own was failing.John was born in Aylesbury on 8 April 1932, the only child of Wilfred and Minnie Birtchnell. His father was an aircraft fitter. The family moved to Gloucester when he was five, his father taking a job in a nearby aircraft factory. John attended Sir Thomas Rich School. His schooling was interrupted when, at the age of 12, he fell from a tree, sustaining a compound fracture of his arm and nearly dying of septicaemia, being saved by the recent introduction of sulphonamides. A second medical emergency was the outcome of his quest for knowledge, when, at the age of 15, learning that six berries of deadly nightshade would be lethal, he thought it would be interesting to experience the effects of three.Already confirmed in his wish to be a psychiatrist before he studied medicine at Edinburgh University, he did house jobs in psychiatry and neurosurgery, then senior house officer posts in Liverpool in neurology and psychiatry, obtaining the Diploma in Psychological Medicine in 1963. After clinical posts at Crichton Royal Hospital (Dumfries) and St John's Hospital (Aylesbury) he went to Aberdeen. His earliest research interests were in the possible short- and long-term consequences of parental death, the topic of his MD thesis, at Aberdeen University, where he subsequently trained full time in psychotherapy, obtaining the Aberdeen University Diploma in Psychotherapy.For the remainder of his career he worked for the Medical Research Council, commencing as an MRC Clinical Research Fellow in the Department of Mental Health, Aberdeen University, where he worked on the Aberdeen Case Register, then moving in 1970 to the MRC Clinical Psychiatry Unit at Graylingwell Hospital, Chichester, under the directorship of Dr Peter Sainsbury. Here the focus was research on suicide and attempted suicide. On Dr Sainsbury's retirement in 1982, this unit was disbanded and John was relocated to the MRC Social Psychiatry Unit at the Institute of Psychiatry, London, where he worked for most of his career. After his retirement in 1998, he continued to work as an Attached Worker with the Section of Clinical Psychiatry at the Institute.British Journal of Medical Psychology (1989\u20131995) and it is a measure of his ability to work collaboratively across disciplines that, as well as being a Fellow of the Royal College of Psychiatrists, he was awarded the Fellowship of the British Psychological Society and Honorary Membership of the British Association of Art Therapists.He was the editor of the A young man preoccupied with his nose. He wrote papers on art therapy and contributed over a 20-year period to an annual residential art therapy school at Leeds Metropolitan University.John was a keen amateur artist and developed an interest in art therapy while at Aberdeen. It was there that he made a film He married Rosemary (Niven) in 1961 and they divorced in 1969. He met his second wife, Sandra, in 1970, when she came on secondment to the MRC Unit in Chichester, the courtship ritual including writing two papers together. Following marriage in 1973, they had two sons. In later years, he developed Alzheimer's disease which had a chronic course. His illness spared him the grief of the loss of his younger son in 2020. He is survived by his wife, elder son and grandson."}
{"text": "To analyze the concept of men's health care and identify its essential, antecedent and consequent attributes in the health context. This is a concept analysis structured in the theoretical-methodological framework of the Walker and Avant Model. An integrative review was carried out between May and July 2020, using keywords and descriptors: Men's Care and Health.  The concept of men's health care is structured by 240 attributes, 14 categories, 82 antecedents and 159 consequents, from the selection of 26 published manuscripts. The design was evidenced from the dimensions: Intrapersonal, psychological and behavioral related to masculinities, interpersonal, organizational and structural, ecological, ethnoracial, cross-cultural and transpersonal. The concept of men's health care revealed the male specificities regarding the recognition of the place of health care and the daily exercise in the lived experience. Most of the scientific production is directed to the hegemonic masculinity model, centered on the profile of white and heterosexual men, in which other peripheral models of masculinities that include black, poor men, residents in traditional communities and minority sexual and/or gender groups, are little present.When performing a search in global databases such as the Medical Literature Analysis and Retrieval System Online - MEDLINE/ PubMed, the absence of studies related to the health care of men was identified, as well as the development of defined concepts, in which only the presence of isolated terms and/or uniterms was recognized. In this scenario, the apprehension of the available findings justified the decision to contribute to the development of the concept \u201cmen's health care\u201d. Given the above, this study aimed to analyze the concept of health care for men and identify essential, antecedent and consequent attributes in the context of health.This is a concept analysis based on the theoretical-methodological model of Walker and Avant, whose composition is systematized in eight stages, namely: 1. Selection of the concept; 2. Delimitation of the objectives of the analysis; 3. Identification of the use of the concept in the literature; 4. Determination of essential attributes; 5. Identification of the model case; 6. Identification of contrary cases; 7. Identification of the background and consequences of the concept under analysis and 8. Definition of the empirical references of the developed concept.As proposed by Walker and Avant in the first stage, it was defined as a question for the development of the concept: How can men's health care be conceptualized? Thus, we adopted the inclusion criteria of the reviewed studies to achieve development, namely: having been produced in the area of health sciences, social sciences and humanities; presenting health care involving the male public as the centrality of the object/concept and composing relevant findings for the development of the concept in the health field. In the second stage, the objective was defined, followed by the third and fourth stage, which consisted of the theoretical exploration of the conceptual attributes. An integrative review was carried out on the elements that make up men's health care, in order to investigate the existence of theorized concepts, employment, frequency of appearance, adequacy, correlation and the definition of these in the literature. In order to compose the textual corpus of the study, the stages proposed by Mendes, Silveira and Galv\u00e3o were adopted, namely: 1. Definition of the review question; 2. Search and selection of primary studies; 3. Extraction of data from primary studies; 4. Critical evaluation of primary studies; 5. Summary of the review results; 6. Presentation of the review.The questions adopted for data extraction in the literature were defined through the PICo strategy, whose acronym means: Population/Problem: Man; Interest: Essential, antecedent and consequent attributes; Context: Health care,Three stages were structured for the organization of search strategies. To this end, the search strategy was used: \"Men's health\" AND \"Care\" in the Virtual Health Library (VHL) to find uncontrolled descriptors contained in the articles of interest. Then, there were combinations of controlled descriptors, obtained in the Health Sciences Descriptors (DeCS) and uncontrolled, obtained in the initial search, plus the Boolean operators \"OR\" and \"AND\". Finally, this strategy was adapted for each database .The search and selection of the studies were carried out from September to December 2021, by two researchers who were authors of the study, independently, and the divergences were resolved by a third researcher. The following databases were used: MEDLINE/PubMed, CINAHL, LILACS, BDENF, Scopus, Web of Science and SciELO. For the management of the collected material, the Endnote was used. The selection of studies followed the recommendations of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) method,For the development of the concept, we extracted from the empirical data: definition, concept, and antecedents, essential and consequent attributes. In this context, the defining essential attributes are configured in words or expressions that are used to structure the essential properties that determine the concept of interest, which makes it individualized from other existing analogous and/or approximate concepts. The antecedents and consequences of this concept are outlined as situations, events and/or incidents, which emerge a priori and a posteriori, in due order, the phenomenon of interest investigated, which results as a consequence, in this case, the health care of men. After this stage, the data were codified and allocated into analytical categories, in which the essential attributes of men's health care were composed of characteristics: Intrapersonal, psychological and behavioral related to masculinities, interpersonal, organizational and structural, ecological, ethnoracial, cross-cultural and transpersonal.The analysis of the results of the review evidenced in the literature was descriptive, in which the synthesis of each study included in the review was presented, as well as comparisons between the studies. In addition, a thorough and exhaustive analysis of the direct relationship between the elements and the phenomenon investigated was carried out. The structuring of the development of the concept of health care for men is organized in the presentation of the scientific productions selected for the composition of the corpus of analysis, followed by the exposure of the use of terms related in the literature in different areas of knowledge, the delineation of the derivation/development of the concept from its essential attributes, the definition of the concept, the antecedents and consequences, the model case and the otherwise.The identification of the use of terms related to the concept of health care of men present in the literature was organized by the appearance in the areas of knowledge, expressed in When based on the survey, selection and dissection of the literature on the subject, submitting it to the derivation for the development of the concept, the essential attributes related to the health care of men were apprehended, represented in model case was developed, described below: [...] \"Adult man has observed his body, his mind and spirit daily, which made it possible to recognize a drop in his income at work. When experiencing pain and changes in sexual dynamics, he talks to his partner; he seeks to consume foods that he believes can increase potency, indicated by friends. He reflects on what occurs to him and seeks to recognize the place of this pain, and the reasons for its occurrence, later, he tries to change the pace of his activities, adopts physical exercises and relaxation; he tries to think of positive situations. He uses the references of care experienced in the past, seeks guidance from significant people, family, friends, co-workers and neighbors; he adopts integrative and complementary practices, seeks assistance in traditional spaces and in health services. He recognizes himself as vulnerable, external to his desires, fears, and concerns and expresses his feelings and emotions. He reveals the tensions between his state and the pressures of hegemonic masculinities. When feeling afraid of becoming ill, he resorts to his socio-affective, environmental, bioenergetic, ethnic/racial, cultural, spiritual and/or religious network, and allows himself to be cared for by others to face the adverse situation and reintegrate into his daily activities that make up his sociohistory\u201d. In order to illustrate the operability of the applicability of the concept of men's health care, a is presented, as follows: [...] \u201cAdult man realized that he has not been yielding at work as before, he feels constant pain but takes medication on his own or drinks a beer. He believes that this discomfort will pass, because he thinks he is strong enough to overcome this situation and continue working in the same way. When he realizes that tiredness affects his sexual activity, he avoids intimate encounters and touching this aspect with his partner. Sometimes he is afraid of getting sick, he feels irritated and he feels confident not to cry, he thinks about seeking help, but soon gives up thinking about it he can solve this situation alone and goes back to work\u201d.As a way to illustrate the non-operability of the concept of men's health care, the opposite The structuring of antecedents and consequences for the health care of men are represented from the qualification as harmonious and disharmonious, when considering their characteristics in relation to health care. The antecedents of the concept were structured in dimensions: intrapersonal , interpersonal, macrosocial, ecological, ethnic-racial, cross-cultural and transpersonal, which relate to the interactions described below: Intrapersonal : Illness; autonomy and independence; cycles and/or phases of life; personal beliefs; male beliefs; food and body culture; diseases; male identity; normative models; intelligible practices; performances; subsistence; male universe; force vectors; experiences.Interpersonal (socio-affective interaction): Discursive fields; affective determinants; medical discourses; femininity; female historical-cultural reference; medical guidance; therapeutic plans; marital, family, maternal, paternal and socio-affective relations; references of care; sexualities; female universe.status; urbanization.Macrosocial (interaction with structures of society): Accesses - diagnostic tests, internet, health services; social environment; provided by institutions; conjuncture; daily life; contexts - social and life; social constructions - gender - masculinities; social class; culture; social determinants; city dynamics; factors - generational, historical, political, risk; communication - cellular telephony; social imaginary; social metaphors; health care models; world of work - conditions, locations, value; organization of health services; social organization; health plan; family provision; racial relations; wealth; economic situation; social Ecological (interaction with the environment): Animal and plant coexistence; emigration and migratory flows; territorial and regional insertion; geographical location; nationality; agricultural, environmental, ecological and ethnic relations.Ethnic-racial: Ethnic-centered experiences; ethnic teachings; ethnic acculturation.Cross-cultural (interaction with culture): Adoption and influence of local customs and popular knowledge.Transpersonal: Adoption of beliefs and philosophies; desires around personal fulfillment; ancestral, spatial, spiritual, faith and religious influences; ways of existing, seeing care, health and living life; ritual practices.The consequent of the concept were structured in dimensions: intrapersonal , interpersonal, macrosocial, ecological, ethnic-racial, cross-cultural and transpersonal, described below:Intrapersonal: Healthy and balanced eating; abandonment of habits harmful to health and/or addictions; adoption and directing efforts to promote a healthy lifestyle and habits, preventive care with physical and mental health, aesthetics, relaxation, leisure, daily measures to control diseases, improvement of sleep pattern; learning, perception and concern with health care; self-examination; evaluation of signs and symptoms; knowledge of the body; control in food consumption, weight, metabolic levels, blood perfusion; moderate consumption of alcoholic beverages; dedication to work and the family; decrease in exposure to the risks of greater health problems, the emergence of diseases and aggravation of others already existing; elaboration of individualized forms of care; adequate coping with the effects and treatments of diseases; emission of healthy behaviors; positive coping with the disease and/or health problems; hydration; hygiene; independence for self-care; management of intrapersonal barriers to care; manifestation of emotions and feelings; maintenance of the practice of positive attitudes towards oneself, life, health status, good functioning of the body and continuity of care and healthy longevity; changes in health behaviors; objectification of care, health and life; personal organization and care routines; health promotion, physical, psychosocial and spiritual well-being and health prudence; recognition of the importance of health care; rest; subversion; personal and symbolic appreciation; zeal.Interpersonal: Adherence and regular monitoring of consultations and/or interventions and/or prescriptions and/or treatments and/or health-disease-aggravation therapies, implemented by professionals in health services; Adherence to available family support; Adoption of care with the home environment; Support received and provided to loved ones/family members; Care of the other; Care for sexual and reproductive health; Child and/or child care; Being with the other; Establishing relationships with and between people; Affective involvement and/or manifestation of affection; Establishment and strengthening of trust and family and socio-affective bond; Interaction with health professionals; Immunization; Modeling of good behavior with others; Practice of physical activity and/or physical exercises; Obtaining referrals from health services; Participation in activities offered in the health service ; Preservation of marriage and harmony of the home and health habits arising from conjugality; Medical search for diagnosis; Conducting diagnostic tests; Recreation and/or socialization with friends; Overcoming weaknesses caused by widowhood; Use of medications according to medical prescription and/or safe recommendation; Use of primary health services.Macrosocial: Access to attractions in the community; support received in the workplace; search for help from others; search for improvement in quality of life; sharing with the social other; collective coexistence; work performance; willingness to obtain social support; engagement in intellectual activities; involvement in social projects; exercise of good coexistence and company; strengthening with the social network; engagement in labor and union activities; structuring of modes for care, health and life; establishment of levels of care and health care; management of responsibilities towards the family; management of barriers imposed by daily, by work, by the health system and by economic/financial difficulties; maintenance of functional and work capacity; improvement of social skills; motivation to attend public spaces; participation of group activities in the community and/or educational groups; promotion of future reduction of spending on health; promotion of social and work well-being; provision of material resources for care to occur; preservation of the workforce; reduction of the pace of daily activities and work; overcoming patriarchal values and gender barriers, masculinities and other social character; use of informational support in access to guidance and instruments arising from social incentive; healthy life.Ecological: Agricultural cultivation; ecosophy; establishment and/or closer ties with the environment/earth; environmental preservation.Ethnic-racial: Racial self-affirmation; good ethnic coexistence; establishment of mechanisms for overcoming and combating racism and racial discrimination; strengthening of ethnic relationships; valuing knowledge, cultures and ethnic traditions.Transcultural (interaction with culture): Ancient knowledge transmitted from generation to generation; search for traditional knowledge; preservation of family traditions; overcoming cultural barriers; use of teas and products and/or natural and/or home remedies from traditional and/or ancestral popular knowledge.Transpersonal: Achievement of happiness; accumulation and/or acquisition of life experiences; well-being; search for help, assistance and/or spiritual and life healing; search for balance; going to church; participating in religious groups; promotion of spiritual well-being.\"The health care of men is a set of conceptions, attitudes and practices, which is structured individually and/or collectively in the intrapersonal, behavioral, interpersonal, macrosocial, ecological, cross-cultural, ethnocultural and transpersonal dimensions in a given socio-cultural and territorial inscription. This care is directed both individually and collectively to men and by themselves, based on the beliefs and expectations about the male being in the world. In the individual sphere and experience, care is manifested anchored in the notions of the productive and sexual body, in an intersubjective and psycho-emotional way, which involves values, self-recognition of the need to take care of oneself, singular experiences, search for personal fulfillment, ethnic agreement and transcendence. In the collective sphere, interpersonally care is manifested in interactions with its socio-affective network; community, environmental and culturally emerges and is expressed under the influence of the social construction of masculinities and femininities, of ecosystemic and socio-historical experiences\u201d.From the identification of the attributes of the concept of \u201cmen's health care\u201d, the stage of conceptual definition was carried out. The concept developed showed that the health care of men is based on previous references and is structured in male and female learning of gender, which outline attitudes, behaviors, stereotypes and practices that demarcate impressions of the place of man in the ways of being, of seeing himself, health, care, environment and life: [...] -When raising the essential attributes of the concept of men's health care, the expressiveness of existing phenomena was observed, which had different ramifications and origins, which led us to outline structures that were based on the dimensions of men's being and existence in a given socio-historical, cultural, gender and masculinities context, sexual identities, territory, schooling, age and generation, race/color/ethnicity, the world of work, daily and complex life and social class.-To develop the concept from the identification of essential attributes, it was noted in the material that there was a greater centrality and frequency of appearance of findings related to men's health care with regard to the set of actions, attitudes, characteristics, conceptions, components, state, motivations, orientations, perceptions, positions, feelings and experiences arising from the identity constructions of men. In addition, they were also linked to the principles, values, subjectivities, imaginary and intelligibilities that strongly guided the construction of habits and lifestyle in relation to health care.The health care of men reserves great centrality in the individual sphere of the subjects, which has a significant approximation with the hegemonic aspects of masculinities, when gender norms based on patriarchy and machismo are printed. Such findings may result in harm to the self-care of health by influencing the adoption of isolated, unsafe care measures, as seen in the context of male self-medicalization, the removal of this public from health services, resistance to adherence to health therapies and prevention strategies. ,-,,-,-,,,,,Although the studies were developed between the 1990s and 2000s, men of different ages were investigated, and even the most current studies, there was a marked nuance for the exercise of biophysiological care, corporeality.-,,-,,,-Regarding the dimension of interpersonal essential attributes, we observe the presence of communication phenomena, the relationship that men establish with and among people who are in their cycle and/or socio-affective network.-locus of social and political inscription.,-status and responsibilities required and the way these elements influence the health care of men-The essential macrosocial attributes are related to phenomena arising from occupation, family, socioeconomic level, culture, values and social ideologies and evolutionary relationships of intra and interpersonal character of society. Men's health care is closely linked to the dynamics of the world of work, social class, mobility, exchanges, social conflicts, as well as emerging from ways of life, everyday life and complexity. In this sense, the attributes reveal the emergence of processes such as assemblages, cultural influences, representations, life stories, objectification, organization, daily life, ethics, the health-disease process, health promotion, quality of life, social responses, routines, experiences and vulnerabilities.,,,,When trying to identify essential attributes and frame them in ecological dimensions, in which the presence of a health care interconnected to the habitat, the ecological niche and the intimacy of men with the maintenance of the ecosystem was observed, specific phenomena were glimpsed. In this way, the preservation of local customs, the position of being in community, ecosophy, the relationship with the physical and social, animal and vegetable environment, as well as the presence of the interrelationship with space, the world, nature, organisms and the earth, were identified.,(-),,,-,,-(53)It was also noted the incorporation of attributes related to ethnic and cross-cultural dimensions, seized in studies whose male population investigated was permeated by the influence of structural markers of age and generation - elderly men, territory - rural, riverside and peasant men and race/color - black men.The concept of men's health care involved the following dimensions/aspects: intrapersonal, psychological and behavioral related to masculinities, interpersonal, macro-social, ecological, ethnic-racial, cross-cultural and transpersonal. In addition, the impact of this study is based on the advancement of scientific knowledge on the subject and the potential for feasibility in generating contributions to health science and practice, whether from an epistemological and conceptual perspective, or to practice from the reformulation of public policies, orientation of the service and health care and construction of care technologies. The concept analyzed can be useful to support the practice directed to the health care of men in the various scenarios of action, in the field of nursing and health, strengthening the structuring of instruments for clinical care, teaching, research and development of public policies for men, considering the antecedents, attributes and consequences of the care of this population."}
{"text": "MEFV mutations. Up to now, however, no nationwide research of autoinflammatory diseases with standardized contents which can integrate with data of other international studies has been performed in Japan.In recent years, responsible genes for autoinflammatory diseases have been increasingly known and clinical phenotype-genotype correlations of these diseases have been explored through international clinical databases such as EUROFEVER project. However, clinical features of genetic disorders could be affected by countries and races of the patients. Actually, patients with Familial Mediterranean fever in Japan show the different distribution of both clinical features and We have established autoinflammatory diseases database in Japan. In this research, we designed this database for integration with that of EUROFEVER project in cooperation with Pediatric Rheumatology international trials organization. This integration will enable us to evaluate clinical features and genotypes of autoinflammatory diseases patients in Japan in comparison with the European patients, which will provide further evidences of these diseases, leading to appropriate diagnosis and treatment for the affected patients.Most of diagnoses of the patients with autoinflammatory diseases in Japan have been performed in the central specialized hospitals. In this research, we have collaborated all these hospitals and will collect the patients diagnosed as autoinflammatory diseases through these hospitals. In addition to the diseases devoted to EUROFEVER project, other candidate diseases such as Nakajo-Nishimura like syndromes are included. Inclusion criteria and database contents of the patients are designed by reference to that of EUROFEVER project. Patients\u2019 information will be obtained from collaborated hospitals and the hospitals which actually will treat the patients. Before participation of this study, each collaborated hospital conformed to institutional review board of each hospital and the Declaration of Helsinki.Pilot study using paper-based registrations and questionnaires has been closed, and this analysis is ongoing. Now this research is in the transition to web-based system. We hope to show these results in Autoinflammation 2013.We have established autoinflammatory diseases database in Japan. This research is ongoing now.T. Kawai Grant / Research Support from: the Japanese Ministry of Health, Labor and Welfare, R. Nishikomori Grant / Research Support from: the Japanese Ministry of Health, Labor and Welfare, M. Awaya: None declared, K. Nakagawa Grant / Research Support from: the Japanese Ministry of Health, Labor and Welfare, K. Izawa Grant / Research Support from: the Japanese Ministry of Health, Labor and Welfare, T. Yasumi Grant / Research Support from: the Japanese Ministry of Health, Labor and Welfare, O. Ohara Grant / Research Support from: the Japanese Ministry of Health, Labor and Welfare, T. Heike Grant / Research Support from: the Japanese Ministry of Health, Labor and Welfare"}
{"text": "Aquatic Biosystems. We welcome submission of original research manuscripts, reviews, and commentaries to the journal.Aquatic biological systems are a critical part of the structure and function of earth's biosphere. While attention of the scientific community is often focused on the reaction of biological systems to changes in the environment, these systems also have profound effects, or actions, on the environment. Throughout the evolutionary history of earth, the rise and/or fall of different aquatic biosystems has impacted the character of the biosphere. At no time have environmental changes been more important to all life on earth than in the modern era, which underscores the need for the new journal,  While the nature of the last common ancestor of all life remains enigmatic, geological evidence indicates the evolution of diverse prokaryotic microorganisms early in the earth's history. Around 3 billion years ago, the concerted metabolic activities of oxygen-evolving aquatic photosynthetic bacteria led to an oxygen-enriched atmosphere, and the development of a UV-protective ozone blanket, both of which provided the antecedents for an explosion of biological diversity and biomass. Two billion years later, the rise of larger and structurally more complex algae and aquatic plants provided new habitats and energy sources for the expansion of aquatic animal populations, which in turn formed the basis of new food webs.Subsequent shifts in the dominance structure of aquatic biological communities, driven in part by continental drift and sea level changes, influenced the chemical and geological character of the biosphere. A primary example of such a shift in dominance was the proliferation of planktonic coccolithiphores in the early cretaceous, leading to vast calcium carbonate deposits on the ocean floor and alterations in ocean chemistry. Modern studies of the ocean floor are leading to discoveries of complex communities, such as near hydrothermal vents and submarine brines, which may represent a snapshot of the early history of planet earth.Most recently, during the past few ticks of the evolutionary clock, the rapid surge in human population and development has reached a scale and dimension that can significantly alter the structure and function of aquatic biosystems, even on a global scale. The increasing and widening threats posed by the actions of human biosystems to the integrity and sustainability of aquatic biosystems highlight the importance of understanding how these systems function, and their resilience to environmental change. Understanding the aquatic microbial community and its effects on plants and animals is key to choosing a sustainable future. It is also important to place the reactions of aquatic biosystems to human actions within the context of non-anthropogenically-driven changes in the environment, such as climatic cycles.st century. Success will require open access to information and the concerted and long-term commitment of scientists, managers and policy makers. This commitment must extend to exploring innovative ways to prevent, minimize or reverse damage to aquatic biosystems, including the development of engineered biosystems aimed at renewable production of essential resources and mitigation of harmful waste materials, such as greenhouse gases, excess nutrients and pollutants. In other words, countering the consequences of negative actions with positive actions, in order to avoid negative reactions by critical aquatic biosystems.The complexity of this task will require the use of all available resources, including the wide range of technological capabilities driving basic and applied research in the 21Aquatic Biosystems. The scope of the journal ranges from the molecular and organismic levels to global systems and processes, reflecting the wide range of research in aquatic biological systems. The journal encourages reports on a wide array of environments, including lakes, rivers, marshes, springs, lagoons, solar pans, estuaries, and the open seas and ocean, and their micro- and macro-flora and fauna. The focus is on the relationships between the environment and biological systems, encompassing microbial genomics, physiology, and ecology, biogeochemical cycling, food webs, paleolimnology, biodiversity, conservation, resource management, and ecosystem structure and function. Engineered systems, such as for aquaculture, renewable resource, biofuels, biotechnology, and biomedical production, as well as constructed wetlands, are within the scope of Aquatic Biosystems.In order to facilitate communication across such an interdisciplinary spectrum, we launch the new Open Access independent journal named Aquatic Biosystems is to bridge across freshwater and saline systems, between basic and applied research, and from gene systems to ecosystems. The online Open Access format of the journal is designed to accelerate the process of disseminating important research results and information, in order to better meet the needs and demands of the highly dynamic and global science, management, and private sectors. We invite our international community of fellow scientists to contribute to Aquatic Biosystems.The goal of"}
{"text": "The authors would like to acknowledge Matt Ardito and Annie De Groot of EpiVax, Inc.  for providing the predictions that were used to synthesize the tetramers. None of the authors are affiliated with EpiVax, Inc. Epivax, Inc. had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript, aside from the above-mentioned contribution. The authors have declared that no competing interests exist."}
{"text": "Francisella tularensis. The agent was named after Tulare County, California, where the agent was first isolated in 1910, and Edward Francis, an Officer of the US Public Health Service, who investigated the disease. Dr. Francis first contracted deer fly fever from a patient he visited in Utah in the early 1900s. He kept a careful record of his 3-month illness and later discovered that a single attack confers permanent immunity. He was exposed to the bacterium for 16 years and even deliberately reinfected himself 4 times.An infectious, plaguelike, zoonotic disease caused by the bacillus Tularemia occurs throughout North America, many parts of Europe, the former Soviet Union, the Peoples Republic of China, and Japan, primarily in rabbits, rodents, and humans. The disease is transmitted by the bites of deerflies, fleas, and ticks; by contact with contaminated animals; and by ingestion of contaminated food or water.Clinical manifestations vary depending on the route of introduction and the virulence of the agent. Most often, an ulcer is exhibited at the site of introduction, together with swelling of the regional lymph nodes and abrupt onset of fever, chills, weakness, headache, backache, and malaise."}
{"text": "That year there were many deaths in the village.Germs flew like angels from one house to the nextand every family gave up its own. Mothersdied at their mending. Children fell at school.Of three hundred twenty, there were eleven left.Then, quietly, the sun set on a day when no onedied. And the angels whispered among themselves.And that evening, as he sat on the stone steps,your grandfather felt a small wind on his neckwhen all the trees were still. And he would tell usalways, how he had felt that night, on the skinof his own neck, the angels, passing.Copyright 2004 by Lola Haskins. Reprinted from Desire Lines: New and Selected Poems, BOA Editions, 2004, by permission of the author and the publisher through American Life in Poetry, an initiative of Ted Kooser, the 2004-2006 poet laureate consultant in poetry to the Library of Congress; the American Life in Poetry project is supported by The Poetry Foundation, The Library of Congress, and the Department of English at the University of Nebraska-Lincoln."}
{"text": "Environmental Health Perspectives in 2004  for Meat, Poultry, and Egg Products, administered by the USDA [U.S. Department of Agriculture] FSIS, is an interagency program designed to identify, rank and test for chemical contaminants in meat, poultry, and egg products.They continue,The NRP requires the cooperation and collaboration of several agencies for its successful design and implementation. The USDA FSIS, the EPA [U.S. Environmental Protection Agency], and the Department of Health and Human Services (DHHS) FDA are the primary federal agencies managing this program. The FDA, under the Federal Food, Drug, and Cosmetic Act, establishes tolerances for veterinary drugs, and action levels for food additives and environmental contaminants. The EPA, under the Federal Insecticide, Fungicide, and Rodenticide Act , establishes tolerance levels for registered pesticides\u2026. Representatives from FSIS, FDA, EPA, the USDA Agricultural Research Service (ARS), the USDA Agricultural Marketing Service (AMS), and the DHHS Centers for Disease Control and Prevention (CDC) collaborate to develop the scheduled sampling program.Setting and enforcing safety levels involves several steps, one of which is the collection of meat and poultry samples, followed by statistical analysis, interpretation, and action. The NRP sampling plan is designed to identify samples with residues above the allowed levels. The data are then analyzed as categorical values . Current methods of data analysis do not include estimation of mean values that can then be extrapolated to the national food supply. It was by analyzing the data as a continuous variable that my coauthors and I were able to describe the high levels of arsenic in chicken in 2004 .Concerns about arsenic levels in chicken are of increasing importance because of the increased per capita consumption of chicken over the past decade ."}
{"text": "The understanding of the decision-making process in the introduction of new vaccines helps establish why vaccines are adopted or not. It also contributes to building a sustainable demand for vaccines in a country. The purpose of the study was to map and analyze the formal decision-making process in relation to the introduction of new vaccines within the context of health policy and health systems and identify the ways of making decisions to introduce new vaccines in Bangladesh. During February-April 2011, a qualitative assessment was made at the national level to evaluate the decision-making process around the adoption of new vaccines in Bangladesh. The study population included: policy-level people, programme heads or associates, and key decision-makers of the Government, private sector, non-governmental organizations, and international agencies at the national level. In total, 13 key informants were purposively selected. Data were collected by interviewing key informants and reviewing documents. Data were analyzed thematically. The findings revealed that the actors from different sectors at the policy level were involved in the decision-making process in the introduction of new vaccines. They included policy-makers from the ministries of health and family welfare, finance, and local government and rural development; academicians; researchers; representatives from professional associations; development partners; and members of different committees on EPI. They contributed to the introduction of new vaccines in their own capacity. The burden of disease, research findings on vaccine-preventable diseases, political issues relating to outbreaks of certain diseases, initiatives of international and local stakeholders, pressure of development partners, the Global Alliance for Vaccines and Immunization (GAVI) support, and financial matters were the key factors in the introduction of new vaccines in Bangladesh. The slow introduction and uptake of new vaccines is a concern in the country. Rapid action on the application of GAVI support and less time taken by the Government in processing the implementation and administrative work may expedite the introduction of new vaccines in future in this country. Immunization, a proven tool for controlling and eliminating life-threatening infectious diseases, can avert 2-3 million deaths each year globally. It is one of the most cost-effective health investments . UniversHaemophilus influenzae type b (Hib), hepatitis B (Hep-B), pneumococcal conjugate vaccine (PCV), and rotavirus vaccines are particularly geared toward children of developing countries where the burden of disease is high . New vaccines tend to be considerably more expensive than existing vaccines, and some targeted diseases are relatively \u2018hidden\u2019 and, therefore, may lack demand from public and political perspectives . The sloTo control the vaccine-preventable diseases, the Government of Bangladesh has been working to expand the EPI by introducing new vaccines. Bangladesh introduced the pentavalent Hib vaccine in January 2009 to prevent severe child pneumonia and meningitis. However, the formal decision-making process in relation to the adoption of vaccines was never studied in Bangladesh. The purpose of the present study was, therefore, to map and analyze the formal decision-making process in the introduction of new vaccines within the context of health policy and health systems and identify the ways of making decisions to uptake new vaccines in the country.During February-April 2011, a qualitative assessment was made at the national level to assess the decision-making process in relation to the adoption of new vaccines in Bangladesh.For policy analysis of the decision-making process in the adoption of vaccines, the study included: policy-level people, programme heads or associates, and key decision-makers of the Government, private sector, non-governmental organizations (NGOs), and international agencies at the national level.In total, 13 key informants were purposively selected from relevant government, non-government and international agencies, and most informants were the members of any or more committees on EPI.Data were collected by interviewing key informants and reviewing secondary documents.Key informant interviews: Considering the complexity of the decision-making process as it is driven by many different factors and involves multiple actors, the key informants were selected from the Ministry of Health and Family Welfare (MoHFW); Ministry of Local Government, Rural Development & Co-operatives (MoLGRD); Ministry of Finance; Directorate General of Health Services (DGHS); EPI; Dhaka City Corporation; World Health Organization (WHO); United Nations Children's Fund (UNICEF); representatives from different committees, including National Committee for Immunization Practice (NCIP), Scientific and Technical Sub-committee (STSC), Inter-agency Coordination Committee (ICC), National Steering Committee for Polio Eradication and Measles Control (NSCPEMC), and NGOs. Data were collected from the actors involved in decision-making on the following: time taken in decision-making, factors that influence decision-making, decisions on financing and barriers faced in the introduction of new vaccines, steps taken to solve the problems, why vaccines are adopted or not, and demand for new vaccines.Review of secondary documents: Secondary documents relating to the adoption of new vaccines were collected and reviewed. Types of documents reviewed included: comprehensive multi-year plan of the national immunization programme of Bangladesh for 2006-2010 and 2011-2016, systems research relating to EPI, policy analysis-related documents on new vaccines, immunization surveillance system-related documents, unpublished documents relating to upcoming vaccines, and minutes of meetings of different committees.Secondary data: Evidence from the review of policy documents provided general information necessary to describe the general context and introduction of new vaccines.Analysis of qualitative data: Analysis of qualitative data began following the initial data collection from the field and led to refinements as the study progressed. The interviewers prepared transcripts after the completion of each interview. At first, the transcripts were carefully read, the main findings were listed, and then the coding of main findings was carried out. After reading, re-reading, and coding the texts, the main themes were begun to formalize. Each theme was then examined separately and fully within the available data.The respondents were interviewed after obtaining their informed consents. Efforts were made to ensure that all respondents were properly informed about the study and they thoroughly understood their involvement. Participation was voluntary. The participants were ensured that refusal would have no adverse consequences for them. They were also assured that the information provided by them would be used for research purposes only and would not be shared anywhere by their names. Interviews were conducted according to the convenience of the respondents.The Research Review Committee and Ethical Review Committee of icddr,b approved the study before its implementation.The Government of Bangladesh is the main actor in making decisions on the introduction of new vaccines. The respondents mentioned that the key people involved in decision-making are: Director, Primary Health Care (PHC); Programme Manager, EPI; and Director General, DGHS. Their roles included the formulation of policy about the implementation of the existing EPI vaccines and taking initiatives for the introduction of new vaccines. They are also the key persons in all national-level EPI-related committees. The Joint Secretary, PHC-WHO at the MoHFW and the Joint Secretary, Budget, at the Ministry of Finance are particularly important. Although they do not participate in different forums relating to the introduction of new vaccines, their signatures in the Global Alliance for Vaccine and Immunization (GAVI) application for the introduction of new vaccines are essential.According to the key informants, the academicians also play important roles in introducing new vaccines. The academicians included professors of paediatrics, immunology, virology, and liver transplantation. Most respondents reported that high value is given to the opinions of the academicians in relation to the introduction of new vaccines. They stated that, if the specialists and academicians do not agree with the introduction of any vaccine, the concerned authority would not approve its introduction.All the informants reported that the introduction of new vaccines is determined based on scientific evidence. They stated that researchers and scientists are very important in providing scientific information on the need for the introduction of new vaccines. Most respondents mentioned the contribution of researchers in the introduction of the Hib vaccine. They said that, before the introduction of the Hib vaccine, good data were available to understand the burden of disease. According to them, a survey was conducted by the international research institutions and medical colleges. Findings of studies provided information on the burden of diseases and the need for the introduction of Hib vaccine. They shared the findings with the policy level, which influenced the introduction of the vaccine in the country. The respondents informed that the researchers conduct studies and make recommendations to determine which vaccine should be introduced on a priority basis.Representatives from different professional associations play an important role in the introduction of new vaccines. The associations included: Bangladesh Paediatric Association, Bangladesh Medical Association (BMA), and Bangladesh Hepatological Society (BHS). Some of them are members of different committees on EPI, and they influence in introducing a new vaccine. One respondent said:You know.\u2026BHS has been pressurizing the Government to introduce Hep-B birth dose. At a certain point, our Hon'ble Health Minister became convinced about it, and he is in favour of introducing it at least at the facility level before its introduction at the outreach centres.The informants stated that the media generally do not have a major role in the introduction of new vaccines. The media play roles in the implementation of a new vaccine but their role in decision-making is minor. Normally, the vaccines are introduced in phases. The respondents mentioned that the reason for the lower level of influence of the media is that, if the media are involved in decision-making, they may publicize about the vaccine all over the country, which may create confusion among the people.All key informants reported that the development partners, especially WHO, UNICEF, and GAVI, play important roles in introducing a new vaccine in Bangladesh. The other development partners, such as World Bank, USAID, and UK-AID, are also the key actors in this regard. WHO and UNICEF provide technical support to Director, PHC and Programme Manager, EPI, about initiation and preparation of GAVI application, capacity assessment of cold-chains, and implementation of a new vaccine. Some key informants stated that the role of WHO and UNICEF is more important than the Government in terms of the introduction of new vaccines. They said that no matter whether the Government is interested or not but if WHO desires, they can introduce a vaccine in BangladeshIn response to a question about the role of GAVI, the respondents mentioned that the GAVI mainly provides financial support for the introduction of new vaccines. They also added that the GAVI has some priority vaccines to introduce. If their requirements are fulfilled, they support us and provide vaccines.The GAVI funds are used under the guidance of ICC. The ICC consists of members from different governments and NGO stakeholders. Secretary, MoHFW, is the chairperson of the committee. Other members include: Director General of DGHS; Director General of Family Planning (DGFP); Joint Secretary (PHC and WHO); Programme Manager, Child Health and Limited Curative Care; and Deputy Secretary of the MoHFW. The members of the ICC from other sectors include: Joint Secretary, Local Government Division, MoLGRD; Joint Secretary, Finance Division, Ministry of Finance; Director  of the Ministry of Environment; Secretary, National Polio Plus Committee of Rotary International; development partners, such as WHO, UNICEF, USAID, World Bank, UK-AID, JICA, Royal Netherlands, and Sida; representatives from NGOs; and others, such as icddr,b, Save the Children-USA, Immunization Consultant, and GAVI. ICC is part of the decision-making body in the introduction of new vaccines.In Bangladesh, the NCIP formulates policy and monitors the EPI. It is the final body for taking steps in the introduction of new vaccines. The committee is chaired by the Secretary of MoHFW. Other members of the committee include: Director General, DGHS; Director General, DGFP; Joint Secretary ; Joint Chief (Planning); and Directors and Programme Managers, EPI, MoHFW. Other members also include professors at different medical colleges, representatives from professional associations, and development partners. The committee plays a vital role in making decisions on the introduction of new vaccines.Under the supervision of the NCIP, the STSC has been formed to review the policy of EPI. Director General, DGHS, is the chair of the committee. Other members of the committee include: Directors of National Institute of Preventive and Social Medicine (NIPSOM), Institute of Epidemiology, Disease Control and Research (IEDCR), PHC, Maternal and Child Health, MoHFW; Professors at medical colleges; Programme Manager, EPI; representatives from professional associations; and representatives from WHO and UNICEF. The issue of introduction of new vaccines is first discussed in this committee for further processing.Information on the burden of disease from research organizations leads to initiation of the process of introducing a new vaccine. Whenever information on the burden of disease comes from researchers and the Government and other technical personnel become convinced, the Government starts the process of introducing a new vaccine. The first step in the process of introducing a new vaccine is to discuss it in the STSC. The STSC also discusses about the possible funding sources, GAVI support, cold-chain capacity, and sources of other support in introducing the vaccine. If the STSC is satisfied and approves, a proposal is sent to the NCIP for its approval. Whenever the approval is provided from the NCIP, steps are taken to apply for GAVI support for the introduction of the vaccine. Before submitting the GAVI application, the ICC must endorse the proposal .The respondents informed that whenever the NCIP and ICC approve the introduction of a new vaccine, the EPI headquarter starts the preparation of GAVI application for support. After receiving the complete application, the GAVI reviews it and sends it back with their comments and queries for clarification. After having satisfactory responses to their comments, the GAVI approves the application for the introduction of a new vaccine .The respondents actively involved in the preparation and submission of the GAVI application informed that almost two years are normally required to start the implementation of a vaccine after the submission of an application to the GAVI. The GAVI generally sends their comments six months after receipt of an application. It also takes some time to address the comments provided by the GAVI and resend the application to them. After resubmission of the application, it requires again around six months for the GAVI to take a decision and inform of their approval. According to the respondents, almost another one year is required to complete all the formalities and administrative work to start the implementation of the vaccine. The respondents from the EPI informed that they submitted an application to the GAVI for its support for the introduction of the Hib vaccine in 2007 in Bangladesh, which was finally implemented in 2009.The prevalence and burden of disease, findings of research on vaccine-preventable diseases, active participation of all key stakeholders, political issues relating to outbreaks of certain diseases, initiatives from international and local stakeholders, pressure from development partners, financial matters, and the GAVI support are the key factors that influence the introduction of new vaccines in Bangladesh. All the key informants stated that the GAVI, WHO, UNICEF, and other development partners have influenced the introduction of new vaccines. These international stakeholders not only influence by financing the introduction of new vaccines, they also provide technical support to the Government for the introduction.The political issues relating to the outbreaks of certain diseases also influence decision-making. Some key informants stated that, in 2009, the newly-formed political government felt certain pressure of the Haemagglutinin type 1 and Neuraminidase type 1 (H1N1) pandemic in Bangladesh. At that time, the H1N1 pandemic became a political issue through the media coverage. Without any analysis of mortality and morbidity due to H1N1, the Government had to take decision to bring the H1N1 vaccine in the country to reduce the public panic prevalent at that time.Most respondents stated that the financial factor is important for introducing new vaccines because new vaccines are usually more costly than the traditional vaccines. For introducing any new vaccine, the Government needs support from the development partners, particularly from the GAVI. The respondents also acknowledged the GAVI's contribution to two vaccines previously introduced, such as Hep-B and Hib. They stated that the Government can co-finance in introducing the new vaccines.In Bangladesh, while introducing new vaccines, decisions are jointly taken by the Government, academicians, researchers, representatives from different professional groups, and development partners. The Government, however, plays the key role. Without the contributions of other groups mentioned above, new vaccines might not be introduced in the country. The MoHFW initiates and forwards the GAVI application for a new vaccine after being vetted by the expert academicians. The researchers help the Government by providing relevant information to the policy-makers on the burden of disease, gathered from different studies and demand for new vaccines. The professional groups contribute to providing expert opinions about the introduction of new vaccines. The development partners, especially WHO and UNICEF, provide technical support to the concerned department of the MoHFW in the initiation and preparation of GAVI application, assessment of cold-chain capacity, and implementation of a new vaccine. The study participants mentioned that the role of WHO and UNICEF is remarkable in the introduction of new vaccines. All the actors work with positive attitudes toward the introduction of new vaccines. No negative attitude was observed among any actor involved in the introduction process of a new vaccine.The process of introducing a new vaccine contributed to establishing a formal procedure in Bangladesh. Whenever information on the burden of disease becomes available from researchers and the Government and other technical personnel are convinced, the Government starts the process of introducing a new vaccine. The first step in the process is to discuss it in the STSC. The STSC also discusses about the possible funding sources, GAVI support, cold-chain capacity, and support from other sources in introducing the vaccine. If the Sub-committee is satisfied and approves, a proposal is sent to the NCIP for its approval. When the approval of the NCIP is accorded, steps are taken to apply for GAVI support for the introduction of the vaccine. Before submitting the GAVI application, the proposal has to be endorsed by the ICC. This formal procedure became structured and functional while introducing the Hib vaccine in Bangladesh in 2009.The findings of the present study have shown that about two years are generally required to introduce a new vaccine after the submission of an application to the GAVI. The GAVI generally takes six months to send their comments to the Government. A considerable time is also needed in the resubmission of the application and making a decision by the GAVI. The findings of the study revealed that, after according approval by the GAVI, one year was required to complete all formalities and administrative work to start the implementation of the Hib vaccine. The slow process in the introduction and uptake of new vaccines is, thus, a concern in Bangladesh.The prevalence and burden of a disease, research findings on vaccine-preventable diseases, political issues relating to outbreaks of certain diseases, initiatives from international and local stakeholders, pressure from the development partners, and financial matters are the key factors in the introduction of new vaccines in Bangladesh. The GAVI, WHO, UNICEF, and other development partners influence the decision in the introduction of a new vaccine. Political issues relating to the outbreaks of vaccine-preventable diseases also influence in making decisions. The Government needs financial support from the development partners, particularly from the GAVI, for introducing a new vaccine,. The issue of co-financing helped the Government take over the vaccine cost gradually. Therefore, the system of co-financing may be considered while introducing new vaccines in the country.The GAVI Alliance's initiative to introduce new vaccines in Bangladesh is of utmost importance for children of the country. The role of Alliance in providing financial and technical resources for this purpose is crucial, especially given the high costs of such vaccines .The findings of the study indicate that slashing the funding gaps for immunization and achieving financial sustainability will require several important actions in Bangladesh. For instance, a larger public-sector budget resulting from economic growth, greater government commitments to immunization within health budgets, greater multi-year commitments from donors, reduction in vaccine prices, and a major sustained effort by the GAVI Alliance to support Bangladesh to introduce new vaccines and to permit sufficient time and planning for a transition away from GAVI support may enable Bangladesh to become financially self-sustainable. Findings of others suggest similar actions for poor countries ,18.The burden of disease, findings of research on vaccine-preventable diseases, political issues relating to outbreaks of certain diseases, initiatives of international and local stakeholders, pressure from the development partners, GAVI's support, and financial matters are the key factors in the introduction of new vaccines in Bangladesh. To expedite the introduction and uptake of new vaccines, it is important that the GAVI takes rapid action on the application for its support and the Government takes less time to complete the administrative work.The study was funded by the London School of Hygiene & Tropical Medicine (LSHTM), (Grant No. 803). icddr,b acknowledges with gratitude the commitment of LSHTM to its research efforts. The authors thank all key informants for their participation in the study. The authors also thank Mr. Wazed Ali, Senior Field Research Officer, icddr,b, for his assistance during data collection and writing of the manuscript."}
{"text": "There is a grammatical error in the Funding section. It should read: This project was generously supported by Parks Canada, the Western Transportation Institute-Montana State University (WTI), the Woodcock Foundation, the Henry P. Kendall Foundation, and the Wilburforce Foundation. Other support was provided by the National Fish and Wildlife Foundation, Alberta Conservation Association, Calgary Foundation, and the Mountain Equipment Cooperative. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."}
{"text": "Memories can be the most precious of possessions. Today I write about over 50 years of my journey with allergy. More than naming my field of specialization, allergy has been my passion, and has become, in its way, my own life's companion.My journey of love with allergy began in 1960 at the Royal Victoria Hospital in Montreal, Canada. I believe I was the first Asian to have trained under the legendary Dr. Bram Rose, a brilliant disciplinarian who was then President of the American Academy of Allergy . My husband, Dr. Manuel Lim, had begun his training in Otolaryngology at the Royal Vic under Dr. James McNally the year before. Manuel had made an appointment for me with Dr. Rose that July. I will never forget my first meeting with Dr. Rose in his office. His directives to me, a young fellow about to embark on a career in allergy, were blunt, to say the least: \"When you do not know the answer, say that you do not know it; and when you are not sure, say nothing. I cannot stand people who talk through their______.\" His colorful words are forever carved in my memory, because they amounted to a rigorous standard for working in our specialty: be accurate, tolerate no nonsense. In the decades to come, I learned to fully appreciate my training under Bram  , I owe what I am today. They form the pillars of my professional life.I was allowed to see patients after a month at Royal Vic, and after 3 months I became part of the team, presenting at journal clubs and joining research. In September 1960, 6 months after my arrival at Royal Vic, Bram sent me with the \"boys\" to Washington, DC, to attend my first American Academy of Allergy meeting at the height of winter. A generous mentor, Bram introduced me to luminaries of allergy in the 1960s , and to younger physicians who would become famous in the years to come . This early mentorship and collegiality sparked an intense desire for the pursuit of knowledge in allergy, a solid foundation for what I could become as an allergist.In 1961, Bram gave me a grant to attend my first International Association of Allergology and Clinical Immunology (IAACI) convention. It was a thrilling and terrifying experience for me, because all the \"giants\" in the field  were in attendance at New York City. In fact, the IAACI, now the World Allergy Organization (WAO) has become a tradition for me: I have not missed a meeting since 1967, the year when I also became Fellow of the American Academy of Allergy. A year after I qualified for the American Board of Allergy and Immunology in 1975, Dr. Alec Sehon nominated me to serve as member-at-large of the IAACI Executive Board a year later. It was a great privilege for me to be the first female physician to sit on the IAACI board.Let me now switch gears and describe the early decades of our specialty in the Philippines. I returned to my homeland from my training in Royal Vic in June 1963, and my arrival caused quite a stir. At that time, allergy was still considered a \"controversial subspecialty.\" Asthmatics were in the hands of pulmonologists, patients with atopic eczema/dermatitis and urticaria were being seen by dermatologists, and those suffering from allergic rhinitis were treated by Otolaryngologists. In such a situation, my friends in Manila worried about my potential patient base as an allergist. In fact, at one of my first public lectures on allergy, our specialty was dismissed by a prominent Philippine University's Chair of Dermatology who stated that \"allergy is a waste basket diagnosis.\" I was crushed, but Dr. Arturo B. Rotor, my country's first trained allergist and Assistant Dean of the University of the Philippines' College of Medicine, defended my presentation as a concise summary of the state of the field. Encouraged, I began consulting with Dr. Rotor about my idea of organizing a national society of allergy, but at that point, such a dream seemed unrealistic since there were only 5 allergists in the country.The discovery of IgE by Professors Bennich and SGO Johannson Figure  and KimiThe 1970s were a formative period for allergy in the Philippines. In the early 1970s, with the help of palynologist Dr. Pacifico Payawal and pharmacist Gloria Laserna, both formerly with the National Science Development Board (NSDB), I conducted pioneering pollen surveys in 5 regions of the Philippines and mold surveys in Metro Manila. I conducted these studies because, as Oren Durham once said, \"the allergist must know his pollens.\" Morris Webb of Hollister-Stier laboratories and Dr. Bob Esch of Greer laboratories created extracts from the local pollen fiora I supplied, while with the help of Dr. Vin Bristow, the Commonwealth laboratories of Australia, Dr. John Trinca, and Kathy Stringer, we were able to analyze and identify Philippine house dust mites. Three pioneering Filipino allergists  disseminated the knowledge of allergy and immunology to urban centers and rural towns in the Philippines, using chalkboards and mimeographed handouts, speaking to both friendly and pessimistic audiences of various religious and ideological groups. A handful of pioneering researchers on allergy represented various Philippine universities: myself and Dr. Noche of the University of Santo Tomas (UST), Dr. Agbayani and Dr. A. Lingao of the University of the Philippines (UP), and Dr. Manuel Ferreria of Manila Central University. I also remember Dr. Avelina Bacnis for her principles and discretion. A Secretary of PSAI for more than ten years, Dr. Bacnis refused to be elected President. And I appreciate the contributions of another of the ten founding members of PSAI, Dr. Amelia Ochoa-Bulmer, who served as Secretary-Treasurer of PSAI and who is currently in private practice in the Philippines. At present, research is being carried on by a younger generation of Filipino allergists, among them, Dr. Agnes Gonzales-Andaya and Dr. Remedios Ong at UST, Dr. Madeleine Sumpaico at UP-Philippine General Hospital, Dr. Manuel Po and Dr. F. Padua at Fe del Mundo Medical Center and National Kidney and Transplant Institute. The PSAI became a member of the IAACI in 1976 and today, what is now called the Philippine Society of Allergy, Asthma, and Immunology (PSAAI) has nearly a hundred members. The PSAAI is in very good hands.One of PSAAIs greatest accomplishments, to my mind, is our hosting of the 1998 Third Asia Pacific Congress of Allergology and Clinical Immunology in Manila. Graced by the presence of then WAO president, Prof. SGO Johannson, and over 30 international speakers, the Congress drew a record number of attendees, with over 1300 participants from all over the world. I remain incredibly grateful to WAO for honoring me in Munich, Germany with the 2005 Outstanding Clinician Award; this was the greatest surprise of my life, and to this day I feel humbled, honored, and privileged to be so recognized. In coming to the final section of this editorial , I would like to thank Professor Lanny Rosenwasser and Sofia Dorsano for their invitation to contribute my perspective on changes in our field and the continuing importance of global exchanges to our specialty. In that spirit, I would like to offer these observations and recommendations:I would like to see the WAO continue to play a formative part in encouraging the development of national allergy societies throughout the world. For nations in what used to be called the \"Third World\" and is today referred to as the \"Global South, \" honoraria for the most distinguished and sought-after international speakers can be prohibitive. WAO's help in this regard--either through cosponsorship of speakers or organizing volunteer lecturers to speak at national allergy societies overseas--could make a crucial difference. WAO, through the World Allergy Forum and (GLORIA), has already been giving grants to national allergy societies of at least one speaker for their conventions, and I would like to see such grants expanded. A tandem between a clinical allergist and a clinical immunologist would be ideal. Locally, I believe that continuing medical education credit requirements should be mandatory for the national medical societies.In an era of transnational economic recession, many allergists who would like to attend international conventions may be barred from doing so by financial considerations. Discounts could be given to delegates from developing nations and perhaps, like the AAAAI and ACAAI, seniors  could be offered free or discounted registration. In the Philippines today, both government grants and pharmaceutical sponsors rarely underwrite the travel costs of delegates to international medical conventions; in the few occasions when they do, they tend to prioritize infectious diseases and cardiovascular and endocrine disorders to the detriment of immunology and allergy.Dr. Allen Kaplan and Dr. Carlos Baena-Cagnani, both Past Presidents of WAO, were among the first to voice the ideal of a global exchange of ideas on allergy, allowing poor and wealthy nations alike to share ideas. In my view, national allergy societies play a crucial role in both national and global exchanges, providing critical education and training for specialists and allowing collegial partnerships and discussions with other specialists. By eludicating proper management techniques, such national and transnational fora ultimately help to improve the quality of life for our patients.Felicidad Cua-Lim, MD  is the Founding President of the Philippine Society of Allergology and Immunology (1972-1978) and has served as Honorary President of the Philippine Society of Allergy, Asthma, and Immunology from 2000 to the present. She was also Founding Chair of the National Asthma Movement (1994-1996), President of the Philippine College of Physicians (1996-1997), and President of the Asia Pacific Association of Allergology and Clinical Immunology (1998-2000). In addition to being named Outstanding Clinician by the WAO in 2005, she was honored as Outstanding Physician of the Year by the Professional Regulation Commission in 1984, Honorary International Distinguished Fellow by the American College of Allergy and Immunology in 1990, and Most Distinguished Physician by the Philippine College of Physicians in 2002. She taught at the University of Santo Tomas for 40 years, retiring as Professor 1 in 1995."}
{"text": "The aim of this study was to analyze the influence of filters  to improve the image of Cone Beam Computed Tomography (CBCT) in diagnosis of osteolytic lesions of the mandible, in order to establish the protocols for viewing images more suitable for CBCT diagnostics. 15 dry mandibles in which perforations were performed, simulating lesions, were submitted to CBCT examination. Two examiners analyzed the images, using filters to improve image Hard, Normal, and Very Sharp, contained in the iCAT Vision software, and protocols for assessment: axial; sagittal and coronal; and axial, sagittal and coronal planes simultaneously (MPR), on two occasions. The sensitivity and specificity  of the cone beam computed tomography (CBCT) have been demonstrated as the values achieved were above 75% for sensitivity and above 85% for specificity, reaching around 95.5% of sensitivity and 99% of specificity when we used the appropriate observation protocol. It was concluded that the use of filters  to improve the CBCT image influences the diagnosis, due to the fact that all measured values were correspondingly higher when it was used the filter Very Sharp, which justifies its use for clinical activities, followed by Hard and Normal filters, in order of decreasing values. According to the parameters published by the American Academy of Oral and Maxillofacial Radiology (AAOMR), criteria should be used by dentists who are responsible for the clinical management of patients with anormalities in the oral and maxillofacial region .Although the combination of conventional projections and panoramic radiographs is appropriate in a large number of clinical situations, radiographic assessment can often be facilitated by multiplanar image viewing, including the computed tomography images , 3.Furthermore, technological evolvement results in improvement of diagnosis of bone lesions. In this regard, filters of refining the image can be used to further enhance CBCT images, producing better diagnosis of osteolytic lesions of the jaws. The evaluation of the presence of bone destructions is fundamental, since it directs the prognosis, planning, and conducting of the therapeutic process.Following these statements, the purpose of this study was to analyze the impact of image filters and observations parameters in diagnostic enhancement of CBCT image, in order to establish protocols for CBCT interpretation, regarding the scope of mandibular osteolytic lesions diagnosis.in vivo situation, the specimens were installed in a plastic container containing about 1 liter of water, so as to be totally submerged. Subsequently, the tomographic acquisition was performed using a cone beam device iCAT cone beam 3D dental Imaging System , with the following acquisition parameters: 0,25\u2009mm of voxel size and 40 seconds of time of acquisition.The sample consisted by CBCT scans of 15 dry mandibles, in which lesions were produced involving only cortical or cortical and medullary, using a high-speed hand piece with dental carbide burs . The lesions were located in the buccal or lingual cortex of the mandibular body, and they presented different dimensions, shapes, and loci numbers, depending on the size of the used burr, in order to simulate uni- and multilocular lesions. In order to simulate the attenuation caused by soft tissue in an After acquisition of RAW data, the images were stored in natively universal DICOM format to avoid data loss and transferred to workstation located in an environment adjacent to console. Original volumes of CBCT scans were examined by two examiners, radiologists with previous experience in reports of CT scans, independently, who analyzed the images in the iCAT Vision software (version 1.6.20), without prior knowledge of any information on the simulated lesions, and the interpretation followed the principle of randomization of the images, on a personal computer, according to the established protocols of observation, on two occasions with an interval of seven consecutive days between assessments. The evaluation of artificial bone perforations followed the protocol of interpretation and was always the same for all images taken by the same examiner.All assessments were conducted individually and sequenced (a filter to improve the image at a time) for each examiner and images in question, under controlled light and environment free of external stimuli. evaluation of images obtained by CBCT acquisition on axial images with the use of following filters: hard, normal, and very sharp, through the program iCAT Vision in an independent workstation; evaluation of images obtained by CBCT acquisition on coronal and sagittal protocols with the use of the same sequence of image filters; evaluation of images obtained by CBCT acquisition on axial, coronal, and sagittal protocols simultaneously (MPR) with the use of the same sequence of image filters.The sequence analysis of the images complied with the following protocols:During the study of the images, only the studied image plane was displayed on the computer monitor, remaining the other pictures hidden using tools available in the program, in order to avoid interference in the assertion of presence or absence of mandibular lesion. Then, data were recorded properly for subsequent statistical analysis.P < 0.5).The statistical evaluation was performed by using validity test (sensitivity and specificity), positive predictive value (PPV), negative predictive value (NPV), and accuracy , to estaIn order to check the reproducibility of the method above, testing intra- and interobserver agreement, were obtained Kappa scores including obtaining an interval of 95.0% of confidence for the population Kappa.The significance level used in the decision of the statistical test was 5%. Data were entered via Excel 2007 spreadsheet, and the software used to obtain statistical calculations was SPSS version 17.0 for windows  [This work was submitted to the Ethics Committee of FOUSP under number 149/03, protocol 151/03.Tables Tables The cone beam computerized tomography (CBCT) was a big step in the improvement of CT examinations in dentistry, because the proposed improvements added quality to the image, facilitating diagnosis, and also increase the study, the facility, and the interest of dentists , 6. The use of cone beam computed tomography as a tool to perform morphologic and morphometric studies of the mandible is due to the advantages of this type of scan features, such as the observation of an extensive region of the mandibular arch, including areas and anatomical structures adjacent to the mandibular canal, allowing a precise analysis of the tract and its relationship with anatomical reference points , 8.The use of reduced thicknesses cut and reduced sizes of voxels in CBCT allows greater sensitivity and specificity \u201311.Our results found, in general, sensitivity above 75% and specificity above 85% Tables to 4. AcThe use of more advanced algorithms and the greatest number of visualization tools have an important role in determining the number of bone lesions in the jaws, as well as improving the process of diagnosis and treatment \u201317, thusSuomalainen et al., in 2008 , said th initial screen display: hard filter for all images, screen for planning implants: hard filter for all images, screen for ATM viewing: hard filter for the 3 first images and normal filter to Condyle images in preview mode Ortho, MPR screen: normal filter for all images, Cephalometric screen (Ortho view mode): very sharp image filter for left and right top images and hard filter for all others.According to the manual of use of the iCAT Vision software, patterns of use of filters to improve the images to be followed are the following:According to the results obtained in our research, Normal filter was inferior for the visualization and detection of simulated osteolytic lesions in the jaws.The use of filters  to refining the image is critical for sensitivity and specificity involved in the diagnosis of lytic areas of the jaws. The evaluation of the presence of bone destruction is very important, since it directs the prognosis and the planning and conducting of therapeutic process. High-resolution iCAT CBCT images resulted in an increase in sensitivity without jeopardizing specificity .Observation protocols play an important role in the analysis of mandibular bone lesions. The junction of viewing plans (MPR), in our study, shows excellent values of sensitivity, specificity, and accuracy, with respect to the assertion of the presence of simulated osteolytic lesions .Analyses were done by regions of the mandible , and with regard to verification of the presence of bone lesions, the values of the measures were correspondingly lower for lesions located in the lingual and higher for lesions found on the buccal .In the present study, stands out the agreement between the examiners, in each assessment, with the gold standard, which ranged from 84.3% to 89.3%, whereas the agreement of each examiner was higher at the second moment of your assessment. Kappa values ranged from 0.77 (good agreement) to 0.84 (excellent agreement) .In the evaluation of intraobserver agreement in the assessment of loci number, In the evaluation of interobserver agreement  comparedin vitro study, and based on the values found, it can be a basis for further studies, including those performed in vivo.The analysis of intra- and interobservers kappa values showed excellence in most of the results, demonstrating the reproducibility of the method used. Thus, this was an  The sensitivity and specificity  of cone beam computed tomography (CBCT) for diagnosis of osteolytic lesions (simulated) in the mandible, using standalone workstation, was shown. The influence of filters  to improve the CBCT image was confirmed, and the very sharp filter was higher, which justifies its use for clinical activities, followed by normal and hard filters, in order to decrease values. The best protocol for visualization the simulated osteolytic lesions was the MPR."}
{"text": "The aims were to identify whether there is burnout and the burnout levels of doctors and nurses working in ICUs . Also, to identify factors that may lead to the development of burnout in doctors and nurses working in the ICU.Application of a self-completion questionnaire with three items: the sociodemographic data of the study population, experiences in the workplace, and the Maslach Burnout Inventory - General Survey (Portuguese Version for Investigation 2006). For the implementation of methodological tools, we requested the authorization of the relevant institutional bodies, the ethics committee and directors of services. The professionals who participated in the study were asked for informed consent, whether formal or informal. Observation of the contexts of work and interviews was also done. In this study we will focus on the results of the questionnaire. Statistical analysis was performed using SPSS v.17.0.A total of six hospitals, 10 polyvalent adult ICUs in the north of the country, 300 professionals, 73% nurses. Age of respondents was a median 32 years, with 8 years of professional experience and 4 years on the ICU. Results of the MBI: average levels of burnout in physicians and nurses working in the ICU. The risk of developing burnout is highest being a nurse 1:54 OR, yet there is no statistically significant difference at 95% . Nine percent of professionals studied showed burnout, 31% with Burnout syndrome and high risk of burnout. Distribution of levels of burnout by occupational category: higher levels of emotional exhaustion in nurses, personal and professional achievement smaller in nurses, and higher depersonalization in doctors.The results of the study underline the importance of promoting the prevention of burnout in doctors and nurses in the ICU."}
{"text": "Patients with colorectal cancer undergoing surgical treatment require planning and preparation of interventions for prevention of postoperative complications, especially considering the complexity and commitment of its clinical and psychosocial condition.To identify and synthesize the factors that influence the occurrence of postoperative complications and establish the implications of these scientific evidence for nursing care.It is an integrative review of literature where descriptors were used, wound, colorectal cancer and complications with search in the databases Medline, CINAHL and Lilacs, resulting in a sample of 10 scientific articles.Results indicated that the preoperative bowel preparation, staging and tumor location, surgical technique and care of the wound in the postoperative period as the factors influencing the occurrence of postoperative complications.Thus, measures of prevention and infection control can be implemented that are related to the rigor of the completion of the enema, ensure the conduct, preparation and guidance of patients for diagnostic tests and specialized  , fitness and education on pre-operative surgery and its consequences, evaluation of patient outcome and the surgical wound and hospital discharge planning with primary care for the patient and family, encouraging the physiological recovery and wound healing. These nursing interventions could help in decreasing the rates of postoperative complications and mortality of this clientele, as well as improve the quality of perioperative nursing care.J. Silva Other review, H. Sonobe: None declared, D. Andrade: None declared, A. Giordani: None declared, C. Naka Shimura: None declared, E. Watanabe: None declared."}
{"text": "It is a great honor to assume the role of Editor-in-Chief of the Journal of Epidemiology from Dr. Tomotaka Sobue. Under Dr. Sobue\u2019s outstanding leadership, the average impact factor reached 2.113 in 2012, and the expansion of the Journal beyond its original base has continued to accelerate. Indeed, the Journal is now recognized as an international rather than a domestic journal, and manuscripts from abroad account for two-thirds of the total. On behalf of the Board, I wish to thank Dr. Sobue for his inspiring dedication and service.Like many journals, the Journal of Epidemiology has recently faced major challenges in the global publishing environment. One broad-reaching change has been the introduction of open access licensing. Our adoption of the Creative Commons Attribution License (CC BY v3.0) for all papers allows authors to retain ownership of the copyright of their papers, but also allows anyone to download, reuse, copy, reprint, distribute, or modify the paper, provided they cite the original authors and source. The global change in policy towards open access for papers supported by research grants is unstoppable, and our decision to adopt this model is critical to the future of the journal.Second, the Editorial Board warmly welcomes the participation of five new associate editors from abroad, starting from 2014. We believe these new colleagues will contribute to the continuing globalization of the Journal.The editorial team seeks to maintain the Journal\u2019s high international standards and will continue to publish original and review articles on a wide range of topics. Looking to the future, our goal is to establish the Journal as one of the leading journals in epidemiology. I warmly welcome the participation and support of every reader in attaining this goal.Manami Inoue, MD, PhDEditor-in-ChiefJournal of EpidemiologyProject ProfessorAXA Department of Health and Human SecurityGraduate School of MedicineThe University of Tokyo"}
{"text": "Please view the complete, correct, equations here: In the Methods section of Experiment Two, there is an error in the third, fourth and fifth equations. The coefficient of the complex valued result (A"}
{"text": "The codes and practices of professional morality had been enunciated centuries ago in the traditional Indian systems of medicine. The modern code of medical and research ethics has its origin in the Nuremberg Code, Universal Declaration of Human Rights, Code of Medical Ethics by Medical Council of India, World Health Assembly Helsinki Declaration, Belmont report and the Revised Council for International Organizations of Medical Sciences (CIOMS) guidelines. The revised Indian Council of Medical Research (ICMR) guidelines have been adopted in 2006.The ethical principles of autonomy, justice, non-maleficense and beneficense are applicable to any research undertaken. Careful attention has to be given to the processes of taking consent, assent from minors, re-consent, community engagement, risk-benefit assessment, interventions, data management and follow up. Special concerns for cohorts include the difficulty in conveying results due to the absence of immediate benefits and unpredictable susceptibility due to genetic variations. There are issues of confidentiality and stigmatization due to the allotment of unique identification. There is a need for translational research in cohort studies to understand the priorities, validity and applicability in different cultural settings and the role of community based participatory research. There are concerns in research methodology due to shifting from acute paradigm to chronic paradigm, involvement of special population groups.Bio-banks have advantages such as advancement of scientific knowledge, present and future medical benefits for the individual, improved pharmaco-genomic understanding and commercial benefits through patents. The major ethical concerns revolve around collection, storage and management of samples. Human dignity, right to share benefits, intellectual property rights, access to personal data, sample sharing by researchers, movement of samples outside the country, samples from deceased or non-traceable persons are all issues which has to be carefully thought out. Breach of confidentiality and unwanted information flow can result in anxiety, depression, social stigma and discrimination. There are also issues of cultural and social acceptability for taking samples.The ICMR has issued guidelines for DNA banking in 2006 for primary and secondary use of samples. A draft DNA Profiling Bill, 2007 is under the consideration of the Indian Parliament which looks to legalize the collection and analysis of DNA samples and to create a balance between the constitutional rights of an individual and the public interest along with accountability and transparency in the practice of DNA collection and testing. It will be essential to establish standards for laboratories, staff qualifications, training, proficiency testing, collection of body substances, custody trail from collection to reporting and a data Bank with policies of use and access to information therein, its retention and deletion. Thus genetic technology faces ethical challenges in the clinical, social, economic, scientific, legal and political domains."}
{"text": "The rapid and evolving nature of hair research has led to the foundation of the European Hair Research Society (EHRS) in 1989, dedicated to the advancement of basic and clinical research focused on hair. Since the first meeting in Brussels, Belgium, the Society has held annual meetings in different cities in Europe, which attract more and more hair experts from universities, research institutions and industries from all over the world. Indeed, the EHRS stands in close contact with international hair research societies, and together with the North American Hair Research Society, the Korean Hair Research Society, the Society for Hair Science Research (Japan), the Australasian Hair and Wool Research Society, and the Indian Hair Research Society, co-organizes international scientific meetings.th annual meeting of the EHRS will be held this year in Jerusalem, Israel, from July 6\u20139, 2011 [http://www.ehrs.org or go directly to http://www.ehrs.org/conference/2011jerusalem/). The main conference will be preceded by a specialized hair course covering aspects of hair anatomy, pathology and genetics, fungal and parasitic infestations of the scalp, drugs affecting the hair and hair-associated contact dermatitis. The course will also present the basic and updated methods of hair trichoscopy. The opening lecture will be exceptionally attractive, and will discuss the momentous topic of \u201cHair in Movies\u201d.The 15\u20139, 2011 . The sciDuring the following two days, all major aspects of basic and clinical hair research will be discussed, from hair follicle physiology and biochemistry and hair growth cycles, through various pathological conditions of hypotrichosis and hirsutism, alopecia areata, androgenetic and cicatricial alopecia to various techniques of hair imaging and medical, molecular, cosmetic and surgical methods for hair regrowth or removal.Prof. Desmond Tobin was selected to give the prestigious John Ebling lecture, an honor awarded to leading scientists in hair research for their exceptional achievements in this field. The topic of the lecture this year is the hair follicle melanocyte. In addition to plenary lectures on current topics of broad interest, short talks will be selected from the submitted abstracts and will be presented. We expect a large poster session, incorporating topics from all fields of hair research. The best posters and lectures will be honored with a Poster and Lecture Prizes. The EHRS is dedicated to the encouragement of the scientific careers of young investigators, and also grants the annual Jurgen Schweizer Prize for the best presentation during the meeting. Additionally, a Travel Grant will be provided to selected delegates after acceptance of their abstract. But above all, the EHRS allows young people to interact with leading hair researchers in an unhurried, intimate atmosphere. The unperturbed atmosphere of the EHRS meetings allows also for informal close interactions, and these unscripted meetings make the EHRS especially valuable and distinctive.The venue of the EHRS 2011 will be the Ramada Hotel, located close to the heart of the city of Jerusalem. In addition to enjoying the scientific spirit of this meeting, delegates will also have the opportunity to appreciate the beauties of Jerusalem and its surroundings. Jerusalem is unique for incorporating a magnificent mix of cultures and people, and its breathtaking historical sights are sure to become an unforgettable experience for visitors. The social itinerary will include a visit to the Israel Museum, Light and Sound Show at the David Tower, Tour of the Old City of Jerusalem, Masada and the Dead Sea.jerusalem2011@ehrs.org. Early registration via jerusalem2011@ehrs.org by April 15th. We look forward to welcoming you in Jerusalem on 6\u20139 July, 2011.We invite you to submit abstracts for posters and oral presentations via Yours friendly,"}
{"text": "Infantile spasms  is a severe form of encephalopathy that typically affects infants younger than 2\u2009years old. Pediatricians, pediatric neurologists, and other pediatric health care providers are all potentially key early contacts for families who have an infant with IS. The objective of this article is to assist pediatric health care providers in the detection of the disease and in the counseling and guidance of families who have an infant with IS.Treatment guidelines, consensus reports, and original research studies are reviewed to provide an update regarding the diagnosis and treatment of infants with IS. Web sites were searched for educational and supportive resource content relevant to providers and families of patients with IS.Early detection of IS and pediatrician referral to a pediatric neurologist for further evaluation and initiation of treatment may improve prognosis. Family education and the establishment of a multidisciplinary continuum of care are important components of care for the majority of patients with IS. The focus of the continuum of care varies across diagnosis, initiation of treatment, and short- and long-term needs. Several on-line educational and supportive resources for families and caregivers of patients with IS were identified.Given the possibility of poor developmental outcomes in IS, including the emergence of other seizure disorders and cognitive and developmental problems, early recognition, referral, and treatment of IS are important for optimal patient outcomes. Dissemination of and access to educational and supportive resources for families and caregivers across the lifespan of the child with IS is an urgent need. Pediatric health care providers are well positioned to address these needs. Infantile spasms  is a severe form of epilepsy of early infancy . AlthougThe etiologic classification of IS includes the categories of cryptogenic and symptomatic. The cryptogenic form of IS occurs in 10% to 40% of IS patients. In infants with cryptogenic IS, no underlying cause is identified and the children have normal development prior to the onset of IS . OutcomeWithin symptomatic IS, a defined underlying cause is present, usually with developmental delay at onset of spasms. The percentage of IS cases classified as symptomatic has increased over time due to improved diagnostic techniques, such as metabolic and genetic testing and neuroimaging. It is estimated that approximately 60% (in living infants) to 90%  of children with IS have an associated underlying disorder that is evident . Causes PubMed was searched for IS treatment guidelines, consensus reports, and original research studies. Relevant studies were reviewed to provide an update regarding the diagnosis and treatment of infants with IS. Web sites were searched for educational and supportive resource content relevant to providers and families of patients with IS.ARX mouse model), or propose a final common pathway underlying all causes of IS [Little is known about the pathophysiology of IS. The causes of IS appear to be extremely variable , and a ces of IS . The stres of IS . Adrenoces of IS ,28. Othees of IS .In the great majority of cases, parental observation of spasms initiates the clinical evaluation of IS -32. Parehttp://www.youtube.com/watch?v=35wRjuvg9MI  and developmental regression. Even a brief EEG recording may confirm the diagnosis, but if IS is suspected, a prolonged awake and asleep video-EEG study is recommended . IntericThe recommended approach to EEG evaluation, during the diagnostic evaluation and during follow-up to determine treatment effectiveness, is an overnight inpatient 24-hour video EEG to capture both hypsarrhythmia and spasms. It will allow the exclusion of other movements that may mimic IS and allow the investigation of other seizure types that may be occurring. If hypsarrhythmia or spasms do not occur, and the events continue at home, the EEG should be repeated in 1\u2009week or as clinically indicated. If developmental regression is present, the EEG should be repeated earlier than 1\u2009week. If an inpatient video EEG is not available, a prolonged 4-hour to 8-hour EEG video during a waking and sleep period may be completed as an outpatient; it is particularly important to capture non-REM sleep.Once spasms and hypsarrhythmic EEG have been documented, determining the cause of IS becomes the focus of the clinical evaluation -32. The Recently, an IS consensus group reviewed the most recent practice guidelines from the American Academy of Neurology and the Child Neurology Society for the medical treatment of IS , and outThe most recent practice guidelines from the American Academy of Neurology and the Child Neurology Society for the medical treatment of IS, which reviewed the available evidence as of 2004, state that ACTH is probably effective and vigabatrin is possibly effective in the cessation of spasms and abolition of hypsarrhythmia . The praChildren with IS who do not respond to first-line treatments may be considered for epilepsy surgery  or the ketogenic diet, though no controlled trials are available for the efficacy of the ketogenic diet in IS. There currently is insufficient evidence to recommend protocols using new or emerging therapies for IS . The evoThere was consensus among the ISWG that use of ACTH is effective as first-line therapy for IS. Within the United States (US), natural ACTH is used, whereas outside the US tetracosactide, a synthetic ACTH compound, is frequently used. There was insufficient evidence to precisely define the optimum ACTH dose and duration of treatment for IS, although short duration was preferable  . The moshttp://www.lundbeckshare.com). Children on vigabatrin are required to have periodic ophthalmic evaluations beginning with a baseline evaluation at initiation of therapy (no later than 4\u2009weeks after starting treatment) and at least every 3\u2009months while on therapy, as well as 3 to 6\u2009months after cessation of treatment . This is particularly important as parent/caregiver distress may interfere with the ability to comply with providing medical care to the child at home.Given the possibility of poor developmental outcomes in IS, including the emergence of other seizure disorders and cognitive and developmental problems ,53, the Children with IS often require an evaluation for early intervention programs for developmental impairment. Because available resources vary by community and by state, parents/caregivers should ask the treating physician about local services. Additionally, parents/caregivers can search for services using the Internet, ask about listings of social services at their local library, and determine whether their county of residence publishes information about social services and resources relevant for IS and comorbid disorders. Parents/caregivers are encouraged to create a support network and engage family and friends in the search for information and services. Persistence is important; if initial contacts do not lead to desired services, parents/caregivers should seek assistance from alternative service organizations. The optimal management of IS is complex, and care across the lifespan may be complicated by ongoing seizures, intellectual disability and learning disorders, or behavioral and/or psychological issues. Adults who have a history of IS may require discussion of future guardian issues, group home applications, and respite care options .Table Assistance programs for children with IS help uninsured and under-insured families gain access to medications and financial support (premium/co-payment assistance program) by working with pharmaceutical companies and insurance plans (see Table IS imposes a significant ongoing challenge to the child\u2019s family and caregivers, as well as to health care professionals. Early detection and referral to a pediatric neurologist for clinical evaluation and prompt effective treatment is strongly recommended as it may improve prognosis. To best navigate the medical environment and optimize clinical care, the child\u2019s family and caregivers need access to up-to-date information about IS, effective treatments, and establishment of a multidisciplinary continuum of care, which includes access to resources for psychosocial support. Further dissemination of and access to educational and supportive resources for families and caregivers across the lifespan of the child with IS is an urgent need.The development of this manuscript was supported by an unrestricted grant from Questcor Pharmaceuticals, Union City, CA. The supporter was not in any way involved in the development of the scientific content of this manuscript.Dr Wheless has received grants from NIH, the Shainberg Foundation, UCB, Ovation, Questcor, Marinus, Ortho-McNeil, King, Cyberonics, and Eisai; is a consultant for UCB, Ovation, Questcor, Marinus, Ortho-McNeil, King, Cyberonics, Pfizer, Eisai, Valeant, CyDex, and Neurelis; is a member of a speakers bureau for UCB, GlaxoSmithKline, Ortho-McNeil, Cyberonics, Pfizer, Eisai, Shire, and Valeant; and has received honoraria and reimbursement for travel expenses from Questcor.Ms Gibson has received grants from Questcor, Ovation, Valeant, Eisai, Ortho-McNeil, and GlaxoSmithKline; and has received honoraria and reimbursement for travel expenses from UCB, Questcor, Ovation, and Sepracor.Ms Rosbeck has received reimbursement for travel expenses from Novartis Oncology. The Tuberous Sclerosis Alliance has received grants from Lundbeck, Questcor, Novartis Oncology, UCB, and Cyberonics.Ms Hardin, now retired, was formerly Vice President of Patient Services at the National Organization for Rare Disorders, where she had oversight of the Acthar Gel Patient Assistance Program and the Infantile Spasms Co-payment Assistance Fund, both of which received support from Questcor Pharmaceuticals.Ms O\u2019Dell is a consultant for and has received honoraria and payment for development of education presentations from Ovation and Questcor; and has received grants and reimbursement for travel expenses from Questcor.Dr Whittemore has received grant funding from NIH, and has received reimbursement for travel expenses from Novartis Oncology. The Tuberous Sclerosis Alliance has received grants from Lundbeck, Questcor, Novartis Oncology, UCB, and Cyberonics.Dr Pellock is a consultant for Eisai, Jazz, King, KV, Marinus, NeuroPace, Ortho-McNeil/Johnson & Johnson, Lundbeck, Pfizer, Questcor, UCB, and Valeant; has participated in an advisory board for Eisai, Ortho-McNeil/Johnson & Johnson, Lundbeck, Questcor, UCB, and Valeant; is a lecturer for Eisai, Ortho-McNeil/Johnson & Johnson, Lundbeck, Questcor, UCB, and Valeant; is a researcher for Eisai, Marinus, Ortho-McNeil/Johnson & Johnson, Lundbeck, Pfizer, Questcor, UCB, and Valeant; and has received honoraria and reimbursement for travel expenses from Questcor.JWW contributed to the conception and design of the paper, contributed to the drafting of the paper, contributed to revising the paper, and gave approval of the final version. PAG contributed to the conception and design of the paper, contributed to the drafting of the paper, contributed to revising the paper, and gave approval of the final version. KLR contributed to the conception and design of the paper, contributed to revising the paper, and gave approval of the final version. MH contributed to the conception and design of the paper, contributed to revising the paper, and gave approval of the final version. CO contributed to the conception and design of the paper, contributed to the drafting of the paper, contributed to revising the paper, and gave approval of the final version. VW contributed to the conception and design of the paper, contributed to revising the paper, and gave approval of the final version. JMP contributed to the conception and design of the paper, contributed to revising the paper, and gave approval of the final version.The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2431/12/108/prepub"}
{"text": "Screening, brief intervention, and referral to treatment (SBIRT) appears to be an important tool in Brazil and Latin America to address the use/abuse of alcohol and other drugs and to help implement and organize preventive activities, particularly in the services of primary health care (PHC). Nevertheless, there are few studies evaluating the implementation of SBIRT in PHC of Latin American countries, identifying elements that promote positive results in the prevention and/or reduction of consumption according to each situation. Therefore, this study presents a method for implementing SBIRT developed in the PHC of a small/medium Brazilian city, highlighting challenges and possibilities for its dissemination in other cities and countries in Latin America. This is a research intervention, with data collection and evaluation through participant observation. The entire process was evaluated to the suitability to local needs, determining factors that could facilitate or impede its implementation. The method developed consisted of six stages: initial contact and planning, diagnosis and mapping, raising awareness, training and monitoring. In the process of implementation the hindering points detected were: insufficient resources , shortage of integration and intersectional health care settings, lack of participation by physicians, focus in dependence, scarcity of participation of civil society and absence of spaces where this population could participate. However, the participation of community health workers and nurses in the implementation and organization of SBIRT, the actions implemented by health teams, such as educational and preventive practices in schools and discussion groups with communities, are positive prospects for the implementation of SBIRT in the Latin American PHC context. Finally, the method presented is considered a useful model to other Latin American cities and countries, with necessary adaptations. Despite the advances, progress is needed in preventing alcohol and other drug abuse in Latin America, with long-term measures."}
{"text": "Over the past few decades, major advances in the field of molecular biology, coupled with advances in genomic technologies, have led to an explosive growth in the biological data generated by the scientific community. The critical need to process and analyze such a deluge of data and turn it into useful knowledge has caused bioinformatics to gain prominence and importance. Bioinformatics is an interdisciplinary research area that applies techniques, methodologies, and tools in computer and information science to solve biological problems. In Nigeria, bioinformatics has recently played a vital role in the advancement of biological sciences. As a developing country, the importance of bioinformatics is rapidly gaining acceptance, and bioinformatics groups comprised of biologists, computer scientists, and computer engineers are being constituted at Nigerian universities and research institutes. In this article, we present an overview of bioinformatics education and research in Nigeria. We also discuss professional societies and academic and research institutions that play central roles in advancing the discipline in Nigeria. Finally, we propose strategies that can bolster bioinformatics education and support from policy makers in Nigeria, with potential positive implications for other developing countries. The advent of high-throughput sequencing and computational approaches to biological data analysis means biology will never be the same again, and Nigeria is one of the developing countries making modest progress with respect to this. It is obvious that computing and sequencing are rapidly and drastically changing the face of biology. This has led the global scientific community to the relatively new disciplines of computational biology and bioinformatics. Needless to say, it is common knowledge that bioinformatics asks lots of questions that cut across all life sciences and turns the answers into knowledge for the benefit of scientists, pharmaceutical companies, and the public. For example, the World Wide Web has made it possible for a single public database of genome sequence data to provide services through a uniform interface to a worldwide community of users In this article, our working definition of bioinformatics shall be \u201can emerging scientific field involving the development and integration of techniques, such as applied mathematics, statistics, computer science, chemistry, and biochemistry, to solve biological problems.\u201d Obviously, by providing algorithms, databases, user interfaces, and statistical tools, bioinformatics makes it possible to complete important work such as comparative genomics, proteomics, interactomics, metabolomics, and all other \u201c-omics\u201d research. Over the years, there have been several bioinformatics training events, including workshops, and modest research in this field in Nigeria.The beginning of bioinformatics in Nigeria dates back to the early part of year 2000, and so far, it is still developing, with modest accomplishments. To the best of our knowledge, four key organizations were initially involved in the development of bioinformatics in Nigeria. They include Covenant University, University of Ibadan, National Biotechnology Development Agency (NABDA), and University of Ilorin. These institutions organized several workshops, seminars, and symposia on bioinformatics at the beginning of the study of bioinformatics in Nigeria. In addition, the West African Biotechnology Workshops Series (WABWS) The credit for the first national bioinformatics training awareness in Nigeria can go to the region-wide training courses on molecular biology and bioinformatics organized by the West African Biotechnology Workshops Series between 2002 and 2005. The series featured notable workshops, such as the Applied Malaria Bioinformatics Workshop in 2004, the WABWS Advanced HIV Sequence Analysis in 2005, and the WABWS Advanced Viral Bioinformatics Course in 2005, at the University of Ibadan.The Covenant University's Computer and Information Science Department launched its bioinformatics activities with a workshop in 2005, which was tagged, \u201cInternational Workshop on Pattern Discovery in Biology (IWPDB).\u201d In 2009, Covenant University organized the second International Workshop on Pattern Discovery in Biology. This workshop was supported by EMBnet and focused on bridging the gap between biologists and bioinformaticians. The workshop highlighted the fundamentals of bioinformatics and the systematic approach for understanding biological data using computational methods In furthering the development of the discipline in Nigeria, the University of Ilorin, through its Department of Physiology and Biochemistry, in collaboration with the West African Bioinformatics Research Institute , organized an introductory bioinformatics training workshop in 2006 and organized training in bioinformatics and computational molecular biology techniques in 2008. Since 2009, several intermediate and advanced bioinformatics workshops and/or courses have been held in different parts of Nigeria. For instance, Chevron Biotechnology Centre, Federal University of Technology, Yola, organized a series of hands-on training workshop on molecular biology and biotechnology between 2009 and 2011. These workshops featured significant training on bioinformatics. These training opportunities provided capacity building in bioinformatics for several Nigerian scientists and other scientists from neighboring countries.However, although bioinformatics is taught at the postgraduate level in many Nigerian institutions, it remains the case that only a few Nigerian universities teach the course at the undergraduate level. Therefore, more in terms of bioinformatics research and education is expected from Nigeria. Nevertheless, some universities are making modest progress with respect to this. Worthy of note are the Covenant University, University of Ibadan, and University of Ilorin, which offer MSc and PhD degrees in computer science with specialization in bioinformatics. Other universities, such as the Federal University of Technology, Yola, offer bioinformatics as a course in their biotechnology and biochemistry degree programs.The current strength of bioinformatics and computational biology research work in Nigeria is not yet at its full potential because of inadequate institutional support. This notwithstanding, a new generation of Nigerian scientists with expertise in bioinformatics is emerging, and bioinformatics training is spreading. Therefore, it is hoped that bioinformatics research will receive a boost in the near future. As an indication of current and past research efforts in bioinformatics in Nigeria, Plasmodium sp., the parasite that causes malaria, is transmitted by the female Anopheles mosquito. Resistance to anti-malarial drugs has become a major challenge, especially in Africa, where about 90% of malaria cases occur. This, in part, informs the research interest in this area. Covenant University's bioinformatics research cluster is one of the most active research clusters in the country. The group is currently leading bioinformatics research in malaria within the country. Other research foci of the cluster include studies involving microarrays and data mining/analysis, as well as database design and management.The trend shows a consistent increase in bioinformatics publications in the last two years, with most of the bioinformatics research focusing mainly on malaria Despite this progress in the field of malaria research in Nigeria, a lot still needs to be done and published in reputable journals that are indexed in leading databases. Searches from the PubMed, Web of Science, and Scopus databases retrieved only a limited number of publications from Nigerian scientists. In the same manner, NABDA is leading bioinformatics research in the country in the areas of human genome variation and visual analytics, in collaboration with the Wellcome Trust Sanger Institute (WTSI) and the Visual Analytics in Biology Curriculum Network, United States, respectively. WTSI has particularly played a major role in providing continuous research capacity building in Nigeria and other parts of Africa. Details of major research foci, as well as research projects in some bioinformatics research groups and academic institutions in Nigeria, are summarized in In addition, there has been an upsurge of interest among Nigerian scientists in undertaking bioinformatics and computational biology research in institutions overseas. This has led to many of them pursuing such interests either as research fellows, doctoral students, or postdoctoral fellows in several institutions in Europe and the Americas. Expectedly, this is fostering opportunities for mutually beneficial international research collaborations and expanding the research networks of Nigerian scientists. It is hoped that this new attitude and interest will, in the near future, positively impact on the overall development of bioinformatics research and education in Nigeria.The number of institutions involved in bioinformatics education and research in Nigeria is gradually increasing at an encouraging pace. As a field of science that is relatively new in Nigeria, only a few institutions are currently actively involved in bioinformatics research in the country . HoweverSegun A. Fatumo was Founder and pioneer President of the Regional Student Group Africa (2007\u20132009) of the Student Council of the International Society for Computational Biology (ISCBSC). He is currently an H3ABioNet NABDA Node Visiting Research Fellow at the Wellcome Trust Sanger Institute and University of Cambridge. He is Vice President of Africa Society for Bioinformatics and Computational Biology (2011\u2013present).Moses P. Adoga is president of Regional Student Group West Africa (RSG West Africa) of the ISCB-SC and a faculty member at Nasarawa State University, Nigeria.Opeolu O. Ojo is Research and Training Director at Chevron Biotechnology Centre, Modibbo Adama University of Technology, Yola, Nigeria and currently a Research Fellow at the University of Ulster, Coleraine, United Kingdom.Olugbenga Oluwagbemi is Vice President of RSG West Africa and holds a PhD from Covenant University and formerly a Fulbright Research Fellow at the John Hopkins University, Baltimore, Maryland, US.Esther T. Adeoye is currently a master's student of information management at the University of Hradec Kralove, Czech Republic and formerly a graduate research intern at Covenant University Bioinformatics Research Group.Itunuoluwa Ewejobi is a faculty member and a PhD student at Covenant University and a former Research Fellow at the German Cancer Research Center (DKFZ), Heidelberg, Germany under the DAAD fellowship.Marion Adebiyi is the immediate former President of RSG West Africa and a faculty member at Covenant University, Ota, Nigeria.Ezekiel F. Adebiyi is Professor and Head of the Covenant University Bioinformatics Research (CUBRe) and Covenant University H3ABioNet Node.Clement O. Bewaji is Professor of Biochemistry at the University of Ilorin, Nigeria and the Director of Research at WABRI.Oyekanmi Nashiru is Professor and Director of molecular biology and bioinformatics department, National Biotechnology Development Agency, NABDA/FMST, Umar Musa Yar'A dua Expressway, Abuja, and H3ABioNet NABDA Node, Abuja, Nigeria.Bioinformatics research efforts in Nigeria have been thriving over the years with increased support from international scientific organizations for training, research, and conference participation. Many Nigerian members of the International Society for Computational Biology (ISCB) have benefitted from such support. This has made it possible for the members to present their work at conferences in different aspects of bioinformatics, biotechnology, and computational biology.www.bioinformatics.org), Regional Student Group Africa (RSG Africa), Regional Student Group Morocco (RSG Morocco), International Society for Computational Biology Student Council (ISCBSC), and ASBCB.Within the African continent, many Nigerian members of the African Society for Bioinformatics and Computational Biology (ASBCB) hold prominent positions and play influential roles in the society. In the past few years, Nigeria produced the president of the society. Presently, Nigerians hold the position of vice president and secretary of the society. Many Nigerian scientists have participated significantly in organizing ISCB Africa and ASBCB conferences across the continent. For instance, in 2009, Nigerian bioinformatics students and scientists initiated and participated in the first African Virtual Conference In 2005, at the first IWPDB, which took place at Covenant University, Ota, Nigeria, the Nigerian Society for Bioinformatics and Computational Biology (NiSBCB) was established. The society aims to strengthen and expand bioinformatics education and research across Nigeria through:Promoting the exchange of ideas and resources in the fields of bioinformatics and computational biology and facilitating local and international collaborations among Nigerian scientists and educators.Promoting the establishment of infrastructural facilities.Facilitating access to bioinformatics and computational biology infrastructure.Advancing and promoting bioinformatics and computational biology in Nigeria.Serving a global community by influencing governmental and scientific policies, providing high quality research publications, and hosting professional meetings, and through distribution of valuable information about training, education, employment, and relevant news from related fields.Developing the application of bioinformatics in Nigeria in collaboration with individuals, groups, and organizations.Due to the need to introduce bioinformatics to more universities in Nigeria Connect Nigerian researchers, educators, industrialists, and policy makers to resources and opportunities in the field of bioinformatics.Showcase the benefits of bioinformatics for the development of the economy of Nigeria.Promote the integration of bioinformatics in the Nigerian educational system.Organize activities that promote bioinformatics through short courses, workshops, and seminars.Link NBREN members with other bioinformatics networks and societies across the globe.In addition, NBREN will organize bioinformatics-related events, facilitate research, recommend policies to the government, develop a national bioinformatics curriculum, and organize bioinformatics training workshops and conferences in Nigeria.Challenges facing the introduction and the development of bioinformatics in Nigeria have been reviewed in earlier publications In addition to funding, other recognized challenges include inadequate facilities for consistent research, inadequate training and capacity-building opportunities, infrastructural problems such as inadequate power supply, and lack of appropriate national policy/strategy for bioinformatics education and research.The contribution of bioinformatics to developments in biological science education and research has been identified. Interestingly, as the awareness of the discipline is becoming more prevalent within the academia in Nigeria, so is the interest of new-generation scientists in this emerging scientific discipline. It is also clear that research in bioinformatics is gradually becoming entrenched in Nigeria and is becoming increasingly useful in tackling some of the health challenges facing the country and the rest of Africa.However, the development of the discipline is faced with several challenges, ranging from funding to inadequate infrastructure. Public-sector\u2013driven investment in scientific research and development, particularly bioinformatics, in Nigeria is minimal. Like in most developing countries, this has led home-based Nigerian scientists to rely on personal efforts in bioinformatics education and research. To a large extent, these efforts have been fruitful. The number of research articles in bioinformatics from Nigeria is increasing. Nigerian scientists are becoming more involved at both local and international levels. The teaching of the discipline at undergraduate and postgraduate levels within the nation is becoming more widespread. We therefore believe that bioinformatics and computational biology can be bolstered in Nigeria by the formulation and implementation of governmental policies that aim to foster the twin disciplines through research funding, capacity building, and pedagogic activities within universities and research institutions across the country.http://www.covenantuniversity.edu.nghttp://cubre.covenantuniversity.edu.nghttp://cubre.covenantuniversity.edu.ng/index.php/nigeria-society-for-bioinformatics-and-computatational-biology-nisbcb/http://www.nabda.gov.ng/http://www.run.edu.nghttp://www.uniben.eduhttp://www.wabri.orghttp://www.unilorin.edu.nghttp://www.asopah.orghttp://public.tableausoftware.com/views/ngr_bioinfo/research_groups"}
{"text": "In February 2010, Shahid Beheshti University of Medical Sciences (SBUMS) organised in Tehran a very high standard conference on ocular inflammation and uveitis. Several members of the executive committee of the Society for Ophthalmo-Immunoinfectiology in Europe (SOIE) took active part in that meeting and we thoroughly enjoyed the superb hospitality given to us by our Iranian colleagues. After 3 days of friendly contacts, stimulating exchanges and mutual convergence of opinions and interests, the idea emerged to work on one issue of Journal of Ophthalmic and Vision Research (JOVR) devoted to uveitis and inflammatory eye diseases. This partnership between the SOIE and SBUMS led to the project resulting today and publication of the present issue. Such collaborative work, building bridges between clinicians and researchers from different parts of the world, corresponds exactly to the philosophy of the SOIE, a society dedicated to teaching and promotion of knowledge in the field of uveitis and inflammatory eye diseases in Europe and beyond. Since its formal foundation in 2005 in Lausanne, Switzerland, SOIE has organised courses and meetings in Monte Carlo, Monaco in 2006, Krakow, Poland in 2007, Cappadocia, Turkey in 2008, the oasis of Tozeur, Tunisia in 2009, St. Petersburg, Russia in 2010, Bad Blumau, Austria in 2011 and Vilnius, Lithuania 2011. To expand its range of activities, a sister society the Society for ophthalmo-immunoinfectiology in Europe and the Middle-East (SOIEME) was established in 2011, in order to intensify contacts in that part of the world, an example of which is the collaboration that led to the present achievement.This issue was planned to include and combine articles by Iranian authors on one side and from authors in connection with the SOIE on the other side. After a little more than one year of work and efforts, we succeeded to build an issue consisting of 14 peer-reviewed articles, equally divided between contributors from Iran and from the SOIE.In this editorial, articles originating from the SOIE will be commented, while Professor Masoud Soheilian, the other guest-editor of this issue, will present Iranian contributions in his editorial.In their original article, Papadia M and colleaguesAs an illustration to this article, Bouchenaki and HerbortThree review articles on pediatric uveitisPediatric uveitis is a topic that is not dealt with in a unanimous and consensual fashion, making it the subject of controversies. Ilknur Tugal-Tutkun, vice-president of the SOIE and one of the recognized uveitis specialists in Turkey, based her review on an extensive personal experience.In their review on CNS diseases and uveitis, Allegri P, Rissotto R and colleaguesPiergiorgio NeriFinally, two interesting case reports showing the importance of ICGA in choroidopathies conclude the series of seven articles related to the SOIE. Papadia and HerbortThe collaborative effort between our two medical backgrounds resulted in the present issue of the JOVR that will hopefully interest ophthalmologists in both settings and will lead to closer contacts and better mutual appreciation and understanding.We truly hope the reader will enjoy this special JOVR issue on uveitis and intraocular inflammation."}
{"text": "Following the publication of this article , it was The authors declare that they have no competing interests.CR carried out the molecular genetic studies and the interpretation of the results. RAC and LM made substantial contributions to interpretation of data and participated in manuscript preparation. AS, TK, SME, DP, AC and RC were involved in the clinical evaluation of patients and manuscript revision. DT made substantial contributions to conception, analysis and interpretation of data and drafted the manuscript. All authors read and approved the final manuscript."}
{"text": "To address the Appraisal and Prospects for Person-Centered Medicine in Croatia, members of the Local Organizing Group met during the First International Congress of the ICPCM in Zagreb, Croatia on November 8th, 2013.Starting at the Zagreb School of Public Health in 1927, the promotion of person-centered medicine and people-centered health care, based on the teachings and legacy of professor Andrija \u0160tampar, has been occurring in Croatia for decades. Professor Andrija \u0160tampar, one of the founders of the WHO and a representative at its first general meeting, considered by many as the father of public health, pioneered various public health projects in Croatia and abroad. He was, above all, a great educator who inspired many of his students and the general public alike, to promote the concept of health for all and the importance of health-related activities within the community, with emphasis on the responsibility of each individual for his/her own health. Croatia is a country with a long history of patient associations, as well as one with an array of public health projects recognized worldwide. Recently, a group of enthusiasts gathered here in Croatia to undertake the creation of a variety of projects related to the development of person-centered medicine, with the help of leading academic associations along with the President of the Republic, Professor Ivo Josipovic. Among other things, a multitude of programs were introduced to the curriculum of the University of Zagreb School of Medicine at the undergraduate and post-graduate levels, with the aim of perfecting the curriculum to reflect the concepts of person-centered medicine. Various symposiums, workshops, media activities, collaboration with patient associations within Croatia, post-graduate seminars, and national conferences about psychiatry and person-centered medicine were held in Zagreb in 2012, and an English-language book was published with the collaboration of over a hundred authors from Croatia and abroad entitled \u201cThe person in medicine and healthcare - from bench to bedside to community\u201d. Croatian representatives were actively involved in a variety of activities of the International College of Person-Centered Medicine (ICPCM) and organized the First International Congress of the International College of Person-Centered Medicine in November 2013.With that in mind, we believe that Croatia could contribute significantly to the development of person-centered medicine and people-centered health care, within Croatia and abroad. We intend to continue the activities promoted by ICPCM and its associated institutions. Therefore, we resolve to undertake a project entitled \u201cThe International Academy for Person-Centered Medicine and People-Centered Healthcare\u201d. The goal of this project is initiate various multimedia educational activities for health care professionals, patient associations, and the general public with the intention of promoting fundamental provisions and principles of person-centered medicine, people-centered health care, and promote the culture of health and wellness. Our plan is to submit a declaration of intent to the ICPCM for collaboration on this project. We are convinced that, together, we can make our community better and healthier. There is no future without a clear understanding of the past, the future is being built today, and today is yesterday\u2019s tomorrow, so we have to continue working together and learning from one another."}
{"text": "One of the main conceptual changes in the 20th century medicine is the inclusion of social dimension. The \u201cgolden era\u201d of Parson\u2019s medical model , which uAs a reaction to the negative situation in the Croatian medical system, the Centre for Palliative Medicine, Medical Ethics and Communication Skills (CEPAMET) was founded on September 21, 2010. The Centre is semi-autonomous unit within the School of Medicine, University of Zagreb. The conceptual framework of the Centre is devoted to education, organization, and research in three domains: palliative medicine, ethics, and health communication. The interdisciplinary team involved in the CEPAMET creation consists of experts in psychiatry and psychology, neurology, oncology, and general practice. The Centre also has an advisory board, consisting of the most prominent international and national experts.Despite the obvious lack of the palliative medicine facilities and overall positive attitudes in the general public ,4, palliProper communication skills have often been neglected in medical education in Croatia, but in the EU and USA there is an emphasis on communication in different, often tricky, situations that physicians encounter on a daily basis. The CEPAMET will offer education in these skills to both undergraduate and postgraduate students, as well as other professionals. Several CEPAMET units are constructed as communication skills laboratories, where students and professionals will have a chance to practice with real-life and simulated patients using video cameras and scales, such as Roter Interaction Analysis System and Cambridge Guide to Medical Interview ,7. This Several members of CEPAMET have already been assigned a role in the Teaching Committee of the European Association for Communication in Health Care. Despite numerous studies in the area of medical communication, the evidence-based outcomes of communication interventions are still largely unclear . The devThe third area of interest of the CEPAMET is medical ethics. With the progressive social and technological changes in the Croatian medicine, the issue of ethics, ethical conduct, and ethical problems is more important than ever. To deal with this problem, several guidelines are being planned to improve ethical conduct and avoid possible ethical pitfalls in the everyday medical practice. Medical ethics principles are often neglected in education and cognitive processes. The CEPAMET strives to popularize ethics in medical community and educate professionals in current opinions and philosophical theories regarding the issue. Furthermore, education is meant to be focus-oriented, guiding physicians and students through the complex and commonly problematic world of applied ethics, as opposed to teaching and proposing theoretical stance.Although CEPAMET is certainly an ambitious project, it is only a small step toward improving our medical reality. Without substantial support from various levels of our health care system, academic community, civil society, and patients, CEPAMET\u2019s goals are unlikely to be met. Therefore, we would also like to offer a possibility of collaboration to both national and international partners, in order to further contribute to the development of patient-centered medicine in Croatia."}
{"text": "The neglected infections of poverty represent the latest threat to the poorest people living on the Gulf Coast of the United States and in Washington, District of Columbia.Together, Hurricanes Katrina and Rita and the BP oil disaster have shed light on a tragic level of poverty in the northern Gulf of Mexico, especially for the African Americans living in Louisiana, Mississippi, and Alabama. According to the National Center for Children in Poverty at Columbia University, more than 40% of black children in each of these states currently live in poor families, and over 12% of children from Louisiana and Mississippi live in extreme poverty, defined as families with incomes that are less than half of the federal poverty level In previous papers I have noted high rates of parasitic and related neglected infections among the poorest Americans living in distressed areas, but especially in inner cities, the American South, the border with Mexico, and Appalachia A fresh look at the neglected infections of poverty reveals the extreme vulnerability of the US Gulf Coast to these conditions, which includes Louisiana, Mississippi, and Alabama, as well as neighboring regions of Texas and Florida . Among tAedes mosquitoes Since I first wrote about neglected infections in the US two years ago, the prospect of dengue and its most serious complication, dengue hemorrhagic fever, have emerged as additional and now imminent threats to the people living on the Gulf Coast. Between 1946 and 1980, no cases of dengue occurred in the continental US Toxocara eggs have been detected in soil samples in Baton Rouge Toxocara was recently noted to frequently occur with toxoplasmosis co-infections Non-vector-borne neglected infections are also now highly prevalent among the poorest people living on the Gulf Coast. Trichomoniasis exhibits a 10-fold higher prevalence among African American women Although the District of Columbia does not have statehood, as a unique federal district it is often treated as an autonomous region and compared in rankings with the 50 US states. Today, Washington, D.C., rivals Louisiana, Mississippi, and Alabama as among the worst in terms of life expectancy and health index If reconstruction plans for the Gulf Coast and Washington, D.C., are ever implemented, an important component should be directed towards the neglected infections of poverty in these areas. I am particularly concerned about the Gulf\u2019s vulnerability to emerging dengue fever infections, while for both the Gulf Coast and Washington, D.C., we must urgently address neglected diseases that disproportionately affect African American populations, including toxocariasis, toxoplasmosis, trichomoniasis, and congenital CMV infection; and those that affect Hispanic Americans, including Chagas disease and cysticercosis. The fact that we know so little about the neglected infections of poverty in America\u2019s most distressed areas is representative of just how glaring these conditions are as health disparities.In 2008, I suggested that we must urgently address the neglected infections through programs of active surveillance and assessments of disease burdens, studies to examine the mechanisms of transmission in poor communities, efforts to control or eliminate these infections through public health interventions that include treatment or vaccination and health education, and a program of research and development to create a new generation of drugs, diagnostics, and vaccines"}
{"text": "Understanding the metabolic fate of small organic molecules is of fundamental importance to the successful design and development of drugs, nutritional supplements, cosmetics and agrochemicals ,2. In th"}
{"text": "Shared decision making (SDM) - involving patients in decisions relevant to their health - has been increasingly influential in medical thought and practice around the world. This paper reviews the current status of SDM in Israel, including efforts to promote SDM in the legislation and healthcare system, its influence in medical training and the national health plans, and funding for SDM-related research. Published studies of SDM in Israel are also reviewed. Although informed consent and patients' right to information are regulated by Israeli law, little provision is made for SDM. Further, there are few organized programs to promote SDM among medical professionals or the public, and governmental support of SDM-related research is minimal. Nonetheless, patients have begun to influence litigation in both formal and informal capacities, medical schools have begun to incorporate courses for improving physician-patient communication into their curricula, and the largest national health plan has initiated a plan to increase public awareness. A review of the limited research literature suggests that although patients and physicians express a desire for greater patient involvement, they often have reservations about its implementation. Research also suggests that despite the positive effects of SDM, such an approach may only infrequently be applied in actual clinical practice. In conclusion, though not actively promoting SDM at present, Israel's universal coverage and small number of health plans make rapid, widespread advances in SDM feasible. Israeli policymakers should thus be encouraged to nurture burgeoning initiatives and set plausible milestones. Comparing the status of SDM in Israel with that in other countries may stimulate further advancement. Shared decision making (SDM), \"the attempt to involve patients in decision-making tasks, especially where decisions, in the face of uncertain or equivocal evidence of benefit, are sensitive to personal preferences\" , has groIndeed most patients wish to take an active part in choosing among alternative courses of action regarding their health, with the physician either participating in the decision or providing relevant information and then allowing the patient to decide autonomously . Beyond Though ultimately manifest at the level of the patient-physician encounter, SDM must first be legally mandated and medical professionals must be trained to incorporate its principles into their practice. Further, research studies are necessary to monitor its status and drive improvement. Moreover, these activities must be supported and promoted by national health, legal, and other organizations. Some countries have allocated resources for the promotion and evaluation of SDM. In Germany, the ministry of health funded the research consortium ''Patient as partner in medical decision-making'' . In CanaGerman Journal for Evidence and Quality in Healthcare (ZEFQ) on the global status of SDM . MB is the director of the Center of Clinical Quality & Safety, Hadassah Hebrew University Medical Center. GS is the director of the Center for Health Law, Bioethics and Health Policy, Ono Academic College, a senior researcher at the Unit for Genetic Policy and Bioethics, Gertner Institute for Epidemiology and Health Policy Research, and a professor of Law with the University of Virginia. GMD is researcher at the Center for Medical Decision Making, Ono Academic College.TMS, formerly a researcher at Princeton University, is the founding director of the Center for Medical Decision Making, Ono Academic College, and holds an adjunct position at Wharton School of Business, University of Pennsylvania. OG is a senior researcher at the Unit for Genetic Policy and Bioethics, Gertner Institute for Epidemiology and Health Policy Research and author of the book"}
{"text": "In 1961, Chafetz [Research presented at the September 2011 International Network on Brief Interventions for Alcohol and Other Drugs (INEBRIA) conference in Boston was from around the globe, covered alcohol and other drugs, crossed a variety of health settings and practitioners, and showed the sophistication that has been reached in the field. Research discussed when, where, and for whom SBI has or might not have efficacy, how to implement SBI programs, adaptations of SBI, costs and effectiveness, and many other topics. Nonetheless, despite the excitement, breadth, and sophistication, the fact remains that few patients eligible for SBI receive the service, and, as a result, opportunities to improve health and save health care costs are missed. Most people with alcohol and drug use disorders receive no treatment.At least in some cases, SBI is ready for dissemination. And, with solid evidence available, health reforms promised in the US and elsewhere, and an international discussion taking serious shape regarding the integration of care for medical, mental health, and substance use conditions, SBI may have reached a tipping point for dissemination and implementation as well as for small- and large-scale studies of remaining efficacy and effectiveness questions.The editors of ASCP invited INEBRIA attendees and presenters to submit their studies for peer review and possible publication. The initial core of this thematic series, \u201cScreening and brief intervention for unhealthy alcohol and other drug use,\u201d is the result of that call for papers, a seed that we expect will grow as the SBI literature continues to become more robust. Papers will cover a range of topics from what the efficacy of SBI really is, to effectiveness in people with mental health and drug use conditions, to adolescent SBI, to health professional attitudes towards SBI, to SBI implementation research and even to state-of-the-art SBI research protocol design, among others. We hope this series begins a long and serious conversation."}
{"text": "The following information was missing from the funding section: BBSRC, DEFRA, NERC, the Scottish Government and the Wellcome Trust, under the Insect Pollinators Initiative crops project. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."}
{"text": "A funding organization was incorrectly omitted from the Funding Statement. The Funding Statement should read: Part of the work was funded by an internal grant of the University Hospital Regensburg (ReForM-C), and by the Wilhelm Sander-Stiftung, Munich and Ingolstadt, Germany. The funders had no role in study design, data collection and analysis,decision to publish, or preparation of the manuscript. No additional external funding was received for this study."}
{"text": "This video presents the story of a university extension project called \"Clean Hands\" which originated from a master's dissertation in 2006, based at the Center for Studies and Nursing Research for the Prevention and Control of Healthcare Associated Infections (NEPIH) based at the Center for Studies and Nursing Research for the Prevention and Control of Healthcare Associated Infections (NEPIH) at the School of Nursing, Federal University of Goi\u00e1s, Brazil, and is registered with the Pro-Chancellor of Extension at the university. Since its creation, the project has developed activities to encourage the establishment of hand hygiene (HH) in health care, in cooperation with professionals, academics, patients and caregivers, as well as in scientific events, with academics and health professionals. After the outbreak of H1N1 in 2009, the project developed campaigns in municipal daycare centers (CMEI), the Municipal Department of Education, of the city of Goi\u00e2nia, Goi\u00e1s, Brazil, targeting children, parents and workers. In these campaigns, different promotion strategies are used: informative stylized banners depicting HH; educational brochures, a song parody CD, demonstration of proper HH technique, using poster paints on children\u2019s hands; a puppet theater; and face-to-face discussions about the importance of, obstacles to, and benefits of HH. Annually, the project hosts a festival of parodies with the theme of HH, called \"CANTA FEN\", which brings together academics and healthcare professionals. The project\u2019s day-to-day operations are normally run by five students, supported by the other members of NEPIH, currently 33 staff members , participating in the activities of the project. Up to February 2013, the project has performed about 180 campaigns (45 were for children) reaching approximately 8,000 people. Participation in the project has contributed to the development of skills and competencies with regard to the implementation of health promotion strategies with different audiences and requires that students constantly stay up to date on the subject. The festival of parodies has helped to empower its members to conduct scientific and cultural events and promote emphasis of the subject in a playful manner.None declared."}
{"text": "The funding information should read as follows: IBM funded this study through the employment, at the time of the study, of Isidore Rigoutsos, Niina Haiminen, and Laxmi Parida. Between them they conceived, designed and performed the experiments, analyzed the data and designed the assembly evaluation protocol. David Kuhn is employed by USDA-ARS SHRS and received no funding for this study from IBM. He participated in the analysis and interpretation of data, and the writing of the paper."}
{"text": "Second International Symposium on Recent Advances in Environmental Health Research was organized by Jackson State University (JSU) from September 18 \u2013 21, 2005 at the Regency Hotel in Jackson, Mississippi. The symposium was built upon the overwhelming success of the 2004 conference that was also organized by JSU and co-sponsored by the National Institutes of Health (NIH) RCMI-Center for Environmental Health, the U.S. Department of Education Title III Graduate Education Program, the U.S. Environmental Protection Agency, and the JSU office of Research. This international meeting commemorated 20 years of the NIH-NCRR Research Centers in Minority Institutions (RCMI) Program, a congressionally mandated program initiated by the NIH in 1985 with the mission to expand the national capability for research in the health sciences. Over the years, RCMI institutions have played a significant role in addressing important biomedical research questions that are critical in managing the health needs of the nation in a cost-effective manner. At JSU, the RCMI program has served as a catalyst for excellence in biomedical research and education. Research conducted through the RCMI Program is providing a strong scientific basis for understanding the pathogenesis and for discovering innovative therapies for human diseases such as cancer and AIDS. Through the RCMI Program, doctoral students trained at JSU have gone on to obtain competitive post-doctoral positions at prestigious institutions such as Harvard Medical School, John Hopkins Medical Center, Purdue University Medical Center, and the NIH. As echoed by President Ronald A. Mason, Jr., \u201c\u2026JSU is proud to be integral part of the very successful and productive RCMI Program. This symposium highlighted the excellence in biomedical, clinical, and behavioral research conducted by RCMI institutions\u2026\u201dThe In an attempt to contribute global solutions to these environmental challenges, scientists around the world, have been more and more involved in bioenvironmental research, studying the toxic mechanisms of action of various environmental agents, developing new approaches for detecting or remedying environmental damage, identifying and characterizing genes involved in the manifestation of environmentally-related diseases, and providing the public and policy makers with scientific tools that are critical for environmental health decision-making.Second International Symposium on Recent Advances in Environmental Health Research served as a platform for environmental and biomedical scientists-biologists, chemists, toxicologists, public health scientists, engineers, and policy makers interested in bringing about substantial contributions to addressing global environmental, and sustainable development issues, to communicate the latest advances in scientific research and new developments on critical environmental and human health topics including the following:New Frontiers in Environmental Health Research: The causes of most human diseases have been attributed to the complex interactions between genetic factors and environmental exposures. Hence, control and prevention measures highly rely on the understanding of the cause and effect relationships between these factors and disease development. In recent years, new areas of research such as toxicogenomics, proteomics, and functional genomics have emerged, with the aim of understanding molecular mechanisms of health and disease. Also, the recent advances in the molecular biology of the cell cycle regulation have given new life to our understanding of cancer in particular, and the idea that defects of regulation in cancer cells may partially explain successes that have been achieved in cancer chemotherapy. Specific areas of symposium research presentations included gene expression studies, proteomics, gene-environment interactions, functional genomics, biomarkers of effect, sensitivity and effect, signal transduction and gene activation; and molecular targets of disease chemotherapy.Environmental Toxicology and Health Risk Assessment: Growing public awareness of the potential risk to humans from toxic chemicals in the environment has generated demand for new and improved methods for toxicity assessment and rational means for estimating health risk. Many environmental agents such as metal ions, polycyclic aromatic hydrocarbons, pesticides/herbicides, UV-light, food additives, and viruses are known to induce various types of illnesses including cancer in humans. Several symposium presentations dealt with research elucidating the cellular and molecular mechanisms by which these environmental agents induce toxicity, mutagenesis, and carcinogenesis, as well as research on hazard assessment of exposure to physical, chemical and biological agents; dose-response evaluation and model development; exposure assessment analysis; and health risk characterization; and management.Emerging Topics in Computational Biology, and Environmental Modeling: Using of computational methods and procedures to investigate environmental and biological phenomena has made remarkable progresses. This field includes analysis of human genome data, prediction of DNA and protein structure and function, design of biomaterials and therapeutic agents, studies into small molecule-biomacromolecule interactions, and other related computational method development. Therefore, several symposium presentations dealt with the computational analysis of the physical and chemical properties of several environmental compounds, as well as on quantitative structure activity relationship (QSAR) studies for developing predictive toxicology models associated with exposure to these compounds.Health Disparities and Environmental Security: In recent years health disparities and biological and chemical terrorism have emerged as major issues in public safety and homeland security. With recent advances in laboratory technologies, it is often possible to measure specific genetic variations as risk factors for specific types of disease. Equally important is the evaluation of the role of modifier factors such as environmental exposures or other genes that may exacerbate the genetic risk leading to differences in disease susceptibility among individuals. Since the events of September 11, 2001 regarding the attacks on the World Trade Center and the Pentagon, and the subsequent anthrax attacks on several people, our collective thinking with regard to our vulnerability to terrorism has completely changed. The specific areas of research presentations included the following: health disparities and cancer; health disparities and heart disease; health disparities and infectious diseases; and bioterrorism/chemical terrorism.Medical Geology and Human Health: Recent concerns over health-related issues arising from exposure to environmental substances have raised substantial interest in a new field termed \u201cmedical geology\u201d. In fact, naturally-occurring toxic metals such as arsenic, cadmium, lead, and mercury are now known to cause serious public health problems in several areas of the world. Likewise, the geographical distributions of several infectious diseases such as malaria, meningitis, and schistosomiasis, have been linked to intrinsic climatic and environmental factors. Research on this topic dealt with disease ecology, toxicology, pathology and/or epidemiology with regard to the emerging subject of medical geology.Natural Resources Damage Assessment and Management: Several environmental influences including natural and anthropogenic factors have been linked to ecosystem vulnerability. Monitoring and assessment data are therefore needed for science-based decision-making with regard to environmental management. Papers for presentation on this topic included those related to: a) conceptual modeling for ecological risk assessment, b) assessment of the physical, chemical, and biological characteristics of specific ecosystems, c) applications of GIS and remote sensing technology to environmental assessment and management, and d) bioindicators for environmental management.Building on the foundation of the first symposium, the The symposium attracted 260 participants from 21 countries representing all five continents, and more than 150 scientific presentations across the disciplines of environmental health and biomedical sciences. As stated above, the scientific program was composed of six plenary sessions where oral/platform presentations were given by more than 40 invited speakers. In addition, there were two poster sessions \u2013 one for faculty and professional scientists, and one for students \u2013 with more than 100 abstracts. The submitted full length manuscripts were peer-reviewed, and selected for publication by experts in their respective fields. The accepted papers are being published in three volumes as special issues of the International Journal of Environmental Research and Public Health.Environmental Endocrine Disrupting Chemicals and Epigenetic Gene Imprinting; focusing on the new mechanisms to understand the environmental component of human disease. Many thanks to Mrs. Zelma Leflore and her students for providing the technical assistance with the technology needed for platform presentations, emails, and other services.We wish to extend special thanks to Dr. Sheila McClure, Director of the NIH-NCRR-RCMI Program, Bethesda, Maryland, for serving as Banquet Speaker, and Dr. James Townsel, Director of the RCMI Center for Molecular Neurosciences at Meharry Medical College, Nashville, Tennessee, for serving as Distinguished Speaker for the Second Honorary Biomedical and Health Information Lecture Series\u201d at the symposium. He made a distinguished lecture on the Commitment to Eliminate Health Disparities and the Need to Achieve Diversity within the Biomedical Workforce. Thanks are also extended to all our conference presenters, session chairs, and keynote speakers, and especially Dr. John McLachlan, Distinguished Professor of Environmental Studies at Tulane University, and Director of the Center for Bioenvironmental Research at Tulane/Xavier Universities, for giving the inaugural presentation on Special thanks are extended Dr. Ronald Mason, Jr. (President), Dr. Felix Okojie , Dr. Velvelyn Foster (Interim Provost and Vice-President for Academic Affairs), and Dr. Mary Myles (Director of Title III Program) for their administrative support. We would like to acknowledge the authors for their involvement and cooperation, and for their outstanding contributions to advancing science and sound decision-making in the critical area of environmental health sciences. Special thanks are also extended to all the peer-reviewers who took time off their busy schedules to carefully and critically review each of the manuscripts.On behalf of the entire organizing committee, the greatest acknowledgments go to our major symposium sponsors including the U.S. Department of Education Title III-Strengthening the Environmental Science Ph.D. Program at JSU, National Institutes of Health RCMI-Center for Environmental Health, and JSU Office of Research Development and Federal Relations."}
{"text": "On February 27\u201328, 2004, scientists, clinicians, researchers, women's health advocates, educators, policymakers, and representatives from nongovernmental organizations and community-based organizations gathered in Atlanta for the first International Conference on Women and Infectious Diseases (ICWID): From Science to Action. The Office of Minority and Women's Health of the National Center for Infectious Diseases, Centers for Disease Control and Prevention (CDC), spearheaded the conference. It was cosponsored by the World Health Organization, the Pan American Health Organization, the Department of Health and Human Services (DHHS), and the American Society for Microbiology.The broad ICWID steering committee included representatives from the DHHS Office on Women's Health, the National Institutes of Health Office for Research on Women's Health, the National Institute of Allergies and Infectious Diseases, the National Institute for Child Health and Human Development, the Fogarty Center, and the Office of Women's Health of the Health Resources and Services Administration. Academic, community-based, and philanthropic organizations as well as numerous CDC entities were involved. The conference's goal was to enhance prevention and control of infectious diseases among women worldwide. The conference's 400 attendees from 25 countries  and 30 U.S. states recognized the need for a forum to address the complex set of concerns and issues surrounding women and infectious diseases.Julie Gerberding, director of CDC and administrator of the Agency for Toxic Substances and Disease Registry, opened the conference with an overview of the impact of infectious diseases on women. The address reminded listeners of the female face of infectious diseases: women may be biologically more susceptible to certain infections and suffer more severe complications. Other keynote speakers included Paul DeLay of the Joint United Nations Programme on HIV/AIDS, Carol Bellamy of the United Nations Children's Fund, and Mirta Roses Periago of the Pan American Health Organization.The theme of the conference was \"From Science to Action.\" In 35 sessions, attendees discussed practical application of scientific knowledge in areas such as HIV, infectious causes of chronic diseases and other infectious disease\u2013chronic disease relationships, gender roles in infectious disease transmission and prevention, sexual coercion and its effect on infectious diseases in women, sexually transmitted diseases, health disparities, healthcare workers and caregivers, immunization, effective community-based strategies, the role of cultural competence in women's health, and more.The Bill and Melinda Gates Foundation sponsored 26 ICWID scholarships, which allowed persons from nongovernmental organizations and community-based organizations from 10 countries and four continents to attend who otherwise would not have had the opportunity. These ICWID scholars will amplify the conference's impact by taking the knowledge and insights gained back to their home countries and organizations.Streptococcus infections and achievements in other arenas, participants emphasized the many challenges remaining for the future. With the continuation of such efforts, the newly spotlighted female face of infectious diseases can also be the face of hope and progress.The conference successfully illuminated the female face of infectious diseases. While celebrating successes in the prevention and control of prenatal and neonatal Group B"}
{"text": "Foot pain affects up to 24% of people aged over 65 years, and is associated with difficulty undertaking activities of daily living, problems with balance and gait, an increased risk of falls, and reduced health-related quality of life. Established risk factors for foot pain in this age-group include female sex, obesity and chronic medical conditions such as osteoarthritis and diabetes. However, given the significant age-related changes in the structure and function of osseous, muscular and soft tissues in the foot, the contribution of lower limb biomechanical factors to the development of foot pain in older people is receiving increased attention in the research literature. This presentation will provide an overview of (i) the epidemiology of foot disorders in older people, (ii) the physiological changes that occur in the ageing foot, (iii) the role of biomechanics in understanding the potential mechanisms underlying the development of foot pain, and (iv) the role of plantar pressure analysis for the assessment and management of foot pain in this age-group."}
{"text": "The 27th edition of the 2006 Report of the American Academy of Pediatrics (AAP) Committee on Infectious Diseases, known to most clinicians as \"The Red Book,\" is considered the \"Bible\" of pediatric infectious diseases. In addition to providing an updated and exhaustive summary of the clinical manifestations, etiology, epidemiology, diagnostic tests, treatment, isolation, and control measures for >200 pediatric infectious diseases, this reference discusses a number of related topics, including management. With >350 liaisons and collaborators from the Centers for Disease Control and Prevention, the Food and Drug Administration, the National Institutes of Health, the Canadian Paediatric Society, the World Health Organization, and others, the 12-member 2004\u20132006 Committee on Infectious Diseases issued the current edition, which reflects the state of the art at the time of publication and is updated every 3 years.The Red Book began as an 8-page mimeographed report assembled in 1937 by the Committee on Immunization and Therapeutic Procedures for Acute Infectious Diseases (currently the Committee on Infectious Diseases) and titled \"Immunization Procedures.\" A revision issued in 1938 in pamphlet form was actively sought, and annual issues became more comprehensive, with the addition of 76 pages reflecting the increase in therapeutic antimicrobial drug options in the ensuing 10 years.The current 992-page 27th edition has newly added sections, including key developments in combination vaccines, the 2006 AAP standards for child and adolescent immunization practices, parental refusal to vaccinate, updates on prevention of mosquitoborne infections, and updated information on emerging infectious diseases and pathogens, including Baylisascaris, metapneumovirus, West Nile virus, coronaviruses, pertussis, tuberculosis, and pneumococcal, meningococcal, and varicella infections. Expanded discussions of drug interactions as well as the revised American Heart Association recommendations for the prevention of bacterial endocarditis are presented. Many website resources have been added throughout the text to provide the reader with links to expanded information about the topic.The text is organized into 5 sections with a comprehensive list of appendixes. Section 1 reviews active and passive immunization and provides a practical discussion of numerous aspects of vaccine administration, including vaccine shortages, reporting of vaccine-preventable diseases, and parental misconceptions about vaccinations. Section 2 provides recommendations for care of children in special circumstances, including the topic areas of biological terrorism, children in out-of-home child care, infection control, and medical evaluation of internationally adopted children. This section serves as a comprehensive resource for both general and infectious diseases pediatricians. The 3rd section, an alphabetical summary of infectious diseases, comprises the bulk of the text. Sections 4 and 5 address the expanding category of antimicrobial agents, therapy, and prophylaxis, including guidelines and indications for their appropriate use.http://www.aapredbook.org). This site also lists errata from the current edition and allows readers to register to be notified when new errata are posted, when new policy statements are issued, and when site updates and new features are added. Readers may also register for a customized citation/keyword alert.The area of infectious diseases is rapidly emerging and changing, so the guidelines presented in the current edition may have undergone updating and revision following publication. Therefore, readers are urged to monitor updated recommendations issued by the Committee on Infectious Diseases on the Red Book Online website (The 27th edition of the Red Book is a vital resource for adult and pediatric infectious disease practitioners as well as general practitioners and is considered by many the quintessential resource and reference for clinical practice."}
{"text": "Capacity building in health research generally, and helminthiasis research particularly, is pivotal to the implementation of the research and development agenda for the control and elimination of human helminthiases that has been proposed thematically in the preceding reviews of this collection. Since helminth infections affect human populations particularly in marginalised and low-income regions of the world, they belong to the group of poverty-related infectious diseases, and their alleviation through research, policy, and practice is a sine qua non condition for the achievement of the United Nations Millennium Development Goals. Current efforts supporting research capacity building specifically for the control of helminthiases have been devised and funded, almost in their entirety, by international donor agencies, major funding bodies, and academic institutions from the developed world, contributing to the creation of  North\u2013South \u201cpartnerships\u201d. There is an urgent need to shift this paradigm in disease-endemic countries (DECs) by refocusing political will, and harnessing unshakeable commitment by the countries' governments, towards health research and capacity building policies to ensure long-term investment in combating and sustaining the control and eventual elimination of infectious diseases of poverty. The Disease Reference Group on Helminth Infections (DRG4), established in 2009 by the Special Programme for Research and Training in Tropical Diseases (TDR), was given the mandate to review helminthiases research and identify research priorities and gaps. This paper discusses the challenges confronting capacity building for parasitic disease research in DECs, describes current capacity building strategies with particular reference to neglected tropical diseases and human helminthiases, and outlines recommendations to redress the balance of alliances and partnerships for health research between the developed countries of the \u201cNorth\u201d and the developing countries of the \u201cSouth\u201d. We argue that investing in South\u2013South collaborative research policies and capacity is as important as their North\u2013South counterparts and is essential for scaled-up and improved control of helminthic diseases and ultimately for regional elimination. During their deliberations, and in the previous reports of this collection Building research capacity is a long-term process that requires a systemic and inter-sectoral approach to developing appropriate regulatory frameworks , building and maintaining physical infrastructure, and investing in human resources, equipment, and training in an environment conducive to research commitment and institutional support Inter-country differences are mainly due to major investments that have been made by the developed world towards research and development (R&D) activities, especially in the proportion of the gross domestic product (GDP) that the countries' governments are willing to invest in research for an expected return. In some developed countries, long-term investment has resulted in extensive infrastructure, existence of national expertise and national and international academic prestige, a tradition in research funding, and a more expeditious path between basic and clinical, translational research and its implementation into public health policy and practice. Investments in research and innovative technologies have tremendously improved health in the developed world because of these countries' clear health research policies, including the setting up of priorities at institutional, national, and regional levels. The readily available and opportune deployment of such resources has led to rapid advances in controlling infectious agents that have epidemic potential. However, in the developing world, and especially in most African countries, adequate investments by most DECs in research capacity building to support prevention, control, and elimination of infectious diseases of poverty are insufficient. In addition to the paucity of highly trained researchers, there is a considerable brain drain of the already scarce numbers of trained professionals, fragmentation of research with much duplication of efforts, and a lack of focus on distinct national needs. According to Chauhan The purpose of this review is to examine the level of capacity building in DECs, highlight some of the challenges that hinder the development of health research capacity with particular reference to poverty-related infectious diseases, summarise (not exhaustively) available research capacity building initiatives and policies and their implications for helminthiasis research and control, and provide recommendations for improvement of research capacity building towards the control and elimination of human helminthiases. ACBF, African Capacity Building FoundationAPOC, African Programme for Onchocerciasis ControlAusAID, Australian Agency for International DevelopmentBioMalPar, Biology and Pathology of Malaria Parasite NetworkB&MGF, Bill and Melinda Gates FoundationCAPES, Brazilian Federal Agency for the Support and Evaluation of Graduate EducationCDTI, Community-Directed Treatment with IvermectinCGMRC, Centre of Geographical Medicine Research CoastCNPq, National Research Council of BrazilCSRS, Swiss Centre for Scientific Research, C\u00f4te d'IvoireDBL, Danish Bilaharziasis Laboratory-Institute for Health Research and DevelopmentDEC, disease-endemic countryDFID, Department for International Development, United KingdomDIMACS/MBI, Center for Discrete Mathematics and Theoretical Computer Science/US\u2013African Biomathematics InitiativeDRG4, Disease Reference Group on Helminth InfectionsEFINTD, European Foundation Initiative for African Research into Neglected Tropical DiseasesFIOCRUZ, Oswaldo Cruz FoundationGDP, gross domestic productHKI, Helen Keller InternationalICEMR, International Center of Excellence for Malaria ResearchIDRC, International Development Research Centre, CanadaIRD, Institut de Recherche pour le D\u00e9veloppement, FranceJAF, Joint Action Forum (APOC)JICA, Japan International Cooperation AgencyKEMRI, Kenya Medical Research InstituteKFPE, Commission for Research Partnerships with Developing Countries, SwitzerlandKNUST, Kwame Nkrumah University of Science and Technology, GhanaMDG, Millennium Development GoalM&E, monitoring and evaluationMRC, Medical Research Council, United KingdomNGDO, non-governmental development organisationNTD, neglected tropical diseaseOCP, Onchocerciasis Control Programme in West AfricaPDP, product development partnershipRAPLOA, rapid assessment procedure for loiasisR&D, research and developmentREA, rapid epidemiological assessmentREMO, rapid epidemiological mapping of onchocerciasisRNSA, Regional Network for Schistosomiasis in AfricaRNAS+, Regional Network for Asian Schistosomiasis and other Zoonotic HelminthsSCI, Schistosomiasis Control InitiativeSCORE, Schistosomiasis Consortium for Operational Research and EvaluationSPHD, Section of Parasitology, Health and Development (of former DBL)STH, soil-transmitted helminthiasisSwiss TPH, Swiss Tropical and Public Health InstituteTB, tuberculosisTDR, Special Programme for Research and Training in Tropical DiseasesTWAS, The Academy of Sciences for the Developing WorldUNICEF, United Nations Children's Fund UNDP, United Nations Development ProgrammeUSAID, United States Agency for International DevelopmentVBD, vector-borne diseaseWHO, World Health OrganizationThere is great disparity in research capacity for parasitic diseases between the developed countries of the North and the developing countries of the South as well as among, and within, the latter. Inequalities in health research\u00a7 contribute to inequalities in health and ultimately wealth. These inequalities are even more pronounced in the case of infectious diseases of poverty and helminthiasesThere have been a number of high-level meetings on research for health in disease-endemic countries (DECs)\u2021, with the Bamako Call to Action 2008 concluding that to remedy the above, a greater proportion of the countries' GDP should be invested in science and technology and at least 2% of the ministries of health's budgets should be invested in research and research capacityThose countries of the South  that have invested substantially in biomedical research and research and development (R&D) have greatly increased their scientific output, halted or reversed brain drain, and excelled at product development partnerships and innovation Capacity building is a long-term, systemic, and inter-sectoral process, of which training of scientists is only a component. A more comprehensive approach requires physical infrastructure, appropriate equipment, conducive research environment, regulatory frameworks including the establishment of ethical review boards, attractive pay and working conditions, and substantial government support, including a competitive national research funding agency and monetary investmentThere are a number of international initiatives aiming to strengthen capacity building and establish interdisciplinary and multinational teams addressing infectious diseases of poverty in general and neglected tropical diseases (NTDs) and helminthiases in particular. Nearly all are funded by industrialised nations, accentuating North\u2013South alignment. Although these initiatives are very welcome, they remain somewhat unbalanced\u00a7An umbrella term referring in this paper to research in biomedical, public health, social science, and environmental (among others) disciplines related to human health.\u2021In the context of this paper, DECs are countries endemic for poverty-related infectious diseases, including HIV, tuberculosis, malaria, and emerging, zoonotic, and neglected tropical diseases.Research must focus on national priorities and high disease burden conditions in DECs, with emphasis on evaluating interventions that aim to strengthen research capacity and health systems, and activities that translate knowledge into action and benefits to the local population To achieve the MDGs, several recent high-level meetings on research capacity and policy have called for action on health research  interest for potential support, be transparent and conduct open competitions for the best projects, scientifically and in terms of potential impact, have the possibility for a level of sustainability, integrate research and training, and help leverage external funding to support the national and regional efforts in research and training.It is evident that more interaction among nations with similar health problems and common infectious diseases is essential to facilitate exchange of experiences as well as training of individuals to help achieve the MDGs. This requires a great deal of investment from both international and national funding bodies to develop the facilities and the capabilities of scientists who can drive research aimed at developing more effective tools and strategies to fight infectious diseases of poverty. Improving prevention and control strategies for NTDs will result in poverty alleviation and consequent achievement of the MDGs. However, this will require a sincere commitment, a governmental political resolve, and competitive and transparent mechanisms to use health research as a driver towards sustainable human resource development, economic growth, and poverty reduction. Collaborative research is surely one of the best means for strengthening such research capacity, and in general, it has been the case that scientists in DECs welcome collaboration with the more industrialised nations of the North as a vehicle for overcoming barriers to conducting research, obtaining training and funding, and promoting the exchange of ideas. Unfortunately, scientists of DECs seem less enthusiastic about collaboration between countries within their own continents and regions http://apps.who.int/tdr/svc/grants/calls/grants-dec-investigators-2010). More recently, in 2010, the TDR has sponsored research and training exchanges between African scientists from Niger, Nigeria, and Uganda and the National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention in Shanghai regarding schistosomiasis control. This has resulted in a fruitful South\u2013South connection between two previously separate TDR-supported networks in schistosomiasis, namely, the Regional Network for Asian Schistosomiasis and other Zoonotic Helminths  and the Regional Network for Schistosomiasis in Africa . Through this newly cemented collaboration, the two networks can learn from one another to build their capacity and expertise (http://www.who.int/tdr/publications/documents/tdrnews86.pdf). Another significant step in the right direction is the proposed relocation to Africa of the TDR-supported Initiative to Strengthen Health Research Capacity in Africa (ISHReCA), at present based at TDR/WHO in Geneva, and sponsored by the Wellcome Trust, among other funders (http://ishreca.org/).It is also true that most efforts towards health research and NTD capacity building in DECs have been made with the impulse of institutions based in industrialised countries. One of the major international organisations that has played an important role in building research capacity is the Special Programme for Research and Training in Tropical Diseases (TDR), based at the World Health Organization (WHO). The TDR has over the past 30 years sponsored the training of graduates from DECs at both master's and doctorate levels, notwithstanding specialist technological training, and further support (in the form of re-entry grants) to return to their own countries and establish productive research. The emphasis is on developing the research, management, and leadership capacities of DEC scientists and fostering research environments for long-term sustainability, quality processes, and strategic partnerships (http://www.wellcome.ac.uk/News/Media-office/Press-releases/2009/WTX055742.htm). This is in addition to longer-established African-based programmes such as the KEMRI-Wellcome Trust Research Programme at the Centre of Geographical Medicine Research Coast (CGMRC), in Kilifi, Kenya (http://www.kemri-wellcome.org/). There are many other such programmes, and http://www.acbf-pact.org/).In 2009, the Wellcome Trust funded the African Institutions Initiative, aiming to develop institutional capacity to support and conduct health-related research vital to enhancing people's health, lives, and livelihoods through the formation of seven new international and pan-African consortia , with eahttp://www.cnpq.br). This scheme funds meetings, research, and seed money to evaluate potential on collaborative efforts. In partnership with the Academy of Sciences for the Developing World , an autonomous international organisation based in Italy that promotes scientific capacity and excellence for sustainable development in the South, CNPq also supports students from African countries to be trained in Brazil at post-graduate and post-doctoral levels. Furthermore, the Oswaldo Cruz Foundation (FIOCRUZ), with support from the Brazilian government, recently established an initiative with the Mozambican National Institute of Health to create a master's programme in health sciences, with the goal of providing qualified human resources for health research and innovation for Mozambique Regarding South\u2013South initiatives, Brazil has, since 2008, supported collaboration and training of African scientists through the Pro-Africa Program for Thematic Cooperation in Science and Technology of the National Research Council  incur very low national investments in research in general, and have a low productivity in science and technology Establishing and nurturing collaborations in research is undoubtedly one of the best vehicles for building and strengthening research capacity in DECs, and emphasis should be placed on long-term partnerships. Efforts to incorporate as co-workers multinational members of interdisciplinary teams can be of immense value, which should be encouraged and cultivated http://www.worldbank.org/); the Bill & Melinda Gates Foundation ; the Carter Center (http://www.cartercenter.org/index.html); Fogarty International Center (http://www.fic.nih.gov/); GlaxoSmithKline (http://www.gsk.com/); Helen Keller International ; the Japan International Cooperation Agency . The challenge is how to ensure that low-income countries create a stable demand for sustainable control, anthelmintic distribution, and the research that supports these activities. In responding to this demand, it is crucial that there is an appropriate supply of trained personnel at various levels, and that the countries are able to raise adequate resources to complement or eventually replace what is already received from external sources, thus sustaining the success of control and elimination efforts made once donor fatigue occurs, or donor funding is diverted somewhere else. An excellent example of such a transition from external donor funding to internal, DEC funding is the African Programme for Onchocerciasis Control (APOC). APOC is funded entirely from voluntary contributions channeled through the APOC Trust Fund, and has fostered North\u2013South, North\u2013South\u2013South, and South\u2013South partnerships  such as the World Bank ; it manages the APOC Trust Fund and reports annually to the Joint Action Forum (JAF) on the financial situation of APOC. Community-directed treatment with ivermectin (CDTI) activities are funded through three mechanisms: trust funds available through APOC, contributions from the national governments of APOC countries, and funds from non-governmental development organisations (NGDOs). To extend APOC activities until 2015, US$60 million were raised during the JAF meeting in Brussels in December 2007, when in celebration of the 20th anniversary of the donation of Mectizan (ivermectin), the manufacturer and donor of the drug, Merck & Co., Inc., also became a financial donor of APOC.http://www.who.int/apoc/about/funding/en/index.html).Over 80% of funds are spent on technical and operational activities in endemic countries. Simulium yahense, which have led to the elimination of this vector species on the Bioko island of Equatorial Guinea Not only are the treatment activities of CDTI financed through this mechanism, but also APOC provides funds to encourage operations research and enable evaluation of its impact by multidisciplinary and international teams with a strong cadre of African scientists. Examples are the studies for the feasibility of elimination through insecticidal larviciding of the Bioko form of APOC is an example of North\u2013South support being extended to South\u2013South cooperation. APOC and TDR have supported relevant operations research in the areas of rapid epidemiological mapping of onchocerciasis (REMO), rapid epidemiological assessment (REA) of onchocerciasis, rapid assessment procedure for loiasis (RAPLOA), and CDTI as a community-empowering strategy. All this has contributed significantly to improved capability and increased number of researchers in onchocerciasis-endemic countries of Africa. APOC has supported research in the onchocerciasis-endemic countries either financially  or by maThe successes achieved by control programmes, like the former Onchocerciasis Control Programme in West Africa (OCP), the current APOC, and the Schistosomiasis Control Initiative (SCI), have been partly realised because of the fundamental and operations research carried out within the umbrella of the programmes activities In many DECs, scientists and/or lecturers from research institutions and universities work mainly as individuals rather than as teams. This leaves the new entrant, the young scientist/lecturer, in a place where there is little or no guidance, direction, or an environment that will facilitate his/her career development and progression. Moreover, facilities and inputs for scientific research available to the young scientist are limited. To facilitate research capacity in DECs, there is a need for senior scientists/faculty staff members at higher levels to mentor junior researchers. Having a mentor with expertise, peer esteem, and networking skills provides an invaluable triad function: guidance and direction for the development of a career pathway; research facilities, laboratories, and group support for practical experience; and access to a network of contacts for projection in the national and international arenas. Mentors and role models provide not only exposure to robust and demanding academic and research environments and a vision of what is expected and possible to achieve, but also opportunities to participate and present in international conferences, and obtain feedback on research dissemination activities, manuscripts, oral presentations, and grant preparation. The introduction of the junior fellowships by the European Foundation Initiative for African Research into Neglected Tropical Diseases (EFINTDs)  is a stehttp://www.biomedcentral.com/developingcountries/events/openaccessafrica). However, a considerable amount of investment by higher education and research institutions is needed to maintain the necessary funding for electronic journals, digitised archives, bibliographic databases, and printed literature that are not easily available in DECs. Furthermore, fast and reliable Internet access is sometimes lacking in DECs, which in turn limits the access of researchers in those countries to open-access information via the Internet. For a compilation of web-based bibliography databases of epidemiology, parasitology, and tropical medicine resources from the Spanish-speaking Latin America and Caribbean regions, see http://www.cambridgetrusts.org/partners/capes-brazil.html).Strict open-access publication policies, subsidies by the research funders of wealthier nations, and the growth of prestigious and high impact open-access journals  have ameliorated the access of scientists in DECs to high quality and updated peer-reviewed research. In particular, BioMed Central has recently launched \u201cOpen Access Africa\u201d, a collection of initiatives designed to increase the output and visibility of scientific research published by African learning institutes. The Kwame Nkrumah University of Science and Technology (KNUST) in Kumasi, Ghana, is the first African Foundation Member to participate in BioMed Central's free membership scheme , bioinformatics, and computational biology that can, in the medium and long term, have a major impact on disease control or elimination http://www.finlay.sld.cu/english/eindex.htm), and was recently licensed to GlaxoSmithKline The path forward is not impossible, however. Some DECs in South America, the Caribbean, and the African regions, despite similar challenges, have been able to develop adequate research capacity. For example, Brazil, Cuba, and South Africa have made major technological advancements in the field of functional genomics, bioinformatics, and vaccine development. Notably, the scientific output and impact of these countries' researchers have increased internationally, and consequently the brain drain has been reduced or halted A further challenge hampering the effective development of research capacity building is the lack of application of the same rigorous monitoring and evaluation (M&E) practices to capacity building work that are implemented in other areas, with most activities lacking standard quality assurance processes at the design stage, and not being routinely tracked, monitored, and evaluated Given the lack of political will and financial commitment by most DECs to support research capacity building, the role of global and regional efforts has become crucial in supporting and sustaining the control of helminth infections. These efforts include various established research partnerships between the developed countries and the developing nations. Establishing these North\u2013South partnerships in the form of consortia, networks, and collaborations between research institutions has made valuable contributions to research capacity and should be encouraged, although this requires significant financial investments For such partnerships to work effectively, they should include major players such as local research institutions, universities, and researchers on infectious diseases of poverty, managers of control programmes, and policy-makers. They should also provide a forum for an active involvement of the DECs and their scientists to ensure that the priority needs of these countries, as well as the training of local human resources, are met. For a more comprehensive account of \u201cdesirables\u201d in establishing \u201cwin-win\u201d partnerships between the North and the South, readers are referred to the \u201c11 Principles for Research in Partnership with Developing Countries\u201d prepared and published by the Swiss Commission for Research Partnerships with Developing Countries (KFPE) Malaria research initiatives are good examples of such integrated successes. Although it is a large and highly competitive field, a number of networks exist to foster collaboration, communication, and interactions not only amongst international members, but also among local members. An example is the Biology and Pathology of Malaria Parasite , a network of excellence funded by the European Commission, which has been successful in establishing and strengthening malaria communities and laboratories in both Europe and malaria-endemic countries In addition to these North\u2013South partnerships, research capacity building can be reinforced by facilitating and providing more opportunities for South\u2013South collaborations http://ec.europa.eu/health/programme/funding_schemes/index_en.htm); the training and capacity building programmes of the Section for Parasitology, Health and Development  of the former Danish Bilharziasis Laboratory , and of the former Swiss Tropical Institute ] in Basel, http://www.swisstph.ch/); the US Agency for International Development , and in particular the USAID's Neglected Tropical Disease Program (http://www.neglecteddiseases.gov/index.html); the Neglected and Other Infectious Diseases Program of the B&MGF (http://www.gatesfoundation.org/topics/Pages/neglected-diseases.aspx); the New York-based Ford Foundation International Fellowships Program (http://www.fordifp.net/); the International Development Research Centre of Canada ; AusAID (http://www.ausaid.gov.au/) in Australia; the Institut de Recherche pour le D\u00e9veloppement  in France; the Department for International Development of the United Kingdom ; the Wellcome Trust (http://www.wellcome.ac.uk/), and the Medical Research Council  also in the UK, as well as other foundations, initiatives, and programmes , bioinformatics, and computational biologyDetection and monitoring of resistance to anti-parasitic and anti-vectorial measuresOptimisation of existing, and development of novel diagnostics, drugs, and vaccinesEconomic evaluation of the health impact of helminthiases and of deployed interventions for cost-effectiveness analysis of control programmesIn order to increase DEC research output, gain external visibility, and improve success rates in obtaining studentships, fellowships, and research awards in an increasingly competitive environment, capacity building strategies should include formal training in paper-writing, oral presentation skills, and grantsmanshipMonitoring and evaluation (M&E) instruments should be devised and deployed to assess the effectiveness of research capacity building strategies in the same rigorous way they are applied to quantify the impact of control interventions. This would provide evidence-based arguments for the continuation and improvement of capacity buildingFigure S1Concept and Strategy of the Hashimoto Initiative for Global Parasite Control. WB: World Bank; WHO: World Health Organization; MFA: Japan Ministry of Foreign Affairs; MHW: Japan Ministry of Health and Welfare; JICA: Japan International Cooperation Agency; G8: The Group of Eight ; NMIMR: Noguchi Memorial Institute for Medical Research; WACIPAC: West Africa Centre for International Parasite Control; KEMRI: Kenya Medical Research Institute; ESACIPAC: Eastern and Southern Africa Centre of International Parasite Control; ACIPAC: Asian Centre of International Parasite Control (adapted from reference (PDF)Click here for additional data file.Table S1Examples of Current Research Capacity Building Initiatives in the Area of Health Research, Helminthiases, and other Infectious Diseases of Poverty with Particular Reference to Africa.(PDF)Click here for additional data file.Text S1Examples of North\u2013South and South\u2013South Research and Capacity Building Initiatives in Helminthiases and other Infectious Diseases of Poverty.(PDF)Click here for additional data file."}
{"text": "Toward a New Psychiatry: Philosophical and Ethical Issues in Classification, Diagnosis and Care' http://www.biomedcentral.com/series/newpsychiatry.This Editorial introduces the thematic series on ' Diagnostic and Statistical Manual (DSM-5) of the American Psychiatric Association, which upon release in spring of 2013, is hoped to instantiate greater consistency, and improve the ways that psychiatric disorders are classified and diagnosed [In the main, medicine has progressed substantially in recent years due to technological advances that have arguably enhanced methods to analyse research data, improved diagnostic techniques, and enabled more effective therapeutics. Such advancements are also being employed increasingly in psychiatry; in particular, progress in neuroimaging and other neurophysiological techniques, developments in behavioural sciences and psychotherapies, and developments in psychiatric genetics have all contributed to knowledge of mental illnesses. However, we must ask if, and in what ways these developments actually have affected the science, practice and clinical value of psychiatry. In addition, psychiatry is also confronting increasing diversity in socio-cultural values, norms and perspectives. The constructs of normality and abnormality, mental health and disorder, and the need for varying types of preventive and therapeutic interventions are undergoing iterative change. In part, this is reflected in, and influenced by the fifth edition of the Such re-assessment and revision will be important as worldwide social changes prompt new challenges and opportunities in psychiatric research and practice: international ethnic, religious and political beliefs and behaviours are becoming evermore prevalent, and the field is gaining prominence in non-western nations such as Japan, China and India. These changes necessitate reflection and insight in the philosophical and scientific bases of the profession, the ethical, legal, and social implications, as well as questions and problems that may be incurred through its articulation. Namely, how will - and perhaps should - advances in neuroscience, neurotechnology and genetics alter studies, concepts and the practise of psychiatry? In what ways might the DSM-5 affect the practical, ethical and legal aspects of the field, and its role in society? How might psychiatric diagnostic and therapeutic practices be best suited to meet the contingencies of non-Western societies? What specific constructs, paradigms, tools and techniques might shape and define this future path?Toward a New Psychiatry: Philosophical and Ethical Issues in Classification, Diagnosis and Care', addresses these questions, concepts, problems and possible solutions from multi-disciplinary perspectives. The issue begins with a paper by Shadia Kawa and James Giordano that presents the historiography of the DSM and posits the implications of both the history of the DSM, and the potential of the DSM-5 to affect the current and future canon and practice(s) of psychiatry [This thematic issue, 'ychiatry . James Pychiatry . In respychiatry .The use, utility and real value of the psychopharmacological (vs psychotherapeutic) approach to depression is addressed in a point-counterpoint dialectic provided by John Ioannidis, and John M Davis and colleagues, which then raises important questions about the actual nature of psychiatric disorder ,6. IndeeAs a result of advancements in the neurosciences, studies of brain-behaviour relationships have increasingly become part of the psychiatric literature, as evidenced by the application of neuroimaging tools, such as functional magnetic resonance imaging (fMRI). But neurotechnological approaches, while important, are not without limitations, and like any tool, must be used in ways that are technically correct, ethically sound, and effective in practise. Kristina M Visscher and Daniel H Weissman argue that advances in cognitive neuroscience research can be facilitated by greater sharing of raw fMRI data between researchers, thereby allowing effective comparison, syntheses and validation of research-based information that can be translated into more meaningful clinical diagnostics and therapeutics . StudiesWhile striving to define notions of technical rectitude, and individual and social good are crucial to the practise of any form of medicine, we must ask what new developments in the neurosciences, and changes in society portend for the future of psychiatry, and its place in contemporary cultures? Jennifer H Radden explicitly deals with such issues in her examination of patient rights, the nature, values and varied needs of mental health consumers, and the ways that reconstructive cultural semantics may influence clinical, ontological and socio-legal distinctions relative and relevant to psychiatric care . ExplicaPhilosophy, Ethics, and Humanities in Medicine). Submissions addressing these themes are invited to the following journals for inclusion: BMC Medicine; BMC Neurology; Genome Medicine BMC Psychiatry; BMC Neuroscience; and Philosophy, Ethics, and Humanities in Medicine.The ideas and opinions detailed in these papers represent insights to the ways that changing conceptualisations of mental function, health, disorder and illness inform and direct the current and future practices of psychiatric research and treatment. We aim to continue to publish important articles which address these issues, and invite you to submit your manuscript to this cross-journal, thematic series , will be explored further in a two-day conference: BMC Medicine at BioMed Central. Jigisha Patel is the Medical Editor for BMC-series journals at BioMed Central. James Giordano is the Editor-in-Chief for Philosophy, Ethics, and Humanities in Medicine.Sabina Alam is the Editor of"}
{"text": "To address the issue on Person Centered Health Professional Education, members of the Board of the International College of Person-Centered Medicine (ICPCM) and participants of the First International Congress of the ICPCM met during the Congress in Zagreb, Croatia on November 8th, 2013.We, participants in the First International Congress of Person-centered Medicine and the Board of the International College of Person-Centered Medicine, call for action to promote person-centered health for all through transformative educational concepts, programs and actions.Person Centered Medicine seeks to place the whole person in context at the center and as the goal of clinical practice and public health. It articulates science and humanism to achieve health care actions that are ethical, holistic, culturally sensitive, relationally attentive, individualized and seek common ground for joint diagnostic understanding and shared decision-making for prevention, treatment, rehabilitation and health promotion. It also endeavors for people-centered development of health services and public health policies, all supported by person-centered education, training and research.In order to advance person-centered medicine and health through educational efforts, we derive strength, inspiration and guidance from the many international bodies that regularly participate in our discussions, among them the World Federation for Medical Education, the International Association of Medical Colleges, and academic institutions from across the world. We also draw information and documentation from the proceedings of relevant events such as the the Geneva Conferences and International Congresses of Person-centered Medicine as well as from pertinent publications such as the International Journal of Person Centered Medicine.Person-centered educational efforts need to be attentive to the different aspects and levels of the educational domain, including conceptual bases, institutional organization and culture, selection and development of health professional students, instructors and mentors, interactional mechanisms among students, teachers, patients and families, educational settings, curriculum development and evaluation, educational methods, and broader issues on education, health and society.We therefore propose the following educational and related actions:1. Enhancement of the conceptual bases of professional training and public education by grounding them in ethics and human rights, knowledge of the bio-psycho-socio-cultural determinants of ill health and positive health, attention to personal values and preferences, and the flourishing of well-being and life projects.2. Analysis and optimization of the organization and culture of educational institutions to be supportive of person-centered health for and with students, faculty and administrative colleagues.3. Selection of students who are suited to the goals and responsibilities required of health professionals and commitment to their personal development in addition to their broad technical training.4. Selection of instructors and mentors who are suited to their educational responsibilities and commitment to their continuing professional and personal development.5. Facilitation of dynamic interactions among students, instructors, patients and families by ensuring opportunities for dialogue at all levels, promoting inter-disciplinary training, and engaging patients as instructors.6. Promoting curricular developments that have person-centered guiding principles, that include curricular experiments and mechanisms for their evaluation, that consider a balance between concentrated blocs and longitudinal integration for the achievement of educational objectives, and that incorporate the continuum of health promotion, prevention, treatment, rehabilitation and palliative care.7. Exploring the design, implementation and evaluation of person-centered educational methods such as experiential and reflexive learning, communicational exercises, training groups with patients and families, shadowing mentors, employing video recordings for feedback purposes, community visits and practice, utilization of narratives, practice of artistic activities, motivational interviewing, establishing common ground among clinicians, patients and families for diagnosis and care, articulation of competence- and performance-training, and ability to work with patients from different cultures and social conditions in a respectful and collaborative manner.8. Promoting health in individual patients and in society by active education of patients, addressing broad issues on determinants of health and the impact of cultural, religious and social factors on health and health care, identifying and reducing health hazards in the environment and society, and being all involved in shaping sound health policies.The International College of Person-centered Medicine is committed to the above listed recommendations and calls on governmental, intergovernmental and non-governmental organizations to collaborate on the advancement of these educational efforts toward the promotion of person-centered medicine and health."}
{"text": "Vivienne Ho was not included in the author byline. She should be listed as the third author and affiliated with Center for Vascular Biology, University of Connecticut Health Center, Farmington, Connecticut, United States of America. The contributions of this author are as follows: Conceived and designed the experiments, performed the experiments, analyzed the data, and contributed reagents/materials/analysis tools."}
{"text": "Jun Saegusa was incorrectly omitted from the list of authors of the article. Dr. Saegusa should be indicated as the eighth author and affiliated with Department of Dermatology, School of Medicine, University of California Davis, Sacramento, California, United States of America. The contributions of this author are as follows: Performed the experiments and analyzed the data."}
{"text": "In Rinderpest and Peste des Petits Ruminants: Virus Plagues of Large and Small Ruminants, Tom Barrett (now deceased), of the Institute for Animal Health, Pirbright Laboratory, Surrey, UK, and his co-editors have subtly presented the main developments in the quest to conquer these diseases. The instructive text, which touches on the key dynamics of both deadly diseases, incorporates considerable historical detail, infection biology, and information on disease diagnosis, control, and eradication. This book consists of high quality scientific and historical research based on the editors\u2019 experience with morbilliviruses and collaborations with other researchers worldwide. In total, 22 scientists have contributed their expertise on various infectious diseases to the monograph\u2019s 17 chapters.Throughout, the contributors have tried to maintain an appropriate balance between peste des petits ruminants (PPR) and rinderpest (RP). This hypothesis-based balancing act is important to understand PPR. A future significance of PPR can be realized by the phrase stated by the editors, \u201cIf rinderpest becomes a disease of the past, PPR is certainly a disease of the future.\u201d The book starts with an historical account of the RP and PPR diseases accompanied by photographs from the 18th century. These photographs are detailed, illustrative, and fascinating. Of particular interest are a condolence letter, written by Emile Roux from Institute Pasteur to the widow of Joseph Hamoir, with whom Emile Roux worked on rinderpest, and a group photo, including Robert Koch, of his visit to the Imperial Veterinary Laboratory  in 1897 where he conducted experiments to immunize cattle with the bile taken from an animal that had succumbed in a virulent outbreak of rinderpest. The book focuses on the following issues: relative position of each member in the genera, comparative molecular biology, pathophysiology of the infectious diseases, global epidemiologic patterns, contribution of countries in the eradication of the disease under the Pan African Rinderpest Campaign Programme and the Pan African Programme for the Control of Epizootics, viral immune suppression, and molecular diagnostic approaches being developed. For all these issues, the importance for clinicians of accurate diagnosis and management and prevention of infectious diseases is highlighted. Because of the current sensitivity about an emergence of PPR and the successful Global Rinderpest Eradication Programme, the contributors believe that PPR can be controlled similarly and its spread prevented. Thus, the last 7 chapters emphasize the traditional prophylactic measures, potency of vaccines and possibility of vaccine use, the history of vaccine improvement, recent advances in vaccine development, implementation of international control campaigns for the eradication of RP and PPR by using vaccine, and a brief overview of the pathogenesis and eradication of measles virus. Finally, the editors assess the real cost and benefits of the Global Rinderpest Eradication Programme campaign and predict that the world will soon be free of RP, at comparatively little cost.Although the book discusses many aspects of the current situation, such as epidemiological distribution, progress in vaccine development, and advances in the diagnosis of PPR diagnostic procedures, information regarding the most recent developments is lacking; a few chapters were written in \u22482000 before the increase in PPR research. Still, I consider this to be the only book that comprehensively describes PPR. It is suitable not only for academics and researchers, but also for virologists, infectious disease specialists, vaccine researchers, and clinicians. Moreover, this book provides appropriate scientific source material suitable for undergraduate and graduate studies."}
{"text": "This e-book presents a collection of research and review articles related to the spread, control and basic understanding of vector borne diseases all over the world. It is well known that a multidisciplinary point of view is necessary in order to develop a global vision of this emergent problem. Therefore, in order to promote this holistic approach to the knowledge of vector borne diseases, this e-book contains a total of 19 collaborations of entomologists, epidemiologists, virologists, parasitologists, bacteriologists, zoologists and veterinarians of Europe, Africa, Asia, and America. The title perfectly reflects some of the global factors that are behind the emergence and/or reemergence of vector borne diseases.It is now well known that several climatic, environmental and sociodemographic changes that have occurred over the past years are some of the most important causes for the resurgence of many diseases worldwide. However, global change, defined as the impact of human activity on the fundamental mechanisms of biosphere functioning, includes not only climate change, but also habitat transformation, water cycle modification, biodiversity loss, synanthropic incursion of alien species into new territories, or the introduction of new chemicals in nature.Although there is a large and varied group of vectors worldwide, in this e-book we have examined the two most important disease vectors in our opinion: mosquitoes and ticks. Studies about the presence and transmission rates of viruses like West Nile, assays about mosquito control with new and encouraging methods, studies related to the importance of vector control strategies, research results about the role of asymptomatic cases of anthroponosis like Dengue, and investigations about the impact of climate trends on diseases transmitted by ticks and mosquitoes, are some of the issues that can be found in this Research Topic.As editors of this Research Topic, we would like to acknowledge sincerely all coauthors for their valuable and interesting contributions and we wish the readers of this e-book a productive and enjoyable reading of some of the most innovative work related to vector borne diseases."}
{"text": "We inadvertently failed to include the complete list of all coauthors for this work . The fulAW is an employee of Bristol-Myers Squibb which produces dasatinib and BMS911543. The remaining authors declare that they have no competing interests.FMJ conceived and designed the project, supervised all the experiments, and wrote the manuscript. SP, BS, and TM helped to design and performed all the animal and bench experiments. CJC and YZ performed the gene expression analysis and prepared the corresponding figures. JM, DB, MDW, and SYL assisted with the study design and tissue acquisition, critically reviewed the data, and reviewed the manuscript. Additionally MDW performed all the histologic tissue analyses including interpretation of the IHC and prepared the corresponding figures. AW and ML were involved with the pre-clinical development of BMS-911543 and assisted with the study design and preparation of the manuscript. All authors gave final approval of the manuscript."}
{"text": "It is my great privilege to take over as Editor-in-Chief of the Journal of Epidemiology after Dr. Tomotaka Sobue, who served in that role between 2008 and 2010. Under the outstanding leadership of Dr. Sobue and his team, an online submission system was started in 2008, and the number of manuscripts from abroad has substantially increased. In 2010, 40% of submitted articles were from Japan, 12% from Europe, 11% from China, 9% each from Taiwan and countries in the Middle East, 5% from Korea, 6% from other Asian countries, 6% from the United States, and 2% from South America. The average impact factor from 2007 through 2009 was 1.73.The journal will continue to cover a broad range of high-quality epidemiological research throughout the world and to contribute to the basic, clinical, public health, and political sciences. The editorial team seeks to maintain our high international standard by publishing original and review articles on a variety of research topics in order to eventually establish us as one of the leading journals in epidemiology.Hiroyasu Iso, MD, PhD, MPHEditor-in-Chief, Journal of EpidemiologyProfessor of Public HealthDepartment of Environment and Social MedicineOsaka University Graduate School of Medicine"}
{"text": "There is an error in the funding statement. The correct funding statement is, \"This work is supported by the Natural Science Foundation of China (NSFC) under grants No. 61174150, No. 70771011, and No. 60974084, the Program for New Century Excellent Talents in University of Ministry of Education of China (No. NCET-09-0228), and fundamental research funds for the Central Universities of Beijing Normal University. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.\""}
{"text": "The affiliation for the third author is incorrectly assigned. The correct affiliation for Giovanni Colonna is the first affiliation: Department of Biochemistry and Biophysics and CRISCEB - , Second University of Naples, Naples, Italy."}
{"text": "Reports of secondary bloodborne transmission of vCJD add to the uncertainty about the future of the vCJD outbreak. The only variant Creutzfeldt-Jakob disease (vCJD) patient identified in the United States died in 2004, and the diagnosis was confirmed by analysis of autopsy tissue. The patient likely acquired the disease while growing up in Great Britain before immigrating to the United States in 1992. Additional vCJD patients continue to be identified outside the United Kingdom, including 2 more patients in Ireland, and 1 patient each in Japan, Portugal, Saudi Arabia, Spain, and the Netherlands. The reports of bloodborne transmission of vCJD in 2 patients, 1 of whom was heterozygous for methionine and valine at polymorphic codon 129, add to the uncertainty about the future of the vCJD outbreak. Western blot and immunohistochemical analyses of tonsillar biopsy tissue demonstrated the presence of protease-resistant prion protein, which supported the diagnosis of vCJD. By September 2002, the patient was bedridden. An experimental treatment with quinacrine was given to the patient for 3 months, but she showed little improvement. She remained in a state of akinetic mutism and died in June 2004, \u224832 months after illness onset.The patient was born in Great Britain in 1979 and immigrated to the United States with her family in 1992. She had no history of surgery or receipt of blood or blood products, and she was never a blood donor. Consistent with findings for vCJD patients in the United Kingdom associated with potential foodborne exposure, this patient was homozygous for methionine at polymorphic codon 129 of the prion protein gene. A full autopsy was performed, and neuropathologic examination of brain tissue showed the presence of florid plaques and severe cortical atrophy . ImmunohThis patient is the only US resident with a confirmed diagnosis of vCJD. She was likely exposed to BSE while growing up in the United Kingdom from 1980 to 1992, which suggests an incubation period of 9\u201321 years . The illAs of early August 2005, 157 vCJD patients were reported from the United Kingdom: 13 have been reported from France, 3 from Ireland, and 1 each from Canada, Italy, Japan, Portugal, Spain, the Netherlands, and the United States . SimilarCertain characteristics distinguishing vCJD from classic CJD raised early concerns about possible secondary bloodborne spread of vCJD, especially in light of the lack of experience with this newly emerged disease. Of specific concern was the detection of the agent in lymphoid tissues and the possibility of prionemia as the agent spreads from the gut to the brain. In 1997, to monitor for the possible bloodborne transmission of vCJD, researchers in the United Kingdom began investigating recipients of blood components obtained from donors who subsequently died of vCJD , predominantly psychiatric manifestations at illness onset, delayed appearance of frank neurologic signs, absence of a diagnostic electroencephalographic pattern, presence of the pulvinar sign on MRI, and a longer median illness duration  (http://www.cjdsurveillance.com), which was established to facilitate autopsy performance and testing (In June 2005, the US Department of Agriculture confirmed BSE in an \u224812-year-old cow born and raised in Texas. This is the first time an indigenous BSE case was detected in the United States. A previous BSE-positive cow identified in Washington State was imported from Canada ("}
{"text": "This review traces the evolution of modern medical education in India on the one hand and the formation of the Indian Psychiatric Society and the progress of postgraduate psychiatric education on the other hand, all in the context of Indian psychiatry. The topic is covered under the headings standard of psychiatric education, the goals, competencies required, impact of psychiatric disorders, relation of medicine to psychiatry, and the directions for the future of postgraduate psychiatric training. Modern medical education in India began in 1822, in a medical school at Calcutta. The medium of instruction was the language of the region, into which English medical books were translated. In the year 1833, Lord William Bentick, the then Governor General of India, appointed a Committee to examine the question of medical education in India. The committee recommended the abolition of the medical school and the establishment of a medical college in its place. Consequently in the year 1835, two medical colleges were started in India, one in Calcutta and the other in Madras. The duration of the medical course was four years, which was extended to five years in 1845.[The Indian Medical Council Act No. XXVII of 1933, was brought into force on 1 November 1933, and the Medical Council of India (MCI) was constituted thereunder on15 February 1934. From time to time, amendments have been made in this Act. The council has been primarily concerned with undergraduate medical education, but during the last six decades, particularly after the new Medial Council Act of 1956, it empowered the Council to look after Postgraduate Medical Education. According to Section 20(1), the Council may prescribe standards of postgraduate medical education. Consequently, the Postgraduate Medical Education Committee of MCI has made valuable recommendations regarding the nomenclature of postgraduate degrees, the courses and period of studies, examination systems, recognition of training institutes, and postgraduate teachers.There has been a tremendous growth in medical education since 1935, but more so, during the last three decades. Today there are 313 recognized medical colleges and admit35133 students every year. As on July 2010, there are 112 Medical Colleges and Postgraduate Institutes, which admit266 M.D. degree students in Psychiatry each year, besides which, 55 Medical Colleges have training facilities for 124 D.P.M. students. In addition 50 to 60 Postgraduates appear for D.N.B. of the National Board of Examination. It may be important to mention that the first M.D. Psychiatry course was started by Medical College at Patna in 1941 and the first M.D. Candidate was late Prof. L.P. Verma, a Past President of I.P.S. and Past Editor of Indian Journal of Psychiatry and Neurology.The Indian Psychiatric Society was founded in January 1947 and significantly in the same year the Society appointed a committee on Post-graduate Psychiatry Education. The need for P.G. training in Psychiatry was mentioned by Dr. C.C. Saha during his Presidential address by him in 1962 at Agra. Since th20This trend is gradually changing, and during the last four decades, dramatic developments have taken place regarding the growth of psychiatry. Today it is obvious that like most other specialties, psychiatry is becoming increasingly specialized and fragmented.The development of psychiatric education, including its objectives and standards is guided by the Medical Council of India, a statutory body established in 1933. Since 1956 it has had a permanent Committee on Postgraduate Medical Education, whose function it is to formulate rules and curricula of studies and the minimum requirements for teaching centers. It also maintains the quality of teachers and examinations conducted by the universities, so as to bring about uniformity of standards.In many ways the recommendations of the Council are mandatory and should be fulfilled before an institute/ college is recognized as a Postgraduate Department, and the following areas are essential:(a) The teaching staff must be adequate and qualified(b) The student to teacher ratio must be satisfactory, normally one postgraduate student (MD) per teacher per year-recently this ratio has been changed to two MDs for one teacher from 2010(c) The ratio of student to number of patients he handles must be satisfactory(d) Each postgraduate teacher must have at least 40 in. patients with out-patient, follow-up and adequate laboratory facilities, and a library for research, in the unitThe selection of MD students must be strictly on merit, and in some institutions credit must be given to their work in rural areasThe duration of a postgraduate degree course must be for a minimum of three years and for the diplomas two years, after one year of compulsory rotatory internship in a recognized medical institution. This period of three years training has to be full-time, and every postgraduate student must be either a full-time resident or a full-time scholarWith regard to the content and method of training, the main purpose must be to expose the student, by graded residency posts, to all branches of clinical psychiatry and also neurology. The student must participate in the care and management of patients, and must be given increasing responsibility as his experience develops. By the time he is in his last year of training, he must be able to diagnose and initiate treatment independently. He has to become conversant with the allied subjects, such as, neuroanatomy, neurophysiology, neurobiochemistry, including electroencephalography, neuroradiology, psychology, and social work, during his trainingOrganization of the teaching program is a complex task for anyone given this kind of responsibility. It is easy to preach ideals but difficult to practice, and at present our leaders face two formidable tasks: First, to train and provide service to the mental healthcare of 1.2 billion population, and second, to maintain high standards in the scientific field in order to ensure a high quality of teaching and research activityMD Three yearsDPM Two yearsThe modular approach in teaching is essential. Training must involve learning experiences targeted at the needs of the community and also at exposing the students to community-based activities. A combination of both formative and summative assessment is vital.To produce competent and knowledgeable specialists and/ or medical teachers and to research in psychiatry.To achieve this, it is recommended that postgraduate students recognize the health needs of the community, and be able to carry out professional obligations ethically. To master most of the competencies, it is necessary to grasp the speciality required for the needs at the secondary and tertiary levels, and be aware of the contemporary advances in the discipline. To acquire a spirit of scientific inquiry, research methodology and epidemiology are essential. Further it is suggested that they acquire the basic skills in teaching the medical and paramedical professionals.Sufficient understanding of the basic sciences relevant to the concerned specialityTo diagnose and manage the majority of conditions in the specialityTo plan and advise measures for the prevention and rehabilitation of the mentally sickTo demonstrate skills in the documentation of individual case records of morbidity and mortalityTo have empathy and a humane approach toward patients and their familiesTo have skills for the implementation of a national health program effectively and efficientlyTo organize and supervise healthcare services, demonstrating adequate managerial skills in the clinic/ hospital settingTo develop a self-directed learning ability, recognize continuing educational needs; select and use the appropriate learning resourcesTo develop skills in using educational methods and techniques for teaching of medical studentsTo demonstrate being an effective leader of a health teamSimilar to every discipline, every postgraduate student in psychiatry shall aim at the development of specific competencies, defined and spelt out in clear terms. Each department shall produce a statement and bring it to notice of the trainees at the start of the program so that he or she can direct the effects toward the attainment of these competencies.Components of the postgraduate curriculumThe major components of the postgraduate curriculum shall be to include relevant theoretical knowledge and to develop practical and clinical skills and attitudes, including communication skills, training in research methodology, and thesis writing skills.Basic sciences, in Neuroanatomy, Neurophysiology, Genetics, Neurochemistry, Neuroimaging, Psycho pharmaclogy, Psychology, and Social Sciences, including Statistics and EpidemiologyDiagnostic assessment of all psychiatric diseases including a basic knowledge of Internal Medicine and NeurologyEtiopathogenesisTherapeutics relevant to all Psychiatric disordersPrognosis of various disordersNecessary knowledge about prevention and mental health promotion and research methodologyA written curriculum is necessary, as it defines competency and expectation, program evaluation, and helps in the proper assessment of learners.After the completion of training, the trainees must be knowledgeable about the aspects of those bio-medical, social, and psychological sciences that underpin the practice of clinical psychiatry. In particular, trainees should be able to demonstrate the knowledge of those aspects of neuroanatomy, neurophysiology, neurochemistry, neuropharmacology, and other biological sciences, which are relevant to understanding psychiatric disorders, including those aspects of psychology, sociology, anthropology, and other social sciences, which are relevant to psychiatric disorders. It must also focus on the various biological, psychological, social, and cultural models of the etiology of psychiatric disorders. The theoretical underpinnings of the major treatment modalities for psychiatric disorders, including biological, psychotherapeutic, and social and family interventions are essential.A minimum of six months in Neurology and Primary Care,18 months minimum in General Psychiatry, which includes inpatient, day hospital, rehabilitation, and outpatient services, is necessary. Rotations can include adult, geriatric, child, and adolescent patients. A minimum of six months of complimentary didactic/clinical rotations will be available. It must include three months in consultation and liaison psychiatry and three months in community-based psychiatry.The evaluation of the training process should focus on motivation and empathy. Knowledge in psychiatry, including patient care, communication skills, professionalism, and empathetic development, must be evaluated. Formative and summative assessment should be an integral part of the evaluation process.Appropriate assessment devises should be used for evaluation; for instance, objective structured clinical examination, examination on written or computer-based, multiple-choice questions, chart-stimulated recall oral examination, case logs, and so on. The self-assessment evaluation process should take into consideration the cultural and regional factors.The present evaluation process for the MD degree is not very satisfactory and needs improvement. It should include faculty evaluation by residents, to improve the teaching and development of the faculty. Program evaluation by residents and faculty must be used to improve educational programs. Evaluation of teaching materials and tools must also take place regularly. The role of an individual supervisor in the evaluation process is essential to convey the accumulated evaluation data. Oral and written evaluation must take place twice a year, to determine the level of educational progress and the quality of the curriculum and not just at the end of three years. Patients\u2019 log books must be an integral part of the evaluation process.The evaluation must be compatible and must encompass clinical psychiatry, including clinical assessment and the delivering and monitoring of treatment, and also multiprofessional case management, with ethical professional practice, as also management and leadership issues. The evaluation must also include research, informatics, and knowledge management, and must be demonstrable, culturally sensitive, and deliverable in terms of available local training facilities. Training must have explicit, assessable learning objectives, which must be reviewed and revised as necessary. Similarly evaluation must be rooted in evidencebased practice. There must be feedback from the trainees and the evaluation methods must be modified accordingly.After the completion of their training, the trainees must be knowledgeable about the epidemiology, etiology, psychopathology, clinical features (including complications), and natural history of psychiatric disorders and psychological reactions in both the individual and the caregiver, including concepts of the impairment, disability, and handicap. A sound knowledge of the assessment and care of these conditions is also expected. In particular, trainees must be able to demonstrate the knowledge of the incidence and prevalence of illnesses at different ages and in various populations, as also the history of the evolution of the concepts of psychiatric disorders and principles of treatment. Similarly understanding of the influence of specific factors on the assessment and care of psychiatric disorders, including: Age, intellectual capacity, co-medical illness, gender, culture, spiritual beliefs, and socioeconomic status, are important.They must also understand the influence of various factors that affect the outcome of treatment and the principles underlying the choice and integration of interventions in psychiatric disorders, including relative cost effectiveness. The principles of legislation, which relate to the practice of psychiatry, with particular emphasis on mental health legislation, including its local application, must also be gathered. The phenomenology of psychiatric disorders, including the definitions of psychiatric symptoms and their significance, psychiatric diagnosis, and the criteria on which these are based, within the framework of one of the widely accepted classification systems such as ICD or DSM, the possible causative or exacerbating factors in psychiatric disorders, the natural history of the disease process in psychiatric disorders, which enables identification of the severity of the disease, the urgency of the need for treatment, the stage of the need for treatment, and the prognosis must be understood.Similarly, after the completion of training, trainees must be knowledgeable about the impact of psychiatric disorders on patients, their families, caregivers, and significant others. They should also have knowledge about the impact on patients with psychiatric disorder and their treatment, including the broader potential impact on multiple areas of the patients\u2019 life and lifestyle. They must also know the particular impact on patients with psychiatric disorder and their treatment, when this treatment involves hospitalization and involuntary treatment. The impact of the psychiatric disorder on the families and caregivers, including an awareness of their needs and their role in the care of a patient is important. Community consequences of psychiatric disorder and implications for the community of policies for the care and treatment of people so affected, is another aspect that trainees need to gain knowledge about, along with understanding the attitudes and responses of the community to psychiatric disorder, including the implications of stigma to the patients, their families, and caregivers.The trainees must have a knowledge about the appropriate management plans for psychiatric disorders, including(a) Physical and psychological investigations and assessments,(b) Psychotherapeutic techniques, (c) Psychopharmacological and other physical therapies, (d) Situations in which referral to or consultation with colleagues in psychiatry and other disciplines is appropriate, (e) understanding of rehabilitation programs.After the completion of training, trainees must be knowledgeable about the general medical and common surgical conditions. Higher levels of knowledge, tempered by maturity and experience, are expected in those areas of general medicine that are particularly related to psychiatric practice. In particular, trainees must be able to demonstrate knowledge of the presentation, investigation, diagnosis, and treatment of medical conditions, particularly in those areas related to psychiatric practice. Their knowledge of further investigations that are necessary to confirm or reject diagnostic hypotheses, to aid the patient\u2019s management, the basic principles involved in the management of significant medical illnesses, the interaction between medical and psychiatric disorders, the psychosocial and cultural aspects of medical illness and its significance to patients and their families, with regard to both the illness and its treatment, are desirable.The long case history is an essential component of the final examination. Time \u2013 one hour, personal style, format \u2013 case history, identifying data, How the patient presented his problem \u2013 which led to his presentation to the clinic, history must be sufficient, with details \u2013 which help to give meaning and substance to the diagnostic formulation and help to arrive at a diagnosis, and the context in which therapy would be affected, including a rehabilitation plan. It must also include physical examination \u2013 neurological, cardiovascular system, respiratory system and eye-fundus.Title \u2013 15 minutesPersonal StyleMental status examinationNeurological examination if requiredBrief history \u2013 relevantSymptomsSignsDiagnostic formulation with tentative diagnosis, with justificationTreatment planningFormat must includeViva must includePharmacotherapyBehavior therapyPsychotherapyForensic psychiatryHistory of psychiatryClinical syndromesRecent researchAny other aspectsSpot test must includePsychological testsEEGX-rays + MRI + CATPsychiatrists have played a prominent role in shaping the mental health program and providing mental health care to patients in every country. It is true for India too. However, their influence is in part a byproduct of their own professional preparation. The global information about the quality and quantity of training of psychiatrists is largely unavailable. Similarly, there is a wide variation in the training programs, in spite of MCI regulations and guidelines. There is a constant need for retrospective introspection. How satiRecently, WHO in collaboration with the World Psychiatric Association (WPA) has brought out an interesting publication\u2018Atlas: Psychiatric Education and Training Across the World 2005\u2019. This isThe structure and requirements of the healthcare delivery system in each countryThe role of legal and other accreditation bodies such as the MCI, established under the law of the land, which define and set standards of postgraduate medical education in the universities and medical institutions, which maintain and implement standards and impart trainingIt needs to be emphasized that the goal of postgraduate training in all specialties, including the field of psychiatry, is to produce competent and knowledgeable specialists and teachers, who can meet the needs of the community, carry out professional obligations ethically, be aware of contemporary advances in the discipline, and have some foundation in the principles of research methodology.There are some established systems in the education system that are applicable in the field of postgraduate training in medicine, including psychiatry, which can be usefully incorporated to help in this direction, namely, (a) uniform admission policies, (b) some uniformity in the content of the training program, (c) the organization of the curriculum, which can be evaluated (d) the outline of the training program including the standard methods of instruction, (e) objective assessment methods, (f) to develop acceptable guidelines with regard to the relationship between the institution/College/University and the external, national or Today, specialists licensed in one country rarely have extended practice privileges in another country. In some countries, the license for specialists is even restricted for practice in only some provinces of the country. The implications are obvious\u2013the assessment method must be harmonized within the country and some international standards need to be developed\u2013WHO is an established body under the U.N. Organization. Accordingly, WHO is a body that can take the necessary steps to meet this goal. It is not an easy path, but needs patience and sustained efforts to meet the challenge.The WHO, whose primary mission is that of directing and coordinating International Health Work, must take vigorous steps to develop the standards of medical education at the undergraduate and postgraduate levels and strengthen the accreditation process. This will certainly improve the quality of health care."}
{"text": "After publication of this work , we noteMEM, SAK, VRG and DEL contributed to the design of the experiments; MEM, HEG, SAK and XZ, performed the experiments; TAPFD and PB designed the plasmids used to express the recombinant proteins that formed the nanoparticles; TAPFD and YY made the gold nanoparticles; MEM and DEL wrote the manuscript. All authors read, were involved in interpretation of results and approved the final manuscript."}
{"text": "More than 90 people attended a March 25\u201327, 2004, conference on Ethics and Epidemics. This conference was sponsored by the Albany Medical College\u2013Graduate College of Union University Masters in Bioethics Program, the University at Albany School of Public Health, the New York State Department of Health, and the Wadsworth Laboratories. Attendees came from Australia, Africa, Asia, Europe, Canada, and the United States. Among the 24 papers and panels, presentations were made by George Annas, professor and chair of Health Law at the Boston University School of Public Health; Ezekiel Emanuel, chair of the Department of Clinical Bioethics of the Magnuson Center of the National Institutes of Health; Thomas R. Freiden, commissioner, New York City Department of Health; Matthew Wynia, director of the Institute of Ethics of the American Medical Association; Kenyan bioethicist Angela Wassuna associate for International Affairs of the Hastings Center; and 19 other bioethicists and health professionals.Presentations ranged from case studies to health policy debates. Many reviewed the history of epidemics, emphasizing their global nature and the imperative of global strategies for epidemic control. Several papers examined recent epidemics and explored new strategies for dealing with epidemic control while respecting human rights. The consensus was that the old policeman model of public health needs updating. Discussion focused on how best to balance public safety, professional responsibility, personal liberty, and human rights, while effectively containing epidemics. Emanuel and Wynia reaffirmed the responsibility of physicians and first responders to put their health and lives at risk in combating epidemics. Yet, noting the vulnerability of first responders (in the Toronto severe acute respiratory syndrome [SARS] outbreak and elsewhere), they distinguished between bravery and foolhardiness, arguing that just as professionals have a responsibility to protect the public from disease, the public, in turn, has a responsibility to provide the training, equipment, and resources to minimize the need to take risks.Virtually all conferees observed that the public health infrastructure needs substantial rebuilding to cope effectively with epidemics. Annas, however, noted that in bioterrorist assaults the control of biologic agents is a public health problem to be dealt with by public health officials, not by the U.S. Department of Defense or the U.S. Department of Homeland Security. He further stated that policies on epidemic control that involve consistent, open, and truthful communication with the public\u2014like those used in New York and Toronto during the recent SARS outbreak\u2014create cooperative environments that minimize conflicts between freedom and safety and limit the effects of isolation and quarantine. However, Emanuel et al. asserted that the traditional enforcement authority of public health law was essential and needed as a fallback. The result of the debate was that 21st century methods need to be developed to control infectious disease epidemics that reconcile the need to protect public health and respect human rights.http://www.bioethics.union.edu under \"News.\" For further information contact bioethics@union.edu or 518-388-8045.The conference program is available on"}
{"text": "News from the Society for Cardiovascular Magnetic Resonance The Society has begun 2011 on multiple highpoints, yet these have been tempered by a recent and particularly saddening low - the untimely death of Stefan Fischer. For those of you unaware, Stefan was the Director of Clinical Science for Philips Healthcare, North America, an important developer of CMR pulse sequences, tools and equipment that remain critical standards today; he was a long-standing member of SCMR with friends too numerous to count in our Society and field. I had known Stefan for well over a decade, and knew him as fiercely intelligent, strong-willed yet gently firm in his guidance, purposeful in increasing the benefits we impart to patients with our technology, and always practical. His passing leaves a gap that is impossible to fill, both in our Society, and in our hearts. I trust that the work we pursue in this Society will continue to live up to those characteristics and ideals that he embodied.To recap key Society events thus far, the year began with the 2011 SCMR Annual Scientific Sessions held in conjunction with the Euro CMR Working Group in Nice, France. It was a great success with a record number of participants from around the world. Much of that success can be attributed to the constant and hard work put forth by the Program and Abstract Chairs, Sven Plein, MD, and Raymond Kwong, MD, who put together an outstanding scientific program with a compelling array of scientific presentations, excellent posters, invited talks, and thought provoking case-sessions. The opening plenary was an important prelude to the thrust of the meeting where Michael Lauer, MD, of the NHLBI, emphasized the critical importance of CMR investigators and clinicians to design trials that alter patient outcome, as opposed to simply providing a superior diagnosis - a theme that was emphasized repeatedly as necessary to maximize CMR's impact on clinical care.During the meeting, the Society awarded its first Gold Medal Award, given for distinguished and extraordinary service to the field of Cardiovascular Magnetic Resonance and to the Society. Fittingly, Gerald Pohost, MD, and Charles Higgins, MD, two long-standing and esteemed leaders in CMR and the Society were the inaugural winners of this annual award.Outside of the annual meeting fantastic news was received about our journal: the Journal of Cardiovascular Magnetic Resonance saw its impact factor increase from 2.28 to 4.33!, placing it within the upper tiers of both cardiovascular and imaging journals. This near doubling reflects the committed leadership of Journal Editor-in-Chief, Dudley Pennell, MD, to continually increase both the quality and quantity of CMR scientific publications, and to expand the reach and impact of the JCMR within the field of cardiovascular investigation. Great thanks are to be extended to Dr. Pennell and to the journal's Editorial Board for their tireless efforts on behalf of the JCMR. Please continue to send your important scientific work to our flagship journal.Elsewhere, the Society continues to make progress in standardization of CMR, aspects that are essential for its continued adoption. In recent years the publication of recommendations for standardization of data acquisition  and repoVictor Ferrari, MD, the prior Education Committee Chair, along with James Moon, MD, the Web Editor, and his team have recorded and posted the majority of presentations from the 2011 meeting, making them available for continued review. In addition, the team has recently completed and made available on the Society's website, the first SCMR Online Course in CMR covering topics including CMR Physics, Safety, Techniques, and up to 35 Clinical Cases. These new educational courses are available for credit toward Level 1, 2, and 3 training in CMR, and should help facilitate training for those new to CMR. To further advance the Society's educational goals, SCMR has joined with the Euro CMR Working Group to develop an international standard credentialing examination for CMR to serve the needs of CMR practitioners world-wide. The exam will be available by the 2013 Annual meeting.Moving now beyond recent accomplishments and looking to the immediate future, the Society's Board of Trustees has spent multiple days of intensive meetings in Strategic Planning that have led to refining the Society's Vision and Mission statements, along with identifying a series of themes - Societal Alliances & Partnerships, Clinical Evidence, Education, Communication, and Technological & Efficiency Advances - from which many new projects and directives have been developed. These Strategic Planning sessions, held at this year's annual meeting and at the mid-year Board meeting in Philadelphia in June of this year, have given us a roadmap of where we would like to go and how we can get there, as well as the tools for doing so more effectively. Expect that these projects will engage the Board, committees, and many of our members to help drive the numerous new initiatives.As an international Society we have for years embraced a more global perspective, though one that remained relatively U.S., Europe, and Japan-centric; nonetheless, the rapidity and breadth of globalization necessarily requires a further expansion of our vision and ability to adapt. To date we are doing an admirable job: as highlights, a Middle East working group has been formed and a new imaging society in India seeks opportunities to collaborate; increasing activity from our Latin American group has led them to request that the Society consider holding an annual meeting in Latin America ; and through the efforts of former President Gerald Pohost, MD, we are making plans for a jointly sponsored meeting in China in the fall of this year, along with the development of a Chinese working group. To come full circle, the European Chapter (via the Euro CMR Working Group of the European Society of Cardiology) has developed an outstanding CMR registry that already has resulted in multiple publications; there are further ongoing efforts to expand the registry with help from the U.S. and Asia study groups, pushing it further toward a truly global CMR registry.The Society is also expanding its outreach efforts and has recently nominated an SCMR member to a U.S. governmental advisory panel for imaging reimbursements, and in the process, and for the first time, collaborated with and cross-sponsored candidates from sister imaging societies . We expect more such policy-influencing nominations to come. Perhaps most importantly the Society is in process of a broad collaborative effort bringing together vendor partners, contrast manufacturers, the NIH and FDA, corelab and post-processing experts, and CMR thought leaders for design and initiation of a large-scale, multi-center clinical trial to push CMR to the forefront by demonstrating its clinical relevance and superiority - efforts that bring to reality the themes Michael Lauer, MD, emphasized at the 2011 annual meeting earlier in this report.So in summary, I believe that this is an exciting and invigorating period for the Society, where the coming years will see growth along multiple avenues, continuing robustness and preference for CMR in cardiovascular care, and greater collaborative efforts that will further advance the field and the Society. The Board is working hard, and despite the challenging times we face today, the future continues to look bright.To conclude, let me add that we are finalizing plans for the 2012 SCMR meeting. Raymond Kwong, MD, and Jeanette Schulz-Menger, MD, our Program and Abstract Chairs, respectively, have put together a terrific program. Multiple tracks aimed at clinicians, basic scientists, and pediatric CMR imagers are planned. Immediately prior to the annual meeting SCMR will hold a two-day joint workshop in concert with ISMRM: \"Exploring New Dimensions of Cardiovascular Flow and Motion\". We expect that this will be another spectacular annual meeting, and one you won't want to miss. Please remember the abstract deadline of October 3rd, and make your plans to come to Orlando, Florida, during February 2-5, 2012, where we hope to welcome many familiar and even more new faces to the meeting. For those making plans further ahead, be sure to pencil in your calendars the dates for the 2013 meeting to be held February 1-4, 2013 in San Francisco, California."}
{"text": "Over the past 20 years the Fundacion Salud de Ayurved Prema Argentina has spread the knowledge of Ayurveda throughout Latin America. The Fundacion is based in Buenos Aires in the Argentine Republic, where it now runs courses in two of the country\u2019s major medical schools - at the School of Medicine of the University of Buenos Aires, and the National University of Cordoba\u2019s School of Medicine. Based on an MoU with Gujarat Ayurveda University, at Jamnagar, Gujarat, the Fundacion has been accredited as a Collaborating Center for teaching, assistance and research in the field of Ayurvedic Medicine in Argentina. This has led to successful missions to other countries in the region where the Fundacion and its associates have been able to start dialogues with governments, and in places hold sizeable courses. The knowledge of Ayurveda is now spreading throughout South and Central America and hardly a country remains untouched by it. The Fundaci\u00f3n de Salud Ayurveda Prema  is a nonprofit organization registered with the Argentine government. Its goal is to contribute to the promotion of Ayurveda medicine and all its preventive and therapeutic resources of value in the health field. The aim of the Foundation is to help Ayurveda attain the best possible status within Argentina\u2019s medical community and with the general public. Our vision is to improve and perfect the health of the peoples of Latin America using Ayurveda.We have now been spreading Ayurveda in the Argentine Republic and Latin America for over 20 years, focusing our efforts on both the medical profession and the people. Throughout this time, our interest has been to integrate useful elements of traditional approaches to medicine such as Ayurveda, which is our specific field of knowledge, with mainstream medicine and scientific research methods in an atmosphere of mutual respect, acknowledgment, and positive assessment. Currently, we are conducting four postgraduate courses on Ayurvedic medicine, all certified by the most prestigious universities in the country. In the fields of teaching and research, our goal is to preserve the wealth and purity of Ayurveda\u2019s teachings, and to demonstrate its usefulness for modern biomedical science.On January 5, 2001, after obtaining approval from India\u2019s Ministry of Foreign Affairs and Ministry of Health, the Fundaci\u00f3n de Salud Ayurveda Prema signed a Memorandum of Understanding (MoU) with Gujarat Ayurveda University  in the presence of Shailaja Chandra , the Governor of the Gujarat State, and other top Indian officials. The MoU accredited the foundation as a collaborating center for teaching, assistance, and research in the field of Ayurvedic Medicine in Argentina.In 2000, the School of Medicine of the University of Buenos Aires approved our first postgraduate course on Ayurvedic medicine. Founded Officials from five different departments of the School of Medicine had examined the course program for a year. Without exception, they deemed it of interest to the medical community as a whole. They considered that it had appropriate objectives, a well-developed analytical curriculum, sufficient instructional resources, an adequate schedule, as well as good infrastructure and assessment procedures. The course was finally approved by the School Board and the Dean. It is intended for medical doctors, psychologists, pharmacists, and other professionals in the health field. Several Indian ambassadors to Argentina like Pramathesh Rath (2006 and 2007) and R. Viswanathan (2008) have also delivered lectures to the course.Later, in 2002, an annual advanced postgraduate course on Ayurvedic medicine, accredited by the University\u2019s School of Medicine and designed for health professionals, was added. from theAYUSH, S. S. Savrikar; Director of the Institute of Postgraduate Teaching and Research, and former Vice-Chancellor, Gujarat State Ayurved University, M.S. Baghel; Director National Institute of Ayurved, Jaipur, Ajay Kumar Sharma; and Professor of Ayurveda, Gujarat State Ayurved University, H. M. Chandola.Well-known and respected Ayurvedic scholars and doctors from leading Indian institutions have supported the courses through their articles, including, among others, former Vice-Chancellor, Rajasthan Ayurveda University, R. H. Singh; former Vice-Chancellor, Gujarat State Ayurved University, and Ayurvedic Advisor, Dept. of Support of top academics from India\u2019s major educational institutions devoted to Ayurvedic studies has made it possible for us to transmit Ayurveda\u2019s fundamentals and its most relevant therapeutic tools completely faithfully. It has also enabled us to enrich course content through scientific interchange with well-known institutions at the highest academic level. All this was made possible by the MoU with Gujarat State Ayurveda University.In April 2010, a new biennial postgraduate course on Ayurvedic medicine exclusively for medical doctors was started at the National University of Cordoba\u2019s School of Medicine. The UnivMore than 450 professionals, 250 of whom were medical doctors, have now taken our postgraduate courses, while another 500 nonprofessional students have participated in courses on Ayurvedic principles and Ayurvedic massage. Students come from many countries in addition to Argentina, including Uruguay, Brazil, Paraguay, Chile, Bolivia, Peru, Ecuador, Venezuela, Colombia, Panama, Costa Rica, Mexico, Spain, Portugal, Italy, and the USA.For the last 3 years, we have been participating in an optional Course on Complementary Medicine for students of the School of Medicine at the University of El Salvador, in Buenos Aires. We also run regular courses on Ayurvedic massage for health technicians. These give technicians a more integrated and holistic approach to patient care, and have attracted great interest.Since 2005, we have also offered online courses on the principles of nutrition in Ayurveda. By implementing several educational strategies that establish a more personal relation with students, and so replacing the direct contact in normal courses, we have achieved a very positive response. This has enabled our students, who come from all Spanish-speaking countries, to share their personal growth and transformation experiences; the latter often extend to their families, making it possible for whole family groups to acquire better health habits.We have also conducted lectures, seminars, workshops, and conferences on various Ayurveda topics in Ministries of Health, Schools of Medicine, and professional and scientific associations in most Latin American countries: Mexico, El Salvador, Honduras, Nicaragua, Costa Rica, Panama, Colombia, Venezuela, Ecuador, Peru, Brazil, Paraguay, and Chile, even Spain and India .For example, in 2002 we coordinated and taught a course at the University of the Americas, Panama. The course, which led to a \u201cDiploma in the Ayurveda Nutrition System, Manual Therapies and Body Aesthetics for Healthier Tourism,\u201d was conducted with assistance from the Panama Institute for Tourism. We also conducted training workshops for low-income families on the Ayurvedic use of local medicinal plants. Another example: in 2006 and 2007, we were invited to take charge of Ayurveda training at an Online Course on Complementary Medicine at the School of Medicine, National University of Chile.A crucial aspect of successfully introducing Ayurveda practice in Latin America has been our approach to Ayurvedic medicines. We have counseled the appropriate Health Departments within the Health Ministries of Venezuela and Costa Rica to give them scientific information, and help their personnel understand the background of the therapeutic use of such medicines, thus facilitating their official registration.At present, Ayurvedic medicines produced in India are officially registered in Venezuela, Costa Rica, Nicaragua, and Honduras. In other Latin American countries, we make use of local herbal medicines. We have taken immense trouble to make accurate correspondences between local medicinal plants and those originating in India. For example, we have developed a list of medicinal plants from Latin America and the West that can be used in Panchakarma procedures.In order to spread Ayurveda most effectively, we took a step we regarded as essential: translation of some of the important, classical Ayurveda texts into Spanish, the second most spoken language in the world. Similarly, we brought out Spanish language publications on distance courses on Ayurvedic medicine,\u20139 and a The translation of the six volumes of Charaka Samhita, a task tSome papers resulting from our research work and surveys on different subjects, such as \u201cThe International Acceptance of Ayurvedic Formulations,\u201d \u201cPhysiolOur relationship with Gujarat Ayurveda University has led to four Intensive Training Seminars in Jamnagar, in which students from our own Foundation, other Latin American countries, and Spain have participated. The Seminars included training classes, observation of Ayurvedic procedures, visits to botanical gardens, and scientific exchanges with professors of the Institute of Post Graduate Teaching and Research in Ayurveda, as well as with other teachers at the University. Reciprocally, Indian professors and experts from many Western countries, such as Subhash Ranade and Robert Svoboda, have participated in workshops and seminars in Argentina.As a result of our postgraduate courses, and seminars conducted in many countries of the Latin American region, and in India, some of our students have been able to establish new Ayurvedic centers in their countries of origin.Ayurveda offers practical solutions to many problems in modern life. In Argentina, as in other countries in the last few years,18 there Put to the test in several cultures, Ayurvedic principles have proved useful in both prevention and cure the world around. Our course participants come from many countries, and have subsequently attested to the validity and wisdom of these principles.The World Health Organization has recognized Ayurveda to be a very sophisticated system of traditional medicine. Ayurveda21What the new millennium specifically requires is integrated training of health professionals to fulfill increasing demands in the West. Health professional teams, patients, and the general public are all experiencing a deep need for a system that integrates body, mind, and spirit. Our time demands a personalized approach to prevention, and effective, natural methods of treatment, with low levels of side effects or adverse responses.In the world\u2019s most prominent universities, there is currently a trend to include courses on complementary and alternative medicine. A 1998 survey of American schools of medicine found that, of the 117 which answered the questionnaire out of 125 surveyed, a total of 123 courses were taught at 64% of the university medical schools.[It has always been held that universities are the proper place for evolution of thinking as they offer an environment of freedom for discussion of ideas, and encouraging the advancement of science. Our postgraduate courses have been approved since they offer a framework for mutual respect and tolerance for different ways of viewing health and treating illness. As narrated above, these considerations have led to our courses being recognized by Argentina\u2019s best traditional learning institutions such as the University of Buenos Aires and the National University of Cordoba.The World Health Organization has urged that interchanges between traditional and modern medicine be promoted. To achieOf all systems of traditional medicine, Ayurveda seems to be best understood by people in Latin America and the West, and thus most up-to-date. Experience confirms that its ancient wisdom is easily accepted and incorporated both by professionals, health workers, and the general public. We find increasing numbers of people and institutions turning to its concepts and resources to care for individuals and families, and to heal disease. Participants in our courses tell us that Ayurveda\u2019s holistic and scientific approach improves and deepens the practical work of physicians, psychologists, nutritionists, physiotherapists, kinesiologists, nurses, yoga teachers, nutrition counselors, manual therapists, and other health professionals and technicians.Fundaci\u00f3n de Salud Ayurveda Prema is open to possible forms of collaboration with other Ayurvedic institutions: (a) in order to organize training visits for its members to Ayurvedic centers in India, and visits of foreign Ayurvedic professors to Argentina; (b) to carry out scientific research projects to demonstrate to the biomedical community the value and usefulness of Ayurvedic resources and remedies; and (c) to support work on the provision of Ayurvedic texts in Spanish.Ayurveda has shown its potential to solve some of our age\u2019s greatest health problems. We are glad to be a part of this movement. Those trained in this ancient Science of Life will be at the forefront of a highly positive and enriching trend in the field of health."}
{"text": "World Allergy Organization Journal  has recently published a number of position papers, statements and guidelines on topics of global importance in allergy and clinical immunology, including hereditary angioedema [http://www.waojournal.org). This significant publishing activity represents the ongoing goals of the WAO Journal to provide the most up-to-date and useful information on critical topics of global relevance in the field of allergy/immunology. Since the switch by the World Allergy Organization (WAO) of its Journal to an online-only format five years ago, the Journal has disseminated timely, informative original studies and reviews that offer a global perspective. Now in the sixth year of publication, there are a number of important updates and changes regarding the WAO Journal that should be highlighted.The gioedema , urticargioedema , probiotgioedema , biodivegioedema , as wellgioedema , an effoWAO Journal is now published by BioMed Central, as of January 2013, introducing a new era for the Journal in the open-access publishing arena. The Journal\u2019s former publisher, Lippincott Williams & Wilkins, partnered with WAO to create and develop the WAO Journal as a fully online publication, and at the time of its launch, it was one of the few of its kind. This recent move to open access publishing reinforces the vision of the WAO Journal as a fully accessible authoritative resource for allergists, immunologists and all medical professionals interested in the field. While the Journal has been freely available to all individual members of the WAO Member Societies, it is now fully open to readers everywhere, and its contents will also be available through PubMed Central. This move is pmount in the continuing evolution of the WAO Journal as an indispensable source of new research and authoritative review of scientific and clinical advances and knowledge in the allergy community worldwide.The Another significant change coming in the Journal\u2019s sixth year is an editorial transition, as this will be my last year as Editor-in-Chief. This represents a completion of my five-year tenure in this role. Over the next six months WAO will be searching for and evaluating a potential new Editor-in-Chief, derived and solicited from all corners of our community. The new Editor-in-Chief will ideally serve for a few months as Deputy Editor-in-Chief, assuming full responsibility as Editor-in-Chief in January 2014. It is satisfying to see, during my term as Editor-in-Chief, the progress the Journal has made as the flagship publication of the World Allergy Organization in providing a global forum for the exchange of research and information on allergy, asthma, and clinical immunology through publication of original research, clinical reviews, position papers, and epidemiological studies that contribute practice-relevant science in patient care."}
{"text": "Critical Care has agreed to publish extended abstracts submitted by invited renowned scientists from all over the world; that is, Europe, the Americas, Asia. Neuroprotection - potentially achieved by targeted temperature management  - is essential in emergency and acute care management of various severe neurologic and cardiologic diseases. Beyond neuroprotection - for this aim, therapeutic hypothermia has been established after resuscitation of patients with cardiac arrest due to a shockable arrhythmia and in neonatal asphyxic encephalopathy - therapeutic hypothermia and prophylactic controlled normothermia have been published in single case reports, retrospective, open, but also in prospective randomised controlled trials in many other emergency disciplines in which both neuroprotection and protection of other organs and tissues are the target of our therapeutic endeavours. The Medical University Innsbruck, Austria, is happy to organise this conference on temperature management, therapeutic hypothermia and prophylactic normothermia respectively, to be held in Portoroz, Slovenia. In accordance with the first Meeting on Hypothermia, which was held in Miami, Florida, USA (CHilling At the Beach), we are proud to suggest the acronym CHAB standing for take Care for Heart And Brain, characterising the major target organs of therapeutic and, possibly also, prophylactic temperature management. Again, we have been able to gather most renowned scientists, neurointensivists and intensivists, emergency physicians, cardiologists and other specialists to cover the entire scientific and clinical spectrum of emergency temperature management, technical aspects of cooling and management of potential complications including shivering, but also temperature management in neurology, neurosurgery, intensive care medicine, in the operation theatre, cardiology, infectious diseases, and so forth. Beyond that we cross borders and discuss hypothermia and intracranial pressure, pharmacodynamics in hypothermic patients and the influence of hypothermia onto pharmacokinetics/pharmacodynamics, hypothermia in refractory status epilepticus or heat stroke, hypothermia and advanced neuromonitoring, hypothermia and nutrition, shivering and the critical issue of rewarming, amongst other topics.It is a pleasure to announce the 2nd Innsbruck Hypothermia Symposium. We are very happy that per se - to neuronal damage. Knowing the medical literature and knowing the issue of potentially life-threatening side effects and complications incurred by this invasive therapeutic manoeuvre, it is the foremost aim of this symposium and this supplementary issue of Critical Care to discuss all these aspects of targeted temperature management in emergency, critical care and, in particular, neurocritical patients and conditions. For this reason the organisers have agreed that the discussion of these various issues, being so important for general critical care, neurocritical care and emergency medicine, must be distributed as widely as possible, making it available to critical care and neurocritical care specialists all over the world. Therefore we are extremely grateful to the Editors of Critical Care for providing a forum for all of the extended abstracts of all invited speakers, covering the entire field of adult emergency and critical care medicine. We do hope and we are convinced that this supplementary issue will be a source of inspiration and knowledge, hopefully becoming a work of reference for intensivists, neurologists, neurointensivists, cardiologists and all emergency physicians alike. It is the aim of the organisers to establish a series of such symposia within the next years in order to keep up with all the developments in this field and to maintain the highest possible level of knowledge of targeted temperature management in the community of emergency and intensive care physicians.The aim of this symposium is to enhance the knowledge on temperature management, increase the readiness and stimulate the preparedness to institute therapeutic hypothermia and/or prophylactic controlled normothermia, respectively, in patients in need of tissue and organ protection, uncontrolled body temperatures possibly adding -"}
{"text": "Alcohol Research & Health examines addiction to multiple substances\u2014that is, combined dependence on alcohol and other drugs (AODs), including marijuana, cocaine, and opioids. It seems fitting, then, to begin the issue with a look at what constitutes \u201caddiction.\u201d The Oxford English Dictionary (pp. 24\u201325) traces the term addiction to Roman law, under which addiction was a \u201cformal giving over by sentence of court; hence, a dedication of person to a master.\u201d This notion of relinquishment of control by the addicted person is the central feature of many lay and professional definitions of the term. The study of addictive behavior crosses several disciplines, including, among others, behavioral neuroscience, epidemiology, genetics, molecular biology, pharmacology, psychology, psychiatry, and sociology. Articles in this issue examine aspects of AOD use disorders from the perspective of some of these varied disciplines.This issue of  Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM, both in its revision of the third edition  identifies impaired control over substance use as the essential feature of dependence, which is \u201ca cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems.\u201dThe term \u201csubstance dependence\u201d has gained great currency because of its use in the The dependence syndrome, which forms the basis for the diagnostic approach used in DSM\u2013III\u2013R, was first described for alcohol by Alcohol Research & Health examine aspects of AODUDs from the perspective of some of these varied disciplines. However, given the pros and cons of the use of the terms dependence and addiction, as well as the absence of a clear consensus on which is preferred, in this volume the terms are used more or less interchangeably.The terminology used to describe alcohol and other drug (AOD) use disorders (AODUDs) is of key importance to both the study and the clinical care of people suffering from these conditions. AODUDs result from a combination of genetic, environmental, social, and psychological factors. The heterogeneity of addictive disorders is well recognized, with a key dimension of subgroups being the pattern of dependence on multiple substances . The stuFour articles in this volume focus on the etiology and development of AODUDs. The article by Drs. Dick and Agrawal discusses both genetic and environmental risk factors for AOD use and for co-occurring dependence on AODs. In a related article, Dr. Wand describes how stress and the genetics of the stress response influence risk for dependence. Dr. Cruz and colleagues\u2019 article reviews the neurobiological mechanisms of addiction and how they may influence co-morbid AOD use. Drs. Thatcher and Clark review psychological risk factors for adolescent AOD use, including parental substance use disorders and psychological dysregulation; child deficits in cognitive, behavioral, and emotional regulation that lead to experimentation with AODs; and the development of substance-related problems.Other articles in this issue focus on the epidemiology and timing of AOD use. Dr. Falk and colleagues report on the co-morbidity of AOD use and disorders in the general population. Dr. Martin distinguishes between the use of alcohol at the same time as other drugs and alcohol consumption that occurs separately from other drug use.The diagnosis and treatment of AODUDs are covered separately in this issue. In the first of two articles, Drs. Arnaout and Petrakis describe challenges to the diagnosis of AODUDs and factors\u2014such as the patient\u2019s gender, family history, and course of illness over time\u2014that influence the accuracy of diagnosis. The second article, by Drs. Arias and Kranzler, examines the literature on the treatment of patients with co-morbid AOD dependence, including concurrent and sequential treatment approaches, psychotherapy and pharmacotherapy, and treatment matching.Alcohol Research & Health adequately presents the literature on the prevalence, complex mechanisms, adverse consequences, and challenges to the evaluation and treatment of co-occurring use, abuse, and dependence on AODs.Clearly, AOD use, abuse, and dependence are far-reaching phenomena. Similar to the concept of craving, which seeks to provide an experiential basis to explain compulsive drug use but which has limited precision, the meaning of the terms substance abuse, dependence, and addiction will continue to evolve and must be further validated empirically. Refining these terms is central to helping researchers and clinicians understand more fully the phenomena to which they refer and to develop methods to diagnose and treat co-morbid AODUDs effectively. Despite the lack of consensus on terminology, we hope that this issue of"}
{"text": "Funding information was incorrectly given in the Acknowledgements section.In addition, a funding organization was incorrectly given in the Funding Statement. The Funding Statement should read: \"The authors are thankful to the College of Medicine Research Centre (CMRC), Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia, for supporting the work. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.\""}
{"text": "To the Editor: In May 2003, a previously healthy, 42-year-old rice farmer and miller, living on the Plain of Jars (Xieng Khuang Province) in northeast Lao People's Democratic Republic (PDR) (Laos), dehusked and polished glutinous rice in her hand-operated rice mill. While milling, her hand slipped, removing the skin covering the interpharyngeal joint of her right index finger, on a dusty, wooden part of the machine. She did not recall the implantation of a wood splinter. During the following 4 weeks, multiple firm, erythematous lesions developed, which were not tender, fluctuant, or itchy, at the site of the injury and on the medial and anterior aspects of the lower and upper arm (,Sporothrix schenckii, the cause of sporotrichosis, and the diagnosis was confirmed by sequencing the 18S rRNA gene, which showed 100% identity to that of S. schenckii (,pper arm . The lesS. schenckii is a dimorphic fungus found in soil, hay, decaying vegetation, and moss. Persons exposed to these environmental foci, such as farmers and gardeners, are especially at risk. Percutaneous inoculation is presumably the main method of infection, although inhalation and insect and mammal bites and scratches, especially from armadillos and cats, have been implicated (,,Sporotrichosis has been described from North and South America, Europe, and Japan. In Asia and Australasia, it has been described from India (With 73% of the Lao population living on <US$2/day (,Diagnosis by histopathologic examination and culture may be difficult, and identifying laboratories in different regions of the subtropics and tropics with an interest in diagnosis of sporotrichoid lesions and the capability to perform culture and PCR would facilitate the diagnosis and awareness of this disease. Itraconazole, which has become the drug of choice for lymphocutaneous sporotrichosis, is expensive. Saturated solution of potassium iodide is an inexpensive alternative and appears to be effective, although adverse effects occur frequently ("}
{"text": "The Asian College of Psychosomatic Medicine (ACPM) was founded as the Asian Chapter of the International College of Psychosomatic Medicine (ICPM-AC) in Tokyo on April 12, 1982.The first president was Hitoshi ISHIKAWA (Japan), the vice-presidents were Mahalingam MAHADEVAN  and Burton G.BURTON-BRADLEY (Papua- New Guinea), and the general secretary was Sueharu TSUTSUI (Japan).th World Congress of the International College of Psychosomatic Medicine (ICPM) held in Kyoto, Japan, September 5-9, 1977.Five years previously, preparation for creation of the ICPM-AC was started at the 4The First Congress of the ICPM-AC was held by the President Yujiro IKEMI in Tokyo on May 19-20, 1984. The main members in the early stage were Y. IKEMI, H. ISHIKAWA, S. TSUTSUI, Taisaku KATSURA, Tetsuya NAKAGAWA. Hiroyuki SUEMATSU and others from Japan and Hsien RIN (Taiwan), Seock Young KANG (Korea), M. MAHADEVAN. B.G. BURTON-BRADLEY and others from other Asian countries.nd to the 9th, were held approximately every two years, in Japan, India, Malaysia, Taiwan, Korea, and China. The name was changed to the Asian College of Psychosomatic Medicine (ACPM), and the 10th to 14th congresses were held in Taiwan, Okinawa (Japan), Australia, Korea, and China.Thereafter, academic congresses of the ICPM-AC, the 2The current president of the Executive Board of ACPM is Chiharu KUBO, the Director of Kyushu University Hospital.th ACPM and will be hosted by Tserenkhuugyin LKHAGVASUREN in Ulaanbaatar, Mongolia from August 24-26, 2012.The next academic congress is the 15Participating countries have expanded to include Asian-Oceanic countries such as Mongolia, Micronesia, Australia and Sri Lanka.The main themes of the congresses have focused on psychosomatic disorders, culture - bound syndromes, oriental medicine, etc... To date,\"Health promotion\"by raising the level of mental health based on psychoneuroendocrinoimmunomodulation has been very important. Prevention is also important in the Asia - Oceana area, from the viewpoints of both psychosomatics and culture.Above all, an awareness of existential, authentic health is a sure way to promote healthy longevity and psychosomatic well - being.To pursue happiness and well-being subjectively, objectively, and ecologically will be the most important purposes of ACPM in the future. The following year, on March 31st, 2010, the \"Fifty Years of the Japanese Society of Psychosomatic Medicine Annals\" was published [st through 14th Congresses and a list of the presidents and their profiles [st Congress of the Japanese Society of Psychosomatic Medicine, held in Sendai on June 25th, more detailed descriptions of the circumstances of the congresses of ACPM and their contribution to the Japanese Society of Psychosomatic Medicine journal \"Psychosomatic Medicine\", because they would be valuable resources for the future. With Professor KUBO's consent, I, the Vice-President of the ACPM, took charge of compiling the contributions.November, 2009 marked the 50th World Congress of the International College of Psychosomatic Medicine (ICPM) held in Kyoto in 1977, and I was also a presenter at the 1st Congress of the Asian Chapter of the International College of Psychosomatic Medicine (ICPM-AC) held in Tokyo,1984. There was an Asian Chapter Establishment Committee Meeting with plenary lectures held between these two conferences in Tokyo on April 12th, 1982; however, I did not have information of this event. Therefore, I started inquiring and trying to collect information regarding it as well as other areas that did not have sufficient information. The notes of the Establishment Committee Meeting with the plenary lectures could not be found at the ACPM executive office, located at Kyushu University Hospital, and it was difficult to contact the people who were involved in the event. Thus, I sent inquiries to Professor A. N. Singh, in Canada, but little information was obtained. While I was struggling to find this information, with the strong cooperation of Professor Koji TSUBOI at Toho University School of Medicine I was able to get in contact with Professor Emeritus Sueharu TSUTSUI, who was the first General Secretary of the ICPM-AC. Finally, the information necessary to write this article was obtained in this way. I would like to give special thanks to Hiroyuki SUEMATSU, the President of the \"Fifty Years of the Japanese Society of Psychosomatic Medicine Annals\"; Chiharu KUBO, the ACPM President; the ACPM executive office at Kyushu University Hospital; Emeritus Professor Sueharu TSUTSUI; Professor Koji TSUBOI, and the many others who assisted in the writing of this article.Fortunately, I was able to observe the organization of the Asian Chapter of the ICPM at the 4The Asian College of Psychosomatic Medicine (ACPM) originally started as The Asian Chapter of the International College of Psychosomatic Medicine (ICPM-AC). The name ICPM-AC was used for the 1st to the 9th Congresses, and the present name, ACPM, has been used since the 10th Congress.th World Congress of the International College of Psychosomatic Medicine (ICPM)[th to 9th, 1977, a movement to establish an Asian Chapter was begun and a preparatory committee was set up.When the 4ne (ICPM),2 was heth, 1982. At that time, memorial lectures were given by four distinguished psychosomatists; Yujiro IKEMI (Japan), Alfred M. FREEDMAN (USA), Jinichi SUZUKI (Japan) and Masamoto HIGUCHI (Japan). The President Hitoshi ISHIKAWA (Japan), the Vice Presidents Burton G. BURTON-BRADLEY (Papua-New Guinea) and Mahalingam MAHADEVAN , and the General Secretary Sueharu TSUTSUI (Japan) took office, and Yujiro IKEMI was appointed Honorary President. It was decided that the ICPM-AC Congress would be held every two years in Japan or another Asian country.The ICPM-AC Establishment Committee Meeting was held in Tokyo on April 12st Congress of the ICPM-AC was hosted by President Yujiro IKEMI in Tokyo, Japan on May 19th and 20th, 1984. The opening ceremony took place at Nippon Seinenkan, located in the Meiji Shrine outer garden. During the ceremony, Taisaku KATSURA, who was the General Secretary of the 1st Congress of the ICPM-AC, took the role of master of ceremonies. First, President IKEMI gave a welcome address, which was followed by the greetings of ICPM-AC President Hitoshi ISHIKAWA, the Vice Presidents M. MAHADEVAN and B.G. BURTON-BRADLEY, and the General Secretary Sueharu TSUTSUI. ICPM President Chase P. KIMBALL delivered a congratulatory address and Masayoshi NAMIKI, the President of the 25th Congress of the Japanese Society of Psychosomatic Medicine, gave a congratulatory address.The 1st Congress of the ICPM-AC, plenary lectures were given by Jiro KANEKO, the Honorary President, and Yujiro IKEMI, the President. Also, eight special topics were presented, including those by Professor A.N. SINGH (Canada), Professor Hsien RIN (Taiwan), and Professor B. H. FOX (USA). In addition, 82 presentations were made on general topics. The first conference was a prosperous beginning, with participants from Japan, Taiwan, Korea, China, Malaysia, India, and Papua-New Guinea [At the 1w Guinea .nd Congress of the ICPM-AC, a continuation of the 1st Congress of the ICPM-AC held by conference president Yujiro IKEMI in Tokyo on May 19th and 20th , 1984, was hosted by President A.N. SINGH in New Delhi, India from December 12th to 15th, 1986. The main theme of the conference was \"Asian Perspective in Psychosomatic Medicine\" and participants came not only from Japan, India, and Malaysia but also from Indonesia, Thailand, and Australia. Hitoshi ISHIKAWA passed the presidency on to Sueharu TSUTSUI. After the conference, the participants enjoyed sightseeing at the Taj Mahal, Bodh Gaya, and other wonderful places [The 2rd Congress of the ICPM-AC was hosted by conference president M. MAHADEVAN in Kuala Lumpur, Malaysia from December 25th to 27th, 1988. Its theme was the same as the 2nd conference, \"Psychosomatic Medicine Asian Perspective\". Sultan Azlan SHAH (Perak State) was selected as the Honorary President of the 3rd Congress [The 3th Congress of the ICPM-AC was hosted by conference president Jinichi SUZUKI in Sendai, Japan, on April 20th and 21st, 1990. Its main theme was \"Psychosomatic Medicine in Primary Care\". At this conference, participants from Brazil joined for the first time [The 4rst time .th Congress of the ICPM-AC was hosted by conference president Hsien RIN in Taipei, Taiwan, from September 4th to 6th, 1992. Its main theme was \"Panic and Anxiety\". President RIN, the head of the Department of Psychiatry, National Taiwan University College of Medicine, studied at the Hokkaido Imperial University School of Medicine in Japan. Because of this, he developed a strong relationship with Japan and held a special welcome reception program for Japanese guests with visit to memorial places at the medical school of the former Taihoku Imperial University [The 5iversity .th Congress of the ICPM-AC was hosted by conference president Chiharu KUBO in Fukuoka, Japan on June 5th and 6th, 1994. Its main theme was \"Psychosomatic Medicine Symposium-East and West\". Many participants and speakers came from China and Professor Wolfram SCH\u00dcFFEL from Germany joined as a special participant [The 6ticipant .th Congress of the ICPM-AC was hosted by conference president LIU Zengyuan in Dalian, China from September 5th to 7th, 1996 with many Chinese participants. After the conference, the participants visited Hill 203 in Ryojun (Lushun) where one of the fiercest battles of the Russo-Japanese War was fought [The 7th Congress of the ICPM-AC was hosted by conference president Byung Il MIN in Seoul, South Korea from October 28th to 30th, 1998. The participants interacted with the staff of Kyunghee University, learned Korean history and culture, and visited a folk village and other special places [The 8l places .th Congress of the ICPM-AC was hosted by conference president Sueharu TSUTSUI in Tokyo, Japan on September 29th and 30th, 2000. Its main theme was \"New Encounter between Mind and Body-Stress Management in the 21st Century\" and a large number of speakers gave presentations. At the Executive Board Meeting of this conference, the name \"The Asian Chapter of the International College of Psychosomatic Medicine\" (ICPM-AC) was changed to \"The Asian College of Psychosomatic Medicine\"(ACPM) and this new name has been used since the 10th Congress. Also, the presidency was handed over from Sueharu TSUTSUI to Chiharu KUBO [The 9aru KUBO .th Congress of the ACPM was hosted by conference president Ming-Been LEE in Taipei, Taiwan on September 28th and 29th, 2002. Starting with this conference, the official name of the conference became \"The Asian College of Psychosomatic Medicine\" (ACPM). Ten years had passed since the 5th Congress was last held in Taiwan hosted by conference president Hsien RIN. The 2nd conference in Taiwan was held at the same site as the 1st conference. Its main theme was \"Psychosomatic Medicine and Health Promotion\" with about 250 participants. There were eight sessions of oral presentations and six poster sessions [The 10sessions .th Congress of the ACPM was hosted by conference president Hiroshi ISHIZU in Okinawa, Japan on October 23rd and 24th, 2004. Its main theme was \"Culture and Psychosomatic Medicine\". The president's lecture, titled \"Psychosomatic Medicine of Okinawan Culture and Healthy Longevity\", as well as 6 special lectures, 1 symposium, 1 panel discussion, 2 educational lectures, 30 oral presentations, and 112 poster presentations were well received. The documents state that the symposium theme was chosen to be \"Present and Future of ACPM\" and all of the past presidents were invited. Also, for the future development of the ACPM, the congress president invited as special guest lecturers Professor Tserenkhuugyin LKHAGVASUREN, President of the National Medical University of Mongolia  and Drs. Hiroshi ISMAEL and Imaculada J. GONZAGA-OPTAIA from the Federated States of Micronesia of the Pacific, who participated for the first time. Unfortunately, Professor Futa HELU of the Kingdom of Tonga could not participate due to other business matters. In addition, a professor in Kazakhstan was unable to be contacted. Despite these absences, the participants expanded our organization to include areas of the Asian-Pacific region from Mongolia in the north to Australia in the south and from Canada in the east to Sri Lanka in the west. In the Executive Board Meeting, the sites of the next four conferences were decided; The 12th Congress at Melbourne, Australia, the 13th Congress at Seoul, South Korea, the 14th Congress at Beijing, China, and the 15th Congress at Ulaanbaatar, Mongolia [The 11th Congress of the ACPM was hosted by conference president Lorraine DENNERSTEIN in Melbourne, Australia on December 24th and 25th, 2006. The theme picked for the conference was noteworthy, \"Sexual Health and Psychosomatic Medicine\". The conference was successful due to of the tremendous support from Vice-President of the 12th Congress, Koji TSUBOI, Professor of Psychosomatic Medicine at Toho University School of Medicine, Japan [The 12e, Japan .th Congress of the ACPM was hosted by conference president Bong Yul HUH in Seoul, South Korea on August 31st and September 1st, 2008. Ten years had passed years since the 8th Congress held in South Korea hosted by President MIN. Due to the influx of South Korean pop culture into other areas, a large number of people came to the conference and many distinctive Korean features were included in the presentations at the well-received conference. Kyung Bong KOH played the role of co-President [The 13resident .th Congress of the ACPM was hosted by conference president ZHAO Zhifu in Beijing, China from September 10th to 12th, 2010. The China National Convention Center, a fantastic building that is located in the center of Beijing and that was renovated for the Beijing Olympics, was the site of the conference. More than 400 topics were presented. The conference was especially well organized. The participants had the opportunity to see traditional Chinese Opera at the welcome party, visit the Great Wall, a World Heritage site, where one could enjoy the distant view of Inner Mongolia, and visit the Ming Dynasty Tombs. President ZHAO's son, Dr. ZHAO Peng, who is studying abroad at the Department of Psychosomatic Medicine of Kyushu University, ably assisted President KUBO in preparing for the conference [The 14nference .th Congress of the ACPM will be hosted for the first time in Mongolia at Ulaanbaatar by conference president Tserenkhuugyin LKHAGVASUREN from August 24th to 26th, 2012. Members of ACPM in Japan are inviting people from far and wide to come and back up the conference as much as possible. The first Mongolian Workshop of Psychosomatic Medicine was held on October 20th, 2006, and the Mongolian Society of Psychosomatic Medicine was established recently [The 15recently . We expeth Congress of the ACPM. The Indonesian Society of Psychosomatic Medicine, also newly established in 2010 in Jakarta, has its center at the National Indonesian University. For these newly established Asian societies of Psychosomatic Medicine to hold the conferences, it is important that as many of our members participate and present as many topics as possible. We would especially encourage the members of the Japanese Society of Psychosomatic Medicine to do all they can to assist these new societies.Most recently, Indonesia announced its candidacy for the 16It is time to conclude this overview of the history and perspectives of the ACPM. When the ACPM began as the ICPM-AC, the members of ICPM from the United States, Canada, and other countries joined the conferences to support the developing East Asian Societies of Psychosomatic Medicine, such as those in South Korea, Taiwan, China, and Japan, which have become the core Asian societies. However, gradually all of the countries involved in the East Asian Societies of Psychosomatic Medicine had become highly developed. In the near future, our goal is to support the newly established and developing Societies of Psychosomatic Medicine of Mongolia, Indonesia, and other countries and we must do our best to foster the Societies of Psychosomatic Medicine of the Pacific Islands and other smaller countries. Psychosomatic Medicine is \"The Medical Science of Happiness\" which brings about human health in a true sense. We would like to ask all of the members of the Japanese Society of Psychosomatic Medicine for their support in assisting the developing Societies of Psychosomatic Medicine.Bio-Psycho-Social Medicine so that other members of the Societies of Psychosomatic Medicine outside of East Asia can better know what has been happening here and in the Oceanic Area.The ACPM has no official published journal, but publishes a booklet of the abstracts of presentations given at each Congress. Each Congress is well structured and abstracts are published at the beginning of every conference. Unfortunately, the abstracts are not available to everyone; thus, we have contrubuted this article containing data about the ACPM to"}
{"text": "The Funding section is incomplete. The complete funding section should read: \"This paper forms part of the projects CGL2007-62469 and CGL2010-16447, subsidized by the Ministry of Science and Innovation, the European Regional Development Fund, the Government of Aragon  and the \"Instituto de Estudios Altoaragoneses\". The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.\""}
{"text": "Food allergy is an important public health problem that affects approximately 5 percent of children and 4 percent of adults and may be increasing in prevalence. Despite the risk of severe allergic reactions and even death, there is no current treatment for food allergy: the disease can only be managed by allergen avoidance or treatment of symptoms. The diagnosis and management of food allergy may vary from one clinical practice setting to another, and patients frequently confuse non-allergic food reactions, such as food intolerance, with food allergies. In response to these concerns, the National Institute of Allergy and Infectious Diseases , working with 34 professional organizations, federal agencies, and patient advocacy groups, led the development of clinical guidelines for the diagnosis and management of food allergy. These guidelines are intended for use by a wide variety of healthcare professionals. Topics addressed include the epidemiology, natural history, diagnosis, and management of food allergy, as well as the management of severe symptoms and anaphylaxis. The guidelines were published in December 2010, but Dr. Matthew J. Fenton, from the NIAID, will provide a summary of the guidelines and the methods used to draft them."}
{"text": "Nanoscale Research Letters contains scientific contributions presented at the International Conference on Superlattices, Nanostructures and Nanodevices (ICSNN 2010), which was held in Beijing, China from July 18-23, 2010.This special issue of ICSNN 2010, attended by more than 260 participants from 24 countries and regions, is the sixteenth meeting in this biannual conference series. ICSNN 2010 was devoted to a continuation of the efforts by the research community to understand new phenomena in the physics and technology of superlattices, nanostructures and nanoscale devices, to highlight contributions from young scientists in this field, and to explore unconventional ideas in these areas that get insufficient attention at many conferences.There are thirty papers in this special issue, covering a wide range of research fields including nanostructure fabrication techniques, nanoelectronics, graphene, quantum dots, quantum wells, spinelectronics, and magnetic/semiconductor hybrid nano-systems.We would like to express our appreciation to all members of the International Advisory and Program Committees for their invaluable suggestions and selection of the invited speakers and scientific contributions. Our special thanks go to Professor Jean-Pierre Leburton for his advice to the local organizing committee.We also thank the authors for their excellent contributions, as well as the referees whose feedback and comments ensured the high quality of this special issue.We are looking forward to the next conference in 2012!Conference ChairmanShushen Li, Institute of Semiconductors, Chinese Academy of Sciences, ChinaLocal Organizing ChairmanJian Liu, Institute of Semiconductors, Chinese Academy of Sciences, ChinaGuest EditorsShushen Li, Institute of Semiconductors, Chinese Academy of Sciences, ChinaJian Liu, Institute of Semiconductors, Chinese Academy of Sciences, ChinaPingHeng Tan, Institute of Semiconductors, Chinese Academy of Sciences, China"}
{"text": "Hemiptera Congress (EHC) took place in the small seaside resort Amaliapolis, Greece, the Hemiptera congresses are regularly held every two-three years: EHC 2 in Fiesa, Slovenia (2001), EHC 3 in St. Petersburg, Russia (2004), EHC 4 in Ivrea, Italy (2007) and EHC 5 in Velence, Hungary (2009).Since 1998, when the First European Hemiptera Congress in Bulgaria, erected during the Fifth Congress in Hungary, had been a surprise and an honour for the Bulgarian hemipterists, and, of course, it is a recognition for the work of Prof. Michail Josifov, renowned taxonomist of Palaearctic Heteroptera, and a tribute to his memory. The geography of the European meetings on Hemiptera shows an interesting trend: five of all six congresses are held on the Balkan Peninsula and the neighbouring countries in south-eastern Europe, Hungary and Italy. The explanation of this fact should be the rich fauna of this region, very suitable for congress trips, more than in many other countries.The nomination to host and organize the Sixth European Later, the entomologist Alexi Popov, Director of the National Museum of Natural History in Sofia, kindly accepted to be Chairman of the Congress. He is not a hemipterist, but knowing personally some of the remarkable taxonomists in this field, was happy when agree to lead the Organizing Committee and to help the preparation and realizing the Congress.The institutional co-organizers of the Congress become National Museum of Natural History (Bulgarian Academy of Sciences), Institute of Biodiversity and Ecosystem Research (Bulgarian Academy of Sciences) and St. Kliment Ohridski University of Sofia.An international recognition of the Congress is the patronage of Director-General of UNESCO Ms Irina Bokova and the promise for financial and other support.Hemiptera were described from.As venue of the Congress, we chose Scaptopara Campus of the American University in Bulgaria, Blagoevgrad. This town, situated 100 km south of Sofia, has a remarkable location. It is situated at the foot of Rila Mts., the highest mountain on the Balkan Peninsula, and is only 30 km from Kresna Gorge in Struma Valley. These are areas with most cold-resistant and most thermophilic fauna in Bulgaria, where many new species of Hemiptera names of George Willis Kirkaldy) and Zoological label as literary form .The website of the Congress, arranged by the Organizing Committee members and maintained by Ilia Gjonov, comprises the whole information of interest to the participants, including as well the history of the previous congresses. The Organizing Committee published for the participants a booklet by Victor Fet, a well-known taxonomist on scorpions. Prof. Fet  for many years combined his biology with literary work involving themes of modern natural science and their philosophy. The booklet consists of three literary pieces: The tale of Prime Minister and a Golden Bedbug , The Kirkaldy connection . Most hemipterists took part from Poland (15), Czech Republic (9) and Germany, Austria, Hungary, Bulgaria (6 participants each).The Sixth European Bulgaria . For comDuring the four days of plenary sessions, 102 reports  altogether were delivered and presented, and in this respect the Congress in Bulgaria also exceeds to a large degree the previous ones. There were 11 plenary sessions , one posHemiptera treating faunistics and biogeography of the Mediterranean Basin and Europe more generally as well as on taxonomy and phylogeny of Cicadomorpha, Fulgoromorpha, Heteroptera, Aphidoidea and Psylloidea; complex application of ecological, acoustic, genetic, palaeontological and behavioural methods; applied research and pest control.The reports presented were focused on general aspects of studies on The Congress was opened by the Chairman Assoc. Prof. Alexi Popov and welcome speeches were delivered as well by Prof. Sakis Drosopoulos, initiator of the European congresses and organizer of the First congress; Prof. Matija Gogala, Vice-president of the Slovenian Academy of Sciences and Arts; and Prof. Ernst Heiss, former President of the International Heteropterists Society .The Organizing Committee initiated an award for young researchers in memory of Michail Josifov due to the sponsorship of Asen Nikolov Foundation and Pensoft Publishers. The organizers decided to present three equal rewards for achievements in hemipterology and as support of participation in the Sixth Congress. Eleven researchers applied with their abstracts for the award. The Scientific Committee of the Congress discussed the applications and three applicants were chosen as winners by voting: Qiang Xie (China), Ond\u0159ej Balv\u00edn (Czech Republic) and Vikas Suman (India) . CertifiPageBreakPageBreakJuniperus excelsa); Xerothermic meadows and pastures of Chrysopogon gryllus, Bothriochloa ischaemum and Festuca valesiaca;Sub-Mediterranean pseudo-steppes with annual herbs; Balkan pseudomaquis; Prickly juniper (Juniperus oxycedrus) scrub. Part of the territory of the gorge is under the protection of Tisata Reserve and its buffer zone. According to the Bern Convention, it is declared as a CORINE site and will be part of the European Union NATURA 2000 Network. The gorge is of worldwide importance for the conservation of the habitats of the Grecian juniper and the Oriental plane forests. It is also a biological corridor for the migration of large mammals between the surrounding mountain ranges as well as a very important bird migration route (Via Aristotelis). Only among Heteroptera, 419 species are reported from the gorge. Twelve of them are endemic taxa and for nine other the gorge is the type locality. The second collecting place was the area between the Rozhen Monastery and Melnik. The habitats are similar but with forests of Platanus orientalis instead of Juniperus excelsa, xerothermic meadows and pastures, and sub-Mediterranean pseudo-steppes. Impressive is the picturesque historic town of Melnik. The region comprises the landmark of Melnishki Piramidi, declared as a protected area in 1978 for the purpose of preserving the uniqueness of these earth formations in sand-clay rocks. Because of its European importance for the preservation of rare and threatened habitats, plants and animals, Melnishki Piramidi was declared as a CORINE site in 1998.First stop of the one-day field trip was Kresna Gorge . The KrePageBreakeight-day collecting trip. Localities were visited in Rila Mts. (Rila Monastery), Vlahina Mts., Struma Valley , Pirin Mts. (Popovi Livadi site at 1400 m asl), Western Rhodope Mts. , Eastern Rhodope Mts.  and Sredna Gora Range (Vakarel). The rich collected material of Hemiptera will serve for future investigation of Bulgarian fauna. Various methods for collecting were used, namely hand sampling, sweep netting, light towers, suction samplers. Matija Gogala recorded the songs of some species of Cicadidae. Gernot Kunz photographed many living insects.Ten participants in the Congress from United Kingdom, the Netherlands, Germany, Austria, Italy, Slovenia and Bulgaria, guided by Ilia Gjonov, took part in an The Congress stimulated scientific debates, promoted the communication and cooperation between researchers from different countries, established new contacts and initiated further investigations. We shall keep in our memory the valuable discussions and the exchange of ideas, partly realized and born in the informal meetings during the Welcome party, Congress dinner and Farewell party.Heteroptera. At that time, a photo exhibition in the Museum, dedicated to the diversity and significance of Hemiptera for the ecosystems and the people, presented to the audience this significant part of the biodiversity and PageBreakits conservation. The Congress initiated median interest and public support for the Bulgarian science in these heavy times.After the congress closing some of the participants visited the National Museum of Natural History in Sofia and its rich collections, especially the valuable collection of Michail Josifov of Palaearctic Unfortunately, because of the objective difficulties, UNESCO could not support financially the congress and because of different objective and subjective reasons the publication of this volume was delayed for about half a year.Advances in Hemipterology. The selection was made according to the standards of the hosting journal ZooKeys following peer review recommendations and editorial decision. We wish to thank the reviewers for the valuable and creative remarks during the selection process and the improvement of the manuscripts accepted for this volume, which are the first successfully published proceedings of the European Hemiptera congresses.Thirty-three manuscripts were submitted for the special issue"}
{"text": "AllerGen NCE Inc., the Allergy, Genes and Environment Network, is a national, multi-disciplinary, multi-sectoral network for research and discovery, knowledge translation and capacity building. AllerGen is dedicated to improving the quality of life for allergy asthma and related immune disease sufferers by supporting research that leads to new diagnostic tests, better medications, more effective public policies and an increase in the number of medical professionals researching and practicing in this area. The Networks of Centres of Excellence (NCE) program, of which AllerGen is a part, is a strategic initiative aligned with Canada\u2019s Science and Technology strategy. The NCE program aims to close the \u2018development-to-delivery\u2019 gap, and accelerate the rate at which research results contribute to new, evidence-based, cost-effective policies, products and services that generate social and economic benefits for Canadians.The burden of allergy, asthma and related immune disease is significant and growing world-wide, and while the underlying causes of these diseases are actively being studied, the origins of these diseases are still not well understood. According to the results of the International Study of Asthma and Allergies in Childhood (ISAAC) Study, Phase III 2003) results, 47% of Canadian children have suffered from allergic rhinitis; 39% have experienced wheezing; 22.4% have been diagnosed with asthma; and, 19% have experienced atopic eczema [003 resulThe economic impact of these diseases in Canada is in excess of $15 billion annually, when one includes the cost of ambulatory care, in-patient stays, emergency department visits, physician and facility payments, prescribed medications and productivity losses at school, work and at home as a direct result of these diseases . This anGlobally, asthma is more prevalent among the developed countries and in major city centres . Among tresearch into practice, and knowledge to action, to improve allergic disease and asthma awareness, education, management and control.Given the Canadian Institutes of Health Research\u2019s strategic vision to position Canada as a world leader in the creation and use of knowledge derived from health research that benefits Canadians and the global community, Canadian researchers and their international partners have a significant opportunity to work in collaborative networks to accelerate the translation of A recent analysis by Teresa To, from The Hospital for Sick Children , revealsKnowledge Translation Planning Tools for Allergic Disease Researchers. This tool provides a guide for researchers, their stakeholders and partners to collaboratively develop translational strategies and tactics that will help accelerate the rate of dissemination, uptake and application of allergy, asthma and related immune disease research to improve the quality of life for patients, facilitate optimal care by health providers and reduce the economic drag resulting from the burden of these diseases [Building upon the work done in 2004 by a team led by Rejean Landry, AllerGen developed a publicly available KT planning tool called diseases . Working"}
{"text": "The journal is dedicated to expedite rapid publication of manuscripts that significantly advance the knowledge of nutrition and metabolism related to exercise physiology, diabetes, obesity, lipidemias, metabolic syndrome, atherosclerosis, cancer etc. Nutrition & Metabolism also publishes manuscripts pertaining to biochemistry of metabolism, cell signaling, molecular and cellular biology of nutrients, nutrient gene interactions and other areas that have implications for human nutrition and medicine. Current, but not exclusive, interests are metabolic effects of diet composition, interactions of macronutrients, effect of nutrients on gene expression, metabolic control and compartment models, nutritional effect of hormones, and genomic analysis of dietary phenomena.Nutrition & Metabolism was co-founded by Drs. Feinman and Hussain in 2004 as an open access, peer-reviewed, online journal to keep readers up-to-date on recent developments in important areas of nutrition, exercise physiology, clinical investigations, and molecular and cellular biochemistry of metabolism. Nutrition & Metabolism publishes approximately 36% of the submitted articles. The journal received an impressive first impact factor of 3.00 in 2009 indicating that published papers were highly cited soon after their publication  determines the suitability of the manuscript for publication in Nutrition & Metabolism. Articles of low perceived importance or poor quality are immediately returned to authors with no further review. If the manuscript is deemed suitable for further evaluation, it is sent for peer-review. The first priority is given to anonymous, unbiased peer-reviewers suggested by the computer based on their publications related to the subject of the article. In addition, we solicit opinion from at least one member of the editorial board. Further, consideration is also given to the reviewers recommended by the authors. Hence, every paper undergoes a stringent peer review process to evaluate objectively the quality, originality, and scientific merit of the papers. After publication, the papers are open to comments by the scientific community. The comments are first reviewed by the editors for their validity and correctness and then sent to the authors for their response. Both comments and responses are published online and have open access.Every paper undergoes a two-tier, quality control, evaluation process. First, Editor-in-Chief, Managing Editor, or an Associate Editors (Nutrition & Metabolism your first choice to disseminate your precious data.Besides the dedication and expertise of the Editorial Board members and reviewers, the success of the journal depends on the valuable contributions from investigators. Hence, we solicit comments from all the authors about the integrity and timeliness of the review process, authenticity, clarity and appropriateness of the reviews, and any other comments that would make Nutrition & Metabolism is published by BioMed Central, part of Springer Science+Business Media. BioMed central is committed to ensuring open access peer-reviewed biomedical research. This means that published material is freely and universally accessible online. It is archived in at least one internationally recognized free access repository, and its authors retain copyright, allowing anyone to reproduce or disseminate articles, according to the BioMed Central copyright and license agreement. Nutrition & Metabolism\u2019s articles are archived in PubMed Central, the US National Library of Medicine\u2019s full-text repository of life science literature, and also at INIST in France and in e-Depot, the National Library of the Netherlands\u2019 digital archive of all electronic publications. The journal is also participating in the British Library\u2019s e-journals pilot project, and plans to deposit copies of all articles with the British Library.Nutrition & Metabolism is the identification and publication of timely and important contributions to the field of nutrition & metabolism. We invite potential authors to visit the journal homepage http://www.nutritionandmetabolism.com, and submit their new and exciting papers online.One of the major goals of Ahmed Bakillah, Managing EditorM. Mahmood Hussain, Editor-In-ChiefJanuary 1st, 2013"}
{"text": "Martin KaplanJohn McFadyeanKarl F. MeyerCalvin W. SchwabeDecide first, then turn the page.Here is a clue: He founded the discipline of veterinary epidemiology and the concept of One Medicine.Is he: This is a photograph of Calvin W. Schwabe (1927\u20132006). In a career that spanned 52 years, Schwabe made valuable contributions to a broad array of subjects, including epidemiology, zoonotic diseases, interactions of veterinary and human medicine, public health practice, livestock health in pastoral societies, ancient origins of human and veterinary medicine, and the philosophy of science. Calvin Schwabe is best known as one of the two 20th century founders of the discipline of veterinary epidemiology and the concept of One Medicine . The other founder of veterinary epidemiology and the One Medicine concept is James H. Steele, who worked at the Communicable Diseases Center (now Centers for Disease Control and Prevention) in Atlanta, Georgia.Calvin W. Schwabe was born on March 15, 1927, in Newark, New Jersey. He graduated in 1948 with a BS in biology from Virginia Polytechnic Institute. In 1950, he received an MS in Zoology from the University of Hawaii. In 1954, Schwabe was awarded a DVM (with highest honors) from Auburn University, and in 1955, he received an MPH in tropical public health from Harvard University. His ScD in parasitology\u2013tropical public health was awarded by Harvard in 1956.From 1956 until 1966, Dr. Schwabe was a member of the medical and public health faculties of the American University of Beirut. There he developed a notable research program on hydatid disease and other parasitic zoonoses and founded a joint Department of Tropical Health within the medical and public health faculties and a Department of Epidemiology and Biostatistics within the School of Public Health. Beginning in 1960, he served as a consultant to the World Health Organization, developing a collaborative global program on hydatid disease research and control. During 1964\u20131966, he directed several parasitic disease programs at the World Health Organization headquarters in Geneva, Switzerland.In 1966, Schwabe established the Department of Epidemiology and Preventive Medicine at the University of California, Davis, School of Veterinary Medicine, the first of its kind in the world at a veterinary school. He also established the Master of Preventive Veterinary Medicine degree program that teaches the principles and strategies of population-based medicine, disease surveillance, and prevention and control of diseases of food animals and zoonotic diseases that affect humans and animals. Today, his graduate students populate leadership positions in public health and research in many universities and government agencies.In his masterwork, Veterinary Medicine and Human Health, first published in 1969, as well as in his many other writings, Schwabe promoted the concept of One Medicine, that is, stronger links and collaborations between the fields of human and veterinary medicine. Schwabe believed that the critical needs of humanity include combating diseases, ensuring sufficient and safe food, improving environmental quality, and creating a society in which humane values prevail. He saw the world as an ecosystem of interdependent civilizations and cultures in which human progress is inexorably linked with the co-evolution of the animal kingdom. Schwabe coined the term One Medicine, a concept previously expressed by Rudolph Virchow and William Osler, to focus attention on the commonality of human and veterinary health interests. One Medicine is the science of health and disease in which differences between humans and animals are not considered. Schwabe pointed out that most infectious diseases of humans have an animal origin. Schwabe also recognized the essential role of veterinary medicine in advancing medical research. Because human medical progress had been so dependent on veterinary studies, he urged schools of veterinary medicine to assume a much greater role in the training of scientists to conduct research to improve human health. He outlined specific reforms in the curricula of schools and colleges of veterinary medicine that would provide for the education of medical investigators.Disciples of Schwabe and Steele have taken the One Medicine concept and advanced it into the One Health Initiative. The One Health Initiative is a movement that seeks to forge greater collaboration between the health disciplines, following the paths created by Schwabe and Steele. For example, at the University of California, Davis, School of Veterinary Medicine, where Schwabe taught for 25 years, the Calvin Schwabe One Health Project seeks to produce a new generation of veterinarians who will be ready to lead collaborative, multidisciplinary efforts to improve global health. With expertise in biohazard events, food and water safety, vector-borne diseases, established and emerging zoonotic diseases, herd health, foreign animal risks, and public health issues such as antimicrobial drug resistance, graduates of the program will be positioned as true One Health advocates and practitioners of the future.In his book Cattle, Priests, and Progress in Medicine, Schwabe shows the link between animals and humans in medical progress by recounting highlights in the history of medicine since ancient times. He describes the early history of humans in terms of animal cultures, focusing on the ancient Nile Valley, and points to similarities in medical knowledge between present-day so-called cattle societies in northeastern Africa and the ancient people of the Nile. He discusses the comparative healers of ancient Egypt, the founders of Greek medicine, the Arabic contribution, and the beginnings of modern medicine. Schwabe shows that over the centuries many of the most notable breakthroughs in improving human health have been closely associated with observations and experiments on animals other than humans.In Unmentionable Cuisine, Schwabe looks at food prejudices or why we eat what we eat, why we reject certain food sources as unpalatable, and the nutritional value of all food sources. He also introduces his readers to a vast number of authentic recipes, collected from all over the world, including recipes for preparing bugs, cow eyes, fertilized duck eggs, dog stew, and armadillo and turkey testicles, that are staples in some cultures but abhorrent to persons in other cultures.Cal Schwabe was a man of great charm and intellect. He had many colleagues and admirers throughout the world. He belonged to the small class of people who are givers rather than takers\u2014fountains rather than wells. Cal Schwabe was a Renaissance man, not merely because of his wide-ranging scholarly interests, but because he created a real renaissance in 20th century public health by showing the way to the unity of veterinary and human medical sciences."}
{"text": "More than 25 years have passed since the discovery of a filovirus, Marburg virus, which caused an epidemic of hemorrhagic fever among laboratory workers in Marburg, Germany, in 1967. The persons affected had contact with the blood or tissues of monkeys or with other infected persons. Marburg virus has reappeared only three times since its discovery, with the largest and most recent outbreak occurring in 1999 in Durba, Democratic Republic of the Congo. Ebola virus, another filovirus, was first described in 1976 during two hemorrhagic fever epidemics in Zaire and Sudan. Since then, Ebola virus has caused large hospital outbreaks of hemorrhagic fever in Kikwit, Zaire, in 1995, and Gulu, Uganda, in 2000. Ebola virus has also been implicated in small chains of transmission among persons with direct contact with intermediary hosts, mostly nonhuman primates in the central African countries of Gabon and Republic of the Congo.The reservoirs for both viruses are still unknown, and the rarity of outbreaks and the remote location of human outbreaks make it difficult, if not impossible, to study the pathogenesis of the human disease. Thus, animal models have been the best, and often only, approach available for studying the progression of disease caused by Marburg and Ebola viruses. Dr. Ryabchikova, the principal author of this book, and her laboratory group have studied the pathogenesis of filoviruses for several decades by using animal models and electron microscopy, a unique approach that has made her one of the few filovirus experts in the world. This book is a compilation not only of her work but of all the information available on Marburg and Ebola viruses.The first three chapters of the book provide a general review of filovirus history, laboratory methods (with an emphasis on electron microscopy), viral structure, morphology, and replication. Chapters 4 and 5 provide more specific details on infection of the target cells  in different organs and during the course of filoviral infection. In chapter 6, the authors deal with the \"hemorrhagic\" side of Ebola and Marburg virus infection. Not all patients infected with these viruses bleed, and when bleeding disorders do occur, no correlated infection of endothelial and hematopoietic cells occurs. Dr. Ryabchikova has found that changes in the microcirculation system, such as the appearance of hemorrhages, clotting, and fibrin deposits, vary by virus and by animal species. Chapter 7, which describes pathologic changes in the organs during the course of filoviral infection, could have been combined with chapter 5. Likewise, the last chapter, which covers immunopathology, appears more like a discussion of the previous chapters.Much of the data have already been published in the Russian or Western literature. However, this book provides one source for all information available on Marburg and Ebola viruses and has a great advantage over other sources. The number and the quality of the illustrations are impressive, and a comprehensive index is provided. The book will prove useful to clinicians and researchers interested in understanding the pathogenesis of hemorrhagic fevers, and it will provide researchers working with other viruses a lesson in the benefits of using electron microscopy technology."}
{"text": "The Autonomous University of Yucatan is a major public university in Mexico, and the largest institution for superior education in the southern part of the country, with 772 academics attending over 20,000 students. It offers 43 undergraduate and 53 graduate programs in all areas of knowledge.On October 12, 1975, Dr. Alberto Rosado G. Cant\u00f3n, rector of the University at this time, created the Biomedical Research Center to provide the institution with a leading facility to perform scientific medical research. The Center was named in honor of Dr. Hideyo Noguchi, the famous Japanese scientist who worked on yellow fever in the region from 1918\u20131920 and received a Doctorate Honoris Causa from the School of Medicine of the University in 1920. The Research Center initiated its activities with three departments: Tropical Pathology, headed by Dr. Jorge Zavala-Velazquez; Reproductive Health, headed by Dr. Thelma Cetina-Canto; and Physiology, headed by Dr. Heriberto Arcila-Herrera. In 1976, the Center was strengthened by the incorporation of several researchers in social sciences, and renamed \u201cDr. Hideyo Noguchi\u201d Regional Research Center. In 1987, it became organized in a Social Science and a Biomedical Unit, to accommodate wider research interests encompassing virology, microbiology, parasitology, reproductive health, human genetics, hematology, social medicine, neurosciences, regional development, Mayan identity and culture, and political and social processes.The department of Tropical Pathology initially pioneered some key research in Mexico and in the region in the area of tropical medicine and several neglected diseases. It also served as a seed for the training of several young researchers who contributed to the growth of the Research Center by becoming group leaders themselves in the following years, including Dr. Andrade-Narvaez, Dr. Puerto-Manzano, Dr. Farfan-Ale, and Dr. Barrera-Perez, and more recently Dr. Zavala-Castro, Dr. Garcia-Miss, Dr. Acosta-Vianna, and Dr. Vargas-Gonz\u00e1lez, among others.Today, the Center has established itself as a major research facility in southern Mexico, hosting 66 researchers and 44 research technicians. Its mission is to develop research in health, disease, social sciences, and humanities of regional, national, and international relevance. In 2012, the Biomedical Unit alone received a total of about US$1,500,000 in external research grants from a number of national and international funding agencies. The Center also plays a major role in the training of qualified human resources in health and social sciences. Over the years, 336 undergraduate and 73 graduate students have developed their theses in its laboratories, and many more received training during shorter internships. The staff of the Center also contributes to formal teaching in many of the academic programs of the University, thus bringing cutting-edge knowledge and research to students in biology, chemistry, human and veterinary medicine, mathematics, and social sciences, among others. The creation of a M.Sc./Ph.D. program in Health Sciences in 2009 was a major milestone toward increased scientific capacity building.Importantly, infectious and tropical diseases have remained at the heart of its research and teaching activities, and the \u201cHideyo Noguchi\u201d Regional Research Center has contributed significantly to the ranking of the Autonomous University of Yucatan as one of the most productive institutions in the area of tropical medicine and neglected disease research in Mexico . The uniSalmonella, Rickettsia, Leptospira, Toxoplasma, and E. coli), and parasites (Trypanosoma cruzi and Leishmania), as evidenced by some highly cited studies.Throughout the years, the Center has contributed major advances in the understanding and control of several tropical diseases caused by viruses , bacteria  mexicanaPeromyscus yucatanicus, a wild mouse from the region, as a unique animal model mimicking human disease, to further unravel the mechanisms of disease progression Leishmania has also been identified and is being further developed by the group of Dr. Dumonteil Leishmaniasis has been studied at the Research Center since 1982 through a series of integrated and multidisciplinary approaches investigating epidemiological, clinical, immunological, parasitological, entomological, and socioeconomic aspects of the disease. Pioneering studies by the group of Dr. Andrade-Narvaez in collaboration with the University of Texas have focused on the characterization of the immune response of patients, in an attempt to understand the changes in cytokine balance involved in the different clinical presentations of infections by Triatoma dimidiata, the main vector in the region, to develop and adapt vector control interventions to the ecology and biology of this species that is able to seasonally invade houses The study of Chagas disease has been at the heart of the Center since its creation in 1975, with the first eco-epidemiological studies performed in the region by Dr. Zavala-Velazquez. With a seroprevalence of 1\u20135% in the region, and a national average of at least 1\u20132%, Chagas disease remains nonetheless a controversial health problem in Mexico, with limited epidemiological surveillance and no national vector control program. Key research by the group of Dr. Dumonteil, in collaboration with the University of Perpignan, France, has focused on Riskettsia spp., and Leishmania is strengthening epidemiological surveillance. Nonetheless, published research needs to better contribute to the shaping of regional and national health policies and research priorities. Another challenge is to consolidate the many years of growth of the Research Center by fostering the continued incorporation of high-level researchers and the training of a new generation of health professionals. Finally, an important lesson learned, and a key factor contributing to the growth of the different research groups, has been the fundamental support of an impressive network of collaborators from national and international institutions (over 90 collaborating institutions). It is hoped that further expansion of this network through new collaborations will promote further growth and impact of the Center. In this situation, the \u201cDr. Hideyo Noguchi\u201d Regional Research Center is emerging as a major reference center for research and training in tropical and neglected diseases, with a growing influence at the national, regional, and international level.A major challenge for the Center is to increase its social impact and promote the translation of the knowledge generated into public health policies and research priorities. Several researchers serve as advisers to local and national health authorities, and their expertise in the diagnosis of several pathogens such as dengue, West Nile virus, influenza,"}
{"text": "DARU Journal of Pharmaceutical Sciences (DARU) is one of the 47 scientific journals of Tehran University of Medical Sciences (TUMS). When the journal was launched in 1991, articles were published in the Persian language; English abstracts were then added in 1995, and finally it completed the transition to publishing in the English language for both abstracts and full-text in early 1999.The main scope of this journal is to serve as a platform for all areas of drug conception, design, manufacturing, classification and assessment. DARU welcomes outstanding studies from basic research to clinical investigations as original papers, systematic reviews, meta-analyses, general reviews, mini-reviews, short communications, and editorials from the global scientific community.http://www.icmje.org), Committee on Publication Ethics , World Association of Medical Editors , and European Association of Science Editors  and request authors to meet these guidelines in submitting their manuscripts. For clinical trials, this journal requires registration in a public trials registry also.DARU considers guidelines provided by International Committee of Medical Journal Editors  were accepted and 41 (56%) were rejected. The average review time has been 23 days.DARU is indexed and abstracted in many abstracting and indexing databases such as ISI Web of Science, PubMed Central, Scopus, Excerpta Medica/EMBASE, Scirus, Directory of Open Access Journals (DOAJ), Biological Abstracts (BIOSIS), EBSCO, Asian Science Citation Network (ASCN), CAB Abstracts, Chemical Abstracts Service (CAS), Free Medical Journals, Global Health, Google Scholar, HINARI, Index Copernicus, Index Medicus for WHO Eastern Mediterranean Region (IMEMR), International Pharmaceutical Abstracts (IPA), Natural Product Extracts (NAPRALERT), Open J-Gate, SIR.Publication as the final important stage of any scientific research is necessary for development of sciences and knowledge of the world. By publication, world scientists talk to each other and share their idea, thoughts, findings, and opinions. The science of pharmacy is not an exclusive and thus we need all scientists of the world to consider this journal as one of their favorite to share their studies with others. The editorial board and managers of this journal try their best to develop knowledge and technology in the field of pharmacy in the globe by adhering higher standards of editing and publication to meet the needs of academics, researchers and professionals."}
{"text": "The number of science editors' associations is growing to resolve a variety of professional problems. The main objective of the associations is to educate their members by facilitating dissemination of information, publishing scholarly journals, books, networking of experts, and regular meetings. There are many science editing associations \u2013 general and specialized, traditional, and new. The article presents activities of some of these associations, which include upholding standards of science writing, editing, indexing, research reporting, peer review, editorial independence, and other editorial policies. It now reaches a level above 200\u2009000 . The maiIn modern-day science editing, both integrity and honesty are defined by professional societies accumulating wisdom, experience, and skills, and supporting individual researchers and editors in their efforts to make their field of science more advanced.The role of science editors' societies is evolving to solve the numerous problems of efficient writing, editing, and publishing. The exponential growth of scholarly publications and the digitalization of the whole publishing industry dictate the necessity of launching new organizations or expanding the functions of old ones. As such, it is not surprising that there is a variety of international, regional, and local associations, each concerned with unique and sometimes overlapping sets of writing and editing challenges . Some of the international associations are presented in Though science editing is a field of science itself, it is still poorly represented in the academic community, and subsequently editors' credentials are not uniformly accepted. Throughout the world, there are only a few accredited and internationally recognized degree and non-degree programs dealing with the core content of research methodology and editing ,8. The kActa Informatica Medica for 2011. Last, but not least important, are the EASE handbook for science editors and European Science Editing quarterly journal. The journal is widely indexed by a number of online catalogs, databases, and digital libraries to serve broad spectrum of interests of editors from different professional backgrounds. It covers a variety of issues in science communication, publishing ethics, scientometrics, and informatics (European Association of Science Editors (EASE) is one of the leading organizations fostering editors' continuous education. It is a scientific member of the International Union of Biological Sciences, the International Union of Geological Sciences (IUGS), the International Council of Science Unions (ICSU), and is in formal associate relations with UNESCO. Perhaps the main indispensable benefit offered to members of EASE from Europe and rest of the world is the triennial congress. Another essential source of information is the EASE guideline for authors and translators available on the EASE Web site . It is aScience Editing, a quarterly journal, and the regularly updated \u201cWhite Paper on Promoting Integrity in Scientific Journal Publications,\u201d the set of guidelines on editorial policy adopted by editors and publishers of influential biomedical and other journals such as Science, Cell, The New England Journal of Medicine, Proceedings of the National Academy of Sciences of the United States of America, and Annals of Internal Medicine. The document comprehensively covers functions of editors and peer reviewers, authorship criteria, conflicts of interest, and scientific misconduct. It is primarily of interest to biomedical science editors.Council of Science Editors  is the US-based association promoting excellence in editorial policies, peer review, and publication ethics. Among a variety of educational sources , CSE offHigh standards of medical communication are advocated by American Medical Writers Association (AMWA) and European Medical Writers Association (EMWA). Both organizations publish quarterly journals, arrange annual meetings, and a series of workshops. On the basis of its workshops, AMWA published two volumes of \u201cEssays for biomedical communicators\u201d presenting effective writing and language editing tips for authors and editors. Also, AMWA introduced a series of self-study workshops or educational modules on ethics, medical terminology, basics of English grammar and punctuation, structuring sentences, and biostatistics. The modules presented as CD-ROMs are invaluable educational tools for medical communicators.International Committee of Medical Journal Editors (ICMJE) is a working group of several general medical journals, also known as the Vancouver group. Its main document, \u201cUniform Requirements for Manuscripts Submitted to Biomedical Journals,\u201d is a primary source of information on publishing ethics, copyright issues, manuscript structuring, and formatting for authors, peer reviewers, and editors of biomedical journals . The majCommittee on Publication Ethics (COPE) is the UK-based group of editors. It has worldwide representation, particularly among editors of medical journals, and the membership of journals published by Elsevier, Springer, Informa Healthcare, DovePress, and other major publishers. COPE published 17 flowcharts for editors on how to handle disputes over changes in authorship, undisclosed conflict of interest, suspected plagiarism and duplicate publication, data fabrication, and complaints against editors . It alsoMedical editors may also benefit from resources offered by the Enhancing the QUALity and Transparency Of health Research (EQUATOR) Network. EQUATOR's staff is formed by experts from the Centre for Statistics in Medicine, Oxford, UK. Its main goal is to promote transparent and accurate reporting of research data by educating authors, peer reviewers, and editors. The digital library of the Network contains numerous publications on science writing and links to reporting guidelines presented in the form of checklists and flow diagrams: CONSORT , STARD (STAndards for the Reporting of Diagnostic accuracy studies), PRISMA  statements, STROBE  checklist for cohort, case-control, and cross-sectional studies, etc. These statements are endorsed by learned societies such as CSE and the World Association of Medical Editors (WAME) and incorporated as a part of editorial policies in numerous biomedical journals.World Association of Medical Editors (WAME) is the leading organization upholding standards of biomedical editing worldwide. Its membership is free and open to all those with experience in scientific and technical editing in big or small journals. Perhaps the main benefit of membership is the access to Listserve discussions, offering solutions to a variety of problems encountered by editors in their editorial practice. Also, WAME has archived its Listserve discussions and issued policy statements on editorial independence, conflict of interest, impact factors, authorship, etc. Novice editors may advance their skills by adhering to the guidelines presented in Syllabus for Prospective and Newly Appointed Editors. Adherence to WAME's statements and the use of other related resources by members is strongly encouraged, and may be helpful for increasing the quality and widening indexing of their journals.To meet specific needs of medical editors from different countries and regions, several national and regional associations were launched in the past decade. The Eastern Mediterranean Association of Medical Editors (EMAME) and the Forum for African Medical Editors (FAME) are good examples of the regional organizations with specific scope of interests and goals. Improving medical writing skills, avoiding plagiarism, and arranging fair peer review are top priorities for both EMAME and FAME. Both regional associations regularly arrange meetings and publish guidelines addressing specific issues of research culture and integrity in science scholarship .In the era of digitalization and changing requirements toward online and print publication, science editors are under pressure to keep up with the pace of changes ,17.s (ALPSP) is one of the few organizations regularly providing updates and advice on how to meet increasingly demanding indexing criteria of prestigious databases. In this regard, Learned Publishing, the quarterly journal of the Association, can be viewed as a must-read periodical for editors from different backgrounds.Learning new information technologies, switching to electronic editorial management, improving publishing standards, and meeting indexing criteria of citation-tracking databases such as Science Citation Index-Expanded (SCI-E) and Social Science Citation Index (SSCI) is becoming a matter of survival and further development for most scholarly journals. Available educational resources of most science editing organizations scarcely cover these issues. The Association of Learned and Professional Society PublisherArthritis and Rheumatism, Annals of the Rheumatic Diseases, and Rheumatology.Along with many helpful resources of the learned societies, some of which are presented in In conclusion, current flow of scientific information and constant growth of scholarly publications require a more systematic approach toward the education of science editors. In this regard, learned societies play the central role by facilitating distribution of information and networking, developing guidelines and policy statements, advocating the editors' interests, conducting research, and publishing periodical literature. To unite specialists with common professional, regional, social, educational, and other needs, and to resolve a variety of the ever changing problems, new associations and networks are forming, some of them on the basis of old ones. Here we are reminded of Albert Einstein's famous quote: \u201cLife is like riding a bicycle. To keep your balance you must keep moving.\u201d"}
{"text": "Asia has some of the largest conglomerations of human populations and also the fastest growing economies of the world. About 23% of the world\u2019s population lives in the South Asian region, and one-fifth of psychiatrically ill patients in the world live in this part of the world. Despite vast cultural, religious, geographical, and political diversities, the factors influencing mental health remain the same throughout this wide region, as highlighted at the recently concluded Asian summit, where the slogan, \u2018One vision, one identity, one community,\u2019 was launched. Thus, the need to strengthen regional cooperation in the field of mental health has always been felt. This article highlights facts about influence of Indian Psychiatry research as well as of some Asian countries in the world psychiatry and vice versa. Asia has some of the largest conglomerations of human populations and also the fastest growing economies of the world. About 23% of the world\u2019s population lives in the South Asian region, and one-fifth of psychiatrically ill patients in the world live in this part of the world. The South Asian Association for Regional Co-operation (SAARC) was formed on December 8, 1985, in Dhaka, Bangladesh. The seven member states are Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka. Afghanistan has become a new member since 2005.Despite vast cultural, religious, geographical, and political diversities, the factors influencing mental health remain the same throughout this wide region, as highlighted at the recently concluded Asian summit, where the slogan, \u2018One vision, one identity, one community,\u2019 was launched. Thus, the need to strengthen regional cooperation in the field of mental health has always been felt.unmada (oonma-tha) \u2014 dating back to 1500 BC, exists in the Atharva Veda, the most ancient authentic Indian medical scripture. Descriptions of conditions similar to schizophrenia and bipolar disorder appear in the Vedic texts; these texts differentiate doctors practicing magical medicine from scientific physicians and surgeons, who lived and practiced in cottages surrounded by medicinal plants. An ancient textbook of Ayurvedic medicine, Therapeutics and Surgical Practice by Charaka and Susrutha, has a vivid description of schizophrenia. It states clearly that only an expert in the field of mental health should treat people with this illness. Other traditional medical systems, such as Siddha, which recognizes various types of mental disorders, flourished in southern India. The great epics such as the Ramayana and the Mahabharata made several references to the disordered states of mind and means of coping with them. The Bhagavad Gita is a classical example of crisis intervention psychotherapy.[The medical compendia of ancient India are replete with references to mental health, covering a spectrum of diagnoses, classification, and treatment methods. A description of insanity \u2014 Till about seventeenth century all abnormal behavior was believed to be act of the \u2018devil,\u2019 that is, \u2018Against God\u2019. The \u2018Mentally ill\u2019 were considered evil and described as witches. Gradually over passing time, mental illness was considered as a \u2018deviant behavior\u2019 and mentally ill were considered socially unacceptable and put in jails along with other criminals. In the modern era, there was a shift from \u2018evil\u2019 to \u2018ill\u2019. Mentally ill were called \u2018mad\u2019 or \u2018insane\u2019 and were placed in special places called \u2018asylums\u2019. However, gradually these asylums became the place for human exploitation. Phillipe Pinel was the first Psychiatrist to free these mentally ill from the asylum. Clifford Beers work, \u2018The mind that found it self,\u2019 brought to light the treatment meted out to these people in asylums, resulting in a strong reaction to the plights of the mentally ill. This uproar resulted in the starting of the \u2018mental-hygiene\u2019 movement.In the twentieth century, the work of Freud and \u2018B. F. Skinner and J. B. Watson\u2019 gave a scientific combination of biological and social theories to explain the etiology of mental illness.Psychiatric epidemiology has gone through various stages of growth over the past five decades in India, starting from the first psychiatric epidemiological study by Dube, in 1961,The International Pilot Study of Schizophrenia and the 7The Madras cohort was followed up for another 10 years and it was found that it had a better outcome in marital and work functioning than has been reported for similar populations in the West.12 AnotheIn India, relapse is difficult to ascertain. Rehospitalization is one of the chief criteria of relapses in the West, but is not so here. This is The role of the family in the Indian scene is all-pervasive, influencing as it does the decision to seek help , the nature of help , the need to continue treatment, and other issues such as employment and marriage. A report by Srinivasan and Thara describeThe recognition of the importance of families has led to the creation of facilities for families to stay with patients in some centers, such as the National Institute of Mental Health and Neurosciences in Bangalore, and the Christian Medical College in Vellore. This facilitates the extensive participation of families in therapeutic programs. The burden on families of people with mental illness is emotional, physical, financial, and medical. Two instruments have been developed specifically to study this burden.16 CopingSouth Asia has been lacking in the field of mental health research mainly due to lack of adequate financial support and infrastructure, and poor collaboration among various health agencies in the region, due to political barriers among the countries.The whole of South Asia faces the problem of \u2018inequalities in health\u2019. The majority of people live in rural areas or urban slums, with no access to care. New delivery systems are needed to target this large group. Pathways to care should be determined and traditional sources  should be explored.Some potential areas for research collaboration in South Asia have been identified: psychiatric rehabilitation, treatment of major depression, culturally acceptable psychotherapy, delivery of mental health services, epidemiological studies, burden of care, course and outcome of mental disorders, acute psychoses, classificatory systems, psycho education, and transcultural psychopharmacology.Individual countries like India have made some significant contributions in psychiatric research. The work of various agencies has been commendable, and the Indian Council of Medical Research, the World Health Organization, the Department of Science and Technology of the Indian Government, the Indian Council of Scientific and Industrial Research, and the United Nations Children\u2019s Fund have been noteworthy among them. Various psychiatric associations have been formed, such as, the Asian Federation for Psychiatry and Mental Health (AFPMH), in 1981, , the South Asian Forum for Psychiatry and Mental Health (SAFPMH), in 2002, , and the SAARC Federation of Psychiatry (SFP), in 2004. The global pharmaceutical companies are also targeting India, by involving several Indian institutions in various international multicentric studies. Also noteworthy is the contribution of the Indian Psychiatric Society (IPS), as it is the largest ensemble of trained psychiatrists in South Asia and has a major role in coordinating research in the region. The Society has promoted the participation of the whole region in its annual conferences, in order to promote better intra-regional cooperation in research.Our society sprouted from the Indian Association for mental hygiene founded in 1929, by Berkeley Hill. In 1935, the Indian division of the Royal Medico-Psychological Association was formed due to the efforts of Dr. Banarasi Das. Thanks to the efforts of Dr. Nagendra Nath De, Major R. B. Davis, and Brigadier T. A. Munro, the association gained its new name, the Indian Psychiatric Society (IPS) on 7 January, 1947. The rules and regulations were framed by the eminent Psychiatrists of that period . The first annual meeting held on 2 January, 1948, at Patna was presided by N.N De.19 The soThe achievements include academic updates as part of professional development, publications like IDEAS and ClinThe Indian Psychiatric Society is a member of the WPA (World Psychiatric Association) and the SAARC psychiatric federation. The SAARC psychiatric federation comes under the Asian Federation of Psychiatric Association (AFPA). IPS has links with the Indo-American Psychiatric Association, Indo-Australian Psychiatric Association, British Indian Psychiatric Association, and the Indo-Canadian Psychiatric Association. Another organization involved in the training and service delivery representing 18 countries is the South Asian Forum International (SAFI).The collaboration and the goodwill of these bodies should be encouraged for the benefit of Indian Psychiatry. The Royal College of Psychiatrists can assist in teaching and training, in collaboration with IPS.India is a multicultural, multi-ethnic, pluralistic society with enormous socioeconomic disparities. This variety on the one hand is exciting, stimulating much research in the field of behavior and mental health, and on the other hand, it is a daunting task to provide affordable and effective mental healthcare, especially to the remote rural corners of the country. The low budget accorded to health and the unenviably low priority of mental health does not make this task any easier.But yet, various studies in India, such as IPSS and DOSMED, have given the world a different outlook toward the role of family in psychiatric illnesses and helped in bringing out various forms of therapies involving family members, which significantly affect the outcome of patients with chronic mental illness. India has played a pivotal role in leading from the front in the region of south Asia in the field of research and patient care, and guiding other countries in psychiatry care.This is clearly the most exciting time in history for the field of psychiatry. The expansion of our knowledge base, as the result of advances in clinical description, neuroscience, and other areas related to etiology and treatment have led to important developments in our approaches to the diagnosis and treatment of individuals with psychiatric illnesses. For example, there has been an increasing recognition of the impact of cultural influences and spiritual beliefs as important factors influencing presentation of illness and symptomatology.The increasing number of mental health professionals, the availability of newer drugs, access to information, and the presence of a few centers of excellence augur a bright future for the mental health scene in India, which will be another step in developing the field of psychiatry. This will provide the vitally needed qualitative thrust to psychiatric teaching and research."}
{"text": "Dr. Aristotelis Tsiakalos is not correctly included in the author byline. Dr. Tsiakalos should be listed as the ninth author and affiliated with Third Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece. The contributions of this author are as follows: Performed the experiments."}
{"text": "The stated purpose of the second edition of Mycobacterium bovis Infection in Animals and Humans is to provide medical professionals, allied health scientists, research workers, and graduate students with current information on the significance of M. bovis in the control and eradication of tuberculosis in animals and humans. This newest edition deals with topics such as the public health significance of M. bovis, pathogenesis of M. bovis, epidemiology of M. bovis (with an entire chapter on molecular epidemiologic techniques), PCR detection of M. bovis with formalin-fixed tissues, and DNA vaccines. As with the first edition, the second edition delivers several updates from various countries on the status of M. bovis infection in animals and humans. Little accessible published information has been available on this topic, which makes the book especially useful.The second edition also deals with several areas not covered in the first edition, including molecular epidemiology, evolution of the M. tuberculosis complex, tuberculosis caused by M. pinnipedii in fur seals and sea lions, the economics of bovine tuberculosis, and cost-benefit analysis of disease eradication programs. Several chapters deal with timely issues related to tuberculosis in wildlife.In spite of its strengths, the second edition adds little additional information to material provided in the first edition on the topics of pathogenesis or diagnosis of bovine tuberculosis. In addition, although most of the photomicrographs are adequate, several are of such poor quality that they are of little use. Also, as with any multiauthored volume, some repetition occurs on general topics. The book achieves its stated purposes, however, and will be especially useful as a reference for researchers, regulatory agencies, and graduate students. It will be less informative for those interested in detailed discussions on research in the field of pathogenesis or diagnosis of M. bovis infection."}
{"text": "Geneva Declaration was regularly issued, focusing on the conference\u2019s main theme and was widely distributed . The First International Congress of the ICPCM was held in Zagreb, Croatia on November 7-10, 2013. The main theme was the Whole Person in Health Education and Training. Zagreb was chosen due to the enduring legacy of professor Andrija \u0160tampar, president of the first WHO World Health Assembly, founder of Zagreb University\u2019s School of Public Health, and pioneer of person- and people-centered care. Gathering participants from 29 countries, the Congress was a true example of an interdisciplinary collaboration. The emphasis was on establishing strong links between experts dealing with science, clinical work, and art in medicine, as well as between experts and patient groups . Students also had an important role and contemporary teaching methods were promoted, eg, the use of trained actors as simulated patients, and patients as teachers. Also the integration of all fields of health care when working with patients and their families was emphasized, which is a relationship which must truly be a collaborative partnership. As health care in general is a very complex and dynamic system, reflecting social changes, in recent decades great attention has been paid to the quality of communication in medicine and medical interview (7-9). When we talk about different forms of communication in medicine, we must never forget the importance of communication through art (10). Person-centered management takes into account psychological, physical, social, and spiritual aspects of health and disease. Therefore, education in medicine must be interdisciplinary and directed toward the person rather than the symptom, diagnosis, or disease, with the emphasis on experiential learning. In a community, whether local, national, or international, we must work together toward the same goal: a culture of person-centered medicine and public-centered health care.During the last decade, a series of new models have transformed our understanding of the concept of health and of the implementation of health care systems. Person-centered medicine (PCM) model is one of them (1). The International College of Person-Centered Medicine (ICPCM) promotes medicine of the person, for the person, by the person, and with the person. The ICPCM emerged from the ongoing annual Geneva Conferences as a strong international network of dozens of leading world-wide medical organizations and institutions (2-4). The first Geneva Conference on Person-Centered Medicine was held in May 2008, under the auspices of ten global institutions, including medical organizations, international bodies of health professionals, and associations of patients and families. Starting with the Fifth Geneva Conference, a Declarations are relevant to the framing of crucial areas in health care, raising awareness, and facilitating transfer of knowledge across the different stakeholders involved in health care. During the Zagreb Congress, two documents were formulated and adopted: the Zagreb Declaration on Person-Centered Health Professional Education (11) and the Zagreb Statement on the Appraisal and Prospects for Person-Centered Medicine in Croatia (12). The Zagreb Declaration on Person-centered Health Professional Education consists of eight recommendations. In the Zagreb Statement on the Appraisal and Prospects for Person-Centered Medicine in Croatia, formulated by local participants and the local organizing group, it was emphasized that activities in Croatia can contribute significantly to the development of person-centered medicine and people-centered health care, in Croatia and abroad.Ars medica (the art of medicine) is both art in medicine and medicine of art, as well as a journey from the culture of illness toward the culture of health, from symptoms and diagnoses toward man and person. Medical education is a critical component of person-centered health care, which is developed from the ground up and requires a revised approach to teaching of clinical skills . It is the first step in the establishment of a culture of person-centered medicine among its practitioners and patients alike.Person-centered medical education is a key priority in the implementation of person-centered medicine and people-centered health care. We must see patients as persons within their physical, psychological, social, and spiritual totality."}
{"text": "There are increasing evidence highlighting the importance of incorporating issues of global health into pre- and post-graduate medical curricula. Medical international cooperation is a fundamental component of strategies to include global health issues in post-graduate medical curricula.Here we describe a seven-year cooperation between the Non Governmental Organization (NGO) \u201cDoctors for Africa CUAMM\u201d and the Pediatric Residency Program (PRP) of the University of Padua  that offers residents a well-articulated personalized international child\u2019s health (ICH) elective in Africa, called \u201cJunior Project Officer\u201d. The elective includes: a careful candidate selection process; pre-departure educational course; preceptorship in Padua and Africa, personalized learning objectives, a personalized job description, a six-month hands-on learning experience in Africa, evaluation of the experience, and formal private and open feed-backs/reports.Between 2006 and 2012, 14 residents aged from 27 to 31 years, six attending the III, nine the IV and two the V year of residency completed the six-month stage in Africa. All worked in pediatric in-patient units; seven also worked in out-patient clinics, six in emergency rooms and seven in community health centers. Eleven were involved in teaching activities and four in clinical research projects. All residents claimed to have achieved their learning objectives.A strong partnership between the NGO and the PRP, and well-articulated personalized learning objectives and job description contributed to a successful ICH elective. There is increasing pressure to incorporate issues of global health into pre- and post-graduate medical curricula in order to provide new generations of doctors with a multicultural perspective on health care-3. The NDespite the relevance and benefits of programs offering ICH electives, and despite numerous recommendations and guidelines on how to build them-12 majorBetween 2006 and 2012, the Pediatric Residency Program (PRP) of the University of Padua  joined the Junior Project Officer (JPO) program promoted by the Italian non-governmental organization (NGO) \u201cDoctors with Africa CUAMM (Collegio Universitario Aspiranti e Medici Missionari)\u201d, which oCUAMM, the first NGO in the field of healthcare to be officially recognized in Italy, is the largest Italian body working to improve and safeguard the health of African populations. The organization has long-term goals, and provides quality healthcare services that are open to all. Its philosophy is to help Africa by creating, supporting and promoting training environments and to create within the international medical community a culture open to global health issues. It is present in seven Sub-Saharan African countries: Angola, Ethiopia, Mozambique, South Sudan, Uganda, Sierra Leone and Tanzania. It operates through volunteers, namely, health professionals such as doctors, nurses, midwives, technicians and administrative staff. These volunteers provide support to hospitals, health districts , motor rehabilitation centers, nursing schools, and Medical Universities .The JPO project launched in 2002 offers doctors in training the possibility of a rotation in one of hospitals in Africa in which CUAMM volunteers work. It also aims at eliciting a vocation to work in the field of international medical cooperation. It is directed to residents in Infectious Diseases, Internal Medicine, Obstetrics and Gynecology, Pediatrics, Public Health and Surgery.The PRP of the University of Padua is a 5-year national accredited program for post-graduate training in Pediatrics. Approximately 80% of learning activities takes place in the clinical setting, in which medicine is practiced under the supervision of a faculty member with the goal of increasing levels of responsibilities during training. The remaining learning activities are formal lectures, seminars, workshops. Residents rotate through 15 of the 25 divisions/services of the Department of Woman\u2019s and Child\u2019s Health of Padua and of affiliated hospitals during their first three years devoted to provide general pediatric competences; rotations last between 3 to 6 months. During the last 2 years of training, residents select elective rotations in pediatric subspecialties involving, at most, 3 divisions; each rotation lasts from 6 to 12 months.The JPO elective is open to residents in their third year onwards. Only one resident at a time can go to Africa.Candidates are selected based on their professional profile, notably pediatric knowledge, level of autonomy, manual skills and reliability, and on the results of an interview with members of the Resident Affairs Committee (RAC) and with representatives of CUAMM. The interview is designed to understand the candidate\u2019s motivation join the project, to describe all the potentially negative and positive aspects of the experience and to try to evaluate the probability that the candidate will successfully complete the program.After the initial screening, residents are required to attend a professional training course  organized by CUAMM. This consists of six three-day modules held on a monthly base; the first is devoted to the basic principles of health cooperation with countries that have limited resources and the inspiring concepts of \u201cDoctors with Africa CUAMM\u201d; the second module introduces the basis of \u201cStrengthening Health Systems\u201d and the strategic approach adopted by the NGO in Africa. The remaining modules provide general concepts of hospital management and public health, and information about the diagnostic and therapeutic guidelines established for the main tropical infectious diseases, about the status of mother and child health in Africa, and about the more relevant critical issues and the main programs activated to address them.Once a candidate has successfully undergone the interview and the pre-departure course, the possible destination in Africa is identified, based exclusively on the presence on site of a pediatrician from CUAMM who can function as a local tutor and on safety issues related to the local social and political situation. A preceptor in Padua (one of the authors \u2013 LDD), chosen among RAC members because of experience in international medical cooperation and commitment to the JPO project, was assigned to each resident.Once the resident, the hospital in Africa and the CUAMM volunteer serving as local tutor are selected, the overall learning objectives of the training . All his/her activity is carried out under the supervision of the local tutor in Africa.The 6-month ICH elective is counted as any other rotation that is mandatory for residents during their training. Consequently, it is subject to the usual PRP evaluation process, which foresees evaluation of the residents by tutors, and of the quality of the rotation and of the tutors\u2019 performance by residents, based on validate questionnaires. TherefoCUAMM provides participants with the necessary insurance coverage for personal and professional risks, and assistance in applying for VISA and work permits, as required, and lodging on site in residences rented by CUAMM. The residency program covers travelling costs, whereas residents must pay for all other expenses they incur in Africa from the salary they continue to receive from the University.The JPO program is governed by a memorandum of understanding, signed by CUAMM and the University of Padua, according to which the NGO and the University undertake to cooperate to improve the health status of the population in Africa by making available their own specific resources and competences.Before the JPO project started in October 2005, RAC members visited the hospitals chosen for the project. The aims of the site visit was to meet the local political and health authorities, to describe the PRP, to see the hospitals and their facilities in order to acquire an overall sense of the environment where residents are expected to work.Between 2006 and 2012, of the 135 residents who participated in the PRP and were eligible for the JPO, 22 declared their interest in joining the project and attended the preparatory course. One dropped out because she did not feel psychologically prepared, and seven were unable to go to Africa for contingent reasons. Thus, 14 residents went to Africa . Their age ranged from 27 to 31 years; six were attending the III, nine the IV and two the V year of residency. While in Africa, all worked in pediatric in-patient units; seven were also involved in out-patient clinics, six in emergency rooms and seven in territorial health centers. Eleven were also involved in teaching activities for local nurses and doctors in-training, and four carried out a clinical research project while in Africa.As reported in Table\u00a0To our knowledge, this is the first article to describe the strategic framework of an ICH elective for students enrolled in a European PRP. Furthermore, no other Italian pediatric residence programs offer similar experience based on such an articulated framework. During the seven years that the PRP of Padua University participated in the JPO project, there was always a candidate for the ICH elective. Moreover, all the 14 residents who participated in the elective completed the six-month stage abroad, without having encountered any major problems, which is remarkable given the duration of the stage. Notably, all felt they had undergone an important human and professional experience. Therefore, the JPO project, as carried out by the PRP of Padua University, is a useful example of how to offer ICH electives to pediatricians in training  while in Africa. As witnessed by the residents\u2019 feedbacks, this tutorship was greatly appreciated. The tutorship in Africa was considered equally effective. In the two cases in which the resident did not experience a positive tutorship in Africa, the situations were carefully monitored, and the problems did not prevent the residents from completing their ICH elective and reporting positive comments.The MOU of the University of Padua, within which the PRP operates, is a key factor of our IHC elective. In fact, in this MOU the University of Padua endorses the CUAMM-PRP partnership and thus recognizes the educational value of the JPO project and its impact on society as a whole. Thus, the CUAMM-PRP partnership has the status of an academic endeavor and consequently sets rigorous standards for its development and implementation. The MOU served also to provide the administrative and legal elements necessary to run the project in Padua. Our experience suggests that PRPs offering ICH electives should have a formal, officially recognized (by the authorities governing the PRP) relationship with international medical organizations that are well positioned in countries with limited resources. Such organizations are able to facilitate the access of residents to hospitals in Africa, identify local expert tutors and provide all the resources necessary to support the residents\u2019 presence in Africa. Ideally, they should share CUAMM\u2019s commitment to education.We are aware that such an ICH does not fulfill all the requirements of a complete pediatric global health education. UndoubtFinally, if one of the reasons to offer an ICH was to solicit professional vocations in the field of international medical cooperation, it is noteworthy that two of the residents who participated in the ICH are currently involved in programs of international medical cooperation (and one of them with CUAMM).In conclusion, we decided to make the pediatric community aware of the model we used to offer an ICH elective with the aim of stimulating a debate on this matter and of generating criticisms and ideas. This, in turn, might encourage other PRPs to offer ICHs to residents. Indeed, more should be done to implement the culture of medical global health in medical post-graduate programs. It is important to raise future generations of doctors with the concept that we live in a world of strong inter-dependency where everyone should practice medicine in the part of the world in which they work but with their gaze directed to wider horizons.ICH: International child health; JPO: Junior project officer; MoU: Memorandum of understanding; NGO: Non Governmental Organization; PRP: Pediatric residency program; RAC: Resident affairs committee.All authors declared no competing interest with the contents of the manuscript.LDD: Among the ones conceiving the MPO project for the Pediatric Residency Program of Padua; intervened in collecting the data of the experience, analyzing them and in writing the paper; preceptor in Padua for the residents in Africa. GPer & EB: Past and present chairman of the Pediatric Residency Program of Padua, they intervened in supporting the JPO project, in analyzing the data and in writing the manuscript. DC & GPut: the Founder of the JPO project in Italy; they intervened in supporting the JPO from the CUAMM size, in supervising the analysis of the data and of the manuscript. AG: Chair of the organizing committee of the JPO project, she intervened in developing the capturing forms for analyzing the data regarding the experience, in data managing and in formulating the first set of analysis. All authors read and approved the final manuscript.DC, MD, Director, Doctors with Africa CUAMM, Padua, Italy. EB, Full Professor of Pediatrics, University of Padua, senior member of the Resident Affair Committee; Chair of the Pediatric Residency Program of Padua University since October 2012. LDD, Associated Professor of Pediatrics, University of Padua, Chair of the Pediatric Divisions, expert in post-graduate medical training; Vice-Chair and senior member of the Resident Affair Committee of the Paediatric Program of Padua. AG, JPO Project Manager \u2013 Human Resources Department, Doctors with Africa CUAMM, Padua, Italy. GPer, Full Professor of Pediatrics, University of Padua, Director of the Department of Woman\u2019s and Child\u2019s Health of the University of Padua, Italy; Chair of the Pediatric Training Program from 2005 to September 2012; presently member of the Resident Affair Committee. GPut, MD, Head of Planning, Doctors with Africa CUAMM, Padua, Italy."}
{"text": "DEAS is an on-going population-based, representative survey of community-dwelling people living in Germany. The survey started in 1996, and the fifth wave will be conducted in 2014. It comprises cohort sequential data, i.e., both repeated cross-sectional surveys and panel data for people aged 40 and over.How healthy are people as they age, what are possible causes and consequences, and what can be derived from this with a view towards health promotion in older people? The German Ageing Survey, funded by the Federal Ministry of Family Affairs, Senior Citizens, Women and Youth (DEAS; To date, DEAS has considered people born between 1911 and 1968, and over 14,700 participants have been interviewed face-to-face and been given written tests and questionnaires. The survey aims at knowing more about the living conditions and the quality of life of people in middle-age and later life, and at knowing more about changes over time, both on the individual and the societal level. Thus DEAS covers a large range of subject areas, including family and social networks, work and retirement, participation, economic situation, well-being, psychosocial resources, as well as health and health behaviour. The data allow both the analysis of individual health trajectories and health changes on the societal level: How healthy will older people be in the next years or decades? For this purpose, different birth cohorts can be compared that have reached the same age at different points in time.The present findings suggest that birth cohorts born later report less illnesses, lower ailments and higher physical activity, which points to better health and health behaviour of subsequent cohorts. Overall, these findings are in line with those from other surveys in Germany, though the comparison of different studies is limited. One reason for this is the use of different health indicators, which is perhaps most evident in the measurement of chronic illnesses and multi-morbidity. Additionally, other factors such as the in- or exclusion of very old or institutionalised people and the use of cross-sectional surveys versus panel data might contribute to heterogeneous findings on health trends.For the study of health trends in ageing societies, multiple health indicators are needed to allow for the fact that differences between various health components become more pronounced in later life. Aiming at harmonising concepts and instruments to assess healthy ageing, as initiated by the Robert Koch Institute, is therefore highly appreciated."}
{"text": "The concept encompasses the human population, domestic animals and wildlife, and the impact that environmental changes  such as global warming will have on these populations. Visceral leishmaniasis is a perfect example of a small companion animal disease for which prevention and control might abolish or decrease the suffering of canine and human patients, and which aligns well with the One Health approach. In this review we discuss how surveillance for leishmaniases is undertaken globally through the control of anthroponootic visceral leishmaniasis (AVL) and zoonotic visceral leishmaniasis (ZVL). The ZVL epidemic has been managed to date by the culling of infected dogs, treatment of human cases and control of the sandfly vector by insecticidal treatment of human homes and the canine reservoir. Recently, preventive vaccination of dogs in Brazil has led to reduction in the incidence of the canine and human disease. Vaccination permits greater dog owner compliance with control measures than a culling programme. Another advance in disease control in Africa is provided by a surveillance programme that combines remote satellite sensing, ecological modelling, vector surveillance and geo-spatial mapping of the distribution of vectors and of the animal-to-animal or animal-to-human pathogen transmission. This coordinated programme generates advisory notices and alerts on emerging infectious disease outbreaks that may impede or avoid the spreading of visceral leishmaniasis to new areas of the planet as a consequence of global warming. L. donovani complex, order Kinetoplastida. The aetiological agents are: L. donovani in India and Central Africa and L. infantum in the Americas, the Middle East, Central Asia, China and the Mediterranean. The human disease is lethal if not treated early after the onset of clinicopathological abnormalities that include: malaise, anaemia, cachexia, hypergammaglobulinaemia, hepato-splenomegaly and progressive suppression of the cellular immune response. L. donovani complex species are intracellular parasites of macrophages of lymphoid organs such as the spleen, lymph nodes, bone marrow and liver. Their biological cycle alternates between the amastigote form in the vertebrate host and the promastigote form in the gut of the sandfly vector. More than 90% of human cases of VL occur in India, Sudan, Bangladesh and Brazil. Each year 500,000 new human cases of VL are reported .L. donovani and involves a severe parasitism of the blood and skin and an anthropophilic vector, making man the reservoir of the disease. In contrast, ZVL with dogs as reservoir hosts is usually associated with L. infantum and is found in the Americas, the Middle East, Central Asia, China and the Mediterranean. ZVL is considered a canid zoonosis in which sandflies become infected mostly by feeding on the skin of canids and humans are the final host of the parasites. Blood-parasitism in people with ZVL was at first considered not to occur . In Eureservoir  or in oreservoir  and in ceservoir .L. infantum infection with increasing age of dogs . Explaiiewed in ,20 Sanch .P. perniciosus than of L. longipalpis , but vesing BCG  or muramsing BCG  adjuvantsing BCG . The vacpressure . There inine ZVL . Leishmu to 2006 . In Ara\u00e7campaign .\u00ae has also been licensed in Brazil. It is composed of the recombinant A2-antigen of Leishmania amastigotes and is adjuvanted by saponin , explaiiewed in -82 and riewed in , 85 84]\u00ae has alsiewed in ; immunotiewed in  and 24 diewed in ; and in iewed in , there icontrols . There icontrols  and the Leishmania-infected dogs are thought to reside in Italy, Spain, France and Portugal as determined by published serological surveys from those countries [Leishmania vaccine is due to be released in selected countries endemic for the disease [While in Brazil an average of 4,000 human cases of ZVL is reported annually, in Europe, the incidence of human ZVL is relatively lower, with a total of approximately 700 reported new cases per year for all southern European countries . An estiountries . Autochtountries  northernountries , north wountries  and soutountries . The Eurountries . In soutountries ,94 is prountries -97. In tountries . In 2011 disease . It willIn Iran, ZVL is not controlled by serological testing and culling infected dogs, but by the use of deltamethrin-impregnated dog collars. These measures were reported to reduce the risk of infection in dogs by 54% and in children by 43% .Leishmania infection in the domestic dog population is fundamental in order to avoid the spread of ZVL between dogs and man. A high level of infection in dogs, particularly in impoverished areas, is often recorded just before the start of a human epidemic and may be an important predictor of an impending outbreak of disease in the human population [The control of pulation . It is cThe One Health concept is a worldwide strategy for expanding interdisciplinary collaborations and communication in all aspects of health care for man, animals and the environment. As monitoring of ZVL in companion animals is extremely important for the control and prevention of the human disease, ZVL is one of the best examples of a disease whose successful control and eradication depends upon the use of a One Health strategy.The authors declare that there is no conflict of interest regarding the present work and that sponsors had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.CBPS did the review of the literature and wrote the article. MJD conceived the idea of the article as part of the work of the WSAVA One Health Committee and critically reviewed the article. Both authors read and approved the final manuscript."}
{"text": "Interval timing (IT) is an essential capability of living organisms from invertebrates to humans that allows them to accurately estimate durations in the range of seconds to minutes. In peak interval procedure ,2 subjecWe implemented a minimal Striatal Beat Frequency (SBF) model ,6, that The states of all OSC neurons determine the vector of state that is received by each spiny neuron together with the vector of state of OSC stored in MEM at CT. In our implementation, the output is generated through coincidence detection, i.e., dot product, between the current state of OSC and the state of OSC stored in MEM at CT. Biological noise induces different types of variabilities, e.g., random fluctuation in the frequencies of OSC neurons, errors in storing/retrieving the criterion time in MEM, etc. We investigated both analytically and numerically the properties of the output function generated by the SBF model and found that: (1) in the absence of any variability in the parameters of the SBF model, the width of the output function that measures the spread of behavioral responses is constant, therefore, violating the scalar property, (2) if variability is allowed, for example in the memorization/retrieval of CT, then the output function of SBF model is always Gaussian, which is a consequence of the central limit theorem, regardless of the probability distribution function (pdf) of fluctuating parameter. Moreover, we found that the scalar property is also preserved regardless of the pdf of fluctuating parameters."}
{"text": "Rx for Change to provide a comprehensive, online database of the evidence for strategies to improve drug prescribing and use.Globally, suboptimal prescribing practices and medication errors are common. Guidance to health professionals and consumers alone is not sufficient to optimise behaviours, therefore strategies to promote evidence-based decision making and practice, such as decision support tools or reminders, are important. The literature in this area is growing, but is of variable quality and dispersed across sources, which makes it difficult to identify, access, and assess. To overcome these problems, by synthesizing and evaluating the data from systematic reviews, we have developed We use reliable and valid methods to search and screen the literature, and to appraise and analyse the evidence from relevant systematic reviews. We then present the findings in an online format which allows users to easily access pertinent information related to prescribing and medicines use. The database is a result of the collaboration between the Canadian Agency for Drugs and Technologies in Health (CADTH) and two Cochrane review groups.Rx for Change currently contains over 200 summarised reviews, structured in a multi-level format. The reviews included in the database are diverse, covering various settings, conditions, or diseases and targeting a range of professional and consumer behaviors.To capture the body of evidence on interventions to improve prescribing and medicines use, we conduct comprehensive and regular searches in multiple databases, and hand-searches of relevant journals. We screen articles to identify relevant systematic reviews, and include them if they are of moderate or high methodological quality. Two researchers screen, assess quality, and extract data on demographic details, intervention characteristics, and outcome data. We report the results of our analysis of each systematic review using a standardised quantitative and qualitative format. Rx for Change is a novel database that synthesizes current research evidence about the effects of interventions to improve drug prescribing practices and medicines use. The safe and effective use of medicines is an important aspect of quality healthcare. While there is an abundance of data on the clinical effectiveness and safety of various drugs, this does not ensure that the drugs are being appropriately prescribed or taken; in fact, suboptimal prescribing and medication errors are common across countries . ResearcRx for Change http://www.rxforchange.ca.To address these problems, the Canadian Optimal Medication Prescribing and Utilization Service (COMPUS) program, within the Canadian Agency for Drugs and Technologies in Health (CADTH), and in collaboration with the Cochrane Effective Practice and Organisation of Care (EPOC) Group and the Cochrane Consumers and Communication Review Group (CC&CRG), have created and continue to update an online database of interventions to promote evidence-based prescribing and medicines use, called Rx for Change is a novel, publicly-accessible database that we initially developed and populated with review-level evidence, and made available online in April 2007. We update it regularly to reflect accumulating and changing evidence and provide decision makers with reliable, up-to-date, evidence-based information in the form of reader-friendly summaries. In the database, we present key findings from systematic reviews that evaluate the effects of interventions directed at professionals, consumers, and organizations in a systematic way. This paper describes the methods for developing and populating the Rx for Change database and highlights key content and the significance of the database for healthcare policy makers, researchers, professionals, and consumers.Rx for Change database is to provide an overall synthesis of the evidence from systematic reviews on the effectiveness of interventions for improving prescribing by healthcare professionals and medicines use by consumers. The methods that we used to populate the database parallels systematic review methodology. We use reliable and valid methods to search and screen the literature, and to appraise and analyse the evidence from relevant systematic reviews. We then present the findings in an online format which allows users to easily access pertinent information related to prescribing and medicines use.Our goal for the Rx for Change database online in a publicly accessible format and has recruited additional funding for this project.In partnership with the Canadian Federal, Provincial, and Territorial Health Ministries, COMPUS identifies and promotes optimal drug therapy and encourages evidence-based information in decision making among healthcare providers and consumers. COMPUS hosts the Rx for Change database, EPOC maintains and updates the evidence from published systematic reviews on professional interventions that impact on the delivery of care, as well as organisational, financial, and regulatory interventions that influence prescribing behaviour. For the purpose of this paper, the methods used to identify and evaluate interventions targeting prescribing will be described.EPOC produces systematic reviews of interventions to improve healthcare delivery and healthcare systems, such as audit and feedback, distribution of educational materials, and decision-support tools using a well-established taxonomy of interventions and methods. In addition, EPOC has conducted overviews of existing Cochrane reviews as well as non-Cochrane systematic reviews to assess and synthesise the evidence in the area of professional behavior change ,5. For tRx for Change database, the CC&CRG is responsible for maintaining and updating the evidence on the effect of consumer-targeted interventions, such as providing consumers with information or education on medicines use, or promoting medicines self-management skills among consumers.The CC&CRG produces systematic reviews of interventions targeted at consumers (patients and their family members or carers) to promote consumer participation in healthcare. The CC&CRG has developed resources and tools to help organise and synthesise the evidence in relation to consumer communication and participation, and members of the group are currently undertaking an overview of systematic reviews of interventions directed at consumers to improve medicines use . For theRx for Change equals four highly trained staff members shared between both Cochrane groups, in addition to supervision from senior research staff.Using the combined expertise of the two Cochrane review groups, we developed the methods used for the synthesis and the presentation of the findings for this database. Human resources required in successfully maintaining With the assistance of an information specialist, we conduct comprehensive regular searches of electronic databases, including MEDLINE, EMBASE, Database of Abstracts of Reviews of Effects (DARE), and the Cochrane Database of Systematic Reviews (CDSR). In addition, we systematically hand-search the CDSR and DARE databases as interventions targeting consumers' use of medicines are not well indexed.http://www.cadth.ca/index.php/en/compus/optimal-ther-resources/interventions/methods). A flow diagram illustrating the methods and procedures for the database can be found in Figure Each year, we identify several thousand potentially eligible citations. Using explicit inclusion criteria, two researchers independently screen titles, abstracts and full text articles for relevance, and compare results. We resolve disagreements through discussion and, when necessary, through consultation with a senior team member  out of the total number of studies for each comparison. We also include any additional review data, such as meta-analyses or effect sizes. We then compile the results from each comparison and present them in a 'Table of Results.' We use standardised decision rules and statements to descriptively report on the general and medicines-specific 'Results' and 'Conclusions' of each review. For example, we use the term 'generally effective' if two-thirds or more of the studies favor the intervention.We organize the reviews of interventions directed to professionals and the delivery of care using the EPOC taxonomy of interventions. This taxonomy groups interventions into five broad categories: interventions targeting healthcare professionals, changing the organization of healthcare, financial interventions, regulatory interventions, and structural changes. Each category includes a number of specific interventions. Examples of interventions targeting professionals include reminders, educational meetings, and audit and feedback. Because the consumer literature on medicines use had not been previously well organised, the CC&CRG developed a taxonomy of consumer directed interventions ,10. ExamWith each update of the database, we combine new evidence with existing evidence and intervention summaries are updated. We display flags that indicate which interventions have been recently updated with new evidence.We present the database in a multilevel approach. In the first level, we provide a list of interventions grouped into five categories: professional, consumer, organisational, financial, and regulatory Figure . In the Rx for Change database on professional behaviour change [We launched the database in April 2007 and have since updated it three times Table . We initr change  and consRx for Change is a well-designed database containing valuable information for researchers, healthcare providers, and policy makers. Since its inception, we have received positive feedback about the database from international users about its value, applicability, and quality. Within a year of its launch, it had accumulated more than 25,000 page views. With increasing awareness of the database and its ongoing updates, we anticipate that this interest will continue to grow. We will continue to disseminate key messages to local and international groups about which interventions are effective, and where gaps in the evidence exist. We will continue to explore methods to disseminate and translate key messages to end users, particularly as new evidence is found and added to the database.Rx for Change database has provided the opportunity for EPOC and CC&CRG to collaborate with organizations that have strong links with healthcare decision makers . This collaboration promotes the use of research evidence and ensures that the data is available to the general public, healthcare professionals, and policy makers.The Rx for Change database to facilitate and improve the processes of accessing, searching, identifying, and using research to inform evidence-based prescribing and medicines use. It provides reliable, up-to-date, evidence for a wide range of users and is organised in an easy-to-browse format. We take the quality of the evidence into consideration to provide useable summaries that are relevant to decision-makers. This database is a first-in-class tool, and we will continue to promote it to ensure that it is utilized to its full potential.We created the BL is currently employed by CADTH. MW, AM, JW, and AS have been or are currently employed by EPOC. JG is the Coordinating Editor of EPOC. RR, NS and DL are currently employed by CC&CRG. SH is the Coordinating Editor of CC&CRG.MW participated in the design, data collection, analysis, coordination of the study, and drafted the manuscript. RR, AM, JW, NS, DL, AS, and SH participated in the design, data collection, analysis, and coordination of the study and contributed to the manuscript. BL participated in the design of the study and provided feedback on the manuscript. JG conceived of the study, participated in its design and coordination and provided feedback on the manuscript. All authors read and approved the final manuscript."}
{"text": "In our consistently doing what we know is right and important for \"Medicine and Life\", we can express selfesteem and satisfaction after full honest effort with the successful carrying out of the First International Congress \"Health \u2013 Food \u2013 Welfare\" which took place at Aro Palace Hotel, Brasov, 15-17 October, 2011, under the patronage of the Romanian Patriarchate, The Romanian Academy, The Ministry of Public Health, The Ministry of Agriculture and Rural Development, The Ministry of Education, Research, Innovation and Sport in collaboration with the International Association of Distribution (A.I.D.A Bruxelles) and EHI Retail Institute. The quality of leadership has been demonstrated by the considerable willingness for cooperation proved by all the stakeholders. That is the reason why we are experiencing a real joy, because, as William Shakespeare said, joy\u2019s soul lies in the doing.Professor Florian Popa, Rector of the \"Carol Davila\" University of Medicine and Pharmacy, Bucharest and President of the Organizing Committee, and the three Honorary Presidents, Professor Eliot Sorel/George Washington University/USA, Professor Bernd Hallier/Germany, Professor John L. Stanton/University of Philadelphia, USA and other leading professors attending the event to cooperate in the future on the following topics: - a Romanian Competence Center for Global good agricultural practices  and \u201csmartagrifood\u201d; enriching the Eurasian Youth Forum by a \"Black Sea/Caspian Sea Area Initiative\" to promote together higher education, innovation and the Bologna process; pushing that initiative of cosmopolitan Youth Organizations also via the Astana Economic Forum in Kazakhstan organized among others by the Eurasian Club of Scientists, the Club of Madrid and the G 20. The parties concerned want to use those three activities to create student exchanges by EU-projects like Tempus, Erasmus and Leonardo da Vinci as well as with transatlantic cooperation involving the USAID, USDA and identify the link between higher education, innovation the business community and future employment opportunities and sustainable development in the Eurasia region.As it is already well known, on that occasion a letter of intent had been signed  by"}
{"text": "After publication of this work , we noteMr. Meseret and Ms. Fanaye have held supervisions, consultancies and follow up while we are conducting our research. The other authors declare no conflicts of interest.YW: Participated in conception and design of the study, data collection, analysis and interpretations of the findings, reviewed the manuscript; GF: Participated in conception and design of the study, analysis and interpretations of the findings, drafting the manuscript and write up; GY: Supervision of the study, analysis and interpretations of the findings, reviewed the manuscript; DM: Participated in analysis and interpretations of the findings, reviewed the manuscript; MA: supervision of the study, consultation, follow up and reviewed the manuscript; FA: supervision of the study, consultation, follow up and reviewed the manuscript"}
{"text": "After publication of this work , we noteThe authors declare that they have no competing interests.CWC, CLC, LKH, HJT and HHC participated in the design of the study and draft the manuscript. SWC, HYS and CWH participated data collection and performed the statistical analysis. CJS conceived of the study. All authors read and approved the final manuscript."}
{"text": "Hospital acquired infections are a major cause of morbidity and mortality and markedly increased health care costs. Critically ill patients who require management in an Intensive Care Unit are particularly susceptible to these infections which are associated with a very high mortality. Selective decontamination of the digestive tract (SDD) may reduce these infections and improve mortality but it has not been widely adopted into practice. We aim to 1. Clarify reasons why clinicians have avoided implementing SDD into clinical practice despite the current best-evidence 2. Describe barriers to SDD implementation and 3. Identify what further evidence is required before full scale clinical implementation would be considered appropriate and feasible.We have developed an international 'multi-lens' approach to investigate SDD from several perspectives. In case studies we will identify accounts of implementation of SDD in practice, in terms of the behaviours performed by the full range of individual clinicians, accounts of how SDD was first introduced into the Unit and specific content that may be used to populate the content of behaviour change techniques to be used in an implementation intervention and procedures to consider in order to deliver an implementation trial. In a 4 round Delphi study we will identify the range of stakeholders' beliefs, views and perceived barriers relating to the use of SDD. We will generate hypotheses about key beliefs about SDD and will inform the feasibility of any future randomised controlled trial. In large-scale nationwide postal questionnaire surveys of the state of current practice we will identify the factors predicting acceptability of an effectiveness or implementation trial using, and informed by, the theoretical domains structure. In semi-structured interviews with active international clinical trialists we will assess the feasibility of a randomised controlled trial and identify challenges and barriers to undertaking research in the field of SDD research.We believe these methods will allow us to determine whether clinical implementation trials or further large effectiveness trials are required before full scale implementation into clinical practice. Each year in the UK 140,000 patients are admitted to an intensive care unit (ICU) and of these almost 60,000 will die within a year of admission. Hospital acquired infections (HAI) are a major clinical problem for modern health services as they are associated with morbidity and mortality as well as high additional health care costs. Critically ill patients are extremely susceptible to HAI and these are associated with a high additional mortality, prolonged hospital stays and a large health care resource utilisation. Between 20 and 50% of ICU patients suffer from such infections and major efforts are being undertaken to improve these outcomes [An intervention that has gained much interest in reducing HAI is selective decontamination of the digestive tract (SDD). SDD involves the application of topical non-absorbable antibiotics to the oropharynx and stomach and a short course of intravenous antibiotics -14. The Despite this evidence base, ICU practitioners have not widely adopted this intervention with only 10-15 ICUs (out of 240) reporting that they undertake SDD in the UK ,15. ExisIt seems that until there is high quality evidence demonstrating clinical effectiveness, cost-effectiveness and the ecological impact of SDD in a range of health care systems, this intervention is unlikely to be implemented and thus patients will be denied a potentially life saving therapy. However, despite the clear importance of HAI in critically ill patients, and despite a multi-national appreciation and prioritisation of the importance and urgency of this research topic, it remains unclear why this intervention has not been implemented. Little is known about clinicians' beliefs about the existing evidence base, the perceived benefits and risks of SDD in clinical practice, the factors that influence current practice and likely barriers to implementation. Further, it is also unclear whether there is a requirement for further high level evidence of effectiveness before implementation would become acceptable and what sort of study would be feasible and acceptable to clinicians and trialists. This multi-method study will address these issues in three regions .The overall aim of this study is to identify the perceived risks, benefits and barriers to the use of SDD in critical care units. To achieve this aim, the following objectives are proposed  listed):1. To identify and precisely describe the clinical intervention in units and hospitals that deliver SDD:RQ1: What are the components of the intervention of SDD?\u2022 RQ2: How has SDD been implemented and delivered into practice?\u2022 2. To identify the range of beliefs, interpretation and views about the current evidence base relating to the use of SDD in key stakeholder groups:RQ3: What are the views of key stakeholders about the likely positive and negative consequences of implementing SDD in ICUs?\u2022 RQ4: What are the views of key stakeholders about the likely barriers to implementing SDD in ICUs?\u2022 RQ5: What are the views of key stakeholders of the internal/external validity and adequacy of the existing evidence base for SDD?\u2022 3. To identify current practice and assess the acceptability of further randomised controlled trials in the field of SDD in a wide group of intensive care clinicians and infectious disease clinicians/medical microbiologists:RQ6: What are the current practices and intentions of intensivists and infectious disease clinicians/medical microbiologists about SDD?\u2022 RQ7: If there are uncertainties in the evidence base, do these clinicians believe they could be addressed in a clinical trial and what research questions, trial design(s) and interventions would be optimal and what predicts these beliefs?\u2022 4. To assess the feasibility of a proposed effectiveness randomised controlled trial comparing SDD against a control group in ICUs among international intensive care clinical trialists:RQ8: What are the likely challenges in undertaking a large multi-national randomised controlled study of SDD in ICU?\u2022 The study will use a 'multi-lens' approach to investigate SDD from several perspectives and in three national regions  to allow greater understanding and international comparisons of the issues that relate to the implementation of this therapy. The investigation will involve four inter-related stages , we will sequentially build a picture of respondents' beliefs and views on SDD. We will further assess the likely factors influencing the acceptability of any future randomised controlled trial comparing SDD against a control group (not including SDD) in ICUs and/or a proposed randomised controlled trial comparing implementation strategies for SDD against a control group in ICUs. Rounds 1 to 3 will be conducted independently within each region, whilst round 4 will be multi-region.There is a broad range of estimates of suitable sizes for a Delphi panel, but smaller sizes (such as 10 per stakeholder group) have been deemed appropriate where panel members have similar training . Four keThe Delphi study report will present (i) the perceived importance of each specific belief about the use of SDD in ICUs; (ii) the acceptability and feasibility of conducting an effectiveness trial; and (iii) the acceptability and feasibility of conducting an implementation trial. In round 4, the data from each regional setting will be presented to all international participants by email. The international comparisons in this round are important, to increase the generalisability of the results and of any future study result, since lack of generalisability may have been a major factor limiting the uptake and implementation of SDD in the past. This round will require that the investigations conducted in each country use a broadly parallel time frame, so that the feedback is presented to all participants with similar time intervals. The full Delphi results will allow us to consider how best to elaborate the key findings from the nationwide survey of the state of current practice, described below.This stage will be conducted in all three regions using large-scale postal questionnaire surveys using existing databases of intensivists and infectious disease clinicians/medical microbiologists in each region. This questionnaire design will be informed by the theoretical domains structure  but onlyParticipants from all three regions as well as European investigators will take part in this stage. We will interview expert national and international clinical trialists in the intensive care field including trialists with experience in SDD to identify challenges and barriers to undertaking research in the field of SDD research. We will seek to recruit 10 participants from across the UK, Europe, Canada and Australia. Semi-structured one-to-one interviews using a topic guide developed from the previous phases as well as from expert experience will be used to study this area. Questions will address potential trial design issues (e.g. need for cluster randomisation), specification of the SDD intervention and of control group care; outcome measurement; recruitment; ethical considerations and other issues raised in the observational and Delphi studies. Data will be transcribed and analysed using content analysis . A full This research will lead to an evidence-based decision about whether to proceed to a clinical trial to evaluate an SDD intervention or an implementation trial . The applicant team/project steering group will make an assessment of whether a trial is necessary, justifiable, acceptable and feasible based on possible patterns of results from the national surveys, for example:1. If intention to implement SDD is low or variable, and predicted by attitude scores and/or scores for specific beliefs about the consequences (benefits and harms) of implementing SDD, it will be judged appropriate to proceed to trial.2. If intention to implement SDD is low or variable and predicted by scores relating to social influence (e.g. pressure from colleagues in other disciplines), this would suggest that an implementation intervention could be effective if delivered by an identified opinion leader, clinical lead or local 'champion' through team meetings. We would proceed to an implementation trial to evaluate such an intervention.3. If intention to implement SDD is low or variable and predicted by beliefs relating to lack of capacity to implement SDD (e.g. resource issues), this would suggest that an implementation intervention could be effective if it focuses on barrier identification and generation of strategies to overcome barriers, known as 'coping planning' , we woul4. If intention to implement SDD is low or variable and predicted (in the multi-level model) at the Unit level, rather than by individual clinicians' views of the evidence, we would design an intervention directed at ICUs rather than individual clinicians. This would be informed by the behavioural analysis of SDD implementation in ICUs where it is currently practised. We would proceed to an implementation trial to evaluate such an intervention.5. By contrast, if intention to implement SDD is high , then the current low level of implementation will be attributable to an 'intention-behaviour gap', suggesting that external barriers prevent clinicians from translating their intentions into action. This pattern of results would suggest that an implementation trial to test strategies for facilitating uptake would be appropriate.Findings about acceptability and feasibility of a clinical trial would also inform the decision about how best to proceed. Specifically:1. If willingness (intention) to participate in a trial is low we will not proceed to a clinical trial.2. If willingness (intention) to participate in a trial is high this will indicate that the trial is sufficiently acceptable to proceed. We will also take into account scores for perceived ease or difficulty of participating.We will also use the consensus data from the Delphi study and the investigation of two ICUs where SDD has been implemented, to decide: (i) behavioural  issues that would need to be addressed in order to mount a trial; (ii) ethical issues relating to informed acceptance of trial entry among eligible patients; (iii) trial design issues including measurement of outcome and process variables. If any one stakeholder group seems to be uniformly of the opinion that there are no design features that would make a trial acceptable, and/or if a third (or more) of the members of two (or more) groups deem any such trial unacceptable, the clinical trial should not be pursued further. Depending on the views expressed about the existing evidence base  we will consider the place of an implementation trial to change clinical practice. If appropriate, the change techniques that would form the components of such a trial will be selected using methods previously reported by members of the research team ,28. The The issue of hospital acquired infections in critically ill patients is a significant issue causing excess morbidity and mortality as well as an excess health care delivery costs. The intervention SDD has the promise to improve these outcomes and is not widely used. This rigorous multi-national study intends to identify the perceived risks, benefits and barriers to the use of SDD in critical care units. This research could lead to a variety of further interventions including a multi-centre effectiveness RCT or implementation study.The authors declare that they have no competing interests.BHC has participated fully in the design of this study and in the writing this paper and has seen and approved the final version of the paper. JF has participated fully in the design of this study and in the writing this paper and has seen and approved the final version of the paper.MKC has participated fully in the design of this study and in the writing this paper and has seen and approved the final version of the paper. LM has participated fully in the design of this study and in the writing this paper and has seen and approved the final version of the paper. IS has participated fully in the design of this study and in the writing this paper and has seen and approved the final version of the paper. JG has participated fully in the design of this study and in the writing this paper and has seen and approved the final version of the paper.BHC is the chief of the Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto and Professor of Anaesthesia at the University of Toronto. JF is an academic Health Psychologist at the University of Aberdeen, Aberdeen, UK. MKC is a clinical trialist and Director of the Health Services Research Unit at the University of Aberdeen, Aberdeen, UK. Lauralyn MacIntyre is a critical care specialist and associate scientist in clinical epidemiology at the Ottawa Health Research Institute, Ottawa, Canada. IS is a Staff Specialist in intensive care at the Nepean Hospital, Penrith, New South Wales, Australia. JMG is a Professor in the Department of Clinical Epidemiology at the Ottawa Health Research Institute, Ottawa, Canada.The SuDDICU groups include-SuDDICU UK study group - Jill Francis, International methods lead, Reader in Health Psychology, Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland, UK; Geoff Bellingan, UK clinical lead, Director, Intensive Care Unit, University College Hospital, London, UK; Marion Campbell, Director, Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland, UK; Brian Cuthbertson, Canadian and International lead, Chief, Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Martin Eccles, Professor of Clinical Effectiveness, University of Newcastle, Newcastle, UK; Marie Johnston, Professor of Health Psychology, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK; Graeme MacLennan, Senior Statistician, Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland, UK; Craig Ramsay, Director, Health Care Assessment Programme, Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland, UK; Louise Rose, Assistant Professor of Nursing, University of Toronto, Toronto, Ontario, Canada; Kathy Rowan, Director and Professor, Intensive Care National Audit and Research Committee, London, UK; Rob Shulman, ICU Pharmacist, University College Hospital, London, UK.SuDDICU Canadian study group - Brian Cuthbertson, Canadian and International lead, Chief, Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Jill Francis, International methods lead, Reader in Health Psychology, Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland, UK; Karen Burns, Clinician Scientist and Attending Physician, St Michaels Hospital, Toronto, Ontario, Canada; Deborah Cook, Canada Research Chair in Critical Care, McMaster University, Hamilton, Ontario, Canada; Peter Dodeck, Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada; Niall Ferguson, Assistant Professor and Attending Physician, University Health Network, Toronto, Ontario, Canada; Richard Hall, Professor of Anesthesiology and Pharmacology Associate Professor of Surgery Dalhousie University and The Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada; Lynn Johnston, Professor of Medicine, Chief of Infectious Diseases, Dalhousie University, Halifax, Nova Scotia, Canada; Salmann Kanji, ICU pharmacist, Critical Care Unit, The Ottawa Hospital, Ottawa, Ontario, Canada; John Marshall, Professor of Surgery, University of Toronto and Attending Surgeon, St Michaels Hospital, Toronto, Ontario, Canada; Lauralyn McIntyre, Clinical Epidemiology, Ottawa Health Research Institute, Ottawa, Canada; John Muscedere, Associate Professor of Medicine, Queen's University, Intensivist Kingston General Hospital, Kingston, Ontario, Canada; Joe Pagliarello, University of Ottawa, Ottawa, Ontario, Canada; Louise Rose, Assistant Professor of Nursing, University of Toronto, Toronto, Ontario, Canada; Fiona Webster, Knowledge Translation Scientist, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Merrick Zwarenstein, Director Centre for Health Services Science, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.SuDDICU Australia and New Zealand Study Group - Ian Seppelt, Australia/New Zealand lead, Nepean Hospital, Penrith, New South Wales, Australia; Simon Finfer, Professor of Intensive Care and Staff Specialist, Royal North Shore Hospital and the George Institute, Sydney, Australia; Jeff Lipman, Professor and Head ICU, Royal Brisbane and Women's Hospital, Brisbane, Australia; John Myburgh, Professor, Intensive Care Unit, St George Hospital Sydney and the George Institute, Sydney, Australia; David Paterson, Professor Infectious Diseases and Microbiology, Royal Brisbane and Women's Hospital, Brisbane, Australia; Brian Cuthbertson, Canadian and International lead, Chief, Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Jill Francis, International methods lead, Reader in Health Psychology, Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland, UK;"}
{"text": "It is mandatory for sponsors of clinical trials and contract research organizations alike to establish, manage and monitor their quality control and quality assurance systems and their integral standard operating procedures and other quality documents to provide high-quality products and services to fully satisfy customer needs and expectations. Quality control and quality assurance systems together constitute the key quality systems. Quality control and quality assurance are parts of quality management. Quality control is focused on fulfilling quality requirements, whereas quality assurance is focused on providing confidence that quality requirements are fulfilled. The quality systems must be commensurate with the Company business objectives and business model. Top management commitment and its active involvement are critical in order to ensure at all times the adequacy, suitability, effectiveness and efficiency of the quality systems. Effective and efficient quality systems can promote timely registration of drugs by eliminating waste and the need for rework with overall financial and social benefits to the Company. High levels of quality are essential to achieve Company business objectives. Quality, a source of competitive advantage, should remain a hallmark of Company products and services. High quality is not an added value; it is an essential basic requirement. Quality does not only relate solely to the end products and services a Company provides but also relates to the way the Company employees do their job and the work processes they follow to produce products or services. The work processes should be as efficient as possible and continually improving. Company employees constitute the most important resource for improving quality. Each employee in all organizational units is responsible for ensuring that their work processes are efficient and continually improving.Top management should provide the training and an appropriate motivating environment to foster teamwork both within and across organizational units for employees to improve processes.Ultimately, everyone in a Company is responsible for the quality of its products and services.A Company in the role of a sponsor of clinical trials can best achieve its business objectives by establishing and managing robust quality systems with their integral quality documents including standard operating procedures (SOPs).A quality system is defined as the organizational structure, responsibilities, processes, procedures and resources for implementing quality management. Quality management includes those aspects of the overall management function that determine and implement the Company quality policy and quality objectives. Both quality control and quality assurance are parts of quality management.th principle in the International Conference on Harmonization Good Clinical Practice (ICH GCP) guideline clearly states that systems and procedures that assure the quality of every aspect of the  trial should be implemented. The sponsor is responsible for implementing and maintaining quality assurance and quality control systems with written SOPs to ensure that trials are conducted and data are generated, documented (recorded) and reported in compliance with the protocol, Good Clinical Practice (GCP) and the applicable regulatory requirements. Although a sponsor may transfer any or all of its trial-related duties and functions to a contract research organization (CRO), the ultimate responsibility for the quality and integrity of the trial data always resides with the sponsor., and local, national, regional and international legal, ethical and regulatory requirements.The quality assurance department under the leadership of a Quality Assurance Manager will ensure the following:Appropriate global and affiliate-specific quality documents  are determined, developed and implemented.Personnel involved in clinical research and development are, and remain, properly qualified and trained for job roles for which they are made responsible. The training will include new staff induction, ongoing quality awareness training including training in applicable SOPs and other quality documents, training for changing roles within and between functional units, and training resulting from an analysis of needs including the results of audits and regulatory inspections, top management reviews and employee appraisals. Further education and additional training needs should be constantly assessed by the Company.All clinical research and development activities are conducted according to Company quality standards, current GxPs, and all applicable local, national, regional and international legal, ethical and regulatory requirements as defined in the quality documents, to meet with Company quality objectives and customer requirements.A system is put in place to track all global and affiliate-specific quality documents and to maintain an up-to-date overall inventory of all historical and effective quality documents.Personnel will have written job descriptions which will clearly define their roles and responsibilities, and the processes and SOPs which they have to follow.A system is put in place to initiate and maintain a personal file on each employee, containing his/her current curriculum vitae, job description, education and training records and personal and professional development plan.An auditing function, independent of the operational units and the quality control system, is created to plan, conduct, and report internal and external audits and to support and monitor their close-out via appropriate corrective actions and preventive actions (CAPA) plan.4 The effA system is put in place to oversee customer audits, regulatory inspections and Company certifications/accreditations as applicable.A system is put in place to a) share audit and regulatory inspection findings and learning with the relevant functional units and top management, b) promote auditing-in-tandem, and cross-pollination of auditors, c) track all internal and external audits, customer audits and regulatory inspections, and d) track status of findings  made during audits and regulatory inspections.Liaison is maintained with functional units, affiliates, and human resources for continued personal and professional development (basic and advanced knowledge-based and skill-based training and retraining) of employees worldwide.Liaison is maintained with and between functional units and affiliates to promote standardization, improve communication, and to enhance efficiency of quality systems through cooperation.All functional units and affiliates are kept up-to-date with various established and emerging local, national, regional and international legal, ethical and regulatory standards.Continual quality improvement initiatives  are identified, implemented and monitored via the Plan\u2013Do\u2013Check\u2013Act (P\u2013D\u2013C\u2013A) cycle.6Persons responsible for the quality assurance system are available in an advisory role to employees worldwide on matters related to the quality systems, regulations in force including GxPs and regulatory compliance.Standardization is defined as an activity that gives rise to solutions for repetitive application to problems in various disciplines including science and it is aimed at achieving the optimum degree of order in a given context. Generally, the activity consists of the process of establishing  and implementing standards. Therefore, standards are the ultimate result of a standardization activity and within the context of quality systems consist of quality documents or documents related to the quality systems.The quality documents consist of Company policies, quality management plan, SOPs, working instructions, conventions, guidelines, forms, templates, logs, tags and labels. They are established by consensus and approved by a nominated body and they provide for common and repeated use, rules, guidelines or characteristics for activities or their results with a view to promote transparency, consistency, reproducibility, interchangeability and to facilitate communication. The hierarchy and types of quality documents relevant to quality systems will depend upon Company business objectives and business model. SOPs are Level 2 quality documents and, along with other relevant quality documents, ensure the effectiveness and efficiency of quality systems.The ICH GCP guideline defines SOPs as \u201cdetailed, written instructions to achieve uniformity of the performance of a specific function\u201d. Simply pFor an activity to become the topic of an SOP, it must be either subject to regulations or it must address a task important within quality systems or between quality systems and other functional units. Quality systems related SOPs should generally cover the following topics in order to capture the core quality control and quality assurance activities and processes:Definition, format, content, compilation, indexing, review, approval, update, distribution and archiving of quality documents;Definition, format, content, review, approval, update, distribution and archiving of quality management plan;Definition of and activities related to quality control of clinical trials and compilation of trial-specific quality control plan;Initiation and maintenance of personnel files including format and content of curriculum vitae, job description, training records and personal and professional development plan;Top management reviews of quality systems and issuance of management review reports;Selection and management of contract auditors;Format, content, compilation, review, approval, update, distribution and archiving of audit program;Format, content, compilation, review, approval, update, distribution and archiving of audit plan;Planning, conduct, reporting and close-out of risk-based internal and external audits;Planning, conduct, reporting and close-out of specific audits of sites, processes, systems and documents: sponsor site, third party  site, investigator site, quality management system including SOP management, education and training and auditing, document management system including archives, data management system including information technology support, serious adverse events management system, pharmacovigilance system, medical dictionary management system, and regulatory submission documents ;Planning, conduct, reporting and close-out of for cause/directed audits;Hosting of customer audits;Preparation of sites for regulatory inspections;Coordination and management of regulatory inspections;Format, content, compilation, review, approval, update, distribution and archiving of CAPA plan, and assessment of its effectiveness;Change control to ensure that changes and the current status of quality systems related components including documents are identified; andRoles and responsibilities of quality assurance in handling of scientific misconduct/fraud.The importance of properly established and managed quality control and quality assurance systems with their integral well-written SOPs and other quality documents for the achievement of Company business objectives cannot be ignored. They serve as a passport to success by assisting the Company to achieve high-quality processes, procedures, systems, and people, with eventual high-quality products and services and enhancement of the following:Customer satisfaction, and therefore, customer loyalty and repeat business and referral;Timely registration of drugs by eliminating waste and the need for rework;Operational results such as revenue, profitability, market share and export opportunities;Alignment of processes with achievement of better results;Understanding and motivation of employees toward the Company quality policy and business objectives, as well as participation in continual quality improvement initiatives; andConfidence of interested parties in the effectiveness and efficiency of the Company as demonstrated by the financial and social gains from Company performance and reputation."}
{"text": "Originals were translated into popular reproductions on matchboxes, postcards, calendars, and home designs, all illustrated with a richness reminiscent of the Byzantine icons he loved and collected. Accessible and dynamic, they became part of the vernacular, their figures harmoniously integrated with the surroundings in complex linear compositions. Curves, spirals, and intricate ornamentation spilled over into architectural and folk designs and dominated graphic art.\"We can't allow a split\u2026 ranking one art above the others,\" wrote artist Henry van de Velde in 1895, articulating a doctrine of art nouveau: art should affect the lives of all people, should enter their homes and influence their furnishings, uniting beauty and utility  to glassware (Louis Comfort Tiffany in New York).For Mucha the astonishing success of his popular designs was only a prelude to what he considered his best work, The Slav Epic, a monumental painting inspired by his devotion to the Czech people. He died of pneumonia before the work was finished. Reaction to the painting was mixed, and his fame, particularly among his compatriots, diminished, to be revived again during the 1960s and remain strong to this day.Zodiac, on this month's cover, shows why Mucha's work was instantly popular. The image exudes comfortable familiarity even as it invites contemplation. The human figure and its surroundings, harmonious and integrated, are evocative of nature. Floral and celestial elements are arranged symmetrically around a portrait, the focus of the intricate composition. Gaze and posture show directness, innate confidence, a sense of self. Filled with energy and movement, she is the dominant star in the celestial sphere. And \"flowering\" into the complex botanical frame, she captivates with poise and modesty. An exotic gypsy queen, she holds the mysteries of the zodiac, the flow of time, the riddles of nature, the fortunes of the world, deriving her power and magnetism from the symbols surrounding her, in perfect harmony and balance with the content of the universe.A common motif in Mucha's work, the zodiac alludes to the birth of life and tries to identify and define it, predict its course, and control its outcome. Derived from the artist's faith in the spiritual aspect of art and the power of tradition as source of inspiration, it does what art nouveau sought to do, elevate folk elements to fine art accessible to everyone.The desire near the end of the 19th century to beautify and advance the world culturally as it was advancing and evolving scientifically is understandable. Social purpose in art, which graces the mundane for the common people, is no different from social purpose in medicine, which improves and extends their lives. Public service for the greater good is like fine art for the masses. Mucha's Zodiac seems a fitting astrologic birthday card, as the Centers for Disease Control and Prevention celebrates 60 years of identifying, describing, explaining, and preventing unknown elements for the benefit of humanity."}
{"text": "Investment in nanotechnology is now a given constant by governments, research centers and companies in both more developed countries and emerging markets. Due to their characteristics, such as high stability, ability to enable antigen identification on specific cells in the human body and controlling the release of drugs and, therefore, improving therapies, nanoparticles have been the subject of research and patent applications in the pharmaceutical field. According to the Organization for Economic Co-operation and Development (OCDE), patent data can be used as a source of information in order to measure science and technology activities. Thereby, this paper presents an analysis based on patent documents related to nanotechnology in the pharmaceutical sector. As a result, the analysis of patents demonstrate primarily that nanobiotechnology attracts high levels of R&D investments, including nanoparticle-based chemotherapeutic agents/drugs, monoclonal antibody nanoparticle complexes and their role in drug delivery or contrast agents with non-toxic effects. The global nanotechnology industry was valuing $300 billion (bn) in 2011 and is expected to be worth $1.6 trillion at the end of 2013 and $35,000 bn by 2041. Nanotechnology\u2019s fastest growing sector\u2014nanobiotechnology\u2014is poised for a rapid growth, especially in the field of targeted drug delivery therapies in the oncology sector. The nanobiotechnology market will reach $6 bn by 2017 [There is a myriad of new opportunities in terms of advances in medical science and the treatment of diseases affecting humans. Applications of nanotechnology in medicine and physiology are represented by material and equipment designed to interact with the body on a sub-cellular (or molecular) scale, with a high level of specificity . In moreIt has become increasingly necessary to understand the effects and level of application of biological systems together with nanostructures in the development of research linked with the areas of medicine and health.The applications of nanobiotechnology allow the creation of material and equipment at the same level as the live organisms, bacteria and even plants. The ability to work on this scale not only provides more control of the biological world, but also leads to empowerment from the use of extraordinary inventions that nature itself has produced after thousands of millions of years of evolution .Not only biomedicines and conventional drugs, such as those used for chemotherapy, but also short strands of interference RNA (gene silencers) are frequently incorporated in vehicles, such as polymers or lipidoid molecules, for the purpose of directing a preferential trajectory in the human organism .The utilization of nanoparticles allows the liberation of a therapeutic agent in a pre-defined location in the organism, the treatment of a huge number of diseases, including diabetes, Alzheimer\u2019s disease, several inflammatory infections, such as arthritis and rheumatism and asthma, as well as cancer.A plethora of other potential benefits of nanobiotechnology in the area of health can be cited, including:\u2713The new techniques involving molecular images, which allow us to understand the physiological processes of the human body on the nanoscale, thus leading to the development of methods to diagnose and treat diseases more accurately and sensitively. One example in particular is superparamagnetic nanoparticles using proteins for the molecular imaging of cancer;\u2713ex vivo tests;The new qualitative tools of analysis that will allow for a better understanding of the working of cells at a molecular level and, particularly, the cells related to diseases. The union of proteomic and metabolomic genes into nanobiotechnology will allow for the development of more efficient and specific medicines for each type of disease. Another benefit will be the development of more sensitive and specific \u2713Nanosensors and nanorobots, which when introduced into the body orally or intravenously, can identify and destroy cancerous cells or those infected by a virus, as well as regenerate damaged issue. These nanorobots can also be used to monitor vital functions  in patients that require constant medical care.The use of bibliometric indicators can be an efficient method to analyze research activities. Patent documents are the most important source of technological information, as they contain 71% of all the technology developed around the world, as well as the advantage of being globally standardized. Statistics on patents have been used as indicators of the results of invention-related activities . This paThe aim of this paper is to analyze the main trends of patenting related to nanotechnology applied to the pharmaceutical sector.For the recovery of patent documents, the database selected was the Derwent Innovations Index (DII), with the coverage of more than 11 million patent documents filed, published\u2014and eventually granted\u2014from 1963, in more than 40 countries. This database contains patent applications in the areas of chemistry, electricity and electronics and engineering, and its main advantage is the fact that all the patent documents in it are indexed, and their summaries were drawn up by specialists in the area. As such, the summaries are full of keywords and available in English, together with their titles, independent to the country the patent application was filed in and published, which facilitates the recovery of the documents using defined search strategies.The main reasons for the choice of this patent database were:\u2713\u00ae[The possibility of exporting the patent documents recovered in the search, in their entirety, using software designed to work with this type of information, such as, for example, the commercial software, Vantage Point\u00ae, used in\u2713The availability of Manual Codes, a classification attributed in the database to all the patent documents indexed in it. This classification also has a hierarchical structure, such as the International Classification of Patents (IPC) , althougFor the search of patent documents related to nanotechnology applied to the pharmaceutical sector, the classifications in the Manual Codes were selected as listed below , which aRemoving the patent documents that were in more than one of the nine series in For the purposes of restricting the series of patent documents obtained, focusing on the special issue \u201cBioactive Nanoparticle 2012\u201d in the section \u201cBiochemistry, Molecular Biology and Biophysics\u201d of this journal, searches were made in the \u201cabstract\u201d field of the documents, using the keywords listed in The keywords used define different areas of nanobiotechnology, and some are significantly intersected. Of the 17 documents related to the toxicity of nanomaterials, 11 are also contained in the area of nanoparticle toxicity, and the others have a similar focus on this group. In addition, in the areas of nanoparticle cell interaction and nanoparticle protein interactions, the documents of the top-ranked entities filing patent applications are also largely included in the area of nanoparticles used for drug delivery.Given this, the main focal points and the analysis of the main patent applications filed fall into the following four areas:\u2713Toxicity of nanoparticle;\u2713Nano-imaging agent;\u2713Nanoparticle for drug delivery;\u2713Cancer-targeting nanoparticle.The analysis was based on the top applicants of patents in the four focal points cited above. Based on The trends of the main applicants for each area in A total of 347 patent applications were filed under this subject around the world in the last ten years and involved 268 different applicants, either in partnerships or not, of which 216 have single applications. This means only one patent application per applicant.The leader in patent applications filed in this field is General Electric, with 10 patents, followed by the Massachusetts Institute of Technology (MIT), with eight patents. Four other entities filed seven patents each: the Irish company; Abraxis Bioscience LLC (a Celgene Corporation subsidiary), the French Institute, Centre National de La Recherche Scientifique (CNRS), the Irish Elan Pharma International, Ltd and the University of California, in the United States. Only the patent applications filed by the main institutions were considered in this analysis.As cited, General Electric (GE) is the company holding the most patent documents under the subject of toxicity and nanoparticles. There are no partnerships in the documents analyzed, and the focus of the use of nanoparticles is related to compositions. The composition for a magnetic resonance imaging contrast agent useful for obtaining a magnetic resonance image (MRI) of a tissue or organ of an animal or human that minimizes toxicity or other discomfort to patients is the main issue in US2006018835 . Along tIn second place under this topic is MIT, with eight patents, of which two were filed in partnerships. The patent application filed in partnership with Brigham & Women\u2019s Hospital Inc. relates to the new composition comprising a nanoparticle and a biocompatible polymer. The composition is useful in delivering drugs for treating pathologic conditions, e.g., cancer. The composition reduces the amount of a drug present in tissues of the body that are not targeted . The parThe seven patent applications identified and attributable to Abraxis Bioscience are mainly based on administering compositions comprising nanoparticles , useful for treating pulmonary hypertension, lung cancer, esophagus cancer and that reduce side effects and are non-toxic \u201323.The Irish company, Elan Pharma, which focuses on the area of biotechnology, has seven patent applications filed under the same topic, with only one in partnership with Alkermes Pharma Ireland Ltd. The patents filed by this company concern, for example, nanoparticulate composition comprising a drug that exhibits chemical stability under environmental conditions, such as prolonged storage periods, and does not require the addition of potentially toxic solvents . AnotherBeing a research institute, the Centre National de La Recherche Scientifique (CNRS) has partners in six of the seven patent documents selected. Most of these partners are universities or other research centers, such as Universit\u00e9 Paris Sud, Lyon University, the University of Versailles Saint Quentin En Yveline, University Fourier Joseph, the University of Strasbourg, the Macromolecular Chemical ASCR Institute, Montpellier University, Rennes University and Institute National Sante & Recherche Medicale. Only one company was identified as a CNRS partner, Ethypharm SA. The patent documents filed by CNRS with its partners, Universit\u00e9 Paris Sud and Ethypharm, are related to, for example, biodegradable polymeric nanoparticle composite useful for the manufacturing of a drug used to treat cancer, bacterial or viral systemic infections and the encapsulation and vectorization of molecules having a therapeutic effect. The polymer exhibits less instability and toxicity on non-cancerous cells .The patent documents filed by the University of California in this area did not include any partners and are related to determining the toxic potential of nanomaterials (NMs) and comprises providing a culture of cells, adding a quantity of NMs and performing assays for oxidative stress on the cells. The invention provides test procedures to ensure the safe manufacturing and use of NMs . AnotherConcerning the patent documents related to the application of nanotechnology in the sector of agents of molecular imagery, 327 patent applications were filed between 2002 and 2012. Of particular note in this universe is the total of 241 patent applications made, either in partnership or not, of which 178 were made by a single entity, and that four entities filed more than five patent applications.The leader in this field is General Electric, with 20 patents, followed by the University of California, with nine patents, Konink Philips Electronics, with eight, and the University of Texas System, with six.in vivo magnetic resonance imaging measurements and comprises carbon-13-enriched fullerene or carbon nanotube molecules [General Electric (GE) is the company with the most patent documents filed in the field of nanotechnology related to image agents. Of the 20 documents analyzed, only two were made with partners, one with Oxford University (USA) and another with the company, Hammersmith Imanet Ltd. In the patent documents filed by GE alone, the technological focus is mainly related to contrast agents used in magnetic resonance, as in patent application, US2005260137, related to a contrast agent useful for magnetic resonance imaging that comprises several nanoparticles and provides enhanced relaxation, high signal-to-noise ratios and targeting abilities . The conolecules . Patent olecules .in vivo imaging and therapy that detects diseased cells by MRI, PET or deep tissue near-infrared (NIR) imaging. Patent application, WO2010096828, is related to a layered nanoparticle comprising a biocompatible layer useful for manufacturing multi-model imaging reagent for imaging living tissue and for treating cancer [The University of California, second in the ranking in this field, filed nine patent applications, all in partnerships. The abstract supporting patent application, US2006003464, presents a nano-crystal that emits light when energized and an affinity molecule linked to the semiconductor useful for determining the presence of detectable substance in a biological material and for imaging the same sample by both light and electron microscopy . AnotherKonink Phillips Electronics filed eight patents in the area of nanotechnology associated with image agents, and only one was made in partnership with FEI Corp. As examples, we can cite WO2005070473, which refers to a contrast agent, useful for manufacturing an ultrasound contrast agent comprised of solid metal nanoparticles having an acoustic impedance useful in diagnosing ultrasound contrast imaging and imaging an isolated tissue sample or organ; and patent application, WO2006054240, is related to a contrast agent for medical diagnostic and imaging, comprising metal nanoparticles encapsulated in and/or attached to non-proteinaceous biocompatible or biodegradable matrix particles ,36.in vitro diagnosing of cancer in a subject [The University of Texas System filed six patents, with partners in only two, one with the University of Rice William Marsh and the other with the University of Ohio States. Their focus on nanotechnology is mainly linked to imaging agents. For example, patent application, US2008124281, relates to a magnetic resonance imaging contrast agent for molecular imaging applications in cancer . The MRI subject .A total of 294 patents were filed in this field by 224 institutions, of which 166 were single entities. Of this last group, approximately 60% were made by universities and/or research centers, suggesting that although still an emerging technology, significant advances have been made over the past few years, with applications in several different areas and that already account for some of the applied research and innovations in the biomedical area. Most of these patents were filed by American institutions, with around 80 of the applications. This data can be corroborated when looking at the timing of the patent filings, excluding those still not published, due to the statutory 12-month grace period for a public disclosure.The National University of Tsing Hua, in Taiwan, was the leader in terms of patent applications in this field; with 12 filings, of which 11 were made in partnership with GP Medical Inc. Nine of these patent applications involved a composition of nanoparticles, which uses a shell of chitosan, a non-toxic and soft-tissue compatible molecule that enhances diffusion across mucosal epithelia, loaded with the drug to be administered. It is known that hydrophilic medicines, such as peptides and proteins, do not diffuse easily to the blood flow through the intestinal epithelium, and the acid environment in the stomach can degrade these medicines when administered orally, which emphasizes the therapeutic relevance of these new pharmaceutical compositions .In second place was the University of California, with seven patent applications. Patent application, WO2008066965, highlights a manufacturing product that provides biocompatible nanostructures with an increased surface area for enhanced cell and bone growth used in a drug delivery orthopedic device or dental implant, while WO2011143201 presents a new multi-drug conjugate with the main advantage that it controls the molar ratio among multiple drugs and their concentration taken up by the same target cell, optimizing combination therapy regimes ,41.The Massachusetts Institute of Technology is next, with a total of six applications, of which two were made in partnership with Brigham & Women\u2019s Hospital Inc. and one with the Children\u2019s Hospital in Boston. Of note among these, WO2008011561, is an application protection for new end-modified poly (beta-amino esters) polymers useful for delivering polynucleotides, contrast agents, RNAi and siRNA for delivering nucleic acids in gene therapy, which have the great advantage that the polymers exhibit improved chemical properties, such as degradation time and ionizability . AnotherA total of 245 patent documents were retrieved in this category. Most of the applications were based on a pharmaceutical composition containing nanoparticles for treatment, not for a specific type of tumor, but several types, including prostate, breast, ovarian, lung, colon, bladder, lymph and melanoma.The main patent filer is the Massachusetts Institute of Technology, with a total of 11, of which six were made in partnership with Brigham & Women\u2019s Hospital, one with Bind Biosciences Inc., another with Cornell University, one with Northwestern University and, finally, one with the Children\u2019s Hospital in Boston.In general terms, the patent applications are for new methods and compositions for delivering drugs for cancer or for treating cancer. Patent application, WO2008124639, for example, relates to a controlled-release system comprising target-specific stealth nanoparticles useful for target-specific treatment of a disease and the delivery of a therapeutic agent . It is wThe possible uses cited in the abstracts include not only the treatment of tumors, but also various other diseases. The already cited application, WO2008124639, includes the treatment of atherosclerosis and restenosis, for example . On the in vivo imaging and therapy that detects diseased cells with greater sensitivity than is possible with existing technologies and targets molecules that localize normal or diseased cells initiating the apoptosis of diseased cells [The University of California is in second place in this field, with a total of nine patents. Approximately 90% of patent applications are related to the treatment of several types of tumors, using some extremely original ideas. US patent, 2006019900, illustrates the utilization of a protein in cellular adhesion, alpha-4-beta-1 integrin, for treating cancer and an inflammatory or autoimmune disease. The big advantage is that the ligand displays high binding affinity, specificity and stability and is more resistant to cleavage or degradation from proteases found in plasma, gastrointestinal tract and tumor cells . The apped cells .To illustrate the existing partnerships between entities, we drew up the following chart  for the As can be seen in In the toxicity and nanoparticles area, the partners of MIT are Brigham & Women\u2019s Hospital Inc. and the University of Northwestern. In nano-imaging agents, the patents were filed by MIT with General Hospital Corporation, University of Cornell and Brigham & Women\u2019s Hospital Inc. In nanoparticles for drug delivery, MIT has patents with Brigham & Women\u2019s Hospital Inc. and Children Hospital Boston, and in cancer-targeting nanoparticles, the partners of MIT are the University of Northwestern, the University of Cornell, Children Hospital Boston, Harvard College, the Immune Disease Institute and Brigham & Women\u2019s Hospital Inc. Furthermore, Brigham & Women\u2019s Hospital Inc. has partnerships with the Immune Disease Institute and Harvard College in this area. It is remarkable that the partnership between Harvard College and the Immune Disease Institute is the strongest one, as can be seen by the intensity of the line connecting the two institutions in The rising development of nanotechnology in the area of biomedicine can be attributed to the technological advantages, including better distribution profiles of medicines in the organism and directing them to specific organs, which reduces the necessary doses and, consequently, the toxicity and adverse effects. In addition, the possibility of the controlled release of therapeutic agents makes therapy far more efficient and convenient for users, with better patient adhesion to the treatment, particularly those with chronic diseases that require continued administration and repeated doses of medicines.Also, the toxicity of the nanoparticles and nanomaterial in general is a question that has had an impact in terms of the development of innovations, mainly due to the scarcity of information related to the potential risks to human and environmental health. However, an analysis of the patents that combine toxicity with nanotechnology appears to justify the use of nanoparticles, generally encapsulated as drug delivery or contrast agents, with a non-toxic effect.One of the main challenges faced in the development and use of medicines for cancer is to ensure that they are concentrated primarily in the affected organs, at selected levels of toxicity in cancerous cells, thus preserving the healthy ones. Due to their reduced size, nanoparticles tend to accumulate in tumors, with less effect on other parts of the organism, which increases the therapeutic efficacy and reduces the main adverse effects caused by chemotherapy, such as vomiting, diarrhea and hair loss.Dynamic, proactive and socially responsible research will drive nanomedicine as it plays an increasingly integral and transformative role in medicine and public health in the 21st century."}
{"text": "There are post-mortem investigations of serious scoliosis with a LILF of the DM. In early research, it was considered to be a secondary phenomenon, as a consequence of the vertebra\u2019s edges pressure in the vertebral channel, towards the dura mater..First, to prove that the LILF of the DM is not the secondary phenomenon. On the contrary, the LILF of the DM, like a hooked bowstring, causes a serious idiopathic scoliosis. Second, to create an MRI test, so any competent scoliosis expert, could see an initial LILF of the DM, and predict early a dangerous development of scoliosis.We used the Cheneau - Abbott type braces with the non-magnetic parts, and the side position of patient for MRI-test. We investigated the form, and the locations, of the spinal cord in the corrected position of the scoliosis spine.We find that the starting scoliosis has LILF of DM in several cases. These are serious scoliosis in future.The MRI test, for a LILF of the DM, can help to make a forecast of the future development of scoliosis. We can make the early scoliosis treatment easy, by separation of the LILF of the DM, like Edville Gerhardt Abbott (1913), by overcorrection brace, or maybe by micro invasive surgical releasing in the future."}
{"text": "The meaningful consideration of cultural practices, values and beliefs is a necessary component in the effective translation of advancements in neuroscience to clinical practice and public discourse. Society\u2019s immense investment in biomedical science and technology, in conjunction with an increasingly diverse socio-cultural landscape, necessitates the study of how potential discoveries in neurodegenerative diseases such as Alzheimer disease are perceived and utilized across cultures. Building on the work of neuroscientists, ethicists and philosophers, we argue that the growing field of neuroethics provides a pragmatic and constructive pathway to guide advancements in neuroscience in a manner that is culturally nuanced and relevant. Here we review a case study of one issue in culturally oriented neuroscience research where it is evident that traditional research ethics must be broadened and the values and needs of diverse populations considered for meaningful and relevant research practices. A global approach to neuroethics has the potential to furnish critical engagement with cultural considerations of advancements in neuroscience. In an interdisciplinary effort bridging the clinical neurosciences, ethics, and geriatric services, we are engaged in community-based research with a First Nation population in Canada, in which a large family carries a presenilin-1 (PS1) gene mutation leading to early onset familial Alzheimer Disease (EOFAD). Our primary research goals are to explore the intersections of Western knowledge, traditional teachings, and culturally specific understandings about EOFAD. Through the evolution of this work, we have been faced with and have addressed unexpected internal and external challenges related to community-wide confidentiality. The internal challenges involve the Nation\u2019s competing interests to guard against the possibility of stigma that may be associated with a predisposition to an incurable neurodegenerative disease, while also championing the benefits of research participation in a manner that fosters autonomy and self-determination. The external challenges involve achieving comprehensive outreach to individuals at rural and dispersed regions of the country, varying biological and cultural definitions of family, and the interconnectedness of family, community, and Nation. Both the internal and external challenges are of scholarly and procedural importance to the research team and Nation, and of personal significance to the community members.There are ample existing research principles and guidelines that underscore the importance of protecting Indigenous communities; however, their scope is limited and they do not fully address the practical and conceptual challenges of community confidentiality when engaged in community-based research with a First Nation population. The unique and precarious circumstances described here highlight the importance of continuously revisiting issues in confidentiality, community-engaged discovery in the protection of Indigenous peoples in research, and the importance of seeking solutions that are mutually beneficial and supportive. Further, these challenges highlight the requirements for a global approach to neuroethics, which must strive to broaden traditional Western research ethics and grapple with these complex considerations of culture in neuroscience research.The intersections of neuroscience, neurotechnology, and society raise challenging ethical questions about how related developments may be perceived and utilized across cultures. The field of neuroethics addresses the ethical and legal issues of these innovations and their wide-ranging implications in the public sphere . WhetherThrough the advancement of a community-based research study about the experiences of a First Nations population with EOFAD, challenges of confidentiality have elucidated the need to broaden traditional Western understandings of research ethics and the integral role that neuroethics has in addressing these complex issues. While the case-study provided here offers only a limited scope of the ethical challenges in culturally relevant research, it will allow for further investigation into the complex interactions between research in neuroscience and the diverse populations affected by this research.a populations that deals with confidentiality at the level of the community presents an array of unique challenges warranting additional attention. Confidentiality in health research has traditionally focused on the individual, with the patient/research participant at the center of ethical and privacy concerns  their physical, social, economic and cultural environments, where applicable, as well as concern for the community to which participants belong\u201d  variables and differences are manifest, and \u2026 adopt a more dialectical approach\u201d . Thus, aWeijer, Gold and Emanuel write, \u201cCodifying protections for communities in research is a dialectical process that will require addressing these issues by proposing and refining potential safeguards based on conceptual reflection and practical experience\u201d . ResearcaWe use the term Indigenous to refer to the First peoples of North America, Australia and New Zealand. Within Canada, these populations include First Nations, M\u00e9tis and Inuit peoples. We use the term First Nation when referring to the specific Indigenous population with which we are working. The term Indigenous is akin to Aboriginal or Native American.The authors declare that they have no competing interests.Concept and design: SS, JI, BLB. Collection and assembly of the data: JI, SS, BLB, LB. Data analysis and interpretation: SS, JI, BLB, ED, RV, LB, Drafting of the article: SS, JI, BLB. Critical revision of the article: BLB, JI, RV, ED, LB, SS. Final approval of the article: all authors. Obtaining of funding: JI, BLB. All authors read and approved the final manuscript.SS is the Project Director on Cross Cultural Understandings of Aging and Dementia at UBC\u2019s National Core for Neuroethics.BLB is Professor Emeritus, Division of Geriatrics, Department of Medicine, UBC.RV, Secwepemc First Nation, is Associate Professor, School of Social Work, UBC.ED is a genetic counsellor at the UBC Hospital Clinic for Alzheimer Disease and Related Disorders and Clinical Instructor in the UBC Faculty of Medicine, Department of Medical Genetics.LB is a PhD student in the Interdisciplinary Studies Graduate Program and National Core for Neuroethics, UBC.JI is Canada Research Chair in Neuroethics, Director of the National Core for Neuroethics, and Professor of Neurology, Division of Neurology, Department of Medicine, UBC."}
{"text": "Twenty years ago, and still in some textbooks, allergy was regarded as a \"disease of the rich,\" with a rising prevalence only in industrialized or western countries. This has changed: allergy has become a major health problem in almost all countries of the world, both in terms of individual suffering, medical management, and quality of life, as well as a socio-economic burden. People in Papua New Guinea or Tanzania are experiencing very similar allergic diseases and symptoms as patients from S\u00e3o Paulo, New York, Moscow, or Tokyo. Yet there are considerable differences in management, diagnostic and therapeutic modalities, and especially with regard to eliciting allergens and modifying environmental factors. Globalization is not only an economic phenomenon. In addition, the world has grown together in science and in the medical field.There is a need for more information, exchange of experience, and for a discussion forum at an international level. Allergy with its interdisciplinary character involves the expertise of various fields both in clinical medicine and in research and experimental science. Allergy manifests itself as various conditions with a colorful spectrum affecting different organs and following quite variable pathomechanisms.The World Allergy Organization (WAO), as a global federation of 74 national and regional societies for allergology and immunology, is launching the new journal \"WAO Journal,\" addressing this need for information, exchange of experience, and international discussion.The journal will be practice-oriented and offer the highest level of information in a strictly peer-reviewed system. It offers space for reviews both at the postgraduate education as at the advanced research level, originals, and letters, where exceptional case studies, concise reports on study findings, or expression of opinions and discussion of recent topics of controversy will be published.The journal has established an excellent group of experts in the editorial board who represent at the same time the various features of clinical and experimental allergology and relevant subdisciplines and the various geographic areas of the world.The WAO Journal will reach over 30,000 allergists all over the world directly online; it will be available for free for the first year for all individual members of national allergy societies as well as nonmember subscribers. The new journal is in direct tradition grown on the basis of Allergy and Clinical Immunology International--The Journal of the World Allergy Organization, which has been the official organ of WAO for 19 years and has been discontinued by December 2007. This decision never was caused by dissatisfaction; Allergy and Clinical Immunology International--The Journal of the World Allergy Organization was one of the most successful allergy journals, at one time reaching 17,000 allergists, with editions in several languages. At this place, special thanks should go to the founding editor, Alain De Weck, and to the long-time editor, Allen Kaplan, who have done an excellent job together with Hogrefe Huber publishers, Dr Christiane Hogrefe, Dr Rob Dimbleby, and Christina Sarembe. The decision for a new journal reflects a new philosophy of publication, concentrating on the electronic way, with many advantages starting from the speed with which articles can be accepted, reviewed, and published, decreased costs, the opportunity for digital content (including videos and animation), easy searching of contents, and independence from postal services, just to name a few.Coeditor in Chief Lanny Rosenwasser and myself are eager to push \"WAO Journal\" to become one of the premium international journals in allergy in a truly global endeavor!Johannes RingEditor-in-ChiefMunich, Germany, January 2008"}
{"text": "Frank John Fenner , one of Frank was born in Ballarat, Victoria, Australia, but his family moved to Adelaide, South Australia, when he was 2 years old. He received a bachelor of medicine and surgery degree (1938) and a doctor of medicine degree (1942) at the University of Adelaide. During 1940\u20131946, he was an officer  in the Australian Army Medical Corps and served in Australia, Palestine, Egypt, New Guinea, and Borneo. At various times, he worked as a medical officer in a field ambulance and casualty clearing station, a pathologist in a general hospital, and, most prominently, as a malariologist. For his work in combating malaria in Papua New Guinea, he was made Member of The Order of the British Empire. As Frank noted later, the highlight of his military service was meeting and marrying a nurse, his wonderful wife, Ellen, known to all as Bobbie. Bobbie died in 1995, but ever after Frank said that his marriage was the most important part of his life. Frank is survived by his daughter, Marilyn, grandson, Simon, granddaughter Sally, and great-grandson Jasper.Mycobacterium tuberculosis, Frank worked on M. ulcerans, the etiologic agent of Buruli ulcer, the third most common mycobacterial disease worldwide after tuberculosis and leprosy.After his war-time service, Frank was recruited to work at The Walter and Eliza Hall Institute of Medical Research in Melbourne by Sir Frank Macfarlane Burnet. Initially, they worked on ectromelia virus infection in mice . In 1949, he received a fellowship to study at the Rockefeller Institute for Medical Research in New York City, where he worked in the laboratory of Ren\u00e9 Dubos. While Dubos worked on Returning to Australia in 1949, Frank was appointed Professor of Microbiology at the new John Curtin School of Medical Research (JCSMR), a unit of the Australian National University (ANU), in Canberra. He then began studying myxoma virus infection in rabbits. Throughout the 1940s and 1950s, Australia had severe rabbit plagues. Frank\u2019s classic work on myxomatosis culminated in his classic 1948 paper  such greats as Gordon Ada, Alan Bellett, Bob Blanden, Stephen Boyden, John Cairns, Peter Cooper, Colin Courtice, Peter Doherty, Jack Eccles, Stephen Fazekas de St. Groth, Adrian Gibbs, Alfred Gottschalk, Royal Hawkes, Dick Johnson, Bill Joklik, Kevin Lafferty, Graeme Laver, Fritz Lehmann-Grube, George Mackaness, Barrie Marmion, Ian Marshall, Brian McAuslan, Peter McCullagh, Cedric Mims, Bede Morris, Chris Parrish, Ian Ramshaw, Rob Webster, David White, and Gwen Woodroofe.And on the side, Frank published 23 books, of which 4 have become symbols of the march of virology through one of its most expansive eras: The Biology of Animal Viruses (2 editions)  named Frank the chairman of the Global Commission for the Certification of Smallpox Eradication. The last known case of naturally transmitted smallpox occurred in Somalia in 1977, and WHO set in place a comprehensive global program to make sure that pockets of infection had not been overlooked. Eradication of the disease has been regarded as one of the greatest achievements in human history, and it was Frank\u2019s great honor to officially pronounce global eradication to the World Health Assembly in May 1980. He later said that making this pronouncement stood out most among his many achievements: \u201c[The pronouncement] was accepted unanimously by the World Health Assembly on that day.\u201dFrank had an abiding interest in the environment, and in 1973 was appointed foundation director of the Centre for Resources and Environmental Studies at ANU; he held this position until his retirement in 1979. The Centre became part of the Fenner School of Environment and Society in 2007. It was in this role, late in his career, that Frank publicly expressed a gloomy prospect for the future of humankind: environmental degradation, global warming, overpopulation. In retrospect, this view now seems at odds with Frank\u2019s otherwise positive view of life, especially in regard to the grand prospects of advances in medical science in support of human welfare.Frank played many national and international leadership roles  as it was established by Sir Christopher Andrewes, Andr\u00e9 Lwoff, and Peter Wildy at the International Congress of Microbiology in Moscow in 1966. Frank was unable to attend the next Congress in Mexico City in 1970, but in his absence was elected the second president of the committee (the first president was Peter Wildy). These were formative days; the basic structure of virus taxonomy as we know it today emerged from the work of the committee, under the presidencies of Peter Wildy and Frank Fenner, as the committee met at the first 3 International Congresses of Virology  . This memory can start with Frank\u2019s vignette in his autobiography . The bottle eventually was emptied and we lamented its passing, but the next evening as I perchance opened the cupboard, there was a new bottle. Frank had mysteriously found a place to replenish the elixir, but of course he never explained his action. I must admit that as we sat and sipped that scotch the topic of conversation was often virology. Afterward, my son Rick sent Frank a copy of his video of the trip, so there was much email traffic back-and-forth reliving each adventure. Life at its fullest.Does all this capture Frank Fenner, the man, the friend who has died? If not, then words cannot serve what memories can. Whenever we think of the rise of virology from its roots in pathology and the infectious disease sciences, to its flowering in the first laboratory experiments in viral biology and pathogenesis, and to the beginnings of molecular virology, the name Frank Fenner will be remembered. Whenever we who knew him as a friend think of the emergence of virology as a distinct discipline, at the time of the first International Congresses of Virology (1968 forward), his role will be remembered with great fondness. Whenever we extend these memories to the more personal aspects of life, Frank\u2019s quiet, unassuming character, a character with a steel spine and great insight and understanding of people, will be recalled, again with fondness mixed with great respect. He will never be forgotten."}
{"text": "After publication of this work , we noteThe authors declare that they have no competing interests.WS and DB jointly designed the study and supervised all fieldwork. Additionally, WS analyzed and interpreted the data and drafted the manuscript. VC and AG co-supervised WS during study design, analysis and interpretation of data. VC gave further input in manuscript preparation, which was also contributed to by AG. HZ participated in the design and management of fieldwork. JZ and GC conceptualized the project, managed the coordination and oversaw all implementation activities. MS participated in the design of the study, providing technical and administrative support throughout the entire implementation of the research project. All authors read and approved the final manuscript."}
{"text": "The State of the Science of Endocrine Disrupting Chemicals - 2012 (WHO/UNEP 2013), an extensive update of an earlier document, Global Assessment of the State-of-the-Science of Endocrine Disruptors  and the World Health Organization (WHO) released sruptors . Over thFirst, as described in the new report (WHO/UNEP 2013), the convergence of wildlife, laboratory animal, and epidemiology data suggests a greater role for EDCs in disease, even more than was predicted just 10 years ago. Taking the animal and human evidence together, the report demonstrates a strong likelihood that exposure to EDCs during fetal life and/or puberty plays a role in the proliferation of male and female reproductive problems, endocrine-related cancers, infections, asthma, obesity, diabetes, and behavioral and learning disorders, including attention deficit/hyperactivity disorder (ADHD).The incidences of these conditions have increased significantly not only in the United States but across the globe. Because genes do not change fast enough to explain this increase, environ-mental causes must be involved. The environmental contribution to disease is estimated to be 24\u201333% of the global disease burden . Althougin utero and the first years of life) is a very sensitive time for EDC-induced health effects , EDCs are a global problem and will require global solutions. EDCs have contaminated the world via the natural flow of air and water. Several hundred EDCs have been measured in humans and wildlife, even in remote places such as the Arctic. Thus, it is now impossible to examine an -unexposed population anywhere on Earth. To improve health, environmental health scientists and toxicologists need to work more closely with colleagues in endocrinology, genetics, developmental biology, epigenetics, and clinical medicine to bring EDC research into the mainstream of science.The State of the Science of Endocrine Disrupting Chemicals - 2012 (WHO/UNEP 2013). I commend WHO/UNEP and the scientists who worked for more than 2 years to produce this report. It is an important source of data on EDCs and should be mandatory reading for everyone who is interested in protecting and improving human health.These and other important topics related to EDCs and their effects are detailed in"}
{"text": "The Indian Diaspora, especially in North America, is a visible force in the field of psychiatric medicine. An estimated 5000 persons of Indian origin practice psychiatry in the USA and Canada, and an estimated 10% of these are in academic psychiatry. Wide ranging contributions, from molecular biology of psychiatric disorders to community and cultural psychiatry, are being made by this vibrant group of researchers. This article is a brief summary and work-in-progress report of the contributions by Indian \u2013 American psychiatric researchers. Although not exhaustive in coverage, it is meant to give the reader an overview of the contributions made by three waves of researchers over a span of 50 years. The Indian diaspora that has migrated to North America over the last 50 years, from 1960 until now, has established itself as a formidable intellectual force in Science, Engineering, Technology, Medicine, Education, Literature, and other fields. \u2013 a publThe first wave of immigrants who pursued academic psychiatry arrived in the 1960s, to settle in the largest cities of Canada and the USA. This was the period when biological psychiatry and psychopharmacology were developing. Psychoanalytic psychiatry was on the wane and University Departments were transforming. Deinstitutionalization was in progress, community and social psychiatry were on the ascent, and biopsychosocial models of psychiatric disorders were being formulated. Foremost among this first wave of researchers was the Montreal group, which worked out of Douglas Hospital and Allan Memorial Institute of the Department of Psychiatry at McGill University. Jambur Ananth who had trained at the All India Institute of Mental Health, in Bangalore,  began his research career here in 1968. His collaborators included eminent researchers such as Samarthji Lal and NP Vasavan Nair. After a 13-year productive research career, Ananth moved to the University of California, Los Angeles in 1981. Ananth was a prodigious researcher and published over 400-articles, several books, and many book chapters. There are several themes to Ananth\u2019s research, including, but not limited to, the biology and psychopharmacology of Schizophrenia and Depression. It would not be an exaggeration to say that until the year 2005, Ananth tested and helped develop virtually all psychopharmaceutical agents of the previous three decades. Noteworthy among his contributions are the role of nicotinic acid in psychoses, studies of the first and second generation antipsychotics, and antidepressants, and treatments for tardive dyskinesia. He edited the first text book on psychopharmacology authored predominantly by Indians.[In Chicago, Illinois, USA, another group of Indian researchers had formed in the late 1960s. Dr. Nedathur Narasimhachari, an organic chemist and faculty in the Department of Psychiatry at the University of Illinois and Illinois State Psychiatric Institute, worked closely with psychiatrists Harold Himwich and later John Davis. Their studies on the role of serotonin and its toxic variants in psychosis, and the presence of phenylethylamine in the human brain, are an important part of the history of biological psychiatry. Another stalwart psychiatric researcher from this institution, also not a psychiatrist is Ghanshyam Pandey. He is a professor of pharmacology in psychiatry at the University of Illinois Chicago and the Psychiatry Institute under the umbrella of the Illinois State Psychiatric Institute. Dr Pandey is a versatile researcher in many aspects of neurotransmitter function and is best known for his ground breaking research on the role of serotonin receptors in suicide. This institute has served as the formative and sustaining ground for many second-wave Indian psychiatrists and scientists, including psychiatrists Prakash Desai , Nagamani Pavaluri (Pediatric mood disorder), and Rajiv Sharma  who are all currently on its staff. Another pioneer from the \u2018first wave\u2019 with a lasting contribution to neuropsychiatric disorders is Dr. Harbans Lal, who promoted the concept of neuroprotection well before it became a fashionable term. Lal, a pharmacologist, held various teaching and research positions at the University of Kansas, University of Chicago, and University of Rhode Island, and eventually settled as Chair of Pharmacology and Neurosciences at the Medical College of the University of North Texas Health Science Center. Dr Sachin Pradhan, also a pharmacologist has contributed to our understanding of the effects of psychomimetic drugs such as PCP and inhalants. He has had a long tenure at Howard University in Washington DC, and edited a text book of pharmacology. Separately, he also published a book on the contribution of Indians in USA.[The second wave of researchers consist of those that began their research careers in USA or Canada between approximately 1985 and throughout the 1990s. By now, some of these academicians have nearly 30 years of contributions to their credit and occupy endowed chairs and leadership positions in academic psychiatry. Although no exact count exists, it is estimated that there are at least 50 such researchers forming a solid core of psychiatric academicians of Indian origin. Geographically, they have spread their wings across the span of USA and Canada, and are at leading academic centers of the two countries. This group has accumulated an impressive record of contributions from the bench to the remote corners of the community, and has deservedly acquired a reputation for intelligence, originality, diligence, collegiality, collaboration, and leadership, nationally and internationally. There are too many individuals in this cadre to mention all, and it is beyond the scope of this article to review their work individually. See Dr. Rohan and Dr. Mary Ganguli, Dr. Dilip Jeste, Dr. Matcheri Keshavan, Dr. Shitij Kapur, Dr. Ranga R Krishnan, Dr. Madhukar Trivedi and Dr. Lakshmi Yatham epitomize the cream of this crop. Jeste developed his research career at the National Institute of Health (USA) before moving to the University California at San Diego. The first phase of his research focused on the biology and treatment of schizophrenia, and subsequently on the identification and treatment of tardive dyskinesia (TD). TD had become a major challenge in the treatment of schizophrenia and it was important to know through systematic studies, its prevalence, cause, and potential treatment. Dr. Jeste rose up to this challenge and provided researchers and practitioners reliable data on the prevalence of TD over the short and long term. In the second phase of his research career, which started at UCSD, Dr. Jeste shifted his attention to geriatric psychiatry, and quickly assumed the mantle of an undisputed research leader in this field. Especially noteworthy is his work on psychoses in the elderly. Jeste also took on various leadership roles including being President of the Association of Geriatric Psychiatry and an editor of its flagship journal. Dr. Ranga Rama Krishnan of the Duke University is a prolific biological researcher of international fame. His group at Duke has conducted numerous investigations on the biology of depression, and championed the concept of vascular depression in the elderly, based on their original findings of excessive hyperintensity lesions demonstrated by magnetic resonance imaging. They are also considered leaders in the development of technology for psychiatric brain imaging. Ranga Krishnan became the first chair of Indian origin in a major private university such as Duke, and has gone on to International leadership in medical education by leading the development of the Duke Graduate Medical School in Singapore under the aegis of the Duke University and the National University of Singapore. Both Dr. Jeste and Dr. Krishnan were inducted into the Institute of Medicine, an honor bestowed on very select academicians. This speaks for the high stature they hold in the medical academia. Matcheri Keshavan is an alumni of NIMHANS, Bangalore. Dr. Keshavan received advanced research training in Vienna and worked at the Maudsley in London. In USA, his career began at Wayne State University, although the majority of his work occurred during his tenure at the Western Psychiatric Institute and Clinic (WPIC) of the University of Pittsburgh. Of late, he was appointed as an endowed professor and one of the Vice Chairs at the Harvard University. Keshavan\u2019s contribution to the understanding of the first episode of psychoses, especially the integrity (or lack thereof) in the neuronal energy mechanisms, demonstrated by magnetic resonance spectroscopy is an excellent example of his incisive insights into the biology of psychosis. Another area of much clinical and biological research by Keshavan and his group has been in the neurodevelopmental origins of schizophrenia. The WPIC in Pittsburgh serves as the psychiatry department of the University of Pittsburgh. With prominent Indian academicians such as Rohan Ganguli, Mary Ganguli, and Keshavan generously offering their expertise and mentoring early career psychiatrists, it has been a nidus for many budding psychiatric researchers of Indian origin. Although often mentioned together, Rohan and Mary Ganguli have made very different and specialized contributions in their fields of expertise, respectively. Rohan Ganguli has conducted extensive studies in the immunology of schizophrenia, and in more recent years has concentrated his efforts on the metabolic burden in this disease, especially that associated with atypical antipsychotics. Mary Ganguli is a geriatric psychiatrist, best known for her work in the epidemiology and assessment of dementia, including a cross-national study between the Monongahela valley in Pennsylvania, USA, and Ballabgarh, Haryana, India. The nidus effect is also visible in many prominent universities where a researcher of Indian origin has excelled, attracting younger researchers to the department. Duke University is one such where Ranga Krishnan\u2019s presence and leadership has led to a nexus of both senior and mid-level Indian psychiatrists, such as, Prakash Masand , Meera Narsimhan , Ashvin Patkar (Addiction Psychiatry), Murali Doraiswamy , and others have gone to establish niche areas of research and onto academic leadership roles in their own right. Two other examples are (1) University of Texas, South Western Medical Center (UTSW), where MadhuKar Trivedi leads an internationally acclaimed mood disorders institute. Trivedi\u2019s leadership role in the largest, publicly supported algorithmic treatment research program of depression, is well-recognized. This study (STAR-D) provides an excellent roadmap for treating depression for clinicians and researchers, alike. UTSW has 10 psychiatrists of Indian origin on its full-time faculty roster, with wide ranging academic specializations; (2) University of California at San Diego (UCSD) where Dilip Jeste has served as the magnet, with recent early-career psychiatric researchers Ipsit Vahia and Gowri Savla Nayak. These selective examples serve as powerful evidence of how brilliant individuals with research excellence transform programs and departments to the benefit of many. Institutions in India and elsewhere aspiring for their own excellence would be well advised to emulate this.In reviewing the first wave of researchers, the work of Indo-Canadian investigators at McGill was mentioned. Within the second wave, the work of what might be termed the bipolar group is especially note worthy. Vivek Kusumakar at Dalhousie University, until he moved to Johnson and Johnson Company in the USA \u2013 he had an untimely death in 2009, and Lakshmi Yatham at University of British Columbia, Vancouver, both alumni of NIMHANS have lead major research in the treatment of bipolar disorders. They co-chaired the Canadian Network for Mood & Anxiety Treatments (CANMAT) and developed the bipolar treatment guidelines in Canada; Yatham is president of the International Society for Bipolar Disorders. The University of Western Ontario, University of British Columbia \u2013 Vancouver, University of Toronto and its affiliates have served as fertile grounds for the pursuit of academic careers by Indo-Canadian Psychiatrists , D. Devanand , Sanjay Dube (psychopharmacology), Choudhary Jampala (phenomenology and biology of schizophrenia), Geeta Jayaram , Shitij Kapur , Arifulla Khan , Vivek Kusumakar , Ashok Malla (early psychosis), Anil Malhotra , Rahul Manchanda , Sukdeb Mukherjee , Viswajit Nimgaonkar (psychiatric genetics), Phillip Ninan , Uma Rao (pediatric mood disorders and addictions), Rajiv Tandon , Gunwant Thaker (biology of schizophrenia), Lakshmi Yatham (bipolar disorder treatment), and Vikram Yeragani .Lest the reader get the impression that Indo-American psychiatric academicians have focused their careers only on biological psychiatry, it should be emphasized that many noteworthy contributions have been made in the psychological aspects as well . CV RamaThere are three other important modalities of scholarly contributions made by psychiatrists of Indian origin in the USA and Canada. The first modality is through book writing or editing. Although sometimes a book is a culmination and summary of many years of an individual researcher\u2019s work, it may also be a compilation of the research of many authors in one place, and at other times it is a more user-friendly, narrative of one\u2019s experiences and observation of a subject in depth. Tables The third modality has focused on the other dimension of academic psychiatry, namely, psychiatric education and has attracted some of the brightest minds among Indian\u2013American psychiatrists. Mantosh Dewan was one of the earliest to chair a University Department of Psychiatry at the State University of New York in Syracuse , followed by Ranga Krishnan at Duke University. Since then, and especially in the last decade, many Indian\u2013American academicians have been appointed to this coveted leadership position including Nutan-Atre-Vaidya, Anand Kumar, and Murali Rao, in Chicago. Many psychiatry residency directorships are (have been) occupied by Indo-Americans, including Chetan Haldipur, Bhaskar Dave, Nyapati Rao, Nalini Juthani, and others. Among the recipients of the Nancy Roeske Certificate for Teaching Excellence awarded by the American Psychiatric Association (APA), is a long list of psychiatrists of Indian origin. Nyapati Rao has especially played a strong role in the development of the residency curriculum, and the newer methods of examination for the American Boards. Geeta Jayaram distinguished herself by becoming the first (and so far only) Indo-American psychiatrist to have been the Scientific Program Director of the Annual APA meetings for four years, and Dilip Jeste and Prakash Desai are the only Indo-American psychiatrists to have won the national elections to important positions within organized psychiatry. These accomplishments although not traditional research are mentioned, as the reader will no doubt appreciate the impact of such accomplishments on the training opportunities, including research training, and on the academic recruitment, career development, and productivity of younger Indian psychiatrists migrating to America.Significant scholarly contributions have also been made in specialties such as child and adolescent psychiatry by Shashi Elongovan (foster care), Vivek Kusumar , Uma Rao , Aradhana Sood , and others. Women\u2019s mental health has benefited from the dedication and research of several Indian psychiatrists including Shaila Misri at the University of Vancouver in Canada, Shamsa Sonawalla in Harvard, and Lilian Gonsalves at the Cleveland Clinic. Ashok Srinivasaraghavan  has been a leader in Law and Psychiatry. Asha Mishra  in Community Psychiatry, Ramakrishna Shenoy (VCU) and Jaisimha Rao  in Developmental Disorders, and Chetan Haldipur  to the history of psychiatry, especially as it pertains to ancient India, to name only a few, have made unique contributions.In the twenty-first century, a new and much larger group of academicians of Indian origin is emerging to carry on the good work of their predecessors. Of the 5000+ psychiatrists of Indian origin in North America, it is estimated by this author that over 500 are now in academic psychiatry. A small sampling of names is included in There can be no question that Indian American psychiatrists have woven strong threads in the fabric of American Psychiatry and that this experience has been a mutually advantageous relationship. Indian\u2013American psychiatrists form a strong and integral part of American psychiatry, and it is hard to imagine the latter without the former. The growth of the IAPA and recognition of its formidable strengths is one indicator of this core role and strength.The challenges confronting psychiatrists in India wishing to migrate and pursue a research career are uphill requirements of the American licensure system, limited availability of mentors, lack of strong networking within the Indo\u2013American academic community, extremely competitive nature of federal funding, and the occasional glass ceiling that one confronts in career advancement. From the perspective of contributions in India by the Indian-American psychiatric research community, we should add that the absence of clear and user-friendly mechanisms in India for academic collaborations, joint appointments, restrictions on overseas travel for Indian collaborators, restrictions on research with DNA and biological tissues, and limited research infrastructure in most Indian institutions, have all worked to limit such contributions. The potential is indeed unlimited, and the benefit to advancement of knowledge and the care of our patients is tremendous, if only we can effectively address these challenges, and harness the full potential of the proven current generation and the extremely talented next generation in both countries. The Indo-US and Global Health Care Summits and the recent Indo-Global Psychiatry Initiative are good examples of current efforts to do so. On balance though, the accomplishments have far outweighed the challenges. We may comfortably and confidently declare this natural experiment of immigration to the USA / Canada a colossal success for the psychiatrist, psychiatry, and most importantly our patients."}
{"text": "In the 1960s, there was a growing awareness of the need to develop closer ties between radiologists in the various nations of Asia and Oceania. Not only would this provide opportunities to learn from one another, but more importantly, it would contribute towards furthering harmonious regional and international relationships. To this end, in the northern hemisphere of this region consideration was given to forming a Far Eastern Society, whilst in the southern hemisphere of the region, national radiological societies in Australia, New Zealand and some South-East Asian countries had similar ideas.Since 1923 the International Society of Radiology (ISR) had provided leadership as the world authority in radiology by way of the International Congress of Radiology (ICR) held every 4 years, and by establishing important standing committees such as the International Commission on Radiological Protection. With representation from the majority of the world\u2019s nations, ISR was a suitable forum to discuss matters of general interest for members as well as the wider community.However with the passage of the years, the influence of ISR waned as a result of the emergence of large regional societies. By the mid-1960s a zonal pattern was developing.In the Americas, the Radiological Society of North America (RSNA), begun in 1928, brought together Canada and the United States and was growing from strength to strength due much to its considerable available financial resources to promote training and research. Another society, the Inter-American Society of Radiology, embracing both North and South America, characterised by being multilingual, had been established in 1933, and continued to the present, but has not reached the level of significance of RSNA. The yearly RSNA congress thus became the main focus for manufacturers and the trade industry to exhibit their latest wares and radiologists from worldwide flocked to Chicago to see what was on offer as well as to attend the excellent academic programmes.In the European zone, there was the European Association of Radiology (EAR), a federation of national societies founded in 1962, and the European Congress of Radiology (ECR), the organising body of the eponymous congress, which was founded in 1967 and conducted congresses every four years. Over time, no doubt stimulated by the success of RSNA, European radiologists set about to improve the stature of their Society through the European Congress of Radiology. This was well under way by the 1960s and today, ECR is held every year in Vienna.Another important factor which encouraged the development of regional congresses came from the trade houses. With the exponential escalation of radiology as expected, individual countries, with increasing numbers of radiologists, established their own national annual congresses and looked to the various firms and trade houses for financial and other support. In addition subspecialty societies and meetings evolved, placing further burdens on the resources of companies. Understandably, the commercial world saw that supporting only large regional congresses was a way to rationalise their commitments. By the late 1960s, there was a trend towards the large company headquarters supporting only major congresses, leaving the question of assisting national meetings to their local agents. This was the state of affairs when the thought of setting up a regional society in the Asia and Pacific region was contemplated.The idea of setting up the Asian-Oceanian Society of Radiology (AOSR) came about in the late 1960s when questionnaires were circulated to 13 constituent nations/territories and opinions were sought . Then in 2010, Korean Society of Radiology (KSR) took over the management and AOSR was registered in Korea.The original chain was donated by Dr. Principe of Philippine, but regrettably, it later become lost. It was remade and was donated by Korean Radiological Society under the leadership of Professor Man Chung Han  was the News Sheet, which was mailed to contacts of National Societies . These seminars were held in different countries to allow more area coverage and to enhance fellowship between Asian radiologists. To further promote radiological education in the region, the teachers and speakers of ASDIR were nominated from the local organisers and from the region  and members were SK Aggarwal (India), KS Cho (Korea), HM Liu (Chinese Taipei) and S Suthipongchai (Thailand). AOSR has always been active in educational activities and continues to be so, represented in various forums organised by RSNA, ISR/ICR, International Radiology Quality Network (IRQN) and sharing its experience and progress with other regional radiological organisations.th year of Anniversary of AOSR. There are 23 Member Societies comprising of Bangladesh Society of Radiology & Imaging, Chinese Society of Radiology, Chinese Taipei Society of Radiology, College of Radiology Academy of Medicine of Malaysia, Fiji Radiology, Hong Kong College of Radiologists, Indian Radiological & Imaging Association, Indonesian Radiological Society, Japan Radiological Society, Korean Society of Radiology, Macau Radiology Association, Mongolian Radiological Society, Nepal Radiologists' Association, Philippine College of Radiology, Radiological Society of Pakistan, Radiologist Ministry of Health Tonga, Royal College of Radiology of Thailand, Samoa Society of Radiology, Singapore Radiological Society, Sri Lanka College of Radiologists, The Royal Australian & New Zealand College of Radiologists, Uzbekistan Radiology Society and Vietnam Society of Radiology and Nuclear Medicine. AOSR is now registered in Korea and managed by the Korean Society of Radiology. The website is http://www.theaosr.org. The Asian Oceanian Journal of Radiology (AOJR) is affiliated with the Biomedical Imaging & Intervention Journal (BIIJ).This year marks the 40With the support of the Member Societies and healthcare professionals, one can anticipate the continual growth of AOSR with the rapid advancement of radiology in our region."}
{"text": "Macroglossia is a morphological and volumetric alteration of the tongue, caused by muscular hypertrophy, vascular malformation, metabolic diseases, and idiopathic causes and also associated with Down and Beckwith-Wiedemann syndromes. This alteration can cause dental-muscle-skeletal deformities, orthodontic instability, masticatory problems, and alterations in the taste and speech. In this paper we present a case of true macroglossia diagnosed in a female patient, 26 years, melanoderma, no family history of disease, with a history of relapse of orthodontic treatment for correction of open bite, loss of the lower central incisors, and complaint of difficulty in phonation. The patient was submitted to glossectomy under general anesthesia using the \u201ckeyhole\u201d technique, with objective to provide reduction of the lingual length and width. The patient developed with good repair, without taste and motor alterations and discrete paresthesia at the apex of the tongue. Macroglossia is an uncommon condition that can lead to several alterations like dental-muscle-skeletal deformities, orthodontic treatment instability, masticatory, and breathing and phonation problems, characterized by increased size of the tongue, can be caused by congenital malformations or acquired diseases. The most common causes are muscle hypertrophy and congenital vascular malformations, such as lymphangioma and hemangioma, they are also characteristics found in the Beckwith-Wiedemann syndrome, and can be present in the Down syndrome \u201314. It cAccurate diagnosis of true macroglossia is obtained through the signs and symptoms of this alteration, which is of fundamental importance for the correct indication for surgical treatment, in order to restore proper function and provide stability for orthodontic treatment .The surgical treatment indicated for the true macroglossia is the reductive glossectomy. Several techniques have been proposed in the literature to enable the reduction of the tongue. Peripheral incisions with marginal resection of tissue have as complications hipomobility and change in the form of the tongue that becomes globular , 20, 22.This paper aims to present a case of true macroglossia treated surgically using the keyhole technique.Female patient, 26 years, melanoderma, was referred by the Department of phonoaudiology with complain of difficulty in speech and history of orthodontic treatment for correction of anterior open bite that resulted in complete recurrence. No history of systemic diseases or drug allergies or family history of her disease. On physical examination, the tongue was increased both in length and in width, with anterior open bite and interposition of the tongue, impression of the lingual surface of mandible molars on the edges of the tongue, loss of the tooth 31 and 41, occlusion in Class I of Angle, reversion Spee curve in the mandible and marked in the maxilla Figures , with diThe technique chosen for reduction glossectomy was the \u201ckeyhole\u201d technique with the goal of reducing the tongue in width and length. The patient underwent general anesthesia nasotracheal intubation, and the tongue was pulled out of the oral cavity through three repairs with nylon suture 3-0 fixed to the surgical field to maintain the symmetry between the sides and facilitate the demarcation of the incisions, which was performed with methylene blue Figures . After iTo determine the real need of surgical treatment is of fundamental importance to define the signs and symptoms of true macroglossia. The diagnosis must be based on clinical findings .In cases of true macroglossia, as presented, in the literature several reductive glossectomy techniques are suggested. Each technique has a purpose in accordance with the clinical aspect.In the presented case the keyhole technique was used which is indicated for reduction of length and width of the tongue, preserving the vasculonervous bundle and with few reports of sensory and functional deficits , 25, 28.Surgical reduction of the tongue is an uncommon procedure, being indicated in specific cases; the keyhole technique allows anterior and median partial resection, technically simple, minimal morbidity, and good functional result."}
{"text": "The expanding list of antiretroviral drugs, the increasing possibilities in therapy of HCV and other co-infections represent an attractive setting for individualized prescription. However, there has been considerable hype, and limited impact of pharmacogenetics in care.The development of pharmacogenetic tools would be of interest considering the complexity of treatment, the cost, and the expectation of long-term exposure. It would also be desirable given the possibility of serious toxicity, but also treatment intolerance, cumulative toxicity or the unfavorable interaction of drugs and aging, metabolic, cardiovascular and bone disease processes.This presentation will review available tests, the position of agencies on the inclusion of pharmacogenetic information in labels, and a perspective on developments in genomic medicine."}
{"text": "Study of healthy aging of the hypothalamic-pituitary-thyroid axis is difficult, since aging is accompanied by the increased frequency of various thyroid diseases and of extrathyroidal disease, as well as by the increased intake of medicines modulating the function of this axis. Nevertheless, researchers managed to determine that in the paraventricular nucleus of aged humans the number of neurons synthesizing TRH is increased. In the pituitary, the number of thyrotrophs also increases, and the cells are commonly hypertrophic. In the thyroid, epithelial cells are smaller, the amount of colloid decreases, and the whole gland becomes smaller and denser. It is still not known how aging affects secretion of TRH. Healthy aging is accompanied by the slight increase of concentration of TSH (highest concentrations of this hormone were detected in centenarians), and the night peak of its secretion is lower. In healthily aging humans, concentrations of T3 and of fT3 decrease, concentration of rT3 increases, and concentrations of T4 and of fT4 remain stable.According to the current theory of aging, the direct cause of aging is the accumulation of stochastic damage to DNA, and to proteins and lipids. The most important  damaging factors are the reactive oxygen species (ROS), by-products of the cellular metabolism, especially of the respiratory chain in mitochondria. Most likely, the function of the hypothalamic-pituitary-thyroid axis influences the rate of aging, since the function of the respiratory chain and, therefore, the rate of production of ROS, remain under the control of T3. Consequently, slowdown of the T3-dependent metabolism might promote longer life through slower production of ROS. This hypothesis is supported by the above described epidemiological observations showing that healthy aging is accompanied by the decreased activity of the hypothalamic-pituitary-thyroid axis and by the fact that in long-lived humans  the activity of this axis is lowest compared to younger age groups. Because of this, subclinical hypothyroidism in 65 years old or older humans might be, in fact, a manifestation of healthy aging of the thyroid gland, and this is why in these individuals this condition should not be \u201cautomatically\u201d treated. Instead, the patient should be regularly examined (if we do not want to omit the overt hypothyroidism), and decision to treat should be taken individually, based on the biological age, the clinical state, the presence of other diseases, the results of biochemical tests, etc.The percentage of aged humans with anti-TPO and anti-TG auto-antibodies is much higher compared to young individuals, but above the age of 80 the percentage of such individuals decreases. Aging is accompanied by the increased frequency of hypothyroidism, hyperthyroidism, and of thyroid cancers. Their symptoms are commonly untypical and, because of this, might be confused with signs of aging per se or with symptoms of other diseases. Nevertheless, all these diseases should be adequately diagnosed and treated."}
{"text": "For years, emerging infectious diseases have appeared worldwide and threatened the health of people. The emergence and spread of an infectious-disease outbreak are usually unforeseen, and have the features of suddenness and uncertainty. Timely understanding of basic information in the field, and the collection and analysis of epidemiological information, is helpful in making rapid decisions and responding to an infectious-disease emergency. Therefore, it is necessary to have an unobstructed channel and convenient tool for the collection and analysis of epidemiologic information in the field.Baseline information for each county in mainland China was collected and a database was established by geo-coding information on a digital map of county boundaries throughout the country. Google Maps was used to display geographic information and to conduct calculations related to maps, and the 3G wireless network was used to transmit information collected in the field to the server. This study established a decision support system for the response to infectious-disease emergencies based on WebGIS and mobile services (DSSRIDE). The DSSRIDE provides functions including data collection, communication and analyses in real time, epidemiological detection, the provision of customized epidemiological questionnaires and guides for handling infectious disease emergencies, and the querying of professional knowledge in the field. These functions of the DSSRIDE could be helpful for epidemiological investigations in the field and the handling of infectious-disease emergencies.The DSSRIDE provides a geographic information platform based on the Google Maps application programming interface to display information of infectious disease emergencies, and transfers information between workers in the field and decision makers through wireless transmission based on personal computers, mobile phones and personal digital assistants. After a 2-year practice and application in infectious disease emergencies, the DSSRIDE is becoming a useful platform and is a useful tool for investigations in the field carried out by response sections and individuals. The system is suitable for use in developing countries and low-income districts. For years, emerging infectious diseases (EIDs) have appeared worldwide and not only threatened the health of people, but also a significant burden on global economic and public health With the development of communications, the Internet, intelligent mobile-phone services and WebGIS, new technologies have been widely used in the domain of the prevention and control of infectious diseases, use of unstructured event-based reports, internet media report and XML forms for infectious disease reporting and surveillance is a new application http://www.geoepi.com for personal computer (PC) users and http://m.geoepi.com for mobile-phone users. DSSRIDE is a semi-open system, and used in infectious disease surveillance and response to emergencies industry, users who want using this system could contact the administrator of the system and send E-mail to yapin0215@163.com to sign a \u201cUser service agreement\u201d and obtain user name and password. The permission of the user would describe in the agreement.In recent years, there have been outbreaks of several emerging infectious diseases in China; i.e., the SARS epidemic in 2003 We collected baseline information including the spatial distribution of notifiable infectious diseases and information relating to natural foci, hosts, vectors, medical services, the population census, and the characteristics of the geographical environment, transportation and climate for each county in mainland China. These data were obtained from the Chinese Center for Disease Control and Prevention, the National Bureau of Statistics of China, the National Meteorological Bureau of China, and projects of natural foci investigation The system structure of the DSSRIDE comprised a user interface, server service and control interface with a B/S (Browser/Server) structure. The user interface included the functions and permissions and could be accessed by PC, PDA or mobile phone. Additionally, the location information in fields was obtained by keyword enquiry or Global Positioning System (GPS) tracking, and the function of the DSSRIDE was then performed according to the location information. The server service provides a map and data service. In this study, Google Maps was used to display geographic information and to make calculations related to maps. In addition, a control interface was designed for the manager of the system; administrative users were permitted to carry out actions such as creating or deleting usernames, and adding or revising data of the system .The system was mainly designed with four modules of function. Firstly, the system was designed to collect epidemiologic data in the field and to send the data to a database via a wireless Internet service. Secondly, an enquiry module was designed to display the baseline information of the spatial distribution of infectious diseases, natural foci, hosts, vectors, medical services, and population, and the characteristics of the geographic environment, transportation and climate. In addition, a customized epidemiologic questionnaire was designed for users to use in real time and online. Lastly, a query tool for handling different types of public health emergencies and obtaining associated professional knowledge was designed to assist medical workers and decision makers.Information including questionnaire results, text, pictures, voice recordings and video recorded in the field can be collected and sent to the database via wireless internet services from PCs, PDAs and mobile phones in real time by different users. Experts and officials can analyze the data to understand the dynamics of the infectious disease emergency, the temporal and spatial distributions of patients, the population at risk, the susceptible population, and probable influencing factors. More than 200 types of questionnaires including individual-case questionnaires and epidemic-case questionnaires are provided by the DSSRIDE. The system also provides epidemiological questionnaires customized according to users\u2019 actual demands in the field. In addition, the geographic location is important for field investigations. In the DSSRIDE, location information is collected by a GPS unit or keyword enquiry, and the information of longitude and latitude is then integrated into the report data. The spatial distribution maps, figures of the epidemic curve, and patterns of gender, age and occupation can be created quickly, and epidemiologic analyses are conducted in real time. Additionally, users can export these additional data to an Excel spreadsheet for further epidemiology analysis in professional software, such as SPSS or STATA, which are not included in the DSSRIDE system.To understand the transmission risk of infectious diseases in decision making during emergencies, the baseline information of infectious diseases, hosts, vectors, medical services, the geographic environment and climate in the field is needed, and it is important to raise the efficiency of handling emergencies. This information can be determined from the location information in the DSSRIDE. Queries and spatial research can be carried out using Google Maps on a PC, PDA or mobile phone. The DSSRIDE provides 10 categories of 206 epidemiological questionnaires for users. The system also provides the function that novel questionnaires can be customized in the field by users. Administrative users have the permission to manage questionnaires, including new questionnaires that are customized and optimized versions of existing questionnaires. Common users have the permission to put in, browse, modify, enquire about, and analyze questionnaire data and to export the information in a table format. Investigation and disposal workers can use the existing questionnaires or create novel questionnaires using the custom-tailor according to their needs in the field. Options for filling out questionnaires are readily provided by the system, and include uni-selections, multiple-selections, text, tables, and times. Users can choose the format of the questionnaire according to whether they are using a PC or PDA, and they are able to fill out, send, or review questionnaires online. The data of reported questionnaires are written to the database directly. Permitted users can analyze the data and transmit the results to the investigation worker in real time. The DSSRIDE integrates flow diagrams for the handling of an emergency, including handling cases of severe infectious diseases, emerging infectious diseases, food poisoning, nuclear, chemical and biologic hazards and other public health emergencies. Disposal workers and decision makers can be assisted by the flow diagrams in different emergencies, and can also be provided with information relating to the emergency, information for the prevention and control of infectious diseases, information relating to laboratory diagnosis, information relating to law, and information relating to medical services, disinfection, insecticides and sterilization, and case analyses.The users of the DSSRIDE are classified into super administrators, administrators and general users. These users have the same permissions in terms of epidemiological detection, epidemiological statistical analysis, guidance for handling infectious disease and professional knowledge enquiries. However, there are different permissions for epidemiological investigations in the field and data collection. Besides having the permissions of the administrator, the super administrator can create an administrator and add, modify and delete data in the system. The administrator can create a general user and browse the data reported by the general users.In 2009, pandemic influenza A (H1N1) emerged and spread globally. We collected information relating to cases in the early stage of the epidemic in mainland China from May 10 to June 22 using the DSSRIDE and analyzed the characteristics of these cases. This study established a decision support system for response to infectious disease emergencies using WebGIS and mobile services (DSSRIDE). The DSSRIDE provides functions including data collection, communication and analyses in real time, epidemiological detection, the provision of customized epidemiological questionnaires and guides for handling infectious disease emergencies, and professional knowledge querying in the field. These functions of the DSSRIDE could be helpful for epidemiological investigation in the field and the disposal of materials in an infectious disease emergency.The DSSRIDE is an integrated decision support system to aid the response to infectious disease emergencies and it is accessed easily by PCs, PDAs and mobile phones. It is thus suitable for use in the field, which is its main difference when compared with other information systems of infectious disease surveillance. In addition, most surveillance systems of infectious disease focus on data collection, communication, and display; e.g., the surveillance system for infectious diseases of pets in Chile and the surveillance systems for the distribution of mosquito species and global HPAI The successful application of the DSSRIDE requires investments including those in software and hardware. There are three types of hardware: the data and map server, PCs, and mobile phones (including PDAs). The servers are used to run the DSSRIDE and provide the service to the users. Users use PCs, mobile phones and PDAs to access the system to collect, transmit, browse and analyze data in the field and in offices. In the market, many brands and models of mobile phones support access of the DSSRIDE; e.g., Nokia, Motorola, HTC, and Blackberry. Considering the low cost of application, normal-configuration hardware is suitable for using the DSSRIDE, and low-income districts can be included in the system. The interface and database of the DSSRIDE were designed in Chinese, and apply to Chinese language districts and populations. The system is designed flexibly, and it can be easily adapted to not only the response to animal infectious disease emergences but also to the response to bioterrorism, earthquakes, flood and other natural disasters.The DSSRIDE is a decision support system used in infectious disease emergencies. The system includes functions for field investigations, data collection, transmission and analyses in real time, epidemiological detection, customizing questionnaires, and querying professional knowledge. The DSSRIDE provides a geographic information platform based on the Google Maps application programming interface to display information of infectious disease emergencies, and transfers information between workers in the field and decision makers through wireless transmission based on PCs, mobile phones and PDAs. Users can gain the baseline information at sites of emergencies, such as the baseline information of infectious diseases, hosts, vectors, medical services, geographic environment and climate. The DSSRIDE is simple, flexible and cheap, and is suitable to use in developing countries and low-income districts. The DSSRIDE can be used by different users such as international organizations, nations and provinces, hospitals, and survey groups. The DSSRIDE can easily be extended to adapt other domains such as animal infectious diseases, plant diseases and insect pests in agriculture, bioterrorism, earthquakes, floods and other natural disasters. It could be helpful for handling infectious disease emergencies or other public health events.Ethics is a key problem in the system application, and we attach great importance to this issue. The users of the system may be health agencies, hospitals, temporary teams of investigators or other agencies or organizations. Before such groups begin using the system, we will sign an agreement with the appropriate ethics committee to avoid ethical problems.The patient\u2019s private information must be kept confidential. Anyone wanting to use the data must be reviewed by the appropriate ethical committee and sign a confidentiality agreement. All individuals need to comply with the relevant laws and regulations in using the data."}
{"text": "Vinci, a small town near Florence, Italy, dates back to Roman times, when it was inhabited by the Etruscans. \"But this town is even more renowned for having given its name to the famous Leonardo da Vinci, who, in any discipline of science and art he dedicated himself to, surpassed all his contemporaries\" wrote Emanuele Repetti in his geographic dictionary of Tuscany , the languid eyes, the puzzling backdrop of nature, the intricate loops of the neckline, the calm hands, even the absence of visible facial hair (eyebrows and eyelashes were not the style) add to the mysterious, semi-abstract quality of the face.The enigma of Leonardo's creation and the intrigue surrounding its origin, identity, and meaning can only be a metaphor for his own life and ideas and, by extension, ours. An archetype of the Renaissance, this man who would and could do everything must have peered inside himself for answers he had sought far afield. And just as he dissected and outlined the physical body, he sought to find and paint the spirit. Always the scientist, he knew that a portrait alone, no matter how exacting, would not do. Rejecting the flat background of tradition, he added the landscape. Part dream, part romantic reality, it provided perspective and connected the figure to the world, adding to the enigma and possibly holding the definitive interpretation.The puzzles of our era, unknown pathogens, many of them vectorborne, emerging biological threats, ecologic disasters, antimicrobial drug resistance can also benefit from meticulous observation, accurate recording, added perspective, and the interdisciplinary approach to knowledge. Just as with Leonardo, the art is in the science."}
{"text": "Sir,The concern about male reproductive and sexual health and, concomitantly, the health of their sexual partners is set in the context of rapid spread of human immunodeficiency virus (HIV) and increasing rate of sexually transmitted infections (STIs) in India. In the context of HIV prevention, a reduction in the prevalence of other STIs can help in decreasing the rate of transmission of HIV.In the present scenario, men, in general, do not feel comfortable seeking services from family planning clinics and young people, in particular, often feel embarrassed. Men\u2019s reUnder the Research and Intervention in Sexual Health: Theory to Action (RISHTA) project at the International Institute for Population Sciences, a male health clinic was established in one of the three experimental communities. RISHTA interventions successfully demonstrated the strategies of effective community health education programmes and also the efficacy of engaging Ayurveda, Unani, Siddha, Homeopathy and Allopathic providers in HIV/STI risk reduction among men. PROFAMILThe choice of the paradigm in a community will depend on the pattern of utilization of health services by males, type of services already existing and the resources available. The exclusive male health clinic model poses a challenge of intensive resource requirement for establishment and maintenance. Being in the era of integrated health programmes, a similar model shall thus be a practicable choice."}
{"text": "The aim of the current study was to explore the relationship between housework and health of retired older adults, and to provide new evidences and clues for the effects of housework on health.The data came from the baseline survey of the Tongji-Dongfeng Cohort Study with 25,501 participants. The independent variable was housework including child care, elder care, grocery shopping & cooking, and washing clothes & cleaning house. The dependent variable was self-reported two-week illness. Age, education, marital status, smoking and drinking were used as potential confounding variables. There are gender differences in the four types of housework, with higher prevalence among women than among men. The prevalence of two-week illness in women was higher than that in men. After adjusting for potential confounding variables, the four types of housework had almost no significant effects on two-week illness, except for washing clothes & cleaning house with a negative effect for women .The association of housework with health, especially of child care, elder care, and grocery shopping & cooking without significance and of washing clothes & cleaning house with significance for women, would provide a valuable clue for in-depth study of housework, namely the effects of housework on health would be subdivided into the dimensions of psychological and social activity besides physical activity, and it may not be suitable to simply classify housework as a kind of exercise. Population aging, longer life expectancy, and relatively earlier retirement ages have enhanced interest in research on lifestyle and health for older adults In recent decades, most of the studies on housework have focused on gender inequality in young married couples and prime-age adults. Several sociological theories have been developed as explanations of gender inequality, including the relative resource model, the gender ideology model, the time availability model and so on Some studies suggest a positive association between perceived unfairness in the division of housework and depressive symptoms for women In research on the health of older adults, most of the studies have focused on socio-economic status, utilization of health services and health care, and health-risk behaviors, including smoking, alcohol consumption and physical activity. A solid evidence base supports the positive relationship between regular physical activity and health, and studies have largely examined the effects of brisk walking, leisure time exercise, or occupational activity rather than domestic activities In China, due to traditional Confucian ideology To address the above issues, the current study offers empirical evidence about housework and retired older adults in China. The aim of the current study was to explore the relationship between housework and health of retired older adults, and to provide new evidences and clues for the effects of housework on health.n\u200a=\u200a27,009) of the invited participants agreed and provided baseline blood samples and questionnaire information between September 2008 and June 2010. Among those who did not participate in this study, most moved to other cities. The Medical Ethics Committee of the School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, HUST, and Dongfeng General Hospital, DMC, has approved this study. All participants provided written informed consent. The effective questionnaire of the current study was 25,501, and the valid rate was 94.42% .The data came from the baseline survey of Tongji-Dongfeng Cohort Study The independent variable was housework in the last six months. Most researchers agree that major housework includes cooking, cleaning, shopping for groceries and household goods, doing dishes, and laundry. In addition, comparing China\u2019s traditional family with families in modern Western countries, there was this large difference: many Chinese older adults lived together with their children (including married adult children), and even their parents, which was due to both socio-economic status and the Chinese culture of filial piety of which the latter may be the more important. Combined with previous studies on housework in China The dependent variable was self-reported two-week illness, which was continuously used in the China National Health Services Survey from the first (1993) to the fourth (2008) with a cycle of every five years Data was analyzed using the SAS statistics package, release 8.2 . We constructed logistic regression models to analysis the effects of housework on prevalence of two-week illness. Unadjusted and adjusted OR and 95% CI were calculated using univariable and multivariable regression analysis, respectively. Two logistic regression models were conducted separately for male and female. Two-sided tests were used for all analyses, and p-values of 0.05 or less were considered statistically significant.The socio-demographic characteristics of the 25,501 subjects are shown in In addition, age and education level had significant associations with two-week illness, whether in men or in women. For men, former smokers and former drinkers are more likely to report two-week illness in comparison with never smokers and never drinkers ; for women, both current and former drinkers were more likely to report two-week illness , but there was no association with smoking.To our knowledge, the current study provided the first empirical data about housework and its associations with self-reported two-week illness in retired older adults in China. The results showed that there are gender differences in the four types of housework, with higher prevalence among women than among men. The prevalence of two-week illness in women was higher than that in men. However, the association of the four types of housework with self-reported health was almost not significant, except for washing clothes & cleaning house with a negative effect for women.As to gender differences in housework, the results of the current study confirmed those of the previous studies Regarding the effects of housework on health, there are few studies at present, and the existing studies mainly targeted at prime-age adult women In addition and perhaps more importantly, the association of housework with health in the current study, especially of child care, elder care, and grocery shopping & cooking (which were not significant) and of washing clothes & cleaning house (which were significant for women), would provide a valuable clue for in-depth study of housework. In fact, it is not difficult to perceive that the three types of housework without significant association have the common feature of interpersonal interactions; on the contrary, washing clothes & cleaning house involve almost no communication with others, and to some extent are boring. Perhaps the physical activity in housework would benefit health, but the interpersonal/social and psychological activity , were not used in the current study housework and its associations with health, especially of child care, elder care, and grocery shopping & cooking (which were not significant) and of washing clothes & cleaning house (which were significant for women), which would provide a valuable clue for in-depth study of housework. The effects of housework on health would be subdivided into the dimensions of psychological and social activity besides physical activity, and it may not be suitable to simply classify housework as a kind of exercise.Despite these limitations, the current study provides initial evidence of"}
{"text": "Evidence of the role of hand hygiene (HH) in reducing morbidity and mortality rates associated with infection stimulated the creation of the \"Clean Hands\" project.To present the experiences and outcomes of the project \"Clean Hands\" that, over the past seven years, has developed a program to encourage hand hygiene.The project is based at the Center for Studies and Nursing Research for the Prevention and Control of Healthcare Associated Infections (NEPIH) at the School of Nursing, Federal University of Goi\u00e1s/Brazil, and has developed activities to encourage HH since 2006 within the healthcare establishment, with professionals, academics, patients and caregivers; municipal daycare centers, with children, parents, and workers; and in scientific events, with academics and healthcare professionals. Strategies that have incentivized compliance with HH procedures: informative stylized banners depicting HH; educational brochures, a song parody CD, demonstration of proper HH technique, using poster paints on children\u2019s hands; a puppet theater and face-to-face discussions about the importance of, obstacles to, and benefits of HH. Annually, the project hosts a festival of parodies about HH, called \"CANTAFEN\", which brings together academics and healthcare professionals.The project\u2019s day-to-day operations are normally run by five students, supported by the other members of NEPIH, currently 33 staff members , participating in the activities. The project has performed about 180 campaigns (45 were for children) reaching approximately 8.000 people.Participation in the project has contributed to development skills and competencies with regard to the implementation of health promotion strategies with different audiences and requires that students constantly stay up to date on the subject. The festival of parodies has helped to empower its members to conduct scientific and cultural events and promote emphasis of the subject in a playful manner. Although the nature of the project as an extension program hinders the assessment of the impact on adherence to HH, it is possible to infer a much larger number of beneficiaries than those directly benefitted by the actions of the group.None declared"}
{"text": "The importance of strong science, technology, engineering, and mathematics education continues to grow as society, medicine, and the economy become increasingly focused and dependent upon bioscientific and technological innovation. New advances in frontier sciences  generate ethical issues and questions regarding the use of novel technologies in medicine and public life.In light of current emphasis upon science, technology, engineering, and mathematics education , the pace and extent of advancements in science and biotechnology, the increasingly technological orientation and capabilities of medicine, and the ways that medicine \u2013 as profession and practice \u2013 can engage such scientific and technological power upon the multi-cultural world-stage to affect the human predicament, human condition, and perhaps nature of the human being, we argue that it is critical that science, technology, engineering, and mathematics education go beyond technical understanding and directly address ethical, legal, social, and public policy implications of new innovations. Toward this end, we propose a paradigm of integrative science, technology, ethics, and policy studies that meets these needs through early and continued educational exposure that expands extant curricula of science, technology, engineering, and mathematics programs from the high school through collegiate, graduate, medical, and post-graduate medical education. We posit a synthetic approach that elucidates the historical, current, and potential interaction of scientific and biotechnological development in addition to the ethico-legal and social issues that are important to educate and sustain the next generation of medical and biomedical professionals who can appreciate, articulate, and address the realities of scientific and biotechnological progress given the shifting architectonics of the global social milieu.We assert that current trends in science, technology, medicine, and global politics dictate that these skills will be necessary to responsibly guide ethically sound employment of science, technology, and engineering advancements in medicine so as to enable more competent and humanitarian practice within an increasingly pluralistic world culture. Scientific knowledge and technological tools have enabled the heuristics and advancements that have led to rapid progress in several fields  that are constituent to the profession and practices of modern medicine. Indeed, much of the current scope, tenor, and capability of medicine have been expanded, if not defined, by scientific and technological capabilities . Yet, meIf we are to prioritize science, technology, engineering, and mathematics  pursuant to medical and biomedical education, training, and practice, then it is essential to do so in ways that genuinely appreciate and apprehend these pursuits as human enterprises that are devised and articulated, and impact the boundaries of human culture and its societies. In other words, we must ground STEM education to the reality that STEM \u2013 as contributory to medicine, and like medicine itself \u2013 are human endeavors for and within the sphere of humanity, human conduct, and human ecology. We opine that to meet the opportunities, benefits, challenges, and burdens generated by the study, development, and use of STEM in real-world scenarios, education must not only be multi-disciplinary, but must engage the natural, physical, and social sciences as well as the humanities in an integrative model that 1) obtains a solid foundation in humanitarian sensitivities, 2) engages knowledge of STEM to address the challenges of modern medicine enacted on a global scale, and 3) entails the humanities and social sciences to assess and direct the value and utility of STEM  within current culture, and as means to shape health, culture, and societies of the future.Fortification of STEM education is important if we are to train medical and biomedical professionals to possess the knowledge, skills, and innovative acumen that will be required to keep pace with \u2013 and within \u2013 the worldwide groundswell of scientific and technological (S/T) progress. To be sure, S/T advancement requires significant economic support, and in turn, can elicit tremendous economic growth. Much of S/T research is conducted by, and subsidized through, the infrastructure of the so-called \u201ctriple helix\u201d of academic, government, and commercial research institutions . For exaOn many levels, the triple helix model provides a viable framework for STEM education and training . As hybrIn-STEPS) that provides a framework upon and through which to build competencies in the content, constructs, and applications of convergent sciences, as well as the knowledge and skill sets necessary to realistically observe, and meaningfully address and guide, the conduct and uses of science and technology as human enterprises [In-STEPS paradigm are to integrate scientific and humanitarian disciplines at all levels from high school through undergraduate, graduate, medical and post-graduate medical education. This will 1) provide an early exposure to issues and social implications of scientific and technological research and applications; 2) generate a deep understanding of specific ethical, legal, and policy issues that are relevant to those ways that frontier domains of science and technology can be used or misused in medicine to alter the human condition, human predicament, and various aspects of social action; and 3) develop insights and capabilities to enable more thorough and valid deliberation and direction of the ways that science and technology should be employed within clinical care to sustain the values and goods of individuals, communities, and societies [Toward this end, we have proposed a model of integrative science, technology, ethics, and policy studies  within the fabric of STEM-based pre-medical and medical education will be important to developing the abilities to responsibly (and arguably more effectively) work in and lead science, biotechnology, and medicine as well as those fields that inform and develop the policies and laws that steer and regulate science, technology, and medicine as socio-public resources, services, and good(s) ,8,9. In Currently, both the United States\u2019 National Science Foundation (NSF) and the National Institutes of Health (NIH) require training in the responsible conduct of research  for all students involved in projects and programs that are pursuing or have been awarded (NSF or NIH) grant funding ,14. Despquid pro quo such that ethics education would be required for potential and/or sustained funding of S/T research. It is possible that the addition of ethics coursework could be seen as a mere \u201ccheck in the box\u201d to secure ongoing fiscal support in the face of widespread university and federal budgetary cuts. Even so, this can still be seen as a plus-sum situation: if an adequate level of NSF and/or NIH funding were to be provided to support such ethics coursework (or curricula), appropriated monies could be used to re-fortify humanities\u2019 programs that could be specifically designed to more authentically and effectively inter-digitate with the sciences and medicine.While NSF and NIH requirements stop short of mandating that institutions develop and provide full coursework to all students in S/T majors \u2013 inclusive of medicine \u2013 we maintain that such a dictate might in fact be defensible (and laudable). This would establish both a defined necessity for the purposeful conjoinment of ELSI-STEM, and do so as a In-STEPS as proposed herein. The importance of integrating ethics and policy into STEM education increases as S/T innovation outpaces the development of policy and law. To wit, the rate of scientific discovery and technological product development has increased over the past two decades. Using neuroscience and neurotechnology as an example, a mean increase of 73% across sub-disciplines  can be seen by assessing the indexed, peer-reviewed literature of the past ten years [However, while necessary, simply providing training in, or a course on RCR is not, to our view, in and of itself sufficient to meet either the full scope of NSF and NIH intent, or, more specifically the idea and agenda of en years . As scieKnowledge about the process of politics is crucial as a variety of private entities  and political factions are exerting increasing influence on standards, regulations, and laws that bear upon the viability of the development and use of biomedical S/T advances as public good(s) . In thisceteris paribus stance and incurring frank ethical imperialism as western precepts and standards are enforced (or perhaps more accurately inflicted) upon other groups with dissimilar needs, values, and norms. On the other hand, there is the risk of treating any and all situations as prima facie contingencies, and defaulting to laissez faire ethical relativism. Both cases pose a potential risk for exertion of biopower and biopolitics [This diversity necessitates more than a mere superficial appreciation, as there are risks of negatively bi-modal ethical consequences if socio-cultural considerations are less than thorough. On one hand there is the risk of assuming an exclusively western politics : the forpolitics . It may politics . But, hopolitics ?st century world stage [To be sure, any such bioethics must recognize cultural, if not some level of moral plurality . At veryld stage . If, in ld stage ,9,23-25.The goal will be to establish an educational system \u2013 if not paradigm \u2013 that will develop, enable, and empower actors upon the new world stage who will be able to direct the use of S/T innovation through an understanding of both science, and \u201c\u2026principles which represent the full moral experience and concerns of real human beings\u201d , p.18. IIn overview, this integrated system would progressively weave historicity, ethics, and policy studies into STEM courses over the course of students\u2019 educational career. Early on, at the high school level, course content-specific examples could and should be integrated into regular class work. High school level curricula are generally more prescribed than those at higher levels of education and as such, integration would best be facilitated through collaborative initiatives connecting STEM teachers with those in the humanities. An increase in grant funding from organizations such as NSF and NIH, or through university outreach opportunities, would provide substantial support for such initiatives, particularly since individual grants at this educational level are often smaller in amount.In-STEPS curriculum could be supported in a number of different ways. University funding should support representatives of academic departments collaborating toward both the integration of ELSI into STEM courses and STEM applications into classes in the humanities. Similarly, ELSI should be integrated into medical school curricula as an expansion of the current ethical coursework and training. Increased grants from NSF and NIH in scientific ethics education\u2014as an expansion of funding programs that support the current RCR initiatives\u2014should support the development of new interdisciplinary seminars group-taught by professors in multiple departments and schools so as to guide study of the reciprocity of STEM and ELSI; such interdisciplinary courses could also access funding sources in the humanities, thereby enhancing overall fiscal support as well. Combined funding initiatives that encourage collaboration between humanities and STEM-related organizations would also facilitate integration in the professional realm and encourage the bilateral translation of academic coursework to the professional scenarios.At the undergraduate, graduate, and medical school levels, an In-STEPS paradigm extend beyond the educational sphere to impact and encompass the scope and tenor of interdisciplinary professional development. Working within the In-STEPS approach, each field would foster and encompass its own particular means of integrating related STEM-ELSI issues. Opportunities for trans-professional collaboration could be supported through intra- and inter-organizational networking opportunities. By developing and sustaining cross-professional relationships, consideration, and communication between medicine, the sciences, engineering, and the humanities can be focused both upon understanding how science and technology offers\u2014and provides\u2014potential to improve the human condition, as well as upon acknowledging and bearing the responsibility to define, prevent, and/or mitigate the ethical, legal, and social burdens, risks, and harms that such S/T advances might yield upon the current and future world stage.The effect(s) of such an In-STEPS paradigm to affect a more scientifically capable, yet sustainably humanitarian, ethos and telos of medicine.Just as research is fostered, supported, and sustained through the structure and function of the \u201ctriple helix\u201d conjoining academia, government, and private industry, so too must be the educational training of future biomedical professionals who will bear responsibility for the effects that an ever-expanding fund of scientific and biotechnological knowledge and capability will yield upon the practice of medicine, humanity, world culture, and global environments, writ both small and large. These professionals must put to use their integrated knowledge of the ethical, legal, and social issues and how they work within and inform the continued development and application of scientific and technological advances in the medical diagnoses and care. The model we propose is specifically aimed at addressing this need, and our ongoing work is dedicated to collaborating with multidisciplinary, international colleagues and institutions to further develop and realize the The authors declare that they have no competing interests.MA conducted primary research and drafted the manuscript. JG developed the core constructs, advised research and helped to draft the manuscript. Both authors read and approved the final manuscript.At the time of this work, MA was a graduate student at Georgetown University and Visiting Scholar at the Potomac Institute for Policy Studies. MA currently serves as a Research Analyst at the Presidential Commission for the Study of Bioethical Issues, however, this article was written in her private capacity. No official support or endorsement by the Presidential Commission for the Study of Bioethical Issues or the Department of Health and Human Services is intended, nor should be inferred.JG is Chief of the Neuroethics Studies Program at the Edmund D. Pellegrino Center for Clinical Bioethics, and Professor in the Division of Integrative Physiology, Department of Biochemistry, and Graduate Liberal Studies Program of Georgetown University, Washington, DC. He is Clark Fellow in Neurosciences and Ethics at the Human Science Center of the Ludwig-Maximilians Universit\u00e4t, Munich, Germany; William H. and Ruth Crane Schaefer Distinguished Visiting Professor of Neuroscience and Ethics at Gallaudet University, Washington, DC, USA, and a Senior Fellow of the Potomac Institute for Policy Studies, Washington, DC, USA.The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6920/13/58/prepub"}
{"text": "Stomach cancer is the most common cancer in Japan, China and Korea, and is the second leading cause of deaths from cancer globally, although the incidence and mortality have been declining over the years . DietaryMore interestingly, when stratified by country (Japan versus China) in the subgroup analyses performed by Kang et al. , a signiIt should be noted that there are some limitations regarding the interpretation of the meta-analysis. First, as green tea is consumed mainly in Asian countries, such as China, Japan, Korea, and a few countries in the Middle East and North Africa , we are"}
{"text": "Due to an error introduced during the production process, the Funding statement is incorrect. The correct Funding statement is: This work was funded by Centers for Disease Control, Department of Health, Taiwan, Republic of China. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript."}
{"text": "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.\"A grant was assigned incorrectly to the third author. The grant was issued to the second author, Yong-ming Yao. The correct funding statement is: \"This study was supported, in part, by grants from the National Natural Science Foundation of China ("}
{"text": "Annals of Occupational and Environmental Medicine (AOEM). The AOEM is an open access, peer-reviewed, online journal that considers original research in occupational and environmental medicine. The online manuscript submission has been successfully implemented for the journal and is now open for new submissions at http://www.aoemj.com.On behalf of the editorial board, I am pleased to announce the launch of a new international journal \u2013 The AOEM is aimed at clinicians and researchers in the wide-ranging discipline of occupational and environmental medicine and health. The topics include but are not limited to the interactions between work and health, that is, subjects like occupational and environmental epidemiology, toxicology, hygiene, diagnosis & treatment of diseases, management, organization and policy.the Korean Journal of Occupational and Environmental Medicine (KJOEM) as the official journal of the Korean Society of Occupational and Environmental Medicine (KSOEM). The KJOEM has been published only in Korean every year since 1989, started biannual publication in 1989, triannual publication in 1996, and quarterly publication in 1998. The KSOEM has endeavored to make the KJOEM a high-quality journal in occupational and environmental medicine mainly for researchers, workers, employers, and the government in Korea.The AOEM under its new name, will succeed In line with recently changes in research boundaries and recommendations of the National Research Foundation (NRF) of Korea, we made the important decision to transform the KJOEM into an English language, high quality, international journal in occupational and environmental medicine. In order to meet the goal, we have created the Advisory Editorial Board of the AOEM, consisting of world-class, excellent and experienced professors and researchers in occupational and environmental medicine. We have also implemented a very efficient administrative system in the AOEM for streamlining the whole process from manuscript submission to on-line publication for authors.Annals of Occupational and Environmental Medicine for your newest and most interesting research.I would like to thank my colleagues for their support and suggestions to make the launch of this new journal possible. I hope you will consider the The author, Sang Baek Ko, has given permission for his photo to be used as the cover page."}
{"text": "The \"Bone Involvement in Arthritis\" International Meeting was first held in Venice, in 2004, with the objective of bringing together distinguished international experts in the fields of bone metabolism and rheumatic diseases to discuss emerging knowledge regarding the interplay between rheumatic diseases and the bone tissue. The growing interest and the continuous progresses on the topic led to the organization of six other meetings, which included several different established clinicians and/or researchers.Since its origin, the meeting focused on the interactions between the bone tissue, the immune system and the cartilage in osteoarthritis, rheumatoid arthritis and spondyloarthropathies, always considering the two sides of the coin: the basic and clinical. In past years, as well as this year, specific sessions were dedicated to osteoarthritis (OA), rheumatoid arthritis (RA) and ankylosing spondylitis, respectively, with a starting session considering the general aspects of the topic. In this context, the bone damage as an early manifestation of arthritides, the systemic skeletal involvement in RA, the crucial role played by subchondral bone in the pathogenesis and progression of OA, the pathophysiology of glucocorticoids damage on the bone tissue, and the potential beneficial effects of newly approved agents such as bisphosphonates and biologics, but not only, were discussed.In 2011, the meeting has been named, for its first time, \"Osteo-Rheumatology\", thus implying the necessity of giving a more clear definition to topics presented and the issues raised. Even this year, experts in bone and rheumatic diseases interacted to improve our knowledge regarding the bone involvement in arthritis and to raise issues to be addressed in the future."}
{"text": "AbstractZombrus bicolor (Enderlein) (Hymenoptera: Braconidae: Doryctinae) in a Tuscan vineyard of the Siena province  represents the first record of this species in western Europe. A female was captured in summer 2009 with a malaise trap located in an organic vineyard. Until this finding, the species was recorded only in the Oriental regions of continental China, Taiwan, Korea and Japan and, very recently, in the eastern and southern parts of the Palaearctic region.The finding of  Zombrus bicolor (Enderlein) (Hymenoptera: Braconidae: Doryctinae) was collected in June 2009 in a malaise trap located in a vineyard (cv Sangiovese) of an organic farm in the Montalcino district . The trap was installed at ca 180 m above sea level in a typical rural Tuscan landscape, with vineyards included in rolling, gentle hills surrounded by cultivated grassland areas, PageBreakwoods and strips of shrubs, and wild bushes of deciduous trees. Until the current finding, Zombrus bicolor had only been reported as an Eastern Palaearctic and Oriental species, based on the description of specimens collected in Taiwan, China, Mongolia, Japan, Korea and, very recently, in Kyrgyzstan and in the European part of Russia (Astrakhan province)  .Zombrus bicolor are two males stored in the collection of the Museum of the Zoology Institute in Warsaw (Poland). These males were collected by H. Sauter in 1907 in Takao (Formosa), the old name of the current city of Kaohsiung in south-western Taiwan, and subsequently described by The type specimens of Zombrus bicolor  (Coleoptera: Cerambycidae)  . This wo in 2007 .These sp in 2007 , are con in 2007 .Anoplophora chinensis in the areas where we collected Zombrus bicolor, we cannot exclude that the braconid, in its movement to West Europe, had been carried by these or other specific hidden hosts.Though data are not available at the moment on the presence of"}
{"text": "More than 13 billion years ago, the universe emerged and continued expending after the Big Bang. 4.6 billion Years ago, our earth was formed in solar system with no oxygen and no any signs of life. 3.8 billion years ago, primitive elements of life of RNA and DNA were accidently formed within rocky vent in deep water of Atlantic Ocean. From single cell to multiple cell life, and to multi-organ species, it took billions years. The ocean turned blue, the land got green and oxygen fills our air. The life started move on to the land. The lives were evolving for adapting with the surrounding environment and the forms of life were diversified.However, inside each basic block of life, the cell, our common ancestor inscribed the deep common marks. From genome to protein, to signal transduction, to organelles, to cell membrane, we all life on earth are in a big family. This is the basis for our human who benefit from using our sister species to do medical experiments.The fates of life are also in common. Through the journey of birth, growth, aging and death, we all reach the same destiny. Cells are subject to the fates of senescence, mutation, apoptosis, and necrosis. The clock of life is tickling down in according with the shortening of telomeres.Once our tissue is injured, regardless of either from inside of autoimmune response or metabolic disorder, or from outside micro-organism invasion or traumatic damage, our repairing potential is intrigued, which induces the common reactions include inflammatory cells infiltration, extracellualr matrix formation. Once the damage is repaired, the inflammatory cells commit programed death, the apoptosis, and healing is achieved. If the injure continues and inflammation persists, the fibrosis and scaring process dominate, and then, the organ lost function and slides to end stage.Understanding the nature of common origin of life and exploring common path of disease would help us to see a big picture about life science, and lead to generate big ideas to deal with disease. With integration of multi-discipline collaborations, the common targets for treatment of diseases are being identified and right strategies can be developed. Efficiently developing new drugs and wisely applying old ones, rationally combining biologic with small molecule, focusing on both physical and mental would speed successes in translation and achieve the healthy lives in human being, and even dial the life clock back."}
{"text": "The complex and controversial history of this centuries-old public health strategy offers guidance for its future use. In the new millennium, the centuries-old strategy of quarantine is becoming a powerful component of the public health response to emerging and reemerging infectious diseases. During the 2003 pandemic of severe acute respiratory syndrome, the use of quarantine, border controls, contact tracing, and surveillance proved effective in containing the global threat in just over 3 months. For centuries, these practices have been the cornerstone of organized responses to infectious disease outbreaks. However, the use of quarantine and other measures for controlling epidemic diseases has always been controversial because such strategies raise political, ethical, and socioeconomic issues and require a careful balance between public interest and individual rights. In a globalized world that is becoming ever more vulnerable to communicable diseases, a historical perspective can help clarify the use and implications of a still-valid public health strategy. The risk for deadly infectious diseases with pandemic potential  is increasing worldwide, as is the risk for resurgence of long-standing infectious diseases  and for acts of biological terrorism. To lessen the risk from these new and resurging threats to public health, authorities are again using quarantine as a strategy for limiting the spread of communicable diseases  was adopted as an obligatory means of separating persons, animals, and goods that may have been exposed to a contagious disease. Since the fourteenth century, quarantine has been the cornerstone of a coordinated disease-control strategy, including isolation, sanitary cordons, bills of health issued to ships, fumigation, disinfection, and regulation of groups of persons who were believed to be responsible for spreading the infection  of ships with suspected plague-infected passengers or crew. In 1683 in Marseille, new laws required that all persons suspected of having plague be quarantined and disinfected. In ports in North America, quarantine was introduced during the same decade that attempts were being made to control yellow fever, which first appeared in New York and Boston in 1688 and 1691, respectively  virus, began spreading in China in February 1957 and worldwide later that year. Vaccines had been developed in Western countries but were not yet available when the pandemic began to spread simultaneously with the opening of schools in several countries. Control measures  varied from country to country but, at best, merely postponed the onset of disease for a few weeks pdm09 pandemic. The history of quarantine\u2014how it began, how it was used in the past, and how it is used in the modern era\u2014is a fascinating topic in history of sanitation. Over the centuries, from the time of the Black Death to the first pandemics of the twenty-first century, public health control measures have been an essential way to reduce contact between persons sick with a disease and persons susceptible to the disease. In the absence of pharmaceutical interventions, such measures helped contain infection, delay the spread of disease, avert terror and death, and maintain the infrastructure of society. Quarantine and other public health practices are effective and valuable ways to control communicable disease outbreaks and public anxiety, but these strategies have always been much debated, perceived as intrusive, and accompanied in every age and under all political regimes by an undercurrent of suspicion, distrust, and riots. These strategic measures have raised (and continue to raise) a variety of political, economic, social, and ethical issues (,The historical perspective helps with understanding the extent to which panic, connected with social stigma and prejudice, frustrated public health efforts to control the spread of disease. During outbreaks of plague and cholera, the fear of discrimination and mandatory quarantine and isolation led the weakest social groups and minorities to escape affected areas and, thus, contribute to spreading the disease farther and faster, as occurred regularly in towns affected by deadly disease outbreaks. But in the globalized world, fear, alarm, and panic, augmented by global media, can spread farther and faster and, thus, play a larger role than in the past. Furthermore, in this setting, entire populations or segments of populations, not just persons or minority groups, are at risk of being stigmatized. In the face of new challenges posed in the twenty-first century by the increasing risk for the emergence and rapid spread of infectious diseases, quarantine and other public health tools remain central to public health preparedness. But these measures, by their nature, require vigilant attention to avoid causing prejudice and intolerance. Public trust must be gained through regular, transparent, and comprehensive communications that balance the risks and benefits of public health interventions. Successful responses to public health emergencies must heed the valuable lessons of the past (List of publications chronicling the influenza pandemic of 1918\u20131919."}
{"text": "Cancer is one of the leading causes of morbidity and mortality in the world, and the global burden of cancer is predicted to grow rapidly in the coming decade. While cancer affects all communities indiscriminately, there are striking differences in the incidence and mortality among different populations. These large differences reflect a combination of differences in the prevalence of risk factors, differences in genetic susceptibility, and/or variations in cancer detection, reporting, classification systems, treatment, and follow-up. Unfortunately, developing nations or nations in the so called economical transition are those with the fastest growing cancer problem. The International Agency for Research on Cancer estimated that over a half of newly diagnosed cases and two-thirds of cancer deaths occur in low and medium-income countries . PrioritThere are striking variations in the regional cancer patterns. Among European countries, wide differences are observed in the quality of cancer care, especially between developed and low-resource, transitional countries . In geneIn order to appropriately allocate financial and other resources in the fight against cancer it is essential to have epidemiological information, plan treatment strategies, and address access issues. An important first step that could provide a basis on which to plan future epidemiology projects and ultimately to improve the quality of cancer care in Croatia is gaining accurate knowledge on the cancer registry data in Croatia.Croatian Medical Journal (CMJ) publishes six articles by different groups of authors led by Dr Ariana Znaor from Croatian National Institute of Public Health (This issue of the c Health -9. They c Health ,11. In pc Health . Of courc Health . Early dc Health ,12.The most important factors that influence cancer mortality rates are adequate cancer prevention, screening, diagnosis, and treatment . Also, tCMJ, the incidence data were obtained from the Croatian National Cancer Registry and the mortality data from the Croatian Bureau of Statistics or from the World Health Organization mortality database. In addition to incidence and mortality data collected by cancer registries, data related to underlying risk factors and treatment of patients should become more available, leading to more important and valuable information from a health outcomes point of view.In the articles published in this issue of the In conclusion, new and comprehensive data about selective cancer incidence and mortality in Croatia highlight the importance of the subject and the need to invest more in all known activities related to the fight against cancer \u2013 education, prevention, early detection, better access to adequate anticancer treatments, and multidisciplinary work."}
{"text": "Halmstad University's profile as the University of Innovation consists of the strong area of Health and Lifestyle. As many European societies are characterized by societal challenges, this strong area will turn out to be an area of research that has strong future relevance. Challenges related to an aging population, increased mental illness among young people, marginalization of disabled people, and the issues related to working life and health will be monitored by researchers within work and welfare with the help of qualitative studies.Although indicated as divided, the research areas of welfare and working life are intimately intertwined because welfare systems need to be organized. As welfare systems are based on the fact that health and well-being are dependent on organizational principles of stable structures that enable individual freedom and equal opportunities, the opposite of organizing will probably lead to health problems, both within a wider society and within organizations. Thus, the division work and welfare focuses on innovative approaches to health and well-being from a structural, organizational, and individual perspective. The division has an interdisciplinary approach with research in fields such as welfare and education systems and their impact on vulnerable groups, different aspects of working life and work organization, and culture and social life (Jonasson, it involves human existence through social and embodied and subjective experiences that affect health and well-being (see Merleau-Ponty, All types of organizations create different conditions for health and well-being. The research concerning work, health, and well-being will continue to explore the relation between the organizations of humans, and the health and well-being consequences from an individual, group, and society level. In different words, Theoretical and methodological development concerning work, well-being, and health will also be developed within this division of the journal. It involves observations, interviews, action research, and ongoing as well as summative evaluation approaches, many of which may be placed within the traditions of phenomenology, ethnomethodology, and wider qualitative methods (Garfinkel, Qualitative studies of work, welfare, and health also aspire to participate with research that propels innovations and can be utilized in response to future societal challenges. The division of work and welfare has committed to the university strategy for innovations. Research concerning work and welfare will therefore include focus on humans, work, welfare, marginalized groups, organizations, and health and life styles, where qualitative approaches will be important for producing research that is of benefit for society.Mikael JonassonDepartment of Social- and Health Sciences, Halmstad University"}
{"text": "The first Asia Pacific Bioinformatics Conference was held in 2003 in Adelaide, Australia, and has been an annual event ever since. While the locations of the previous conferences have been in the Pacific Rim, this is the first time that APBC is being held in South Asia. India is not just an emerging economy but also a burgeoning center for biotechnology and related sciences.This ISCB affiliated event was well publicized through the web, various related mailing lists and carefully targeted poster displays. We received a healthy number of submissions from 31 countries: Netherlands, Denmark, Chile, Sweden, Poland, Saudi Arabia, Portugal, Philippines, Malaysia, France, Ireland, Iran, New Zealand, United Arab Emirates, Norway, Israel, United Kingdom, Italy, Switzerland, Australia, Singapore, Japan, Republic of Korea, Germany, Bangladesh, Canada, Hong Kong, Taiwan, China, United States and India. We are happy to observe that the participation covers all continents, with the exception of Africa. While the list here has been compiled using the location of the affiliated institutes, we are certain that the authors themselves represent a wider geography than this.We received 231 submissions, about forty percent more than we expected (and surpassing each of the numbers in the previous editions of APBC). We have deliberately used a very flexible definition of \"bioinformatics\", as it is a continually evolving field, to define the scope of the conference. The diverse composition of the program committee (see Additional file The program committee, working in all time-zones, did an excellent job, burning the midnight oil when required. We targeted about three independent reviews for each of the submissions. We received four reviews for 1 paper, two reviews for 49 papers and three reviews for each of the remaining. None of the papers with two reviews were close-calls. At the end of the day, we made the difficult decision of selecting 67 papers for oral presentation at the conference and publication in BMC Bioinformatics. We are cognizant of the fact that due to the typical constraints of a conference setting many worthy submissions did not make it to this short list. Judging by the diversity of the topics as well as the reviews, we have decided deliberately not to indulge in 'best paper' assignments. We are very grateful to the program committee members who invested a significant amount of time and energy, in spite of their busy schedules, to carry out their tasks in an objective and timely manner.The authors declare that they have no competing interests.Program Committee.Click here for file"}
{"text": "In the Funding statement, an additional grant from the Korea National Cancer Center is incorrectly omitted. The Funding statement should read: \"This study was supported by grant-in-aids from the Korea National Cancer Center  and a grant (2009-022) from the Asan Institute for Life Sciences, Seoul, Republic of Korea. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.\""}
{"text": "It's almost 10 years since the computational systems biology concept has been proposed in 2002 [In addition to the progress on individual research works, the past decade also witnessed the boom of societies of computational systems biology. In China, Systems Biology and Bioinformatics have become intensive research topics and attracted many leading scientists working in biology, physics, mathematics, and computer science. Optimization, statistics, and many other mathematical methods have been widely adopted in the field. Four years ago, we launched an international symposium on Optimization and Systems Biology, which focused on bridging opportunities between optimization methodology and systems biology problems. We are happy to see the mutual benefits both in solving specific biological problems and in new theory and algorithm development . In 2010http://www.sysbio-cn.org/). Initially the society has over 120 members and a council with 35 board members representing the universities and research institutes all over China. The board member elected Prof. Luonan Chen, a professor from Shanghai Institutes for Biological Sciences, to be the founding president of this new society. Importantly, the society will keep supporting the series conference of ISB and has made it the annual conference for all the members. In addition, the Technical Committee on Systems Biology of IEEE Systems, Man, and Cyberstics society decided to financially sponsor the 5th International Symposium on Computational Systems Biology (ISB 2011), with the goal to provide a forum for exchanging ideas and information among researchers and engineers in the field of Systems Biology from engineering perspectives.Therefore, Prof. Xiang-Sun Zhang, the honorary president of Operations Research Society of China (ORSC), proposed to establish a computational systems biology society under ORSC to emphasize the integration of experimental and computational research to understand the complex biological systems. The idea was greatly supported by Prof. Ya-Xiang Yuan (the president of ORSC) and also the scientists in this field. As a result, the Computational Systems Biology Society of ORSC in China was formally set up in 2011 . To match the name, we call for the participants from an even wider range. In addition to the sponsorships from IEEE SMC, Computational Systems Biology Society of ORSC, National Natural Science Foundation of China (NSFC), Academy of Mathematics and Systems Sciences of CAS (AMSS), Shanghai Institutes for Biological Sciences of CAS (SIBS), it was further sponsored by Sun Yat-Sen University.We strongly believe that the joint efforts of societies, funding agencies, research institutes, and universities will further push the development of computational methodologies for systems biology and the practical applications in biology, medicine, drug discovery, and engineering in future.A three-day international conference on Computational and Systems Biology was held in 2-4 September, 2011 (IEEE ISB2011) in Zhuhai, which is a beautiful city in south China. More than 100 researchers including engineers, physicians, mathematicians, and biologists from China mainland, United States, Hong Kong, Taiwan, Japan, Korea, Australia, and Singapore enjoyed both academic exchanges and natural scenes. In the opening session of IEEE ISB2011, Prof. Luonan Chen announced and all the participants celebrated the establishment of Computational Systems Biology Society in ORSC of China.http://ieeexplore.ieee.org/xpl/mostRecentIssue.jsp?punumber=6026104. Sixty-three papers in this volume cover wide range of computational systems biology and all the papers are indexed by EI. Moreover, the reviewers from the Program Committee of IEEE ISB2011 selected 21 papers to be recommended for a special issue in BMC Systems Biology after significant extension of their original versions on the Proceedings. Each submission has been peer reviewed and evaluated by three independent reviewers on the quality, originality, soundness, and significance of its contributions and the significant improvement regarding to the IEEE ISB2011 proceeding paper. Here we focus on some of the highlights of the meeting by categorizing and briefly introducing these selected papers.The Proceedings of the 5th International Conference on Computational Systems Biology (IEEE ISB2011) have been published by IEEE and are available online One of the most important keyword for computational systems biology is network ,5. BiomoAnother keyword for systems biology is dynamics . DynamicIn addition to network and dynamics, the most important aspect of systems biology is data analysis and integration . ParticuIn addition to computational study at the systems level, computational systems biology approaches also can be utilized to study the molecular function of single gene or protein, because cellular functions of genes involved in specific biological processes depend on genetic, physical, and other types of interactions. In this issue, Min Xu and Frank Alber proposed a gradient-guided alignment methods based on two subtomogram similarity measures, a real space as well as a Fourier-space constrained score to align and average a large set of cryo-electron subtomogram, which emerges as an important component for structural system biology. Hari Krishna Yalamanchili et al. designed a novel automated protein functional assignment method based on the neural response algorithm, which simulates the neuronal behavior of the visual cortex in the human brain, to fill the gap between the number of sequences and their annotations. Yan Zhang et al. conducted comparative genomics studies to identify a novel DNA-binding protein, YebC, which may serve as a key transcriptional regulator that mainly regulates the gene expression of RuvABC resolvasome in bacteria.From a more general perspective, evolutionary systems biology focuses on one of the core problems of all biology, i.e., the evolutionary interplay between the genotype and the phenotype . The bidThe authors declare that they have no competing interests.YW drafted the manuscript. XSZ and LC read and approved the manuscript."}
{"text": "There were errors in Affiliations of the third author, both in the PDF and the online version. The correct Affiliations for Narayanan Srinivasan is 3. Centre of Behavioural and Cognitive Sciences, University of Allahabad, Allahabad, India."}
{"text": "The year 2010 will be proclaimed the \u2018Thoma Ionescu Year\u2019 for the Romanian medicine. This occasion marks a unique double anniversary: 150 years since the birth of the great scientist and 100 years since his surgical demonstrations during an Anglo\u2013American tour in New York, Philadelphia, Rochester and Chicago.Brother of politician Take Ionescu, Thoma signed up for the University of Medicine in Paris, in 1879, after graduating \u2018Sfantul Sava\u2019 High School, while, at the same time, attending the courses of the Faculty of Law, which he graduated in 1882. After this, he passed the exams for non\u2013resident and resident medical studentship, thus completing his clinical and surgical training.Simultaneously with his activity in the hospital as an extern and an intern, he gained the titles of associate anatomy prosector in 1887, and afterwards full anatomy prosector at the Faculty of Medicine in Paris, after passing certain examinations where he got the first prize.th year, for the Surgery Department, and he obtained the second place, thus receiving the silver medal in Surgery. In the same year, his memorial, presented at the competition for the medal, and entitled Internal Retroperitoneal Hernias, obtained the \u2018Laborie\u2019 prize of the Academy of Medicine in Paris, a prize worth 5 000 francs, awarded to \u2018the work which determined the faster progress in Surgery in the current year\u2019. Together with being granted with this prize, the physician Thoma Ionescu became laureate of the Academy of Medicine in Paris.In 1885, after another examination, he was appointed provisional intern of the hospitals and worked at Bicetre, in Bourneville's Epilepsy Department. In 1886, he was appointed full intern of the hospitals and he spent all four years in surgery, being an intern for Peyrot (Bicetre), Paul Berger (Tenon), Le Dentu (St. Louis) and professor Verneuil . In 1890, he competed for the medal offered to the interns of the 4L'evolution intrauterine du colon pelvien / Intrauterine Evolution of the Pelvic Colon, and, after an exam where he won the first prize again, Thoma Ionescu obtained the title of associate professor in Paris (1892\u20131894). In the same year, the Ministry of Public Education in Paris commissioned Thoma Ionescu, who was at that time prosector in Paris, to study and report the anatomy teaching methods used at the universities of Germany and Austria.In 1892, he presented his PhD thesis, entitled Anatomie du tube digestif / Anatomy of the Digestive Tract, in the important anatomy treaty elaborated by Poirier and Charpy, where he described for the first time in the medical literature, the duodeno\u2013jejunal fossae, the sigmoid fossae, the rectal sheath and the rectal wings.In 1894, he wrote a chapter entitled In 1895, due to a special law, the Department of Topographical Anatomy and surgical clinic was founded in the Faculty of Medicine in Bucharest, and, Thoma Ionescu was asked to become the chairman. In 1897, he participated in the International Medical Congress in Moscow, where he presented the resection of the cervical sympathetic in exophthalmic goiter and epilepsy.At the 1898 Marseilles Congress of Gynaecology, obstetrics and paediatrics, Professor Thoma Ionescu gave a lecture on the complete abdominal castration in case of uterus\u2013annex septic lesions. Anatomist by formation, then surgeon, he understood from the beginning that the fundamental bases of the surgical education also rely on the knowledge of the surgical anatomy besides the experimental surgery. That is why the Institute of Anatomy was divided by Ionescu into a Department of Topographical Anatomy and one of Experimental Surgery. The knowledge of topographical and operational anatomy allowed both the teacher and his school to imagine or improve a number of surgical techniques and methods, some of which are also valid today .Anatomie topographique du duodenum et hernies duodenales / Topographical Anatomy of the Duodenum and Duodenal Hernias). He innovated numerous fields of surgery, practicing the extraction of tumours of the optic nerve without damaging the globe of the eye; he conceived and accomplished a radical operation of uterine cancer and of the suppurations of the annex glands; he introduced new surgical procedures in splenectomy, by removing the spleen; in the surgery of the duodenal ulcer, the rachianesthesia for abdominal surgery, the resection of the rectum; the resection of the stomach in case of severe ulcers; he introduced a special procedure in the temporal\u2013maxillary ankylosis; in herniorrhaphy, in craniotomy, by cutting a section of the skull for brain operations, etc. As a morphologist, he published important studies regarding the topographical anatomy of the pyloric region of the duodenum, of the pelvic colon. He presented the results of his researches in numerous scientific works, among which: Tuberculose herniare / Hernial Tuberculosis (1891); Gastrectomies pour cancer / Gastrectomies for Cancer (1891); Technique operatoire des gastrectomies pour cancer / The Surgical Procedure of  the Gastrectomies for Cancer (1891); Sur la resection du nerf maxillaire et du ganglion de Meckel / On the Resection of the Maxillary Nerve and of Meckel's ganglion (1896); Resection totale et bilaterale du sympathique cervical dans le traitement du goitre exophtalmique et de l'epilepsie / Complete and Bilateral Resection of the Cervical Sympathetic in Curing Exophthalmic Goiter and Epilepsy (1897); Nouveaux procedes pour la cure radicale des henies inguinales / New Procedures for the Radical Cure of the Inguinal Hernias (1897); Temporary Craniotomy (1898); Treating Glaucoma by Resecting the Cervical Sympathetic (1898); Preliminary Cystotomy in the Resection of  the Urethra (1898); La splenectomie / The Splenectomy (1898); Traitement chirurgical du cancer de l'uterus / Surgical Treatment in the Uterine Cancer (1900) and so on and so forth. He was also an innovator in the field of Anaesthesiology, promoting high class rachianesthesia, used in surgical procedures of the head and the neck, procedure known as the \u2018Romanian method\u2019 ; he also conceived a high number of surgical instruments, many of them for the use in the abdominal cavity.His other contributions, considered classic, regard the anatomical study of the pharynx, peritoneum, abdomen, duodenum, pelvic colon, etc. .Between 1909 and 1910, in New York and afterwards in Rochester, in brothers' Mayo clinic, Ionescu did surgical demonstrations on upper segments of the body, under high rachianesthesia. In the field of gynaecology, he described the procedure of Cuneo'hysterectomy for the correction of the retro deviations of the uterus and was one of the first in the world to accomplish the resection of the sacral sympathetic in pelvic pains, by using his own technique.Le sympathique cervico\u2013thoracique / The Cervico\u2013thoracic Sympathetic  monograph.In 1902, while dealing with the cancer of the cervix, he proved, on the basis of the histological examinations of pelvic ganglions, that the Wertheim operation is incomplete and he recommended the extended lymphadenectomy of the pelvis. Thoma Ionescu is one of the first surgeons in the world preoccupied with the surgery of the sympathetic. He extended the exeresis of the cervical sympathetic chain to the first thoracic ganglion in Basedow disease and in epilepsy, before Jaboulay. He extended the indication of this kind of intervention in glaucoma, essential migraine and angina pectoris, and associated stellectomy with the cervical\u2013thoracic sympathectomy . These studies are included in He founded the journals \u2018Archives des Sciences Medicales\u2019 (1896) and \u2018Revue de Chirurgie\u2019 (1897), being also the founder and organizer, together with Constantin Dumitrescu Severeanu, of the Surgery Society in Bucharest, in 1898.Thoma Ionescu was elected three times Dean of the Faculty of Medicine in Bucharest, between 1906\u20131912, 1921\u20131923, and 1925\u20131926. Between 1912 and 1915 he was Rector of the University of Bucharest.He was one of the supporters of the creation of the Romanian national state: in 1918 he took part in the National Council of Unity of the Romanians in Paris. He was the first Romanian delegate to the sessions of the United Nations, between 1920 and 1921.In June 1925 he became a member of honour of the Romanian Academy."}
{"text": "Microbiological food safety surveillance is a system that collects data regarding food contamination by foodborne pathogens, parasites, viruses, and other harmful microbiological factors. It helps to understand the spectrum of food safety, timely detect food safety hazards, and provide relevant data for food safety supervision, risk assessment, and standards-setting. The study discusses the microbiological surveillance of food safety in China, and introduces the policies and history of the national microbiological surveillance system. In addition, the function and duties of different organizations and institutions are provided in this work, as well as the generation and content of the surveillance plan, quality control, database, and achievement of the microbiological surveillance of food safety in China. Food safety is one of the most important concerns of humans, and closely related to health, economic development, and social stability . In receIn 2000, the Department of Health began the surveillance of foodborne pathogens according to the planning of the Global Environment Monitoring System-Food Contamination Monitoring and Assessment Program. As the supporting organization for national food safety, the Institute of Nutrition and Food Safety of China Center for Disease Control and Prevention commissioned some provincial Centers for Disease Control and Prevention to launch surveillance and establish the National Surveillance Network of foodborne pathogens based on a project from the Ministry of Science and Technology . In AuguThe Food Safety Law of the People\u2019s Republic of China was issued in 2009 and legally clarified the role and duties of the national food safety surveillance system for contamination and hazard factors in food . One regListeria monocytogenes, Salmonella spp., and E coli O157:H7 in over 1900 samples, including raw meat, cured meat, yoghourt, raw milk, ice cream, and aquatic products of animal origin for eating raw [Development of the microbiological surveillance system of food safety in China has passed through two stages. The first stage encompassed the surveillance of foodborne pathogens from 2000 to 2009. It aimed to evaluate food safety risk, develop policy and standards, and guide food hygiene supervision, production, and consumption. The number of participating provinces gradually expanded from 32.3% (10/31) in 2000 to 71.0% (22/31) in 2009, and prefecture-level cities covered from 10.5% (35/334) in 2000 to 51.2% (171/334) in 2009. In 2000 the surveillance only tracked contamination of ting raw . With tiThe second stage was the establishment of the National Microbiological Surveillance Network in 2010. For the implementation of food safety surveillance required by the food safety law of the People\u2019s Republic of China issued in 2009 , the NatFor efficiency, the national food safety surveillance plan was jointly issued by NHFPC, the Ministry of Industry and Information Technology (MIIT), the Ministry of Commerce (MOFCOM), the General Administration of Quality Supervision, Inspection and Quarantine (AQSIQ), the Food and Drug Administration (CFDA), and the State Administration of Grain (SAG), according to the Food Safety Law of the People's Republic of China and its implementation regulations .The national microbiological surveillance program aimed to obtain the levels and trends of main microbiological contaminants of major foods in China, determine the potential sources and distributions of the hazards, provide a scientific basis for food safety risk assessment, standards setting, and tracking and evaluation; these actions help in taking appropriate risk control measures timely.The China National Center for Food Safety Risk Assessment (CFSA) is responsible for providing technology guidance to the national food safety surveillance, personnel training and quality control; in addition, CFSA gathers, analyzes and manages the surveillance data, and identifies food safety problems and puts forward timely proposals. When the national surveillance is issued yearly, the CFSA gathers experts from epidemiology, microbiology, statistics, and quality control fields to draft and revise the manual guiding future surveillance work.The provincial Health and Family Planning Administrative Departments must establish regional surveillance programs according to the national surveillance plan\u2019s content and requirements. It should clearly appoint the technological institutions for implementation, management, trainings, analysis of the regional surveillance data, and notification and consultation of the surveillance results.Food safety surveillance in China is very different from the European Union. In China, the national government pays most of the costs of annual food safety surveillance, and every province must complete all of the work according to the national surveillance plan, and, additionally, provide a real-time report of all detailed surveillance results to the central government ,12. An a(1)Foods with greatest health hazards and highest risks must be included;(2)Food easily causing health effects on special groups such as infants and young children must be emphasized;(3)Foods with wide and significant consumption should be taken into consideration;(4)Foods and items ever involved in domestic food safety accidents in the past or with high attention by consumers must be included;(5)Foods involved in health hazards abroad, with evidence of possible existence domestically must be included.The Health and Family Planning Commission issues an annual notice of advice and proposal to the National Food Safety Surveillance Plan from the Administration of Quality Supervision, Inspection and Quarantine, State Administration for Industry and Commerce, State Food and Drug Administration, and relevant research institutes and industry associations. CFSA is responsible for the summary and analysis of all concerns and suggestions, and invites experts from different departments involved in food safety supervision, industrial management, food inspection, and laboratory quality control for panel discussion. The resulting draft is proposed to related departments, and, after consultation, a final food safety surveillance plan is formed with the approval of all relevant departments. The surveillance items and content of the plan must be guided by the following principles:Salmonella in raw meat and Vibrio parahaemolyticus in fish. Special surveillance explores the contamination source and critical control points, which includes processing surveillance and surveillance of food chains, e.g., Cronobacter spp. in infant powdered formula processing surveillance and Vibrio parahaemolyticus in aquaculture, sales, and catering of freshwater fish. These two kinds of surveillance are closely related. For example, routine surveillance showed that the contamination level of Vibrio parahaemolyticus in freshwater aquatic products of animal origin is similar to seawater aquatic products of animal origin, and special surveillance was initiated to trace the source of Vibrio parahaemolyticus in freshwater fish. The surveillance of the food chain enables detection of hazards so that systematic control and intervention strategies can be adopted. Emergency surveillance is a quick-start process used only in the event of food safety emergency incidents, when unplanned risk assessment is needed.There are three types of microbiological surveillance: routine, special, and emergency surveillances. Routine surveillance includes a wide range of representative organisms to obtain the overall microbial contamination and its trend in foods, e.g., To ensure scientific and accurate sampling and data analysis, and to improve the ability of surveillance institutions, CFSA organizes technological trainings in sampling, examination methods, and data reporting every year. Provincial-level institutes should train the municipal-level counterparts with the same contents, and amplify the training contents according to the actual situation, e.g., internship in the laboratory. There is detailed requirement for the design of a concrete implementation plan for sampling, quality control, analysis methods, information reporting, and data management in the annual manual of surveillance.Surveillance work in every institute should incorporate a quality management system. CFSA organizes and develops methods for quality control, for example, to distribute quality control analysis samples for examination, evaluate data quality and work performance yearly in each province, and communicate at the annual work conference and training meeting the outstanding experiences. Provincial-level institutes should be responsible for the improvement of municipal-level institutes with wrong examination results and other mistakes.All these data are submitted to CFSA by the Network System of National Food Microorganism surveillance . In ordeSalmonella, Cronobacter spp., Bacillus cereus, Staphylococcus aureus, Listeria monocytogenes, Vibrio parahaemolyticus,Campylobacter jejuni and Clostridium botulinum, as well as hygiene indicator bacteria such as E. coli and other Enterobacteriaceae. Parasites are relatively less monitored, and mainly include nematodes, Angiostrongylus cantonensis, and Trichina spp. The only virus monitored is Norovirus. The information database of food microbial contamination in China has been established, which gradually clarifies food contamination of main foodborne pathogens in different regions, seasons, packaging types, food categories, brands, and sampling sites in China. The contamination data regarding main foodborne pathogens and indicator bacteria are well representative, but it is still necessary to strengthen the surveillance of foodborne viruses, parasites and several pathogens due to the fact that only part of the laboratories can perform an analysis. For example, Campylobacter jejuni is one of the world\u2019s most important food poisoning pathogens [There are over two million pieces of data from about 500,000 samples, including various kinds of major foods and local foods related to foodborne diseases. Surveillance items include mainly foodborne pathogens such as athogens , howeverThe nationwide network and system for food microbiological surveillance is the responsibility of CFSA, who acts as the technical leader in this work, the provincial and prefecture level institutions as technical support and backbone, respectively.Salmonella spp. and Listeria monocytogenes often contaminate cooked meat. In addition, the contamination rate of Salmonella spp. in raw chicken is higher than that in live chicken, due to cross contamination in the slaughterhouse. As favorite and delicious foods of many Chinese, raw aquatic products pose a high risk for foodborne diseases because of Vibrio parahaemolyticus and listeria monocytogenes.Through continuous surveillance and accumulating scientific data, the basic contamination levels and trends in major foods, such as meat and meat products, milk and dairy products, eggs and egg products, animal products, cooked rice flour products, infant and young children foods, and many other kinds of Chinese meals, are now clarified. The current monitoring results show that the overall situation of relevant foods is good, although some food safety problems remain. The microbiological contamination level in bulk products is higher than that of prepackaged products. However, foodborne pathogens were still isolated from prepackaged products, especially those produced by contract manufacturers and small businesses. Seasonal differences also occur, with higher detection levels in the second and third quarters for microbial contamination of bulk products, but not prepackaged products. Microbiological contamination is higher in street stalls, especially unlicensed mobile stalls when compared with other sampling sites. However, there are exceptions. For example, bulk ice cream at a large hotel has higher microbiological risk than that served in the fast-food cafe, perhaps due to the length of shelf life in the big hotel. Cross contamination during food processing is common; for example, fruit salad is higher risk than whole fruit, and Listeria monocytogenes in ready-to-eat food have been used in the food safety risk assessment project \u201cquantitative risk assessment of Listeria monocytogenes in ready-to-eat food, where suggestions were provided to the classification and revision of \u201cNational Food Safety Criteria For Foodborne Pathogen\u201d (GB 29921-2013) [Bacillus cereus in powdered infant formula from 2011 to 2013 [Bacillus cereus contamination in powdered infant formula and the necessity of setting-up relevant microbiological criteria.Food surveillance provides basic data and technical support for risk assessment and standards-setting, and promulgation of food safety laws. The surveillance results provide advices and tips for assessment projects, relevant analysis methods, and standards of food safety. For example, the data regarding 21-2013) . Accordi to 2013  and crit to 2013 , Austral to 2013 , the relCronobacter spp. occurrence in this retail product decreased rapidly from 1.1% in 2012 to 0.35% in 2013. Additionally, the surveillance system has changed the focus of food safety priorities. For example, the notification of contamination by Cronobacter spp. and Bacillus cereus in goat powdered infant formula provided clues for the supervision and administration of this kind of food. A 0.94% and 2.51% occurrence of Salmonella spp. and Listeria monocytogenes in bulk packed cooked meat products in the Chinese retail market is higher than these in the pre-packed cooked meat with an occurrence of 0.03 % and 0.28 %. However, as one of the most popular foods for Chinese and one of the most common sources of food poisoning in China, there is no microbiological food safety criteria for bulk packed cooked meat in China, which has caused particular attention of the government and highlights that the next step of risk assessment and criteria development is necessary.To give full play to the role of food safety surveillance, CFSA timely analyzes the reported results, immediately organizes examination when necessary, and identifies possible potential hazards based on timely and accurate principles. For example, the control of production process of powdered infant formula was initiated from 2013 to 2014 to find the contamination source due to persistent contamination of retail products from 2011 to 2012. The contamination of foodborne pathogens decreased greatly in the infant powdered formula by this two-year action, and the incidence of The national microbiological surveillance data only reflect the overall Chinese food safety situation, but not special aspects of every province, autonomous region, and municipality. The sample numbers are relatively low to complete a comprehensive and systematic risk assessment at the provincial level. Therefore, it is recommended to establish a local investment and safeguard mechanism to develop local microbiological surveillance, especially for local characteristic foods.It is very important to apply information technology in the development of surveillance. Currently, the value and significance of spatial analysis technology of a Geographic Information System in the application of risk analysis and early warning is being explored. An exchange platform will be built to share the national food safety surveillance data between different organizations and institutions. These advances in data security, data analysis, and early warning will improve the timeliness of data utilization and response. In addition, the use of network information will become an important field of food safety risk assessment, with the continuous advance of the \"big data\" era on the internet.It\u2019s been proved that surveillance system is a powerful tool for increasing food safety. The Chinese government has worked hard to build a comprehensive surveillance system, but there is still much work that needs to be done despite the rapid development over the past six years."}
{"text": "The Cancer Screenee Cohort Study was first established in 2002 by the National Cancer Center in South Korea to investigate all possible risk factors related to cancers and to expand biological specimen banking for the development of effective methodologies for cancer detection, diagnosis, and prevention. As of July in 2014, total 41,105 participants were enrolled in this cohort. Data were collected via questionnaire, clinical examination, cancer screening, and biological specimen testing including blood, urine, and exfoliated cervical cells. The highest incidence was found to be thyroid cancer, according to a nested case-control study that was linked to the National Cancer Registry information as of December 31, 2011. Case-control, cross-sectional, and cohort studies have been published using these data since 2009. Diet and nutrition was the most published topic, followed by genetics, hepatitis B virus and liver cancer screening, methodologies, physical activity, obesity, metabolic syndrome, smoking and alcohol consumption, and blood type. Evidence from the Cancer Screenee Cohort Study is highly anticipated to reduce the burden of cancer in the Korean population and aid in the detection, diagnosis, and prevention of cancer. A cohort study is one type of observational research design performed over a specific follow-up period in which individuals with an incident disease of interest are compared with those who do not develop the disease. In South Korea, the Korean Multi-Center Cancer Cohort study (KMCC) was established in four geographically-defined urban and rural regions in 1993 and included adults in the general population-based over 35 . The KoGOther developed countries such as the US, Japan, and Europe initiated large cohort studies throughout the last few decades to investigate the associations between risk factors and cancers. For example, the Japan Public Health Center-based prospective study on cancer and cardiovascular diseases was based in 11 public health centers and included a study population of more than 140,000 participants who had been followed from 1990 (cohort I) and 1993 (cohort II) . This EuAdapted after careful review of these previously implemented cohort studies, the Cancer Screenee Cohort Study was established in 2002 by the Center for Cancer Prevention and Detection at the National Cancer Center (NCC) in South Korea. The purpose of this study is to investigate possible risk factors related to cancers and to expand the banking of biological specimens for the development of effective methodologies for cancer detection, diagnosis, and prevention in the Korean population. In last decade, several influential cohort studies have been established and developed with the help of Korean government. In particular, the NCC collects some of the most representative data on cancer epidemiology, and it is highly anticipated that these data will help reduce the burden of cancer in the Korean population. Herein, this paper is to introduce the establishment and achievements of the Cancer Screenee Cohort Study at both national and international levels since 2002.From August 2002 till July 2014, 41,105 participants aged between 30 and 70 years were enrolled in this cohort study. Collected demographic data included the participants\u2019 age, gender, marital status, education level, household income, job, smoking habits, alcohol consumption, and family history of cancer . ParticiThe institutional review board of NCC approved this study in August 2002. All participants provided informed consent, were informed of their right to withdraw from the study at any time without penalty, and were informed that the purpose of this study is to detect, diagnose, and prevent cancer in South Korea.By matching resident registration numbers with participants, the incidence of cancer cases in the cohort was confirmed by linking with the Korea National Cancer Incidence Database of the Korea Central Cancer Registry . The incSince 2009, the results of this study have been published in scientific journals. Published topics include diet and nutrition (14 publications) -23, geneData from this cohort study will help determine risk factors of specific cancers in the Korean population. The findings of this study are also expected to be used for the development of a scientific model to determine the influence of interactions between genetic and environmental factors, and provide evidence-based preventive medicine at an individual level. Moreover, the findings of this study will aid in the design and evaluation of policies on a national level and in the exchange of scientific knowledge and manpower to coordinated future national and international studies."}
{"text": "Food safety is a global priority and an important public-health issue as foodborne diseases (FBDs), infections, and intoxications are a major cause of morbidity, mortality, and economic burden worldwide. Recognizing the importance of food safety in preventing and controlling FBD as an important cause of illness and deaths worldwide, the World Health Organization (WHO) adopted Resolution WHA 53.15 in 2002, establishing food safety and the prevention and control of FBD as a global priority. Further, in May 2010, the WHO adopted Resolution WHA 63.3 urging its Member States to improve evidence-based food safety efforts by conducting disease burden studies. Similarly, the Pan American Health Organization (PAHO), as the WHO Regional Office for the Americas, included food safety as one of its strategic objectives in its 2008-2012 Strategic Plan and FBD Surveillance as one of the five components of its hemispheric Plan of Action for Food Protection.Precise information on the burden of illness (BOI) is needed to help guide the FBD control efforts. In response to the gap in data, the WHO launched an initiative to estimate the global burden of FBD in collaboration with multiple partners in 2006 and developed a rigorous approach for BOI estimation worldwide. For several years, PAHO/WHO has been catalyzing the creation of capacity in Member States to quantify the national burden of foodborne diseases. Recently, some countries in the Americas published estimates of foodborne disease burden. Nevertheless, in large parts of the Americas, such estimates are completely lacking.In the Caribbean countries, the epidemiology of food- and waterborne illnesses at the community level is poorly understood. Little information on disease burden and aetiology is available, thereby limiting appropriate prevention measures. To better understand the epidemiology of FBD, measure its burden and impact, and thereby develop appropriate prevention and control measures, PAHO/WHO and the Caribbean Epidemiology Centre (CAREC), in collaboration with Member States and strategic partners, executed a Caribbean BOI study from 2008 to 2012 in seven countries . These BOI studies provide evidence-based information to guide the allocation of limited resources intended for the health agenda, appropriate intervention measures, and to ensure the sustainability of the Caribbean tourism economies.At the time when these studies were done, CAREC was a PAHO/WHO centre. As of January 2013, CAREC became part of the Caribbean Public Health Agency (CARPHA), the latter being governed by the Caribbean Community (CARICOM). CARPHA continues with the responsibility for preventing disease, promoting heath, and responding to public-health priorities in the Caribbean region. The strategic partners in the Caribbean BOI studies were: Public Health Agency of Canada, University of Laval in Canada, University of the West Indies in Trinidad, Ross University in Dominica, St. George's University in Grenada, and the Caribbean Eco-Health Programme (CEHP). The CEHP was designed to address the challenge of building capacity and capabilities, translating and transferring knowledge, technology, and skills to public and environmental health professionals working in the CARICOM region. The PAHO/WHO and CAREC-led Caribbean BOI studies were one of four components of the CEHP. Funding was provided by PAHO, CAREC, Member States, and largely by a grant from the International Development Research Centre, Ottawa, Canada, that was obtained by the CEHP.As of June 2012, the BOI studies estimated the prevalence and burden of acute gastroenteritis (AGE), specific FBD pathogens, risk factors of infections, economic costs, and gaps in AGE surveillance and, thus, provided information to guide appropriate FBD reduction efforts and food safety policy interventions for the seven countries in the Caribbean region. This Supplement of JHPN presents the findings of the burden of illness studies in respective countries. All countries used a similar methodology to conduct the population-based and laboratory-based surveys. Using a series of multipliers derived from the two national surveys, the burden of AGE, FBD, and specific FBD pathogens was calculated. Saint Lucia conducted the first BOI study. Lessons learnt from this pilot study were used in improving the implementation of the studies in other countries of the region.These BOI studies are the first to be conducted by the Caribbean Member States to estimate the prevalence and burden of AGE and FBD. The findings are profound and have provided valuable information to guide appropriate FBD reduction efforts and food safety policy interventions for the Caribbean. This syndromic approach is a relatively simple and low-cost initial step in gathering reliable information on the burden of disease associated with food consumption. However, we recognize that complementary approaches are needed to define better the burden of diarrhoeal illness associated specifically with the transmission of foodborne pathogens. Foodborne diseases are an important cause of morbidity and mortality in the Caribbean. The calculation of the cost of unsafe food, and especially of the burden arising from microbiological contaminants in food, is a starting point for determining the real burden of disease. The Caribbean BOI studies will continue under CARPHA, with support from PAHO, using additional data being obtained in Antigua and Barbuda, Belize, and Bermuda.www.idrc.ca) and the Cooperative Agreement of the Centers for Disease Control and Prevention, USA.I would like to thank the national authorities in each country for the support in conducting the studies; CAREC/CARPHA and PAHO secretariats for the coordination and management of country-specific studies and for support for publication of this JHPN Supplement. This work is made possible with the aid of a grant from the International Development Research Centre, Ottawa, Canada (Again, thanks to all involved in this great work."}
{"text": "The first Euroanalysis conference took place in Heidelberg, Germany, more than 30 years ago. Since 1972, the meeting have focused on various analytical chemistry issues, and been established as a forum for the analytical community from academia, governance, and industry in Europe with worldwide recognition. Euroanalysis, held biannually, with the venue rotating among European countries, was hosted so far by Austria, Belgium, France, twice in Germany, Hungary, Ireland, Italy, Portugal, Serbia, Spain, Switzerland, and twice in Poland (the last in 2013). The main organizer of the Euroanalysis conferences is the Division of Analytical Chemistry of the European Association for Chemical and Molecular Sciences (EuCheMS).The 17th European Conference on Analytical Chemistry, held in Poland from August 25 to 29, 2013, was organized by the Polish Chemical Society and Committee on Analytical Chemistry of the Polish Academy of Sciences. Supported by EuCheMS, IUPAC, and the Polish Ministry of Science and Higher Education, the event was jointly organized by the Faculties of Chemistry of the Warsaw University of Technology and the University of Warsaw.The main aim of Euroanalysis XVII was to share ideas on recent developments of instrumentation and application in the field of analytical chemistry towards human well-being and sustainable development. Continuing previous successful conferences, both fundamental research and practical analytical applications were discussed.The conference was held in Warsaw, a city of opportunities, entertainments, art, and science.The conference began with well-attended short courses, organized for Sunday, 25th August. The opening ceremony conducted at the Great Hall at the Technical University of Warsaw was followed by the special plenary lecture given by Professor Adam Hulanicki, distinguished and worldwide recognized Polish analytical chemist. You can read his view on the history of Polish analytical chemistry in this issue.A special session was dedicated to the DAC EuCheMS Award Ceremony of the Robert Kellner Lecture; this time the award was given to Jurgen Popp. After the special laudation given by Paul Worsfold, Raman spectroscopy and its use for biomedical analysis were intensely discussed by Jurgen Popp.The conference program was divided into various thematic sessions, covering environmental, biomedical, forensic, and food analysis; trace elements and speciation; industrial and process analysis; separation techniques; electrochemical methods and devises; as well as recent progress in modern analysis. Analytical methods for cultural heritage and art, education in analytical chemistry as well as chemometrics, quality assurance, and metrology were discussed during the conference. The scientific program was concluded by the special keynote lecture on \u201cQuantification of human errors in chemical analysis using expert judgments\u201d given by I. Kuselman. Close to 600 posters were presented during the entire conference, and six of them were awarded Best Poster Awards by Springer. Besides the presentation given by senior scientists, it is worth highlighting the large number of young scientists and the high scientific level of their contributions.The social program aimed to provide an occasion for informal discussion and enriching friendships with analytical chemistry societies. The key points were as follows: Sunday evening get-together in the main building of the Warsaw University of Technology to greet friends and welcome them to Warsaw; Beer Barbecue party in \u201cGo\u015bciniec Wiecha\u201d in Heritage Park outside of Warsaw, an excellent opportunity to taste local specialties of the Mazovian village cuisine on Monday evening; beautiful costumes, live folk music, and dance given by dancers on the stage of the famous \u201cTeatr Polski\u201d gave the chance for a music-and-dance trip around various regions of Poland during the enjoyable Tuesday evening; last but not least was the conference Gala Dinner, which took place on Wednesday in the Main Hall of the Warsaw University of Technology, which specially for this evening was turned into a unique ballroom complemented by a spectacular composition of light and music.The very intense program of Euroanalysis made the days in Warsaw pass extremely quickly. During the closing ceremony, held on Friday, the participants expressed their appreciation to the organizing committee for all their effort to assure an excellent atmosphere during the conference.The next Euroanalysis event will be organized in 2015, in Bordeaux; good luck to our friends from France!"}
{"text": "After publication of this work , we note1*, David Altshuler1, Margit Chadwell2, Juliann Binienda2.Mio NakamuraMN made substantial contributions to conception and design, acquisition of data, analysis and interpretation of data, and drafted the manuscript. DA made substantial contributions to conception and design, acquisition of data, analysis and interpretation of data. MC made substantial contributions to the inception of the study, revision of the manuscript, and is Medical Director of the student-run free clinic. JB made substantial contributions to conception and design, analysis and interpretation of data, and revised the manuscript. All authors read and approved the final manuscript."}
{"text": "In the PDF download of this article, the publication date is listed incorrectly. The correct publication date is March 4, 2015.The Funding section also contains an error. The Funding statement is repeated, appearing twice instead of just once. The correcting Funding statement is: Financial support was received from the DFID Animal Health Programme , the DFID/RCUK programme on Zoonoses and Emerging Livestock Systems , and the ICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR). The funders had no role in study design, data collection and analyses, decision to publish, or preparation of the manuscript."}
{"text": "The grant number for the second funder, the Natural Science Foundation of Liaoning Province, is incorrect. The correct grant number is: 201102247. Please see the full, correct funding statement below.The funders of Scientific and Technological Project of Liaoning Province (Grant No.2009225007-7) played an important role in study design, data analysis, preparation of the manuscript and decision to publish, the Natural Science Foundation of Liaoning Province (Grant No. 201102247) played an important role in the sample collection and diagnosis of the NSCL/P."}
{"text": "Over the past century, the study of genetics has revolutionized our understanding of life on earth. Our knowledge of trait heritability from parent to offspring has been central to predict the trajectory of evolution, studying disease, and successful breeding of crops and animals. The field of genetics continues to grow in leaps and bounds due to next-generation sequencing, metagenomic approaches, genetic engineering, a better understanding of epigenetics, and, most recently, the creation of synthetic chromosomes , but the potential for application of this knowledge seems limitless."}
{"text": "Improving on previous social protection schemes, in 2000, policy-makers created the Mexican Social Protection System in Health (SPSS), an insurance scheme to expand financial coverage for health care, and especially to reduce and eliminate out-of-pocket health expenditures by the poorest households. Mexico has been widely applauded for achieving universal health coverage, meaning financial coverage, in 2012. However, such an achievement does not, by itself, result in adequate services for women's sexual and reproductive health and rights . Two key SPSS programmes prioritise SPSS enrollment for pregnant women and their families, and send out mobile units to work with rural midwives. SPSS also provides financial support for the treatment of cervical cancer, breast cancer and mental health, as well as other services that are critical over a woman's lifetime.While the SPSS has helped reduce the risk of crippling health costs for many of the poor, only limited information is available on the percentage of SPSS coverage that applies to SRHR services, and the impact on SRHR has been inadequate. For example, if the pace of the decline in the maternal mortality ratio, from 56.1 in 2002 to 43 in 2013, continues, Mexico will not meet its Millennium Development Goals (MDG) 5 goal of 22.2 (Government of Mexico, Office of the President, At least three factors inhibit progress and must be improved in the years ahead. First, the SPSS emphasis on financing has meant that the following key aspects of care have been neglected: improving the quality of services; strengthening and modifying the distribution of services within the health infrastructure; developing effective referral systems; increasing the number of skilled health workers, especially midwives and other primary- and mid-level providers; and ensuring access to translation for indigenous women in order to facilitate their effective use of services (CIDE & CONAPRED, Second, Mexico is a Federal Republic, and meeting the right to health for all is the responsibility of 32 states, posing some major challenges for quality assurance and the efficiency of resource spending, among other areas.Third, many women face other significant barriers to accessing SRHR services, including low levels of education; subordination within families and communities; lack of transportation; violence; as well as stigma and discrimination based on ethnicity, sexuality, race and age; all of which require stronger multi-sector policies and programmes to overcome.It is critical for the SPSS, and similar initiatives in other countries, to reduce and eliminate profound inequalities affecting women's access to health services, especially those that are based on income, age, ethnic origin and geographical residence. This requires allocating the maximum available resources, a human rights standard, to public health financing, particularly for SRHR.Finally, the international right-to-health standards for the availability, accessibility, acceptability and quality of goods, services and facilities need to be central to the next stages of health services development. This requires transparency in health sector budgeting and expenditures, effective accountability mechanisms and data collection and monitoring systems that, among other things, enable programme managers, policy-makers and others to track quality of care and individual health outcomes, not just services provided. It further requires mechanisms through which redress can be sought when human rights are abused or the government does not live up to its obligations under international human rights law."}
{"text": "A sample of 13 articles was selected. studies have highlighted the decrease of urinary tract infection related tocatheterism through reminder systems to decrease of people submitted to urinarycatheterism, audits about nursing professionals practice and bundles expansion.the present review systemizes the knowledge of used strategies by healthprofessionals on introduction to international recommendations, describing a ratedecrease of such infection in clinical practice. About 15% to 25% of hospitalized people are submitted to vesicalcatheterization. In most cases, this technique is used without proper indication, extendingits unnecessary use. CAUTI is referred to in several studies about increase on mortalityand morbidity, as well as hospitalization, and, consequently, associatedcosts.Catheter-associated urinary tract infection (CAUTI) is frequent on hospitalized people.On infections associated to health care, catheter-associated urinary tract infectioncorresponds to 40%. About determined that UTI rate was superior to 560 thousands when compared toother HAIs, with a mortality rate of 2.3%, and bacteriuria (which develop bactareamia)cases lower than 5%. UTI is the main cause of infecctions on secondary nosocomialbloodstream, about 17% of nosocomial bactareamia origin from urinary, with an associatedmortality of 10%. Society for Healthcare Epidemology of America (SHEA) estimates between17% and 69% of CAUTI can be prevented through infection control recommendations, basedon evidences.However, it is pointed out that when compared to other healthcare-associated infections(HAI), urinary tract infection (UTI) presents a low morbidity. A study carried out inthe USA determi. Currently, the practice based on evidences is a highlight in a culturethat aims a quality standard for safe care. However, it is pointed out that many timesprofessionals face a few embarrassments regarding the connection between results fromthe most current and practical investigation. The way actions and/or strategies areapplied for implementations, in one document, providing practical changeable tools toreaders, based in measurable results. This systematic review supplies the answer to thisneed, gathering the scattered knowledge on literature and facilitating the access tosafe practices based on evidences. The study's goal was to search evidences regardingstrategies that health professionals found out on practice to apply/implement of CDCrecommendations and CAUTI prevention. The investigation suggests that CAUTI prevention goes through recommended actions, andbased on evidences that lower the rate for this infection. Simple initiatives as handhygiene, use of a reliable technique, maintenance and the way the catheter is removedcan contribute to prevent the associated infection. An unnecessary urinary catheterismand the period of permanency of catheter influence the infection development, beingmodifiable factors. CurrenThe structure of this systematic review on literature was based on the CAUTI thematic,elaborating the initial question, defining eligibility criteria, selecting articlesamples and further analysis and results discussion. To obtain the answer to the initialquestion \"What are the strategies health professionals use for implementing the Centersfor Disease Control and prevention (CDC) guidelines for CAUTI prevention?\". A systematicreview of the literature was made to reach this goal. As a research strategy, the following health descriptors were used: urinary ANDinfection AND catheter AND nurs*. To find answers to this question, the goal was toperceive how nurses operationalized the recommendations of the Centers for DiseaseControl and prevention on praxis and intervention on CAUTI prevention.(r), Nursing & Allied Health Collection,Cochrane Plus Collection, MedicLatina, MEDLINE(r), Academic Search Complete,ACS - American Chemical Society, Health Reference Center Academic, Nursing ReferenceCenter, ScienceDirect Journals, and Wiley Online Library. Face to the studiedphenomenon, the eligibility criteria were established according to The temporal limit of research was from January 2007 to December 2014, for fullyavailable papers, as a way to contextualize the thematic in the past seven years. Thedatabases used were CINAHLComparison [C] was removed. Wealso considered, when selecting the studies, the bibliographic referencesmentioned. On the initial phase, 92 articles were obtained, from which, 38 wereexcluded by their titles. After reading 53 abstracts, 29 articles were rejected.Twenty-five articles were fully analyzed, from which 12 were rejected, according theinclusion/exclusion criteria, leading to 13 articles selected to perform the systematicreview on literature. We would like to highlight that the exclusion of articles was also related to lack ofinformation about parameters considered important for the analysis; participants,interventions, results, study's draw. Facing the studies' diversity and non-relevance tothe investigation question, the parameterentioned. On th, determining that most of the selected articles presented a high level ofevidence, considering about 70% are on evidence level Ib. On evidence level Ib, thescientific evidence comes from, at least, a random clinical trial. Following twoarticles placed on evidence level IIa, and two articles on level Ia, the last one beingthe higher evidence level. On level IIa, the evidence was obtained through a forward study controlledand well designed, without randomization. On level Ia, the scientific evidence obtainsthrough a met-analysis of random clinical trials. The 13 selected articles, accordingthe evidence level, are presented on Afterwards, the articles were classified in accordance to evidence level, determce level. On levThe results are presented in table, with the analysis of studies selected to reviewliterature, specifying each one according to author, year, country, participants,interventions, results and design . Wemade, promoting a more consistent validity for the resolution of theproblem.In the search for better evidence, we concluded that the articles present a high levelof evidence for the answer to the matter being investigated. They are in between thelevels I and II of evidence, promot(11-12) what was defined was the time of development ofthe studies, and not the number of clients.The number of participants in the analyzed studies varied between 50 and 4,963. In tworetrospective studies (-), the results were similar in comparison to smaller groups. We determinedthat, despite the difference in the methodology applied, the results of the studies areanalogous. In the majority of them, there was an intervention phase and apost-intervention one. Some studies motivate the formation of nurses about the guidelines ofprevention of CAUTI, revealing extreme importance in their duties .Although big difference between the number of participants in different studies, havinggroups with more than 2,000-7, thies ,-,17.Taking into account the obtained results, according to (15) - UCAM - based on scientific recommendationfor the prevention of CAUTI, the nurses managed to improve the records under themanipulation done in the technique of vesical catheterization. The records, asindicators of vesical catheterization and evaluation of the necessity to keep thecatheter, have motivated the removal of the catheters considered unnecessary(-). According to the guidelines of CDC , the early removal of the urinary catheter contributes for the preventionof the infection associated to this device.By making the audit document - UCAM -ssary-. Accord of CDC , the ea. The justification used by the nurses was based on appropriate indicatorsdescribed on scientific evidence, concerning the need of the urinary catheter. In thecases in which the catheters were not removed, the duration of the catheterizationdecreased, so did the incidence of CAUTI.One of the strategies used by the nurses was to remind the doctor about the necessity ofthe urinary catheter-,10. T. The term bundle was developed by the Institute for Healthcare Improvement(18) to describe a set of intervention, based on evidence and directed tothe clients/population who are under inherent risks care. This set of intervention, whenimplemented together, originate significantly better results than those implementedindividually. The bundle used were related to the insertion technique and themaintenance of the vesical catheter, to avoid the urinary catheter, and also, limitingits duration.The dominant strategy throughout the studies is the application of bundles of manyformats in the prevention of CAUTI -,-14. Trovement to descr. On the other hand, when the indication for the usage of catheter was notpresent, it was removed after analysis with the doctor. With the application of thealgorithm it was subjacent the daily evaluation of the necessity of the urinarycatheter. Both studies allowed the reduction of the usage of the vesical catheter andthe incidence of CAUTI.Another identified strategy was the creation of the algorithm for the maintenance of theurinary catheter, based on evidence, whenever really necessary ,17. O. In this study, there is a decline of the usage and unnecessary usage ofthe vesical catheter. The decision making is based on evidence of the nurses insuspending the vesical catheterization. The nurses were based on the recommendation ofscientific evidence for the making of protocols of performance in the prevention ofCAUTI, from its insertion and maintenance, until the evaluation of the necessity ofcatheterization.With the purpose of assessing the necessity of the urinary catheter on clients, theimpact of the daily participation of a nurse with management duties (nurse-led) wasevaluated in the multidisciplinary visit and the assessment proposing the removal of thecatheter . In thi(19-20).Determining the crucial and decisive role that the health professional play in theprevention and control of urinary infection associated to urinary catheter. Theawareness of the professionals for this problematic is a fundamental starting point forthis supported practice, seen in some studies in which education was one of the tools for the starting point of thischange.In summary, the health professionals, based on CAUTI prevention guidelines, present manymethods of implementation, responding, in an efficient way, to this problematic. Theattention during the procedure, handling of the vesical catheter, duration of thecatheterization and staff training are of extreme importance1-20.Detedies,-,17 in The strategies applied in the implementation of guidelines have lessened the incidenceof CAUTI, however, they appear in the literature in a disperse way. This review bringsup knowledge, once it systematizes results of the practice and it allows the healthprofessionals access to effective, up-to-date infection control strategies, withpositive results in the quality of health care., as well as, the absence of the nurs* descriptor associated to the researchto other professionals and, consequently, other strategies of practical implementationof international recommendation. At last, the selected sample for the review was of areduced number and more studies are necessary to increase the number of strategicevidence of implementation, as well as its contribution for effective changes in carepractice.As limitations of this study, we highlight the process of selecting the sample done onlyby a reviewer and the usage of the nurs* descriptor on the research strategy. The criticanalysis of the criteria on the series of studies by two reviewers would result betterconsistency in this review, as wel The intervention based on evidence can promote the evaluation of the necessity ofurinary catheterization and removing the catheter when not necessary and allowing thereduction of the CAUTI rate.In relation to the goal of this study and in summary, the main strategies ofimplementation of the guidelines were the performance of audition to the procedure,reminder systems for the assessment of the necessity of urinary catheterization and theimplementation of bundles. The strategies found by the nurses to respond to thisproblematic were efficient, with the development of the health team, based on theprevention and control of the infection and the improvement of the safety of the personwho seeks the health services and are put through this technique. In practice, policiesshould be implemented to promote the early removal of the catheters, as well as, thosethat are not necessary, avoiding negative consequences to the client and theinstitution, namely the hospitalization period. This review, besides systematizing thestrategies found by the health professional in the implementation of the guidelines inthe prevention of CAUTI, opens the gates to new investigation on this area, as astarting point and gaps that can arise. It is important to emphasize the necessity ofmore studies about the intervention of health professionals in the performance andmaintenance of the vesical catheterization technique and, consequently, in theprevention of CAUTI. The strategies described by them are not enough, they need healthprofessionals awareness and motivation on this problematic and studies on other sectionsthat can contribute to the prevention and control of infection associated to healthcare."}
{"text": "An exhausting process of bureaucratization, an ever-changing stream of rules dictated by fluctuating succession of parliamentary majorities and new governments, an irregular system of evaluation and recruitment of new human resources: this is the photography, raw but real, of the current situation concerning University and Research in Italy. The alarm was recently launched in an open letter addressed to the Minister of Education, University and Research, signed by forty-eight senior members of the Accademia Nazionale dei Lincei, the oldest scientific academy in the world and the highest Italian cultural institution . A shareTo exacerbate the already dramatic framework, indeed, the status of Italians doctoral students and post-docs who, according to a just published survey, at the end of their training would have very little chance to work in a more or less stable manner in the world of research and career prospects virtually nil . You can"}
{"text": "Projection of current trends in maternal and neonatal mortality reduction shows that many countries will fall short of the UN Millennium Development Goal 4 and 5. Underutilization of maternal health services contributes to this poor progress toward reducing maternal and neonatal morbidity and mortality. Moreover, the quality of services continues to lag in many countries, with a negative effect on the health of women and their babies, including deterring women from seeking care. To enhance the use and provision of quality maternal care, countries and donors are increasingly using financial incentives. This paper introduces the JHPN Supplement, in which each paper reviews the evidence of the effectiveness of a specific financial incentive instrument with the aim of improving the use and quality of maternal healthcare and impact. The US Agency for International Development and the US National Institutes of Health convened a US Government Evidence Summit on Enhancing Provision and Use of Maternal Health Services through Financial Incentives on 24-25 April 2012 in Washington, DC. The Summit brought together leading global experts in finance, maternal health, and health systems from governments, academia, development organizations, and foundations to assess the evidence on whether financial incentives significantly and substantially increase provision, use and quality of maternal health services, and the contextual factors that impact the effectiveness of these incentives. Evidence review teams evaluated the multidisciplinary evidence of various financial mechanisms, including supply-side incentives  and demand-side incentives . At the Summit, the teams presented a synthesis of evidence and initial recommendations on practice, policy, and research for discussion. The Summit enabled structured feedback on recommendations which the teams included in their final papers appearing in this Supplement. Papers in this Supplement review the evidence for a specific financial incentive mechanism  to improve the use and quality of maternal healthcare and makes recommendations for programmes and future research. While data on programmes using financial incentives for improved use and indications of the quality of maternal health services support specific conclusions and recommendations, including those for future research, data linking the use of financial incentives with improved health outcomes are minimal. Globally, the UN estimates show that maternal mortality has fallen 47% between 1990 and 2010  with a high burden of maternal death often underutilize family planning and maternity services that facilitate healthy childbirths, save maternal and newborn lives, and ensure a healthy start for their young children. To address the lack of utilization and quality of maternal health services, many countries have recently used financial incentives (FIs). Evidence of the effectiveness of FIs for improved maternal healthcare was reviewed at the US Government Evidence Summit on Enhancing Provision and Use of Maternal Health Services through Financial Incentives convened by the US Agency for International Development and the US National Institutes of Health on 24-25 April 2012 in Washington, DC. The papers in this JHPN Supplement provide an overview of each of the financial incentives, along with conclusions and recommendations based on the literature reviewed and presentations made at the Evidence Summit.Women's use of healthcare services that potentially reduce the risk of death due to pregnancy is very low in many parts of the world. For example, contraceptive prevalence is 24% in Africa and 58% in South-East Asia compared to the 71-80% coverage in countries with high and upper mid-level income , 48% of To focus the Evidence Summit on the critical barriers women face, which could prevent them from availing of services that could help them plan for and promote healthy pregnancy and birth, USAID carried out a scoping exercise in 2011. In this exercise, maternal health experts and teams from various international health organizations identified the following categories of barriers: family and community factors, health system constraints, poor quality of services, and governance issues leading to poor accountability at higher levels. Within these categories, important elements contributing to the low use and quality of services were identified .Lack of knowledge and awareness among women, families, and decision-makers may contribute to delays in recognizing the initiation of labour and the need for skilled birthing care, especially urgent in the event of an obstetric complication. Distance to facilities, poor road conditions, seasonal problems, and lack of transportation can lead to delays in the decision to travel to service facilities. The costs associated with transport, care, and medications as well as the opportunity costs of family members travelling with the woman may also affect decisions to seek care. Furthermore, village or facility \u2018gatekeepers\u2019, through ignorance or corruption, may delay or prevent women in labour or with complications from accessing the services that would save their lives. Fundamentally, the lack of agency that denies women the ability to make informed decisions independently can often lead to non-use of maternity services or delays in accessing care.On the supply side, there are also many factors that negatively effect provision of quality care. For example, poorly-designed and coordinated referral systems can prevent or slow access to emergency care. Inadequately-integrated and coordinated vertical programmes can also result in missed opportunities to provide essential maternal care. Services that should be available on a 24-hour basis may not be open or staffed at night or on weekends. Inferior medical infrastructure, including lack of water or electricity and essential drugs and equipment, may also affect the capacity to provide even the most basic level of care.Moreover, inadequate, poorly-trained and/or disempowered staff may provide substandard care. Dysfunctional incentives in the health system, such as low salary structures that do not vary based on performance, inadequate mechanisms to support, supervise, and hold health workers accountable, may result in low levels of motivation, absenteeism, and lack of innovation and quality. Healthcare providers may, in some cases, neglect or verbally or physically abuse women in outpatient clinics and even in childbirth in health facilities, thus discouraging the use of services and/or providing low quality of care that contributes to loss of life.At the policy level, poor political commitment and weak governance can lead to low standards, inadequate budget, lack of supervision, graft, and services that are simply not accountable to the women and communities they are supposed to serve.Among the many barriers that contribute to the underutilization of lifesaving services, financial barriers are significant, especially on the demand side. In 20 countries, with more than one recent Demographic and Health Survey (DHS), half (52%) of women surveyed, on average, identified lack of money as the biggest problem to using health services . Financiet al. in this Supplement.An important criterion for choice of inquiry through the Summit process was the importance of a barrier that could be improved through programmatic guidance based on available evidence. The importance of FIs and their evaluation is supported by the World Bank, its extensive experience in result-based financing for health , and by Many countries and donors have turned to financial incentives in the last decade as a solution to underutilization and poor quality of maternal services. Various financial instruments, including vouchers, performance-based incentives, conditional cash transfers, and others, are being implemented in a variety of settings with the broad goal of reducing maternal mortality and morbidity by enhancing the use and quality of maternal health services. The motivation for the Summit was the global demand to demonstrate linkages between financial incentive instruments and health outcomes.et al.in this Supplement.A systematic review of relevant English language publications since 1990 was undertaken, utilizing eight standard databases. There was a subsequent call for relevant additional papers from Expert Review Team members. In all, 139 references were provided to the Expert Review Teams to serve as the basis for a summary of findings and recommendations. The methodology for the literature review is described in the article by Higgs Prior to the Summit, three evidence review teams comprised 56 experts in finance, maternal health, and health systems, reviewed and analyzed the evidence of various financial mechanisms, including: (i) supply-side mechanisms, such as performance-based financing, user fees, and various insurance mechanisms; (ii) conditional cash transfers in which programmes condition cash payments to poor households on the use of maternal health services; and (iii) other demand-side incentives, such as vouchers for the use of services and of insecticide-treated bednets, user fee exemptions, and subsidies for such items as food and transport to the clinic. The analyses focused on two key questions to assess the effect of financial incentives on the provision and use of maternal health services:What financial incentives, if any, are linked positively or negatively to maternal and neonatal health outcomes, the provision and use of maternal health services, or to care-seeking behaviour by women?What are the contextual factors that impact the effectiveness of these financial incentives?At the Summit, the experts presented a synthesis of the evidence and analyses to a wider audience with the goal of formulating recommendations on practice, policy, and research. The Summit enabled structured feedback and dialogue on the conclusions and recommendations of the reviews. The Evidence Summit also explored cross-cutting issues and challenges that Summit participants advised the global community to address in future programming, research, and investment decisions.The success of programmes using financial incentives for maternity care depends, in part, on the context within which they are implemented and the design of the FI. To explore fully how the context and design of the incentive programme influence outcomes, key questions were identified during the initial evidence review and then during the Summit to identify factors that could influence FI programme results .Evidence review teams reviewed the available literature with these questions in mind, and Summit participants shared their experience and debated some of these issues.The reviews and discussions of the Summit concluded that the use of FIs, particularly conditional cash transfers, increases utilization of maternal health services, which has been typically slow over the two decades since the Millennium Development Goals were established .It is less apparent that such incentives improved the quality of maternal healthcare, primarily because of the lack of internationally agreed upon quality of care standards across the range of maternal health services. Metrics for measuring quality of care are needed both to determine the impact of incentive programmmes and what should be rewarded, particularly in the context of supply-side incentive programmes. The latter require indicators that can be routinely measured, collected, verified, and paid on, all without creating unintended negative consequences. Standardized quality of care criteria must be an immediate priority for maternal health experts.The evidence of impact of the financial incentives on health outcomes is weak and of poor quality. However, impact measures, especially of significant change in the reduction of maternal mortality, are typically not feasible in the short timeframe and limited study populations described in the literature reviewed. Long-term studies should be undertaken to assess the sustainability and the health impact of FIs for maternal healthcare.The Summit review also provided lessons for donors, researchers, programme implementers, and country-specific policy-makers to consider for future financial incentive programmes that are effective, ethical, and evidence-informed.et al. (in this Supplement) summarizes these findings and recommendations across all incentive instruments on coverage, quality of maternal care, impact, implications for research, programme design, and implementation.The specific findings of the evidence review on each of the supply- and demand-side mechanisms, including performance-based incentives, health insurance, user fee exemptions, conditional cash transfers, and vouchers, are presented in the papers of this Supplement. Morgan Financial incentives for maternal health inherently involve both health and financial sectors. Therefore, it was not surprising that the Evidence Summit identified a lack of a strategic alignment between maternal health and economic expertise in the design, implementation, and assessment of financial incentive schemes for maternal health. Increased collaboration between the economic and maternal health communities is required to better inform the design of research to assess effectiveness and understand the \u2018hows\u2019 of programmes. Furthermore, maternal health experts and programme designers need to be more conscious of the implications for health systems of incentive programmes they support. A closer collaboration between finance and health sectors can enhance programmes and policy to deliver informative data and conclusions to governments of the low- and middle-income countries and donors on what the most sustainable, equitable, and effective incentive programmes are to improve maternal and neonatal survival.Very few studies considered, evaluated, and reported on the effect of incentives on both supply and demand sides. Whether designed as supply- or demand-side programmes, it is useful to measure effects on both supply and demand sides.There is also a need for prioritized research agenda to develop more evidence. This agendum needs to be developed among key partners, including governments, development banks, donors, and universities, with the balanced input of economists and public health specialists knowledgeable about maternal health. Duration of initiatives and appropriate timing of measurement of results need to be specified to ensure that research documents both short- and long-term impacts of financial incentives.There is an urgent need for action, as we approach 2015, for evaluation of the progress towards MDG 5 and planning for the post-2015 world where ending the preventable maternal death needs to remain a priority , with anThis work was carried out by US Federal Government Employees and persons supported through contractual mechanisms by the federal government. This is an open-access article under the terms of the Creative Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided that the original authors and source are credited. The views and opinions in this paper are those of the authors and not necessarily of the United States Agency for International Development nor the National Institute of Allergy and Infectious Diseases. Among the authors, MES is paid by the United States Agency for International Development. ESH is paid by the National Institute of Allergy and Infectious Disease and was on assignment with the Bureau for Global Health at the United States Agency for International Development during the planning of the Evidence Summit. MK is currently paid by the United States Agency for International Development through an Intergovernmental Personnel Act Assignment Agreement with Johns Hopkins University School of Public Health and, during the summit planning, was paid by John Snow, Inc."}
{"text": "It was chaired by Dr Beatriz Amendola, Professor Gordon McVie and Professor Umberto Veronesi. Specialists from Europe and America were invited as guest lecturers.The first international Over 300 people are attended the conference from all areas of oncology, doctors, physicists, medical technologists, nurses, residents, students, social workers, journalists, pharmaceutical chemists, from all over the country and abroad, including India. The success was achieved as a result of the multidisciplinary approach to the pathologies, which prompted significant interest from the audience.The \u2018eContouring\u2019 course (radio-oncologists) was taken by a large number of participants, the result of great interest in the subject, and the undoubtable merit of the guest instructors.ecancer, Dr Beatriz Amendola, President of the symposium and Dr Jorge Jimenez, President of Foro Nacional de Cancer Chile, and former Minister of Health.For the opening ceremony, we were honoured with the presence of Professor Gordon McVie, Founder of  Several scientific modules were carried out throughout the conference, with the aim of addressing and updating the community on radiotherapy indications, in cancers that are most prevalent in Latin America. The modules addressed the following topics: lung cancer, breast cancer, gynaecologic cancer, and cancer of the head and neck. The themes were presented in a multidisciplinary manner, in which all of the pillars involved in the treatment of cancer were included, such as surgery, radiotherapy, and medical oncology. We also used the opportunity to discuss, by means of satellite sessions, the current status of radiotherapy in Latin America, and giving participants the opportunity to interact and evaluate new emerging technologies with industry symposia.This conference constitutes An \u2018eContouring\u2019 course was conducted, supported by Varian Medical Systems and EduCase, as well as ASTRO (American Society for Radiation Oncology).ecancer are fundamental to the extinction of these barriers and the emergence of a more team-guided effort to research.This event was held in high regard by the community of oncology professionals in Chile, as it allowed for a multidisciplinary focus such as surgery, radiotherapy, and chemotherapy in the management of patients with cancer. It is important to highlight that in Latin American countries, the studies are carried out in a manner that are relatively isolated from the rest of the community, which is particularly different to what occurs in the rest of the world, specifically Europe, where research is carried out in a coordinated fashion within the different countries, experiences, and findings are shared and no boundaries are present to set back the medical progress in this part of the world. For this reason, contributions, such as the courses, provided by The principal objective of this conference was to demonstrate multidisciplinary cooperation in analysing the different pathologies. With the use of more modern technologies and equipment, considering the pros and cons of each specific one, the individual experiences of the correspondents, their case-by-case interpretation, the potential practical problems, and how to approach them.In the lung cancer module, Dr Andres C\u00f3rdova, President of the Radiotherapy Society of Chile, emphasised the importance of tobacco consumption in the appearance of this cancer and called to attention the high prevalence of tobacco consumption in Chile. In addition, Dr C\u00f3rdova demonstrated the superiority of pre-screening for prevention with low-dosage TAC in relation to radiography of the thorax in high-risk populations, emphasising the importance of prevention. Subsequently, Dr Claudio Suarez, thoracic surgeon of Santa Maria de Santiago Clinic, discussed the different types of surgical interventions, their advantages and disadvantages, as well as how a good programme for early detection can greatly improve the statistics for survival.Dr Beatriz Amendola of the \u2018Innovative Cancer Institute\u2019 Miami, EEUU, presented lectures in relation to radiosurgery in general and the management of metastasis in lung cancer. Dr Amendola emphasised the increase in the incidence and negative results of treatment in cases of late detection. It was demonstrated how stereotactic body radiation therapy (SBRT) has been gaining prevalence, specifically in elderly patients or those patients presenting comorbidities that present an impediment to surgical intervention. With regards to the treatment of metastasis, the importance of SBRT in vertebral, hepatic, and cerebral metastasis, and the associated subdivisions, was demonstrated.Dr Lus E Raez, of the Memorial Cancer Institute, discussed the systematic management of Lung Cancer, with particular focus on personalized therapies and the positive outcomes seen with the use of TKI, with ALK and ROS-1 inhibitors in selected patients. Dr Raez also discussed Immunotherapy and its results in cerebral and hepatic metastasis.Dr Marco Amendola of the \u2018Innovative Cancer Institute\u2019, discussed imaging techniques in lung cancer, referring to the staging, the follow-up and restaging, highlighting the importance of imaging for the organisation of radiotherapy, using the different techniques, particularly the use of positron emission tomography-computed tomography (PET-CT).ecancer, presented the following: Life After Protons, also referring to the successful evolution of ecancer since its foundation in 2007. In regards to protons, Professor McVie explained the characteristics and differences from photons, as well as their application in adults and children. Images of isodose were demonstrated throughout different locations, such as liver, head and neck, and breast.In the module discussing breast cancer and global radiotherapy, Dr Maria Laplana of the Catalan Institute of Oncology presented a conference on IORT (intraoperative radiotherapy), SBRT (stereotactic body radiation therapy), and HDR-IGBT (high-dose rate image-guided brachytherapy), comparing the different techniques and discussing the statistics regarding them. Subsequently, Professor Gordon McVie, of King\u2019s College London, Founder of Dr Herbert Cardenas, radio-oncologist at the National Institute of Neoplastic Diseases (INEN) Peru, demonstrated his experience with V-MAT (volumetric modulated arc therapy), comparing this approach with fixed IMRT in different locations and its individual advantages.Dr Ana Maria Ciudad, of the Arturo Lopez Perez Foundation, Santiago de Chile, presented the Uterine Cancer module. Dr Ciudad discussed the integral management of cervical and uterine cancer in Chile, providing mortality rates and their evolution in time, as well as demonstrating a national research study, presenting figures from different stages and their treatment outcomes and results. Dr Clemente Arab, gynaecologist of the Arturo Lopez Perez Foundation and the hospital of Tisne de Santiago, discussed the topic of surgery in gynaecological cancers, indications with parametrectomy, types of surgery in low-risk tumours, the use of sentinel ganglions, and the use of radical abdominal trachelectomy.Dr Arno Mundt, radio-oncologist of Moffit Center, Florida, talked about radiotherapy in tumours of cervical cancer and the combination with surgery and/or chemotherapy, neoadjuvant chemotherapy with varied schemes, radio-chemotherapy and novel drugs. Dr Mundt also discussed the novel uses of radiotherapy in cancer of the vulva, endometrial cancer, and selected patients with ovarian cancer.In the international presentation, Dr Bernardo Vizcarra of Oncosalud Peru referred to radiotherapy and its evolution in time, as well as its applications in Peru, specifically in lesions of the central nervous system (CNS).The session presented by Dr Hugo Marsiglia, of the Arturo Lopez Perez Foundation, Santiago de Chile, discussed the 2016 consensus in radiotherapy for breast cancer. Dr Marsiglia demonstrated research studies carried out in patients were or were not treated with radiotherapy, in an elderly population of patients with breast cancer, and the clear advantage of treating with radiotherapy, the use of IOERT in young patients, various subdivisions and treatment of ganglionic areas.In the subsequent module, addressing cancer of the head and neck, Dr Adela Poitevin of Medica Sur, Mexico, discussed the general principles of the management and diagnosis of this type of pathology, as well as its prevalence in Latin America. Dr Poitevin demonstrated rates, risk factors, and treatment concepts.Dr Beatriz Amendola analysed radio-surgery (SBRT) in recurrent head and neck cancer, re-irradiation, as well as different techniques and dosage. Dr Amendola demonstrated different cases with their respective isodose curves, in different localisations and their encouraging results.Dr Gustavo Sarria, radio-oncologist of Oncosalud, Peru, discussed advanced techniques in regards to treatment of cancer of the head and neck, the results observed with IORT, brachytherapy, the evolution of different techniques of external radiotherapy and the comparison of V-MAT and fixed gantry IMRT.The following session was in the hands of Dr Beatriz Amendola. Dr Amendola discussed radiosurgery in the base of the skull and cervical vertebrae, particularly meningioma and vertebral metastasis, highlighting its promising results. Practical recommendations were given in regards to the delineation of volumes and potential risks of complications. Following this conference, Dr Luis E. Raz presented a discussion on the growth and evolution of the systemic management of head and neck cancer, particularly the use of immunotherapy, the importance of HPV, chemotherapy for induction and alternative schemes.The conference presented by Dr Arturo Madrid, surgeon of the Head and neck in the German Clinic of Santiago de Chile, discussed robotics, highlighting its advantages in lesions of the amygdala, the learning curve and potential use in other locations. Following this presentation, Dr Eugenio Vines, of the Service of Radiotherapy, Catholic University of Santiago, discussed re-irradiation in head and neck cancer. Dr Vines demonstrated cases of recurrent disease and the incidence of secondary primary malignancies with different re-irradiation techniques and their results.Dr Claudio Sole, radio-oncologist of the IRAM Oncology Clinic of Santiago, presented a session discussing the medical advances and novel trends in the treatment of prostate cancer. Dr Sole elaborated on different treatments for specific risk factors, dose escalation and varied fragmentation.Dr Sebasti\u00e1n Sol\u00e9, also from the IRAM Oncology Clinic of Santiago, discussed novel strategies for the treatment of locally advanced rectal cancer, comparing specifically conventional radiotherapy versus shortened radiotherapy, and the importance of time periods in regards to treatment.To bring the conference to an end, Dr Arno Mundt discussed the medical advances in radiotherapy and its application to gynaecological cancer. Dr Mundt compared the varied techniques by means of their use, advantages, disadvantages, results and their complications.During the eContouring course, which attracted a large number of participants, themes regarding the use of eContouring in lung, cervical, uterine, endometrial, prostate, head, and neck cancer were analysed. The guest instructors Dr Adela Poitevin, Dr Arno Mundt, Dr Marco Amendola, and dosimetrist Alejandro Iglesias, provided a brief introduction, a review of the anatomy and volumes to embark upon, as well as potential constraints. It is worth noting that prior to this course, participants were tasked with several assignments, to be carried out in their homes. It was a complete success.In addition, the presence of satellite symposia allowed the participants to experience the latest projects and technologies of the industry: Elekta, Reich, Varian and Siemens were all participating.The meeting was valuable as the topics were very interesting and of current importance. Similar meetings are expected to be replicated in other Latin American countries."}
{"text": "The gaps observed between the use of research evidence and policy have been reported to be based on the different methods of using research evidence in policymaking by researchers and actual policymakers. Some policies and policymaking processes may therefore be particularly well informed by research evidence compared to others. The aims of the present article are to explore the use of research evidence in health-enhancing physical activity (HEPA) policies, identify when research evidence was used, and find what other types of evidence were employed in HEPA policymaking.Multidisciplinary teams from six EU member states analysed the use of research evidence and other kinds of evidence in 21 HEPA policies and interviewed 86 key policymakers involved in the policies. Qualitative content analysis was conducted on both policy documents and interview data.Research evidence was mostly used to justify the creation of HEPA policies and, generally, implicitly without citation. The policies analysed used many types of evidence other than citable research. The evidence used in HEPA policies was found to fall into the following categories: societal framework, media, everyday knowledge and intuition, research evidence, and other types of evidence.Research evidence seems to be the only type of evidence used in policymaking. Competition between the use of other types of evidence and research evidence is constant due to the various sources of information on the Internet and elsewhere. However, researchers need to understand their role in translating research evidence into policymaking processes. The health benefits of physical activity (PA) are supported by research evidence as well as the international public health community and its policies, including the World Health Organization (WHO) . RegularHowever, there are strong economic and moral, and occasionally political, arguments for making better use of research evidence in policymaking . EconomiPrevious international research on HEPA policies \u201322 has lInstitutions, interest groups, and networks interact with individuals and their ideas at different times and places during the policymaking process . In poliThis study is part of the EU-funded project Research into POlicy to enhance Physical Activity (REPOPA), with the overall aim of integrating scientific research knowledge, expertise, and real world policymaking processes. This could increase synergy and sustainability in promoting health and preventing disease, and promote physical activity in structural policymaking through different research and networking activities. The aims of the present article are to explore the use of research evidence in HEPA policies, identify when research evidence was used, and indicate which other types of evidence were used in HEPA policymaking. The study may be considered valuable in providing information on effective translation of research evidence into HEPA policymaking processes, which would ultimately lead to more effective HEPA policies.Each research team in the partner countries suggested relevant HEPA policies for consideration. Prior to the selection of HEPA policies for the study, the research team, e.g. principal researchers in each partner country, looked at the objectives, primary stakeholders involved, subpopulation specificity of policies, processes leading to release of the policies, and selection of documents used for the development of the policies. The policies were then categorised as national, regional, or local. Based on this primary inventory and in order to focus on the most recent developments, documents were selected according to the criteria of policies focusing on HEPA, being published by public authorities and representing HEPA policies in force at the beginning of 2012. The selected national, regional, and local HEPA policies ensured at least some variation in the scale and topic of the expected policy change: from major changes, such as governance structures and legislative perspective, to minor changes such as programmes, advice services, or building playgrounds. Some of the national, regional, and local policies belong to a \u2018package\u2019 of national, regional, or local policies created after elections for respective development purposes. They therefore also reflect wider policymaking processes and possibly the use of a wide base of research evidence. In the case of \u2018package\u2019 policies, the study concentrated on the specific policy documents for HEPA issues only. For the final set of HEPA policies, 21 policies from six European countries were selected with variation across the types of policies and policymaking processes. The topics of the sample of HEPA policies included in the analysis contained public health aspects , HEPA aspects , infrastructure , and places for PA  . The stuTo assess the use of research evidence in HEPA policies, content analyses of policy documents and semi-structured interviews were used. The content analyses of the policy documents and the interviews complemented each other to identify the various ways of using evidence in policymaking. The intention was to facilitate comparisons between countries in the use of research evidence in policymaking and take into consideration contextual differences through interviews. In each country, a policy was identified along with the content, stakeholders, and processes in relation to the relevant research. A series of questions was put to the stakeholders and policymakers to recall the use of research evidence. Further questions were allocated depending on the references to the use of research evidence in speeches, statements, guidelines, and similar background documents.The HEPA policy process was split into agenda-setting and policy development phases in order to identify the use of research evidence at different stages of the policymaking process on various topics and issues. The agenda-setting phase and the use of research evidence were mostly traced through interviews and the use of research evidence in the policymaking process through policies or other supporting documents. The agenda-setting phase and the use of research evidence were dependent on interviews, as most of the countries did not have records on the decisions made in the agenda-setting phase, whereas the policymaking phase was often described in policies or related background documents.Based on the literature review for the project proposal and its update upon acceptance of funding for the use of research evidence in policymaking, the study was undertaken using a qualitative descriptive approach inspired by political sciences , 31, pubThe content analysis of HEPA policy documents followed the ideas of Ritchie and Spencer  and consWhere appropriate, a published protocol and tool developed by Lavis et al.  and HannThe common guideline that was developed covered the criteria for the selection of policies, theoretical models of the policymaking phases based on Kingdon , the focDuring the HEPA policy document analysis, key informants for each policy were identified for face-to-face semi-structured interviews in order to verify the findings of the content analysis stage and gather information on any gaps in the uncited or implicit use of research evidence. The purposeful sampling of 87 informants in six countries was based on the selection criteria of the interviewees being directly involved in the policymaking process and able to report on the use of research evidence or other kinds of evidence in the policymaking process. In each policy, one of the interviewees was employed at the organisation responsible for the policy. The interviewees had been involved in policymaking processes of the policy on which they were interviewed and were policymakers, researchers, public sector officers, or other influential stakeholders. All the interviewees were contacted by email or phone by the research team in each country with basic information on the project and consent forms in the local language. The interviews were conducted by research team members with backgrounds in health and social sciences in the local language, recorded when accepted and transcribed for the analysis. An interview guide was developed by the REPOPA team led by the work package leader. In the guide, the questions for the policymaking process were split into agenda-setting and policy development phases. The questions followed the protocols , 15 withTo adapt the interviews for each context, each country team conducted between one and three pilot interviews to modify the questions, interview process, and language.The semi-structured interviews were selected as a method to gain complementary information and to facilitate the adaptation of questions to each policy and case. The stakeholder interviews for each policy verified facts identified during the content analysis of policy documents, gaps in the information gathered in the use of research evidence, and the needs of policymakers to use evidence in the policymaking process.In the semi-structured interviews, the interviewees were asked to recall the policymaking process period, review their files before the interview, and explain the policymaking process and the parties involved. The main issues in the interviews were how and why research evidence and other types of evidence did or did not enter into the policymaking, as well as the origin, influence, and characters of policymaking. The topics covered included policy changes, their significance, the use of research evidence and other types of evidence in bringing the content and change into the policy, the factors describing how and why the issues appeared on the policy agenda, and the factors influencing the way the policy developed.The selected HEPA policy documents and interviews were mapped, coded, and further analysed using the interview questions as guidance. Each HEPA policy and transcribed interview was reread, coded, sifted, charted, and sorted according to the key issues and themes, confirming the patterns of use of research and other evidence, and categorised into various topics and themes. The interviews were analysed by the country-based research teams using an interpretative approach derived from a content analysis of the policy . The codDemographic and statistical data (facts and reports used as a background or for prioritising policy areas)Non-systematically derived peer-reviewed scientific literature Systematically derived peer-reviewed scientific literature International, transnational, national, regional, or local standards and guidelinesKnowledge derived from community consultations, stakeholder workshops, and in-house consultationsNational reports Knowledge derived from expert consultations or policy briefs developed by research institutionsThe policies and interviews were further analysed to identify the use of evidence to support the policies. For the distinction between research evidence and other types of evidence, a list of evidence with modifications was developed based on Lavis, Ross, and Hurley . EvidencIn the content analysis stage, the policy documents were reviewed to identify the explicit use of research evidence. When research evidence was cited, the content was analysed to establish the way the citation supported the policy statements or position in addressing the issues. The research evidence was published as journal articles, book chapters, working papers, or reports typically produced by research institutes, universities, or other independent research units. Other types of evidence referred to readings, information from media, and interaction with peers or stakeholders. Involvement of people in hearings, working groups, meetings, and the like was also looked for in the policy documents and interviews.Finding patterns when research was used required a framework for determining the contexts in which policymaking occurred , 27, 40.The interviews complemented the understanding of the use of research evidence in the agenda-setting and actual policymaking phases of HEPA policies. Policy documents  providedBy contrasting and searching for internal patterns, connections, and explanations for themes, categories, or issues in the content analysis, it was possible to describe the HEPA policymaking process, involvement of stakeholders and use of research evidence, and other types of evidence for judging HEPA policies for, for example, various subgroups. Sometimes, research evidence on health determinants and efficacy of interventions was used to legitimise actions, with other types of evidence used to accommodate contextually salient factors such as culture, community and organisational values, resources, and political priorities, which defined the usefulness of evidence for HEPA policymaking and implementation.Explicit citable use of research evidence was mostly found in the justification of HEPA policies and when stating a specific study or publication as a trigger for a policy. It seemed that the visions and goals of the policies were not validated by research evidence but by other types of evidence. For the justification of the policies, instead of using peer-reviewed scientific articles, the policymakers used various types of secondary publications, such as national and international reports and recommendations. In other parts of the policy, such as target setting or actions for target groups, explicit research evidence was rarely used.Neither policy document analysis nor interviews provided information on whether explicit or implicit evidence or citable research evidence was really influencing policies or whether implicit evidence was informed by research evidence.The study found that most countries did not have routine reporting mechanisms for policy decisions during policymaking processes that would have been accessible for this study. Some countries had records available in the form of media communications, lists of members of the various committees, working groups or legislative commissions, and report databases. Theoretically, in the agenda-setting phase, priorities are set out for the policymaking process and in the actual policymaking development phase the research evidence should support the issues to be considered, chosen, and selected as part of the policy. Nevertheless, in the studied HEPA policies, the decisions made in the agenda-setting and policymaking phases were not recorded and therefore the information on the use of research evidence was based on what was found in the documents and their references and in the recall of interviewees.Where research evidence was used, it was identified in an ad hoc manner in the policymaking phase and consisted of epidemiological research, population studies or statistics, and case studies. Peer-reviewed research articles and research based on surveys, as well as monitoring, evaluation, and implementation studies were rarely used. When the HEPA policies used citable research evidence, it was not necessarily peer-reviewed scientific articles. Instead, various types of national and international reports and recommendations were used. In most cases, when paragraphs in the policy documents suggested being informed by scientific knowledge, explicit research evidence was seldom referenced.According to the interviews, the research evidence used in HEPA policymaking was based on previous strategies, programmes, recommendations, guidelines, alignments, traditions, political support, trends, legislation, or economics Figure\u00a0. In the Policymakers obtained other types of evidence from experiences, such as earlier national or international good practices, projects or programmes, or information gathered from personal networks Figure\u00a0. MeetingThe most challenging part of the different types of evidence used in the policymaking was the use of the Internet and media information for policymaking. The challenge was even stronger when the policymaking process had occurred some years ago, which was the case for most of the policies. According to the interviews, for the political level of policymaking, the media and its attention to certain topics during the policymaking process seemed to be an important source and legitimation of information and concern for taking up the issue in the policy.Based on the content analysis of policy documents and interviews, the types of evidence used were listed, the items from which were classified and categorised; these five broad categories, namely research evidence, other types of evidence, societal frameworks, media, and everyday knowledge and intuition, are depicted in Figure\u00a0The aims of the study were to assess how, to what extent, and where research evidence and other evidence were used in HEPA policymaking. In this qualitative study of the content analysis of 21 policy documents and 86 stakeholder interviews from six European countries, it was found that most countries did not have routine reporting mechanisms for policy decisions using research evidence during the policymaking processes. This can be considered a weakness in the transparency of the policymaking processes. Other related reports were available, but they were not necessarily related to policies or policymaking processes as such, they did not reflect the chosen policies, or particularly explain, describe, or confirm the use of specific research evidence in policymaking. Overall, from the content analysis of the policy documents, it was established that there was a lack of citable research evidence use in policy documents as it was rarely explicitly expressed. This was also confirmed by the interviews with stakeholders involved in policymaking. It was found that implicit evidence, such as common knowledge, facts, and practices, were primarily used in the policies.However, when investigated in more depth, the study proved that the use of other types of evidence and broader societal framework information (both of which may or may not have been informed by citable research) was common. The use of non-citable research evidence was difficult to define, as many guidelines, standards, and recommendations by international and national organisations are based on citable research but without explicitly showing the citations used. In addition, public hearings and experiences from other sectors and colleagues from networks as other types of evidence confirmed the expectation that various types of evidence were used in policymaking. As shown in a previous study , 42, theThe content analysis approach showed that research evidence seems to be only one type of information used in policymaking, and competition between the use of other types of information and research evidence is constant due to various sources of information on the Internet and elsewhere. To navigate the use of evidence in policy and practice, it is therefore necessary to understand how ideas spread through systems, how decisions and policies are made, and how capacity is required to use evidence in policymaking . The useEvidence-informed policymaking is a contingent, complex system-like, non-linear, and emergent process of producing, managing, and implementing new knowledge. Most authors appear to agree with at least the possibility that evidence-informed policymaking can work as a virtuous cycle in order to improve policymaking, even if there are widely divergent ideas about what constitutes the component parts of the evidence-informed policymaking process, how this can and should be done, and what it should achieve . PolicymThe aim of the study, based on successive phases of policy analysis and stakeholder interviews, was to allow more in-depth identification of evidence use for HEPA policymaking and of the pattern of evidence use. One major limitation of this study was that the interviewees did not recall the policymaking process in detail, even if the policies were still in force. The evidence used in the policymaking process also remained unclear to some extent despite selection of the most recent HEPA policies to minimise recall bias. However, this study clearly shows that there is a need for future policy research to take into account the various types of evidence used in policymaking and to choose a study design that can minimise recall bias. A further study area is the use of the Internet and its sources of research evidence and other types of evidence in policymaking. Additional countries would have increased the validity of the results and a variety of approaches to HEPA and the use of research evidence. However, the selected policies were not necessarily from the same levels due to the non-existence or unavailability of similar policies across the six countries.The use of research evidence identified through this study will be relevant to other researchers and research units working with policymakers at national, regional, and local levels. Similarly, the findings yield useful approaches for consideration by policymakers who work with researchers in academic institutions. These research-policy nexuses are clearly intended for practical applications in policymaking. Not all research is meant for this purpose. Research evidence seems to be only one type of information used in policymaking. Competition between the use of other types of information and research evidence is constant due to various sources of information on the Internet and elsewhere. In addition to the research evidence, other types of evidence from good practices, experiences from networks, work-related knowledge, and public hearings were used in policymaking; for example, values, traditions, interests, and opinions also influence everyday knowledge for policymaking. Moreover, past policies, regulations, and other policies influence and are used to frame policies. However, the use of research evidence seems to depend on close contacts between policymakers and researchers as well as on easy availability of and access to information. Making better use of research evidence in developing HEPA policies requires researchers to understand their role in policymaking and in translating research into policymaking .Consolidating and revising HEPA policies to be more informed by research evidence at national, regional, or local level would strengthen systematic assessment of structures and institutional arrangements of HEPA policies and make them more effective. HEPA policies are embedded within a wider socio-economic context, and HEPA policies should therefore target wider determinants of physical activity and its impact on health. Using more explicit research evidence in policymaking could also offer alternatives and options for research evidence in more transparent ways."}
{"text": "Dr. Michael Tamilia is not included in the author byline. He should be listed as the third author and affiliated with Lady Davis Institute for Medical Research-Jewish General Hospital; Montreal, QC, Canada and Division of Endocrinology, Jewish General Hospital; Montreal, QC, Canada. The contributions of this author are as follows: Dr. Tamilia was involved in the very early process of the work describe in the paper, in both discussions and experimental design."}
{"text": "Effective delivery of drugs via liposomes in the treatment or prevention of disease is the aim of numerous researchers worldwide. Therapies include those for cancer, microbial infections, hormone and enzyme deficiencies, metal detoxification, gene deficiency or malfunction, as well as vaccines. Intimate knowledge of the structure and physical properties of liposomes, and of ways such properties influence their behaviour within the biological milieu, is central to their success.The discovery of liposomes in the mid-1960\u2019s ,3,4.in vivo, namely its interaction with the biological milieu in the living animal and, as a result, the proposition of an array of therapeutic applications. Following a period of \u201cdisillusionment\u201d of those (mainly in industry) with expectations unjustified by the degree to which liposomes had been developed at that time, the 1980s were a period of reflection and consolidation. This was also a period of advancements in improving liposomal stability in biological fluids such as blood [The use of liposomes in drug delivery and targeting is often discussed in the context of decades marked by significant milestones. Thus, the 1970s are noted for the initial understanding of the system\u2019s behaviour as blood , in lipoas blood  in termsin vivo at the cellular and subcellular level, facts about the fate of intravenously injected liposomes and entrapped contents were easy to establish. We were able to show [My involvement with liposomes, described in more detail elsewhere  began wi to show ,4, that  to show . It was Being aware of the need for specific drug action in a multitude of therapies, exploration of the potential uses of liposomes was extended to cancer and antimicrobial (intracellular) therapy ,15,16, aet al. [A major potential disadvantage of the liposomal carrier is that, following intravenous injection, it is rapidly intercepted by the fixed macrophages of the liver and spleen. However, the involvement of the RES in vesicle uptake is the basis of the mode of action of several of the licensed liposome-based products, including vaccines against Hepatitis A and influenza. Added to this is the promise ,23 of liet al. , led to et al. . It turnet al. . Consequet al. ,32,33,34Such is the structural versatility of the liposomes, it renders the design of vesicle versions destined for specific needs practically limitless. In this respect, newer developments  include"}
{"text": "Researchers and trialists face many uncertainties when designing and conducting research. Embedded methodology studies can help to resolve these. However, despite hundreds of thousands of trials, there are probably only a few hundred studies assessing the effects of different methods for doing this research. The concept of the SWAT  programme is to aid the development of such research by increasing awareness of, and stimulating interest in the need for this research and providing a framework and resource to inspire and generate ideas, and to store, disseminate and modify such research. The programme was established as part of the development of an All-Ireland Hub for Trials Methodology Research in collaboration with the Medical Research Council's Network of Hubs in the UK and the Global Health Network. It will facilitate this research into research. Each SWAT comprises of simple, one or two page protocols and, as of April 2015, 19 different SWAT outlines have been registered. This presentation will detail the SWAT concept, and describe the core outline which consists of the following sections: background, intervention, comparator, allocation, primary outcomes, secondary outcomes, analysis, possible problems, likely costs, publications, and version information. The SWAT website will be available to view, and examples of completed SWATs will be shown. The presentation should stimulate ideas for future SWAT, and encourage researchers to see how they might maximize the impact of embedding research into research, leading to improvements in the design of future clinical trials and other studies."}
{"text": "Balamuthia mandrillaris can cause a serious infection of the brain, other organs , and rarely, spinal cord. Originally isolated from the brain of a mandrill that died of meningoencephalitis at the San Diego Zoo, Balamuthia mandrillaris is named for the late professor William Balamuth of the University of California at Berkeley, for his contributions to the study of amebae. More recently, B. mandrillaris has been shown to be transmissible through organ transplantation.A free-living ameba naturally found in the environment,"}
{"text": "Sickle cell disease is a life-long genetic disease that begins in childhood, affecting the structure of erythrocytes, altering the healthy biconcave shape to a crescent shape, leading to the blockage of veins, thereby resulting in organ damage . There iThe mortality rate associated with SCD has remained high in Africa, despite the use of appropriate interventions to manage the various forms of crises . In the There are five treatment approaches for SCD that are tailored to the clinical phenotype of a patient, namely supportive, symptomatic, preventative, abortive and curative approaches . The supBlood transfusion: Blood transfusions improve the oxygen-carrying capacity and oxygen-delivery efficiency of blood to the tissues and decrease the blood concentration of sickle cells and improve perfusion of tissue microvasculature. Transfusions are typically used to ameliorate chronic anaemia and pain episodes [episodes , and areepisodes , 18. Furepisodes , is one episodes  and blooepisodes . This evHydroxyurea: Hydroxyurea is an oral, cytotoxic, anti-metabolic and -neoplastic drug for principal haematological disorders. The first clinical application of HU was in 1984 [ in 1984  and sinc in 1984 , protect in 1984 , long te in 1984 , toddler in 1984  and infa in 1984 . The mos in 1984 . The tri in 1984 . However in 1984 , HU is s in 1984 . This wa in 1984  leading  in 1984 , 33. Sim in 1984  with the in 1984 . Similar in 1984 , 37, and in 1984 . Further in 1984 . This isHaematopoietic stem cell transplantation: Currently, allogeneic HSC transplantation is the most successful curative treatment for SCD [ for SCD . This me for SCD , 40. To  for SCD . Transpl for SCD . Althoug for SCD , immunos for SCD . Using t for SCD . The fin for SCD . Using a for SCD . As enco for SCD . The ave for SCD . The SCTEvery 2 years, Africa sees the birth of a number of SCD-affected children equal to the sum of the American and European populations affected by SCD, where most of these children die before age 5 . One of The data available on clinical trials and reports conducted outside of Africa is illustrative that a range of treatments are available and have been successful at curing SCD. What is required is the implementation of strategies to affordably avail these treatments in Africa, particularly HU and ultimately, HSC transplantation, through a collective effort from researchers, physicians, state departments of health and the private sector. This approach is likely to foster collaborative healthcare and research networks across the continent, ensuring the continued development of scientific and technological capacity in Africa to effectively manage the high disease burden of haematological disorders such as SCD."}
{"text": "Reporting guidelines, such as the Consolidated Standards of Reporting Trials (CONSORT) Statement, improve the reporting of research in the medical literature . Many such guidelines exist and the CONSORT Extension to Nonpharmacological Trials  provides suitable guidance for reporting between-groups intervention studies in the behavioral sciences. The CONSORT Extension for N-of-1 Trials (CENT 2015) was developed for multiple crossover trials with single individuals in the medical sciences , but there is no reporting guideline in the CONSORT tradition for single case research used in the behavioral sciences. We developed the Single Case Reporting guideline In BEhavioural interventions (SCRIBE) 2016 to meet this need. This statement article describes the methodology of the development of the SCRIBE 2016, along with the outcome of 2 Delphi surveys and a consensus meeting of experts. We present the resulting 26-item SCRIBE 2016 checklist. The article complements the more detailed SCRIBE 2016 explanation and elaboration article  that provides a rationale for each of the items and examples of adequate reporting from the literature. Both these resources will assist authors to prepare reports of single case research with clarity, completeness, accuracy, and transparency. They will also provide journal reviewers and editors with a practical checklist against which such reports may be critically evaluated. University courses generally prepare students of the behavioral sciences very well for research using parallel, between-groups designs. By contrast, single-case methodology is \u201crarely taught in undergraduate, graduate and postdoctoral training\u201d Kazdin, , p. vii.To address these issues we developed a reporting guideline, entitled the Single-Case Reporting guideline In BEhavioural interventions (SCRIBE) 2016, to assist authors, journal reviewers and editors to improve the reporting of single-case research. This Statement provides the methodology and development of the SCRIBE 2016. The companion SCRIBE 2016 Explanation and Elaboration (E&E) article . None of the designs below the solid horizontal line meets these criteria and they are not considered single-case experiments: The B-phase training study comprises only a single (intervention) phase; the so-called \u201cpre\u2013post\u201d study does not take repeated measurements during the intervention (B) phase. In the Figure, we place the A-B design in an intermediate position between the nonexperimental single-case designs  and the four experimental designs above the dotted horizontal line because it has weak internal validity, there being no control for history or maturation, among other variables. As a result, it is regarded as a quasiexperimental design  in a single participant who serves as his or her own control, often incorporating randomization and blinding.The medical Journal of Behavioral Education in 2012, Remedial and Special Education in 2013, the Journal of School Psychology and Neuropsychological Rehabilitation in 2014, Aphasiology in 2015) and methodological quality recommendations . In order to ensure representation from experts in areas of single-case investigations in clinical psychology, special education and single-case methodology and data analysis, another five experts were invited to the steering committee . Of course, other content experts exist who would have been eligible for the steering committee, but a guiding consideration was to keep the number of members to a reasonable size so that the project was manageable. In the early stages of the project, steering committee members were instrumental in item development and refinement for the Delphi survey.A 13-member steering committee for the SCRIBE project was formed comprising a Sydney, Australia, executive . An additional three members who had spearheaded the CENT initiative  were invited because of their experience and expertise in developing a CONSORT-type reporting guideline in a closely related field  those identified in a systematic review previously conducted by the CENT group . We examined the quality of authors\u2019 work, as described in their reports, using our methodological quality scale , and an additional three experts recommended by steering committee members. Graphed results were provided to respondents, along with anonymous comments on the items from the other panel members. A complete data set of responses for Round 2 was collected from 45 participants. Again, the ratings of importance for each item were mostly very high, all items having median importance ratings of at least 8/10, but the range of responses decreased. According to the criteria of von der Gracht (2012) consensus was achieved for 82% of items (36/44) which had IQRs of 2 or less on the 10-point scale. The remaining eight items had IQRs from 2.25 to 4 and were discussed in detail at the consensus meeting.As depicted in Figure Sixteen world experts in single-case methodology and reporting guideline development attended a 2-day consensus meeting, along with the Sydney executive and two research staff. Representation included clinical-research content experts in clinical and neuropsychology, educational psychology and special education, medicine, occupational therapy, and speech pathology; as well as single-case methodologists and statisticians; journal editors and a medical librarian; and guideline developers. Delegates met in Sydney on December 8 and 9, 2011. Each participant received a folder which contained reference material pertinent to the SCRIBE project, and results from both rounds of the Delphi survey. Each of the Delphi items contained a graph of the distribution of scores, the mean and median scores of each round of the survey, along with the delegate\u2019s own scores when s/he completed the Delphi surveys.The meeting commenced with a series of brief presentations from steering committee members on the topics of reporting guideline development, single-case methods and terminology, evolution of the SCRIBE project, and description of the CENT. Results of the Delphi survey were then presented. Delegates had their folder of materials to consult and a PowerPoint presentation that projected onto a screen to facilitate discussion. A primary aim of the consensus meeting was to develop the final set of items for the SCRIBE checklist. The final stages of the meeting discussed the documents to be published, authorship, and knowledge dissemination strategy.During the meeting the 44 Delphi items were discussed, item by item, over the course of four sessions, each led by two facilitators. The guiding principles for discussion were twofold. First, item content was scrutinized to ensure that (a) it captured the essence of the intended issue under consideration and (b) the scope of the item covered the necessary and sufficient information to be reported. Second, the relevance of the item was examined in terms of its capacity to ensure clarity and accuracy of reporting.Three delegates at the consensus meeting  took notes about the amalgamation and merging of items where applicable and refinements to wording of items. Final wording of items was typed, live-time, into a computer that projected onto a screen so that delegates could see the changes, engage in further discussion, give approval, and commit to the group decision. In addition, the meeting was audiotaped for the purpose of later transcription to have a record of the discussion of the items and inform the direction and points to describe in the E&E document.Figure By the end of the meeting, delegates reached consensus on endorsing 26 items that thus constitute the minimum set of reporting items comprising the SCRIBE 2016 checklist. The SCRIBE 2016 checklist consists of six sections in which the 26 aspects of report writing pertinent to single-case methodology are addressed. The first two sections focus on the title/abstract and introduction, each section containing two items. Section 3, method, consists of 14 items addressing various aspects of study methodology and procedure. Items include description of the design , participants, setting, ethics approval, measures and materials , interventions, and proposed analyses. The results (Section 4) and discussion (Section 5), each contains three items. Section 6 (documentation) contains two items pertaining to protocol availability and funding for the investigation.In total, 24 Delphi were merged into seven SCRIBE items because they referred to the same topics: (a) SCRIBE Item 5 (design) contained three Delphi items ; (b) Item 8 (randomization), two Delphi items (sequence and onset of randomization); (c) Item 11 (participant characteristics), two Delphi items (demographics and etiology); (d) Item 13 , two Delphi items ; (e) Item 14 (measures), nine Delphi items ; (f) Item 19 (results), two Delphi items (sequence completed and early stopping); and (g) Item 20 (raw data), four Delphi items . One of the Delphi items relating to meta-analysis, was considered not to represent a minimum standard of reporting for single-case experimental designs and accordingly was deleted.The audio recording of the 2-day consensus meeting was transcribed. The final guideline items were confirmed after close examination of the conference transcript and the SCRIBE 2016 checklist was developed  can use the checklist to evaluate whether the report meets the points outlined in the guideline. Users will find the detailed SCRIBE 2016 E&E document  and a SCRIBE website (www.sydney.edu.au/medicine/research/scribe) provides information and links to the SCRIBE 2016 publications. SCRIBE users are encouraged to access the website and provide feedback on their experiences using the SCRIBE and suggestions for future revisions of the guideline. Future research will evaluate the uptake and impact of the SCRIBE 2016.Following publication of this SCRIBE 2016 Statement and the E&E article  replication, which is of critical importance for establishing generality, (b) the coding of different aspects of the studies as potential moderators in meta-analysis, and (c) evaluation of the scientific quality of the research. All of these factors are relevant to the development of evidence-based practices.Robyn L. Tate, John Walsh Centre for Rehabilitation Research, The Kolling Institute of Medical Research, St Leonards, New South Wales, Australia, and Sydney Medical School Northern, The University of Sydney; Michael Perdices, Department of Neurology, Royal North Shore Hospital, New South Wales, Australia, and Discipline of Psychiatry, The University of Sydney; Ulrike Rosenkoetter, John Walsh Centre for Rehabilitation Research, The Kolling Institute of Medical Research, and Sydney Medical School Northern, The University of Sydney; William Shadish, School of Social Sciences, Humanities and Arts, University of California, Merced; Sunita Vohra, Department of Pediatrics, University of Alberta; David H. Barlow, Center for Anxiety & Related Disorders, Boston University; Robert Horner, Department of Special Education and Clinical Sciences, University of Oregon; Alan Kazdin, Department of Psychology, Yale University; Thomas Kratochwill, School of Educational Psychology, University of Wisconsin\u2014Madison; Skye McDonald, School of Psychology, University of New South Wales; Margaret Sampson, Library and Media Services, Children\u2019s Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Larissa Shamseer, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada, and School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa; Leanne Togher, Discipline of Speech Pathology, The University of Sydney; Richard Albin, Department of Special Eduction and Clinical Sciences, University of Oregon; Catherine Backman, Department of Occupational Science and Occupational Therapy, University of British Columbia; Jacinta Douglas, Department of Communication and Clinical Allied Health, La Trobe University; Jonathan J. Evans, Institute of Health and Wellbeing, University of Glasgow; David Gast, Department of Special Education, University of Georgia; Rumen Manolov, Department of Behavioural Sciences Methods, University of Barcelona; Geoffrey Mitchell, Discipline of General Practice, University of Queensland; Lyndsey Nickels, Department of Cognitive Sciences, Macquarie University; Jane Nikles, Centre for Clinical Research, University of Queensland; Tamara Ownsworth, School of Applied Psychology, Griffith University; Miranda Rose, Department of Communication and Clinical Allied Health, La Trobe University; Christopher H. Schmid, School of Public Health, Brown University; Barbara Wilson, Department of Neuropsychology, Oliver Zangwill Centre, Ely, Cambridgeshire, United Kingdom.The SCRIBE Group wishes to pay special tribute to our esteemed colleague Professor William Shadish (1949\u20132016) who passed away on the eve of publication of this article. His contribution at all stages of the SCRIBE project was seminal.http://arcblog.apa.org.Funding for the SCRIBE project was provided by the Lifetime Care and Support Authority of New South Wales, Australia. The funding body was not involved in the conduct, interpretation or writing of this work. We acknowledge the contribution of the responders to the Delphi surveys, as well as administrative assistance provided by Kali Godbee and Donna Wakim at the SCRIBE consensus meeting. Lyndsey Nickels was funded by an Australian Research Council Future Fellowship (FT120100102) and Australian Research Council Centre of Excellence in Cognition and Its Disorders (CE110001021). For further discussion on this topic, please visit the Archives of Scientific Psychology online public forum at In order to encourage dissemination of the SCRIBE Statement, this article is freely accessible through Archives of Scientific Psychology and will also be published in the American Journal of Occupational Therapy, Aphasiology, Canadian Journal of Occupational Therapy, Evidence-Based Communication Assessment and Intervention, Journal of Clinical Epidemiology, Journal of School Psychology, Neuropsychological Rehabilitation, Physical Therapy, and Remedial and Special Education. The authors jointly hold the copyright for this article.http://dx.doi.org/10.1037/arc0000026.supp]Supplemental data for this article can be accessed here. ["}
{"text": "There is an error in the spelling of the affiliation for all of the authors. All authors are affiliated with: Department of Neuroscience, Mayo Clinic, Jacksonville, Florida, United States of America."}
{"text": "An incorrect grant number is in the funding statement. The correct funding statement is as follows: This work was partly supported by a Grant-in-Aid for Young Scientists (B) 25750042 from the Ministry of Education, Science, Sports and Culture, a grant for the special scientific research program aimed at the improvement of QOL  via oral function in collaboration with universities from the Ministry of Education, Culture, Sports, Science, and Technology, and a research grant supported by Kojinkai Foundation, and the President discretion research budget of the University of Tokushima. No additional external funding received for this study. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript."}
{"text": "Department of Health and Human Services, the Task Force is an independent, nonfederal, unpaid panel of public health and prevention experts whose members are appointed by the Director of CDC. The Task Force provides information for a wide range of decision makers on programs, services, and policies aimed at improving population health. Although CDC provides administrative, research, and technical support for the Task Force, the recommendations developed are those of the Task Force and do not undergo review or approval by CDC."}
{"text": "Ying Huang is not included in the author byline. She should be listed as the eighth author and affiliated with Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, United States. The contributions of this author are as follows: Analyzed the data."}
{"text": "To describe the profile of morbidities and expenses related to hospitalization of the elderly compared to the adult population (20 to 59 years).A descriptive, cross-sectional investigation of hospitalizations of the elderly (60 years or older) in Brazil during the period from 2002 to 2011, with data from DATASUS and based on ICD-10.Although the highest number of hospitalizations were in the adult age range, the expenses were greater with the elderly, and in this case especially with mental and behavioral disorders, musculoskeletal and connective tissue diseases, followed by circulatory diseases and external causes.The results suggest the adoption of more comprehensive policies and increased investment in health promotion, disease prevention, and appropriate and suitable treatment for the most prevalent diseases in the elderly, particularly in primary care. However, in addition to these demographic changes, there are simultaneous alterations in the epidemiological profile, both in morbidity and mortality of the population, especially due to reduced incidence of infectious parasitic diseases and increase in non-communicable diseases.In a current context of health sciences, similar to various developing countries, Brazil is rapidly aging. This is a reflection of a process called demographic transition, resulting from the reduction in mortality and fertility rates. As a consequence of this change in age profile of the population, greater fiscal pressures are expected on public healthcare services and social security, generating a great demand for health services which will in turn lead to an increase in expenditures with medical costs and hospital admissions.It is estimated that the population over 60 years in age will go from less than 20 million in 2010, to approximately 65 million in 2050,5. In this way, an outline of the profile and statistics of hospitalization rates of the elderly may serve as a model for drawing up more effective strategies of health promotion and disease prevention.If, on the one hand the elderly display a greater burden of diseases and disabilities, and therefore, use a large portion of the health services, on the other hand, inefficiency and high costs related to the current models of elderly healthcare stand out.In this regard, the Unified Healthcare System Hospital Information Services  provides a database that accounts for 80% of hospital admissions in the country, enabling not only profiling of hospitalizations, but also allowing an assessment of their economic impactBased on questions as to the true proportions of hospitalization costs of the elderly in Brazil, this investigation had the objective of describing the profile of morbidities and expenses related to hospital admissions of the elderly compared to those of the adult population (20 to 59 years).. For comparison purposes, the adult age range was also presented, considered from 20 to 59 years.A descriptive cross-sectional study of hospital admissions of the elderly (60 years or more) in Brazil during the period from 2002 to 2011.This population was grouped into three categories: 60 to 69 years, 70 to 79, and 80 years or more, considering the stages specified by Fletcher & Fletcher. The run chart studied is based on official and secondary data on hospital admissions obtained from the SIH-SUS. The variables analyzed were gender, age, type of Hospital Admission Authorization , cost of hospitalization, days of stay, and working diagnosis, as per chapters of the International Classification of Diseases and Health-Related Problems \u2013 Tenth Revision (ICD-10). For the working diagnosis, all the chapters of ICD-10 were used except Chapter XV, which refers to admissions for natural deliveries and caesarean sections (codes 080 to 084.9), maintaining disorders related to pregnancy and puerperium.The resident population during the period (2002 to 2011), used to calculate some of the coefficients, was made available by the SUS Information Technology Department (DATASUS) and the primary causes of hospital admissions among elderly Americans.The major groups of causes were considered, as well as diagnoses due to selected causes including circulatory system diseases; respiratory system diseases; digestive system diseases; infectious and parasitic diseases; genitourinary diseases; external causes; endocrine, nutritional, and metabolic diseases; nervous system diseases; mental and behavioral disorders; neoplasms; musculoskeletal system and connective tissue diseases; and other diseases. This list was partially set up, for comparison purposes, based on the major causes of hospital admissions among the elderly Brazilian populationThe analyses were performed based on absolute numbers, percentages, and a few indicators, namely: The data from hospitalization records are not subject to sampling error, since they cover the totality of events occurred. However, they suffer the effects of random error in the registration process and population estimate. Since it is a study that uses secondary data from an electronic database that makes such information available for access to the general public (DATASUS), this investigation was not submitted to a Committee on Research Ethics in Human Beings. The development of this investigation occurred during the period from August 2002 to December 2012.During the 10 years considered in this study, there were 20,590,599 hospital admissions among elderly Brazilians within the scope of SUS. Of these hospitalizations, 11,434,487 (55.5%) corresponded to the female gender, and the sum of values paid for all these hospitalizations was R$ 21,545,274,041, as displayed on The elderly represented 16.11% during the period, contributing towards 27.85% of hospitalizations and 36.47% of the resources paid for them. The ratio between the percentage of values paid for hospitalizations and the percentage of the population increases gradually with age in men and women. This ratio was equal to 3.55 for elderly men, 1.57 for elderly women, and 2.26 for the elderly of both genders. When these data are divided by age range, the cost/inhabitant ratio increases significantly with age: 0.76 in the range of 20\u201359 years; 1.85 in 60\u201369; 2.65 in 70\u201379; and 3.05 in the range of 80+ years.Still on As to regions, the Southeast Region showed higher mean values than the rest. The cost/day of hospitalization is the highest in the North (R$ 103.81) and South (R$ 103.07) Regions, and the latter one represents the highest daily values among the elderly (R$ 125.64). Both adults and the elderly remain in the hospital longer in the Southeast Region , while in the North Region the values are 5.9 days for the elderly and 4.4 days for adults.As can be seen, the daily values of hospitalizations show a similar distribution among adults and the elderly, especially for circulatory system problems. In the elderly population, external causes have a higher value than in the other age groups observed. As to length of stay, in general, those aged over 60 years spend more time hospitalized, except for infectious diseases and nervous system disorders. It is noteworthy mentioning that the length of stay for mental and behavioral disorders reaches 103 days among the elderly .The hospitalization rate  has a coThe hospitalization rates of the elderly, in general, were higher than in the population aged 20\u201359 years, being nine-fold higher regarding the circulatory system diseases; with the exception for mental and behavioral disorders, in the male population, and from the same cause besides genitourinary system diseases among women.On Considering the use of a secondary database coming from healthcare services, such as the SIH-SUS, a few limitations can be identified: the possibility of emitting more than one AIH  for the same individual , and the remunerative structure of the system that privileges financial logic in detriment of epidemiological logic, facts that can compromise information reliability and validity..Nevertheless, such data have been increasingly more used in epidemiological research, besides the fact that such a system offers an expressive volume of data that represents about 80% of admissions of the entire hospital network of the country, factors that can reproduce such questioning,9,10.As to the data raised by the present investigation, hospitalizations in the adult population predominated, reaching 77% of hospitalizations among people of the female gender. As to the elderly population, one notes a prevalence of use of hospital services 1.6-fold greater in males, following the tendency of other studies.The value paid for hospitalizations is greater among the adult population, a reflection of the greater number of users of SUS at working age. However, the ratio of cost per inhabitant is expressively greater in the elderly population, especially among men, which enables stating that hospitalizations of the elderly are more costly than those that occur among individuals between 20 and 59 years of age. A study performed in 2004 found a cost ratio about four times higher among the elderly relative to the adultsTaking into consideration the differences between the genders, one must consider aspects inherent to the health culture of society, in which men, since early times, do not have the habit of caring for their health nor of seeking treatment at healthcare units. With time this fact leads to an increase of diseases in this population that are generally diagnosed at more advanced stages, requiring more specialized and expensive treatments. Whereas women tend to seek health care units more frequently, having treatments and investing in prevention and self-care, justifying less hospital expenses when they are aged. and genitourinary system diseases, described higher expenses with hospitalizations along the South-Southeast axis.The mean value of hospitalizations expressed the greatest cost in the Southeast Region, which was justified by longer hospital stay among its users, despite the fact that the daily cost of admissions in the North and South Regions has higher values. No references were found in literature covering the distribution of diseases with a national perspective, but other studies about specific disorders, such as suicideOne must consider that the most prevalent diseases up until the beginning of this decade, i.e., circulatory, neurologic, and neoplastic diseases, had their mean values decreased relative to mental and behavioral disorders, and musculoskeletal conditions. This is considered as a possible result of health-related actions performed by the Family Health Strategy , which has assisted the population in promoting health, control and prevention of diseases., in addition to specific approaches as to stroke, other cerebrovascular and cardiovascular events, and circulatory system diseases, which in this case have an extensive relation with vaccination of the elderly against the influenza virus, as a national strategy focused on the Primary Care services as from 1999.Such actions have been the focus of recent studies that considered the ESF a protective factor for the elderly as to chronic and degenerative diseasesdelirium, an acute organic ailment of which onset will initiate a series of events that can culminate with loss of independence, increased morbidity and mortality, besides elevating length and costs of hospitalization and care after hospital discharge.In considering the higher results of the mean value of hospitalization and hospital length of stay, there is an expressive amount of cases related to mental and behavioral disorders. One of the primary etiologies, which may be associated to this result, is .As to musculoskeletal and connective tissue diseases, those with greatest prevalence were osteoporosis, arthrosis, chronic spondylitis, arthritis, and rheumatism, with growing numbers and consolidating as a public health concern, a predominance of cardiovascular disorders was also observed, as well as in a study that analyzed national information during two specific periods: 1994 and 2005, with 32% and 28% of cardiovascular events, respectively.In calculations relative to the rate of hospital admission and cost indexes, the prevalence of circulatory system diseases was observed among adults. In a study that evaluated the diseases that most affected the elderly during the period from 1998 to 2005 in a city in the state of Paran\u00e1.A prospective study performed in Greece comparing hospital admissions in three distinct months of the same year identified similar results, especially regarding the greater prevalence of hospitalizations due to circulatory system diseases, followed by musculoskeletal and gastrointestinal diseases.As to hospitalizations of the elderly related to the respiratory system, a large part presents with a direct relation with the influenza virus, which in Brazil has a seasonal distribution and an approximate prevalence of 22 cases per thousand inhabitants, influenced by geographic density, age distribution of the population, and climate conditions. Complications of this virus may cause severe respiratory problems, such as pneumonia.In addition to a better perception and evaluation of the strategies of Primary Care, especially within the ESF context, the role of health professionals, especially nurses, overcomes difficulties, such as lack of human and material resources, training of professionals, and an adequate physical structure, prioritized by care aligned with human values, respect, and autonomy for the elderly person, which may contribute favorably towards reduction of the most common diseases in the aged.In a broader context of health promotion, the inclusion of the elderly in activities that favor their social interaction, life habits, etc, should be highlighted. Some initiatives, such as a group of elderly individuals linked to a hospital geriatrics service, identified improved overall quality of life in the individuals, resulting from the psychological and social support they received from peers and professionals, and the benefits from the group activities, as well as a tendency towards elevation observed in the social relation and general domainsAcademia da Cidade (City Gymnasium) implemented by the Ministry of Health, in 2011. This initiative seeks to create places where people can exercise, engage in sociocultural activities, receive orientation, and develop projects integrated with Primary Care, which could serve even as an entry into the health system. Some studies have already shown the effectiveness of this proposal, which is not only for the elderly, but they generally are the ones that participate in it, in addition to those who would not have the means of paying to go to a gymnasium.A public initiative that may be effective in most frequent diseases of the elderly and in longer hospital stays, is the As a consequence of an older population, health promotion (in the vastness of its practice), actions of health education, prevention of diseases, and retarding of diseases and fragilities, as well as maintenance of independence and autonomy, may guarantee better quality of life to the elderly.In the present investigation, distinct indicators were used to evaluate costs related to hospitalization of the elderly. Without going into the merit of the scope of each one, the results showed differences and similarities, composing a more complete picture for assessing of such health costs.The results presented here allow one to infer that admissions of the elderly population are more costly than those conditioned by the adult population, expressed by most of the indicators observed. Health complications related to the aging process itself are covered, such as chronic diseases, possible failures in health promotion actions and prevention of diseases, in addition to an increment in prevalence of diseases rarely investigated in literature to date, such as the primary causes of the expenses.These effects may be reduced with the adoption of more comprehensive policies and greater investment in actions of promotion, prevention, and opportune and adequate treatment for the most prevalent diseases in the aged. These policies may and should serve as subsidies for the preparation and implementation of actions capable of bringing favorable changes to the lives of the elderly and to the Unified Healthcare System, as the structure in charge of their care, among many other responsibilities."}
{"text": "Problem vs. recreational users may be segregated (to enable their comparison) using information available from each study's instruments, on key addiction phenotypes (e.g., craving, withdrawal, difficulties in controlling use, persistent use despite harmful consequences on mental health, and socio-occupational functioning, higher priority given to drug use than to other activities and obligations; APA., Finally, we propose the development of an agreed-upon instrument to objectively assess key features of cannabis addiction vs. non-problem use in neuroscientific settings, as most measures of cannabis related problems are borrowed from those used for other substances, the features of which may not fit those relevant to cannabis dependence (Lorenzetti et al., In conclusion, we call for a greater, systematic and coordinated research effort internationally, to identify pathways in and out of CUDs and fill the existing gap between the limited knowledge on CUDs and the increasing availability of cannabis products.VL and JC formulated the key concepts and led the writing of the commentary; NS, HG, CS, and MY contributed to the concepts and writing of the commentary. AV contributed to the key concepts and to the writing of the commentary.NS is supported by the Australian Research Council Future Fellowship FT110100752. MY is supported by the National Health and Medical Research Council of Australia, Senior Research Fellowship.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "The affiliation for the third author is incorrect. Michal Ginter is not affiliated with the Paleontology Section but with the Faculty of Geology, University of Warsaw, Warsaw, Poland."}
{"text": "Of these, most, 339(74.1%), involved the lack of access in all regions of Brazil. The main accessconstraint was the prolonged waiting time for surgery. Other constraints were theexcessive waiting for medical appointment with experts, doing examinations andcancellation of surgeries. the access to surgical assistance, by users of the Brazilian health system, is notwidely guaranteed, reinforcing the need for integrated governmental actions,organization of the health care network, management of health care and humanresources to overcome the challenges imposed to achieve the Universal Access toHealth and Universal Health Coverage. This is because, often, it is the only solution to avoid them in case ofinjuries, traffic accidents, burns, disasters, violence, obstetrical complications,emergency abdominal and non-abdominal conditions, and others that may significantlyaffect the quality of life, such as cataract and congenital malformations.Surgical condition is essential for prevention of chronic disabilities andmortality-2. Thrmations..Surgery is at the end of the spectrum of the classic curative model. Thus, regardless ofsuccessful prevention strategies, surgical conditions will always be responsible for asignificant portion of the burden of disease in a population. In developing countries,in particular, where conservative treatment is not readily available, the incidence oftrauma and obstetric complications are high and with significant accumulation ofuntreated surgical diseases.(-). As a result, surgical pathologies are aggravated, affect the socioeconomiccondition of the active population, impair the quality of life, and become potentiallylethal.However, the access and coverage of essential surgical care, as part of the human rightto health, are not widely guaranteed-3. Asylethal..In addition to improve the quality of life, the quality of surgical interventions, andincrease access to surgery, it can assist in achieving the United Nations Millenniumgoals for 2015; considering that surgery enhances the reduction of child mortality goal4) and improves maternal health  for obstetric complications treatment. Inaddition, surgery may contribute to reduce the number of people living in poverty , since surgical conditions can keep people outside the labor market and imprThus, considering the importance of the global surgical assistance, its impact on thequality of life of patients, limitation of access and health care coverage, and interestin answering some emerging challenges in nursing, this study aimed to characterize theaccess to surgical assistance in Brazil.Caixa Preta da Sa\u00fade[HealthBlack Box] database.Documentary study, with a quantitative approach, carried out from a secondary source ofdata, of public domain, of the electronic .This database, created in March 12, 2014, is the result of a non-governmental initiativeof the Brazilian Medical Association. It is an electronic communication channel withusers of health care that aims to receive and compile, into a database,complaints/records on the issues that affect the public and private health in Brazil.Voluntarily, anyone, from anywhere and at any time, can send photos and videos,complaining failures and describing the difficulties faced in the search for healthcare. Complaints are forwarded to the Public Prosecution for formal verification of thefacts reported, thus contributing to the government and managers to take the necessaryprecautions.We considered as an inclusion criterion the records containing information aboutsurgical assistance in Brazil. To select them, we used the following descriptors:surgery, surgeon, surgery center, to operate, operation, preoperative, postoperative,surgical, anesthesia, and anesthesiologist.The data were collected in March, 2015. In the electronic database (accessed by theaddress http://www.caixapretadasaude.org.br) all records were selected for the period of12 months , of each Brazilian municipality. After readingeach record, we selected those that contained the descriptors previously defined. Forthe collection, we used a structured instrument, with the following variables: lack ofaccess, waiting time for surgery, waiting time for appointment with a specialist,waiting time for examinations, cancellation of surgery, and surgical specialty.Statistical analyses were carried out using the Statistica software 12.0. The resultswere expressed as mean and standard deviation for the quantitative variables and infrequency and percentage for the qualitative variables. We used the Chi-square test toverify differences in the proportions between regions of the country, and the one-wayAnalysis of Variance (ANOVA) for comparison between average values. For all theanalyses, a p<0.05 significance level was considered.Regarding ethical aspects, we used information from the public domain, present on theInternet. Thus, we obtained an authorization of the responsible people for the database,since they are the trustee of the information. In addition, we followed all ethicalprinciples required for analysis and dissemination of data.There are 3773 (100%) records related to health care in Brazil. Of these, 458 (12.3%)involved surgical assistance. Most of the surgical records, 339 (74.1%), involved lackof access in all Brazilian regions, according to Other records about surgical assistance, 119 (25.9%), comprised hospital care regardingphysical structure, such as precarious conditions of hospital facilities and poorhygiene; the given assistance, which included the lack of information about users,humanization and quality regarding the services related to human resources, includingmedical malpractice and negligence, and also negligence of health professionals with theusers and their families (data not shown). We found that the main access constraint wasthe waiting time for care, at different points of the health care network, with apredominance of waiting list for surgery, according toCaixa Preta da Sa\u00fade, the critical center of surgical assistanceis predominantly the lack of access of the user to surgery. For users, the prolongedwaiting time is the main access constraint to primary health care.Surgical assistance is essential. However, in this study, we noted that, accordingtoCaixa Preta da Sa\u00fade database. This is a provocative and relevanttool, which gives voice to the Brazilian health system users, and has the potential toconstitute an important mechanism of ombudsman. Indeed, it is a tool which exposes theweakness of the public health system in Brazil, illustrating with dramatic tones thedifficulty of many people to at least have their complaints heard, and much lessmet.According to the indexed literature, this is the first study that uses information fromthe . Moreover, it is a powerful means of promoting health, well-being, andhuman development.On these findings, it is believed that health care in Brazil is often against thefundamental assumptions of Universal Health Coverage, in which all people should haveequal access to health actions and services of quality, according to their needs overlife. The Universal Health Coverage should be the main objective and guideline of healthsystems, and its fundamental premise is the right everyone has to the highest standardof health care. Moreovelopment.. Additionally, regarding Internet access in Brazil, there is a markedinequality between regions. Regions with more access, Mid-West, South and Southeast,surpass the North and Northeast regions. Thus, this disparity may have limited the use of the tool by Brazilians,particularly in the Northern region.Regarding the number of records, it was observed that the Southeast region significantlysurpassed other regions. This greater potential of use of the tool in this region can bedue to the higher population density. On the other hand, the Northern region, withsmaller number of records, has the lowest population density (3.9 people perkm\u00b2). Additi.It is noted that the Southeast, as the main user of the tool, faces limitations to theUniversal Health Access and Coverage, similar to other regions, even with highersocioeconomic development and better welfare conditions, regarding the number of beds,specialized hospitals available, and operations per inhabitant when compared to theNorth and Northeast..Regarding the lack of surgical access, this is not a new problem: health systemsworldwide, regardless of the socioeconomic status of the countries, deal with it. InBrazil, the waiting list for elective surgeries is a reality with regional nuances as toprocedures with longer or shorter lists, whether measured in number of patients orwaiting time..We noted that the waiting comprised all the course of the user in the health carenetwork. Considering that the user, due to the presence of signs and symptoms, accessesthe network searching for medical care in the basic care. Once acknowledged the need,there is the referral to the specialist in the outpatient care. After a long process ofappointments, research, expert evaluation, and the need for surgical treatment, the useris placed in a waiting list for surgery, which will occur in the hospital careinstance..Similarly, a study conducted to verify the barriers to the access to the treatment ofcataracts showed a gap between the search for specialized medical care and surgicalresolution. The contributing factors were the difficulty in preoperative examinations,number of times the patient needed return to the service (3.2\u00b11.5) as well as thewaiting time between the first consultation and the surgery (3.2\u00b12.6 months). The amountspent on the preoperative examinations ranged from 5 to 170 BRL.. It is recognized that the incorporation of records is voluntary anddepends on the users with access to Internet. Thus, we should be cautious ininterpreting this result, because official data from health services can scale moreprecisely the reality of the waiting list for the service in the regions of the country.Despite this constraint, this result shows a cruel and legitimate reality, complained byusers who were drastically underserved.In this study, we showed an excessive waiting time, over one year, to surgical care inall regions of the country. In the South region, there was a longer waiting time, withsignificant difference in relation to the Mid-West, North, and Northeast regions.However, studies show variations from 3 to 6-month in waiting time, with more accessibleservices in the South and Southeast regions,12. I.It should be noted that the prolonged waiting for care occurs when demand is greaterthan the capacity of the public system. Often, the list reflects the inadequacy ofpublic funding for health. And is one of the main problems of public health systems,being a permanent source of political and social discontent.. Data from Caixa Preta da Sa\u00fade show that, in addition tothe predominance of lack of access, in certain situations, the prolonged waiting time onthe list for surgery does not ensure the care. Eventually, the user deals with a newobstacle, the cancellation of surgery as a result of inadequate infrastructure. Inaddition, when users access the hospital care, the infrastructure is precarious, andthere is no quality in the assistance offered.Achieve Universal Access to Health and Universal Health Coverage is a permanent, complexand challenging task. Data f.In Brazil, despite the urgent need for tackling the current challenges relating toachieve Universal Access to Health and Universal Health Coverage, it should berecognized that, in health, an advance landmark was the health reform, which culminatedin the creation of the Unified Health System (SUS). The result of the struggle ofBrazilian society, politics and government actions, provided a significant expansion ofaccess to health care, through the Family Health Strategy..Following this direction, from 2014, member states of the World Health Organization/PanAmerican Health Organization have been focusing on concurrent and independent actions toexpand the equitable access to complete health services, of quality, and focusing on thepeople and communities, to promote the expansion of Universal Access to Health andUniversal Health Coverage.. However, what was supposed to be an emergency strategy has become themodus operandi for access, being a palliative measure, costly to thesystem and that does not guarantee the access to surgical assistance in a sustainableway, since the extended waiting time in the list for surgery persists, with negativeimpact on health and quality of life of patients.More specifically on access to surgery, we highlight the mutual-aid group of surgeries,government-funded, through allocation of extra resources. The mutual-aid group aims tomeet the repressed surgical demands through concentration of efforts of the healthservices to accomplish a significant number of surgeries in a short time. Howevepatients.. This ensures a gap favorable to the offer of a private health system,which firmly established in a neoliberal policy guarantees the access to who can affordit, increased the fact that, at the highest level of power, it is used as lobby andpolitical influence to perpetuate a cycle of abandonment of the public health system andfavoring the private initiative. In summary, it is said that the State deserts itsfunction as provider of the citizens' health, to deliver it as a consumer or customer toprivate agents.In relation to the political and economic aspects, constraints to the access to healthin Brazil, we noted that the public investment in health system remains, unacceptably,below the desired levels and, significantly, lower than international standards. Thus,the public spending on health care was responsible for only 48% of total healthexpenditure, accounting for only 7.2% of the total public expenditure, significantlyless than the total value of 14.3%. The total expenditure on health per capita per yearis, on average, 427 USD. From this amount, only 204 USD were invested by the government,a much lower value when compared to an overall expenditure of 429 USD per capita or forinvestment from developed countries such as the United States of America  or Europe .When it comes to surgery, there are public investment restrictions similar to thosementioned above, confirming the finding of a government practice of severe public healthunder-funding. From 1995 to 2007, 32,659.513 non-cardiac surgeries were analyzed. Therewas substantial increment of 20.42% in the number of surgical procedures. However, theepidemiology of surgeries in Brazil differs considerably, from international standards.Annually, about 38 million surgeries are held in the United States of America, and 7million in Europe. In Brazil, there were approximately 3 million non-cardiac surgeries.Additionally, it was noted that the costs of the procedures are lower, and the mortalityrate is higher in developed countries. Thus, we concluded that the access to surgicalinterventions is poor and uneven, with insufficient number of surgeries accomplished,and surgical results are even worse when compared to international standards(-). Thus, it is believed that an integrated approach, which includes endlessjoint efforts in the political and economic aspects, in the organization of the healthcare network, management of health services and human resources, will enable to overcomethese challenges, in such a way that health and other social rights of Braziliancitizens are widely guaranteed.Therefore, only a systemic change is able to overcome the challenges imposed to achievethe Universal Access to Health and Universal Health Coverage-15. T. Furthermore, given the social determination of health, the economic crisisand social inequality must confront, education must be improved, the environment must bepreserved, and the increasing demands of an ageing population must be met. Equally important, the influence of the medical and pharmaceuticalindustry in the health sector must be mitigated, which is often subservient to theinterests of the market, to the detriment of the interests of the population, amongothers.Regarding the political aspect, it is imperative that government policies face thechallenges related to the macroestructure complexity, so that they can overcome thechallenges imposed to health. Thus, for improving health, it is necessary to improvegovernance, i.e., a greater degree of responsibility of the public sector, lesscorruption, and assumption that provide the public health system is a constitutionalduty of the State,14. F.Regarding the health care network, to optimize the deployment of mechanisms andstrategies of organization and integration of assistance network contributes to promotethe capacity of health systems to provide more coordinated care, minimize accessbarriers between assistance levels, and a health care more synchronized and in a propertime. However, it should be recognized that one of the main obstacles to the integrationof the health services network is the prolonged waiting time for the care.(-).Regarding the organization of the network to surgical assistance, aiming to improve theaccess and qualification of social assistance practices, the access to specialized andhospital services should occur, predominantly, through reference of Family HealthStrategy. Additional actions include the development of protocols to facilitate theaccess to specialized and hospital care. To undertake efforts along with otherprofessionals, to further integration, exchange and information continuity between basicand specialized care. Definition of access measures, such as the waiting time forprimary care, consultations with specialists, diagnostic tests, and waiting for surgeryand, based on these indicators, to establish strategies for better management ofwaiting-17..In outpatient level, we recommend instituting careful research about the needs of theusers in a waiting list situation, namely: clinical criteria such as health statusdeterioration, disease evolution, disabling pain, and mobility limitations;socioeconomic criteria concerning the ability to live and work independently, inaddition to the emotional aspects. This allows the user the re-evaluation of prioritywhile in the waiting list, and reconducting the family health team, for continuousmonitoring,17.(17).In addition, encouraging the development of guidelines for determining safe andacceptable waiting period, development of prioritization tools of assistance to considerthe psychosocial characteristics, definition of responsibilities to operationalize theprioritization process, being a surgeon, nurse or other healthprofessional.Strictly regarding to the management of resources, comparisons show that greater supplyof beds, health professionals and health expenses are effective strategies, inlong-term, in management of the waiting. Thus, the ability of the health services can beoptimized. We suggest the payment for productivity, quantitative and qualitativeinvestment in human resources, evidence-based practice support, and use of idle capacityof surgical center on weekends, among others,17.. Especially nursing, due to the constraint potential in completely meetingthe needs of the population, in the different points of the health care network.However, deep imbalances and gaps remain in the availability, distribution, composition,competence and productivity of health human resources, especially in primary healthcare.Human resources are considered one of the central pillars for Universal Access to Healthand Universal Health Coverage. Especilthcare..Thus, enhancing the scope of nursing practice requires political will for change.Notably, in the political field, it is essential the development of infrastructurepolicies that support the nursing profession, including regulation, scope of practice,certification, undergraduate studies, graduate studies, continuing education and wagereform.In the field of professional performance, nursing, in partnership with other healthprofessions, must assume the commitment to public health, through the construction andconsolidation of the SUS. To make this commitment involves overcoming Cartesian healthassistance practices, aiming the completeness of the care, introjecting the premises ofhealth policy in force, incorporate them into your practice, and act in the organizationof health care networks, with emphasis on primary health care..In the field of training, nursing must have the commitment to the construction of valuesthat structure it as a social practice, provided through the interpretative looks of itshistory and open to the current reality, considering the political, economic and socialstructure in force in the country, health care models and their coverage, as well as theinternal struggles of workers in the process of work and future challenges.Caixa Preta da Sa\u00fade database, most records aboutsurgical assistance involved the lack of access in all regions of Brazil. The mainaccess constraint was the prolonged waiting time for surgery. Thus, we observed that theaccess to surgical assistance, by the Brazilian health system users, is not widelyguaranteed. This reinforces the need for integrated governmental actions, organizationof the health care network, management of health care and human resources to overcomethe challenges imposed to achieve the Universal Access to Health and Universal HealthCoverage.According to the Therefore, if Universal Health Coverage is assumed as a government priority and also ofhealth services, it will stimulate the nursing to expand its role in the construction ofa system of universal, equitable and complete public health."}
{"text": "Mitchell P. Fink, MD Fig.\u00a0, one of Mitch graduated from the Washington University School of Medicine in St. Louis, MO, in 1976 and completed general surgery training at the National Naval Medical Center in Bethesda, MD, in 1981. Thereafter, he held faculty positions at the Bethesda Naval Center and the University of Massachusetts, where he worked as surgeon and intensivist. In 1992 he moved to the Harvard Medical School, eventually becoming the Johnson and Johnson Professor in Surgery and surgeon-in-chief at the Beth Israel Deaconess Medical Center. He moved to the University of Pittsburgh in 1999, where he subsequently became the inaugural chair of the Department of Critical Care Medicine. He founded several companies based on discoveries from his laboratory and, in 2007, left the university to oversee the formation of one of these ventures. In 2009 Mitch returned to academia, joining the faculty at University of California Los Angeles where he held the title of Professor of Surgery and Vice Chair for Critical Care.During his career, Mitch cared for thousands of patients with skill and compassion, amassed a great body of experimental and clinical research, trained and mentored hundreds of physicians and scientists, demonstrated wonderful entrepreneurship, and carved a vision of modern multidisciplinary critical care with lasting benefits for our entire field. For decades, academic medicine has praised the rare individual who excels as the so-called triple threat: teacher, clinician, and scientist. Mitch was all three and more, adding to these triple roles the rare gift of visionary leader in both academia and industry. I have never known anyone quite like Mitch.Nature while still in medical school. While working in Bethesda, he forged close relationships with the National Institutes of Health critical care group, conducting a number of seminal experimental studies that both helped to establish the utility of animal models to probe the host response to sepsis, trauma, and shock and to inform our current understanding of these syndromes. Later, Mitch would conduct pioneering work using cell-based models of organ dysfunction to tease out the cellular response to stress from hypoxia and endogenous and exogenous danger signals, exploring key concepts of mitochondrial dysfunction and dysoxia. In addition to his passion for experimental research, Mitch also conducted many highly cited clinical studies, co-wrote the Textbook of Critical Care, and served on the editorial boards of numerous journals including Critical Care, Critical Care Medicine, and Intensive Care Medicine.His extraordinary career began early with a first author paper in To all of his work, Mitch brought four enduring characteristics: knowledge, logic, creativity, and focus. He maintained an encyclopedic knowledge of the world, able to quote relevant papers, data, and information off the top of his head from a dizzyingly wide range of art, science, politics, and history. He also exercised crystal-clear logic, distilling the most complex problem into a series of simple steps, whether this was a complicated piece of basic science or a tough business decision facing a start-up biotechnology company. Having concisely summarized any problem, he then brought great creativity and inventiveness to probe and tackle its solution. Finally, he always kept a clear sense of purpose, making sure neither he nor his colleagues ever lost sight of the larger goals of advancing medical knowledge and saving lives.I came to know Mitch during his tenure in Pittsburgh when he oversaw one of the most prolific and successful eras in our history, serving as a wonderful mentor and colleague, and launching the first multidisciplinary department of critical care medicine in a US medical school. In our daily contact with Mitch, we saw not only his intellect and drive, but also his warmth, compassion, wit, and grace. His door was always open, ready to listen to everyone from senior colleagues to junior residents and new staff. He had words of kindness and advice to coach us through every disappointment and words of praise and respect for every accomplishment. For me, as for many, Mitch was unquestionably one of the most supportive and influential people we have ever known. Through both his words and actions, he taught us not just about medicine and science, but about life, relationships, honor, duty, and service. We have lost an immense presence. Mitch is survived by his wife, Judy, and children, Matt and Emily. We extend our deepest condolences to them. He will be deeply missed."}
{"text": "International collaboration is growing exponentially  and reseRecognizing the value of research networking, Cedars-Sinai Medical Center (CSMC) started building in 2002 a regional research organization in CEE by establishing International Research and Innovation Management program. During the first four years of the program, CSMC established partnerships with research institutions in Croatia, Czech Republic, Hungary, Romania, Slovakia, and Ukraine. CMSC provided training on research and innovation management, technology transfer infrastructure, and management capacity. In 2006, it formed the Regional Cooperation for Health, Science and Technology (RECOOP HST) Consortium with eleven CEE universities and research organizations from the following countries: Croatia, Czech Republic, Hungary, Romania, Slovakia, Ukraine, and the USA .In 2012, CSMC registered with the Consortium the Association for Regional Cooperation in the Fields of Health, Science and Technology at the Court of Debrecen in Hungary. The newly established Association included members from 8 countries, adding Denmark and Poland to the consortium, and involving 14 higher education or research organizations.The Association promotes creative thinking and helps its members to make decision whether they want to \u201cpublish and disclose\u201d or \u201cprotect and publish.\u201d Special attention is paid to young scientists and their education on scientific communication and technology transfer. In 2012, it carried out several integrated multidisciplinary, multicenter research studies within the joint RECOOP Life Science Research Platform and formed 18 CSMC RECOOP Research Centers (CRRC) in 7 countries  to facilitate the cooperation on translational and clinical research in the field of genomics-proteomics, epigenetics, metagenomics, molecular biology, metabolomics, and nano-biotechnology. Besides that, among its highest priorities is the involvement of medical and PhD students into the CRRCs\u2019 research programs.RECOOP Life Science Research Platform already completed a number of short term (1-2 years) pilot research studies, which are now being converted to midterm (5 years) projects. The clinical studies are planned to continue for a minimum of 20-30 years and follow up the women, men and newborns registered in the Electronic Data Entry Forms, started in 2011 .The RECOOP HST Association annually organizes the Bridges in Life Sciences Conferences to review the scientific progress in the Association. At the annual meeting, the Scientific Advisory Board selects the top ten young scientists, for whom the Association covers the attendance costs of summer schools and workshops on manuscript writing and intellectual property protection.RECOOP plays a significant role in the integration of life science research activities in member countries of Visegrad Four European Macro-Region  and their neighboring countries . The Association paves the way for GLOBAL Research Programs of the National Institutes of Health and the World Health Organization, and private funds such as Bill & Melinda Gates Foundation and Clinton Foundation .In Croatia, the RECOOP HST Association includes researchers from the J. J. Strossmayer University School of Medicine in Osijek and University of Split School of Medicine. Professor Ana Maru\u0161i\u0107 from the University of Split School of Medicine, who has extensive experience in teaching and studying research methodology ,9, contiSince CEE countries are considered a scientific periphery, there must be an even stronger impetus to increase their participation in international research consortia. Sustained engagement in training programs and joint applications to research funding can stimulate research network development . RECOOP As part of the ongoing process of European integration , the REC"}
{"text": "CDC and Emory University\u2019s Rollins School of Public Health will cosponsor a 6-day course on Environmental Microbiology: Control of Foodborne and Waterborne Diseases at Emory University, Rollins School of Public Health. This course on the surveillance of foodborne and waterborne diseases is designed for public health practitioners and other students interested in the safety of food and water. It provides a broad overview of the major foodborne and waterborne diseases.This course describes how information from surveillance is used to improve public health policy and practice in ways that contribute to food and water safety. Discussions focus on the microorganisms and chemical agents responsible for food and water-transmitted diseases, the diseases they cause, pathogenesis, clinical manifestations, reservoirs, modes of transmission, and surveillance systems. The transport, survival, and fate of pathogens in the environment, the concept of indicator organisms as surrogates for pathogens, and the removal and inactivation of pathogens and indicators by water and wastewater treatment processes will be analyzed. Examples of the public health impact of quality assurance programs, such as hazard analysis and critical control points, on control foodborne and waterborne diseases in industrialized and developing countries will be highlighted.http://www.sph.emory.edu/epicourses), or by e-mail .This course is offered to matriculating students at Emory University and to nonmatriculating public health professionals. Tuition will be charged. The application deadline is December 15, 2013, or until all slots have been filled. Additional information and applications are available by mail , by telephone (404-727-3485), online ("}
{"text": "Background: Pasteur Institute of Iran was established in 1919 with the aim to produce vaccines and prevent communicable diseases in Iran. Over time, their activities extended into areas of research, education and services. Naturally, such a vast development begs establishment of a comprehensive management and monitoring system. With this outlook, the present study was carried out with the aim to design a performance assessment model for Pasteur Institute of Iran that, in addition to determining evaluation indicators, it could prepare the necessary grounds for providing a unified assessment model for the global network of the Pasteur Institutes. Method: This study was designed and performed in 4 stages: first; design of indicators and determining their scores. Second; editing indicators according to the outcome of discussions and debates held with members of Research Council of Pasteur Institute of Iran. Third; implementation of a pilot model based on the Institute\u2019s activities in 2011. Fourth; providing the pilot model feedback to the stakeholders and finalizing the model according to an opinion survey. Results: Based on the results obtained, the developed indicators for Pasteur Institute of Iran evaluation were designed in 10 axes and 18 sub-axes, which included 101 major and 58 minor indicators. The axes included governance and leadership, resources and facilities, capacity building, knowledge production and collaborations, reference services, economic value of products and services, participation in industrial exhibitions, status of the institute, satisfaction and institute\u2019s role in health promotion. Conclusion: The indicators presented in this article have been prepared based on the balance in the Institute\u2019s four missions, to provide the basis for assessment of the Institute\u2019s activities in consecutive years, and possibility of comparison with other institutes worldwide.  As one of the principle members of the health and research system, Pasteur Institute of Iran can play an important role in providing the community prevention and control of disease and in achieving the objective of Iran's national future outlook in 2025. Pasteur Institute of Iran is a longstanding member of the International Network of Pasteur Institutes. This network operates with membership of over 30 institutes across the five continents. It is a research, manufacturing, and educational organization that was established in 1919 with the aim of supporting public health and preventing communicable diseases. The necessity for establishing this scientific institution was initially to produce vaccines and to prevent communicable diseases. However, the current policies of this institute include implementing basic and applied research in diagnosis of diseases, providing prevention and control methods, manufacturing biologic and laboratory products, education and research in other medical science fields, holding independent practical units in various specialized areas, and conducting joint educational and research projects with similar centers in national and international levels [An overview of the global network of Pasteur Institutes reveals that, generally, activities of this network members involve in research, public health, education and production, national and international collaborations, interaction with the industry, community etc. . The annThe present study was conducted in 2011 in four stages as follows:Stage one. Available reports of other Pasteur Institutes as the members of global network of Pasteur Institutes, published reports of the Pasteur Institute in France (as the first in the world), and even the newest Pasteur Institute in China, national comprehensive scientific map and health scientific map in Iran as well as constitutional and strategic plan of Pasteur Institute of Iran were reviewed. Based on the reports from other Pasteur Institutes in the world, generally, activities of most institutes include research, education/training, production, clinical services, and providing professional health services, nutrition, food security, environment, and attention to the necessary infrastructures, such as the physical space, human resources and budget, cooperation with the community and industry, utilization of research findings, the institute\u2019s role in public health, national and international collaborations, being a reference source at national and international levels given the previous history and prospects through outlining the vision, the mission, objectives, and defining strategies.Through analysis of the mentioned documents, a list of categories and sub-categories of indicators were listed based on the responsibilities, mission, and strategies of Pasteur Institute of Iran and the health research system model . At the Stage two. The developed indicators were discussed with the members of Research Council of Pasteur Institute of Iran, and the model provided was revised according to the members\u2019 comments.Stage three. According to the values of each indicator and their axes, score of each indicator was determined. Furthermore, a pilot evaluation model was carried out to evaluate the applicability of each indicator in 2011.Stage four. The results of the pilot study were reported to the Research Council of Pasteur Institute of Iran with the aim of finalizing evaluation indicators and scores, assessing challenges and providing strategies to conduct annual performance evaluation based on the developed indicators. The evaluation model was then finalized.The indicators developed for performance evaluation of Pasteur Institute of Iran were designed in 10 axes and 18 sub-axes consisting of 101 major and 58 minor indicators. The axes included: 1) governance and leadership, 2) resources and facilities, 3) capacity building, 4) knowledge production and collaborations, 5) reference services, 6) economic value of products and services, 7) participation in industrial exhibitions, 8) status of the institute, and 9) satisfaction and institute\u2019s role in health promotion. Each axis included a number of sub-axes, each sub-axis had some major indicators, and some major indicators contained one or more minor indicators.Based on Other governance criteria included the presence of clear policies and strategies for the Institute\u2019s activities in the form of strategic program, with its indicators considered to consist of content, including having a vision, a mission, and a mission statement, objectives and an action plan, a monitoring and evaluation program, and the ways of other stakeholders participation of in program development.Finally, a clear ethical program includes ethical committee activity in terms of number of meetings, composition of members based on the approval of the Ministry of Health Research Department, supervision method of the committee on the referral projects in need of assessment and on its implementation process. In total, 159 marks were considered for this axis, which included 130 marks for autonomy of Pasteur Institute of Iran, 19 for strategic program, and 10 for ethics.According to The physical resources were analyzed in terms of the physical space and facilities. These assessment criteria were performed by the opinion of the head of training/research groups in terms of qualitative and quantitative indicators of laboratory commensurate with the groups/department objectives, quality of materials used, advanced equipments and finally quality and quantity of production and service units appropriate for the strategic program.In total, this axis scored 658 marks consisting of 50 marks for financial resources , 438 marks for human resources , and 170 marks for the physical resources.Based on According to the indicators in  Other sub-axes and the following indicators in this axis were included in a model for the first time. Thus, no information was available on these sub-axes. The sub-axis of communications and cooperation contained indicators of membership in science and technology parks, membership in international branches/networks, and collaborations with WHO as a \u201ccollaborating center\u201d. For the publication of scientific/research journal, based on indexing databanks , full marks were allocated for first publication, or a percentage was allocated for subsequent years, depending on the type of profile. The indicator of \u201cAwards\u201d achieved in festivals was accounted according to the festival and national or international institutions (various agencies in the United Nations). The sub-axis of technology and innovation, through indicators of number of incubators, number of knowledge-based companies according to subject, number of spin-off companies according to subject, and time of establishment were awarded full marks for the first year, and a fifth of marks for subsequent years.The sub-axis of training and technical consultations was awarded marks according to type of organization such as other Pasteur Institutes in the world, other scientific/research organizations abroad, the World Health Organization, Ministry of Health and Medical Education, industry and other universities, research centers and scientific institutions of the country, and also according to type of presentation, correspondence, electronic mail, or in person. The sub-axis of regulated guidelines and summaries was considered from the end-user\u2019s perspective  and type of guideline or summary  and means of information transfer . In terms of scoring, no limitation was implemented in the collaboration and knowledge production and publication, considering the nature of indicators.Other indicators are presented in The referential nature of services in terms of laboratory, specialty, and technology at national, international, and regional levels was considered according to the first year or subsequent years of services. The indicators of economic value of products and services and the value of knowledge generated were considered in terms of geographical spread of product and service utilization and marketable production project (inside and outside of the country). The presence in industry exhibitions was assessed in terms of number of pavilions of Pasteur Institute of Iran (in the country and abroad). The status of the institute at national and international levels was considered according to a written opinion of the public visiting the institute, opinion survey conducted in organizations interacting with the institute and other stakeholders. Finally, world ranking of the institute was considered. In terms of satisfaction, the level of satisfaction and loyalty to the organization among the personnel of Pasteur Institute of Iran as internal stakeholders (members of faculty and experts) was considered. The most important outlook of the institute, its role in health promotion, will be investigated through its role in promoting equity in health indicators according to the opinion of stakeholders in the Ministry of Health . All indicators in et al. [Based on the nature of Pasteur Institute of Iran, in the governance and leadership axis, in addition to strategic program indicators and the ethical committee activity considered by Jalalinia et al.  and conset al. , financiet al. [et al. [In the resources and facility axis, although Pazargadi et al. , 10 cons [et al.  emphasizIn relation to capacity building axis and the presence of structures, only managerial structures in areas of education, research, services, and production were active. Also, creation of other structures based on the discussed indicators will be effective in promotion of the institute in future.According to the existing evidence, missions of the world\u2019s Pasteur Institutes, including Pasteur Institute of Iran, have been different from those of academic centers. Over the years, the role of Pasteur Institute of Iran in controlling fatal communicable diseases such as plague and rabies and more recently, hemorrhagic fevers support this claim. In recent years, two new responsibilities as education and production have been added to the previous research and service responsibilities of the institute. Of course, in the past, the institute had collaborations with universities and Ministry of Health in terms of professional education and training on the job, and even directly produced B.C.G. vaccines and other products used in prevention and control of communicable diseases. With new missions causing improvement in quality of research and services and eventually community health promotion and equity in health, the national and international credibility of Pasteur Institute of Iran will be enhanced. However, if the attraction of education and production retreats the institute from applied and targeted research and responding to the public health needs, and Pasteur Institute of Iran neglects its holistic and equitable role, undoubtedly, an interminable loss on the country\u2019s healthcare system will ensue. Fortunately, the Board of Trustees of Pasteur Institute of Iran is fully aware of this issue, and has special supervision and attention to the strategic plans and evaluation indicators of Pasteur Institute of Iran. The indicators presented in this article have been produced in accordance with maintaining balance in four missions of the institute, so that, it can provide a basis for evaluation of activities of the institute in consecutive years, and perhaps, for comparison with other institutes in the world. The important point is that the presented indicators and scores are merely suitable for a beginning in evaluation and can be altered in future evaluations. Of course, this should not harm the old mission of the Pasteur Institute of Iran."}
{"text": "Morbidity and Mortality Weekly Report (MMWR) series of publications.Stephen B. Thacker, MD, MSc, a retired Assistant Surgeon General in the U.S. Public Health Service, and recent Director of the Office of Surveillance, Epidemiology, and Laboratory Services at CDC, died on February 15, 2013, in Atlanta, Georgia. He was 65. Dr. Thacker served with distinction in key CDC positions, including Deputy Director (Acting), during a career that spanned more than 36 years. He was the recipient of two of the U.S. Public Health Service\u2019s highest individual honors, the Distinguished Service Medal and the Surgeon General\u2019s Medal. Throughout his public service, he provided essential support to the Born in Independence, Missouri, Dr. Thacker was educated at Princeton University and the Mt. Sinai School of Medicine. He completed a residency in Family Medicine at Duke University and obtained an MSc degree at the London School of Hygiene and Tropical Medicine. He was board-certified in Family Medicine and Public Health and General Preventive Medicine. During his career, he published over 240 articles and book chapters on public health and health care.MMWR series: in 1983, Dr. Thacker conceived and helped to launch the Surveillance Summary component of the MMWR series to advance the science and effectiveness of this essential function in U.S. public health practice.Dr. Thacker joined CDC\u2019s Epidemic Intelligence Service (EIS) Program in 1976 and was assigned to the Washington, DC, health department. Beginning with an early leadership role as director of CDC\u2019s public health surveillance office and continuing throughout his career, he made substantive contributions to the public health practice of surveillance that have been institutionalized in the United States and globally. One example is the enduring effect of his influence on the MMWR through surveillance, Dr. Thacker provided ongoing, routine, senior-level review of the contents of each issue of the MMWR weekly throughout most of his career. His expertise in epidemiology, public health practice, and related disciplines, and his knowledge of and insights about CDC history were highly valued by MMWR editors and added substantially to the quality, accuracy, and integrity of the publication.In addition to his contributions to"}
{"text": "Osorio.There are errors in the Competing Interests section and in the affiliations listed for 12The complete, correct Competing Interests information is as follows: Author Jorge E. Osorio is fully employed by Takeda Vaccines. He was a co-founder of lnviragen, Inc. a company that licensed the live attenuated dengue vaccine candidate from the CDC and that was later acquired by Takeda. He has actively worked in the preclinical and clinical development of this dengue vaccine and is also a patent holder on chemical formulations that provide increased stability to the vaccine. He has a direct financial interest in seeing the dengue vaccine developed, approved and commercialized.The correct affiliations for Jorge E. Osorio are as follows: Department of Pathobiological Sciences, University of Wisconsin, Madison, Madison, Wisconsin, United States of America, and Takeda Vaccines, Inc."}
{"text": "Reason for Corrigendum:Due to an oversight, there was a mistake in the affiliation of the Corresponding Author Farhat Afrin, as published. Also, in the original article, we have neglected to thank our sponsors Deanship of Scientific Research, Taibah University, Medina, Saudi Arabia, grant number 7127 to FA and HH. The correct Acknowledgments should have been published as:donovani culture. Our thanks are due to Mr. T. A. Nagarjuna and Dr. V. Gupta, BD-JHFACS Academy, Jamia Hamdard, for their immense help and cooperation in flow cytometry work. We are also thankful to Mrs. F. Ahmad who extended help in plant collection and extraction. Our collaborative Microbiology Research Group at Faculty of Applied Medical Sciences, Taibah University, Kingdom of Saudi Arabia is gratefully acknowledged for meeting the publication cost and process apart from their significant roles and scientific participation in the work. The present study was supported by theDeanship of Scientific Research (grant number 7127), Taibah University, Medina, Saudi Arabia, Department of Science and Technology, Department of Biotechnology and Central Council for Research in Unani Medicine (CCRUM), Government of India.Present study was financially aided by Department of Science and Technology, Department of Biotechnology and Central Council for Research in Unani Medicine (CCRUM), Government of India. GC was formerly recipient of Senior Research Fellowship from CCRUM and Basic Research Fellowship from University Grants Commission (UGC), under UGC-Special Assistance Grant (SAP) received by Department of Biotechnology, Jamia Hamdard, during the period of study. We profoundly thank Dr. N. Ali, Indian Institute of Chemical Biology, Kolkata, India, for providing us L. The authors apologize for this oversight. This error does not change the scientific conclusions of the article in any way.GC, MI: Designed and conceived the study, performed experiments, analyzed, and interpreted the data. MW: aided in carrying out in vivo experiments. DS, HO, and HH: contributed to reviewing of manuscript. FA: conceived and supervised the work, and contributed to designing of experimental plan and execution of work along with analysis and interpretation of data, manuscript writing and reviewing the manuscript. All the authors approved final version of the research article.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "The surge of the new interdisciplinary centers, the new titles and slogans, these days, are all a genuine attempt to lead a responsible change of the research and development as well as the treatment paradigm towards better healthcare in particular, and well being to ALL, in general. The goal is to change the paradigm in health care - from delayed interventional medicine to predictive personally tailored medicine, from reactive to preventive medicine and from disease to wellness, facing the major needs of society. Based on the remarkable achievements in the past decade, the CKTS  approach was presented by the NSF Dec. 2012) reflecting the series of workshops held around the world. The \u201cHolistic approaches to wellness and human development\", is one focus, among other wide range of recommendations in the broad area of science. That is fully aligned with the practice of medicine that is moving from a passive coincidence model to an active convergence model, including micro and macro environmental effects. At the center of this transformation is the intersection of physiology, molecular profiling and information technology, combined with a number of converging technologies that affected the human cognition, communication and quality of life. The common denominators were the availability and compatibility of technologies, functional imaging including brain imaging, enabling of big data analysis, etc. The practical goal is to provide inspired translational research from basic science to preventive, predictive and personalized medicine. As a practical enabling system, a Simultaneous Systematic Analysis (SSA) approach is suggested, to provide the broadest possible insight into the individual comprehensive functioning in the surroundings - as one refined complex system- over time and modes of actions. The targeted platform envisioned will enable and encourage an open, innovative systematic effort, sharing all findings and combining all acquired knowledge, technologies and expertise, focused on a specific phenomenon or disease. The approach suggests an operational mode for multilevel, multisource research that would reduce barriers, encourage creativity and innovative research, while enabling responsible and safe sharing of all findings. It can be envisioned as a matrix scheme, applied, for example, to drug efficacy, in which the rows represent the various levels of the patient  and the columns represents the various research and professionals working groups, each focusing on a specific aspect of the micro- and macro-environment (see figure 2 reflectThe iii-3 Cancer Center - (Infection-Immunity-Inflammation Driven Cancer Diseases), at Tel Aviv University, is another feasibility study, as an example, to the SSA approach - shortening the time-lag for patent administration - the regulatory scheme and procedures.- education paradigm change at all formal levels from childhood to graduate studies.- academic institute's structure and culture adaption at all levels: teaching and collaborative research paradigm including adjusting the personal evaluation and promotion schemes."}
{"text": "S. Department of Energy, Office of Science, Office of Biological and Environmental Research, through contract DE-AC02-05CH11231 between Lawrence Berkeley National Laboratory and the U. S. Department of Energy. The United States Government retains and the publisher, by accepting the article for publication, acknowledges that the United States Government retains a non-exclusive, paid-up, irrevocable, world-wide license to publish or reproduce the published form of this manuscript, or allow others to do so, for United States Government purposes. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.There is information missing from the Funding section, specifically regarding the United States Department of Energy and the Lawrence Berkeley National Laboratory. The correct statement is as follows: This work was supported by a grant to PCR from NIH (GM59962) and NSF (1237975). This work was part of the DOE Joint BioEnergy Institute ("}
{"text": "Investigators from University of Oulu, Finland, evaluated the diurnal and seasonal occurrence of the first febrile seizures (FS) in 461 children in a population-based study of 1522 children. Investigators from University of Oulu, Finland, evaluated the diurnal and seasonal occurrence of the first febrile seizures (FS) in 461 children in a population-based study of 1522 children. The first FS occurred most often in the evening, peaking between 6 and 10 PM (31%), and least often at night, in the early morning hours between 2 and 6 AM (8%) (P < 0.001). This diurnal pattern was repeated in different seasons according to the variance in daylight duration. FS occurred irregularly throughout the year, most frequently in the winter, concurrently with the febrile episodes, and least frequently in the summer. The diurnal and seasonal variations in the occurrence of FS did not follow the amount of daylight throughout the day or year or variation in the secretion of melatonin. Rather, FS are strongly associated with episodes of fever, infections, and elevated body temperature. The maximum temperature of the fever in patients with FS  was similar throughout the year. [COMMENTARY. The seasonal and diurnal variations in the occurrence of febrile seizures (FS) observed in children in Finland  are repoSeveral factors may be involved in the cause of FS, including age dependency , genetic susceptibility , cytokine and immune response to infection, fever and height of body temperature. The maximum height of a fever, not the rate of rise, is the main determinant of risk of FSs, a finding demonstrated in animals , 7. In a"}
{"text": "The fourth International Conference on Family Planning (ICFP) was held in Nusa Dua, Indonesia, on January 25\u201328, 2016. Themed \u201cGlobal Commitments, Local Actions,\u201d the conference stressed the importance of global and local partnerships to shape and influence the role and contributions of family planning in attaining health and development goals, in particular the new Sustainable Development Goals. Hosted by the Bill & Melinda Gates Institute for Population and Reproductive Health at Johns Hopkins Bloomberg School of Public Health and the National Population and Family Planning Board of Indonesia, the conference attracted more than 3,000 participants and featured more than 500 oral presentations, 400 posters, and 90 panels and plenaries.We conceived this special issue of GHSP, comprising articles presented at ICFP, in collaboration with the Gates Institute to help disseminate important findings and lessons learned beyond conference participants to the larger health and development community. When reviewing the individual oral presentations accepted to the conference, we found at least 64 (13% of those accepted) that focused on long-acting reversible contraceptives (LARCs). It was clear to us that LARCs were an important focus of the conference and had unparalleled potential to reduce unmet need for family planning and improve contraceptive prevalence around the world.This special issue includes 11 articles that focus specifically on programs that deliver LARCs and how they were implemented so that others can learn from their experience. The articles address a range of cross-cutting topics, from training, supervision, mentoring, and task sharing to quality of care , vouchers, postpartum family planning, postabortion family planning, and family planning service delivery in fragile environments. The countries featured in the articles include Bangladesh, Cambodia, Chad, the Democratic Republic of the Congo, Kenya, Pakistan, Senegal, Uganda, and Yemen.\u2013Global Health: Science and PracticeThis special issue is by no means an exhaustive review of the issues related to LARCs, but the articles provide important insight into the benefits and challenges of delivering LARC services, yielding important lessons that can be applied in other settings and that are also applicable to delivery of family planning services in general."}
{"text": "The funders had no role in study design, data collection, data analysis, data interpretation, or writing of the article. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.There are errors in the Funding section. The correct funding information is as follows: This project was supported by Bill and Melinda Gates Foundation , Antoinette Darville, MD, Maureen Maguire, PhD, and Grace Saguti, MD, who were generous with their time and advice and met before and during the study. The authors thank all of our colleagues in Niger at Programme National de Sant\u00e9 Oculaire who collected samples and data. We also thank the NTD support center, the Task Force for Global Health, and the 15 experts surveyed at the WHO NTD-STAG Monitoring and Evaluation Working Group meeting."}
{"text": "INDUS-EM is India\u2019s only level one conference imparting and exchanging quality knowledge in acute care. Specifically, in general and specialized emergency care and training in trauma, burns, cardiac, stroke, environmental and disaster medicine. It provides a series of exchanges regarding academic development and implementation of training tools related to developing future academic faculty and residents in Emergency Medicine in India. The INDUS-EM leadership and board of directors invited scholars from multiple institutions to participate in this advanced educational symposium that was held in Thrissur, Kerala in October 2013. From October 23 to October 27, 2013 the 9th annual INDUS-EM conference entitled \u201cPrinciples, Practices, and Patients,\u201d was held in Thrissur, Kerala, India. The conference faculty was composed of physicians from India, the United States of America, Israel, and the United Kingdom. The conference had over 2,800 attendees and was aimed towards medical students, nursing students, residents, and junior faculty. The focus of the international faculty and participants at this conference was two-fold; The first portion of this effort was (1a) to provide a two day pre-conference research symposium (EM-LEADER--emergency medicine leadership in education and academic development via enterprising research), whereby students, residents and junior faculty would be introduced to concepts of how to conduct successful research through the acquisition of research funding by successful grant writing, and how to successfully navigate administrative quagmires, and (1b) to understand and be aware of the basic concepts of statistics, epidemiological methods, use of the electronic medical record, how to write a manuscript, and other scientific methods through specific examples, while at the same time attempting to imbue an ethical thread throughout the scientific curriculum; especially in regard to the protection of human subjects participating in clinical trials and studies, and the protection of their personal information. The second portion of international participation in regard to education and consultation was a trauma and critical care workshop where techniques of airway access, venous and arterial access, methods of monitoring, diagnostic methods, and clinical evaluation of the critically ill patient were highlighted. This curriculum was presented during the Summit Program  has made progress regarding emergency medicine (EM) 1). Medicine in India, and particularly EM, still faces an acute self-imposed ethical-societal challenge. While there have been improvements recently, India lacks an emergency service system that is responsive, effective, and time sensitive [. Medicinlden hour. Since tot exist .The INDO-US Joint Working Group (JWG) and like-minded, Indian-allied physicians have embarked on an educational journey through the vehicle of an annual INDUS-EM educational summit. With the hopes of reaching the hearts and minds of the medical and nursing students, residents, other young medical professionals, and faculty members, they intended to change the philosophy of the approach of the Indian medical community to modern EM. Furthermore, they hoped to make an ethical precedent to provide appropriate and outstanding care to India\u2019s citizens and visitors by formally trained specialists in well-equipped facilities. This report of the 9th INDUS-EM LEADER conference summarizes the educational efforts made toward the above-mentioned philosophy and ethical precept.The meeting was broken into two specific portions, (1) a pre-summit meeting entitled, EM-LEADER (emergency medicine leadership in education and academic development via enterprising research), which covered academic leadership skills, clinical research, publication, the electronic medical record, and grant writing; and (2) the main summit.Dr. Mamta Swaroop, Assistant Professor of Surgery in Trauma and Critical Care from Northwestern University, Chicago, Illinois, USA and the Co-Chair of the OPUS 12 Foundation\u2019s International Medicine Expert Group started the first day of the pre-summit research conference with a researcher\u2019s perspective of the skills needed to publish in an academic medical center, focusing on leadership and mentorship aspects of the academia. She additionally lectured on the topics of patient and data confidentiality and their vital importance in conducting ethical research.Dr. Stanislaw P.A. Stawicki, Associate Professor of Surgery and Director of Research in the Division of Trauma, Critical Care, and Burn at The Ohio State University, Columbus, USA presented several lectures. His first lecture revolved around the need to pursue funding of research through sources in industry to alleviate the increasing lack of resources from local, state, and federal government. He advised the audience on how to pursue such finding, and the importance of the ethical standards that were needed when collaborating with the private sector in regard to presentation and publication of results. His second lecture was an examination of the necessary approach required to receive approval for research in academic medical centers from an organization\u2019s Institutional Review Board (IRB) and from Ethics boards. The third lecture explained how to organize an original research manuscript. His final lecture of the day covered plagiarism and academic dishonesty and its implications regarding both individuals and institutions.Dr. David P. Bahner, Professor of EM from The Ohio State University, Columbus, OH, USA gave a perspective on the logistics of the use of office staff and trainees in pursuing research and education, especially in regard to their value and appreciation of collaborative efforts to pursue academic research and excellence. Dr. Bahner\u2019s second lecture was a discourse on ethical authorship sharing and its importance to collaborative research efforts. His third lecture involved an explanation of how to write a review article.Dr. Thomas J. Papadimos, Professor of Anesthesiology, Vice Chair for Academic Affairs, Section Director of Anesthesiology Critical Care Medicine, and Director of Critical Care Service at the Ross Heart Hospital at The Ohio State University, Columbus, OH, USA started his lecture block with an important discussion regarding clinical colleagues and a faculty member\u2019s relationship to the institution\u2019s administration. His second lecture was on the topic of intellectual property; what it is, how it affects the academician-inventor, and to what to expect and not to expect from an institution\u2019s office of technology. His third lecture involved the techniques of data collection and storage, the associated pitfalls, and the associated important and necessary ethical considerations. His final presentation of day one of the pre-summit explained how to write a letter to the editor and how to write case reports.Dr. Lorenzo Paladino, Assistant Director of Research at the State University of New York (SUNY)-Downstate, Brooklyn, New York, USA presented a lecture on researching overcrowding, violence, and abuse; its methods, and ethics. He provided a second lecture on the basics of data analysis regarding tests and software.Dr. Dimitrios Papanagnou, Assistant Professor of EM and the State University of New York (SUNY), Brooklyn, New York, USA and Mr. Kevin Pohlman, CHSE, NREMT-P, a simulation specialist, presented an informative session on the evaluation of educational tools to improvise teaching, especially the ultrasound use.The first lecture was presented by Dr. Sanjeev Bhoi of the All India Institute of Medical Sciences (AIIMS), New Dehli, India. His presentation on the use of electronic medical records in the process of development and research in EM and Trauma was well received. He further delivered an update on the progress of the electronic medical record in India.Asking the Right Research Question. He followed later in the afternoon with a lecture on patient safety and how to design and conduct patient safety research. Dr. Papadimos then gave an extensive lecture on grantsmanship which included the idea/hypothesis process, searching for funding, content of a proposal, writing skills, alliances to strengthen the application, budget and justification, support letters, and building a resume. This was followed by a panel discussion with Dr. Papadimos, Dr. Stawicki, Dr. Bhoi, and Dr. Galwankar.Dr. Sagar C. Galwankar, Chief of EM, Global Hospitals, India, Assistant Professor, University of South Florida, Tampa and the Scientific Chairman of the INDUS-EM 2013 Conference, then gave a detailed lecture on ethical animal research and how the US medical system handles animals in its biomedical investigative processes. Dr. Stawicki then began the grantsmanship seminar with a lecture entitled Dr. Bonnie Arquilla, Associate Professor of EM, State University of New York (SUNY), Brooklyn, New York gave a session focusing on mass casualty situations research. Dr. Arquilla was followed by Dr. Tracy Sanson, Associate Professor of EM and Emergency Residency Program Director at the University of South Florida, Tampa, Florida, who gave a lecture on presentation and communications skills.The EM-LEADER session ended with a round table discussion of research ideas for the Indian network of Critical Illness and Injury Translational Trial Experts (INCIITTE) led by Dr. Sagar Galwankar and Dr. Sanjeev Bhoi of AIIMS, New Delhi, India.The summit program was expansive and varied regarding topics of discussion. Due to the limited scope of this article, the reader is referred to the INDUS-EM 2013 Internet Website for further details regarding the Summit . HoweverThe Future of Predictive Modeling and its Contribution to Patient Safety. Dr. Stawicki also presented a special lecture titled Advanced Imaging in Post Mortem Setting: Is Autopsy Going Digital?On the first day of the Summit, Dr. Papadimos was the Shri. Tarsem Kurmar Garg Oration Inaugural Endowed Keynote speaker, and delivered a lecture entitled: Day one of the summit continued with a lecture series entitled the Adult ABC of resuscitation, although not required for the trauma and critical care certification course, it set the tone. The lectures discussed ACLS, stroke care guidelines, rapid sequence intubation and fluid and blood product resuscitation by Indian and US faculty. It served to introduce the attendees for the next 3- day Trauma and Critical Care Resuscitation Course (TCCRC) starting in the ED and continuing on to the operating room or the ICU.The certification course started with the FORT  the afternoon of day one. The room was overflowing with medical students, nurses, and junior and senior level faculty from all disciplines to take part in this ATLS based trauma approach that was to be the foundation of the TCCRC.Dr. Swaroop started the afternoon with a warm up case and discussion of the importance of collaboration which set the stage for the ABCs of Trauma.Dr. Harry L. Anderson III, co-director of the Surgical Intensive Care unit and Surgical Critical Care Fellowship Program Director at St. Joseph Mercy Medical Center, Ann Arbor, Michigan, USA, then addressed the secondary survey and engaged the audience with interactive questions.The course then focused on injuries by body system. Dr. Moshe Michaelson, Director Emeritus of the Trauma Unit and Department of EM at the Rambam Health Care Campus, Haifa, Israel started with the lecture on injuries specific to the head, intra and extradural, the face and the neck. Dr. Vineet Kumar, an Assistant Professor of Department of General Surgery at Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India then continued with a lecture on chest trauma. Dr. Colin G. Kaide, an Associate Professor of EM from The Ohio State University, Columbus, Ohio, USA then gave a dynamic lecture on abdominal trauma intermingled with EM residency photographs. Dr. Stawicki then lectured about the extremes of age and the pregnant patient and the cautions that must be taken with each group.The next speaker, Dr. Tamara Worlton, an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA, with active duty military experience as a member of a forward surgical team to care for critically wounded personnel in Afghanistan lectured about extremity blast and burn injuries that she has seen and that are common in many parts of India with domestic and international terrorism.Dr. Himanshu Kataria, a Consultant in EM at St. Helens and Knowsley Teaching Hospitals NHS Trust and Dr. Ram Manohar, a Consultant in EM at Wirral University Hospitals NHS Trust in the North West region of the United Kingdom then led the skills session and the simulation. The audience was divided into 4 rotating groups. A trauma scenario simulation, pelvic binding, logrolling, and helmet removal were the skills performed at the stations. Trauma faculty manned each station, which allowed the audience one on one time and an opportunity to practice their comprehension of the didactics and ask questions.Day two focused on resuscitation in the emergency room and more in-depth perspectives of critical care related to the EM patient. Dr. Kaide began the morning series with a presentation on trauma resuscitation. He presented landmark studies and evidenced-based guidelines, highlighting the clinical application. His lecture covered a variety of topics from airway management to massive transfusion in trauma.Dr. Ravi S. Tripathi, an Assistant Professor of Anesthesiology and Critical Care from The Ohio State University, Columbus, Ohio, USA then presented a discussion of trauma specific to cardiac injury. His presentation on fundamentals of cardiac resuscitation focused on blunt cardiac injury as well as life threatening cardiac conditions such as cardiac rupture, fatal arrhythmias, and acute coronary syndrome leading to trauma.In continuing with a hemodynamic focus, Dr. Anderson addressed managing patients with life-threatening infections, sepsis, and septic shock. Dr. Anderson highlighted key trials and publications that played heavily in the recent update of the Surviving Sepsis Campaign recommendations and their application to trauma patients.The morning then changed focus to neurologic injury and trauma with a joint discussion by Dr. Stawicki and Dr. Tripathi. Dr. Stawicki laid the groundwork for the discussion in his presentation that focused on neurophysiologic principles and their practical application. The discussion of management of intracranial hypertension was especially useful. Dr. Tripathi followed Dr. Stawicki with a review of stroke care, both ischemic and hemorrhagic. The lecture focused on initial management of the stroke patients, stabilization, and establishing infrastructure for stroke care.The morning concluded with a presentation by Dr. Michaelson. After the morning focused on individual organ injuries, Dr. Michaelson offered insight into patient triage, for both mass casualty as well as in a busy emergency department.During the afternoon, workshops were hosted by both local medical school and visiting programs. These hand-on seminars focused on diagnostic modalities such as emergency and trauma ultrasound as well as therapeutic modalities integral to trauma care such as airway management, wound care, suturing, splinting, as well as toxicology life support.The critical care course has evolved significantly since its 2012 iteration at the 8th INDUS-EM Summit in Nashik, Maharasthra, India. Conceived by the OPUS 12 Foundation faculty, the course now includes international faculty from several high-profile academic institutions.The 2013 course started with Dr. Anderson who addressed bedside and advanced diagnostics used to evaluate patients in the ICU. He was followed by Dr. Bahner who provided a perspective on the usage of ultrasonography at the bedside, with numerous video cases to highlight a plethora of abnormal findings. Dr. Kaide then presented a series of vignettes to emphasize disease processes that can be deadly if missed.Dr. Swaroop continued the curriculum with a concise and comprehensive presentation on mechanical ventilatory support. There was a significant amount of discussion from the audience regarding the benefits and actual usage of rescue therapy in ARDS, focusing on capabilities of local hospitals to handle such complex patients.Dr. Kapil Dev Soni, an Assistant Professor of Critical & Intensive Care at Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi then followed with a lecture about basic and advanced hemodynamic support. He discussed the theoretical and practical uses of various hemodynamic monitoring devices and vasoactive medications. This was followed by Dr. Worlton, who conducted a video presentation and a discussion of key techniques for performing bedside procedures, focusing on practical tips for safe and effective conduct of each respective procedure.Dr. Stawicki ended the morning and concluded the course with a lecture on blast injury management, followed by a discussion of pitfalls and pearls in ICU care. The last session focused on common errors in trauma and critical care management, as well as on patient safety topics. The course ended with certificates given to the attendees of all three days of the course. Certificates of appreciation were also given to course faculty and directors.EM-Leader accomplishments included dissemination and instruction in techniques of scientific inquiry, including epidemiology and statistics and data acquisition; instruction on how to write grants and the administrative processes related to research and grant funding; the advantages of the electronic record and its potential uses in research; the ethical pitfalls in the scientific method, the funding of projects generally, and the protection of human subjects. In the trauma and critical care education portion, established life saving techniques in regard to monitoring, diagnosis, evaluation, and treatment were taught and this course was followed by a certification examination.India has limited educational and clinical resources in regard to emergency medicine, trauma, and critical care. The medical educational value that was added to this population of students, residents, and young faculty included preparation for scientific inquiry and techniques of clinical intervention for successful care of the seriously ill patient. This curriculum will be presented through the next decade of INDUS-EM conferences. While the topic and themes of the Summit Program will change from year to year, the EM-leader preconference education and the trauma critical care portion will continue. As the conference changes its venue each year, a different portion of the country will be exposed to the above-mentioned  concepts.Crucial next steps in the provision of appropriate emergency, trauma, and critical care in India will be the expansion of true emergency rooms that are staffed by competent practitioners in properly equipped facilities. \u201cCasualty areas\u201d must be replaced by state-of-the-art emergency facilities, and manned by appropriately trained physicians. For this to happen India and her friends such as the United Kingdom and the United States of America must assist in the training of Indian residents. In this vein, emergency medicine residents in India will now be admitted to the examination in Emergency Medicine by the appropriate medical educational organizations of the UK, and even permitted a minimal amount of training time in the UK. Thus, there will be training and some confirmation of minimal expertise as an expectation for those manning emergency facilities. These educational efforts must be persistent and consistent.Money, Management, and Manpower in Medicine. It will be held in Lucknow, the capital city of Uttar Pradesh from October 15 to the 19th 2014. The focus will be the business of medicine with 15 tracks, 16 workshops and over 200 national and international faculty. A multifaceted topic that is sure to stimulate many controversial and enlightening conversations. The discussion of the business economics of medical practice in India, and the associated ethics, will involve a series of wide-ranging discourses that are currently in evolution. Such an intellectual intercourse will require the serious application of scientific, social, and ethical precepts to an evolving and growing technological marketplace in one the largest economies of the world.The next meeting will be the 10th anniversary of INDUS-EM and will be entitled, The safe, effective, and ethical delivery of healthcare  to all populations in India is what the Indian and international participants of INDUS-EM strive to promote and augment. Such an enterprise requires intense, repetitive, and inclusive efforts among all members of the medical and public health community, both in India and the greater global community.The authors declare that they have no competing interests.All authors contributed equally. All authors read and approved the final manuscript.All authors were lecturers at the conference as representatives of their particular institutions."}
{"text": "WHO alerts to the epidemic behavior of diabetes (DM): more than 190 million people worldwide suffer from diabetes and this number will double by 2030 . In Brazil, IDF estimated in 2014 that the number of diabetics was 11.6 million. Aging, urbanization, sedentary lifestyle, high fat diet and obesity are seen as responsible for this situation. In addition to the cost of treatment, complications of the syndrome, overtax and overwhelm the health care system. Thus, only public policies are insufficient, being essential the efforts of researchers and health teams to carry out projects for the guidance of the population, who often have no basic knowledge, compromising the effectiveness of treatment.Carry out actions, especially for the elderly, involving students in the selection and placement of information about etiology, symptoms, diagnosis, treatment, side effects and drug interactions of DM.This project is part of an extension program with continued actions, involving 20 volunteers students, per event, and Uninorte and UFAM teachers. The activities have multivariate approaches, are cyclical and redundant, ensuring maximum participants. In the first half of 2015, the subjects were: pharmaceutical and nutritional guidance, physical activity and risks of alcohol consumption and smoking. Diabetic people interested in the Monitoring Group, scheduled for Sep/2015, were registered. These people will receive glucometer and a data collection form for monitoring capillary blood glucose and receive guidelines. Also will be offered, the molecular test for the registered ones with a possible diagnosis of MODY 2 or 3 .The activities took place in the Dr. Thomas Foundation and Senior Park/Vieiralves, Manaus, AM. 70 people were served. Of these, 4 diabetic female, have registered. The accession of the elderly, especially women is a goal, as they generally are more receptive to information, make appropriate medical monitoring, influencing your partner and being an example to children and grandchildren.The project confirms the importance of university extension for the formation of a professional who recognizes in their proactive actions a way to benefit the community. The exchange of experiences promote changes in habits and learning, whose expected benefit is to prevent and/or minimize the complications of diabetes by improving the quality of life."}
{"text": "The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.The Funding section is incorrect. The complete, correct Funding statement is: The Joyce W. Vickery Scientific Research Fund from the Linnean Society of NSW ("}
{"text": "In the economy of knowledge, ingenuity and dynamism, innovation and technology are considered essential levers, and knowledge and creativity key factors. Globalization and liberalization have generated a new dynamic of competition, a dynamic competitiveness, in which the focus is on the ability of performing, including in related fields. Today we are witnessing a moment when a strong emphasis is placed on the development of some new theoretical models in communication and on the development of innovative methods of observing and measuring the communication behavior. The social interaction, interpersonal communication, mass communication, intercultural communication, research of physical and chemical mechanisms of brain activity, observing in real time some processes which take place at the cellular and molecular level, interest for research and knowledge of the element which offers significance to the human being, the brain, etc., elements which seem to be more often under the \u201cmagnifier\u201d of progresses in understanding the human symbolical processes. That is why Neurosciences have shaped as a distinct field. The dynamics of neuroscientific research had an exponential development and the social impact is considered very powerful. \u201cHowever, what makes a brand strong is the collective nature of the perceptions about it\u201d \u2013 affirmed the Marketing specialists. In addition, the perceptions regarding an incontestable personality in the field of research in neurosciences and the echo of its performing and high quality research activity impressed the target public. So, this kind of recognition took place on the occasion of the exceptional medical scientific and educational event organized by the Foundation of the Society for the Study of Neuroprotection and Neuroplasticity (SSNN), together with the Romanian Society of Neurology (RSN) and \u201cIuliu Ha\u0163ieganu\u201d University of Medicine and Pharmacy in Cluj-Napoca, under the aegis of the European Federation of NeuroRehabilitation Societies (EFNRS) and the  World Federation for NeuroRehabilitation (WFNR), - RoNeuro Brain Days, which hosted the 5th Edition of the European Teaching Course on Neurorehabilitation which took place in the period 1-4 June 2015, in Cluj-Napoca, in \u201cGheorghe Marinescu\u201d Amphitheater of \u201cIuliu Ha\u0163ieganu\u201d University of Medicine and Pharmacy, and, which managed to reunite under one single roof important personalities in the medical field and world scientific research from countries such as Germany, USA, Austria, Italy, United Kingdom, Ukraine and Romania. Prof. Michael Chopp, PhD, was awarded \u201cDoctor Honoris Causa\u201d title at the proposal of Prof. Dafin F. Mure\u015fanu, MD, President of the Romanian Society of Neurology (SNR) and President of the Society for the Study of Neuroprotection and Neuroplasticity (SSNN), \u201cIuliu Ha\u0163ieganu\u201d University of Medicine and Pharmacy in Cluj-Napoca. On this occasion, distinguished Michael Chopp, PhD, joined the Henry Ford Health System in Detroit in 1983. He was appointed Vice Chairman for Research of the Department of Neurology in 1991, Scientific Director of the Henry Ford Neuroscience Institute in 1999, and is the Zoltan J. Kovacs Chair in Neuroscience Research. Dr. Chopp is also Distinguished Professor of Physics at Oakland University in Rochester, MI.He received his MS and doctorate degrees in Mathematical and Solid State Physics from New York University. After nearly 10 years of working as a Physicist and as a Professor of Physics, Dr. Chopp made a career change and turned his interest to translational research in neuroscience.Dr. Chopp\u2019s research has primarily focused on: 1) cellular and molecular biology of ischemic cell injury, 2) the pathophysiology of stroke, traumatic brain injury, peripheral neuropathy, multiple sclerosis, and glioma, 3) combination thrombolytic and neuro and vascular protective therapies for stroke, 4) mechanisms of neuroprotection, 5) cell-based and pharmacological neuro-restorative therapies for stroke, traumatic brain injury and neurodegenerative disease, 6) molecular and cellular mechanisms underlying neurogenesis and angiogenesis and the induction of brain plasticity leading to functional and behavioral recovery after neural injury, 7) treatment of glioma, 8) exosomes/ microRNA for the treatment of neurological injury and disease, and 9) magnetic resonance imaging.Dr. Chopp has received multiple awards and recognitions for his research efforts, including the American Heart Association Thomas Willis Lecture Award, the Abraham White Distinguished Science Award, and the Lecture of Excellence and World Stroke Organization Award. Dr. Chopp has 623 peer-reviewed publications and has given 414 plenary lectures and invited presentations. He has served on and chaired National Institutes of Health (NIH) study sections and has served as a consultant to government agencies, the U.S. National Institutes of Health, and the pharmaceutical industry. Prof. Michael Chopp, PhD is first his great curiosity, knowledge assimilation through a profound understanding of the facts and data, which at first, were filtrated by his reasoning. What is very impressive is his power of perception, organizing skills and knowledge deepening, as well as the presentation of the most abstract problems in simple and easy to understand forms, especially the high quality and performance of his research activities. A distinctive feature of Executive EditorAssoc. Prof. Dr. Eng. Victor Lorin Purcarea"}
{"text": "PLOS Neglected Tropical Diseases more than six years ago, I have written about the interface between disease and geopolitics. The neglected tropical diseases (NTDs) are the world's most common infections of people living in poverty Since the founding of In the Americas, there are at least three major zones where NTDs concentrate.In 2008, I found that Brazil has the largest number of NTDs in the Western hemisphere; they are particularly common among the millions of Brazilians who live on less than US$2 per day Almost 10 million people inhabit the Gran Chaco, an area that spans eastern Bolivia, Paraguay, northern Argentina, and portions of two Brazilian states\u2014Mato Grosso and Mato Grosso do Sul Mesoamerica includes Mexico's poorest states in the southern region, such as Chiapas, Guerrero, and Oaxaca SSA has a high concentration of NTDs globally, accounting for approximately one-quarter to one-third of the world's cases of the three major intestinal helminth infections , more than one-third of the LF, one-half of the trachoma, and all or most of the schistosomiasis, onchocerciasis, loiasis, and human African trypanosomaisis (HAT) I have referred to Nigeria as \u201cground zero\u201d for the NTDs because it ranks first in SSA in terms of the number of cases of all three intestinal helminth infections, schistosomiasis, LF, and onchocerciasis DRC ranks closely behind Nigeria in terms of the total number of NTD cases, ranking second or third in most of the NTD disease categories and first in HAT and leprosy These three adjoining nations have also suffered from widespread conflict and NTDs in recent years, and with it high rates of trachoma, schistosomiasis, and intestinal helminth infections The largest number of NTDs currently occurs in Asia, led by the large emerging market economies of India, Indonesia, and China Indonesia alone has approximately 10% of the world's cases of intestinal helminth infections, LF, and leprosy, in addition to more than one-half of the dengue deaths in Southeast Asia and a significant problem with other arbovirus infections and yaws Nearly one-half or more of the cases of visceral leishmaniasis, LF, and leprosy occur in India and South Asia, in addition to one-third of the rabies deaths, one-quarter of the cases of intestinal helminth infections, and a massive but still ill-defined burden of disease from dengue and Japanese encephalitis Rapid economic growth in eastern China has left behind high levels of disease and poverty in China's southwestern provinces of Sichuan, Guizhou, and Yunnan, where some of the highest rates of intestinal helminth infections are found Approximately 65 million people live on less than US$2 per day in the Middle East and North Africa. These impoverished individuals suffer from high rates of intestinal helminthiases, LF, schistosomiasis, fascioloiasis, leishmaniasis, leprosy, and trachoma These ten areas exhibit some of the world's highest concentrations of NTDs, although they vary with respect to having a modest prevalence among a large population versus hyperendemicity among a smaller population. Of interest is the finding that, with the important exception of SSA, they mostly include middle-income countries and nations belonging to the G20 This list represents a personal view of what I consider some of the most important NTD-affected areas in the world. I welcome comments and opinions from the NTD community on other regions and parts of the world I might have missed or where the readers believe there should be renewed emphasis for control and elimination."}
{"text": "There is an error in the Funding statement. Please view the correct Funding statement here.This work was supported by academic research funds of Konkuk University in 2013, Seoul, South Korea. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."}
{"text": "The health systems in the Americas region are characterized by fragmentation and segmentation that constitute an important barrier for expanding coverage, achieving integrated primary health care, and reducing the inefficiency and discontinuity of care.An assessment of the HRH programmes that have been implemented at country level was developed as part of the measurement of the 20 Human Resources for Health ).The exercise was a combination of academic research and the development/application of an advocacy tool, involving policy makers and stakeholders to influence decision-making on the development, implementation or change the HRH programmes, while building evidence through a structured approach based on qualitative and quantitative information, and exchange and dissemination of best practices.Chile and Peru in the Andean region and Argentina, Paraguay and Uruguay in the Mercosur.The presentation will cover the methodological challenges, as well as a summary of the main findings of the study that included 15 countries: El Salvador, Costa Rica, Guatemala, Honduras, Nicaragua, Panama, Dominican Republic and Belize in Central America, Ecuador, Colombia,"}
{"text": "Single cell transcriptome defined as the entire RNA or polyadenylated products of RNA polymerase II on a cell can describe the gene regulation networks responsible for physiological functions, behaviours, and phenotypes in response to signals and microenvironmental changes. Single cell transcriptome/sequencing has the special power to investigate small groups of differentiating cells, circulating tumour cells, or tissue stem cells. A large number of factors may influence the extent of single-cell heterogeneity within a system. It is the opportunity that the single-cell sequencing can be used for the identification of genetic changes in rare cells, e.g. cancer and tissue stem cells, in clinical samples. The methodologies of single-cell sequencing have been improved and developed with the increase of the understanding and attention. The clinical research and application of the single cell sequencing analysis are expected to identify and validate disease-specific biomarkers, network biomarkers, dynamic network biomarkers. The single cell research and value will be also dependent upon the understanding of genomic heterogeneity, planning and design of study protocol, representative of selected and targeted cells, and sensitivity and repeatability of the methodology. The single cell sequencing can be used to develop new diagnostics, monitor disease progresses, measure responses to therapies, and predict the prognosis of patients, although there are still a large number of challenges and difficulties to be faced. It would be more values and specificities of the single cell sequencing to integrate with the function of cells, organs, and systems of the body, the clinical phenotypes of patients, and the description of clinical bioinformatics. Single cell transcriptome defined as the entire RNA or polyadenylated products of RNA polymerase II on a cell can describe the gene regulation networks responsible for physiological functions, behaviours, and phenotypes in response to signals and microenvironmental changes. Methods of single cell transcriptome analyses have been developed and significantly improved with advantages and disadvantages ,2. SinglSingle cell transcriptome/sequencing has the special power to investigate small groups of differentiating cells, circulating tumour cells, or tissue stem cells. Tang et al. defined the dynamic molecular changes with cell-fate changes during the conversion from the inner cell mass cells of blastocysts to pluripotent embryonic stem cells using RNA-Seq transcriptome analysis at the resolution of single cells . MoleculA large number of factors may influence the extent of single-cell heterogeneity within a system, e.g. the source of analyzed tissues, biological conditions or microenvironments of the individual cell. The single cell transcriptome was suggested to avoid, or at least reduce, the variability of clinical samples, in order to define new cell classifications, transitional states, biological distinctions, or biomarkers. Shalek et al. recently demonstrated that the inflammatory stimulus lipopolysaccharide could induce an extensive, previously unobserved, bimodal variation in mRNA abundance and splicing patterns in bone marrow-derived dendritic cells using single-cell RNA-Seq analysis . It indiIt is the opportunity that the single-cell sequencing can be used for the identification of genetic changes in rare cells, e.g. cancer and tissue stem cells, in clinical samples which may contain hundred cells in body fluids and biopsy with fine-needle. It seems that one of clinical applications of single-cell sequencing should be to understand the genomic profiling of copy number or sequence mutations in rare cells. The challenge in the identification and validation of therapeutic targets is to define the cell heterogeneity, especially to differ between cancer and pre-cancer cells, activated and non-activated inflammatory cells, or functional and non-functional cells, between sampling micro-regions, between cells at various stages, or between responses to therapy. For example, our previous studies on genetic comparison of mouse lung telocytes with mesenchymal stem cells and fibroblasts demonstrated that about 10-20% of genes expressed differently between 5 and 10\u00a0day cell culture of lung telocytes per se . It indiThe methodologies of single-cell sequencing have been improved and developed with the increase of the understanding and attention. The single cell sequencing is expected to detect the genomic heterogeneity in the primary disease and provide useful information for selecting therapies, monitoring the efficacy and efficiency of the therapy, predicting the potential outcomes of patients, if the disease would be monogenomic one which hardly exists in clinical practice. It is more important to consider the interactions between genes, proteins, cells, organs, as well as the critical role of the tissue microenvironment, when clinical studies are designed for the single cell sequencing analysis. Single-cell sequencing was evidenced to have the high sensitivity in the identification of rare chemoresistant clones in the primary cancer and to investigate questions of whether resistant clones were pre-existing in the primary cancer or appeared in response to therapies . The chaAnother potential or new hope is to develop new type cells for therapies by bioengineering or modifying targeted genes selected from the single cell sequencing. It believes that the construction of a phylogenetic tree of a human lifetime and the contribution of genetic heterogeneity to the organism can be defined and figured out by the single cell sequencing analysis of the different cells from endodermal, mesodermal, and ectodermal tissues from an individual. The sub-classification or new discovered populations of cell types can be found by gene expression profiles and epigenetic status, although the relationship between genome sequence, epigenetic status, and gene expression, and the functional capacity of the cell remain unclear . The newIn conclusion, the clinical research and application of the single cell sequencing analysis are expected to identify and validate disease-specific biomarkers, network biomarkers, dynamic network biomarkers. The single cell research and value will be also dependent upon the understanding of genomic heterogeneity, planning and design of study protocol, representative of selected and targeted cells, and sensitivity and repeatability of the methodology. The single cell sequencing can be used develop new diagnostics, monitor disease progresses, measure responses to therapies, and predict the prognosis of patients, although there are still a large number of challenges and difficulties to be faced. It would be more values and specificities of the single cell sequencing to integrate with the function of cells, organs, and systems of the body, the clinical phenotypes of patients, and the description of clinical bioinformatics."}
{"text": "After publication of the original article , the autIn addition to the study sponsors the Bill and Melinda Gates Foundation (grant number 48027) and MIDAS (grant number U01-GM087728), the authors gratefully acknowledge funding of the NTD Modelling Consortium by the Bill and Melinda Gates Foundation in partnership with the Task Force for Global Health. The views, opinions, assumptions or any other information set out in this article are solely those of the authors. The authors thank the data and safety monitoring committee, including Douglas Jabs, MD, MBA (chair), Antoinette Darville, MD, Maureen Maguire, PhD, and Grace Saguti, MD, who were generous with their time and advice and met before and during the study. The authors thank all of our colleagues in Niger at Programme National de Sant\u00e9 Oculaire who collected samples and data. This trial is registered at ClinicalTrials.gov, number NCT00792922. We also thank the NTD support center and the Task Force for Global Health."}
{"text": "The aim of this special issue is to focus on recent developments and achievements in the theory of function spaces, sequences spaces and their geometry, and compact operators and their applications in various fields of applied mathematics, engineering, and other sciences. The theory of sequence spaces is powerful tool for obtaining positive results concerning Schauder basis and plays a fundamental role in creating the basis of several investigations conducted in nonlinear analysis. The compactness is very often used in fixed point theory and its applications to the theories of differential, functional differential, integral, and integrodifferential equations.The research papers in this special issue cover various topics like geometry of Banach spaces, Schauder basis and dual spaces, sequence spaces and their topological and geometric properties, approximation of positive linear operators by matrix and nonmatrix methods, convergence and stability results for iterative process, applications of iterative methods to a nonlinear integral equation, Littlewood-Paley operators on Morrey spaces, matrix transformations between certain sequence spaces, measures of noncompactness and their applications in characterizing compact matrix operators, fixed point theorems and their applications, and so on."}
{"text": "Best papers of this conference were covered. PCO'2013 attracted participants from many countries and from across the PCO community in Europe and all over the world, for a meeting of vivid exchanges and lively debates. The PCO'2013 conference provided an excellent floor for investigators and practitioners to promote their newest advances in power, control, and optimization to the wider community of scientists and practitioners, for identifying research challenges for their fields, as well as promising research developments in theory, methods, and applications, and for fostering given and creating new interactions with colleagues from related research areas of modern PCO areas and their emerging applications.This special issue of this journal is devoted to the PCO global conference organized a successful conference in the research areas of power systems, control systems, and optimization in Prague, the capital of Czech Republic. This special issue focuses on best and high quality selected papers which were presented at the PCO global conference. Well-known and new methodologies and techniques of optimization were used to solve some of the complicated and hard problems in the areas of power systems, control systems, and optimization.Applications of optimization techniques are well known in the research areas of power systems, control systems, and computer science. The current trends on application of metaheuristics techniques are very popular among the researchers in the areas of power systems, control systems, and computer science across the globe. In this regard, the PCO'2013 and our special issue focused on new development and contribution of the current research to the body of the knowledge in the area of PCO. The topics included are (i) optimal power; (ii) optimal control; (iii) optimization; (iv) cams, gears, wheels, and valve optimization; (v) android phone, mobile, WiMax, and wireless communications; (vi) smart grid, microgrid, distribution, and chaotic systems; (vii) scheduling and assignment problems; (viii) healthcare, bioinformatics, and signal processing; and (ix) future energy planning and the environment.This special issue was open for interested authors in all power, control, and optimization areas, and they were welcome to submit their recent findings and best results. BothThe subjects of power, control, and pptimization as elaborated in our special issue are so closely related to the emerging questions and challenges on energy and electricity, from engineering, applied mathematics, operational research, computer science and data mining, education, and social sciences, both quantitatively and qualitatively, and they reach out very far and, eventually, to the living conditions of people on earth."}
{"text": "This article presents a history of the early electroencephalography (EEG) of psychopathy, delinquency, and immorality in Great Britain and the United States in the 1940s and 1950s. Then, EEG was a novel research tool that promised ground-breaking insights in psychiatry and criminology. Experts explored its potential regarding the diagnosis, classification, etiology, and treatment of unethical and unlawful persons. This line of research yielded tentative and inconsistent findings, which the experts attributed to methodological and theoretical shortcomings. Accordingly, the scientific community discussed the reliability, validity, and utility of EEG, and launched initiatives to calibrate and standardize the novel tool. The analysis shows that knowledge production, gauging of the research tool, and attempts to establish credibility for EEG in the study of immoral persons occurred simultaneously. The paper concludes with a reflection on the similarities between EEG and neuroimaging\u2014the prime research tool in the current neuroscience of morality\u2014and calls for a critical assessment of their potentials and limitations in the study of immorality and crime. Approximately 70 years later, modern neuroscience has appropriated immorality and delinquency as viable objects of research. Especially the emergence of neuroimaging technology in the last two decades facilitated research on the good, the bad, and the brain. According to some, a revolution in understanding morality is on its way  in 1952 was an attempt to homogenize classification. Among others, the definition of one particular mental disorder was arduous: psychopathy.Immorality has to be understood in context\u2014as well as corresponding mental disorder concepts and their putative biological manifestations. Ideas on a hereditary, physiological, or neurological basis for anti-sociality, violence, and crime have a long and multifarious history Rafter, . In the \u201cIt is a confusing term; it is misleading, and it means nothing.\u201d ."}
{"text": "Environmental modification by anthropogenic actions, disordered urban growth, globalization of international exchange and climate change are some factors that help the emergence and dissemination of human infectious diseases transmitted by vectors. This review discusses the recent entry of three arboviruses in Brazil: Chikungunya, West Nile, and Zika virus, focusing on the challenges for the Country\u2019s public health. The Brazilian population is exposed to infections caused by these three arboviruses widely distributed on the national territory and associated with humans. Without effective vaccine and specific treatment, the maintainance and integration of a continuos entomological and epidemiological surveillance are important so we can set methods to control and prevent these arboviruses in the Country. Infectious diseases have some peculiarities that distinguish them from other human diseases, such as the unpredictable and explosive character on a global level, transmissibility, close relationship with both the environment and human behavior, and the ability to be prevented and eradicatedIn addition to the interference and modification of ecosystems by human action, other factors are related to the emergence of arboviruses in those countries, such as disordered urban growth and processes of globalization and expansion of international exchange, as well as climatic changesGlobal warming is also an important factor in the transmission dynamics of pathogens to humans. Global temperature increase affects the mosquito vectors by reducing the development time of the larvae and, thus, increasing rapidly the population of adults. It also decreases the extrinsic incubation period, i.e., the time for the virus to reach the mosquito\u2019s salivary gland, making it suitable to transmit this etiologic agentThe aim of this comment was to discuss the recent entry of the arboviruses Chikungunya (CHIKV), West Nile (WNV), and Zikavirus (ZIKV) in Brazil, focusing on the challenges for the Country\u2019s public health.Alphavirus genus of the Togaviridae family. CHIKV was first isolated in 1952/1953, during an epidemic in East Africa (Tanzania and Mozambique). The term \u201cChikungunya\u201d is derived from the Makonde language, spoken in some areas of northern Mozambique and southern Tanzania, which means \u201cthat which bends up\u201d, referring to the posture gained by the patient due to severe arthralgiasChikungunya fever is caused by a virus that belongs to the ,This arbovirus did not receive much attention until 2005, when outbreaks struck some Indian Ocean islands, as the French island Reunion, where more than 240,000 people were infected and 203 diedAedes genus, such as the Aedes furcifer-taylori, e.g., and nonhuman primatesAedes (Stegomyia) aegypti and with humans. However, during the epidemic of Chikungunya in the Reunion island, low numbers of Ae. aegypti and high density of Aedes (Stegomyia) albopictus were found in the areaAe. albopictus, turning this mosquito into an excellent vector for humans in several areas where Ae. aegypti is absent,In Africa, the cycle of CHIKV occurs mainly in forested areas, involving wild mosquitoes of the Ae. aegypti and Ae. albopictus show high vector competence, which makes this arbovirus a potential threat to the CountryAt the end of 2013, the first case of local transmission of CHIKV was reported in the Americas, in the Caribbean region. Just a year later, at the end of 2014, South American countries, such as French Guiana, Venezuela, Colombia, Suriname, Paraguay, and Brazil had already reported the local circulation of CHIKV  Flavivirus genus of the Flaviviridae family. WNV was first isolated in a feverish woman in the West Nile district of Uganda, Africa, in 1937. Then, some outbreaks of this arbovirus were reported elsewhere in Africa, Middle East, Asia, and EuropeWest Nile fever is caused by a virus that belongs to the Flavivirus genus as etiologic agentThe entry of WNV in the West occurred in late August and early September 1999, in New York City, United States of America. The city had a human encephalitis outbreak, which indicated the presence of an arbovirus of the ,Most patients infected with WNV are asymptomatic, but the symptoms include fever, headache, nausea, and vomiting. Generally, the recovery is complete, but weakness and fatigue may last longer. Less than 1.0% of infected people develop the most aggressive form of the disease, showing severe neurological problems, such as meningitis and encephalitis, which may lead to death. Such manifestations are more common in older adults and immunosuppressed peopleAedes and Anopheles in Africa, Europe, and United States, undoubtedly, the Culex genus encompasses the main mosquito vectors of this arbovirus, including Cx. quinquefasciatusThe WNV cycle is maintained in nature by birds and mosquitoes, while humans and horses are considered final hosts, as they do not act as infectious sources for the vector,In South America, serological evidence of WNV was detected in horses and birds in Colombia, Venezuela, and Argentina. In Brazil, the first serological evidence of WNV activity occurred in 2009, in the Pantanal region, state of Mato Grosso do Sul, with the virus isolation in horsesFlavivirus genus of the Flaviviridae family, ZIKV was first isolated in rhesus monkeys, in 1947, in the Zika forest, Uganda. The isolation of ZIKV in humans was confirmed in Nigeria, but some serological evidence of human infection by this arbovirus have also been reported in other African countries, such as Egypt, Tanzania, Gabon, and Sierra Leone, as well as in Asian countries, such as India, Malaysia, Thailand, and IndonesiaAlso belonging to the ,,In 2015, Brazil reported the first autochthonous human cases of Zika, confirming the recent entry of this arbovirus in the Country. Bahia and Rio Grande do Norte were the first Brazilian states to report cases of ZIKV infectionAedes genus, Ae. aegypti being the main vector in Brazil. The symptoms of this arbovirus appear a few days after the mosquito bite, they last from three to 12 days and include low-grade fever, arthralgia, myalgia, headache, conjunctivitis, and maculopapular rash,,The most common form of ZIKV transmission is by the bite of infected female mosquitoes of the ,The emergence of arboviruses in places that were safe represents a potential challenge for public health in many ways.The recent entry of CHIKV, WNV, and ZIKV in Brazil and in other countries of the Americas exposes the population to the infection, once all individuals are susceptible; in addition, no vaccines are available as prophylactic method and no antiviral drugs are effective for the treatmentAe.aegypti and Cx. quinquefasciatus have wide distribution in Brazil and are extremely associated with humans and the urban environmentAe. albopictus is present in almost all national territoryAe.aegypti, for instance, new technologies have been used to control this dengue vector, Chikungunya, and Zika in Brazil, such as the release of genetically modified adults or mosquitoes infected by the Wolbachia bacteria. However, more research is required to confirm the effectiveness of these methodsThe noteworthy association of mosquito vectors with humans is also a challenge. Ae. aegypti and Cx. quinquefasciatus. Climate change also contributes to the proliferation of mosquito vectors. The increased rainfall frequency, which has been observed in some places, entails the accumulation of water in more containers, increasing the supply of natural or artificial breeding sites for female mosquitoes to deposit their eggs. On the other hand, the period of drought in certain areas forces people to store water in barrels or other artificial deposits, which serve as breeding sites for the proliferation and increase of vector populationsThe environment also represents an obstacle to the control of these vectors. Disordered urban growth, combined with the pollution of rivers and ditches, provides artificial oviposition sites for the proliferation and dissemination of mosquitoes, especially of Other relevant challenge for public health is the diagnosis of these new arboviruses. In Brazil, several arboviruses circulate, such as Mayaro (MAYV), Venezuelan Equine Encephalitis (VEEV), Eastern Equine Encephalitis (EEEV), Rocio (ROCV), and Dengue virus (DENV), which present many symptoms similar to those observed for CHIKV, WNV, and ZIKVFinally, despite the lethality of CHIKV and ZIKV being considered low, cases of coinfection with other arboviruses have been reported in patients from other continentsThe recent entry of new arboviruses challenges physicians, health professionals, and researchers to perform an active and ongoing investigation about specific symptoms and serology of vectors, etiological agents, and of environmental and social factors that may be associated with the epidemics and the emergence of new cases. Thus, the strengthening and integration of entomological and epidemiological surveillances is necessary, so we can set methods to control and prevent these diseases in the Country."}
{"text": "There is an error in the byline. Prof. Lin Yun-Feng should be included as the fourth author. The correct affiliation for Prof. Lin Yun-Feng should be #1: Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. The contributions to the manuscript are as follows: Conception and the design of the work, acquisition of data, or analysis or interpretation of data; final approval of the version to be published."}
{"text": "Influenza viruses cause annual epidemics of respiratory tract disease that affect all age groups. Many developing countries do not have an influenza surveillance system or adequate laboratory capacity for virus detection. The objective of this study was to describe the influenza surveillance systems in the different countries in the tropics and to identify outstanding research needs. A questionnaire was designed and sent to 52 NICs and MoHs in the different countries in tropical Asia and Africa to gather information on the surveillance systems, sentinel sites, specimen and data collection, and laboratory testing. Replies were received from 32 NICs and MoHs (61.5% response) \u2013 17 were located in tropical Asia and 15 in Africa. There are 20 WHO recognized NICs in tropical Asia and 14 in tropical Africa, all with virus isolation and polymerase chain reaction (PCR) testing capacity. Of the Asian countries, only Hong Kong and Singapore reported that the patient population from the sites represents the broader community. In tropical Africa, only Senegal has sentinel sites distributed all over the country contributing to the geographic representativeness of the surveillance system. The rest of the countries in Africa have just established their influenza surveillance system in the past decade and are working toward geographic expansion of the ILI and SARI sites. Limited laboratory capacity or infrastructure to perform influenza surveillance makes difficult to justify the importance of influenza vaccine or other influenza control measures as a strategy for improving population health in the tropical region. Influenza is a highly communicable acute respiratory disease which affects populations for centuries . The infTo understand the different influenza surveillance systems in the different countries in the tropical region, a questionnaire was designed to gather information specifically on the surveillance system, sentinel sites, specimen and data collection, and laboratory testing. The questionnaire was sent to the different National Influenza Centers and/or Ministry of Health. Additional information was obtained either online from the Ministry of Health websites of the different countries. Annual reports and presentations made by the National Influenza Centers or Ministries of Health to International Conferences  were also included.Questionnaires were sent to 52 National Influenza Centers (NICs) and Ministries of Health (MOHs) in the different countries in Tropical Asia and Africa. Replies were received from 32 NICs and MOHs (61.5% response). In this study 32 countries were included among which 17 were located in tropical Asia. For Africa, only 15 countries were included. These were the countries whose National Influenza Centers responded to the questionnaires sent or responded by providing presentations or publications from the country.In Asia, the Tropic of Cancer runs from west to east through Saudi Arabia, United Arab Emirates, Oman, India, Myanmar, Southern China and Taiwan and the Tropic of Capricorn runs through Australia. Some 19 countries including 4 in the Middle East  are situated in the tropical region. India, in southern Asia, lies mostly in the tropics, and all countries of Southeast Asia are tropical countries. Places located in the Pacific including parts of Australia, Micronesia, the Marshall Islands, Kiribati, and most of the other island nations of Oceania in the South Pacific are also considered tropical.In tropical Asia, Singapore and Indonesia were the first countries to conduct influenza surveillance in the 70s. New Caledonia, Hong Kong, and Taiwan followed in the 1990s. All the rest started after 2000 with Laos, Bangladesh, and Sri Lanka starting in 2007. ILI and SARI surveillance have been initiated in all the countries in tropical Asia except for Malaysia and Cambodia. Malaysia currently focuses on ILI while Cambodia does ILI and ALRI (acute lower respiratory infection) surveillance. All countries publish their influenza surveillance data in WHO FluNet except for Saudi Arabia and Taiwan , Table 2In Africa, the Tropic of Cancer runs from west to east through the African countries Western Sahara, Mauritania, Mali, Algeria, Niger, Libya, Chad, and Egypt. The Tropic of Capricorn runs from west to east through the African nations Namibia, Botswana, South Africa and Mozambique. The only countries that cannot be called tropical are Morocco and Tunisia in the north and Lesotho, South Africa, and Swaziland in the South. The rest lie entirely or partly within the tropics.In West Africa, from only 2 countries conducting influenza surveillance in 2006, 6 additional countries have established a functional in-country surveillance system. Mauritania has just started Flu Surveillance. From only 1 functional WHO recognized National Influenza Centers in 1996 , there are now 4 NICs in the region . In Middle Africa only Cameroon, Angola, Central African Republic, and the Democratic Republic of Congo have functioning Influenza Surveillance systems. Chad, Equatorial Guinea, Gabon, and Sao Tome and Principe currently do not have Influenza Surveillance systems. In East Africa, the countries with Influenza Surveillance systems include Ethiopia, Tanzania, Kenya, Uganda, and Rwanda. All these countries have National Influenza Centers recognized by the WHO. In the Horn of Africa, only Ethiopia has a functioning Influenza Surveillance system. In Southern Africa, Madagascar, Mozambique, Zambia, and South Africa have Influenza Surveillance systems. There are 3 WHO-recognized National Influenza Centers in Southern Africa \u2013 1 in Madagascar, and 2 in South Africa. South Africa is not included here as most of country is located outside of the tropics , Table 4There are 21 WHO-recognized National Influenza Centers in Tropical Asia: 3 in India, 2 in Vietnam, 2 in Malaysia, and 1 each in Bangladesh, Indonesia, Myanmar, Sri Lanka, Thailand, Cambodia, Hong Kong SAR, Taiwan, Fiji, Papua New Guinea, New Caledonia, Laos, The Philippines, and Singapore. Except for Maldives, Brunei, and East Timor, all of the countries in the Tropical region in Asia have Influenza Surveillance systems. There are 14 WHO-recognized National Influenza Centres in Tropical Africa: Cote d'Ivoire, Senegal, Ghana, Nigeria, Cameroon, DR Congo, Angola, Uganda, Rwanda, Sudan, Ethiopia, Kenta, Tanzania, and Madagascar.Human Influenza surveillance comprises of 2 components: Influenza-Like Surveillance (ILI) and Severe Acute Respiratory Infection (SARI). ILI and SARI surveillance have been initiated in all the countries in tropical Asia except for Malaysia and Cambodia. Malaysia currently focuses on ILI while Cambodia does ILI and ALRI (acute lower respiratory infection) surveillance. ILI and SARI surveillance have been initiated in all the countries in tropical Africa except for Cameroon and Senegal which only focus on ILI surveillance for the moment. The surveillance systems in tropical Asia and Africa use the existing World Health Organization (WHO) case definition for Influenza-like illness  and incoThere are 20 WHO recognized NICs in tropical Asia and 14 in tropical Africa. All with virus isolation and polymerase chain reaction (PCR) testing capacity. Previously the methods employed for virus detection were mainly virus isolation and the haemagglutination inhibition test. Subsets of the specimens undergo viral culture and characterization. The on-going presence of the highly pathogenic avian A (H5N1) influenza virus since early 2004 increased the need for PCR (polymerase chain reaction) as part of the diagnosis process in order to improve the accuracy and efficiency of testing. Virologists and laboratory technicians in the NIC of the countries have been trained overseas on influenza laboratory diagnosis and detection. For most of the NICs, epidemiologists are full-time employees. Relevant technical personnel have been trained by staff from the WHO or US CDC or Institut Pasteur.In terms of surveillance sites, for Asia, only Hong Kong and Singapore reported that the patient population from the sites represents the broader community. This is most probably due to the size of the state and the healthcare IT network and integrated surveillance system. For India, samples are representing almost all the regions in the country, but not the individual states. For archipelagos like The Philippines and Indonesia with more than 7,000 and 13,000 islands respectively, obtaining a truly representative sample may be a challenge. However, the majority of the population is concentrated on the major cities, i.e. Metro Manila and Java where several sentinel sites are located. The rest of the countries in Asia are working toward geographic expansion of the ILI and SARI sites. Maldives, Brunei and East Timor do not have a National Influenza Center.In tropical Africa, only Senegal has sentinel sites distributed all over the country contributing to the geographical representativeness of the surveillance system. The rest of the countries in Africa have just established their influenza surveillance system in the last decade and are working towards geographic expansion of the ILI and SARI sites. Several countries do not have the laboratory capacity or infrastructure to perform influenza surveillance. These countries include the following: Benin, Burundi, Cape Verde, Chad, Comoros, Djibouti, Equatorial Guinea, Eritrea, Gabon, Guinea, Guinea Bissau, Lesotho, Liberia, Malawi, Namibia, Botswana, Mauritania, Mauritius, Sao Tome and Principe, South Sudan, Seychelles, Somalia and Zimbabwe.The burden of influenza in the tropical Asia and Africa is still not fully understood. However there have been some studies to learn more, particularly in Thailand, Myanmar, and India. Philippines and Bangladesh are currently conducting burden of disease studies. Defining the epidemiology and burden of influenza is high on the priority list of the WHO Southeast Asian Region and Western-Pacific region 2011 Bi-regional Plan for Further Strengthening National Influenza Surveillance . In AfriRespiratory specimens  are collected early from ILI and SARI patients using established protocols. For most of the countries in tropical Asia and Africa, it is not feasible to collect specimens from all patients therefore systematic sampling is done. There is no generic number of specimens collected in each site and this depends on several factors like seasonality and attack rates , 13. MosAll NICs and MoHs in tropical Asia and Africa collaborate with the WHO. Initiatives for building national capacity in the countries in tropical Asia and Africa include cooperative agreements with the US Center for Disease Control and Prevention (CDC) in Atlanta, United States of America. In tropical Africa countries like Nigeria, DR Congo, Angola, Ethiopia, Kenya, Rwanda, Tanzania, Uganda, Zambia and Mozambique these agreements have been instrumental in the establishment and improvement of national influenza surveillance capabilities. In Ghana, Mali, Burkina Faso, and Togo influenza surveillance receive assistance from the CDC via the US Naval Medical Research Unit-3 (NAMRU-3).In some countries, the NICs are hosted within the International Network of Pasteur Institutes. In tropical Africa Cote d\u2019 Ivoire, Senegal, Sierra Leone, Central African Republic, and Madagascar are part of the network. In tropical Asia Vietnam, Cambodia, and New Caledonia are part of the Institut Pasteur network. In tropical Asia, Saudi Arabia, Cambodia, Singapore, and Indonesia collaborate with NAMRU. Saudi Arabia collaborates with NAMRU-3 while the other Asian countries work with NAMRU-2.There are existing influenza surveillance systems in several countries in Asia and Africa. WHO and different organizations such as the US CDC, NAMRU, and Institute Pasteur lend support to National Influenza Centers and laboratories in Asia and Africa. Surveillance will allow determination of the rates of influenza and a description of the clinical characteristics of the disease. With such epidemiologic data, public health officials will have better data in order to formulate influenza control strategies for either seasonal or pandemic influenza. Most of the countries are working toward geographic expansion of the ILI and SARI sites. Very few countries in tropical Asia and Africa have the capacity to measure the diseases burden of influenza. About half of the countries in Africa still do not have the laboratory capacity or infrastructure to perform influenza surveillance. This makes it difficult to justify the importance of influenza vaccine or other influenza control measures as a strategy for improving population health. Governments have taken steps to identify and focus on gaps in knowledge as indicated by the increasing development of surveillance networks, the organization of scientific congresses such as the African Influenza Scientific Symposium, ANISE meetings and the WHO  meetings. Although these efforts have not yet resulted in a great increase in published manuscripts and data, this situation should change within the next few years. It is important to encourage national laboratories to publish results of their studies. Collaborations between countries should be strengthened for efficient utilization of laboratory services and capacities."}
{"text": "Department of Health and Human Services, the task force is an independent, nonfederal, unpaid panel of public health and prevention experts whose members are appointed by the Director of CDC. The task force provides information for a wide range of decision makers on programs, services, and policies aimed at improving population health. Although CDC provides administrative, research, and technical support for the task force, the recommendations developed are those of the task force and do not undergo review or approval by CDC."}
{"text": "Department of Health and Human Services, the task force is an independent, nonfederal, uncompensated panel of public health and prevention experts whose members are appointed by the Director of CDC. The task force provides information for a wide range of decision makers on programs, services, and policies aimed at improving population health. Although CDC provides administrative, research, and technical support for the task force, the recommendations developed are those of the task force and do not undergo review or approval by CDC."}
{"text": "The health systems in the Americas region are characterized by fragmentation and segmentation, which constitute an important barrier to expanding coverage, achieving integrated primary health care, and reducing inefficiency and discontinuity of care.An assessment of the human resources for health (HRH) programmes that have been implemented at the country level was developed as part of the measurement of the 20 HRH regional goals for 2007\u20132015, adopted in 2007 by the Pan American Sanitary Conference (CSPA).The exercise was a combination of academic research and the development/application of an advocacy tool involving policy makers and stakeholders to influence the decision-making in the development, implementation, or change of HRH programmes while building evidence through a structured approach based on qualitative and quantitative information and the exchange and dissemination of best practices.This paper covers the methodological challenges, as well as a summary of the main findings of the study, which included 15 countries: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama in the Central America, Dominican Republic in the Caribbean, Chile, Colombia, Ecuador and Peru in the Andean sub region, and Argentina, Paraguay, and Uruguay in the South Cone. Despite the different contexts, the results showed that the programmes evaluated faced common challenges, such as lack of political support and financial unsustainability.The evaluation process allowed the exchange and dissemination of practices, interventions, and programmes currently running in the region. A shared lesson was the importance of careful planning of the implementation of programmes and interventions. The similarities in the problems and challenges of HRH among the participating countries highlighted the need for a cooperation programme on the evaluation and assessment of implementation strategies in the Americas region. In the last decade, the central role of the workforce in improving the health sector has become evident. Several studies have identified signals in the relationship between the quantity and quality of workers and the expansion and qualification of access to health services. Despite this, however, there is still a crisis in the health workforce, characterized by a shortage of professionals, an inadequate skill mix, and an unequal distribution of professionals ,2.In response to this crisis, there is a growing demand for countries to develop and implement programmes for the management and planning of human resources for health (HRH). The interventions aim to confront complex issues, such as the migration of health professionals, the need to make the health system more responsive to demographic changes and the ageing population, and the challenge of ensuring the presence of professionals in remote and rural locations .Moreover, the failure of health system reforms has been associated with the failure to strengthen the policies, planning, and management of HRH early in the process. In a systematic review, significant gaps were found in knowledge about the way training, regulatory, financial, and organizational mechanisms affect the supply, distribution, and performance of health care workers. Additionally, the data available tend to come from high-income settings and may not apply to low- and middle-income countries (LMICs) .According to Peters et al. , despiteThis article describes the process and results of the evaluation of health human resources programmes developed through cooperation between the Pan American Health Organization (PAHO) and the Institute of Social Medicine, State University of Rio de Janeiro. The study covered 15 countries in Latin America Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama in the Central America, Dominican Republic in the Caribbean, Chile, Colombia, Ecuador and Peru in the Andean sub region, and Argentina, Paraguay, and Uruguay in the South Cone.The programmes\u2019 evaluation started from concerns raised in the monitoring process of the 20 regional goals for human resources for health for 2007\u20132015 adopted by the Pan American Sanitary Conference in 2007 [The HRH programmes\u2019 evaluation at the regional level could also allow sharing of information and trends, identifying emerging issues, and promoting opportunities for future collaboration. Because of this cooperation process, different partners can exchange information about best practices. The evaluation was developed not only as an academic research but also to contribute to changes and the improvement of HRH programmes and policies, by empowering and encouraging the creation of a network.The evidence and reflections presented in The World Health Report 2006  and the At the 27th Pan American Health Conference, 20 regional goals to be achieved by 2015 were established in the process of transforming health systems towards the renewal of primary health care and the integration of services. The goals were grouped according to the five critical areas mentioned in the Toronto Call to Action: 1) define policies and long-term plans, 2) improve the distribution of professionals, 3) regulate professional flows and migration, 4) create healthy work environments, and 5) establish links between training institutions and services .The Toronto Call to Action in 2005 and, thereafter, the Regional Goals for Human Resources for Health 2007\u20132015 have established a strategic framework to direct efforts in HRH management, recognizing the importance of HRH planning and guidance of health systems based on primary health care and universal coverage. To monitor the 20 regional goals, a methodology was developed that allowed establishing a baseline and identifying the needs and progress in every area covered in the goals, as well as recognizing the priorities to be addressed in the implementation of HRH public policies. The evaluation process of the HRH programmes analysed in this article is part of this context of international cooperation, information exchange, and dissemination of practices and interventions.The approach proposed had three main components, completed in accordance with the possibilities in the different countries included in the evaluation. The first step was to identify and list the programmes and interventions that each country has implemented or is implementing to address HRH recruitment, deployment, and retention concerns and problems. As a result, it has built an inventory of programmes to be analysed and studied in depth, resulting in evidence on the challenges in HRH management and policy.The second step started with a description of the programme, including the identification of indicators of programme results from government reports and other data sources. A programme description conveys the mission and objectives of the programme being evaluated. It should be sufficiently detailed to ensure understanding of the goals and strategies of the programme, its capacity to effect change, its stage of development, and how it fits into the larger organization and community. The description enables comparisons with similar programmes and facilitates attempts to connect programme components to their effects ,9.The aspects included in the programme description were need, expected effects, activities, resources, stage of development, context, and a logic model -13. A loTo obtain more details on the programme-implementation process and its results, a formal questionnaire was used to collect data from secondary sources but also to interview key informants. Additionally, the information gathered was used to complete a logic model for the purpose of identifying and linking all major components and mapping the process of programme implementation.In the third step of this study, a template was developed for the country report to put together all the information gathered and to analyse the processes and results of the programme in relation to the expected outputs and outcomes.The stages of the programme evaluation are interdependent; that is, the success of each step is dependent on the success of the step before it. Therefore, there was an effort to clearly define and agree on programme goals, activities, and indicators, trying to assure the stakeholder participation and acceptance. Figure Aprogrammeis defined as a long-term (more than 1\u00a0year) formal plan of action, with a sequence of actions that describe how a health system or service will operate, including details such as roles and responsibilities, planned expenditures, results, etc. Less formal, and generally shorter-term than a programme (one year and less), aninitiativeis defined as a coherent set of actions, activities or interventions that are linked to an ultimate goal and one or more policy or programme objectives and have certain resources  to meet the objectives and contribute to the achievement of the goal.The respective country authorities, along with the national offices of PAHO/WHO, selected the national assessment teams. To support these teams in the preparation, data collection, interviews, and so on, an agreement was made with the PAHO/WHO Collaborating Centre on Health Workforce Planning and Information at the Institute of Social Medicine at the University of the State of Rio de Janeiro (IMS/UERJ). This made possible the conduct of face-to-face and virtual meetings with national teams to support the programme evaluation process. Although the basic process and objectives were the same in all countries, it was possible to take into account the capabilities of each country and allow flexibility in the way they deepened their evaluation . For theAfter listing the programmes and initiatives, the following criteria were used to select the programmes to be evaluated: at least one HRH programme/initiative on HRH, effect (impact) on the health system, total amount of programme funding, scope of the programme (population and geographic area), temporary extension (over a year), and the availability of information.Results related to changing partner and stakeholder attitudes and behaviour as a factor for the successful development, implementation, and management of programmes were only marginally addressed.Although the studied countries differ significantly in their political, social, economic, and geographic contexts, the HRH programmes and initiatives showed that the actions of these countries have been directed to strengthening national health systems, oriented towards primary health care with universal and equitable coverage. Beyond that, many of the challenges faced in the implementation of human resource programmes are the same across countries; these include the difficulty of training HRH, the lack of political will and financial support, weak HRH information systems, fragile/weak HRH governance, and difficulties in hiring and retaining health professionals in the public sector and in their allocation in remote and rural areas.Issues related to the programme design were described as challenges by some countries. For instance, in Honduras, most of the programme development is not based on any previous design, and there is no regular discussion regarding the adaption of the programme to human resources training and the health needs of the population. Another example is Chile, where the biggest challenge for programme design is the appropriate planning of the project. In El Salvador, there is still little consistency between HRH programmes and health needs.The fragility of intermediate and long-term planning remains a challenge in achieving the overall HRH objectives in countries such as Costa Rica, Nicaragua, Ecuador, and Argentina. In El Salvador, Costa Rica, Guatemala, Honduras, Panama, Dominican Republic, and Argentina, programme implementation was described as a big challenge, especially when extending the programme to the national level.The lack of clarity of roles was identified by Paraguay and Honduras as a challenge in programme development. The need for different authorities to understand their new roles in the programme was mentioned in Honduras. In Paraguay, there is a need to clarify and improve the coordination among different actions, programmes, and institutions to avoid overlap or inattention. The overlapping of actions by different participants or institutions also exists in Panama. Challenges at the participant level were reported in El Salvador, Costa Rica, Guatemala, Honduras, Dominican Republic, Chile, and Panama.Low acceptance of the programme by professionals was reported in Guatemala, where medical specialty residents partially rejected the programme, and in the Dominican Republic, where doctors struggled to be evaluated on their performance. The resistance of professionals to changes in the health system was highlighted in El Salvador, whereas in Honduras, low adherence to the changes by the community was found, in addition to resistance among professionals.In Guatemala, the Health Secretary was considered as a key player, whereas in Nicaragua, the importance of an integrated approach to planning HRH policies was stressed. In Argentina and Paraguay in Mercosur and in Chile, Ecuador, and Peru in the Andean region, the importance of the planning process was also highlighted. Peru cited the value of planning in expanding the access and coverage of health care.The countries identified the importance of community participation and an intersectoral approach in implementing HRH programmes. Guatemala, Chile, and Peru emphasized the importance of a common vision among stakeholders and cooperation among technical and academic institutions towards the establishment of a shared responsibility among stakeholders. In El Salvador, intersectoral work (interagency cooperation), albeit slow, was reported to be effective.The set of programmes presented are aligned with the five challenges of the Toronto Call to Action. Tables\u00a0In seven countries, the analysed programme is related to the first challenge of the Toronto Call to Action: \u201cTo define policies and long-term plans on human resources\u201d. From this viewpoint, El Salvador has established a planning process for organizing primary health care and a programme for training managers. These programmes were made possible by strengthening the institutional capacity with the establishment of the Department of Human Resources Development.All the countries have addressed the second challenge of the Toronto Call to Action to \u201cplace the right people in the right places\u201d through initiatives and programmes related to professional training. Almost all the countries have made efforts to increase the number of specialists in different medical fields and to strengthen primary health care (PHC), indicating the concern of local governments with the training of health professionals and technicians.Cierre de Brechas plan in Chile provided funding for the training of medical specialists who were committed to provide public health services in areas with critical shortages. The Sistema Nacional de Acreditaci\u00f3n de Residencias del Equipo de Salud programme in Argentina involves the establishment of minimum requirements for the medical residency system, with places and priorities defined according to regional needs. Panama, Guatemala, Costa Rica, Peru, Ecuador, and Colombia also presented programmes aimed at training specialists to meet the needs of the population.The Formaci\u00f3n de T\u00e9cnicas Universit\u00e1rios de Parter\u00eda programme meets the challenge of reducing maternal and neonatal deaths by training people to integrate health teams in their own communities.The strengthening of PHC or its implementation through HRH training was related to programmes in the eight countries in the Central American region. In Guatemala, the The third challenge of the Toronto Call to Action focused on the regulation of health worker flows and migration. This evaluation found seven countries trying to address the HRH self-sufficiency issue in HRH policy.Ecuador Saludable, Vuelvo Por Ti, began in 2012 and aimed to promote the return of health professionals who were abroad to cover gaps in critical specialties and areas. A website was initiated for registering professionals working abroad who were interested in returning to the country; these professionals were offered professional stability and specialization programmes. By the end of 2013, about 700 professionals had been hired through the programme, and the experience brought by these professionals was highlighted for its contribution in enriching the sector.Ecuador was the only country that developed a programme directly related to the migration of health professionals. The said programme, Five countries addressed the fourth challenge of the Toronto Call to Action, which addressed the need to \u201cpromote healthy work environments and commitment to the institutional mission of ensuring quality health services for the entire population\u201d. Ecuador targets 80% of health workers by 2017 with its labour stability plan, whereas Uruguay started in 2012 a programme to reform medical services, with the aim of improving the quality of care, prioritizing primary care, and enhancing the quality of life of medical professionals.Seven countries assessed programmes related to the fifth challenge, which involves developing interaction mechanisms between training institutions and health services to improve the training of health workers (Target 17). For instance, in 2012, the Dominican Republic developed a programme in agreement with the Universidad Aut\u00f3noma de Santo Domingo, aiming to train human resources based on the primary health care model.Because the \u201cToronto challenges\u201d are correlated, the evaluation naturally found that the programmes are also connected to more than one challenge, thus reinforcing the correlation.Communication mechanisms and changes in organizational culture were identified as a development strategy in Argentina and El Salvador, particularly when it comes to managing the HRH. Regarding budget support, Honduras, Ecuador, Argentina, and Chile reported that support in terms of resources facilitates the implementation of programmes. The importance of information as support was identified in Ecuador, Argentina, and El Salvador.Costa Rica reported that the implementation of the programme taught them the importance of the nursing profession. Honduras identified as interesting the lesson that the empowerment of health workers is a key factor in the implementation of a new health delivery model because of their management capacity.The Central American countries highlighted the importance of training in strengthening primary health care. In El Salvador, Costa Rica, and Honduras, the need to promote closer ties between health training and practice was emphasized. In Guatemala, the need to strengthen supervision to improve the quality of training programmes was stressed. Training health professionals was also a challenge in Argentina, Chile, Panama, and Ecuador.The lack of health professionals with adequate skills and competences, especially in PHC, was described as a challenge in Belize, Honduras, and Paraguay. Aiming to increase health coverage and ensure the quality of training and services, 14 of the 15 countries had programmes and initiatives to promote integration between educational institutions and health services, with the specific goal of improving the skills, capabilities, and training of doctors, nurses, and other technical professionals focused on primary health care and different specialties.Argentina, Uruguay, and Ecuador also cited the lessons learned regarding staff training, but these were not assessed in this study.In Central America, Dominican Republic identified IT development as a good practice that allows the systematization of administrative and financial procedures concerning staff contracts. Costa Rica recognized the importance of professional regulation and a competitive recruitment process. Peru, Paraguay, and El Salvador reported good practices related to changes in health care, including comprehensive care, the importance of teamwork, and community and family health models. The importance of teamwork was also reported in El Salvador. Meanwhile, Paraguay cited employment status and compensation as ways to reduce moonlighting.Lack of financial sustainability and challenges regarding the availability of information for the planning, implementation, or continuity of the programme were also identified. Difficulties related to the programme budget was highlighted and described in El Salvador, Belize, Costa Rica, Guatemala, Honduras, Panama, Ecuador, Chile, Argentina, and Uruguay. Such financial constraint was responsible for restricting the maintenance and expansion of programmes and for obstructing the establishment and implementation of a national HRH policy.Just as decisions related to HRH cannot be considered only by using economic criteria, so without adequate funding, it is not possible to address the health needs of the population, achieve the agreed-on goals, and guarantee the remuneration of health workers. For instance, in Costa Rica, there is an understanding that there are insufficient financial resources to address the health needs of the population and strengthen HRH. Honduras does not have a defined budget for human resources development. Ecuador had to postpone the first payments to those health workers who returned to the country from abroad, causing huge dissatisfaction. Further, Uruguay limited the number of new areas in the training programme due to lack of financial resources. Because of the weakness of the processes and the difficulty of developing projects or of integrating programmes within health systems, programmes and projects often develop in isolation, dependent on the availability of donor funds and without connection to the system as a whole.In many countries, such as Argentina, Guatemala, and El Salvador, the need to establish work agreements with educational institutions was mentioned. In addition, the identification of key stakeholders and the creation of institutional spaces of negotiation  can compensate for the lack of cooperation between these institutions and the lack of involvement of key partners in HRH programmes.The study results showed that the lack of supporting data and information remains a critical challenge for El Salvador, Costa Rica, Guatemala, Honduras, Dominican Republic, Chile, Argentina, and Paraguay. For instance, the importance of improving the data quality and of training staff on data collection tools was mentioned in Paraguay, whereas, in Argentina, local managers had difficulty updating the HRH data regularly.An increase in the use of virtual platforms in distance training programmes was observed. For instance, in Argentina, this sort of technology has been used to train professionals and tutors in a virtual campus for public health.In Costa Rica and Chile, retaining health professionals in the public sector was reported as a challenge, whereas El Salvador mentioned the burden of migration and high turnover of HRH. The difficulty of retaining health professionals in rural areas was also a challenge in Panama, El Salvador, and Paraguay. In Belize, this challenge is exacerbated because of the geography, low-population density, and scattered population, which make it even more difficult to organize health care services in remote and inaccessible areas. Difficulties in ensuring access to health services, increasing coverage, reducing waiting times, providing health care 24\u00a0h a day, and decreasing PHC gaps were considered as challenges in Nicaragua, El Salvador, Dominican Republic, and Ecuador.The concerns found in this research are similar to the ones noted by Ranson  and DussUnderstanding the nature of policy implementation and looking at this process can shed light on the barriers to and facilitators of more effective implementation . TherefoImplementation is an ongoing process of decision-making by key actors, who work in complex policy and institutional contexts and face pressures from interested as well as opposing parties. As such, the motivation, flow of information, and balance of power and resources among stakeholders influence the policy-implementation processes .In this study, most of the challenges involved in several phases and elements along the programme-to-action continuum were related to planning and programme design, stakeholder engagement, context, resources, and operational issues, which shape the decisions and actions at various levels.The initial stages of HRH programme development, such as the design and implementation planning, are crucial processes. According to Bhuyan et al. , the proAnother key issue in programme implementation is the involvement of and coordination with the stakeholders. These stakeholders include the groups or individuals responsible for the implementation, the people affected by the programme, and the officials and professionals accountable for achieving the programme goals. The involvement of stakeholders in the implementation can be challenging because this often requires \u201cjoint actions\u201d in response to new partnerships that did not exist previously ,19.The insufficient commitment of key participants to implement programmes also emerged as a challenge. In some cases, stakeholder groups and organizations are not always committed to the same outcomes and must reach an agreement to support the implementation. As the programme implementation unfolds, additional stakeholders may find themselves being affected by the changes and may seek to also insert themselves into the process .To be feasible, HRH planning and implementation require the involvement of stakeholders, along with a solid financial basis and the necessary resources, such as time, skills, technology, equipment, information, and others. The programme descriptions highlighted situations in which a mismatch existed between the planned activities and the resources available for their implementation.Intersectionality was identified as a key issue for HRH planning to provide comprehensive and quality health services. Most of the programmes analysed seemed quite comprehensive, in terms of including training institutions, ministries of health, professional associations, and community associations as key stakeholders in the process of changing and reforming health systems and delivery models.Other difficulties in implementing HRH programmes include the following: lack of motivation for teamwork, unqualified recruitment mechanisms, outdated laws, unregulated health services provision, absence of impact measurement on the quality of care programmes, unmonitored activities, low educational level of candidates from rural communities, and nursing workload (rotating and moonlighting schedules).Although some of the initiatives and programmes evaluated were related to health training and labour management, almost all the countries considered success to be related more to the achievement of changes in the health delivery model and the reduction of HRH and health inequalities. Despite the current challenges, the countries have made progress in increasing the coverage of primary health care especially in the most vulnerable areas, providing vocational training, and strengthening the planning and establishment of a national human resources policy.This study provides information on a set of HRH programmes currently being developed in the region, including the challenges and lessons learned by each country at the national and regional levels. The value of evaluation as an institutional practice is a factor that was noted by all the countries and that needs to be promoted. The study results\u2019 are consistent with the findings from other studies and authors -22.It is interesting to note that, although much is being done towards the achievement of health care goals, the gap between what can be done and what is being done is increasing. The success in reducing this gap will be determined largely by the successful development of the health workforce in alignment with the improvement of health systems, including on health system governance and financing.The relevance and importance of the evaluation process and the need for its institutionalization should also be emphasized, having shown its benefits and proven its relevance, as well as the need to enhance international cooperation in this area ."}
{"text": "Robert Kissling , a pillaThe fondest of memories return; they remind the authors, his colleagues, and friends that it was with this attitude that the viral disease programs of CDC were established and have been maintained through the years. Bob, as an eminent virologist and a leader of CDC\u2019s viral disease programs, left a permanent legacy.Born in Toledo, Ohio, Bob attended Otterbein College, was awarded a DVM and an MSc from the College of Veterinary Medicine, Ohio State University, and then spent a year at the graduate school of the University of California at Davis. In 1947, the year after CDC was founded, he joined the US Public Health Service and began a long and distinguished career with CDC, then known as the Communicable Disease Center.The 1950s was a period of great progress in field and laboratory research in virology and at CDC\u2019s Virus and Rickettsia Section in Montgomery, Alabama. Bob began collaborative studies of the natural history, epidemiology, and pathogenesis of vectorborne viral encephalitides and began a career-long interest in rabies research; CDC developed an outstanding reputation in these areas, not the least because of Bob\u2019s contributions. While in Montgomery, Bob married Martha Eidson, his laboratory technician, and they had 3 children.In 1958, Bob and guest researcher Robert Goldwasser succeeded in adapting the then-new immunofluorescence methodology to detect rabies viral antigen in brain specimens of animals suspected of being rabid  and the emergence of increasingly sophisticated approaches to virus research, virus detection and identification, and the means to guide CDC\u2019s mission of disease prevention and control. Two new diseases are exemplary of the importance of his work, Marburg hemorrhagic fever and Lassa fever.In 1967, cases of hemorrhagic fever occurred among laboratory workers in Germany and Yugoslavia who were processing kidneys for cell culture; the kidneys were from African green monkeys that had been imported from Uganda. A new virus, Marburg virus, was isolated from patients and monkeys, first in Germany but shortly thereafter at CDC. From the beginning, it was realized CDC must have the capacity to deal with this virus and that Marburg virus was dangerous, calling for the best biocontainment of the day. CDC borrowed a mobile containment laboratory from the National Institutes of Health; the containment level provided was about what would be called Biosafety Level 2+ today. The work was led by Bob (As understood clearly by Bob, the Marburg virus episode had to be the impetus for the development of permanent biocontainment facilities at CDC. A glove port cabinet line laboratory was constructed, which opened in 1968. Completion of the laboratory coincided with the emergence of Lassa fever in West Africa. Early work on Lassa virus elsewhere was terminated after 1 person died and another nearly died; all virus stocks were sent to CDC. Under Bob\u2019s leadership, Tom Monath and others set to work to develop diagnostic systems and uncover the natural history and reservoir host of Lassa virus (Retiring to a farm north of Atlanta in 1973, Bob and Martha were at last able to bird-watch, farm a bit, and enjoy the wildflowers. Martha died in 1999 and Bob, whose health was declining, moved to North Carolina to enjoy his children, grandchildren, and great-grandchildren. A gentleman of common sense, practical sense, he was always polite, always helpful, always willing to teach, and greatly respected by his peers. Bob Kissling was one of the giants of CDC."}
{"text": "After publication of the original article  it was bThe original Funding information contains an incorrect number. The original sentence reads as:This work was supported by a Grant-in-Aid  from the Japanese Ministry of Education, Culture, Sports, Science and Technology.The revised sentence, with the correct number reads as follows:This work was supported by a Grant-in-Aid  from the Japanese Ministry of Education, Culture, Sports, Science and Technology.26861729.Please note that the number 60615798 should instead be"}
{"text": "Postgraduate medical education is founded on a tradition of service and education and is grounded in the realities of the twenty-first century. The very nature of the postgraduate enterprise is evolving in front of us all, and this is having a wide-ranging impact in a variety of areas. At stake is both the delivery of quality patient care and the preparation of the next generation of competent physicians. The engagement of the medical profession is an essential part of this reformation.One of the fundamental questions facing contemporary medicine is how best to organize the work hours of physicians who are undergoing clinical training. The postgraduate medical education of the physicians we refer to as \u201cresidents\u201d is recognized by those within and outside medicine as an enterprise dedicated to preparing new physicians to enter independent practice. It is a time of great commitment for all involved \u2013 to learning, to patient care, and to the professional development of future leaders of health care teams. It is also a period that can be experienced through a number of perspectives: that of the residents and the patients they care for, the faculty who teach them, the training programs that support their progress, the certifying bodies that ultimately endorse them for entry into practice, and the administrators in the teaching hospitals where residents learn to balance their dual roles as learners and service providers on a health care team. These perspectives differ and diverge, and they also, ultimately, lead to the inherent tensions within residency in the modern era: education versus service, supervision versus autonomy, and quantity versus quality of care, among many others.Throughout much of the world, the hours that residents work have gradually decreased since the 1980s. This change has accelerated within the past five years with recent legislative and regulatory changes in Europe, the United States, Canada, and other jurisdictions. The question of how long residents should work has been the subject of heated discussion within the profession and among the broader public for almost three decades.BMC Medical Education arose from symposia on the topic of resident duty hours held at the annual International Conference on Residency Education in 2010 and 2011. These symposia, entitled respectively \u201cDuty hours across borders\u201d and \u201cSolutions across borders,\u201d took place as the most recent round of duty hour reforms were announced and implemented in the United States, the United Kingdom, and Canada, and both symposia included presentations by many of the authors of papers included in this issue. Importantly, these sessions provided an international forum to explore the challenges that can arise as a result of \u2013 and potential solutions to \u2013 changing duty hours, a dialogue we have capitalized on with this special issue.The impetus for this special issue of To accurately interpret the published data, it is essential to understand the historical context and the specifics of prior duty hour regulations.Early in the twentieth century, residents in North America actually resided in hospitals, providing after-hour \u201con-call\u201d medical services as part of their training . Until tThe impetus to restrict duty hours varied from jurisdiction to jurisdiction. An initial catalyst for change in North America was the death of a college student, Libby Zion, in 1984 . ConcernAlso in 2011, in Canada, the province of Quebec ruled that shifts of 24 hours or more contravened both the provincial and national charters of rights and freedoms. As a result, duty hour schedules in the province were limited to no more than 16 continuous hours.In the European Union (EU), the movement to limit resident duty hours followed a somewhat different path. The European Working Time Directive (EWTD) was implemented in 1998, establishing the right of EU workers not to be required to work excessively long hours. This affected a number of professions, including those in the health sector. In the United Kingdom, doctors in training were exempted from these restrictions until 2004. Beginning in that year, hours for doctors in training were gradually reduced, finally reaching in 2009 a maximum of 48 per week, with no more than 13 consecutive hours of work .Resident work hours have also decreased in Australia and New Zealand over the past 20 years. As in Europe, the major driver of this change has been resident well-being rather than patient safety.A detailed survey of the current state of duty hour limits across these jurisdictions can be found in this issue in Sir John Temple\u2019s paper \u201cResident duty hours around the globe: where are we now?\u201d This issue examines the impact of changing resident duty hours through a number of lenses. Changes to the hours that residents work can be expected to have different effects on resident satisfaction and well-being, medical education, teaching faculty, patient safety, and the structure of health care delivery in teaching hospitals. These effects may vary by jurisdiction, reflecting differences in the structures of both health care delivery and medical education systems.BMC Medical Education, we felt it essential that these perspectives be reflected and explored. An international panel of expert authors provides historical and current perspectives across different domains of medical education and health service delivery. The crucial voice of residents is well represented from a range of jurisdictions. The result is a rich array of distinct scholarly perspectives on this important topic.The challenges and solutions may also differ between specialties, as the nature of practice and learning differs. As we assembled this special issue of The first set of papers in this issue address the intersection of duty hours with patient safety , residenThis special issue culminates with a discourse on the important issue of finding our way forward. Three solutions-focused papers explore strategies for adapting to changing resident duty hours. These articles examine how to improve continuity of care , a new mAs the editors of this special edition, we are pleased to be sharing the fruits of our international journey of residency education. These perspectives from around the globe articulate commonalities and differences from which we can learn and develop new ideas. We thank the authors for thoughtful contributions that describe their realities and solutions, and we hope that you will find the result thought-provoking, insightful, and valuable.Supplement Co-Editors:Dr. Kevin Imrie, MD, FRCPCPhysician-in-Chief, Sunnybrook Health Sciences CentreVice-Chair, Education, Department of Medicine, University of Toronto Professor of Medicine, University of TorontoDr. Christopher Parshuram, MB, ChB, D.Phil.Physician, Critical Care ProgramSenior Scientist, Child Health Evaluative Sciences, The Research Institute, Hospital for Sick ChildrenAssociate Professor Paediatrics, Critical Care, Health Policy, Management & Evaluation Faculty, Centre for Quality Improvement and Patient Safety, University of TorontoDr. Jason Frank, MD, FRCPCDirector, Specialty Education, Strategy, and Standards, Office of Specialty Education, The Royal College of Physicians and Surgeons of CanadaAll authors contributed to the concept, drafts, and revisions of this manuscript. All approved the final version.The supplement co-editors and authors declare that they have no competing interests."}
{"text": "Diabetes is a chronic disease, which deteriorates the quality of life of patients and reduces the life span. In the treatment of diabetes, first behavioral methods are used, then oral anti-diabetic drugs, then, in the course of the disease progress, a combined therapy (non-insulin plus insulin) and finally, solely insulin therapy. Unfortunately, many patients are afraid of including insulin for the treatment. By delaying the proper therapy, patients expose themselves to the increased risk of complications due to the macro- and microvascular pathologies. The prevention, prediction and minimalizing of the short- and long-term complications is a main focus of health care and it is at the front of the activities of many local and global organizations .Our two years long study (2011-2012) on the quality of life of the out clinic patients in Wroclaw suffered from the diabetes type 2, revealed the following: 1 quality of life was highest in patients treated with oral anti-diabetic drugs and the lowest in patients treated with insulin, only, and 2. general physical health of patients was worse than the general mental health. Moreover, we stated that the patients are more prone to develop depression than the general population. Besides of treatment method, within the factors that influence the quality of life, we found: age, disease duration, gender, obesity and presence of other diseases, including diabetes complications.One of the frustrating for patient complication, problematic in the treatment, is development of the diabetes foot, which is very often leading to the amputation, which in turn, shorten the patients\u2019 life. Therefore, remote monitoring of the feet condition may allow for due to time medical intervention.Prevention of the complication as diabetic food may be possible by assessing the conditions for the pathology development. We expect that the local temperature distribution, as well as podobarographic data differ in healthy population and diabetes patients. Multi-institutional clinical study will help to gather enough data which may be exploited for finding the predictive factors of diabetic foot development. In patients already suffering from this complication, it could be possible to react promptly in order to prevent amputation. Such an approach will allow treating patients individually, simultaneously in the most economic way."}
{"text": "There are some missing grant numbers in the funding statement for this article. Please refer to the correct funding statement below:This work was supported by grant No. 8107513, No. 81370744, and No. 30901279 from National Natural Science Foundation of China . The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."}
{"text": "Dr. Bruno Medeiros is not included in the author byline. He should be listed as the eleventh author and affiliated with Division of Hematology, Stanford University School of Medicine, Stanford, CA, USA. The contributions of this author are as follows: Conceived and designed the experiments, performed the experiments, and analyzed the data."}
{"text": "Dr. Constance Travers should be included in the author byline instead of the Acknowledgments. He should be listed as the seventh author, and his affiliation is #1: Abt Associates, Boulder, Colorado, United States of America. The contributions of this author are as follows: Conceived and designed the experiments, analyzed the data, and wrote the manuscript."}
{"text": "A probabilistic, simplerandom sample composed of 67 records of patients with Parkinson's disease whoparticipated in a rehabilitation program, between March of 2009 and April of 2013.The research was conducted in three stages, in which the nursing terms were mappedto natural language and crossed with the Nursing Interventions Classification. a total of 1,077 standard interventions that, after crossing with the taxonomyand refinement performed by the experts, resulted in 32 interventions equivalentto the Nursing Interventions Classification (NIC) system. The NICs, \"Education:The process of the disease.\", \"Contract with the patient\", and \"Facilitation ofLearning\" were present in 100% of the records. For these interventions, 40activities were described, representing 13 activities by intervention.  the cross mapping allowed for the identification of corresponding terms with thenursing interventions used every day in rehabilitation nursing, and compared themto the Nursing Interventions Classification. In recognition of the first descriptions performed by James Parkinson in 1817,Parkinson's disease (PD) was thus entitled years later by Jean-Martin Charcot. The meanage of onset of symptoms is 60 years of age, and the incidence increases with age andmay affect up to 5% of the population over 79 years of age. The mean duration of thedisease, from diagnosis through death, is 15 years, and the relationship of mortality inmales to females is two to one-The causal relationships remain as evasive as when described in 1817, however,pathological signs related with genetic and environmental components are stronglydiscussed In this sense, the nursing care provided to the individual with this disease, permeatesthrough the aspects of this condition related to symptomatology; it is considered to bemultisystemic, progressive, and incurable. In the rehabilitation context, the nurse, asa professional member of the multidisciplinary team, has an important role in healthpromotion, treatment of complications, and adaptation to the limitations imposed by thedisease. The nurse directs the plan of care to meet the needs of each patient andfamily, guiding the search for the patient's independence in relation to his/herphysical, cognitive and behavioral limits through an appreciation of his/herpotential-In this scenario, the adoption of standardized nursing care prevails, based on legal,ethical, scientific and methodological premises. Thus, care grounded in the nursingprocess enables interactivity, since it is based on mutual relationships of nurses, themultidisciplinary team, the patient and the familyThe Nursing Interventions Classification (NIC) is among the various classificationsystems referring to the interventions to be used with the nursing process. -This taxonomy, of North American origin and worldwide scope, was developed in order todocument and communicate nursing care by integration of data in computer systems, andprovides a source of data for research-Therefore, the importance of studies that address the nursing interventions in therehabilitation of patients with PD, structured in an elected classification system, isundeniable. The nursing research that addresses this issue converges on the currentglobal trend to better understand the disease, its symptoms and treatment, contributingto the scientific progress in this area, which will be reflected in improved patientcare. However, currently, it is observed that nursing scientific production in thiscontext remains scarceBased on the above, this study aimed to perform the nursing language term cross-mappingof the records of rehabilitation patients with Parkinson's disease, with the NursingInterventions Classification (NIC) system.,,This was a descriptive, quantitative study, developed in accordance with the technicalprocedure of documentary research, using records as a primary source of data collection.The methodological framework uses concepts and principles of cross-mapping. This methodwas chosen because it allows the linguistic comparison and semantics betweennon-standardized terminologies with the chosen classification systemThe International Center for Neurorehabilitation and Neuroscience in the city of Rio deJaneiro, Brazil, was the scenario for this research. Children and adults withneurological sequelae, originating from congenital or acquired central nervous systeminjury, receive care in the rehabilitation area of this center. The team isinterdisciplinary and patient care includes contextualized and individualized guidance,recommending the involvement of family members and caregivers.This center has electronic medical records of patients in which the care provided by thenurse is documented without the use of standardized language. For this research, theauthors considered the records containing nursing interventions described as nursingterms in natural language.From the inauguration of this Centre, in March 2009, until the beginning of thisresearch, in April 2013, there were 1,266 patients admitted who were diagnosed with PD:796 had nursing assessments. To determine the sample, the inclusion criteria includedthose patients whose chart contained five or more nursing records, totaling 167. Therecords of patients who, in addition to the diagnosis of PD, had a medical diagnosisthat characterized other parkinsonian syndromes, such as secondary Parkinsonism, forexample, were excluded. Thus, 148 records were obtained. From this total, thecalculation for a probability sample of the simple random type was calculated using theformulaIn this case: N = 148 records (population size), E = 9% (tolerable sampling error), n0 =123 records (first approximation of the sample size) and n = 67 records (samplesize).Thus, the sample consisted of 67 patient charts, which represented 45% of the totalpopulation, and 9% of sampling error. Of these, the last five nursing assessments wereconsidered for this study, totaling 335 analyzed nursing assessments..The study limitation is the adoption of a 9% error, instead of 5% that is usually usedas maximum error. However, this limitation was considered by the multiplicity of nursingrecords obtained in each medical chart, which provided significant data collection forthe researchers.After conducting three pilot tests, for training and improvement of three researchers onthe method, the cross-mapping was completed, simultaneously, from June to December of2013, in three stages: 1) extraction and standardization of terms, 2) separation andcomparison of non-standardized terms with those standardized by the NIC, and 3)evaluation and refinement of the mapping.The first stage was conducted from August to November of 2013, in which the threeresearchers performed the electronic extraction of information that comprised thedatabase containing: 1) patient data, 2) medical diagnosis and the progression of PD, 3)parts of nursing assessment containing the context of the intervention, and 4)separation of the nursing language terms that indicated or excluded interventionhypotheses (verbs). For example; in the part of the nursing evaluation, which wasdescribed \"Performing bladder re-education\", the term \"bladder re-education\" washighlighted after the fragmentation of the record. Similarly, in the part in which therewas the description, \"The patient was instructed regarding home adaptation strategies topromote greater safety for the performance of daily activities\", the words: \"Instructed\"\"Home adaptation\" and \" Safety\" were highlighted in the database.Data were arranged in an Excel spreadsheet for Windows, and then, normalized accordingto the adequacy of verbal tenses, spelling correction, standardization of gender andnumber, and the exclusion of repetitions, synonyms and casual expressions that do notdesignate particular concepts.From December of 2013 to May of 2014, three researchers proceeded to the second stagethrough cross-mapping of the terms identified in the previous step, with the NICtaxonomy. The following rules of cross-mapping were considered: 1- mapping the \"meaning\"of the words, not just the words, 2- using the \"keyword\" in the intervention to map tothe NIC intervention, 3- using verbs as \"keywords\" in the intervention, 4-mapping theintervention from the NIC intervention label for the activity, 5- maintainingconsistency between the intervention being mapped and the NIC definition of theintervention, 6- using the more specific NIC intervention label and 7- mappinginterventions that have two or more verbs for the two or more corresponding NICinterventionsThe nursing terms in natural language were compared with the NIC interventions. Thecategorization of the nursing terms was performed with a combination of analyses, where:when the term found, was matched with the classification system term, it was categorizedas an exact match, and when that term had similar concepts, synonyms and related terms,it was categorized as a partial match. For presentation of the results, the exact andpartial matches were considered to have the same value.In the examples previously cited, the term \"bladder reeducation\", extracted after thefragmentation of parts of the nursing record, and assumed to be a nursing intervention,was considered to be an exact match with NIC. However, the terms \"oriented\", \" homeadaptation \"and \"safety\" were considered to be partial matches, and were correlated tothe standardized NIC intervention, \"Environmental Management: Safety.\" In this case, aconsistency was observed between the context of the intervention described in thepatient record, with the definition of the intervention proposed by NIC, which is:\"Monitoring and manipulation of the physical environment to promote safety\"The data of this stage were organized under the title of the intervention, definition,non-standardized terms and standard NIC terms that corresponded to confirmatory clinicalevidence for the presence of the intervention.From June of 2014, the third stage was achieved by means of the evaluation andrefinement of cross-mapping. At this stage, expert nurses analyzed the collected data;two were experts in nursing classification and three in the PD rehabilitation. Forselection of these nurses, a minimum clinical experience of five years, or a doctoratewith experience in research on nursing classification systems was required. Therelationship between the contexts of interventions, the non-standardized terms and NICinterventions was established through the agreement of experts. This step was conductedin individual cycles and in-group. In the second cycle, the consensus of experts wasobtained, and the statistical agreement analysis was not necessary.Data were analyzed considering their absolute frequency, percentage, means and standarddeviations. The development of the study met the national and international standards ofethics in research involving human subjects (Protocol No 691310).The characteristic profile of the 67 patients of the sample was: 63% male, mean age of69.3 (\u00b1 10). The progression of PD ranged from one to 24 years, with a higherrepresentation of those who had one to eight years of disease progression (75%).In the case of nursing interventions, there were1,077 standard interventions identifiedin the 67 patient charts analyzed, representing a mean of 16 interventions per patient.The highest concentration of interventions was focused on the context of healthpromotion. After cross-mapping with the taxonomy, and refinement made by the experts, 32interventions equivalent to the NIC terminology emerged. Of these, nine (28%) had afrequency of occurrence higher than 50%. The interventions, \"Teaching: Disease Process,\"\"Patient Contracting,\" \" Learning Facilitation,\" and \"Teaching: Group\" were present inall patient charts, with a mean of 2.6 repetitions. This occurred because nurses indifferent contexts implemented these interventions. During the analysis of the patient records, it was possible to identify that nursesperformed all steps of the nursing process. With regard to interventions, these wereperformed in two ways: interventions of an individual character and interventionsconducted with a group of patients.For individual assistance, the nurse performs consultations based on the nursingprocess, guided by clinical reasoning. However, even without the adoption of astandardized language, the nursing diagnoses, interventions and expected outcomes areestablished, which are described in the patient records. In the planning step, the nurseevaluates whether the result to be achieved requires intervention by means of individualor group approach. However, guided by clinical reasoning many patients were included bynurses for both approaches,. In other words, for those patients who had not achieved theexpected outcomes, these were also individually addressed after group intervention, andvice versa.The data shown in In addition, the standardization of the approaches with patient groups was identified,represented by lectures, interactive sessions, and providing illustrative teachingmaterials. The topics of the lectures focused on the interrelationship of thepathophysiological aspects, pharmaco-therapeutics and lifestyle, in the context ofrehabilitation. Thus, the theme of each class was focused on: the PD; the risk factorsfor cerebrovascular diseases, such as hypertension, diabetes mellitus and dyslipidemia;bowel constipation; and, activities of daily living. For all of these, In terms of characteristics of the sample of this research, the findings converge withstudies showing that PD tends to occur more frequently in men, especially in the agegroup over 60 yearsRegarding the progression of the disease, the results of this study haverepresentativeness, showing that the neurodegenerative process of PD is nonlinear, butit is concerned with individual aspects,With regard to nursing interventions, the results demonstrate effectiveness of themethodological tools used in this study, which enabled the achievement of objectives.The cross-mapping identified nursing language terms prescribed by nurses in the recordsof patients with PD who participated in the rehabilitation program, and compared them tothe standardized NIC language, which is globally recognized. This method is a viabletool in the standard language implementation process in health services, as it allowsthe nurses to compare data consistently and generalizableFurthermore, nursing interventions, as part of the nursing process, are recognized inthe care plan, which is developed in order to eliminate or minimize a nursing diagnosis,seeking to achieve the goal or pre-established outcomeThus, the interventions mapped and described in this study are highlighted, which weredirectly linked to educational practice, and used by nurses as the main tool for healthpromotion. Health promotion, as a change strategy in technical healthcare models, hasbeen used for decades as an alternative for expanding the quality of health and life ofthe population, by intervention with individuals and the understanding of thehealth/disease process, such as social productionIn the context of neurological rehabilitation, the actions for health promotion areaimed toward recovery, but, mainly, for the adaptation to limitations imposed by thedisability, according the needs of each patient/family. These actions are primarilyguided by functional, motor, psychosocial and spiritual aspectsThe nursing interventions related to intestinal disorders, which in this study wererepresentatively described, lead to research showing that among the non-motors symptomsof PD, bowel constipation is the most prevalent. This alteration is present in 70-80% ofthese individuals, and is mainly related to neuronal degeneration occurring in the vagalcenter of bowel control, and which may be present at any stage of neurodegenerationHowever, these measures depend on change in the patient's lifestyle. The nurses usereferences beyond the biological in their work methodology, and recognize that theactions required for adherence to long-term treatment and care are deeply interrelatedwith the culture, i.e., with the lifestyle, habits, routines and rituals in the lives ofpatients, converging with contemporary scientific referencesIn the analysis of the activities developed, educational actions based on contextualunderstanding to guide the individual / family are carried out according to the maininterventions. However, a multiplicity of alternatives and the creativity of nursesinvolved are evident in the rehabilitation process of the patient with PD, which bymeans of generalized actions, attempts to address the peculiarities inherent to eachindividual/family. They seek to empower patients to work effectively on their socialreintegration. This provides a dynamic movement and permanent redefinition of knowledgefor acquiring skills and attitudes that are better for a quality of life, by acquisitionof a critical-reflexive attitudeThe application of the nursing process in the practice of neurorehabilitation isevidenced by the results of this study, through the expression of the clinical methodused by nurses in the rehabilitation of patients with PD. The performance of thefollowing specific steps of the nursing process  provided the nursing care to the individual / family, in order to considertheir singularities, and in an extended mode, converge with professional recommendationswidely discussed in the nursing literatureDuring the analysis of records, the recognition of the nurses about their role in therehabilitation process with the patient who progresses with a neurodegenerative,multisystem and still incurable disease was clear.. Their full involvement in thisprocess allowed for prescribing interventions, mostly permeated with the principles ofhealth promotion. Thus, rehabilitation was based on the search for patient potential,aimed at his/her restoration through reciprocal and realistic goals. These actions maylead to the opportunity for a life with better quality, reemergence of self-esteem,independence and family involvement, which confirms the principles ofneurorehabilitation, as discussed in the scientific community areaThe cross-mapping enabled the comparison of existing information in the patient recordsof patients with PD with the standardized interventions of the NIC. In addition, thenursing interventions used in the clinical practice of rehabilitation nurses wereidentified, with actions grounded in health promotion and family involvement.Standardization of language is encouraged to enable documentation of nursinginformation, contributions to patient care and facilitation of communication betweennurses and other health professionals. The use of the NIC terminology can contribute tostandardizing nursing care within the rehabilitation of patients with PD, in order toensure quality of the professional care, leading to significant benefits for theprofession.The existing gaps in scientific knowledge about the effectiveness of nursinginterventions in this population constitute the main limitation of this study, sincethere was no possibility of such comparative data due to the lack of studies in thisarea. Furthermore, further studies are needed, with more representative sample sizes, tominimize the possibility of error."}
{"text": "Nowadays, hepatitis is of the most important health priorities around the world, where information plays a very significant role in specialized diseases prevention planning, and policy- and decision-making processes. Thus, this study addressed challenges of hepatitis information management and investigated the outcomes of establishing a hepatitis information management system to overcome such challenges. To this end, this research intended to study the implementation of an Electronic hepatitis information management system.This is an applied-developmental study with following specifications and procedures: preparation of study proposal and design, justification of the design\u2019s stakeholders, approval of the design by the Postgraduate Education Council of Faculty, determination of pilot hepatitis control center, software development, deciding on control, prevention, and treatment centers, and finally development of a network-based system for collecting and managing hepatitis information.Results indicated that the inconsistency and lack of integrity of data, as well as the lack of communication between related units prevented timely information register of viral hepatic patients and services that are provided to them. This inhibited the possibility of considering a follow-up process. However, the implementation of this system and involvement of relevant units greatly solved these problems.Results show that the implementation of an electronic system for the management of hepatitis control, prevention, and treatment is a regional and national requirement; since, this system with its empowered infrastructure is capable in providing desired services to all laboratories, counseling and health centers, specialized clinics, and physicians connected to the hepatitis network. This enables them to follow up and monitor patients\u2019 conditions. That mentioned system paves the way for the analysis of gathered information, managers\u2019 and specialists\u2019 access in different regions to the data for making appropriate and accurate decisions. Nowadays, viral hepatitis, especially the blood-borne types (i.e. B and C), and hepatitis prevention are widely recognized significant health priorities, since 5-10% and more than 50% of hepatitis B and C cases develop chronic diseases and liver cancer . HepatitAlthough the fecal-oral-borne viral hepatitis and water-borne hepatitis (i.e. A and E) do not develop chronic hepatitis, they are responsible for several mortalities and morbidities around the world. Studies in Iran also present their endemic status. Hepatitis A and E are epidemic in countries with low rank on levels of health. Iran is an endemic area for hepatitis A and E infection .Economically, hepatitis is among the most costly diseases. A study into hepatitis B  related outpatients in China, 2010, has estimated a direct treatment cost of 43,311/28#, carrying a significant financial burden on the patient and society .An effective disease management requires the disease surveillance system design and implementation to investigate determinant factors in disease incidence and distribution, specify the infected different ages and sex groups and disease process, predict and reach an early diagnosis of epidemics, and contribute to the design and evaluation of health interventions .Despite the development of disease management centers in many developed and developing countries, data standardization and creation of registries and healthcare systems structure have been given less attention . ConsequIn this regard, the lack of an information management system for hepatitis control has led to sporadic data collection; as a result, there is not any comprehensive system for gathering, processing, monitoring, and controlling such data . AccordiConsequently, this study was conducted aiming at designing and implementing an electronic hepatitis information management system to approach the mentioned limitations.This is an applied-developmental study with following specifications and procedure: preparation of study proposal and design, justification of the design\u2019s stakeholders, approval of the design by the Postgraduate Education Council of Faculty, adoption of the Control, Prevention, and Treatment Center of Zabol as the pilot center, determination of affiliate centers, analysis of the current and future situation, system design and development, and eventually implementation of a network-based system for collecting and managing hepatitis information.As a result, after the development of desired software, the measure was taken to implement it in affiliated centers including laboratories, consulting and health centers, and hospitals, under the hepatitis network of Zabol University of Medical Sciences. The aim was to record the information of patients with viral hepatitis from the early diagnosis phase in the system electronically. Indeed, a profile similar to the electronic health record is created, where demographic information, risk factors, infection diagnostic practice, early diagnosis signs, family information, paraclinical measures, signs and symptoms of diseases, physical examination, tests, healthcare plan, and follow-up outcomes are precisely recorded. All users, including nurses and physicians, can record and manage the information if their access to the system is given.The regional organizations and institutions participating in the research are as follows:1)The Health Deputy of University2)The Health Consulting Center3)The Hepatitis Control, Prevention, and Treatment Center4)The Blood Transfusion Center5)The Reference Laboratory6)The university affiliated health centersAfter the implementation of the design, following results were achieved: setting up the electronic hepatitis information management system in the Hepatitis Control Center of Zabol and other related health centers at the regional level, connecting the system to referral centers, creation of electronic profile during the diagnosis, treatment, and consulting processes in case of diagnosed infection, providing the affiliates with the system accessibility to get informed about and involved in healthcare team, and preparation of required reports.After system setting up, one-year information of patients with hepatitis B was recorded from March 21, 2014 to March 21, 2015. Then, the epidemiological information was obtained from the system and analyzed in Excel in form of statistics and tables. A number of this information is provided as some examples.According to the one-year information recorded in the system, the age groups of HBV infected patients were 15-19 to upper than 60. Improvement of health information systems is the first step in progressive health system management capabilities. The healthcare decision makers at every managerial level should gain maximum benefit from information to be capable of making precise data-based decisions and policies, and meeting managerial requirements of healthcare service providers , 2013b.Results showed that the majority of developed and developing countries require such systems for promoting the level of health, making correct policies and developing micro and macro plans. They have managed to meet their needs by setting up information management and record systems. The electronic system for hepatitis information management, like any other system software such as operation systems and database management systems, should be periodically improved to either eliminate its errors or add new functions . To be eEpiTrax software is an example for performance challenges in system implementation; since, contrary to its rapid and successful implementation, it has not become fully operational, due to system performance problems, especially when large forms are attached to the cases. The other reported challenge is connected with data accessibility and the applications of business intelligence system .The electronic healthcare system for specific diseases is also associated with performance limitations including short history of the company development, limited management capabilities such as patient tracking and reporting .It is noticeable that the evaluation process in form of system epidemiological output analysis is among the dynamic and [currently] developing methods . RegardiConsidering that Sistan and Baluchestan Province, along with Golestan Province, has the highest rate of hepatitis B (38/3)  April, tIn this study, 60.3% of the infected people were male, and the majority of the involved patients were in the 20-29 age group. Other studies also suggest infection age reduction in recent years . This maOn the one hand the main research objective is the design and implementation of healthcare information management system for patients with viral hepatitis in regional Hepatitis Prevention, Control, and Treatment Centers. On the other hand, addressing this and similar subjects is a mission of healthcare system at different healthcare and policy levels. So, it is concluded that national micro and macro policy-making and planning in the healthcare area urgently require integrated, comprehensive, accurate, and updated information. This is not possible without the necessary information systems.Due to the lack of information integrity, information inconsistency, and disconnection between relevant units and service provision authority, viral hepatic patients\u2019 information is not recorded and controlled timely. Although, by operating this system and collaborative participation some of the problems are solved, involvement of specialists and researchers in the areas that hepatitis information is recorded and management is required. In general, findings of this study suggest the hepatitis information management system as a solution to many challenges and problems of patients, physicians, and decision-makers in healthcare area. For further improvement and development, this study provides following recommendations: broader participation of relevant specialists, and greater coordination among healthcare policy- and decision-makers in implementation of specified and approved tasks. These allow us to take more effective step in prevention, control, and treatment of viral hepatitis and to perform more efficiently in favor of national health promotion.Additionally, cooperation among laboratories, the blood transfusion centers, and academic network affiliated consulting, healthcare, and medical centers in accurate, timely, and software-based information record and delivery can greatly contribute to the reduction of time and money expenditures.Another important point is helping patients through covering all medical and particularly specialized laboratory measures by responsible organizations via trust infrastructure. Equipping the Healthcare System with an electronic system for specialized service providing can help it in supporting the patients registered in the designed information management system by providing accurate information of them. Finally, the use of this system not only prevents significant financial burden on the society but also facilitates and accelerates the follow-up and healthcare processes."}
{"text": "Community-Acquired Pneumonia. European Respiratory Monographs. Sheffield: European Respiratory Society; 2014, ISBN 978-1-849-84049-1.Chalmers JD, Pletz MW, Aliberti S (Eds):  Community-acquired pneumonia (CAP) is the most common cause of death from infectious disease worldwide, and over the past 25\u00a0years there has been dramatic progress in research about all aspects of this disease. The European Respiratory Monograph devoted to this topic is a comprehensive review of the topic aimed at a broad range of health professionals, including critical care physicians.The 20 chapters of this monograph span topics from CAP epidemiology to bacteriology, pathogenesis, risk assessment, diagnosis, therapy and prevention. As is emphasized in the introduction by Tobias Welte, the future management of this illness will focus on prevention and personalized care, modified to account for individual variations in the immune response. However, for the present we need to manage this disease on a daily basis, and the discussions in the book provide much practical information for those assessing and treating patients with severe CAP.The topics of interest to ICU physicians include: assessment of illness severity, with a discussion of prognostic scoring systems; empiric therapy selection, with a good review of the role of dual-agent therapy for severe pneumonia; management of acute respiratory failure, with particular caution about the judicious use of non-invasive ventilation for pneumonia patients, and the need for timely intubation in selected patients; and the management of sepsis due to CAP. The discussion of sepsis nicely summarizes the literature about early goal-directed therapy, the selection of the type of fluid to support blood pressure, the use of vasopressors, and the role of corticosteroids in sepsis. Several other chapters include topics of vital interest in the ICU, such as the assessment of response to therapy, the use of non-antibiotic therapies, and the role of macrolides as anti-inflammatory agents. There is also an important discussion of the cardiovascular complications of CAP, a recently appreciated area of interest, which can explain some of the long-term sequelae of this illness.Community-Acquired Pneumonia is comprehensive and inclusive, most of the authors are European and they have interpreted some of the data and controversies from a perspective that is not always consistent with a North American viewpoint. Most notable among these issues is the commentary about the lack of utility of the concept of healthcare-associated pneumonia, yet very few concrete recommendations are given about how to manage this population of patients, if they are to be considered suffering a form of CAP. Other omissions include a limited discussion of the epidemiology of pneumonia in the ICU, the role of dual antibiotic therapy in pneumococcal bacteremia, the management of influenza in the ICU, and the importance of hospital-based immunization.Although Community-Acquired Pneumonia is an excellent, balanced and comprehensive summary of an important and common illness; providing a great resource for physicians of all types, including those who work in critical care.On balance, CAP: community-acquired pneumonia.The author declares that he has no competing interests."}
{"text": "It is well known by specialists and others that traumatic brain injury (TBI) is the main cause of death in young people under 40 years old and, at the same time, represents the cause of approximately two-thirds of post-traumatic deaths.Data from the World Health Organization show that 11,5 million Europeans who have survived traumatic brain injuries currently present physical disabilities or cognitive and emotional disorders.The main types of traumatic brain injuries include the following: brain fractures, brain contusions, brain dilacerations, diffuse axonal injuries, and extradural, subdural and intracerebral hematomas. The official data show a growing incidence of the traumatic brain injuries.Annually, there are almost 245,000 individuals hospitalized with such traumas, and 66,000 of these patients die due to complications.The number of cases of traumatic brain injury in Romania is continually rising. With an incidence of 300 cases per 100,000 citizens, our country annually registers over 60,000 new TBI cases. Every 8 minutes, a Romanian has a traumatic brain injury. TBI represents 36-40% of the total traumas, and when the association with other traumas is considered, the share rises to 60-65%. Moreover, TBI represents 25-30% of the invalid segment of the population. In addition, 75% of the individuals who die due to road accidents have a traumatic brain injury.According to the official data, Romania is at the top of the list for TBI among the EU countries, with a death rate due to road accidents of 92 deaths per one million citizens, which is greater than the average of the number of 52 deaths for other countries. Prof. Dafin Mure\u0219anu, MD, the President of the Romanian Society of Neurology (RSN) and President of the Society for the Study of Neuroprotection and Neuroplasticity (SSNN) declared \u201cThe number of traumatic brain injuries is continually rising due to many factors, starting with the development of the auto industry and the way technology evolves in transportation and ending with the growth of the rate of domestic accidents. From the data we have at present, we can state that the incidence oscillates between 1,4 million and 1,6 million in Europe, with most of the victims being treated in emergency situations. Traumatic brain injuries must be treated seriously and carefully because they usually have critical medical-social, economic and judicial implications. However, Romania faces some problems in these cases. First, there is a lack of neuropsychologists. We do not have specialists in memory recovery. It is not enough to be able to move again. It is at least as important to be able to communicate and reintegrate in the society. There are only a few centers in Romania in which the patient is treated by multidisciplinary neurorehabilitation teams. There should be a center in every town and a community neurorehabilitation strategy, and a private system of alternative care should be developed.\u201dJust as TBI treatment has undergone exponential development the field of neurological recovery, which has obviously generated an acceleration of research efforts during the last several years.12th Annual Conference of the Academy for Multidisciplinary Neurotraumatology (AMN), organized by the Society for the Study of Neuroprotection and Neuroplasticity (SSNN), which took place in Dubai, during the 14th and 17th of November 2014.The new discoveries in TBI and also in cognitive recovery, together with many other important themes, represent the main subject of one of the most important medical events of the year 2014. The event is the \u201cThe event had a large number of participants, including medical personalities from Europe, Asia and the United States of America, and had a complex scientific program, which included actual themes regarding the evaluation of the progress achieved in the treatment of traumatic brain injuries. The importance of the Congress was great because it reunited people with a vast professional experience who have managed to integrate the information offered from interdisciplinary perspectives as a whole\u201d, the distinguished Prof. Dafin Mure\u0219anu, MD, declared.The Society for the Study of Neuroprotection and Neuroplasticity (SSNN) was founded in 2005 by an international team of doctors and researchers at the initiative of Prof. Dafin Mure\u0219anu, MD, from \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy in Cluj-Napoca and Prof. Ovidiu B\u0103jenaru, MD, from \u201cCarol Davila\u201d University of Medicine and Pharmacy in Bucharest. It is a scientific organization dedicated to fundamental and clinical research with the purpose of creating a discussion forum for a better understanding of the endogen neurobiological processes, as well as the development of pharmacological and non-pharmaceutical therapeutic strategies in the field of neuroprotection and neuroregeneration.10th Edition of the Congress of the Society for the Study of Neuroprotection and Neuroplasticity, which was held in Athens and was organized by the Society for the Study of Neuroprotection and Neuroplasticity (SSNN) and presented in the Editorial of the last issue of the Journal of Medicine and Life, 2014.The Congress was very important because it took place only two weeks from another resonant event: The Romania was represented in the 12th AMN Congress 2014 by Prof. Dafin Fior Mure\u0219anu, MD, the President of the Society for the Study of Neuroprotection and Neuroplasticity in Romania, Prof. Gelu Onose, MD, President Co-founder of the Romanian Society for Neurorehabilitation and Prof. Dorel S\u0103ndesc, MD, Secretary of State in the Ministry of Health-Care and President of the Romanian Society of Anesthesia and Intensive Care.The Congress had great international participation, reuniting well-known specialists from Argentina, Hong Kong, Austria, Switzerland, the USA, Germany, and the Netherlands. Dafin Mure\u0219anu \u2013 Romania, Wai Poon \u2013 Hong Kong, Volker H\u00f6mberg \u2013 Germany and Suhail Abdulla Al-Rukn \u2013 United Arab Emirates were in charge of the welcome address at this important event.Prof. Dafin Mure\u0219anu, MD, presented the advances in brain protection and recovery in traumatic brain injury.The well-known specialist Volker H\u00f6mberg, Chairman of the scientific program committee of the AMN, from the Department of Neurology, Heinrich Heine University, Dusseldorf, and one of the representatives of Germany, discussed the future of scientific meetings: what new formats are needed.Jan-Peter Jantzen, Head of the Department of Anesthesiology, Intensive Care Medicine and Pain Management, Academic Teaching Hospital Hannover, Nordstadt, Germany, presented, during the debates session, the problem of ICU management of traumatic brain injury - therapeutic coma, bringing important arguments for the application of this method.Moreover, Johannes Vester, Department of Biometry and Clinical Research, IDV Data Analysis and Study Planning, Krailling, Germany, presented the multidimensional approach in clinical neuroscience research \u2013 advances and challenges.Dorel S\u0103ndesc, Secretary of State in the Ministry of Health-Care in Romania and President of the Romanian Society of Anesthesia and Intensive Care (Romania) underlined the most important aspects of the brain death concept as well as organ transplantation.Prof. Gelu Onose, MD, President and Co-founder of the Romanian Society for Neurorehabilitation in Romania discussed neuroprotection \u2013 with the use of some main related molecules \u2013 in patients with subacute/ subchronic conditions following severe central nervous system lesions.Russell Andrews, Ames Associate, Ames Research Center in California, one of the representatives of the USA, discussed the disaster response: an opportunity to improve global healthcare in the 21st century, and Karin Diserens, Head of the Unit for acute Neurorehabilitation, Service de Neurologie, Departement Neurosciences Clinique, Lausanne, the representative of Switzerland, discussed the disorders of consciousness in early neurorehabilitation.Nicole von Steinb\u00fcchel, Vice President of the AMN, Institute of Medical Psychology and Medical Sociology, University Medical Center, Georg-August University, G\u00f6ttingen, Germany, discussed the outcome of individuals after mild traumatic brain injury.Thanks to an excellent organization and organizational team, which has outdone itself, the Congress had the expected outcome, ensuring exquisite accommodations and working conditions to all the participants. After the end of the highly interesting and complex scientific sessions, the participants visited the most important places in Dubai.In addition, we should mention the contribution of the \u201cRoNeuro\u201d Institute for Neurological Research and Diagnostics of \u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy in Cluj-Napoca, Romania, as well as the contribution of the Academy of Medical Sciences in Romania in the process of organizing the resonant congress.Executive EditorAssoc. Prof. Dr. Eng. Victor Purcarea"}
{"text": "Recommendations are offered regarding interventions for child care centers, primary and middle schools, high schools and colleges, outdoor occupational or recreational and tourism settings, and mass media and multicomponent communitywide campaigns. Summaries and links to the individual recommendations are available at Established in 1996 by the U.S. Department of Health and Human Services, the task force is an independent, nonfederal, uncompensated panel of public health and prevention experts whose members are appointed by the Director of CDC. The task force provides information for a wide range of decision makers on programs, services, and policies aimed at improving population health. Although CDC provides administrative, research, and technical support for the task force, the recommendations developed are those of the task force and do not undergo review or approval by CDC."}
{"text": "Hand surgery in Malaysia began modestly with the correction of claw deformity in leprosy patients early in the last century, and began to evolve over the years into the treatment of injuries in plantation and industrial workers, at home and then in road crashes.With training of some of our surgeons in various overseas centres, particularly in the UK and then in USA and Singapore, hand and microsurgery began to be developed in General Hospital Kuala Lumpur and University Malaya Hospital, when they returned home.An international three-day conference on hand surgery in Kuala Lumpur in the mid-1980's created greater awareness on the topic and helped to bring hand surgery to the fore-front, with setting up hand clinics, training in micro-surgery, and so on, in the major hospitals in Kuala Lumpur initially.Today, there are dedicated hand surgeons, technicians and hand therapists in the major government and private hospitals throughout the country, providing excellent services in this specialised and demanding area of trauma and reconstructive surgery."}
{"text": "Knemidocoptic, from the Greek knemid  and koptein (to cut), refers to the morphology and pathogenesis of mites of the genus Knemidocoptes, which are burrowing mites of birds. Commonly known as scaly face, scaly legs, or tassel foot, knemidocoptiasis affects primarily the face and legs of birds around the world worldwide and can be fatal.From the Latin"}
{"text": "Health Information Economy (HIE) is one of the broader, more complex, and challenging and yet important topics in the field of health science that requires the identification of its dimensions for planning and policy making. The aim of this study was to determine HIE concept dimensions.This paper presents a systematic methodology for analyzing the trends of HIE. For this purpose, the main keywords of this area were identified and searched in the databases and from among 4775 retrieved sources, 12 sources were studied in the field of HIE.Information Economy (IE) in the world has passed behind four paradigms that involve the information evaluation perspective, the information technology perspective, the asymmetric information perspective and information value perspective. In this research, the fourth perspective in the HIE was analyzed. The main findings of this research were categorized in three major groups, including the flow of information process in the field of health , and information applications in the same field  and the underlying fields.According to the findings, HIE has already developed a theoretical and conceptual gap that due to its importance in the next decade would be one of the research approaches to health science. Stiglitz declared that in the field of economics, perhaps the most important break with the past lies in the Information Economy (IE) theories . IE is oIn various literature, the IE is expressed as one of the basic needs for economic development , qualityIE has passed behind different paradigms that can be divided in four approaches. These approaches are information evaluation, information technology evaluation, asymmetric information, and information value perspective.The first approach of IE theory is based on information sector evaluation. Machlup and Port performed two main studies in this field. Their famous studies determine the flow of movement from an industrial society to an information society, and try to show the characteristics of the information society . Porat aThe second paradigm in IE, is information technology economy, that can be observed in the reports of the next decades of the Organization for Economic Co-operation and Development (OECD) and activities of United Nations Conference in Trade And Development (UNCTAD). In fact, the IE has the approach of information technology. UNCTAD\u2019s annual reports from 2005 to 2012 are in this aspect .The third paradigm is a conceptual approach. This approach is Information asymmetry. Information asymmetry deals with the study of decision in transaction where one party has more or better information than the other. Akerlof demonstrated how a market can collapse if critical pieces of information are missing. In 2001 the Nobel Prize in Economics was awarded to George Akerlof, Michael Spence, and Joseph E. Stiglitz for their analyses of markets with asymmetric information . In addiThe other type of conceptualization of the IE to emerge focuses on the information value . ShapiroThis can give rise to a new approach in the IE. From the perspective of information value, the overflow of information and access to information on the current location plays an important role in marketing information. The approach to information as a commodity is considered independent and different from other goods .This discussion illustrates the magnitude, complexity and, importance of the IE and at the same time indicates that the next decade will be the decade of IE research and policy age. The HIE is also more complex topics due to the health information and clinical data. Despite of HIE importance, research showed the lack of theory criticism in this field. The aim of this study was to evaluate different views on the economy of the world\u2019s health information in order to determine the dimensions of the field. A systematic review was undertaken in order to provide understanding of the global status of HIE theoretical dimensions.In This paper, a systematic review was used of the HIE literature, using a structure strategy in English and Persian language from 1964 to 2014. Search strategies were performed the following databases:Scopus, Web Of Science, Pubmed, Science Direct, Doaj, Ebsco, OCLC, Google Scholar, Yahoo, Eric, Google books, Proquest, Jstore.Major search keywords consist of: HIE, health information economics, health economy of information, health economics of information and medical data economy.Publications selected based on the inclusion /exclusion criteria.Inclusion criteria includes criteria pertaining to publication characteristics, such as full text publication, peer reviewed publication, English and Persian language publication.Exclusion criteria includes duplicate publications, asymmetric information and research with a focus on information and communication technology removed.The inclusion/exclusion results of the search are shown in The databases search yield, 4775 papers. However, review of the title excluded 2488 duplicated studies. After reviewing abstract and full text studies, in total 12 studies met the inclusion criteria. The selected studies information is presented in The main subjects of HIE categorized in seven major groups expressed in In this study, the results were presented in seven categories:The First, production of information, the Second, data collection, third, data processing, fourth information dissemination or distribution, fifth, applications of information (usage), sixth, information economy contextual aspects, and finally, information attributes are selected groups.Health data and information applications consist of education, research, health industry, policy, legislation, and decision-making .HIE contextual aspects underlay factors such as security, privacy, copyright, and the role of technology.Finally, the end of this research is to study the characteristics of the information as an economic commodity.Dimensions of HIE have controversial approaches in selected studies. Therefore, all of the seven topics in HIE aspects demonstrated in conclusion part based on systematic review studies.In this study, Major topics of HIE categorized in seven groups. The first step is the production of information. This aspect mentioned in many studies . The terNowadays information is available so quickly, and so expensively and broadly. The problem is not information production or information access but information overload. Nobel Prize winner economist Herbert Simon believes that \u201cA wealth of information creates a poverty of attention\u201d . Health data and information applications consist of education, research, health industry, policy, legislation, and decision-making   depends on the accuracy, correctness and trustworthiness of the information, and the privacy and security to control the disclosure of personal information .In many studies , information unusual attributes as a commodity, and security and safety are major controversial dimension in HIE.We believe that HIE has already developed a theoretical and conceptual gap that due to its importance in the next decade would be one of the important research approaches to health science."}
{"text": "The following information is missing from the Funding section: This paper is part of the PhD thesis project of S. Romero-Cordoba, a student of the Biomedical Sciences PhD Program of the Autonomous National University of Mexico.The complete, correct Funding statement is: This work was funded by the National Institute of Genomic Medicine (INMEGEN/CI/019/2009). S. Romero-Cordoba, RRV, and RAL received a PhD scholarship from the Mexican National Council of Science and Technology. This paper is part of the PhD thesis project of S. Romero-Cordoba, a student of the Biomedical Sciences PhD Program of the Autonomous National University of Mexico. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."}
{"text": "Globally, there are growing efforts to address diseases through the advancement in health research and development (R&D), strengthening of regional cooperation in science and technology (particularly on product discovery and development), and implementation of the World Health Assembly Resolution 61.21 (WHA61.21) on the Global Strategy and Plan of Action on Public Health, Innovation, and Intellectual Property (GSPA-PHI). As such, the Association of Southeast Asian Nations (ASEAN) is responding to this through the establishment of the ASEAN-Network for Drugs, Diagnostics, Vaccines, and Traditional Medicines Innovation (ASEAN-NDI). This is important in the ASEAN considering that infectious tropical diseases remain prevalent, emerging, and reemerging in the region. This paper looks into the evolution of the ASEAN-NDI from its inception in 2009, to how it is at present, and its plans to mitigate public health problems regionally and even globally. Please see Additional file The Association of Southeast Asian Nations (ASEAN) has a continuum of member nations at different stages of economic and health development, with the majority of the countries belonging to the middle- and low-income categories .While there are ASEAN member states that are more advanced in terms of health systems and programs, the majority still suffer from communicable and non-communicable diseases ,3. InfecThese tropical infectious diseases form part of the neglected tropical diseases (NTDs) alluded to by international organizations. These diseases include infections that have shown low economic returns for investments in health products R&D. However, from a human capital perspective, these so-called NTDs not only place a significant burden on the health system, but they also adversely affect productivity and efficiency of human capital in their respective societies .Budgetary limitations for health research also cause difficulty in pursuing R&D initiatives. With scarce resources for health research, efforts to pursue health research activities in many of the ASEAN nations are limited .In terms of human resources, the ratio of R&D personnel to the population varies across the ASEAN nations with countries including Singapore, Malaysia, and Thailand having more R&D personnel than the rest of the ASEAN nations. The proportion of researchers to population is also much higher in the more developed nations in the ASEAN  compared to those which are less economically developed . It is aConsidering all of these public health challenges and hindrances to providing better quality of health in the ASEAN, activities towards the establishment of a regional health innovation network were initiated with the goal of enhancing product discovery and providing a sustainable essential health R&D through intraregional collaboration\u2014a framework suggested by the World Health Assembly (WHA) Resolution 61.21, Global Strategy and Plan of Action on Public Health, Innovation, and Intellectual Property (GSPA-PHI) ,8.The ASEAN Network for Drugs, Diagnostics, Vaccines, and Traditional Medicines Innovation (ASEAN-NDI) was founded in 2009 in line with the objectives of the GSPA-PHI, which include promotion of R&D, development of North\u2013South and South\u2013South partnerships to support capacity building, and establishment of strategic research networks to facilitate better coordination of stakeholders. It was conceptualized to parallel the African Network for Drugs and Diagnostics Innovation (ANDI), a network championed by the World Health Organization Special Programme for Research and Training in Tropical Diseases (WHO-TDR), which started the idea of establishing regional innovation networks.th Meeting of the ASEAN Sub-Committee on Biotechnology (SCB) in Bali, Indonesia on 25\u201326 May 2009, and was later adopted by the ASEAN Committee on Science and Technology (COST) as its own initiative. The ASEAN, through the COST, approved the creation of the ASEAN-NDI in 2009. Start-up funds to support the establishment of the Network were provided by the WHO-TDR. The Philippine Council for Health Research and Development (PCHRD) of the Department of Science and Technology (DOST) served as the secretariat of the ASEAN-NDI, with its Executive Director, Dr. Jaime Montoya, as the overall coordinator , which results in duplication and wastes time and resources. This shows that although collaborating ventures may have limitations imposed by funding/sponsoring partners, the ASEAN member states need to explore and expand collaborative engagements to other ASEAN member states with the end goal of enhancing capacity in the region and minimizing duplication of efforts.Asia, including the ASEAN, is a major player in the future of pharmaceuticals. The recent slowdown in major Western countries has led to the outsourcing of developmental work in developing countries including the ASEAN  and the creation of a Task Force (TF) that will serve as an ad hoc group who will guide the development of the plan. On 20 October 2011, the first ASEAN-NDI Task Force meeting was held in Manila, Philippines where the initial outline of the draft SBP and timelines were discussed.human resources, technological capacity, and financing to ensure sustainable health, development, and security. These inputs will be translated into research and eventually into the production of innovative health products and services that will be made available within and even outside the ASEAN. The vision, mission, and objectives of the ASEAN-NDI are summarized in Table\u00a0The ASEAN-NDI is envisioned to become Asia\u2019s premier facilitator for collaborative innovation in R&D for health products, benefiting primarily the ASEAN but more open to global markets. As a network involving the ten ASEAN member countries, the ASEAN-NDI will build the needed The R&D and delivery value chain structure  basic research, (2) assay/model development, (3) compound/candidate screening, (4) lead generation/optimization, (5) pre-clinical trials, (6) clinical trials, and (7) manufacturing and delivery/access. It is regional and even global in extent, involving private enterprises, public sector institutions and governments, non-profit organizations, and donor agencies, which may have done related work on the priority disease areas in the past, and may be willing to collaborate .The governance structure will comprise a policy-making and strategic direction setting by a 14-person Governing Council and a four-person Executive Committee. The ASEAN-NDI is to be designed to operate in a hub-and-spokes model  will also be established. The most important outcome of the ICs will be the coordinated and cooperative strategy that the stakeholders develop through the sharing of best practices, and R&D knowledge to meet the common challenge at hand.Details regarding the SBP were presented during the First ASEAN-NDI Stakeholders Meeting in Manila on 5 June 2013. Future plans for the ASEAN-NDI, including the proposed collaborative activities, were also discussed, taking advantage of the presence of representatives from the WHO, and the Africa and China NDIs. These activities include holding joint regional consultations on the development of demonstration projects, collaborating in setting up a global health R&D observatory, and forming a wider network composed of the regional innovation networks.The ASEAN-NDI will improve health R&D by driving innovation through collaboration not only among the ASEAN member states but with other networks and health R&D institutions. Engagement of non-ASEAN stakeholders is also vital considering that infectious diseases and NTDs are emerging in European countries and other Western states. In Europe, a surprisingly high incidence of NTDs was recorded among more than 150 million Europeans, especially those living below the poverty line ,17.The same is the case in the Middle East and North Africa where parasitic infections such as fascioliasis, leishmaniasis, and schistosomiasis are prevalent, and viral infections such as dengue and Rift Valley fevers have emerged .In a recent study by Hotez and Papageorgiou (2013), it was deduced that one way to address NTDs and infections of poverty is to establish a center for fundamental and translational research in which product development activities including R&D on drugs, diagnostics, and vaccines are conducted . This isThe ASEAN-NDI will coordinate research by partnering with research networks, developing capacity-building initiatives, supporting R&D infrastructural improvement, advocating for more research investment, and enhancing regional access to health products. It will start by enhancing collaboration among the ASEAN member states to address the specific health needs of the ASEAN, but collaboration with other countries will soon follow. This is consistent with the GSPA-PHI goal of making a network of networks wherein the ASEAN-NDI can partner up with other NDIs  that have been established and form the nucleus for South-South collaboration . With a Through regional network collaboration, global health problems will be addressed by properly channeling resources and partnering on projects according to collective needs. This will capacitate the different regions to contribute to the advancement of global health R&D while providing solutions for their own health challenges.The roadmap for the ASEAN-NDI has been laid out. The ASEAN is now awaiting its full implementation to achieve its goal of becoming the premier facilitator for collaborative research in health products in Southeast Asia.The stage is set for all its stakeholders\u2014government institutions, public and private research institutions, the private sector, non-government organizations, and international organizations\u2014to unleash their full potential in health R&D in the ASEAN region, particularly in the areas of drugs, diagnostic kits, traditional medicine, and vaccine development, for the benefit of all.Next steps for the establishment of the ASEAN-NDI include: (1) Setting up the permanent Secretariat office in the Philippines; (2) establishing the governance structure, including the selection of the Governing Council members and the ASEAN-NDI country hubs; (3) conducting fundraising activities; (4) developing/screening the first set of projects and programs of the Network, and (5) the application of the Network to be an official ASEAN-affiliated office.APAST: ASEAN Plan of Action on Science and Technology; ASEAN: Association of Southeast Asian Nations; ASEAN-NDI: ASEAN Network for Drugs, Diagnostics, Vaccines, and Traditional Medicine Innovation; COST: Committee on Science and Technology; DOST: Department of Science and Technology; GSPA-PHI: Global Strategy and Plan of Action on Public Health, Innovation, and Intellectual Property; IC: Innovation Communities; NTD: Neglected Tropical Disease; PCHRD: Philippine Council for Health Research and Development; R&D: Research and Development; SARS: Severe Acute Respiratory Syndrome; SBP: Strategic Business Plan; SCB: Subcommittee on Biotechnology; UNESCO: United Nations Educational, Scientific, and Cultural Organization; WHA: World Health Assembly; WHO: World Health Organization; TDR: Special Programme for Research and Training in Tropical Diseases; TF: Task Force.All authors have no competing interests.All authors gave substantial contributions to the study conception and design, and in the acquisition, analysis, and interpretation of the data. NCP and CLR prepared the draft manuscript, while BR and JCM revised it critically for important intellectual content. All authors contributed, read, and approved the revision and the final draft.Multilingual abstracts in the six official working languages of the United Nations.Click here for file"}
{"text": "However, their incorporation into the National Health Service havebeen limited because it can not provide access and universal coverage to healthservices in an equitable manner throughout its territorial extension and in thedifferent levels of care. the implementation of the right to health is complex and will require mobilizationof the state and political financial, educational, technological, housing,sanitation and management actions, as well as ensuring access to health, anduniversal coverage. Talking about the right to health implies reference to a set of legalnorms that establish the rights and obligations of the state, collectively and alsoindividually, regulating and monitoring the relationships between them. It also refers to access and universal coverage of health services, inquality and quantity for the whole population.The right to health is part of the context of social rights, one of the most difficultrights to protect, especially when civil and political rights are considered, as it een them. It als(-). In this context, the health systems and their governments, to guaranteethis coverage, should act on the social and environmental determinants ofhealth(-), pointing out that the performance of these factors should be a task of allstate sectors.Universal health service coverage should offer high quality services and access, alsoprioritizing promotion, prevention, treatment, rehabilitation and palliativecare-4. Infhealth-5, po. All of these barriers contribute to the deprivation of the right to healthof populations.In many countries, especially developing countries such as Mozambique, there are severalobstacles to accessing healthcare services, which are an obstacle to universal coverage.Among these are: lack of sanitary infrastructure, insufficient human resources, lack ofequipment, higher demand, difficulty of paying users for the services performed,professional attitudes and characteristics of health services. All of.The independence of Mozambique from Portuguese domination in 1975 did not necessarilymean the full exercise of the right to health for most of the population. Rather, thegreat challenge is exactly to improve the high rate of chronic malnutrition, especiallyin children, high food insecurity, low levels of education of women, poor access to safedrinking water, inadequate levels of availability to basic sanitation and access to highquality health services, and the equitable distribution of health care professionals inurban, peripheral and rural areas where health needs are higher.(-). Access to health services becomes effective when accompanied by universalcoverage, understood as the development of health financing systems by the State thatallow people to use services and health actions without financial burden, such as directdisbursement to obtaining needed health care. This requires that services are provided equitably, regardless ofgeographic location, cultural values, beliefs, religion and ethnicity. Lack of accessand universal coverage constitutes a barrier for realization of the right to health inMozambique.These are some of the challenges that reveal the difficulties of the State inoperationalizing coverage targets and universal access to health, caused also by thelack of funds for the health system, deficient information systems, negativerelationships between health professionals and the people, and late referral for morespecialized care of patients with certain conditions from the clinics of lower levels ofcare -5. Aclth care,6. ThScopus , however, no article on Mozambique was found. For academiccontribution to this discussion, legislation about the right to health was used,elaborating some questions that will guide this reflective study: what international andregional instruments ratified the right to health in Mozambique? What are the legalinstruments in Mozambique that include the right to health? With what theoretical, legaland social frameworks can the gap between theory and practice on the right to health inMozambique be understood? To answer these questions, the article presents as itsobjective the discussion on the right to health, incorporation into legal instrumentsand the deployment in practice in the National Health System in Mozambique.Aiming at deepening this subject, a literature review was performed in the databases ofthe Latin American and Caribbean Literature in Health Sciences - (LILACS), PubMed and and Viswambharan and Priya, taking documentary analysis as an analytical process, from documentarysources, which enables the identification, verification and examination of documents,expanding and questioning the background. The use of document analysis extends theknowledge, whose understanding requires a contextual historical approach, allowing thecomprehension of the processes of evolution of practices, behaviors, trends andapplication of certain measures.This was a documentary analysis of a qualitative approach, which followed the guidelinesof Souza, Kamorski and Luis and Visnd Priya, takingmeasures.For this study, all official legislation of Mozambique on the right to health publishedin the Bulletin of the Republic of Mozambique between 1975 and 2010, were used, inaddition to the Constitution. The African Charter on Human and Peoples' Rights and theInternational Covenant on Economic, Social and Cultural Rights were also consulted. After exhaustive reading of the documents, three empirical categories were established:\"instruments of humans rights and their interrelationship with the development of theright to health\"; \"the national health system in Mozambique\"; and \"gaps between theoryand practice in the consolidation of the right to health in the country.\"Five national legislative documents were analyzed: the Constitution of the Republic ofMozambique, 2004; a decree-law; and three laws. Then, the three empirical categories were analyzed, mobilizing the bibliography thatshows the situation of the existence of the right to health or lack thereof, coverageand access to health services.When the nation, a member of the World Health Organization and the African Union,approved instruments affirming the right to health, Mozambique was still a Portuguesecolony, without the legal structure to include this prerogative into the rule of law.But, with its independence in 1975, Mozambique acceded to several international andregional human rights instruments that directly or indirectly addressed the guarantee ofthe right to health. For a better illustration, Mozambique participates as a member state of several international and regional treatiesrelevant to the implementation of the right to health, although it has not ratified theInternational Covenant on Economic, Social and Cultural Rights. , which explicitly states the responsibility of the State to provide accessto health services for all Mozambicans in Article 49, \"all citizens have the right tomedical and health care, according to the law and the duty to promote and protect publichealth\". Although the previously mentioned article refers to the guarantee to health,the Constitution does not clearly explain the country's obligation to provide equitablehealth services to all.In the domestic context, Mozambique has important tools that are able to guarantee theright to health, especially the 2004 Constitution of the Republic, which , although, it does not indicate which instruments, or constitutional- orintra-constitutional instruments the state will use for social participation.In addition to the constitutionality of guaranteeing the right to health for thepopulation, Mozambique, through its Constitution, emphasizes the importance of socialparticipation in health, especially on the promotion and protection of public health,with the involvement of Community bases, althou. The Charter implies the mission of any member state to the commitment toensure the health of its population, while it does not assure the guarantee as aresponsibility or duty of the state, however, it reinforces individual freedom to enjoythe best health that one is capable of obtaining.Regarding the State's responsibility, the African Charter on Human and Peoples' Rights,ratified by the government of Mozambique, mentions in Article 16 that \"everyone has theright to enjoy the best health that he is able to achieve\" and reinforces also that \"themember states of this charter are committed to taking the necessary measures to protectthe health of their populations and to assure medical care in case ofillness\". The Ch. Mozambique still faces major challenges to the equitable offering of the status of rightto health, not only in improving health services, but in ensuring effective and broadactions, which act positively on the social determinants that affect the right tohealth. In this sense, the actions for the fight against food insecurity, public safety,supply and access to clean water, sanitary measures in private and public environments,access to basic and higher education, environmental sanitation, poverty reductionpolicies, and the consumption of alcohol, drugs and tobacco, which are socialdeterminants that limit access and universal coverage for health services,5. , nationalized the private clinics that existed during the colonial period,in order to maximize resources by offering greater access to health care services thatprovided indiscriminate assistance to Mozambican citizens. The Decree, in Article 1,states that \"all activities relating to the prevention and treatment of disease as wellas the technical preparation of the staff team must be exclusively performed by theState\". Therefore, all activities of primary, secondary and tertiary care became thesole and exclusive responsibility of the State, which became the sole provider andpromoter of health services for the entire country, thereby assuming control ofPortuguese hospitals and private clinics. This context is derived from a political position of a government withsocialist characteristics, which emphasizes access to health and pharmaceutical care forthe Mozambican population through the principles of equality and equity.Upon the independence of Mozambique, the Council of Ministers, through Decree-Law N.5/75 of 19 August 1975, nation clinics. This c, which emphasizes in Article 1 the gratuity of prophylactic health actions.In this regard, the Ministry of Health (MoH) adopted a payment criterion with a fixedvalue for medical and pharmaceutical appointments in the 11 provinces of the country,considered affordable prices for everyone.In 1977 this situation changed as a result of Law N. 2/77, which , factors that occasioned misinformation and the impossibility of havingwhat was established by the MoH. Associated with these facts, most of the populationlived in rural areas where health services were less available, further aggravating theright to access to health.The adoption of participation through payments used to limit access of the population tohealth services, as the country at that time had a high unemployment rate (30%) and ahigh illiteracy rate (68%), factorin light of the Republic Constitution of 1990, which established the rightto medical and health care for all citizens through the MoH. Its goal was healthpromotion, disease prevention, care and rehabilitation, associated with training ofhuman resources and research for its continued development. Thus, the NHS established ahealth organization at different levels of care: primary level - consists of healthcenters and units, each comprising its respective areas of health; secondary level -consists of district general and rural hospitals; tertiary level - consists ofprovincial hospitals; and quaternary level - consists of central and specializedhospitals. The institutions that are part of the NHS under the MoH management are thehygiene centers, vocational training institutions, specialized laboratories and researchinstitutions.In 1991 new changes are perceived through the creation of the National Health System(NHS), Law N. 25/91in lightThe NHS centralizes financial resources and organizes the technical instructions of theMoH hierarchically by the provincial guidelines. Thus, the Central Government determinesthe percentage of the State's general budget for the MoH, which varies from year toyear, and the State distributes it to the provinces. This centralization means thatfinancial resources are channeled mostly to health facilities in the tertiary andquaternary levels, to the detriment of health centers, which are mostly in rural andperipheral areas of the cities, thereby reducing access of the population to healthfacilities, which interferes with the full right of access to health services for thepopulation living far from urban centers.(-).Another factor that must be considered is that the MoH depends on donations ofinternational organizations and partner countries, especially Western, to perform itsactions. These resources do not always meet the needs for coverage and access to healthservices for the population, not only because they are scarce, but also because they arenot geographically allocated equitably, giving privileges to high-complexity hospitals,directly interfering with the population's right to health-6..Resuming the discussions on nationalization, in 1991 during the advent of thedemocratization, the NHS admitted its inability to be the only provider of healthservices, resuming the activities of private health care, which had been nationalizedafter the independence of the State. On the other hand, in 2004, the State officiallyrecognized the need for activities of practitioners of traditional medicine by approvingthe traditional medicine policy and its implementation strategy, whose main objectivewas its integration to the NHS to guarantee access to primary health care and qualityfor the entire Mozambican population.. This recognition does not seem to be necessarily valuing this healthpractice and the importance of traditional physicians, but rather highlights alimitation of the NHS in offering universal access to health services and coverage tothe entire population, since in this period the NHS covered only 40% of services, andthe rest were covered by traditional health practitioners and private health care. Itshould be noted that even given every effort by the State, the NHS had covered onlyabout 50% by 2013.This recognition represents advances that the State has been providing since itsindependence for the consolidation of the traditional medicine area, with the creationof the Traditional Medicine Research Office in 1977, and the creation of the Associationof Traditional Physicians of Mozambique. This ry 2013,.The fact that traditional medicine has been recognized as an NHS participant undoubtedlyadds value to the right to health and respect for local culture, to the extent thatpeople can consult traditional physicians freely. However, there is still no effectiveintegration of these health practices within the NHS, thereby not ensuring theregulation of the MoH on the supply of these services and systematized protocols withreferral and counter-referral that enable the coordination of care in a more articulatemanner, making the guarantee to the right to health even more difficult. It is importantto note that traditional medicine covers 100% of all of the Mozambican population,namely, even people who have access to the NHS also access the traditional medicinesystem.(-).Although the right to health depends on specific legislation to ensure rights andduties, it requires mutual efforts to function. In this context, the importance ofavailability is emphasized, which involves the construction of infrastructure and theexistence of health care services in a sufficient amount for the whole population;accessibility, which involves health care services that are available to the entirepopulation without discrimination; physical accessibility, in which health facilitiesare available to all, including the reduction of distances and means of transportationavailable to meet the needs of users, greater attention to the most vulnerable people inthe communities; and accessibility, which implies the recognition of the difficulties ofaccess to work, and greater equity in payments, which should be as accessible aspossible for all when they exist; the population's access to information withoutdiscrimination and the duty of health professionals to respect medical ethics andrecognize the cultural issues in the contexts in which they work can be an obstacle incare-6.. In Mozambique, where most of the population is unemployed, and althoughthe payment amounts are \"symbolic\", they interfere with access and universal healthcoverage of services, in costs of medical consultation, medicines, and mainly intransportation for those who live in locations that are far from health facilities.Finally, in order to ensure this right, there must be quality services, equipment andhuman resources. In Moz. In this context, the States make an effort to implement the right tohealth, according to its financial conditions, as stated by Pact 1966: \"each MemberState in the present Pact is committed to adopting measures, (...) especially in theeconomic plans and technical contexts, to the maximum of its available resources inorder to progressively achieve (...), the full realization of the rights recognized inthe present Pact, including (...) the adoption of legislative measures\". Most importantly, in this process of right to health, is the recognitionthat the State has an immediate duty to fulfill essential obligations, having asresponsibilities to regulate, design and implement policies and mobilize financialresources.The right to health has been established as a regulated and progressive implementationright, as the lines or principles for the fulfillment of State programs areconceived. In thieasures\". Most i. A community-based intervention would also be important to guarantee accessto a wide variety of promotional, preventive, curative and rehabilitative healthservices(-).For the right to health to be effectively implemented for the population, empowermentwould be required, including universal access to education, health, employment,promotion of equality of gender within ethnic groups, and the institutional ability torespond-,,11. Aservices-4..But what happens in Mozambique? In order to have the right to health, financialresources for the various levels of the NHS and other health subsystems are essential.among other factors; political decentralization in the implementation and coordination,so that decisions are made at other levels ; andmedical technology, which involves a set of tools and processes that effectively respondto health care needs.. Although the gross domestic product (GDP) has been growing in recentyears, around 7% per year, the budget allocated to the NHS state is 6.6%, below therecommended 15%in the Africa region .The challenges presented, and one of the aspects to be considered, relate to thefinancing arranged by the Mozambican state, one of the lowest in the Southern Africanregion, with an external dependence for about 66% of their spending. Mozambique spendsapproximately 39 dollars per capita on health, representing much less compared to theregional average. Althou region .. The country lacks quantity and quality medical technology, materials andprocesses; therefore it does not have sufficient infrastructure to fully meet theaccess to diagnostic tools that are able to respond safely to the laboratory diagnosisof different diseases that affect the population. Although the coverage of healthservices has improved, it is still low to meet all the health needs of thepopulation.This decentralization and transparency are not well defined by the MoH, since there isno visibility on accountability for the population as a whole, although there is a setof policies, strategies, laws and regulations,,12. Tcesses-,15; tlation,, 17.; but the state of the right to health is still far from being effectedwithin the whole population. Other factors associated with lack of coverage of healthservices in countries such as Mozambique are related to social inequalities, governmentpolitical systems(-) and, in the case of the African countries, political and economicinstability is added. For countries with these characteristics, the universal servicecoverage requires reforming systems, promoting the principles of equity, solidarity andcollective action to overcome inequalities(-), since the absence of all this cannot guarantee universal access andcoverage and consequently, the right to health.One cannot deny the improvements in some health areas, such as the increase of birthsattended by health professionals, set at 54.3%; reducing poverty by almost 50%; andreducing neonatal mortality from 50% to 30.4%,,; but thystems- and, inThe theme of the right to health is complex, as permeated by various spheres, includinghealth, law, financial policies, education, technology, housing, sanitation andmanagement.In Mozambique, the State's actions, represented by the NHS, show the gap between therecommended policies and health practices, with an incipient focus on equity andquality, although there is an increased demand for health services systematically.The difficulties of access and universal coverage, and hence the establishment of theright to health, is a reflection of: underfunding in health; difficulties decentralizingcare processes and medical technologies; minimal coverage of NHS; lack of qualifiedprofessionals and a pricing policy to maintain these professionals; difficulty with workconditions and processes in health care; few activities in the interdisciplinary andteamwork fields; and systematic practice of professionals, such as nurses.For the people to have the right to health, in addition to the actions implemented bythe government, there is also the need for participation of the population, by usingsocial control mechanisms, requiring greater access and coverage of health services bythe State.For the general population of Mozambique, traditional medicine practices can consist ofan expansion of universal access and coverage of health services that are contracted,supervised and regulated by the State."}
{"text": "Recommendations for HIV Prevention with Adults and Adolescents with HIV in the United States, 2014, is now available online at http://stacks.cdc.gov/view/cdc/26062. This guideline was developed by CDC, the Health Resources and Services Administration (HRSA), the National Institutes of Health (NIH), and five nongovernmental organizations: the American Academy of HIV Medicine, the Association of Nurses in AIDS Care, the International Association of Providers of AIDS Care, the National Minority AIDS Council, and the Urban Coalition for HIV/AIDS Prevention Services. The recommendations are intended to advance the goals of the National HIV/AIDS Strategy for the United States: prevent new HIV infections, increase the proportion of persons with HIV who are aware of their infection, prevent HIV-related illness and death, and reduce HIV-related health disparities  includes dozens of practical decision-support tools, training aids, fact sheets, and other materials that can support implementation of these recommendations.A companion resource library web site (available at"}
{"text": "The author of the above-mentioned paper would like to make the following correction to the first paragraph of the Acknowledgments section on page 16.\u201cThe author received editorial support in the preparation of this report from Kristin Carlin and Jennifer Schwinn, Peloton Advantage, LLC, Parsippany, NJ, USA, funded by Celgene Corporation, Summit, NJ, USA. The author, however, directed and is fully responsible for all content and editorial decisions for this manuscript. The named author meets the ICMJE criteria for authorship for this manuscript, takes responsibility for the integrity of the work as a whole, and has given final approval for the version to be published.\u201d"}
{"text": "Professor Glyn Humphreys was born 28 December 1954 and passed away 14 January 2016.Prof. Glyn Humphreys's early career was spent at the University of Bristol from where he was awarded his B.Sc. (1976) and Ph.D. (1980) in Psychology. At the early age of 24, Glyn was appointed to his first lectureship in the Department of Psychology in Birkbeck College, University of London. Almost all of his students were older than him! Through intellect and hard work, he made rapid academic progress, and was appointed as Professor of Psychology in 1988. While at Birkbeck, he was appointed the Ronald Tress Prize for advancements in his field, the first of many such awards. During his time in Birkbeck an equally important step in his life was made by meeting his wife Jane. Both of them moved to the University of Birmingham in 1989 where Glyn became the Head of the Department of Psychology, a position that kept for 15 years steering the department to the elite of institutes in the UK and worldwide. Most recently Glyn was the Watts Professor and Head of Experimental Psychology Department in Oxford University.Glyn's contributions to research were enormous: he contributed to many areas including cognitive psychology, cognitive neuropsychology, computational modeling, social cognitive neuroscience, neuro-rehabilitation and cognitive diagnostics. Most notably his work on understanding the cognitive effects of stroke led to the development of the Birmingham Cognitive Screen in 2012. Glyn was also the president of Experimental Psychology Society from 2002 to 2004 and editor of three international journals. Glyn's work was recognized by numerous awards from the British Psychological Society , Humboldt Research, 1998, Royal Society , University of Hong Kong  and European Society for Cognitive Psychology . He was a fellow of the Royal Society of Medicine, the Humboldt Foundation, Ecoles des Hautes Etudes en Sciences Sociales and the British Academy. He was awarded an Honorary Life Fellowship of the Belgian Association for Psychological Science in 2002 and the British Psychological Society in 2012. Most recently, Glyn was awarded a Lifetime Achievement Award by the British Psychological Society in 2015.Glyn was a giant in research and he collaborated with huge number of researchers from all over the world including Birkbeck, Birmingham, Oxford. His lab was notable for its \u201cfamily feeling,\u201d where new ideas were encouraged, fostered and supported. He was a mentor rather than supervisor, and his generous nature inspired those around him to aim higher, to think deeper, to be more responsible, to respect colleagues, to be compassionate and kind. Notably, the neuropsychological patients he worked with felt so respected and honored by him that they felt privileged to contribute to his research. In short Prof. Glyn Humphreys was a giant in science, humanity and kindness, and inspiration to many individuals around the globe.Glyn survived by his wife Jane, his daughter Katie, his sons Iain and Alec and his grandchildren, Madeleine, Jake and Freddie.The author confirms being the sole contributor of this work and approved it for publication.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "International Journal of Qualitative Studies on Health and Well-being's thematic cluster on Health, Physical Activity and Lifestyle, it is our privilege to introduce the theme and six original articles included in the cluster. The papers address some central aspects of the theme  from psychological, sociological, pedagogical, medical, and also interdisciplinary perspectives through implementation of different qualitative research approaches  and designs . The author team is internationally representing Sweden, Denmark, and the United Kingdom. Two review papers open the cluster and are followed by four research papers.As guest editors of the Physical activity, or the lack of it, is a major public health issue in many countries. The World Health Organization (WHO) has reported that physical inactivity is one of the ten leading causes of death in developed countries resulting in about 1.9 million preventable deaths worldwide annually WHO, . ConsideInternational  paper, Staveborg Kerkel\u00e4, Jonsson, Lindwall, and Strand  provide In the fourth paper, Lindqvist, Kostenius, Gard, and Rutberg  exploredIn the fifth (single case study) paper, Stelter  shared hIn the sixth (research) paper, Papathomas, Williams, and Smith  used narInternational Journal of Qualitative Studies on Health and Well-being and attract more researchers in the sport/exercise sciences to contribute to the journal in future.Finally, as guest editors we wholeheartedly thank the authors for their tireless efforts in creating interesting and high-quality contributions, and all the reviewers for their constructive comments that contributed to raise the scientific quality of the thematic cluster. Our deep thanks also go the editors of the journal and the publisher, for smooth cooperation during the preparation process. We do hope that this thematic cluster will contribute to expanding the scope of the Urban Johnson Sport and Exercise Psychology School of Health and Welfare Halmstad University, Halmstad, Sweden E-mail: urban.johnson@hh.sNatalia Stambulova School of Health and Welfare Halmstad University Halmstad, Sweden"}
{"text": "By the time of his death on 23 November 2012, Michael (Mike) E. Robbins had gained a national and, indeed, international, reputation as a leader in the field of radiation-induced normal tissue effects. For the final decade or so of his career, Mike had been based at Wake Forest Medical Center, an institution where he had developed a world-class research program looking at the prevention and treatment of radiation-associated tissue injury, with a specific interest in radiation-induced brain injury. Although the impact of Mike's body of work in the latter area of research is clearly highlighted in the paper proffered by Prasanna et al. , his deaBorn in London, UK, in 1954, Mike began his academic career at Thames Polytechnic, London (now the University of Greenwich), and received his bachelor's degree in Applied Biology in 1976. He remained at Thames Polytechnic for his postgraduate studies, investigating the effects of parathyroid hormones on the kidney in domestic fowl, and obtained his PhD in 1980. That same year, Mike joined the staff of the Churchill Hospital Research Institute, University of Oxford, as a post-doctoral fellow, where he was first introduced to the world of radiation biology. He readily integrated his prior knowledge of kidney function with the tenets of radiation biology and, in parallel with prestigious research groups such as Moulder et al. , helped In 1993, Mike moved to the United States, where his initial appointments were as Associate (subsequently full) Professor in the Department of Radiology and the Director of Research for the Free Radical and Radiation Biology Program at the University of Iowa. While in Iowa, his reputation as an innovative researcher within the radiation biology and the wider scientific communities continued to grow. Although his overall interests in normal tissue injury remained relatively broad until the time of his death, it was during this period that medical problems within Mike's family, most notably with regard to his wife, Lucy, brought a deeper focus to Mike's research on brain radiation biology: For example, he began to more closely investigate the response of both brain tumor and normal tissue to radiation therapy, and how interactions between the two, dependently and independently, affect late outcomes.With his move to the Wake Forest School of Medicine in 2001, as a Professor in the Department of Radiation Oncology and Section Head of Radiation Biology, Mike continued this work, developing a senior leadership role in the Thomas K. Hearn Brain Tumor Center of Excellence. He fostered strong collaborative ties and gained the respect of investigators from both inside and outside his home institution, for example with the Blomgren  and, with her support, continued his scientific initiatives against cancer, up to and even during his own illness. In addition to research, Mike had other passions, including racing/sport motorcycles, World War II history, traveling, and hiking with his wife and dogs, Dash, Chase, and Stella. For many of us within the radiation biology community, Mike was a beloved friend and colleague and will be greatly missed, especially for his keen scientific mind, his passion and enthusiasm, his mentoring and counsel, and for his dry sense of humor.Mike is survived by his wife Pam, his mother, Liliane, his brother, Mark and sister, Monique."}
{"text": "The report, which focuses on cardiovascular disease, is available at http://www.thecommunityguide.org/annualreport/index.html.The Community Preventive Services Task Force recently posted its Established in 1996 by the U.S. Department of Health and Human Services, the task force is an independent, nonfederal, unpaid panel of public health and prevention experts whose members are appointed by the Director of CDC. The task force provides information for a wide range of decision makers on programs, services, and policies aimed at improving population health. Although CDC provides administrative, research, and technical support for the task force, the recommendations developed are those of the task force and do not undergo review or approval by CDC."}
{"text": "Department of Health and Human Services, the task force is an independent, nonfederal, uncompensated panel of public health and prevention experts whose members are appointed by the Director of CDC. The task force provides information for a wide range of decision makers on programs, services, and policies aimed at improving population health. Although CDC provides administrative, research, and technical support for the task force, the recommendations developed are those of the task force and do not undergo review or approval by CDC."}
{"text": "The information is available at Established in 1996 by the U.S. Department of Health and Human Services, the task force is an independent, nonfederal, uncompensated panel of public health and prevention experts whose members are appointed by the Director of CDC. The task force provides information for a wide range of decision makers on programs, services, and policies aimed at improving population health. Although CDC provides administrative, research, and technical support for the task force, the recommendations developed are those of the task force and do not undergo review or approval by CDC."}
{"text": "As an important component of traditional medicine, Traditional Chinese Medicine (TCM) is widely spread and applied in more than 100 countries across the world. The standardization of TCM is very important for the international application of Chinese medicine. In this paper, we have explained and analyzed the standardization situations of TCM in China with the purpose of providing reference for standardization and international development of TCM. WHO Traditional Medicine Strategy: 2014\u20132023 released by the World Health Organization shows that TCM has spread to more than 100 countries and has grown into an international industry [TCM has been widely applied to prevention and treatment for various diseases from ancient times till now . TCM, a industry .As the country of origin and application of TCM, China has a unique TCM theoretic system and effective treatment methods. In recent years, after the constant transformation of concepts and methods, great breakthroughs and remarkable achievements have been made in terms of standardization of TCM, but some problems remain . In this Several Opinions of the State Council on Supporting and Promoting the Development of Traditional Chinese Medicine, in which \u201cpromoting the standardization of TCM\u201d was included.Standardization of TCM, under the principle of \u201cunification, simplification, coordination, and optimization\u201d and by its comprehensive use, refers to developing and applying standards to the various links, processes, and objects of TCM such as medical care, scientific research, education, industry, culture, and management, to promote academic development and propagation of achievement of TCM, to standardize management of TCM, to guarantee the quality and safety of TCM, to promote the modernization and international communication of TCM so as to achieve good economic and social benefits, and to achieve guiding and supporting a series of activities for the purpose of the comprehensive development of TCM . StandarIn the National Work Conference on Traditional Chinese Medicine convened in 2011, Comrade Li Keqiang, a member of Central Politburo Standing Committee of the Communist Party of China and Vice Premier of the State Council, stressed that \u201cthe construction for the standardization of TCM should be strengthened.\u201d Twelfth Five-Year Planning Outline for National Economic and Social Development of the People's Republic of China, National Development and Reform Commission has included \u201cpromotion of standardization and normalization of TCM\u201d as one of the important tasks. Ministry of Science and Technology took the lead to formulate Traditional Chinese Medicine Innovation Development Planning Outline 2006\u20132020, in which the standardization of TCM was set as one priority area for being the standard specifications of the international traditional medicine. Standardization Administration of the People's Republic of China will support the TCM as an important field for international breakthrough and arrange almost hundreds of standard items of TCM in the service standard development plan.In theDuring the \u201cEleventh Five-Year Plan\u201d period, the TCM standard system has been basically established. The system consists of four categories of standards, namely, basic standards, technical standards, management standards, and working standards , and for Classification and Codes of Diseases and ZHENG of Traditional Chinese Medicine (GB/T15657-1995) as China's first national standard for classification of TCM diseases stipulates the classification principles and coding methods of diseases and ZHENG of TCM and has the corresponding computer software, promoting the standardization of TCM clinical diagnosis; Clinic Terminology of Traditional Chinese Medical Diagnosis and Treatment-Diseases (GB/T 16751.1-1997), Clinic Terminology of Traditional Chinese Medical Diagnosis and Treatment-Syndromes (GB/T 16751.2-1997), and Clinic Terminology of Traditional Chinese Medical Diagnosis and Treatment-Therapeutic Methods (GB/T 16751.3-1997) specify the basic terminology of common diseases, syndromes, and therapeutic principles of TCM to improve the medical quality of TCM and the level of scientific management of medical institutions of TCM positive role and Basic Theory Terminology of Traditional Chinese Medicine (GB/T 20348-2006) provides the basic standard for the terminology of TCM theories such as Yin and Yang, five elements, and main and collateral channels, which is of great significance for the inheritance and innovation of TCM and meeting the needs of the teaching, scientific research, health care, management, and foreign exchange of TCM [The formulation of basic and general standards of Traditional Chinese Medicine started with the focus on formulation and revision for basic theoretical terminology, terminology of some subjects of TCM and their classification and codes, and other standards to achieve TCM terminology standardization. Five national standards of TCM have been issued in succession, namely,e of TCM . Criteria of Diagnosis and Therapeutic Effect of Diseases and Syndromes in TCM (ZY/T001.1-94) and Clinical Guidelines for Emergency Treatment of Internal Medicine of Traditional Chinese Medicine (YY228), and TCM academic societies have issued over 50 technical specifications [ Criteria of Diagnosis and Therapeutic Effect of Diseases and Syndromes in TCM is the first industry standard of TCM in China for 9 clinical departments with 406 diseases and syndromes, including internal medicine, surgery, gynecology, and pediatrics, marking that the major progress was made in the standardization of TCM industry in China.The clinical practice of TCM needs not only the guidance of TCM theory but the tools of medical treatment. From the 1980s to 2002, TCM authorities have issued nearly 70 technical standards such asications . Criteri Routine and Technical Operation Regulation of Nursing Care in TCM (ZYYXH/T 1.1-2006~ZYYXH/T 1.18-2006) for nursing care of clinical departments such as internal medicine, surgery, gynecology, and pediatrics, 19 standards for the series of Technical Specification of Health Preservation and Prevention of Chinese Medicine (ZYYXH/T 158-2010~ZYYXH/T 176-2010) with massage on the spine, the whole body, pediatrics and moxibustion, medicinal liquor, acupoint sticking, cupping, and so on to guide and standardize technical operations of TCM health care of care physicians and technicians and make technical operations more standardized and more safe, 1 standard of Classification and Determination of Constitution in TCM (ZYYXH/T 157-2009) as the important reference basis for the clinical practice, to determine the specification and quality evaluation, 10 standards for the series of Standard Specifications for Study and Compilation of Traditional Chinese Medicine Classics (ZYYXH/T 362-2012~ZYYXH/T 371-2012) for proofreading TCM classics, 1 standard of Clinical Guidelines of Chinese Medicine on Sub-Health (ZYYXH/T 2-2006) for clarifying the understanding of subhealth of TCM, common syndromes, and intervention principles of TCM on subhealth to gain the scientific, standardized diagnosis and intervention on subhealth and provide evidences for the feasible health management plan and intervention measures on subhealth [ Guidelines for TCM Diabetes Prevention and Treatment (ZYYXH/T 3.1-2007~ZYYXH/T 3.15-2007) for the course, complications, and merged diseases of diabetes to have detailed and normative prevention and treatment strategy of TCM, achieving the standardized, scientific prevention and treatment of TCM of diabetes [ Guideline for Diagnosis and Treatment of Tumor in TCM (ZYYXH/T 136-2008~ZYYXH/T 156-2008) for the standard of differentiation of syndromes and signs for classification and diagnosis and treatment of TCM of common malignant tumor  established Committee of TCM Standardization Technology with the code of ISO/TC249 (tentatively) . In ISO/ Codes of International Classification of Diseases (ICD-11), WHO has decided to include the traditional medicine, and China has actively participated in the preparation of traditional medicine. All of the works lay an important milestone for the international standardization of TCM and also are the important opportunities for China to regain the initiative in the international standardization.Upon the revision ofSince 1980s, the constant exploration on the standardization of Traditional Chinese Medicine (TCM) has made certain achievements. However, on account of its long-term, arduous, and complex nature, the current TCM standardization still falls behind with the developmental needs of TCM.Since TCM standardization is still in its developing phase and inadequate in publicizing and implementing, a number of TCM practitioners still hold weak consciousness and different cognitions towards TCM standardization, thus resulting in their infirm identity, urgency, and responsibility for carrying out TCM standardization . TherefoPublished standardization at present revealed limited coverage in criteria of TCM, emphasizing the foundation and operation without covering in all areas. The application of the latest industry standards of seven clinical trials of TCM into clinical trials for 11 kinds of gynecology diseases has gained international recognition , which m Clinic Terms of Traditional Chinese Medicine in 1997, it has not yet been revised till now. As a consequence, the lagging update of standards makes them detached with reality and thus unable to truly reflect the current academic level and management requirements of TCM, which hinders the popularization and application of TCM standards [Many of the present standardizations are mainly based on the literatures and lack of evidence-based medicine and clinical evidence, which impede their execution in clinical practice . Moreovetandards .For the present situation, methodology researches of the standard revision need to be improved to reach a redaction method suitable for its own features of TCM, which will perform a positive effect on TCM standardization. the Guidance on Strengthening the Standardization of Traditional Chinese Medicine, under whose direction support system of TCM standardization is bound to receive a much more comprehensive and orderly development.Development of TCM standards is witnessing booming growth, while the progress of related support system is comparatively slow, which is still in its infancy and in need of further refining. So far, the management, implementation, and supervision system of TCM standardization is still incomplete; surveys and feedbacks of its applicability are also imperfect; what is more, it also shows a shortage of talented professionals in such a field . In 2012Most of the present established TCM standards are domestic, with few international ones. So it is important to take full advantage of China's status as a permanent member of international standardization organization as well as its working role in secretariat of TCM technical committee, so as to play an active part in setting development strategies, regulations, and projects of TCM standardization; besides, dominance of TCM international standardization should be seized in order to promote the transformation of TCM standards to international ones . The Medium- and Long-Term Development Plan about the Standardization of Traditional Chinese Medicine (2011\u20132020) has been published, and we believe, under its direction, there will be a more scientific and orderly development of TCM standardization for the services of people's health.The standardization of TCM is a gradual process, as well as a course of innovation and academic progress. Because of its fundamental, strategic, and global effects in development of TCM, the standardization should be promoted under a comprehensive plan and top design and proceeded with phased and planned steps . The Med"}
{"text": "Lean thinking is on the rise in health surveys,particularly internationally, especially in the USA and UK, improving thestructure, process and outcome of care and management actions. However, it is anemerging theme in nursing.  this study showed that the use of lean thinking in the context of health has atransforming effect on care and organizational aspects, promoting advantages interms of quality, safety and efficiency of health care and nursing focused on thepatient. This term wasfirst used by Krafcik and popularized by Womack and Jones, in 1992 with the publicationof the book \"the machine that changed the world\"-The term, -Despite the origin of lean thinking in the industrial context, its principles have beenused in various scenarios, including health. This universal applicability of the leanconcept is due to the similarity of the production processes of organizations,regardless of their specific nature, which try to plan and execute a series of actionsin a certain sequence and time, to provide value for a customer The introduction of lean thinking in health, or, lean healthcare, occurred in astructured and systematic way in 2006. That year, the Lean Enterprise Academy (LEA), aBritish non-profit, organization dedicated to the study and dissemination of leanthinking, organized the first congress on the implementation of lean principles inhealth services ,-Since then, health organizations have adopted lean thinking as a strategy to providebest care in several countries, including the United States-Thedacare (Wisconsin);Virginia Mason Medical Center (Washington), and Martin Health System (Florida); Sweden-Astrid Lindgren Children's Hospital; United Kingdom - the Bolton Hospitals; andAustralia- the Flinders Medical Centre Lean within the health environment is still little explored in Brazil. During the searchon Google Scholar, in 2014, five Brazilian studies were found: one article and fourdissertations. The studies explore aspects of applicability and benefits of lean in ahospital laundry Lean thinking consists of a systematic approach that enables the identification andelimination of waste in production processes, focusing mainly on aggregate quality anddelivering to the customer only what he considers to be of value Another principle is the elimination of activities that do not generate value, alongwith any waste . Such waste does not allow that the process of care and treatment occurwithout interruption, detours, returns or delays. Thus, with the elimination of theseissues, the efficiency of activities and quality of service simultaneously increase-In the health service, the aspects that the patient values include a better, safer,faster, qualified and decisive care, according to his/her needs, aiming for the fullrecovery of his/her well-being (19). It is a widely diffused model within the quality health assessmentarea Several studies in the international literature about lean in health care aim tocontribute to these scientific publications and innovations addressing this theme,therefore, the present study presents the contributions of this management model basedon the triad of the quality evaluation model in health proposed by Donabedian,-Process corresponds to the set of activities that occurbetween professionals and patients during care delivery and includes both the technicalcomponents of care , as well asinterpersonal relationships ,-Outcome refers to the effects of care on the patient's healthstatus and also includes the customer and staff satisfaction with receiving andproviding care, respectively ,-The three domains or conceptual assessment variables of this model are: structure,process and outcome. Structure is related to the physical and organizational settings,in which care occurs. Attributes included are: material resources , human resources ,and organizational structure In light of the foregoing, the question is: what evidence is available in the scientificliterature regarding the use of lean thinking in health care and nursing? How do leanpractices impact the actions of health care in relation to the structure, process andoutcome dimensions?Thus, the objective was to demonstrate the scientific knowledge about lean thinking inthe health area, emphasizing the impact and contributions to health care andnursing.An integrative literature review was adopted to meet the objective of the study. This isa wider type of revision that includes both experimental and non-experimental research,allowing for the synthesis of multiple published studies and the development of acomprehensive explanation of a specific phenomenon. This method provides foridentification of gaps in current knowledge that need to be understood with thedevelopment of new studies. The steps of this review were: statement of the researchquestion; data collection; data evaluation; analysis and interpretation of data;presentation of results; and conclusions (24-25). Data collection was conducted in February and March of 2015, using: the Latin Americanand Caribbean Health Sciences (LILACS), Publisher Medline (PubMed), Cumulative Index toNursing and Allied Health Literature (CINAHL), Scopus, Web of Science, Emerald and inthe electronic library, Scientific Electronic Library Online (SciELO) databases. Using these syntaxes, the following results were obtained: 26 articles in LILACS, 348articles in PubMed, 181 articles in CINAHL, 567 in Scopus, 174 in Web of Science, 62 inEmerald, and 77 in SciELO, totaling 1,435 publications.The inclusion criteria for articles were: original articles with abstracts availableonline, published from 2006 to 2014, in Portuguese, Spanish or English, that focus onlean thinking-related to health, as well as its contributions to the professional careactions of the area. This timeframe was used due to the fact that lean, in health, beganto have greater visibility from the year 2006 (5). Articles duplicated in more than onedatabase were deleted and only one was used. The final sample consisted of 47 articles, PubMed (seven), CINAHL (seven), Scopus, (20),Web of Science (11), Emerald (2), as described in Data categorization was guided by the triad of a conceptual model for quality assessmentin health, developed by DonabedianBased on the year of publication, an increase in new articles was observed, consideringthe 47 that were selected that were written over the years. The year of 2012 recordedthe highest number of published articles, at 11 (23.4%).Journal of Health Organization and Management with fourarticles (8.5%); and two articles (5.9%) published in each of the following journalsrelated to lean thinking in health: BMC Health Services Research withthree articles (6.4%); Quality & Safety in Health Care;Canadian Journal of Emergency Medical Care; InternationalJournal of Health Care Quality Assurance; Leadership in HealthServices; Quality & Safety in Health Care;Quality Management in Health Care.Regarding publication language, all articles included were published in English, in 37different journals, especially those related to management and quality in health care,such as the Regarding the country of origin of publication, 16 (34%) were submitted from the UnitedStates, seven (14.9%) from the United Kingdom, five (10.6%) from Holland, eight (17%)from Sweden, and two (4.3%) from Canada. Australia, Spain, Italy, Luxembourg, Malaysia,Norway, China accounted for another 14.9%, with one article for each country. Twostudies (4.3%) were conducted in more than one country. No articles were identified fromSouth America.In relation to scenarios where the studies were conducted, the hospital environment washighlighted with 44 articles (93.6%). The most exploited sectors were: emergency rooms,operating rooms, and intensive care units. The other sites studied were primary care,with two articles (4.3%) and one article (2.1%) on both scenarios: hospitals and primarycare.Regarding the type of study, all articles included in the review were derived fromoriginal research; 28 (59.6%) used a quantitative approach, 12 (25.5%) a qualitativeapproach, and seven (14.9%) a mixed approach search. Another aspect analyzed was the profession of the authors. In this regard, of the 47articles, 28 did not specify the professional background of the authors. Of the 19 whoprovided this information, it is emphasized that ten articles had nurse participation,four with the exclusive authorship coming from this profession.The use of lean thinking is on the rise in health research in the global context andappears across multiple care settings. In this sense, it is observed that the articleswere published in different journals which identify heterogeneity in the publication ofthe issue, but a homogeneous distribution of the number of articles published betweenthem.(6.73).Most studies were implemented in the United States, which may be associated with thepioneering of this country in the implementation of lean concepts inhealthWith regard to the scenarios used for conducting these studies, the hospital environmentpredominated, across various units. This demonstrates the applicability of lean at amultiplicity of hospital care facilities. A similar result is described in a previousliterature review on the implementation of lean thinking in healthcareThe incipient participation of nurses as authors on this subject was observed. Thisresult may be associated with the origin of lean thinking in the area of administrationand engineeringRegarding the content of the articles, the results will be discussed according to thecategories of quality assessment from the triad in health.,,,Regarding the physical structure of the places where care is provided, the studieswere implemented in various units, including: chemotherapy-,-,-Regarding the normative, technical and administrative instruments, lean thinkingguides should be standardized and simplified care processes in order to reducebureaucracy and facilitate health care. These changes inspired by lean reduceambiguity at work, a more continuous flow of care, and allows team members to be moreautonomous in the execution of activities and problem solvingIn a study performed in a surgical centerIn another study,,,(36.56).It is highlighted that the use of lean thinking provides economic improvements andpositive impacts on the financial income of healthcare organizations, by increasingthe capacity for patient careAnother attribute of the structure component is human resources. By using lean tooptimize the operating room capacity at a hospital in Luxembourg, it was possible toincrease the number of annual surgeries without any increase in the quantity ofpersonnel. However, this required training and motivation of the hospital staff,which had repercussions on eliminating unnecessary waiting periods and stress beforesurgery and increased the transfer rate of patients in the operating room to otherunits-The lean methodology is anchored in appreciation and respect for people, professionaltraining and instructions on the workplace, enabling the improvement of professionalsinvolved in the care process and optimizing the quality of care and patientsafetyResearch performed in the United States revealed that the ideal professional toconduct a lean transformation in a hospital is the nurse because he has experienceleading multidisciplinary teams and is committed to patient care, and can viewhospital systems from the patient's perspectiveInformation systems, also recognized as a component of structure, bring together aset of data, information, and knowledge to support the planning, development anddecision-making processes of health professionals involved in patient care for thehealth system patientsA study performed in diagnostic support services in a clinical hospital in the UnitedKingdom (UK)Another study performed in an emergency room in SwedenIn addition to allowing the comparison between the current and future state in aparticular care environment, the combination of simulation with lean thinking canmake the flow of care more efficient, reducing the waiting list of patients andassisting in the selection of optimal resources, the process for service managementin hospitals, eliminating or minimizing the use of a trial and error approach,,-,,,For the care process to succeed there must be commitment, involvement and continuedsupport of leaders for the \"front line\" professionals in the health institutions(8.74).Lean thinking is the assumption that nurses and other professionals working on the\"front line\" of health services are better able to decide what patients need to havetheir needs met, considering good clinical practiceA study performed in a UK hospital specializing in cardiothoracic care highlightedthe importance of managerial skills as essential strategies to facilitate theimplementation of lean in health care, such as: open dialogue; ability to inspirepeople to approach old problems in new ways; maintaining the enthusiasm of workers;and the development of actions to facilitate and enhance communication amongprofessionals The application of lean principles improves patient care. In a study performed in ahospital emergency room in Canada, for patients with acute coronary syndrome, it waspossible to reduce the time of medical interpretation of the electrocardiogram (ECG),medical evaluation, and administration of acetylsalicylic acid through the use oflean principlesTo achieve these goals some changes were necessary in the process of care for thesepatients, including: a specific ECG room next to the emergency triage was created;nurse triage is now the first contact for the patient in the unit, rather than thesecretary; materials and equipment were relocated to reduce the movement of the nurseand the patient at the time of service; a procedure was established for immediate ECGinterpretation by the doctor; readjustment of risk stratification tools for use bynurses; screening and clarification of the criteria for activation of the flowchartfor care of patients with acute coronary syndrome. The application of lean principlessignificantly improved the performance of early diagnosis and therapeutic targets foremergency cardiac care in this service.,,,,,,,(36.55 to 56); andmanages change and problem-solving using a scientific approach,,In addition to improving the care provided to patients, lean thinking is a methodthat seeks to understand the processes in order to identify and analyze problems andexisting waste,-,,-,-,,-,,,-,-,-,(45.67); Kaizen-,,,-,,,,-,,,,,,Lean uses several tools to improve care processes, among which the following werehighlighted in the articles: value stream mapping,-,,,-,-,-,,-,-,,-,-,-,-,,,,,,,,,,,-,,,,,,,,-,,-,,,(27 to 29.38), increasedpatient satisfaction-,,(27 to 28.41); increased access tocare,,,,,--(41.54), reduction in employee overtime(27.59); early hospital discharge,,All the articles analyzed reported successes and benefits for outcomes when using leanprinciples in health, both in health care and organizational aspects. The main effectsfound were: increased productivity and staff efficiency(28.61). It is essential that there is a continuous learningenvironment to facilitate the implementation of Lean principles. The challenges inimplementing the Lean system are: to maintain the support of health professionals andleaders of hospitals, availability of time, resources and lack of training of leaders /managers with vision in Lean,,,,However, in order for lean systems to improve metrics of care and patient satisfaction,health professionals, hospital managers, and the stakeholders involved will depend onthe team's degree of commitment to lean principles and organizationalcultureThis study enabled us to show that Lean thinking in health is a management model thatimproves the structure, process and outcome, from the care and management actions. Theprinciples of Lean thinking is widespread in various contexts of health, such asemergency, oncology, pharmacy, intensive care unit, radiology, orthopedics, mentalhealth clinics and cardiology services.The main impacts from the application of this thinking in health are increasingproductivity and team efficiency; reduction in waiting time for patient care;standardization of care process, reducing costs, improved teamwork, reduction in thepatient's hospital length; increasing the quality of service provided; increased patientsatisfaction; increasing patient safety and health professionals; and employeesatisfaction.It emphasizes the need for further studies on the applicability of Lean thinking in careenvironments in Brazil due to most publications focus on an international level, mainlyin the United States and the United Kingdom. It is also important to highlight theimportance of new nursing research that specifically objectifies the participation ofthe profession in this context. The participation of nurses in the scientific literaturerelated to this issue is still incipient, even though he has been considered aprofessional able to lead a Lean transformation."}
{"text": "The last thirty years have been characterized by tremendous growth in the number of existing health networks world-wide; yet, little is known about why such networks emerge, what their effects are, and their roles in the governance of health .can mean, and what it should mean, given the constraints and realities. Each partner contributes toward the network by strengthening the capacities of the medical, legal, and/or justice sectors to care for survivors of SGBV, and by building an evidence base for SGBV programming. Partners develop, implement, and evaluate core elements of a multi-sectoral response model that incorporates the overlapping and complementary responsibilities of the health, police and justice, and social service sectors. The ethos of the Africa Regional SGBV Network centers on the conviction that survivors require access to all services, but that it may not be feasible, appropriate, or cost-effective to deliver all services in one location. Through their interventions over the years, network partners have not taken the conventional understanding of a multi-sectoral approach for granted, but have instead allowed other viewpoints and actions to emerge in regard to such an approach. Where necessary, partners have conceived programmatic response to survivors' service needs differently, testing out innovative and, sometimes, daring approaches.The 'Africa Regional Sexual and Gender-Based Violence (SGBV) Network' emerged in the East and Southern African region in 2006. Led and coordinated by the Population Council, this network materialized as a consequence of the landscape of SGBV work in the region. At the time, while discourse and initiatives related to SGBV prevention were not unheard of, far less attention was being given to programmatic response to the service needs of SGBV survivors. With initial funding from the Swedish-Norwegian Regional HIV and AIDS Team for Africa, Embassy of Sweden, Lusaka, Zambia, the Population Council identified a number of implementing partner organizations in East and Southern Africa to facilitate collective action around the issue of responding to the needs of SGBV survivors in the region. Since then, network partner organizations have continued to work on fostering a multi-sectoral response  in their countries and beyond - exploring what such a response means in low-resource settings, what it Africa Regional SGBV Network convened a meeting in Washington, DC, USA. The meeting commemorated the 16 Days of Activism Against Gender Violence and raised awareness of interventions for survivors of SGBV in low-resource contexts. The forum reflected a culmination of efforts from seven years of grounded research and practice-building in the field of SGBV, and brought together network partner organizations from Kenya, South Africa, Swaziland, and Zambia, in addition to policy, practitioner, and researcher audiences from the Washington, DC area.On December 4, 2013, for the first time ever, the This volume of extended abstracts summarizes network partner presentations delivered during the meeting. The presentations centered on each partner's interventions and main results, coupled with the effectiveness of partners' endeavors in responding to the needs of survivors. The notion of 'effectiveness' as employed here draws on Shiffman's  definitichange the world to meet their members' perceptions of what reality should look like [Effectiveness refers to the extent to which networks are able to ook like . We examAfrica Regional SGBV Network have engendered in the East and Southern African region.Accordingly, this collection of extended abstracts highlights the nature of policy consequences that the efforts of the The current volume appears during an exciting time of 'climate change' in SGBV work, where SGBV prevention initiatives in particular are receiving mounting attention in the East and Southern African region. While there is good reason for this near-singular focus on prevention, this volume will remind readers that any supposed dichotomy between 'prevention' and 'response' is artificial, at best. Both are closely interconnected and critical, and work hand in hand with one another. In responding to SGBV, we prevent it - and in preventing SGBV, we respond to it. Furthermore, compared to other parts of the world, SGBV 'prevention' and 'response' alike are in their infancy in East and Southern Africa.Africa Regional SGBV Network is 'changing the world' to meet its members' perceptions of what reality should look like in regard to programmatic response to the needs of survivors in the region.In responding to SGBV, and in bringing about policy consequences (as defined above), the Population Council and its partners are changing the way the world thinks about the critical health and development issue that SGBV represents in East and Southern Africa. Indeed, as each of the extended abstracts in this volume demonstrates, in diverse ways, the"}
{"text": "Moststudies were published after 2013 (57%), originating from the United States andUnited Kingdom (77.8%). It was observed the use of social networking among nursingstudents, postgraduate students, mentors and nurses, in undergraduate programmes,hybrid education (blended-learning) and in interprofessional education. The socialnetworking sites used in the teaching and learning process were Facebook (42.8%),Ning (28.5%), Twitter (21.4%) and MySpace (7.1%), by means of audios, videos,quizzes, animations, forums, guidance, support, discussions and research group. few experiences of the use of social networking in nursing education were foundand their contributions show the numerous benefits and difficulties faced,providing resourses for the improvement and revaluation of their use in theteaching and learning process. Web-based social networking are activities resulting in connections and interactionsbetween individuals and groups using a wide variety of tools. These tools include email,blogs, instant messaging, text messages and posts as well as programs that enabledigital information sharing in video, audio or text format. Social networking websitesintegrate these tools in easy to handle formats and allow users to determine how andwith whom they will share their informationThe increase in the use of social networking, evidently, has become a common phenomenonin recent years and generated great impact on the development of forms of interactionand socialization among studentsIn this way, social networking represents an attractive tool for the educational field,because the students are thoroughly familiar with them and willing to establish morefluid communication with the aim to exchange knowledge, information and ideasThe educational use of social networking is growing among academics as a powerful toolsfor teaching and learningTeachers have been engaged in using technology to make learning more personalized,interactive and dynamic, making it easier for students to work with audio, video,interactive games, and more recently, with blogs and social networkingIn short, social networking can be a perfect tool for learning, however, despite theincrease in their use, only few students use them for school purposesHaving knowledge of the possibilities of the use of social networking in teaching andtaking into account the panorama of healthcare education, has social networkingtechnology been used in nursing education? That was the guiding question of this study,with the purpose of knowing the possibilities, ways, successes and failures of their usein this area of study.To identify the use of social networking in nursing education.The integrative literature review was the research method used to achieve the objectiveof this study, since it has as an advantage the possibility of synthesis and analysis ofthe scientific knowledge already produced about the research theme.This research method is characterized by presenting an extensive methodological approachwith regard to the literature reviews, allowing the inclusion of multiple studies withdifferent research designs for the complete understanding of the phenomenon studied.This method combines both data of the theoretical literature and empirical, andincorporate wide range of purposes: definition of concepts, review of theories andevidences, and analysis of methodological problems on a particular subjectThe six steps followed to elaborate the integrative review were: definition of theresearch subject, establishment of the inclusion and exclusion criteria for theliterature search, definition of the information to be extracted from the studies,evaluation of the studies included, interpretation of results and data synthesisThe inclusion criteria for this review were the studies published throughout the periodallowed by the selected databases, aiming at including the largest possible number ofarticles, taking into consideration the contemporaneity of the subject studied.According to the exclusion criteria, it was removed studies addressing the use of socialnetworking with other approaches, such as:- in higher education of other professional groups, elementary education, highschool education and technical education;- in research using social networking as a data collection method andinterviews;- in the approaches on the use of social networking as a security method inschool environments;- in the approaches on the user's safety in the use of social networking;- in the posts and comments from students on social networking;- regarding to the ethical aspects of the use of social networking;- in education focused on the patient and on community;- on the use of other technologies such as Wikis (hypertext), videoconferencing, virtual environments, mobile devices, blogs (websites in theformat of dairy), YouTube, text messaging, Web sites and simulation of virtualreality.The studies were resulting from journals indexed in the databases: Latin American andCaribbean Health Sciences (LILACS), Spanish Bibliographic Index of the Health Sciences(IBECS), Cochrane, Brazilian Nursing Databases (BDENF) Scientific Electronic LibraryOnline (SciELO), Cumulative Index to Nursing and Allied Health Literature (CINAHL),Scopus, PubMed, CAPES Periodicals Portal and Web of Science.A query in the Descriptors of Health Science (MeSH) and in the Medical Subject Headings(MeSH) was performed for the selection of articles, and it was identified and used thedescriptors: social networking and nursing education.Aiming at analyzing any publication related to the theme and in order to expand thestudy sample, the keywords \"social networking sites\" and \"nursing education\" were alsoused as search strategy, with the main question and the inclusion and exclusion criteriapreviously established as guidelines to maintain the consistency in the search forarticles and avoid possible bias.In April 2015, therefore, a search using the descriptors and a second research using thekeywords were carried out in all databases .Firstly, it was carried out the reading of the titles and abstracts of the total sample,taking into account the inclusion and exclusion criteria. Thus, of the total of 489articles found, 97 articles were selected.In a second moment, of the 97 articles selected, it was performed the removal of 72duplicate articles, and the sample consisted of 25 articles.In the third moment, it was carried out the reading in full of those 25 articles, and 11articles were removed for not meeting the inclusion and exclusion criteria, thus thefinal sample was composed of 14 articles.For the analysis in full of the selected articles, an instrument of collection andsynthesis of data was used in order to extract, organize and summarize the informationand facilitate the construction of the database.The instrument developed and validated by Ursi and Galv\u00e3oIn this integrative review of the 489 articles found, 14 articles met the inclusion andexclusion criteria and composed the sample, as shown in In this integrative review, it was found an article in 2007, two in 2008, two in 2010,one in 2011, three in 2013 and five in 2014.According to the population target of the nursing education, it is emphasized that sevenarticles cite the use of social networking with nursing students (50%), an article waitsfor the approval for its use with postgraduate students in nursing (7.1%), an articlementions the use of social networking by nursing mentors (7.1%), an article uses socialnetworking to newly hired nurses in a neonatal hospital (7.1%) and four articles listthe benefits of its use in nursing education (28.6%).Among the seven studies involving nursing students, it was observed that four wereperformed in undergraduate nursing programmes (57.1%), one was developed in hybrideducation involving nursing students (14.3%) and two addressed the interprofessionaleducation among nursing students and other professionals (28.6%).Regarding the study sites, it was observed that among the articles that used socialnetworking with nursing students, the majority of them (44.5%) were developed in theUnited States of America (USA), with two studies in Minnesota, one in Arizona and oneinvolving eleven universities in the USA. In addition, there was a study developed inMalaysia, one in Queensland, Australia and another one in Glamorgan, United Kingdom.The study involved the use of social networking for mentors in nursing and it wasdeveloped at the University of Nottingham in UK, and the study involving newly hirednurses of a neonatal hospital was also held in London in UK. In this way, the studiesanalyzed were developed in several countries and in total, four studies (44.5%) werecarried out in the US, three (33.3%) in UK, one was performed (11.1%) in Malaysia andone in Australia.Analyzing the authors of the studies in this review, it can be observed that almost halfof publications on the subject in focus were discussed by two authors: Skiba DS (4:28.5%) and Pittenger AL (2: 14.2%).Among the topics covered on the use of social networking with nursing students, it wasobserved that the topics and subjects were very diversified, and thus it was possible tohighlight: information technology and project management, safe administration ofmedications, disparities in the healthcare system in the US, recommendations for theincorporation of social networking in education, diabetes management, critical care andthe practice of ethical and moral behavior.Social networking sites have been used in different ways for nursing education. Sixarticles (60%) used them in teaching of a certain content by means of audios, videos,quizzes, animations, forums, guidance and support; three articles (30%) used them onlyfor the discussion after the transmission of the content and 1 (10%) in the formation ofa research group.According to the types of social networking used in the articles included in thisreview, it is noticed that 6 (42.8%) involved the social network Facebook, 4 (28.5%)used Ning, 3 (21.4%) used Twitter and 1 (7.1%) mentioned the benefits of MySpace.Regarding the studies that addressed other approaches on the use of social networkingwith nursing students, it was observed that two described social networking as tools tobe used in nursing education, a study reported the benefits of using social networking(Facebook and MySpace) to the educators and two others mentioned the benefits to thestudents.The tools used in nursing education were posts, explanations, study groups, academicadvising, connection between students, access to external resources, opportunity forreflection, flexibility, collaboration and feedback.Among the results and benefits cited with the use of Facebook and MySpace, it ishighlighted as benefits for the educators the possibility to learn through socialnetworking, interact with students, work in network with other professionals andestablish interaction and connection without leaving the house in times of financialcrisis.Regarding the students, the social network Facebook allows a better interaction with andamong students, can be used in academic discussions, allows to connect and interact witha wider audience, helps students in the exploration of their professional identity andin the improvement of their social and cognitive skills, allows a social support,increases the time dedicated by the student to learning, can be used in deeperapproaches, helping students to develop their ability to think critically andanalytically. Additionally, Facebook can also be used in research groups and, finally,it can be considered as a novel method for guiding and supporting learning. Besides thebenefits resulting from the use of Facebook, it was also mentioned the difficulties incommunicating complex ideas and the possible increasing lack of attention, which cancause procrastination.With respect to the social network Twitter, it was mentioned that it presents a quickway to communicate with students, facilitates virtual discussion, encourages sociallearning with changes in the dynamics of the classroom, facilitates active, interactiveand reflective learning, enables students to feel as part of the community, allowsstudents to reflect on their own learning and their experiences, sharing them withteachers and other students. However, the use of 140 characters as allowed by thissocial network was considered as a limitation by the participants, who had norestriction of time or space, however, at this time, they have mentioned it in relationto the number of characters.Regarding the social network Ning, it was verified visibility and effectiveness inintegrating interprofesional education, with the addition of knowledge through thecontribution of students of other regions and, consequently, increased understanding ofthe content addressed. It also allows social interaction and active learning, besidesthe perception of improvement of the quality of the discussion with the presence ofteachers in the social networking. Furthermore, Ning is a less expensive way ofinterprofessional education, involving various occupational categories separated due totime and space. It should be added the fact that it is feasible for companies infinancial terms, with regards to the education of workers, because there is no need torelease these workers from the work shift. However, it was not considered easy to handlefor almost half of the study participants.In a study, it was analyzed the form of control by the teachers, on social networking,demonstrating the educator's performance in three different situations. The groupwithout guidance of the teacher failed to achieve the objectives proposed, the groupthat was completely controlled by the teacher only reached the academic proposal and thegroup headed by the educator showed more interaction, discussion, collaboration andemotion transmission, when compared to the other groups.It was also performed the analysis of the teacher's participation at two differenttimes: in a synchronous moment, in which teachers and students were connected in theclassroom, and in an asynchronous moment. There were difficulties in both moments. Inthe synchronous moment, students and teachers were not able to follow the same steps;and in the asynchronous moment, students showed the need of the presence of theteacher.On the basis of the recommendations of the studies included in this review, it wasobserved the need for the safe and proper use of social networking as teaching tools,since they are tools that represent a platform for learning, however, teachers are theones who should plan the scope of an accurate result in the knowledge. Furthermore,educators need to know this kind of learning, addressing the formative and summativeevaluation and should decide how to promote the interaction with their students,exceeding the physical space of the universities and reaching the cyber spaces of theirchoices.-Social networking can provide many opportunities to innovate the teaching and learningprocess and lead to a reflection on the choice of the methods for assessment of the useof these tools-,,It is important to highlight that some studies were conducted in order to provide tostudents freedom to choose the way of interaction, providing, along with socialnetworking , other communication platforms such as Moodle,blogs and forums. Moreover, students gave priority to the access through social network,in relation to the other methods already known in the academic environment,In addition, it was observed that not all students had, previously, an account in socialnetworkingIt is emphasized the need and importance of the presence of the teacher, both in thesynchronous or asynchronous moments, in the use of social networkingOther considerations were addressed in the studies analyzed, such as the importance ofsafety and ethics in the use of social networking-,,The types of interaction were used in various ways, with the students, between students,between students and former students, between students of different professions, betweenstudents and teachers, between students and experts, between students and professionals,with other audience, showing the possibilty to eliminate the barriers of time andspace-,The benefits of using various social networking in nursing education are immense, bothfor the students and educators, which includes the interaction, integration andconnection among students, socialization with teachers, work in network, discussions,social support, reflection and sharing their own learning and experience, possibility ofinterprofessional education and achievement of an active, interactive and a reflectivelearning,,Besides allowing interaction with a wider audience, social networking helps students toexplore their professional identity, enhancing their social and cognitive skills,--Social networking is a subject of study that is still beginning to gain space and theanalysis of the articles can also identify the difficulties encountered in the use ofeach social network ,The recommendations and gaps of the studies show that more research must still becarried out to better understand the use of social networking by students and understandtheir immersion in online discussions groupsThe limitation of this study is related to the small number of internationalpublications found and absence of national publications, which may be related to thekeywords used. The social media descriptor, defined in MeSH as a platform that offersthe ability and tools to create and publish information accessed through the Internet,was not used in this study because of the lack of articles employing this descriptor inthe searches carried out.The results of this study show that social network sites used in the process of teachingand learning were Facebook, Ning, Twitter and MySpace, showing the various contributionsof their use for the area of education in nursing, such as the benefits to the students,educators, professionals and institutions, besides the tools and the way to use them inthe process of teaching and learning.It was observed that social networking was used to transmit various contents in thenursing field, demonstrating completeness in the transmission and discussion of simpleand complex issues, depending on the form of action, control and participation of theteacher. It is also worth mentioning its use in the face-to-face education, distancelearning and hybrid education, both the professional and interprofessional learning,proving to be able to be used in many contexts and in many ways, either for thetransmission of content, discussions or interaction, depending on the objectivesproposed by educators.The difficulties encountered in the use of each social network, as well as theirspecificities, contribute to the improvement of the techniques and evaluation of theirindication in teaching. Further studies are still required, according to therecommendations and gaps identified in this review, especially in relation to theunderstanding of the use of social network by students and ways of assessing thesetools."}
{"text": "This Corrigendum is issued because the Department of Psychology, and the NeuroMi \u2013 Milan Center for Neuroscience are part of, and belong to, the same institution, namely the University of Milano-Bicocca, Milan, Italy. They are not two different institutions, as we erroneously stated in the original manuscript: that erroneous statement may affect the funding of our institutions. Accordingly, Dr. Bolognini and Dr. Vallar have 2 (not 3) affiliations: University of Milano-Bicocca, and IRCCS Istituto Auxologico Italiano, Milan, Italy. We state that the correction and the revised information do not affect the scientific validity of the results.NB, CR, and GV have contributed equally to all stages of this work.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "We note with profound sadness the unexpected death of Alan J. Magill, MD, FASTMH, immediate past-president of the American Society of Tropical Medicine and Hygiene (ASTMH), on September 19, 2015 outside Seattle.Alan was president of our Society in 2014. He served with distinction, bringing to this elected position his characteristic enthusiasm, optimism, and focus. A noteworthy feature of his presidential year was the Ebola outbreak in Africa; he led efforts by the Society to address this horrific epidemic, including support for urgent scientific work and communication, and the need to respect the human rights aspects of the epidemic. He was greatly interested in the future of the Society, in particular its attention to its core missions of sharing scientific evidence, informing health policy, fostering career development, recognizing excellence, and advocating for investment in tropical medicine research. His efforts allowed us to move noticeably closer to the Society's vision of a world free of tropical infectious diseases.Alan was the director of the Malaria Program of the Bill & Melinda Gates Foundation. Under his leadership the Foundation made great strides in its ambitious goal to eradicate malaria. Although there is a long way to go, we have clearly turned the tide on malaria and we have Alan to thank as one of the leading engineers of this success story. More broadly, he was an enthusiastic educator about infectious diseases, and a global leader in the fight against them.Hunter's Tropical Medicine and Emerging Infectious Diseases, a leading textbook; serving as coeditor for CDC Health Information for International Travel (the Yellow Book), the leading resource for travel medicine information in the United States; and authorship of numerous scientific papers and book chapters on malaria, leishmaniasis, travel medicine, and other topics in infectious diseases and military medicine.Following his medical training, Alan served with distinction for 26 years in the U.S. Army Medical Corps, with a focus on clinical infectious diseases and research. His activities included clinical work in Germany, leading the Parasitology group at the U.S. Naval Medical Research Unit No. 6 Peru, directing research efforts to identify important impacts of malaria and leishmaniasis in U.S. military campaigns, and leadership in infectious diseases research at the Walter Reed Army Institute of Research. He was then a program leader at the Defense Advanced Research Projects Agency before moving to the Bill & Melinda Gates Foundation. Among Alan's many accomplishments were leading multiple research efforts at the U.S. Department of Defense, including the development of multiple diagnostics and treatments for malaria and leishmaniasis; discovery of a novel parasitic disease, viscerotropic leishmaniasis; serving as lead editor on the ninth edition of Alan's passion, good humor, intellect, and drive will be greatly missed by the ASTMH. His impacts were huge, with broad contributions on tropical infectious diseases and travel medicine over many years; mentoring generations of clinicians, soldiers, and scientists; and leadership of enormous efforts to control and eradicate malaria and other infectious diseases. For our Society, Alan brought focus to our mission and vision. His contributions and sprit live on as we work to fulfill his goal of a world free of malaria and other serious tropical infections."}
{"text": "Creative and Sensitive, involving 17 ostomized subjects and family members at amunicipal outpatient clinic. The ethical aspects were complied with. Acharacterization form was used, as well as Creativity and Sensitivity Dynamics:\"speaking map\", \"body-knowledge\" and \"calendar\". Critical Discourse Analysis wasapplied. the health needs and care demands of the ostomized patients and their familymembers, in their multiple dimensions, were constituted in the home and community,outpatient and social context, implying new orientations for nursing care. Theunveiling of the data brought elements that constituted guidelines, in amacrosociological approach, to achieve the expanded integrality of nursing care.the ostomized clients are unique in their genre/peculiar from Latin sui generis,calling for strategies that respond to and distinguish their specificities.Elaborating a Public Health Policy that improves and reorganizes the care demands,taking into account these individual biopsychosocial and spiritual aspects, is apossible and irrevocable target in the attempt to achieve better conditions ofhealth and wellbeing. Adding up to the definition, the term process means reflexive activityintended to achieve knowledge on something. Thus, as part of the nurse's modes ofaction, based on the valuation of culture, it could characterize a clinical nursing carepractice.The guidelines for a comprehensive care program to ostomized patients and their family,proposed in this articles, are considered here as a process-based technology in amacrosociological approach. Social technology is understood as a set of applied arts andsocial techniques to support social work, serving as a tool of social inclusion andimprovement of quality of life. Hence, it comprises a replicable product, technique ormethod, developed in the interaction with the community, and represents and effectivesolution of social transformation. Addingpractice..In view of the social group studies, the stoma is a surgical derivation of viscera to the skin at a different point from thenatural excretion orifice. In this surgery, the colon or part of the urinary system is linked to the abdominal wall, communicating them withthe outside with a view to the elimination of feces and/or urine. Thus, the stomapatients starts to use a collector bag stuck to the abdomen to protect theskin..The social repercussions in health for stoma patients and their family start when thestoma needs to be installed and there are difficulties to accept this new situation.There exists evidence that the diagnosis and installation of the stoma influence thelives of the patients and the people they relate with. The clients suffer a biologicalrupture and are confronted with different changes in their life process, ranging fromthe change in the gastrointestinal physiology, when they lose control of theirsphincters, from self-esteem to altered body image, acknowledging their body asdysfunctional. Hence, the stoma alters not only the biological system, but also affectsthe individuals emotional and physiologically, impairing their social relationships.Therefore, they feel stigmatized as they suffer surgical complications in thepostoperative phase and face problems in the experience of their sexuality. In functionof the anatomical change of their body, the way of life of patients living with a stomafor elimination changes. These transformations, in turn, condition the patient's family,affect, professional and social life, entailing the need for family support and aprofessional care structure with a view to faster and more effectiverehabilitation..Based on the observations in the Group of Ostomized Patients that served as the researchscenario, it could be evidenced that, in daily nursing care, the support granted toostomized subjects' problem, in its multiple dimensions, privileges the restoration andmaintenance of the physical body damaged by the surgical derivation. This care model,which remains rooted in the biomedical perspective, does not highlight the multipleSocial Determinants of Health (SDH) that strongly influence the course of life of stomaclients and their families, such as social, economical, cultural, ethnic/racial,psychological and behavioral factors that, as a whole, determine and condition themaintenance of health and the occurrence of diseases. In that perspective, thedifferences in health conditions among human groups may not be justified by biologicalfactors but, on the opposite, the differences in health conditions seem to result fromsocially constructed habits and behaviors and, mainly, from factors beyond theindividual or group's direct control.As social human beings, stoma patients and their relatives are subject to these SDH,linked to their life and health conditions, inherent in the family system with anelimination stoma. Therefore, they need to be unveiled with a view to investing in the\"causes of the causes\" of the health problems and their developments, facing thedifficulties in life with the surgical derivation, entailing the possibility to achievethe integrality of care. The emergence of a specific program to consolidate theorganization of a support network and the operation of a health care process for thisgroup, in the singular space, should be considered. In that sense, the goal was: todescribe the care needs and demands that mark that discursive practices of ostomizedclients and their families, and to discuss guidelines for a comprehensive care programto ostomized clients and their family, organized by macrosociological categories.. Paying attention to the public policies in force in care to stoma clientsand their families can serve as an important tool to assert the rights and duties of SUSusers, managers and health professionals.Concerning the public policies for stoma patients, these have gradually advanced tosupport best practices in the Unified Health System (SUS). In search of alignment withinternational studies, the lack of research that directly focuses on health policies forthe social group being assessed could be observed. One North American study on theDevelopment of a Self-Management Program for Stoma Care is highlighted, which emergesfrom the stoma patients' quality of life recommendations/suggestions, considering theimpact of the surgical derivation on physical, psychological, social and spiritualaspects. Paying. The discussion on the social relationships and their repercussions forhealth serves as the theoretical background to study the achievement of care integralityin view of the contemporary order of capital that alienates and thingifies the relationsbetween the social being and the Social Determinants of Health in the model by Dahlgrenand Whitehead, coping with inequities in health at the different degrees ofgovernability: the general, the private and the singular, as well as the problematizing pedagogy in health, mediating the dialoguewith stoma clients and their relatives.Qualitative field research developed through the Creative and Sensitive Method (CSM) asthe data production axis for the construction, analysis and validation of the researchresults. The dihitehead, copingsingular, as welelatives.The participants were 11 ostomized clients, being seven adults and four elderly; and sixfamily members, being four adults and two elderly, involved in and affected by the stomaproblem in their daily life, totaling 17 subjects. The participants were distributed infour distinct groups of data production, consisting of different family systems, in viewof the criterion that groups should contain between six and eight members at most. Theparticipants were identified using alphanumerical codes, in the order in which the datawere produced, described as follows: researcher/group coordinator (C), research aids (A)and ostomized patients (O). The family members were identified according to the numberattributed to their ostomized patient . Each group was also identified forthe sake of a better organization of the data production and analysis: G1, G2, G3 andG4.Plataforma Brasil, in compliance with National Health CouncilResolution 466/12, Ministry of Health, and approved on November 27th 2012,Opinion 155.748, CAAE 07399512.2.0000.5238. To develop the research, the following stepswere implemented: request for authorization to access the place of study, entry in thescenario and start of the data production process, based on the random collection ofpotential subjects, which took place at the place of study between December/2012 andMarch/2013, where individual interviews were held to collect the participants'characteristics, after they had accepted to participate in the research by signing theInformed Consent Form (ICF). In that sense, during other meetings, three types ofCreativity and Sensitivity Dynamics (CSD) were developed with each group ofparticipants, called \"Spoken Map\", \"Body-Knowledge\" and \"Calendar\", in that order.The research scenario was a Group of Ostomized Patients at a municipal outpatient cliniclocated in Campos dos Goytacazes, RJ. The project was registered on theThe CSD \"Spoken Map\", rooted in the social space, was conducted as follows: on a sheetof paper, each participant (ostomized client and family member) should freely drawand/or write the places/routes taken to attend to their needs after the stoma, outlininglimits and challenges they face along this route. The central theme of the CSD\"Body-Knowledge\" was \"the care demands, what they need to take care and what they do\",where each group participant manifested the place the maintenance care for the stomaclient's body and the relative's body occupied on the silhouette of four physicalbodies, two females and two males, drawn on a sheet of brown paper for the participantsto frame. The CSD \"Calendar\" served to synthesize the data production: on a sheet ofpaper, the subjects should develop an individual artistic production linked to thecentral theme about what the ostomized client (or relative) needs to feel complete andtaken care of. The participants were offered several magazines, scissors, glue, coloredand ballpoint pens..The group discussions were audio recorded electronically. Next, the artistic productionswere organized and digitalized. The combination of the data developed with all thetechniques made up the textual corpus of the research production report, subject tofloating reading to apprehend the main ideas and apply the Critical Discourse Analysis(CDA), triangulating the data that emerged.Among the 17 research participants, 11 were ostomized, with a predominance of ostomized(7), colostomized (9) women. On average, the surgical derivation had been installed for113 months. Ages ranged from young adults to elder elderly. The majority (6) wasmarried, had finished secondary education (4), was evangelical (5) and Catholic (5) andgained a mean family income of one minimum wage (6). The six participating relatives hadthe following degree of family relationship: husband (2), cousin (1), aunt (1), sister(1) and wife (1). The majority (5) started the monitoring in the preoperative phase ofthe ostomy, were female (4), between 34 and 67 years of age. The marital situation ofmost of them was married (3), being (1) divorced and (2) single, with unfinished primaryeducation (3), evangelical (3) and Catholic (3). A family income between one and threeminimum wages was predominant (3).start of the whole newlife (O1). The causes of the adult and elderly, colostomized or ileostomizedresearch subjects' permanent or temporary stoma included reports of tumors, polyps,Firearm Perforation (FP), ulcerative rectocolitis, Chron disease and medical errors,such as inappropriate diagnosis and intestinal abscess due to tubal infection, caused byan examination done wrongly.The research participants used language as a form of social practice. The health needs,care demands and borderline situations, in their multiple dimensions, which marked theirdiscursive practice, were constituted in the domestic and community, outpatient andsocial context, one influencing the other, implying new orientations for nursing care.The stoma clients had different causes underlying the installation of the stoma, whichthey called \"surgery of life\" , being the eat and accomplish dreams, cultivate hope and be optimisticabout the future in view of the new condition of being ostomized , despite difficultiesto accept it: ... a good environment for our daily care, healthy eating, calmplace... for you to take care of yourself... People's love, the kindness of ourrelatives... (O4).The participating stoma patients highlighted that, to feel complete and truly taken careof, they need to I had to buy the box of bag and stomahesive I bought it, because I left thehospital, look, I didn't do it through X, I did it through a privatehospital... (O11). This bag, one possesses one quality and the otheranother, you see? (F4). It's the quality of the bag...(F3). ... for us ostomized patients it would be good to have like... a placejust for us, you see, mainly a bathroom... (O4).The needs and demands of the stoma patient's physical body include the needs and demandsrelated to the maintenance of the stoma, with particular attention for theparticularities of elderly stoma patients; basic hygiene and esthetic care: use ofadjuvant and accessory equipment that attends to their specificity . The quality of the material offered in the market is a constant concern,as what best adapts to the user is not always considered, from the perspective of hiswellbeing and comfort, but what corresponds to the interests of the economic system: ......then I also mentioned the good, because a good diet is extremely important always,despite our restrictions because of the stoma, right?! (O11).Care with meals also stands out because of some adaptations and dietary restrictions theclients go through because of the stoma. The knowledge gained from experience in thisgroups helps to test foods, identifying foods that help to neutralize odors or producestrong smells, foods that soften the feces or provoke intestinal constipation and othersthat produce increased flatulence. In addition, the location of the stoma, the baselinedisease and comorbidities are factors inherent in the diet to be followed: ... I am unable to sit still, work occupies the mind when youoccupy the mind, often I even forget that I use the bag (O1). ...contact with nature, contact with people and with the human being created byGod... (O4).As regards the access to professionals and support networks, besides the family as animportant core of support and care, the networks that take care of the body image and spirit (church) stood out in their respective social spaces.Concerning the socio-interactive needs, the family constitution, leisure and work wereemphasized. The latter serves as a form of social acknowledgement, besides constitutingan escape line from different kinds of problems deriving from the presence of the stoma.The availability of technology, such as the mobile phone, also favors the socialinteraction: ... because in society the laws refer to the rights of citizens, and whichshould be respects, and because it's also difficult for us to get safety and healthcare... (F1).The need to have their rights guaranteed is also highlighted as a matter of citizenship:Some needs and demands of the family members are similar to those of the stoma patients.Besides basic care for health maintenance, the relatives exhibit dynamics characteristicof everyone living with people who present some kind of impairment or who truly serve ascaregivers. In turn, they suffer the social consequences it implies. The thematicsynthesis of the groups highlighted important aspects for the relatives' physical andpsychospiritual health: waking up early, use of sunscreen, use of sunglasses andprescription glasses, going to the gym, exercising and stretching, healthy eatinghabits, water intake, sleep and rest, hygiene and bodily esthetics, creation andmaintenance of bonds at work, with neighbors, friends and family, need for a healthy andcalm mind and spiritual and religious support, such as going to church frequently,reading the bible and praying. In the inter-discourse produced, the care needs anddemands inherent in the relatives' health deserve attention and inclusion in a nursingprocess, with a view to achieving the integrality of health care. The family systemneeds to be balanced to jointly cope with the limitations imposed on the wellbeing ofostomized patients and their family members.In this social group's discursive practice, borderline situations also emerged as afrontier/problem/challenge for the family system's life and health dynamics, as follows:fragmented social networks, contradictions/conflicts in the search for a healthierlifestyle, general environmental conditions and unbalanced/maladjusted/disorganizedhousing conditions and their influence on self-care, unfavorable socioeconomicconditions, alienation from work and its consequences and demands for human life, lackof professional care or its instability, particularities of elderly stoma patients -vulnerability to repercussions of the stoma, the social environment of the stoma patientand its influence on the psychological aspect and how it promotes social practice.Particular attention should be paid to the difficulty to accept his physical conditionin the social sphere, the production of foods and its influence on the behavior of theintestinal elimination stoma. These elements were taken into account in the planning ofthe macrosociological approach guidelines, with a view to better conditions of healthand wellbeing, considering the need to achieve integral health care.. In that perspective, care for a user is an effort towards a complete,holistic and therefore integral approach of each person with health needs who, for acertain period in his life needs nursing care.The integrality of health care needs to be addressed in different dimensions to beachieved as fully as possible in health care. Further approximation betweenprofessionals and users is needed, so that the needs of individuals and groups start toguide the actions, breaking with the vertical imposition of conducts. In tha. They involve a process of measuring the health shortage in a population,in the form of losses in a certain health profile. Assessing them implies constructing ahealth or disease profile. The need grows as the health deficit increases.These needs, characteristic of the human condition, as \"needs for food, shelter,reproduction and health, besides autonomy and freedom\" and the respective demands,\"products of the social relations and linked to lacks\" are social and historicallydetermined. They iUnderstanding that these needs can be captured in the microspace of care, from amacrosociological perspective, producing care demands in health and nursing, thesedemands need to guarantee, in their modus operandi, the possibility to see the client asa whole, in constant interaction with the dynamic environment, allowing the client tofeel complete and truly taken care of. The elements of the macrosociological dimensions that permeate the life of human beings are fundamental to achievehealth and wellbeing. All health needs and care demands included in the macrodimensionneed to be considered to plan actions each professional needs to perform with the userswho need care. Therefore, a retun to the microspace of care is needed to supportprofessional attitudes coherent with the specific health needs of each social group andeach human being.The abovementioned dimensions go beyond the health needs of the people without this kindof surgical derivation. The family system of the ostomized patients is graduallyaffected and their members are involved in the existential movement of these dimensions,assuming responsibilities to offer the support needed in the context of this new stateof being a family. As a result of this imposed condition, the family gains new healthneeds and care demands that accompany the therapeutic itinerary of their ostomizedrelative, beyond what existed before the ostomy.. Thus, to devise the organization of a Comprehensive Health Care Programfor Ostomized People and Families in the Outpatient Context, these subjects need to bevalued as protagonists of care, sociocultural beings with specific demands, and situatethem as active participants in the health care process. Therefore, it is important toinvest in guidelines organized according to macrosociological dimensions, as discussednext.Considering health as the synergy of different factors and the subjects as abiopsychosocial and spiritual complex, the current public policies aim to welcome themin their context and take precedence through autonomy, physical and moral integrity.Therefore, the basic intent is to comply with the doctrinarian principles of the SUSregarding universal access to services, integrality and equality in health care. TheNational Humanization Policy is highlighted, concerning its emphasis on the social needsand interests of the different actors involved in health. Its political actions,therefore, are based on the challenges of constructing and expanding the spaces ofexchange among these actors, in the advance from a new ethics that moves and sustainsthe institutional support function. Thus, User participation in health conferences and councils needs to be encouraged, developedin the context of the SUS, besides user satisfaction research with a view to improvingthe service offered/shared. Investments are needed in the integration of the outpatientclinic with the health service network, from the perspective of interdisciplinarity,adding other types of services that go beyond the traditional concept of health, in viewof the need to work with the intersectoral approach in the contemporary world,guaranteeing referral and counter-referral.Concerning the biological and psychological-affective dimension, the physical andsocioemotional particularities of body maintenance of intestinal and urinary stoma usersare highlighted: change of (drainable and closed) collector bad, maintenance of closedcollector bag, daily maintenance of drainable collector bag for urostomy,self-irrigation, use of adjuvants , prevention of late complications , use of accessories (belt and adhesive tape), sun bath and equipment protectionduring common bath, with a view to reaching a healthy skin around the stoma, color,shape, size, protrusion, moisture, mucous integrity - with normal characteristics of astoma, effluent control, pain relief, self-esteem, safety, autonomy, comfort, wellbeing,happiness, satisfactory sexual activity, self-concept, congruent daily activity,increased life expectancy, among others. The increased availability of collector bagsand adjuvants that attend to the emerging singularities of clients in the SUS contextshould be highlighted.In the esthetic dimension, as a form of physical human beauty, the supply of estheticcourses and treatment options for stoma patients should be taken into account, with aview to contributing to the maintenance of their self-esteem and well-being, mainlyfocused on women. In the socioeconomic and professional field, financial counseling inthe family system is relevant, besides encouraging the effective participation of healthprofessionals, stoma clients and their relatives in the Association of Ostomized People.The promotion of professional courses for ostomized people should be considered, with aview to facilitating their (re)insertion in the job market, paying attention to thelimits and possibilities to assume certain functions that may diverge due to theirhealth condition.The need emerged to promote a healthy outpatient and home environment, covering theaspects of hygiene, temperature, ventilation, lighting, color therapy and aromatherapy.In the technological dimension, the personal needs related to SUS are considered, suchas the need to promote technological participation. In addition, the professional needsare considered with a view to achieving a health work process with individual andcollective care, aiming to maximize and control health care involving clients with atemporary elimination stoma and their relatives, concerning the care and support neededfor reconstructive surgery; individual and collective care for the relatives of stomapatients, so as to include them in care for their ostomized relative and also to receivecare; the implementation of consults by different professionals: nurses, physicians,social workers, psychologists and nutritionists, for support and adjustment of thedisequilibria due to the confection of the stoma in the different dimensions of thelives of clients with intestinal/urinary stoma and their family members; identificationand monitoring of late complications; implementation of home visits to understand thehome context and family dynamics and dialogued orientations on self-care; besides themanagement of material, staff and physical structure, inherent in the functioning of theoutpatient clinic and the development of activities promoted by health professionalsworking at the service and registered users.In the cultural dimension, the development of playful and sociocultural activities ishighlighted, such as games, sports, music, drama appropriate to the physical, social andmental capacity of each participant. Also, the educational field comprises: dialogical,group-based and individual education in health for the problematization of borderlinesituations, experienced in the concrete reality of the people involved in the careprocess deriving from the installation of the stoma, with a view to achieving self-careand permanent education for the health professionals involved. In addition, thedevelopment of interdisciplinary field studies is highlighted, in response to theproblems that emerge in this social group and the dissemination of the knowledgeproduced. The religious-spiritual need strongly emerged in the statements of theostomized participants and their relatives, evidencing the health care demand thatguarantees respect for these subjects' religiosity and/or spirituality..When considering the implementation of these guidelines, organized according to themacrosociological dimensions mentioned, the interdisciplinary perspective of healthneeds to be adopted. This is a common thematic point that acts as an integrator andmediator in the circulation of disciplinary discourse, in which reciprocity, mutualenrichment and a trend towards the horizontalization of the power relations between thefields coexist, overcoming the disciplinarity and fragmentation of knowledge andtherefore relating it with the reality and the problems of modern life, in search ofcare for the integrality of human beings..In the field of interdisciplinarity, the team's efforts will be directed at thesituation inherent to each health service. Different professionals with aparticular/specific background will adopt distinct perspectives in function of a commonobjective, which does not mean the juxtaposition of knowledge, nor the annulment of thespecificity of each field. This nevertheless implies awareness of the limits andpotentialities of each knowledge field with a view to opening towards collectiveaction.With a view to the appropriate functioning of a Comprehensive Health Care Program forOstomized People and Families, a physical structure should be provided that is relevantto the activities to be developed, with qualified and quantitatively sufficient staff,according to the number of registered users, printed material and/or the computerizationof health care, collectors and protective and safety equipment for stoma patients, aswell as fixed and daily consumption material for professional actions. It is importantto invest in communication media like mobile phones and the internet, in view of theirrole in a globalized world where information is multiplied exponentially. The healthprofessionals need to recover for the sake of continuing changes in daily practice,encouraging evidence-based practice and scientific research. This technology is alsorelevant for communication among health care networks, with a view to takingresponsibility for the users' referral and counter-referral and for administrativeactivities.. In that interval, the nurses advise the patients about care for the stoma,meals, hygiene, preparing them for self-care and the return to daily activities.Concerning the nurses' specific actions in the program, the nursing consultation ishighlighted, involving the implementation of the five phases of the nursing process andcontinuing education, including training and educational programs. In professionalnursing practice, the nurses are considered essential in the rehabilitation process ofostomized patients, as they are present since the diagnosis of the stoma. In tha. This precaution will influence the organization of the stomal therapyservice, the planning and implementation of care that will guarantee the specificitiesrequired to manage this social group's quality of life.It is important to consider the particularities of elderly patients concerning thechanges characteristic of the aging process: anatomic-physiological, cognitive,functional and psychosocial. This p. In line with Brazilian studies, international research has identifiedcoping experiences of stoma patients in the course of their lives, as physical,psychological, social and spiritual aspects are affected. Hence, they need adjustmentsto maintain their quality of life, which is a possible target with the help of health services and nurses,whether specialists or not, despite the presence of the stoma.The nurses are responsible for devising health action strategies that transcend thedisease focus, with a view to promoting means to help the elimination stoma users tomake decisions, express feelings and help them to cope with the changes in their bodyimage for the sake of survival. In lin of life, which he stoma.The operation of health care, the commodification of care and the lack of effectiveapplication of basic concepts in the execution of humanized, comprehensive, technicalwork that is faithful to the SUS principles negatively affect the problem-solvingability of the borderline situations the people experience in the context they live in.Thus, investments are needed in the organization of a health service network thatmaintains a flow in line with the peculiar needs of a certain social group, with a viewto achieving health in a broad sense. Achieving this comprehensive state of health,often considered utopic and revolutionary, which is dynamic in the course of daily life,represents an emerging challenge not only for the SUS users, but also for the healthprofessionals and their managers, wherever they are. Nevertheless, it is not considereda na\u00efve objective, but feasible when practicing and devising health from amacrosociological perspective, with a distinguished professional attitude, based onsensitive listening to the users' health needs and promotion of articulation andeffective integration with the different spaces: general, particular and singular.In the development context of this research in health and nursing, challenges and limitsemerged in the conception phase of a singular project, and mainly in the data productionphase, where difficulties occurred to capture the subjects and maintain the groupsconstituted to develop the CSD, although the reliability criteria were complied with,related to the saturation of the data: empirical, theoretical and categorical. Theresults discussed here are not enclosed in their construction, in view of the concept ofknowledge as inexhaustible, unfinished and incomplete, besides the complexity derivingfrom the multiple changes the elimination ostomy causes in the lives of the peopleinvolved. Through these results, it was verified that the health needs of stoma patientsand their relatives, as well as the borderline situations this social group isconfronted with, are captured in the microspace of their social relationship, producingcare demands in health and nursing. Imprinting a macrosociological perspective on thesedemands, based on the subjects' multiple voices in their singular space, through theprofessional's sensitive and qualified listening, is the route to achieve the expandedintegrality of care."}
{"text": "Dr. Victor Abertondo and Dr. Michael Lee are not included in the author byline. They should be listed as the thirteenth and fourteenth authors respectively and are both affiliated with the Department of Agronomy, Iowa State University, Ames, Iowa, United States of America. The contributions of Dr. Victor Abertondo are as follows: Conceived and designed the experiments, performed the experiments, and analyzed the data. The contributions of Dr. Michael Lee are as follows: Conceived and designed the experiments, performed the experiments, analyzed the data, contributed reagents/materials/analysis tools, and wrote the manuscript."}
{"text": "It is hard to estimate the value of vaccines. They have contributed substantially to the reduction of burden from communicable diseases and associated mortality. Each year, three million lives are saved, thanks to vaccination , 2. In dJournal of Market Access and Health Policy is dedicated to vaccines and consists of a series of seven articles that present undeniable and robust evidence on benefits of vaccination from an economic perspective. We consider it extremely important to highlight these benefits in order to retain public trust in vaccination and to keep and strengthen the reliability of immunisation policies and programmes. All the seven articles give a broad overview of several aspects related to immunisation:They depict the impact of vaccination on economic growth, sustainability, and efficiency of healthcare systems. It has been shown that economic growth is driven by improved health \u20136. VacciThey show the true economic and societal value of vaccination. There are several intangible gains provided by vaccination that are ignored by traditional economic analyses. These include outcome-related productivity gains , behaviour-related productivity gains (influence on fertility and consumption choices), and community externalities  among others , 12.They also discuss short- and long-term benefits that can be obtained with vaccination in the context of relatively low levels of investments. Several examples demonstrate that, apart from commonly recognisable long-term gains, vaccines are also able to provide short-term benefits, which result in rapid returns on investments \u201318.Finally, they give ideas on actions that need to be taken by governments, international agencies, and other stakeholders, such as the medical community, in order to make benefits of vaccination programmes fully recognised and appreciated.This special issue of the The present series constitutes a comprehensive source of information on the benefits of vaccines and depicts the usefulness of vaccines from different angles and perspectives. They help realise the broad spectrum of benefits that add to health, and of the economic and societal gains of immunisation. Conveying this message to the patients and authorities, thereby ensuring increased awareness of the true value of vaccination, is of great importance in today's world in Europe where vaccine's hesitancy and underuse may lead to severe outbreaks, as recently observed in Germany, with measles outbreaks, and in Spain, where one case of diphtheria was registered for the first time since 1987. Promoting and strengthening the role of vaccines is in line with a document recently published by the Council of the European Union (Mondher\u00a0Toumi, Editor-in-ChiefFaculty of Medicine, Public Health DepartmentResearch Unit EA 3279, University Aix-MarseilleMarseille, FranceWalter RicciardiEuropean Public Health AssociationDepartment of Public HealthCatholic University of the Sacred HeartRome, Italy"}
{"text": "Philosophical Transactions of the Royal Society as a stand-alone issue in 1981. We do this from the broader perspective of the study of infectious disease dynamics, rather than the specific perspective of the dynamics of insect pathogens. We argue that their 1981 paper fits seamlessly in the systematic study of infectious disease dynamics that was initiated by the authors in 1978, combining effective use of simple mathematical models, firmly rooted in biology, with observable or empirically measurable ingredients and quantities, and promoting extensive capacity building. This systematic approach, taking ecology and biology rather than applied mathematics as the motivation for advance, proved essential for the maturation of the field, and culminated in their landmark textbook of 1991. This commentary was written to celebrate the 350th anniversary of the journal Philosophical Transactions of the Royal Society.We discuss the context, content and importance of the paper \u2018The population dynamics of microparasites and their invertebrate hosts\u2019, by R. M. Anderson and R. M. May, published in the  In 1766, Daniel Bernoulli, working on a mathematical analysis of the benefits of smallpox inoculation, wrote \u2018in a matter which so closely concerns the well-being of the human race, no decision shall be made without all knowledge which a little analysis and calculation can provide\u2019 )"}
{"text": "Participants of the individual intervention (II)received nursing consultations every six months and those of the groupintervention (GI) took part in weekly meetings for three months. Data werecollected through four questionnaires: Identification questionnaire, Problem Areasin Diabetes Questionnaire (PAID), Summary of Diabetes Self-Care ActivitiesQuestionnaire (SDSCA) and the Diabetes Knowledge Scale (DKN-A). Data were analyzedusing the Friedman and Mann Whitney tests, considering a statistical significanceof p \u2264 0.05.  there was an increase in knowledge about the disease in the II (p<0.003) andGI (p<0.007), with reduction of the impact on the quality of life in the II(p<0.007) and improvement in self-care actions in the GI (p<0.001).  in both intervention models improvements were observed in the indicators, overthe six month monitoring period. Accordingly, the Ministry ofHealth, through the National Health Agency (ANS), stimulated changes in privatehealthcare providers, and the Normative Resolution (RN) No. 94, of 2005, established thecriteria for the development of health promotion programs. This is due to health promotion being a community empowerment process inthe practice of improving the quality of life and health, including greaterparticipation in the control of this process, and contributing to the development ofintegral healthcare.The high rates of morbidity and mortality from type 2 diabetes mellitus (T2DM) determinethe need for proposals for the reorientation of a healthcare model that prioritizes thepractices that promote health and the integrality of the care, in botalthcare.. Thus, health promotion and health education are strictly linked,considering that for effective health promotion it is necessary to articulate technicaland popular knowledge, and mobilize institutional and community, public and privateresources. Thus, health education constitutes a tool to improve individual andcollective health conditions, reinforcing the maintenance of positive health habitsthrough a multi-dimensional approach toward the health-disease process.In this context, health education is the theoretical and methodological basis for healthpromotion actions, as it can support both diseases prevention and rehabilitation andpromote citizenship, personal and social responsibility related to health and contributein the training of multipliers and caregivers. Thus,  process.. Thus, health education differs from the traditional model of knowledgetransmission.Health education is now considered a social process, which is defined as any influenceexperienced by individuals, capable of modifying their behavior. It is related to theimplementation of problem-solving activities by health professionals, which valorize theeveryday experience of individuals and social groups, and encourage the activeparticipation of the learner in the educational process. It involves the adoption ofapproaches systematically planned and implemented in a non-coercive manner. Thus, .Accordingly, educational activities, in which a key element is health education, areexperiences materialized in organized and systematized activities, inherent to thehealthcare project at all levels of care. They permit the appropriation of knowledge,improvement of the quality of life of the population, reduction of problems and damageoriginating from the diseases and a critical reflection regarding the actions necessaryto resolve such problems, involving system users and health professionals, especiallynurses..Therefore, for educative actions to generate learning, it is necessary for them to bebased on an accessible and emancipatory type of health education, that is, the dialogicmodel of health education that is primed by problematization, the construction ofknowledge and skills, and based on dialogue, prolonged changes in behavior and greaterautonomy for the individual..In this sense, the national and international literature on health education and T2DM,produced between 1997 and 2007, shows that the majority of studies were experimental andemployed the following strategies: interactive education, community educationalintervention, operative groups, seminars, monitoring of clinical and biochemicalparameters, home visits, educational conferences, activities regarding nutrition andphysical exercise, ophthalmological exams, case reports and educationalcolonies.. Therefore, among the relevant factors to be considered in the evaluationof such programs, the literature highlights knowledge about the disease, the impact ofdiabetes on the quality of life and the adoption of self-care actions, which may predictdisease control in the daily life of the individual(-).It should be noted that studies on educational activities based on dialogic healtheducation and developed in the private sector with individuals with T2DM are stillincipient. Despite this gap in the literature, a study that aimed to analyze healthpromotion actions in diabetes education, developed in groups of a private healthcareprovider, reports that the activities were dynamic and driven by the needs cited by theparticipants. In the same study, the authors consider the importance of studies that aimto evaluate the effectiveness of the educational programs, aiming to support theredirection of new strategies also within the private health context. Therefdividual-12..In accordance with the above, in a study that evaluated the effectiveness of individualand group intervention offered by the outpatient clinic of a public hospital in BeloHorizonte, the authors found that the results of both strategies were similar regardingattitudes, changes of behavior and quality of life, however, with greater effectivenessin the group intervention, with regards to laboratory exams.These findings highlight the importance of knowing the effectiveness of different typesof educative health actions, in the context of a private healthcare provider. Thus, thefollowing research question arose: is there a significant difference between individualand group educational interventions, related to the effectiveness regarding knowledgeabout the disease, the impact of diabetes on the quality of life and the adoption ofself-care actions? Linked to the research question, the aim of this study was to comparethe effectiveness of two educational interventions used by a healthcare provider in themonitoring of individuals with type 2 diabetes mellitus (T2DM), regarding knowledge ofthe disease, impact on quality of life and adoption of self-care actions.Therefore, aiming for collaboration to overcome the traditional model of healtheducation, the present study proposed the implementation of individual and collectiveeducational activities, mainly based on dialogue, with individuals with T2DM.This was a comparative, longitudinal and prospective study, developed in a healthcareservice of Londrina, state of Paran\u00e1. The choice of this institution was made due itoffering a \"Chronic Patient Monitoring Program\", which aims to perform health education,and more specifically, to encourage self-care, behavior change, improved quality of lifeand the reduction of healthcare costs.People with hypertension and diabetes are included in the program and monitored byprivate physicians. The program consists of biannual nursing consultations, telephonemonitoring and educational group activities. During the nursing consultation a physicalexamination, anamnesis and general guidance regarding the disease, treatment andself-care attitudes are carried out. Telephone monitoring is performed by the same nurseresponsible for accompanying the patient, three months after the consultations. Duringthis monitoring a pre-established script is used to identify attitudes that favorself-care, with an important focus on the use of medicines, doubts and problems thatarise in the daily life. The group health education activities are provided for peoplewith available time and interest. The group educational intervention consisted of 12weekly meetings, with duration of 120 minutes each, for a period of three months, beingheld on fixed dates and times. The groups are conducted by a multidisciplinary team,consisting of a nurse, nutritionist, psychologist and social worker.In the groups, health education activities are carried out in order to encourage changesin habits related to nutrition and disease care at the family and individual levels. Theexpectations and doubts of the participants regarding a particular theme are identifiedat each meeting. Entertainment and audiovisual resources - figures, fictional food andposters, are used in the discussion of these aspects.For the present study, a population was selected by convenience from a specific field ofstudy: individuals who were enrolled in the Monitoring Program, between October 2011 andFebruary 2012. All individuals with T2DM (with or without comorbidities), of bothgenders, over 18 years of age, and enrolled in the program during this period wereinvited to participate in the study while waiting to be attended.In the period mentioned above, of the 270 subjects enrolled, 85 did not have a diagnosisof T2DM, and of the 185 who met the inclusion criteria, 35 refused to participate in thestudy. Therefore, 150 subjects with T2DM were effectively studied, who, for the purposesof the study, were divided between individual and group interventions, according tooption/availability, as the health service provider, being private, did not allow theparticipants to be allocated randomly.Data were collected through semi-structured interviews, conducted in a private roomwithin the institution, between October 2011 and July 2012, at three different moments,according to the trajectory of the patients in the service: the first moment (M1)occurred at the time of inclusion into the program, during the first nursingconsultation; the second moment (M2) occurred three months later, during the telephonecontact; and the third moment (M3), six months after the first, during the secondnursing consultation. It should be noted that, as a function of this investigation,guidance and clarification of doubts, usually performed during the consultations andtelephone contacts, throughout the study period, only occurred after the application ofthe data collection instruments. In total, four questionnaires were used, as describedbelow..- Identification questionnaire - applied only at the first moment, consisting of openand closed questions that addressed: a) sociodemographic characteristics  andb) clinical characteristics: presence of comorbidity ; time of diagnosis of diabetes; use of diabetes medications; and dataregarding the clinical and laboratory examinations. Data for glycated hemoglobin wereobtained from consultation of patient records and capillary blood glucose was verifiedat the three moments. Controlled postprandial glycemia was considered when \u2264 160 mg/dland uncontrolled glycemia when > 160 mg/dl, good glycemic control of glycatedhemoglobin was considered when \u2264 7%, and inadequate glycemic control when > 7%mg/dl., consisting of 20 questions, distributed over four dimensions: emotional,food-related, social support and treatment problems. The total score ranges from 0-100points, with higher scores indicating high levels of emotional distress.- Problem Areas in Diabetes Questionnaire (PAID), validated in Brazil, consisdistress., consisting of 17 items, distributed over six dimensions, which enables theevaluation of adherence to self-care activities, taking as reference the frequency withwhich certain activities were carried out in the previous seven days. In the analysis ofthe adherence, the questionnaire items were parameterized in number of days of the week,from zero to seven, zero being the worst possible situation and seven the morefavorable. In the items that assess the consumption of foods high in fat and sugar, thevalues are reversed.- Summary of Diabetes Self-Care Activities Questionnaire (SDSCA), validated inBrazil, consisreversed., consisting of 15 items related to the general knowledge of DM, whichinvolves: basic physiology, food groups and their replacements, DM management insituations of complications, and general principles of disease care. The responses are presented in a multiple choice scale and the total scoreranges from zero to 15 points, with scores lower than seven indicating unsatisfactoryknowledge, and scores equal to or greater than eight indicating satisfactoryknowledge.- Diabetes Knowledge Scale (DKN-A), also validated in Brazil, consisase care. The renowledge.The data from individuals who participated in at least eight of the 12 meetings heldwere considered for analysis. The IBM SPSS 20. software was used for the performance ofthe statistical tests To verify that the groups of participants were comparable in termsof sociodemographic and clinical variables, at the moment before the interventions, thenonparametric test of proportions was applied. The only significant difference was inthe use of antidiabetic medication, thus demonstrating that the groups were notstatistically different in the majority of the variables used, enabling comparisons tobe performed.Based on the Kolmogorov-Smirnov and Shapiro-Wilk tests, the data distribution wasconsidered non-normal. Therefore, Friedman's test was used for the comparison of eachtype of intervention, at the three different observation moments, and Friedman'sMultiple Comparison test was performed to verify the difference, to evidence at exactlywhich moments the differences occurred; and the Mann Whitney test to compare the resultsof the Individual Intervention with those of the Group Intervention, at each moment. Inall tests, the level of significance was set as p-value \u2264 0.05.The development of the study met the national and international standards of ethics inresearch involving human subjects, according to Resolution 196/96 of the National HealthCouncil. The project that gave rise to this study was approved by the PermanentCommittee of Ethics in Research with Human Subjects (COPEP), of the State University ofMaring\u00e1 (Authorization No. 516/2011). All participants, after clarification of theobjectives and criteria for participation, signed two copies of the Informed ConsentForm (ICF).Of the 150 individuals included in the study, 120 (80%) participated in the secondassessment, and 114 (76%) in the third. Considering the mode of intervention, the lossof 31 subjects (28.9%) was verified from the individual intervention and five (11.63%)from the group intervention. Among the reasons for leaving, 28 cases were due totermination of the health plan, six due to change of city and two due to seriouscomplications in the health status.Regarding the initial assessment, it was found that the 150 individuals participating inthe study had a mean age of 60 years (\u00b1 12.49 years), a mean individual of income of 5.5minimum wages (\u00b1 9.85), more than half (56%) were female, and the majority were white (80%), lived with a partner (74%), and had more than eight years of education (64%). Itwas also found that the majority of the participants had satisfactory knowledge aboutthe disease (71.3%), perceived a high impact on their quality of life (76%) andpresented good adherence to self-care practices.It can be observed in The data from this study show improvements in the scores related to knowledge about thedisease, after six months of intervention, in both groups; improvements in the scoresrelated to the impact of the disease on the quality of life, after three and six months,only for the individual intervention; and a positive influence regarding the adherenceto self-care practices, at three and six months, only for the group intervention. conducted with T2DM subjects, which also identified the effectiveness ofboth types of intervention, individual and group, at different moments and referred tothe same aspects evaluated. However, in the present study, the group interventionconstituted an extra activity in relation to the individual intervention, in that itsparticipants took part in both approaches. Educational activities implemented by healthprofessionals together with individuals, families and community, are essential forcontrolling this disease, as the complications of diabetes are directly related toknowledge about the disease, considering that this supports the performance of dailyself-care and the adoption of a healthier lifestyle. Individual or group interventions comprise the educational strategies mostcommonly used in the health promotion and monitoring of patients withdiabetes. However, it is important to consider that certain educational strategiescan encourage the active participation of the individual in controlling the disease andpreventing its complications or, on the contrary, simply strengthen the curativecharacter focused on the disease and on the transmission of information.Thus, these findings corroborate the results of an experimental study conductifestyle. Individiabetes. Howeveormation.. In addition, in the present study, an increase of values related toknowledge of the disease was observed over six months, both among participants of theindividual intervention as well as among those who participated in the groupintervention. Strategies aimed at health education should be employed, aiming for thedevelopment of self-care. In health education, one of the indicators most used for assessment indiabetic patients has been the level of knowledge about the disease, as this variable isrelated to the efficacy of the program.The number of individuals who, at the beginning of the program, already presentedsatisfactory knowledge regarding the disease was high, a fact that differs from asimilar study conducted in a primary health unit, in which the level of knowledge wasconsidered unsatisfactory for the majority of the individuals, which was shown to beassociated with the low educational level of the study participants. In addelf-care. In hea program., therefore the presence of the diagnosis of diabetes influences theself-perception of physical and psychological well-being.Regarding the impact of the disease on the quality of life, it was observed that at thestart of the intervention individuals perceived a high impact of diabetes in theirlives, and after six months there was a reduction of this impact, being significant forthe participants of the individual intervention. These data show how the performance ofmonitoring of these individuals can benefit them, as highlighted by the literature,which refers to the care of the disease, coping with emotional imbalances, management ofthe treatment and improved quality of life, therefll-being.. Therefore, in line with the results of the present study, it has beenconcluded that individual monitoring by the nurse, directed toward self-management anddisease control, helps to reduce the impact on the quality of life ofindividuals.A study conducted in Denmark, with 143 T2DM individuals, found no significant differencebetween individual and group interventions with regard to improving the quality of life,except for the improvement of clinical data in the individual intervention, which mayhave contributed to these individuals evidencing a lower impact of thedisease. Therefividuals.However, it should be emphasized that statistically significant decreases in the impactof the disease on the quality of life occurred in the individuals who only participatedin the nursing consultations . This may be related, in part, tothe small number of group intervention participants, undermining the identification ofassociations even when they existed.In clinical terms, the absence of changes in the impact of the disease among the groupintervention participants could be, on one hand, due to a possible lack of motivation ofsome people, when they realized that other participants improved their quality of life,causing them to become despondent, due to their difficulties. On the other hand, thepossibility of nurses not valuing the moment of individual care should be considered, asthey believed that the patients were being well assisted in the group and, therefore,gave more time and care to those that only received the nursing consultation.. The multidisciplinary team, therefore, tends to favor the reduction of thestress associated with the disease, receptivity to the treatment, self-esteem, sense ofself-efficacy and a more positive perception regarding the health.In relation to self-care, an increase of positive actions  was identified in participants of both groups.However, after six months, this reduction was only significant for the individuals thatalso participated in the group intervention. This data can be related to the fact thatthe group activities make possible dialogue, reflection, exchange of knowledge and,consequently, the co-responsibility of individuals with diabetes for their own health.In addition, the participation of a multidisciplinary team in the group activity enablesthe integrality of the healthcare, as it favors the contact with and access to knowledgeof different health professionals. The mue health..Furthermore, the commitment of individuals to self-care practices largely depends oncultural and educational aspects related to personal skills and limitations, lifeexperience, health status and the resources available. When an individual is unable tomeet their self-care requirements, it is the function of the nurse and healthcare careteam to determine at what level this occurs, defining the necessary methods ofsupport.Finally, the allocation of the participants into groups by convenience, no control ofvariables e.g. the presence of comorbidities, and also the rate of loss in the groupswere considered limitations. Regarding the group intervention, it is emphasized that thenon-randomization of the participants resulted in the inclusion of people who hadalready shown an interest in participating in this activity, which may have facilitatedthe change in self-care attitudes. There was also a large difference between theeducational approaches, in terms of the frequency of meetings, with the members of theindividual intervention participating in only the two nursing consultations and the telephone contact, while those of the group intervention participated in thesesame activities and at least eight weekly meetings.Despite these limitations, the results are valid, especially when comparing the behaviorof the groups at the three different moments. They can support and motivate theprofessional practice in the implementation of health education activities in differentcontexts.The study results show that the individual intervention for people with T2DM, throughbiannual nursing consultations, favored the clarification of doubts, the acquisition ofknowledge about the disease and the reduction of its impact on the quality of life ofthe individuals. Furthermore, by adding health education actions in groups to theseconsultations, in addition to promoting the acquisition of knowledge, the occurrence ofgreater adherence to self-care practices was also observed, although the reduction ofthe impact of the disease on the quality of life of patients was not significant.The results also showed that in the two types of intervention significant changesoccurred from M1 to M2 or M3, but not from M2 to M3. This means, on one hand, that theacquired knowledge and behavior have permanence in time, as they did not decrease fromM1 to M3; while on the other hand, apart from the influence of personal motivation,usually observed at the beginning of the interventions, it was found that people have alimit for the acquisition of knowledge and behavioral skills. These particularitiesindicate that health professionals who treat patients with chronic diseases, such asT2DM, must consider the need for adjustments in the educational program, aiming toensure the maintenance of the benefits achieved, regardless of the type of educationalintervention used.Thus, the performance of studies to assess the effects of the interventions 12 monthsafter their completion is proposed, in order to identify whether the benefits remainover the long term, which would characterize the residual effect of interventionspreviously performed. Therefore, it is appropriate to propose the continuation ofstudies of this nature, through qualitative methodologies that enable the identificationof the elements that contribute to changes, the comprehension of how these elements workin these changes, and the clarification of the boundaries between individual and groupinterventions in the modulation of self-care, considering that the educational processconstitutes something dynamic and therefore subject to continuous and multidimensionalassessment."}
{"text": "The authors declare that MICRO-PLUS Konzentrate GmbH, now a subsidiary of BIOMIN Holding GmbH, financially sponsored this project. The authors GM and CP are affiliated with BIOMIN, which produces the phytogenic feed additive used in this trial. BS, affiliated with MICRO-PLUS Konzentrate GmbH at the time the experiment was conducted, is currently affiliated with BIOMIN following the acquisition.At the time this experiment was conducted, the Institutional Animal Ethics Committee standards for conducting research on poultry species were not established, thus no committee approval was required, and the experiment was conducted according to the ethical norms of the University. The principal investigator of the study has provided the journal\u2019s Editorial Office a retrospective statement that approval was not needed.GM: final approval of the version to be submitted, drafting the article, or revising it critically for important intellectual content; BS: contributions to conception and design of the experiment and analysis and interpretation of data; SH: contributions to conception and design of the experiment, acquisition of data, and analysis and interpretation of data; CP: final approval of the version to be submitted, drafting the article, or revising it critically for important intellectual content."}
{"text": "The Latin American Symposium on Oncological Gastroenterology (SLAGO) took place between the the 16th and 20th of April, 2013. This important conference has been organized by the Chile Cancer Foundation every two years since 2007.This event brings together specialists from the majority of the Latin American countries, as well as recognised professionals from the United States, Canada and Europe. The growth of this event in its short history has been enormous. When the first convention took place in 2007, there were a total of 230 participants; in this fourth edition in 2013, the number of participants surpassed 1,100. These figures and the quality of the event have made the SLAGO convention the third most important oncological gastroenterology event in the western world, after ASCO GI and the ESMO congress. Since the second version of this conference, it has been held in Vi\u00f1a del Mar, Chile, a beautiful coastal city on the pacific, where the event will continue to be held.This conference brings together all the different fields that are part of oncological gastroenterology, such as medical oncologists, radiotherapists, oncological digestive surgeons, endoscopic digestive gastroenterologists, radiologists, pathologists and a panel of experts in nutrition and palliative medicine.Course on Pre ONS Oncology Nursing CongressFirst Meeting of Oncology NursingFirst Latin American Symposium on pharmaceutical chemicalsOncological Kinesiology workshopsCourse on Nutrition and Digestive CancerPalliative medicine workshopPsycho-oncology workshopColorectal Cancer ConsensusOncological patient reunionAmong the participants and attendees at this important event, the following countries can be highlighted: Germany, Argentina, Canada, Belgium, Bolivia, Brazil, USA, Spain, France, New Zealand, Peru, Mexico, Uruguay, Venezuela and Chile.SLAGO, in its essence, encourages the participation and development of gastroenterology and oncology in Latin America and aims to be an instance of best practice and on-going training for the various professionals involved in this area of oncology. For this reason, as well as looking for transversality amongst the various professions in parallel, the following activities have been developed:The main purpose of this convention was to discuss current therapies and diagnostics and bring together health professionals who research new treatments on a daily basis, encouraging them to share experiences and the latest treatment options for neoplasia which compromise the entire digestive system.www.slago.com.This Congress was chaired by Dr Jorge Gallardo of Chile, and various topics of interest were developed. The curriculum and slideshows can be downloaded from After these five days of activity, it can be concluded that both the Latin American and Caribbean participants agreed that this conference is the largest gathering of the highest impact in the region, which ranks as one of the most important and busiest in this field, and they have therefore committed themselves to spread the word and attend the next SLAGO conference in 2015.hereWatch videos from the conference"}
{"text": "One of the great founders of the Romanian surgery school, Professor Ion Juvara was honored in the continuity tradition of recognizing the value of the ancestors in the enthusiastic and full of warmth environment of the beginning of the academic year in the Aula Magna of \u201cCAROL DAVILA\u201d UNIVERSITY OF MEDICINE AND PHARMACY in Bucharest.The laborious activity of Professor Ion Juvara was abundantly and excitedly presented by famous personalities of the University: Acad. Ioanel Sinescu, Rector of \u201cCarol Davila\u201d University of Medicine and Pharmacy, Prof. Mircea Beuran, MD, Head of the Surgery Clinic of the Emergency Hospital in Bucharest and the Head of the Surgery Department, Prof. Traian Patrascu, MD, Head of the Surgery Clinic of \u201cCantacuzino\u201d Hospital, Prof. Dan Sabau, MD, from \u201cLucian Blaga\u201d University in Sibiu, famous followers of the exceptional surgeon and also Prof. Radu Palade, MD, a famous surgeon, son of the great scientist George Emil Palade, who had the chance of meeting Ion Juvara when he was only 3 years old. The ceremony was admirably completed by the memories full of emotion and nostalgia of the great surgeon\u2019s family who was also present at the event. Just as the speakers underlined, Prof. Ion Juvara, MD, was a true personality, who has unmistakably marked the Romanian surgery field of the second half of the last century. Born 100 years ago in Bucharest, he enrolled, when still being young, on a singular trajectory of performance; occupying the first position in all the professional competitions he took part in.Among the professors who have marked the professional trajectory of young Ion Juvara, there are two great personalities of the Romanian medical school: Francisc Reiner and Nicolae Hortolomei, and among the friends from his youth \u2013 the future laureate of Nobel Prize, George Emil Palade.As the speakers confirmed, the scientific level, the impeccable technique, and last, but not least, the courage based on the objective appreciation of his own possibilities, allowed professor Juvara to approach the pioneering fields of surgery in that period of time: the first surgeries on the thyroid gland made together with professor Hortolomei, the first thymectomies, the new interventions on the thorax or heart, being only few of the paths opened by this great surgeon\u2019s talent and visionary spirit.His prodigious scientific activity includes 460 presented or published papers. The main scientific contributions, which have remained in history as true \u201cmilestones\u201d in the field of surgery are the ones concerning the thyroid gland, organic hypoglycemia due to pancreatitis or the treatment of myasthenia gravis by using thymectomy. The studies on reinterventions in gastric surgery and in extrahepatic biliary tracts have also been of great interest until present, his preoccupation for a clear and an in-depth study of knowledge in a field so sensitive and difficult, of imperfections and surgical failures being remarkable. In 1996, at the venerable age of 83 years old, at the end of a fulfilled road both from the family point of view and from a professional one, professor Ion Juvara stepped quietly out of life, entering the legend.And the legends never die! Executive EditorAssoc. Prof. Dr. Eng. Victor Lorin Purcarea"}
{"text": "Advances in medical science procedures and their utilization in the field of oncology improved the survival of patients. In consequence, these advances have influenced the practice of physiotherapy. Physiotherapists utilize physical agents with the objective to enhance the health, welfare and quality of life and thus they can play important role in the management and rehabilitation of patients with prostate cancer (PCa). Urinary incontinence (UI) and erectile dysfunction (ED) are effects normally associated with the radical prostatectomy and radiotherapy due to the damage of the muscles of the pelvic floor (MPV). The aim of this work is to present findings related to the PCa and how the physiotherapist can guide the patient in relation to the knowledge and understanding of the anatomic structures related directly with the pelvic floor, the correct breathing and the perception of the MPV, as other muscles of the pelvis. Interventions of the physiotherapy will re-train the muscles of the pelvis by improving the active retention strength of the MPV in order to overcome the insufficiency (mainly the UI and ED) of the injured muscles. In conclusion, it is suggested to consider and to offer to the PCa patients the techniques related to the physiotherapy before and after the treatment. Cancer is characterized by an uncontrolled growth of abnormal cells in the body and it is considered a national health priority area in several countries due to the burden that it places on the individual, families and the community -3.An important consideration is that the non-communicable diseases (NCD), including cancer, are overtaking infectious disease as the leading health-care threat in some of middle-income and low-income countries and NCD are the major health and socio-economic issue. In general, Latin American and Caribbean countries are struggling to try to respond to increasing morbidity and death from advanced disease. The health-care systems in these countries face many challenges to treat patients with advanced cancer, due to (i) inadequate funding; (ii) inequitable distribution of resources and services; (iii) training, and distribution of health-care personnel and equipment; (iv) lack of adequate care for many populations and (v) geographic situation pf the houses of the patients. Moreover, the information to the prevention is not totally available to the entire population , 4a, 4b.Nevertheless, advances in health and in general biomedical investigations have improved survival and quality of life of the patients with cancer. In consequence, older cancer survivors have represented an important group in the population -6. TheseBesides the knowledge about clinical interventions, the physiotherapist needs to be in contact with the recent advances, in general, of the scientific literature involving cancer. Moreover, this professional must know about the risk factors and participate in actions and attempts to aid in the prevention of this disease -9.The risk of some cancers, such as prostate, may be reduced in people living in areas of high ambient solar radiation or with high sun exposure in comparison with the individuals where the converse is the case -12. In aNaturally, the information about the protection against the unnecessary and undesirable exposition of the sunlight is also very important , 16.The general knowledge about the actions to aid to prevent the prostate cancer (PCa) is highly desirable, due to undesirable clinical conditions due to the consequences of some techniques used to treat the Pca, as the radical prostatectomy (RP) and the radiotherapy (RT). These conditions can bring bothersome, as the urinary incontinence (UI) and the erectile dysfunction (ED), as they can comprise directly the sexual health and the quality of life of the patient. It is important that the interprofessional team, including a physiotherapist, be prepared to discuss these questions and to present strategies to help the patient in the various stages of the treatment , 18.The procedures of the physiotherapy, in general, have the purpose of developing, maintaining and restoring the maximum movement and functional ability of each individual, considering the specific limitations, the disease and the medications related to the patient. The role of the physiotherapist within the interdisciplinary group is well defined in various clinical conditions, as with the patient with PCa , 9, 19.et al, 2012  the knowledge and understanding of the anatomic structures related directly with the pelvic floor, (ii) the correct breathing and (iii) the perception of the muscles of the pelvic floor, as other muscles of the pelvis. Specific attention is given to the comprehension of the functions of these muscles, especially to the relevance of the levator ani muscle , 25-31. al, 2009 , during al, 2009  that hasal, 2009  has beenUI and ED has been also treated with the various exercises (kinesiotherapy) involving the muscles of the pelvic floor in patients submitted to RP. Prior to a pelvic floor muscle exercise program, an anal assessment is performed to grade the strength, endurance and speed of the anal sphincter and the puborectalis muscle. Pelvic floor muscle exercises are individually taught to ensure that they are being performed correctly , 32. TheSexual health is a state of physical, emotional, mental and social well-being in relation to sexuality. Sexuality is influenced by the interaction of biological, psychological, social, economic, political, cultural, ethical, legal, historical, religious and spiritual factors -36. ConsFigure PCa is the most commonly diagnosed solid cancer among men worldwide and is the most frequent of all cancers in Europe and North America. Mortality rates tend to be higher in less developed regions of the world including parts of South America, the Caribbean, and sub-Saharan Africa , 38, 39.In Table The high relevance of the cancer can also be demonstrated by the number of scientific research  identified on September 10th 2012 in the database system PubMed  . The keyThe early diagnosis of PCa has been facilitated by the determination of the prostate specific antigen (PSA), rectal touch and ultrasonography, which has subsequently led to a high cure rate in the early stages (stage I/II) of the disease. , 41-43. In general, RP is a curative and appropriated therapy for any patient whose tumour is clinically confined to the prostate. Other factors affecting treatment decisions include patient factors, such as (i) Current symptoms , (ii) Current age (preference under the age of 70 years), (iii) Concurrent illnesses may determine suitability or not for surgery, (iv) Patient preference  -48.In Table RT is another option for treatment of PCa and it uses high-energy X-rays or other types of ionizing radiation to try to kill the cancer cells in various organs/tissues. In addition, RT combined with androgen deprivation therapy (ADT) is used in patients with locally advanced tumors and/or those with high Gleason scores, characterized as intermediate or high-risk profiles .Table Naturally, the clinical conditions and the early diagnosis of the PCa will minimize the undesirable findings due to the therapeutic procedure. Severe complications following RT can occur and these undesirable findings depend on the type of the procedure used in the surgery and UI and ED have also been associated with the RT , 47, 50.As presented before, UI and ED are undesirable side effects normally associated with the RP and RT due to the damage of the muscles of the pelvic floor , 45, 46.ED, in general, is usually due to a multifactorial etiology, comprising organic, psychological, or mixed aspects, and may often require a multidisciplinary approach for assessment and treatment. Organic causes encompass vascular, neurologic, hormonal, as a result of medications, pelvic surgery (mainly RP), RT, diabetes or mixed factors. In general, any condition that can cause damages to the nerves or impair blood flow in the penis may lead to ED. Pelvic surgery  might damage cavernous nerves and arteries near the penis, causing ED , 46.The economic burden of ED is not just limited to the cost of diagnosis and treatment. Other impacts on the Society and in diary life that are difficult to quantify are shown in Table et al, 2009 , physiology and hydrodynamic transport urine of the voiding mechanism, thus detailing the stages of filling and emptying as well as the sphincter behavior. Common urodynamic findings in post-RP patients are (a) internal sphincter deficiency and (b) bladder dysfunction (detrusor instability and decreased compliance) , 25-30.et al, 2009  using physiotherapy procedures, since both the duration and degree of UI after RP decrease in these case , 53-55.When a patient with PCa is referred to undertake physiotherapy procedures before the surgery or radiotherapy, it is possible to teach him about the perception of the muscles of the pelvic foor, facilitating the performance of exercises involving these muscles associated with an ideal breathing, just after the RP or RT , 25-30.Besides the ED, another clinical conditions related to the sexual functions can appear in the patient submitted to a RP, as the loss of ejaculation and the decrease of the libido and orgasm , 46, 48.Several options of treatment are available to treat ED, as psychosexual counseling, medication, use of physiotherapy , intracavernous injection therapy, vascular surgery, and use of a penile prosthesis. The clinical interventions used in the physiotherapy provide noninvasive methods that are easy to perform, painless, and inexpensive , 52, 53.Most physiotherapy treatments for ED focus also on pelvic floor muscles. It is relevant to consider also the arrangement of the muscles at the base of the penis, as well as the other local structures that, with the time without erection, can lead to veno-occlusive ED. ED can be a result of a sequence of penile morphologic alterations post-RP. The physiotherapist will guide the patient to do exercises for the muscles direct related to the pelvic floor and also to the muscles indirectly related with the pelvis, such as abdominal and gluteal muscles. When they are contracted an increase of the local blood flow to the pelvic region is verified. This process seems to lead to a release of NO to the penis, acting on endothelium vasodilation and dependent on the flow, increasing in oxygen supply to the penile tissue and keeping the erectile tissue healthy , 29, 53.The physiotherapist, from his assessment, can also help the patient with PCa in the presurgical period in which the exercises for the pelvic floor and for the respiration that will be performed in the post-surgical period can be learned early by the patient. Moreover, the knowledge and the perception of the muscles of the pelvic floor by the patient will be very important. As these muscles are located inside the pelvis, they are considered a continence muscle group giving structural support for the pelvic organs and the pelvic sphincters . Based on urethral continence maintained by muscles of the pelvic floor, the procedures of the physiotherapy of this muscle group can retake the control of the urinary continence or maximize it, also by nerve stimulation, according to the consensus, which can inhibit the detrusor muscle, increasing the quality of life of patients with PCa , 25-30.On physical examination is evaluated the strength and the tone of the pelvic floor muscles through the anal sphincter, perineal sensation and bulb-cavernosum reflex. Maneuver effort, such as coughing, can evaluate the sphincter function, which can be performed with the patient standing, with the bladder full, and where he is asked to simulate cough. From this assessment is given the goal of treatment , 25-30.The perception of the muscles of the pelvic floor may be increased with the use of the electrotherapy and this technique might guide the patient to correct contraction of the muscles of the pelvic floor. Two types of electrodes can be used in the electrotherapy; internal  and external electrodes Figure  and 3b , 55, 57.In Figure Beneficial effects of pre- and postoperative pelvic floor re-education are clear, since both the duration and degree of UI after RP can be distinguishably decreased , 21, 54.Concerning ED, when a man wakes up from a RP he will almost certainly have ED initially. If there is going to be a recovery of erectile function, it may take 18-24 months to occur. Approximately 30% of men will recover erectile function and medication  will usually boost this recovery. However, physiotherapy procedures could be another suitable option without contraindications. In addition, the patient that has learned about the exercises involving the muscles of the pelvic floor can start these exercises immediately just after the surgery or after the catheter removal , 58.Mechanical vacuum devices cause erection by creating a partial vacuum, which draws blood into the penis, engorging and expanding it. The physiotherapist will guide the patient to do exercises for the muscles direct related to the pelvic floor  and also et al, 2002  develops strategies towards the prevention, research, education and control of the cancer. Important medical developments and relevand scientific findings have permitted that people with cancer can survive with their disease and with the side effects of their disease and its treatment for longer , 68, 70 People are living longer with their cancers, which in many cases are treated as chronic disease, due to the early detection and advances in treatment options. Physiotherapy has responded to the improved outcomes and patient demand for quality of life improvements by instituting new treatments and education, such as informing about the possible importance of the sunlight in the prevention of the PCa , 5, 70 aet al, 2009 (As Katz and Katz, 2008  and Bernal, 2009 , it is rWhen the available procedures to minimize the clinical complications of the RP or of the RT are considered, it is highly relevant to emphasize that the decrease of the appearance of complications occurs in patients thar have undergone physiotherapy before the RP and the improvement of the symptoms is observed due to the procedures of the physiotherapy just after the RP , 18. Duret al, 2009 (et al, 2006 (et al, 2009 (Dorey al, 2009  have repal, 2006  suggest al, 2009  describeet al, 2012 (Zhu al, 2012  have evaet al, 2011 (Khoder al, 2011 , have evet al, 2010 (Yamanishi al, 2010  have evaet al, 2005 (et al, 2009 (Wilson al, 2005  and Doreal, 2009  has repoet al, 2012 (Baumann In conclusion, the knowledge of the patient about his situation as well as the involvement of the family and partner must be strongly considered. Moreover, it is also important to explain and present all the possibilities involving the treatment of the PCa. In addition, it is highly desired thal all the modalities of procedures that are available to aid in the prevention of undesirable clinical conditions. Furthermore, it is suggested that is necessary to consider the techniques related to the physiotherapy before and after the treatment of choice to the PCa."}
{"text": "The present study was conducted to investigate the prevalence of musculoskeletal disorders and eye and vision complaints among the computer users of King Abdulaziz University (KAU), Saudi Arabian Airlines (SAUDIA), and Saudi Telecom Company (STC). Stratified random samples of the work stations and operators at each of the studied institutions were selected and the ergonomics of the work stations were assessed and the operators' health complaints were investigated. The average ergonomic score of the studied work station at STC, KAU, and SAUDIA was 81.5%, 73.3%, and 70.3, respectively. Most of the examined operators use computers daily for \u2264 7 hours, yet they had some average incidences of general complaints  and relatively high level of incidences of eye and vision complaints and musculoskeletal complaints. The incidences of the complaints have been found to increase with the (a) decrease in work station ergonomic score, (b) progress of age and duration of employment, (c) smoking, (d) use of computers, (e) lack of work satisfaction, and (f) history of operators' previous ailments. It has been recommended to improve the ergonomics of the work stations, set up training programs, and conduct preplacement and periodical examinations for operators. The one thing that has had the greatest impact on our lives in modern time is the computer. Along with smaller size and affordable prices, there has been the advent of the Internet. This has ensured that people use this technology either at their work place or at home. Meanwhile, the applications of computer technology and the accompanying use of video display terminals (VDTs) are revolutionizing the workplaces worldwide, and their use will continue to grow in the future.Although these developments may perform operators' tasks efficiently, they could face some factors such as work stress, repetitious tasks, boredom, interpersonal factors, unsafe postures, and poor design of workstation that will negatively affect their health, performance, and productivity. For example, the development of VDTs technology may have contributed to the increase of users' health problems such as cumulative trauma disorders (CTDs) of upper extremity and back pain \u201354 as weHowever, the application of ergonomics principles to office workstations will reduce such health risks. For example, one of the goals of the ergonomic processes is to design or modify people's work and other activities to be within their capabilities and limitations , 85\u201388. Currently computer related injuries are developing into an epidemic among computer users. It is estimated that, worldwide, 25% of computer users are already suffering from computer related injuries . The UniThe tremendous use of computer by the staff members, technicians, and students at King Abdulaziz University (KAU), by our experience, has been accompanied by increase in the number of attendances to University Medical Directorate (Services) with general, eye and vision, and musculoskeletal complaints. When this observation was brought to the attention of KAU officials, they urged and encouraged concerned personnel to study the nature of this problem and propose remedial actions.Meanwhile, one of the first institutions that had applied computer technology in Saudi Arabia was the Saudi Airlines tickets' reservation offices (SAUDIA). It is considered to be one of most eligible areas to conduct a study regarding VDT health related problems. Putting this in mind, KAU urged concerned personnel to include it in the present study. Also, the Saudi Telecom Company (STC) works in Jeddah comprises nearly 430 VDT workstations where 360 operators and mostly 70 supervisors work for whole shifts. There have been some claims that these operators and supervisors suffer some general musculoskeletal and eye and vision complaints. Consequently, these works have been decided to be included in this study.to evaluate the magnitude of the problem of inconveniences in the use of computers in KAU, SAUDIA, and STC, as well as the inconveniences in the computers' workstations,to investigate computers' operators health complaints,to investigate environmental and behavioral factors contributing to the occurrence of the complaints,to propose remedial actions that might contribute to reducing these complaints.The objectives of the present study wereInventories of the computer workstations and operators in the different colleges and units of KAU, in the different departments and units of SAUDIA tickets' reservation offices, and in the different departments and units of STC head office in Jeddah had, primarily, been conducted to assess the magnitude of computer use there. The findings of the inventories are summarized in Representative random samples of 100 workstations, and operators , were selected from each of the three institutions, considering that the selection of the sampled stations and operators had been affected by the readiness of the individual administrations and operators in the different departments and units to participate in the study. The selected stations are also presented in U.S. Department of Health and Human Services, Centers of Disease Control, and Prevention (CDC), Evaluation Checklist;National Institute for Occupation Safety and Health (NIOSH) Ergonomics Work-Place Evaluations of Musculoskeletal Disorders Checklist;U.S. Department of Labor, Occupational Safety, and Health Agency (OSHA) Computer Workstation Ergonomic Checklist;University of California Computer Workstation Self-Evaluation Checklist;California State University Ergonomics Evaluation Checklist;Cornell University Ergonomics Checklist;University of Virginia Library Ergonomics Evaluation Form;Institute for Occupational Physiology at the University of Dortmund Checklist for Computer Workstation;Atlantic Mutual Centennial Insurance Company Workstation Checklist.A study form entitled \u201cErgonomics Rating of Computer Applications\u201d was developed to assess the ergonomics status of the studied computer workstations. The form was designed after reviewing the ANS/HFES Committee document , and manThe ergonomics score for the evaluation of the workstation is 43, distributed by the different components. Each component has certain number of scores, determining the maximum score of the component as shown in Each score item is clearly presented to be answered by \u201cYes\u201d or \u201cNo\u201d to avoid any personal differences or any bias by the evaluators. The \u201cYes\u201d answers are counted to represent the score out of 50, and some ten stations were evaluated to test the study from and found to be satisfactory for the conduct of the study. Furthermore, the evaluation of the workstations was carried out, only, by the authors for quality assurance of the data collection. The study form has been designed in four major sections including the following.Section (1). It includes basic information of investigated organizations (colleges/units), particularly as related to presented services.Section (2). It includes ergonomics rating of investigated workstations by checking the details of each component of the work place, includingdesk, as related to space of desk top, layout of the desk, top equipment, desk top and distance from operator's eye, and existence of comfortable resting facility for operators' hands and rest;seat, as related to dimensions, casters, operators' leg clearance, armrests, back rest, seat cushion, and seat comfort ability and stability;footrest, as related to need, availability, and status of footrest;display screen, as related to location, height and tilting of the monitor, distance from operator's eye, freedom of screen from glare and reflection, stability of image and freedom from flickering, ease to read characters, and possibility of adjusting screen brightness and contrast;keyboard, as related to dimensions, location with reference to operator's hands and elbows, and exchanging operation between keyboard and mouse without operator's hand extension or twisting wrist;mouse, as related to its location with reference to operator smooth running and operator's awareness of its details of operation and maintenance;document holder, as related to need, availability, and status of the document holder;space and room layout, as related to adequate access to work place, availability of space to maneuver the seat, work correct posture, availability of adequate space for equipment needed for work, location of monitor with reference to windows, freedom of work area from obstructions, and hazards of tripping and neatness of the work area;task and posture, as related to freedom of operator's hands from phone while typing and resting his hand wrists;illumination, as related to level of lighting, status of luminaries and illumination fixtures, use of blinds on windows, and background of the screen with surrounding environment;noise and thermal environment, as related to level of quietness and status of air conditioning in work area.Section (3). It includes work organization rating, by investigating work organization, work hours, rest pauses and noncomputer work assignment, and work load.Section (4). It includes training and provision of information, by investigating operator's on-the-job and formal training, certainty of his use of software, keying habits, operator's capability of control of his workstation and work environment, and operator's adoption of good posture and avoiding visual fatigue at work.A study form entitled \u201cImpact of Computer Use on Operators\u201d was developed to evaluate the effect of computer use on operator's health as reviewed and/or recommended by the NIOSH , WHO 5]5], and ASection (1). It includes basic data, including name, gender, address, workstation, age, education, and smoking habit.Section (2). It includes work data, including work type, duration of employment, formal training, work speed, daily hours of computer use, nature of computer use (continuous or intermittent), and work satisfaction.Section (3). It includes health disorders before present work, including previous ailments or complaints of the musculoskeletal system and complaints of the eye and vision.Section (4). It includes current symptoms, including the general complaints and their frequency, the eye and vision symptoms and their frequency, the maximum work hours before their occurrence and the time required for their release, and the musculoskeletal disorders and their location, description, frequency, and persistence, as well as the approached medical treatment and the sickness absenteeism as related to the work-related ailments.The collected data were visually inspected for fliers, then introduced into PC, and subjected to statistical analysis using Microsoft Excel 2007.The ergonomics scores of the studied workstations in the three institutions are illustrated in The demographic and occupational characteristics of the studied populations of the computer users/operators in the three institutions are presented in Tables Most of the study populations were nonsmokers  and 26% of them at STC were light smoker (smoking index less than 200) that might be added to the proportion of the nonsmoker there to be 88%. This distribution might, however, be biased by the relatively young age of the examined subjects.Considerable proportion of the populations either had no vision problems before employment , or were short-sighted , while the rest were long-sighted or had other vision problems . Similarly, more than one half of the populations at the three study locations had no musculoskeletal symptoms before employment , while considerable proportions of the populations had neck pain . The rest of the populations had such symptom at one or more body locations.More than one half of the population of KAU (52%) was either typist (23%) or involved in comprehensive office tasks (29%), while 40% of them were involved in data entry (22%) and data acquisition (22%). However, at SAUDIA, 77% of the populations were involved in data entry (54%) or data acquisition (23%) while 20% of them were involved in communication tasks and none of them was typist. Similarly, at STC, 86% of the populations were involved in communication tasks (53%) or data entry (33%), and none of them was typist. While 58% and 61% of the populations at KAU and SAUDIA, respectively, received on-the-job training only, and the rest received formal training for different periods, the opposite existed at STC, where 72% of the population received formal training for different periods, and only 28% of the population received on-the-job training only. Consequently, 61% of the populations at KAU and 70% at SAUDIA considered their work speed as average  or slow , while 45% of the population at STC considered their work speed as fast and 55% of them considered their work speed as either average (49%) or slow (6%).Considerable proportions of the populations at KAU and STC used computer for 7, 8, or 9 hours per day (44% and 39%), while the whole population at SAUDIA (100%), and 53% of them at STC, used computer for 6 hours. On the other hand, 36% of the operators at KAU used computer for 3, 4, or 5\u2009hrs. per day, while none of them at SAUDIA, and 9% of them at STC, operated computers for these shorter periods. However, only 53% of the SAUDIA population operated computer continuously in comparison to 85% of the STC and 61% of KAU populations. Meanwhile, mostly 70% of KAU (69%) and STC (68%) populations had rest pauses <25% of the work shift, and 22% of the two populations got rest pauses 30%\u201340% of the shift, while the whole SAUDIA population had 25%\u201329% of their shift as rest pauses, in comparison to 9% and 10% of the other two populations.Eighty-two percent of the computer users in KAU, 72% of the operators at SAUDIA, and 60% of operators at STC were satisfied (and many were even very satisfied) at their work, particularly as related to their excellent satisfaction by their colleagues, work control, job attitude, and vigilance requirement, while the boredom from repetitive work and monotony and the work stress were the main causes of dissatisfaction among them, particularly the SAUDIA and STC populations .The operators' health complaints are presented in Tables Only 41% and 46% of KAU and STC populations, in comparison to 61% of SAUDIA population, reported eye and vision symptoms. The most predominant eye symptoms were eye redness, tearing, pain, and redness, and the most predominant vision symptoms were blurring, particularly for distance objects, as well as sensitivity to light .Thirty percent, 49%, and 39% of the KAU, SAUDIA, and STC populations were free from musculoskeletal symptoms. The main occurring symptoms were aching, tingling, numbness, pain, and stiffness, which occurred, mostly sometimes, and, to a less extent, often . The higThe effects of age and duration of employment  on the incidence of operators' health complaints are shown in Tables The impact of the ergonomics score of the workstation on the incidence of operators' complaints is shown in Out of the many factors considered for their effects on the incidences of the operators' complaints and symptoms, the smoking habit, the type of work, workers satisfaction, and the operators' history of musculoskeletal complaints and of eye and vision before joining present work showed some effects as indicated in Tables It is worth noting that the lowest eye and vision complaints occurred among the operators who had the lowest level of education , which might be interpreted by their relatively lower involvement in vision tasks than the operators having higher levels of education.As related to the impact of type of work on the incidence of complaints, results in Nevertheless, the work satisfaction showed clear impact on the incidence of health complaints among the examined computer users, where the percentages of those who were free from complaints got higher by the improvement of work satisfaction ; meanwhiThe history of previous ailments among computer users/operators, also, had some impact on the reported complaints among them, where the percentages of the present complaints among the subjects who had no previous ailments were less than among the other subjects reporting related ailments' history Tables \u201318.The average ergonomics score at STC was 81% which may be considered as a good level. However, and unexpectedly, the average ergonomics scores at KAU and SAUDIA were only 73.3% and 70.3%, respectively. It had been anticipated that the average ergonomics scores for the computer workstations existing in leading institutions like KAU and SAUDIA should be considerably higher.Although the examined populations in KAU and STC were relatively young and, consequently, had relatively short employment work duration, were relatively highly educated, had relatively low smoking index and low history of ailments before employment, had some type of on-the-job and/or formal training, mostly use computer daily for <7 hours and continuously getting rest pauses, and were mostly satisfied at work, yet they had somewhat high incidences of general complaints , vision complaints, and musculoskeletal complaints. However, within SAUDIA population, surprisingly, the highest health complaints were among the youngest operators, who also had the lowest duration of computer work, as well as among those who had on-the-job and/or formal training; meanwhile, no systematic effect of the workstations' ergonomic scores on the incidence of the complaints was observed. These anomalies might be attributed to having some of the operators who developed complaints there left or changed their work.Naturally, the operators who were satisfied by their work and those who were conducting comprehensive works  as well as those who had no, or inconsiderable, history of previous ailments had the least incidence of the health complaints.Meanwhile, higher incidences of the complaints existed among the smoking operators and those who did not work continuously with computer, as well as those who rated themselves as fast operating.In summary, the incidence of the various complaints had been demonstrated, generally, to increase by (a) the decrease in the ergonomics score of the workstations, (b) the progress of age and duration of employment, (c) the increase of smoking habit, (d) the continuous daily use of computer, (e) the lack of work satisfaction, and (f) the history of operators' previous ailments. However, unexpectedly, no effect could be demonstrated of the operators' formal training and the daily hours of computer use, on the incidences of the complaints.It is anticipated that the incidences of the different complaints among the examined population increased by their progress in the duration of work. Therefore, it is recommended that rapid actions should be taken to improve the ergonomics of the computer workstations. The improvement of each workstation should be considered separately with reference to the evaluation checklist of its individual components.Setting up training programs for computer operators to efficiently use their computers and optimize their posture and movements inside their computer workstations based on ergonomics principles is highly recommended. Also, motivation of workers to learn about computer work-related health disorders, their causes, etiology, preferable postures and movements, and the role of fitness exercise, and encouraging them to take rest pauses within their work shifts, all are recommended.It is recommended to conduct preplacement examination for computers' operators to exclude subjects with history of ailments that might be aggravated by computer use and to have available health baseline for the employed subjects as well as periodical medical examination  to assure normal health background and to early discover any deviation from normality.Finally, the study recommends extending the research to cover the sectors of computer and VDTs users, particularly those employed by small offices and medium-size enterprises where it is anticipated to have ergonomics poorly designed workstations. Also, particular interest may be forwarded to investigating the presently studied complaints among the female computer users in KSA."}
{"text": "Iron (Fe) is an essential micronutrient and its deficiency is a serious nutritional problem for all living organisms. This is because Fe is not only a basic requirement in cellular functions such as the redox reactions in photosynthesis and respiration, but is also required in the enzymatic processes like DNA replication, lipid metabolism, and nitrogen fixation in plants  from the Ministry of Education, Culture, Sports, Science and Technology of Japan; a Grant-in-Aid for Scientific Research from Nara Institute of Science and Technology supported by The Ministry of Education, Culture, Sports, Science and Technology, Japan. SZ acknowledges the DBT, New Delhi, India for award of CREST, Overseas fellowship to undertake this research.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "Background: The global burden of conduct disorder is a major public health concern. Although there are different reports on the prevalence of conduct disorder in different Middle Eastern countries, to date, no research has reviewed them. Therefore, we aimed to conduct a systematic review and meta-analysis on the literature and present the prevalence of conduct disorder among children and adolescents in Middle Eastern countries.Methods: Those cross-sectional studies with any type of random or non-random sampling, which described the prevalence of conduct disorder prior to age of 18, for at least one gender in the general or school-based populations who resided in Middle Eastern countries were included in this review. The scientific databases of PubMed, Scopus, Google Scholar, Index Medicus for the Eastern Mediterranean Region (IMEMR), Islamic World Science Citation Center (ISC), and Grey Literature including conference proceedings, and hand searching of key journals were searched from 1995 to the end of 2014. Two reviewers assessed the quality of the included studies independently and extracted the relevant data. Discussion: This review provided a picture of different frequencies of conduct disorder in Middle Eastern countries and analyzed the sources of heterogeneity. Systematic Review Registration: PROSPERO CRD42014014996 Conduct disorder is characterized by aggressive behaviors towards people and animals, deceitfulness or theft, destruction of property and serious violations of rules which persist in the child or adolescent during the past 12 months prior to age 18  revealed a prevalence rate of 32.9% for conduct disorder in Iranian children and adolescents . AnotherIn this systematic review, we aimed to investigate the prevalence of conduct disorder in the Middle East. Although there are different reports of prevalence of conduct disorder in different regions of the Middle East, to date, no research has reviewed them. Therefore, we conducted a systematic review and meta-analysis on the literature and presented the prevalence of conduct disorder among children and adolescents in the Middle East. Also, the heterogeneity of conduct disorder frequencies in the various countries of the Middle East was assessed, and the potential sources of heterogeneity were analyzed.Inclusion and Exclusion CriteriaCross-sectional studies including descriptive and survey studies, with any type of random or non-random sampling were included in this systematic review. The included studies described the prevalence of conduct disorder among children and adolescents prior to age of 18 for both genders, and at least one gender, in the general or school-based populations, residing in Middle Eastern countries. Moreover, the included studies defined conduct disorder based on the third, fourth and fifth versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM).We excluded clinical or interventional studies, and researches reporting the prevalence of conduct disorder with comorbidities, and we also excluded those studies conducted on single or high-risk groups.Search StrategyTo identify the included studies, we systematically searched five databases including PubMed, Scopus, Google Scholar, Index Medicus for the Eastern Mediterranean Region (IMEMR), and Islamic World Science Citation Center (ISC). We also searched grey literature including conference proceedings. Moreover, hand searching of key journals and reference lists of all the included studies were reviewed. Moreover, we searched all studies from 1995 to the end of 2014. The following key-terms were included: Conduct disorder, prevalence, and The Middle Eastern countries . Also, tThe two authors selected the included studies independently based on the full texts.Data Collection and AnalysisData ExtractionRelevant data were independently extracted from the included studies and entered into the data extraction form by the two reviewers, who resolved the inconsistencies of the extracted data through consensus. The extracted data included the followings: The first author, publication year, journal, survey years, study design, name and population of the study location , district of study location , sample size, response rate, gender, age, type of sampling, sample population , type of school (state/private), instruments, paternal and maternal occupation, level of paternal and maternal education, number of siblings, family income, maternal and paternal loss, addiction and crime of family. Quality AssessmentFor this review, we used the method and result sections of the STROBE checklist for quality assessment of the selected cross-sectional studies . This toStatistical Analysis and Data SynthesisWe used graphical methods and fixed or random effect models for the statistical analysis of the data. Sub-groups analysis or meta-regression was used to assess the sources of heterogeneity. Also, sensitivity analysis was performed, and publication bias was assessed using graphical methods and statistical tests. In this review, we investigated the studies conducted on the prevalence of conduct disorder in Middle Eastern countries from 1995 to the end of 2014 in order to analyze the sources of heterogeneity. The findings revealed a picture of different frequencies of conduct disorder in Middle Eastern countries, and contributed to a better understanding of the heterogeneities among the various reported prevalence rates of conduct disorder. The findings of this review may improve policy decisions, leading to a reduction in conduct disorder symptoms and providing improved special services for children and adolescents with conduct disorder.We will not be able to combine or meta-analyze the results, if there is methodological heterogeneity between the studies. Also, we may not be able to access to all gray literature in our review.This review provided a picture of different frequencies of conduct disorder in Middle Eastern countries and analyzed the sources of heterogeneity."}
{"text": "Department of Health and Human Services, the task force is an independent, nonfederal, uncompensated panel of public health and prevention experts whose members are appointed by the Director of CDC. The task force provides information for a wide range of decision makers on programs, services, and policies aimed at improving population health. Although CDC provides administrative, research, and technical support for the task force, the recommendations developed are those of the task force and do not undergo review or approval by CDC."}
{"text": "Department of Health and Human Services, the task force is an independent, nonfederal, unpaid panel of public health and prevention experts whose members are appointed by the Director of CDC. The task force provides information for a wide range of decision makers on programs, services, and policies aimed at improving population health. Although CDC provides administrative, research, and technical support for the task force, the recommendations developed are those of the task force and do not undergo review or approval by CDC."}
{"text": "Most biliary tract neoplasms are malignant and have been traditionally divided into cancers of the gallbladder, the extrahepatic bile ducts, and ampulla of Vater. Although infrequent, bile duct carcinomas and cancer of the gallbladder are not rare. In the United States, an estimated 6,000 to 7,000 new cases of carcinoma of the gallbladder and 3,000 to 4,000 new cases of carcinoma of the bile ducts are diagnosed annually. Familiarity with the imaging characteristics of gallbladder and bile duct neoplasms is important to expedite diagnosis and appropriate treatment of patients who often present with nonspecific symptoms of right upper quadrant pain, jaundice, and weight loss. This workshop presents the CT and ultrasound features of biliary tract neoplasms important for early diagnosis, staging, and follow-up of these often lethal neoplasms"}
{"text": "The economic burden of chronic diseases and conditions  requires new solutions not only in traditional clinical settings (in-patient treatments), but also in innovative healthcare scenarios (out-patient long-term monitoring).New technologies can provide clinicians and patients with many solutions at different levels: diagnostic and monitoring, early risk detection, treatment and rehabilitation, provision of feedback and alerts, and motivational strategies that facilitate changes in dysfunctional behaviors or maintenance of healthy lifestyles. A health technology assessment approach is necessary in order to collect evidence to evaluate the clinical and cost effectiveness of new tools and to strengthen the political choice to use health technologies in clinical fields.Telemedicine, e-health, and m-health scenarios can improve health outcomes, quality of life, and well-being and facilitate functional patient empowerment and engagement. Mobile technologies in particular can offer advantageous solutions: m-health could be considered an evolution of e-health and defined as the practice of medicine and public health as supported by mobile communication devices. Indeed, the m-health approach has the potential to overcome many of the limitations associated with the traditional, restricted, and highly expensive in-patient treatment of many chronic pathologies.A range of electronic health systems have been implemented in chronic disease management using stationary and mobile computers, smartphones, and other mobile platforms with differing access to data technology. New innovations in technology are required to meet the challenges associated with overcoming various barriers such as organizational and technological difficulties, lack of technology acceptance, costs of system implementation and maintenance, lack of system interoperability with other informatic tools, reduced communication between clinicians and patients, and difficulties in data processing due to the limitations of devices used in patient monitoring.There is potential for the development of a new and innovative model of healthcare as represented by such technologies as telemedicine, e-health applications, biomedical sensors and devices, integrated platforms and technologies for remote monitoring and management, web and Internet based clinical protocols, and m-health solutions. This model has the potential to offer healthcare that is tailored to the specific needs of the individual, whilst providing the benefits of a mobile, noninvasive, balanced, integrated, and lifestyle friendly framework that is useful from both a preventative and intervention-focused perspective.The major aim of this special issue is to bring to light new international developments in the management and rehabilitation of a range of chronic diseases and clinical conditions, such as stroke, dementia, cardiovascular diseases, dialysis patients, or those with facial paresis. A range of technological developments, lifestyle, and environmental factors have been described in relation to these diseases, including a rehabilitation system for stroke patients using vibrotactile feedback, a new system of facial movement analysis for facial paresis, an exploration of the effects of exercise for dialysis and cancer patients, and the influence of environment on those with dementia and coronary artery disease.In conclusion, as demand for the management of a range of chronic conditions increases in the imminent future, there is likely to be considerable scope for the integration of clinical psychology and medicine. A key future challenge for those working in both traditional and m-health/e-health settings will be to further develop the evidence base for chronic care management in order to enhance technological standards and fine-tune both clinical protocols and organisational models.Gianluca CastelnuovoGiancarlo MauriSusan SimpsonAngela ColantonioStephen Goss"}
{"text": "Journal of Neuroinflammation is an Open Access, online journal published by BioMed Central. Open Access publishing provides instant and universal availability of published work to any potential reader, worldwide, completely free of subscriptions, passwords, and charges. Further, authors retain copyright for their work, facilitating its dissemination. Open Access publishing is made possible by article-processing charges assessed \"on the front end\" to authors, their institutions, or their funding agencies. Beginning November 1, 2004, the Journal of Neuroinflammation will introduce article-processing charges of around US$525 for accepted articles. This charge will be waived for authors from institutions that are BioMed Central members, and in additional cases for reasons of genuine financial hardship. These article-processing charges pay for an electronic submission process that facilitates efficient and thorough peer review, for publication costs involved in providing the article freely and universally accessible in various formats online, and for the processes required for the article's inclusion in PubMed and its archiving in PubMed Central, e-Depot, Potsdam and INIST. There is no remuneration of any kind provided to the Editors-in-Chief, to any members of the Editorial Board, or to peer reviewers; all of whose work is entirely voluntary. Our article-processing charge is less than charges frequently levied by traditional journals: the Journal of Neuroinflammation does not levy any additional page or color charges on top of this fee, and there are no reprint costs as publication-quality pdf files are provided, free, for distribution in lieu of reprints. Our article-processing charge will enable full, immediate, and continued Open Access for all work published in Journal of Neuroinflammation. The benefits from such Open Access will accrue to readers, through unrestricted access; to authors, through the widest possible dissemination of their work; and to science and society in general, through facilitation of information availability and scientific advancement. Journal of Neuroinflammation is an Open Access, online journal that is published by BioMed Central, an independent publisher committed to Open Access for peer-reviewed biomedical research [Journal of Neuroinflammation. Open Access publishing is made possible by article-processing charges (APCs) assessed \"on the front end\" to authors, their institutions, or their funding agencies. The Journal of Neuroinflammation will introduce APCs of around US$525 per article for manuscripts submitted on or after November 1, 2004. This charge will be waived for all authors from institutions that are BioMed Central members, and in additional cases for reasons of genuine financial hardship.research . Among tTraditional journals generally do not charge authors for publication . Instead, article access is traditionally paid for by readers, either through subscriptions or through fees assessed for online viewing and downloading. Over the past decade, escalating journal subscriptions have resulted in cash-strapped libraries cancelling journal subscriptions , thus liJournal of Neuroinflammation's Open Access policy changes the way in which articles are published. First, all articles become freely and universally accessible online, immediately upon acceptance, so an author's work can be read by anyone at no cost. Second, the article authors retain copyright for their work, and grant to anyone the right to reproduce and disseminate the article, provided that it is correctly cited and no errors are introduced [Journal of Neuroinflammation's articles are permanently archived in PubMed Central [The troduced . Third,  Central , the US  Central  in Germa Central  in Franc Central , the NatOpen Access has four broad benefits for science and the general public. First, published work is disseminated freely and instantly to the widest possible audience, without barriers to access. Authors are free to reproduce and distribute their work at will, for example by placing it on their institution's website. Open Access publication has been shown to actually increase article citations and impact because of this easier availability . Second,Journal of Neuroinflammation. Authors will be asked to pay around US$525 upon acceptance of their article for publication. Submitted articles that are not accepted will incur no charge. There will be no charges for authors from institutions that are institutional members of BioMed Central. Currently this includes NHS England and all universities in the UK, the US National Institutes of Health and 136 other institutions and universities in the USA, the World Health Organization, and almost 200 additional institutions in 37 other countries [Article-processing charges will allow continued Open Access to all article published in ountries . Potentiountries . FinallyJournal of Neuroinflammation does not levy any additional page or color charges on top of this fee. Because we are an online-only journal, any number of color figures, photographs, and 'extra' pages can be included at no extra cost. Such color and page charges, as assessed by more traditional journals, can easily exceed our flat US$525 per-article APC. Another common expense with traditional journals is the purchase of reprints for distribution, and the cost of these reprints is also frequently greater than our APCs. The Journal of Neuroinflammation provides free, publication-quality pdf files for distribution, in lieu of reprints.The APC pays for an electronic submission process that facilitates efficient and thorough peer review, for publication costs involved in providing the article freely and universally accessible in various formats online, and for the processes required for the article's inclusion in PubMed and its archiving in PubMed Central, e-Depot, Potsdam and INIST. There is no remuneration of any kind provided to the Editors-in-Chief, to any members of the editorial board, or to peer reviewers; all of whose work is entirely voluntary. Although some authors may consider US$525 expensive, it must be remembered that British Medical Journal, for instance, recently announced that it cannot continue to provide free access to its website [Several traditional journals now offer free access to their articles online, but this is different from Open Access as defined by the Bethesda Statement . First,  website . They ar website .Journal of Neuroinflammation. The USA-based Public Library of Science (PLoS) is a new, non-profit organization that, like BioMed Central, is dedicated to online, Open Access publishing. PLoS has started two new Open Access journals, with APCs of US$1500 for each accepted article [APC-funded Open Access is not unique to BioMed Central or to the  article . PLoS ha article , providiJournal of Neuroinflammation. The benefits from such Open Access will accrue to readers, through unrestricted access; to authors, through the widest possible dissemination of their work; and to science and society in general, through facilitation of information availability and scientific advancement. We ask for your support in this important movement by submitting your next article to Journal of Neuroinflammation or to another Open Access journal.Article-processing charges will enable full, immediate, and continued Open Access for all work published in At Journal of Neuroinflammation, the work of the Editors-in-Chief, the Editorial Board, and of all invited outside peer reviewers is entirely voluntary, without tangible remuneration of any kind. Our goal is publication of biomedical research of the highest quality, and our (intangible) rewards lie in the achievement of these goals. Decisions about manuscripts are based entirely on the quality of the work, and not on the ability of authors to pay article-processing charges.APC = article-processing charge."}
{"text": "To analyze the profile of the compounded cardiovascular medicines prescribed in neonatology in Brazil.Intensive Care Neonatal, Off-Label Use, Pharmaceutical Preparations, in the databases Virtual Health Library (VHL), PubMed, and Scientific Electronic Library Online (SciELO). Review articles and guidelines were excluded. The quality of the evidence was analyzed, and 10 articles were selected to integrate the study.An integrative bibliographic review was carried out, including studies published in the last 20 years. The used descriptors were: The profile of routine prescrption in the neonatal unit was evaluated. The main cardiovascular medications prescribed as compounding formulation were: Spironolactone, Captopril, Furosemide, Hydrochlorothiazide, Propranolol, Amiodarone, Nifedipine, Carvedilol, Digoxin, Enalapril, Epinephrine, and Hydralazine. The drugs were obtained from adaptations of dosage forms, through the transformation of capsules or tablets into liquid formulations, as a solution, suspension, or syrup, as well as in the form of solutions prepared from active pharmaceutical ingredients. The compounding of medications made drug therapy possible in neonatology, considering that such medications do not have registration of the oral liquid dosage form in the country, despite being part of the List of Essential Medicines for Children of the Word Health Organization.It was possible to analyze the profile of compounded cardiovascular medicines prescribed in neonatology in Brazil. The results showed the need for the development of medications suitable for the neonatal population, and the standardization of operational procedures for preparing extemporaneous formulations in neonatology to increase drug safety. Turner proposes the classification of off-label medication use when the medication is used in the dose, age, route of administration, and/or indication other than registration, while its unlicensed use is defined by the use of extemporaneous formulations.The pediatric age group is known to be a therapeutic orphan, due to the low availability of formulations adapted to this population. As a result, there is a high prevalence of off-label and/or unlicensed use of medications.Newborns or neonates (0\u201328 days after birth) use off-label drugs 90% of the time and can reach 100% in neonatal intensive care units. Due to the lack of information on the safety, efficacy, and quality of these drugs, a high frequency of adverse drug events (ADE) is observed in this population, especially among hospitalized patients. have shown that extemporaneous formulations are widely used, due to the lack of liquid dosage forms for oral use suitable for neonatology, especially for medicines of the cardiovascular pharmacological group. This is due to the patient\u2019s physiological and anatomical immaturity. In this context, formulations for oral use are the ones with the best cost-effectiveness and lower risk, allowing better adherence, compatibility with medicine dispensers, and greater ease of administration (which can be done by tubes); however, some disadvantages have been reported, such as the difficulty in guaranteeing stability, the palatability of the formulation, the possibility of interaction with the tube and with formulas that replace milk and with other medications. Such factors must be evaluated, standardized, and validated during the preparation of formulations in the hospital setting, including the addition of excipients to maintain the homogeneity and stability of the pharmaceutical formulation.Several studiesIt is worth considering that drugs registered in the oral liquid dosage form can be good alternatives for use in the practice scenario, after evaluating their specificities and their suitability for the neonatal population, even with regard to the toxicity of the excipients and the dose.Pediatric pharmaceutical services in Brazil: recommendations and strategies to expanding coverage, access and rational use of medicines in children, the present review aimed to map the cardiovascular medicines used in neonatology in Brazil, considering those that have unlicensed use, related to the transformation of the original dosage form, described in the literature, but which are not registered in the Brazilian Health Regulatory Agency . With this mapping, the authors proposed that safe alternatives be sought for the use of these drugs, guiding both the facilitated registration based on formulations already registered in other countries and the validation, standardization, and provision of information on methods for compounding extemporaneous formulations in neonatology.In this scenario, in line with the document intensive care, neonatal, off-label use, and pharmaceutical preparations. The consulted databases were the Virtual Health Library (VHL), PubMed, and the Scientific Electronic Library Online (SciELO). The search was individually carried out by two researchers in June and July 2020 and considered publications from the last 20 years. After reading the abstracts, according to relevance and consistency, the following inclusion criteria were applied: original articles written in Portuguese, Spanish, and English languages; open access articles; and focused on Brazil. Exclusion criteria were: opinion articles; reflection articles; congress proceedings; editorials; articles that do not directly address the topic or that did not include neonatal patients in the scope of the study.An integrative review of the literature was carried out, through the established guiding question: what are the cardiovascular compounded medications needed in neonatology inpatient units in Brazil? To answer this question, searches were performed using the descriptors  to assess information on the registration of the oral liquid dosage form in the United Kingdom, as well as to verify if the medicines were part of the List of Essential Medicines for Children of the World Health Organization, if the medications had a registration of the oral liquid dosage form at ANVISA, through the System of Consultation to Registered Products (Sistema de Consulta a Produtos Registrados), and if there was information on the use of these medicines in the National Therapeutic Form  for neonatal patients.The results were compared with documents of the British National Formulary for Children (BNFC)A total of 16 articles were chosen, which addressed cardiovascular medications prescribed in neonatology. Seven duplicate articles were excluded and one from an alternative source was added. The 10 final articles were included for evaluation and discussion. The flowchart of the process for selecting articles for analysis is shown in The 10 studies were named by the editors as originals. As for the types of study, there were five descriptive studies; two cross-sectional studies; two cohort studies; and one prospective study, covering the years of publication between 2009 and 2020. All studies enabled to evaluate the prescription profile within the routine of the unit. All studies described the use of cardiovascular medications compounded for neonatology in a Neonatal Intensive Care Unit (NICU), according to the inclusion criteria.The 10 articles used in the analysis of the present study are described in  Captopril, Furosemide, Hydrochlorothiazide, Propranolol, Amiodarone, Nifedipine, Carvedilol, Digoxin, Enalapril, Epinephrine, and Hydralazine.For better data analysis, the cardiovascular drugs indicated in the studies are presented in  and verified the existence of registration of the oral liquid dosage form in Brazil and in the United Kingdom, as described in The present study also compared the presence of the cardiovascular drugs mentioned in this review with the List of Essential Medicines for Children, of the World Health Organization, Captopril, Furosemide, Hydrochlorothiazide, Propranolol, Amiodarone, Nifedipine, Carvedilol, Digoxin, Enalapril, Epinephrine, and Hydralazine. Considering that the articles have representative data of the routine of that clinical unit, the most cited drugs are more likely to be part of the list of medicines standardized for a given establishment. Therefore, these drugs are important medicines in neonatology.The studies used in this review state that the most indicated cardiovascular medications in pediatrics and neonatology are: Spironolactone, evaluated the demand for compounding oral liquid pharmaceutical formulations containing cardiovascular drugs, through interviews with pediatricians. In the interview, physicians identified the main drugs whose pharmaceutical formulation represented a problem in pediatrics, such as Captopril (5mg/mL), Spironolactone , Hydrochlorothiazide (50mg/5mL), and Propranolol (4 and 8mg/mL).Costa et al. described the cardiovascular medications prescribed to different groups of neonates through a cross-sectional study carried out in the Pediatric Intensive Care Unit (ICU) of a hospital in the city of Belo Horizonte , and found prescriptions containing the drugs Captopril, Furosemide, and Hydrochlorothiazide for neonatal use. Pereira et al. studied the use of magistral oral solutions and suspensions in newborns and children at a university hospital, by analyzing compounding request forms for patients admitted to the neonatal, obstetrics, and pediatrics ICU. This study mentioned pediatric oral liquid preparations of Captopril, Furosemide, Spironolactone, Hydrochlorothiazide, Hydralazine, Amiodarone, Propranolol, and Enalapril, which were produced in the compounding pharmacy, under the responsibility and guidance of the pharmacist.Ferreira et al. studied prescriptions for newborn patients with a mean age of 15 days and analyzed the prescriptions of compounded medication for newborn patients and their pharmacotechnical feasibility. The authors observed that drugs were obtained in the form of solutions based on the drug Captopril; as suspensions, for delivering the drugs Spironolactone and Furosemide; and as syrup, for delivering the drug Propranolol.Passos et al.. They are obtained from adaptations of dosage forms, through the transformation of capsules or tablets into liquid formulations such as solution, suspension, or syrup. This process occurs in 75.63% of medications in the pediatric ICU, due to patients\u2019 difficulty or inability to swallow and the need for lower doses.Such drugs are not marketed in Brazil in liquid form, but are used in hospitals to make treatments viable. Therefore, they are invariably prepared extemporaneously. found that the cardiovascular drugs most prescribed in underdoses were Spironolactone, Captopril, and Furosemide, while Captopril and Digoxin were among the most prescribed drugs in overdoses, with the majority of overdoses occurring among lactating women.A relevant aspect in relation to obtaining pediatric medicines is the dose adjustment, which must be performed through complex calculations, which in turn are necessary to adapt the formulation indicated for adult use to another formulation aimed at pediatric use, usually with very small doses, as those used for neonates. Thus, Ferreira et al. which are essential to adapt the shelf life, packaging, storage, control procedures of quality, and traceability of these drugs. In this context, the use of such medications has become less safe and with less predictable results.Within this scenario, it is necessary to understand that the production of extemporaneous formulations, from the transformation of solid oral dosage forms into liquid oral dosage forms, represents a risk due to the presence of different excipients in the composition of these pharmaceutical products, which can cause adverse events in patients. In addition, there is the lack of information on bioavailability and physical, chemical, and microbiological stability of the resulting formulations that are not readily available, Thus, the compounding of medicines has a fundamental role in obtaining the feasibility of the drug therapy in neonatology.Moreover, the non-complete use of the compounded medication by the pediatric patient can occur and generate financial losses. Nevertheless, given the total absence of a suitable dosage form for this group of patients, compounding can still represent one of the alternatives to make the prescribed treatment feasible. it was verified that, with the exception of Captopril and the liquid oral form of Propranolol, the main drugs, such as Spironolactone, Furosemide, and Hydrochlorothiazide, are referenced for the treatment of priority diseases. Furosemide is included in the core list of the document, which deals with the minimum drugs necessary for an effective, safe, and cost-effective treatment for priority diseases in the health system. Conversely, Spironolactone and Hydrochlorothiazide, despite being part of the document, are included in the complementary list, concerning medicines to treat priority diseases that require specific diagnosis and therapy with a specialized professional, and must be evaluated as for safety and cost-effectiveness.Regarding the presence of the cardiovascular drugs mentioned in this review that are part of the List of Essential Medicines for Children of the World Health Organization,Captopril, although not listed in the document of the World Health Organization, has a well-established use for the treatment of various conditions in neonatology, such as: hypertension, heart failure, proteinuria in nephritis, and diabetic nephropathy in type 1 diabetes mellitus. The protocols for use, indication, forms of administration, and monitoring care are described for term and preterm neonates in the BNFC.Digoxin, despite being part of the core list of essential medicines for children of the World Health Organization and having its use established by the BNFC, was not observed in the NICU in this review. This result can be attributed to the fact that there are drugs with a higher therapeutic index, such as Propranolol and Amiodarone, to treat supraventricular arrhythmias, which is the main indication for the use of Digoxin in neonatology.The therapeutic class of diuretics includes the main prescribed drugs, as they are medicines of first choice in the treatment of pulmonary edema in neonates, which can be caused by conditions such as pulmonary stress or bronchopulmonary dysplasia, as well as in the clinical management of neonates with congenital heart disease. Overall, diuretics can be prescribed together, as long as they belong to different classes and act synergistically: Spironolactone as a potassium-sparing diuretic; Hydrochlorothiazideas a thiazide diuretic; and Furosemide as a loop diuretic. This can be attributed to the fact that there are regulatory incentives to gather information for important medicines in pediatrics, such as, for example, the pediatric investigation plan, in the registration of a particular drug or class of drugs, in addition to financial incentives and patent extension for companies that produce drugs with information on efficacy and safety for pediatric use.In addition, it was verified that, among the main cardiovascular medicines compounded for neonatology in Brazil, none has a registration of the oral liquid dosage form at ANVISA. Conversely, in the United Kingdom, four are registered, one of them being Chlorothiazide (ATC code: C03AA04), a thiazide diuretic that replaces Hydrochlorothiazide. Chlorothiazide is registered as a liquid oral dosage form and its use is licensed for neonatology. In comparison with the BNFC, it can be noted that there is no official reference of information for the safe and effective use of important drugs in neonatology (and pediatrics as a whole) in Brazil. The BNFC has pieces of information ranging from protocols for the administration and maintenance of therapy, standardized strategies for compounding extemporaneous forms, and data on efficacy and safety, including management of adverse events, doses, and medications registered and available on the market, and charged costs.None of the cardiovascular medicines compounded for neonatology had information on their use in the latest edition of the National Therapeutic Form. and the authors highlighted the need to also evaluate data on toxicity of excipients to ensure that the formulation is suitable for this age group.All cardiovascular drugs described in this review, regarding the demand for pharmaceutical compounding, can be classified as compounded medications necessary in neonatology, due to the lack of registration of the oral liquid dosage form in Brazil. This approach takes into account the adaptability of oral liquid dosage forms with regard to their cost-effectiveness and the suitability of this form concerning the anatomical and physiological immaturity of the neonate. This approach has already been used by Castro et al.,Assist\u00eancia farmac\u00eautica em pediatria no Brasil , which compiles recommendations and strategies that address these aforementioned points, seeking, in the long term, to correct the gap in access to safe and effective medications and to ensure the rational use of medicines for the pediatric population.Furthermore, there are few governmental, regulatory, or financial incentives for the manufacture and/or registration of dosage forms intended for pediatrics in the country, or for gathering safety and efficacy information, or even an official reference for unified information, for cases in which the need for compounding and the use of the unlicensed form are justified by the principle of beneficence. However, in 2018, a document was published within the scope of the National Medicines Policy entitled  Carvalho et al. correlated the non-standardized and unlicensed use of drugs in the NICU with severity scores and showed that the greater the severity of the clinical involvement, the greater the chance of the patient receiving a drug of this classification.Finally, it is worth highlighting that the use of off-label and unlicensed drugs in neonatal and pediatric patients may be associated with the emergence of adverse events.The main limitation of this study concerns the search for Brazilian articles, which should be considered regarding the generalization of data, despite the comparison with the BNFC.In this study, through the literature review, it was possible to map the cardiovascular drugs needed in neonatology in Brazil, such as Spironolactone, Captopril, Furosemide, Hydrochlorothiazide, Propranolol, Amiodarone, Nifedipine, Carvedilol, Digoxin, Enalapril, Epinephrine, and Hydralazine. Despite their well-reported use in the literature, these medications are not registered as an oral liquid dosage form in the country, in contrast to the United Kingdom. Moreover, none of these drugs has an official reference for safe and effective use in neonatal patients in Brazil.The lack of appropriate formulations for pediatric use has repercussions on medical practice in Brazil and is exacerbated by the lack of adequate conditions for the compounding of medications by pharmacists in Brazilian hospitals. Such factors highlight the need for investment in the production and registration of medicines suitable for the pediatric population with the creation of regulatory and financial incentives for the pharmaceutical industry, as well as validation, standardization, and provision of information on methods for compounding extemporaneous formulations in the neonatology to increase the safety of these drugs, which are essential to improve the access of this group, therapeutic orphan, to safe, effective, and quality treatment and to reduce health inequities."}
{"text": "During the Coronavirus disease 19 (COVID-19) pandemic, isolation and prevention measures to reduce COVID-19 contagions are essential for the care of all people; these measures should comply with the principles of inclusion and accessibility for people with disabilities (PWD), with all kinds of deficiencies and levels of dependency. Thereby, the aim of this article is to present the measures adopted for PWD or people with rehabilitation needs, for containment, mitigation, or suppression of the SARS-CoV-2 virus in different countries of all continents and of all income levels.A narrative approach was used in this article. First, a broad search was carried out in the 193 member states of the UN, and then 98 countries that issued any document, report, or information related to disability and COVID-19 were selected. Finally, 32 countries were included in this article because they presented official information. We considered official sources, the information available in the government, or on the health ministry page of the country. In this way, the countries that presented information which did not correspond to an official source were excluded. The search was conducted in August 2020 and updated in March 2021.First, the non-pharmacological general interventions for PWD included informative measures and general recommendations during the stay at home, isolation, and biosecurity measures, contagion prevention, detection of positive cases, mobilization measures, and measures implemented in institutions or residences of PWD. Second, we identified the economic and social benefits provided to PWD during the pandemic. Finally, we identified the measures taken by countries according to the type of impairment  during the COVID-19 pandemic.In response to the COVID-19 pandemic, only 50% of countries from the five world regions created and implemented specific measures for PWD to containment, mitigation, or suppression of the SARS-CoV-2 virus. There is very little specific information available about the measures to continue with the care of people with rehabilitation needs and the long-term follow-up of PWD, and for the prevention and response to violence, especially for women with disabilities. The Coronavirus disease 2019 (COVID-19) pandemic began in the city of Wuhan (China) at the end of 2019 and it was declared, according to the WHO  represent a vulnerable population; in this way Centers for Disease Control and Prevention (CDC) and WHO stated that some PWD may be more likely to become infected with the SARS- CoV-2 virus, or may develop a serious illness due to the underlying medical conditions, congregational living environments, systemic social inequities, and some barriers they might face in accessing healthcare during the pandemic \u20138. ThereIt is expected that COVID-19 affects this vulnerable population. Too often, PWD is left behind in emergencies, and this is a risk in the ongoing COVID-19 pandemic . PandemiIn some countries where health services have been accessible and affordable, governments find it increasingly difficult to respond to the growing health needs of populations and the rising costs of health services . During In this way, rehabilitation services must keep continuing during the pandemic; it is an essential component of high-value care to optimize physical and cognitive functioning to reduce disability. In this way, the interruption of these services may affect the well-being and quality of life of PWD and impose more burdens on a population that is already vulnerable , 16. SomOne study described the timely innovative proposals of scientific associations and rehabilitation professionals of different countries, focusing on delivering rehabilitation services, protection and prevention measures, physical distancing, isolation, hand washing, and disinfection measures in the context of the COVID- 19 pandemic. In this way, measures to prevent and protect against transmission of COVID-19 are necessary for all patients in rehabilitation care around the world .Bettger  publisheThis information allows for knowing some of the adaptations and reorganization of the rehabilitation services carried out in different countries to the health emergency by COVID-19, which had an impact on PWD or with rehabilitation needs , 18. UntThe main aim of this study was to describe the measures adopted by different countries around the world and of all income levels to guarantee universal coverage, access to information, and actions for prevention and mitigation of direct and indirect consequences of the COVID-19 pandemic, on PWD and with rehabilitation needs.We used a narrative approach  to identWhich were the responses and measures adopted by different countries for PWD and with rehabilitation needs, for containment, mitigation, or suppression of the SARS-CoV-2 pandemic?A narrative approach was used to identify the measures adopted by different countries for PWD or with rehabilitation needs during the COVID-19 pandemic. First, a broad search was carried out in the 193 member states that belong to the UN . Then 98In this way, the countries that presented information that did not correspond to an official source were excluded. We considered the official sources, the information available in the governments, or the health ministry pages of the country. Thus, we excluded 66 countries that presented information that did not correspond to an official source. We considered the following official sources: (1) The information is available on the government page of the country. (2) The information is available on the ministry page of the country. We excluded other sources of information, such as NGOs, foundations, private organizations, or independent organizations because this was not the focus of this review. The search was conducted in August 2020 and updated in March 2021.Eight researchers  conducted the data extraction using a predefined form to record the following information: (1) date of the declaration of emergency; (2) specific measures for PWD related to social distancing, biosecurity measures, travel restrictions, detection and tracking of cases, isolation of cases of PWD, economic benefits, and others related to the guarantee of rights; and, (3) specific measures according to the type of disability: hearing disability, visual disability, physical disability, cardiopulmonary limitation, intellectual disability, autism, and dementia.Finally, four researchers with expertise in rehabilitation screened the search results and selected 32 countries from five world regions: Africa (5 countries), America (10 countries), Asia (6 countries), Europe (9 countries), and Oceania (2 countries). Hence, 32 countries were included in this article because they presented official information issued by the government or the health ministry's official pages refer to .We categorized the information in non-pharmacological interventions for general PWD and interventions according to specific types of disabilities. First, we included the following interventions: informative measures and general recommendations during the lockdown, protection measures and prevention of COVID-19 contagion, detection of positive cases, management, and isolation of PWD; mobility, transport, and isolation; and measures taken within care institutions. Then, we categorized the interventions according to the following types of disability: visual impairments, hearing impairments, physical disability, cardiopulmonary limitation, and mental function that included autism, dementia, and intellectual disability.The findings reflect that some governments have made an effort for reducing the transmission of the disease in this vulnerable population because they have recognized the importance of providing access to health services and the need to adopt special and different measures for the prevention of contagion in PWD  refer t.Some countries made a declaration that PWD could have a greater vulnerability in this pandemic because they are constantly faced with physical barriers in the application of hygiene measures or social distancing. Besides, they require support from other people to carry out their daily activities .6).In this synthesis, we considered the following impairment conditions: visual, hearing, physical impairments, cardiopulmonary limitations, and alterations in mental function \u20136.People with visual impairments may have a higher risk of contagion by SARS-CoV-2 because daily they need to be in contact with objects, surfaces, or assistive devices to recognize the environment and to move in the space. For this reason, the countries around the world focused on recommendations based on frequent handwashing, cleaning of assistive devices, such as sticks, guide dogs, and other recommendations mentioned in Around all continents, the need to implement sign language to obtain better and clearer access to all information about COVID-19 has been recognized. This action would improve the rights of people with hearing impairment. The government states that not only translation is important, but it needs actions to prevent and mitigate the spread of COVID-19 in this population, such as the following measures shown in Most of the countries have a general concern regarding the people with physical disabilities, that is the cleaning of assistive devices and surface contact areas because this population usually needs help from another person and close contact with people or their own devices refer to .Countries focus their attention on preventing contagion by COVID-19 in people with any impaired cardiopulmonary function because they have a higher risk to develop secondary complications due to Coronavirus. In this way, most measures seek to prioritize the special care that this population group should have when they have a virus infection refer to .Some countries issued information focused on recommendations to orient people with autism, intellectual disabilities, or dementia. Governments issued information in easy-to-read material with information focused on prevention measures to avoid the spread of the virus. Furthermore, countries issued recommendations and advice about the care of mental health in this population during the pandemic refer to .Some American countries, such as Colombia, created programs to identify the PWD who had support needs to ensure their levels of quality of life and food security during the COVID-19 state of emergency . Chile mBrazil invested in the Social Assistance System with the aim of maintaining programs, projects, and services in the vulnerable areas of the country, mainly for the care of PWD and the elderly . The UniThe European countries, such as France made exceptional provisions to avoid any violation of the rights of the holders of the allowance for PWD, to deal with the social and economic consequences of the COVID-19 epidemic . Italy pIn Asian countries, such as Japan, there were guidelines for financial support for children with disabilities, due to the temporary closure of special support schools . The govIn some countries of Oceania, such as Australia, there was a payment to PWD to help them keep their jobs . New ZeaIn Africa, the country of Zambia carried out an inclusive, multi-partner socio-economic impact study on the effects of the COVID-19 outbreak to ensure that no one was left behind by targeting the most vulnerable group, such as PWD and the marginalized groups .In this narrative review, we described the non-pharmacological interventions for PWD that included informative measures and general recommendations during the quarantine period, isolation, and biosecurity measures, contagion prevention, detection of positive cases, mobilization measures, measures implemented in institutions or residences of PWD, the main economic and social benefits provided to PWD, and the measures taken by countries according to the type of impairment  during the COVID-19 pandemic.The WHO called for an action to strengthen the rehabilitation planning and implementation, including sanitary emergency preparedness and response to the current COVID-19 pandemic , 169. Invia telemedicine and through community-based networks, ensuring equitable healthcare access; guidelines prohibiting blanket decisions on medical rationing, solely on the grounds of disability, employment, and financial protection delivered through disability-related welfare provision; the development of support frameworks for people who need to shield from COVID-19 but who are outside of the social welfare or social care context ; education interventions and reasonable accommodations through online special education classes, accessible education activities, and distribution of educational materials; social care services, including psychosocial support, personal assistance, and support for independent living; prevention from and response to violence, in the forms of accessible hotlines for gender-based violence, especially for disabled women, and emergency services and shelters prepared to meet the needs of the disabled people; measures addressing the intersectional disadvantage the disabled people face, including the early release of disabled prisoners, and the provision of accessible health services for homeless people; and the inclusion of disabled people in the recovery phase, ensuring that structural changes are implemented, making the societies more inclusive (The disability considerations of WHO during the COVID-19 outbreak included the following: the provision of accessible information; provision of health services nclusive .Therefore, it is evident that there has been a real concern for the protection of the rights of PWD by supranational organizations which called on governments to guarantee the protection and promotion of the rights of PWD, as evidenced in our recent synthesis about the rights of PWD during the COVID-19 pandemic .Although there have been explicit statements about the prevention and mitigation measures from several countries, others did not do it, as many countries from Africa, Asia, and America especially, central America. Fewer were the declarations to continue with the care of people with rehabilitation needs and the long-term follow-up of PWD. These kinds of responses were timely and more creative on the part of a professional's associations . Only 35Most of the countries involved in this synthesis had an inclusive response to the pandemic with the creation of measures for PWD but not all countries developed specific measures for each type of impairment. We also note that some countries developed guidelines about the recommendations to be taken for a specific type of disability, while other countries only issued a little information about it; also, some other countries only adapted the recommendations that other countries issued.The North American countries had a broad focus on the population living in the residential centers or home cares. Some other countries in Europe, such as the United Kingdom and Spain, had a real concern for people with impaired cardiopulmonary function. Most of the recommendations issued by the countries for people with a physical impairment only focused on the cleaning of assistive devices or surface contact areas; however, the recommendations in this population could be covered in a broader way.However, our findings are consistent with the WHO report that states that PWD may have a greater risk of acquiring COVID-19 because they daily deal with barriers to implementing basic hygiene measures, difficulty in carrying out the social distancing, the need to touch contact surfaces, assistive devices, or some objects to obtain information from the environment, or for the physical support. Besides, some others are institutionalized and others face barriers to the access of the public health information .As Bettger  describeOur results are consistent and support Armitage's approach that COVID-19 mitigation strategies must include PWD to ensure that they maintain respect for \u201cDignity, human rights, and fundamental freedoms, and avoid widening existing disparities\u201d . This reMoreover, we share the approach of Ceravolo et al.  which stPandemics, such as COVID-19, place everyone at risk, but certain risks are differentially more severe for groups already vulnerable by the preexisting forms of social injustice and discrimination . For thiEven though an exhaustive search was made in the national pages of each country, relevant information, issued by different countries, such as reports, guides could have been disregarded due to the language of the information, or perhaps there was no easy way to access this information. The consensus process of recommendations is heterogeneous and, in some cases, not clear. Lack of evidence is inherent because no studies on long-term outcomes were available. Data about the care of PWD in low- and middle-income countries is lacking. There is little information about the measures to continue with the care of people with rehabilitation needs and the long-term follow-up of PWD. Besides, the information is scarce about the consequences of COVID-19 in PWD, and we do not know the effectiveness of the implementation of these prevention measures in disabled people or with rehabilitation needs.We suggest that appropriate actions and prevention strategies for PWD should be implemented to reduce the contagion of COVID-19, such as vaccination prioritization, access in public places to wash hands when they are away from home, and provision of accessible information for this population through all media.It is necessary to strengthen and provide health services through telemedicine, telerehabilitation, and home-based rehabilitation, ensuring equitable access to medical care. Besides, we suggest that PWD who need educational interventions and reasonable accommodations for learning can use other methods for their learning, such as online special education classes or accessible educational activities. Also, we consider it important to strengthen social care services for PWD in times of confinement and social distancing.In those countries where specific guidance for the provision of rehabilitation for PWD was not prioritized, we recommend that national rehabilitation associations and providers make statements to ensure access to rehabilitation services.Therefore, we call for action from all authorities and other stakeholders to continue and strengthen the creation of measures that manage to address the needs of PWD and to reduce the barriers they experience in the current pandemic. In this contingency, it has not been enough to maintain the health care conditions for PWD. The need to work on strengthening communication and innovation in health care, the integration of countries and human groups to build the way of living in a new world, called the \u2018New Normal\u2019 is evident.In summary, our findings suggest that most countries around the world have adopted appropriate actions, creating and designing measures and strategies for PWD in response to the health emergency due to COVID-19. The response of different countries to the pandemic showed the need to implement actions for the prevention of contagion of PWD, their families, caregivers, and health professionals who provide rehabilitation services.However, there is very little specific information available about the measures to continue with the care of people with rehabilitation needs and the long-term follow-up of PWD, and for the prevention and response to violence, especially for women with disabilities. Finally, it is important to highlight that PWD is still a vulnerable population because they are constantly facing barriers that hinder the implementation of prevention and protection measures in the COVID-19 pandemic.LL: definition of the research question and the objectives of the study, elaboration of the methodology for the research, selection of studies, data extraction, synthesis, elaboration of results, and writing the final article. MS: information selection, information research in different organizations, data extraction, information analysis, elaboration of the results, and writing the final article. JV: design and organization of templates for data extraction, content data extraction, and data organization and grouping. MG: analysis and preparation of results and annexes and writing the final article. AP: definition of the research question and the objectives of the study, elaboration of the methodology for the search, selection of studies, and data extraction. VO: synthesis, elaboration of results, selection, extraction, analysis of data from different associations, and writing the final article. LM: selection of studies, data extraction, and synthesis of results. KC: selection of information, information search in different organizations, data extraction, and information analysis. RD: selection, extraction, analysis of data from different associations, and writing the final article. CG: synthesis and elaboration of results and writing and reviewing the final article. DP: data extraction, synthesis and preparation of results, and writing the final article. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "Taking the entire education system in Taiyuan City, Shanxi Province, Central China, as an example, this paper uses the questionnaire survey method to analyze the effect of artificial intelligence (AI) on role cognition in the education system. The education system targeted by this questionnaire survey involves 8 categories: preschool education, primary education, secondary education, higher education, adult education, computer network education, enterprise education, and social education; the respondents include 368 teachers, 402 students or learners, 118 school managers, and 124 family members of students or learners in all above education categories. The questionnaire design has a total of 34 question classified into 6 role cognition items, with a 5-level score; a total of 1012 questionnaires were distributed, and 978 were recovered with a recovery rate of 96.64%, in which 957 were valid questionnaires with an effective rate of 97.85%. The study results show that the learning of AI-assisted courses is strongly dependent on course role cognition, and the construction of role cognition is related to the understanding of course content, teaching methods, and activity methods. Therefore, the effect of AI on role cognition in the education system needs to be systematically analyzed from the aspects of function realization form, resource presentation method, supporting hardware form, teacher-student interaction method, and representation method of works. As connecters, teacher's role cognition is limited by the degree of understanding learners, the amount of resources, and data processing capabilities, but the advantage is that they can flexibly monitor and adjust. AI technology is flexible and diverse, it functions in learning and teaching activities in a variety of ways, and there is no agreement on the terminology to describe its role in role recognition. The results of this paper provide a reference for further researches on the effect of AI on role cognition in the education system. Artificial intelligence (AI) capable of autonomous perception, understanding, prediction, and action is an unprecedented powerful learning technology, which enhances the flexibility and adaptability of computers as interactive subjects in the process of teaching and learning. In the context of promoting the research and practice of AI education on a large scale, it is very necessary to systematically sort out the microscopic mode of action and role cognition of AI in supporting learning and teaching . In thisThe arrival of the era of AI has had a huge impact on role cognition in the traditional education system, requiring teachers to establish a new concept of talents, teachers and students, and teaching concepts, and reunderstand the role of teachers. Although each scholar has different views on role cognition, they all share a common view that role cognition is the early stage of the role development process . For teaTaking the entire education system in Taiyuan City, Shanxi Province, Central China, as an example, this paper uses the questionnaire survey method to analyze the effect of AI on role cognition in the education system. The education system targeted by this questionnaire survey involves 8 categories: preschool education, primary education, secondary education, higher education, adult education, computer network education, enterprise education, and social education; the respondents include 368 teachers, 402 students or learners, 118 school managers, and 124 family members of students or learners in all above education categories. Taking secondary education as an example, the sample selection first randomly selects a class of five grade students in each school and then selects students with odd student numbers in each class as the survey object. For the convenience of the survey and to ensure the randomness of the sample, the parents or relatives of the selected student sample are taken as the family sample. The teacher sample was identified as qualified and full-time teachers, excluding principals, deans, and other administrators and service personnel. The detailed chapter arrangement is as follows: Using the method of questionnaire survey, this study takes the entire education system of Taiyuan City, Shanxi Province in Central China as an example to explore the effect of AI on role cognition in the education system. The education system targeted by the questionnaire involves school education system, computer network education system, enterprise education system, and social education system; the school education system also includes preschool education, primary education, secondary education, higher education, and adult education. The objects of the questionnaire design include teachers, students, administrators, and family members of various education categories. The questionnaire sorted out a total of 64 descriptions of the role cognition of various objects in various educational systems and then further sorted out the descriptions into 34 questions. Finally, according to literature materials, these 34 questions were classified as 6 role recognition items. The questionnaire uses a 5-level score, and the subjects are asked to make a choice of \u201cextremely important,\u201d \u201cvery important,\u201d \u201crelatively important,\u201d \u201cnot very important,\u201d and \u201cnot important\u201d for each question listed in the above order and make a 5-point rating of 5-1 .The questionnaire of this study includes three parts: basic information, investigation themes, supplementary questions, and open-ended questions. The investigation subject part consists of 34 questions and is classified into 6 role cognition items: morality and discipline, knowledge and professionalism, activities and communication, guidance and consultation, research and practice, and goals and feedback. The thematic parts of the questionnaires used in this study for teachers, students, administrators, and families are consistent with each other and aim to understand the perceptions and attitudes of various object roles in various education systems with the possibility of side-by-side comparisons. At the end of each questionnaire, supplementary items of self-made questions are designed, such as \u201cplease write the questions that you think are important but not listed in the question, and give the corresponding score.\u201d An open-ended question was also designed at the end of each questionnaire: \u201cWhat other suggestions do you have,\u201d aiming to further obtain more materials to have a more comprehensive understanding of the effect of AI in the effect of AI in the education system.The selection of the questionnaire survey sample adopts the combination of purposeful sampling and random sampling. A total of 5 units in each of the preschool education, primary education, secondary education, high education, adult education, network education, enterprise education, and social education in Taiyuan City, Shanxi Province, were selected, including 368 teachers, 402 students or learners, 118 school managers, and 124 family members of students or learners. The detailed sampling distribution of each system is shown in Teacher questionnaires were distributed and recovered with the assistance of the educational affairs department of the surveyed units; a total of 368 questionnaires were distributed, and 348 were recovered with a recovery rate of 94.57%, in which 343 were valid questionnaires with an effective rate of 98.56%. The student questionnaires were distributed and recovered by a combination of online and offline methods; a total of 402 questionnaires were distributed, and 399 questionnaires were recovered with a recovery rate of 99.25%, in which 393 were valid questionnaires with an effective rate of 98.50%. The school manager was distributed and recovered with the assistance of management department of the surveyed unit; a total of 118 questionnaires were distributed, and 118 were recovered with a recovery rate of 100%, in which 117 were valid questionnaires with an effective rate of 99.15%. The family questionnaires were distributed and recovered by means of online links; a total of 124 questionnaires were distributed, and 113 were recovered with a recovery rate of 91.13%, in which 104 were valid questionnaires with an effective rate of 92.04% .t-test and one-way analysis of variance were used to analyze the effect of AI on role cognition in the education system.Statistical analysis was carried out on 34 questions in the main part of the survey, text analysis was used for self-made questions and open-ended questions, and they were classified as qualitative analysis. SPSS 19.0 statistical software was used for statistical processing, the input data were analyzed, and the measurement data were expressed as mean \u00b1 standard\u2009deviation. The From a psychological point of view, role cognition is the foundation, and role behavior is the foothold. Therefore, this study discusses in the order of role cognition, role emotion, and role behavior and regards role identification as a structure that integrates knowledge, emotion, and behavior. The learning of AI courses is strongly dependent on course role cognition, and the construction of role cognition is related to the understanding of course content, teaching methods, and activities. The form of function realization, the way of resource presentation, the form of supporting hardware, the way of interaction between teachers and students, and the way of representation of works are systematically analyzed. The design and practice of the cognition of the learning roles in the course support are highly consistent with the educational concept and value cognition of the AI course. Most of the supporting role cognition used in the current AI course teaching is based on code programming or graphical programming, and some schools have participated in the development of some learning role cognition . Most ofWith the support of AI technology, respecting the individual characteristics of learners and providing personalized guidance for learners is about to become a reality. Based on the learner's personal information, cognitive characteristics, learning records, location information, media social information, and other databases, the AI program can self-learn and build a learner model and continuously adjust and optimize the model parameters based on the expanded and updated data set, thereby realizing the push of personalized resources, learning paths, and learning services. The clearer the individual's cognition of the theoretical positioning of the role, the more successful the role plays; otherwise, it may lead to the failure of the role. Role cognition is also the premise and foundation of role behavior. There is still a big difference between face-to-face communication and face-to-face interaction between people. For the learning of students in school, it is necessary to respect the knowledge structure of the course, take into account the students' learning interests, and discover hidden laws based on data such as learning content, teacher suggestions, students' interests, and learning behaviors, so as to build an effective learning support model .The analysis of the effect of AI in the education system is characterized by active intervention in the learning process of students according to the cognitive characteristics of different students on the basis of data analysis, so as to optimize the learning process and scientifically evaluate learning effectiveness. The adaptive learning system based on cognitive level ability can apply the model to guide, intervene, optimize the learning process, and make scientific evaluation, which can be regarded as a system with real intelligent and adaptive functions. The application of AI technology in the establishment of students' personalized learning space, optimization of personal learning process, and improvement of learning efficiency can be expected, and its value is relatively easy to judge. The effect of AI is far lower than the role that students can play in the process of propositional knowledge learning. But in fact, on the one hand, the data processed by the perception layer is quite scarce, which greatly restricts the possibility of perceiving students' knowledge level and learning status through AI; therefore, it is still difficult to produce a truly intelligent and adaptive system.In role identity theory, scholars believe that role identity includes multiple dimensions, such as role cognition, role emotion, and role behavior. The feelings expressed by the individual's evaluation of the role cognition and the role affection are affected by the individual's experience of the role played and the environment in which the role is located. The combination of AI technology and education and teaching system has greatly improved the interaction between teachers and students in classroom teaching and the uniqueness of the education model . The popAccording to the different forms of existence, roles can be divided into three levels: expected roles, comprehension roles, and practical roles. An expected role is a set of ideal behavioral norms and action patterns set by a society or an organization for a specific social role; so, it is sometimes called an ideal role. The comprehension role is the behavioral norm and action mode that the individual understands, recognizes, and internalizes to the level of concept and consciousness. Practical roles are the practical behaviors and results that individuals show in the process of playing roles and performing normative duties according to their understanding of roles . When anArtificial intelligence has a positive and significant impact on both the cognitive and noncognitive levels of roles in the education system, and the effect at the cognitive level is higher than that at the noncognitive level. At the same time, AI has a positive effect on students' creative thinking ability, problem-solving ability, and academic performance. It further shows that AI has great potential in cultivating students' multiple abilities. Making full use of the advantages of AI's teaching aids to design courses will bring about the improvement of students' cognitive ability in different dimensions. AI has positive effects in different school stages, and the effect is the best in primary schools. The analysis results show that AI has positive and significant effects in elementary school, junior high school, high school, and university, and the effect is the best in elementary school, achieving a highly significant effect . Under tArtificial intelligence is sometimes unable to achieve detailed and emotional education; so, teachers should be confident in their status and role as educators. The effect of AI in the education system can be analyzed through the three core driving forces of big data, cloud computing, and deep learning to track and record the learning process of learners, pay more attention to the behavior and emotional changes of students, and analyze them according to AI. The data of intelligent statistics further analyzes the law of students' emotional changes and the incentives that cause emotional changes. The role cognition in the education system can take targeted and effective positive intervention methods to guide students to adjust and control their emotions, which is conducive to the sense of belonging, security, and identity of the role, thus producing a positive emotional experience. As shown in Teachers should have the courage to face reality, constantly enrich their literacy, and do a good job in information-based teaching and handle the cooperation and distribution relationship between teachers and AI. Facing the ever-developing AI technology environment, teachers should do a good job in coping with implementation, accurately positioning their own work, rationally distributing workload, and realizing human-machine symbiosis. Teachers should pass on moral emotions and logical innovative thinking to students, so that knowledge is always passed on in emotions, which is a human characteristic that cannot be replaced by AI. The natural learning environment includes teaching objects and public facilities in the real teaching environment. Teachers should reflect the subjectivity of students in environmental design . All envAI technology may already play the role of teachers in the education system and perform their knowledge imparting responsibilities, which will also lead to the gradual weakening of teachers' identity and status as knowledge imparters. The knowledge level of students is no longer the only criterion for measuring the quality of school education. The so-called good school is a school where teachers can give full play to their own advantages and values and can cultivate students' information literacy, coordination, and cooperation with AI: a school for innovative thinking and creativity to better adapt to the future society. According to this, some scholars have asserted that the work form of teachers in the future will not focus on teaching, and their responsibility will no longer be knowledge instillation . The effRole cognition is the premise and prerequisite of role transformation; role cognition is the key factor affecting role identity. The social role theory holds that individual role-playing is mainly affected by two factors: internal and external factors. The external factor is people's social expectations for the role, and the internal factor is the individual's role cognition. This kind of personalization will increasingly show the characteristics of objectivity and quantification. In a certain social situation, the social function of the role is displayed through the behavior of the subject, which is a collection of its behavior. Teachers can only meet expectations in behavior if they know what role they should assume in their ideological understanding. Teaching role cognition is a general metaphor for the role or way in which a computer system supported by AI technology plays a role in promoting learners' learning process . In the In the era of AI, in the process of promoting intelligent education, teachers and students are prone to risks in the transformation of teaching roles. For teachers, role change is a change in knowledge structure, teaching methods, and thinking concepts. In addition, through the accumulation of learners' learning data on a regular basis, targeted learning process analysis is carried out, and the weak links of students' learning are more clearly and intuitively understood through big data. However, in the face of the advanced AI technology in the future, some teachers may worry that they will be replaced, or they may not be confident that they can master intelligent technology well. There are also some teachers who may overtrust AI, which leads to the decline of their own abilities and gradually loses their own unique reflection on teaching . For stuSince the knowledge organization and reasoning process in the expert system is a simulation of the way of thinking of human experts, the organization of the knowledge base and the systematic reasoning process can better reflect the thinking process of role cognition in the education system. In the process of building a knowledge base, role cognition needs to conceptualize, formalize, and organize the fragmented and unformed knowledge. As shown in Traditional school teaching pays more attention to scores and results and mostly adopts the summative evaluation method of standardized tests. Although the formative evaluation advocated now is also widely promoted by schools, most of them focus on form, and the concept of focusing on scores is still deeply rooted. Although the emergence of AI cannot fundamentally subvert this method of teaching evaluation, it is necessary to use various forms of tests to understand students' mastery of learning content. Teachers not only assume the role of knowledge imparting but also need to have good intellectual literacy and cultivate students' core literacy and moral sentiment. They need to learn to use AI; otherwise, they will be easily eliminated, and they need to reflect on their relationship with AI to enhance their self-worth. In addition, text recognition, speech recognition, image recognition, and biometric recognition can monitor and evaluate the learners' psychological state and attention state in real time according to the learners' words, voices, demeanor, movements, expressions, etc. The visual form presents role cognition in the education system and provides timely feedback for teaching. The AI system can work in a wider range, but the information grasped by each object is relatively shallow, and most of the learners are in a specific cognitive state, lacking personality, emotion and behavior management, family background, learning history, etc.The advent of the era of AI has had a huge impact on the traditional perception of teachers' roles, requiring teachers to establish a new outlook on talents, teachers and students, and teaching, and reunderstand the role of teachers. First of all, teachers should establish a new concept of talents that everyone can become a talent, correctly view the differences and individuality of each student, and pay attention to the individualization of students' learning needs . Every sTaking the entire education system in Taiyuan City, Shanxi Province, Central China, as an example, this paper uses questionnaire survey method to analyze the effect of AI on role cognition in the education system. The education system targeted by this questionnaire survey involves 8 categories: preschool education, primary education, secondary education, higher education, adult education, computer network education, enterprise education, and social education; the respondents include 368 teachers, 402 students or learners, 118 school managers, and 124 family members of students or learners in all above education categories. The education system can make use of this characteristic or expand on the original basis to meet the needs of students' own learning needs. After all, it cannot replace human learning and innovation. This is the subjective condition for students to form a correct learning attitude and motivation to further enhance their independent learning ability and creativity. From the perspective of technology acceptance, the information literacy of teachers and students is directly related to the perceived ease of use and perceived usefulness of intelligent technology, and such technology perception will largely determine teachers and students' willingness to use intelligent technology and their perceived usefulness. The research results show that the learning of AI courses is strongly dependent on course role cognition, and the construction of role cognition is related to the understanding of course content, teaching methods, and activity methods. Therefore, AI plays a role in role cognition in the education system. The role of the project needs to be systematically analyzed from the aspects of function realization form, resource presentation method, supporting hardware form, teacher-student interaction method, and representation method of works. As a connecter, teachers are limited by the degree of understanding learners, the amount of resources, and data processing capabilities, but the advantage is that they can flexibly monitor and adjust. AI technology is flexible and diverse, it functions in learning and teaching activities in a variety of ways, and there is no agreement on the terminology to describe its role. The results of this paper provide a reference for further researches on the effect of AI on role cognition in the education system."}
{"text": "Parkinson's disease is a chronic neurodegenerative disease, which can be alleviated in drug treatment, but with evident side effects. At the same time, increasing evidence shows that exercise can significantly improve the symptoms of patients with Parkinson's disease, with an effect that cannot be achieved by drug treatment. The related research on exercise on Parkinson's disease increases rapidly with the passage of time. However, the research analysis on Parkinson's disease by means of bibliometrics is rare. The purpose of this study is to perform a bibliometric analysis of the research hotspots and development trends of the global movement on Parkinson's disease from 2012 to 2021.The literature was derived from the Web of Science core collection database, and the social science citation index was set as SCI-EXPANDED. The language was set to English, and the literature category was set as article and review and published from 2012 to 2021. CiteSpace and other software were used to analyze the relationship among published documents, countries, institutions, journals, authors, references, disciplines, and keywords.Movement Disorders journals are the main institutions and journals. The cited keywords show that trial, cognition, and interference are the research hotspots and development trends in recent years.A total of 2,222 articles were included in the analysis. The analysis showed that the publication volume increased with the increase in years, with a total of 76 countries and 546 academic journals published; the largest number was that of the United States. The journals are mainly concentrated in the fields of neurology, sports, and ophthalmology. Rush University and The number of published articles on Parkinson's disease by exercise has increased rapidly in the past 10 years, and the bibliometric analysis can provide useful information for future research teams and researchers. Parkinson's disease (PD) is one of the most common neurodegenerative diseases  is a quantitative statistical method for the study of published literature , references, disciplines and keywords, and development trends are extracted using CiteSpace and Microsoft Excel software. The extracted literature data are counted and analyzed in the analysis software, and visual maps and intuitive charts are developed. This study explains the impact of exercise on PD through the following parts: (1) the distribution and development trend is analyzed according to year, country, discipline, institution, and author; (2) the cooperation among countries, institutions, and authors is analyzed; (3) through cluster analysis, citation analysis, and H-index analysis in this field, the citation frequency is the sum of the cited times of all items in a set, which can generally reflect the quality of publications. H-index is the number of papers whose citations are larger than H. This new method is used to evaluate academic achievements. H-index can accurately reflect the academic achievements of researchers and can be used as an index to measure the output of scientific research achievements of researchers Hirsch, . (4) TheA total of 2,222 articles have been included, as shown in As shown in As shown in Disciplines were involved in all 2,222 papers on exercise intervention on PD, and we analyzed the top 10 published disciplines . The neuNew England Journal of Medicine (impact Factor 91.253 in 2020). Patients with Parkinson's are randomly assigned to Taijiquan for resistance training and stretching exercises according to the degree of disease, after 24 weeks of intervention twice a week. Compared with resistance training and stretching exercise, Taijiquan can significantly improve balance, posture control, and other functions of patients with PD and effectively reduce the incidence of falls in patients with PD , citation , citation per article (61.61), and H index (25). Open access has 33; it plays a leading role in the field of PD, and its main research direction is neurosciences neurology, rehabilitation, and sport sciences. Rush University, McGill University, University of Toronto, Columbia University, Oregon Health, and Science University cooperate closely with other institutions.Among the 2,222 articles searched, 10,046 authors participated in the publication of 546 journals and produced a network graph of related authors . The cooParkinsonism-related Disorders journals is the largest (107). The number of citations in the journal Movement Disorders  and the number of citations per article (66.43) are the highest, and the journal has the highest impact factor (10.338 in 2020) and the highest H index (33). The number of PLoS ONE journals Open access (71) is the highest. A total of 546 academic journals on exercise on PD have been published, As shown in New England Journal of Medicine, Lancet Neurology, Angewandte Cheme International Edition, Brain, and Movement Disorders according to the ranking of impact factors.The production table of the top 10 papers cited in sports on PD research is shown in The analysis of references is an important part of bibliometrics research. The citation degree of keywords reflects the degree of concern of the discipline and can reflect the trend of the development of the discipline. PD is the second-largest neurodegenerative disease; it is second only to Alzheimer's disease , accounting for 61% of the total, indicating that exercise has received more attention in the field of PD in recent years. The years 2012 to 2013 had the highest citation volume , the highest citation volume per article (43.84), and the highest H index (62). However, the growth in the number of papers in this form does not indicate an improvement in the quality of the literature. This condition is because the retrieval process of literature data extraction only obtains the number of papers in this field, and the quality cannot be judged by the quantity. The high volume of papers and citations can only reflect the attention of the scientific research team in this field. The rapid increase in the publication of papers in the past 5 years may be related to the Guide to American Physical Activity published in 2018, which points out that physical exercise can effectively reduce the risk of many chronic diseases, and that the elderly should engage in various forms of physical exercise, such as balance, aerobics, and resistance exercise  and the number of citations per article (66.43) are the highest, with the highest impact factor (10.338 in 2020) and the highest H index (33). It is the most influential journal in this field in the United States.The volume of articles is mainly concentrated in the United States, China, and Germany. Through the analysis of authors and journals, Bloem BR and Nieuwboer A are the main authors in this field; they maintain a high volume of articles and centrality. Among the articles on exercise on PD, Bloem BR, and Nieuwboer A have a randomized controlled trial published in the journal The dual-map overlay , timelinBased on WOS data, this study makes a bibliometric analysis of the current situation and trend of exercise research in the field of PD in the past 10 years with CiteSpace and other analysis software. A total of 2,222 articles were retrieved from 546 academic journals in 76 countries. In addition to the analysis of the volume of publications, citations, and the cooperative relationship among countries, institutions, and authors, the classification of disciplines, types of documents, references, and keywords are analyzed.This research also has certain limitations. The retrieval strategy is limited to the WOS core database. The social science citation retrieval is set to SCI-Expanded, the language is English, and the papers are limited to articles and reviews. These factors may lead to errors in the results, that is, some high-quality and high-impact articles may not have high citations or be late in publication and are ignored, whereas some high-cited articles may not result in hotspots.This study analyzes the papers on PD published in the past 10 years and provides a new perspective for research in this field. Although some limitations exist, it fully expounds on the research hotspots and future development trends of exercise in the field of PD research. The analysis results may enable exercise therapy to carry out more research in the field of PD. Sports will receive increasing attention in the field of PD in the future, In conclusion, this study may help researchers to quickly understand the knowledge structure and current hotspots in the field.The original contributions presented in the study are included in the article/J-WC wrote the paper. S-HD performed the data analyses. T-CC and KZ contributed to the conception of the study and helped further revise the paper. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "Giovanni Paolo Martelli passed away on 8 January 2020 , nine daLongidoridae. Upon his return to the Institute of Plant Pathology at Bari in 1963, Giovanni established the Plant Virology Laboratory to study viruses and virus diseases of economically important vegetable plants, as well as grapevines and fruit trees such as citrus, stone fruit, olive and fig. The Plant Virology Laboratory quickly became nationally and internationally eminent under Giovanni\u2019s leadership.At the beginning of his scientific career, Giovanni had acquired highly significant knowledge of Plant Pathology. In the 1950s, he investigated the biology and control of plant pathogenic fungi that infect olive trees, grapevine, fruit and vegetable crops, and described new micromycetes and diseases . At a yoMost of Giovanni\u2019s teaching career was spent at the University of Bari. From 1965 to 1969, he taught Microbiology; he then spent a two-year term (1971\u20131973) teaching Plant Pathology at the University of Palermo and directing the Institute of the same name. Back at the University of Bari, he was appointed Full Professor and served as Chair of Plant Virology for 30 years, from 1980 to 2010, when he retired [At the University of Bari, Giovanni directed the Institute of Plant Pathology (later to become a Department) from 1980 to 1986 and the Department of Plant Protection and Applied Microbiology from 2000 to 2006. His primary aim was always the advancement of knowledge, and he transmitted his passion to colleagues and collaborators. Among the faculty members involved in plant virology research when Giovanni was Chair of Plant Virology were Maria Antonietta Castellano, Donato Gallitelli, Pasquale Piazzolla, Antonio Quacquarelli, Marcello Russo, Vito Savino and Makis Vovlas. All held important academic and research positions during their careers.As a member of the Board of Professors for the Ph.D. program in Plant Pathology from 1984 to 1991, and for the Ph.D. program in Plant Protection starting in 1992, Giovanni was an outstanding example of scientific integrity and rigor.Giovanni Martelli in Rome in June 2012 relaxing with old friends.His competence was widely acknowledged. Starting in 1972, Giovanni was a member of the Scientific Council of the Institute of Applied Phyto-Virology of the CNR in Turin. He was also a member of the Scientific Council of the Plant Biosynthesis Institute of the CNR, Milan.In 1982, he established the CNR Study Center on Viruses and Virus-like Diseases of Mediterranean Crops, based in Bari, and became its director until his retirement in 2010. Among the scientists who were hired early by CNR and contributed to its scientific success were Donato Boscia, Angelantonio Minafra and Luisa Rubino. The Center no longer exists as such; it later merged with the Institute for Sustainable Plant Protection (CNR-IPSP), with Donato Boscia as its research director. From 1989 until its disbandment, Giovanni chaired the Scientific Council of the Research Group of the CNR on Viruses and Virus Diseases of Plants.In 1985, Giovanni was among the supporters of the International Course on Production and Protection of Mediterranean Fruit Crops (now Integrated Pest Management of Mediterranean Fruit Crops) at the Mediterranean Agronomic Institute of Valenzano (Bari), an Italian subsidiary of Center International de Hautes Etudes Agronomiques Mediterraneennes, of which he was the coordinator of the related \u201cMaster of Science\u201d program in Plant Virology until 2008.Giovanni investigated viruses and virus diseases of crops grown in the Mediterranean basin, including fruit trees, grapevine , vegetabIn the mid-1980s, Giovanni established a molecular biology/immunology research unit for the use of recombinant DNA technology and monoclonal/polyclonal antibodies in different research projects . Some reGiovanni was an international recognized authority on viruses and virus diseases of grapevine, and he is considered the founder of modern grapevine virology ,27,28,29Vitis and Prunus spp. [Giovanni never ignored or forgot the application of applied plant virology to grapevine and other plant species. In 1963, he established a thermotherapy unit for producing virus-free grapevine and fruit trees . In the nus spp. .Giovanni carried out study missions on behalf of the Food and Agricultural Organization (FAO) of the United Nations, United Nations Development Program (UNDP), CNR, and the Italian Ministry of Foreign Affairs. He was a member of the Steering Committee of the FAO-UNDP Regional Project on Control of Virus and Virus-like Diseases of Fruit Crops, the Comit\u00e8 d\u2019Evaluation of the Institut National de la Recherche Agronomique (INRA) and the Comit\u00e8 Scientifique du Laboratorie d\u2019Ingenierie Agronomique de l\u2019ENSAT-INPT. Giovanni was also invited to participate in study missions by officials from five countries in North Africa , eight countries in the Middle East , most Eastern European countries, one country in Central Asia (Afghanistan), two countries in the Far East (China and Japan), Australia and New Zealand. These missions established international scientific collaborations with scientists in various institutions in these countries.Giovanni Martelli in June 2012 on top of Vittorio Emanuele II Monument (Il Vittoriano) in Rome City Center. Behind Giovanni, the Winged Victory Statue on Chariot.Closteroviridae [Flexiviridae [Tombusviridae [Tymoviridae [Fimoviridae, which includes the genus Emaravirus [groups and viruses were not recognized taxa and did not correspond to any taxon in the \u201cparallel\u201d classification. Group members did not represent species and had only vernacular English names [Giovanni had an excellent background in Latin. In 1978, he became an active member of the International Committee on Taxonomy of Viruses (ICTV) of the International Union of Microbiological Societies. He chaired the study group on the family oviridae ,34. He wiviridae ,36, Tombsviridae , Tymoviroviridae  and Fimoaravirus . For sevsh names ,41. The sh names .Foveavirus, Aureusvirus, Tepovirus [Martellivirales [Bromoviridae, Closteroviridae, Endornaviridae, Kitaviridae, Mayoviridae, Togaviridae and Virgaviridae.Giovanni described novel plant virus genera, e.g., epovirus ,44,45,46epovirus . In 2021ivirales , includiPhytopathology, European Journal of Plant Pathology and Vitis. He also served as senior editor and, from 2002, as Editor-in-Chief of the Journal of Plant Pathology . He was extremely convinced of the importance of editorial roles in the advancement of knowledge, and his reviews were always very helpful to the authors, allowing them to improve their research work and presentation of results.Giovanni served as an associate editor of Giovanni was Chairman of the International Working Group on Vegetable Viruses of the International Society of Horticultural Sciences from 1979 to 1981, and President of the Italian Phytopathological Association from 1980 to 1986. He also represented the Italian Phytopathological Association in the International Society for Plant Pathology. Moreover, he was a member of the Executive Boards of the Italian Society of Virology and of the Italian Society of Plant Pathology, of which he was President (2002\u20132004). Giovanni was a member of many scientific societies and committees, including the Italian Academy of Vine and Wine (of which he was a member of the Academic Council), a member of the National Winemaking Committee of the Ministry for Agricultural and Forestry Policies, the Georgofili Academy, the National Academy of Oil and Olive, the National Academy of Agriculture and Apulian Academy of Sciences, and he was a corresponding member of the National Academy of the Lincei and of the Agricultural Academy of Turin. He was a member of the American Phytopathological Society, the Association of Applied Biologists, the British Society of Plant Pathologists, the Mediterranean Phytopathological Union, the Society of Plant Molecular Biology, the Italian Plant Protection Society the Italian Society of Plant Pathology and the Italian Society of Virology. Giovanni also chaired numerous scientific meeting sessions at national and international conferences.Giovanni is the co-author of a textbook on Plant Virology and one book on viruses of vegetable crops. He is also the co-author of two books ,29 and tIn recognition of his scientific achievements, Giovanni was awarded the Gold Medal Diploma from the Acad\u00e9mie d\u2019Agriculture de France for a book he co-authored on grapevine viruses in 1982; and in 1997, he was elected Fellow of the American Phytopathological Society [Xylella fastidiosa subsp. pauca as the causal agent of the olive trees decline in southern Italy, completely sequenced the bacterial DNA genome and determined its size as a 2,514,616 base pair, and established that the bacterial country of origin is Costa Rica in Central America [Philaenus spumarius was experimentally proven to be the vector of the olive-infecting bacterial strain [During the last decade, Giovanni vigorously defended the integrity of science and scientists when plant pathologists at the CNR in Bari were viciously and falsely attacked by individuals or groups of individuals deprived of phytopathological scientific knowledge while Bari scientists correctly identified the bacterium  America ,49. The l strain .Beyond his scientific achievements, Giovanni\u2019s legacy lives on in the hundreds of people across the world that he trained, mentored, encouraged and supported in various ways. He advised many graduate students and postdoctoral fellows, who have gone on to careers in academia, industry and beyond. Giovanni was generous in accepting seminar invitations and delivering keynote addresses at national and international meetings. As such, thousands of junior and established scientists had the opportunity to interact with him throughout his career. His interactions were characterized by warmth and generosity. Overall, Giovanni will be remembered as a brilliant plant virologist, the founder of modern grapevine virology and a very kind and wonderful human being who had a great impact on the people around him.Giovanni is survived by his wife Nicoletta, their daughter Maria Carla and their son Giuseppe, and he was a proud grandfather to his five lovely grandchildren, whom he adored."}
{"text": "Learning Difficulties relates to significant and unusual difficulties in the acquisition and use of one or more of the following areas: listening, speaking, reading, writing and mathematical skills. In the last twenty years, following the research conducted by cognitive psychology, from neuropsychology, from pedagogy and from the confrontation between educators and psychologists, the attention was focused on the cognitive modalities of the subjects engaged in learning tasks.Thanks to the study of cognitive styles and Learning Styles thelearning subject was placed at the center of the educational project, stimulating from on the one hand there is also reflection on teaching styles and the most appropriate ones methodologies, teaching methods and methods of approaching the individual disciplines and, on the other hand, prompting clinicians to research around the intellectual peculiarities of each subject and a outline a descriptive criterion of his / her cognitive functioning profile.The intellectual scale (WISC IV) of 32 children (aged between 7 and 15 years) with specific learning disabilities was analyzed, in order to highlight the underlying intellectual functioning and any cognitive styles.According to the international scientific literature, the results show a greater fall in the area of working memory, followed by the cognitive domain concerning processing speed.In detail, by analyzing the individual subtests, greater difficulties are noted, at all ages, in the processes of abstraction and conceptualization, in short-term auditory memory, in the speed of processing and visual-praxic motor coordination."}
{"text": "The health information system is a component of the healthcare system. The health information system in health services in Indonesia has experienced many problems in getting support for policy making, the implementation of the industrial revolution 4.0, and national health insurance (JKN). To answer the above problems, it is necessary to make a concept of health information systems in health services that based on environment and one health perspectives. This research was part of the thematic research of the 2019 JKN National Health Facilities Survey (Rifaskes) in Indonesia. The systems approach and cross-sectional research were carried out by collecting quantitative data. A structural equation model with Lisrel 88 software was used to model the health information system. The health information system produced a concept that included the following structured input components: governance, human resources, infrastructure, types of information system (IS) , and financing; process components: funding, technical guidance, and verification and validation; and output components: open access, standards and quality, utilization, bridging, and security. The concept for strengthening the health information system prioritizes improving the output components  in the process components  while the input components . Indonesia implements sustainable development in the health sector based on the principle of non-discrimination. Sustainable development begins with strengthening the system, which in this case is the health information system. The health information sys-tem can only be the basis for decision-making if the data is accurate, open, and interoperable, which was called one data in 2018 . The heaIn this case, the Ministry of Health is like a health organization, where this organization has service efforts in the form of hospitals, health centers, and clinics. The Ministry of Health also has administrative management at each level, from the central administration all the way to the smallest sub-district. Health service efforts with these administrations aim to make health services more accessible for communities in order to promote a healthy society , 15. To In this article we propose an environment and one health framework for developing a high-level prospective concept of the implementation of health information systems in healthcare organizations. Based on the existing framework, we identified several critical dimensions that exist in the health information system, namely, management, financing, human resources, infrastructure, and the types of existing information systems  as an effort to achieve national health goals at the sub-district, district, provincial and national levels. This captures two important characteristics in the healthcare delivery process: the level of mediation and the level of internal and external collaboration.This paper was developed based on the results of research on health information systems with Ethics Permit LB.02.01/2/KE.186/2019 .The study was conducted in 2019 (July\u2013December) in 7 provinces  in 103 districts with 420 healthcare units   and external (Border Remote Areas and Islands (DTPK) fiscal capacity) topics. Processes covered funding, technical guidance, and verification. And outputs consisted of quality standards, data utilization, bridging/interoperability, open access, and security. The researchers used a generic health facility research data collection team that had been retrained for the purposes of this thematic data collection. Researchers supervised the collections twice to maintain the quality of the research.The analysis required structural equation modeling using the Lisrell method . The firThe research revealed several very useful findings, which were largely missing in existing literature. Several variables formed the input component: leadership/governance, human resources, infrastructure, funding, management information systems, program information systems and JKN information systems, types of health services, health service facilities according to DTPK status, fiscal capacity status. Thus, the variables of monitoring and evaluation, technical guidance, and verification and evaluation form the components of the process. Furthermore, the standard and quality variables, data utilization, bridging and interoperability, open access and security, formed the output components .Information system modeling is essentially input modeling with several steps, namely, making an initial estimate and making a final estimate. The final estimation results of indicators that met the requirements of good validity were governance, human resources, infrastructure, funds, IS management, IS Program, and IS JKN [absolute value of Standardized Factor Loading (SFL) > 0.50]. However, several indicators had an SFL <0.50  and were thus be excluded from the measurement model .The process modeling shows the initial estimation and final estimation of the indicators that comprised the process components that met the requirements for entering the measurement model. The three indicators that comprised the process component can be seen in the .Output modeling produces initial estimates of 5 constituent variables.The Path Diagram shows that the SFL of Standard, Utilization, Bridging, Open Access, Security \u2265 0.50. The five indicators are valid indicators for the output variable. The next modeling forms a full model using the inputs, processes, and outputs and considers SFL, composite reliability, and validity. The  and Fig below shThe  below ilFrom the The results showed that the indicators of leadership/governance, HR, infrastructure, financing, IS management, IS Program, and IS JKN comprise the input components of the health information system in this modeling. Regulations that relate to the results of this study are the 2012 National Health System  article 2 paragraph 1, which states that health information is part of health management. Furthermore, Article 3 states that in the management subsystem includes health information and regulation. In the implementation of the JKN health information system at the public health center, the health information system was constrained by the lack of internet and human resources . To contIn implementing the health information system at the health office, there were problems with human resources, supporting facilities, and commitment from the activity leaders who had not been trained to understand good data and information management , 24. As Further modeling finds that several indicators that make up the process components are technical guidance, monitoring, and evaluation as well as verification and validation. In some cases of recording and reporting systems, if there is no monitoring by village supervisors and program holders, it will usually be late. Because it is late, the head of the puskesmas often does not have time to check and dispose of it. Thus, it is signed and reported to the health office , 25. TheThe results of modeling the output components revealed the vital indicators of standards, utilization, bridging, open access, and security. The final modelers with the highest influence are HR, governance, program, infrastructure, funds, IS JKN, and management. In the process component, it is necessary to successively improve the health information system in monitoring and evaluation, technical guidance, verification and evaluation. Meanwhile, the output components are open access, standards, PE, the use of bridging, and security. Several studies have found that health information systems need bridging or interoperability. Too many health centers using health information systems require users to enter the same health data repeatedly, especially about the patient's social identity and clinical data, which makes the work inefficient . There nThe health information system is a means to support health services provided to the community. An effective health information system provides information support for the decision-making process at all levels, even at puskesmas or small hospitals. Not only data, but also complete, precise, accurate, and fast information can be presented with a well-organized and well-implemented health information system , 31. TheThe health services concept in the JKN era for strengthening the health information system that based on environment and one health approach is formulated by each components including standardized and utilized input, process, and output. These can include factors such as bridging, open access, and security. In process, the recommend strengthening components, especially funding, verification, technical guidance. It is also important to strengthen input components: funding, human resources, governance, information system programs, infrastructure, JKN information systems, and information system management.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The study was approved by the Institutional Ethics Committee of Indonesian Ministry of Health (LB.02.01/2/KE.186/2019). Written informed consent was obtained from the participants.All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.This research was funded by the National Institute for Health Research and Development, Indonesian Ministry of Health. The publication was also funded by the Hibah PUTI UI 2022 (NKB-455/UN2.RST/HKP.05.00/2022). The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer ID declared a shared affiliation with the author(s) AA to the handling editor at the time of review.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "The production of some alcoholic beverages very often requires the use of wood from various tree species to improve the quality parameters  of the drink. The review discusses the types of wood used in the production of wines, beers, and flavored vodkas. Changes occurring in wood during the process of toasting barrels or wood chips are described. The compounds derived from wood that shape the aroma, taste, and color of alcoholic beverages are presented. Depending on their origin, they were classified into compounds naturally occurring in wood and those formed as a result of the thermal treatment of wood. Next, the influence of the presence of wood on the quality of alcoholic beverages was described, with particular emphasis on wine, beer, whisky, and brandy. The final part of the article presents innovative techniques using wood to impart qualitative features to alcoholic beverages. The taste and aroma of most alcoholic beverages depend on many factors, including climatic and soil conditions, the type of yeast used for fermentation, the quality of the raw material subjected to fermentation, and beverage production technology. Building the sensory characteristics of alcoholic beverages is really about obtaining a variety of desired chemical compounds. These compounds come from various stages of liquor production, but it is important that they are obtained in the right proportions . One of Alcoholic beverages have been produced by man since ancient times and have been known in all civilizations. Initially, people made only non-distilled beverages, mainly beer and wine. Amphorae and clay jars were most often used for fermentation, maturation, and storage, but due to their high weight and impermanence, they have been replaced by more technically advanced wooden barrels. The beginnings of barrel production date back over 2000 years. Originally, barrels were produced mainly in northern parts of Europe, where climatic conditions prevented the use of clay as a raw material for the production of jars and other vessels used initially in the production of alcoholic beverages . In the The original use of wooden barrels, i.e., the production, storage, and transport of beverages, has now been significantly limited. Nowadays, tanks and containers made of acid-resistant steel are used for these purposes, and wood is mainly used as a factor supporting the sensory qualities  of alcoholic beverages . The maiQuercus genus, whether or not toasted, may be used for the production and aging of wine. The most frequently chosen types of wood for the production of both barrels and wood chips are oak and chestnut, which are approved for use in wine production by the OIV  ..2].It was shown ,15 that The consumer value of wine consists of many factors, primarily sensory parameters, i.e., aroma, taste, and color. The quality of wines is largely shaped by oenological processes performed both during fruit cultivation and wine production ,45. The In the case of red wines, compounds derived from wood, such as furfural, guaiacol, whisky lactones, eugenol, vanillin, and syringinaldehyde, have the greatest impact on their aroma parameters. Furfural, as one of the most important compounds of woody origin, is responsible for giving wine the flavor of dried fruit and roasted almonds . Bautistcis and trans, which give the wine different aromatic notes. The cis form is responsible for weak coconut, earthy, or sometimes moldy notes, while the trans form gives the wine spicy, celery, or coconut notes. In winemaking, whisky lactones are usually associated with coconut, vanilla, and spicy aromas, but they may change depending on the grape variety used [Whisky lactones derived from oak wood occur in two stereoisomers, ety used . Guaiacoety used .The concentration of guaiacol and 4-vinylguaiacol depends mainly on the time of maturation, as well as on the type and dose of oak chips. These compounds can also be used as an indicator of the degree of wood toasting due to their chemical origin. In addition, 4-vinylguaiacol and 4-vinylphenol can be formed in the process of enzymatic or thermal decarboxylation from cinnamic acids . Esters The approval of chestnut wood for winemaking has resulted in an increase in the variety of aromas in wines. The use of chestnut in the aging of wines may promote the formation of more phenols and gallic acid compared to oak wood. Chestnut wood is also characterized by greater oxygen permeability than oak wood, which results in a low content of catechins, epicatechins, and anthocyanins in the wine aged with its use, which most likely undergo accelerated polymerization. Chestnut gives the wine fruity notes, and in the case of oak wood, the aromas of vanilla, smoky, and spicy are more noticeable .The typical color of red wines is due to the presence of many anthocyanins and their derivatives. Unfortunately, the total anthocyanin content decreases diametrically with wood aging. The reason for this gradual decrease in monomeric pigments is the reaction of the native grape anthocyanins with the constituents of the wood and with the oxygen passing through the micropores of the wood. These changes are manifested by a decrease in the intensity of the color of the wine and differences in shade compared to wines not aged in the presence of wood .White wines were traditionally rarely aged in barrels or with oak chips. It was believed that this procedure lowered their quality due to the masking of the original fruit and floral notes found in white wines. Esters, alcohols, and terpenes are responsible for these specific floral and fresh notes of white wines ,65. TherThe production of beer became a part of the culture and tradition in many countries . Before the advent of stainless steel, barrels were a typical vessel used for the storage and transportation of beer. Some styles of beer, e.g., porter, often had to be aged for about 6\u201312 months in wooden tanks in order to soften their harsh taste .Some types of beer are closely associated with aging in barrels. The Belgians used, and continue to use, the process of enriching the flavor composition with barrels. Currently, around the world, there is a so-called beer revolution, where beer production in small, craft breweries is rapidly developing. The increased development of this branch of industry has forced producers to compete more, which is why breweries try to distinguish themselves primarily by the originality of their products . For thiToday, in search of new, interesting, and attractive flavor compositions for beers, these beverages are barreled or other methods are used to obtain a flavor composition derived from wood. In the case of beer, malt and hops are the ingredients responsible for providing the aromatic compounds associated with the character of a particular style of beer ,80. ContBrettanomyces yeast and Lactobacillus and Pediococcus bacteria. They reside mainly in the pores of barrel wood, where they are difficult to remove during washing, but their presence is necessary during the production of traditional sour beers. This is also the reason for maintaining appropriate sterility in the production of commercial beers. In relation to other styles, these organisms are responsible for beer defects, which makes wood chips an interesting alternative to barrels. The use of chips allows for faster maturation effects associated with taste sensations that would not be possible to obtain in barrels [In addition, the use of wood in the production of beer may be associated with the loss of some compounds as a result of their absorption by wood or as a result of evaporation . Quite p barrels .Whisky is produced mainly from barley in a process that includes stages such as mashing, fermentation, distillation, and maturation. It is thanks to this last stage that the whisky acquires its final character, which is appreciated all over the world. It is from the wooden barrel that the compounds responsible for the aroma and specific color pass into the drink. Aging in oak barrels also increases the antioxidant potential of whisky by increasing the concentration of phenols, furans, and acidic compounds ,86,87. SThe method and time of maturation vary greatly and are often determined by local or international laws depending on the final product. Another factor influencing this process is the ratio of wood surface to volume of liquid, so the use of smaller barrels can have a significant impact on increasing the extractivity of compounds contained in wood . Compouncis isomer is responsible for sweetness and coconut notes, while the trans isomer is responsible for floral sensations. The highest intensities of caramel and burned notes were found in the brandies aged in chestnut wood. The toasting level of the barrels had a significant effect on the majority of the aroma descriptors, namely fruity, vanilla, woody, spicy, caramel, burned, smoke, green, tails, and glue. Brandies aged in heavily toasted barrels presented the highest intensities of vanilla, woody, spicy, caramel, burned, and smoke and the lowest intensities of fruity, green, tails, and glue [The types of brandy include flavored vodkas made from many different raw materials, primarily from grapes, but also from other fruits. What raw material will be used to produce brandy depends mainly on the region, its availability, and its price. For this reason, there are significant differences in quality, taste, and smell between particular types of brandy . Brandy and glue . Accordiand glue  the degrand glue .A specific type of brandy is Brandy de Jerez. It is a spirit produced in Southern Spain and obtained from wine spirits and distillates that were aged in <1000 L oak barrels previously seasoned with Sherry wine. Brandy de Jerez, in addition to typical compounds extracted from wood, also contains other compounds that come from sherry wine, such as tartaric, lactic, or succinic acids . In thosMicro-oxygenation accelerated the changes taking place in cider distillates when compared to traditional aging in barrels. Furthermore, a higher degree of brandy oxidation led to a higher concentration of benzoic derivatives, total acetaldehyde, oak lactones, and gallic acid and a more pronounced decrease in the levels of 3-methyl-1-butyl acetate and 2-phenylethyl acetate . CaldeirThe qualitative changes of alcoholic beverages  described above that occur under the influence of contact with wood during maturation are influenced to some extent on the concentration of ethanol in these beverages. The drink penetrates the wood and washes out various compounds that shape the aroma, taste, and color of the drink. Variables here include the use of new or used barrels, toast levels, char levels, how the wood was seasoned, as well as the storage conditions during maturation. Water and alcohol penetrate the wood structure and initiate the hydrolysis of the hemicelluloses and lignin. The possibility of compound migration from wooden barrels or chips is related, among others, to the concentration of alcohol and the method of wood processing ,103. TabThe aging of alcoholic beverages without the addition of wood, with some exceptions, had almost no effect on the level of volatile compounds . The preApart from extraction of volatile compounds, compound losses inherent to subtractive ageing were also observed as a direct result of wood application. Concentrations of ethyl acetate and ethyl decanoate decreased in all beverages after contact with wood. In the distillate, hexyl acetate, 2-phenylethyl acetate, and ethyl dodecanoate were adsorbed on the wood, mainly due to hydrophobic interactions .Ultrasound is defined as sound waves with a frequency exceeding the limit of hearing for the human ear. In the food industry, waves with frequencies from 20 kHz to 10 MHz are used. The most important task of ultrasonic treatment is to modify the structure of the raw material, thanks to which the intensity of mass exchange is strengthened and chemical and biological changes occur that affect the properties of the final product . Ageing 2 in wine production. Santos et al. [In many cases, efforts are made to shorten the maturation time of alcoholic beverages and to reduce costs by replacing barrels with wood chips. A technique for reformulating alcoholic beverages can be the use of high pressure (HHP). Tao et al.  showed ts et al.  treated s et al. . The uses et al. . It alloPulsed electric field (PEF) is usually used for non-thermal inactivation of microorganisms . In wine"}
{"text": "With the rapid development and application of artificial intelligence (AI) in medical field, the diagnostic ways of human health and the social medical structures have changed. Based on the concept of holism and the theory of syndrome differentiation and treatment, TCM realizes comprehensive informatization and intelligence with the help of AI technology in data mining, intelligent diagnosis and treatment, intelligent learning, and decision-making. Furthermore, the intelligent research of TCM technology will further promote the improvement in TCM diagnosis and treatment rules and the leaping development of TCM intelligent instruments. In this article, we performed a systematic review of scientific literature about TCM and AI. Moreover, the practical problems of TCM intellectualization, the current situation and demand of TCM, and the influence of AI in the TCM field are discussed by searching for literature using TCM scientific databases, reference lists, expert consultation, and targeted websites. Finally, we look forward to the application prospects of AI and propose a possible future direction of intelligent TCM in the current health-care system in China. Traditional Chinese medicine (TCM) is a complete medical knowledge system, which is based on the philosophy of Yin-Yang and Five Phases and essential Qi. It has accumulated rich theoretical and practical experience for thousands of years after long-term clinical practice and test \u20133. TCM rArtemisia annua, so it can be considered a chemical medicine. Tu Youyou, a researcher in TCM, has successfully extracted artemisinin and saved millions of lives around the world and won the 2011 Lasker Award in clinical medicine and the 2015 Nobel Prize in Physiology or Medicine. In general, TCM is a medical system whose main content is to study the treatment of diseases and adapt to nature [On the other hand, with the dramatic increase in the prevalence of chronic conditions, the chemical medicines cannot fully meet the needs of health preservation, disease prevention, and treatment. Chemical medicines usually refer to the active ingredients extracted from natural minerals, animals, and plants as well as drugs prepared through chemical synthesis or biosynthesis. The experiences and knowledge in TCM can play a great role in human health and the large-scale development and application of natural medicines. TCM not only contains herbal plants, but also includes Chinese herbal extracts and minerals. Chinese herbal medicine is considered as an important supplement and substitute medicine in the Western countries as they are generally extracted from natural products with mild therapeutic effects, few side effects, and no artificial additives , 11. Arto nature \u201314. In rWestern medicine was mainly introduced into China in the 19th century and gradually dominated the Chinese market. At present, TCM and Western medicine are two major schools of medicine in China. The Chinese have realized that TCM and Western medicine have different characteristics and functions, which manage to combine the best practices of TCM with Western medicine , 16. GenOn the other hand, the Chinese medicine of minorities, such as Miao medicine, Hui medicine, and Tibetan medicine, are also formally practiced in the Chinese health-care system \u201319. The Artificial intelligence is a comprehensive interdisciplinary subject based on the computer science, cybernetics, information theory, neuropsychology, philosophy, etc., which is a new emerging and developing frontier subject with new ideas, concepts, theories, and technologies , 21. NowAs an important branch of computer science, AI has laid an important theoretical foundation and made great progress after more than 60 years of development. Nowadays, AI is widely used in the diagnosis of common clinical diseases in modern medicine. For example, Hirasawa et al. designed a CNN system capable of automatically identifying gastric cancer from a large number of endoscopic images, which is promising in aiding the diagnosis of gastric cancer . Wang etThe combination of TCM and AI began in the 1970s, with the birth of the first international expert system of TCM, which was named \u201cTCM Guan Youbo Hepatitis Diagnostic and Treatment Procedures,\u201d as a landmark event. In the decades since, TCM expert system has made progress with the help of clinical practice guidelines, database, and the knowledge of specialists, assisting in standardizing TCM diagnostic models. For example, Weng et al. explored the quantitative diagnosis of the blood stasis syndrome, wherein the changes in tongue bodies of 352 patients of the blood stasis syndrome and 218 patients of non-blood stasis syndromes were observed by the expert system of tongue inspection of TCM . Wang etChina's population aging has the characteristics of large population, fast aging speed, and long duration of aging peak. In 2019, China's 60-year-old population has exceeded 248 million, accounting for 17.8% of the total population , 33. TheRealize the \u201cimprovement in the service ability of community-level Chinese medicine\u201d proposed in the 13th Five-year plan of TCM. According to the plan, more than 85% of the community health service centers and 70% of the township health centers will set up comprehensive service areas of TCM. The informatization need to be strengthened and the proportion of TCM diagnosis and treatment volume will strive to reach about 30% in the total medicine diagnosis and treatment. All community health service institutions, township hospitals, and 70% of village clinics will have the capacity of TCM service by 2021.Accelerate the cultivation of TCM talents. At present, the doctors graduated from medical colleges are more inclined to identify diseases from Western medicine perspective in the process of disease diagnosis and treatment. In addition, the general practitioners in primary health institutions are most from Western medicine. Even many doctors who graduated from TCM colleges also have embarked on the road of westernization of TCM. In short, the Westernization of TCM is to replace the thinking of TCM with the thinking of Western medicine and then guide TCM to prescribe for patients. Therefore, the whole primary medical environment usually lacks a real atmosphere of TCM diagnosis and treatment. With the help of TCM intelligent system, it can shorten the training cycle of TCM talents, improve the supply speed of TCM professionals, and reduce the cost of training young doctors who graduated from a college of TCM. They usually focus on classroom learning, theoretical learning of TCM and Western medicine, and adopt the methods of learning from teachers, and oral and personal teaching. Students can follow teachers for consultation, prescription, and ward rounds. With the combination of theory and practice, teachers can demonstrate and guide students at any time, which help students better establish diagnosis and treatment thinking and use actual cases to understand the obscure theoretical knowledge in books.Improve the service level of TCM hospitals' diagnosis and treatment. With the help of TCM intelligent medical association, the diagnosis and treatment level of medicine students, general practitioners, and TCM students will be greatly improved. The improvement in TCM diagnosis level not only meet the people's medical needs, but also enhance the confidence in TCM diagnosis and treatment. In particular, it is necessary to accelerate the construction and development of TCM, so TCM can better serve the health of the community-level people in China.Expand the coverage of TCM services. The intelligent system of TCM has broad prospects and huge demands in clinical assistant diagnosis, telemedicine, and personal health management. The establishment of regional TCM intelligent medicine association cloud platform will help students to realize intelligent prescription and directly transmit diagnostic information to users as well as expand the coverage of TCM services. This online intelligent diagnosis modes of TCM are of great significance to the people who live in remote areas. Obviously, there is a broad prospect in theory and practice, which the demand of TCM intelligent system is getting more and more attention in China. The total production value of TCM industry in recent years is shown in Recently, the Chinese government has undertaken enormous efforts to modernize TCM by investing capital in scientific research and the economic value exploitation of TCM. The report of the 19th Session of National Congress of the Communist Party of China, held on October 18, 2017, once again put forward that \u201cWe will support both traditional Chinese medicine and Western medicine, and ensure the preservation and development of traditional Chinese medicine,\u201d and upgrade to the level of \u201chealthy China initiative,\u201d which means that TCM has entered a new era from supporting development to inheriting development. The law of the People's Republic of China on TCM clearly points out that encourages scientific research institutions, colleges and universities, medical institutions, and pharmaceutical manufacturers to use modern science and technology and TCM methods to carry out scientific research on Chinese medicine, strengthen the integration exploration of Chinese and Western medicine, and promote the inheritance and innovation of TCM theories and technical methods. Meanwhile, the State Council of China issued the current situation and the strategic plan of the TCM development in 2016\u20132030. According to the survey, the establishment of intelligent TCM is mainly based on the following reasons:AI is often used in expert medical system that is mainly a computer program designed by using the principle and method of expert clinical diagnosis to simulate the diagnosis process of TCM practitioners. It can help doctors to solve many complex medical problems, which effectively avoids misdiagnosis caused by human factors and improves the speed and accuracy of TCM diagnosis. For example, TCM intelligent robots can imitate human finger massage, precisely measure the hardness, achieve precise sensing and control of flexible soft tissues, and then calculate the pressure required for the massage by AI algorithm. They generate visual reports that allows doctors to use empirical data to measure the rehabilitation of patients and avoid misdiagnosis caused by human factors. In the field of TCM materials, the identification accuracy of TCM is improved by AI technology, near-infrared spectroscopy analysis, deep learning model, and multimodal fusion technology. Compared with traditional manual identification, multimodal fusion identification of TCM has shorter cycle and lower cost by image technology.On the other hand, intelligent TCM inherits and develops the medical theory and enrich clinical experience, which make the intelligent TCM diagnosis system very close to the diagnosis and treatment level of TCM experts. Furthermore, the process of intelligent diagnosis for the disease with single condition greatly promotes the inheritance of the experience of the famous Chinese medicine practitioner. The famous Chinese medicine practitioner refers to the outstanding representatives of the academic development of contemporary TCM. Their academic thoughts and clinical experience are the concentrated embodiment of the academic characteristics and theoretical characteristics of TCM. So, the application of AI technology is an intelligent treatment method integrating treatment and evaluation. The main achievements of the combination of TCM and AI can be divided into four categories: multisource data integration and construction, medical model change, experience inheritance, and intelligent instruments. The intelligent analysis process of TCM is shown in Yi=f(Xi).TCM syndrome differentiation is a comprehensive description of patients' pathological state. The syndrome covers a large amount of dynamic information about human body, such as physical signs, tongue pulse, age, and constitution. It has multisource, multilevel, nonlinear, and strong uncertainty characteristics. Moreover, the big data of TCM also include the monograph of ancient Chinese medicine, literature journal, medical record monograph of famous and old Chinese medicine, medical record, community health file, wearable equipment data, astronomical and geographical data, etc. These data are scattered in different spatial locations, so it is difficult to collect and integrate them. The long and tedious process must be gradually integrated and accumulated. However, AI technology, such as text mining, web crawler, intelligent matching, etc., can quickly collect valuable knowledge in the text file and timely find the disease consistent with the symptoms of TCM. According to the characteristics of knowledge, different recording methods were taken. People will classify and manage the existing prescriptions, ancient books, and encoded TCM knowledge; comprehensively collect; and centrally edit. For some who are difficult to express, such as oral expression and personalized knowledge, we usually retain and input their original treatment process and retain some details in the treatment to the greatest extent. TCM doctors used AI models to establish standardized and unified diagnosis and treatment terms and realize language conversion. These intelligent methods are often suitable for converting symptom combination to diagnosis and treatment plan combination, so as to complete the function relation construction of These lines of information of different groups people can be collected, stored, and analyzed, then relevant diagnosis and treatment reports are given, forming a huge human symptom database. It can not only enrich and improve the exist clinical database, but also better promote the development of TCM digitalization. Large database is of great significance for the accuracy and sensitivity of TCM intelligent diagnosis. To some extent, TCM researchers can provide explanations for the scientific nature of TCM disease diagnosis and treatment by mining its potential objective laws from a large number of clinical data. The independent recognition, independent learning, independent judgment, and intelligent clinic treatment and diagnosis will be ultimately achieved with AI technology, database, and advanced algorithms. In addition, the construction of the database requires the collection and input of data as well as the characteristics of TCM.The research of TCM should aim at the key points of scientific and technological innovation, such as biomedicine and system science, clarify the scientific connotation of TCM theory, and innovate and develop the theory and technology of TCM. New technologies such as information, biology, new materials, and emerging new methods are organically combined to strengthen the circular demonstration of the scientific nature of TCM data. The database construction should also take root in the clinical front line, strengthen the scientific nature of data, and explore the construction of evidence-based medicine system with the characteristics of TCM.2O medicine delivery, health management, Chinese medicine media, Chinese medicine education, intelligent equipment etc. Specifically, the intelligent diagnosis equipments of TCM mainly use AI algorithms to simulate the diagnosis and treatment thinking of TCM to make a diagnosis and give a corresponding diagnosis and treatment plan. The different prescriptions can be provided for different diseases according to the analysis results of literature data, severity degree of disease, and patient situation. The doctor's task is to make choices and judgments based on their own clinical experience. For instance, Zhang et al. extracted the diabetes feature parameters from standard tongue image and established diagnosis model based on support vector machine algorithm [With the maturity of information technology, the online and offline data fusion is effectively realized, which changes the traditional diagnosis and treatment mode of TCM. AI integrates a multidisciplinary integrated medical model and multipath diagnosis and treatment and makes up for the deficiencies of TCM data, information, technology so that personalized, fragmented, and fuzzy TCM clinical experience and knowledge have a more scientific expression. At present, the development of the field of \u201cTCM\u2009+\u2009AI\u201d mainly has several models: Chinese herbal medicine e-commerce, online consultation, Olgorithm . Hu et algorithm . Allwoodlgorithm . The facAI technology can discover the correlation between the data in the massive TCM data and conduct training, learning, and optimization. Moreover, AI converts TCM classics and clinical diagnosis and treatment experience into data and form a large number of TCM databases. With the popularity of the Internet, the accumulation of data has accelerated. It provides a foundation for the application of industrial intelligence technology in the field of TCM. We should mine information from past data, especially the theories and clinical experience of well-known veteran TCM experts, and use scientific research methods to upgrade traditional experience to scientific law, so as to provide basis and ideas for further basic research. At the same time, the government has strengthened the supervision of data quality of TCM, improved the evaluation system, established internal and external linkage database, and comprehensively evaluated all kinds of data. In this way, the personalized and fragmented clinical experience of TCM has a scientific expression, and personal experience can be transmitted and exchanged. The model is adopted to determine the clinical diagnosis elements of prominent TCM experts, the structured data were transformed, and the diagnosis and treatment information database of TCM was summarized and established. For example, Cai et al. established TCMIO, a comprehensive database of TCM on Immuno-Oncology, which can be used to explore the molecular mechanisms of TCM in modulating the cancer immune microenvironment. All of these data, along with cheminformatics and bioinformatics tools, were integrated into the publicly accessible database . Zhang eThe intelligent instruments are necessary to realize accuracy and rapid diagnosis of disease in the AI era. TCM attaches great importance to individual differences and needs to give syndrome differentiation diagnosis opinions according to the constitution of human body and the drug efficacy, but the diagnosis and treatment modes are easily affected by individual subjectivity or external factors. Compared with TCM diagnosis and treatment, precision medicine has seemingly different aspects. Syndrome differentiation and treatment is the essence of TCM diagnosis and treatment and the basic principle of TCM in understanding and treating diseases. Precision medicine includes precise detection, precise conditioning, precise diagnosis, and precise treatment. Under the guidance of the holism, it studies the precise correspondence and laws of human symptoms and signs, diseases, symptoms, etc. Therefore, the diagnosis and treatment concept of syndrome differentiation and precision medicine have similar starting point and focus. It also reflects the great connotation and breadth and depth of understanding of TCM in the process of disease diagnosis and treatment. The application of AI equipment can well solve this problem in TCM diagnosis aspects. The possible medical accidents caused by external factors can be avoided by objective and rigorous data processing.Pulse diagnosis and tongue diagnosis, as the basic links in the diagnosis of TCM, have attracted more and more attention. Pulse instruments mainly collect pulse information of patients through high precision sensors and conduct independent analysis and diagnosis according to unified standards. For example, professor Cui Ji has developed the pulse map identification standards of flat, smooth, and chord pulse by measuring the index range of pulse map characteristic parameters . Zhang eTCM workers are responsible for disseminating TCM knowledge and promoting Chinese culture. TCM hospitals account for the vast majority of TCM medical institutions and play a key role in providing TCM medical services and promoting TCM culture as well as technology. AI technology can detect the characteristics of most diseases by the massive TCM database, which make the ancient and modern TCM data be an endless precious resource rather than an empirical \u201cgarbage data\u201d that are difficult to deal with. At present, the multitype database of TCM has become a solid information for TCM with its abundant data. The TCM stroke prevention database contains data on the treatment of stroke with TCM, acupuncture, and massage from 1996 to 2006. It has established epidemiological information, diseases, syndromes, and other related content and realized the analysis of four categories of factors including clinical research, diagnosis, treatment, and disease relationship as well as the purpose of disease-related data sharing services and data mining. Ai et al. screened the literature on TCM treatment of diabetic retinopathy through the Web of Science, ScienceDirect, PubMed, Google scholar, and CNKI online databases. In addition, they summarized and analyzed the prescriptions, herbs, and identified compounds of TCM on the treatment of diabetic retinopathy from the aspects of anti-inflammation, antioxidative stress, antiangiogenesis, and antiapoptosis .With the improvement in TCM informatization and the development of AI technology, intelligent TCM is imperative for the construction of modern medical system with Chinese characteristics. The development of intelligent TCM system not only covers information release, medical service, health management, medical organization cooperation, and doctor-patient communication, but also innovates the medical service mode, builds the information sharing service system, and makes the medical service move toward the real sense of intelligence and convenience. Importantly, the advance of intelligent TCM should be organically combined with the construction of grassroots TCM and the development of smart city, such as building a \u201chealthy TCM hut\u201d model that promotes the improvement in grassroots TCM service level, which will bring new development opportunities for the overall industry of TCM.AI is the representative of the latest round of technological and industrial revolution. At present, it has developed to the fifth generation, which can handle massive information, carry out cloud computing and reasoning, and simulate human thinking with logic reasoning function. AI technology is mainly used in research and development of intelligent syndrome differentiation system and intelligent diagnosis and treatment equipment in TCM. The utilization of intelligent instruments and the medical records based on patients' condition can be used to determine the syndrome type of the disease and then select the responding treatment method. It expands the research scope of TCM and increases the research means, as well as enriches the methods of TCM.Ancient and modern TCM classics and experience are digitized, and AI is used in data mining and processing. All data are stored in the cloud system, including TCM classics, TCM clinical diagnosis and treatment data, human health status data, etc., which can be searched and obtained at any time and anywhere. With the help of TCM database, TCM doctors can quickly grasp the existing TCM experience and realize intelligent retrieval and consultation of TCM diagnosis and treatment plans.The scale of TCM databases has gradually increased, and the level of intelligence has become more in-depth and proficient. The wide application of intelligent sensor technology, such as wearable devices, mobile phones, and smart terminals, makes patients use intelligent diagnostic instruments to diagnose and analyze independently user's physical state. At this stage, all kinds of intelligent diagnostic instruments will be developed and used to help people solve many practical problems.Intelligent TCM will be integrated into daily life and become a part of human life. The modernization intelligent TCM of multidisciplinary, multilevel, and multimethods is established based on the cross cooperation. The defects of TCM dialectics' subjectivity and fuzziness are well avoided by various intelligent treatment models and advanced algorithms. In the process of disease diagnosis and treatment, intelligent TCM will be recognized and accepted by doctors and patients and gradually popularized throughout the country.On the other hand, the thinking ways and scientific theory of TCM are similar to the complex scientific thinking mode. Therefore, it is the classic representative of complex science, which is in accordance with the development direction of future science in some extent. AI has brought many opportunities for China's economic and social development, as well as great chances and challenges for TCM in future. We can learn and improve diagnostic means with the help of TCM big data, but also constantly inherit and innovate human experience. In terms of the development of intelligent TCM, I consider that it will probably go through three stages: digitalization, intellectualization, and popularization.Despite its limitations, all medicine is a form of local knowledge that is a relevant part of human medicine. The medical knowledge of different nationalities and countries are digitized, which can gather the vast ocean of medical big database. Furthermore, the medicine systems also need to integrate the medicine wisdom of different nationalities and countries. In the era of AI technology and advanced algorithms, TCM, as an ancient science and art, is brought to a greater height for its ultimate mission of benefiting human health. There is no doubt that TCM will not only provide health services for the Chinese nation, but also will make an important contribution to the health of people all over the world."}
{"text": "X enterprise. Through the questionnaire survey, it is found that through the comprehensive application of artificial intelligence technology, the new system has a higher degree of intelligence than the existing system, and its construction can effectively improve the timeliness and accuracy of financial decision-making, while reducing the cost of financial decision-making. It is conducive to promoting the integration of management accounting and financial accounting.The quality of financial decision-making is very important to the future development of an enterprise, but it is often affected by the completeness of useful information for decision-making and the subjective factors of decision makers, and is often unstable. With the development of computer technology, the financial decision support system came into being, which improved the quality of financial decision to some extent. However, although the existing financial decision support system has achieved dataization to a certain extent, it still faces problems such as artificial leadership, insufficient intelligence, and poor decision-making efficiency, and cannot fully meet the needs of decision-makers. The explosion of artificial intelligence technology in recent years has provided potential improvements to financial decision support systems. In this article, we conduct a detailed analysis of the deficiencies in the current financial decision support system, build the mechanism and implementation path of the financial decision support system under artificial intelligence, and design a digital and intelligent financial decision support system. At the same time, we apply the proposed financial decision support system to the financial practice of  The quality of financial decision-making is the life source of an enterprise and is of great significance to the sustainable and stable development of the enterprise. For a long time, the construction of a financial decision support system has been the concern of scholars. The financial decision support system realizes scientific and effective financial decision-making by comprehensively managing the upstream and downstream financial information of the enterprise, integrating the actual financial situation of the enterprise in the whole process, and integrating internal and external information \u20133. In reThe traditional financial decision support system cannot effectively mine the financial information of enterprises, resulting in the inability to distinguish the value of information, including information and usage information. Judging from the decision analysis system and big data technology implemented by some listed companies and Internet companies, the full mining of data value can greatly improve the efficiency and quality of decision-making . HoweverIn order to effectively improve the quality of corporate financial decision-making and promote the deep integration of artificial intelligence technology and the financial field, it is the general trend to build a financial decision support system under artificial intelligence. In order to lay a foundation for the construction of the financial decision support system under artificial intelligence in theory, so as to better guide its construction and application in practice, this article conducts in-depth research on its mechanism and implementation path. Based on artificial intelligence technology, this article investigates the application status of the existing financial decision support system and the necessity and feasibility of the elements contained in the mechanism and implementation path of the financial decision support system under artificial intelligence. On this basis, this article constructs the mechanism and implementation path of the financial decision support system under artificial intelligence. Finally, through the case analysis of the A group that applied the system, the results prove the effectiveness of our proposed system.The study of decision support systems (DSSs) began in the 1970s, when Scott et al. first proposed the term management decision systems and proposed the application of computers in the decision-making process . The devAt the same time, with the development of computer and Internet technology, foreign scholars are also deepening the research on new financial decision support systems, and they have put forward suggestions for improving financial decision support systems from the perspective of specific technical applications. Rupnik and Kukkar proposed the application of data mining technology in decision support systems . Tang etThe existing system mainly assists financial decision-making by providing information, which makes it actually mainly play the function of a calculator, and cannot directly provide decision-making suggestions to managers \u201318, as sThe financial decision support effect of the existing system is not good \u201321. In tOverall structure of our proposed system is shown in The data layer mainly performs data collection, cleaning, data mining, and storage. With the help of automatic data transmission programs and natural language processing technology, it is possible to quickly obtain useful information for internal decision-making such as business and financial information, audit information, and credit information stored in the local database, as well as government policy information, tax information, exchange rate information, and market information published on the Internet information, legal information, macroeconomic information, and other external information. These massive heterogeneous data are cleaned and mined to form multidimensional useful information for decision-making, and are classified and stored in the data warehouse. The data warehouse lays a strong data foundation for the deep learning of the new system and financial decision-making. At the same time, the advance processing and classification of data also provides a guarantee for the timeliness of financial decision-making.The analysis layer is responsible for carrying out financial analysis, financial forecasting, and financial decision-making activities. Financial analysis is the basis for carrying out financial forecasting and decision-making, and financial decision-making depends on the results of financial analysis and financial forecasting. The analysis layer includes knowledge base, method base, model base, and their respective management systems and artificial intelligence analysis system. The knowledge base stores various financial knowledge, common sense and reasoning rules, and other data, the method base stores financial analysis, forecasting, and decision-making methods, and the model base stores financial analysis models. On the one hand, the management systems of the three databases are responsible for receiving the instructions of the artificial intelligence analysis system and fetching the required knowledge, methods, and models from the corresponding libraries, and on the other hand, they embed deep learning algorithms to automatically carry out new knowledge, new methods, and models in the background. The establishment of new models and the improvement of existing knowledge, methods, and models, so as to update the knowledge base, method base, and model base in time. The artificial intelligence analysis system is responsible for receiving the financial decision-making goals conveyed by the human-computer interaction system and accordingly sends instructions to the database management systems and data warehouses, receives data for analysis, and finally feeds the results back to the human-computer interaction system. The artificial intelligence analysis system includes several inference engines embedded with deep learning algorithms. Some of these inference engines are responsible for determining the types of knowledge, methods, models, and portraits required according to financial decision-making goals, and the other is responsible for financial analysis to generate various portraits. A part is responsible for the generation of financial forecasts and decisions.The interaction layer is the link between the new system and decision-makers. Human-computer interaction systems use speech recognition and natural language processing technology, so decision-makers can use natural language to communicate with new systems. In the process of financial decision-making, the human-computer interaction system forms financial decision-making goals through the processing of natural language and at the same time communicates the financial decision-making goals to the artificial intelligence analysis system. After completing the financial decision, through the human-computer interaction system, output the financial analysis report, the financial forecast report and the financial decision report that integrates the above report information, or the customized report prepared according to the needs of the decision-maker.With the help of the Internet, the new system can obtain massive amounts of structured, semi-structured, and unstructured data such as financial statement information, supply chain information, market information, industry information, securities market information, and online public opinion information in real time. These raw data describe the company's own financial situation and the external financial decision-making environment it faces from many aspects, but these data are chaotic in structure and uneven in quality, and cannot be directly used for financial analysis, so data cleaning and data mining are required. The raw data processed by big data technology have become multidimensional decision-making useful information and is classified and stored by subject. Taking a certain type of product as an example, through multidimensional decision-making useful information, we can extract relevant information from multiple dimensions such as product model, output, sales volume, and main market and quickly obtain the sales of the product at a certain time and place. Just as the liquidity of assets can be judged by indicators such as current ratio and quick ratio, and through these multidimensional decision-making useful information, deep learning algorithms will determine the solvency, profitability, operating ability, growth ability, risk tolerance, risk appetite, and other factors should be evaluated and judged. Compared with the previous evaluation results obtained by solidified indicators, the results obtained by artificial intelligence technology based on exponential indicators are more accurate, thus ensuring the appropriateness of financial decisions. Further carry out financial analysis, financial forecasting, and financial decision-making based on useful information for decision-making. With the help of existing financial analysis methods and corresponding deep learning algorithms, it is possible to analyze and evaluate the solvency, development, profitability, and operational capabilities of enterprises. The financial analysis data together with the enterprise characteristic data constitute the enterprise portrait.Similarly, through the analysis and processing of useful information for multidimensional decision-making on other topics, various types of financial decision-making information groups such as external environment portraits, asset portraits, and customer portraits can be obtained. When the financial decision target is generated, according to the model obtained by the deep learning algorithm during training, the new portrait is customized, and the various portraits are matched with each other and the future under different matching paths.Predicting and analyzing the results of financial activities is to obtain financial forecast data. On this basis, the action path that can meet the financial decision-making objective to the greatest extent is selected as the financial decision. Decision-makers can revise the output financial decision through man-machine dialogue, and the revision process will affect the final decision model to improve the quality of the next decision. After obtaining a satisfactory financial decision, decision-makers can choose to output a general financial decision report or customize a personalized report. Useful information for decision-making is the starting point for financial decision-making. Therefore, the new system does not screen information when collecting information, so as to ensure the comprehensiveness of useful information for decision-making. Further processing of these data is required to improve the relevance and availability of useful information for decision-making. For unstructured data, it uses natural language processing technology for structured processing, extracts key entity information, and mines the data relationships contained in this information.Combining data mining with data-cleaned structured data, the new system can obtain high-quality decision-making useful information including the data itself and the complex relationship between the data. Financial decision-making methods and models are the link between useful information for decision-making and financial decision-making, reflecting the logical relationship and causal relationship between the two. Therefore, financial decision-making methods and models have a significant impact on the quality of financial decision-making. Here, we introduce two classical deep learning methods as decision models, namely, recurrent neural network (RNN) and long short-term memory. The equation for RNN is denoted asxt is the input features, which consist of price features and technical indicator. ft, it, and ot represent forget gate, input gate, and output gate, respectively. ct and ht represent cell state and hidden state, respectively.For LSTM, the equation is denoted asBecause our model is deployed on a financial system, computational complexity is a consideration, we improve the LSTM so that it can be deployed on high-traffic financial decision support systems. Specifically, the improved LSTM formula is as follows:Meanwhile, considering the black-box characteristics of the deep learning model, we added attention mechanism in the improved LSTM to improve the interpretability of the model. The attention mechanism enables models to adaptively discover potential patterns in input data, thereby improving model performance by identifying important features. Besides, the identification of important features also provides guidance for financial personnel to explain the decision-making process of the model. The formula for the attention mechanism is as follows:Using deep learning algorithms, we feed the new system with decision-making information, and if it makes the right financial decision, we give the neural network that made the right decision more weight, and less weight if it does not. This process is the training process of the new system. After training enough times, the new system will sum up its own financial decision-making methods and models, making financial decisions without human involvement. These financial decision-making methods and models may be different from the current solidified models. Compared with solidified models, these methods and models are more complex functional systems and have a higher degree of fitting to the data. And as the number of training increases, these methods and models will become more complex, and the quality of financial decisions will continue to improve. When the new system receives the financial decision objective, the financial decision support process is initiated. The new system will select the financial decision-making methods and models that have been trained according to the financial decision-making objectives and select useful information for decision-making according to the methods and models. After calculation and analysis, a financial decision is finally generated.X company and collect data for assessment in order to verify the efficacy of the suggested financial decision support system. Internal demands, rules, objectives, and external pressures are all factors that financial decision support systems consider. As a result, before the update, each category is assessed against the planned structure and compared to Enterprise X's decision support system: S1 for internal pressure, T1 external pressure, U1 goals and financial criteria, with subgoals, JA1 job satisfaction , JA2 cognitive skills, JA3 employee contribution to the company, JA4 employee strength, JA5 individual effort, JA6 timely reaction, JA7 accessible resources, JA8 organizational characteristics, and JA9 maturity to company activities. The classification results are grouped into U1 and U2 groups, and the final classification result is generated as an output of the organizational development decision support system.We execute real applications at The priority function value is obtained based on the consistency of the clusters and thresholds. If the value is below 0.1, it is acceptable, and others are considered unacceptable. Based on the weights, the priority value of the proposed system is measured and compared with the previous system, as shown in The priority values of our proposed system are assessed and compared to the existing system using the weights, as illustrated in X enterprise shows that the system we propose not only inherits the digital characteristics of the existing system but also better utilizes intelligent technology to organize the flow of data, and realizes the improvement of decision-making efficiency.The application of the financial decision support system can have a positive impact on enterprise financial decision-making, including making financial analysis more comprehensive and accurate, improving the comprehensiveness of useful information for decision-making, and improving the timeliness of financial decision-making. However, the existing system is not widely used, and its functions are not comprehensive enough to meet all the decision-making needs of decision makers. The main reason for this situation is that the existing systems generally have the problems of low degree of intelligence, high cost of system construction and operation, insufficient timeliness of decision-making support, and poor decision-making effect. By realizing the extensive application of artificial intelligence technology in financial decision support systems, a financial decision support system under artificial intelligence can be constructed. The application of digital and intelligent systems can provide decision-makers with more comprehensive and accurate decision-making useful information, and under the condition of ensuring the principle of cost and benefit, expand the scope of financial decision support, improve the scientificity and objectivity of financial decision-making, and reduce the probability of irrational decision-making. It will improve the overall financial decision-making quality of the enterprise and ensure the long-term stable and healthy development of the enterprise. This article proposes a financial decision support system composed of data layer, analysis layer, and interaction layer. Driven by digitalization and intelligence, it provides financial analysis, forecasting, and decision support services including financing decisions, investment decisions, cost decisions, dividend distribution decisions, and special financial decisions. AI technology is applied throughout the financial decision-making process. First of all, the new system mines and organizes the data collected in each basic database, draws various portraits, and stores them in the data warehouse. When the decision-making target is received, it supplements the decision-making useful information according to the decision-making target, and performs portrait matching, so as to obtain financial decision-making. Subsequently, the scheme can be modified and improved with the help of human-computer interaction to form the final scheme. The empirical research on the actual application of"}
{"text": "Modern medicine must move from a wait-and-see and remedial system to a preventive and interdisciplinary science that aims to provide patients with personalised and precise treatment planning .Personalised medicine (PM) is becoming increasingly important in the clinical and research settings of all medical disciplines, including pediatrics. PM focuses on the phenotyping of individual patients at the same clinic, allowing tailored screening, diagnostics, and treatment ,3. ChildTo achieve and implement the PM approach, the digital twin system (DTS) has been proposed. The DTS is composed of a physical element (the patient), a cybernetic element (the patient\u2019s DT), and two-way interactions between the two elements. The sensors transform the signals of the patient into the DT of the patient. Artificial intelligence software processes the signals to act through recommendations or automatic adaptations of the patient\u2019s management .Due to the high complexity of the human body and its functional mechanisms (not fully elucidated), no DT of the whole human body has actually been designed . HoweverAn artificial pancreas for children with type 1 diabetes, combining a closed-loop glucose control system and insulin infusion algorithm, opened the way for DTS in the management of paediatric chronic diseases .In the near future, DTS are likely to be developed for other complex chronic diseases of paediatric age.A future application may be for paediatric obesity, one of the most critical public health challenges. Childhood obesity is a multisystem condition that has various complications . GeneticThis information, combined with longitudinal metabolomic, immunological, biochemical, behavioural, and gut microbiota parameters, could define a digital replica of oneself used to implement a personalized nutritional program, offering a revolution in obesity management .In childhood asthma, likewise, where different determinants of asthma symptoms need to be considered, including the treatment and the environment , DTS could be used to define the appropriate treatment in real time and/or to adopt the appropriate mitigation measures in subjects at high risk of asthma, and to determine an optimal medication dose and treatment plan, leading to a decrease in both the costs and the difficulties involved in clinically managing the disease ,8. AssocThe role of DTS in the management and treatment of other non-communicable diseases, such as preventable cancers, neurodegenerative disorders , and rarAn interdisciplinary approach is mandatory for DTS proposals, as artificial intelligence, data science, and engineering concepts can identify risk factors over the course of the patient\u2019s life, potentially enabling personalized simulation of life-course multimorbidity risk and thus improving health outcomes ,11.The first stage of the DTS development for healthcare is the training of a predictive model, using machine learning, by identifying key factors over the patient\u2019s lifespan that predict the risk of later multimorbidity associated with disease . ThroughA DTS in the health system offers a virtual disease representation, offering the possibility to test scientific hypotheses and predict the interaction of pathogenic components and their effect on children and adolescents .The DTS produces highly realistic models of real systems ,5,11. InThe complexity and costs of DTS will be comparable to those of projects such as the Human Genome Project; in addition, DTS may lead to an improvement in health and access to healthcare, performing early diagnosis of diseases, performing personalized treatment, and offering innovative research directions ,12,13.However, for the clinical implementation of DTS, a wide range of technical, medical, ethical, and theoretical challenges , particuThe topic of DTS represents current and future health challenges in pediatrics as a tool which promises to promote and protect the health of children, maximize the efficiency and efficacy of PM in the healthcare system, and to offer an innovative perspective for research."}
{"text": "The COVID-pandemic context is characterized by a global ambiguity, reflecting the unexpected onset of pandemic, unpredictability and amplitude of the related dangers, questionability and the side effects of the policy measures used to protect people.The development of theoretical framework for understanding variability in the reactions to COVID situation and self-regulatory mechanisms.Conceptualization and analysis of individual psychotherapy cases in the framework of psychodynamic approach.Five typical patterns of anxiety, defensive functioning and mentalization structures were identified: Paranoial pattern is marked by flooding with persecutory anxiety, exaggerated subjective uncertainty. reflected in chaotic boundlessness, incoherence, fantasies of hostility, splitting and polarization of self and others. Depressive pattern reflects inability to sustain ambiguity due to deficiency of internal supports, overly dependence on others, conformity, obedience to authority and denial of personal standards and individuality. Noogenic pattern refers to negative affective states, generated by the ambiguity, contradictions and ambivalence of information. The means to regulate it include the lowering of the level of psychical functioning, with cognitive simplification, preference for order, routine and predictability. Transgression pattern suggests maniacal fascination with the dissipation of limits, normative restraints and rules, and the triumph of the narcissistic-perfectionist permissiveness. Constructivity pattern consists of the pleasure from explorations and insights, creation of new meanings, creative reappraisal and reconstruction of ambiguous situations.The typical patterns of experiencing ambiguity that were singled out may have diagnostic and prognostic significance in evaluating the individual resource potential in situations of COVID related dangers and isolation."}
{"text": "The corrected Author contributions statement appears below.EP, T-TP, LV, QR, HP and SK performed the experiments. EP and QR analyzed the data. PVdS, EP and GO conceived the study. EP and PVdS wrote the first drafts of the manuscript. EP, T-TP, LV, HP, SK, GO and PVdS critically read and edited the manuscript. All authors contributed to the article, read the article and approved the final version.Furthermore, one picture of the lungs in The authors apologize for these errors and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "Converciencia, a program designed to connect Guatemalan scientists residing abroad with their country of origin. Converciencia has been a flagship practice for over 15 years. This program involves three main groups of participants: (i) science and technology (S&T) policy agents, (ii) the scientific community , and (iii) host institutions . This article presents a comprehensive and balanced overview of the Converciencia program applying an in-depth analysis of its creation, evolution, leading trends, and legacies. Using a qualitative methodology and conducting a four-level analysis  allowed for the identification of nuances of this S&T practice in the context of a scientifically lagging country such as Guatemala. The detailed data collected through documentary and desk review, gray literature, focus group discussions, and semi-structured interviews resulted in a framework to highlight the strengths, weaknesses, opportunities, and threats (SWOTs) in the planning, organization, implementation, monitoring, and perception of the results achieved by Converciencia. Findings portray the contrasting views and perceptions from a single S&T practice, depending on the participating parties' roles and responsibilities. Direct participants examined how Converciencia has achieved its objectives while questioning the effectiveness and impact that the resources allocated to the initiative have yielded over time. Evidence indicates that despite the design, coordination, and evaluation limits of Converciencia, the GSD, the scientific community in Guatemala, and the host institutions are interested in the continuity of the practice. Indeed, the main recommendation involves restructuring and turning Converciencia into a robust S&T policy. Converciencia as a policy engaging the GSD could produce greater results and impacts by involving all the key actors in co-designing activities, clearly determining roles and responsibilities, and establishing performance and impact indicators for evaluation.In 2005, the Guatemala National Secretariat of Science and Technology (Senacyt) introduced  It was founded in 1991 and managed by Colciencias . Its purpose was to channel the research potential of Colombians living abroad to the country and link them to research institutions for the creation of scientific capacity. R-Caldas relied on connections among Colombian diplomatic missions abroad to identify and reach out to the Colombian SD. The engagement activities of the members of the R-Caldas were classified into four categories: (i) identification of research areas with possibilities of cooperation and formulation of joint projects, (ii) training of human resources and return of researchers, (iii) internships and mobility, and (iv) communication and scientific dissemination. In Argentina, Programa Raices (a network of Argentine researchers and scientists) was designed by the Ministry of Science, Technology, and Productive Innovation in 2003. It became a national policy in 2008 managed by the National Agency for Scientific and Technological Promotion and the National Council for Scientific and Technical Research. The objectives included permanent or temporary repatriation of Argentine researchers residing abroad, development of networks linking local researchers and those of the diaspora by realization of short stays, dissemination of job opportunities agreed upon with the private sector and foundations, and dissemination of scientific and technological activities , a project developed between 2013 and 2016, as a series of engagement strategies related to the Brazilian diaspora of science, technology, and innovation promoted by the Brazilian government. This project was designed and implemented by the Brazilian Industrial Development Agency (Abdi) and was funded by the Brazilian Trade and Investment Promotion Agency (Apex-Brasil). The project aimed to set up a \u201cnetwork of networks,\u201d engaging active initiatives and Brazilian professionals  and foreign professionals with ties with Brazil. Some of the project's main components included building partnerships and research cooperation to develop business and projects in intensive knowledge and technology areas. The case of Uruguay involves the program Circulaci\u00f3n de Uruguayos Altamente Calificados . The program was created in 2005 to \u201cactively and effectively link highly qualified Uruguayans residing abroad with national institutions\u201d  disciplines. The diversity would facilitate communication between colleagues to implement collaboration mechanisms in multiple fields. Several of them intersect with aspects related to the country's development process.From the policy perspective, some cases can be highlighted in the context of Latin America, particularly the cases of Colombia, Argentina, Mexico, Brazil, Uruguay, and Costa Rica. Chaparro et al.  show thaConverciencia as the single identified initiative designed and implemented by the Guatemala National Secretariat of Science and Technology (Senacyt) aimed at connecting Guatemalan scientists living and working abroad with their country of origin. This initiative has incorporated the participation of grassroots actors, including members of the GSD and host institutions (co-organizers). Converciencia has also mobilized broader sectors of the society, such as the media, the industry/productive sector, other public institutions, organizations from the civil society, and students in middle, high school, and universities. Converciencia has used valuable and scarce human and financial resources, which should be analyzed against the achieved results. The review of this S&T practice follows a four-level analysis adapted from Patton et al.  or significant policies addressing the relevance of the migration of skilled individuals and the eventual connection among them and with their country of origin. This research intends to bridge such gaps. This article presents a comprehensive review of n et al. , p. 31 tConverciencia since its origin.This study was carried out using a qualitative methodology in which three types of methods were used to collect data: (i) focus group discussions, (ii) semi-structured interviews with key respondents, and (iii) documentary and gray literature review. Primary and secondary data were collected to incorporate the perspectives of the three main parties involved in Converciencia. This category emphasized the selection criteria . The review of relevant literature contributes to a deeper understanding of the policy and practice analysis. Complete details of the participants can be found in the supplementary data. Following data collection, a multi-layered policy analysis was conducted.In addition, the authors developed a body of gray literature for review using annual reports from Senacyt from 2005 to 2020. This was complemented by media coverage and published news related to This section presents the discussion and findings following a four-level policy and practice analysis. This level of analysis refers to the general characteristics of the practice. It includes the most relevant features, namely, vision, parties involved, roles and responsibilities, and resources. It is essential to include the perspectives reported by all the parties involved.Converciencia as an S&T practice has taken place for over 15 years. One of its main objectives has been to connect the GSD with local scientists, the industrial sector, the academic community, and society. Institutions from the public sector involved in organizing Converciencia include the National Council for Science and Technology (Concyt) and Senacyt. Other institutions with indirect involvement in different editions have included the Ministry of Education, the Congress of Guatemala, and the Technical Training and Productivity Institute (Intecap). From the scientific community, the main representation has been the RedCTI. However, researchers and scientists working in local universities and research centers have also been part of Converciencia activities. Host institutions co-organizing Converciencia have mainly included those with presence in the capital city of Guatemala. However, in various editions, host institutions have participated in co-organizing/hosting Converciencia in a few departments (provinces) of Guatemala. Other actors with sporadic participation include international organizations, non-governmental organizations, and industry and private firms. In this level of analysis, it is crucial to describe the involvement of the main actors and stakeholders that have consistently participated in Converciencia. Converciencia are illustrated in different colors, nodes, and veins.Concyt formulates the country's science, technology, and innovation policy. It aims to direct and coordinate the national scientific and technological development with the executing functions of Senacyt  provides a detailed summary of the main highlights of Converciencia reported each year. Converciencia is referred to each year. Interestingly, some patterns emerge in terms of the absence of performance indicators and difficulties in conducting a comparative/monitoring analysis. Also, a period with no activities related to Converciencia was confirmed from 2013 to 2016.Senacyt is the government institution that, in response to a mandate by Concyt, designed Converciencia, RedCTI was founded. This was promoted by the National Secretary of Science and Technology, the Presidential Commissioner for Science and Technology, eleven members of the SD of Guatemala, and eight scientists residing in Guatemala representatives of the Council of Notables . The main objective of this network was to generate academic coordination between different Guatemalan institutions and to engage Guatemalan scientists with RedCTI. Also, part of its goals was to identify academic content of diffusion, teaching, research, innovation, science communication, and knowledge transfer for the development of Guatemala. RedCTI constitutes one of the main actions supported by Senacyt to promote S&T for national development. As of February 2022, RedCTIlicentiate), 29% (57) master's degree, and 65.9% (129) hold doctoral degrees (Ph.D.). The reported country of residence shows that 54.6% (107) indicated their country of residence as Guatemala and that 45.4% (89) reside abroad. In this aspect, a more comprehensive concentration of GSD is found in the United States with 18.3% (36), followed by Mexico at 5.6% (11) and 4.6% in France (9). Other destinations with less presence include Argentina, Chile, Canada, Germany, England, the United Kingdom, South Korea, Taiwan, Japan, etc.In 2005, with the framework of the first RedCTI were invited to participate in Converciencia. Likewise, within the framework of the event, until 2019, participation was in-person and required mobility. Members of RedCTI held a general assembly in which they declared the importance of the continuity of Converciencia. RedCTI considered Converciencia an essential space for the Guatemalan scientific community and their interaction with society, sharing the country's scientific developments.Each year, members of Converciencia, the role of the host institution was designed as a co-organizer sharing with Senacyt logistic, organizational, and follow-up responsibilities. The level of involvement of each host institution and the number of participants (single or recurrent) have changed over time. Universities, research centers, and a few public institutions have played a recurring role in co-organizing Converciencia. Among their functions, host institutions provide infrastructure (their facilities host the activities) and audience . The activities, in the context of Converciencia, include academic events  and visits to laboratories and different facilities. Host institutions have expressed their intention to have more influence on planning and organizing Converciencia. In other words, they seek to act as true co-organizers and not as passive bystanders. However, as it will be discussed later, their involvement has been limited to logistics , with no influence on the organizational aspects of the event.Since the first edition of Converciencia activities and speakers. The coverage has been focused on highlighting the academic background of the speakers, the activities in the context of Converciencia, and the roles and contributions of the host institutions, especially in cases with interactions between scientists, children, and young students. Frequently, the coverage has transcended the informative perspective incorporating a critical or reflective approach. News and reports have highlighted the importance of increased investment in science, technology, and innovation for Guatemala. Also, media posts written by scientists living in Guatemala have described the need to rethink Converciencia toward GSD engagement with local scientists beyond dissemination activities.Senacyt has reached out to the media to provide coverage for Converciencia in the leading national newspapers  means. Notwithstanding, the reviewed media coverage included three private newspapers, Prensa Libre, El Peri\u00f3dico, and La Hora, one public newspaper, Diario de America Central, and one digital portal, Soy502. These news reports were the ones found in online search engines using the keyword \u201cConverciencia Guatemala.\u201dReviewing the news coverage and publications addressing pers see  makes itThis level of analysis refers to the argumentation regarding elements that impact or cause the analyzed policy/program/practice.Converciencia. The activities related to this practice have changed, reflecting the vision and priorities set by the institution's top authority. Converciencia's key events. The following analysis was developed according to interviews with each National Secretariat of Science, interviews with host institutions, and public report results from the annual activities of Senacyt. In countries such as Guatemala, where re-election is impossible, governmental officials may show a terminal logical behavior and strategic defection during transitions that affect policy sustainability. Also, new government officials dissociate from the outgoing government to fit in with the new government, leading to a lack of continuity  strengthening science and technology in the country, (ii) exchanging experiences with the GSD, and (iii) seeking solutions to latent problems in Guatemalan society.Secretary Rosa Maria Amaya was among the co-founders of Converciencia went beyond founding RedCTI. Not all established local researchers participated in the conception of Converciencia, only awardees of the National Science Medal. This created continuous friction over time. Various researchers working and residing in Guatemala with established careers describe Converciencia as an elitist event where they were not invited, and their work in the country was not valued.Additionally, to be the first program of its kind searching for collaboration with GSD and local scientists, the results from the first Converciencia was suspended , with a background in industrial engineering and academic and industry trajectory, d Cobar, . Rubio CConverciencia was not valuable. He did not identify a positive impact of bringing the scientists' diaspora to Guatemala for one week a year to Guatemala City to share experiences, especially when 80% of the participants were the same each year. Pokus Yanquian launched the National Week of Science and Technology in different regional locations of the country. His goal was to engage the youth to pursue science careers in other departments of Guatemala. Local researchers liked the regional approach, but the program was focused on dissemination to young generations and there were no other potential collaborations. The GSD was not invited to this event, and RedCTI was inactive. This period shows a steep decrease in the participation of scientists. The general political situation in Guatemala was unstable, reflected in the consecutive transition between three vice presidents in this period. Cobar  led him to envision linking the GSD with the scientific community in the country. He was interested in bridging the academic sectors from Guatemala with the GSD for potential collaborations. In addition, his priority was to promote science for the Guatemalan new generations. One of the first modifications of Converciencia during that period was to locate some activities in different regions of the country and different host institutions using the universities as part of the scenarios to develop collaborations. Converciencia had public open calls to apply as a speaker, making it easier for other scientists interested in the event. Host institutions selected their preferred speaker and activity from a list provided by Senacyt. The GSD participating in Converciencia felt a significant affinity to the vision of the head (related to his scientific background). Most of the scientists from the diaspora felt that their voices were heard. Nevertheless, some local scientists considered they were not the protagonists of these events, causing conflicts in their perception. Host institutions also felt left out of the planning, limiting the outcomes.Oscar Cobar Pinto was the Secretary who relaunched Converciencia as \u201cone of 20 activities implemented by Senacyt each year.\u201d Her vision for Converciencia was to restructure the activity to be more connected to the Guatemalan population, the country, and the industry's needs. She considered the past events of Converciencia as activity occasions disconnected from the harsh realities of Guatemala. Her perception of Converciencia was of a time and resource-consuming event with limited results and impact. In 2020, Converciencia was developed without significant changes in organization and scope; however, due to the COVID-19 pandemic, the event was entirely implemented through remote/digital online formats with no in-presence activities. Researchers appreciated that the event was online, and there were no significant expenses involved . The GSD participating in the event had a larger audience, but interactions with peers and networking opportunities were constrained.At the time of this research, Ana Judith Chan was the incumbent National Secretary of Science, who has a master's degree in International Business Law. She is a former President of the Guatemalan Mexican Chamber of Commerce and Industry (Camex). She considered This level of analysis refers to the set of ideas and the worldview held by the actors that influence (justify) their behavior, actions, and decisions. It is based primarily on their interpretation of the ideas that shape the policy/program/practice under analysis.Converciencia's limitations found in its design, coordination, and evaluation processes. These three aspects show that although Senacyt gave greater relevance to the participation of the scientific diaspora during the days of the event, they were neither included in the previous stages (planning) nor in the posterior stages . The priorities of Converciencia topics were driven by the government's vision and did not engage the GSD with the rest of the scientific system. Converciencia limitations.The analysis of Senacyt's annual reports released between 2005 and 2020, contrasted with the assessments derived from the focus groups, allows for the emergence of Converciencia was conceived as a program contemplated in the National Plan for Science, Technology, and Innovation (2005\u20132014), over time, the policy perspective shifted and reduced it to a yearly event. The annual reports repeated knowledge exchange as a critical characteristic of Converciencia, but according to Participant . Researchers appreciate the GSD attitude toward learning and collaboration. Media coverage of the importance of science during the event has been one of the strengths highlighted by local researchers. Moreover, Converciencia is well-established and well-known, and has been running for many years, facilitating marketing and promotion strategies. The joint doctoral program between Unam and Usac organized by one of the researchers visiting the event has been one of the outcomes of Converciencia that have generated measurable results, i.e., various Guatemalans who graduated from doctoral programs currently occupy leading positions in academia, mobility, and research exchange between Unam and Usac, and other collaboration agreements with Cambridge University and Ictp organized by the other co-founders of Converciencia.Converciencia is a one-time a year event; for most participants, it does not have continuity in collaborations with other researchers. Many activities have been organized without defining the target public; it has not been clear to the audience or the scientists participating. Stakeholders from the industry had identified the lack of participation of industry and other sectors in these events. Also, the profiles of scientists have been repetitive every year. Participants have also specified bad logistics in event planning, timing, and booking, including lack of regional participation and inclusion of indigenous scientists or indigenous participants. None of the events were available in indigenous languages. Most of the researchers residing in Guatemala consider that the program has more weaknesses than strengths. They have described the program as unidirectional without room for collaboration. Additionally, there is no evidence of the benefits achieved with the funds expended in the program. Guatemalan scientists, including the members of the RedCTI, have not been considered for co-designing the program. This group should be fundamental to Converciencia planning due to their seminal contribution to the origin of the program.Lack of engagement of local scientists with the event has been identified in all the interviews. There have not been enough incentives for local scientists to participate. There has not been a match among scientists working in the same area to generate spaces for collaboration. The number of events assigned to each scientist has been extensive, limiting only to disseminating research results and not allowing communication between different sectors to evaluate collaboration opportunities. Converciencia in collaboration with universities, research centers, RedCTI, and local scientists has been identified as an opportunity to create longer and established relationships between the participating scientists. According to the local researchers, The Converciencia funds' allocation in the Senacyt annual operation plan should continue but under a collaborative approach focusing on Guatemalan researchers' needs. Converciencia has an assigned annual budget that can continue over time and is an advantage to consider with a better restructuring and with a more collaborative approach to listening to the Guatemalan researcher's needs. Likewise, there is an opportunity to invite scientists who carry out scientific dissemination to participate in the event.One of the main opportunities identified is that the platform could allow for follow-up and concrete collaborations between scientists residing abroad and in the country. It can also promote connections among scientists, NGOs, civil society, and industries. Also, a new cohort of scientists has been identified as an opportunity. This is because of the renewed energy and innovative ideas that they can potentially bring. Designing Converciencia has been changing with every transition in the top direction of Senacyt. Moreover, there is not enough participation of established local scientists who consider Converciencia an elitist event. They perceive that the event only highlights the work of Guatemalan scientists residing abroad, along with local results. Another threat identified by researchers living in Guatemala is the potential message that science can only be done outside Guatemala. According to researchers, politicians on duty have been another threat since they guide the event for their propaganda interests. The most significant danger mentioned by all scientists is the unwillingness of decision-makers to allocate a budget to science, technology, and innovation.The main threats involve changes in policy direction, budget allocation, and structure of the event which occur when the government administration changes. The focus of Converciencia. The perspective of the host institutions is critical for explaining different challenges and opportunities experienced in their roles as co-organizers of This level of analysis refers to the \u201cideal\u201d version of the policy/program/practice, for which actors and stakeholders present a set of recommendations to improve.Converciencia offers opportunities to assess its relevance as a policy/practice. Participant  in Italy. In addition, the transfer of environmental virology with the University of Barcelona was promoted. These three initiatives were promoted by three scientists from the GSD who co-founded Converciencia, Concepci\u00f3n Toriello, Fernando Quevedo, and Oscar Cobar Pinto. These examples shared as a common feature the need to follow up and engage in sustained collaborations as opposed to episodic, isolated activities.The evidence of successful results from ticipant  providedConverciencia should focus on inter-institutional exchanges and transfer knowledge by co-creating postgraduate programs with GSD institutions and local institutions. Another participant provided an example of results from Converciencia, a joint publication derived from the 2019 edition in which a member of the GSD working in Chile collaborated with scholars in the host institution and presented the research results in international conferences and journals.According to Participant , a visioConverciencia has responded, according to some comments from the Participant  How does Converciencia policy impact the GSD? (ii) How does it feel to the GSD, local researchers, and the research, technology, and innovation system representatives? (iii) How does it work for the GSD and local researchers?The policy cycle model has a sequential development rational approach. The model first defines the problem, then formulates the policy and implements it, and finally evaluates it  the number of dissemination activities, (ii) the number of participants, and (iii) the number of speakers. Nevertheless, some of the expected indicators from scientists and host institutions for an efficient Converciencia policy are: (i) the number of research visits from local Guatemalan researchers, professors, and students to foreign GSD affiliated institutions, (ii) the number of exchange research visits from the GSD to Guatemala, (iii) the number of co-written research proposals between the GSD and local researchers, (iv) the number of scientific publications that resulted from collaborations between Converciencia participants, (v) the number of scholarships for local students, professor, or researchers that resulted from interaction with the GSD, (vi) the number of equipment donated through the GSD management, (vii) the number of joint Master or Ph.D. programs co-created with the GSD and local scientists, (viii) the number of young Guatemalan inspired to pursue a scientific career due Converciencia, (ix) the number of research or development projects funded and approved because of the collaboration of Converciencia participants, (x) the amount of investment from the Guatemalan industry for research projects with Converciencia participants, and (xi) the number of new spin-offs or start-ups generated through research results of Converciencia collaborations, among others. Converciencia.The KB: conceptualization (lead), data curation (lead), project administration (lead), methodology (lead), resources (lead), validation (lead), and writing the original draft (lead). SA: conceptualization , data curation , supervision , project administration , writing the original draft , and visualization (lead). LGVP: investigation (supporting), visualization (supporting), conceptualization , and writing . All the authors contributed to the article and approved the submitted version.SA was employed by New Sun Road. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "In recent decades, nursing has witnessed many changes in Iran. Despite the numerous advances in nursing, the health system faces many challenges in community health nursing. This study aims to review the challenges in community health nursing in Iran and provide an evidence-based solution as well.This article is an integrated review of the literature regarding the challenges in community health nursing published between 2000 and 2021 in the databases Scopus, Medline, Cochrane Database of Systematic Reviews, Science Direct, Google Scholar, Scientific Information Database (SID). After performing searches, 20 articles were selected and studied. Data analysis was done using Russell approach (2005).The results of this study were summarized in 6 themes consisting of challenges in community health nursing education, practical challenges in community health nursing, policy-making challenges in community health nursing, management challenges in community health nursing, and infrastructural and cultural challenges. Solutions were also proposed to address each of the above issue.The results of the study showed that diverse challenges exist in community health nursing in Iran, considering that community health nurses play an important role in providing primary health care and community-based care. In order to solve these challenges, the authors have some recommendations: modifying the structure of the health system with the aim of moving toward a community-oriented approach from a treatment-oriented one, developing laws to support community health nurses, creating an organizational chart for nurses at the community level, modifying nursing students' training through a community-based approach, and covering community-based services and care under insurance. An examination of nurses' status and position in the service provision system around the world shows that nurses constitute the largest group of health care workers , 2. CommIn all developed countries, community health nursing has had a significant growth in the health care system . In CanaIran is a populated country in the Eastern Mediterranean region, where health services are provided at public, private, and charity sectors , 17. In health for all as a goal, the proof of which is the presence of nurses in blood pressure screening program in 2012  formulating the research problem, objective, and question, (2) collecting data or searching through articles, (3) evaluating data, (4) data analysis, (5) interpreting and presenting the results .Considering the items discussed in the introduction, this study is conducted to determine the challenges of community health nursing in Iran and the related solutions. Two key questions guiding the review process include \u201cWhat are the challenges of the community health nursing discipline in Iran?\u201d and \u201cWhat are the solutions to address these challenges?\u201d Answering these two key questions will help detect the challenges of community health nursing, propose solutions to address them, and promote the community health nursing discipline.In this study, the target population consisted of all the studies (articles and dissertations) that had been conducted in the field of community health nursing regarding its challenges, barriers, and solutions, the full texts of which were accessible. Available resources, including all the studies on the challenges of community health nursing, were reviewed in this study. A comprehensive search was done through the databases Medline, Scopus, Cochrane Database of Systematic Reviews, Science Direct, Google Scholar, and Scientific Information Database (SID) for the papers published between 2000 and 2021 in eligible English or Farsi journals.The keywords that were searched consisted of community health nurse, community-based nursing, public health nurse, nursing challenges, nursing position, and primary health care. The keywords were investigated both separately and in combination with each other . FinallyThe relevant articles were evaluated based on the title, abstract, text, as well as the inclusion and the exclusion criteria. The inclusion criteria for the studies consisted of the following: (1) examining the challenges of and barriers against community health nurses and its position, (2) containing the keywords or their equivalent in the title or abstract of the article (3) Being written in either Farsi or English. The exclusion criteria included the following: (1) not accessing the original paper and the information on its methodology, (2) being written in other languages, (3) being irrelevant to the research question. It is noteworthy that in this study, there were no limitations in terms of research method, so that the results of various studies could be used.After doing the systematic search, the studies related to the search keywords were found. After removing the duplicate titles (79 articles), the title, the abstract, and the full text of the studies were reviewed by the research team, and the inclusion and the exclusion criteria were applied. Twenty-four articles were excluded due to being irrelevant and 55 articles entered the screening stage, 20 of which were excluded. Then 35 articles were examined regarding eligibility and, finally, 20 articles were included in the study. The studies were selected by a research team consisting of two nursing professors  and one nursing PhD student . Furthermore, the research team came to a consensus through more discussion regarding the points of disagreement.At this stage, the articles were reviewed separately. Finally, 20 articles related to the purpose of the study were reviewed and analyzed. Each article was read completely and the results of the studies were extracted from them. After extracting the results of the articles, their results and statistical analysis were compared. The results with the highest frequency in these articles were further interpreted in the next phase.At this stage, according to the analysis of the related studies, their comparison, and the data frequency, the following items were extracted.n = 79), 55 studies entered the screening phase and their titles and abstracts were evaluated. In total, 35 studies were included in the selection phase, and 20 remained in the study . Seven reviews were of qualitative type , seven reviews were cross-sectional descriptive, and one was a comparative study. Eighteen reviews were published in English and two were published in Farsi. The majority of the reviews investigated the position and the role of community health nursing in the health service delivery system and its challenges. About 40% of the reviews are related to the studies on the situation of community health nursing and the barriers against its provision in Iran. Two reviews have studied community health nursing education in Iran, and seven reviews proposed strategies to solve the challenges of community health nursing.By analyzing the reviews, six themes emerged in the field of community health nursing challenges, and six other themes concerned the strategies to overcome the challenges. The details are displayed in There are several challenges regarding community health nursing in Iran, which have been addressed in previous studies input, process, and output.Several challenges were mentioned in the literature in regard with the education, which were divided into the three areas Students' poor understanding of community health nursing lessons, considering the community health nursing apprenticeship as futile, and, in some cases, even as a chance to rest, as well as their poor motivation for active participation were mentioned as important challenges . MoreoveAnother challenge in this area is the insufficient skills and experience of nursing educators in the field of community-based educational planning, their inadequacy in conducting community health apprenticeship programs and the related evaluations, and ineffectiveness of community health apprenticeship , 42. In The poor presence of community-based care in the nursing education and focusing on hospital care have been referred to as one of the most important challenges according to several studies. Nursing education in Iran is more focused on clinical education. Most nursing schools train their students to play the traditional nursing role, while community needs the training of nurses according to holistic perspectives , 19, 40.Recruiting nurses only in clinical settings such as hospitals and the absence of a particular and appropriate professional position for nursing and community health nursing graduates in health centers has prevented nursing graduates from acquiring the necessary skills to provide health care , 42.One of the most important challenges in this field is not defining positions for the provision of nursing services in the community and various settings of the health system. Therefore, in hospitals, which are considered as the main position of nurses, appropriate roles are not defined for them with the aim of health promotion . AnotherOne of the important areas of community health nursing is performing home visits and the provision of care and counseling in the home environment. A challenge that community health nurses face in this regard is the problems with ensuring their safety .The lack of mutual interaction between nursing and other institutions of the health system and nurses' lack of involvement in policymaking regarding their own field of study has resulted in neglecting the role and the position of nurses in the health system. On the other hand, health policy makers have not taken the nursing profession seriously because physicians are dominant in the health system. In other words, the nurse's role and position in the field of prevention and community-based services has been ignored. The chaos and the disorder in the health system, as another challenge, has prevented the fulfillment of one's actualrole . On the managerial actions, and the lack of knowledge of the community health nursing profession.In the field of management, several challenges have been mentioned in the articles, which were divided into two areas: The lack of an effective management system for the use of community health nursing services has been mentioned as one of the most important challenges, as health managers have to make appropriate strategic plans . AnotherOne of the important challenges is nursing institutions' lack of knowledge of nursing and its specialty disciplines . The heainsurance coverage and funding, executive protocols, and interdisciplinary cooperation.In regard with of infrastructure, several challenges were pointed to in the articles, which were divided into three areas: Another challenge is the high cost of health service provision in the community in the form of home visits and the fact that they are not paid by insurance. Allocating less funds for providing community-based care than for treatment care and hospitalization is another challenge in the Iranian health system , 31, 33.The absence of clear guidelines for making assessments, classifying patients and care seekers, wages and salaries, allocating funds and determining personnel adequacy and competency in the community-based care and home care system is another important challenge in this regard .There is no interdisciplinary cooperation and coordination among different sectors of community such as health centers, municipalities, and the police to provide community-based care by community health nurses . While tPublic distrust of and negative attitude toward the capabilities of non-physician experts in providing prevention and health services is another challenge in Iran , 16.In previous studies, several strategies were mentioned for each group of community health nursing challenges.In order to solve the challenges in this area, the following strategies can be used:A solution to instructors' challenges: one strategy is to hold training courses for community health instructors so that they can provide and train quality nursing services outside the hospital. It is also possible to provide information on new educational strategies, novel learning opportunities in the field of community health, new tools, and new methods of student assessment to the community health nursing instructors in workshops. In addition, qualified instructors should be hired to teach community health, and short-term training programs should be developed and prepared in the field of geriatric nursing, school nursing, occupational nursing, community-based rehabilitation, and behavioral disease counseling for senior community health nursing professionals in order to promote nurses' position and role in the educational, treatment, and health care teams , 43, 44.A solution to students' challenges: the strategy is to hold pre-teaching workshops in various fields of community health with the aim of preparing students to share their apprenticeship goals and motivate them. Furthermore, to train nursing students for community health nursing discipline, participatory processes with key stakeholders such as health centers and deputies, regional hospitals, clinics and schools as well as specialty nursing programs should be used to empower nurses, instead of providing conventional and routine clinical trainings , 6, 16.Modifying nursing curriculums with the aim of focusing on community-based education, developing evidence-based curriculums based on the health needs of different regions of the country, and considering community health nursing practice is an effective strategy , 2, 29. This group of challenges can be addressed by reviewing and reforming the process of hiring community health nurses and creating an organizational title for hiring community health nurses in schools, factories, prisons, and comprehensive health centers . In otheThis challenge is possible to be solved by involving community health nurses, as professionals in this field, in health-related issues at large scale. Policymakers should also publicize laws and policies in support of community health nurses and develop guidelines that align community health nurses' roles with their skills and areas of practice , 6, 26. community health nurse and its capabilities  which was financially supported by the Nursing Care Research Center in Chronic Diseases of Ahvaz Jundishapur University of Medical Sciences (NCRCCD-9837).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "Improving carbon reserves is considered to be an important way to alleviate global warming. However, there is a lack of research work based on the perspective of metropolitan area, and there is also a lack of analysis on the leading influencing factors of spatial distribution of carbon storage in subregions of metropolitan area. In this study, Nanjing metropolitan area (NMA) is taken as the research area, and the InVEST model is used to calculate the spatial distribution of regional carbon reserves, and the evolution of carbon reserves distribution in recent 20 years is analyzed. Then, based on the random forest (RF) model, taking the whole study area and subareas as the research scope, a regression model of each selected impact factor and carbon reserves is established, and the leading factors of spatial distribution of carbon reserves in NMA are obtained. The results show that the overall carbon reserves level in the study area is in a downward trend. Through the application of the RF model, the leading factors of the spatial distribution of carbon reserves in NMA and its subareas are derived. The research proves that the application of the RF model in the analysis is helpful for city planners and governments to make plans and improve regional carbon storage more effectively. To meetreserves .2 emissions come from cities [Since 1850, changes of LULC have caused the global terrestrial ecosystem to lose 145 Pg C [m cities , 7. UrbaIntegrated Valuation of Ecosystem Services and Trade-offs (InVEST) model, which runs fast, requires less data, and is practical, to study the carbon reserves in watersheds [At present, the methods used to study the carbon reserves at home and abroad mainly include biomass method , 9, booktersheds , 14, cittersheds \u201317, spectersheds , and othWith the deepening of China's urbanization process, the development of Chinese cities has shifted from focusing on each city's own urbanization to focusing on interregional cooperation and development among different cities , 20. TheThe random forest (RF) model is an ensemble learning algorithm , 29, whiTo sum up, we select Nanjing metropolitan area (NMA), the first national metropolitan area in China, as the research area. We calculate the regional carbon reserves spatial distribution by using the InVEST model, and verify and analyze the evolution of carbon reserves distribution in the past 20 years (2000\u20132020). The core of our work is to establish the regression model of each influencing factor and carbon reserves based on the RF model, and obtain the leading factors of spatial distribution of carbon reserves in NMA, in order to provide the basis for realizing carbon neutralization, improving the carbon reserves capacity of the ecosystem, and reasonably formulating the land use strategy in NMA.Nanjing Metropolitan Area (NMA) is the first planned national metropolitan area in China . NMA is NMA involves a number of different administrative divisions belonging to different provinces, and the regional scale is large, and the economic volume, ecological environment, and other factors of each constituent city are very different. Therefore, we not only explore the influencing factors of carbon reserves change in NMA, but also explore the differences of those factors in different subareas of NMA. Generally speaking, the planning of administrative regions at all levels in China is mostly based on the county level or above . Taking each county-level region in NMA as a unit and combining with the development plan of NMA published by the National Development and Reform Commission of China, the research area is divided into three subareas: urban core area (UCA), urban planning area (UPA), and urban expansion area (UEA). https://www.geodata.cn) of China's national science and technology infrastructure. The extracted images of elevation and slope are from GDEM\u00b7V2 of Land Processing Distributed Activity Archive Center (LP DAAC) of NASA. Normalized Difference Vegetation Index (NDVI) data is calculated by using 59 Landsat-8 remote sensing images taken in 2020. Potential evapotranspiration, average temperature, road network, railways network, population, and urban water system data are from the Data Center of Resources and Environmental Sciences, Chinese Academy of Sciences (https://www.resdc.cn/).All the data used in the thesis are projected and resampled in ArcGIS software before further processing. The data describing the spatial distribution characteristics of annual precipitation come from the National Earth System Science Data Center  as the research area, the spatial distribution of regional carbon reserves is calculated by using the carbon module of InVEST model, and the evolution of carbon reserves distribution in recent 20 years (2000\u20132020) is analyzed.\u2009 Second, we select the land use types and the driving factors of land use evolution required for the research as the influencing factors adopted in the research.\u2009 Third, based on the RF model, the regression models of various influencing factors and carbon reserves are established for the whole study area and each subarea to obtain the dominant factors of NMA carbon reserves spatial distribution.This thesis can be divided into the following three steps: Ctotal is the regional total carbon reserves, Cabove is the aboveground biomass carbon reserves, Cbelow is the underground biomass carbon reserves, Csoil is the soil carbon reserves, and Cde\u2009\u2009a\u2009\u2009d is the dead organic matter carbon reserves (t/km2).This paper discusses the regional evolution trend of carbon reserves in NMA based on InVEST model. We calculate the spatial and temporal distribution of Carbon reserves in NMA from 2000 to 2020 using the Carbon module of InVEST model. The carbon reserves calculated by Carbon module include four carbon pools, i.e., aboveground biomass carbon pool, underground biomass carbon pool, soil carbon pool, and dead organic matter carbon pool. The calculation formula of carbon reserves is as follows :(1)CtotaCarbon reserves is affected by factors such as location, altitude, hydrothermal condition, and land use, which leads to differences in carbon sequestration characteristics in different regions, thus affecting terrestrial ecosystems , 44. TheBased on the above, combined with the LULC in 2000, 2010, and 2020, we can obtain the carbon reserves distribution of NMA in the corresponding years. Then, according to the principle of equal interval, the distribution of carbon reserves in NMA obtained in the previous steps is divided into level A, B, C, and D from low to high, and the proportion of the four levels in each year is calculated, respectively. Finally, the carbon reserves data of adjacent years are subtracted to get the change of carbon reserves every 10 years.The distribution of regional carbon reserves is influenced by many factors, which are the result of the interaction of physical and chemical conditions of various types of land and various factors such as nature and society , 44. TheAccording to the scale of the study area and the actual situation of the required data, a sampling surface with a unit grid of 3\u2009\u00d7\u20093\u2009km was set up in NMA by using ArcGIS software, and the grid data including carbon reserves distribution and various influencing factors are sampled. On this basis, taking the carbon reserves of NMA in 2020 as dependent variable and various land use types and driving factors as independent variable, the RF model is used to deduce and analyze the leading factors of carbon reserves' distribution.The random forest algorithm is a combination classification algorithm proposed by Breiman , and it In the process of learning and training of RF, data are generally divided into training set and test set for modeling and simulation (prediction) . FirstlyR2, coefficient of determination) between the predicted values and actual values of test set are analyzed. Generally speaking, if the R2 of the model is greater than 0.8, the model can be considered as meeting the requirements. After the running of the model, we can get the order of the characteristic importance of each influencing factor, so as to get the leading factors of carbon reserves distribution.In this study, the RF model is constructed by using the extracted related variables. According to the method of modeling, the data (feature) sample set is divided into two parts: training set  and test set . The error and goodness-of-fit  and is the most important factor affecting the distribution of carbon reserves in NMA. NMA is located in the middle and lower reaches of the Yangtze River with abundant rainfall. There are a large number of lakes in the area, among which Xuanwu Lake and Gucheng Lake of Nanjing City, Gaoyou Lake of Yangzhou City, Hongze Lake of Huai'an City have relatively large water scales, which directly affects the regional carbon reserves distribution. In urban areas, the vegetation coverage is better in the areas with larger slope, such as Mount Zijin, Mount Niushou, and Mount Lao, where the carbon sequestration is relatively higher. For UCA, vegetation coverage, LULC_Cultivated lands, LULC_Artificial surfaces, and LULC_Water bodies are the leading factors, of which, vegetation coverage has the largest effect (64.10%) and contributes more than half. The UCA has a high degree of urbanization and is the core functional area of NMA. The artificial surfaces account for the largest proportion, and human activities have the most profound impact on the surface cover. The most important source of carbon reserves in this area is the vegetation. Compared with forests, the vegetation coverage derived from NDVI can better reflect the regional vegetation cover, and has a stronger explanation power for the regional carbon reserves distribution. For UPA, LULC_Water bodies, LULC_Artificial surfaces, vegetation coverage, and LULC_Cultivated lands are the leading factors that dominate the distribution of carbon reserves in the region, of which LULC_Water bodies, LULC_Artificial surfaces, and vegetation coverage have the similar explanatory power , with the comprehensive impact rate exceeding half. A large number of lakes are distributed in the UPA, and the urban development in the region cannot be underestimated. At the same time, the forest coverage is better than that of UCA. Therefore, the contribution to the distribution of carbon reserves is higher than that to UCA. For UEA, LULC_Water bodies, slope, and LULC_Artificial surfaces are the leading factors affecting the spatial distribution of regional carbon reserves, of which the contribution of LULC_Water bodies is more than half (54.40%). The urbanization rate of UEA is in the relatively lowest position in NMA, and the area distribution of water bodies involved in the region is relatively larger, such as part of Hongze Lake. In addition, a large number of mountains with good coverage of associated vegetation directly affected the regional carbon sequestration and carbon reserves distribution.This paper provides a new idea for the study on the influencing factors of the spatial distribution of regional carbon reserves, and the indexes system adopted can provide a reference for the study of urban carbon reserves. This paper can help landscape and urban planners planning, but also has some limitations.First, InVEST model can be used to evaluate ecosystem services at different scales, and the evaluation results can be displayed visually. However, the evaluation results of this model are greatly affected by the land use classification. For example, in this study, land use types are divided into six categories, and each land use type is assumed to be homogeneous internally, so the model lacks consideration of regional internal heterogeneity. In addition, the differences in economic development of different sites and different metropolitan areas may lead to the nonuniversality of the evaluation indexes system. Therefore, it is necessary to establish the different models to evaluate different regions of different cities, which needs to be considered in further research. At the same time, because the InVEST model is based on land use, factors other than land use may be overlooked in the analysis.Firstly, in future research, we can model different types of cities and evaluate them according to local conditions. Secondly, it can take more cities as the research object, and the commonness and difference between each category can be analyzed at the same time, thus proposing a more universal evaluation indexes system, determining the commonness problems between cities according to the regression analysis results, and proposing a more universal planning strategy. Thirdly, we can list other influencing factors except land use in the follow-up research, so as to carry out analysis and discussion. At the same time, as a holistic and systematic project, carbon reserves research should be actively integrated into related disciplines to promote the overall cooperation among different disciplines.In this study, Nanjing metropolitan area (NMA) was taken as the study area, and the Carbon module of InVEST model was used to calculate the spatial distribution of regional carbon reserves, and the evolution of carbon reserves distribution in recent 20 years was analyzed. Then, based on the random forest (RF) model, taking the whole study area and subregions at all levels as the research scope, a regression model of each influencing factor and carbon reserves is established, and the leading factors of spatial distribution of carbon reserves in NMA were derived.The results show that the overall carbon reserves in the study area is in a downward trend. The leading factors of the whole study area are LULC_Water bodies, slope, vegetation coverage, and LULC_Artificial surfaces, among which the influence of LULC_Water bodies is the most obvious. The leading factors of urban core area are vegetation coverage, LULC_Cultivated lands, LULC_Artificial surfaces, and LULC_Water bodies, among which the vegetation coverage contributes the most. The leading factors of urban planning area include LULC_Water bodies, LULC_Artificial surfaces, vegetation coverage, and LULC_Cultivated lands, among which the explanatory power of LULC_Water bodies, LULC_Artificial surfaces, and vegetation coverage is similar, and the combined contribution offers more than half. The leading factors of urban expansion area include LULC_Water bodies, slope, and LULC_Artificial surfaces, among which LULC_Water bodies is the most important one.Based on the results of the RF model, we can get the order of the characteristic importance of factors, thus providing the basis for decision-making. According to the research results and the above analysis, we can put forward the direction of NMA and the planning of each subareas, especially in the context of the increasingly prosperous carbon trading market. How to improve the regional carbon reserves more efficiently in urban planning, the RF model can have more room to play its role."}
{"text": "Communications Biology 10.1038/s42003-019-0741-7, published online 05 February 2020.Correction to: In the published version of this paper, the members of the Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium were listed in the Supplementary Information; however, these members should have been included in the main paper. The original Article has been corrected to include the members and affiliations of the PCAWG Consortium in the main paper; the corrections have been made to the HTML version of the Article but not the PDF version. In the PCAWG Drivers and Functional Interpretation Group, the affiliation for Erik Larsson has also been changed from \u2018Computational Biology Center, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA\u2019 to \u2018Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden\u2019. Additional corrections to affiliations have been made to the PDF and HTML versions of the original Article for consistency of information between the PCAWG list and the main paper."}
{"text": "Dear Colleagues,Although the drowning mortality rate has decreased in Iran from ten years ago, it is still considered a serious health problem. Guilan University of Medical Sciences is hosting the 4th National Conference on Drowning Prevention from 7th to 8th of September 2021 which is the fourth one in this series. We once again present a conference about the drowning prevention challenge in Iran. In addition, the event focuses on the following topics: drowning surveillance, national drowning registry system, and how to best utilize primary care system for implementation of drowning prevention strategies. We are also pleased to announce that the accepted abstracts will be published in the Journal of Injury and Violence Research (JIVR).The Drowning Prevention Conference 2021 has been made possible with the support of Non- Communicable Disease Department, Deputy of Health, Ministry of Health and Medical Education, Iran, Karolinska Institutet, Sweden, and JIVR Team in Kermanshah University of Medical Sciences, Iran. I would like to offer my sincere thanks to all of the supporters especially Dr. Alireza Moghisi, head of Injury Department of MOH, Iran, Dr. Reza Mohammadi in Karolinska Institutet, Dr. Alireza Ahmadi in Kermanshah University of Medical Sciences, and Dr. Shahrokh Yousefzadeh-Chabok, chair of GRTRC, Iran.Finally, I would like to extend my gratitude to the chancellor of Guilan University of Medical Sciences, Dr.Arsalan Salari for giving us the opportunity to hold this event."}
{"text": "Under the background of the promotion of the Olympic effect of the 2022 Beijing Winter Olympics and the in-depth implementation of the national ice and snow industry's strategy of \u201cexpanding from the south to the west and expanding from the east,\u201d China's ice and snow industry has ushered in a new period of development. By applying literature and logical analysis, etc., with in-depth analysis of various subjective and objective supplies for the integration of China's ice-snow industry and ecocultural tourism in Hunan Province, it is considered to be driven by the bidding and preparation effect of Beijing Winter Olympic Games in 2022. The supply capacity of ice-snow industry venues, professional facilities, and public services are gradually strengthened, and the soft power of construction of the ice-snow industry needs to be coordinated and improved. The problem of safety is prominent and it is urgent to build a safety prevention and emergency management of ice-snow tourism.The integration of ice-snow sports and ecotourism industry has gradually became a prototype, but the integration point, line, and surface still need to be further strengthened and expanded. Accordingly, this paper puts forward a method to realize the transformation and upgrading of the commercial operation mode of the integration of ice-snow industry and ecological culture tourism, comprehensively to improve the ecological innovation ability of ice-snow tourism public service, to create multi-industry ice-snow industry cluster area, and to construct the basic framework system of risk prevention and control and management with multisubject participation and other relevant strategies. With the full implementation of the preparation and successful holding of the Beijing Winter Olympics, the effect of the Winter Olympics on promoting the regional ice-snow tourism industry industry is being fully released. Under the background of the new era of symbiosis, sharing and win-win tourism economic development, ice-snow tourism industry, as a new form of tourism development with ecological, economic, cultural, integrated, protective, and systematic attributes, is an important part of the most dynamic and potential sunrise industry, white industry, health industry, and people's livelihood industry in the world-recognized regional tourism . In viewThe prominent green, low-carbon, safe, and balanced attributes of ec-tourism fit the harmonious coexistence of ice and snow industry development and society, human beings, and nature. The deep integration of ice and snow tourism and ecotourism is the historical necessity to realize the sustainable development of the ice and snow tourism industry . HoweverTaking Daweishan Ski Resort, Dongshanfeng Ski Resort, Three Bear Ski Resort, Liuyang Ruixiang Ski Resort, and Changde Taohuayuan Ski Resort in Hunan Province as investigation objects, the integration of skiing industry and regional culture, architecture, commerce, and trade is the main investigation content. This paper conducts in-depth analysis from two aspects: the supply of ice and snow industry itself and its integration with related industries.The obtained data were processed with the commonly used statistical methods such as the average, standard deviation, and single sample-t test of Microsoft-Exeel2017 and SPSS20.1 in OFFICE2017.The methods are as follows: (1) Questionnaire design and testing. According to the relevant literature, combined with the practical needs of this study, this paper constructs the index system of ski industry supply capacity and integration with other industries in Hunan Province. Through two rounds of expert interviews and adjustments, the validity of the questionnaire is ensured to be greater than 80%. (2) Questionnaire survey and recovery. Using cluster sampling, five ski resorts currently operating in Hunan Province were selected as the survey objects and field research methods were adopted. Through paper questionnaires and face-to-face interviews with ski resort managers, the actual situation of each index in the supply of ice and snow tourism and its integration with other industries were collected. Five questionnaires were sent out with a recovery rate of 100%.With the combination of strategic transplantation and strategic innovation, this paper studies the realization path of deep integration of ice and snow sports industry with other industries.Influenced by natural geography and climatic conditions, the development of ice-snow industry sports for the masses in the south of the Yellow River in China is hindered by more realities . The supAs can be seen from 6. From the internal point of view of the ice and snow industry, as a type of tourism, the ice and snow tourism industry is inseparable from the six elements of tourism . From the external point of view, the ice and snow industry is closely related to the service industry, agriculture, and manufacturing. In the integration of ice and snow industry and other industries, the construction of a core industrial chain and extension industrial chain of ice and snow industry are the main manifestations. In this complex system, the integration of ice and snow industry should first consider the integration of ice and snow sports with elements such as catering industry, hotels, shopping centers, and transportation. With the upgrading of ice and snow industry, the integration of ice and snow industry with manufacturing, construction and cultural industries will continue to strengthen. The development of ice and snow industry in southern China is relatively late. The first ski resort in Hunan Province opened in 2011, with a short operating time and low integration with other local industries. Far from meeting the needs of public tourism, Hunan indoor ice and snow tourism venues tourism product homogeneity degree is high, there is no characteristic ice and snow brand. From the perspective of tourists, the lack of characteristic ice and snow service supply will greatly reduce the value and attraction of regional ice and snow tourism industry [The ice-snow tourism industry is a new sports tourism industry with the characteristics of ice-snow resources and tourism industry produced by the cross-integration of ice-snow tourism and other industries . The intindustry . From thindustry . TherefoWith the bid to host the 2022 Beijing Winter Olympic\u2014Zhangjiakou Winter Olympic radiation effect, China' ice-snow tourism industry ushered in the golden decade of rapid development. However, the sudden public security crisis during 2019\u20132021 had a negative and profound impact on the tourism industry . The iceIce\u2010snow industry is an information intensive industry type. The complexity of the ice-snow tourism industry market and the details of tourism products containing information components affect and determine the share of the ice-snow industry . The uniIce-snow tourism industry is a complex system with specific structure, function, and goal. It is a complex system involving social, economic, and environmental factors. It has its own spatial structure, time structure, and space-time structure. The exchange and normal operation of energy, material, and information with the outside world can be realized only by maintaining stable interrelation and orderly interaction among the elements of the system . Ice-snoHunan province is the birthplace of Huxiang culture. After thousands of years of historical and cultural breeding and practice, Hunan Province has formed unique sports, food, architecture, drama, folklore, manufacturing, and other characteristics of culture. It can be said that these regional tourism superstructures, as well as the creation of tourism products on the basis of multilevel and more complex tourism attraction, are more likely to realize the sustainable development of the tourism industry. To achieve the integration of regional ice-snow industry and ecological culture in Hunan Province, it is necessary to reflect the regional spatial characteristics and advantages, organically combine Hunan civilization with ice-snow industry and ecological civilization, realize ecological guidance, continuously coordinate the relationship between economic benefits and environment, and provide effective supply of ecological ice-snow tourism industry experience and related tourism ecological services for sports tourists. From the perspective of time dimension, the integration of ice-snow industry and ecocultural tourism should also undergo a dynamic periodic process of germination, development, consolidation, stagnation, decline, and revival. All aspects and stages of industrial integration are intertwined and continuous. At different stages, the integration of ice-snow industry and ecological culture tourism shows different risk conditions. The challenge of how to solve the problems in the integration of the two needs to rely on the extensive and reliable information data of the fusion destination. On the other hand, time dimension can also be understood as a social structure and operational structure. Foreign research shows that in the process of deep integration of the two, it is increasingly dependent on the coordinated participation of technology, organization, and other changes, especially marketing activities and management. Tourism, as one of the largest industries in the world, has significant social, environmental, economic, and political implications. Its own spatial and temporal structure characteristics show that the impact of tourism development is far more complex than what decision makers usually say. The impact of tourism not only occurs in destinations but also occurs at all stages of tourists' travel. The integration of ice-snow industry and ecocultural tourism is affected and restricted by broader social and environmental changes. It is also destined to the continuous adaptation and adjustment process of ice-snow tourism industry and related industries, select a reasonable integration model, and enhance the operational potential of local tourism planning and management departments.Objectively speaking, it is complex to accelerate the integration of ice-snow tourism industry and ecocultural tourism, which not only needs to be promoted from the aspects of government policy support, cultural derivation of ice-snow tourism industry, and industrial technological progress but also needs to be driven by innovation of strategic opportunities of Beijing Winter Olympics. First of all, the Beijing Winter Olympics can not only provide a huge market space for China to promote the upgrading of the ice-snow tourism industry industry itself but also provide important support from the regional ice-snow industry venues and the landing of ice-snow industry. projects. It can form a strong impetus for the upgrading of regional ice-snow tourism industry industry to promote the sustainable development of regional ecological economy from the transformation of government management functions and the consumption concept of public ice-snow tourism industry. Second, as a sunrise industry with high correlation, strong driving force, vigorous vitality, and great growth potential, ice-snow tourism industry will also become an important foundation and driving force to promote regional ecological and economic development under the incentive of Beijing Winter Olympics. At the beginning or earlier stage of industrial development, various factors should be comprehensively considered, and the protection of the ecological environment should be implemented in the whole tourism industry and its subsidiary industries, as well as the continuous adjustment and optimization system construction, that is, the ecological function should be implemented in the whole process of tourism industry and related industries, and the ice-snow industry and related related industries should be specifically implemented. Its management and operation should highlight the ecological development direction and implementation path from the aspects of enterprise planning, product marketing, human resources management, and so on. In the integrated development of ice-snow industry and ecotourism, the government should cooperate and interact with tourism enterprises and nonprofit organizations in advance. From the formulation of ecological policies, implementation in supervision, reward, and punishment, the government should innovate the theory and method of tourism public service to explore and innovate the way, service system, service organization, service concept, and service function of tourism service and establish a new performance evaluation system to make the government's public service work measurable. The government should actively build a communication bridge between the tourism industry and related industries and the people, mobilize the national social media force, and carry out multidimensional low-carbon, environmental protection, safety, and balanced ecological national education.The public service of ice-snow tourism industry scenic spot is an important supply factor of ice-snow tourism industry destination, and it is the core index parameter in the construction of modern ice-snow tourism industry brand. It reflects the soft power level of modern ice-snow tourism industry brand and the core competitiveness of tourism products. In a modern society full of competition and rapid growth, tourism itself and tourism demand are changing rapidly. New technologies, more experienced consumers, global economic restructuring,, and damage to the ecological environment pose some challenges to the industry. Compared with the super regions of ice-snow industry in Europe and America, the supply of China's ice-snow tourism industry is more manifested in the limitations and deficiencies of tourism service level and ability. From the domestic point of view, in addition to the gap between the scale of ice-snow tourism industry, tourist reception, and other quantitative indicators, the reception capacity and service level of ice-snow tourism industry scenic spots in China are also different from those in the north. Especially with the continuous deepening of the integration of ice-snow industry. and ecological culture tourism, the quality and efficiency of public services in ice-snow industry and related industries are higher. From the perspective of tourism public security services, the international spread of new pneumonia from the end of 2019 to 2020 has a significant impact on the world tourism economy. The expectation for the ecological security of tourism and related industries in society can be said to exceed all periods of history. From the perspective of ice-snow tourism industry itself, at present, the participation mode of ice-snow tourism industry in China is also changing from the ice-snow tourism industry of the travel agency team to the self-help tourism of the destination. The personalized, popular, scattered, and normalized trend of ice-snow tourism industry activities is becoming increasingly obvious. This kind of change causes the passenger to the ice-snow industry tourist scenic spot security, the ice-snow industry tourist scenic spot information release and provides the ice-snow industry tourist scenic spot traffic guidance service demand to be stronger. At the same time, with the continuous improvement of people's participation in southern ice-snow tourism industry activities, tourists' awareness of rights protection is increasing. Visitors for snow and ice tourism scenic safety complaints, snow and ice tourism information and self-driving tour services, snow and ice tourism scenic information, and other public service platform requirements are also increasing. Based on the above changes in security, technology, and demand, it is urgent for the current ice-snow industry enterprises to upgrade public tourism services.Under the background of globalization, the supply of public services for the integration of ice-snow industry and ecological culture tourism in China has undergone profound changes, and the traditional tourism public service practice has also become more humanized and fragmented. The construction of public services for the integration of ice-snow industry and ecological culture tourism is a huge, complex, and dynamic system. Its supply includes various forms of government, market, and social organization, which requires the establishment of a variety of cooperative mechanisms for governance subjects. This process is usually manifested as a dynamic system formulation and implementation process. With the deepening of the integration of China's ice-snow industry and ecological culture, the public service of China's ice-snow tourism industry destination has undergone unprecedented changes. China's ice-snow industry and related industries are more dependent on technology supply, which is not only reflected in the efficiency and scope of professional services, medical security, health, and safety guarantee network supply but also reflected in the connectivity of tourism traffic, in advance payment, marketing, catering, hotels, and other aspects. The ice-snow industry and related industries in the new era of public service requirements also need to re-bound government, market, and social relations. The state's public service function of tourism destinations has gradually transited and transferred to the market-oriented supply mode, and the state supply has begun to shift from dominance to regulation. The government intervenes in the level and quality of public services in ice-snow tourism industry areas through market access, service quality, and interval regulation. In the process of forming this goal, the government provides subsidies in the form of state payment for parts that are difficult to bear by enterprises, so as to ensure that public services meet the increasing public demand for tourism destinations. By innovating the regulatory mechanism of tourism public services and other legal construction, the state optimizes the efficiency of tourism administrative services and provides strong policy support and effective supervision for the integrated development of enterprises. In terms of public services of China's ice-snow industry enterprises, according to the higher requirements of the technical specifications of the market-oriented management of public services, it is necessary to improve the construction of the standardization system of tourism public services in a timely manner, optimize the tourism public service environment, and use scientific and technological means to build a network service platform, so as to provide data support for the integration of ice-snow industry. and ecological and cultural tourism, so that society and consumers can use the network service platform to rating and comment on the tourism process, so as to better improve their services and provide a convenient, safe, fast, and green service for ice-snow industry tourists.The prevention and control of ice and snow tourism is an important guarantee for the sound operation of ice and snow tourism. Based on Feng's ice and snow tourism prevention and control model , combineIt shows the key factors of tourism prevention and control in different periods of the integration of ice and snow sports and ecological and cultural tourism. From With the deepening of integration, the integration system and policy system of ice-snow industry and ecological and cultural tourism are further improved. The capital operation of ice-snow industry enterprises is more rational and standardized, and the role and status of science and technology are becoming more and more prominent. The integration of ice-snow industry and high-tech leads to a large number of new formats. The state gradually gives way to enterprise risk management, and the integration work is more completed through enterprises. From the development of the European ice-snow industry enterprises, it can be seen that in the late stage of the integration of ice-snow industry and local culture, ice-snow industry is more closely intertwined with culture, architecture, food, catering, and other elements. Industrial integration makes the independent industrial value chain partially or completely integrated, and new formats become a new driving force for regional economic development. Big data and artificial intelligence are more closely combined with these industries. Enterprises rely more on market rules, and risk early warning mechanism is more perfect and reliable.From the current development trend of ice-snow industry. in Europe and the United States, the integration of ice-snow industry and ecological culture tourism will be more \u201chuman needs.\u201d The risk of ice-snow tourism industry mainly focuses on service safety risk, ecological risk, and scientific and technological safety. The risk prevention and control of ice-snow industry enterprises pay more attention to the operational process, and the prevention and control is more institutionalized and operable. The ice-snow industry enterprises can more accurately analyze the current situation of organizations, environment, goals, tools, measures, and other factors and optimize the construction of early warning, supervision, evaluation, and control mechanisms. As the supervisor, the state uses policy advantages to further strengthen market supervision and enterprise operation supervision, so as to effectively avoid the existing and potential risks from the market and enterprises and form a solid defense barrier. However, the prevalence of new coronavirus pneumonia has brought an unprecedented impact on China and the world's ice-snow industry and has brought great challenges to the prevention and control of China and the world's ice-snow industry sports industry. Although the state and society have initiated emergency mechanisms and established a risk-based prevention and control strategy based on risk levels and regional gradual increase, top-down command, bottom-up feedback channels, and joint prevention and control of different departments in China\u2009+\u2009neighboring countries\u2009+\u2009the world, but unpredictable risks still exist. Therefore, in this sense, the construction of risk prevention and control system is still a long way to go.To realize the great-leap-forward development of China's ice-snow industry, it is necessary to reform and adjust the following aspects: Firstly, on the basis of accelerating the construction of the dynamic mechanism of expansion of the south, west, and east of the construction of the ice-snow industry venues, improving the supervision and management subject, investment subject and the periodic effect of the construction of the regional ice-snow industry venues, the government's policy of promoting the construction of the ice-snow industry venues, market demand, construction funds, investment and financing methods, accelerating the self-upgrading of the regional ice-snow industry in the process of marketization, commercialization and informatization, and optimizing the industrial structure of the ice-snow industry. In order to improve the supply quality and efficiency of ice and snow industry, it is necessary to comprehensively improve the professional equipment and human resource allocation of ice and snow industry in the region; correctly handle ice and snow tourism product innovation and business model innovation. Increase the supply of public service products in ice and snow tourism attractions, in order to promote the development of China' s ice and snow industry in the south, west and east.. Second, it is necessary to resolve the shortage of funds for promoting the development of ice-snow industry's \u201cexpanding from the south to the west and expanding from the east\u201d by the Beijing Winter Olympics, and to use a variety of models to promote the multicenter spatial integration of ice-snow industry, so as to realize the new situation formed by the Beijing Winter Olympics in promoting the development of ice-snow industry and promote the sustainable development of ice-snow industry expanding from the south to the west and expanding from the east."}
{"text": "Understanding the Sichuan potted landscapes, one of the five types of traditional Chinese potted landscapes, is important for exploring the development of Sichuan landscape architecture in Southwest China. In this study, we analyzed the shape and aesthetic characteristics of the traditional regular bonsai of the Sichuan style according to trunk features, branch patterns, tree shape, branch arrangement, and branch and plate numbers. Studies have shown that the flat-branch-type branch plate slopes downward and the bottom rises, and the number of branch plates is 2n + 1 , which is a proportional sequence. The ratio of the main pile height to the footplate is approximately 1.5:1\u20132:1, the pot:footplate ratio is <1:1, and the maximum bend:trunk ratio is <1:2. There were extremely significant differences between the length of the foot plate and its adjacent branch and plate length and the distance between the branch and plate. Interestingly, the rolling branch-type plants are characterized by vertical curved branches, oblique curved branches, and curved branches, reflecting the beauty of harmony and symmetry. Overall, the regular-style Sichuan tree potted landscape is mainly characterized by the beauty of rhythm and symmetry. Chengdu, Sichuan, is known as the land of abundance. The long cultural and historical evolution in the region has nurtured the development of the elegant and elaborate Bashu culture and rich and colorful local traditional arts, including the Sichuan art of potted landscapes (Bonsai and Penjing) that represents the intersection between landscape and culture. The Sichuan art of potted landscapes originated in the Shu-Han period, and the most prominent examples are the Zhangsong ginkgo potted landscapes in Lidui Park in Dujiangyan . During Traditional Sichuan potted tree landscapes can be divided into two types: regular style and natural style. In the regular style, the branches and twigs of the entire plant are incorporated. Twigs are colloquially called lamellar branches , also knThe Sichuan-style regular tree stump bonsai model has existed in China for nearly a thousand years. Previous studies have retained a large number of documents, but some documents are difficult to understand due to their long history. At present, the existing modern literature on the shape of the branches and plates of Sichuan-style bonsai mainly describes ten regular bonsai and the Three Shapes and Five Styles modeling characteristics of their branches and plates ,9. In teIn general, there are many regular bonsai works with a history of hundreds or even thousands of years existing around Chengdu that are worthy of esoteric exploration. At the same time, the research on the shape of the branches and plates of the Sichuan-style bonsai mainly focuses on various branch and plate techniques, and there are few records of the arrangement of the relevant branches. To address this gap, this study analyzes the expressiveness, rhythm, stem proportion, and flexibility of the regular-style Sichuan potted tree landscape from the aspects of the trunk height, branch and plate shapes, quantity, arrangement, and branch and trunk ratio of the entire regular-stump bonsai. Its aesthetic patterns and forms are detailed so that the world can more easily understand the Sichuan-style bonsai and innovatively absorb and apply it to bonsai production and garden landscaping.As shown in We found that the center of gravity of all trees was located on the centerline, which was also in accordance with the general law of natural plant growth. Moreover, each layer consisted of left and right branches, which were symmetrically distributed on both sides of the trunk ,13. TherAs seen in Traditional regular-style Sichuan potted landscapes are characterized by the proportional relationship among the branches. The length of the branch plate on the stump is generally determined by the length of the foot plate  ,23. The In this study, we also found that there were some customary ratios for the relative heights of various parts of the trunk. For example, there was a large bend in the lower part of the trunk for the drop-turn A, three-There are two types of traditional flat-branched trees in Sichuan potted landscapes: standard flat-branched and nonstandard flat-branched types. The common features of the two types are that the twisted and flat branches of the entire plant are flat and downward sloping, and the leaf tips are raised. However, there are obvious differences between the two types of branches; standard flat-branched branches have clear veins, some left branchlets that are similar to leaves, and some right branchlets that are similar to lateral veins, which are evenly distributed on both sides of the main branch, and all branches are neatly arranged ,18. In cTraditional regular-style Sichuan tree potted landscapes have 5\u201315 layers of branches from bottom to top; the top layer usually has only one branch, which is formed by the confluence of left and right branches, and the numbers of branches and twigs of the whole tree are consistent ,20. The The branches in the traditional regular-style Sichuan tree potted landscape imitate the natural shape of the natural tree crown, so all potted landscape artists shape the branches into structured layers. Each layer consists of a pair of branches, and several branches are arranged according to the rules of the structure to form a regular canopy ,25. In tIn production, it is not easy to achieve a standard regular pattern. The tree stumps in potted landscapes have natural forms. Due to the limited number of branches of tree stumps, branch trays are sometimes not grown in predetermined positions but are grown to preserve the symmetry of the trunk and balance. However, flay and float branches can overcome this issue because of their flexibility . The flaAs shown in From the lateral view, both the large curly branch type and the small curly branch type had a regular cone shape surrounding the trunk, and the branches were distributed in a well-proportioned manner throughout the stump. From the vertical perspective, however, both were elliptical. All branches were neatly arranged around the trunk, and the space among the branches was full and natural.For large branches, the following features were observed: the leaves and branches faced outward slightly; the top of the trunk, side branches, and branches were not cut off; all the space was filled; the leaves faced outward; the top of the branches faced outward; and the entire tree potted landscapes were plump and formed a standard cone, arranged neatly, with no convexity or concavity. For small branches, the top of the trunk did not stick, but there were vertical bent branches, oblique bent branches, and back bent branches. There were gaps in the branches, branches were pointed at open areas, the branches of the entire plant were evenly arranged, and the overall form was cone-shaped ,27. For For Sichuan potted landscapes, if the flat branch type highlights the overall effect, then the curly branch type is more prominent in terms of the combination of flowers and leaves ,5,7. In The semiflat/semirolled type is between the flat branch and the rolling branch types. The flower branch approach was similar to that of the flat branch type but also similar to the small rolling branch subtype of the rolling branch type. The only difference was that there were no twisted branches and vertical curved branches with several consecutive curves or occasional curved branches .Malus halliana to the flat-branched type and slightly more difficult to convert Chaenomeles speciosa. Most of the pile heads of this style had no branches on the top and had pointed tops when they were first plastered. Therefore, the ancient M. halliana and the stem heads of C. speciosa all exhibited a flat branch-type plate with a dignified and vigorous posture , as well as field work observations, explanations from 100 bonsai masters (belonging to generations of bonsai family inheritors) during on-site production, and accurate measurement methods.Taking Sichuan bonsai as an example, this study focused on visiting 10 Sichuan-style bonsai museums, including the bonsai garden of Chengdu Dufu Thatched Cottage Museum, the bonsai garden of Chengdu Wuhou Temple Museum, the bonsai garden of Chengdu Baihuatan Park, the bonsai garden of Chengdu People\u2019s Park, the Lidui Park of Dujiangyan, the bonsai museum of Sanyi Horticulture, the Chengdu Wangjianglou Park, Chengdu Wenjiang Chen\u2019s bonsai garden (Kaiqin Chen\u2019s former residence), Baihua Garden in Zigong Guangzhou Garden, and Chongqing Nanshan Botanical Garden bonsai garden, as well as 108 bonsai gardens in 9 municipal districts, 4 county-level cities, and 6 counties around Chengdu and 32 bonsai gardens in Chongqing, including Xiaochangkou, Guanyin Bridge, Daping, Dadukou, and Yangjiaping. The research samples were determined in accordance with the classification method and related standards of Chen\u2019s Banjing Pile-Heading Technique , and theIn particular, several research methods were utilized: field visits, questionnaires, interviews with well-known potted landscape artists, comparisons of potted landscape books, the observation of field works in various regions, obtaining on-site production explanations by potted landscape masters, and comparisons of product quality. Different types of data were collected during the study: plant height, number of branches and trays, distance between branches and trays, length of branches and trays (the distance from the base of the branch to the center of the tip), the ratio of the length of the branches, and the height and width of the pot where the stump was located. More than 5000 potted landscapes were tested. The classification of potted landscape samples was performed in accordance with the classification method and related standards of Chen\u2019s \u201cThe potted landscapes Pile-head Pantying Technique\u201d ,17,22,23In Sichuan regular-style bonsai, under the principle of following a strict structural rhythm, all the tissues of the modeled trees, such as branches, panels, flowers, and fruits, etc., are shown to exist harmoniously and serve completely around the main trunk, reflecting the ethical spirit and logical morality. Specifically, the trunks of ten kinds of bonsai with different shapes rotate in a straight line around the center formed by the top of the trunk and the root. The \u201cflat branch-style\u201d branch plate of the Sichuan school slopes downward, and the bottom rises. There are certain regularities between the number of branch plates, the height of the main pile and the foot plate, the pot and the foot plate, and the largest bend and the trunk. The front of the whole plant is trapezoidal in shape, and the sides are different, which embodies the beauty of rhythm, symmetry, and harmony. The rolling branch plant type of the Sichuan style is conical from the plane view and oval from the top view, emphasizing the harmonious beauty and symmetry of the plant. These findings of this study could evoke a deep understanding of the Sichuan regular-style bonsai, and on this basis, innovatively develop Sichuan-style bonsai while absorbing and applying it to Sichuan bonsai production and urban garden construction."}
{"text": "This work presents the results of four cooperative-creative game programs (Game Programs). In all four studies, experimental designs with repeated pretest-posttest measures and control groups were used. Validation samples ranged from 86 to 178 participants, randomly assigning participants to the experimental and control conditions. Before and after each program, a battery of assessment instruments was applied to measure the variables under study. The intervention consists of conducting a weekly game session during the school year. The results of the posttest covariance analyses confirmed a significant impact: (1) in social development, by increasing various positive social behaviors and decreasing many negative social behaviors; by increasing assertive cognitive strategies and prosocial resolution of interpersonal problems; and by enhancing relationships and positive communication among group members; (2) in emotional development, by improving self-concept, peer image, and emotional stability; and (3) in cognitive development, by increasing verbal intelligence, verbal and graphic-figurative creativity, as well as creative personality behaviors and traits. This work provides empirical evidence of the relevance of cooperative-creative play in child development. Play is inherent to a child\u2019s very nature, and psychologists, philosophers, and pedagogues have referred to its importance for the development of personality. From the conclusions of the studies, it is clear that \u201cplay, that activity par excellence of childhood, is a vital and indispensable activity for human development, as it contributes relevantly to psychomotor, intellectual, social, and affective-emotional development\u201d . From diVarious observational, experimental, and correlational studies  have conConcerning the development of intelligence and creativity, scholars of the subject have underlined the relevant role of children\u2019s play in the evolution of thinking that leads to abstraction, as well as in the development of creativity e.g., . RegardiOther observations relate to affective-emotional development, where play is seen as an activity that allows achieving psychological balance in the first years of life. Play provides the opportunity to express negative feelings, experiment with alternative solutions, process new information without the consequences it would have in real life, resolve affective crises, and express/control emotions e.g., . DifficuPlay is an instrument of expression and emotional control, essential for growth. This activity contributes to the integration of the personality because children play for pleasure, to express aggressiveness, to master their anxiety, to increase their experiences, to establish social contacts, etc. Play has a vital role in children\u2019s affective-emotional balance, as it enables the expression and release of childhood tensions. Various cognitive and emotional processes are deployed in the symbolic game of representation, developing children\u2019s creative thinking and key emotional competencies . The diaRecapitulating the contributions of play to children\u2019s integral development, we can confirm that play is a vital activity for human development because the ludic activities that children perform throughout childhood allow them to develop their thinking, meet needs, elaborate traumatic experiences, discharge tensions, explore and discover the joy of creating, fulfill their fantasies, reproduce their acquisitions by assimilating them, relate to others, broaden their horizons, etc. Therefore, it can be said that stimulating play is synonymous with promoting child development, and this activity also has a significant preventive and therapeutic function. A recent review  of the e(I) Physical and sensory development: Thanks to the movement games that children play from early ages , children can discover new sensations; progressively coordinate the movements of their body, which become more refined, more precise, and more effective; structure the mental representation of the bodily schema, the \u201cI-body\u201d, which is the first \u201cbrick\u201d in the construction of personality; discover themselves at the origin of the material modifications they produce when they build or model; explore and expand their sensory and motor skills; conquer their own body and the outside world; have mastery experiences that foster self-confidence; and more importantly, they obtain intense pleasure.(II) Intelligence and creativity: Motor and sensory manipulative games are an instrument for the development of motor thinking. Play, in addition to being a source of learning, opens up areas of potential development. In play, attention and memory are doubled. Representative play fosters cognitive decentralization, which drives the development of symbolic thinking, or representative intelligence. Symbolic play encourages fantasy\u2013reality discrimination. Social play facilitates language development. Play promotes the development of higher psychological functions because fiction is a necessary avenue for the development of abstract thinking. Play originates and develops imagination and creativity.(III) Social development: Games of representation stimulate the development of positive social behaviors  and decrease the negative ones (aggressiveness). In games of representation, children discover the social world of adults, the rules that govern these relationships, and how to prepare for work. Games of representation promote moral development because they are a school of self-control and will and an assimilation of norms of conduct. Games of representation foster various social competences . In addition, studies that have analyzed the effects of rule games (structured around objective rules whose transgression constitutes a fault), i.e., games of sensorimotor combinations  or intellectual games , conclude that, in these games, children develop strategies of social interaction and learn to control aggressiveness because the rules regulate the control of behavior, and they are a school of responsibility and democracy.(IV) Affective-emotional development: Play is a pleasurable activity that generates emotional satisfaction and feelings of happiness. Symbolic play, games of representation, is an activity that allows the control of the anxiety generated by difficult and traumatic experiences. Play is an activity that allows the control of the anxiety generated by internal sources, aggressiveness, and child sexuality. Symbolic play, games of representation, is the performance of forbidden and/or unattainable desires. Play encourages the expression of emotions and facilitates emotion regulation. The game of representation facilitates the progressive process of psychosexual identification. Play is a means of learning conflict-resolution techniques. Play in general improves self-esteem, is a means of self-affirmation, is proof of children\u2019s personalities, and is an early source of a sense of identity. Symbolic play, games of representation, enhances the capacity for empathy. Play has a significant therapeutic value.Cooperative games are defined as games in which the players give and receive help to contribute to a common end. These games stimulate communication, cohesion, and trust, and they are based on the idea of accepting, cooperating and sharing, and playing and inventing together . Within According to Since the 1970s, observational and experimental studies have proven the benefits of cooperative play in child development. The results of the review of these studies can be seen in In addition, research comparing the differential impact of cooperative and competitive games confirms the advantages of cooperation. Some studies  confirmeIn summary, previous studies have shown the effects of cooperative games on variables of social, emotional, and psychomotor development, although few have shown the effects on variables related to intelligence and creativity. Therefore, this work aimed to show the positive effects of \u201cGame Programs\u201d, cooperative play programs, in all the dimensions of child development. The empirical studies carried out with the four intervention programs had three main objectives: (1) to design the intervention programs configured with cooperative-creative games targeting different age groups; (2) to carry out an experimental implementation of the programs that consists of applying a weekly intervention session during an entire school year; and (3) to evaluate the effects of these cooperative experiences on factors of social, affective-emotional, and psychomotor development, as well as on intelligence and creativity.The current work summarizes the effects of four psychoeducational intervention programs based on the research question about how cooperative-creative play may have significant benefits for child development. Throughout the last two decades, different studies were carried out to test the significance of results regarding competency development, and in this current work, we proposed to review these findings, offering a global perspective of the outcomes and postulating that cooperative-creative games have relevant benefits for several variables of socio-emotional development, as well as for the development of intelligence and creativity. The programs designed and evaluated in the previous work and summarized in the current manuscript contain games with two structural components: cooperation and creativity. On the one hand, they are configured with cooperative games, i.e., games that consist of giving and receiving help to contribute to a common goal and to achieve team goals with the necessary contribution of all players, and, on the other hand, they are configured with creative games that structurally contain dynamics that activate verbal, graphic-figurative, plastic-constructive, and/or dramatic creativity.Validation samples in each of the four programs were chosen randomly, and participants were randomly assigned to the experimental and control conditions. In the Game Program 4\u20136 years , there wThe four Game Programs were evaluated experimentally and are evidence based. In order to measure the effects of each program on child development, successive investigations were proposed using the experimental designs of repeated pretest-posttest measures with control groups.After selecting the educational centers, in the four studies carried out to evaluate the effects of each program, a set of evaluation instruments was administered before and after applying each program (September and June) to measure different development variables that the program was hypothesized to affect. The groups were randomly assigned to the experimental or control conditions. The experimental participants performed an experimental implementation of the programs, consisting of receiving a weekly intervention session during an entire school year. The duration of the sessions was variable: 75 min in preschool (4\u20136 years), 90 min in the first and second cycle of Primary Education (6\u201310 years), and 120 min in the program of the last cycle of Primary Education (10\u201312 years).To avoid the Hawthorne effect, the control participants carried out the curricular activities of their school program, thereby receiving a different type of instruction and the same level of attention. They carried out the activities of the tutorials that the educational centers had detailed in their educational projects. In these tutorials, for example, they talk about the problems that may exist in the group, about issues related to social interactions or emotions, etc. Therefore, it is unlikely that the Hawthorne effect was produced in the control participants, since during the time that the experimental ones were carrying out the cooperative-creative game program, the control ones were carrying out tutoring activities, which offered them the same level of attention.The study met the ethical values required in research with human beings, following the fundamental principles included in the Declaration of Helsinki, its updates, and current regulations . The participants and their parents were informed of the study. Consent was obtained from all parents of the participants involved in the research. Parents had to inform if they did not want to participate in the study (passive consent). All parents accepted the participation of their children, largely due to the expectation of the benefits that the programs could have on their children\u2019s development. The children were informed and also had the opportunity not to participate; however, all the children accepted to participate in the cooperative play sessions.To evaluate the effects of the four programs before and after each intervention, several evaluation instruments, with psychometric guarantees of reliability and validity, were administered to measure the dependent variables that the program was hypothesized to affect. The variables evaluated and the instruments used are presented in Taking previous works as a reference, a line of psychoeducational intervention configured with four cooperative and creative game programs, the Game Programs were systematized. These programs, which targeted children in early childhood (pre-school) and Primary Education  prevention, as this experience attempts to prevent developmental problems; (2) development, as these experiences are intended to enhance the integral development of children who do not present difficulties in their growth, focusing primarily on various socio-emotional aspects and creativity; and (3) therapy because, through these games, we try to socially integrate children who have difficulties in their social, emotional, or intellectual development. On a more specific level, the Game Programs propose the following concrete objectives.They promote social development by stimulating children\u2019s knowledge of each other, increased multidirectional, friendly, positive, and constructive interactions with their group peers, and group participation; friendly intra-group relationships; verbal and nonverbal communication skills, such as presenting, actively listening, dialoguing, negotiating, and making decisions by consensus; an increase in social behaviors that facilitate socialization , as well as a decrease in disruptive socialization behaviors ; prosocial behavior ; and moral development, such as accepting social norms implicit in the instructions of the games .The Game Programs promote affective-emotional development by fomenting the identification of various emotions; the understanding of various causes of positive and negative emotions, as well as the consequences thereof; the expression of emotions through dramatization, activities with music-movement, and drawing and painting; coping with or the resolve of negative emotions; empathy for the emotional states of other human beings; emotional stability; self-concept-self-esteem; and feelings of pleasure and subjective psychological well-being.They stimulate the development of factors of intelligence and creativity, such as attention; memory; the capacity for symbolization; verbal logical reasoning; and verbal creativity (language), graphic-figurative creativity (drawing/painting), plastic-constructive creativity (construction of objects), and dramatic creativity (representation of roles).As previously explained in the introduction, games within the program stimulate communication, cohesion, trust, and the development of creativity underpinned by the idea of acceptance, cooperation and sharing, playing, and inventing together. This is conducted through the following 5 essential points: (1) everybody\u2019s participation; (2) dialogue and active communication; (3) mutual cooperation; (4) fiction and creation; and (5) fun. Programs contain various types of games and use various group dynamic techniques for the development of action and other techniques to stimulate and regulate discussion.The Game Programs contain a wide range of cooperative games that stimulate prosocial behavior  and creativity . Many programs and game books were reviewed to design these game proposals. Some of the activities included were adapted from other programs that had similar objectives. For example, some are games of In the implementation of the program, a weekly game session is carried out throughout the school year of variable duration, 75 min in preschool, 90 min in the first and second cycle of Primary Education (6\u201310 years), and 120 min in the last cycle of Primary Education (10\u201312 years). The experience takes place on the same day, on the same weekly schedule, and in the same physical space (a large classroom free of obstacles). The same adults always direct the sessions, including the teacher of the group, who directs the dynamics of the game, and an adult with psycho-pedagogical training (psychologist), who carries out the assessment before and after implementing the program and the systematic observation of the game sessions.The organization of a game session was generally structured with a sequence of 2\u20134 cooperative-creative recreational activities and their subsequent debates. The session was organized around three phases, led by the group\u2019s regular teacher.Opening phase: The sessions begin with the group members sitting in a circle on the floor. In this spatial position, the objectives of cooperative and creative games are briefly discussed: having fun, making friends, learning to help each other, learning to collaborate with classmates to perform things as a team, learning to listen to each other, be respectful of others\u2019 ideas, and be original, creative, imaginative, etc. Usually, the adult communicates the opening of the cooperative play session to the group, and, in the first sessions, he/she informs them about the general objectives of the experience, but after 2 or 3 sessions, he/she asks the group about its objectives to encourage two-way communication (feedback) about the objectives of the game program.Development phase of the game sequence: In this phase, the 2, 3, or 4 games that make up the session are carried out successively, with the following procedure for each recreational activity. (1) The adult presents the instructions of the game to be played, and the members of the group play the game following the instructions. (2) After each game is played, a discussion takes place related to the actions and interactions that occurred in the game. For this purpose, the players sit on the floor in a circle, and the adult asks questions related to the objectives of the program, the specific objectives of the game performed, or what he/she observed during the game .Closing phase: After performing the game sequence, the closing phase begins, in which reflection and dialogue about what happened during the game session  take place. The adult leading the intervention asks the group members how they felt during the game session and whether they want to comment on any aspect of the session that was not addressed in the dialogue or debate phases after each game. Closure is an exercise of reflection during which the players verbalize the positive aspects of the experience, as well as the problems that arose and the solutions to them. Thus, its role in the children\u2019s cognitive-moral development is important. In this phase, the adult, besides promoting communication within the group about the experience, provides social reinforcement, the verbal assessment of the helping behaviors, dialogue, or cooperation observed, emphasizing the value and creativity of the products elaborated in the activities involved in this process.To clarify the type of activities contained in the Game Programs, three games are described below, informing about the specific developmental functions they stimulate.Cooperative drawings: Teams of 4 players are formed, and each player receives one-half of a sheet of white cardboard and a pencil. First, each team member makes a drawing for 10 min, for example, a house. Then, the adult says, \u201cpass the drawing to the right\u201d, and each player gives the drawing they have made to their classmate on the right. Now, they have 5 min to add elements to their classmate\u2019s drawing; for example, to the drawing of the house, the player adds a tree. The operation of passing the drawing is conducted 3 times, so that all the members of the team add elements to the drawing of their three classmates, resulting in 4 drawings made with everyone\u2019s cooperation. In the last pass, each player receives the drawing that they began and colors it to their liking with the paint box they share. At the end, there is an exhibition with all the drawings, and the participants comment on them. This game encourages non-verbal communication (active listening), group cohesion (feelings of belonging), cooperation , the pleasure of creating (feelings of achievement and mastery that improve self-concept), feelings of acceptance (each player has a necessary role to perform the game), as well as attention, the ability to symbolize, graphic-figurative creativity, visual-spatial perception, and eye-hand coordination.Discover the excitement: The group is divided into teams of 6\u20137 players, to each of whom an emotion is assigned . The players of each team have 15\u201320 min to agree on how to represent the situation so that the rest of the players can guess the emotion from the scene. For example, they may express sadness by dramatizing a funeral or joy by representing a birthday. Team members clarify how to represent the emotion, they disguise themselves, and they create some supporting material for the performance. Subsequently, each team performs the representation in turns, and the rest must guess the emotion expressed. This game stimulates verbal and non-verbal communication (active listening and decision-making), cooperation (role representation and coordination with other roles to represent the scene expressing the emotion), group cohesion (feelings of belonging), the pleasure of representing and guessing the emotion expressed, the ability to identify and express emotions through dramatization, feelings of acceptance (each player has a necessary role to perform the game), attention, symbolization, and dramatic creativity.The new evolution of species: The group is divided into teams, and each team receives a sheet of white cardboard, several photos of animals, scissors, and various glues. The game consists of cooperatively inventing a new animal species. To do this, team members must select photos of animals, and then cut out different anatomical parts  that they will use to form the body of the new animal. When they have enough cutouts of different body parts of different animals, they begin to paste them onto the cardboard, configuring a new invented animal made up of parts of other existing animals. Then, they invent a name for their animal and make a brief description of it . Finally, an exhibition is held with the animals created and each team presents its animal. This game promotes verbal communication (active listening and decision-making), cooperation , group cohesion (feelings of belonging), the pleasure of creating (feelings of achievement and mastery that improve self-concept), feelings of acceptance (each player has a necessary role to perform the game), attention, the capacity for synthesis (configuration of the whole through the integration of parts), plastic-constructive creativity, visual perception, and eye-hand coordination.d: <0.2, small, 0.5 = medium and >0.8 large). To calculate the ANCOVAS, the usual procedure was followed. In each variable, the posttest was introduced as the dependent variable, the pretest score as the covariate, and the condition  as a fixed factor.To analyze the effects of the program with the data obtained in the assessment instruments applied in the phases pretest-posttest, we calculated the means and standard deviations of each target variable for the experimental and control participants in the pretest phase, in the posttest phase, and in the differences pretest-posttest. In addition, we conducted univariate analyses of variance (ANOVAs) with the pretest and the posttest scores, comparing the experimental and control conditions. To further probe these effects, taking into account the differences between the two conditions in the pretest phase, analyses of covariance (ANCOVAs) were then performed with the posttest scores (covarying out the pretest scores) on each of the dependent variables, and effect sizes were calculated  in each of the four investigations validated these experiences. The evaluation of the programs for the four age levels ratified numerous positive effects when comparing the change in various development factors in the children who participated in these cooperative-creative game experiences during the school year  compared to those who did not have the opportunity to play the games that academic year (control group). The descriptive (means and standard deviations) and inferential  results in the pretest and posttest phases and the pretest-posttest difference are presented in In the evaluation of the program targeting preschool children , the resIn the research on the program for children aged 6 to 8 years , the resIn the research of the program for children aged 8 to 10 years , the resThe results of the posttest covariance analyses see  in the eThe results obtained in the successive studies confirmed the positive effects of the Game Programs on various social, emotional, intellectual, and psychomotor factors of child development, validating this line of psychological intervention based on cooperative and creative play for the development of children\u2019s personalities from ages 4 to 12 years. These results provide empirical evidence of the relevance of cooperative-creative play in child development and validate game programs to promote child development in educational, family, and therapeutic contexts.These results point in the same direction as other studies that confirmed the positive effects of play on various factors of social, emotional, and psychomotor development  and alsoThe work of the design, implementation, and evaluation of the four Game Programs, which have been developed for more than two decades, provides empirical evidence of the contributions of play to integral child development. This line of research allows us to conclude that play, cooperation, and creativity are relevant activities for child development, providing empirical evidence of the important contributions of cooperative-creative play to psychomotor, intellectual, social, and affective-emotional development. In addition, the results ratify the perspective of many psychology and education professionals who emphasize the inclusion of ludic group activities as a preventive and developmental instrument in clinical and educational contexts.The effects of the programs on the different variables of social, emotional, psychomotor, and intellectual development are derived, on the one hand, from the characteristics of the games themselves and, on the other hand, from the emphasis that is made during the debates of the game sessions. In these phases, we reflect on the satisfaction generated by receiving positive messages about oneself, as well as on the moral damage and its impact on one\u2019s behavior of perceiving negative messages about oneself. It also reflects on the benefits of cooperating versus competing, the difficulties of working in a group, or the pleasure of creating, etc., thereby stimulating cognitive and moral development with their consequent implications on behavior and development. In addition, in these debates, the adult who directs the intervention values and reinforces the prosocial behaviors observed in the course of the session, the expression of feelings, the creativity of the ludic products elaborated cooperatively, etc., and all this promotes positive behavioral, cognitive, and emotional change.The results obtained when evaluating the intervention programs, on the one hand, ratify many of the hypotheses proposed and, on the other hand, are consistent with various investigations carried out on children\u2019s play . In the"}
{"text": "The coronavirus disease 2019 (COVID-19) pandemic suspended face-to-face assistance offered by community spaces, such as day centers (DCs). People with dementia (PwD) and their families were faced with the risks posed by social detachment and suspension of treatments.This study aimed to present a virtual day center (VDC) program offered as a preventive strategy to reduce the damage caused by social isolation and interruption of treatment imposed by the pandemic.The experience report, describing the feasibility of a VDC program, offered to 26 PwD and their caregivers, during the first year of the pandemic. The VDC held individual and group meetings with PwD and their families and psychoeducational support groups for caregivers.The attendance rate in group activities was 80%, and that in the caregiver group was 68%, showing a good virtual interaction. Throughout the year, three PwD interrupted the service due to difficulties of the caregivers to reconcile the schedules of the activities with their professional commitments and the absence of a support network, three others died, and two were institutionalized. PwD remained physically, socially, and cognitively active through daily virtual activities. Guidance and support for caregivers contributed to the organization of routines and adaptation to the isolation and maintenance of the bond. Family meetings made it possible to mediate conflicts and expand the support network.VDC is a promising modality to assist the needs and demands of PwD and their caregivers. VDC can contribute to the expansion of this intervention to individuals and families who do not have access to face-to-face treatment. The emergency preventive action was social distancing, with circulation authorized only for basic needs. To reduce its traumatic impact on individuals, families, and communities, it requires agility of the social responsibility in the organization of prevention and intervention strategies.The coronavirus disease 2019 (COVID-19) pandemic has burdened health systems. has been correlated with increased morbidity in COVID-19, and people with dementia (PwD) have an increased risk of COVID-19. In addition, PwD would have a higher risk of contamination due to cognitive impairment, which would limit their ability to understand the pandemic and the need for biosafety procedures, such as washing hands, wearing masks, and maintaining social distance. COVID-19 can worsen cognitive impairment and increase the incidence of psychological and behavioral changes, temporarily during the infectious process, or permanently if the duration of the infectious condition is very long.The vulnerability of the elderly, such as hypertension, diabetes aggravating the situation of socioemotional isolation frequently reported by PwD caregivers. Livingston et al. suggested that social isolation is a risk factor for dementia, presenting a relative risk higher than the risk associated with alcohol abuse, physical inactivity, diabetes, and air pollution.Social detachment can increase the feeling of loneliness, emotional isolation, and disconnection from existing relationships, This context imposed the reorganization and flexibility of families, health services, and community support networks. For these reasons, the team of the DC for PwD of the Center for Alzheimer\u2019s Disease and Other Mental Disorders in Old Age (CDA) of the Psychiatry Institute (IPUB) of the Federal University of Rio de Janeiro (UFRJ) restructured the intervention to a model totally virtual. This experience report presents a VDC for PwD and caregivers, from March 2020 to February 2021, during the COVID-19 pandemic.The pandemic suspended outpatient care and the closure of community and psychosocial care spaces, such as the day centers (DCs). Consequently, the PwD and their families began to experience a critical situation, given the risk and impact of discontinuing treatment.We designed a qualitative study to report a virtual day center (VDC) experience offered for 26 PwD and their caregivers. This study is part of the research project approved by the Ethics Committee of IPUB/UFRJ (CAAE: 80423217.4. 0000.5263). All PwD and their caregivers signed the informed consent form. Demographic and clinical data, frequency of activities, and information on PwD and caregivers were collected from medical records. The availability of Internet resources, computers, and tablets was informed through the telephonic interviews. Mini-Mental State Examination (MMSE), duration of the disease, treatment duration, and caregivers . The descriptive data analysis was performed using SPSS\u00ae software, version 26.0 .Descriptive statistics were used to present the sociodemographic and clinical data of PwD, which were assessed through in the medical records by the attending physician at the last face-to-face consultation, gender, education, marital status, diagnosis, age, Clinical Dementia Rating (CDR), 34.6% were in the mild stage with a mean MMSE score of 24.4, 38.5% were in the moderate stage with a mean MMSE score of 19.1, and 26.9% were in the severe stage with a mean MMSE score of 8.5. The mean attendance time was 61.6 months, with a range of 14\u2013189 months. The sociodemographic and clinical data are shown in Most of the PwD (80.76%) are at the age of 70\u201389 years and have a diagnosis of Alzheimer\u2019s disease . According to the CDR,The PwD showed satisfaction during the virtual meetings. The majority of PwD and their caregivers (69%) participated in the activities and groups of caregivers during the 12 months of the program. Three PwD discontinued after 3 (8%) and 6 months (4%), respectively. Two were institutionalized (8%) after 7 and 9 months of care, respectively, and three died after 2 (4%) and 9 (8%) months of participation, respectively.The majority of PwD (76.9%) cohabited with their caregivers, being cared for their children (65.4%) or spouses (30.8%). Most of the caregivers (96.2%) were females, and 23.1% did not have a family support network. All of them had access to a smartphone with Internet access, and approximately 30% had a computer or tablet. The sociodemographic data of the caregivers are shown in It was observed in the caregiver\u2019s organization of routines, adoption of creative mediation strategies in the care relationship, and new stress-mediating practices, such as meditation and aromatherapy. Caregivers shared their experiences with peers in groups of caregivers with a frequency rate of 68%. Most of the families (54%) who participated in family meetings, which contributed to the engagement of new members of the family network in care, expanded the support network of caregivers. The DC is theoretically guided by the Reuven Feuerstein\u2019s theory of Mediated Learning Experience, whose paradigms are the structural cognitive stimulation, the centrality of the caregiver role, and the modification of the environment. In addition, the Conceptual Model of Alzheimer\u2019s Caregivers Stress proposed by Pearlin et al., which considers the impact of primary and secondary stressors on caregiver burden.The DC offers an intervention program that assists PwD referred by the clinical staff of the CDA outpatient clinic after diagnosis. Before the pandemic, users attended the service accompanied by a caregiver, twice a week, staying 4\u20136 hours a day. The team includes psychologists, occupational therapists, music therapists, and students from the Specialization Course in Psychogeriatrics. The therapeutic program includes cognitive, motor, and psychosocial stimulation activities, which is preferably carried out in groups, i.e., psychoeducation groups, and support for caregivers, food, and recreational tours.The implantation of the VDC was performed in the following three steps.In the second half of March 2020, the DC staff established an emergency intervention plan with the objective of minimizing the risks and mitigating the suffering of its users. The first virtual strategy was to establish contact by video call, twice a week, with the caregivers and PwD who attended the DC. The 26 PwD were divided into three groups, considering the level of cognitive and functional impairment. Each group was accompanied by a team member, two psychologists, and an occupational therapist, respectively. The initial objectives were to maintain the link with PwD and their family; know how families were organizing, their understanding of the pandemic and biosafety measures; identify risk and protection factors and reinforce coping strategies; identify patterns of dysfunctional responses and mediate the adoption of new behaviors; and advise on low-risk alternatives for the purchase of food and medicines and what procedures should be adopted in case of contamination of the PwD or caregiver.Four videos were recorded and sent via WhatsApp, addressing topics such as the pandemic, its risks, psychological impact, and coping and biosafety strategies; the organization of routines; and virtual strategies for socio-affective interaction and recreational activities. The Physical Activity and Psychoeducation Program for Autonomous Life with Quality (PROAPTIVA), a CDA extension project, recorded four videos with movement guidelines to encourage mobility and avoid a sedentary lifestyle.Development of nine handouts with cognitive stimulation activities, with different levels of complexity to meet the PwD in their different commitment profiles. The handouts were sent via email or post.To facilitate the development of a repertoire of more functional and less impulsive behavioral strategies, the team implemented two actions as follows: At this stage, 100% of caregivers adhered, and the use of technology did not represent an obstacle. In some cases, we observed difficulties in understanding the need for biosafety rules and restricting visits, family conflicts, breaking contracts with formal caregivers, and overlapping tasks for caregivers. Some caregivers showed risk behaviors and anxious responses, such as agitation, unnecessary exits, difficulty sleeping, obsessive cleaning, irritability, and need for exacerbated control in the management, infantilization, and demands incompatible with the cognitive and functional limitations of PwD. In these cases, the caregivers reported and the professionals observed during the video calls that some PwD had disorientation, agitation, apathy, depression, and daytime sleepiness. The active listening offered in video calls helped the caregivers to express feelings and reflect on the patterns of behavior adopted, in addition to assisting in the adoption of more adaptive behaviors. In contrast, some caregivers showed greater resilience and adaptive coping strategies that favored family life.For the development of the work, the team held weekly supervision meetings, in which the cases were discussed and the activities planned. These meetings also served to welcome team members into their own fears and difficulties in dealing with the pandemic.From the first week of April, the focus was to help PwD and caregivers to establish a routine that would organize the experience of seclusion at home, encouraging self-care practices and socio-interactive activities. The PwD and their caregivers participated in a video call per week, lasting 60 minutes, comprised of 2 dyads. The pairs of PwD were formed considering their cognitive profiles. We started our first experience of a virtual group activity with 100% of user adhesion. In the meetings, we encouraged the exchange of experiences between PwD and caregivers. We talked about biosafety care and carried out the activities of cognitive stimulation , by keeping the meeting as playful as possible. We maintained a second individual weekly contact for each dyad, in which we reviewed the exercises of the handouts carried out throughout the week and received individualized demands. Thus, virtual activities, homework, and physical activity guided by the PROAPTIVA videos enabled a more active routine for PwD. The group activity represented a stimulus to sociability, being expected by everyone. For dyads with severe PwD, two individual weekly video calls were added, since virtual interaction was more difficult and required more individualized management. All meetings lasted, on average, for 60-minute sessions.Regarding technology, cell phone, or computer, some older caregivers were initially reticent. These caregivers as well as mild PwD received training to handle the cell phone . The mild PwD achieved greater autonomy in relation to caregivers. In turn, PwD with moderate and severe difficulties needed to be accompanied by caregivers in activities, due to the limitations imposed by sensory difficulties \u2014 auditory or visual \u2014 and/or cognitive.After a month of the pandemic, there was no forecast of returning to normal, which required a reconfiguration of the program.The team, PwD, and caregivers were already adapted to virtual activities. Thus, we proposed to start cognitive stimulation groups with four dyads. The groups had 60-minute sessions, twice a week, coordinated by two professionals from the DC team. In response to caregivers\u2019 requests, psychoeducation and support groups for caregivers were initiated weekly. The PROAPTIVA team started to offer virtual groups of physical activity. The training consisted of a supervised program of 45 minutes of multimodal physical exercises  twice a week. The daily virtual activities helped caregivers to implement routines for waking hours, food, hygiene, and sleep. For PwD with severe disabilities, in addition to psychoeducation and cognitive stimulation, individual video calls were added for the practice of physical activity given by a physical educator. Some PwD and caregivers regularly participate in the virtual choir. PwD who were most anxious started in person or group psychotherapy.Throughout the year, demands for family meetings for various purposes emerged: guidance on biosafety behaviors and on the risks of family visits; activation of family support networks as a socio-affective or operational resource for purchases; and mediation of past conflicts or those that arose during quarantine. Surprisingly, more family members attended the virtual meetings than those that used to happen in person before the pandemic when it was more difficult to reconcile schedules.The VDC therapeutic program, with regular activities four times a week, will continue until the face-to-face service is authorized. In these 12 months, we included some virtual parties that brought together all users and the team, such as Easter, Christmas, and birthdays. In addition, some resources to stimulate self-care and stress mediation were presented, such as meditation exercises at the beginning of the groups of caregivers, lectures on nutrition, and a minicourse on the use of aromatherapy in daily life.In the third month of the pandemic, 1 PwD and 1 spouse were diagnosed with COVID-19 and died. At this moment, the activities were permeated by sadness and mourning shared by all participants. In groups, the caregivers reported the fear of death of PwD and themselves. Three PwD interrupted the intervention due to caregivers\u2019 difficulty in reconciling the activities of the VDC with their professional commitments and the absence of a support network. In November, two PwD died but were not due to COVID-19. Two PwD with greater impairment were institutionalized due to their caregiver\u2019s illness. In both cases, institutionalization proved to be the best alternative for other family members. The team analyzed, with these families, the costs and benefits and strategies for adapting PwD to their new environments, given the restriction of visits imposed by the pandemic. In May 2020 and February 2021, we paid two virtual tributes to our deceased friends because the pandemic made the farewell rites fundamental to facilitate the mourning.During this period, the team\u2019s cohesion was fundamental. The weekly supervision meetings become enriching learning spaces with the revision of the guiding theories in light of new challenges. The adequacy of the intervention methodology took into account the difficulties imposed by technology and the Internet, as well as the specificities of each PwD and their caregiver in their cognitive and socio-affective processes.The social distance imposed a sudden change in everyone\u2019s routine, mobilized intense affections, with a high risk of becoming a traumatic experience. In this context, the support, through video calls, for PwD and their families, to minimize the impact of interruption of treatment presented itself as a viable alternative. The VDC program was built based on the demands, limitations, and possibilities of its users. The adhesion of PwD and caregivers and their adaptation to the use of technology were the main indicators of the feasibility of the VDC. At the beginning of the pandemic, an Inter-Agency Standing Committee (IASC) highlighted the importance of interventions that favor the organization of routines and the adoption of creative mediation strategies, i.e., self-care practices and stress mediators, as strategies to reduce the traumatic impact of the pandemic.Social isolation is a risk factor for dementia8 and represents a risk of increased morbidity and mortality for the elderly in general and for the PwD and their caregivers. The lack of stimuli and the cognitive and physical inactivity resulting from social isolation can contribute to the appearance of neuropsychiatric symptoms, aggravate the clinical condition of PwD, and can increase the burden on caregivers8. In contrast, the literature reveals that the offer of physical, cognitive, and social stimuli positively impacts the well-being, functionality, and cognitive readiness of individuals. and, as an aggravating factor, the limitations such as sensorial, cognitive impairment, and the need for adherence of caregivers in the face of functional dependence. Surprisingly, given the adherence and adaptation to the observed virtual modality, the use of the Internet proved to be a resource for social interaction.In this scenario, the possibility of a regular virtual intervention for PwD seemed impossible, considering that many healthy elderly people have resistance and difficulties in assimilation and adaptation to new languages and technologiesTherefore, it was necessary to adapt activities and methodologies to the virtual modality to a diversified program that met the needs. In general, even in face-to-face activities, flexibility and adaptation of activities and methodologies are necessary according to the characteristics, motivations, resources, and limitations of group members. an objective made impossible by the pandemic. Given the complexity of the situation experienced by caregivers, the support in the pandemic had a triple function: psychoeducational to stimulate the adoption of adapted behavioral and biosafety strategies, minimizing isolation and its potential damage to the health of the dyad and the continuity of treatment. Therefore, the development of the VDC was made progressively in compliance with the guiding recommendations of psychosocial intervention during the pandemic and the demands presented by the caregivers. Most caregivers and PwD voluntarily adhered to the program and maintained their regular attendance for 12 months. Only three caregivers were unable to reconcile VDC activities with professional and family demands. The observed adherence suggests that the VDC played a role in the organization of its routines.Another aspect considered was the risk that virtual activities would represent an additional burden for caregivers. It is known that DC has as one of its objectives to offer a break for caregivers and reduce their burden and exposure to primary stressors, emphasized the role of the social support offered by the caregiver\u2019s relationship network, including the family and the assistance offered by the community-based health technologies, such as DCs, in managing stress, in linking the caregiver to a larger community, minimizing the isolation and alienation that many caregivers experience. Thus, the VDC seemed to favor the engagement of new members of the family network in care and the maintenance of the caregiver\u2019s bond with their peers and with the team, minimizing their socioemotional isolation.Regarding sustaining social engagement as fundamental to the mental health of PwD and their caregivers, Pearlin et al.Old equipment and the instability of the Internet caused possible interruptions in the calls. The qualitative design included a small sample, an aspect that would not permit generalization. Also, we did not apply measures of cognition and neuropsychiatric symptoms, which would allow the effectiveness of the intervention.The integrated care program, in the form of VDC, for PwD and their caregivers represented a challenge in which it was necessary to reinvent and make more flexible techniques, activities, and management, exercising creativity without losing the theoretical and ethical north of the work that the DC proposes, which is based on the sensitive encounter between science and compassion.The knowledge produced in this experience and the results achieved can contribute to the expansion of this assistance to individuals and families who do not have access to face-to-face treatment. Thus, both in the present and in the future, remote assistance can be an excellent alternative to overcome barriers to access health devices."}
{"text": "Due to increased human activity, the amount of copper in air, soil and water has increased. Copper, at minimum concentrations, is essential for the normal functioning of the organism . At higher concentrations, copper is deposited in the liver, brain tissue, and bone marrow.To investigate the protective role of the supplement, glutathione (GSH), the S-donor ligand, in conditions of chronic copper intoxication via the parameters of oxidative stress, ie. Alkaline and acidic DNase values in brain tissue in albino rats of Wistar strain.The model system for testing the effects of copper exposure and the protective effect of GSH was a study on female albino rats of Wistar strain, stored in the vivarium of the Scientific Research Center for Biomedicine, Faculty of Medicine, Ni\u0161, Serbia. Endonucleases, alkaline and acidic DNase activities were determined spectrophotometrically from homogenates of brain tissue.Copper is believed to be a likely cause of oxidative damage to the DNA molecule, as manifested by increased alkaline and acidic DNase activity. The results of this study show that GSH is a potent chelator that binds copper and enables its elimination from the body.In this experiment, the beneficial role of GSH supplements, which has an antioxidant character, in the prevention and reduction of the adverse effects of chronic copper intoxication was demonstrated. In this way, GSH acts as a powerful protector and antioxidant.No significant relationships."}
{"text": "An analysis of the national traffic collision trends in Japan for the January 2018 to June 2022 period using existing statistical data indicates that the number of traffic incidents, injuries, and fatalities decreased over time. After the outbreak of COVID-19 in December 2019, traffic volume decreased. In this study, to explore how the COVID-19 pandemic correlates with traffic collisions, we used the Spearman rank correlation of non-parametric statistical test to compare the number of COVID-19 infections with the number of traffic collisions. The number of COVID-19 infections showed a significant inverse correlation with the number of traffic collisions nationwide, in some regions, and in some prefectures. When the number of COVID-19 infections increased, a State of Emergency or Semi-Emergency Spread Prevention Measures were repeatedly declared. We submit that these measures along with the restrictions on the population\u2019s autonomy and movement to prevent the spread of infection, reduces the number of traffic incidents, injuries, and fatalities owing to a decrease in traffic volume. Therefore, these lessons learned from the COVID-19 pandemic advocate that regulation of vehicle traffic volume is an effective means of reducing the occurrence of traffic collisions. These results can be applied to future policy development to support road safety improvements during unique events. The number of new infections of the coronavirus disease of 2019 (COVID-19) has been increasing worldwide since the Chinese government notified the World Health Organization (WHO) on December 31, 2019 of a case of pneumonia of unknown cause that was detected in Wuhan, Hubei Province. In March 2020, the WHO classified the COVID-19 crisis as a pandemic [COVID-19 can be transmitted through droplet or contact infection. One individual may infect another when droplets containing the virus are scattered by an infected individual when they cough or sneeze and these droplets are inhaled through the nose or mouth of an uninfected individual. Contact infection occurs when an individual touches an object with infected droplets on it and then touches the mucous membranes of their eyes, nose, or mouth with their droplet-covered hand. It is therefore necessary to pay special attention to public areas where more than one individual touches specific items, such as doorknobs, light switches, and suspension rails, and to try to avoid touching one\u2019s mucous membranes without first washing hands. To prevent the spread of COVID-19, it is recommended that the three \u201cCs\u201d be avoided. These are: closed or poorly ventilated spaces, crowded places, and close-contact settings where individuals speak to one another in close proximity. Remote working and staggered working hours have also been advised in an effort to curb the spread of the virus .At the end of January 2020, the Japanese government established a COVID-19 task force headed by the prime minister. This task force promoted various measures to limit the spread of the virus and implement programs to deal with the effects of the pandemic. These programs and policies included the designation of COVID-19 as a designated infectious disease and quarantine infectious disease based on the Infectious Diseases Control Law and the Quarantine Act; regulations for immigrants based on the Immigration Control Law; the improvement of medical care provision systems, including returnee and contact counseling centers at public healthcare centers as well as support for businesses and employment sectors . During The number of traffic collisions in Japan increased along with the increase in the number of motor vehicles owned, reaching a peak of approximately 718,080 collisions in 1970. Immediately after that, the number of collisions decreased slightly as a result of the oil shock and other factors, but later it began to rise again, reaching a high of 952,720 collisions in 2004. Since then, the number of traffic collisions has decreased steadily, and in 2017, an estimated figure of 472,165 collisions took place. This is approximately half the number of collisions that took place in 2004 [We hope that statistical analysis of these interrelationships will lead to a method of regulating traffic collisions. We also expect that the knowledge gained from the results of this study will contribute to the development of policies to support the improvement of traffic safety during future unique events.In the previous study by Shimada , the numThe number of traffic incidents, injuries, and fatalities that occurred in each month for the January 2018 to June 2022 period were extracted from \u201cTable 4\u20131 Road traffic incidents, fatalities and injuries by prefecture (monthly)\u201d in the \u201cMonthly\u201d portion of statistics relating to the \u201cTraffic Accident Situation\u201d component in the \u201cStatistics about Road Traffic\u201d section published on the E-Stat Portal Site of Official Statistics of Japan .The number of traffic collisions that occur in December of each year is the value for \u201cTable 6\u20132 Road traffic incidents, fatalities and injuries by prefecture\u201d in the \u201cYearly\u201d component of the \u201cTraffic accidents situation (December)\u201d part in the \u201cStatistics about Road Traffic\u201d portion , minus tThe term \u201ctraffic collision\u201d refers to a collision that takes place on a road that is caused by a vehicle, streetcar, or train as is prescribed in Article 2, Paragraph 1, Item 1 of the Road Traffic Act. The term \u201cfatality\u201d refers to the death of an individual that results from a traffic collision and occurs within 24 hours of the collision taking place. The term \u201cinjury\u201d refers to both a \u201cserious injury,\u201d which is defined as an injury resulting from a traffic collision requiring medical treatment for 30 days or longer, and a \u201cslight injury,\u201d which requires medical treatment for less than 30 days .The number of new COVID-19 infections for the January 27, 2020 to June 30, 2022 period was extracted from Ministry of Health, Labour and Welfare\u2019s website, especially the page \u201cVisualizing the data: Trend in the number of newly confirmed cases (daily) of information on COVID-19 infections\u201d .The number of traffic collisions, including the number of traffic incidents, injuries, and fatalities that occurred, was extracted for the entire nation, regions, and prefectures for the January 2018 to June 2022 period. In addition, the number of new COVID-19 infections per month for the whole country, regions, and prefectures for the January 2020 to June 2022 period was compared with the number of traffic incidents, injuries, and fatalities that occurred during the same period. The Tokyo prefecture was excluded from the Kanto region and dealt with separately.The population of the prefectures was extracted from \u201cTable 2\u20132 Population by Sex, Age (single years) and All nationality or Japanese, and Average age and Median age by Sex and All nationality or Japanese\u2014Japan, Prefectures (DIDs)\u201d of the 2020 population census, published by E-Stat Portal Site of Official Statistics of Japan in October 2020 .The area of the prefectures was based on the \u201c2021 National Survey of area by prefecture, city, town and village (as of October 1)\u201d that was published by the Geospatial Information Authority of Japan, Ministry of Land, Infrastructure, Transport and Tourism on December 21, 2021 .The information in respect of the number of vehicles owned was extracted from the \u201cTable of number of vehicles owned by prefecture and vehicle model (including mini vehicles)\u201d published by the Automobile Inspection & Registration Information Association at the end of September 2021 .The area of the roads in each prefecture was extracted from \u201cTable 4 current status of roads by prefectures \u201d of road statistics annual report 2020 compiled by the Ministry of Land, Infrastructure, Transport and Tourism .p \u2264 0.05 [For statistical analysis, the Spearman rank correlation of non-parametric statistical test was used to compare the correlations between the number of COVID-19 infected persons, the number of traffic collisions  that occur, population density, and vehicle density. Statistical analysis was performed using version 16 of the JMP Pro software released by JMP Statistical Discovery LLC in 2021. The differences were considered significant at p \u2264 0.05 .From January 2018 to June 2022, the number of national and regional traffic incidents and injuries decreased year by year and the number of fatalities as a result of national traffic collisions also declined , S2 FigsDuring the peak months of COVID-19 infections for the January 2020 to June 2022 period, the numbers of traffic incidents and injuries were found to have decreased to a minimum; further, the number of traffic fatalities showed a downward trend nationwide, as well as in many regions and prefectures, although the number of traffic fatalities varied over the period Figs . The invSpecifically, the first peak of COVID-19 infections occurred nationwide as well as in most regions and prefectures in April 2020. However, the first peak of infections took place in the Tokushima prefecture in March 2020 and the number of COVID-19 infection in the Iwate prefecture was zero from January to June 2020. In the first peak month of COVID-19 infections, the number of traffic incidents, injuries, and fatalities nationwide as well as in the regions, and most prefectures had decreased to a minimum, however, the number of traffic fatalities in the Yamagata, Okayama, Tokushima, and Kochi prefectures increased Figs .The second peak of COVID-19 infections occurred nationwide as well as in most regions and prefectures in August 2020. However, the second peak occurred in July 2020 in the Aomori, Yamagata, Wakayama, and Kagoshima prefectures, and in July and September 2020 in the Miyagi, Tochigi, and Tottori prefectures. In the second peak month of COVID-19 infections, the number of traffic incidents and injuries were minimized and the number of traffic fatalities decreased nationwide as well as in most regions and prefectures, However, there were increases in some areas: the number of traffic injuries nationwide; the number of traffic incidents and injuries in the Kanto region; the number of traffic incidents in the Kinki region; the number of traffic incidents and fatalities in Hokkaido region; the number of traffic incidents, injuries, and fatalities in Chiba prefecture; the number of traffic incidents and injuries in Kanagawa prefecture; the number of traffic injuries and fatalities in Tottori prefecture; the number of traffic incidents in Gunma, Saitama, and Yamaguchi prefectures; and the number of traffic fatalities in Aichi, Shimane, and Kochi prefectures Figs .The third peak of COVID-19 infections occurred in January 2021 nationwide, as well as in most regions and prefectures. However, the third peak occurred in November 2020 for the Hokkaido and Tohoku regions, and in December 2020 for the Chugoku region and the prefectures of Iwate, Yamagata, Shimane, Hiroshima, and Kochi. During month of the third peak of COVID-19 infections, the number of traffic incidents, injuries, and fatalities decreased nationwide, as well as in most regions and prefectures Figs .The fourth peak of COVID-19 infections occurred in May 2021 nationwide as well as in most regions and prefectures. However, the fourth peak occurred in April 2021 in the regions of Kinki and Shikoku and in the prefectures of Yamagata, Nagano, Fukui, Osaka, Hyogo, Nara, Wakayama, Tottori, Tokushima, and Ehime, and in March 2021 in the Miyagi prefecture. In the month of the fourth peak of COVID-19 infections, the number of traffic incidents and injuries decreased and the number of traffic fatalities declined nationwide as well as in most regions and prefectures, except for certain prefectures. The number of traffic injuries in Iwate and Fukui, and the number of traffic fatalities in Aichi increased Figs .The fifth peak of COVID-19 infections occurred in August 2021 nationwide and for all regions and prefectures. In the month of the fifth peak of COVID-19 infections, the number of traffic incidents and injuries decreased, and the number of traffic fatalities declined nationwide as well as for most regions and prefectures; however, the number of traffic incidents and injuries in Nagano, Shimane, and Kyoto; the number of traffic injuries and fatalities in Okinawa; and the number of traffic fatalities in Yamagata and Tokushima prefectures did not decline Figs .The sixth peak of COVID-19 infection occurred in February 2022 nationwide and in most regions and prefectures. However, the sixth peak occurred in January and March 2022 in the Shimane, Hiroshima, and Okinawa prefectures. During the sixth peak of COVID-19 infections, the number of traffic incidents and injuries decreased and the number of traffic fatalities declined nationwide, in all regions, and in most prefectures; however, the number of traffic fatalities in the Tottori and Shimane prefectures increased Figs .th in population density, was the 28th prefecture in vehicle density. The Shiga prefecture, which ranked 16th in population density, was the 14th prefecture in vehicle density. The bottom 15 prefectures (from 47th to 33rd) in terms of population density were Shimane, Iwate, Akita, Kochi, Hokkaido, Yamagata, Nagano, Fukushima, Yamanashi, Tokushima, Tottori, Aomori, Miyazaki, Kagoshima, and Wakayama. The prefectures in the bottom 15 in terms of vehicle density were almost the same as those in the bottom 15 in terms of population density, although there were differences in the order. The Yamanashi prefecture, which was ranked 39th in population density, was ranked 18th in vehicle density and the Wakayama prefecture, which was ranked 33rd in population density, was ranked 20th in vehicle density. The Oita prefecture, which was ranked 30th in population density, was ranked 38th in vehicle density and the Fukui prefecture, which was ranked 31st in population density, was ranked 34th in vehicle density  compared to numbers in 2018 and 2019. However, the number of traffic fatalities varied \u2013S5 Figs.The number of COVID-19 infections showed a significant inverse correlation with the number of traffic incidents, injuries, and fatalities nationwide; in the Tohoku, Chubu, and Kyushu regions, as well as in the Akita, Niigata, and Shizuoka prefectures. In other regions and prefectures, where significant inverse correlations were found, the number of COVID-19 infections showed a significant inverse correlation with either the number of traffic incidents, and/or injuries and/or fatalities. The peak month of COVID-19 infections was different in some regions and prefectures than in others, and the number of traffic collisions increased inversely during the peak month of COVID-19 infections. However, significant inverse correlations were also obtained. The number of COVID-19 infections within misaligned regions or prefectures showed a significant inverse correlation with the number of traffic injuries and fatalities in the Kanto region; the number of traffic incidents in the Kinki region; the number of traffic injuries in the Shikoku region; the number of traffic incidents and injuries in the Fukushima, Ehime, and Yamaguchi prefectures; the number of traffic incidents in the Iwate and Hiroshima prefectures; and the number of traffic injuries in the Kochi prefecture.At the time of the first peak of COVID-19 infections in April 2020, the Act on Special Measures against New Influenza (\u201cthe Act\u201d) was amended to attempt to prevent the spread of COVID-19 and the basic policy response to COVID-19 was determined on the basis of the Act. Based on the amendments made to the Act, the first State of Emergency was declared on April 7, 2020. The initial State of Emergency covered the following seven prefectures: Tokyo, Saitama, Chiba, Kanagawa, Osaka, Hyogo, and Fukuoka. This was later extended to all prefectures on April 16, 2020. During the first State of Emergency, human contact was required to be reduced by at least 70%, with a goal of an 80% reduction, and the nation was requested to refrain from venturing outdoors, using public facilities, holding events, and conducting business . In ApriThe first State of Emergency was lifted in 39 prefectures on May 14, 2020 and in the following prefectures on May 21, 2020: Kyoto, Osaka, and Hyogo. The first State of Emergency was eventually lifted in the Tokyo, Saitama, Chiba, and Kanagawa prefectures of the capital area and in the Hokkaido region on May 25, 2020 after approximately one and a half months . The secIn December 2020, the number of new COVID-19 infections in the capital area reached a high level and on January 8, 2021, the Japanese government declared a second State of Emergency for the capital city area, including the Tokyo, Saitama, Chiba, and Kanagawa prefectures, that was terminated on March 21, 2021. Subsequently, a second State of Emergency was declared in the Tochigi, Aichi, Gifu, Kyoto, Osaka, and Hyogo prefectures on January 14, 2021, and this was terminated on February 28, 2021 in all but the Tochigi prefecture . Unlike with the first State of Emergency, the government did not prevent such a wide range of socio-economic activities in the second State of Emergency, but rather requested restaurants to shorten their trading hours, focusing on situations with a high risk of infection, specifically those involving eating and drinking [By March 2021, the second State of Emergency had been lifted nationwide and the number of COVID-19 infections had stopped decreasing in each prefecture and especially in urban areas, such as Osaka, which exhibited a tendency to rebound. On April 5, 2021 the first Semi-Emergency Spread Prevention Measures were applied to the Miyagi, Osaka, and Hyogo prefectures, but these were gradually extended nationwide as follows: on April 12, 2021 to the Tokyo, Kyoto, and Okinawa prefectures; on April 20, 2021 to the Saitama, Chiba, Kanagawa, and Aichi prefectures; on April 25, 2021 to the Ehime prefecture; on May 9, 2021 to the Hokkaido region and the Gifu and Mie prefectures; and on May 16, 2021 to the Ishikawa, Gunma, and Kumamoto prefectures. As the situation worsened due to the spread of mutated strains of COVID-19 and the healthcare system experienced increased pressure, the government declared a third State of Emergency in the Tokyo, Kyoto, Osaka, and Hyogo prefectures from April 25 to June 20, 2021, and subsequently in the Aichi and Fukuoka prefectures from May 12 to June 20, 2021. The third State of Emergency was declared in the Hokkaido region and the Okayama and Hiroshima prefectures from May 16 to June 20, 2021 as well as in the Okinawa prefecture on May 23, 2021 [The third State of Emergency was lifted nationwide on June 20, 2021, except in the Okinawa prefecture, but the Semi-Emergency Spread Prevention Measures were maintained from June 21 to July 11, 2021 in the Hokkaido region as well as the Tokyo, Aichi, Kyoto, Hyogo, and Fukuoka prefectures and were maintained until August 1, 2021 in the Osaka prefecture. Semi-Emergency Spread Prevention Measures remained in place from April 20 to August 1, 2021 in the Saitama, Chiba, and Kanagawa prefectures without the declaration of a third State of Emergency [As the number of COVID-19 infections increased in Japan, a State of Emergency was declared again. The third State of Emergency in the Okinawa prefecture was only terminated on September 30, 2021, while the fourth State of Emergency was declared in the Tokyo prefecture from July 12 to September 30, 2021 and in the Saitama, Chiba, Kanagawa, and Osaka prefectures from August 2 to September 30, 2021. Semi-Emergency Spread Prevention Measures were implemented in areas where the COVID-19 infections had not yet reached severe levels: in the Hyogo, Kyoto, Fukuoka, and Ishikawa prefectures and in the Hokkaido region from August 2, 2021; in the Gunma, Ibaraki, Tochigi, Shizuoka, Aichi, Shiga, Fukushima, and Kumamoto prefectures from August 8, 2021; in the Miyagi, Mie, Gifu, Hiroshima, Okayama, Toyama, Yamanashi, Ehime, Kagoshima and Kagawa prefectures from August 20, 2021; and in the Kochi, Saga, Nagasaki and Miyazaki prefectures from August 27, 2021. When the number of COVID-19 infections became significant, the fourth State of Emergency was declared: from August 20 to September 30, 2021 in the Kyoto, Fukuoka, Gunma, Ibaraki, Tochigi, Shizuoka and Hyogo prefectures; from August 27 to September 12, 2021 in the Okayama and Miyagi prefectures; from August 27 to September 30, 2021 in the Mie, Gifu, Shiga, Hiroshima and Aichi prefectures and the Hokkaido region. On September 30, 2021, both of the fourth State of Emergency and the Semi-Emergency Spread Prevention Measures were terminated nationwide [The sixth peak of COVID-19 infections occurred around February 2022 and the number of COVID-19 infections rose to an unprecedented level. Therefore, Semi-Emergency Spread Prevention Measures were implemented by the government again in the most heavily infected prefectures, beginning on January 9, 2022 and extending to almost all areas nationwide. The government terminated these Semi-Emergency Spread Prevention Measures on March 21, 2022 [In the regions and prefectures where there was no inverse correlation between the number of COVID-19 infections and the number of traffic collisions, the number of traffic collisions increased during the peak months of COVID-19 infections. Considering the number of traffic collisions that occurred in 2018 and 2019 before the COVID-19 pandemic, we submit that the number of traffic collisions would not be reduced to nil even if the number of traffic collisions that occurred decreased in the peak months of COVID-19 infections as many prefectures showed a tendency towards an increase in collisions in the months with highest numbers of infections \u2013S5 Figs.In addition, during the peak months of COVID-19 infections, the number of traffic collisions did not decrease to a minimal amount in many prefectures: the Tokyo, Kanagawa, Saitama, and Chiba prefectures in Kanto region, Osaka prefecture in Kinki regions, Kyoto and Okinawa prefectures, which were among the top 15 prefectures in terms of population density and vehicle density ; the AomSince January 2020, the Japanese government has declared multiple States of Emergency and implemented various Semi-Emergency Spread Prevention Measures in order to prevent the transmission of COVID-19. Citizens were urged not to leave their homes unnecessarily and the nation became more aware of the importance of preventing the spread of the virus and reducing activities involving human contact. This resulted in a decrease in the traffic volume compared to previous years , 8 and lThe number of traffic collisions was examined in this study, but not the age structure of casualties; the distinction between drivers, passengers, and pedestrians among casualties; the type of vehicle involved in the collision; or the road on which the collision occurred. A more detailed analysis of these data would result in more targeted countermeasures to traffic collisions. Furthermore, analyzing traffic collisions during the pandemic could aid other countries in developing traffic safety strategies.This study used existing statistical data, performed statistical analyses, and compared the results of the analyses to understand the changes in the number of traffic collisions during the various waves of COVID-19 infection in Japan. It was found that from January 2018 to June 2022, the number of traffic collisions that occurred each year exhibited a continuous downward trend. During the peak months of COVID-19 infections, the number of traffic collisions decreased further and reached a minimum. The number of COVID-19 infections showed a significant inverse correlation with the number of traffic incidents, injuries, and fatalities nationwide as well as in some regions and prefectures. Whenever the number of COVID-19 infections increased, a State of Emergency was declared and Semi-Emergency Spread Prevention Measures were issued repeatedly. These measures affected the autonomy of the population and resulted in a decrease in the number of traffic collisions owing to a decrease in traffic volume. Our analysis indicates that controlling the traffic volume is related to a reduction in traffic collisions. Therefore, we submit that the regulation of vehicle traffic volume is an effective measure that can be used to control the occurrence of traffic collisions and subsequent injuries. These lessons learned from the COVID-19 pandemic can be applied to future policy development related to road safety improvements during unique events.S1 Fig(TIF)Click here for additional data file.S2 Fig(TIF)Click here for additional data file.S3 Fig(TIF)Click here for additional data file.S4 Fig(TIF)Click here for additional data file.S5 Fig(TIF)Click here for additional data file.S1 TableInfection: Number of people infected with COVID-19. Incident: Number of traffic collision incidents. Injury: Number of injuries due to traffic collisions. Fatality: number of fatalities in traffic collisions. No: The number is zero in the month. The data in the table represents the peak months for the number of COVID-19 infections and the months of the least number of traffic collision, for example \u201c4\u201d means April, \u201c8\u201d means August, etc., \u201c,\u201d means \u201cor\u201d. The name of the region or prefecture appears in the left column of the table.(XLSX)Click here for additional data file."}
{"text": "Global aging has proceeded at an unprecedented and accelerating rate. The aging of the population creates both opportunities and challenges for older adults, their families, and society in general. Importantly, there is substantial variation in the effects of and response to global aging both within and across nations depending, in part, on prevailing cultural expectations and values, political and economic imperatives, and social and demographic characteristics. Thus, while some regions and countries have responded with innovative policies and programs to better enable the growing cohort of older adults to remain active and engaged in the community, other regions and countries have struggled with their response or barely begun to plan for the rising population of older adults. This symposium assembles editors at five leading gerontology journals to demonstrate the role that peer-reviewed scholarship can play in disseminating knowledge that informs gerontological research, policy, and practice internationally. Editors include: Edward Alan Miller, PhD, FGSA, Journal of Aging & Social Policy; Jeffrey Burr, PhD, FGSA, Research on Aging; Julie Robison, PhD, FGSA,, Journal of Applied Gerontology; Sandra Torres, PhD, FGSA, Ageing & Society; and Julie Hicks Patrick, PhD, FGSA, International Journal of Aging & Human Development. Each presenter will review the scope, content, and focus of their journals and the role and opportunities for international scholarship."}
{"text": "Global Strategy for Women\u2019s, Children\u2019s and Adolescents\u2019 Health in Latin America and the Caribbean (LAC), including adaptation to region specific needs, to end preventable deaths, ensure health and well-being and expand enabling environments for the health and well-being of women, children and adolescents. To advance the equitable achievement of these objectives, EWEC-LAC\u2019s three working groups collectively support LAC countries in measuring and monitoring social inequalities in health, advocating for their reduction, and designing and implementing equity-oriented strategies, policies and interventions. This support for data-driven advocacy, capacity building, and policy and program solutions toward closing current gaps ensures that no one is left behind. Members of EWEC-LAC include PAHO, UNAIDS, UNFPA, UNICEF, UN WOMEN, the World Bank, the Inter-American Development Bank, USAID, LAC Regional Neonatal Alliance, and the LAC Regional Task Force for the Reduction of Maternal Mortality. To date, EWEC-LAC has developed and collected innovative tools and resources and begun to engage with countries to utilize them to reduce equity gaps. These resources include a framework for the measurement of social inequalities in health, data use and advocacy tools including a data dashboard to visualize trends in social inequalities in health in LAC countries, a methodology for setting targets for the reduction of inequalities, and a compendium of tools, instruments and methods to identify and address social inequalities in health. EWEC-LAC has also engaged regionally to emphasize the importance of recognizing these inequalities at social and political levels, and advocated for the reduction of these gaps. Attention to closing health equity gaps is ever more critical in the face of the COVID-19 pandemic which has exploited existing vulnerabilities. More equitable health systems will be better prepared to confront future health shocks.The Every Woman Every Child Latin America and the Caribbean (EWEC-LAC) initiative was established in 2017 as a regional inter-agency mechanism. EWEC-LAC coordinates the regional implementation of the  Global Strategy for Women\u2019s, Children\u2019s and Adolescents\u2019 Health [Global Strategy) was launched in 2016 to \u201c[provide] guidance to accelerate momentum for women\u2019s, children\u2019s and adolescents\u2019 health\u201d and its Operational Framework was approved in the 69th World Health Assembly. The interagency mechanism Every Woman Every Child (EWEC) was created in 2010 by former UN Secretary-General H.E. Ban Ki-moon to catalyze a political movement to advance the health and well-being of women, children and adolescents everywhere and as a framework to support the implementation of the Global Strategy on a global level. In 2017, APR-LAC became the regional inter-agency mechanism Every Woman Every Child Latin America and the Caribbean (EWEC-LAC) with a mandate to adapt and implement the Global Strategy in the LAC context. Given widespread health inequalities for women, children and adolescents in the LAC region [Plan of Action for Women's, Children's, and Adolescents' Health [Roadmap for the Digital Transformation of the Health Sector in the Region of the Americas [In 2013, the Millennium Development Goals (MDGs) were approaching their target year. Despite progress in health in Latin America and the Caribbean (LAC) countries during the MDGs era, differences in health coverage and outcomes among social groups, which we refer to here as social inequalities in health, remained widespread both between and within LAC countries. In this context, the A Promise Renewed for the Americas (APR-LAC) initiative was established to promote cooperation with an equity lens to countries in the Americas and to assist in measuring and monitoring inequalities in reproductive, maternal, children and adolescent health. In 2015, the 2030 Global Agenda for Sustainable Development was launched and the MDGs were superseded by the Sustainable Development Goals (SDGs). Subsequently, the Americas . This arEWEC-LAC is formed by 8 organizations, namely: the Inter-American Development Bank (IDB), the Pan American Health Organization (PAHO), the Joint United Nations Programme on HIV and AIDS (UNAIDS), the United Nations Population Fund (UNFPA), the United Nations Children's Fund (UNICEF), the United Nations Entity for Gender Equality and the Empowerment of Women (UN WOMEN), the United States Agency for International Development (USAID), and the World Bank (WB). Among some of its collaborative partners are the Regional Task Force for the Reduction of Maternal Mortality  and the LAC Regional Neonatal Alliance. EWEC-LAC has three key areas of work: (i) supporting and promoting the measurement and monitoring of social inequalities in health affecting women, children, and adolescents; (ii) addressing social inequalities in health through evidence-based policy-making, and (iii) advocating for public and political agendas that strive for social equity in the health of women, children, and adolescents. EWEC-LAC is therefore structured in three working groups: (i) the Metrics and Monitoring Working Group (MMWG), (ii) the equity-based Policies, Strategies, and Interventions Working Group (PSIWG), and (iii) the Communications and Advocacy Working Group (CAWG), which work together to advance the initiative\u2019s priorities as detailed below.\u201cHealth inequities are the unjust differences in health between persons of different social groups, and can be linked to forms of disadvantage such as poverty, discrimination and lack of access to services or goods\u201d . As a noGlobal Strategy was used as a guide, and emphasis was placed on adapting it to reflect the needs and priorities of the LAC region. The resulting list contains indicators from the SDGs and the Global Strategy. Furthermore, it is structured according to the Global Strategy Framework that includes Survive, Thrive, and Transform objectives as key pillars encompassing preventable deaths, health and well-being, and enabling environments.To measure social inequalities in the health of women, children, and adolescents in the LAC region, EWEC-LAC has defined a Regional Monitoring Framework that includes 32 priority indicators and 6 equity stratifiers [To summarize social inequalities in the health of women, children, and adolescents, EWEC-LAC uses specific methodologies and simple and complex standard inequality measures , 7, 8. TGiven that the emphasis of EWEC-LAC\u2019s data work are equity analyses, data for priority indicators predominantly comes from nationally representative survey programs at the household level, such as the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Survey (MICS) programs, which are a good source for data disaggregated into various socioeconomic characteristics. For some indicators, data may also come from administrative data sources , 10. TheGlobal Strategy targets set for 2030, the monitoring of health inequalities is useful to track and accelerate their progress, and to create accountability on the promise to leave no one behind.EWEC-LAC\u2019s data dashboard also presents visualizations based on historical data to track trends. For example, Fig.\u00a0Another key aspect that promotes reducing social inequalities in health is establishing clear and specific targets for the reduction of current gaps. In this area of work, EWEC-LAC has proposed a methodology to establish SDG 3  targets and reduce their inequalities . It consGlobal Strategy. This work is multi-pronged and involves improving the capabilities of technical country teams to apply equity-based tools and methods; analyzing, documenting and disseminating good practices and lessons learned regarding equity-based approaches; and promoting equity-based policy-dialogue on the health of women, children and adolescents in LAC countries. Collectively, and in combination with efforts to collect and analyze disaggregated data with an equity focus as well as implementation research activities, these actions contribute to improving LAC country capabilities to implement and scale-up evidence-based interventions to reduce national and local inequities in the health of women, children and adolescents.EWEC-LAC works with countries in the LAC region to promote the implementation of evidence-based multi-sectoral policies, strategies, and interventions that reduce inequalities in the health of women, children and adolescents and are in line with country priorities within the context of the SDGs and the To support countries in their equity-oriented health actions, EWEC-LAC completed a systematic review of equity-based approaches to address maternal mortality and adolescent pregnancy. Despite progress in some countries, there is a persistent need across the region for strengthening of multisectoral interventions targeting the most vulnerable populations and addressing structural social determinants in health affecting maternal mortality and adolescent pregnancy.To complement the above resource, EWEC-LAC also developed a compendium of tools, instruments and methods to identify and address social inequities affecting the health and well-being of women, children and adolescents in LAC. The compendium was developed through a systematic search using specific criteria defined by inclusion and exclusion criteria. The search for these tools, instruments and methods was restricted to those published after 2000 in English, Spanish or Portuguese; focused on women, children and adolescents or the general population; and addressing social inequalities in health. Subsequently, the studies that conformed to the criteria were screened and selected independently by two reviewers based on their credibility, dependability, confirmability and transferability; with disagreements resolved by joint review. The compendium is targeted to a wide range of stakeholders, including policy-makers, non-governmental organizations, and academia. It includes key information for each tool, instrument, and method, such as their author, year of design, goals, objectives, design specification, intended users, requirements for implementation, countries and sites where they have been previously implemented, experiences and lessons learned from the implementation, references to access them, and case studies. EWEC-LAC aims to update the compendium periodically, so that it includes state-of-the-art tools, instruments and methods. By providing an overview of these, the compendium may be used to strengthen systematic identification, analysis and responding to social inequities in the health of women, children, and adolescents in LAC.Another example of key activities conducted by EWEC-LAC was a regional competition to identify good practices applying equity-based approaches in reproductive, maternal, adolescent and child health. To participate, these practices had to respond to a specific health challenge disproportionately affecting women, children or adolescents living in vulnerable situations; incorporate or address intermediary or structural determinants of health and health inequities affecting women, children or adolescents living in vulnerable situations; receive government support to ensure long-term sustainability; be replicable in other contexts and on a larger scale; and have a monitoring and evaluation mechanism to track quantitative or qualitative indicators demonstrating impact or results in relation to practice objectives or goals. The competition resulted in the selection of ten country experiences. The good practices and lessons learned are being documented in a report as well as in video format for sharing in the region for potential utilization in other contexts.The LAC region represents a disproportionate number of COVID-19 cases and some of the highest mortality rates in the world . In the Global Strategy in the LAC region. Through these activities, EWEC-LAC identifies key goals, strategies and timelines for the recognition of social inequalities in the health of women, children and adolescents in the LAC region at social and political levels. EWEC-LAC coordinates its communications through social media, newsletters, websites, and public media targeted to specific audiences and tailored to their needs. Furthermore, relevant spokespersons are identified and key messages, taglines and slogans are developed. EWEC-LAC\u2019s communication activities to advocate for health equity also include the creation and dissemination of technical products, which are used in training workshops, and advocacy materials.The implementation of EWEC-LAC\u2019s communication and advocacy activities positions the initiative as a central catalyst for the implementation of the In the context of the COVID-19 pandemic, it is essential to prioritize the health of women, children and adolescents in the LAC region. EWEC-LAC developed an infographic providing five methodological recommendations to improve institutional capabilities to monitor inequalities in the health of pregnant women during and after the COVID-19 pandemic . These rGlobal Strategy in a targeted manner that considers contextual realities and addresses the specific challenges faced in the LAC region. The three working groups of EWEC-LAC work together to support LAC countries in measuring and monitoring their social inequalities in health, implementing equity-based public health strategies, policies and interventions, and advocating for the reduction of social inequalities of health in the region.EWEC-LAC promotes the implementation of evidence-based strategies to reduce social inequalities in the health of women, children and adolescents across the LAC region. Building on preliminary work of the APR-LAC movement, since 2017, EWEC-LAC has played a key role in the implementation of the EWEC-LAC acknowledges current challenges to achieving health equity in the LAC region. Importantly, the COVID-19 pandemic has disrupted the normal functioning of the health system, affected the coverage and quality of health services, and required governments to direct their funding of public health towards policies and actions mitigating the spread of COVID-19. As such, it poses a threat to equity in the health of women, children and adolescents and is exacerbating existing widespread within-country and between-country social inequalities and derailing progress towards the SDGs.Although the COVID-19 pandemic has affected the availability of recent data, complementing survey data with data from administrative sources allows to continue to monitor health inequalities among LAC countries during the pandemic. Nonetheless, it is essential to further improve the collection, reporting, and monitoring of these data, which would allow for greater room for evidence-based policy-making and advocacy for the reduction of social inequalities in health. Particularly, it is important that relevant stakeholders, such as ministries of health, ministries of finance, national statistical institutes, and public and private academic institutions and research centers, collaborate to strengthen national information systems to ensure the collection and reporting for health indicators for women, children, and adolescents disaggregated by equity stratifiers, with data disaggregated at a minimum by age and other relevant characteristics, such as place of residence , race, ethnicity, occupation, education, or socioeconomic status, as well as subnational geographic regions. This would allow countries to monitor social inequalities in health, and especially the inequalities between subgroups to identify those that are left behind, as in , as wellThe work with technical teams from LAC countries has achieved important results to date, such as improving capabilities in applying methodologies for measuring and monitoring inequalities in health. For instance, central technical teams within South American countries were formed and trained in measuring and monitoring health inequalities. Notably, the central team in Chile subsequently trained teams at the subnational regional level, and each of these subnational teams developed profiles of inequalities within each region of the country . NonetheGlobal Strategy and SDGs, approaches, EWEC-LAC remains committed to overcoming these challenges. Now, more than ever, inequity issues could not be left aside. Consequently, for the near term future, EWEC-LAC seeks to promote the reimagining and rebuilding of health systems in the region in the post-COVID-19 era with a focus on equity, and continue supporting countries in strengthening their efforts to promote equity-based policies.Finally, it should be noted that there are multidimensional factors affecting the health and well-being of women, children and adolescents which underscores the importance of a multisectoral approach in which governmental and non-governmental sectors, academia and civil society work jointly to leverage competitive advantages, increase accountability, and ensure an inclusive approach. As 2030, the target year for the"}
{"text": "Food traceability is very important for the quality and safety of agricultural products, which is related to the people\u2019s livelihood and national economy and has drawn great attention from governments and scientists around the world. The existing studies have not yet overcome the crisis characteristics comprehensively and systematically. A traceability system of red jujube is constructed by a hybrid mode of blockchain and the Internet of Things (IoTs). The system integrates the blockchain and the IoT technologies with characteristics of tamper-proof, decentralization, and distributed storage and solves the problem of date quality traceability by designing the technical process and architecture of date quality traceability and the big data of red jujube, jujube plantation, processing enterprise, commercial enterprises, and market administration. The whole process from planting to processing and sales of red jujube are recorded in the block to ensure the realization of quality traceability of red dates in the process. Through the whole process of big data processing, the key information collected in each process is stored in the database to ensure the realization of quality traceability of red dates in the framework. The system can help to minimize the production and distribution of unsafe or poor-quality products, thereby minimizing the potential for bad publicity, liability, and recalls. The quality and safety of agricultural products are related to the people\u2019s livelihood and national economy. The frequent occurrence of agricultural product quality and safety crises has drawn great attention from countries around the world. Quality control in agricultural production and throughout the supply chain is one of the most challenging issues in the world today, especially when it comes to typical food products. The quality and safety of agricultural products are an important study direction at present, which is a multidisciplinary study field. Its purpose is to explore the technology, measure and supervision guarantee system to ensure the hygiene and food safety of agricultural products, reduce the potential disease, and prevent the risk of food poisoning in the process of agricultural products processing, storage, and sales. In recent years, many agricultural quality control systems have been presented and various companies are trying to experiment with joint use of radiofrequency identification (RFID), Internet of Things (IoTs), and blockchain technologies to solve problems in scenarios where numerous untrusted actors get involved .Good traceability systems help to minimize the production and distribution of unsafe or poor quality products and minimize the potential for bad publicity, liability, and recalls. The current food labeling system cannot guarantee that the food is authentic, good quality, and safe. Blockchain technology is a new digital technological approach underpinned by the Industry 4.0. It is used to ensure data integrity and prevent tampering and single point of failure through offering fault tolerance, immutability, trust, transparency, and full traceability of the stored transaction records to all the agri-food value chain partners. Agricultural products traceability management integrated system can produce the data uploaded to the agricultural products of the whole process of cultivation of traceability management integrated system, the digital information, so supervision department can do random inspection of agricultural products, through the data to verify reliability, record results, give consumers a greater sense of trust, enhance consumer confidence. The problems of traceability agricultural products system are summarized as: (1) Enterprises developing traceability agricultural products system are not the same, so traceability information cannot be shared, many system software are not compatible, and the purpose of query cannot be achieved in different systems. Some query terminals can only be queried in supermarkets, which make it inconvenient to use; (2) At present, the traceability system is not unified in many aspects, such as identification code, storage information, and network query system, and it also faces different kinds of food; and (3) The accuracy of traceability is not high, some of them can only be traced back to the enterprise, and the specific process of planting, processing, or transportation cannot be traced.Xinzheng red jujube (XRJ) is a specialty of Xinzheng city, Zhengzhou City, Henan Province, China. It is a good fruit nourishing blood and spleen beauty, has high medicinal value, and its leaves, flowers, fruits, skins, roots, and thorns can be used as medicine. However, the development of XRJ industry is also facing many problems, such as the quality and safety system is not perfect, especially the pesticide and fertilizer residues are too high, which greatly restrict the development pace of XRJ industry. The quality and safety of XRJ is not only a major livelihood issue related to people\u2019s health, but also a major obstacle to the international XRJ trade. To guarantee safety in food, an efficient tracking and tracing system is required. RFID devices allow recording all the useful information for traceability directly on the commodity. By analyzing the problems existing in the quality and safety of XRJ and discussing the quality and safety problems of XRJ based on the IoT, this article tries to construct a quality control system of XRJ based on the IoT, improve the quality and safety control level of XRJ, and then realize the intelligent and scientific management of XRJ production, which have important practical significance for promoting the development of modern XRJ. This proposed system aims to reduce the chemical pesticides, fertilizers and antibiotics usage, stimulating sustainable food consumption, and promoting affordable healthy food for all. Consumers are encouraged to choose healthy and sustainable diets and reduce food waste. Farmers and producers are encouraged to provide more details about food origin, nutritional value, and environmental footprint. The contributions of this article are as follows.(1)A hybrid mode of blockchain and the IoT is used to construct a quality control system of XRJ.(2)Data processing of XRJ traceability system is introduced in detail.(3)The XRJ traceability system is verified in the Henan Xinzheng Xinxing Jujube Industry Corporation Ltd.The rest of the article is organized as follows. In Section 2, the related work is introduced. Section 3 focuses on XRJ quality traceability system in detail. The experiments and analysis are conducted in Section 4. Section 5 concludes the study work and point out the future work.The Internet of Things (IoTs) is an extended network based on the internet through a variety of sensors, RFID technology, global positioning system (GPS), infrared sensors, laser scanner, and other equipment and technology, no need to monitor real-time acquisition, connected, interactive object or process, collect the sound, light, heat, electricity, mechanics, chemistry, biology, location, and other needed information, through all the kinds of possible internet access, to realize the ubiquitous connection between objects and objects, objects and people, and realize the intelligent perception, recognition, and management of objects and processes. The Internet of Things is an information carrier based on the internet, traditional telecommunications networks, etc. It enables all the ordinary physical objects that can be independently addressed to form an interconnected network .At present, XRJ production mainly depends on manual experience management and lack of scientific and systematic guidance. Information acquisition is one of the most important key technologies to realize the high level of facility production of XRJ and to optimize the facility biological environment control. The agricultural IoT plays a crucial role in revolutionizing agricultural production. From the practical experience of developed countries, the IoT has many applications in the field of agriculture and is developing in the direction of reliability, energy saving, environmental adaptability, low cost, information, and intelligence. If it is a jujube production base of thousands of acres, if the IoT technology is applied, manual control only needs to click the mouse tiny action, only a few seconds before and after, can completely replace the tedious manual operation such as watering and fertilization. From the point of view of different stages of XRJ production, whether from the cultivation stage of planting and harvest stage, the IoT technology can be used to improve its work efficiency and fine management.\u2022At the plant preparation stage, a bunch of sensors can be arranged in the greenhouse to analyze real-time soil information and choose the right date varieties.\u2022At the planting and cultivation stage of jujube, the IoT technology can be used to collect temperature and humidity information for efficient management, so as to cope with environmental changes and to ensure plant seedlings grow in the best environment.\u2022At the growth stage of jujube, the IoT can be used to monitor the environmental information, nutrient information, and crop diseases and insect pests in real time. Using relevant sensors are accurate and real-time access to soil moisture, environmental temperature and humidity, illumination, through real-time data monitoring and special varieties of expert experience, combining with control system regulating crop growth environment, improve crop nutrition state, crop pest and disease outbreaks in time period, to maintain the best crop growth conditions. It plays a very important role in the growth and management of jujube.\u2022At the harvest stage of jujube, the IoT technology is used to transfer information such as appearance, fruit diameter, and nutritional composition of jujube to the data center. According to the data of planting environment, weather condition, and fruit tree status, the planting scheme is optimized for next year through big data technology analysis.Through the IoT technology, the production and operation of XRJ can be rapidly transformed from extensive and empirical management to fine and scientific management, so as to improve the yield and quality of XRJ, reduce the production cost of XRJ, and protect the agricultural environment. Data acquisition in Blockchain is a chain of blocks, each containing a certain amount of information, connected in the chronological order of their creation . The chaBlockchains allow people to have a distributed peer-to-peer network where non-trusting members can interact with each other without a trusted intermediary in a verifiable manner. Combining blockchain with the IoT, namely, blockchain-IoT is powerful and can cause significant transformations across several industries, paving the way for new business models and novel, distributed applications . It faciFrom the actual needs of the whole quality and safety management of XRJ, based on the quality and safety standards of XRJ, technical standards of XRJ, safety law, and other regulations and standards, the whole process risk management and traceability system framework of pollution-free XRJ quality and safety are designed. The wireless network remote environment monitoring technology is used to collect and analyze the data of XRJ in the whole circulation links such as XRJ, processing, storage, transportation, and sales, and generate reports with the results, so that managers can understand the situation in each link and solve related problems in time. All the monitoring report and pictures are numbered, using the information classification and coding standards, designing the pollution-free XRJ quality security coding, generating the QR code identification of XRJ, so that the consumers by smartphone scanning, back to the whole process of XRJ circulation. The whole process of pollution-free XRJ quality and safety can be monitored and traced.The XRJ quality traceability system based on hybrid mode is mainly divided into hardware and software system. The hardware module mainly realizes the real-time data collection of crops from planting to processing, circulation and sales of XRJ, and writes the data into the database. The software system is divided into Web Service and Android client. Since the Android client cannot interact directly with the database, this document uses Web Service as a bridge. The Web Service retrieves data from the database and the Android client retrieves data from the Web Service through Simple Object Access Protocol (SOAP).(1) Hardware environment design: The hardware part of the system mainly includes power supply module, sensor module, ZigBee module, and gateway module. The power supply module supplies power to other modules. The sensor module collects environmental data in real time and then transmits the data to the gateway module through ZigBee module. Finally, the gateway module uploads the data to the database through a specific serial port communication program.(2) Software design: The gateway module of the hardware part writes the real-time data collected by the sensor into the database through serial communication. The Web Service obtains data from the database and the Android client obtains data from the Web Service through SOAP protocol. The Android client interacts with the database through Web Service, so as to realize the data query function.The architecture and flowchart of traceability system of XRJ based on hybrid mode of blockchain and the IoT are shown in Choose the high-quality characteristics in XRJ varieties to quality and safety traceability system demonstration experiment, on the basis of sufficient study, analysis of demand, study and development to establish traceability anticounterfeiting XRJ whole-industry chain management system, unified data standard system construction, software and hardware, and the reliable technology are constructed to obtain integrity, practicality, advanced, and scalability. Anticollision method of RFID tag in large dynamic change and fast moving environment is carried out synchronously and is used in traceability anticounterfeiting management system to improve batch tag identification efficiency in complex environment. The advantages and characteristics of the XRJ whole-industry chain traceability anticounterfeiting management system based on radiofrequency identification technology will be gradually promoted to red jujube, planting, and sales enterprises in the province, benefiting the majority of villages and growers.According to the distribution of relevant personnel in the enterprise, the application scheme is determined: (1) personnel in the headquarters. Due to data center server deployment in enterprise headquarters, system administrator in the enterprise headquarters, production management personnel, and technical personnel can switch to the traditional C/S architecture system client data reporting and can carry out data analysis and statistics, the traditional C/S architecture system data reporting and management of the purpose is to improve the response speed data, reduce the influence of Windows Communication Foundation (WCF) frame on system performance; (2) Personnel other than the headquarters. The staff in the base, processing plant, or outside can choose different system clients for data reporting and management according to whether the network is smooth. When the network is not smooth, people can choose the traditional C/S frame system client to input the local data into the local server and carry out the local data analysis and statistics. When the network is normal, people can use the WCF client to synchronize data from the local server to the data center at the headquarters. After the synchronization, the WCF client can directly report data to the data center at the headquarters in real time and analyze and collect statistics over the internet.The Henan Xinzheng Xinxing Jujube Industry Corporation Ltd. is chosen to validate the system. The network infrastructure of the enterprise is better. The enterprise has a provincial planting base of red dates: Nankou red jujube production center and 9 large-scale planting bases. Some bases have poor network infrastructure and the network cannot be guaranteed to be smooth all the time. According to the network infrastructure of the enterprise, it is very suitable to use the agricultural production traceability management system based on hybrid architecture. At present, the client of the whole system has been deployed in three planting bases and the server has been installed in the corporate headquarters. The production management department is in urgent need of obtaining the real planting area, number of trees planted, amount of pesticides and fertilizer applied and their types, yield, and other data of each base. However, such data can only be collected after the production cycle is completed for a period of time. After adopting this system, the above data can be obtained on the same day. In addition, the following functions are also realized: (1) query the planting and production situation of different batches, different people, different bases, and different time periods; (2) Trace codes are formed according to relevant rules; (3) Query the quality management of the whole production process according to the traceability code; and (4) Upload enterprise traceability data to the ministerial traceability data center through the upload component. https://hyperledger-fabric.readthedocs.io/en/release-1.2/network/network.html stable\u201d and Sudo apt-getinstall docker-ce docker-ce-cli container. IO installs the Docker container.After setting up the Fabric operating environment, the next step is to build the Fabric blockchain, consisting of the following major steps: generating certificates and keys, generating genesis blocks, creating channels, starting the Fabric network, nodes joining channels, and installing and instantiating smart contracts.The blockchain-based agricultural product traceability system consists of six modules: source and origin, product, agricultural operation, quality inspection, warehousing and storage, and transportation. The data of agricultural operation, quality inspection, warehousing and storage, and transportation shall be stored in the blockchain after verification. We collectively refer to the data of these four modules as source information. The specific implementation of each functional module of the traceability system is demonstrated through sequence diagram analysis. The system development environment configuration is shown in In the development stage of the system, white-box test is applied to simulate all the kinds of possibilities inside the program to improve the robustness of the processing method. In the test stage, black-box test is used to test each functional module by simulating user behavior. The test results of each module of the system are shown in With the rapid development of economic level, some agricultural product enterprises reduce production costs to maximize the profits of some agricultural enterprises and result in a lot of agricultural product safety incidents in recent years. Therefore, people have to pay more attention to food safety in daily life. This article constructs a set of XRJ quality traceability system and carries on the system analysis and application verification. The hybrid model in the system makes use of its unique time stamp, consensus mechanism, and other technical means to realize the data of jujube planting, jujube purchasing, jujube processing, jujube sales, and other data that cannot be tampered and traceable. At the same time, the market supervision bureau and consumers are included in the date quality traceability supervision system, which breaks the information island of traditional traceability, provides information support, realizes the full transparency of production and sales process to a certain extent, provides technical support for good market operation order, and provides quality guarantee for consumers\u2019 life and health. With in-depth study and development of blockchain technology, coupled with the requirements of high-quality development of the date industry, blockchain technology will provide new solutions to date traceability, pesticide residues, and brand counterfeiting. While establishing XRJ safety supervision and supervision mechanism, relevant departments need to establish traceability XRJ system, implement relevant responsibility to individuals, and strengthen food production supervision at the source.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.Written informed consent was obtained from the individual(s) for the publication of any identifiable images or data included in this article.RJ contributed to the model construction and manuscript writing. PL contributed to the data acquisition and experimental verification.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "With the continuous improvement in the integration of urban agglomeration, a multi-functional, socialized, and complex dynamic system, effective prevention and control of emergent public health events have become increasingly important. Based on the Public-Health Vulnerability-Assessment-System of Urban Agglomeration (PVUA), the temporal and spatial differentiation characteristics of vulnerability in the Guangdong-Hong Kong-Macao Greater Bay Area (GBA) for the period of 2015-2019 are explored, and the vulnerable cities to public health events are identified in this area. The results can be summarized as follows: (1) The overall vulnerability to public health events in GBA decreases in the investigated period. (2) In the temporal dimension, accompanied by social and economic development, the sensitivity to public health events increases in GBA, and the coping capacity change from stable fluctuation to rapid improvement. (3) From the spatial dimension, the sensitivity level in GBA is low in the west, relatively high in the middle, and high in the southeast; the coping capacity is high in the southeast and low in the northwest; the collaborative governance capacity presents a spatial pattern of being low in the south and high in the north. (4) In the period of study, the vulnerability to public health events in Guangzhou and Jiangmen is stable at the lowest level, while that in Zhaoqing, Foshan, and Hong Kong SAR  gradually reduces; the vulnerability in Shenzhen, Zhuhai, and Dongguan is fluctuating, and that in Huizhou, Zhongshan, and Macao SAR is continually maintained at a higher and the highest level. In the 21st century, with its accompanying economic development, the loss caused by major public health emergencies has been increasing yearly. Public health events refer to the epidemic of infectious diseases and mass diseases with unknown causes that have (likely) occurred, which has (likely) caused heavy losses to public health. In 2020, comprehensively promoting the construction of a healthy China was established as a critical task in China's 14th Five-Year Plan for national economic and social development and the vision goal of 2,035, for improving people's quality of life and raising the level of social construction. Therein, improving the mechanisms for monitoring, alerting, and effectively solving public health emergencies is significant for ensuring the overall promotion of a healthy China. In the same year, the General Secretary of the CPC Central Committee, Xi Jinping, stressed the importance of strengthening the prevention and control mechanisms of public health and improving the emergency management system of public health, preventing and coping with major public health emergencies.Gap 1).Health policy needs to be informed by scientifically based evidence . To imprIn disaster management, risk is often described as a function of hazard and vulnerability . VulneraIn public health events, the cross-domain crisis has become the most characteristic and destructive new crisis form, which bears the risk of causing secondary and derivative hazards. The natural defects of structural obstacles limit the conventional urban crisis emergency system. It cannot effectively deal with the new situation and the new problems caused by the cross-domain crisis . City plGap 2).Currently, the studies on cross-regional public security coordination in urban agglomerations primarily focus on theoretical discussions, conceptual model construction, and policy analysis , 48\u201350. Gap 3). Hence, GBA has been constructively selected as this study's research area.At present, the spatial organization of urban agglomerations in China presents a new pattern of 5 + 9 + 6 consisting of five national, nine regional, and six regional urban agglomerations . ThereinTherefore, according to Gap 1\u20133, this research intends to fill the research gaps in GBA by employing the sensitivity-coping capacity-collaborative governance framework for establishing the PVUA dynamic evaluation system innovatively. GBA is adopted as the public health vulnerability empirical research object. The weights of 23 indices are determined by the entropy method, and the vulnerability level and temporal and spatial evolution characteristics of public health events in GBA are extensively explored to provide academic support for developing GBA into a safe bay area.Preconcluding, the main research objective is to investigate public health vulnerability in GBA. The specific objectives may be outlined as follows:To elaborate a dynamic evaluation system for the PVUA by employing the sensitivity level-coping capacity level-collaborative governance level framework;To explore the vulnerability level and temporal and spatial evolution characteristics of public health events in GBA;Based on publicly available data, to identify the vulnerable cities in GBA by holistically respecting public health events conditions;To formulate the risk-avoidance manners for public health events conditions using the weights of 23 indices related to public health events emergency interventions.This study's novelty is in the appraisal of public health vulnerability from the GBA from top-class international urban agglomeration in China. Theoretical and pragmatic contributions are also derived from this study's outcomes. The study builds the PVUA dynamic evaluation system and gives an in-depth comprehension of specific promotion strategies from actual vulnerability performance with a strong potential of advancing stakeholders' and city management department' capacity to actualize higher security level results in future action plans and strategies. Moreover, providing vulnerable ranking cites to policy makers to priorities resource allocation and provide strategies for creating safe GBA. The study proposes the PVUA evaluation system of implementing a proposed safe and sustainable urban agglomeration strategy for GBA, China, which could also be utilized as a tool or model by relevant stakeholders across the globe to objectively and systematically assess public health events emergency performance to allow for prompt preventive/amendatory mechanism.The rest of the paper is organized as follows. In the next section, we discuss the representativeness of the study area and the reasonableness of the source data. Therein, we outline the data employed and the methods to caliber statistical data. And this is followed by arguments justifying the dynamic evaluation system for the PVUA, explaining how the sensitivity, coping capacity, and collaborative governance subsystems reflect different aspects of the potential facilitators and inhibitors of the public health events crisis across urban agglomerations. Then we depict the results of the various subsystems model estimated in GBA and consider which indices appear to contribute most to the subsystems crisis. The fifth section elucidated the vulnerability level data of cities in GBA in five different years, and the reasons for the crisis and the solutions are discussed. Our final section presents some insights and conclusions regarding the role played by the PVUA model in managing vulnerability to public health in urban agglomerations.Outline Development Plan for the Guangdong-Hong Kong-Macao Greater Bay Area of 2019, it was explicitly pointed out to perfect the mechanism of effectively addressing emergencies, and construct an emergency coordination platform for GBA, to perfect the mechanism of effectively handling emergencies. The GBA is one of the regions with the highest degree of openness and the most substantial economic vitality in China , ej for the j index is calculated as follows:Secondly, the entropy value aj for the index is calculated.Then, the information utility value Wj for the j index is calculated.Finally, the weight Wi is calculated proportionally. By summing the weights of the indices of the determined index layer, Wj, the weight of the index of the dimension layer Wi is obtained.By using the utility value for the index information, and according to the additivity of entropy, the weight of the dimension layer Yi for each index in the criterion layer is , the greater value for Y corresponds to higher regional coping capacity and less vulnerability; when the target layer is collaborative governance (negative index), the greater value for Y corresponds to higher regional collaborative governance capacity and less vulnerability.In formula (8), when the target layer is sensitivity (positive index), the greater value for The combined score Y is equal to the weighted sum of the scores of each item, and the formula is:Y is the synthetic score of the evaluated region, and Y1, Y2, and Y3 are synthetic scores of sensitivity, coping capacity, and collaborative governance.In formula (9), Technical Standard of Highway Engineering , the road speed limits are set as 120 km/h for expressways, 80 km/h for urban expressways, 60 km/h for principal arteries, 50 km/h for secondary arteries, and 30 km/h for branch roads, respectively. Firstly, establish the factor data set, import data, verify the network data set, select the service area, and import service points accordingly. Secondly, the travel time for each road to the medical point was calculated using the formula, and fields were added to the attribute table. Thirdly, the impedance is set as a 5-min service area, 10-min service area, and 15-min service area to analyze the fastest path. Furthermore, according to the spatial analysis results, the ratio of compensation area to urban area is obtained to establish the data on rescue time compensation capability for each city.The rescue time compensation capability directly impacts regional risk compensation capability under major public health emergencies. It is closely associated with the distribution of medical stations and driving speed. In the case of emergency disasters and personnel first aid, \u201c120\u201d emergency vehicles are required to arrive at the site of the accident within the shortest time  to perform rescue services . AlthougThe weight of each normalized index is determined by the entropy method, and the sensitivity level of each city in GBA is calculated for each year. According to Regarding the developing trend, the sensitivity levels of Guangzhou, Huizhou, and Jiangmen increased continuously, while that of Dongguan first decreased and then increased since 2016; the sensitivity levels of Macao SAR, Foshan, and Zhongshan followed an \u201cinverted U\u201d pattern of first increasing and then decreasing, and all cities reach their peak values followed by a gradual decrease in 2017 generally showing a relatively stable trend. Among them, the sensitivity level of Macao SAR remains in the high-value area due to the high degree of external dependency and its single-industry structure; however, with the transformation of Macao to a moderately diversified economic entity, the sensitivity level gradually decreased after 2017. The decrease in the sensitivity level of Foshan is mainly reflected in the transformation of its industrial structure . As a substantial manufacturing base in China, the sensitivity level of Foshan decreases due to the transformation of old to new driving forces and the high-quality development of the manufacturing industry in recent years. With the decrease in the external attraction of Zhongshan after 2017, the proportion of the migrant population and community tenants declines, and its sensitivity level decreases. The remaining cities are in a relatively stable state of fluctuation.According to the natural breakpoint method, the sensitivity levels to the overall public health events in GBA during the study period are divided into five classes, as shown in According to the trend of the capacity to cope with public health events in GBA from 2015 to 2019, the coping capacity of all cities in GBA has improved to a certain extent Spatial mapping of the capacity to cope with public health events in GBA from 2015 to 2019 was conducted, the areas in GBA characterized by different coping capacities were obtained, and a five-level division was performed according to the natural breakpoint method . At presCities in GBA have different capabilities for collaborative governance. According to the evaluation data, the collaborative governance capability is divided into five levels. Based on the analysis of the evaluation results Based on the above PVUA evaluation methods, the spatial pattern of five vulnerability types at the city scale in GBA was obtained by the natural breakpoint method in the study area during the 5 years. The study showed that the overall performance of the PVUA at the city scale in GBA was \u201clow in the north and high in the south\u201d during 2015\u20132019 . The res(1) Analysis of the node cities with the lowest levels of vulnerability in GBAThe lowest levels of vulnerability to public health events are found in Guangzhou and Jiangmen. Firstly, with the rapid economic development, the sensitivity level of Guangzhou presents a continuously increasing trend over the entire period . HoweverFurthermore, due to the stability of industrial characteristics and a smaller migrant population, Jiangmen has a low sensitivity level . Althoug(2) Analysis of the node cities with gradual decrease levels of vulnerability in GBAZhaoqing, Foshan, and Hong Kong SAR witness a gradual decrease in vulnerability to public health events. Among them, Zhaoqing and Foshan are at a low sensitivity level due to the characteristics of their industrial structure and low population mobility. In addition, the allocation of health resources and public health expenditure in the two cities are relatively high, and \u201cmedical insurance system, health system, and drug distribution co-reformation\u201d are locally promoted, causing continuous improvement in coping capacity and the emergence of a declining trend of the vulnerability level. Hong Kong SAR has the highest sensitivity level, but its coping capacity is also at the highest level, and the allocation of health resources and public health expenditure constantly increases; thus, its vulnerability level gradually decreases. Furthermore, the vulnerability levels fluctuate in Shenzhen, Zhuhai, and Dongguan. During the study period, the collaborative governance capability of the three cities presents no significant change. At the same time, vulnerability fluctuates due to a correlation between sensitivity and coping capacity.(3) Analysis of the vulnerable cities with a high level of vulnerability in GBAThe vulnerability to public health events remains high in Huizhou, Zhongshan, and Macao SAR. With the transformation of industrial structure and the continuous enhancement of population aggregation in these three cities, the industrial structure should be optimized in the future. Additionally, the number of medical systems, the allocation of health resources, and the public health expenditure should be increased to match the rapid development of the social economy in these cities. Although WHO guidance should be followed, a one-size-fits-all model will not be appropriate . Local gFurthermore, available data suggest the vulnerability of public health events within the urban agglomeration posed by the combination of three factors: sensitivity, coping capacity, and collaborative governance capacity. Sensitivity is a positive factor, and coping capacity and collaborative governance capacity are negative factors for the vulnerability of public health events. According to the analysis of the spatial distribution of various elements in GBA, the spatial distribution of multiple components is inconsistent. For example, among the central cities in GBA, Guangzhou has a high sensitivity to public health events, and its coping ability and collaborative governance ability are high; while Shenzhen has high sensitivity, high coping ability, and medium level of collaborative governance; Hong Kong SAR and Macao SAR are cities with high sensitivity, high coping ability, but low collaborative governance ability; there are also small and medium-sized cities such as Zhaoqing and Jiangmen, which have low sensitivity, low coping ability, and relatively high collaborative governance ability. Based on this, strategy systems that deal with the risk of public health events should clarify the specific levels of various vulnerability factors first, thereupon formulating issue targeted policies to reduce system vulnerability.Framework Agreement on Cooperation in Health and Wellness in GBA in 2018 and the Consensus on Cooperation in Medical and Health in GBA in 2019, GBA focuses on complementing the advantages of each city or region and aiming at jointly building infrastructure and sharing benefits and continues promoting cooperation in high-quality medical resources, public health emergency response, innovation in traditional Chinese medicine, scientific research and services, talent cultivation, diagnosis, and treatment.In general, the overall evolution trend shows gradually expanding areas with low vulnerability, although the volatility of the vulnerability level varies significantly in GBA during the study period. In 2019, apart from Huizhou, Zhongshan, and Macao SAR, most of the cities in GBA fall into areas with moderate and low vulnerability levels , and theAlthough economic indicators are not used in the PVUA evaluation system, the study findings showed that the differences in regional economic levels expressed various vulnerability risks posed by public health events, which might uncover a hidden fact. More specifically, it is likely that the sensitivity level and coping capacity regarding the vulnerability to public health events in urban agglomerations are deeply correlated economic level or socioeconomic level inevitably, which is consistent with previous studies , 63, 64.Simultaneously, as articulated in The Lancet, 14 vulnerability in the present context is a dynamic concept\u2014a person or a group might not be vulnerable at the beginning of the outbreak, but could subsequently become vulnerable depending on the government response . EffectiIn recent decades, with the advancement of urbanization in China, the aggregation and spatial mobility of production factors unique to urban agglomeration cause the safety security of public health events to be distinctly systematic, diversified, derivative, and intersectional. Accurate and effective measurement of vulnerability to regional public health events is most important to ensure people's health, economy, social stability, and political image in urban agglomerations . HoweverIn this study, the spatial and temporal variation characteristics of the sensitivity-coping capacity-collaborative governance of vulnerability of city units in the study area were evaluated based on the PVUA model and GIS analysis (rescue time compensation capability), and entropy method during 2015\u20132019. Simultaneously, based on publicly available data, the temporal and spatial evolution characteristics of vulnerability to public health events in GBA were further explored in this research. The main conclusions are drawn as follows:Population density, road density, population mobility, population structure, industrial structure, and openness are adopted as the six factors to assess the vulnerability to public health events in GBA. Surveillance is critical for improving population health . The senThe capacity of GBA to cope with public health events is assessed based on four factors: the rescue time compensation area, the allocation of medical and health resources, the public health expenditure, and the response of emergency supplies. According to the results, the spatial pattern of the coping capacity of the GBA presents a combined state of diffusion effect and echo effect; the coping capacity is found to be the highest in Hong Kong SAR, Guangzhou, and Shenzhen, reflecting continuous improvement in the medical and health system and the level of medical and health services with the social and economic development in these cities. The medical and health system, the construction of medical and health services, and the public health expenditure of Zhaoqing, Zhongshan, and Huizhou all belong to the lowest development area category, especially Zhongshan has become the core area of the echo effect.General Plan for the development of the Hengqin Guangdong-Macao In-depth Cooperation Zone and The plan for comprehensively deepening reform and opening up of the Qianhai Shenzhen-Hong Kong Modern Service Industry Cooperation Zone in 2021, can promote more freedom and convenience in the flow of people, cargo, capital, and technology. Collaboratively handling public health events, improving the level of collaborative and coordinated management of public health emergencies, and reducing institutional barriers to cooperative management of public health emergencies have become the focus of work to reduce the vulnerability to the risk of public health events in GBA.As a provincial capital city, Guangzhou shows the highest collaborative governance capability in GBA, followed by Zhaoqing, Jiangmen, and Huizhou. The collaborative governance capabilities of Hong Kong SAR and Macao SAR are the lowest. In the future, in-depth cooperation based on \u201cone country, two systems\u201d, together with the The vulnerability to public health events presents a significant declining trend in GBA, demonstrating the inevitable future trend of in-depth cooperation based on the construction of an encompassing high-quality living circle and the concept of excellent health in GBA, continuous enhancement of the capacity of GBA to withstand, handle, and collaboratively govern public health events, the achievement of gradual decline in the regional vulnerability to public health events, and joint development of social economy and medical care as well as public health.In the present study, we developed and validated an dynamic instrument of the PVUA with good initial evidence for internal reliability. PVUA evaluation system was proved in virtual agreement with the actual situation in GBA. Although research on public health surveillance systems is relatively mature , to the via previous research on public health policy and categories may not be prominent representative, and thus subsequent research might introduce more comprehensive research methods to demonstrate the current results. Second, there may be concerns about how the results would generalize beyond this sample to other urban agglomerations of China. Third, our data were based on a single evaluation system, and we assessed the geographical distribution features of the PVUA without conducting a reliability check. Future research might involve the adoption and use of methods in other health-related disciplines to provide evidence of synergistic interactions. Besides, the PVUA was tested in a Chinese urban agglomerations context; how it behaves in other cultural settings remains to be investigated.The study has some limitations that should be taken into consideration. First, we acknowledge that the PVUA dynamic evaluation system presented in the current study Future research should also be deepened and expanded: regarding data processing, high-resolution satellite imagery, satellite data, big data of urban traffic should be introduced, and the data on rush hours, road accessibility and topographic elevation data should be fully considered to obtain more accurate rescue time compensation areas in each city. Moreover, horizontal research in this field is warranted. We invite future research to focus on more elaborate testing to evaluate the validity of the PVUA evaluation system, primarily to evaluate the applicability of the scale to different regions in other cultural settings. In addition, multiple comprehensive research for the PVUA evaluation system is also warranted.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by Hanshan Normal University Ethics Committee. The patients/participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.WC: conceptualization, visualization, writing-original draft, writing\u2014review, and editing. JC: supervision, methodology, funding acquisition, and project administration. HS: supervision, investigation, data curation, and formal analysis. YaZ: validation and formal analysis. SL: data curation and investigation. YiZ: visualization and formal analysis. All authors contributed to the article and approved the submitted version.This research was funded by Guangdong Basic and Applied Basic Research Foundation (2019A1515110928), Guangdong Planning Office of Philosophy and Social Science (GD20CGL09), Hanshan Normal University, China (XN202031), Department of Education of Guangdong Province(2020GXJK091).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "The movement for racial and social justice that swept the United States in recent years has drawn greater attention to life-threatening inequities. The issue of how race-related health inequities are affecting disadvantaged groups has received sharper focus, bringing widespread promises of reform along with it.Nearly 250 declarations of racism as a public health crisis have passed in states, cities, town councils, county and education boards, and public health entities. While resolutions and formal statements themselves are not necessarily legally enforceable, they are an important first step in shifting a narrative that can drive meaningful changes to public health programming, policies, and resource allocation.Racism is a system of structuring opportunity and assigning value based on the social interpretation of how one looks , which unfairly disadvantages some individuals and communities, unfairly advantages others, and saps the strength of the whole society through the waste of human resources. Improving health and addressing inequities requires acknowledging that racism exists, correcting misconceptions that fuel racism, and facilitating healing in communities.In this Research Topic feature, we share what many experts have to say about racialized impacts on health as well as innovations that can foster and sustain transformational change in policies and practices that are driving the social determinants of health and wellbeing. Several underlying themes crisscross the many articles and Editorials including, the need to improve the quality of health data; transforming how we communicate about our past, present, and future; practices and policies that sustain false beliefs in hierarchy; progress of national and state-level legislation to address health inequities, and the importance of community-based participatory research approaches for authentic voices. Many of the manuscripts share real-life examples of how racism and health equity are being addressed across the U.S.Healing Through Policy: Creating Pathways to Racial Justice, an initiative that offers local leaders a suite of policies and practices that are being implemented across the country to help advance health, racial equity, and justice. Healing Through Policy uses the Truth, Racial Healing and Transformation (TRHT) framework, a comprehensive, national, and community-based process to plan for and bring about change, and to address the historic and contemporary effects of racism. First introduced by the W. K. Kellogg Foundation in 2017, the TRHT framework is used by communities around the nation and on dozens of college campuses to promote racial healing and relationship building. The suite is available at: www.debeaumont.org/healing-through-policy.County and city leaders who are looking for practical ways to advance health and racial equity now have a new resource that can serve as a roadmap. In 2021, the American Public Health Association, the de Beaumont Foundation, and the National Collaborative for Health Equity launched All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.GB and RD were employed by American Public Health Association, Washington, DC, United States. The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "Functionally, neuropeptides are strongly implicated in vascular temperature regulations, spermatozoa extrusion, epididymal content transportation, and movement of accessory gland secretions. This review provides an overview of neuropeptides with respect to their synthesis, release, and mechanism of actions, with emphasis on the locally acting neuropeptides, such as substance P (SP), neuropeptide Y (NPY), vasoactive intestinal peptides (VIP), calcitonin gene-related peptide (CGRP), galanin (GAL), cholecystokinin (CCK), C-terminal flanking peptide of NPY (CPON), peptide histidine isoleucine (PHI), and met- and leu-enkephalins (M-ENK and L-ENK) along the male genital tract  of 14 species of mammals and their marked influence on reproduction. This review also revealed from documented reports that the vast majority of neuropeptides present in the autonomic nerve supply to the male genital tract probably coexist with other peptides or with various neurotransmitters . In addition, documented evidence of variation in age, season, and intraspecies differences were identified as notable factors of influence in peptidergic nerve fiber distribution.Neuropeptides are secretory peptides characterized by small chains of amino acids linked by peptide bonds. They are majorly found in some mammalian neurons and glial cells, where they modulate a variety of physiological homeostasis. In the male genital tract, they are mostly found in the neuronal fibers supplying the vasculature, smooth muscle layer, interstitium, and  They act on neural substrates. Of note, distinction exists between neuropeptides and other peptides  in that it is strictly neurons that secrete neuropeptides, while peptide hormones found their origin in the periphery . However, the same sets of regulatory enzymes control the synthesis, modification, and biodegradation of both peptides. Moreover, neuropeptides could exert autocrine, paracrine, and endocrine functions, just like peptide hormones  culminates in the relatively long-lived impacts of neuropeptides. Their actions are enhanced by G-protein-coupled receptors . NeuropeThere is great diversity in the functioning of neuropeptides, and this is highly due to the distinctions in the proteolysis of their precursors, primary sequence, covalent modifications, and length of the peptide . The bioThe mammalian male genitalia consist of organs that are involved in the development, maturation, transportation, and deposition of the male gametes (spermatozoa). By virtue of this, the male genital organs encompass the paired testes, the convoluted duct of epididymis, the deferent duct, the urethra, and the accessory glands . Many peThe focus of this review is to profile the neuropeptides central to the morphophysiological functioning of the vertebrate mammal male genital tract, their distribution, and the variability of their expressions.The main part of the male genitalia, the testis, is innervated by complex networks of peripheral nerve [the superior and the inferior spermatic nerve (SSN and ISN)] fibers originating from the cranial and caudal mesenteric ganglia (these nomenclatures are homologous to the superior and inferior mesenteric ganglia in primates) , 9. The The ISN fiber leaves from both the caudal mesenteric ganglion and pelvic plexus together with the vas deferens and then access the caudal pole of the testes through the proper ligament of the tail of epididymis , 14. TheThe rest of the genital tract receives innervation from the lumbosacral plexuses, which are made up of the genitofemoral , pudendal, and in some species , the ilioinguinal nerves . The genOne of the research paths on the innervation of the reproductive tract in many species of animals studied dealt with the distribution and chemical coding of nerve fibers supplying the male genital organs . SeveralThe abovenamed sets of neuronal markers have been used to localize testicular nerves in the testicular capsules, around branches of the testicular artery, within interstitial Leydig cells, seminiferous tubular interstices, epididymal tubular interstitium, epididymal ductal muscular coat, and in the wall and parenchyma stroma of accessory glands in the Wistar rat, dog, bovine, pig, donkey, monkey, deer, man, camel, giant rat, house musk shrew, and African greater cane rats \u201332. It wWe hereby provide an overview of the documented findings on neuropeptide localizations in the male genital tracts of the different mammalian species.Immunohistochemical technique has been used to localize neuropeptides in the testes of different age categories of man (subadult and adult) , 33, 34.Taino  submittetunica albuginea, mediastinum, perimediastinal, and capsular arteries of the testis. In terms of contribution, about 50% of funicular, mesochial, and caudal nerve access to the testis were found to be NPY positive in the adult and were not expressed in the septula testis. While in the young calf and subadult bovine, the NPY nerve fibers from the three testicular nervous access constituted only about 33%. In addition, NPY nerve fibers were demonstrable in the septula testis of the younger age groups. Concerning the VIP nerve-positive axons, the authors observed immunoreactivity in the tunica albuginea, ligamentum propria, and caudal mesodeferens. The demonstration of VIP-positive nerve fibers in the testis was directly related to age . The CGRP neuropeptide was observed to be immunonegative in the testes of the young and subadult bovine, while in the adult, solitary CGRP fibers were demonstrated in the connective tissues of spermatic cord, cranial mediastinum, tunica albuginea, and mesorchium. Positive SP solitary fibers were seen in the ligamentum bridge situated between the epididymis and testis at the caudal testicular pole in the younger calf. However, SP immunoreactivity was negative in other age groups.The comparative neuropeptide distribution in different age groups of bovine  was investigated by Wrobel and Abu-Ghali . The stuvia the ligamentous bridge connecting the testis and epididymal tail and were restricted to the caudal pole of the testis. Interestingly, the CGRP-positive nerve fibers were not regularly demonstrated in the camel testis; however, Saleh et al.  was profiled by Wrobel and Moustafa . Neuropeeneghini  had prevductus deferens and the lamina propria of the tunica mucosa as well as in muscular coat and axis of ampulla ductus deferentis  in the testes and associated structures  in the cat was equally investigated by Suburo et al. . The stuar septa , 44. On  vessels , 44. It  vessels  reportedtunica albuginea, seminiferous tubular interstitium, mediastinum testis, and septula testis. The VIP nerves were demonstrated in the funicular and supratesticular vascular stroma and in the fibers accompanying the epididymal arteries to the epididymal head. The CGRP formed about 50% of nerve fibers in the subadult and was localized in the intervascular stroma, testicular vascular organ, and tunica albuginea. However, CGRP fibers were less frequently demonstrated in the septula testis and the mediastinum. In case of the adult boars, CGRP nerve axons were markedly reduced. A small population of about 10% nerve bundles were immunopositive for SP in all age categories.Age-related changes in the distribution of nerves access to the testis and its investment in pigs using pan-neuronal markers and neuropeptides have been described by Wrobel and Brandl . It was A previous study by Kaleczyc et al.  revealedtunica albuginea, vascular elements, and mediastinum of the testis, head, body, and tail segments of epididymis as well as the furnicular and abdominal parts of the ductus deferens. There was no immunoreactivity within the spermatogenic elements of the seminiferous tubule. The immunoreactivity was demonstrated only in the tunica albuginea and vascular stroma of the testis, the three segments of the epididymis, and ductus deferens . Moderately positive CGRP immunoreactivity was observed in the tunica albuginea and vascular stroma of the testis, while marked immunoreactivity was restricted to the various epididymal ductus deferens segments. In the case of SP, a similar immunoreactivity density observed for CGRP was displayed in both testis and epididymis.Sienkiewicz et al.  reportedvia probable reciprocal influences with target cells to bring about the morphofunctional postnatal development of the genital system in male rats.Properzi et al.  investigtunica albuginea. In addition, the NPY-positive fiber varicosities were sparsely distributed throughout the testicular interstitial space and appeared to be associated with microvessels and along the seminiferous tubules. The authors did not detect immunoreactivity to VIP in the rat testis. This observation is partially in tandem with negative immunoreactivity to NPY, VIP, and CGRP neuropeptides as observed by Properzi et al.  were investigated in the testis of rats by Rauchenwald et al. . The NPYi et al.  in both i et al.  immunohiductuli efferentes and seven zones of the guinea pig epididymis was investigated by Greenberg et al.  of the epididymis. Ultrastructural features of cholinergic (agranular vesicles), adrenergic , and peptidergic (large granular vesicles) innervations were seen in the interstitial connective tissue of both the efferent duct and the various zones of the epididymis. The localization of these selected peptidergic nerve fibers in some specific regions of the efferent duct and epididymis has been suggested to portend ranging physiological roles including SP mediation of smooth muscle constriction in the epididymal parenchyma and its perivascular structures, and VIP initiation of smooth muscle dilatation at the caudal aspects of the epididymis, the seat of spermatozoa storage.The innervation of the g et al.  using thFunctionally, the ultrastructural features of nerve chemical coding noted by the authors implied a costorage of adrenergic, cholinergic, and peptidergic transmitters in the epididymis of guinea pig.Frungieri et al.  documentThe male sex accessory organs, just like the main sex organs, are supplied by nerves containing not only the classical neurotransmitters, such as acetylcholine and noradrenaline, but also a vast array of peptidergic transmitter candidates . Some ofA considerable quantity of NPY-immunoreactive fibers has been localized in male accessory sex glands receiving dense sympathetic nerve supply . NPY nerPositive CGRP immunoreactive single and thick bundles of nerve axons have been localized in the perimuscular coat, sub-epithelial connective tissue, and in the perivascular spaces of the seminal vesicular gland in the guinea pig, man, and hamster rat , 53, 59.Positive immunoreactivity to PHI has also been documented in man , rat, anThe VIP nerve fibers were majorly localized on the basal part of the seminal vesicular gland and within the muscular coat as well as in vascular elements of the gland in smaller amounts , 61\u201365. Positive immunoreactive SP, enkephalins, and gastrin-releasing peptide nerve fibers have been demonstrated in varied quantities in the smooth muscle and mucosa of the seminal vesicles of man, rat, and guinea pig , 63\u201365. On the possibility of age-related differences in the neuropeptide localization and expression in accessory sex glands, Properzi et al.  reportedKlimczuk et al.  investigRegarding neuropeptide distribution in the seminal vesicle in the donkey and horse, Arrighi and Domeneghini  documentMet-1 and Leu-1 enkephalin-positive nerve fibers were demonstrated in the muscular layer of ductus deferens and its ampulla as well as subepithelial connective tissue of ductus deferens in the horse and donkey, although the donkey had an exclusive demonstration of positive Met-1 and Leu-1 enkephalin nerve fibers in the external muscular layer of caudal epididymis, ductus deferens, ampullary, and vesicular glands. For bombesin/GRP neuropeptide, positive bombesin nerve fibers were exclusively detected in the muscular tunic of the ductus deferens in the horse but restricted to the perivascular regions of ductus deferens in the donkey. Somatostatin peptide was immunonegative to the nervous, connective, muscular and epithelial components in the testis, epididymis, ductus deferens, and accessory glands in the horse and donkey .The report of Higgins and Gosling  on usingAlthough there are conflicting reports of dual possible demonstration of NPY immunopositive nerve fibers in the human prostate , 66. TheThe prostate gland in most animals is rich in VIP nerve fibers and constitutes the dominant colocalized peptides in the cholinergic nerve supplying the glandular epithelium of the prostate gland , 62, 69.Neurokinin and substance P have been sparsely localized in nerve fibers innervating the smooth muscle tunic of man, sheep, dog, guinea pig, rat, and mouse prostate glands , 79\u201381. Macacus fuscatus, using both histochemical [acetylcholinesterase (AChE) reactivity] and immunohistochemical (TH and NPY immunoreactivities) approaches. The authors observed abundant positive TH-like immunoreactive nerve fibers in the interstitium and infrequent distribution in the paraurethral region. Also, NPY-like immunopositive nerve fibers were localized in the interstitium and periprostatic acini on a less abundant basis compared with the TH counterpart. However, AChE-positive nerve fibers were densely demonstrated around the acini compared with the interstitium. The authors also noted that both NPY-like and AChE-positive nerve fibers seemed to be localized in close association with the acini epithelium.Yokoyama et al.  investigThe available report on peptidergic nerve fiber distribution was conducted by Smith et al.  with theArrighi and Domeneghini  observedArciszewski  employedWe provided a concise overview of the neuropeptide profiles in the male genitalia of various mammalian species in mediastinum testis, and vascular stroma within and around the testis. With respect to testicular NPY distribution in the buffalo, rat, and cervine, NPY was demonstrated in the testicular capsule only and/or in the vascular stroma as well as seminiferous tubular interstitium. The mammalian species with the most restricted distribution area (perivascular tissue) of testicular NPY are the donkey and horse. Surprisingly, there is no report yet on the NPY distribution in the dog.Comparatively, the neuropeptide Y has broad immunopositive areas in the testis of man, monkey, rabbit, cat, pig, and camel. The involved parts of the testis in these species include the testicular capsule, peritubular myoid cells, seminiferous tubular interstitium, tunica albuginea, testicular mediastinum, interstitium, and perivascular stroma) were observed in the rabbit, pig, bovine, and cat. This was followed by the camel, cervine, and man with one or two regions  of VIP immunopositivity  of immunopositivity. There was negative immunoreactivity in the testes of the horse, rat, and buffalo. However, in the monkey and ram, there is no available literature on the distribution of CGRP nerve fibers in their testes.Concerning the distribution of CGRP in the testicular parenchyma and associated structures, the broadest distribution is found in the camel, donkey, rabbit, pig, bull, and cat. The specific areas in these animals include the tunica albuginea, testicular mediastinum, septular testis, perivascular stroma, and spermatic cord. Unlike other mammals , immunopositive areas were restricted to one or two areas in the testes. Interestingly, there was negative SP immunoreactivity in the testes of the horse, man, and rat. Also, there is a dearth of literature on SP nerve fiber distribution in the testes of the ram.The camel, donkey, and cat testes have the most enormous SP-positive nerve fiber distribution in the tunica albuginea of man's testis, but immunonegative in the testes of the donkey, horse, and buffalo. There are no existing literatures on the testicular immunoreactivity in other animals. With the exception of positive immunolocalized enkephalin fibers in the muscle coats of epididymis of the donkey and ductus deferens wall of both the horse and donkey, there is scarcity of literature on its presence or distribution in other animals.The reports available for interspecies variation on enkephalin distribution in animals under review are very scanty for meaningful comparison. Enkephalin-positive fibers in the testis were localized only in the Galanin-positive nerve fibers were found only in the cat testicular capsule, interstitium, and perivascular stroma. However, it was immunonegative in the testes of man and buffalo. There is little or no report on its immunoreactivity in other animals.Neuropeptide Y has been consistently immunolocalized in the epididymal interstices and perivascular structures in man. In the donkey and horse, it is exclusively restricted to the peritubular connective tissue. With the exception of NPY immunolocalization on the epididymal epithelium, the camel shared similar NPY distribution with man. There is still a wide literature gap in the demonstration of NPY in the epididymis of quite a lot of mammals including the bull, cervine (deer), buffalo, dog, cat, and monkey.There is a dearth of information on the VIP immunoreactivity in the epididymis of the camel, cervine, donkey, horse, buffalo, dog, and ram. However, vast VIP-immunopositive regions  were exclusively observed in the rat epididymis. The rabbit, pig, and man come next in the extent of distribution of VIP nerve fibers in the epididymis. These sets of animals were immunopositive for VIP in either the epididymal muscular coat or the interstitium. For ducutus deferens, the VIP-rich area is in the muscular coat of the donkey, horse, rat, bull, and cat. There are no existing reports on other animals in this regard.With the exception of the rat bearing three immunopositive CGRP areas in the epididymis , every other mammal  with immunoreactivity had one or two areas positive for CGRP fibers. There are no available reports on the immunoreactivity of CGRP in the epididymis of the cervine, pig, buffalo, bovine, dog, monkey, and ram. The CGRP immunoreactivity in the ductus deferens is reported to be demonstrated in the muscular coat or wall of the cervine, rabbit, and rat, while there is still a huge literature gap in the CGRP fiber presence in the ductus deferens of other animals.The SP-positive nerve fibers had exclusive distribution in one or two regions (muscular coat and interstitium) of the epididymis in the camel, cervine, donkey, horse, rabbit, man, and rat. There is a dearth of literature on its distribution in the epididymis of other animals in this review. On species variation in the SP nerve fiber distribution, immunopositive fibers are restricted to the wall or muscle coats of the epididymis in the cervine, donkey, and rabbit. There are no reports on their immunoreactivities in other animals.Of all the prostates of animals in this review, the donkey, horse, pig, man, rat, and monkey had immunopositive NPY fibers. The NPY immunoreactivities in these animals were confined to one of these parts  of the prostate gland. However, there is a dearth of literature on NPY immunoreactivity in other animals.The positive VIP immunoreactivity was demonstrated mainly in the muscle coat of the prostate gland of six mammalian species  out of the total animals under review. Although the VIP-positive fibers were additionally localized in the perivascular stroma of pig, there is no report on the VIP immunoreactivity in the prostate of other animals.The positive prostatic CGRP fibers were demonstrated in the donkey, horse, man, and rat in two specific locations: glandular interstitium and prostatic epithelium. The prostatic profile of CGRP is still scanty in other animal species.In all the animal species in the review, only five mammals  had positive prostatic SP immunoreactivity precisely in the glandular interstitium, muscle coat, and perivascular stroma. The prostatic SP immunoreactivity is still poorly investigated in other mammals.The only prostatic galanin immunopositive fibers in this review were found in the ram. However, the rest of the other mammalian species still lack documentation on the galanin neuropeptide.On the variation in the demonstration of enkephalin, the donkey is the only species with prostatic enkephalin (leu and met)-positive nerve fibers. Both horse and rat had negative enkephalin immunoreactivity. Generally, the information on prostatic enkephalin immunoreactivity is still lacking in other species.There is no seminal vesicular gland in carnivores . TherefoThe NPY-positive nerve fibers in seminal vesicular gland were demonstrated in four mammalian species  in diverse parts of the gland including the muscle coat, interstitium, perivascular stroma, and epithelium. However, the NPY distribution is still lacking in the remaining mammalian species under consideration.The VIP-immunopositive fibers were variously localized in the muscle coat, interstitium, and perivascular stroma of the seminal vesicle in the horse, donkey, pig, and rat. There is a lack of documentation on VIP neuropeptide distribution in the seminal vesicle of other mammalian species.On the differences in the distribution of CGRP neuropeptide, markedly enormous CGRP-positive nerve fibers were observed in the rat and ram especially in the seminal vesicular epithelium, muscular coat, and perivascular stroma. The CGRP-nerve fibers in the donkey and horse were demonstrated only in the seminal vesicular gland interstitium. There is no information on seminal vesicular CGRP neuropeptide distribution in other mammalian species.The SP-positive immunoreactivity in the seminal vesicle, so far, was found to be widely distributed in the glandular interstitium, epithelium, and muscle coat of the rat. The donkey and ram had fewer areas of SP immunopositivity compared with the rat. The SP immunoreactivity was negative in the seminal vesicle of the horse. There is a lack of information on SP immunoreactivity in the selected mammalian species.With the exception of immunopositive bombesin nerve fibers in the interstitium of seminal vesicular gland, there is no information on its distribution in other mammalian species. Similarly, galanin neuropeptide was demonstrated in the epithelium and muscle coat of seminal vesicle of the rat. There is no data on galanin immunoreactivity in other animal species.The prevailing functional assumptions for the frequent colocalization of catecholaminergic and peptidergic fibers in the testicular parenchyma have been linked to modulation of Leydig cell function since most Leydig cells display \u03b2 adrenergic receptors . The genThe NPY, being the predominant neuropeptide in the muscle layer of the seminal vesicles, has been presumed to play a key functional role in the regulation of the glands' smooth muscle tone, although several conflicting reports of other neurotransmitters responsible for the motor transmission in the seminal vesicles have been established , 96\u201398. The immunolocalization of CGRP within the prostatic epithelial and subepithelial regions of most mammals especially guinea pigs has been associated with the regulation of prostatic secretion . Althougvia its smooth muscle relaxant property on the autonomic regulation of contractility in the seminal vesicle . The density of the nerve fiber loaded with neuropeptides and some of their specific receptors within the male genital tract appeared to differ in various mammalian species. Apart from these, evidence of variation in age, season, and intraspecies differences were identified as notable factors of influence in peptidergic nerve fiber distribution. A summary on the overview of the neuropeptides discussed here is provided in JOO conceptualized the manuscript. JOO and IAA contributed to writing  and making the table in this article, and approved its submission for publication. Both authors approved the submitted final version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "Technological processes carried out in the water environment include the production and processing of engineering materials and giving them specific properties ,2. A larSince the demand for materials and technologies, including the design and control of mechanized and robotic systems used in the water environment, is still increasing exponentially, experimental and simulation studies are an important factor contributing to their wider use .The purpose of this Special Issue is to present the latest developments in the field for processing materials in a water environment, especially at offshore and nuclear plant structures. This includes technologies related to manufacturing, properties, degradation, failures, protection, maintenance and repairs, joining, and the cutting of materials. This Special Issue mainly focuses on assessing the influence of the environment and technology on the behavior of materials underwater. Eleven research articles are published as part of this Special Issue, six of which are devoted to underwater welding.In article , a waterThe content of article  shows thIn article , researcOther issues that are very important from a practical point of view are described in article . The resAnother technological process carried out in the water environment is the cutting of structural elements. Article  is devotThe issues of exploitation and the use of natural energy sources, currently often described in the scientific literature, also apply to the processes and materials used in the air environment ,21,22. TThe results of research on the plasticity of bead-on-plate welds made using two types of seamless, copper-plated, flux-cored wires stored in two locations are presented in article . The tesThe authors of  verify tArticles ,26 are dIn the second article of this research team, the weldability of elements from P91 and P22 steels during welding with the GTAW process is determined. The authors conclude that the inhomogeneity of mechanical properties (impact strength and hardness) across the as-welded joint is reduced after post-weld heat treatment .Materials, Metals, Coatings, Journal of Manufacturing and Materials Processing, and Applied Sciences [These Special Issue articles have been cited 122 times so far. This proves the topicality and importance of the subjects discussed within them. The continuation of the subject of this Special Issue is a Topic entitled \u201cWelding and Joining of Materials in Off-shore and Energy Industry\u201d, which intends to collate articles published in the following journals: Sciences ,28,29,30"}
{"text": "An increasing number of studies have shown the effects of time-restricted eating (TRE) on metabolic diseases and cardiovascular diseases associated with obesity. However, no bibliometric analyses were conducted in this field systematically. In our study, we aimed to visualize the publications about TRE to determine the frontiers and hotspots and then provide references and guidance for further studies. Publications about TRE were exported from the Web of Science Core Collection (WOSCC) database. VOSviewer 1.6.16 was adopted to perform the bibliometric analysis. In our study, a total of 414 publications with 298 articles and 116 reviews were included. The publications in this field showed an upward trend from 2016. A total of 2016 authors contributed to this field. The most productive authors were Satchidananda Panda, Krista A Varady and Emily NC Manoogian. All publications were distributed from about 624 organizations from 49 Countries/Regions. The leading institutions were the Salk Institute for Biological Studies, the University of California San Diego and the University of Alabama at Birmingham, and the most productive countries were the United States, the People\u2019s Republic of China and Japan. All publications were from 182 journals, and the most productive journals were Nutrients, Frontiers in Nutrition and Cell Metabolism. The first highest cited reference with 991 citations was published in Cell Metabolism, and authored by Satchidananda Panda et al. There were four indicating research directions, and the keywords of the green cluster were time-restricted feeding, metabolism, circadian clock, and circadian rhythm. The keywords of the blue cluster were obesity, health, diet, and food intake. The keywords of the red cluster were intermittent fasting, weight loss, caloric restriction, and time-restricted eating. The keywords of the yellow cluster were insulin resistance, metabolic disease, cardiovascular disease, and caloric intake. The main research hotspots in the TRE field were TRE and circadian rhythm, TRE and obesity, TRE and metabolic disease, and TRE and cardiovascular disease. TRE represents new directions to evaluate the effects of the timing of eating on different diseases, especially obesity, Type 2 diabetes mellitus and cardiovascular disease. Previous studies have generated impressive data on the effects of TRE on metabolic diseases and cardiovascular diseases associated with obesity. More high-quality studies are needed to assess the mechanism and efficacy of TRE in a wide range of populations and diseases. Time-restricted eating (TRE) was an approach that all calorie intake is restricted within 12 h without reducing calories . It was via quantitative analysis of previous scientific literature. In our study, we conducted a bibliometric analysis of TRE to display the research status and draw visual maps and explored trends and hotspots in this field to provide the reference to future studies.An increasing number of studies have shown the effects of TRE on metabolic diseases and cardiovascular disease associated with obesity. However, these findings were not summarized and analyzed as a whole. Bibliometric analysis was widely used to investigate the developmental trends and main findings The Web of Science Core Collection (WoSCC) is widely used for bibliometric analysis, which is the most authoritative citation-based database with powerful indexing functions , 11. TheThe relevant records with \u201cFull Record and Cited References\u201d were exported in the format of \u201cPlain Text.\u201d The resulting set of publications was analyzed bibliometrically. The top 10 high-yield authors, institutions, country/region and journals according to publications and the characteristics of the top 20 highest cited publications were summarized.VOSviewer is a bibliometric tool which is developed for constructing and viewing bibliometric maps , 13. TheA total of 414 publications (298 articles and 116 reviews) were included, which was shown in A total of 2016 authors contributed to this field. Among them, Satchidananda Panda was the most productive author from the United States with 26 publications and an H-index of 15, followed by Krista A Varady with 12 publications and an H-index of 8, Emily NC Manoogian with 11 publications and an H-index of 5, Kelsey Gabel with nine publications and an H-index of 5 and Grant M Tinsley with 8 publications and an H-index of 6. Satchidananda Panda, Krista A Varady and Emily N C Manoogian were the most frequently cited authors. The co-authorship map of the authors was shown in the All publications were distributed from about 624 organizations from 49 Countries/Regions. The leading institutions were the Salk Institute for Biological Studies , University of California San Diego , the University of Alabama at Birmingham , University of Illinois (13 publications with 617 citations) and Texas Tech University (10 publications with 609 citations). The network visualization map of institutions was shown in All publications were from 182 journals. Among them, Nutrients was the most productive journal with 65 documents and 972 citations, which was followed by Frontiers in Nutrition with 13 documents and 101 citations, and Cell Metabolism with 10 documents and 3,224 citations. The most frequently cited journal was Cell Metabolism. The network visualization map of all journals was shown in The characteristics of the top 20 highest cited publications were summarized in The network visualization map of keywords was shown in To our best knowledge, this is the first study of bibliometric and visual analysis for TRE. In our study, a total of 414 publications with 298 articles and 116 reviews were included. The publications in this field showed an upward trend from 2016. A total of 2016 authors contributed to this field.The most productive authors were Satchidananda Panda, Krista A Varady, and Emily NC Manoogian. All publications were distributed from about 624 organizations from 49 Countries/Regions. The leading institutions were the Salk Institute for Biological Studies, the University of California San Diego and the University of Alabama at Birmingham, and the most productive countries were the United States, the People\u2019s Republic of China and Japan. All publications were from 182 journals, and the most productive journals were Nutrients, Frontiers in Nutrition and Cell Metabolism. The first highest cited reference with 991 citations was published in Cell Metabolism, and authored by Satchidananda Panda et al. There were four indicating research directions, and the keywords of the green cluster were time-restricted feeding, metabolism, circadian clock, and circadian rhythm. The keywords of the blue cluster were obesity, health, diet, and food intake. The keywords of the red cluster were intermittent fasting, weight loss, caloric restriction, and time-restricted eating. The keywords of the yellow cluster were insulin resistance, metabolic disease, cardiovascular disease, and caloric intake.In this bibliometric analysis, most of the articles were published from the United States, the People\u2019s Republic of China and Japan, and the percentage of articles from the United States was 44%(184/414). Of the top 10 institutions, seven were from the United States. Of the top 10 productive author, six were from the United States. In the field of TRE, the prominent contribution was from the United States. It indicates that the studies from other countries need to be enhanced.Through the combination of highest cited references and analysis of all keywords co-occurrence clusters, the research hotspots and frontiers were as follows: (1) TRE and circadian rhythm. In the top 20 highest cited references, five explored the TRE and the circadian rhythm, and the keywords of circadian clock and circadian were in the green cluster , 21, 25.This was the first study to conduct a bibliometric analysis of TRE. In our study, we displayed the research status and draw visual maps, and explored trends and hotspots in this field to provide the reference for future studies. There were several limitations in our study. First, all data were extracted from the WoSCC, and other databases such as Medline and Embase were not used. Second, only studies published in English were included. Finally, bias may still exist despite our normalization procedures. Further studies will provide new insight into this field.The main research hotspots in the TRE field were TRE and the circadian rhythm, TRE and obesity, TRE and metabolic disease, and TRE and cardiovascular disease. TRE represents new directions to evaluate the effects of the timing of eating on different diseases, especially for obesity, Type 2 diabetes mellitus and cardiovascular disease. Previous studies have generated impressive data on the effects of TRE on metabolic diseases and cardiovascular diseases associated with obesity. More high-quality studies are needed to assess the mechanism and efficacy of TRE in a wide range of populations and diseases.The original contributions presented in this study are included in the article/supplementary material, further inquiries can be directed to the corresponding authors.SW, XL, and YG were responsible for data collection, investigation, figures and tables construction, and writing the original draft. JH contributed to the discussion and final review and editing. All authors reviewed and edited the final manuscript."}
{"text": "The World Health Organization recommends active commuting to and from school as a source of physical activity. Worldwide, active commuting, i.e. walking or biking, is determined by various factors including gender, socioeconomic status of families and neighborhoods, the built envormnet, distance to schools, perceived neighborhood safety, life styles, and availability of walkways, biking paths and parks. Previous studies from Swedish indicate that the proportion of youth being active commuters descres with age, but has also decresed over time. This study aimed at assessing health and environmental factors associated with modes of transportation to and from school among 333 adolescents aged 16-19 living in a middle-sized city in Sweden.The present city has 380 kilometer of walking and biking paths that cover the whole city, of which parts are heated in the winter to avoid snow and ice. Still, only 32% of the adolescents were active commuters to and from school. Active commuting was linked to other healthy behaviours including more frequenct daily consumption of fruits and vegetables and less frequent consumption of junk food. Morover, the presence of well illuminated walking and biking paths was strongly associated with active commuting, as compared to not having access to less illuminated paths. However, the relation between active commuting and socioeconomic status of the neighborhood was complex and needs to be explored in future larger studies.The results will be used to increase awareness of the health and enviromental benfits of active commuting among adolencnets, schools, and local policy makers."}
{"text": "Research in wearables for rehabilitation, assistance, and augmentation have generally focused solely on motor or sensory (in particular haptic) aspects. Considering the combined sensorimotor aspects of such wearables can create new research directions, and stands to improve the function seen in state of the art devices. In this topic, authors contributed works along three broad themes: design, control, and assessment.Varghese et al. and Alvarado-Rivera et al. on the importance of managing the pressures at the interface between the wearer and the robot, or the combined wearer-robot system and the environment in order to achieve high performance goals. The other papers in this group focused on the challenging design requirements in prosthetic hands, proposing designs to incorporate human-like capabilities or distribute the control strategies into passive or mechanically-intelligent structures. Gao et al. presented a differential mechanism to accommodate the high degrees of freedom of the hands with a reduced set of actuators. Hocaoglu and Patoglu focused on recreating the variable stiffness capabilities of human hands with a novel mechanism. Lastly, Weiner et al. developed a prosthetic hand capable of semi-autonomous grasping, relying on a multi-modal sensor network combined with adaptive underactuated mechanisms.With the design theme of the topic, a major motivation and emphasis was placed by Gantenbein et al. presented a review of intent detection strategies for upper limb orthoses. Hocaoglu and Patoglu presented an sEMG-based control strategy to leverage the performance of the variable stiffness actuator introduced in a previous paper in the topic. Instead of seeking to recreate the human impedances, Kumar et al. proposed an admittance controller to enable human-like gait on arbitrary slopes. Also aiming to improve the control of lower limb prosthetics, Hong et al. presented the connections between torso kinematics and gait phase estimation. Lastly, with a focus on rehabiliation instead of augmentation or prosthetics, Topini et al. proposed an admittance controller for use in VR training environments, and examined its performance in a single subject pilot.Several papers within the topic coalesced around a theme of control and intent detection to support wearable robotic implementations. Dissanayake et al. investigated the fatigue in upper limb motions via changes detectable via EEG. Lastly, Patrick, Kumar, and Hur and Patrick, Kumar, Hong, and Hur examined the biomechanical implications of the orthotic and prosthetic kinematic structure, respectively, on the kinematics and kinetics of gait.Several manuscripts focused on a third theme, that of assessment of the combined human-robot system. Taken together, the works in this Research Topic underscore the far ranging applications of considering sensorimotor aspects in wearable robotics, ranging from the design of human-robot interfaces to EEG assessments. These new designs and results are another step toward achieving the potential of wearables, but there are still many open questions and unknowns in this highly interdisciplinary field, which will require further investigation and collaboration.A fundamental limitation in the current research model is the difficulty at achieving long duration studies with large population sizes. In some areas, this may be overcome via commercialization, but in others, the field may need to rely on large studies on standardized equipment, such as open-source designs, such as the Open Source Leg (Azocar et al., Gantenbien et al. are the first steps in this direction. Next steps may look like the creation of standardized performance metrics and methods, such as those proposed for prosthetics (Light et al., To make the next generation of devices, controllers, and interfaces, assessment and inclusion of end users in the initial design and validation process, such as the usability and evaluation from authors such as While kinematic and kinetic assessments have been well established, with advances presented in this topic, the field can also benefit from additional investigation into the connections between sensory and motor function, such as Lowrey et al. . Future Lastly, and at the risk of understatement, the future work is dependent on continued advancement in the miniaturization, proliferation, and optimization of the requisite mechatronic subsystems. As these fields advance, wearable robotics need to be prepared to take advantage of the opportunities the latest, lightest, most efficient, and lowest-cost batteries, sensors, and actuators, and computational resources affords us.All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.This work was partially supported by the Khalifa University of Science and Technology under Award No. RC1-2018-KUCARS and FSU-2021-019.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "The discussion of the control of Chagas disease (CD) is a necessity, which is increasingly current and on the agenda of world public health. This disease has many facets, remaining in endemic countries and appearing in non-endemic countries, given the persistence of old ways of living of the countryman and the current, highly technological living, typical of the modern world. Large migratory movements, social upheavals, inequalities and advances in medicine with the use of blood products, the performance of organ or tissue transplants, together with rapid means of transport, has facilitated the maintenance of the dissemination of this trypanosomiasis globally.Estimates of the number of people with CD at the end of the last decade pointed to the presence of millions affected in South America, Central America and Mexico. The forms of transmission, in several countries, were and are still, mostly vectorial, surprisingly congenital, in addition to the recently recognised oral transmission. The number of patients with chronic CD is very high, because they reflect the sum of cases from several previous years and current ones, considering that this disease has a long and chronic evolution.Trypanosoma cruzi to the United States, Europe, Australia and some Asian countries, with the spread of the infection in these regions being mainly due to the use of blood, blood products and transplants.At the same time, migratory pressure remains between poor and rich countries. This human movement has led a significant number of people infected by In addition to vectorial transmission, congenital, that occurs in endemic countries, transmission through blood and blood products, and by transplants is also observed, demonstrating the contrasts existing in these countries, that is, in addition to the old forms of transmission, more recent forms have appeared. Given these more complex forms of transmission, there are thousands of new cases of CD in several of these regions, with active disease and consequently a significant number of deaths resulting from trypanosomiasis.The second most important cause of transmission in general, which is the main cause in non-endemic countries, is mother-to-child infection, called congenital CD. The distribution of this form of transmission is wide and remains high due to the still large number of infected or sick women of childbearing age.Certainly the transmission by blood and blood products is a risk factor in endemic countries and therefore all blood products should be tested for CD. In non-endemic countries, screening policy varies, with some doing good-quality screening tests and others centring screening in people from endemic areas or those who have visited endemic areas.Finally, all transplant cases need to be conducted rigorously both for the diagnosis of donor infection, drug prophylaxis in people at risk, the in-depth investigation of infection in recipients and treated donors and recipients, and whether or not there were successful therapeutic responses.But the central point of this discussion needs to have another focus. As the article points out, there has been a large progression in diagnosis, currently with serological tests, with high sensitivity and specificity, which allow for a good diagnosis. There are also quantitative polymerase chain reaction (PCR) and mRNA PCR tests, both complex molecular biology techniques, also with excellent predictive values. Laboratory tests have been developed for the identification of trypanosome strains, which allow us to associate those strains more associated with the different forms of clinical evolution of the disease, including those at higher risk of congenital transmission.This extensive presentation of the epidemiological situation above reveals a paradox. All the technology available, especially in rich countries, which has infected immigrants, but in small numbers when compared to endemic countries, is worrisome, given the objective of not affecting non-endemic countries. Technologies which, by the way, are very well received, but are of difficult access by endemic countries.The contrast of this situation lies in the lack of the development of new technologies that can be used in the field, in order to eliminate the transmission vector of CD, since the endemic disease still remains. We need to create tests that can be used in the field, such as rapid tests already in use for HIV, Hepatitis, Syphilis and a multitude of other non-infectious diseases, enabling an easy diagnosis, without requiring large laboratories and thus allowing early treatment of large numbers of newly infected individuals, thus redirecting interventions.The search for drugs or other prevention technologies, such as the use of antiretrovirals used in pre-exposure, is an example to be copied, especially for regions where environmental interventions and access to at-risk populations are still difficult.Why do we not discuss the need to mobilise health services for the annual screening of large at-risk populations in endemic countries, why is the treatment of millions of patients not established as a priority, seeking to use the most modern interventions, but adapted to environments without major health structures?Therapeutics visibly develop due to the social pressure that a disease constitutes to society; this statement is easily identifiable in the development of drugs against H1N1 infection, acquired immunodeficiency syndrome (AIDS) infection, more recently with Coronavirus disease 2019 (COVID-19), among many other infectious diseases or not. Of course all this technology developed for the coping of these pandemics or disease is highly valued, however, one must ask simultaneously, what technological advances have occurred to eliminate the secular CD, which drugs have emerged to cure different forms of the disease and transmission through the placental barrier and, finally, what technology has emerged to control the vectors, that allows the non-infection of these insects, in order to break the natural transmission cycle?Recently, the World Health Organization (WHO) elected a World Chagas Disease Day, an initiative of great value, but which needs to have the goal of breaking the cycle of endemicity, needs to provide visibility to the indignation that humanity must feel with the thousands of agonising deaths annually of men, women and children, who have access to almost no benefit of new technologies and worse, not even to the oldest treatments.T. cruzi infection is not questioned, however, we expect that the call of the reality of millions of lives also directs efforts to save them. This is the main challenge of all development.The importance of new diagnostic methods, new therapies, new uses of organs at risk of infection, in short, of all that science and BIGFARMA have been developing for the management of"}
{"text": "Formerly Professor and Head of the Institute of Psychiatry, Rawalpindi, Principal, Rawalpindi Medical College and Vice-Chancellor, University of Health Sciences, Lahore, PakistanMalik Hussain Mubbashar, the leader of psychiatry in Pakistan for a generation and a pioneer in the development of community mental health services and psychiatric research, died on 10 August 2020, at the age of 75 years. His work in the establishment of community mental health services served as a model for such services in low-income countries throughout the world. Initially, local men were recruited and trained to provide services to those identified in need. This was soon followed by school programmes, which enlisted head teachers, persuading them to include information about mental disorders in their curricula. Professor Mubasshar was remarkably innovative in his approach, for example, recruiting children to identify people in their village who might benefit from seeing a doctor and arranging travel for them. His research activities were always both scientifically rigorous and highly relevant to the needs of people with mental health problems in areas where specialist services were thin on the ground or non-existent. He carried out a community survey of stress and psychiatric disorder in rural Punjab, a prevalence study of psychiatric morbidity among the attendees of a native healer in Rawalpindi, as well as a unique randomised trial of the impact of a school mental health programme in rural Rawalpindi, Pakistan. He had a highly productive publication record, authoring or co-authoring many peer-reviewed papers as well as 28 books.He was highly effective as a teacher. At the Rawalpindi Medical College (RMC), where he was Principal for some years, he reorganised undergraduate education, introducing problem-based learning. As Vice-Chancellor of the University of Health Sciences, Lahore, he made the study of behavioural sciences mandatory in undergraduate medical education. He was responsible for the postgraduate psychiatric training of large numbers of junior doctors, for many of whom he arranged further training in the UK, especially with Professor David Goldberg in the Department of Psychiatry at the University of Manchester, with whom he developed a special link. When they achieved consultant status, many of his former trainees would put up a photograph of Professor Mubasshar in a prominent position in their departments. He was also active in obtaining legal rights for people with mental illness in Pakistan. After years of incessant effort, he was instrumental in the passage of the Mental Health Ordinance 2001. His interest in promoting public policy in favour of the mentally ill more generally motivated him to make links with whoever was President of Pakistan at the time.His influence in psychiatry extended well beyond national boundaries. His Institute of Psychiatry in Rawalpindi was recognised as a World Health Organization (WHO) Collaborating Centre for Mental Health Research and Training, of which he was the Director. Among many other international positions, he was chair of the Global Mental Health Network, Global Forum for Health Research at WHO, Geneva. The WHO Community Mental Health Programme was his brainchild, and he had a particularly influential link with the development of such programmes in the WHO Eastern Mediterranean region.Malik Hussain Mubbashar was born in Lahore on 1 August 1945, the son of Miraj-ud-din Malik and Shahzadi Anwar. His father was a government employee in the irrigation department. After completing his medical training at King Edward Medical College, Lahore, in 1968 with honours, he underwent further medical and then psychiatric training in London at Guy's Hospital with David Stafford-Clark. While in England he passed the membership examinations of three UK medical colleges. He was strongly motivated by having seen in childhood the ill-treatment of the mentally ill.On return to Pakistan in 1972, he was appointed to the Central Government Hospital, Rawalpindi. However, to his disappointment, the administration of the hospital made it abundantly clear that he was not welcome as a psychiatrist and refused him any clinic space to see psychiatric patients. Manifesting his inevitable grit, as he did throughout his career, he set up his table and chair under the shade of a tree in a neglected, remote corner of the hospital. Within 8 years, his department had grown into an Institute and then into a WHO Collaborating Centre.His administrative talents and leadership qualities were rapidly recognised. Professor Mubbashar was closely involved with the College of Physicians and Surgeons Pakistan (CPSP), becoming Dean of the newly formed Faculty of Psychiatry. He was elected President of the Pakistan Psychiatric Society. He served as Principal of the Rawalpindi Medical College before going on to become the Vice-Chancellor of the University of Health Sciences, Lahore.During his lifetime he was accorded many honours. Two of the highest civilian awards of the Pakistani government, Hilal-e-Imtiaz and Sitara-e-Imtiaz, were conferred on him. The CPSP's gold medal for psychiatry, the most prestigious medal in the field, is named the Malik Hussain Mubbashar Gold Medal.In his spare time, he enjoyed visiting rural areas and trekking.Professor Mubasshar is survived by his wife Dr Yasmin Mubbashar, whom he married in 1973, children Sabooh, Aamna, Zainab, Saima, Fatima, Maryam and Imtiaz (five of whom are psychiatrists) and 15 grandchildren."}
{"text": "With the rapid development of the economy and society, the low efficiency and high loss of the traditional power grid can no longer meet the growing social demand, and the power grid market is facing a reform. Smart grid, as a next-generation power system, it can effectively improve the performance of traditional power grids. The ubiquitous power Internet of Things (UPIOT) replaces the traditional grids with efficient, safe, reliable, and flexible new grids, improves the utilization efficiency of the grid, reduces the loss of the power grid in the transmission process, and can meet the needs of different types of markets and users. As an advanced information acquisition and processing technology, wireless sensor networks have been widely used in medical, industrial, agricultural, commercial, and public management fields. It is an important means to promote future economic development and build a harmonious society. In the power system, wireless sensor network technology can be widely used in many fields such as line fault location, real-time monitoring, smart meter reading, and relay protection. In this paper, the basic concepts and overall architecture of ubiquitous power Internet of Things are summarized. Then, we summarize the research status of the wireless sensor network in smart grid, including power equipment, line monitoring, smart grid wireless automatic meter reading, distribution network relay protection, power assets life-cycle management, power grid fault location, and power grid fault diagnosis. In view of the technical characteristics of wireless sensor networks, combined with the production links of power systems, the application framework of wireless sensor network technology in the power systems is constructed. The application of wireless sensor networks is prospected from the aspects of network development of relay protection, application research of smart substation, application research of power grid catastrophe, security protection of power system, and deep-seated ubiquitous power Internet of Things. The traditional power system monitoring and diagnosis system is realized by wired communication, but the wired monitoring system has the high installation and maintenance costs and inconvenient installation , 2. TherThe smart grid combines advanced technologies including sensing, measurement, control, and decision-making. On the basis of the integrated and high-speed communication network, the intellectualization of power grid is brought into full play . ThroughWith the increasing proportion of new energy grid access and the deepening of power reform, the traditional power grid and power enterprises are facing greater external competitive pressure, while the traditional equipment is difficult to match the volatility of new energy, and the lack of interaction with the external environment makes it difficult for enterprises to meet more new demands of users . The intProvide a review of the basic concepts of power Internet of things and the overall architecture of ubiquitous power Internet of Things.Present a comprehensive review of the application statuses of WSNs in ubiquitous power Internet of Things with the aim to represent the state-of-the-art technology by including the most recent approaches.Summarize the challenges of WSNs in ubiquitous power Internet of Things.Provide a review of the development trends of WSNs in ubiquitous power Internet of Things.In this paper, we have deeply studied the application status of wireless sensor networks in the ubiquitous power Internet of Things, challenges, and prospects for future research. In comparison with the current general selection approaches, the main contributions of the proposed work are as follows:The remainder of this paper is organized as follows. The online monitoring of important operation parameters in various links of the ubiquitous power Internet of Things can strengthen the prediction, prevention, and control of equipment status from the aspects of safety, reliability, adjustability, and antidisturbance and provide intelligent auxiliary decision-making for reliable monitoring of transmission lines and scientific operation and maintenance of distribution links , 23, thuWireless sensor network mainly deploys a large number of sensor nodes in the target area, collaboratively perceives and collects various environments or monitoring object information, deeply integrates multiparameter parameters and collaborative processing, and abstracts the state of the environment or object objects . With itFor the smart grid, the general architecture of the ubiquitous power Internet of Things can be divided into the perception layer, the network layer, and the application layer .The sensing layer is mainly composed of several sensing nodes deployed in each sensing object. The sensing network is built up in a self-organizing manner to realize intelligent collaborative sensing, intelligent identification, information collection and processing, and automatic control of the grid object and the operating environment. Through a variety of new microelectromechanical system sensors, intelligent sensors based on embedded systems, intelligent acquisition equipment, and other technical means, the identification and acquisition of the mechanical state, energy consumption, and environmental state of key equipment in each link of smart grid, such as the power generation, transmission, substation, distribution, power consumption, and dispatch, are completed.The perception layer integrates and expands different types of communication networks, such as power wireless broadband, wireless public communication network, wireless sensor network, and power optical transmission network. It realizes the functions of information transmission, routing, and control between the perception layer and the application layer and provides high reliability, high security, and large-scale data transmission services for the perception information. In the application of smart grid, the transmission, convergence, and control of information in power Internet of things are mainly realized by the power communication network, supplemented by the public telecommunication network. The network layer generally includes an access network and a core network. The core network is mainly a power backbone optical fiber network, and the access network is mainly a power fiber access network, a power line carrier, and a wireless digital communication system. The power communication network provides a high-speed bandwidth two-way communication network platform for the application of power Internet of Things.The application layer analyses and processes the information and data of the perception layer according to different business needs. The application layer includes application infrastructure, middleware, and various applications. The various applications of the application layer involve the production and management of the whole life cycle of the smart grid. Through the use of intelligent computing, pattern recognition, and other technologies, the comprehensive analysis and processing of power grid information and the continuous improvement of the level of intelligent decision-making, control, and service of power grid can be realized, so as to promote more convenient, green, and efficient power.Power equipment and line condition monitoring mainly utilizes the increasingly perfect information data platform and various business systems to obtain a large number of equipment, line status, power grid operation and environmental meteorology, and other related data of power equipment operation . Then, bThe high-voltage overhead transmission line is an important part of the power grid. The breeze vibration caused by the breeze and the wind deflection of the wire are the main reasons for the fatigue and breakage of the high-voltage overhead transmission line . The linThere are many types of equipment for transmission, transformation, and distribution in the power grid, and the operation and maintenance workload is large . UsuallyCarry out the state maintenance of power transmission and transformation equipment to improve the utilization rate of equipment, extend the lifetime of equipment, reduce the number of blackouts/blackouts time, and improve the efficiency of transmission. The status monitoring of power transmission and transformation equipment also serves as a diagnostic tool for auxiliary equipment status and plays a huge role in the state maintenance of power transmission and transformation equipment . ThroughUbiquitous power Internet of Things combined with a variety of sensors to form a collaborative sensing network, wireless sensor network technology. In accordance with certain strategy deployment, vibration, displacement, and voltage change, infrared sensors are installed on outdoor lines, poles, distribution transformers, and other equipment . CollectSome experts and scholars have carried out a lot of research on power equipment and line condition monitoring. Morales-Velazquez et al. proposed a field-programmable gate array (FPGA) technology for smart meters based on remote monitoring of grid operation. This technology allows the reconfigurable architecture, allows users to select appropriate processing modules according to their applications, so as to realize real-time understanding of system performance and detection of potential faults . In ordeBased on the main ideas mentioned above, the main structure diagrams of smart grid power equipment and line online monitoring are summarized. The structure diagram of smart grid power equipment and line online monitoring is shown in The traditional electricity consumption statistics use the manual meter reading method, which is usually counted once a month, so that the electricity statistics will have errors. The most important thing is that the power consumption cannot be monitored in real time, which does not meet the requirements of real-time electricity price. The application of the wireless automatic meter reading system based on the wireless sensor network, instead of manual meter reading, can greatly reduce the cost and can monitor the electricity consumption in real-time . The reaAccording to the characteristics of the smart home metering system with short communication distance and large number, the wireless sensor network is introduced into the metering system, and the wireless sensor nodes are installed in the home appliances, coordinating each other between household appliances and smart meters in wireless networks. Neto et al. presented several proposed and existing smart utility meter systems as well as their communication networks to identify the challenges of creating scalable smart water meter networks . In 51]51], an aFrom the system architecture, the network is divided into four parts, namely, smart meters, collectors, concentrators, and host computers. As the lowest-level device of the system, smart meters are meters that measure the use of electrical energy. In the system, the collector acts as the terminal node of the network and is responsible for collecting the data information of the electric energy meter and the data information of the electric energy meter of the station area. The concentrator in this system mainly implements two functions. The first is to implement the function of the network coordinator, responsible for setting up the network. The second is to achieve communication with the host computer. The upper computer actually connects the remote automatic meter reading system with people. The upper computer can view the energy data in real time and can also perform data analysis.In the power grid system, the relay protection is an important measure to protect the stable operation of the power system, which is involved in the measurement and control system of the power system. In order to ensure the sensitivity and reliability of the relay protection device, it is required to install differential protection in the small- and medium-sized motor. Due to the high magnetic field strength inside the motor, if the signal transmission line of the sensor is not well shielded or the wiring is not suitable, the motor differential protection may malfunction due to possible electromagnetic noise. The wireless current sensor combined with the coil can be conveniently installed, and there is no conventional current transformer secondary current saturation problem, and wireless communication is used to avoid complicated wiring problems. The sensor sends digital information containing the current amplitude and phase of some of the motors, and these transmitters have time-division multiplexing without interfering with each other. When the frequency of the receiver is set to the same as that of the transmitter, the signal is received and demodulated to obtain the current measured by the sensor on the spot. This information is used to calculate the differential root mean square (RMS) to trigger an alarm or signal.When the current differential protection is outside the fault, the current transformer error caused by the current transformer saturation is an important factor causing the current differential protection to malfunction. At present, many methods have been proposed for this problem, but these methods are all analyzed and calculated under the condition that saturation has already occurred, and the problem of saturation is not fundamentally solved. Various differential protection systems for coil-based electronic wireless current sensors make it possible to completely solve this problem. Furthermore, the wireless sensor node is coupled with the electronic current sensor, which can replace the wired transmission medium to solve the problem of current signal transmission between the high and low voltage of the electronic transformer. Zhan et al. presented an optimal distributed generation placement method to maximize the penetration level of distributed generation in distribution networks without changing the original relay protection schemes . In 57]57], the The wireless sensor network provides great convenience for the work of relay protection to collect information and ensures the reliability and stability of this information, and fully exerts the function of relay protection. For the substation protection equipment in which the sensing technology is applied, the parameters are set correspondingly not only in the original transformer current and voltage loop, but also in the position of the transformer itself and the primary and secondary equipment. These include current, voltage, and temperature sensors. These settings will give full play to the monitoring function of the sensor and improve the effect of relay protection.In recent years, electric power enterprises have put forward specific management requirements for their asset life-cycle management and actively carry out the linkage correspondence between the stock assets data . The linThe application of different levels of RFID technology is carried out throughout the life cycle of the grid assets to realize storage, batch reading, and data transmission of equipment information, realize the precise management of equipment life cycle, and bring good economic benefits. The use of RFID technology can effectively solve the input and output of important assets and business process control tracking in the whole life-cycle management process of the grid, thereby realizing the optimal management of power assets, thereby reducing the error rate of manual operations. This is extremely important for improving the informationization level of asset management. RFID technology can effectively embed the daily management of assets into the asset management system, realize effective management of daily operations of assets, and strengthen the daily supervision of the system, so as to reduce the pressure of daily management of assets. In , the autWe use the radio frequency identification and identification coding system to automatically identify and locate power equipment, provide technical support for realizing life-cycle management of power assets, improve operational efficiency, and improve management level. The intelligent wireless sensor is installed on the transformer to calculate the cumulative running time and the actual load level; the smart wireless sensor installed on the circuit breaker can automatically record the number of circuit breaker actions, overcurrent conditions, and contact temperature. The data recorded by intelligent sensors are transmitted to the control center through wireless ad hoc networks, and then the remaining service life of the equipment and the current operation status of the equipment are obtained through cloud computing processing data and intelligent analysis and calculation of expert systems. Faults are detected as early as possible, condition maintenance is done well, service life of the equipment is improved, and the life-cycle management of the power assets of the whole network is achieved.In order to ensure the safe and reliable operation of the power transmission network, it is ensured that the background monitoring system can monitor the running status of the transmission line in real time and report the fault location information in time when problems are found on the equipment site. Some experts and scholars use wireless sensor network technology to solve the problem of grid fault location. The block diagram of the wireless sensor network fault location system in the smart grid is shown in Due to the uneven distribution of power plants and power loads, power transmission through long-distance transmission lines is required, which increases the risk and probability of grid failure. Therefore, after the grid failure, the dispatch center needs to collect accurate fault location information immediately. At present, a large number of universities and state grid enterprises have conducted research on this issue and achieved corresponding results.Liang et al. proposed a general method for fault location in complex power grid, and the Manhattan distance is adopted to find out the accurate measuring combinations, by which the preliminary fault location is calculated . Aiming Wireless sensor networks have been recognized as a technology for seamless, energy-efficient, reliable, and low-cost remote monitoring in smart grid fault diagnosis applications. In these power systems, the required information can be provided to the power facility monitoring center via wireless sensor systems, which can greatly improve inspection efficiency and reduce maintenance costs. Real-time information gathered from these sensors can be analyzed to diagnose problems early and as a basis for taking remedial measures. The intelligent technology of wireless sensor network technology applied to power grid fault diagnosis is reviewed. By combing the research on fault diagnosis methods of multiple intelligent technology fusion, the smart grid fault diagnosis method is shown in Excessive temperature in electrical facilities is a common cause of facility failure. In , the autIt can be seen from the above literature that wireless sensor networks have broad application prospects in smart grids and use wireless sensor network technology to realize the intelligentization of power grids in all aspects of power generation, transmission, and power consumption. In the power generation, wireless sensor network technology is used to realize online monitoring of the operating unit, improve the safety and stability of the unit, and realize the state detection and condition maintenance of the power generation equipment. In the transmission and transformation, wireless sensor network technology can effectively monitor the transmission line and substation equipment online, ensure the safe operation of transmission lines and substation equipment, improve transmission efficiency and transmission reliability, and achieve automatic diagnosis. In the power distribution link of the power grid, wireless sensor network technology is used to realize online monitoring and early warning of the status of the distribution network, so as to realize the rapid positioning of distribution line faults and ensure the safe and stable operation of the distribution network. In the power consumption of the power grid, wireless meter reading technology based on wireless sensor network technology can be used to monitor power usage in real time, optimize load forecasting and grid load scheduling, and guide users to save electricity and prevent electricity from being stolen . The chaIn the online monitoring of transmission lines, the deployment of wireless sensor networks will face severe communication networking technology challenges as transmission lines extend in a linear manner. In addition, most of the high-voltage transmission lines are installed in inaccessible places, and the lines are long and narrow. It is necessary to realize multihop wireless network protocols under the condition of ensuring low energy consumption, which has great technical challenges. Another technical constraint is the power supply problem of online monitoring devices. In addition to the serious electromagnetic interference caused by the transmission system transmission, the wireless sensor network is in a strong electric field environment, and it is also easy to couple to generate high induced voltage and penetrate the burnt equipment. This also poses a severe challenge to the transmission line monitoring equipment.In the field of power distribution site operation supervision and intelligent inspection, although the existing system already has the level of intelligence, the application of RFID tags in the existing system is limited to equipment identification and does not have the functions of confirming object status, matching work procedures, and recording operation process, and cannot achieve the ultimate goal of reducing the risk of misuse and potential safety hazards. In addition, the video sensor of the same type of system is not used, and the real-time interaction between the dispatching command center and the field operators cannot be realized. The inspection work (such as the supervision mechanism for the inspection personnel and the automatic information collection process) still needs to be further improved to achieve the purpose of effective, reliable, and safe inspection.In terms of intelligent power consumption information collection, the current power consumption information collection and transmission technology has preliminary application, but there are still problems of reliability, availability, maintainability, and practicality. A single communication technology cannot solve the problem of reliable transmission of power usage information in different areas of electricity.In the construction of intelligent electricity service, the communication network resources for the customer side are insufficient, the interaction functions between various systems and users are not sufficient, and the requirements for intelligent power service cannot be fully adapted. The system functions need further development and integration.In terms of user service technology and equipment, the original system construction is less standardized, and the technical solutions and functions are greatly different. The terminal equipment is diverse in form, the level of intelligence is not high, and the functions are limited.At present, some applications of wireless sensor networks have been explored in the power industry, but there are some problems, such as single business-oriented applications and lack of top-level planning and design for unified applications of ubiquitous power Internet of Things. Moreover, the application environment of the power wireless sensor network is complicated, and the communication technologies involved in the application are diverse, the protocol is complicated, and the data collaborative processing is difficult. For the specific application of power grid transmission and distribution system, the application of the wireless sensor network in power grid has some challenges in five aspects: transmission line inspection, distribution site operation supervision and intelligent patrol inspection, intelligent power information acquisition, intelligent power service construction, and user service technology and equipment.Wireless sensor networks have many distinctive features: (1) peer-to-peer network, data-centric; (2) modularization of hardware structure, simple and convenient system construction; (3) dynamic change of network topology; (4) strong transmission capability, low packet loss rate; (5) high energy efficiency; (6) strong anti-interference ability; (7) multihop routing. The application framework of the wireless sensor network in ubiquitous power Internet of Things can be summarized as data acquisition, data preprocessing, model training, parameter tuning, feature output, function, application unit, and so on. The technical framework of WSNs in ubiquitous power Internet of Things is shown in At present, the ubiquitous power Internet of Things is developing towards high proportion of renewable energy, high proportion of power electronic equipment, multienergy complementary comprehensive energy utilization, and deep integration of physical information. Therefore, it is faced with new energy consumption, safe operation of large power grid, multienergy and high efficiency cascade utilization, information security protection, and intelligent fault diagnosis of equipment. Self-organizing, multihop routing, application correlation, security reliability, and anti-interference based on the technology of wireless sensor network, and its application in relay protection network development, smart substation application research, power grid catastrophe application research, power system security protection and deep-seated ubiquitous Internet of Things are prospected.With the rapid development of Internet technology, information technology has been applied to various fields of power grid. In the relay protection technology, it should also be fully integrated with the network technology to achieve information sharing and information transmission by means of the network technology, so that the speed of information transmission is greatly improved, and the effectiveness and accuracy of information can be guaranteed. In addition, the networking of substation can promote the networking of relay protection. The power equipment is connected by wireless communication network technology, the power information can be transmitted efficiently, which provides great convenience for power work, and the relay protection system is more widely used.Intelligent substation is an important foundation and support for a strong smart grid. The intelligent substation is made up of advanced, reliable, energy-saving, environmentally friendly, and integrated equipment. It transmits information by high-speed network communication platform and automatically completes basic functions, such as information collection, measurement, control, protection, measurement, and monitoring, and supports advanced application functions such as real-time automatic control, intelligent adjustment, online analysis and decision-making, and collaborative interaction. Wireless sensor network technology integrates the intelligent sensor technology, the distributed information processing technology, and the wireless communication technology. Different sensors are used according to the practical application detection needs. According to the communication delay and bandwidth requirements in practical application, different radio frequency communication technologies can be adopted. It is very suitable for monitoring nonelectrical parameters in smart substation. The construction of smart substation can be greatly accelerated by using wireless sensor network technology.The primary goal of the smart grid is to improve its safety and reliability. The main causes of natural disasters causing large-scale power outages in the power grid are failure of the longitudinal protection channel, failure of the main protection, destruction of the power infrastructure, and changes in the protection caused by the grid. At present, most of the existing power communication networks in the world use wired methods for communication. Even a small number of wireless communication networks rely on base stations to transmit information, that is, the existing power communication networks are inseparable from basic communication devices. Under the natural disasters, basic communication devices are very fragile and easily cause network failure. Wireless sensor networks have the characteristics of self-adaptation, self-organization, and multihop. As an effective means to cope with power grid disasters, it is extremely urgent to introduce a new power communication network.The smart grid is a typical information physical fusion system. It uses a large number of sensing devices and complex communication networks to form a complex system of real-time sensing, information services, and dynamic control. Deep information flow interaction will make the power system face more potential threats. The network attack of the power system has the characteristics of strong concealment and long latency. Although it does not directly damage the primary equipment, it can destroy the secondary system to achieve the purpose of attacking the physical power grid. The wireless sensor network technology can automatically identify the characteristics of the network attack and can be used for malware detection and intrusion detection to realize network security protection of the power information physical system. Compared with traditional machine learning methods, wireless sensor network technology can effectively improve the detection efficiency and correct rate of network security attacks.Ubiquitous power Internet of Things is a kind of intelligent service system with comprehensive state perception, efficient information processing, and convenient and flexible application, which makes full use of modern information technology and advanced communication technology, such as mobile interconnection, artificial intelligence, to realize interconnection, and human-computer interaction in all aspects of the power system. It includes a four-layer structure of the sensing layer, the network layer, the platform layer, and the application layer. Through the extensive application of information technology and intelligent technology such as big data, cloud computing, Internet of Things, mobile interconnection, artificial intelligence, block chain, and edge computing, all aspects of resources are brought together to provide sufficient and effective information and data support for planning, construction, production and operation, management, comprehensive services, new business model development, and enterprise ecological environment construction.In this paper, the core technologies of wireless sensor network technology and ubiquitous power Internet of Things are studied in depth, and the power communication network is extended to the production site and users of power grid. It has important guidance and demonstration value for constructing ubiquitous sensing network covering various nodes of grid production, operation, management, and service. On the one hand, the ubiquitous sensing power Internet of Things achieves coverage of more nodes and can comprehensively improve the overall perception, data collection, and service interaction capabilities of grid production, grid services, and grid management. On the other hand, the construction of power Internet of Things and the development of a large number of sensors, terminals, and systems for the collection of the Internet of Things provide a convenient means for data collection, greatly reducing the cost of perceiving various types of data perceived by the power Internet of Things and laying a technical device and the network foundation for the large-scale development and application of large-scale data acquisition and data in the smart grid.With the continuous development of the scale of the ubiquitous power Internet of Things and the accumulation and increase of the data collection scale, the follow-up work will further develop and study the cross-professional integration, deep sharing, and accurate user service technologies based on the data collected by the power Internet of Things, which can provide more scientific, efficient, and intelligent decision support for the production, operation, and management of the power grid."}
{"text": "In 2022, the National Program for Influenza Prevention coalition will have its 10th anniversary; it is one of Poland\u2019s oldest educational initiatives. The National Program for Influenza Prevention was initiated to prevent a further decline and promote influenza prevention in the A(H1N1) post-pandemic years. In this review, we summarize the structure and operational model of the coalition and identify core functional elements that make it a key non-governmental organization involved in the prophylactics of communicable diseases. The coalition-based organization can operate in a complex environment, such as vaccinations requiring scientific, economic, social, and psychological involvement, and communications with different groups. Anchored to the history of the National Program for Influenza Prevention, we review Poland\u2019s vaccination landscape changes from the last ten years. In Europe, before the COVID-19 pandemic, influenza ranked the highest in burden of disease among all communicable diseases . In the Low vaccination coverage, distrust in the effectiveness of seasonal vaccinations, and false beliefs forced collaborators to change the knowledge, attitudes, trust, and the Polish vaccination organization system. Who ignited this change? They were parents of children negatively affected by influenza and young lawyers who opposed the inert attitudes of the state toward the primary prophylactics and healthcare organizations in Poland. In November 2012, the National Program for Influenza Prevention (NPIP) was established. The NPIP focused its educational initiatives on the medical society, the public, local politics, employers, and finally, the government, to shape the influenza infection prevention and treatment system in Poland. The core of the NPIP was medics; however, the initiative quickly gained support from people in the media, science, culture, and business organizations. In 2022, NPIP had its 10th anniversary, making it one of the oldest educational initiatives in Poland. This review, authored by the members of the NPIP scientific council and supporters, discusses the structure and aims of the program, its operational model, and changes made in the flu vaccination landscape in Poland. We present diversified and long-term activities of the NPIP, which enabled better access to influenza vaccines, modified social attitudes, and gradually increased the vaccination rate in Poland.The NPIP has a transparent structure and principles of governance. The NPIP has a council that maintains and directs initiatives and projects. The council includes leaders of infectious diseases, pulmonology, cardiology, pediatric clinics, national and regional consultants in different disciplines of medicine, representatives of pharmacists, and local authorities. Medical stakeholders proactively shape the organization\u2019s culture to support evidence-based practices in its initiatives. Experts from different regions of Poland support them. The council\u2019s role is to adhere to evidence-based and promising practices supporting a straightforward goal to increase the vaccination rate. Supporting members include healthcare practitioners who help to extend the council\u2019s influence via role modeling, i.e., presenting the behaviors required to carry out strategic actions. Operational changes, e.g., the promotion of vaccinations to peers and patients, are more likely to succeed when professionals become part of the change and recognize its value . Other sHealthcare organizations should use evidence-based practices to improve the quality of care. To fulfill this requirement, data-driven decision-making, combined with practitioners\u2019 knowledge, are key determinants in the performance of NPIP. In recent years, NPIP has striven to create a benchmark for institutionalizing evidence-based practices . CreatinVaccinations are the most cost-efficient methods to decrease healthcare costs, morbidity, and mortality of influenza. Considering Poland\u2019s low vaccination coverage, the NPIP focused on identifying actions to increase Poland\u2019s vaccination rate. The VENICE project (completed in 2012) filled the gap in information about national vaccination policies in Europe . VaccinaEarly, the organization received support from experts from the National Institute of Public Health, the National Influenza Center, the Polish Society of Health Education, the Polish chapter of the European Federation of Pharmaceutical Industries and Associations (EFPIA), and the consultancy company Ernst & Young. They consisted of the core of the future NPIP coalition. Members of the NPIP had a common goal: to increase the awareness of the influenza burden and advocate for the influenza vaccination. In time, the scope of the endorsement of NPIP activities increased by developing links with other groups. In the last 10 years, the organization partnered with the Ministry of Health, the president of Poland, the parliament, the Main Public and Military Sanitary Inspectorates, the Ministry of Labor and Social Policy, employer associations, local authorities, and commercial companies. Public health challenges are complex and can be better solved by stakeholders working together. The diversity of partners helps to address the necessary different aspects of problems, which often go beyond medical issues and require social, economic, and public policy insights. The size and heterogeneity of the coalition indicate that NPIP succeeded in attracting individual members and organizations around the common value.The organization became the primary source of public information concerning the number of vaccinations performed every flu season. When the official number was limited to the number of vaccines reimbursed by the payer, NPIP combined data from distributors and the National Institute of Public Health to provide the broadest possible view of annual vaccination action . The datThere are many other examples of evidence-based content and recommendations created by the NPIP. This scientific background is necessary to shape vaccination policies and support the decisions of health authorities. In addition, the fact-based approach easily engages the media\u2014a critical contributor to increase the awareness and education of immunizations.A change in policy rarely immediately follows a recommendation. The NPIP activities require persistence and patience to pursue objectives over a long period. There was an early reaction to the proposition to establish vaccinations against flus in pharmacies. However, two years later, the Minister of Health was vaccinated by a pharmacist. Thus, resistance to failures and persistence to defined priorities are well established in the NPIP. The work of the NPIP is organized around specific routines that help evaluate effects and plan new actions. At the beginning of each year, the scientific council of the organization meets to plan areas of focus and activities. Despite a shared broad vision, the council focuses the annual agenda of the NPIP on a set of key priorities. They include changes in the healthcare system, roles, processes, capabilities that are required to manage vaccination programs, leveraging HCP\u2019s involvement, and improving social communication and access to vaccines. In recent years, the outcomes of the scientific council meetings were published in the white papers , which dFor example, the white paper on pharmacy-based vaccinations  reviewedThe white paper \u201cTogether against infectious disease\u201d targeted HCPs and healthcare institution managers . Here, tCouncil meeting outcomes and white papers are consult by partners and are released during the annual flu meeting. The past flu season is summarized during the event, considering the incidence of the flu and the vaccination rate. It is also the time to recognize journalists who are involved in driving the change in the flu prophylaxis landscape in Poland. The media is a critical stakeholder in increasing the awareness and education about immunization; thus, incentives to engage with media and recognize good journalism, such as annual health feathers, are apparent.The time after the flu season is not silent; the distribution of the outcomes continues in the media during the Academy of Flu organized for HCPs and contacts with local authorities implementing health programs/preparing educational campaigns. The new flu season starts with the flu forum, which provides recommendations for the new influenza season, and the experts debate about necessary systemic changes. During the flu forum, representatives of municipalities are awarded for the organization of educational campaigns and local flu prevention programs. The NPIP looks for and takes opportunities to promote influenza vaccinations in different settings. In 2016, before the Olympic Games in Rio de Janeiro, athletes were vaccinated, with vaccines recommended both for northern and southern hemispheres . The comThe NPIP has an annual calendar and rhythm of engagement, making it a leader among national stakeholders. The scope of actions of the NPIP was recognized as the most comprehensive among different vaccination coalitions . This reEvery NPIP coalition member has a role to play, and partners work together to leverage their strengths. However, none of the achievements can be attributed solely to an NPIP action since they edge on multiple opportunities and synergies. All actions of NIP are directed to specific groups or individual shareholders defined in the VENICE project  and the Key initiatives targeting health authorities were to increase the influenza vaccination in the hierarchy of obligatory and recommended vaccinations in the annual National Immunization Program (NIP), broadening access to vaccinations through reimbursement, and creating possibilities to get vaccinated. The NPIP formed an additional coalition for vaccinations in pharmacies with the Main Chamber of Pharmacy in Poland, supported by members of the Pharmaceutical Group of the European Union (PGEU) and the Employed Community Pharmacist in Europe (EPhEU). The new coalition collected evidence and showed that vaccinations at pharmacies are safe and desired by society ,31. ThisThe NPIP reviewed the different strategies for promoting vaccinations and concluded that these (based on HCP recommendations) are the most effective. Every profession had an outline of activities  and pracThe NPIP collaborates with local authorities regularly. In 2014, the NPIP and the Central and Eastern European Society of Technology Assessment in Healthcare prepared guidelines, a calculator, and a model of the flu prevention program for local governments willing to invest in prevention . They coThe complexity of the vaccination landscape makes it impossible to attribute success to a single stakeholder, even when the NPIP operates based on a broad coalition. The NPIP contributed to policy changes, guidelines, laws, and attitudes toward vaccinations in the last ten years. In 2014, influenza vaccines began to be recommended in the NIP to all children above six months as well as adults instead of only to the groups with high risks of the disease . At thatThe COVID-19 pandemic changed the vaccination landscape in Poland. Vaccinations have never been so crucial for adults before. In the 2021/2022 season, flu vaccines were provided for free for the first time to all adults. Influenza vaccination coverage in older adults reached over 22% as this group shares a common risk of severe courses of both diseases. The NPIP recommended the joint plan for flu and COVID-19, which is based on the synergies between both vaccinations and aims for further improvements in the vaccination coverage [After a dip and years of stabilization at low levels, vaccination coverage started to grow again in recent years . HopefulThis review showed that the long-term and diversified activities bring the desired changes in providing access to vaccines  and vaccinations , as well as a gradual increase in the percentage of Poles vaccinated against influenza."}
{"text": "In the mental health area, the most problematic issues are the involuntary placement of the mentally ill in closed institutions, both under civil and criminal proceedings, and their involuntary treatment. Despite the international efforts of harmonizing measures, the nature and practice of the services still vary from country to country.To analyse involuntary placement of persons with mental disorders in closed institutions under civil and criminal proceedings, which include both psychiatric hospitals and care institutions.Review and analysis of regulations and practice of involuntary placement of a person with a mental disorder in a closed institution in the context of Estonian, Finnish, Russian, and English law, health care and social system.Estonian, Finnish, Russian, and English law distinguish between criminal and civil proceedings regarding involuntary placement of a mentally ill person in a closed institution. However, specifics of the proceedings are different among the countries, e.g. judicial involvement, and deadlines. Also, the provision of forensic mental health services differ among these countries, e.g. in Estonia offenders and non-offenders are kept separately, whilst in England and Russia patients are not distinguished so strictly.The distinction between involuntary placement of the mentally ill in criminal and civil proceedings is distinguished primarily for the reason that in one case the risk arising from the person is directly realized by committing an unlawful act and in the other case the risk arising from the person is directed at themselves or is not qualified as an unlawful act."}
{"text": "Over the last decade, ophthalmology has significantly benefited from advances in vivo non-invasive ophthalmic imaging techniques that play currently a fundamental role in the clinical assessment, diagnosis, management, and monitoring of a wide variety of conditions involving both the anterior and posterior segment ,3,4,5,6.The detection of tissue microstructural changes, even at the subclinical level, can improve our ability to not only make an appropriate diagnosis, but also to elucidate pathogenetic mechanisms and to plan an appropriate management strategy for several pathological conditions. In this regard, for instance, an analysis of the retinal and corneal changes associated with SO tamponade provided important information on the potential effects of this compound on ocular tissues and facilitated the early detection of complications ,13,14,15With regard to the anterior segment, corneal topography and tomography have an established role in the accurate evaluation of the corneal shape as well as in the preoperative assessment for refractive and cataract surgery . They arWith regard to posterior segment, the advent of OCT and OCTA and their recent developments has dramatically improved the assessment of retinal and choroidal disorders. The diagnosis and the management of medical retinal diseases, including AMD, DR, and retinal vein occlusion, has been optimized by the use of these techniques, and the need for more invasive investigations, such as fluorescein angiography, has decreased ,36,37. TThe possibility of combining different imaging modalities can optimize the processes of differential diagnosis, particularly in diseases sharing multiple common clinical aspects, including macular oedema of different etiologies  or inflaFinally, there is a growing interest in the use of artificial intelligence (AI) and deep learning in ophthalmology due to the promising results achieved in the detection of common ocular diseases such as AMD, diabetic retinopathy, and glaucoma, and the potential applications for screening, diagnosis, and monitoring of these conditions . The higIn this issue, we aimed to highlight the multiple potential applications of imaging techniques in ophthalmology, and we hope that this will be appreciated by readers."}
{"text": "Hip fractures are a common type of fracture in the elderly and are characterized by many complications and high mortality. Many topics concerning postoperative rehabilitation of hip fracture in elderly people still remain controversial, and the global research trend in this field has not yet been well studied. The aim of the present study was to illustrate the overall knowledge structure, development trends, and research hot spots of postoperative rehabilitation of hip fracture in elderly people.Articles and reviews regarding postoperative rehabilitation of hip fracture in elderly people from 2001 to 2021 were identified from the Web of Science database. An online bibliometric platform, CiteSpace, and VOSviewer software were used to generate visualization knowledge maps, including annual trends of publications, contributions of countries, institutions, authors, funding agencies, and journals, and clustering of keywords.Injury: International Journal of the Care of the Injured was the most productive journal concerning the research of postoperative rehabilitation of hip fracture in elderly people. The keyword co-occurrence analysis identified six clusters: quality of life study, rehabilitation and outcomes study, cognitive impairment study, operative approaches study, mortality study, and osteoporosis study.A total of 1,724 publications were identified from Web of Science Core Collection (WoSCC). In the past 20 years, the number of published studies on the rehabilitation of hip fracture in the elderly has exhibited an overall upward trend. The USA was the leading contributor in this field, with the largest number of publications  and the most citations . The international cooperation map among relevant countries/regions indicated that the USA collaborated most closely with Canada and China. The University of Maryland and Professor Marcantonio were the most prolific institution and influential author, respectively. There will be an increasing number of publications on the research of postoperative rehabilitation of hip fracture in elderly people, and the United States will stay ahead in this field. Our findings could offer practical sources for scholars to understand the current status and trend of studies on rehabilitation of hip fracture in the elderly and provide references and suggestions for the development of related research in future. Hip fractures are a common type of fracture in the elderly and are characterized by many complications and high mortality . These pLiterature is an important way to explore a certain research field and an important part of global scientific research. Bibliometric analysis can provide information based on a literature database and bibliometric characteristics for qualitative and quantitative assessment of research activity trends over time. It provides a way to capture developments in a field and predict future research directions , 10.Worldwide, many authors have published clinically relevant research findings on hip fracture, including studies on surgical treatment of choice, risk factors affecting prognosis, perioperative management, rehabilitation training, anti-osteoporosis treatment and management measures for patients after discharge \u201315  of the Web of Science Core Collection (WoSCC). Web of Science is an internationally recognized database reflecting the level of scientific research. It includes numerous influential high-quality journals in the world. It is also one of the most frequently used databases in previous bibliometric studies .The retrieval strategy was as follows : TI: \u201chiThe full record of each document, including title, date of publication, author, countries/regions, published journal name, keywords, and abstract, was downloaded from the WoSCC as a txt file and imported into Microsoft Excel 2019 for further data processing and graph plotting. Two authors independently sifted and extracted data for entry and collection. Any differences were resolved by consensus through discussion. Data extracted from the selected articles include the general information about the annual number of publications, citation frequency, average citations per item (ACI), original countries and institutions, authors, journals, funding agencies, and H-index.VOSviewer, CiteSpace  and an online analysis platform were used to perform this bibliometric study. VOSviewer is developed by Van Eck and Waltman of the Center for Science and Technology Studies (CWTS) of Leiden University in the Netherlands. It is a document knowledge unit visualization software based on similarity visualization (VOS) technology, which has unique advantages in mapping the display of the knowledge domain. VOSviewer is used to visualize the coauthorship of countries, authors and organizations, the co-citation of sources, and the co-occurrence of keywords. In the network visualization map created by VOSviewer, different nodes represent various parameters, such as countries, journals, and keywords. The size of nodes in the map is proportional to the number of publications, references, or occurrences. Total link strength (TLS) represents the connection strength between the nodule and other nodes .CiteSpace is a visual analysis software that focuses on analyzing the trends and dynamic changes in scientific research literature and identifies key points in a given field. Betweenness centrality (BC) is an important parameter of centrality that can assess the scientific importance of the nodes in a network, where nodes with high BC value (\u22650.1) are usually indicated by purple rings. For the dual-map overlay of journals, the labels represented different research subjects covered by the relevant journals. The left side of the map displayed citing journals, while the right side displayed cited journals. Different colors and widths of lines originating from the citing map and ending at the cited map indicate the paths of the citation links . In thisA total of 1,724 publications, including 1,571 articles and 153 reviews, were extracted from WoSCC. In the past 20 years, the number of published studies on the rehabilitation of hip fracture in the elderly has exhibited an overall upward trend. Since 2016, more than 100 papers have been published per year with a peak in 2021, with 183 papers . ResearcThe top 10 countries/regions of publication of these papers are noted in For the analysis of institutions, the rough estimate is that more than 2,255 institutions have made contributions to this field. As shown in The economic foundation plays an important role in scientific development. In view of this, a brief summary of the top 10 most active funding agencies and sponsors in this area is provided in Injury: International Journal of the Care of the Injured published the most articles/reviews (84 papers). Disability and Rehabilitation ranked second, with 62 publications, followed by Osteoporosis International (60 papers). According to the JCR 2020 standards, the top 10 most active journals were classified as Q1 in 5, Q2 in 2, and Q3 in 3. The highest Impact Factor (IF) belongs to the Journal of the American Geriatrics Society , followed by the Journal of the American Medical Directors Association  and Osteoporosis International . The IF of the top 10 journals ranged from 2,586 to 5,562. Disability and Rehabilitation, Journal of the American Geriatrics Society, and Archives of Physical Medicine and Rehabilitation. A dual-map overlay of the journals on rehabilitation of hip fracture in the elderly is shown in A total of 362 journals have emerged recently in this research field. The 10 journals with the most publications on rehabilitation of hip fracture in the elderly are listed in Journal of the American Geriatrics Society has been cited 754 times and is the top-cited paper in the field. The second and third most-cited papers were published by Braithwaite et al.  and the Guangdong Provincial Administration of Chinese Medicine Research Project (No. 20201168).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "Dry eye disease (DED) is one of the most common diseases worldwide that can lead to a significant impairment of quality of life. The diagnosis and treatment of the disease are often challenging because of the lack of correlation between the signs and symptoms, limited reliability of diagnostic tests, and absence of established consensus on the diagnostic criteria. The advancement of machine learning, particularly deep learning technology, has enabled the application of artificial intelligence (AI) in various anterior segment disorders, including DED. Currently, many studies have reported promising results of AI-based algorithms for the accurate diagnosis of DED and precise and reliable assessment of data obtained by imaging devices for DED. Thus, the integration of AI into clinical approaches for DED can enhance diagnostic and therapeutic performance. In this review, in addition to a brief summary of the application of AI in anterior segment diseases, we will provide an overview of studies regarding the application of AI in DED and discuss the recent advances in the integration of AI into the clinical approach for DED. The advancement of computer science and the availability of big data has enabled the emergence of artificial intelligence  images; thus, previous studies have mostly focused on the integration of AI into the diagnostic approach of posterior segment diseases, such as diabetic retinopathy, glaucoma, macular degeneration, and retinopathy of prematurity ,12,13,14An ML model using an SVM showed an accuracy of 97% (97% sensitivity and 99% specificity) for the diagnosis of anterior segment disorders, including arcus senilis or cataracts, suggesting the potential of AI as a screening tool . SubsequAI can also be helpful for the diagnosis and management of various ocular surface diseases. Recent studies have shown that DL algorithms can automatically detect the presence of pterygium, classify its grade, and identify referable cases with high accuracy ,25,26, sThe integration of AI into evaluation algorithms based on corneal topography has been proven to improve the accuracy of the discrimination of keratoconus, even in early cases ,38,39,40AI may be useful for the automated evaluation of the corneal endothelium, which might be useful for the long-term assessment of corneal grafts ,49,50,51Dry eye disease (DED) is one of the most common diseases, with a prevalence of 10\u201340% worldwide ,56,57. IThe lack of correlation between dry eye symptoms and signs has often been reported, which renders the diagnosis and monitoring of DED challenging ,63,64. TTo overcome these challenges, AI can be applied to the analysis of DED tests and the construction of protocols for the diagnosis and monitoring of the disease. Many studies have reported promising results of AI-based algorithms for the diagnosis of DED and analysis of the results of DED tests. Herein, we aim to provide a comprehensive overview of the studies and discuss the recent advances in the integration of AI into the approach for the diagnosis and treatment of DED.In 1999, Grus et al.  proposedPhotographs or videos of anterior segment structures, such as the cornea, conjunctiva, and eyelid, taken during a slit lamp examination can provide information regarding the diagnosis of DED and monitoring of its treatment. However, assessment of the photos and videos is often less reproducible and repeatable because of the lack of tools for reliable, objective, and quantitative analysis, in which the application of AI is expected to be helpful for the development of reliable interpretation tools.\u00ae 5M . In this study, the frequency of the incomplete blinking measured using the AI model was closely associated with the signs and symptoms of DED, suggesting the potential of the DL algorithm as a diagnostic tool for DED [In 2007, Yedidya et al.  develope for DED .In 2022, Wang et al.  proposedChun et al.  developeWe have recently shown that AI-based algorithms for the analysis of histopathological images might be a reliable method for the quantitative assessment of the histopathological features of pterygium , suggestInfrared meibography enables the visualization of the two-dimensional silhouette of MGs, and it can provide information regarding the amount of the MG\u2019s dropout, the area of the MG\u2019s acini, and the length of the MG\u2019s duct ,83. HencIn 2012, Koh et al.  proposedTear film interferometry is a valuable tool for the diagnosis and monitoring of DED ,94. It aSubsequently, da Cruz et al.  proposedIVCM is a non-invasive imaging modality that enables real-time visualization of the ocular surface tissue and changes in the ocular surface microstructures associated with DED ,101. HowIn 2016, Al-Fahdawi et al.  introducA new DL algorithm based on GANs, an emerging DL model for the processing of medical images, was first introduced for the automated segmentation of corneal subbasal nerves in IVCM images in 2021 . In compAI can also be helpful for the detection of MGD using IVCM ,111. MarThe results of these studies suggest that AI-based analysis of IVCM images may provide information regarding changes in the corneal nerve, DCs, and MG. However, these microstructural changes may often have little correlation with the symptoms and signs of DED ,63,64. TAS-OCT can provide cross-sectional images of the tear meniscus and a quantitative assessment of tear film parameters, such as the height and area of the tear meniscus, which may be helpful for the diagnosis and monitoring of DED ,113,114.In 2020, Stegmann et al.  introducThe favorable results of the studies introduced in this review indicate that AI can be a critical tool for the management of DED in the future. AI can allow the diagnosis of DED and precise assessment of its severity by integrating the symptoms, signs, ocular and systemic risk factors, and results of various test devices. It can also enable precise monitoring of the treatment response of DED by detecting and analyzing subtle changes in dry eye signs, symptoms, and test results. With technological developments, images of anterior segment structures, meibomian glands, and the tear film can be obtained using mobile devices. By integrating and analyzing these images and clinical information provided by patients and primary healthcare providers, AI can enable telemedicine for the monitoring of DED and mass screening for the disease. AI can also improve the accuracy of the analysis of big data for the evaluation of the risk factors and prevalence of DED in the general population, which may enable the estimation of the risk of DED in each individual in the near future.Advances in ML technology, particularly DL algorithms, have enabled the application of AI in various anterior segment diseases, including DED. AI is expected to be able to integrate the data from medical records, test results, and large population-based studies and provide optimized protocols for the diagnosis and management of DED . The ana"}
{"text": "There is increasing global interest among social scientists of the widening social inequalities which characterize many societies across the world. Interest in the significance of social inequalities related to divisions such as class, gender, age, race and ethnicity, place and location, sexuality, ability, religion, identity, and the intersections between these, is not new. Sociologists have long been interested in how they are experienced, how they shape life chances, and how they help make sense of social relationships. However, the scale and pace of growth in various forms of inequality in the last decade or so, many of which have been exacerbated by COVID-19, has rekindled interest in the corrosive effects of inequality on individuals, communities, and whole societies not only among academics, but also policy-makers, politicians, world leaders, the media, and those whose lives continue to be affected by them.The politics of equality and inequality is also of interest among sociologists of sport, since it is well-established that sports are social phenomena that reflect, reveal, reproduce, and reinforce social inequalities, ideologies, and social exclusion. Sports are also potential sites of resistance to social inequality, of producing social change, of improving life chances, and of fostering social relationships which provide the basis for a more humane social world.The papers in this Research Topic bring together bodies of knowledge in sociology, sport, politics, and policy analysis to examine the production and reproduction of social inequalities, and of the potential challenges to them, in and through the various relationships and processes which constitute sport. In particular, the papers examine inequalities in contemporary social relations which exist in sport focusing on the experiences of women, transgender persons, young people, and older adults. The papers are informed by a range of theoretical approaches including Marxism, Feminism, Bourdieu, and Putnam. The data collected draws from policy reviews, interviews, observation, and co-production methods. The findings demonstrate the significance of ideology, policy, community, and place when understanding how sport can be both a cause of, and solution for, social inequalities, as well as providing sites for promoting health and wellbeing, quality of social relationships, social capital, and trust.Burnett's paper analyses policy frameworks in the context of post-Apartheid South Africa to consider the ways in which people \u201cdo gender\u201d as part of the multiple layers of relative disenfranchisement which also includes class and race. The article demonstrates the continued impact of patriarchal ideology, hegemonic gendered culture, significant others, and the availability of resources and democracy on the lives of women and girls, particularly in terms of barriers to participation in, and leadership of, sport. Burnett makes the case for structural and systemic reform to enable full gender inclusivity and empowerment in sport and society.Pike et al. evaluate a community-led physical activity programme for young people in the United Kingdom. Their findings demonstrate the potential of such programmes for improving levels of physical activity, while also offering the potential for improving relations within neighborhoods and developing a sense of community. The paper argues for the significance of social capital as both cause and effect for successfully influencing policy, and the need to combine social capital with elements of social movements to ensure sustained outcomes.Mansfield et al. critically evaluate the disconnect between research, policy and the promotion of physical activity for older adults. They draw on findings from a coproduced community sport project for older adults with limited income. Their findings demonstrate the need to move beyond focusing on practical barriers to consider the intersections of biological, psychological, and social experiences of older adults to develop a fuller understanding of the complexity and inequality which impact on engagement in, and enjoyment of, physical activity.In the third article, Caudwell and centers on the transgender and non-binary experiences of recreational swimmers. The article examines the impact of feeling unsafe in sports spaces and, in particular, the display of embodiment in public swimming pools. These impact on the experiences of physical activity and also the production of inequality in and through sport. Caudwell demonstrates the potential for such research to inform evidence-based interventions to address social inequality.The final paper in this Research Topic is by Collectively the papers draw critical attention to the various ways in which social inequalities intersect and shape experiences of sport and physical activity participation among particular social groups, and how these experiences simultaneously express, reinforce and exacerbate existing patterns of inequalities in engagement in sport and physical activity. The papers also reveal how participating in community-based programmes can produce various social and health outcomes, including the promotion of opportunities for people to be physically active, but that their impact is limited by the pervasive effects of the deeply entrenched social inequalities which characterize those communities and the societies of which they are a part. As the scale of social inequalities continue to widen across the world, and within individual and between individual countries, the findings of the papers included in this Research Topic will provide an important starting point for future research which investigates the complex relationships between sport, the politics of inequality and our wellbeing.Both authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication."}
{"text": "The author demonstrates the psychodynamic understanding of schizophrenia and describes the ensuing personality-structural psychotherapy. Schizophrenia from a psychodynamic understanding is a disease in the core of the identity with disturbances of the personality functions of identity, ego-demarcation, aggression, fear, narcissism, perception, cognitive abilities and the body- ego. It is the concern of the author to investigate how schizophrenically structured patients and their family members experience the group dynamic field in which the patients grew up and its relations to the illness. The following five topics: contact and experiences within the family of childhood, body care and physical contact, kindergarden and school life, puberty, and contacts outside the family have been investigated.The aim is to show how the family settings and backgrounds are conducive to developing schizophreniaThe author chosed for her investigation the method of biographical interviews, introduced by Witzel (1985). This method of interviewing is problem centered, object and process oriented. The analysis of the exhaustive tape-recorded interviews was made by using the method of qualitative analysis based on the grounded theory.Schizophrenia from psychodynamic understanding is a disease in the core of the identity with disturbances of the personality functions of identity, ego-demarcation, aggression, fear, narcissism, perception, cognitive abilities and the body- ego.It is the concern of the author to investigate how schizophrenically structured patients and their family members experience the group dynamic social energetic field in which the patients grew up and its relations to the illnessNo significant relationships."}
{"text": "Outcomes research is a relatively recent field of study in animal health and veterinary medicine despite being well-established in human medicine. As the field of animal health is broad-ranging in terms of animal species, objectives, research methodologies, design, analysis, values, and outcomes, there is inherent versatility in the application and impact of the discipline of outcomes research to a variety of stakeholders. The major themes of outcomes relevant to the animal health industry have been distilled down to include, but are not limited to, health, production, economics, and marketing. An outcomes research approach considers an element of value along with an outcome of interest, setting it apart from traditional research approaches. Elements of value are determined by the stakeholders' use of products and/or services that meet or exceed functional, emotional, life-changing, and/or societal needs. Stakeholder perception of value depends on many factors such as the purpose of the animal  and the stakeholder's role . Key areas of application of outcomes research principles include comparative medicine, veterinary product development, and post-licensure evaluation of veterinary pharmaceuticals and/or biologics. Topics currently trending in human healthcare outcomes research, such as drug pricing, precision medicine, or the use of real-world evidence, offer novel and interesting perspectives for addressing themes common to the animal health sector. An approach that evaluates the benefits of practices and interventions to veterinary patients and society while maximizing outcomes is paramount to combating many current and future scientific challenges where feeding the world, caring for our aging companion animals, and implementing novel technologies in companion animal medicine and in production animal agriculture are at the forefront of our industry goals. Outcomes research has been defined as research concerned with outcomes, or end results, and entails the application of clinical and population-based methods to optimize healthcare practices and interventions . Albeit Currently, the veterinary and animal health sectors are facing substantial challenges including an increase in the pet population, increase in the costs of veterinary care and products, increased financial limitations of owners and managers, and pressure to increase food supply , 9. ThesThe key themes of outcomes vital to the animal health industry can be distilled to health, production, economics, and marketing, although there are often points of overlap among them. Health and production outcomes are many and well-known in the companion and large animal veterinary fields. Varying based on the targeted species, economic outcomes in companion animals typically reflect cost to the pet-owner, willingness to pay, and overall affordability of veterinary care on an individual animal basis. As food animals are considered a commodity, livestock producers are most interested in an overall low cost and/or an increased net-return on investment. Marketing outcomes, instead, include any characteristic that can be used to market a product and/or service that demonstrates a clear value proposition , such asThe overarching goal of healthcare providers, either human or veterinary, should be to achieve projected outcomes and improve value for patients . Value, For a review on the origins and evolution, as well as principles and application of outcomes research in veterinary medicine, the reader may refer to Cernicchiaro et al. .Every year, the International Society for Pharmacoeconomics and Outcomes Research (ISPOR), the international organization for the advancement of policy, science and practice of the discipline of outcomes research, publishes the \u201cTop 10 Health Economics and Outcomes Research (HEOR) Trends\u201d . Though The use of digital technologies in animal health is also of recent interest for areas like willingness to pay for veterinary telemedicine  and asseReal-World Evidence (RWE) in decision making has prevailed as a top trend in recent years . The appThe utility of outcomes research in the areas of comparative medicine, veterinary product development, and evaluation is demonstrated in the following sections.In comparative medicine, human and veterinary medicine are considered as \u201ctwo branches of one medicine\u201d, as they share similar problems and approaches to solutions for humans and animals . In humaAnimal models are also commonly used in the development of human and animal vaccines for infectious disease prevention and management . Swine hThe longevity of companion animals has been substantially extended thanks to the improvements made in veterinary care as well as the advances in dietary and medical technologies. Attempts to understand the phenomenon of aging, as a way to increase the healthy lifespan of people and animals, has led to innovative initiatives such as the Dog Aging Project , which afunctional and emotional values, leading the way toward an overall improvement of the quality and longevity of human and animal life.Outcomes research in comparative medicine utilizes animal models for veterinary and human medicine evaluation, refinement, and ultimately approval of human and veterinary therapies and interventions, and considers relevant outcomes addressing primarily In the veterinary field, pharmaceutical products and biologicals rely solely on research to provide pivotal information under regulatory guidance in order to receive approval for licensure from the respective agencies . TraditiOutcomes research has been a formal discipline for over two decades, although more formally implemented in the animal health industry in recent years. The foundation of outcomes research is comprised of two elements, outcomes and value. This added component of value is what sets the discipline of outcomes research apart. Value can be measured by many characteristics that satisfy four primary needs: emotional, functional, societal, and life-changing, with the perceived value being determined by the stakeholder. Although decision-makers/stakeholders and values can differ in animal health, human health outcomes research continues to pave the way through shaping outcomes research based on current trends, and through the development and implementation of novel methodologies. Though easily transferable to the animal health industry, work is still needed in interpreting novel technologies utilized in human healthcare, such as long-term cost-effectiveness and decision analytical models. Additionally, the use of Real-World Data and Real-World Evidence to aid and/or supplement in the product licensure process in animal health could transform veterinary product development. While underrepresented in the literature during development due to confidentiality and intellectual property issues, outcomes research plays a role in licensure of veterinary products during the development phase as well as post-licensure as the focus of marketing veterinary products is through comparative efficacy and value proposition. Future efforts of outcomes research in the animal health industry should focus on bridging the gap between novel methodologies and technologies utilized in human health and translating their efforts into the context of animal health.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.DD and NC conceived and outlined and wrote the manuscript. DR, BB, KD, and MM contributed to the article, reviewed, and approved the final version of the manuscript.This study was funded by the Center for Outcomes Research and Epidemiology, the Department of Diagnostic Medicine and Pathobiology, and the College of Veterinary Medicine at Kansas State University.Author KD was employed by Latham BioPharm Group. Author MM was employed by Zoetis. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "New insights into the pathophysiology of mental disorders and innovations in psychiatric care depend on the availability of representative, longitudinal and multidimensional datasets across diverse, transdiagnostic populations. Biobanks usually attempt to collect such data in parallel to clinical routine, which is resource-intensive, puts additional burden on health-care providers, and may reduce the generalizability of the results. Despite containing rich phenotypic and biological information, data generated in routine clinical care is seldomly used for research purposes, because it is usually unstructured and locked in data silos. To truly link clinical practice and research, solutions that optimize the generation and scientific utilization of real-world clinical data are needed.Evaluation of a new digital infrastructure which warrants the efficient, automatized, and structured collection of real-world data in psychiatric care, and integrates the generated data into existing biobanking efforts.We have developed a new documentation system which augments the existing IT-structures, enables the collection of routine clinical data in a structured format and involves patients in the data generation process. In an implementation science approach, to replicate and extend the findings of Blitz et al. , we are investigating the acceptance, efficacy, and safety of the system in our outpatient clinic for affective disorders.First results describing the technical safety, usage metrics, and acceptance of the system, and the quality of the collected data will be presented.Challenges of collecting real-world data for biobanking and research purposes and perspectives on future digital solutions will be discussed.No significant relationships."}
{"text": "Understanding the underlying structure of evolutionary processes is one the most important issues of scientific enquiry of this century. In the twentieth century, scientific thinking witnessed the overwhelming power of the evolutionary paradigm. It not only solidified the foundations of diverse areas, such as cell-biology, ecology, and economics, but also fostered the development of novel mathematical and computational tools to model and simulate how evolutionary processes take place.In addition to the application of the evolutionary paradigm and the discovery of the evolutionary features for processes of diverse nature, there is another interesting aspect which touches upon the emergence of novel evolutionary processes. Namely, the emergence of an evolutionary process requires a complex transition between a prior form where no evolutionary process is undergoing and a posterior form where the evolutionary process has been triggered.Theoretical methods to describe the emergence of evolutionary processes require the consideration of complex systemic notions, such as self-organization, resilience, contextuality, among others. Therefore, complexity and evolution became intertwined notions: evolution not only leads to but also depends on the development of increasingly complex forms and functions.In this Special Issue, we put together eight articles, mostly of interdisciplinary nature, that explore from recent advances in the modeling of complex systems, as well as of the increasing modeling power and growth of databases associated to evolutionary processes.Our first article , by PeteOur second article , by SergOur third article , by Evo Our fourth article , by YukiOur fifth article , by DiedOur sixth article , by TomaOur seventh article , by TomaOur last article , by Laks"}
{"text": "The optimization of the business environment helps to create a good market ecological environment and promote industrial development. Based on the theory of institutional complexity, this study constructs the evaluation index system of China's urban business environment and analyzes the influencing factors using the NCA method. It is found that there is no necessary condition for a single element to constitute the high-level development of the tourism industry, but improving public service, total market volume, and innovation environment play universal roles in promoting the high-level development of the tourism industry. Using fsQCA for configuration analysis, two business environment configuration paths with high-level development of the tourism industry are obtained, which shows that there is no single path to promote the development of the tourism industry. In addition, the antecedent paths of high- and low-level tourism industry development are not the opposite, presenting an asymmetric causal relationship. The above findings reveal the realization path of the business environment for the development of China's urban tourism industry. Under the logic of multiple systems, cities can find the business ecological environment that best matches the development of the local tourism industry. In recent years, China has accelerated the construction of a modern economic system, and the business environment has become the main starting point to promote high-quality economic development. In 2019 and 2020, China released policies and regulations, such as Regulations on Optimizing the Business Environment and Implementing Opinions of the General Office of the State Council on Further Optimizing Business Environment and Better Serving Market Players, which shows that China is paying more and more attention to the development and optimization of the business environment. With the continuous advancement of the reform of \u201cderegulation, management, and service\u201d, China continues to build an international, market-oriented, and legal business environment, and the tertiary industry and emerging industries are growing rapidly. According to the global ranking of business environment measured by the world bank, China's business environment rose from 78th to 46th in 2019 and reached 31st in 2020, ranking among the top 10 economies with the largest improvement in the global business environment for 2 consecutive years. A good business environment is conducive to the development of market players and is an important aspect of highlighting the development of the competitiveness of the country or region  is between 0 and 1, and 0 \u2264 d < 0.1 indicates a low level, 0.1 \u2264 d <0.3 indicates a medium level, and 0.3 \u2264 d < 0.5 indicates a high level , other conditional variables are significant (P < 0.01), but because the effect size is too small, there is no business environment element as a necessary condition.This study uses the NCA method in R software to test the necessary conditions Li,  of the gvel Dul, . It can The bottleneck level reflects the bottleneck value of the causal condition corresponding to a certain level of the outcome predictor. For example, in This study further uses the fsQCA method to strengthen the accuracy of necessary condition analysis. When the consistency is >0.9  The consistency of path 1 is 0.8872, which is greater than the acceptable level of 0.8, the original coverage is 0.1676, and the unique coverage is 0.0135. The coverage is used to compare the interpretation of results by different configurations, and there is no minimum threshold  The consistency of path 2 is 0.8988, which is greater than the consistency recommendation standard of 0.8. The original coverage is 0.6438, and the unique coverage is 0.4897. The core conditions of high public service, high market volume, and high innovation environment combined with the peripheral conditions of high human resource, high financial service, and high digital economy promote the development of the urban tourism industry, regardless of the level of a government environment. These type of cities includes Beijing, Chongqing, Chengdu, Suzhou, Guangzhou, Hangzhou, Wuhan, Tianjin, and other cities. For example, Chongqing issued Work Plan on Optimizing Doing Business Environment in Chongqing in 2019, which provides ideas for comprehensively standardizing government service, implementing the pilot of allowing foreign-invested travel agencies to operate outbound tourism in Chongqing, expanding the opening-up, and combining the implementation of cultural and tourism market supervision, and formed Chongqing's \u201cnegative list of market access\u201d to clarify the objectives and responsibilities of the city's own optimization and reform. \u201cInternet + government service\u201d is implemented, and various work service processes are entered into the supervision platform to make the market more fair and transparent. The whole area tourism of Qiandao Lake in Hangzhou has developed well, with a large number of tourism enterprises pouring in. The reform of the business environment of \u201crunning once at most\u201d just simplifies the business process of enterprises and greatly stimulates the vitality of market players. In innovative management, Hangzhou has optimized the yacht registration procedure according to the characteristics of existing tourism resources, which has better contributed to the development of local water tourism.This study verifies the business environment with a low tourism industry development level, and there are seven configuration paths that produce low-level development of the tourism industry. Among them, 1a, 1b, 2a, and 2b form a second-order equivalent configuration due to the consistency of core conditions in the nested analysis of intermediate solution and reduced solution Fiss, . \u201c~\u201d staTo verify whether the configuration path is robust, this study increases the original consistency from 0.8 to 0.85, it can be seen from This part further analyzes the typical cases. In terms of regional distribution, the proportion of cities with high-level development in the tourism industry in the eastern region, western region, central region, and northeast region is 53.85, 15.38, 19.23, and 11.54%, respectively. Among them, due to the early opening to the outside world and based on good basic conditions, the eastern region has always been in a leading position in the transformation and optimization of the business environment. In Regulations on Optimizing Business Environment issued in 2019, the State Council clearly mentioned that the eastern region should be the leading development of the business environment demonstration area, and the rest of the region should actively follow up the development. There is still a big gap between the business environment and the development of the tourism industry in the western region and Northeast China. Among them, typical cases of high-level development of the tourism industry include Beijing, Hangzhou, Tianjin, Guangzhou, Suzhou, Nanjing, and Shenzhen in the eastern region; Wuhan, Hefei, Changsha, and Zhengzhou in the central region; Chengdu, Chongqing, and Xi'an in the western region; and Dalian, Changchun, and Shenyang in the northeast region. The business environment of these cities is also in the top position. From the perspective of cities, the State Council takes Beijing, Shanghai, Chongqing, Hangzhou, Guangzhou, and Shenzhen as innovative pilot cities to optimize the business environment in China. The four municipalities directly under the central government and some provincial capital cities are typical cities to promote path 2 of high-level development of the tourism industry. That is, the core conditions of high public service, high market volume and high innovation environment combined with the peripheral conditions of high human resource, high financial service, and high digital economy promote the development of the urban tourism industry. A good business environment is a comprehensive achievement under the joint influence of the government environment, public services, total market volume, and other factors. Overall, the development of a business environment in large cities is relatively advanced, comprehensive, and coordinated. As a typical city with high-level development of the tourism industry, it also verifies that the optimization of the business environment gives better development space for tourism industry.Based on the theory of institutional complexity, this study comprehensively uses NCA and fsQCA to analyze and draw the following conclusion: (1) through the necessity condition test, single business environment elements such as government service, human resource, financial service, public service, market aggregate, innovation environment, and digital economy are not enough to become the necessary condition to promote the development of tourism industry. (2) fsQCA analysis shows two configuration paths to promote the development of tourism industry. One is that high public service, high total market, and high innovation environment are the core conditions, complementary high human resources, high financial services and low government environment are the peripheral conditions. The other is that high public service, high total market, and high innovation environment are the core conditions, while complementary high human resources, high financial services, and high digital economy are the peripheral conditions. The existence of different configuration paths reflects that there can be multiple realization paths for the urban business environment to promote the development of the tourism industry. (3) Through the comparison of the research results, it is found that the core conditions of public service, total market, and innovation environment exist in the two paths, which shows that improving public service, total market volume, and creating an innovation environment are more important factors to promote the development of tourism industry. (4) In this study, there are two configurations of high-level development of the tourism industry and seven paths of low-level development of the tourism industry, which reflects that there is an asymmetric causal relationship between the configuration paths of different levels of tourism industry development, indicating that the influencing factors of tourism industry development have the same goal and multiple concurrencies, and the influence combination of different factors can lead to the same development results.Based on the understanding of the connotation of the business environment, this study puts forward development policy implications according to the research results to provide some reference for promoting the development of the urban tourism industry.(1) Perfect public service and an innovation environment are conducive to promoting the development of tourism industry. First, in terms of public service, ensure the normal use and operation of scenic spots and tourism enterprises in terms of water, electricity and gas, accelerate the implementation of preferential policies and reduce the operating costs of tourism enterprises. Improve the tourism infrastructure, realize the full coverage of transportation, communication and electric power, and implement the toilet revolution. Improve the quality of public services, make use of modern technology, strengthen the construction and investment of digital economy and government services in the business environment, and create an \u201cInternet +\u201d model. Set up communication channels between government and tourism enterprises, actively listen to and adopt the opinions of government services, and realize the basic service guarantee in transportation, medical treatment, and other aspects. Second, create a good innovation environment and encourage mass entrepreneurship and innovation. Actively guide tourism enterprises to strengthen cooperation with other service-oriented enterprises, build a close communication platform, broaden development channels and ideas, and continuously optimize the innovative development of tourism enterprises. Increase the financial expenditure on science and technology, effectively transform and make use of scientific and technological achievements, such as the construction of smart tourism, pay attention to the patent protection system, and improve the innovative competitiveness of urban tourism.(2) Focusing on a good government environment, public service, total market volume, and innovation environment coordinating various business environment elements to promote the better development of the tourism industry. First of all, in terms of the government environment, we should carry out innovative services and management in combination with the business problems of the local tourism industry, build tourism policies and regulations in line with their own development needs, set up special measures, and carry out characteristic, quality and efficient measures to optimize the business environment. Second, in the market, standardize the market environment and promote fair competition. Give full play to the functions of government service and supervision, strengthen the supervision during and after the event, ensure the pertinence and effectiveness of supervision, and strictly rectify the market chaos in tourism activities. Regulate the behavior of tourism market intermediaries, strengthen joint law enforcement, expand law enforcement, avoid unfair supervision or malpractice for personal gain, and maintain the order of fair competition in the tourism market. Third, simplify the access principles of tourism enterprises and actively implement innovative and efficient service measures such as \u201crunning at most once,\u201d \u201cone enterprise and one certificate,\u201d and \u201cjoint handling of certificates and licenses\u201d, so as to give birth to more tourism enterprises and operate according to market rules. Actively remove obstacles for the development of tourism enterprises, promote tourism enterprises to build high-quality tourism brands and establish a good corporate image.(3) On the basis of the business environment, we should make up for the shortcomings of the city and promote the comprehensive and coordinated development of the tourism industry. First, in terms of human resources, increase investment in education and introduce professionals in other fields to form a diversified high-quality talent system. Encourage colleges and universities to establish links with local tourism enterprises, strengthen the combination of theory and practice of college students, and cultivate high-quality professionals. Improve human resource-related policies, including preferential policies such as talent introduction policy, talent settlement policy, and entrepreneurship subsidy policy, so as to attract and retain talents, and take a large number of young talents as reserves. Second, optimize financial services and solve the development dilemma of enterprises. Cancel operating service charges and reduce the financial burden of tourism enterprises. Improve the matching and optimization of credit database and financial credit database to maximize the efficiency of financial services. Establish a guarantee mechanism, innovate the government guarantee mechanism of small and medium-sized tourism enterprises, promote the integration of social resources, and provide financial guarantee for the development of small- and medium-sized tourism enterprises.In this study, NCA and fsQCA methods are combined to ensure the robustness of the research results. However, there are inevitably some deficiencies: (1) due to the availability of data, there are some problems, such as incomplete selection of antecedent conditions and inaccurate measurement, which affect the popularization of the conclusion to a certain extent and need to be further improved in future research. (2) The advantage of fsQCA is that it can carry out Boolean logic operation through the fuzzy set and construct configuration effect analysis to achieve the same target result under different conditions, but it cannot determine the influence degree of different factors. In the future, it can be analyzed in combination with multiple regression. (3) This study uses cross-sectional data, but the business environment is a dynamic process of extension and optimization, and longitudinal tracking research can be carried out in the future.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.All authors contributed to the article and approved the submitted version.This work was supported by the Fujian Social Science Foundation Project Research on the Driving Mechanism and Promotion Path of High-Quality Tourism Development in Fujian Province (Grant No. FJ2021B143).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "Intensive Care Research. On behalf of Chinese Research Hospital Association and the editorial board of Intensive Care Research, I would like to take this opportunity to express my heartfelt thanks to the readers and writers who care for and support the journal. Intensive Care Research is co-sponsored by the First Affiliated Hospital of Zhengzhou University and Chinese Research Hospital Association, published in collaboration with Springer Nature. It aims to publish and deliver the latest expert guidelines/consensus on diagnosis, treatment, nursing, management of critical care medicine, case analysis, original research, review, etc. The first editorial board consists of 53 critical care medical experts from 6 countries. Over the past year, members of the editorial board have been forging ahead with their sincere cooperation and joint efforts, making a solid foundation of the journal and a good start towards an excellent critical care journal.As time flies by, 2022 is an extraordinary year for the development of intensive care medicine in China, which coincides with the first anniversary of the publication of Chinese Research Hospital Association is a professional, academic, non-profit social organization composed of medical institutions with the functions of medical service, scientific research and clinical teaching aiming to explore and to build research hospitals, medical scientific research institutes, enterprises and institutions engaged in medical technology innovation and achievement transformation. The purpose of the society is to promote the integrated development of clinical and scientific research, to promote the continuous improvement of the level of clinical diagnosis and treatment, to accelerate the transformation of medical scientific and technological achievements, to promote the continuous generation of compound talents, and to promote the overall innovation of the hospital development model.Since the theory and practice of establishing research-oriented hospital was put forward and implemented in 2004, it has gained a growing degree of recognition and consensus in the domestic medical and health field. Many managers, experts and professors regarded the construction of research-oriented hospital and discipline as a powerful starting point to promote hospital construction and discipline development. Over the past 9\u00a0years, the institute has become a national, all-field, think-tank-type authoritative medical organization with extensive influence with 139 branches, more than 300 clinical and scientific research hospital unit members and more than 21,000 expert members. Chinese Research Hospital Association has gathered leading figures in hospital management and influential experts and scholars at all levels, playing a positive role in promoting medical science and technology innovation and achievement transformation, strengthening the cultivation of interdisciplinary medical talents, establishing modern hospital management system and fighting against COVID-19. In the future, the association will further give full play to the role of think tanks, carry out forward-looking, targeted, continuous and sustainable policy research with the theme of promote the high-quality development of public hospitals, build the association into an internationally renowned and domestic first-class high-level professional organization with Chinese characteristics which can powerfully lead the construction of research-oriented hospital with extensive and in-depth academic exchanges and standardized institution, and make a contribution to promoting the high-quality development of public hospitals, deepening the reform of the medical and health system, and promoting the construction of healthy China at the same time.Intensive Care Research has published a number of high-quality papers related to critical care medicine, timely and effectively spreading the latest scientific research achievements in critical care medicine, and has become an important front for international academic exchanges of critical care medicine.As a new discipline, critical care medicine has been developing rapidly in recent years, attracting increasing attention from the medical circles and society. Since the pandemic outbreak of COVID-19, the importance and role of critical care medicine have been highlighted. Regarding the construction and development of the journal, I have the following suggestions and expectations: (1) Lead the hotspots of critical care medical research, and vigorously enhance the core competitiveness and attention of the journal; (2) Increase the sources of contributions, such as organizing high-level academic conferences, adding special issue columns, inviting contributions; (3) Spread the journal content through multi-channels. Articles published in the journal can be disseminated through the official website of Springer Nature, Google Scholar, WeChat official accounts, Twitter and other databases and platforms, as well as conferences to enhance the academic influence of the journal; (4) Strictly control the quality of papers to ensure quality firstly, which is fundamental; (5) Shorten the review cycle, such as expanding the reviewer team by increasing the number of young editors; (6) Cooperate with overseas co-editors to increase international dissemination and influence.Intensive Care Research will stay true to the original aspiration, forge ahead innovatively, actively lead the research hotspots of critical care medicine and strive to become an excellent critical medical journal as soon as possible!Looking forward to the future,"}
{"text": "Spontaneous vegetation plays an important role in protecting urban biodiversity and the maintenance of urban ecosystems. In this study, we investigated the species diversity, life-form composition, origin, flowering season, and spatiotemporal distribution of spontaneous vegetation in the exhibition and education area of Tangdao Bay National Wetland Park using the quadrat survey method. There were 65 spontaneous association types and 210 spontaneous plant species, belonging to 151 genera and 44 families. The associations and species of spontaneous plants in roadside habitats were found to be the highest. In addition, many species were found in woodland and lakeside habitats, whereas the lowest number of species were found in coastal habitats. The life-form composition included 76 annual and 94 perennial herb species. These plants were of various origins. There were 160 native, 9 domestically introduced, 2 introduced alien, and 39 invasive alien plant species, which predominantly came from the Americas. A single peak was observed from March to November for the spontaneous plant species that were in their growing season, including those of different life forms and from various sources. The same was true for spontaneous plants in their flowering season. During their growing season, the number of spontaneous plant species was highest during September and, during their flowering season, the number of species was highest in July. From April to September, the Shannon\u2013Wiener diversity index for spontaneous vegetation in the roadside habitat was the highest, followed by those for the woodland and lakeside habitats, and that of the coastline habitat was the lowest. The monthly average Shannon\u2013Wiener diversity index for spontaneous plant associations in the four habitats also varied, with a single peak. The diversity of spontaneous plants and alien invasive plants in Tangdao Bay National Wetland Park is high. The wise use and protection of spontaneous flowering plants with long ornamental seasons can effectively reduce the maintenance costs, resource consumption, and energy requirements of the park. Spontaneous plants should also be managed to reduce the harm from alien invasive plants in the park, and alien invasive plants should be removed from the park during their flowering seasons. The rapid process of urbanisation has had considerable negative impacts on natural ecosystems, and this has caused continuous urban environmental problems. The need to maintain the functions of urban ecosystems and improve human well-being has attracted considerable attention ,2. To im2 were designated. These helped expand urban green spaces and effectively protected spontaneous vegetation in some cities. However, constructing them also contributed to an increase in the number of alien invasive plant species in urban areas. Tangdao Bay National Wetland Park, Qingdao City, China, is well-constructed as a destination for tourists and is also a suitable urban green space for locals to relax. Research on the habitat characteristics, species composition, spatiotemporal distribution, plant sources, and biodiversity of spontaneous vegetation in urban green spaces, including national wetland parks, is very important. This information can assist in the construction of landscapes in urban green spaces that incorporate spontaneous vegetation, which can alleviate the loss of natural landscapes in urban areas, improve biodiversity, prevent the invasion of harmful alien invasive plants, satisfy urban residents\u2019 desire for ornamental flowering plants, and help to maintain urban biodiversity and the stability of urban ecosystems [There is a long history of research on spontaneous vegetation . Howeverosystems ,14,15.2 in area. There are three islands in the bay, namely, Tangdao, Niudao, and Jidao. The annual average sea surface temperature is 13.5 \u00b0C, and the tide for Tangdao Bay is a regular semidiurnal tide with an average tidal range of 2.7 m and a maximum tidal range of 3.5 m [Tangdao Bay is located on the southwest side of Jiaozhou Bay, Huangdao District, Qingdao City, Shandong Province, China . The bayof 3.5 m ,17. Most2, of which the wetland area is 1312.8 hm2. The wetland area accounts for 80.2% of the total area of the park. The area encompasses offshore and coastal wetlands, artificial wetlands, and seven wetland types, including shallow-water areas, sandy beaches, muddy beaches, estuaries, reservoirs, ponds, canals, and aquaculture farms. A compound bay-island-coastal ecosystem with a high ecosystem service value is formed by the seven wetland types [The Tangdao Bay National Wetland Park  comprises the waters of the bay, the tidal flats, and a buffer area along the coast, with a width of 50\u2013100 m. The spatial area of the park is 1637.6 hmnd types . The pri2. The number of species, individuals, and species in their flowering season in each quadrat were surveyed and recorded each month, as was the area of the canopy cover formed by vegetation associations. A total of 16, 27, 24, 55, 28, and 41 quadrats were surveyed from April to September, and the positions of most of the quadrats were the same in different months.To study the biodiversity and spatiotemporal distribution of the spontaneous vegetation in Tangdao Bay National Wetland Park, a ring survey line was set up along the main tourism roads, with quadrats in the roadside, woodland, lakeside, and coastline habitats in the exhibition and educational areas of the park. The spontaneous vegetation in these quadrats, which was surveyed monthly between March and November. Only spontaneous plant species were surveyed and, during the growth season, there were no quadrats with only a few spontaneous plants in March, October, and November. Each quadrat had an area of 1 mFlora of China (visit http://www.iplant.cn/foc (accessed on 1 July 2022)), and the Plant Photo Bank of China (visit http://ppbc.iplant.cn/ (accessed on 1 July 2022)). The certified spontaneous plants were divided into four types: native, introduced domestic, introduced alien, and invasive alien plants. Native plants were defined as spontaneous plants with a natural distribution in the area, including Qingdao City, whereas the introduced domestic and alien plants were defined as those intentionally or unintentionally introduced from other areas in China. Alien invasive plants were defined as plants intentionally or unintentionally introduced from other countries worldwide, leading to the establishment of self-reproducing populations through naturalisation. Colonisation by invasive alien species can affect and destroy the native ecology, leading to economic impacts or habitat loss [The spontaneous plant species were determined according to the descriptions in the tat loss ,20. DuriBased on this survey, the vegetation association types, number of spontaneous plant species, composition of family, genera, and species, spatiotemporal distribution, life forms, flowering seasons, distribution frequency in different habitats, and number of native plant species, domestically introduced plants, and alien invasive plants were examined. In addition, the grades of alien invasive plants, simplified dominance index, and diversity index of vegetation associations in the different habitats studied were analysed. The number of alien invasive plant species in the park that were spontaneous plants was compared with that of the Hangzhou Xixi National Wetland Park, Zhejiang Province, and some other wetlands in China. Some measures have been proposed to construct landscapes for flower appreciation and to defend against alien plant invasion. The following formulas were used to calculate the distribution frequency of the spontaneous plant species, the simplified dominance index, and the Shannon\u2013Wiener diversity index of spontaneous vegetation:F) is defined as:iS is the quadrat number of species i and its distribution, and N is the total number of quadrats surveyed during each month [The distribution frequency of spontaneous plants (ch month .iSd) is defined as:iSd is the simplified dominance of spontaneous plant species i, iC is the canopy cover of spontaneous plant species i in the quadrat , and iA is the number of individuals of species i in the quadrat.The simplified dominance for spontaneous vegetation (H) is defined as:iP is the proportion of the simplified dominance of species i of a spontaneous plant to the sum of the simplification dominance of all spontaneous plants in the quadrat.The Shannon\u2013Wiener diversity index , which accounted for 58.97%, 17.95%, 20.51%, and 2.56% of the total species, respectively . There wThe total number of spontaneous plant species in Tangdao Bay National Wetland Park first increased and then decreased from March to November, and a single peak was observed. There were 25 species of spontaneous plants belonging to 24 genera and 10 families in the growing season in March, the number of spontaneous plant species increased to a peak of 181 species from 133 genera and 42 families in September. The spontaneous plants gradually became quiescent in October. In November, at the end of the growing season, 55 species and 49 genera from 24 families were observed .Spontaneous plants in Asteraceae, Gramineae, Leguminosae, and Brassicaceae were more common than those in other families throughout the growing season from March to November. The largest number of spontaneous plant species throughout the year was members of Asteraceae, and 38 species in this family were observed in July. The number of species belonging to Gramineae and Leguminosae families was 29 and 15 in September, respectively. The number of spontaneous plant species in Brassicaceae varied between 9 and 11 from May to September.There were pronounced differences in the numbers of spontaneous plant species in the different habitats that were studied. The number of spontaneous plant species was the highest in the roadside habitat, and there were also many species in the lakeside and woodland habitats. The number of species was the least abundant in the coastline habitat during the entire growing season. Each habitat contained 150, 82, 80, and 24 species, respectively. In September, the number of spontaneous plant species in the roadside, lakeside, woodland, and coastline habitats were 127, 81, 75, 76, and 21, respectively. These were the highest numbers recorded during the year .The number of native, domestically introduced, and alien invasive plant species in the roadside, lakeside, woodland, and coastline habitats initially increased and then decreased, with a single peak during the growing season. The number of native plant species in the roadside, lakeside, and woodland habitats increased from 15, 8, and 3 to 96, 59, and 61, respectively, from March to September. From September to November, the number decreased to 19, 16, and 17, respectively. The number of native plant species in the coastline habitat increased from one to eighteen from March to August and decreased from eighteen to four from August to November. In the roadside habitat, domestically introduced and alien invasive plant species were most common, while in the lakeside and woodland habitats they were less common, and in the coastline habitat from May to September, they were least common. The total number of domestically introduced and alien invasive plant species in the roadside habitat was 31, and they appeared most in July and August. The number of species in the lakeside habitat was 16, and they were most common from July to September. The number of species in the woodland habitat was 14 and was the highest in July. Three species were the most common in the coastline habitat in September and October. The difference in native plant species among the four habitats was the largest, and that of domestically introduced plant species was also high. The least difference was observed in the alien invasive plant species. The differences in the native, domestically introduced, and alien invasive plant species were the highest in the roadside habitat and the lowest in the coastline habitat. The differences in the lakeside and woodland habitats were in between those of the roadside and coastline habitats. The range of seasonal species change was the highest for the native plant species in all four habitats was the largest, and the next highest range was for the domestically introduced plant species. The lowest range was recorded for the alien invasive plant species .From March to November, the proportion of domestically introduced and alien invasive plant species to the total species of spontaneous plants in the four habitats varied between 10.53% and 33.33%. The average proportion of domestically introduced and alien invasive plant species to the total species of spontaneous plants in the four habitats was the highest (27.17%) in April, and the proportion was the highest in the coastline habitat, followed by those of the roadside and woodland habitats, and along the coastline. From May to September, the proportion of domestically introduced and alien invasive plant species to all the species of spontaneous plants in the roadside habitat was the highest, followed by those of the woodland and lakeside habitats, and was the lowest in the coastline habitat. The proportion was the highest in the roadside habitat, followed by those of woodland and lakeside habitats, and was the lowest in the coastline habitat during October. The proportion was the highest in the roadside habitat, followed by the coastline and woodland habitats, and was the lowest in the lakeside habitat in November .Among the four habitat types, the number of annual and biennial herb species was the highest in the roadside habitat, and was lower in lakeside and woodland habitats. The coastline habitat had the lowest number of these species. Perennial herb, woody plant, and annual or biennial herb species were the most common in the roadside habitat, were less common in the woodland and lakeside habitats, and were the least common in the coastline habitat .The spontaneous plant species from different life forms initially increased and then decreased from March to November in all four habitats, and a single peak was observed. The species peaks for annual herbs in the roadside, lakeside, and coastline habitats occurred in September, and were 49, 31, and 8, respectively. The species peak for annual herbs in the woodland habitats was 24 and occurred in August. The temporal changes in the biennial herb species were relatively low in all four habitats for a few biennial herb species, with peaks in the roadside, lakeside, and woodland habitats at 2, 2, and 1, respectively. No biennial herbs were recorded along the coastline. In September, the species peaks for perennial herbs in the roadside and woodland habitats were 56 and 35, respectively, and there were 33 species in the lakeside habitat during August and September. The total number of perennial herb and woody plant species was 10 and was the highest in the coastline habitat in July, August, and September. The number of annual or biennial herb species in the roadside habitat reached a peak of 20 in August and September, whereas the number of species in the woodland and lakeside habitats were 16 and 8, respectively, during July, August, and September. The species in the coastline habitat changed slightly and remained at three species from May to September .Veronica persica, Bidens bipinnata, Coronopus didymus, and Ceratium glomeratum. The number of spontaneous plant species present during their flowering seasons increased to 55 in April and included eight alien invasive plants species, such as Lepidium virginicum, Capsella bursa-pastoris, Chenopodium serotinum, Euphorbia maculata, and Geranium carolinianum. The number of species increased to 106 in their flowering seasons in May and included 20 species of alien invasive plants such as Sonchus oleraceus and Conyza bonariensis. In June, July, and August, there were 132, 137, and 133 spontaneous plant species present during their flowering seasons, including 25, 28, and 27 alien invasive plant species, respectively. Eight species of alien invasive plants, including Erigeron annuus, Aster subulatus, Eclipta prostrata, and Chloris virgata, began their flowering seasons in June. Four species of alien invasive plants, namely, Galinsoga parviflora, Chenopodium glaucum, Amaranthus retroflexus, and Gaura parviflora, entered their flowering season in July. The alien invasive plant, Helianthus tuberosus, entered its flowering season in August. The number of spontaneous plant species in their flowering season rapidly decreased after August. The spontaneous plant species present in September and October were 103 and 62, respectively, and included, 20 and 13 alien invasive plant species, respectively. There were 20 spontaneous plant species, such as Artemisia annua and Cirsium japonicum, and three species of alien invasive plants, namely, Cyperus rotundus, Sonchus oleraceus, and Solidago canadensis, present during their flowering season in November  in March 2022. The curriculum standards added content for teaching interdisciplinary thematic learning in wetlands research, suggesting that junior high schools could implement this guidance through using local National Wetland Parks . Thus, oThis research enhanced the understanding of spontaneous plant diversity in the national wetland park and urban green space of Qingdao City, and can also be used to provide effective guidance for administrators, such as creating diverse landscapes of spontaneous flowering plants with long ornamental seasons, goosing malignant alien invasive plants according to their flowering season to reduce maintenance costs and the consumption of energy and resources by the wetland park, developing strategies for science popularisation and improving the publicity of the park as well as the protection of spontaneous plant diversity of urban green space in Qingdao City. This information can also be used in the design and construction of new national wetland parks.However, this research does have some limitations. For example, the survey area only included the exhibition and education area of the park, which is relatively small. Studying a larger area would be the best way to gain a deeper understanding of the biodiversity and spatiotemporal changes in spontaneous plant species. In addition, research on the invasion tendencies, harm, and mechanisms of alien invasive plants should be investigated in more detail.Erigeron acer, Setaria viridis, Chenopodium album, Artemisia argyi, and Commelina communis, were the most widely distributed. When classified by life form, spontaneous plants were found to be mainly annual and perennial herbs. The spontaneous plants were divided into four types: native plants, domestically introduced plants, alien introduced plants, and alien invasive plants. The alien invasive plants are mainly from the Americas. The total number of spontaneous plant species from different sources or present in different life forms first increased and then decreased with a single peak. In addition, most spontaneous plant species had their main growing season in July and August. The number of spontaneous plant species in their flowering seasons also first increased and then decreased, with a single peak from March to November. In addition, more spontaneous plant species were in their flowering seasons in July than at any other time of the year. The monthly average value for the Shannon\u2013Wiener diversity index of spontaneous plant associations in the roadside habitat was the highest, followed by those of the woodland and lakeside habitats, and that of the coastline was the lowest from April to September. The monthly average values for the Shannon\u2013Wiener diversity index of the associations in the four habitats also first increased and then decreased, with a single peak in July during the same season.The Tangdao Bay National Wetland Park in Qingdao City has a high diversity of spontaneous plants. The associations and species of spontaneous plants in the roadside habitat were the highest, followed by those in the woodland and lakeside habitats, and those along the coastline were the lowest. Twelve species of spontaneous plants, including There are many species of alien invasive plants, including spontaneous plants, in the park during their flowering seasons from March to November. Effective measures for the wise use of spontaneous vegetation should be implemented, protecting the diversity of spontaneous plants, and averting the harm caused by alien invasive plant species in the park."}
{"text": "The purpose of this study was to develop prioritized cancer indicators and measure the population-based monitoring of the entire life cycle of cancer care, guiding the improvement of care delivery systems.Scoping review was performed based on the Joanna Briggs Institute's methodology. Electronic databases were searched in PubMed, Cochrane Library, EMBASE, Ovid Medline, RISS, KISS, and KoreaMed. The searches were limited to articles published in English between 2010 and 2020. No restrictions were applied regarding the publication status or country of origin, and all study designs were included. Gray literature was used to broaden the search's scope, identify new recommendations, need to be in connect with subject experts, and explore pertinent websites. The process and selected indicators were analyzed based on their frequency distribution and percentage.The literature search yielded 6,202 works. In addition, national and international cancer guidelines were obtained from official database reports. A total of 35 articles and 20 reports regarding cancer indicators were finally selected for data synthesis. Based on them, 254 core sets of cancer indicators were identified. The selected indicators were classified into six domains based on the continuum of cancer care and survivor's life cycle, namely, primary prevention , secondary prevention , treatment , quality of care , survivor management , and end-of-life care .There is a growing interest in developing specific areas of cancer care. Cancer indicators can help organizations, care providers, and patients strive for optimal care outcomes. The identified indicators could guide future innovations by identifying weaknesses in cancer prevention and management. Cancer is one of the leading causes of death in Korea, where 243,263 new cancer cases and 80,546 cancer deaths are expected in 2020 . AlthougThe Korea Central Cancer Registry is a nationwide, hospital-based cancer registry initiated by the Korean Ministry of Health and Welfare in 1980 . It compThere are a growing number of studies related to cancer indicators. However, they focus on very specific aspects, such as incidence and mortality, special procedures or radiological treatment, and palliative care. Population-based cancer registries (PBCRs) complementing incidence and mortality by types of cancer have been collected, and it included as one of the 25 core indicators among non-communicable disease Global Monitoring Framework; the necessary technical support in planning and developing PBCRs in low-, middle-, and high-income countries is being provided through the International Association for Research on Cancer (IARC)-led partnership, the Global Initiative for Cancer Registry Development, and has presented a framework for managing patients with cancer based on the cancer life cycle, dividing it into four groups, namely, healthy population, early diagnosis, living with cancer, and dying  (5). TheSeveral studies on the performance or quality indicators of cancer care have shown that the indicators are associated with an improvement in either patient satisfaction or care quality \u20137. FurthScoping reviews are widely used to draw a map and analyze the existing scientific evidence in complex or relatively unexamined fields. We, therefore, initially preferred to review and compare the perspectives and attributes of the national and international cancer care guidelines. The current scoping review sought to find, examine, and describe the scientific literature on cancer indicators related to the measurement of community-based monitoring for the span of cancer care. To the best of our knowledge, this is the first scoping review to examine population-based cancer monitoring for the entire life cycle of cancer.The purpose of this study was to identify the existing scientific literature and international guidelines regarding cancer indicators for the population-based monitoring of the entire continuum of cancer care using a scoping review methodology as prior knowledge of our ongoing project. In addition, the set of review will be providing the key knowledge of population-based cancer indicator measures that support the planning and evaluation of cancer indicators across the cancer-care continuum by elaborating the unique part of our ongoing project. In addition, we will continue this study in order to demonstrate how to concise the selected indicators with proper measurement by the numerator and denominator rate in the future by a panel discussion.This scoping review followed the six steps of the Arksey and O'Malley  and was By using the scoping review methodology, the following specific research questions have to be addressed:\u201cWhat are the national and international guidelines of cancer indicators guidelines, which focus community, based monitoring of cancer indicators? And What are the types of monitoring indicators in cancer management have been reported?\u201d\u201cWhat/Which are the patient, interventions, and outcomes with measurement of cancer indicators are currently in use or could potentially be used for measuring quality of cancer care in the population-based primary and acute or chronic setting across the life cycle of cancer-care continuum?\u201d* OR intervention* OR treatment* OR drug OR quality of life OR survivor* OR end of life OR palliative care OR Review* OR systematic review/ OR meta-analysis/ OR Guideline. These were reviewed to identify evidence-based recommendations.Electronic databases such as PubMed, Medline, PsycINFO, Cochrane Library, Ovid EMBASE, KISS, KoreaMed, and RISS were used to search and identify the relevant scientific literature from May 2020 to September 2020 using a predefined search strategy. The search focused on articles published between 2010 and 2020, and the search terms were cancer OR cancer patients OR survivors AND monitoring AND indicator AND early detectionThe next step examined the existing national and international guidelines regarding the entire life cycle of cancer care based on the website of the American Society of Clinical Oncology and the guidelines of the European Union, World Health Organization, IARC, OECD, National Health Service, Canada, Japan, and South Korea. Some non-English guidelines were translated by the research team. Furthermore, problems resulting from unclear translation or unclear formulation were resolved through team discussion.The next process was initiated by combining both the literature review and additional indicator guidelines. Each concept was converted into an indicator by formulating a definition, numerator, and denominator. All converted topics were checked for loss of information that could result from the research team's translation.All search results were exported from the electronic databases in the Research Information Systems format and imported into EndNote. Titles and abstracts were screened for eligibility, and duplicates were removed. The screening process was repeated by three researchers to ensure reproducibility and verify the outcomes. Articles that were finally selected for a full-text review were uploaded into EndNote. The quality of the studies was assessed using the PRISMA checklist for cross-sectional studies. The research team  conducted the appraisal collaboratively. The reviewed articles were independently assessed by two reviewers (VR and JJ) for fit and relevance, and full-text versions were evaluated to determine inclusion and exclusion. Team reviewers  examined the reviewed articles to resolve any disagreements through several meetings. All the review-related discussions and regular meetings were conducted. All the team members were unable to attend the regular meeting in person due to the COVID-19 pandemic. As a result, a hybrid mode that included offline and online Zoom conversations was deployed to distinguish between literature search and data synthesis.This study focused on original articles on cancer indicators or index measurement activities and did not filter items based on country of origin, publication year, or publication status. Studies using mixed methods, including the Delphi technique, were also included. Studies on cancer indicators, early detection, quality of care, treatment, and end-of-life surveillance were prioritized for review.Studies published in other than English were excluded. In addition, poster presentations, commentaries, review articles, letters to the editor, and editorials were excluded. Articles that were not related to the quality of care and/or cancer indicators were excluded.Data were extracted in PRISMA-ScR Checklist  and orgaThe extracted data chart is collated from the reviewed articles and summarized according to the study characteristics, including the author(s), publication year, country, purpose, research design, setting, target population, and methods of data collection, with the number of indicators and their characteristics . The finvia email; the purpose of the project was explained, and consent was obtained. They reviewed and suggested revisions to the thematic chart based on the cancer life cycle, such as prevention, early diagnosis, treatment, quality of care, survivor management, and end-of-life care, and pointed out gaps in the indicators and the connection to community assessment.Consultations were held with experts on cancer indicators and monitoring . A multidisciplinary expert's opinion included forty-two experts to select the cancer measures according to the priority. We divided the experts into three groups, namely, researchers, policymakers, and clinicians. Then, we randomly selected five researchers, three policymakers, and three clinicians. Of the five researchers, two were from the internal research group, and the remaining three were from the national cancer center and other colleges. Of the three policymakers, one was a director of a public or community health service center, another from the Ministry of Health and Welfare, and the other from the National Cancer Center. For clinicians, we selected one oncologist, one internal physician, and one radio-oncologist. All expert members were contacted A total of 6,202 articles were retrieved from the database, and 21 articles were retrieved through a manual search. A total of 3,234 articles remained after the removal of duplicates, and 2,195 were selected for screening. The retrieved documents were screened for eligibility based on their titles and abstracts. Finally, 35 articles \u201345 were The characteristics of these studies are presented in The national and international guidelines for cancer care search comprised 1,116 indicators \u201365, and A wide variety of 254 cancer indicators and measures are retrieved across the literature as a whole and listed in The aim of this study was to review the scientific articles and international guidelines for the development of cancer indicators and measurement for monitoring the life cycle of cancer care. We have appraised the use and reporting of scoping reviews from electronic databases to select cancer indicators, and our review retrieved 35 scientific articles and national and international cancer care guidelines by gray literature search. Most of the studies from Korea and the USA in equal and consists of population- and patient-level indicators between 2010 and 2020. There was remarkable variability in terms of cancer indicators among selected studies. Our findings were synthesized and reported byclassifications, participants, domains, subdomains, and measurements. It has been suggested that the population-based monitoring of the entire life cycle of cancer care would assess primary prevention, secondary prevention (early detection and diagnosis), treatment, quality of care, survivor management, and end-of-life care. All the classifications are interconnected with the domains and subdomains. Moreover, the study reports of all the guidelines and reviewed contents were converted into cancer indicators and further classified.Cancer prevention can be achieved through primary, secondary, and tertiary methods. Primary prevention involves the practice of healthy behaviors to lower one's risk of developing cancer , 47. ThiA total of 46 indicators related to secondary prevention were identified, such as those concerning early detection and diagnosis , 63, 65,A total of 85 indicators related to treatment and appropriate special procedures were identified. Most treatment-related indicators are handled by health professionals who provide specialized care and monitoring , 48, 55.A total of 33 quality of care indicators were identified, which focused on the care of patients with cancer and their quality of life. Most of the indicators involved healthcare managers or administrators, followed by providers and patients and their families. The selected indicators were medical expenditure , 51, 61 via hospital visits and health practice .The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "This study aimed to compare the prevention and control strategies adopted by the United States and India in the COVID-19 outbreak and analyze the effectiveness of their strategies, in order to provide empirical experience for the prevention and control of the epidemic.This study extracted official data on COVID-19 from various official websites, summarized the policies in place in the United States and India, and evaluated the effectiveness of their policies.The United States has adopted a series of mitigation strategies to control the two waves of epidemic, including strengthening virus detection, calling on the people to wear masks and so on. As of May 30, 2021, although the daily new cases there decreased to some extent, the effect was not ideal. The US\u2019s daily new cases ranked fourth and the cumulative number of confirmed cases ranked first in the world. India has adopted containment strategies in the initial stage of the outbreak, making the epidemic relatively stable. In the later stage, India has turned to adopt mitigation strategies. In addition, many factors including the lack of medical resources and premature relaxation measures led to the rapid deterioration of the epidemic situation. As of May 30, 2021, although the daily new cases in India has a downward trend, it ranked first in the world, and the cumulative number of confirmed cases ranked second.There are differences between the epidemic prevention strategies adopted by the United States and India, especially India\u2019s containment strategies which helped it better control the epidemic in the early stage. However, the epidemic in the two countries is still severe. With the advent of virus mutants and the absence of immune barriers, it is meaningful that the two countries continue to take non-pharmacotherapy intervention measures and accelerate vaccination, according to specific national conditions adopt containment strategies that can control the epidemic more quickly when necessary, and pay attention to the risk of epidemic rebound caused by premature relaxation of epidemic prevention policies. In December 2019, an outbreak of a novel coronavirus SARS-CoV-2 was first reported in Wuhan, China . As of MIn response to COVID-19, governments around the world according to their actual situations adopted various interventions, such as calling for wearing masks, canceling or postponing large gatherings, increasing physical distance between patients infected with COVID-19 and uninfected people, conducting online teaching, and strengthening the screening, tracking and isolation of suspected and confirmed cases. In addition, in many countries, areas with serious epidemic situations have been blocked, entry control has been strict, round-trip flights with severely affected countries have been cut off, entry personnel have been strictly screened, and forced isolation has been carried out as required . In termAt present, the top two countries in the world with the cumulative number of confirmed cases are the United States and India and the cumulative death toll of the United States ranks first and India ranks third in the world, which have attracted the world's attention. It is also very important for them to take appropriate non-pharmaceutical interventions. In addition, India began to implement the vaccination plan on January 16, 2021, but as of May 1, only nearly 10% of Indians have received one dose of vaccine and about 2% have completed two doses of vaccine . TherefoThis study focused on the comparative analysis of non-pharmacotherapy interventions for COVID-19 in the United States and India from January 20, 2020 to May 30, 2021. These two countries have mainly experienced two waves of outbreaks, and the second outbreaks, when the number of confirmed cases and deaths increased rapidly, were more serious than the first wave. We assessed the effectiveness of the epidemic prevention measures taken by the two countries in combination with the epidemic situation.All epidemiological data, including cumulative confirmed cases, daily new cases, cumulative deaths and daily new deaths, were from the public data of the World Health Organization . With reOn January 20, 2020, the first confirmed case of COVID-19 appeared in the United States . At the On January 30, 2020, India confirmed its first case of COVID-19 infection . India iAccording to the trend of the epidemic curve in the United States and India, the two countries have roughly experienced two epidemic stages, that is, the epidemic in the United States can be divided into two stages on September 9, 2020, and the epidemic in India can be divided into two stages on February 2, 2021. However, there are differences in the epidemic curves of the two countries. The two epidemic peaks of India are clearly demarcated, and there is an effective decline in the epidemic situation between the two peaks . But theIn the initial period of the outbreak in the United States, the United States mainly banned non-US citizens from or recently in China. Internally, the CDC advised the public to take daily precautions which did not include requiring healthy people to wear masks. And the US government believed that the COVID-19 virus was similar to ordinary flu, which to a certain extent misled people about the epidemic. The awareness of epidemic prevention of the US government departments and the American public was not high . In MarcIndia's focus in the initial phase of the outbreak was mainly on border control, such as the January 25, 2020 travel warning which asked the public to avoid non-essential travel to China. After the first confirmed case of COVID-19 appeared, India strictly controlled epidemic prevention materials and quarantined close contacts in the community. The number of confirmed cases of COVID-19 has stabilized at a low level. In early March, India mainly dealt with imported cases from Europe, the Middle East, Japan, South Korea and other countries, and local cross-infections gradually appeared. Particularly, the tour groups from Italy caused a sudden increase in the number of COVID-19 cases in India , 14. As While many vaccines have been developed and successfully put into use now, non-pharmaceutical interventions are also important, and the combination of the two can accelerate the success of the global fight against COVID-19. In the COVID-19 pandemic, countries have adopted different interventions at different stages according to their specific national conditions, with different implementation effects. This study described the intervention strategies and specific measures, which were adopted in the United States and India in response to the COVID-19 outbreak, and evaluated the effectiveness of the policies based on the daily number of new cases and deaths in each country.In terms of the policies adopted by the United States and India in this epidemic, the United States has adopted a mitigation strategy. Its prevention and control goals were to control the spread, delay the epidemic speed, and reduce the overall harm. The focus of the implementation was on the treatment of severely ill patients , reflectThe United States has generally adopted a mitigation strategy. An obvious example is that after the outbreak worsened dramatically in the second half of 2020, the president of the United States called for Americans to wear masks and states promulgated measures to limit social distance. On November 15, the Governor of Washington announced statewide restrictions, including prohibiting indoor social gatherings with people outside the home, closing gyms, restaurants and bars that provide indoor services, limiting the number of religious services to 25% of indoor capacity or 200 people, and so on. On December 3, California, where the epidemic was serious, issued a stay-at-home order. After January 2021, the epidemic in the United States has shown a downward trend, but it has not yet reached the time when the policy can be completely relaxed. India adopted a comprehensive blockade containment strategy in the early stage of the epidemic, but it has brought serious economic impact [In the face of the epidemic, after the United States declared a state of emergency, stay-at-home orders were issued in many states in late March 2020. However, by the end of April, when there was no clear indication that the epidemic had been successfully controlled, states or territories began to ease the requirements of social distance, and implement the order of reopening, which is likely to be a political response to the high unemployment rate caused by the government shutdown, rather than a public health response to COVID-19 infection . In May,Similarly, India implemented a total lockdown policy on 25 March 2020, but before the epidemic stabilized and the daily new cases showed a significant decline, India implemented a phased unblocking strategy from June, with the first wave peaking in mid-September. Since then, virus mutation, large-scale political rallies and religious events, and lack of medical resources have contributed to the rapid deterioration of the epidemic in India. It can be seen that premature relaxation of the policy will bring the risk of repeated epidemics. As of May 30, the two countries have shown signs of easing the epidemic, but if they loosen policy too soon, they may repeat the same mistake. In India in particular, daily new cases only declined slightly and daily new deaths remained high, but there were signs that the Indian government began gradually easing restrictions in June, allowing factories to operate and building activities to resume gradually [In the fight against the epidemic, the United States focused on treating patients with severe cases, encouraged those with mild symptoms to stay at home, and avoided large-scale lockdown strategies even when the outbreak deteriorated sharply. The cumulative number of COVID-19 cases in the United States now ranks first in the world. And it should be added that under the national system of the United States, the federal government left most of the decision-making power to deal with COVID-19 to the States , which cIn terms of implementing containment strategies, Chinese practice is a typical case. China through strict containment measures such as timely lockdown of Wuhan, strict management of the \"four types of people\"  and so on, has successfully brought the epidemic under control without large-scale recurrence of the epidemic. From this point of view, compared with mitigation strategies, containment strategies can control the epidemic more quickly to a certain extent.In general, in the early stage of the epidemic, India adopted containment strategies, but after that, both the United States and India adopted mitigation strategies. At present, despite the continuing threat of the mutant strain of the virus, there are signs of lax national epidemic prevention policies. For example, by February 2022, many states in the United States have abolished mask laws. Of course, vaccination efforts around the world are in full swing, including the Indian government's expansion of vaccination centers and increased funding in the United States to expand community-based outreach efforts to increase vaccination . At the There are differences between the epidemic prevention strategies adopted by the United States and India, especially India\u2019s containment strategies which helped it better control the epidemic in the early stage. However, the epidemic in the two countries is still severe in the world. When the virus mutants are coming and the immune barrier is not formed, it is meaningful that the two countries continue to take non-pharmacotherapy intervention measures and accelerate vaccination, according to specific national conditions adopt containment strategies that can control the epidemic more quickly when necessary, and pay attention to the risk of epidemic rebound caused by premature relaxation of epidemic prevention policies."}
{"text": "In the published article, there was an error regarding the affiliations for Saba Saneinia. As well as having affiliation 1, she should also have Key Laboratory of Immersive Media Technology , Ministry of Culture and Tourism, Hefei, China.In the published article, there was an error regarding the affiliations for Rongting Zhou. As well as having affiliations 2, he should also have Key Laboratory of Immersive Media Technology , Ministry of Culture and Tourism, Hefei, China.In the published article, there was an error regarding the affiliations for Fahad Asmi. As well as having affiliations 2, he should also have Key Laboratory of Immersive Media Technology , Ministry of Culture and Tourism, Hefei, China.In the published article, there was an error in the Funding statement. Authors haven't mentioned any funding detail in the recently published manuscript. The correct Funding statement appears below.The research funded by the (1) National Social Science Fund of China (Grant ID: 17BXW034); (2) Key Laboratory of Immersive Media Technology , Ministry of Culture and Tourism, Hefei, China.The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "Neuroinflammation is closely associated with the occurrence and development of autism spectrum disorder (ASD). This study aims to describe the global development history and current status of neuroinflammation in ASD from 2004 to 2021 and reveal the research hotspots and frontiers to provide a reference for scholars in related fields to carry out further research.Journal articles on ASD and neuroinflammation-related research were obtained from the Web of Science Core Collection (WOSCC) database from its inception to 2021. Literature was analyzed visually by VOSviewer, CiteSpace, and R language, including publication analysis, author, institution, national/regional cooperative network analysis, and keyword analysis. We screened the most accumulatively cited 10 experimental papers in the field and the most cited 10 experimental papers in the last 2 years (2020 and 2021) for combing.Brain Behavior and Immunity was the main journal for the study of neuroinflammation in autism, having published 22 related articles. Keyword co-occurrence analysis showed that short chain fatty acid, mast cells, and glial cells have been the focus of recent attention. Burst keywords show that gut microbiota and immune system are the future research trends.A total of 620 publications were included in this study, and the number of publications has increased in recent years. The United States  was the country with the largest number of publications. King Saud University  was the most published institution; Laila Al-Ayadhi Yousef was the most published researcher; the This bibliometric study describes the basic framework for the development in the field of neuroinflammation and ASD through an exploration of key indicators . We found that the key role of neuroinflammation in the development of ASD is attracting more and more researchers\u2019 attention. Future studies can investigate the changes in cytokines and glial cells and their related pathways in ASD neuroinflammation. Immunotherapy to inhibit neuroinflammation may be intensively studied as a direction for ASD treatment or intervention. Autistic spectrum disorder (ASD), also referred to as autism, is a common, highly heritable, and heterogeneous neurodevelopmental disorder characterized by impairments in social communication and social interaction along with restricted, repetitive behaviors, or interests . The curAlthough there were reviews on the topic of neuroinflammation in autism, most of them were about a branch or a specific subfield of neuroinflammation in ASD, and they rarely estimated the current progress and future trend in the field from a macro perspective. By contrast, bibliometrics uses mathematical and statistical methods for quantitative and qualitative analysis of the literature , such asThe Web of Science Core Collection (WOSCC) database, which includes over 12,000 of the most influential international journals, and is considered the most prominent bibliographic database of peer-reviewed scientific publications on many research topics , 28, wasThis bibliographic analysis was carried out using VOSviewer (1.6.17) , CiteSpaBecause VOSviewer is a distance-based bibliometric tool focusing on the visualization of bibliometric networks , this stN = 2, time span = 2004\u20132021, years per slice = 1, selection criteria = top 50 . The prediction curve shows that the research literature in this field will continue to increase in the future. Among the types of published articles  were also reviewed. It is useful for researchers to understand the in-depth research in the field of ASD neuroinflammation, as detailed in This study used a bibliometric approach to analyze the development of neuroinflammation research in ASD over the past 18 years. The quantitative explosion of documentation in this area between 2004 and 2021, particularly after 2013, may be a result of increasing recognition of the role of neuroinflammation in the development of ASD and therefore increased funding for research in this area. In terms of the type of literature, the number of review papers has exceeded half of the experimental papers. On the one hand, the research on neuroinflammation in ASD is in the preliminary exploration stage, and there is relatively little relevant original research. On the other hand, the research methodology in this field is complex and has high demands on the relevant subject groups. Nevertheless, the multiplicity of review articles indicates that researchers maintain a high level of interest in the field, suggesting the importance of neuroinflammation in ASD-related research, which deserves more attention in the future. In terms of countries/regions, the majority of articles are from the United States, Italy, Saudi Arabia, China, and England, which is strongly correlated with the economic development of the countries . In addiFrom the keyword co-occurrence and clustering results of neuroinflammation in ASD research, 491 subject words were clustered into 10 research topics, which are both independent of each other and accompany each other, forming an intricate network structure. From these, this review summarizes four institutional pathways that have been the focus of attention in recent years: (1) Microglia-mediated. Microglia activation in the central nervous system in ASD has been of persistent interest since its identification in 2005. The prevailing view is that microglia subtype dysregulation is strongly involved in the occurrence and development of neuroinflammation in ASD. In patients with ASD, microglia are abnormally activated, there are phenotypic imbalances, and a large number of inflammatory mediators are released, resulting in excessive and persistent immune disharmony, destroying neuronal structure and function, and even engulfing synapses and entire neurons, contributing to abnormal brain development and immature connections . (2) MasThis study also has a few limitations. First, the research was limited to the use of the WOS database as a source of data collection; subsequent studies can include more academic databases  so that the research findings are more objective and comprehensive. Second, this paper only analyzed the co-citation and co-occurrence diagrams, and future investigations using bibliometric-coupled methods will help deepen researchers\u2019 understanding of the trends of neuroinflammation in ASD.Brain Behavior and Immunity being the journal with the most publications and citations. We also identified the key individuals and institutions involved in researching this field and summarized the current hotspot mechanisms of concern. We expect that these findings will provide a new research direction in the mechanism of inflammation and lay a foundation for further research on the development trend and focus of neuroinflammation, the establishment of academic exchanges and cooperation between different academic groups, and the promotion of in-depth research on ASD neuroinflammation. In future research, we can seek to investigate the related pathways, including cytokine and glial cell changes in neuroinflammation in ASD, and immunotherapy for inflammation can be used as a possible direction for ASD intervention programs to promote the recovery of ASD patients.To sum up, this study is the first to use quantitative methods to analyze the research history and development status of ASD neuroinflammation and to visualize the number of publications, countries, journals, authors, institutions, and keywords in the field of ASD neuroinflammation. We found that the annual number of publications has skyrocketed in recent years, and people are paying more and more attention to ASD neuroinflammation, with the United States being the country with the largest contribution and the The original contributions presented in this study are included in this article/YS, J-GZ, and X-HH: study design. YS, J-GZ, W-TL, Y-HL, J-HG, and B-XZ: data collection, analysis, and interpretation. YS: drafting of the manuscript. X-HH: critical revision of the manuscript. All authors contributed to the article and approved the submitted version."}
{"text": "Nowadays, the Internet is commonly used by students for both social activities and the academic field. In this context, problematic mobile phone or Internet use is among the most common risks that have proven to be associated with bullying and cyberbullying ,2. The pThis Special Issue presents a compilation of six studies that try to identify protective, contextual, and risk factors of school violence and, specifically, of cyberbullying and cybervictimization in European and North American contexts: three out of the six works were conducted in Spain and the remaining three studies in Italy, United States, and Canada. In addition to the cultural diversity examined, this Special Issue manages to understand cyberbullying throughout three evolutionary stages: childhood, adolescence, and adulthood. Regarding childhood, two works were carried out with Spanish and Italian samples. On the one hand, the Italian study was conducted with Sicilian primary school students to examine the predictive capacity of sociodemographic variables (gender and age) and mechanisms of moral disengagement  on the manifestation of three different roles that are characteristic of school violence: victims, aggressors, and bystanders . On the As for adolescence, research was conducted with samples from Spain and the United States. The former study focused specifically on intrapersonal emotional intelligence  and the With respect to adulthood, this Special Issue includes two works centered on solutions to cyberbullying suggested by college students from Canada  and charSeveral practical implications are offered by this Special Issue to improve mental health and interpersonal relationships throughout the three evolutionary stages examined. During childhood and adolescence, authors suggest applying programs centered on the development of empathy and inter- and intrapersonal emotional intelligence to prevent both bullying and cyberbullying or to reduce their impact on students\u2019 wellbeing ,5. AccorIn sum, this monograph allows us to conclude that cyberbullying and cybervictimization are a worldwide problem that needs to be address in primary, secondary, and higher education settings. Furthermore, students\u2019 characteristics, according to gender and the three different roles that intervene in school violence situations , must be also considered. As a consequence, these findings can form the basis for collaboration among researchers and professionals of the Health, Psychology, and Education fields in the design of cyberbullying prevention and intervention programs."}
{"text": "Arts and Health'    White, , have th) Smith, . A recen) Smith, . Althoug) Smith, , compareArts is an umbrella term. Using a consultative approach, a definition of the Arts was developed by contacting experts in the field of the arts or arts-health from the UK, Australia, Europe, USA and Canada   a comprehensive list of activities and events which articulated the numerous ways people engaged in the arts. These five art forms are listed below and detailed in The Performing arts ;Visual arts, design and craft ;Community and cultural festivals ;Literature , andOnline, digital and electronic arts .It should be noted that each art form may operate independently, but may also collaborate, communicate and intersect in their arts practice with the other four art forms.Arts engagement  is an umbrella term ,Receptive arts engagement: includes experiencing, attending, listening or viewing art .arts engagement and art therapies are not the same thing  , arts initiatives in a variety of settings to directly promote, maintain or improve health and wellbeing outcomes ; and/orThe practice of applying setting to enhance health and wellbeing in that environment ; and/orThe introduction of works of art  into a health or wellbeing initiatives in arts settings, venues or events to promote, maintain or improve health outcomes .The practice of applying Arts on prescription is a form of social prescribing   for enjoyment, entertainment, socially, as a hobby or as part of an organized program. When a person plays a musical instrument, listen to music, sings, dances, paints, draws, read a novel, writes creatively, attend a festival, gallery or takes part in an art class, program or intervention with an artist, musician, actor, dancer, singer, etc (rather than a therapist) this is arts engagement \u2013 not art therapy/therapies  that is rigorous, appropriate, systematic, trustworthy and transparent, rather than methods based on anecdote and opinion  defines health behavior is an activity undertaken by a person, target group or population for the purpose of promoting, maintaining or improving their health and wellbeing  of a person, a target group or population related to a planned or unplanned activity, event, service, program, intervention, policy, regulation or law  or objective data   and The Minderoo Foundation \u2013 Arts & Culture (Ref: 2022/GR000916). The Ian Potter Foundation and The Minderoo Foundation are two of Australia's major philanthropic foundations. This work is also supported by the Western Australian Future Health Research and Innovation Fund, which is an initiative of the Western Australian State Government (Ref: TFMH2021-CD).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "Dear Editor,Pseudomonas aeruginosa.Ecthyma Gangrenosum (EG) was once considered pathognomonic for sepsis caused by 3) and thrombocytopenia . Blood cultures and a skin biopsy were collected, and liposomal amphotericin B and voriconazole were started. Direct examination identified septate hyaline hyphae  during chemotherapy, and treatment with cefepime was started. After ten days, he once again had a fever, with the appearance of erythematous lesions with a necrotic center on the face and chest. He had neutropenia  and thrombocytopenia . Blood cultures and a skin biopsy were collected. Direct examination revealed non-septate hyaline hyphae  and thrombocytopenia . A skin biopsy was collected, and a direct examination identified the presence of gram-negative rods. No specimen was sent for histopathological examination. Subsequently, multidrug-resistant Pseudomonas aeruginosa was identified in the skin and blood cultures. The antimicrobial regimen was maintained until a clinical resolution was attained.Patient 3: Male, 36 years old, had FN during chemotherapy for acute myeloid leukemia, and treatment with cefepime was started. After four days, he had a fever, and arterial hypotension, with the appearance of an erythematous lesion with a necrotic center on the back region. Antibiotic therapy was expanded to include polymyxin B, amikacin, and meropenem. He had neutropenia (170/\u00a0mmThe present report describes three cases of neutropenic patients who developed EG. All had a similar clinical presentation, with fever recurrence and the appearance of lesions during antibiotic therapy. In the first patient, direct examination suggested the diagnosis of fusariosis, directing the combined antifungal treatment. The cause of death was attributed to the absence of immune reconstitution. In the second patient, the direct examination suggested the diagnosis of mucormycosis, directing the change of the antifungal agent for liposomal amphotericin B. In the third patient, the direct examination suggested the diagnosis of bacterial sepsis, directing the expansion of the antibiotic regimen without the association of antifungal agents.Typically, the EG agent is identified in blood and skin cultures. However, as these results are not promptly available, the treatment is usually the empirical expansion of the anti-infective regimen. The disadvantages of this approach are exposure to toxic drugs and increased costs.The skin biopsy is a safe procedure in thrombocytopenic patients.In summary, we suggest performing an early skin biopsy with direct examination in neutropenic patients with EG.None declared.Yung Gonzaga: Approval of the final version of the manuscript; critical review of the literature; collection, analysis, and interpretation of data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the manuscript; drafting and editing of the manuscript; statistical analysis; design and planning of the study.Thiago Jeunon: Approval of the final version of the manuscript; critical review of the literature; collection, analysis, and interpretation of data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the manuscript; drafting and editing of the manuscript; statistical analysis; design and planning of the study.Jorge Machado: Approval of the final version of the manuscript; critical review of the literature; collection, analysis, and interpretation of data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the manuscript; drafting and editing of the manuscript; statistical analysis; design and planning of the study.Marcio Nucci: Approval of the final version of the manuscript; critical review of the literature; collection, analysis, and interpretation of data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the manuscript; drafting and editing of the manuscript; statistical analysis; design and planning of the study.None declared."}
{"text": "To improve the effectiveness of treatment for atypical depression, it is necessary to revise the accumulated experience, taking into account new knowledge and drugs.Comparative study of the efficacy and safety of therapy for atypical depression (AtD) in the structure of bipolar affective disorder (BAD), recurrent depressive disorder (RDR) and psychogenic depression (PD).Clinical and clinical follow-up methods examined 77 patients with AtD, of which 35 - with bipolar disorder, 18 - with RDR and 24 - with PD. Patients in all three groups received monotherapy with an antidepressant or a mood stabilizer, or a combination of antidepressant and antipsychotic, antidepressant and mood stabilizer, mood stabilizer and antipsychotic, as well as a combination of antidepressant, antipsychotic and mood stabilizer.Agomelatine was the most frequently used (27.3%) and effective in reducing MADRS in all groups both in monotherapy and in combination with other drugs. Also in the PD group, escitalopram and vortioxetine were highly effective. Of the antipsychotics, when combined with antidepressants, sulpiride was found to be the most effective. When comparing the tolerance of antidepressants in all groups showed the best results , agomelatine and venlafaxine, in the BAR group is also vortioxetine.The best strategy for effective and safe treatment of atypical depression is the use of modern antidepressant, which does not increase the symptoms of the atypical spectrum and, if necessary, can be supplemented with some antipsychotics.No significant relationships."}
{"text": "We are very happy to present this Special Issue, for which we acted as guest editors, and which includes scientific contributions from laboratories headed by women active in the field of bioorganic chemistry.We made the decision to undertake this project since we deem that there are still gender biases that put women at a slight disadvantage when disseminating their research, preventing the science community from benefiting from a wider diversity of voices. The issues related to the gender scissor and the leaky pipeline that can be observed with career advancement in the academy, especially in the field of STEM disciplines, deserve our attention and the efforts of all of the scientific community to mitigate the gender gap. In order to embrace gender equality, recognize the career progression of women, and to celebrate the achievements of women in the field of bioorganic chemistry, we present in this Special Issue contributions both from highly renewed woman scientists and young woman researchers who are undertaking their early-stage careers.This Special Issue includes fifteen manuscripts, among which eleven high-quality research articles and four comprehensive review articles in the area of bioorganic chemistry, published from mid-2020 to early 2022.The scope of the Special Issue covers a wide range of topics at the organic chemistry-biology interface, including the synthesis and derivatization of natural compounds and their analogues, and the investigation of their biological activities in the human health field  as well as their possible application in the crop protection field as agrochemicals. An example of nanoparticle-based biomaterial is also included. The techniques employed, besides organic synthesis, are in silico studies (docking procedures and molecular modeling), FT-IR spectroscopy, laser diffraction, PET, fluorescence, STD-NMR studies, enzymatic evaluation, experiments on cell lines, and in vivo studies on mice.Cardona, Matassini and co-workers, from Sesto Fiorentino, Italy, reviewed the properties of carbohydrate-based natural compounds and other sugar mimics as trehalase inhibitors, in view of their potential use as non-toxic and therefore greener and safer pesticides .Within the same field of agrochemicals, Dell\u2019Oste, Spyrakis, Prandi and co-workers from Torino, Italy, described that strigolactones (SG), a class of sesquiterpenoid plant hormones, play a key role in the plants\u2019 response to biotic and abiotic stress. In addition, the authors highlighted the possibility that in the next future these compounds might have an application also in human health, and in particular in the control pathways related to apoptosis and inflammation  . Terpened-annulated pentacyclic steroids based on a regioselective interrupted Nazarov cyclization with trapping chloride ion, and evaluated the antiproliferative activity of the synthesized compounds against two breast cancer cell lines helicenes, interesting building blocks for the production of materials with chiroptical properties, using enantiopure camphanic acids as resolving agents .We want to finish this Editorial by thanking again all of the authors who come from three different continents, namely Europe, Asia and Oceania, for having illustrated so well the importance of bioorganic chemistry in their contributions to this Special Issue.A list of short biographical sketches of the authors, together with the description of the obstacles/challenges encountered during their career, or suggestions to a young woman keen to become a successful scientist in the field of bioorganic chemistry, follows in the Reference section."}
{"text": "During the transition from industrial production to intelligent, there are still a large number of manufacturing industries in the traditional production mode. The problems of slow information transmission, difficult integrated production management, and complicated process parameter control have led to disconnect decision-making from actual production. In addition, the current manufacturing industry is more of a traditional management method, and the upgrade and iteration speed are slow, and it is not combined with the technology of the Internet of Things. Therefore, the purpose of this article is to use the Internet of Things monitoring technology to explore the improvement of high-end manufacturing and analyze the problems and solutions in the process of consistency of ecological environment and economic effects. This article will use the research methods of specific problems and specific analysis to compare the data and draw conclusions. This article will discuss the technical mechanism of the Internet of Things monitoring and introduce the collection and data of production status data of each station equipment in the production workshop during the production process: improving the current production model, learning foreign experience at the same time, quickly carrying out load curve and data center data accumulation on the service capabilities of the park, verifying multiple operating models, and simultaneously exploring new management models. Based on comparative advantage analysis, the study draws similarities and differences in the development of high-end manufacturing industries at home and abroad, learns advanced experience, proposes improved methods and paths, combines new environmental protection paths, and finally proposes energy operation in the park. Build a green and intelligent park to provide a theoretical reference for sustainable development. The research results show that computer monitoring technology and methods have effectively improved the production environment of high-end manufacturing, combined with the development status of the existing ecological and intelligent composite production system; the infrastructure construction of industrial parks in the new era, IT support, services, manpower resources, and industries has developed rapidly. With the fast grow and in-depth use of new information technology like Internet of things, Internet plus, and AI, people's quality of production and life has been greatly improved, which not only promotes the economic development but also provides technical support for the transformation and upgrading of the economic structure. The current smart parks also focus more on smart logistics and IOT construction but lack quality monitoring and supervision. In order to better elevate the green and high-quality development of manufacturing industry, it is necessary to establish a complete monitoring system. In the organizational structure of the monitoring system in the green smart park, monitoring nodes are arranged according to the actual monitoring needs to ensure that the monitoring of the environment in the area and the collection of data and information can be met. It has made great contribution to the sustainable development of high-end manufacturing green smart park.In the development process of high-end manufacturing industry, smart park has become a new trend and new requirement for the development of industrial park. With the promotion of comprehensive national strength, we are improving our quality of life step by step. But at the same time, we cannot damage the ecological environment , 2. GeneSince the 1950s, researchers in developed countries and regions have carried out a variety of targeted scientific research experiments on industrial park monitoring and environmental quality improvement . ResearcStarting from the meaning and traits of the Internet of Things, this paper explores the sustainable development of high-end manufacturing green smart park, expounds the environmental problems brought by the current economic production and construction, mainly existing problems of the industrial park, finds out the reasonable solutions and the balance basis point in line with the monitoring characteristics, and organically combines the two. In the research, the application of the Internet of Things technology to the intelligent monitoring of the park enables the high-end manufacturing industry in the intelligent industrial park to operate more greenly and efficiently. This paper will discuss the mechanism of the monitoring technology and introduce the collection and implementation of the production status data of each station equipment in the production workshop during the production process. Improve the current production mode, learn from foreign experience, quickly carry out the data accumulation of load curve and data center's service ability to the park, verify various operation modes, and simultaneously explore new management mode. Through comparative advantage analysis, this paper studies the similarities and differences in the development of high-end manufacturing industry both at home and abroad, studies advanced experience, puts forward improvement methods and paths, combines the new path of environmental protection, and finally puts forward the experience accumulated based on this mode to explore the optimal mode of energy operation and management in the park, build a green smart park, and provide theoretical reference for sustainable development.Internet of Things refers to the use of a variety of information collection terminals and information collection technology to obtain all kinds of information needed by the system and through the Internet and other carriers to upload these information data to the processing center for centralized analysis and processing, to get the corresponding results and make reasonable regulatory decisions based on them, and finally to transmit the control instructions to each terminal equipment to achieve intelligent control system. Through radio frequency identification technology and intelligent perception technology, data collection of all elements of the factory workshop, including workers, equipment, materials, and environment, is completed. According to the on-site situation, an appropriate networking mode is formulated, and the information of each station scattered in the workshop is collected and aggregated to the upper computer for processing, so as to realize the monitoring and automatic management of industrial production. In the production supervision of many production workshops, they are often faced with complex working conditions and excessive environmental interference. These environmental factors, as well as the operation status and parameter data of equipment, are the key factors affecting product quality. The use and popularization technology can achieve intelligent scheduling by setting up multiple sensor nodes to collect and supervise the data of idle and working state of the equipment and improve the utilization rate of the equipment; meanwhile, it can also collect the parameter data of the temperature and speed during the operation of the production equipment that will affect the product quality in real time, based on which the production process, and adjust and control the parameters to improve the production efficiency.A sensor refers to a measuring device that can convert the measured nonelectrical quantity into a corresponding quantity of electricity or an electrical parameter output that is easy to handle accurately according to a certain law. According to its basic sensing function, it can be divided into ten categories: heat sensitive element, light sensitive element, gas sensitive element, force sensitive element, magnetic sensitive element, humidity sensitive element, sound sensitive element, radiation sensitive element, color sensitive element, and taste sensitive element. In order to obtain information from the outside world, people must rely on the sense organs. However, people's sense organs alone are not enough to study the natural phenomena, laws, and production activities.Data acquisition refers to the process of automatic acquisition of nonelectricity or electricity signals from intelligent acquisition equipment, such as all kinds of sensors and other devices to be tested and other analog or digital units to be tested. Data collection is the combination and interaction of information technology and physical level. The traditional data collection method is very single. From the initial manual input, equipment supervision, and other manual operation methods to the later development of data collection using collection devices, the low efficiency of the process has been restricting the industrial production. Up to now, the production demand is growing day by day, and the amount of data in production is huge, which brings great difficulties for data collection and data specification and cleaning after it; at the same time, the protocol of industrial data is not standard, including Modbus, OPC, can, control net, PROFIBUS, ZigBee, and other types of industrial protocols, which leads to great difficulties in the interconnection of industrial protocols. The emergence of technology brings great innovation to the methods of data collection, processing, and analysis.In different periods and at different levels of social and technological development, the specific manifestations of high-end manufacturing industry are different. The difference in high-end manufacturing is mainly reflected in the way and method of manufacturing, and with the high-end manufacturing, pollution will gradually decrease. Every great change in the field of science and technology has led to a leap in the quality of manufacturing industry: during the first industrial revolution, \u201chigh-end manufacturing\u201d means mechanical manufacturing instead of manual manufacturing; during the electrification revolution, large-scale production activities appear and become increasingly mature; \u201chigh-end manufacturing\u201d represents the production of electrification and automation; with the popularization and application of computer technology, the production is gradually intelligent and large scale. The advantage of \u201cinformatization\u201d is outstanding, which represents the \u201chigh-end\u201d manufacturing mode in the new era. From the industrial point of view, the manufacturing industry that is emerging or is likely to develop into an emerging industry, with high technology content, high-added value, and strong market competitiveness of finished products, is defined as high-end manufacturing industry, which is often referred to as \u201cnew energy\u201d and \u201cnew material\u201d industry. For example, there are \u201cnew energy\u201d industries, such as solar photovoltaic industry, marine wind power, and lithium-ion energy storage battery manufacturing, and \u201cnew material\u201d industries, such as nanobiomaterials, high-performance carbon fiber composite materials, and additive printing technology.n iterations, each training set is classified by a classification algorithm, and the classification error rate is\u03c9iI is the weight of the ith sample and Gn is the nth classifier.In the process of monitoring the production status, understanding the production data, comparing with the green standard, gradient lifting tree is one of the excellent methods, which has been widely concerned and applied in industry and other fields. In this paper, the gradient boosting tree algorithm is used to perform deep learning on the monitored video to convert the monitored production status into visual data. In this paper, XGBoost is used as the research method of extreme gradient enhanced tree computing. Based on GBDT, parallel processing is used, and it has high scalability. According to the previous description, boosting, as an efficient algorithm of integrated learning, can adjust the weight of the learning machine according to its performance in the training process, realize the enhancement of weak learning machine, and improve the accuracy of classification. The process is as follows: (1) all training sets are given the same weight; (2) after After the iteration, all the classifiers are obtained. From the above steps, it can be seen the classification error samples, whose weight will become higher, in order to optimize the next iteration effect. Finally, the sample is obtained by voting classification results. It is proved by experiments that the loss function of boosting is in exponential form, and the gradient lifting decision tree is to make the loss function drop along the gradient direction in the iteration.So as to improve the classification accuracy, XGBoost is the optimal implementation of the algorithm. XGBoost model integrates multiple classification regression cart tree models, which are constructed according to different characteristics, and the value of the leaf node of the tree represents the importance of the characteristics. The expression of XGBoost model can be given:K in the expression refers to the number of cart tree models, yi refers to the predicted value of a single tree, xi refers to the ith input sample, and F refers to the total set of all cart trees with probability in training. XGBoost algorithm does not need to give all the sets of trees but uses gradient lifting method to add a new tree model each time and constantly improves the previous results.Five indicators will be selected, including total industrial output value, number of enterprises, main business income, average number of employees, and production capacity of main products. Among them, the total industrial output value is expressed in the form of currency. The total value of the final products or labor services provided by an enterprise in a certain period of time reflects the total scale and level of production in a certain period of time. The production capacity of main products refers to the core design and manufacturing, application equipment manufacturing, software development and application, system integration, and network operation. The annual production capacity of the five links, such as information service, can be expressed in terms of output value.Five indicators will be selected, including total profit and tax, industrial added value rate, product sales rate, total asset contribution rate, and total labor productivity. Among them, the total profit and tax is an indicator that counts the total profit and tax of the enterprise, which reflects the total profit realized by the enterprise in the quantitative indicator that undertakes the obligation to the region; the industrial added value rate refers to the proportion of industrial added value in the total industrial output value in a certain period of time, reflects the economic indicator that reduces the intermediate consumption, and is also the Internet of Things industry core indicators of development; product sales rate refers to the ratio of sales output value in the reporting period to total industrial output value in the same period, which reflects the extent to which industrial products have been sold and is an important indicator to analyze the balance of production and demand in the Internet of Things industry; total asset contribution rate reflects the relative indicators of the output of total assets of enterprises, reflects the profitability of all assets of enterprises, and evaluates industrial benefit core indicators. The total labor productivity is the comprehensive performance of the production technology level, management level, technical proficiency, and labor enthusiasm of the enterprise, and it is also an important index to assess the industrial efficiency.Five indicators will be selected, including R&D expenditure, number of Internet of Things standards, number of patent applications, number of important research results, and sales revenue of new products. Among them, R&D expenditure refers to all kinds of direct and indirect expenses incurred by enterprises in the research and development process of products, technologies, materials, processes, and standards; the number of important research results refers to the number of key technologies that are conquered and recognized by the state in the fields of perception, transmission, processing, application, and other technologies; the new products refer to the research results that are obtained through technological innovation. The product has a breakthrough in one aspect or obvious improvement compared with the original product, thus significantly improving the product performance or expanding the use function, which has a certain part in boosting the economic efficiency of the product and is conducive to the sustainable development of the city's industry.Five indicators will be selected, including the number of application projects, the number of public service platforms, the number of industrial clusters, the number of key enterprises, and the number of international cooperation. Among them, nonstandard application projects, public service platforms, industrial clusters, and backbone enterprises are all general, standard, independent and controllable application platforms, Internet of Things public service platforms, Internet of Things industrial clusters, and backbone enterprises recognized by the state; international cooperation refers to the establishment of R&D institutions in China and joint R&D and establishment abroad by overseas enterprises and scientific research institutions R&D institutions; this index helps to enhance the international competitiveness of Wuxi Internet of Things industry.In the experiment of this paper, firstly, the industrial equipment is screened, and the appropriate type of factory equipment is selected, and then, the Internet of Things technology is used to arrange the intelligent monitoring equipment in the factory park. Finally, the intelligent monitoring system is tested.24\u2009V industrial switching power supply, PLC, temperature and humidity meter, electric energy meter, temperature control meter, pulse generator, Modbus gateway, wire, and other materials are shown in Assemble the unit data acquisition module, input the PLC's own program, set the slave station address and communication parameters  for each instrument connected to 485 bus, check the circuit and power supply safety, and prepare for the subsequent test. As a comprehensive data acquisition and processing module, PLC is an important test object. Firstly, the signal acquisition function and serial communication function of PLC will be tested, and all kinds of instruments will be connected to the corresponding interfaces of PLC , and then, PLC will be connected through 485 to USB data line direct serial communication with the testing machine computer and data reading and displayed through Modbus poll debugging software. Finally, the test function interface is written through the configuration software, and the data table is read and displayed. The data acquisition and monitoring experiment of the monitoring meter have been completed successfully. The test methods of the temperature inspection instrument, the electric energy meter, and the pulse signal generator are consistent with the above process. After the server and configuration software of the machine room are built, the monitoring screen is projected to the central screen through the remote desktop, so as to realize the production in the workshop site and facilitate the timely supervision and control of the production management personnel.With the widespread use of the Internet, the structural transformation and development of high-end manufacturing industry also need to be improved. Industrial production began to face a series of diversified challenges; the traditional production technology and information management have been unable to meet its development needs. What changed was the birth of diversified integration of the industry, \u201csmart factory,\u201d \u201csmart manufacturing,\u201d and other concepts came out. In this field, centering on intelligent manufacturing, it integrates many technologies such as industrial automation, intelligent logistics, industrial big data platform, and industrial Internet of Things, making manufacturing gradually replaces new blood. Among them, data visualization is very important. Due to the high integration of industrialization and information technology, information technology provides a variety of ways for data collection, such as bar code, two-dimensional code, RFID, industrial sensors, automatic control system, and other technologies that have been fully applied. Through the combination of RF technology and industrial sensors, the data acquisition system covering the whole production system equipment can be realized. At the same time, it is hard to manage a lot of production data only by manpower. Therefore, it is very important to realize data visualization, data centralization, and intelligent control. The intelligent system planning and design of the smart park should take the construction of green buildings and the park as the goal, to achieve functional practicality, timely technology, safety and efficiency, standardized operation, and economic rationality. The intelligent construction planning and design of the park shall be carried out in strict accordance with the building function, building equipment management, building environment management, etc., and the concept of the intelligent park. The planning and design of intelligent monitoring system engineering can know the production status and change the production mode at any time. The intelligent system planning and design of the intelligent park is based on the building and its landscape as the platform, based on the integrated application of various intelligent information, integrating architecture, system, application, management, and optimization, with the integrated intelligent ability of perception, transmission, memory, reasoning, judgment, and decision-making, and providing the park people with a safe, efficient, convenient, and sustainable development function ring environment.Motor parameter acquisition subsystem is the basic measurement unit of the whole motor monitoring system, which is mainly composed of STM32 controller, temperature sensor, voltage, current, vibration sensor, hall speed sensor, LoRa wireless data transmission module, and TFT display interface. Complete the real-time and accurate measurement of the field motor parameters, and transmit the data to the relay data transmission subsystem through the LoRa wireless module, so as to realize the concentration of multiple motor operation parameters. As shown in The relay data transmission subsystem is the intermediate node of the whole motor condition monitoring system to realize the remote transmission and monitoring of motor data. It is mainly composed of STM32 controller, LoRa wireless data receiving module, and Nb IOT wireless Internet of Things module. Through LoRa wireless module, the wireless local area network function of multiple parameter acquisition subsystems on site is completed, and the data of multiple motor equipment on site is centralized. Then, through the Nb IOT module, the field motor parameters are uploaded to the open platform of the telecom IOT in order to awake the remote networking and data access operation of the field motor data.Data storage monitoring service platform is the data storage and remote monitoring interface of the whole motor condition monitoring system. Using the API provided by the open platform of the Internet of Things, the data interaction between the IOT North host computer and the open platform of the Internet of Things is realized, the motor parameters of the front-end parameter collection and transmission unit are acquired, and the acquired parameters are stored in the corresponding data table items of MySQL database. Then, through the remote browser access Tomcat web server, the data in MySQL database is displayed in the remote access end, to achieve the monitoring of the running state of the field motor. As shown in In the parameter setting of quality prediction model based on XGBoost algorithm, some parameters are set as follows, as shown in The unit data acquisition module equipped with each equipment has basically completed the equipment status data acquisition required by production, completed the communication between the lower sensor and the upper computer through reasonable networking, and successfully implemented the real-time monitoring function through the configuration software. In the real-time data acquisition, there is a slight delay deviation between the actual data of the equipment and the acquisition display data, which has no impact on the product production control within the acceptable range. But it also needs to be improved later. So far, the whole data acquisition and monitoring system have been built, and the equipment number, corresponding IP address, and slave station address are recorded in the upper computer software for later query and management. Configuration software has played its due role. It not only collects and transmits the data of the sensors of the lower equipment but also successfully completes the real-time monitoring of the configuration and provides a variety of monitoring management methods such as trend chart and report form, which provides a good foundation for the subsequent improvement and optimization. In conclusion, XGBoost algorithm has a good performance in quality prediction-oriented classification. In the production process, the prediction model can be used to complete the batch of products according to the existing process parameter settings before they are put into production; the prediction of good product rate has a more comprehensive understanding and control of production and processing, as show in As a complex system engineering, the Internet of Things has cross integration with many technologies, such as radio frequency identification, network communication, integrated circuit, computer software and hardware, and system integration. In this technology chain, the backwardness of any link will affect the development of Internet of Things and industry.Worldwide, Philips, French semiconductor, and Texas Instruments basically monopolize the RFID chip market; Intel, Honeywell, Foxboro, and other enterprises have absolute advantages in the sensor market; IBM, Microsoft, Sybase, Oracle, and other international giants seize the leading position in middleware, Internet of Things system integration, and overall solution market; The core technology of information module and intelligent control equipment is also basically in the hands of European and American multinational companies. As far as China's current situation is concerned, due to the limitation of domestic IC design level, there is a lack of independent intellectual property rights in key core technology areas, which restricts the further development. China has successfully cultivated a number of industry leading enterprises in this field, but in sensor manufacturing, Internet of Things system integration application, public service, and other fields, there is a lack of leading enterprises to control high-end products or core technologies, especially those chain leading enterprises that determine technical standards, master the right to formulate technical standards, and can lead the direction of technological innovation and evolution, which have not yet formed. Effective business model and industrial division system lead to the low output value of the core industry.Technological innovation and industrial development have the relationship of mutual influence and promotion. At the same time, the development of industry also needs the combination of industrial model matching with relevant technological innovation. With the increasingly extensive application of the technology and the continuous maturity of common markets, the state needs to guide the industry of Internet of Things from support to independence, promote the connotative development of China's Internet of Things industry, achieve technological innovation and surmount in key technologies, and promote the development of new urbanization with greater advantages."}
{"text": "At present, collaborative industrial parks (CIPs) in the Yangtze River Delta Region (YRDR) have become an important spatial strategy for coordinating regional development. However, existing studies tend to focus on individualized micro-studies, ignoring the regional-scale production space reconstruction by the geographical expansion of CIPs. Based on this, this study takes the YRDR, where the development of CIPs is relatively mature, as an example and systematically analyzes their geographic expansion process and driving mechanism. The results found that CIPs in the YRDR have gone through three stages: the exploration period of CIP construction under the guidance of assistance policies; the blowout development period of CIPs under the demonstration effect; and the complete cluster formation period of CIPs. Regional central cities, such as Suzhou, Hangzhou, Nanjing, and underdeveloped cities, such as Tongling and Xuancheng, are core nodes, with Shanghai\u2013Nantong; Shanghai\u2013Anqing; Nanjing\u2013Huainan; Wuxi\u2013Xuzhou; Suzhou\u2013Suqian; and Jiaxing\u2013Lishui being important elements in the flow channel. The CIP network is basically formed. During this period, the degree of all nodes increased to 134, the network connection rate increased to 2.26, and the network complexity was more significant. Furthermore, CIPs are essentially a form of capital re-territorialization and space restoration organized and coordinated by the government . In the meantime, the market and the social environment, such as residents\u2019 living standards, urban development foundation, urban transportation, and urban investment, also have an important impact on the geographic expansion of CIPs. In the regression results, the coefficients of popu, finance, labor, and passenger are significantly negative, but the coefficients of wage, gdp, freight, and govrd are significantly positive. From the agricultural economy to the later stage of industrialization, the economy and society have basically been organized around cities . HoweverIn the past, scholars discussed the spatial structure of economic and social connections between cities based on the flow of people, traffic, information, and capital ,8. The cWith the development of CIPs in the YRDR, significant changes are taking place in the economic production links between cities. What changes have taken place in economic production linkages under the background of the expansion of CIPs in different places? How is their formation mechanism different from traditional element flow? It is an important direction for this paper to expand existing literature theory. As one of the typical representative regions of regional integrated development in China, the development of CIPs in the YRDR has experienced nearly 20 years. It has transformed from an exploration period to a gradual maturity period, which provides a good case support for us to carry out related research. Therefore, in order to clarify the heterogeneity of its connection with traditional factors for the reconstruction of economic production relations, this study takes the geographical expansion of CIPs in the YRDR as an example, and systematically analyzes the spatiotemporal evolution pattern of its geographical expansion based on complex network methods. At the same time, based on the two-way fixed effects measurement model, the mechanism of its geographical expansion is systematically discussed.\u201cEnclave Economy\u201d first reflects the phenomenon that a foreign-oriented or high-tech industry is dominated by international capital rather than embedded in the local economy ,6, whichLater, with the innovation of the interactive cooperation model between domestic cities, it is given new connotations, and the research scale begins to focus on regions or cities, which mainly reflects the cross-administrative boundary cooperation model between different cities or regions ,16. On tCurrent research mainly focuses on the economic performance , operatiAs for the dynamic mechanism of CIPs , currentThe driving force of the market is the attractiveness of economic benefits brought about by the allocation of resources on a larger scale, and the effective flow of elements is gathered together to achieve the complementation and effective allocation of resources . Some stIn addition, some studies also found that the public, non-governmental organizations (NGOs), social business groups, and other social entities play an important role in the development of CIPs. The cooperative partnership established by cooperative entities based on social factors, such as mutual trust, respect, and social network connections, plays an important role in promoting the transfer of knowledge in the process of cooperation . NGO intOn the whole, current research mostly focuses on individualized micro-research, the scale is mainly concentrated in a city or even a CIP itself, and there is a lack of more detailed research on the changes and trends of macro-structure. In particular, it ignores the analysis of the restructuring of regional-scale production space by the geographical expansion of CIP. At the same time, current research on the driving mechanism of CIPs mainly focuses on government behaviors, and less attention is paid to the influence of the market and social environment. Based on this, the study takes the YRDR as example; conducts a systematic analysis of the spatial production process and organizational model evolution of CIPs; and adopts a combination of qualitative and quantitative methods to systematically summarize the impact of government behaviors, the market, and the social environment on CIPs, which can provide a theoretical reference for cross-urban regional organization of economic activities in the new era.i represents the individual city; t represents the year; K represents the degree value of the dependent variable node ; X represents the driving factor variable; city is the unobservable individual fixed effect of a city; year is the time fixed effect; and \u025b is the random disturbance term. With reference to previous research literature .Centrality: In recent years, in order to fully evaluate the status and role of nodes in the network, scholars have mainly analyzed the degree centrality, adjacency centrality, and betweenness centrality .Degree centrality: Degree reflects the connection between a node and other nodes. Degree centrality is the most direct measure to describe the centrality of nodes. The greater the degree value of nodes, the higher the degree centrality of these nodes and the greater the importance of these nodes in the network . The speThis study takes the Yangtze River Delta Region as the research area . AccordiTaking into account that relevant data on CIPs have not been systematically counted, the research process mainly uses policy documents and the literature to sort out the data, while taking into account the information extracted from news materials and reports to obtain relevant data. Secondly, part of the data is obtained in conjunction with the statistical yearbooks of the development zones of various provinces and cities. These statistics found that after 2010, CIPs in the Yangtze River Delta entered a period of blowout development. At present, according to incomplete statistics , the numAs for the data in Overall, the geographical expansion of CIPs in the YRDR can be roughly divided into three stages: the exploration period of CIPs; the \u201cblowout\u201d development period of CIPs; and the complete cluster formation period of CIPs. In different stages, there are obvious differences in the spatial organization mode of CIPs.The establishment of a Jiangyin\u2013Jingjiang CIP in 2003 opened the prelude to CIPs in the YRDR. In 2006, in order to solve the backward economic development in the northern part of Jiangsu, the Jiangsu Provincial Government issued the \u201cNorth-South Linkage\u201d policy, which has further explored the institutional design of CIPs under the leadership of the government ,45. UndeAt this stage, CIPs basically present a one-way connection, and under the influence of assistance policies, CIPs are basically set up in underdeveloped cities a. In ordFrom the characteristics of the complex network at this stage, there are 11 nodes with a degree of one, accounting for 68.75%. From the perspective of degree centrality, Shanghai has the highest degree value (5) and has the most connections with other nodes in the network, showing high centrality (0.33). This is followed by Lianyungang, Yancheng, Wuxi, and Nanjing , with the degree centrality being all 0.13. In terms of the connection rate and network density values, both are zero, indicating that the interaction and interdependence between these node cities are relatively limited, and the network structure is relatively simple at this time.Inspired by the CIPs in Jiangsu, Zhejiang carried out the construction of the \u201cMountain-Sea cooperation\u201d CIPs, and Anhui carried out the \u201cSouthern and Northern cooperation\u201d CIPs. Zhejiang issued the \u201cSeveral Opinions on the Implementation of a New Round of Mountain-Sea CIP Projects\u201d in 2009 , encouraAt this stage, the scale of CIPs had rapidly expanded and had expanded to Zhejiang and Anhui provinces a. The nuFrom the characteristics of the complex network at this stage, the degree value of all nodes has increased from 24 to 83, an increase of 245%. At the same time, node cities have begun to show a multi-directional development pattern. Among them, there are 13 node cities with a degree value of more than three, accounting for 40.6%. Especially for Shanghai, Suzhou, Wuxi, Nanjing, which have relatively good economic foundations, with degrees of 8, 7, 6, and 4, respectively. These node cities also show high centrality in the network of CIP, with high agglomeration coefficient and node centrality, which makes the hub-and-spoke network structure characteristics outstanding during this period. At the same time, during this period, the network connection rate has increased from 0.85 to 1.59, and the network complexity has increased significantly. The network density has dropped from 0.20 to 0.17, and the overall tightness of the network has dropped. From the distribution of CIP in various provinces, the scale of CIPs in Jiangsu Province continues to expand, especially between Nanjing and Huai\u2019an, between Changzhou and Yancheng, and between Lianyungang and Zhenjiang, and the number of CIP (three or more) has increased significantly. In Anhui Province and Zhejiang Province, CIPs have begun to appear sporadically, but the number of CIPs between urban nodes is basically one; the network connection rate and network density are low, and the network structure is relatively simple. As far as Shanghai is concerned, Shanghai has started cross-provincial CIPs, with Nantong, Yancheng, and Suzhou in Jiangsu Province; Xuancheng and Ma\u2019anshan in Anhui Province; and Jiaxing in Zhejiang Province. However, during this period, CIPs in the YRDR are basically within the province and the newly built CIPs are mainly concentrated in Jiangsu and Anhui provinces, while the number of newly built CIPs in Zhejiang is still relatively small.After 2015, the National Development and Reform Commission of China issued the \u201cGuiding Opinions on Supporting the Development of \u201cEnclave Economy\u201d\u201d . Under tAt this stage, the scale of CIPs continues to expand, and with the development of cross-provincial CIPs, the interconnection of elements between cities has basically been realized a. From tFrom the characteristics of the complex network at this stage, the number of nodes participating in CIPs has increased from 32 to 41, and the degree of all nodes has increased from 83 to 134. During this period, the network connection rate has increased from 1.59 to 2.26, the network complexity has become more significant, and the network has a loop structure. The network density has dropped from 0.17 to 0.16, indicating that, with the geographical expansion of CIPs, the overall network compactness has declined, and the overall network connection has become relatively sparse, which is closely related to the connection between some new nodes in Anhui and Zhejiang. From the perspective of the degree value of the network nodes, there are 11 nodes with a degree value of one in the network, accounting for 26.2%. There are 22 node cities with a degree value of more than three, accounting for 53.7%. The nodes with a degree value of more than five are Shanghai, Suzhou, Hefei, Xuancheng, Ningbo, Lishui, Chuzhou, Wuxi, and Nanjing. Among them, Shanghai, Suzhou, Hefei, Ningbo, Wuxi, and Nanjing are mainly flying-out places, while Xuancheng, Lishui, and Chuzhou are mainly flying-into places. From the perspective of agglomeration coefficient and centrality index, the formation of complete agglomeration further strengthens the network centrality characteristics of many nodes. On the one hand, some cities with high degree have formed a high network centrality, such as Shanghai, Hangzhou, Suzhou, and Nanjing. On the other hand, some cities with relatively backward development foundations are also closely connected with other nodes in the network, such as Tongling and Xuancheng, which also exhibit high network centrality characteristics.To sum up, with the development of cross-provincial CIPs, the complete cluster formation of the network has become more and more obvious, and it has become an important regional space carrier that carries the occurrence and development of economic activities in the YRDR. The spatial distribution of CIP plays an important role in promoting the process of industrial integration in the YRDR.Based on previous research, it is not difficult to find that the evolution of CIPs will not only be influenced by policy guidance, but will also be affected by the market, social, and other factors. It should be noted that in China, social organizations are relatively limited in guiding the construction of CIPs, so this paper does not discuss the social aspects.As a new institutional space, a CIP is fundamentally driven by the spatial movement of capital , and it In addition, the national spatial selectivity has played a significant role in promoting the development of cross-provincial CIPs . It is mIn order to reflect the robustness of the regression results regarding the driving mechanism, this paper conducts a stepwise regression test according to the four variable groups involved. The results demonstrate that the influence of different market factors on CIPs shows obvious heterogeneity . For theOn the whole, affected by the strong government intervention, the geographical expansion of CIPs has broken the cognitive category of traditional economic geography that the flow of factors follows geographical proximity and agglomeration to the megacities; the impact of some factors on the geographical expansion of CIPs presents an anti-marketization characterization. In the regression results, the coefficients of popu, finance, labor, and passenger are significantly negative, indicating that the higher the level of urban population agglomeration and financial development; the more the number of people; and the greater the passenger traffic, the lower the enthusiasm for participating in the construction of CIPs. This phenomenon is contrary to the laws of the market, which may have a lot to do with the development stage of most cities with a high level of economic foundation development in the YRDR. At present, most cities in the YRDR with high development level cannot meet their own development needs in terms of population absorption and financial services, etc. Under the influence of government support policies, they have to participate in the development of CIPs, which makes some factors appear to have anti-market characterization.At the same time, the coefficients of wage, gdp, freight, and govrd are significantly positive. It shows that the geographical expansion of CIPs is still positively affected by market factors, such as the level of local economic development, external production links, the level of scientific and technological development, and the income of residents. This analysis assumes that, with the market-oriented development of CIPs, the foundation of economic development, the connection with external production, the level of scientific and technological development, and the income of residents have become the key factors affecting the high-quality and sustainable development of CIPs, and they have also become an important manifestation of market participation in the construction of CIPs.In addition, the coefficient of house is positive but not significant; the coefficient of sec is negative but not significant; and the coefficient of hum is negative but not significant.In order to ensure the reliability of the regression results of the above-mentioned driving mechanism, this paper also conducts a series of robustness tests.\u2460 Stepwise regression. The stepwise regression results in \u2461 Change the research sample. \u2462 Select some years. Model (4) in In recent years, the policies and practices of CIPs in Jiangsu, Anhui, Zhejiang, Shanghai, and other places have continued to innovate. CIPs have shown the characteristics of diversified types, multiple participants, and cross-regional cooperation. This article conducts empirical research on the evolution and driving mechanism of CIPs in the YRDR. The results demonstrate the following:From the perspective of the geographical expansion of CIPs, we found that, with the geographical expansion of CIPs, city nodes are gradually connected due to the co-construction relationship, and a networked organization model of CIPs has emerged. At present, the core nodes of regional central cities, such as Shanghai, Suzhou, Hangzhou and Nanjing, and underdeveloped cities, such as Tongling and Xuancheng, have been initially formed, with Shanghai\u2013Nantong; Shanghai\u2013Anqing; Nanjing\u2013Huainan; Wuxi\u2013Xuzhou; Suzhou\u2013Suqian; Jiaxing\u2013Lishui, and others being the important elements in the flow channel. The construction of CIPs under the assistance policy has boosted the central position of urban nodes in some underdeveloped regions to a certain extent, and will have a greater impact on the development of the edge cities of the YRDR.From the perspective of the driving mechanism of CIPs, on the one hand, CIPs are a form of the capital re-territorialization and space restoration coordinated and organized by the government . On the other hand, affected by the strong government intervention, the impact of some factors on the geographical expansion of CIPs present anti-market characterization, with the coefficients of popu, finance, labor, and passenger being significantly negative. However, market factors, such as the local economic development level, external production connection, scientific and technological development level, and residents\u2019 income, still play a significant positive role in the geographical expansion of CIPs.In this context, we should give full play to the important role of CIPs in the cross-regional flow of factors, actively guiding developed cities and surrounding underdeveloped cities to carry out the construction of CIPs, guiding cross-regional exchanges and cooperation of factors, and promoting a new round of development of regional integration. Secondly, we should give full play to the dual factors of government and market in future urban and regional development. On the one hand, we should give full play to the government\u2019s macro-control role in guiding the cross-regional flow and connection of elements, giving more development opportunities to marginal cities or underdeveloped areas, and promoting the rapid development of integration by creating policy space, such as CIPs in different places. On the other hand, we should also provide a good market environment for the cross-regional flow of factors, such as the construction of rapid transit system, supporting urban infrastructure, giving full play to the guiding role of the market, and removing the market barriers of cross-regional circulation of factors.This research systematically sorts out the process and driving factors of the geographical expansion of CIPs in the YRDR, which can provide a certain theoretical reference for the production interaction in the YRDR in the new period. On the one hand, in the past, scholars discussed the spatial structure of economic and social connections between cities based on the flow of people, traffic, information, and capital ,8, and tHowever, there are still many problems that need to be further analyzed and improved. On the one hand, this research lacks relatively micro-data, such as the industrial attributes of parks, and the analysis of the spatial impact of CIPs on the industrial structure of the YRDR is lacking. On the other hand, current parks have experienced nearly 20 years of development. How are their development status? What are the later issues that they are facing? Furthermore, this paper only analyzes the process and driving factors of the geographical expansion of CIPs, and there is no validation on whether CIPs play a mediating role in the cross-regional flow. All of these questions need to be analyzed through a field survey system."}
{"text": "Dear Editor,The skin can signal internal diseases such as visceral neoplasms. Any tumor has the potential to cause skin metastases, which can occur via lymphatic, hematogenous routes, contiguity or iatrogenic implantation. Subcutaneous nodules can have inflammatory, infectious or neoplastic etiologies. Skin metastases occur in 1% to 9% of malignancies, and about 10% affect the umbilical region.2Metastasis to the umbilical region has been described as Sister Mary-Joseph's nodule. It is a painless, palpable lump that varies in color from violaceous to reddish-brown and can resemble a vascular structure.A 45-year-old female patient presented with painless nodular lesions in the umbilical and periumbilical region for 6 months, associated with weight loss and abdominal pain. Clinically, she was pale, emaciated, showing a globular and ascitic abdomen, an abdominal mass in the pelvic region, and purplish-brown nodules with an ulceronecrotic surface and hardened consistency in the umbilicus and periumbilical region . The abdIt is essential to know the causes of umbilical nodules, since this cutaneous manifestation can represent an opportunity to make the diagnosis of the primary lesion. Some differential diagnoses are cutaneous endometriosis, pyogenic granuloma, melanoma, squamous cell/basal cell carcinoma, and umbilical hernia.Findings similar to those of the present case (CK7+ CK20-) correspond to primitive tumors that can be located in the breast, lung, thyroid, and gynecological tumors. Specific antibodies were used, excluding adenocarcinoma of other origins and indicating the ovary as the strongest possibility of the primary origin of the umbilical metastases. Finally, it is important to note that in the presence of umbilical nodules, the possibility of cutaneous metastases should be considered.None declared.Ivonne Dannesy Rodriguez Hernandez: Approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscriptPatricia de Franco Marques Ferreira: Approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.Paula Dadalti Granja: Approval of the final version of the manuscript; design and planning of the study; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.Mayra Carrijo Rochael: Approval of the final version of the manuscript; drafting and editing of the manuscript; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.None declared."}
{"text": "In the published article, there was an error in affiliation 3. Instead of Department of Psychology, Beijing Normal University, Beijing, China, it should be Institute of Early Childhood Education, Faculty of Education, Beijing Normal University, Beijing, China.The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "Dear Editor,The auricle or pinna is a frequent target of malignant neoplasms. Half of the tumors are located in the helix, and many defects involve both skin and cartilage, making surgical reconstruction a challenge.in situ squamous cell carcinoma (SCC), measuring 13\u00a0mm in its largest diameter, submitted to Mohs micrographic surgery (MMS) and removed in the first stage. The second patient had an infiltrative basal cell carcinoma (BCC), measuring 8\u00a0mm in its largest diameter, removed in 2 stages, using MMC. Finally, the third case was a well-differentiated SCC, measuring 10\u00a0mm in its largest diameter, resected using the conventional technique  are easily reconstructed with wedge excision and primary closure, unlike larger defects, which require the use of grafts or flaps.Grafts require a preserved cartilaginous structure, with viable perichondrium or cartilage perforations to allow irrigation through the contralateral bed. In composite defects, the structural loss of the helix margin requires cartilage and skin for its repair, which can be performed using the following techniques: composite graft from the contralateral auricle; interpolated flaps using cartilage; chondrocutaneous flap.The chondrocutaneous flap was first described by Antia and Buch, in 1967. The principle of the procedure is to advance the skin and cartilage of the intact portion of the helix adjacent to the defect, based on a wide and secure retroauricular pedicle, with greater preservation of the vascularization of the posterior auricular artery.Therefore, Antia and Buch flap, despite having been described more than 50 years ago, maintains its role among the techniques of helix reconstruction, and its knowledge is important for dermatological surgeons. It is an effective and safe method, performed in a single step with the additional advantage of preserving local vascularization, reducing the risk of necrosis.None declared.Paula Hitomi Sakiyama: Approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; critical review of the literature; critical review of the manuscript.Thiago Augusto Ferrari: Approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; critical review of the literature; critical review of the manuscript.Ra\u00edssa Rigo Garbin: Approval of the final version of the manuscript; design and planning of the study; collection, analysis, and interpretation of data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of studied cases; critical review of the literature; critical review of the manuscript.Roberto Gomes Tarl\u00e9: Approval of the final version of the manuscript; design and planning of the study; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.None declared."}
{"text": "This paper studies the construction and development strategy of intelligent sports system in the context of Chinese National Fitness Program with methods of literature review and model construction. The research shows that there are four dilemmas in the implementation of intelligent sports in national fitness: data security, market monopoly, legal supervision, and product iteration. However, there are also three promoting factors in this regard, including policy guarantee, market demand, and industrial upgrading. Following the principles of scientificity, effectiveness, public welfare, and collaboration, this paper designs a system for intelligent sports in national fitness. The construction of the national fitness intelligent sports system mainly consists of four modules, including basic framework construction, function design, content design, and operation analysis. With the systematic analysis of the status quo of intelligent sports application in national fitness, this paper puts forward intelligent sports development strategies in the implementation of national fitness from four aspects: optimizing the top-level design of government, speeding up industrial transformation and upgrading, constructing market supervision mechanism, and establishing a talent training system. The \u201cNew Generation AI Development Plan\u201d issued by Chinese State Council in 2017 marked that artificial intelligence(AI) would become a key national development field, and AI would be more applied to the real world, so as to improve the efficiency of industrial development, inject power into traditional industries, and promote new industrial reform. With the development of artificial intelligence in the field of sports in recent years, new breakthroughs have been made in sports intelligent manufacturing. As mentioned in the \u201cOutline of Building a Sports Power\u201d and \u201cOpinions on promoting national fitness and sports consumption to promote high-quality development of sports industry,\u201d China will accelerate the application of emerging technologies such as Internet Plus, big data, and artificial intelligence in the national strategy of national fitness, and promote the integrated development model of \u201csports plus.\u201d It can be concluded from a number of national policies that the first step to develop national fitness in China is to encourage new forms of national fitness, improve sports consumption patterns, and upgrade the traditional industrial system. The second step is to promote the open sharing of national fitness data resources, improve the digital infrastructure and security guarantee of national fitness, and accelerate the innovative application of resources. Thirdly, it aims to focus on cultivating and strengthening digital sports economy, and promote digital transformation in all fields of national fitness. Finally, it aims to promote the in-depth implementation of the national strategy of fitness for all and open up a new prospect in building China into a sports power.However, at present, intelligent sports is still in its infancy in the implementation of national fitness, and its application, integration, and development strategies still need further exploration and research. There are many problems in the development of intelligent sports in the national fitness: how to plan the infrastructure layout of intelligent sports in the national fitness? How to coordinate government departments, market, industry, and the public? How to better integrate intelligent sports into this national strategy? How to deepen the implementation of national fitness? It is particularly important to explore the development strategy of intelligent sports in the implementation of national fitness. Therefore, this article is going to construct an intelligent sports system in national fitness from both macro and micro perspectives, and conduct research on the content, function, and operation of this system. The analysis of the development path of intelligent sports can help intelligent sports better integrate and develop in the implementation of national fitness, achieve the best coupling of \u201csports\u2009+\u2009artificial intelligence,\u201d and eventually promote the effective implementation of national fitness strategy.Intelligent sports is a knowledge system which takes sports as the main body, and uses artificial intelligence, Internet, Internet of Things, big data, and other high-tech means to exert a certain influence on human body activities and sports thoughts. From a time perspective, intelligent sports and artificial intelligence emerged almost at the same time. In 1950, Alan Turing first proposed the concept of artificial intelligence based on the intelligence of machines . Deep BlThe development of intelligent sports has become an important research field for scholars at home and abroad. Lapham and Bartlett  studied The application of artificial intelligence in sports mainly includes competitive sports and national fitness. In terms of competitive sports, Trawinski  studied The application of intelligent sports in national fitness mainly refers to data acquisition and collection through big data and cloud computing. However, the use of AI to do data statistics and locate bodybuilders will inevitably cause data security risks. Intelligent sports data security risks are divided into two types: active risk and passive risk. Taking smart fitness centers as an example, smart gyms record members' physical data and workout tracks, and also store members' basic information and consumption levels. Any behavior or movements of members in the centers will be stored as data. The data collected present a risk of being resold by gyms to other data-demanding enterprises  through the backstage big data platform, which will virtually cause serious troubles to customers' privacy. We describe this privacy disclosure as active risks. As for passive risks, given that intelligent sports technologies are not mature enough, the data are mostly processed in a centralized way. This data-processing approach is easy to be attacked by hackers, causing the occurrence of network security events. Due to the worry that they will be tracked by big data, people would choose to reject and resist intelligent sports in life, which makes it difficult to popularize and apply intelligent sports in the process of national fitness.With the continuous application of intelligent sports in national fitness, basic data of national fitness have become important assets for the development of intelligent sports enterprises. Nevertheless, most of the assets are held by enterprises with solid capital, technology, and talent reserves. Intelligent sports giants make full use of the data to develop more targeted and scientific products, making themselves even more powerful. This will gradually lead to polarization, during which small and medium-sized intelligent sports companies eventually go bankrupt while leading enterprises continue to monopolize the market. It will not only cause market disorder of national fitness industry but also abate people's enthusiasm for bodybuilding.In China, Sports Law plays a key role in the development of the sports industry and national fitness, but there are few laws and regulations in the field of intelligent sports. With the continuous progress of the intelligent sports market, the market environment is becoming more and more severe. Vicious competition, lack of market supervision system, and the unfulfillment of market supervision are largely seen and constantly spreading, resulting in the malignant development of intelligent sports. Given a huge profit temptation in the market of national fitness, illegal acts such as piracy of intelligent products, copying of data, and privacy infringement occur from time to time. When violated, enterprises and individuals without legal protection have no place to safeguard their rights, which seriously flounders the market order and the high-quality development of the national fitness industry.The development of intelligent sports mostly relies on technical products, and the upgrading of products will bring consumers better services and renewed experience. For both national fitness firms and individuals, excessive speed of product updating and iteration will bring some losses, and the \u201csubstitution effect\u201d is particularly pronounced. Product updating is bound to affect the experience of consumers, reduce the service life of products, and also exert a certain negative impact on the popularization of national fitness.Nowadays, China is in the critical period of the implementation of national fitness, and thus fostering the intelligent development of national fitness is the future development trend and driving force. As mentioned in the 14th Five-Year Plan for Sports Development and many other public documents, China should vigorously develop the digital sports industry, promote cross-border integration of intelligent digital industries and sports industries, and accelerate the transformation and upgrading of sports through informatization, digitalization, and intellectuality. China has issued a number of policies and plans on intelligent sports to encourage and guarantee the extension of national fitness to the digital field, which is conducive for the rapid development of intelligent sports in the context of national fitness.With continuous popularization and application of science and technology, the public consumption level has been increased and keep-fit has become a popular lifestyle. At the same time, public demand for intelligent fitness is ever-increasing, and the market demand is correspondingly expanding, which will directly impress the value embodiment of intelligent sports in national fitness. In order to realize people's yearning for a better life, it is high time to explore the innovative development mode of intelligent sports and provide high-quality service supply to people. This will also help intelligent sports develop into a new stage of supply-demand balance and industrial maturity.As the development of intelligent sports deepens, the traditional sports industry is being transformed into a high-tech one. New industrial parks and industrial bases have realized fully automated production, packaging, and transportation. The application of intellectual technologies can largely improve product quality while reducing labor and material costs, gradually transforming and upgrading traditional sports manufacturing to a smart one. Industrial upgrading is beneficial in various aspects. As for enterprises, it can greatly raise their development prospect and potential by improving their production efficiency. With regard to consumers, it helps provide more accurate and personalized products and services, and stimulate new demand for sports consumption. From an industrial perspective, it may boost the national fitness industry to high-end manufacturing industry.To build a system of intelligent sports in national fitness helps conform to the new trend of national fitness development, speed up the integration of artificial intelligence and national fitness, promote the application and practice of intelligent sports, raise the health awareness of people, and generate public enthusiasm to participate in fitness. At the same time, the system can optimize the national fitness market to a certain extent, stimulate the market vitality, motivate the market innovative impetus, and improve the market competitiveness.The construction of intelligent sports system in national fitness can cultivate a data-driven industrial system. A national fitness data platform system based on big data and cloud computing will improve interconnection, coordination, and feedback efficiency of governments, markets, and citizens. In addition, the national fitness data are going to be open and shared, which is instrumental for governments to master first-hand data and real-time implementation of national fitness, and timely optimize and adjust implementary measures.The integrated development of artificial intelligence and national fitness can give full play to the active guidance of the government in planning and investing in the national fitness strategy, and further improve the policy-making on finance and market of the digital fitness industry. Furthermore, the full use of advanced technologies is conducive to thoroughly implementing the innovation-driven development strategy in national fitness, accelerating the application of intelligent sports in national fitness, and generating new technologies, formats, and models for national fitness.By setting up an implementary system, the social subjects involved in national fitness can be better managed and coordinated, their multilateral relationship clarified, and their current and future trend mastered. Finally, the orderly implementation of national fitness strategy will come true. Moreover, by setting up a guarantee system in each link, the institutional and political support can be strengthened, the supervision of the national fitness industry perfected, the interests of all social subjects protected, and the market stability ensured.As previously discussed, the application of artificial intelligence technology to national fitness has an essential role to play. For one thing, it can further accelerate the implementation of this national strategy by building a new development model, forming new ideas and providing new technological support for national fitness. For another, through national fitness statistics, intelligent sports can guide the public to scientific fitness, monitor the physical health of sports people, and generate the public enthusiasm for keep-fit. This paper presents a logic framework of intelligent sports system in national fitness see , where tIntelligent sports must follow scientific principles in the implementation of national fitness strategy, and provide precise and effective services for national fitness through big data, cloud computing, and other science and technology. Intelligent sports products should ensure their safety, reliability, and protection of privacy. At the same time, intelligent sports should follow the industry rules and legal norms in the field of sports and artificial intelligence, and participate in the national strategy of national fitness scientifically, safely, legally, and effectively.Internet Plus, Internet of Things, 5G, and other information technologies are the basis for the development of intelligent sports. Compared with traditional sports, intelligent sports has more R&D investment and production costs, so the principle of effectiveness should be respected. For one thing, fitness data collection, processing, analysis, and storage are highly efficient, which embodies the superiority of intelligent sports. For another, faster and better response to the needs of sports-lovers and more effective and scientific fitness services will also reflect the value and significance of intelligent sports.In the strategy of national fitness, intelligent sports application should adhere to the interests of people, strictly abide by the moral code and legal norms, and resolutely prevent the loss of public interest. More specifically, as for public interest, intelligent sports should provide targeted services for people, formulate scientific fitness programs, monitor physical health in real time, and improve the sports rehabilitation system. As for national interest, it should provide convenience for government work, accurately grasp the situation of national fitness in various regions, and offer data reference for formulating more reasonable and effective national fitness plans. Last but not least, from the perspective of enterprises, it is expected to provide new opportunities for the development of enterprises, innovate their development paths, and enhance the protection of their intangible assets.Since intelligent sports itself is the fusion of two different fields, the cooperation and communication between various disciplines are therefore essential. It is necessary to strengthen interdisciplinary exchanges and optimize the integrated development system for multi-disciplinary industries, universities, and research institutes. In addition, since national fitness involves a wide range of social subjects with discrepancies, it requires subjects from different regions, departments, and organizations to enhance cooperation and enlarge exchanges in order to achieve a win-win situation.Base layer. This is the basis for the application of artificial intelligence in the process of national fitness. Artificial intelligence relies on data, algorithms, and hashrate. The data are collected and transmitted by biosensor, photosensor, sound sensor, and chemical sensor. In China, more than 500 million residents regularly take part in physical exercise. The national fitness intelligent sports system is going to establish multiple data subsystems in each province and city. The total system supports data management of projects as large as 10PB, as well as multi-file, distributed storage. The data scale of each subsystem is determined by the system scale, ranging from 1TB to 10PB. The algorithm is to store and calculate through simulation training chip, cloud inference chip, and terminal device chip. The hashrate includes hashrate environment, scale, and application. The national fitness intelligent sports system is mainly funded and constructed by the government. The hashrate is applied to various fields of national fitness, such as intelligent service system, data management system, operation system, etc. The scales of hashrate are divided according to the service areas of each subsystem. The hashrate scales of national and provincial systems should reach the level of intellectual hashrate, supporting 10TFlops or 1000TFlops parallel computing system, as well as multi-node, CPU, multi-processor, and other multi-level parallel computing. Scales of hashrate of each subsystem should be chosen according to scales of database.Data layer. The data layer is the core of the content framework of the national fitness intelligent sports system. It mainly involves data of three comprehensive fitness subjects: government , society , and the people .Management layer. This layer mainly includes database management, operations management, security management and data maintenance. The date are shared and communicated by public and private clouds of the hybrid cloud data storage system.Application layer. The application layer indicates the ultimate goal and social significance of national fitness intelligent sports system. Here, technologies including artificial intelligence, computer vision, biometric recognition, natural language processing, automatic control, image processing, clustering and collaborative filtering technology, and information retrieval are applied to the following systems of national fitness data monitoring, statistics, guidance, and guarantee. At present, these applications are achieved in intelligent fitness venues, intelligent sports equipment, VR games, and training.As highlighted earlier, the engagement of intelligent sports in national fitness requires precision, intelligence, and interconnection, to make the implementation of this national strategy more comprehensive and smart. Based on this, we construct a content framework of national fitness intelligent sports system see  that is From the content framework of national fitness intelligent sports system, we can see that intelligent sports is of great value and significance for the implementation of national fitness. It is because the engagement of intelligent sports is of great help to accelerate and broaden the implementation from multiple perspectives, fields, and levels; provide more convenient and scientific fitness guidance for people; and eventually meet the people's growing demand for bodybuilding and their yearning for a better life.From the perspective of intelligent sports itself, its functions mainly lie in data, calculation, and intelligence. Primarily, through a colossal database and high-speed computing, intelligent sports can simplify the government departments' tracking of the current situation and provide various indicators and information for national fitness policy-making. In addition, by offering portable and convenient work-out activities, it is helpful in innovating the traditional way of national fitness popularization, accurately feeding people's needs for sports and fitness, and effectively arousing public enthusiasm for national fitness.From the perspective of national fitness, intelligent sports is a shortcut in the implementation of this national strategy, due to the fact that it can make measures more efficient and scientific, and make it easier for the public to accept fitness policies and activate fitness motivation. Since national fitness is a nation-wide strategy, involving people from different geographical locations, living environments, and social backgrounds, this huge project requires the help and participation of intelligent sports to better unify and coordinate.The main functions of the national fitness intelligent sports system see  mainly iData statistics and service is an important work of intelligent sports in the implementation of national fitness. From the perspective of governments, they calculate the proportion of people who regularly participate in physical exercise, their exercise frequency, intensity and approaches, use of sports facilities and sites, as well as their levels of sports consumption, etc. In doing so, governments can more accurately grasp the overall situation of national fitness. From the perspective of active people, intelligent sports can analyze personal fitness data to better monitor their own health and master personal fitness effects in real time. At the same time, intelligent sports helps provide sports lovers with reasonable products and avoid excessive consumption. In addition, people can observe the use of sports venues through intelligent sports equipment, and then reserve sports sites more conveniently and effectively, which will also improve the utilization and reduce the congestion of sports venues.Since the service object of national fitness is mainly the people, the main purpose of intelligent sports application in national fitness is to meet the public fitness needs. Fitness guidance and scientific fitness program are the urgent needs of people. Therefore, it is essential to understand people's fitness purpose, hobbies, leisure time activities, and so on through the intelligent sports big data platform, given that it can provide targeted scientific fitness programs, guide the public to participate in sports, avoid wrong movements and mistaken ways, and prevent people from sports injuries or other unnecessary dangers. The superiority of intelligent sports lies in one-to-one service. Thanks to VR, 3D, and other virtual technologies, people can experience simulated training in a multi-scenario and multi-perspective way, which changes the traditional, generalized, and random way of workout. For example, the elderly with heart disease, osteoporosis, and hypertension are not suitable for medium and high-intensity training.At present, a serious shortage of social sports instructors in China leads to difficulties of pre-fitness guidance, post-fitness feedback, and rehabilitation of sports injuries. In the face of the current situation, monitoring fitness behavior and recording fitness track by intelligent sports can solve these problems. In addition, the establishment of fitness feedback and protection system with artificial intelligence can largely help fitness people know more about sports, master more exercise skills, and well control their fitness situation. The service of sports rehabilitation provided by intelligent sports may give less sense of reality for costumers, but the service area is large, the audience is of wide range, the input of manpower and material resources is reduced, and the controllability of the service is enhanced.By constantly upgrading fitness products, intelligent sports can optimize product performance and services, make sports equipment more intelligent and smart, and provide innovative technologies and means for national fitness. Along with the ongoing public adaptation to high-tech intelligent fitness products, people will gradually take physical exercise as an essential part of life. That is how intelligent sports stimulates public enthusiasm and generates public motivation for national fitness. In addition, the function of interactive communication is very easy for people to try, which is conducive for enhancing their affection between friends and relatives, and forming a sustainable and regular way of fitness. The 3D visual simulation technology adopted by intelligent sports can infect and mobilize people around to try workout and finally form the habit of fitness.The core of intelligent sports application in national fitness is to build an intelligent data platform for national fitness see . The plaIntelligent sports is a very complex system in the implementation of national fitness strategy, which involves a large number of people and a wide range of fields. It is necessary to divide intelligent sports into different subsystems. The intricate cooperation, communication, and transformation relationship between each subsystem forms the intelligent sports system and a clear operation mechanism of national fitness. The operation mechanism of the national fitness intelligent sports system see  mainly iThe government department is taken as a pivot for the operation mechanism of social subject of national fitness intelligent sports. Sports government departments need to establish a system for integrated cooperation to better coordinate and cooperate with other social subjects and optimize government management. There is a two-way operation mechanism between governments and other social subjects, which means integrating government departments to formulate national fitness plans and policies for sports enterprises, associations, and the public. Meanwhile, enterprises, communities, social organizations, and the public provide feedback and suggestions on policy planning. At the same time, the government establishes a national fitness talent pool system to provide research projects for talents and expert teams. Conversely, this system also provides expert advice and evaluation for comprehensive fitness planning and policy-making. The operation mechanism of social subject is the basis and guarantee of the intelligent sports system of national fitness, which can motivate all social subjects of national fitness and facilitate the construction of the basic operation system of national fitness.Data operation is the center of intelligent sports in the implementation of national fitness. It mainly includes: \u2460Data input. Firstly, the social subject mechanism provides data of national fitness. Secondly, the intelligent sports big data platform collects all basic data, and then carries out data mining and data feedback for different levels of departments. Finally, the intelligent sports big data platform inputs them into the national fitness big data platform. \u2461Data statistics and analysis. Relevant data input from the national fitness data platform will be fed back to government departments for data reference, which will help departments to summarize current implementation of national fitness. Then, departments will optimize and analyze the data, and finally build a data application model. \u2462Data output. Through data input and analysis, the data will finally be put into practice and application. After that, the superior departments will be fed back and suggested. Lastly, government departments will evaluate the optimized data and adjust and improve the existing national fitness plan.The intermediary mechanism of national fitness intelligent sports system is the internal connection center between the operation data and social subjects, and also the link of the whole system. Firstly, the operation system of social subject collects and summarizes the basic data collected from citizens, markets, and industries through the intermediary mechanism, and transmits them to the database to realize data supply; The database classifies and processes all kinds of data to social subjects through the intermediary mechanism to meet the data needs. Second, the intermediary mechanism preprocesses the data through data stratification, makes statistics and analysis of the processed data, and stratifies and analyzes the national fitness data according to social groups and application fields, so as to improve the processing efficiency of the database. Thirdly, the intermediary mechanism analyzes and manages the whole operation mechanism, reduces operation errors and data processing errors, protects data privacy, and ensures data security. Fourthly, the intermediary mechanism optimizes information processing and information induction, carries out information integration for the overall operation mechanism, and then outputs the final data according to the application objectives. The relationship between data demanders is sorted out in an orderly manner, which greatly improves the cooperation between operating units and achieves information sharing.The basic facilities of the intelligent fitness center are more intelligent and scientific, which can better meet the needs of active people for fitness, improve the quality of fitness service and fitness experience. Firstly, the Internet of Things will be used to intelligently monitor and manage the service efficiency, site maintenance, automatic temperature control and humidity control, and light adjustment of the venue's placement information sensors, temperature sensors, and photosensitive sensors. Secondly, the intelligent fitness center uses the chip to install a series of auxiliary training equipment for sports, which can help green hands master the correct movement and improve fitness efficiency. In addition, smart fitness center provides more convenience and better service for fitness people through APP, SaaS, and IoT intelligent hardware. Finally, the intelligent fitness center has the management and control platform of the whole venue, which is responsible for the operation and maintenance of the whole venue, and can grasp the dynamic of the venue in real time to understand the fitness needs. It can also provide a series of service platforms such as venue reservation, face recognition, and fitness monitoring and tracking.The infrastructure collects data through sensors, chips, and data platforms and feeds it back to the data layer. Smart fitness center collects data of fitness people, venues, and sports events through artificial intelligence, Internet of Things, big data, and other science and technology. Data collected mainly include fitness intensity, sports consumption level, venue utilization, venue management, and so on. The data system processes and classifies the collected data, and finally feeds back the collected data to the management layer.Various data regarding venues collected by intelligent fitness center through the data layer are going to be applied to the venue management system. First, the intelligent fitness center database conducts data storage, retrieval, application, and transformation, and establishes an intelligent fitness center database system. Secondly, the data feedback from the data layer is used to find the loopholes and deficiencies in venue management, operation, and facilities, timely adjusting the management system and maintaining facilities. Finally, the establishment of data security maintenance system is to prevent data leakage or infringement on the privacy of fitness people, and protect the rights and interests of intelligent fitness center.Through the management of data and technology, data, technology, and management mode are put into practice. The first step is to establish the fitness monitoring and tracking system of members according to the national fitness data. The second step is to develop one-to-one fitness guidance programs based on the AI intelligent system, and provide fitness suggestions and exercise prescriptions specifically to meet the fitness needs of members. The third one is to use new technologies to create VR panoramic experience, simulated training, and fitness interaction to enhance the enjoyment of fitness and arouse fitness enthusiasm. Fourthly, to develop a set of management system suitable for the fitness center itself, which is based on the venue management data feedback. This is of help for reducing the operating cost and improving the intelligent level of the venue.Intelligent fitness center operation and management are inseparable from data statistics and analysis, in that customer service, venue operation, facility usage, and flow monitoring all need data support. In addition, the consumption data of intelligent fitness center can help understand bodybuilders' consumption level, provide diversified services, and adjust service content in time. In addition, the smart fitness center summarizes its data to the fitness data platform of the local government, providing data support and reference for the formulation of national fitness plan.The essential function of intelligent fitness center is to provide fitness services for fitness people. First, in accordance with the needs, goals, and physical conditions of different fitness groups, intelligent fitness center develops targeted fitness programs and exercise prescriptions. Second, intelligent fitness center provides AI guidance or professional coach for fitness instruction to prevent sports injuries and ensure a scientific and effective way of fitness. Third, intelligent fitness center provides guidance for venue services, including venue reservation, event information, venue navigation, which can be achieved by APP, Wechat official account, and SaaS.The intelligent fitness center should ensure the health of the fitness people, and timely optimize and improve the potential safety hazards. When there are sports injuries or safety problems in the fitness center, professional trainers, with the help of intelligent equipment, judge the state of injuries, formulate corresponding physical treatment, and keep tracking the injured through AI. In addition, the intelligent fitness center summarizes and uploads the data to data platforms at higher levels. The superior platform also feeds back the data after processing to the intelligent fitness center data platform for improving services and adjusting optimization plans.Intelligent fitness center has a multi-tiered relationship with social subjects, including bodybuilders, venue operators, sports associations, and sports government departments. Fitness people are its main service object. Venue operators are responsible for the management, operation, and maintenance of the venue. Sports associations organize all kinds of mass sports events and sports activities in the fitness center. Government departments conduct overall planning and top-level designs for intelligent fitness center. As we can see, the four subjects are interconnected. According to the service to fitness lovers and sports associations, venue operators collect relevant data and feedback, and constantly optimize venue infrastructure and intelligent services; At the same time, venue operators feed back the information to government departments, which process and summarize the information through the talent pool system, adjust and optimize the national fitness plan, and feed back again to the intelligent fitness center.The intermediary mechanism of intelligent fitness center is jointly constructed by data platform and venue operators. The data platform of intelligent fitness center stores and classifies the basic fitness data, preprocesses simply the data, and then transmits them to a higher level government database system. Finally, different data processing is carried out according to different application purposes. Venue operators are intermediaries connecting all social subjects, meeting the needs of fitness people, providing precise services, and operating the fitness center under the management and coordination of the government. The data information platform and operators jointly build an intermediary mechanism which meets the operational and managerial needs of the entire intelligent fitness center system and becomes the connection center and link of the system.Data operation of intelligent fitness center represents the core of the whole system. First of all, the data of fitness people and venue are collected through Internet of Things, AI, Internet, and other technical means, and uniformly summarized to the data platform of fitness center. Then, the fitness center platform is used to process the data. Part of the data statistics of the venue is used by itself for venue optimization, and others are uploaded to the superior government database for further application and practice. Finally, the superior database processes the data, conducts in-depth analysis according to the application purpose and direction, and then constructs a corresponding model which will be applied into the national fitness plan, realizing the transformation and utilization of national fitness achievements.The top-level design and theoretical and practical system construction for the development of intelligent sports should be a high priority. First, formulate more perfect and specific development plans for national fitness intelligent sports to guide the future development direction and objectives of intelligent sports. Second, fill the gaps in laws and regulations related to intelligent sports, establish a scientific legal system, so that there are laws to follow, and the development rights and interests of intelligent sports in national fitness can be protected. Third, government departments should increase their support for intelligent sports enterprises by establishing funds to encourage the development of small, medium-sized, and micro enterprises. Meanwhile, they are supposed to establish a cooperation mechanism between large enterprises and small, medium-sized, and micro enterprises for their mutual benefit, and give play to the leading and exemplary role of sports giants.The transformation and upgrading of intelligent sports industry are key to the implementation of national fitness strategy. First, give full play to the distinctive characteristics of the intelligent sports industry as specialization, precision, speciality, and innovation to improve the core competitiveness of the sports industry. Second, build a development model of industrial chain and enhance the controllability of the industrial chain and form a vertical ecosystem of the industrial chain. Focus on key industrial domains such as sporting goods manufacturing industry, fitness industry, tourism service industry, and information industry. Accelerate the construction of intelligent sports integration system, which includes multi-industrial combinations of intelligent sports with medical industry, tourism, and health industry. Third, construct a standard system of the intelligent sports industry, create a comprehensive pilot work of national standards, promote the industrial quality standards of intelligent sports equipment and high-end equipment, and establish a collaborative mechanism of intelligent sports standards. Fourth, facilitate the innovative application of emerging technologies such as cloud computing, big data, Internet of Things, Internet, VR, and 5G in intelligent sports, and encourage the public sharing of data owned by intelligent sports enterprises. Build a multi-level and multi-link application system, improve the level of industrial intelligence, construct a digital transformation and upgrading mechanism, and enhance the supply capacity of intelligent sports transformation services.The bottleneck of intelligent sports development needs to be assisted by market operation and supervision. There are great loopholes in the supervision of intelligent sports market, which leads to illegal vendors making huge profits through various means, resulting in the chaos of the market environment. First, the intelligent sports technology should reinforce the privacy security and protection for public interests to avoid potential security risks caused by its own vulnerabilities. Second, government departments and social subjects have to jointly build an intelligent sports security protection system, punish more severely unlawful acts such as infringement and market monopoly, and establish a market oversight committee to regularly inspect and supervise the intelligent sports market. Third, strengthen safety publicity, raise people's awareness of intelligent sports products, strengthen people's legal awareness of intelligent sports, and achieve \u201cuniversal supervision and common resistance.\u201dGiven that talents are fundamental for the development of intelligent sports, establishing a good talent training system is an important step for the sustainable development of intelligent sports. First, tap high-end talents of intelligent sports. At present, China is seriously lacking integrated talents of \u201cartificial intelligence\u2009+\u2009sports.\u201d Experts and scholars in relevant fields at home and abroad should be attracted to enter the intelligent sports industry to provide advanced technical experience. Second, promote the coordinated development of governments, industries, and universities, and that of research and application. Take the intelligent sports market as the leading factor and use government policies to drive the cultivation of intelligent sports talents. Then, establish an intelligent sports innovation platform, introduce high-quality intelligent sports enterprises, encourage efficient and scientific research institutions to strengthen intelligent sports research, and promote the transformation and practical application of innovative achievements to release the vitality of the industry. Third, establish an intelligent sports talent training mechanism. Establish a joint training and development system through four different social subjects: government, market, enterprises, and universities. Rely on the sports science and technology innovation platform, strengthen cooperation and exchange, and create a talent training mode of sustainable output to ensure the positive role of intelligent sports in national fitness.In recent years, the national strategy of national fitness in China has made breakthroughs, and intelligent sports in national fitness has been applied widely, showing great potential and motivation. Intelligent sports applications such as VR games have become one of the important ways for the public to participate in national fitness. With the support and encouragement of various Chinese policies, intelligent sports will surely become the core of the development of the strategy for China to become a sport power in the future. In the development of intelligent sports and national fitness, it is necessary to analyze the opportunities and risks generated by intelligent sports in a dialectic way. We need not only to recognize the superiority and advancement of intelligent sports but also to fully understand the challenges of intelligent sports on the market economy and society. This research indicates that building the national fitness intelligent sports system is the foundation of intelligent sports engagement in national fitness implementation. This study analyzes the logic, framework, content, and operation of intelligent sports system in the national fitness theoretically and practically. It also demonstrates that intelligent sports gives full play to the value of advanced technologies such as big data, Internet in fitness business. The implications of this article are the following. Social subjects should analyze the application of intelligent sports from multiple perspectives, minimize the risks brought about by intelligent sports when enjoying the convenience and effectiveness. Also, the market system ought to be improved, the top-level design enhanced, comprehensive talents of \u201cintelligence\u2009+\u2009sports\u201d cultivated, in order to speed up the great goal of making China a sports power."}
{"text": "This phenomenon has been associated with rising obesity rates worldwide, especially in developed countries. In Brazil, the historical analysis of temporal trends between malnutrition and obesity characterized the nutrition transition in the country and interweaved it with the formulation and implementation of public food and nutrition policies. Such analysis is crucial for understanding certain principles in each context. Thus, this review contextualized the consolidation of obesity as a critical health and public policy issue in Brazil. Our review suggested that the country may still be at the initial stage of care for obesity, and more efforts are needed to contain the advance of the disease in Brazil. The \u201ctransition\u201d concept has been widely applied in many research areas to display significant trends and further understand the population health parameters . \u201cNutritIn Brazil, from the analysis of the historical context in the last 50 years, it was possible to observe an antagonism of temporal trends between malnutrition and obesity that were influenced by demographic transition and culminated in the occurrence of the nutrition transition and epidemiological transition in the country ,7. FolloThis review disclosed the historical progress of the nutrition transition in Brazil and the trajectory of Brazilian nutritional public policies, emphasizing the complexity of food problems and bringing the need for urgent reformulations to meet the new demand of obesity to the health system .The work of Josu\u00e9 de Castro, entitled \u201cGeography of Hunger\u201d, generated available information to compose the first scenario of the food/nutritional problem in Brazil . Escoda Only after 1975 were the inquiries effectively representative of the country\u2019s nutritional situation, and differences between the macro-regions appeared in Brazil . At thatInterestingly, between 1975 and 1989, the epidemiological dynamics of malnutrition showed a unique evolutionary behavior, with a sharp decline in the problem when in all regions, except for the rural Northeast, the prevalence of cases of low body mass index (BMI < 18.5) became equivalent to the values found in developed countries, around 5% . These fIn the 1990s, added to the problem of malnutrition, obesity rates increased . CorroboThe increase in overweight and obesity rates in the Brazilian population was marked by the consumption of processed and ultra-processed foods ,13. As aRecently, a national epidemiological survey showed a significant increase in the obesity rate from 20.8% in 2013 to 25.9% in 2019, with further rises between genders . The morThe global dimensions of obesity demand efforts from international and national\u2019s organizations to establish multisectoral strategies and recommendations from different governance levels  and the Food and nutrition are determinant health conditions and are considered inherent rights for all people. The promotion and guarantee of adequate healthy food and nutrition have been mobilizing efforts from different sectors of the Brazilian government and civil society movements and entities ,22. HereDespite the social inequities observed throughout the history of Brazil that culminated in food insecurity, only in the 1930s the problem of hunger entered the political agenda in Brazil, guided by the research of Josu\u00e9 de Castro . De CastSubsequently, studies of familiar budget and food consumption profiles ascended and were central to establishing the relationship between food and income. Such results contributed to the institution of the salary policy in 1936. It was believed that the minimum wage could guarantee a basic food basket with the necessary nutritional support for the laborers .The landmark of food and nutrition policy was the creation of the Social Security Food Service (SSFS) in 1940. This policy optimized the access to food for the leading benefited population group: laborers. Its principal activities included providing meals, selling food at cost price, food and nutrition education actions, research support, and specialized technical training ,26.Still in the 1940s, other institutions, such as the National Food Technical Service (NFTS), 1942 to 1945; the Institute of Food Technology (IFT), 1944; and the National Food Commission (NFC), 1945 to 1972, were created to implement food and nutrition policies in Brazil, aiming the study of the country\u2019s eating habits and nutritional situation. Right at the beginning, the NFC took \u201cmalnutrition\u201d as the main topic of the agenda, assisting in elaborating the National Food Policy (NFP) with the Brazilian Federal Government. The NFC also created the National School Meal Program (1954) and improved the National School Feeding Program (NSFP) ,25.With the extinction of the NFC in 1972, the National Institute of Food and Nutrition (NIFN) was founded, operating until 1997. The NIFN directed the actions to population groups at risk or with nutritional deficiencies, such as pregnant women, nursing mothers, children, and workforces, through (1) food supplementation; (2) organization of the food production and marketing system; and (3) support social programs ,27.The NIFN was essential in promoting the National Food and Nutrition Program (NFNP), which unified the actions with others developed by institutions. The NFNP faced numerous difficulties and was extinct in 1974 . After tIn the early 1990s, the National Food and Nutrition Surveillance System (NFNSS) was created. The purpose of NFNSS was to produce information that would allow the detection, description, and analysis of food and nutritional problems, identify the geographic and social factors involved, and support policies and procedures to prevent and correct these problems ,26.Another landmark was the implementation of the Unified Health System  through Law number 8.080/1990, founded through the Federal Constitution of 1988 ,29. The In 1999, the National Policy on Food and Nutrition (NPFN) was approved, and the Ministry of Health declared the commitment to the eradication of consequences related to lack of food and poverty, especially children and maternal malnutrition, overweight, and obesity in the adult population . UndeniaAs of 2004, the priority on the political agenda was to strengthen the discussion on food and nutrition security (FNS), first with the reopening of the National Food and Nutrition Security Council (NFNS) and with the approval of the Organic Law on Food and Nutrition Security (OLFNS) in 2006, which instituted the creation of the National Food and Nutrition Security System (NFNSS) ,34. ThenThe program \u201cIntersectoral Strategies for the Prevention and Control of Obesity\u201d of the Ministry of Health, created between 2010 and 2014 , disclosSeveral initiatives have been developed in Brazil to deal with the challenge of reversing the rising overweight and obesity rates and reducing their impact on the population\u2019s disease burden and quality of life . HoweverA recent study by Lopes et al., 2021, investigated the adequacy of basic health units in Brazil regarding structure and work process for obesity management in primary health care (PHC), using data from the National Program for Improving Primary Care Access and Quality. They evaluated three indicators: (i) adequate structure-equipment, human resources, and facilities; (ii) adequate access-available collective and individual healthcare interventions; and (iii) adequate service organization and management-systematization of procedures, adequate use of medical records, matrix support, and permanent education. They found that 7.6% of PCH units presented an adequate structure, only 26.6% of the units presented adequate access to obesity care, and 27.8% were considered to have an adequate service organization. According to the authors, services structure and available materials tend to affect the resolution of PHC actions. In addition, considering that more than 3/4 of the population exclusively uses the public health system and that more than 1 million Brazilians have severe obesity, the lack of adequate structure for diagnosing, evaluating, and monitoring obesity may lead to poorer quality care, increased risk of obesity-related complications and, consequently, increased healthcare spending .Brazil has made commitments with the United Nations to halt the growth of obesity among adults, with a reduction in the consumption of sugary drinks, an increase in the consumption of fruits and vegetables, and a reduction in the consumption of ultra-processed foods. In this sense, Brazil\u2019s National Health Surveillance Agency (NHSA) published a proposal in 2006 to regulate the advertising of foods high in sugar, sodium, saturated fat, and trans-fat in the form of public consultation. The public hearing to present these regulations was held in August 2009 , and the final text was published on 15 June 2012. The resolution aimed to ensure access to health information for all to curb excessive practices that lead the public  to adopt eating habits that are incompatible with health and infringe upon their right to an appropriate diet. The resolution was challenged in court by several lawsuits opened by different sectors and associations (most of which related to the food industry) and was suspended by the federal attorney general despite the commitment of the Health Ministry and the NHSA  . The Bran = 55,570 households, divided into 550 strata). They concluded that the price of ultra-processed foods was inversely associated with the prevalence of overweight and obesity in Brazil: for each 1.00% increase in the price of ultra-processed foods, there was a mean 0.33% decrease in the prevalence of overweight and of 0.59% in that of obesity. The author highlighted that the taxation of ultra-processed foods emerges as a prominent tool in the control of obesity [Interestingly, Passos et al., 2020 investigated the relationship between the price of ultra-processed foods and the prevalence of obesity in Brazil, based on data from the National Household Budget Survey from 2008/09 ( obesity .Regardless of the limitations of public policies implementation, Fernandes et al., 2019, highlighted the innovations presented in the new food- and meal-based Dietary Guidelines for the Brazilian Population, especially the mention of the preference for natural or minimally processed foods and freshly made dishes and meals to ultra-processed products, and the encouragement to culinary and cooking skills. All these recommendations are in accordance with the World Health Organization. In addition, the authors emphasized that public health nutrition policies should be considered as a part of an individual\u2019s right to information about food. Consumers can choose to make healthy choices if they have access to information, comprehend nutritional information, and healthy food preparation is available .The historical progress of the nutrition transition in Brazil interweaves with the trajectory of Brazilian nutritional public policies, emphasizing the complexity of food problems and bringing the need for urgent reformulations to meet this new demand. Our review suggested that the country may still be at the initial stage of care for obesity, and more efforts are needed to contain the advance of the disease in Brazil. In this sense, we highlighted the importance of the government\u2019s commitment to health in various spheres, such as access to adequate and healthy food, social assurance, and sustainability. We also underscored the importance of the nutritional public policies for nutritional surveillance, promotion of health, healthy habits, and primary and comprehensive care for all individuals: from malnutrition to obesity."}
{"text": "In the face of the health challenges caused by the COVID-19 pandemic, healing and therapeutic design (HTD) as interventions can help with improving people\u2019s health. It is considered to have great potential to promote health in the forms of art, architecture, landscape, space, and environment. However, there are insufficient design approaches to address the challenges during the HTD process. An increased number of studies have shown that emerging information modeling (IM) such as building information modeling (BIM), landscape information modeling (LIM), and city information modeling (CIM) coupled with blockchain (BC) functionalities have the potential to enhance designers\u2019 HTD by considering important design elements, namely design variables, design knowledge, and design decision. It can also address challenges during the design process, such as design changes, conflicts in design requirements, the lack of design evaluation tools and frameworks, and incomplete design information. Therefore, this paper aims to develop a conceptual BC enhanced IM for HTD (BC-HTD) framework that addresses the challenges in the HTD and promotes health and well-being. The structure of BC-HTD framework is twofold: (1) a conceptual high-level framework comprising three levels: user; system; and information, (2) a conceptual low-level framework of detailed content at the system level, which has been constructed using a mixed quantitative and qualitative method of literature analysis, and validated via a pre-interview questionnaire survey and follow-up interviews with industry experts and academics. This paper analyzes the process of BC enhanced HTD and the knowledge management of HTD to aid design decisions in managing design information. This paper is the first attempt to apply the advantages of BC enabled IM to enhance the HTD process. The results of this study can foster and propel new research pathways and knowledge on the value of design in the form of non-fungible token (NFT) based on the extended advantages of BC in the field of design, which can fully mobilize the healing and therapeutic behaviors of designers and the advantage potential of HTD to promote health, and realize the vision of Health Metaverse in the context of sustainable development. The coronavirus disease 2019 (COVID-19) has triggered a global mental health crisis , caregivFacing the health challenges posed by the COVID-19 pandemic, applications of healing and therapeutic design (HTD) in the field of art, architecture, landscape, space, and environment to overcome health barriers through the enhancement of aesthetics in design process have shown a positive effect on promoting health . MoreoveA variety of non-drug treatments, art, and design have shown a positive role in promoting mental health . Art theIn the field of design, HTD refers to the use of design as an intervention to positively impact people\u2019s physical and psychological well-being, prevent diseases, and improve health , reduce With the advent of the digital age, the application of intelligent IM, such as BC, building information modeling (BIM), landscape information modeling (LIM), and city information modeling (CIM), to promote sustainable development has shown potential to promote health in different fields. BC is a decentralized trading and data management technology, which allows digital information to be distributed without copying or modifying ,41. A trThe integration of BC and BIM in information management during the life cycle of buildings brings two main benefits: (1) the transition process from BIM to BC will be easier and more efficient; and (2) data security can also be ensured during the construction phase of real estate . MoreoveIn the face of the impact of the COVID-19 epidemic, it is necessary to think about how to effectively respond to the reality of global public health emergencies through design. While COVID-19 has created health challenges, it has also brought unprecedented opportunities for innovation . With thThis paper adopts a mixed quantitative and qualitative method of literature analysis to develop the conceptual BC-HTD framework, which was validated via a pre-interview questionnaire survey and follow-up interviews with industry experts and academics. Using the quantitative bibliometric method, i.e., the Network Visualization of keyword co-occurrence generated by VOSviewer version 1.6.15, which has been developed by Nees Jan van Eck and Ludo Waltman at Leiden University\u2019s Centre for Science and Technology Studies (CWTS) in the Netherlands, can reflect the relationship between different keywords, the frequency of occurrence, and different clusters ,62. TherAs shown in It can be seen from Based on the quantitative analysis results of visual keywords by the VOSviewer software, the following studies are selected for qualitative analysis of specific content. First, the important design elements of HTD and the challenges in the design process are analyzed from the design point of view. Then, the advantages of BC and IM are summarized from the design perspective.The HTD studies are mainly associated with the healing and therapeutic architecture ,68,69, s(1)Understanding and differentiating between different design variables. The change of design variables and the action mechanism of health impact can facilitate the individual and collective reflection of design variables in the overall design suggestions ;(2)Design decision-making process based on different forms of knowledge of stakeholders. Transforming the implicit knowledge of stakeholders into explicit knowledge in the design-driven process of healing and therapeutic architecture enhances communication among stakeholders, and avoids arbitrary decision-making to facilitate the design of healing and therapeutic architecture . AdditioThe HTD emphasizes important design elements in the presentation of architecture, landscape, space, and environment in promoting health via two means:(i)The changes and conflicts in design requirements. For example, due to the lack of consensus between hospital space design and nursing mode, it is easy to have conflicting design needs with nursing mode when designing the healing and therapeutic landscape of the hospital. It takes a long time to plan the design of the hospital from the perspective of architectural environment, which is difficult to flexibly respond to the changing needs over time .(ii)Inconsistent design research framework and methodology. Although there are many studies on the healing and therapeutic environment with diverse methodologies, there is a lack of a unified research framework, which makes further research difficult .(iii)Incomplete consideration of design features. The interrelationships between various design features are easily overlooked when there is HTD for the built and physical environments in which people with dementia live . In addi(iv)Lack of design evaluation tools and frameworks. Facing the dynamic needs of residents for the new generation of buildings, there is a lack of more comprehensive and informed tools to evaluate the effectiveness of the design and use of healing and therapeutic buildings, as well as a framework to clarify people-centered issues .(v)Incomplete collection of design data. When there is HTD through art in the medical environment that are characterized by a diversity of intervention measures and results, the data collection is not comprehensive, data results are difficult to synthesize, and the evaluation of design results becomes difficult . In addiAlthough HTD can promote human health through the medium of art, architecture, landscape, space, and environment, it also faces the following five challenges in the design process, such as hospital design:In order to further explore the challenges of HTD across all the design stages, this paper maps the five challenges during the HTD process one by one in the four design stages of Discover, Define, Develop, and Deliver in the Double Diamond model, as shown in The BC technology, with its features of disintermediation, immutability, and trust, has become one of the most promising and potentially transformative technologies in many industries, which contributes to the SDGs of the United Nations and produces extensive changes in some established industries and practices . BC has In the fields of art and healthcare, BC technology embodies the advantages of promoting the art economy, protecting intellectual property (IP) rights, and enabling data sharing. First, since BC technology brings efficiency and transparency, and adds value to products and services in different fields, the art world has begun to utilize BC technology to promote the art economy . MoreoveIn the field of information technology, BC is a shared data or information database that is unfalsifiable, untraceable, open and transparent, and collectively maintained . TherefoIn architectural design, BIM is a digital technology that uses a three-dimensional (3D) model to establish a set of project databases, which aid to achieve the SDGs of the project\u2019s entire life cycle through the retrieval and application of information . Based oIn addition, the rapid development of BIM technology provides a mature foundation for the development of LIM that is related to the design of landscape architecture, which expands the application objects of BIM. The difference between LIM and BIM is that the LIM has the core elements of terrain, vegetation, water, and the environment . Based oFurthermore, with the rapid development of BIM technology in cities, CIM is also flourishing in city research. The CIM is a technology based on BIM, geographic information system, and internet of things, which can realize the co-growth of digital cities and physical cities, and is also a necessary way to realize smart cities . IntegraIn general, since the CIM includes the information of natural landscape, architecture, and infrastructure , BIM tecAs shown in In the process of BC-driven HTD, the knowledge management of the HTD, such as design information and health information, can inform the knowledge utilization process between the environment, organizations, and individuals from the inflow and outflow of knowledge, as shown in (1)Responding flexibly to changes and conflicts in design requirements. Based on the advantages of BC in (2)Unified design research framework and methodology. The results in (3)Fully considering the design characteristics. The BC enhanced IM directly transmits and uses design information collaboratively, and fully considers the interrelationship between various design features of the virtual built environment and physical environment. The IM presents the virtual 3D model to communicate design concepts and improve the quality of HTD. For instance, Lee et al. point out that digital manufacturing based on BIM provides instant design information and increases work efficiency, which avoids the problem of incomplete consideration of design characteristics caused by traditional paper documents .(4)Improving design evaluation tools. The 3D models presented by the IM are used to simulate and verify the design results, and plan and analyze the elements of sustainable city development. Based on dynamic needs, the IM is facilitated to comprehensively and objectively evaluate the effectiveness of the design and the use of healing and therapeutic buildings, and clarify the human-centered problem framework. Furthermore, the consensus mechanism of the BC aids with design evaluation results. For example, Dantas et al. suggest that BIM and CIM can help city managers make assessments and decisions with simple and accurate data .(5)Comprehensive collection of design data. BIM, LIM, and CIM enhanced by BC can bring seven main benefits to data collection: (a) BC provides transparent and comprehensive information to all the stakeholders at different stages of the HTD life cycle to improve design sustainability. For instance, Shojaei et al. show that BC stores and disseminates data information in different stages of asset construction, such as collection, verification, and extraction, which assists with achieving asset sustainability . (b) BC The potential roles of BC to enhance IM in line with the five identified challenges of HTD are:The development of the conceptual BC-HTD framework is based on the findings of the quantitative and qualitative analysis and the important design elements of HTD and associated challenges, as shown in Based on the relationship between the important design elements, HTD challenges, and the advantages of the BC enhanced IM, the conceptual high-level BC-HTD framework encompasses three levels comprising user, system, and information, as shown in In the user level, BC + BIM/LIM/CIM consolidates the relationship between stakeholders of HTD; emphasizes information exchange, communication and coordination among stakeholders; and stores data of users\u2019 dynamic needs. At the system level, the advantages of BC, such as openness, transparency, collective maintenance, comprehensive and efficient sharing of database, and traceability, address HTD challenges across the four stages of Discover, Define, Develop, and Deliver of the Double Diamond design process model. Additionally, the advantages of communication, collaboration, coordination, and visual 3D model of the IM assist the whole HTD process based on the fields of art, architecture, landscape, space, and environment. In the information level, BC + BIM/LIM/CIM enable the interaction between the user and the system to be transmitted to the design information level and interacting within the level. Moreover, the process totally contributes the HTD information to facilitate with achieving sustainable development via research framework, design requirements, design characteristics, evaluation framework, and design data. As such, design driving and design decision-making process are carried out based on the HTD information. In addition, the distributed network of BC + BIM/LIM/CIM expands the application of sustainable HTD information in different fields, such as art therapy, healthcare, architectural design, and landscape design, in which the BC + BIM/LIM/CIM is used as sustainable technology to promote sustainable development aimed at promoting health and well-being.A conceptual low-level BC-HTD framework is shown in (1)In the part of stakeholders, the BC can be used for multi-party trust connection, such as interconnection, mutual trust, and alliance chain.(2)The approach of establishing incentives based on the BC encourages the stakeholders to fully contribute their own data.(3)For the challenge of HTD, since the BC technology may not be able to work between multiple stakeholders for pure design behavior, the BC technology must have business collaboration, commercial behavior, and transaction behavior to cooperate.(4)The pure function of the BC can be applied to the protection of IP rights. For example, the design draft and phased achievements of the designers can be recorded via the BC, which can be confirmed uniquely with digital assets on the BC technology to ensure non-infringement and measure the designer\u2019s value by transaction behavior.(5)The advantages of the BC, i.e., traceability, consensus mechanism, and smart contract, can help address the challenges of incomplete data collection during the HTD process.(6)Building a real-time design knowledge base with BC enhanced IM is helpful to design decision-making.The conceptual BC-HTD framework for digital health, as illustrated in Furthermore, in line with the suggestions of the participants, the conceptual BC-HTD framework was updated on the user layer in the high-level BC-HTD framework, as shown in The results in The BC tracks the contribution of network participants to measure the value brought with adequately fine granularity  and protMoreover, the results of the quantitative analysis presented in Furthermore, BC presents a great potential in the tokenization of digital assets . BC techAt present, the HTD, which promotes health to achieve sustainable development, faces design-related challenges in the fields of art, architecture, landscape, space, and the environment. The development of emerging IM, such as BIM, LIM, and CIM, is enhanced by BC to promote sustainable development, bringing immediate advantages in solving the challenges of HTD in the field of digital health. Therefore, this paper is the first attempt to apply the advantages of BC to IM with a view to enhancing the HTD process in line with the Double Diamond model of the British Design Council, considering important elements and challenges in the design process. From a research perspective, in the aftermath of the COVID-19 epidemic, this study investigates the application of integration of BC with BIM, LIM, and CIM in HTD, which is aimed at promoting health and well-being heading to the sustainable development. In terms of research content, this paper proposes a BC-driven HTD process and a management process of design knowledge. Moreover, the conceptual BC-HTD framework driven by BC + BIM/LIM/CIM has a high-level framework of three levels, i.e., user, system, and information, and a low-level framework of detailed content at the system level, which has been constructed using a mixed quantitative and qualitative method of literature analysis, and validated and updated via pre-interview questionnaire and follow-up interviews with industry experts and academics. This paper analyzes the process of BC enhanced HTD and the knowledge management of HTD to aid design decisions in managing design information. The potential of BC to quantify the HTD value is constantly being tapped. The results of this study can help future research to quantify the value of design in the form of NFT based on the extended advantages of BC in the field of design, which can fully mobilize the advantage potential of HTD to promote health, and realize the vision of Health Metaverse in future digital health. In addition, the form of NFT based on the BC facilitates mobilizing the healing and therapeutic behaviors of designers in the use of the advantage potential of HTD to promote health in achieving the SDG 3  and SDG 11 (Sustainable Cities and Communities). However, the quantitative analysis based on VOSviewer software in this paper focuses on the WOS core collection database. The conceptual BC-HTD framework is validated by industry experts and academics. As such, the follow-up research could conduct quantitative analysis of multiple databases, such as Scopus and ScienceDirect, and explore a practice approach for BC enhanced IM for HTD to promote health in the context of COVID-19 based on the conceptual BC-HTD framework."}
{"text": "Camellia oleifera), mainly used to produce high-quality edible oil, is an important cash crop in China. Anthracnose of oil tea is a considerable factor that limits the yield of tea oil. In order to effectively control the anthracnose of oil tea, researchers have worked hard for many years, and great progress has been made in the research of oil tea anthracnose. For instance, researchers isolated a variety of Colletotrichum spp. from oil tea and found that Colletotrichum fructicola was the most popular pathogen in oil tea. At the same time, a variety of control methods have been explored, such as cultivating resistant varieties, pesticides, and biological control, etc. Furthermore, the research on the molecular pathogenesis of Colletotrichum spp. has also made good progress, such as the elaboration of the transcription factors and effector functions of Colletotrichum spp. The authors summarized the research status of the harm, pathogen types, control, and pathogenic molecular mechanism of oil tea anthracnose in order to provide theoretical support and new technical means for the green prevention and control of oil tea anthracnose.Oil tea ( Camellia genus, which has rich seed oil content that is produced and highly valuable , histone 4 (HIS4), and \u03b2-tubulin 2 (TUB2) gene polygenic sequences for the first time , methyl jasmonate (MeJA), and so on  and effector-triggered immunity (ETI) , and calmodulin signal, which is helpful to understand the growth and pathogenesis of Colletotrichum spp. , which may function in chitin sequestration and camouflage, was found in Colletotrichum lindemuthianum , cytochrome P450s, carbohydrate-active enzymes (CAZYs), and secondary metabolite (SM) synthetases were enriched ; Postgraduate Scientific Research Innovation Project of Hunan Province (Grant No. CX20200712); Scientific Innovation Fund for Post-graduates of Central South University of Forestry and Technology (Grant No. CX20201008).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "This paper presents data for the application of the vulnerability model in economically depressed areas, through social, economic and capacity variables, with the objective of promoting public policies that contribute to the economic development of the territory and its integration into the labor market  The data set is presented in five complementary files: the first one compiles the variables: neighborhood, family composition, age, type of relationship, educational level, occupation of the head of household, work activity , self-employment and source of income; variables to be processed: gender, age of the head of the household, educational level of the head of the household, educational level of the population group, economically active population, unemployment rate, underemployment rate, total household income. The second file collects the variables: Development Bonus, population identified as \"Montubio\", general IESS, educational level, branches of activity (primary and secondary sector), type of construction, floor material, rooms, family one, family two, family three, family four, latrines, well, river, tanker, rainwater, and persons per family; thus, the indicators of the socio-economic vulnerability model are processed. The third supplementary file presents the dataset exported to Stata for the social and economic characterization, as well as the unemployment and underemployment rate of the population; the fourth supplementary file presents the do-file for the Stata code. The fifth supplementary file presents the original questionnaires translated into English. The socioeconomic characteristics of the head of household are presented in The Vulnerability Model states that the following variables are considered for the calculation of poverty due to unsatisfied basic needs: housing, overcrowding and accessibility to basic services. 22.1The city of Manta is the second most populated city in the province of Manab\u00ed, characterized for being an important seaport located on the central-south coast of Ecuador, facing the Pacific Ocean, in the center of the coastal region, which presents an accelerated demographic growth due to the dynamics of its economy developed by the fishing industry, vegetable oils, assembly plants and tourism. San Juan community is located southeast of the city and is part of its urban zone, where the municipal slaughterhouse, the garbage dump, 12 oxidation ponds, and several recycling companies are located, contributing to the environmental contamination of the sector and the city, due to bad odors and the proliferation of insects, which is aggravated by the inhabitants' activities of raising animals  and making charcoal without any restrictions or controls.Approximately 2217 people live in San Juan community, distributed in five neighborhoods: Santa Marianita, San Juan, San Jos\u00e9, San Ram\u00f3n and Valle Claro; due to the previously described conditions that characterize the place, in the opinion of 2.2For the application of the survey, the census-type sweep technique was used in the five neighborhoods that make up the San Juan site. The survey was applied on February 1, 2019 from 08H00 to 16H00. The instrument used contains three parts: housing characteristics, environmental problems and household data. It collects a total of 71 questions of closed, open and multiple choice type, based on the Household Surveys and Population and Housing Census forms of the National Institute of Statistics and Census of Ecuador. For its application we counted with the participation of research professors of Economic Sciences, Agroindustry and Psychology of the Universidad Laica \"Eloy Alfaro\" of Manab\u00ed, 207 student surveyors, 19 student researchers in training, leaders of each neighborhood who were in charge of socializing and coordinating actions with the inhabitants of the sector and helped in the logistics and coordination in the collection of information. The surveys were conducted to the total population of the San Juan site, obtaining a population of 2217 inhabitants in 619 households.2.3The construction of the vulnerability model is based on the methodology developed by The social variables include: the percentage of poverty due to unsatisfied basic needs and the number of poor due to unsatisfied basic needs, obtained from households with deficient housing characteristics, overcrowded homes, and accessibility to deficient basic services; percentage of beneficiaries of the Development Bonus and Montubia population. In the analysis of economic variables, to determine the economic structure of the territory, the proportion of the population engaged in activities in the primary and secondary sector is considered; and considering social security (Affiliated to the IESS) informality is determined, denoting the unemployment or underemployment of the locality. The capacity variables are determined based on the proportion of the economically active population and the human capital index, which is complemented by the presence of productive or non-productive activities in the territory.The raw data in this article come from open data sources, thus fulfilling the ethical requirement to be published in Data in Brief magazine.Zambrano-Y\u00e9pez Claudia: Conceptualization, Methodology, Writing \u2013 original draft. Guill\u00e9n-Rodr\u00edguez Yaritza: Software, Data curation, Validation.The authors declare that they have no known competing financial interests or personal relationships which have or could be perceived to have influenced the work reported in this article."}
{"text": "Depression in aging may lead to loss of autonomy and worsening of comorbidities. Understanding how positive attributes contribute to healthier and happier aging has been one of the purposes of Positive Psychology. However, the literature still lacks studies that evaluate how depression in the elderly is related to constructs considered positive.The present study aimed comparing scores of constructs of spiritual well-being, social support, self-esteem, life satisfaction, affection, optimism, and hope in the elderly with minimal, mild, moderate, and severe depression and healthy controls in order to investigate possible indirect and mediated relationships between positive constructs and depression.A cross-sectional study was conducted with elderly, 62 of whom were diagnosed with different severity of Major Depression (DSM-V)  and 66 healthy controls matched by age, sex and schooling. The instruments used were adapted and validated versions of the Spirituality Self-Rating Scale, the Rosenberg Self-Esteem Scale, the Medical Outcomes Social Scale of Support, the Life Satisfaction Scale, the Positive and Negative Affect Schedule, the Revised Life Orientation Test, and the Adult Dispositional Hope Scale. After comparing the means of scores between groups, an analysis of normalized partial association networks was performed to investigate the direct and mediated relationships between depression and other evaluated constructs.p < 0.001). The analysis of normalized partial association networks has shown that the relations of depression with the constructs of life satisfaction, self-esteem, and social support are mediated, while the constructs of dispositional hope, positive affect, spiritual well-being, and optimism are indirectly related to depression. The social class was also positively related to depression.Scores of spiritual well-being, social support, self-esteem, life satisfaction, positive affect, optimism, negative affects, and hope differed significantly between the control group and the degrees of depression (Depression in different degrees is associated with a reduction in the scores of instruments that evaluate positive attributes. The constructs directly associated with depression are spiritual well-being, optimism, positive affect, and dispositional hope. The others had mediated relationship. These results may contribute to the planning of future interventions for the prevention of depression among the elderly. Nearly half of the elderly in Brazil (48.9%) presents more than one chronic illness, and one of the most serious is depression . The Beck Depression Inventory II (BDI-II) was used to assess the severity of the depressive episode  with significance adjusted by the Bonferroni test were applied to compare the scores of the PP scales between the depressed and healthy control groups. The level of significance was set at 5% (p \u2264 0.05).Quantitative data processing was performed using SPSS software, version 22.0. After obtaining the total scores of the dimensions were verified the assumptions of normality, homoscedasticity, and sphericity. The Mann-Whitney Subsequently, regularized partial regression network analyses  method , and, as a result, the relationship found in the present study was expected. Fehring et al.  study inIn addition to the studied constructs, it is important to note that among the demographic variables evaluated, the network analysis indicates that social class showed positive correlations with depression, indicating that higher incomes are associated with higher depressive indexes. Network analysis finds a direct negative relationship between social class, optimism, and spiritual well-being with degree of depression. No studies have been found in the literature that relate high social class with higher risk of depression. The studies generally present the opposite, that is, greater risks of depression in individuals with lower purchasing power (Kim et al., Depression in the aging of the individual with higher social class can be seen as the expression of the abrupt decrease of social participation and social and cultural activities experienced by a senior of the upper classes throughout his life. The elderly of the lower classes do not feel as much a reduction in their activities because they have not experienced such great opportunities for social activities as cinema, theater, and travel.The present study allows a comparison of the association between the constructs of Positive Psychology and depression, facilitating the choice of effective and preventive approaches to intervention with this population. This study shows the importance of the promotion and prevention of the health elderly. It also presents a view of network analysis and possible mediation in the relationships between depression and the studied constructs.The study design also does not allow a cause-and-effect relationship between the constructs studied and depression, and it is limited to explore the associations between them. Individuals were no compared by time of use of antidepressant or time of follow-up in the outpatient setting but only by the severity/degrees of the disease.Higher degrees of depression are associated with an increase in negative affect and a decrease in positive affect, as well as a decrease in construct scores of spiritual well-being, social support, self-esteem, life satisfaction, positive affect, optimism, and hope. The relationships between depression and life satisfaction are mediated by optimism. Spiritual well-being, optimism, and depression had greater influence on a network of regular correlations between constructs. Depression presented a higher magnitude relationship in this network, followed by the constructs of dispositional hope and self-esteem, indicating that the three had a stronger impact on the network of constructs. Social class had a positive association with depression, which was unpublished in the literature consulted. The constructs that are strongly and indirectly related to depression are optimism, spiritual well-being, positive affect, and dispositional hope. The findings of this study aim to direct the scientific community in the search for interventions that will be more effective for the depressive patient and for the prevention of this psychopathology in the elderly population. Strategies for therapeutic intervention for the elderly with MDD should focus on spiritual well-being, dispositional hope, affection, and optimism, because that is greater chances of achieving a direct improvement in depression scores."}
{"text": "A case-control study was conducted to explore the application value of PDCA cycle regulation combined with nursing label in nursing safety and quality regulation in disinfection supply centers. n\u2009=\u200913) and the research group . The differences in quality evaluation, disinfection qualification, quality regulation effect, supply satisfaction, job satisfaction, safety awareness, and comprehensive operation skills of nursing staff were compared, and the application value of PDCA cycle regulation combined with nursing label in nursing safety and quality regulation of disinfection supply center was comprehensively analyzed.  The medical staff in the disinfection supply center of our hospital from January 2020 to December 2020 and from January 2021 to December 2021 were included in the control group . The disinfection qualification rate of nurses in the research group was significantly higher, and the difference was statistically significant (P < 0.05). The effect of device quality supervision in the study group was significantly improved, and the difference was statistically significant (P < 0.05). The scores of various supervisions in the study group were significantly higher than those in the control group, and the difference was statistically significant (P < 0.05). The safety recognition ability, risk prevention awareness, service awareness, and theory and operation scores of nurses in the study group were significantly higher than those in the control group, and the difference was statistically significant (P < 0.05). The incidence of adverse events in the study group was lower, and the difference was statistically significant (P < 0.05). The satisfaction of the research group was significantly higher than that of the control group, and the difference was statistically significant (P < 0.05).  The quality score of nursing staff, and quality evaluation in the study group was significantly higher than that in the control group, and the difference was statistically significant ( In summary, the implementation of the PDCA cycle supervision method in the supervision of the sterile supply center in conjunction with the nursing logo is conducive to improving the quality of supervision and sterilization of all work aspects of the sterile supply center, reducing the occurrence of adverse nursing events and promoting the job satisfaction of nurses. In addition, it is conducive to standardizing the operational processes of staff, improving self-learning awareness enhancement, and improving work quality and efficiency. PDCA refers to the initials of Plan (plan), Do (implementation), Check (inspection), and Action (action), respectively, and is the scientific level followed by \u201ctotal quality regulation\u201d (TQM). Through PDCA cycle, the final aim of PDCA cycle regulation is to enhance the quality of service, product, or work step by step and optimize various work . The disThe quality of nursing regulation in the disinfection and supply center is directly relevant to the medical level of the hospital and the health of patients . If the PDCA cycle theory is a standardized and scientific cycle theory system put forward by Dai Ming, an American quality regulation expert, which can be applied to quality regulation . It has The subjects of this study were 13 nurses in the disinfection and supply center of our hospital. The routine regulation method was implemented in the department from June to December 2019, and the PDCA cycle regulation method was implemented from January to June 2020. Among the 13 nurses, 13 were female, aged from 24 to 49, with an average age of (32.64\u2009\u00b1\u20093.29) years, 1 with college degree or less, and 12 with bachelor's degree or above.The disinfection and supply center will implement the routine regulation method from January 2020 to December 2020, that is, to complete the recovery, classification, cleaning, disinfection, inspection, and storage of instruments and equipment according to the routine regulation system and process of the disinfection and supply center. The PDCA cycle regulation law will be implemented from January 2021 to December 2021, and the contents are as follows: (1) The planning stage. A PDCA cycle regulation team was set up under the leadership of the head nurse. According to the four working processes of recovery and classification, cleaning and disinfection, inspection and packaging, and storage and distribution in the disinfection supply center, all nurses were assigned into four groups, each group was led by senior nurses. Before the implementation of the PDCA cycle regulation method, the head nurse summoned the team members to analyze the problems existing in the current disinfection supply center and their causes, worked out the PDCA circulation regulation measures, and planned the regulation objectives of the disinfection supply center and the hospital infection control objectives according to the actual situation of our hospital; (2) The head nurse summarizes the regulation quality according to the relevant standards of each work flow, affirms the effective regulation methods, and continues to use them in the next cycle regulation; the ineffective regulation methods are analyzed to find out the root causes, and the improvement scheme is discussed again. Analyze the achievements and shortcomings of each cycle regulation, and make targeted strengthening and improvement measures; (3) The inspection stage. The PDCA cycle regulation team does a good job in the inspection of each training to ensure that every nurse completes the relevant training within a specified period of time, and examines the nurses regularly, and the assessment results are linked to rewards and punishments. Evaluate the quality regulation of each workflow in accordance with the regulatory objectives of the disinfection and supply center, including recovery and classification regulation, cleaning and disinfection regulation, inspection and packaging regulation, storage and distribution regulation, and equipment maintenance regulation. Collect the feedback of each department, and evaluate the quality regulation effect of each working link according to the opinion. Do a good job in the classification of quality problems. The quality data of unqualified equipment recovery, equipment cleaning and sterilization, and equipment fault treatment are analyzed every month, and the corresponding rectification measures are put forward. Establish a sound reporting system for quality problems, including work defects or errors, damage to valuable equipment, and substandard quality of equipment handling workflow, when serious quality problems occur, they must be reported to the competent department at a higher level, analyze the quality problems, and put forward improvement measures; and (4) The head nurse organizes team members to study the relevant knowledge of PDCA cycle regulation, including regulation concepts, regulation steps and implementation measures, and conducts special training for various work processes and links. Develop work manuals according to all work processes of the disinfection and supply center, including staff operation manual, staff training manual, product maintenance manual, and pressure steam sterilizer operation manual, and record the safe operation of the equipment every day. Each group leader randomly checks all the items in 3 to 5 sterilized bags every month.The group meeting is held once a month to discuss with the group members the problems in the application of nursing signs and the methods of improvement, as well as the design of statistical signs, which are produced and distributed by the request office after filling in the application. The logo design should be eye-catching, reasonable cost, uniform specifications, practical and beautiful, and able to reflect the characteristics of the specialty, in order to improve the quality of nursing management and avoid the occurrence of nursing risks.Mainly including the concentration and method of preparation of various cleaning enzymes and disinfection solutions in the disinfection supply center, uniformly marked in white letters on a blue background and posted on special soaking buckets and corresponding instruments and equipment.The emergency plan is posted on the wall in black letters on a uniform white background so that it can be memorized and, in the event of an emergency, can be implemented immediately in accordance with the regulations to prevent errors and accidents. In addition, next to the autoclave and the cleaning and disinfection machine, the \u201cprevent scalding\u201d care sign is posted in a uniform style with white letters on a black background to strengthen the warning and remind staff to do a good job of self-protection.Standardize and unify the packaging of sterile items used throughout the hospital and fix rigid signs with white characters on a green background on sterile items storage baskets or shelves to facilitate storage and check distribution to improve work efficiency.According to the strict division of decontamination area, sterilization area, packaging area, and storage area of sterile articles, and unified with white letters on a green background in each area to post all kinds of routine operation procedures; at the same time, unified with white letters on a green background to post all kinds of instruments and equipment operation specification flow chart on the corresponding instruments and equipment using waterproof self-adhesive paper, so as to facilitate standardized operation.\u03b1 value was 0.653, which was consistent with the use of this study; (4) the regulation quality before and after the implementation of PDCA cycle regulation was scored by the regulation evaluation scale made by the disinfection and supply center of our hospital, including recovery and classification regulation, cleaning and disinfection regulation, inspection and packaging regulation, and storage and distribution regulation; and (5) to observe the occurrence of adverse events before and after the implementation of PDCA cycle regulation.The main results are as follows: (1) the job satisfaction questionnaire made by the disinfection and supply center of our hospital was adopted to evaluate the nurses' satisfaction with the regulation work. The contents of the scale included regulation quality, safety, operation proficiency, and other dimensions. The evaluation grade is assigned into very satisfactory, relatively satisfactory, acceptable, and unsatisfactory. Satisfaction\u2009=\u2009very satisfactory rate\u2009+\u2009relatively satisfactory rate; (2) to compare the differences in nursing staff's safety awareness, comprehensive operation skills, and cleaning effect before and after the implementation of nursing safety concept education. The safety awareness score form is self-made by our hospital, and is evaluated from the aspects of safety identification ability, risk prevention consciousness, and service consciousness. The full score is 10, and the higher the score, the better the safety awareness. The evaluation of comprehensive operation skills includes theoretical assessment and operation assessment, with a full score of 100. The better the score, the better the comprehensive operation skills; (3) the qualified rates of washing, sterilization, packaging, and distribution of instruments were compared, and the disinfection quality of instruments was scored and compared. Among them, the qualified rate of washing, sterilization, packaging, and distribution of instruments are evaluated according to the requirements and standards of the instructions for the use of related instruments. The quality of disinfection of instruments and the quality of nursing service were scored by the expert group of the nursing department according to the self-made scale made by our hospital. The results of the pretest indicated that the test-retest reliability coefficient was 0.977 and the internal consistency Cronbach's s). The group design t-test was adopted for the comparison and the analysis of variance was adopted for the comparison between multiple groups. Dun-net-t test was adopted for comparison with the control group. The counting data were presented in the number of cases and the percentage, \u03c72 test was adopted for comparison between groups, and a bilateral test was employed for all statistical tests.SPSS23.0 statistical software was adopted to process the data. The measurement data were presented as (P < 0.05). All the results are indicated in Firstly, we compared the quality evaluation of nursing staff. The quality scores of instrument disassembly, cleaning, disinfection, packaging, and environment in the study group were remarkably higher, and the difference was statistically significant (P < 0.05). All the results are indicated in We compared the qualified situation of disinfection of nurses. The qualified rates of sterile dry cans, surgical instruments, endotracheal cannula, oxygen humidification bottles, and laryngoscope instruments in the study group were remarkably higher, and the difference was statistically significant (P < 0.05). All the results are indicated in The quality regulation effects were compared. The qualified rate of instrument washing, sterilization, packaging, and distribution in the study group was remarkably enhanced, and the difference was statistically significant (P < 0.05). All the results are indicated in We compared the regulation scores, and the regulation score of recovery and classification regulation, cleaning and disinfection regulation, inspection and packaging regulation, and storage and distribution regulation in the study group were remarkably higher, and the difference was statistically significant (P < 0.05). All the results are indicated in We compared the scores of safety awareness and comprehensive operation skills. The results of safety identification, risk prevention, service, theory, and operation of nurses in the study group were remarkably higher, and the difference was statistically significant (P < 0.05). All the results are indicated in In the control group, there were 3 complaints, 2 nursing errors, and 1 accident. The incidence of adverse events was 40.00%; there was only one nursing error in the study group, and the incidence of adverse events was 6.67%. The incidence of adverse events in the study group was lower, and the difference was statistically significant (P < 0.05). All the results are indicated in We compared the job satisfaction of nurses. In the study group, 10 were very satisfied, 2 were relatively satisfied, 1 was satisfied, and no one was dissatisfied, with a satisfaction rate of 92.31%; In the control group, 3 cases were very satisfied, 6 were more satisfied, 3 were satisfied, 1 was not satisfied, and the satisfaction was 53.84%. The satisfaction of the study group was remarkably higher, and the difference was statistically significant . The qualified rate of disinfection of sterile dry cans, surgical instruments, endotracheal cannula, oxygen humidification bottles, and laryngoscope instruments in the study group was remarkably higher, and the difference was statistically significant (P < 0.05). The qualified rates of washing, sterilization, packaging, and distribution of instruments in the study group were remarkably enhanced, and the difference was statistically significant (P < 0.05). The score of recovery and classification regulation, cleaning and disinfection regulation, inspection and packaging regulation, storage and distribution regulation in the study group were remarkably higher, and the difference was statistically significant (P < 0.05). The nurses' safety identification ability, risk prevention consciousness, service consciousness, theoretical achievement and operation performance in the study group were remarkably higher, and the difference was statistically significant (P < 0.05). Based on the analysis of this, PDCA cycle regulation is an innovative regulation mode on the basis of conventional regulation, which promotes the development of nursing quality regulation in the disinfection supply center to a scientific and standardized direction. The PDCA cycle regulation method includes four stages: planning, implementation, inspection, and summarization. Firstly, it analyzes the problems existing in the quality regulation process of the disinfection supply center, defines the regulation objectives, and draws up regulation plans and measures, which realize the procedure and standardization of the regulation of the disinfection supply center, so as to urge every nurse in the disinfection supply center to carry out in accordance with the relevant quality regulation standards. After defining the plan and goal, the nurses completed each work in a planned and purposeful way according to the relevant requirements, which not only enhanced the nurses' regulations consciousness but also promoted their work enthusiasm and initiative. PDCA cycle can find the problems in the supervision process in time and take targeted improvement measures to ensure the continuous improvement of nursing quality in the disinfection supply center. The results indicated that compared to before implementation, the incidence of adverse events after implementation was lower, and the job satisfaction of nurses after implementation was higher, and the difference was statistically significant (P < 0.05). This indicates that the implementation of PDCA circulation regulation method in the regulation of disinfection and supply center can effectively prevent and control the occurrence of adverse events such as complaints, nursing errors and accidents, and make all nurses participate in the regulation, which greatly enhances the job satisfaction of nurses. We followed the methods of Ma et al. The same idea can be found in the study put forward by Ma et al. [It was found that the quality scores of instrument disassembly, cleaning, disinfection, packaging, and environment in the study group were remarkably higher, and the difference was statistically significant (a et al. . They haIn summary, the implementation of the PDCA cycle supervision method in the supervision of the sterile supply center in conjunction with the nursing logo is conducive to improving the quality of supervision and sterilization of all work aspects of the sterile supply center, reducing the occurrence of adverse nursing events and promoting the job satisfaction of nurses. In addition, it is conducive to standardizing the operational processes of staff, improving self-learning awareness enhancement, and improving work quality and efficiency. This study still has some shortcomings. Firstly, the quality of this study is limited due to the small sample size we included in the study. Secondly, this research is a single-center study and our findings are subject to some degree of bias. Therefore, our results may differ from those of large-scale multicenter studies from other academic institutes. This research is still clinically significant and further in-depth investigations will be carried out in the future."}
{"text": "Symptoms related to abnormalities in gastrointestinal tract motility and functions are very common in the general population, affecting both pediatrics and adults, from both sexes . These sThe last decade has witnessed important advances in diagnostic tools and technologies used for the improved assessment of gastrointestinal function and motility ,6. A revFurther research has focused on improving our understanding of GERD pathogenesis, in order to ameliorate our diagnostic approach . Indeed,Notably, the application of artificial intelligence (AI) to the upper GI tract is mainly in the field of endoscopy; however, AI systems application is expanding in other upper GI settings, to include GERD, eosinophilic esophagitis, and motility disorders ,20.99m Technetium-labeled egg) is considered the gold standard for gastroparesis diagnosis [As for gastric symptoms, currently, scintigraphy of a solid meal (using aiagnosis . Howeveriagnosis . In addiiagnosis .Disorders in the anorectum such as constipation and fecal incontinence are also common in the general population and cause severe impacts on life quality and productivity . High reNumerous advances in the field of neurogastroenterology and motility have been achieved in recent years, including new imaging testing, developments at the cellular and molecular levels, the evolving role of the microbiome in various functional gastrointestinal symptoms, the role of diet and traditional and complementary medicine in managing functional gastrointestinal conditions, and many other advances from the clinical and laboratory levels. We believe that this Special Issue, in the Journal of Clinical Medicine, is of paramount significance and relevance for shedding light on the recent advances in neurogastroenterology and motility disorders, from pathophysiology to management, at the clinical and laboratory levels."}
{"text": "Moreover, this data set needs to be associated with the patient\u2019s clinical information. The collection and storage of biological material enable a series of studies that will allow the distinction between the healthy and pathological tissues and the genotype and associated phenotypes.Personalized medicine can be defined as a medical approach based on individualized information that allows planning and treatment considering the patient\u2019s clinical and genetic characteristics. Despite the great advance since the creation of the Human Genome Project aimed at identifying all the genes of human beings, the transcription of the gene was found to be not solely responsible for the result of our organism\u2019s responses. Therefore, the investigations of proteomics and metabolomics projects were also initiated, considering the transcription from deoxyribonucleic acid (DNA) to ribonucleic acid (RNA), its production of proteins and products of cellular metabolism.The biobank is an organized collection of human biological material and associated information, collected and stored for research purposes, according to regulations or pre-defined technical, ethical, and operational standards, under the institutional responsibility and management of the stored materials, with no commercial purposes. In other words, it is the democratic storage of biological materials for research on patients, guaranteed by an institution. Contrarily, the biorepository is the storage of biological material during a specific research project, under institutional responsibility and the researcher\u2019s management.Motivations for building a biobank are related to new goals of modern medicine and multidisciplinary practice, such as personalized medicine, early diagnosis of specific diseases like cancer or genetic diseases, and response prediction to targeted therapy with the principles of pharmacogenetics. Ischemia time clearly changes gene expression. Furthermore, the method of tissue fixation can change the results of laboratory tests, resulting into false positives or negatives. Therefore, in the biobank, best practices must be strictly followed.Biobank\u2019s biological materials are valued in terms of the digital traceability of information and presence of clear consent and assent of participants and their guardians (in case of minors), in addition to the technique of sample acquisition, storage, quality control, data collection, correlation to clinical data, data security and access.Several specimens allow storage, like organs, solid tissues, tumors, umbilical cord, feces, blood and its derivatives, urine, cerebrospinal fluid, teeth, saliva, bronchoalveolar lavage fluid, and perfusates (samples from organ perfusion). Samples must be stored based on the objective to be studied with fresh frozen tissue; since specific preparations are required for extracting DNA, RNA, mitochondria, specific proteins, among others.However, the biobank is not restricted to the acquisition and storage of biological materials. The progressive use of artificial intelligence and databases, with the possibility of intersecting the collected materials, retrospectively or prospectively, with associated donor information, pushes new frontiers of knowledge. Additionally, the participants can include their own data using the biobank\u2019s websites or Apps, and can be notified about the usage of their information and material.One of the main biobanks in the world is the United Kingdom (UK) Biobank, managed by England. Currently, it has more than 500,000 participants. Since 2014, magnetic resonance imaging and other images are also being collected. This biobank assesses genetics, physical activities, imaging tests, biomarkers, physical measurements, cognition, and hearing, in addition to prospective questionnaires. Although this large biobank is not compatible with the representation of the general population, as it is a cohort of healthy people, evaluation of public health outcomes can be ideally performed.Franklin Delano Roosevelt, former United States President, died in 1945 after an acute myocardial infarction. He encouraged his successor Harry Truman to develop the National Heart, Lung, and Blood Institute. In 1948, Truman included the first patient in the institute from one of the main cohorts in the world: the Framingham Heart Study. This cohort allowed several publications and guided the consensus on cardiovascular risk and its prevention. This was possible because of the integration of information and storage of biological materials. This is the concept of a biobank.In 2021, 89 biobanks in Brazil had been authorized by the National Research Ethics Commission for the most diverse purposes of collecting biological materials. Based on this tool in the arsenal of translational research, worldwide and in Brazil, the Heart Institute of the Medical School of the University of S\u00e3o Paulo (Instituto do Cora\u00e7\u00e3o da Faculdade de Medicina da Universidade de S\u00e3o Paulo [InCor HCFMUSP]) created the Institutional Biobank, with a capacity for more than 84,000 samples, including the cardiopulmonary department, in which groups can store samples of selected lines of action, such as lung transplantation.Presently, the concept of evidence-based medicine is developing into medicine based evidence, which means, with the acquisition of new information from large databases, associated with materials collected from biobanks and the integration of artificial intelligence, either by deep learning, neural network, or other forms of algorithms. The evidence, that is, the data, will be able to better predict the treatment, target therapy, specific diagnoses, and others. Evidence-based medicine supports personalized medicine, and the biobank plays a key role in this regard. The collection of biological materials and the reproducibility of the technique in different general and specific populations will allow these studies.Specific institutions created for biobank such as the UK Biobank or well-structured educational institutions such as the InCor, with the capacity to store information and biological materials, will be able to collect and provide researchers and the population with answers that is lacking at present, especially focused on the patient\u2019s individuality."}
{"text": "The quality of human settlement environment (HSE) is related to people\u2019s well-being. Since the implementation of the Western Development Strategy and the Grain to Green Program, the HSE in northern Shaanxi has undergone a major transformation. In order to explore the evolution pattern and seek a coordinated development strategy for all systems in the whole region, this paper, from the perspective of \u201cproduction\u2013living\u2013ecological\u201d, evaluates the HSE niche breadth of northern Shaanxi based on the ecological niche theory, analyzes its spatial differentiation characteristics, and identifies the development barrier factors, with the help of ArcGIS spatial analysis tools and the barrier degree model. It is found that: from 2000 to 2020, (1) the niche breadth of HSE in northern Shaanxi is high in the north and low in the south, showing obvious spatial unevenness; (2) the development of transportation promotes the improvement of HSE, but also intensifies the spatial unevenness, and the uncoordinated development rate of transportation and production and living systems has seriously restricted the further development of HSE; (3) the niche breadth of the ecosystem for each county is much lower than that of the production and living systems, and the ecological environment becomes the short board of the improvement of HSE in northern Shaanxi. Based on the patterns and problems found in the study, this paper proposes a strategy to improve the HSE of northern Shaanxi by prioritizing the balanced development of production, living systems, and transportation, strictly implementing the concept of ecological priority, dynamically adjusting the hierarchy of policies, vigorously optimizing the industrial layout, and focusing on the joint improvement of the human settlement environment in the whole region. This study expands the theories and evaluation methods of HSE to a certain extent, and the results have guiding values for promoting the sustainable development of HSE in northern Shaanxi and even the whole Loess Plateau region. Human settlement environment (HSE) is the place where human beings live together, the surface space of the earth closely related to human survival activities, the base on which human beings live in nature, and the main place where human beings use and transform nature . Faced wIn order to achieve the common goal of HSE research, scholars often take the evaluation of livability as the entry point of the research. The object of the evaluation of HSE livability is divided into subjective object , which iIn terms of methods for evaluating HSE, linear weighting and hierarchical synthesis are the current mainstream methods . For exaAlthough scholars have produced rich results in the field of HSE, most of the existing studies have focused on developed areas ,33,34 orIn summary, in order to explore the HSE evolution pattern in less developed regions and seek strategies for the coordinated development of each system, this paper takes northern Shaanxi as an example, based on HSE theory, PLE theory, and ecological niche theory, and uses the niche breadth model, hot spot analysis, spatial auto-correlation, and the barrier degree model to assess the niche of HSE, analyze its spatial differentiation characteristics and the trade-off relationship within the PLE system, and identify the barrier factors for HSE enhancement in the hope of proposing targeted HSE optimization strategies. The introduction of ecological niche theory and the perspective of production\u2013living\u2013ecological are the main innovations of this paper, which expands the relevant theories and evaluation methods of HSE to a certain extent. The results provide some guidance in achieving sustainable development of HSE in a typical region such as northern Shaanxi.4 km2 and includes 2 prefecture-level cities, Yulin and Yan\u2019an, with 21 counties and 4 municipal districts under its jurisdiction  Land use data are taken from the Resource and Environmental Science and Data Center of the Chinese Academy of Sciences (https://www.resdc.cn (accessed on 5 October 2022)). (3) DEM were downloaded from 91 Guardian software, with an accuracy of 30 m \u00d7 30 m. (4) PM 2.5 data (0.01\u00b0 \u00d7 0.01\u00b0) were obtained from Washington University in St. Louis (https://sites.wustl.edu/acag/datasets/surface-pm2-5/#V5.GL.02 (accessed on 8 August 2022)).Considering that the Grain to Green Program and the Western Development Strategy, implemented in 1999 and 2000, respectively, might have a greater impact on the HES in northern Shaanxi, and taking into account the availability of data, this paper takes 2000 as the starting year and 2020 as the cut-off year of the study. At the same time, to facilitate comparative research, this paper selects 2010 as the time point, which divides the research period into two decades. The data are obtained as follows. (1) Indicator data are calculated from the statistical data of Based on the analysis of the connotation of HSE and PLE, summarizing the previous achievements and combining with the situation of the study area, this paper constructs a three-dimensional evaluation index system of production\u2013living\u2013ecological for evaluating HSE ecological niche. The production environment is the foundation of socio-economic development and the key to the enhancement of human well-being. It is concerned with food security as well as the efficiency, intensity, and trends of development, and can be characterized by the scale, efficiency, level, concentration of development, and trends of agricultural production and non-agricultural production . The livIn summary, a total of 16 indicators were selected in this paper to evaluate the HSE ecological niche in northern Shaanxi . The resAccording to ecological niche theory, the niche breadth indicates the degree of resource utilization of a species . For thii, j = 1, 2, 3, \u2026, n; iN is the niche breadth of county i; iS and iP are the state and trend of county i, respectively; jS and jP are the state and trend of county j, respectively; iA and jA are the dimensional conversion coefficients; jS + jPjA is called the absolute niche.Drawing on the niche trend model , this paGi* index of Hot Spot Analysis in Spatial Statistics Tools in ArcGIS was used to perform the cold and hot spot local correlation analysis of the niche breadth of HSE. The formula is as follows:ijW denotes the spatial weight; E mainly detects the dependence of the spatial distribution pattern of things and phenomena, determines the diffusion, polarization, or randomness of the spatial distribution, and is used to reveal the mechanism of interaction between the property values of the research object . The bivjP is the barrier degree of the single indicator to HSE enhancement; jZ is the standardized value of the single indicator; m = 16; jV is the barrier degree of the criterion layer to HSE enhancement.The barrier degree model is a mathematical statistical method to effectively determine the key factors that hinder the development of things, and it is now widely used in the study of impact factors in various disciplines. With reference to the existing research , the barThe spatial differentiation pattern, temporal evolution process, and regional characteristics of the production\u2013living\u2013ecological niche breadth of HSE in 25 counties in northern Shaanxi from 2000 to 2020 are obvious . The detProduction environment: During the study period, the production niche breadth of each county is basically stable, showing the spatial distribution characteristics of high in the north and low in the south. Specifically, from 2000 to 2010, Fugue, Shenmu, Luochuan, and Yuyang had much higher niche breadth values than the other counties, while all other counties had similar values. From 2010 to 2020, although the value of Fugu decreased significantly, from the highest to the fourth highest, Fugu, Shenmu, Luochuan, and Yuyang still had values above all other counties. Over the 20 years, the production niche breadth increased slightly in all the counties of Yulin City, except for Fugu County. However, in Yan\u2019an City, only Baota District and Yanchuan County saw a slight increase, while the rest of the counties saw a decrease in production niche breadth to varying degrees.Living environment: Unlike the production environment, the living niche breadth in northern Shaanxi varied more markedly in space during the study period. From 2000 to 2010, the living niche breadth in the study area shows a circle-like spatial distribution. Baota District is the center of the circle, and the value of its living niche breadth is much higher than that of other counties; in the middle of the circle are the counties immediately adjacent to Baota District, and their values are at the lowest level of the study area; the counties in the north and south ends of the study area are at the outermost part of the circle, and the values of these counties are in the middle for the study area. From 2010 to 2020, the values of living niche breadth in northern Shaanxi change significantly in spatial distribution, which can be summarized as high in the north and low in the south. Specifically, the value of Baota District slightly decreased, and the values of its surrounding counties remained at the lowest level in the study area; the high value of living niche breadth shifted from Baota District to Yuyang, Shenmu, and Fugu, which are located in the northernmost part of the study area.Ecological environment: The ecological niche breadth in northern Shaanxi was much lower than that of production and living environment during 2000\u20132020, and the change in its value is also small, but the change of spatial characteristics is obvious. From 2000 to 2010, the highest values were found in Shenmu, followed by Ansai; the low-value areas were mainly concentrated in the eastern part of the study area; Luochuan and Huanglong, located in the south, and Wuqi, located in the west, also had low values; the rest of the counties were at medium or high levels. From 2010 to 2020, Yuyang, Shenmu, and Fugu, located in the northern region, and Fuxian and Ganquan, located in the southern region, had the highest values; the values in the western part of the study area decreased significantly, and the eastern part remained as a low-value concentration area.The comprehensive evaluation results show that from 2000 to 2020, the niche breadth of HSE in northern Shaanxi has a small temporal variation, but the spatial variation in the north\u2013south direction is obvious, and the overall distribution is high in the north and low in the south. In the north of the study area, Yuyang, Shenmu, and Fugu have the highest values, and in the south, Baota has the highest value, while the peripheral counties in Baota have the lowest level of niche breadth in the study area.The hot spot analysis  helps toZ-test (p = 0.05) as the criterion. With the help of the LISA distribution map, the spatial interaction of two adjacent functions in the region can be better expressed [To deeply explore the spatial trade-offs among production, living, and ecological, the bivariate local autocorrelations of niche breadth within the PLE system from 2000\u20132010 and 2010\u20132020 were analyzed with the help of GeoDa 1.20, using a 5000 m grid as the base unit and xpressed .The trade-off relationship within the PLE system is spatiotemporally heterogeneous . SpecifiOverall, from 2000 to 2020, the HH synergistic area of P-L system, P-E system, and L-E system expanded in the three northern counties of the study area or shifted to this range; LL synergy extended from the east and west sides of the study area to the central part; HL trade-off, LH trade-off, and LL synergistic were interspersed in the southern region.The barrier degree of each factor to HSE enhancement in northern Shaanxi was calculated with the help of the barrier degree model, and the top three factors for each county were listed .Statistics found that (1) from 2000 to 2010, the main barrier factors for HSE enhancement in 19 counties were transportation land density (TLD), total ecosystem services value (TESV), and the number of industrial enterprises above the scale (NIEAS). Except for Baota District, the factor with the highest barrier degree in each unit was TLD. In addition to the three factors mentioned above, the ratio of social security spending to GDP (RSS) had a large impact on the enhancement in Baota, Huangling, Yuyang, Shenmu, Fugu, and Jingbian. (2) From 2010 to 2020, TLD was still the most dominant barrier factor in most counties. The main barrier factors in Baota District changed significantly, from TESV, NIEAS, and RSS to TLD, TESV, and RSS. The three northern counties also changed significantly, with the primary factor changing to RSS, and grain yield per unit area (GYPU) and annual precipitation (AP) becoming important barrier factors.Overall, HSE enhancement in most counties in northern Shaanxi continued to be constrained by transportation and ecosystem services, and only a few counties saw changes in the major barrier factors over the 20-year period. In comparison with the results of the niche breadth measurement and the PLE spatial trade-off analysis, significant changes were still observed in Shenmu, Fugu, and Yuyang in the northern part of the study area, and in Baota in the southern part.Based on the results of the barrier degree measurement, the barrier degree map of the PLE system of northern Shaanxi HSE enhancement was drawn .From 2000 to 2010, the HSE niche of more than half of the counties in northern Shaanxi was mainly constrained by the development level of living environment, and the barrier degrees produced for Shenmu, Huangling, and Luochuan were all greater than 0.45. The main barriers for Baota and Suide were production environment, with barrier degrees of about 0.50 and 0.40, respectively. Nine counties, including Yanchuan, Fuxian, Huanglong, and Hengshan, were constrained by both production and living environments, and the barrier degrees of both systems were above 0.35. The ecological environment had stronger constraints on Fugu, Luochuan, Zichang, and Baota.From 2000 to 2020, the barrier degree of the PLE system to HSE in northern Shaanxi changed to some extent, but living environment constraint or L-P double constraint was the main pattern. The production environment produced serious constraints only in a few areas. Ecological, P-E, and P-L-E constraint patterns did not appear.With the help of the niche breadth model and hot spot analysis, we found that the spatial distribution of HSE niche breadth in northern Shaanxi is characterized by being high in the north and low in the south. The values of Yuyang, Shenmu, and Fugu are the highest in the northern region, and the values of Baota are the highest in the southern region. The low-value areas are clustered in the periphery of Baota District. The reasons for the formation of this feature are complex and varied, and we will discuss it from the perspective of the PLE environment.Agricultural production and industrial economy are direct manifestations of the production environment, and it may be possible to find some reasons for the formation of spatial differentiation of HSE in terms of their changes, i.e., in terms of changes in the production environment itself. In the industrial economy, as economic powerhouses in western China, the energy and chemical industries in Shenmu and Fugu have been ranked among the top in the country in terms of production capacity and output efficiency. The economic benefits from industrial production have laid a solid foundation for HSE enhancement in the northern part of the study area. With regard to agricultural production, taking Yulin City as an example, relevant studies  show thaThe living environment is also closely related to the spatial characteristics of HSE in northern Shaanxi. Transportation is an important grasp of economic development , and likSince the implementation of the GGP, the ecological environment in northern Shaanxi has been significantly improved , and theProduction, living, and ecological environment are not separate. There are intertwined situations between them . For exaFrom the perspective of barrier factors, transportation, ecosystem services, number of large-scale industrial enterprises, and social security expenditures were the main barrier factors for HSE enhancement in most counties in northern Shaanxi from 2000 to 2020. The positive response of economic development to the improvement of transportation level directly drives the enhancement of the HSE\u2019s production and living environment. Since the Western Development Strategy, the rapid development of transportation in northern Shaanxi has contributed to the formation of the HSE niche spatial pattern. However, the contribution of transportation is slightly insufficient compared with the dominant indicators such as industrial output, food production, and economic density. The difference in the development rate of transportation and other factors might be the reason for this result. The amount of ecosystem services, as another important barrier factor, constrains the HSE niche enhancement in various ways. On the one hand, the fragility of the ecological background in northern Shaanxi was the main shortcoming of HSE enhancement. Although it improved over the 20 years, the service capacity and service volume of the improved ecosystem remained at a relatively low level. On the other hand, in order to adapt to the rapid economic development, ecological land has been continuously squeezed by urban and rural construction land, and some of the ecological benefits brought by the Grain to Green Program have been offset. A related study  showed tIn terms of the barrier degree of P-L-E environment, there are mainly two patterns of single living environment barrier and living-production dual barrier for the enhancement of HSE in northern Shaanxi. Combining the barrier degrees at the indicator level, it can be concluded that the constraints arising from the production environment are caused by the decrease in the number of large-scale industrial enterprises, and the constraints of the living environment are mainly caused by the ratio of social security expenditures to GDP and transportation factors. Influenced by transportation factors, the constraint of living environment on HSE enhancement in northern Shaanxi becomes more prominent after excluding the number of large-scale industrial enterprises and the ratio of social security expenditure to GDP. In addition, it is worth noting that the measurement results show that the ecological environment has not produced significant constraints. This is due, on the one hand, to the trade-off between the ecological environment and the living and production environment, and on the other hand, to the fact that the niche breadth of the ecological environment has been at an extremely low level, even producing differences in order of magnitude compared with the production and living environment. Because of this, for northern Shaanxi, the ecological environment is an important shortcoming for HSE enhancement. From the above discussion, it is easy to find that the results of the barrier model are generally in line with the reality of the study area, but the limitations of the method lead to the barrier of some factors being only reflected in the \u201cvalue\u201d. In other words, with socio-economic development, some of the factors are no longer significant barriers to HSE improvement, but they still seem to have some influence from the model\u2019s arithmetic results. Therefore, future studies should not only carefully consider whether the selected indicators or impact factors can be adapted to socio-economic development, but also closely integrate the situation of the study area when analyzing the results to remove unreasonable factors. This will provide a more scientific basis for the proposed strategy.In summary, differences in economic base, resource endowment, and policies have caused spatial unevenness in the PLE niche breadth for HSE in northern Shaanxi. Different development rates of transportation and economy have further exacerbated this unevenness, and even made the transportation level an important barrier factor for HSE enhancement. The fragile native ecological environment and the dramatic expansion of urban and rural construction land have led to the contribution of the Grain to Green Program to HSE becoming limited. In addition, the trade-offs within the PLE system have made it challenging to improve HSE overall. Due to the dynamic and complex nature of the HSE system, when carrying out enhancement optimization, we should distinguish the main and secondary issues, prioritize the main issues while taking into account the shortcomings, and dynamically coordinate multiple secondary issues in the optimization process. For northern Shaanxi, the mismatch in development speed between transportation and production and living environment is the main factor that restricts HSE enhancement, which should be adjusted as a priority. The fragility of the ecological environment has been an inherent shortcoming of the region, and the concept of ecological priority should be consistently implemented. For example, land should be used as intensively as possible when enhancing the production and living environment in order to avoid large encroachments on ecological land and to maximize the ecological benefits brought by various measures. In addition, the imbalance should be broken by optimizing policies and industrial layout and other means to drive the development of low-value areas for HSE niche breadth, thus realizing HSE enhancement in the whole area of northern Shaanxi.Based on niche theory and PLE theory, this paper evaluated the HSE niche of each county in northern Shaanxi from a macro perspective with the help of the niche breadth model, ArcGIS hot spot analysis tool, and barrier degree model, analyzed its spatial distribution characteristics and the barrier factors for enhancement, and put forward development suggestions from the perspective of breaking through the constraints. The main conclusions are as follows.From 2000 to 2020, the overall spatial characteristics of HSE niche breadth in northern Shaanxi showed a pattern of high in the north and low in the south, and the niche breadth value of ecological environment was much lower than that of production and living environment. The rapid development of the energy industry, which has brought about substantial economic growth, was the main reason for the increase in the HSE niche. The differences in resource endowment and economic base, as well as the strategic layout of the government, etc., have led to an uneven level of industrial development among the regions, resulting in the spatial unevenness of the HSE niche in northern Shaanxi, i.e., the production environment has dominated the formation of the spatial characteristics of the HSE niche in northern Shaanxi.The hot spots of HSE niche breadth in northern Shaanxi mainly concentrated in Shenmu, Fugu, and Yuyang, which are located in the northern part of the study area, and the cold spots mainly concentrated in the periphery of Baota District. From 2000 to 2020, the HH synergies of P-L, P-E, and L-E also mainly clustered in the three northern counties, while the LL synergies showed an overall extension from the eastern and western parts of the study area to the central part. In the southern part, the spatial trade-offs of the PLE system were intricate and complex, with HL trade-offs, LH trade-offs, and LL synergies interspersed.The development of transportation has driven the enhancement of HSE in northern Shaanxi, but it has also exacerbated the spatially uneven characteristics of the niche. At the same time, the difference in the development rate of transportation and production and living environment is an important reason to restrict the enhancement of HSE niche in northern Shaanxi, and the ecological environment is an inherent shortcoming of the enhancement.Finally, based on the results of this paper and the actual situation in northern Shaanxi, we propose a strategy to improve HSE by prioritizing the balanced development of production, living systems, and transportation, strictly implementing the concept of ecological priority, dynamically adjusting the hierarchy of policies, vigorously optimizing the industrial layout, and focusing on the joint improvement of the human settlement environment in the whole region."}
{"text": "Sleep problems severely affect the quality of life in the elderly and have gradually gained attention among scholars. As a major hot spot of current research, sleep in older adults is highly exploratory and of great significance for human health.Therefore, in this study, the current state of the art of sleep research in older adults was analyzed through the visual mapping function of CiteSpace software. Using this software, we analyzed popular research questions and directions and revealed the development trends and research frontiers of this field.In this paper, we searched the Web of Science database for sleep-related studies focusing on older adults and analyzed the number of publications, journals, authors, institutions, country regions, and keywords by using CiteSpace software.Sleep has published the majority of the articles on sleep in older adults and has the highest citation frequency. The Journal of the American Geriatrics Society has the highest impact factor and CiteScore among the top 10 journals in terms of the number of published articles. The United States has the highest number of publications and most of the leading institutions in this field are located in the United States, with the University of California, Los Angeles, and the University of Pittsburgh having the highest number of publications. Dzierzewski JM is the most published author and has played an important role in guiding the development of this field. Research in this area is focused on insomnia, sleep quality, depression, and sleep duration.Our results revealed that the number of publications concerning sleep in older adults has gradually increased; after 2017, this field underwent rapid development. The journal The rapid development of sleep research in older adults, which shows a yearly growth trend, indicates that this field is receiving increasing attention from researchers. Insomnia in older adults is the most concerning problem in this field. At the same time, future research should continue to focus on the impact of sleep disorders on older adults to improve sleep and quality of life in older adults. The aging population experiences age-related symptoms, such as slowed metabolism, decreased resistance, and decreased physiological functions, and may even develop age spots and memory loss . With thSleep disorders (SDs) are symptoms of abnormal amounts of sleep, abnormal behaviors during sleep, and disruptions of the circadian rhythm  , 9. SDs Good and sufficient sleep is beneficial to the recovery process from physical diseases, and it is necessary for undertaking daily activities. Furthermore, it can improve the quality of life in older adults , reduce Research on sleep in older adults has gradually increased in recent years. Since elderly sleep is influenced by many aspects, such as sex, sleep habits, physical and mental disorders, and medications, a considerable number of studies exist in this area, and their findings are complicated. Scientific knowledge mapping is a popular research method in the fields of scientometrics and visual analysis, which reveals the development patterns and research hot spots of related fields through visualization . With thThe data used in this paper were obtained from the Web of Science (WOS) database from 1 January 2000 to 1 August 2022. The search was conducted using author keywords (AK) in the form [AK= (older adults) or AK= (older people)] and AK= (sleep). A total of 475 documents were retrieved, after which the items were refined by document type (article) and excluded by types of publication ; thus, 65 items were excluded. The items were manually filtered by excluding reviews, meta, case reports, books, letters, comments, and meetings, through which 13 items were excluded. A total of 397 items were included in this study . The entIn this study, CiteSpace 6.1.R2 software was used to map scientific knowledge, and co-occurrence and clustering analyses were performed on high-frequency terms, research institutions, and countries. Finally, 397 papers were included in the study, and the trend maps of publication volume, authorship, institutional cooperation, geographical distribution, and keyword mapping were drawn to highlight key nodes and research hots pots, thus visualizing the field of sleep research in older adults. Each of these plots represents cutting-edge hot spots and trends in scientific research and can be selectively analyzed based on a particular aspect of the problem . In addiAfter searching and screening, a total of 397 publications were found in the WOS database between 2000 and 2022. It can be seen in Sleep ranks first, with 23 articles, and is also first in terms of citation frequency (508). Ranking second and third are the Journal of Clinical Sleep Medicine and Sleep Medicine, with 22 and 19 articles, respectively. The Journal of the American Geriatrics Society ranks fourth in terms of the number of published articles. This journal ranks first in both impact factor (7.538) and CiteScore (8.8). Overall, 5 of the top 10 journals in terms of the number of published articles are from the United States. This is followed by the United Kingdom, with 4 of the top 10 journals.The included literature was organized and ranked according to the number of published articles, resulting in the top 10 journals in terms of the number of articles . The resEffects of moderate-intensity exercise on polysomnographic and subjective sleep quality in older adults with mild to moderate sleep complaints. This article has 146 citations and is authored by King AC. The article was published in 2008. Among the top 10 cited articles, 4 articles were published in 2010 in Sleep Medicine, Sleep, Psychoneuroendocrinology, and Journal of Medicinal Food. Most of the highly cited articles were published in American journals, namely Journals of Gerontology Series A-Biological Sciences and Medical Sciences, Sleep, American Journal of Geriatric Psychiatry, and Medical Clinics of North.The top 10 most frequently cited articles are listed in As seen from The number and size of the nodes in the author collaboration network map show the frequency of co-occurrence, and the number of connected lines indicates the collaborative network between authors, as well as its strength . There aThe visual analysis of sleep in older adults was performed using CiteSpace software , and theIn order to better understand the research hot spots in the field of sleep in older adults, a keyword clustering map was drawn by running the CiteSpace visualization software . The sciTo better visualize the research dynamics of sleep research in older adults, a keyword time-zone mapping was developed to show the evolution of research hot spots from 2003 to 2022 . High-frWith aging-related physiological changes, the sleep schedule of the elderly also changes, with shorter nighttime sleep, more frequent daytime sleep, and reduced sleep duration. The underlying causes for these problems include physical diseases, mental problems, environment, and living conditions. Through the bibliometric analysis of research on elderly sleep with CiteSpace, the current situation and development trend of the elderly sleep research were identified in terms of authors, institutions, journals, countries, and keywords.The trends in sleep research on older adults are reflected by the number of published papers in recent years. Sleep ranks first in terms of the number of articles. This indicates that the journal has a high academic advantage and influence in the study of sleep in older adults. The main research directions of Sleep are behavioral sciences, clinical neurology, neurosciences, and psychiatry. The top three journals are all in the field of clinical neurology. The Journal of the American Geriatrics Society focuses on geriatrics gerontology. The journal is ranked first in both impact factor and CiteScore, indicating the high quality of academic papers published in the journal. Other journals in the field of geriatrics include BMC Geriatrics, Geriatrics Nursing, International Psychogeriatrics, International Journal of Geriatric Psychiatry, and Clinical Gerontologist.Effects of moderate-intensity exercise on polysomnographic and subjective sleep quality in older adults with mild to moderate sleep complaints. The article focused on the effects of exercise interventions on sleep in older adults. It revealed that moderate-intensity exercise improved sleep quality in older adults with mild-to-moderate sleep complaints (Highly cited research is an essential source of scientific knowledge in any field of study, as it indicates the level of research and trends of development in that field and is the scientific basis for exploring the frontiers of research and hot spots . The citmplaints .The country\u2013region distribution map is a much better depiction of the scientific research differences and distribution in sleep research in each country. Far more papers are published in the United States than in other countries. This indicates that the United States has the highest level of research and influence in the field of sleep research. University of California, Los Angeles, and the University of Pittsburgh rank first in terms of the number of published papers, indicating their outstanding contributions to this field. The University of California, Los Angeles is the cradle of scientific research and high-tech industry professionals in the United States. It invests a considerable amount of human and material resources into research every year. The mapping of institutional collaboration shows that several US research institutions have active collaborative networks with other institutions and that more opportunities exist for academic exchange and learning. Various institutions learn from each other and contribute to the continued development of related research.Author collaboration mapping provides a clear view of the research status of individual scholars in a research area and the collaboration among them . It provKeywords are high-level summaries of the topic of a paper and reflect the research direction and value of the article. Analysis of keywords in the related literature of a certain field helps explore the research hotspots and development trends in that field . KeywordSome studies have shown that approximately half of older adults suffer from SDs, which is closely related to physical health status . The durThis bibliometric analysis of studies involving elderly sleep was conducted with the help of CiteSpace software, using visual mapping to more graphically reveal the trends and patterns in this field, which in turn led to a series of new findings and interpretations. This paper focused on the number of publications, journals, authors, institutions, countries, and keywords, aiming at a macro analysis of the field, so some important detailed parts were not reflected in the study. CiteSpace software was developed based on the Web of Science Core Collection and, therefore, generally relies on this database for analysis. Thus, our choice of databases was limited. Additionally, we limited the search period to January 2000\u2013August 2022, and those articles published after this period were not included.This bibliometric study focused on sleep quality in older adults, providing detailed information on the relevant literature from a global perspective through visualization with CiteSpace. We found that the number of studies in the field of elderly sleep has increased year by year, especially after 2017, with a sharp increase in the number of publications, indicating that this research area has excellent growth potential. Pioneering research on elderly sleep originates from the United States. The research institutions involved in this area are mainly universities. Research hot spots revolve around insomnia, sleep quality, depression, sleep duration, etc. Research topics include sleep quality, cognitive impairment, obstructive sleep apnea, etc. To summarize, this study predicts future research trends in elderly sleep through visual analysis and can provide valuable insight to help understand the research frontiers and hot spots in this field. At the same time, sleep research in older adults is highly exploratory and deserves further development.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.HL contributed to conceptualization, design, and supervision. HJ and WH collected data from the database. FL and ZD analyzed the data. HL and FL wrote the original draft. HL made critical revisions of the manuscript. All authors have read and agreed to the published version of the manuscript."}
{"text": "The assessment of the carrying capacity and suitability of spatial resources and the environment can provide effective guidance for regional planning and make vital contributions to the high-quality advancement of society and the economy. Additionally, this scientific evaluation of the spatial carrying capacity and suitability of urban production\u2013living\u2013ecological space (PLES) has important scientific value as well as practical significance for territorial spatial planning. This paper takes the cities along the Yellow River Basin (YRB) as the research object; establishes the PLES resource and environment carrying capacity evaluation index system; uses the multi-indicator superposition method and entropy weight method to evaluate the ecological importance, production and life carrying capacity of 78 cities in the YRB from 2010 to 2020; obtains the final ecological importance, production and life suitability levels based on the carrying capacity combined with the location conditions; and uses exploratory spatial data analysis (ESDA), the barrier degree model and other methods to determine the cities\u2019 spatial and temporal patterns and influencing factors. The findings indicate that: (1) Ecological importance is characterized by \u201chigh upstream and low downstream\u201d; the suitability for production is higher mainly in the eastern coastal area; the suitability of life as a whole is increasing, and the higher grade is in some provincial capitals and surrounding cities. (2) The local Moran\u2019s I all passed the test, and the relationship between PLES showed a significant positive spatial correlation. The clustering characteristics of ecological importance and production suitability are strong, while the clustering characteristics of suitability for living functions are relatively weak. (3) Biodiversity, significance of water conservation and significance of wind and grit control functions are the main barrier factors affecting the ecological importance of the YRB; industrial value-added output per unit of industrial land, number of industrial enterprises above the scale and GDP per capita are the dominant factors affecting the production suitability of the study area; total water-resource utilization per capita, total sewage treatment per capita and residential land area per capita are the main barrier factors of living suitability. The national land space is a valuable natural resource of the state and the nation, and is the spatial carrier for the nation to carry out production, living and ecological civilization construction. However, rural populations have generally declined in countries around the world, and the hollowing out of people first emerged with the urbanization and industrialization process of recent years. Over the past forty years or so, China\u2019s rate of urbanization has increased from 17.92% in 1978 to 64.72% in 2021, and the rapid development of urbanization and rapid industrialization has caused a strong squeeze on ecological space and agricultural production space [PLES was developed from agriculture\u2019s versatility, which was initially proposed in the Uruguay Round Agreement on Agriculture (URAA) , and acaPLES focuses on identification and classification, spatial conflict, and simulation and prediction. In terms of identification methods, the identification methods of PLES are mainly divided into the top-down indicator measurement method and the bottom-up land-use-type method, with the former evaluating the land use function by constructing an indicator system using the coupled coordination degree model , the entThe evaluation of PLES is a crucial foundation for improving the spatial development of national land , and it In summary, many researchers have researched the PLES from different perspectives and using different methods, which shows the diversification of research themes, rationalization of index construction and maturation of research methods, but there are still areas that need in-depth research. First, most of the studies on the evaluation of the PLES focus solely on the carrying-capacity evaluation of resources and the environment or the suitability of spatial resources and the environment; another key fact to remember is that there are few studies that combine the two. Second, most researchers adopt static evaluation in the process of evaluation, but resource and environment carrying capacity and suitability level are not constant, but experience dynamic change, and dynamic research is the inevitable way to scientifically recognize the evolution of a regional development pattern. Hence, this study takes the YRB as the study area, establishes a multilevel evaluation system based on the idea of PLES based on the traditional evaluation levels of ecology, agriculture and towns in the \u201cdouble evaluation\u201d system, and implements the relatively conceptualized concept of PLES into the \u201cdouble evaluation\u201d process through the screening of evaluation indices. From the perspective of PLES, examining the current situation of the spatial development of national land, analyzing its carrying function and the suitability of development, the concept of PLES is no longer a slogan but is actually reflected in the basic analysis of planning.The Yellow River is located at latitude 31\u00b031\u2032 N~43\u00b031\u2032 N, longitude 89\u00b019\u2032 E~119\u00b039\u2032 E. The YRB originates in China\u2019s Bayan Har Mountains of Qinghai Province, from west to east, flowing through Qinghai, Sichuan, Gansu, Ningxia, Inner Mongolia, Shaanxi, Shanxi, Henan, and Shandong, 9 provinces, and the Yellow River runs through the eastern, western and eastern regions of China. According to natural background conditions, the YRB is relatively rich in land resources, containing 15% of the country\u2019s arable land, but the largest contradiction in the YRB is water shortage, meaning that water resources cannot meet the demand. Although the Yellow River is the fifth longest river in the world, the amount of river runoff is only 2.2% of the national amount of river runoff. The population in the YRB and its downstream irrigation areas mean that 12% of the country\u2019s population use water from the Yellow River. Additionally, 67% of water resources have been developed and used in the YRB. This land for production and living is constrained by topography, water resources and other natural conditions. In terms of the social economy, the YRB\u2019s entire advancements lag behind those of other regions, and there are some problems in regional development that are not balanced; conflicts between environmental protection and economic development are more severe. Generally, the YRB is limited by poor resources and the environment and unreasonable ways of utilizing territorial space, resulting in many problems, such as a fragile ecological environment, a lack of water resources in local areas, and the urgent need to enhance the status of land development. The study area is shown in With reference to national regulations and existing academic research results, combined with the principles of regional specificity, data accessibility and index representativeness, this text used the model of single factor-integrated evaluation to evaluate the carrying capacity of resources and environment in ES, PS and LS around the elements of resources of the land as well as water, climate, natural disasters and socioeconomic factors. The current utilization level based on the shortcomings of the elements is constructed in this text, and the carrying capacity of the PLES is evaluated by measuring the carrying capacity for territory resources, water resources and nature. If development or construction activities in excess of the carrying capacity exceed the bottom line of resources and the environment, then the area is inevitably an unsuitable zone for production and life. The bottom-line restraint of resources and environment carrying capacity as suitability reflects \u201cbottom line thinking\u201d and the goal of forcing the transformation to high-quality development . TherefoThis study takes the YRB as an example, and selects evaluation indexes from soil and water, climate, environment, socio-economic and location conditions from production, life and ecological perspectives to investigate the ecological importance and the maximum scale of production and life, and to analyze and evaluate the importance of ecological protection, the suitability of agricultural production and the suitability of urban construction, respectively. The technical roadmap is as follows .ESDA is a more ideal data-driven analysis method. This method takes spatial correlation as the central concept and uses descriptions and illustrations of the spatial phenomena of objects to discover spatial anomalies and spatial clustering research objects intuitively to explore and study the interaction mechanism of spatial elements. ESDA analysis involves measurement and testing of global spatial autocorrelation and identification of local spatial association.(1)Global spatial autocorrelationGlobal spatial autocorrelation reflects the overall trend of the spatial correlation of observed variables in the whole study area, and the commonly used measurement index is global Moran\u2019s I, which is used to explain the whole spatial correlation of the suitability of the land use of PLES.In Equation (1), (2)Cold- and hot-spot analysis, In Equation (2), In this paper, the obstacle degree model is used to analyse the factors that hinder the suitability of PLES and is calculated from the factor contribution \u201d issued by the Ministry of Natural Resources of China in June 2019 and January 2020 and related research ,37,38. FThe spatial classification of the YRB is based on land use types, with vector data on administrative regions, DEM, NPP (net primary productivity), NDVI , population density, spatial distribution of terrestrial ecosystem types and land use data. The data were collected from the Data Centre for Resource and Environmental Sciences of the Chinese Academy of Sciences. Meteorological data were collected from the National Center for Environmental Information (NCEI) of the National Oceanic and Atmospheric Administration (NOAA) and soil texture-type data from the Harmonized World Soil Database (HWSD). Economic and social statistics are collected from the China Urban Statistical Yearbook 2010\u20132020 and the National Economic and Social Development Bulletin of each municipality, of which water resources data are taken from the water resources bulletin of each province and municipality.Data were processed based on ArcGIS 10.2 software, and the higher level of the significance of ecosystem service function and sensitivity of ecology was taken as the initial result of the ecological protection importance ranking. According to the criteria of the \u201cTechnical Guide for Carrying Capacity Evaluation of Resources and Environment and for Suitability of Territorial Area Development\u201d, the importance of ecological protection will be divided into three parts: the importance of the general level, the importance of the higher level, and the importance of the highest level, and the spatial and temporal patterns of ecological-protection importance levels will be mapped for 2010, 2015 and 2020 .First, ecological patch concentration can portray the scale and spatial differentiation of ecological service functions and ecologically sensitive areas , so the In 2010, the level of ecological importance protection was very high, accounting for 57.75% of the entire region of the study area. The most ecologically crucial places were located in Tianshui, Baoji, Hanzhong, Ankang, Shangluo, Nanyang, Zhumadian, Xinyang, Zhoukou, Shangqiu, Qingdao, Weihai, Yantai and Ulanqab. The areas of high ecological-protection importance were mainly distributed in Bayannur, Ordos, Wuzhong, Yulin, Xinzhou, Anyang, Puyang, Dezhou, Jinan, Binzhou and Dongying. General important areas were mainly distributed in Bayannur, Ordos and Hohhot, but there were generally important areas scattered in a large number of cities. The ecological importance level was 3.28% of the entire region of the study area.In 2015, highly ranked locations were scattered throughout the eastern and western halves of the research area, accounting for 55.74% of the entire region. The cities in the middle reaches of the YRB and cities such as Baoyannur, Baotou, and Ulanqab had an obvious decreasing trend. The generally important areas were scattered primarily in the north and northeast, the proportion reached 40.71%, and the overall trend gradually increased from northwest to southeast. The generally graded areas were mainly scattered in the north. Compared with 2010, there are fewer areas of this class scattered across cities. Many cities have reached the level of high ecological importance and above in all parts of the city, and the area of this level accounts for 3.55% of the entire study area.In 2020, the areas of the ecological importance protection of the highest level were significantly reduced, and they were intensively concentrated in the southeast of the study area, accounting for 47.75% of the total area; important protected areas were mainly concentrated in the Inner Mongolia Plateau and scattered in Jining, Dezhou, Binzhou and other cities, accounting for 46.94% of the study area; areas with an importance of higher levels were mainly concentrated in Ordos, Yulin, Bayannaoer and other cities, accounting for 5.31% of the area. Overall, it shows a trend of increasing grade from the northwest to southeast of the YRB, and the extremely important protected areas appeared to agglomerate.(1)Evaluation of production capacityAccording to the entropy method, the production-carrying-capacity index of each city was calculated. Using ArcGIS 10.2 software, Natural Breaks  was used to divide it into Parts I, II, III, IV, and V, from low to high. The higher the level is, the higher the carrying capacity. For the higher level, the temporal and spatial pattern of production carrying capacity of prefecture-level cities in 2010, 2015, and 2020 was drawn .The figure demonstrates that in 2010, the top-level and upper-middle-level urban production-carrying-capacity areas were mostly concentrated in the lower reaches of the YRB. The top-level production-carrying-capacity areas mainly included Ordos, Yulin, Yanan, Zhengzhou, Jining, Dezhou, Linyi, Weifang, Qingdao, and Yantai; the upper-middle-level areas mainly included Baotou, Luliang, Linfen, Pingdingshan, Zhoukou, Liaocheng, Jinan, Liaocheng, Tai\u2019an, Dongying, and Zaozhuang; the intermediate-level production-carrying-capacity areas mainly included Baoyannur, Ulanqab, Hohhot, Taiyuan, Xi\u2019an, Luoyang, Jiaozuo, Xinxiang, Kaifeng, Shangqiu, and Anyang; the lower production-carrying-capacity and lowest-level areas were primarily found in the northeast and southwest of China, where the research region is located; and the lower and lowest-level cities included Xining, Lanzhou, Baiyin, Guyuan, Xinzhou, and Datong. The overall level showed a gradual upwards trend from west to east.In 2015, the upper middle level and top level areas were concentrated in the north-eastern and southern regions of the entire study region, accounting for 38.67% of the area. Top-level cities included Ordos, Shangqiu and Qingdao, the proportion of which was significantly reduced, the upper middle level areas showed expansion, and the urban carrying-capacity level of the lower YRB decreased significantly; the intermediate level was mainly distributed in the northeast, the Central Plains, and the northwest, and, compared with 2010, it showed an expansion trend; the places at the lower and lowest levels were mostly distributed in the upper YRB. The lower level urban areas gradually moved to the north, and the number of lower level urban areas was decreasing.In 2020, the top-level and upper-middle-level areas accounted for 29.39%, and the area proportion decreased significantly. The top-level areas were mainly localized in Ordos, Yulin, and Shangqiu. The distribution of upper-middle-level areas was scattered and decreased; the south-eastern part of the study region was mostly where the intermediate level area was located. Around the middle reaches and downstream of the YRB showed a decreasing trend. The lower and lowest-level areas spread when compared to 2015, and the lower and lowest-level areas expanded. The carrying capacity of urban areas in the YRB\u2019s lower reaches is significantly weakened.(2)Production suitability evaluationThe suitability of production reflects the degree of the suitability of productive activities in territorial space. The evaluation results are divided into grades I, II, and III. The higher the grade is, the higher the suitability.Alternative areas for different levels of suitability were determined according to the level of carrying capacity: an area suitable for the distribution of production space should first have comprehensive resources and environmental conditions for carrying production activities; the higher the carrying capacity of the environmental foundation and the lower the limitation of disaster risk, the higher the suitability of production. According to the production-carrying-capacity grade, the production suitable area and general suitable area of the alternative area were determined. Ensuring that the level of hazard is sufficient to meet basic production needs, areas suitable for the distribution of production space should have a certain level of flatness, and the greater the relief is, the greater the hazard; therefore, the relief was chosen as the correction factor, and the evaluation result is shown in In 2010, the grade-III-production-suitable regions of the study area were concentrated in several cities in the eastern, central, and northern parts, mainly showing agglomeration distribution, accounting for 28.68% of the area. The second-level-production-suitable areas were mainly found in the central and northern regions, showing that the area around the cities of Ordos, Yulin and Yanan accounts for 62.3%. The majority of cities with Grade-I-acceptable areas are located in the western and northern regions, accounting for 11.02% of the area.In 2015, the level-III-production-suitable area included Ordos in the central and northern parts and expanded to the southwest in the south, including Zhengzhou, Kaifeng, Heze, Jinan, Qingdao, Weihai and other cities. The distribution of the level-II-suitable-production areas expanded, and its area proportion was 68.04%. The area expansion was mainly due to the lower suitability grades of Yulin and Yanan and the higher suitability grades of Datong and Weinan. The level-I-suitable areas decreased, and their area accounted for 7.36%, including the cities of Dingxi, Baiyin, Guyuan, and Pingliang.In 2020, the areas suitable for level-III production decreased in the central and southern regions and expanded in the northern regions, accounting for 19.74%. The areas suitable for level-II production expanded to the southeast, while the level of suitability decreased in the south-eastern regions. The areas suitable for level-I production expanded, and the proportion was 11.78%, with some cities, including Datong and Tongchuan, downgrading their suitability for production .(1)Evaluation of living carrying capacityIn 2010, the areas with higher living capacity levels and above were scattered, among which the level-V-carrying-capacity areas included Hanzhong, Ankang, Zhengzhou and Zhoukou, accounting for 5.80%. The level-IV-carrying-capacity cities included Baotou, Erdos, Wuhai, Shizuishan, Yinchuan, Xianyang, Shangluo, Jinan, Dongying, Qingdao, and Yantai, and the area accounted for 19.11%. The concentrated distribution area of level-III living capacity was mainly in the southeast and western Central Plains, including Ulanqab, Hohhot, Yulin, Xining, Xian, Baoji, Tongchuan, Nanyang, Luoyang, Jining, Weifang, Rizhao and other cities, accounting for 29.18%. The lower living capacity and lowest regions were mainly found in the west and around the Central Plains, showing a rise from west to east, including Lanzhou, Baiyin, Zhongwei, Linfen, Jincheng, Anyang, Puyang, Liaocheng, Dezhou, Binzhou and other cities.In 2015, the level-V-capacity-region distribution was scattered, including Yinchuan, Xianyang, Zhengzhou, Zhoukou, and Ulanqab. The level-IV-carrying-capacity area expanded, including Ordos, Wuhai, Ankang, Yantai and other cities. Compared with 2010, the area of level-III living capacity was significantly reduced, accounting for 26.71%. The carrying-capacity zones of level I and level II were mainly found in the western and central plains regions, with the expansion of the lower level area and a reduction in the lowest level area.In 2020, most regions were found in the west and around the Central Plains, with level-V carrying capacity increasing significantly, accounting for 25.75%, and the southwest and east regions included Bayannur, Ordos, Yinchuan, Hanzhong, Ankang, Xianyang, Zhengzhou, Zhoukou, Jinan, Qingdao and Yantai. The level-IV carrying capacity decreased, and was mainly distributed in some cities in Shandong Province. The cities with level-III carrying capacity were further reduced, and the eastern and northern regions are where they are most prevalent. The carrying capacity of level I and level II is reduced. The carrying capacity of level I is not significantly different to that of 2015, while the carrying capacity of grade II is reduced in the southwest .(2)Life suitability evaluationThe evaluation results of living suitability were classified into three main categories: suitable area, general suitable area and unsuitable area .The degree of transportation convenience has a great influence on life suitability, which mainly represents the support and guarantee ability of road transportation facilities for life activities. Therefore, combined with data representativeness and availability, the highway mileage data of 2010, 2015 and 2020 were selected to represent the degree of transportation convenience. The larger the urban highway mileage data are, the higher the degree of transportation convenience.In 2010, the distribution of level-III suitable areas was relatively scattered, including Erdos, Xianyang, Hanzhong, Ankang, Zhengzhou, Zhoukou, Qingdao and Yantai, occupying 23.08% of the research area. The middle and lower parts of the YRB, as well as the northern section, are where most of the level-II-appropriate regions are located, including Hohhot, Baotou, Taiyuan, Xian, Luliang, Linfen, Luoyang, Xinxiang, Heze, Jinan and other cities, accounting for 59.60% of the total area. The level-I-suitable areas are concentrated in the west and scattered in the central and eastern regions, including Xining, Lanzhou, Baiyin, Qingyang, Yanan, Xinzhou, Changzhi, Puyang, Shangqiu, Zibo and other cities, accounting for 23.08%.In 2015, the spatial pattern did not change significantly. The level-III-suitability area increased, and the level of suitability in Ulanqab increased from level-II suitability in 2010 to level-III suitability. The suitable area for level II showed a decreasing trend, accounting for 58.80% of the area. The suitable area of level I shrank to the west as a whole, accounting for 18.24%.In 2020, the level-III-suitability areas were further expanded, with a westward expansion in the Shandong Peninsula urban agglomeration, accounting for 29.16%. The suitable area for level II was further reduced, accounting for 52.60%. The spatial pattern of the level-I-appropriate area remained unchanged.The exploratory spatial data analysis method was used to measure the spatial agglomeration degree of PLES functions with ArcGIS 10.2. The findings revealed that the Moran\u2019s I of ecological function importance was 0.2321, 0.2682 and 0.2042 in 2010, 2015 and 2020, respectively. The Moran\u2019s I of production function suitability was 0.2824, 0.4411 and 0.2824 in 2010, 2015 and 2020, respectively. The ely weak .Due to the possible defects of global autocorrelation in terms of local instability, the Gi* index of urban functional suitability in the YRB was further divided into four types of areas, specifically including hot spots, second hot spots, cold spots, and second cold spots, using the natural breakpoint method through local spatial autocorrelation analysis . The hotThe obstacle degree model was utilized to identify some contributing aspects that influence the suitability of PLES in the YRB territorial space. The calculation results of the obstacle degree of a single indicator of regional ecological importance are shown in In 2010, the average obstacle degrees of biodiversity, significance of water-source conservation, and significance of windbreaks and sand fixation were 26.28%, 20.83% and 14.29%, respectively. In 2015, the average obstacle degrees were 26.53%, 25.01% and 14.31%, respectively. The average obstacle degree in 2020 was 25.84%, 20.29% and 13.94%, respectively, showing a rough trend of decreasing obstacle degree. The obstacle degree of land-desertification sensitivity was 7.82% in 2010, 8.01% in 2015 and 8.2% in 2020, showing a trend of a gradual increase. In the context of global efforts to promote biodiversity conservation, China has achieved remarkable results after decades of efforts. Chinese efforts to protect the environment and the ecological system have improved collaboration, strengthened the protection of grassland and wetland areas in water-conservation ecological function zones, and promoted the improvement of ecological and environmental quality of the YRB. The YRB\u2019s biological surroundings have shown remarkable improvement, but they still face some problems at present. Since 2010, China\u2019s weather and climate have been unusual: precipitation has increased; high temperatures, drought and waterlogging disasters have been connected; cold and hot space and time alternations have been obvious; extreme weather and climate events have occurred; and heavy rainfall has resulted in multiple river-basin floods and frequent geological disasters. Thus, the land-desertification problem in the YRB continues to be serious.The obstacle factors of PLES suitability of each city in the study area in 2010, 2015 and 2020 were calculated using Equations (3) and (4), and the top three obstacle factors were listed, as shown in Among the primary impediment factors affecting the production suitability of cities along the YRB, the frequency of the output of industrial added value per unit of industrial land showed a decreasing trend . The urbanization rate  and the output value of secondary and tertiary industries per unit of construction land  are gradually increasing. The pattern of economic development has also changed from extensive, low-quality and high-quantity to concentrate on the quality of development, continuous improvement of the economic structure, and fast growth of tertiary and secondary industries. The urbanization rate is conducive to guiding the flow of production components that are two-way, such as land, capital and labour, producing an agglomeration scale effect and resource-allocation wealth effect, and then promoting the transformation, development, enhancement and improvement of production capacity, industrial structure and employment structure, which can effectively improve the suitability of production.Through the analysis of occurrence frequency and average obstacle degree, it is discovered that the most typical barrier factors affecting living suitability mainly include total water use per capita , total sewage treatment per capita , and per-capita residential land area . First, the outstanding total water-resource utilization per capita is a barrier factor because the index levels of Xian, Jinan, Qingdao, Zhengzhou, and Yinchuan are significantly better than those of other cities. These cities have a higher level of economic development and need more water resources than other cities. With the expansion of ecological civilization construction, the urban demand for sewage treatment is increasing daily. Especially given the swift economic growth, the increase in sewage-treatment volume can satisfy urban inhabitants\u2019 needs for a green lifestyle. The appearance of per-capita residential land area highlights that the cities along the YRB have a comparatively modest level of urbanization. Shandong and Henan, as provinces with large populations, still need to solve the outstanding problem of the man\u2013land contradiction.The interannual variation in the main obstacle variables was considered, and almost all the top three major obstacle variables of urban living suitability along the YRB in 2010 included the total water use per capita, total sewage treatment per capita, and per-capita residential land area. By 2020, the main barriers remained the same across cities. However, the frequency of total water use per capita and the total amount of sewage treatment per capita decreased, while the frequency of the number of medical practitioners per 1000 population increased rapidly. The country strengthened the conceptualisation of a water-saving and anti-pollution society, which strengthened the Chinese people\u2019s understanding of water conservation and reduces water pollution. However, improving the quality of medical treatment is the main means to maintain the health of all people. The society\u2019s requirement for life is not only to have enough food and clothing but also to seek a high-quality and healthy lifestyle.The ecological importance level of cities along the YRB has increased overall from 2010 to 2015 and established more obvious zoning in geographic space in 2020, mainly because China\u2019s biodiversity conservation work is effective. However, because the YRB spans a large area, there are large differences in resources and the environment, resulting in the formation of obvious zones of ecological importance; from 2010 to 2020, the cities with higher production suitability are mainly distributed in the downstream, mainly because the Guanzhong-Tianshui region, the Hubao-Egyu region, the Lanzhou-Xining region, and the Central Plains Economic Zone have certain scientific and technological innovation capacities and industrial development potential. The optimized development zones, mainly in the Jiaodong Peninsula, the Yellow River Delta region and the provincial central cities in the basin, have strong comprehensive strength and high production suitability; the suitability of life as a whole continually improved from 2010 to 2020, and the higher suitability level is for some provincial capitals and their surrounding cities. The main reason is that these cities are at a higher level than other cities in terms of transportation and economy, and their infrastructure is relatively complete, which greatly improves the suitability for living.In this paper, the technical framework of PLES delineation in the carrying-capacity evaluation of resources and the environment and suitability evaluation of the spatial planning of the YRB was constructed using precise and simple evaluation indexes and quantitative and modelling evaluation methods. The method has the following advantages: (1) In the evaluation method, the traditional method of the carrying-capacity evaluation of resources and environment and suitability evaluation is optimized and quantitative models such as the entropy weight method are introduced to carry out the comprehensive evaluation of multiple elements, which makes the evaluation results more scientific. (2) In the traditional carrying-capacity evaluation of resources and the environment and the suitability evaluation system of ecology, agriculture and towns, a multi-level evaluation system based on the concept of PLE is established, and the relatively defined concept of PLE is implemented into this process through the screening of evaluation indexes. (3) In terms of evaluation indicators, the number of socio-economic indicators are increased, this improves the authenticity and scientificity of evaluation results, and plays a better supporting role in serving the preparation of territorial spatial planning. Limitations are, mainly: (1) the model evaluation method is relatively accurate, but the data processing and quality requirements are high due to the vector or raster data of soil and water resources, environment, temperature and rainfall included in the indicators measuring ecological importance. (2) Some data are not easy to obtain and the accuracy of the data is not high, which makes the evaluation results of average accuracy, and we will try to obtain more accurate data in the future.(1) From 2010 to 2015, overall, the ecological importance of the cities along the YRB rose, but the magnitude was small. In 2020, cities near the YRB experienced a significant change in their ecological importance level, forming a relatively obvious partition in geographical space. From 2010 to 2020, most cities with higher production suitability were spread downstream, and the maximum number of cities with higher production suitability were present in 2015. From 2010 to 2020, the overall living suitability continued to improve, and the higher level of suitability was in some provincial capitals and surrounding cities. (2) Positive spatial autocorrelation of PLES. The agglomeration characteristics of ecological importance and production suitability are strong, while the agglomeration characteristics of life-function suitability are relatively weak. The distribution areas of cold hot spots of the PLES function overlap in space, to some extent. Most of the cold spots are located in the YRB\u2019s higher reaches, and most of the hot spots or second hot spots were spread in the middle and lower reaches in the YRB. (3) From 2010 to 2020, biodiversity, water conservation and windbreak and sand fixation were the primary impediments to the ecological relevance of the YRB. The output of industrial added value per unit of industrial land, the number of industrial enterprises and GDP per capita were the dominant factors affecting the production suitability of the study area. Among the top three major obstacles to urban-living suitability along the YRB, almost all cities experience the per-capita total water-resource utilization, total sewage treatment per capita, and per-capita residential land area. However, the first three barriers are becoming increasingly less obstructive. Based on the above findings, the following recommendations are made:(1) By defining key functional domains, the balanced growth of various functions can be achieved. With the basic idea of ecological civilization running through the whole process, all departments, provinces, and autonomous areas in the YRB must break through administrative restrictions, plan spatial distribution from a strategic level, optimize spatial structure, and achieve spatial balance.According to the different regional features of the different watershed segments, the protection of the main flow corridors and migration channels should be coordinated in all regions. National parks will be established in the Yellow River Delta and other priority areas for biodiversity conservation. In the YRB\u2019s middle and lower reaches, new nature reserves, ecological protection red lines or protected areas will be established, and the connectivity of existing nature reserves will be strengthened.To implement water-source protection using watersheds, the upstream should closely follow the functional orientation of water conservation and strictly follow the principles of sustainability and efficiency to increase water-resource efficiency. Water and soil conservation should be placed in a prominent position in the middle reaches, and high-energy and high-pollution enterprises should be eliminated. Downstream the river ecosystem\u2019s healthy and green development should be enhanced and the sensitivity of the ecological environment reduced.Major projects should be implemented concerning important-ecosystem protection and restoration, establishing ecological space layouts, matching production and living constantly to improve the quality of sandy plantations. Continuing the implementation of major projects, these should focus on regional ecological protection and restoration, accelerating land desertification, salinization, and vegetation restoration in mining management, and strive to build a new development pattern for combating desertification.(2) Upstream key ecological-function areas and main agricultural product-producing areas should focus on environmental protection, develop an ecological economy and industries that can be sustained by resources and the environment according to local conditions, and should link their own characteristics and advantages with the overall industrial layout of the watershed according to the layout of the main functional areas upstream, thus improving the level of upstream production suitability.In view of the different stages of economic development, differentiated development strategies should be adopted. Industrialization in the eastern coastal area started early, and most cities are at an intermediate and advanced degree of industrialization. However, the central and western regions have been responsible for the country\u2019s main agricultural production, and the industrial base is weak. Therefore, we should pay attention to the interaction between regions, promote the coordinated development between regions, and stimulate positive spatial interaction. According to the original industrial characteristics and their own resource advantages, each region should reasonably plan its industrial layout to form a reasonable division of labour and specialization among regions and to form an industrial cooperation mechanism among regions. The eastern region has a relatively higher suitability level and can provide more funds for the central and western regions, advanced technology and high-level talented people. The central and western regions are rich in resources and can deliver more clean energy to the eastern region. The overall suitability level of the YRB will be improved under the joint action of the west and east regions. This should actively guide the reasonable distribution of the population in cities and surrounding areas and actively develop industries in surrounding areas to promote industrial transfer in core areas.The whole area should promote the transformation of the original resource-based industry into the direction of being fine, high-end and clustered, and promote the integration of manufacturing and service industries; large enterprises should be encouraged as the leaders of industrial development, the direction of industrial development should be clarified, and a scale industrial system formed with small- and medium-sized businesses; To strengthen the planning of the clustering of SMEs in the industrial sector, an industrial cluster system should be formed with a reasonable layout, industrial coordination, complete categories and international competitive advantages.(3) The distribution and control of water resources in the upper reaches of the YRB, where there are few water resources, should be performed in accordance with the overall interests of the basin. The overall notion of \u201creducing agricultural water use, saving water for life, improving ecological water use and ensuring industrial water use\u201d should be adhered to and the limited and scarce water resources exploited. In the middle and lower sections of the YRB, where there are plenty of water resources, within an appropriate range of the resource and ecosystem carrying capacity, water resources should be produced and used. The development philosophy of determining city, land, people and production should be adhered to using water, by refining the total water-use control index in the basin, by improving the water-resources control index system of YRB, and promoting the pattern of allocating water resources. This will continuously strengthen the control of the minimum flow required to maintain the river ecology and environment and implement the unified water-resources management of the main and tributaries of the YRB. To carry out pollution prevention and control, water conservation and control should be comprehensively implemented.In the future, the government should prioritize raising the standard of cheap homes, to achieve a balance between employment and housing, and achieve the goal of \u201clittle but comfortable\u201d to ensure the security, peace and comfort of inhabitants. Although the number of medical practitioners per 1,000 population in China is on the rise, there are obvious regional differences. Therefore, to reduce geographical variations in the availability of medical professionals, attention should be paid to the allocation of doctors in remote areas and to improving medical services in remote areas and mountain villages. In recent years, the demand gap of doctors in certain places has been eased to some extent, but it is a long way from the intended goal, which makes it challenging to meet the need, and the supply\u2013demand disparity will continue for a very long time. In the future, it is necessary to implement the Opinions, strengthen the education of general-practice personnel, and actually succeed in the aim of \u201cfull coverage, filling up the weak points, improving the level and ensuring the quality\u201d."}
{"text": "Emergency information release during public health emergencies is a governance measure to slow down the spread of the epidemic and guide the public in scientific protection. Because of the uncertainty and life-cycle characteristics of public health emergencies, emergency information release represents the process of time dynamics. At present, it is an inevitable trend to establish a collaborative mechanism for emergency information release of public health emergencies to improve the release efficiency and respond to public demand. To determine time evolution characteristics of organizational collaboration in emergency information release, this study took the response to COVID-19 from the central government of China as an example and conducted research based on social network analysis. Based on information from COVID-19-related press conferences held by China's central government, the emergency information release collaborative networks (EIRCNs), and Emergency Organizations-Emergency Information Release Matters (EOs-EIRMs) 2-mode network were constructed. With the time evolution, the tightness, convergence, stability, and connectivity of EIRCNs in public health emergencies presented the process of lowering and then raising. At different stages, the core emergency organization (EO) nodes in EIRCNs continued to maintain a certain degree of activity. Their dynamic processes showed the characteristics of diversification rather than homogeneity. The time evolution of emergency information release matters (EIRMs) reflected the dynamic adjustment of the government's prevention and control measures and responded to the diversification of the public's understanding and protection needs during different stages of the COVID-19 pandemic. The study further examined the driving factors and implementation mechanism of the time evolution characteristics of the collaborative mode of emergency information release. The implementation of EIRMs at different stages had different resource requirements, which were usually achieved by introducing new EOs (Adding resource increment) or increasing the collaborative frequencies among EOs (Activating resource stock). In addition, further research prospects and feasibility interpretation were proposed. The COVID-19 pandemic is the most extensive pandemic afflicting humanity in a century, which is a typical public health emergency , 3. PublDue to the coupling and evolution of the social environment and risk types, the emergency management of public health emergencies also presents complexity and systematicness , 10. CorAt the present stage, to clearly explain and describe the interaction among various functional organizations in emergency management, the study of emergency management networks has been widely concerned by the academic community . NetworkThe remainder of this study is organized as follows: Section Literature review discusses and summarizes the existing studies on emergency information release and emergency management networks and puts forward the feasibility and necessity of this study. Section Methodology and data introduces the research framework and introduces the data source, the proposed analysis method, and key indicators. Section Results presents the main analysis results of this study, including the stage characteristics of the structures of EIRCNs, the attribute characteristics of EO nodes, and the affiliation relations between EOs and EIRMs. In Section Discussion, time evolution characteristics of the collaborative mode of emergency information release are summarized from a system perspective, and influencing factors of network evolution are further interpreted. Section Conclusions and recommendations summarizes the conclusions, contributions, and limitations of the study, as well as discusses the research implications.As its main aim is to support disaster emergency response, maintain social and public stability, and mitigate the loss of disasters, emergency information release has always been a vital issue in academic and governance practice. Meanwhile, with the rapid development of mobile communication, internet, social media, and other emerging media , 18, socEmergency information can be divided into data information about emergencies, emergency response measures taken by the government and relevant departments, emergency protection measures taken by the public, and public service information related to emergencies . The emeResearch on emergency information release belongs to the interdisciplinary research content, involving journalism and communication science, management science, and security science. In the research of emergency information release strategy, existing studies have discussed the effect of implementing emergency information release relying on different release channels and media types, such as press conferences, social media, and information release platforms. It is also essential to pay attention to the difference between the subject and object of emergency information release and consider the particularity of public behavior, such as public response and public adaptability. The mechanism of emergency information release is the core foundation to support the implementation of emergency information release. In the research of emergency information release mechanisms, relevant research is usually conducted from the practical and theoretical levels. On the one hand, the characteristics and practical problems of the current mechanism are discussed and summarized around the system design and policy arrangement of emergency information release. On the other hand, the theoretical frameworks of emergency information release mechanisms are designed based on governance theory, integral government theory, and collaborative theory. There are also studies on the mechanism of emergency information release in different types of emergencies and levels of government departments.To more specifically identify the types and scale of organizations involved in emergency management and explain the interaction relationships of EOs during emergency response, scholars have published several theoretical and case study results about the emergency management network , 27. A nFor the types of research objects, the research of emergency management networks can be divided and summarized according to the types of emergencies, such as earthquakes, floods, hurricanes, forest fires, explosion accidents, public health emergencies, and terrorist attacks. Du et al.  analyzedFor the construction methods of network construction, the academic circles primarily use texts of emergency response plans, actual case reports, and policy texts as data sources to identify types of organizations participating in emergency management. They construct interaction relationships between emergency response organizations to analyze constructing emergency management networks. By analyzing the interaction between EOs, the emergency management network can be constructed. Fan et al.  took govFor the research design, the network structure and node attributes have always been critical analysis perspectives of the emergency management network. Among them, network structure characteristics can effectively reflect the scale of cooperation and evaluate the cooperation performance of EOs , 35, wheIn addition, based on life cycle characteristics of emergency management, the emergency management network shows certain differences in different stages, which are regarded as the dynamic characteristics of the network . On the Emergency collaboration is essential to improve the performance of emergency management . As a viFighting COVID-19 China in Action White Paper and divided the collaboration process of emergency information release of COVID-19 into five stages  Network density refers to the ratio of the number of connections between nodes in the network to the maximum number of connections. The more the connections between nodes, the higher is the network density in the same network scale. When the number of links among nodes is consistent, increasing the network scale will lead to a decrease in network density. For EIRCNs, the higher the network density was, the closer were the collaborative relationships between EOs. In contrast, when the network density is lower, the connections among EOs are less and the network structure is closer.(2) By combing the data of collaborative relationships among EOs obtained in this study, the collaborative relationships between EOs were affected by association frequency. Therefore, EIRCNs were the multi-valued network. The previous concept of network density could not consider the scale of communication and the actual frequencies of connections. The concepts of collaborative depth and relative network density were introduced to further identify the actual connection strength and tightness among EOs in the network. The collaborative depth is defined as the ratio of the actual collaborative frequencies and the number of connections among nodes. Relative network density is defined as the ratio of the actual collaborative frequencies and the maximum number of network connections. In other words, the value of relative network density is equal to the network density multiplied by the collaborative depth.(3) Network centralization is the measure to verify whether there are core nodes in the network, which can measure the clustering trend of EIRCNs to one or more core EO nodes. In this study, degree centralization was chosen as the representative for analysis, which was equal in value to the ratio of the total of the actual difference and the total of the maximum difference of the network node degree centrality. When EIRCNs have high network centralization, the network structure generally has core-periphery characteristics. In contrast, when the network centralization of EIRCNs is low, there is no obvious core EO node, and the network structure shows balanced characteristics on the whole.(4) Network cohesion could describe the dependence of the overall network on core nodes and the balance of network structure. When the network cohesion of EIRCN was low, there was inequality among EOs in the network. The network stability was poor and tended to the dispatching structure. Meanwhile, the power and information of the whole network were relatively concentrated. In contrast, when the network cohesion of EIRCN was high, the network had a uniform structure and was not affected by individual nodes. Resources and information in EIRCN were relatively scattered.(5) Average path length refers to the average associated distance among the EOs in EIRCN, which can express the strength of network connectivity. When the average path length of EIRCN is higher, the communication distance among EOs in the network is longer and the cost of resource transmission is higher. In contrast, when the average path length of EIRCN is lower, the connectivity of the overall network is better. The communication among EOs are not easily affected by other factors, and the costs of forming cooperative relationship are low.Node attribute analysis was used to describe the role of EOs in EIRCNs. In this study, degree centrality, betweenness centrality, closeness centrality, and eigenvector centrality were selected to analyze EO nodes in different stages. The study intuitively and quantitatively expressed the position and measured the importance of EOs in EIRCNs in terms of numerical size and ranking. When the network scale is different, the centrality in various graphs is not comparable. Therefore, this study took normalized centrality as the analysis index.Degree centrality refers to the number of other nodes directly connected to the EO node. In a directed network, degree centrality can be divided into in-degree and out-degree centrality. When the degree centrality of the EO node is larger, it indicates that the node is in the center of the EIRCN and has more network power.Betweenness centrality is a measure of the extent to which the EO node is located in the middle of other pairs of nodes. Betweenness centrality can express the control of the EO node on the network resources and the interaction among nodes in EIRCN. When the betweenness centrality of the EO node is higher, it indicates that the EO is on more geodesic pairs of nodes and has mastered the transmission mode of information and resources of EIRCN.Closeness centrality is the indicator to measure to what extent the EO node is free from the control of other nodes. Closeness centrality is the reciprocal of the average distance between the EO node and all other nodes in the EIRCN. Numerically, when the closeness centrality of the EO node is smaller, it indicates that the node is not the core point of EIRCN. When the closeness centrality of EO node is larger, the node is stronger regarding information resources, power, prestige, and influence.Eigenvector centrality measures the importance of the EO node by comparing the centrality of adjacent nodes. When the EO node has neighboring nodes with strong influence, the eigenvector centrality of the EO node is larger. The eigenvector centrality focuses on the analysis of connection quality rather than the connection quantity of the EO node. The EO node with a larger eigenvector centrality has a higher potential value.To analyze time evolution characteristics of network structure, the EIRCNs of Stage II-Stage V were plotted in sequence see . Table 3From the perspective of basic network attributes, the EIRCNs of Stages II to V contained 31, 55, 45, and 63 EO nodes, respectively. Meanwhile, links between EO nodes in EIRCNs were 101, 167, 132, and 223 in sequence. Accordingly, the network densities of the EIRCNs of Stages II to V were 21.72%, 11.25%, 13.33%, and 11.42%, respectively. From the perspective of the actual collaborative frequencies, 175, 210, 226, and 502 pairs of collaborative relationships were formed among the EOs in Stages II to V, respectively. Correspondingly, both the relative network density and the collaborative depth tended to decline and then rise. This was because in the early stages of the COVID-19 pandemic prevention and control, EOs needed to make immediate emergency response measures to contain the development of the epidemic. Furthermore, because of the lack of familiarity with the characteristics of COVID-19, various EOs often participated in the emergency information release together, forming relatively intensive relationships. Therefore, EIRCN had the highest relative network density (37.63%) at Stage II. When entering Stage III, the number of EOs implementing emergency information release increased, and the network scale of EIRCN expanded rapidly. This reduced the relative network density and collaborative depth of EIRCN to a certain extent but also provided climbing space for developing collaboration between EOs in EIRCN. In Stages IV and V, the relative network density and collaborative depth of EIRCN rebounded as the function division of EOs became clearer and the communication between EOs became closer. The EIRCN of Stage V had the closest connection among EOs and the largest collaborative depth (2.251).From Stage IV to V, the network centralization of the EIRCN increased gradually. Network morphology tended to have a star structure. In the early stage of COVID-19 prevention and control, the distribution of emergency information released by EOs was not clear, and the core nodes of the EIRCN were not exact. With the advance in COVID-19 prevention and control, the types and locations of core nodes in EIRCN became gradually clear, and the network as a whole had a more significant clustering trend toward core nodes. In Stage V, EIRCN had the largest network centralization, which was 91.49%. There was little difference in network cohesion at different stages, indicating that the EIRCN structure and resource allocation tended to be stable. Specifically, network cohesion decreased slightly after the transition from Stage II to III, which was related to the increase in the types and number of EOs. However, over time, the network cohesion of the EIRCN returned to a more balanced state. Contrary to the trend of relative network density and collaborative depth, the average path length of EIRCN showed the evolution path of ascending and then descending. In Stage III, the average path length of EIRCN was the largest (2.013). This indicated that with more EOs, the communication distance and the coordination costs in EIRCN increased. Furthermore, the collaborative efficiency of EOs recovered significantly in Stages IV and V.To sum up, with the increasing tasks for COVID-19 prevention and control, the need for EIRCN for emergency resources also deepened. The network size and the collaborative frequencies of EIRCNs showed an increasing trend. Correspondingly, EIRCN had lower relative network density, collaborative depth, network cohesion, and higher average path length at Stage III. However, with the time evolution, the division of functions was gradually clarified, and the collaborative relationships were deepened. As a result, the network tightness, convergence, stability, and connectivity of EIRCNs gradually enhanced.In Stage II, EO nodes with a high degree of centrality mainly included epidemic prevention and control departments , news and publicity department (SCIO), transportation departments , and policy support departments . In the face of the urgency and uncertainty of the COVID-19 pandemic, the priority of the emergency tasks in the early stage of epidemic prevention and control was stability. Consequently, the types of core EO nodes in EIRCN were relatively concentrated. In Stage III, NHC, SCIO, and MT were still the top 3 EO nodes with degree centrality. Meanwhile, market management and financial service departments , science technology and medical material departments , and public safety department (MPS) became the core organizations in this stage because of the needs of businesses returning to work, vaccine research and development, and social order maintenance. In Stage IV, the epidemic situation in China was under control. In contrast, the pandemic abroad spread rapidly, and, accordingly, the customs, immigration management departments , and civil aviation transportation departments  had a high degree of centrality. The Chinese government promoted the resumption of work and production to improve the speed and expand the scope. The functional departments such as commerce, finance, and development  were at the core of the network. In Stage V, the prevention and control of key time points and critical locations became a vital issue of concern to the government. Therefore, the tourism departments (MCT), education departments (ME), and transportation departments  were closer to the core of the network. SRGJRCM conducted multiple reports on COVID-19 vaccine research and public vaccination, which had a high degree of centrality.Among EIRCNs at different stages, the top 10 EO nodes with normalized betweenness centrality are shown in In Stage II, NHC, SCIO, and MT were the top 3 EO nodes with betweenness centrality, indicating that they had more power and control f more resources in EIRCN. Moreover, the types of EOs with high betweenness centrality were mainly livelihood guarantee departments  and financial support departments . This indicated that the implementation of various emergency tasks in the early stage of epidemic prevention and control could be separated from social and financial resources. In Stage III, NHC, SCIO, and MT still had the highest betweenness centrality, which has a similar trend with degree centrality analysis. During this stage, as the governments needed to take various measures to support the resumption of work, production, and industry, it had great demand and dependence on social order and market order. Therefore, security and legal protection departments  and marketing and industry management departments  occupied more geodesic pairs of nodes in the network. In Stage IV, the spread of the epidemic in China was basically blocked. Consolidating the effectiveness of epidemic prevention and control and orderly recovery of economic and social development became the main theme of emergency information release during this stage. Therefore, in addition to finance  and development (NDRC) departments, MARA, MC, and MIIT also provided corresponding governance resources for industrial production, employment security, and rural epidemic prevention and control. This provided the mediating effect for communication and coordination between EOs in EIRCN. In Stage V, the national epidemic prevention and control entered Ongoing Prevention and Control. The epidemic data, the introduction of experience, and emergency science popularization were vital contents of emergency information release. Therefore, NHC, CCDCP, and SCIO had a high betweenness centrality. Furthermore, departments in charge of key prevention and control locations, such as transportation, tourism, education, and customs, had more resources on the network. This also indicated that the emergency information release in this stage needed more support from heterogeneous EO and diversified governance resources.In Stage II, the top 10 EO nodes with closeness centrality and betweenness centrality were identical in type. However, the top 10 EO nodes with closeness centrality were different in order. This indicated that EO nodes on the geodesic pair of nodes had a higher likelihood of establishing connections with other nodes. More precisely, EO nodes with more network resources in EIRCN are often not controlled by other nodes. Compared with Stage II, in Stage III and Stage IV EIRCNs, six new types of EO nodes were added to the top 10 EO sets, respectively. EIRCN of Stage III corresponded to expanding the EO nodes, including MPS, SAMR, MST, MJ, NMPA, and ME. In the EIRCN of Stage IV, MC, MARA, GAC, MEE, SPB, and SAMR were the newly added top 10 EO nodes. This showed that with the abundance of EIRMs and the expansion of EIRCN, the EO sets that were not easily controlled by other nodes in the network vary greatly. In Stage V, different from the previous two stages, the top 10 EO nodes did not increase significantly. However, it showed similar integration characteristics with previous core EOs, including NHC, SCIO, MT, CCDCP, MIIT, SAMR, ME, MC, GAC, and MCT. NHC, SCIO, MT, CCDCP, and MIIT are the core EOs formed by EIRCN of Stage II. SAMR and ME were the key EOs formed by EIRCN of Stage III. MC and GAC were highly influential EOs formed by EIRCN of Stage IV. This indicated that with the advance in epidemic prevention and control and the development of time, types of EO nodes with high reputation and core influence tend to be stable with the network layout of EIRCN.The top 10 EO nodes of normalized eigenvector centrality in EIRCNs at different stages are identified, as shown in Comparing To analyze differences of EIRMs at different stages and study time evolution characteristics of affiliation relations, the EOs-EIRMs 2-mode networks of Stage II-Stage V were drawn see . In addiMoreover, the same EIRM was issued by different types and numbers of EOs at different stages. With the development of COVID-19 prevention and control, emergency information release had different core issues and EIRMs. In Stage II, the contents of emergency information release mainly included diversified safeguard measures, production of emergency and medical supplies, and epidemic prevention and control of key population groups. Measures for social services and security, including transport services and daily supplies, were the most important, effectively addressing and ensuring people's livelihood during the COVID-19 outbreak. At this stage, the government introduced several financial support, tax relief, and other policies. EIRM7, EIRM10, EIRM5, EIRM12, and EIRM14 (EIRM15 tied) are the top 5 EIRMs with a degree centrality of Stage II.In Stage III, EIRM7 is still the core topic of emergency information release. Specifically, the top 5 EIRMs are EIRM7, EIRM9, EIRM3, EIRM6, and EIRM8. EIRM17 appeared for the first time in EOs\u2013EIRMs 2-mode networks, indicating that COVID-19 became a global pandemic. At this stage, the Chinese government issued several policies on epidemic prevention and control while ensuring economic and social development. Policy publicity and implementation was the key link of emergency information release during this period. Meanwhile, the EOs held press conferences on maintaining market order, resuming work and production, and strengthening employment security. During this period, the heterogeneity of EOs increased. This was related to emergency information release focusing on the contents of emergency science popularization.After the transition from Stage III to IV, the core EIRMs in EOs\u2013EIRMs 2-mode networks were EIRM7, EIRM8, EIRM9, EIRM3, and EIRM14. During this period, as the spread of COVID-19 was effectively controlled in China, the central government shifted the focus of COVID-19 prevention and control to key places, units, and groups, such as rural areas schools, and the aged. The Chinese government determined the strategy of preventing input from outside and rebounding from inside and held several press conferences focusing on the theme of prevention and control measures for imported cases. Meanwhile, the EOs repeatedly briefed the public on the progress of research and development of COVID-19 vaccines. Moreover, the Chinese government made active arrangements for international medical cooperation, export of medical supplies, and international cargo transportation and showed substantial care and concern for Chinese citizens abroad.In Stage V, cases in all parts of China were under control, and the emergency response level was successively lowered. This indicated that COVID-19 prevention and control entered a phase of Ongoing Prevention and Control. The core focus of the emergency information release shifted to EIRM4, EIRM1, EIRM7, EIRM3, and EIRM16. During this period, the Joint Epidemic Prevention and Control Mechanism of The State Council invited EOs of different levels, types, and fields to share their experience and knowledge of epidemic prevention and control. On the eve of every holiday and other key time points, the epidemic prevention and control work was arranged around transportation, tourism, and other issues. During the period of Ongoing Prevention and Control, scientific research departments, medical management departments, and pharmaceutical companies regularly introduced COVID-19 vaccination to the society. In addition, in the face of the COVID-19 global pandemic, customs departments, immigration departments, civil aviation departments, and logistics departments focused on risk prevention and cold chain supervision of imported goods.The above results describe the network structure of EIRCNs, the attributes of EOs, and the affiliation characteristics of EOs-EIRMs in different stages of COVID-19 prevention and control. From a system perspective, it is necessary to further discuss the time evolution characteristics of EIRCNs and EOs\u2013EIRMs 2-mode networks.(1) The network structure of EIRCNs was time evolution because of the differences in network size and the number of collaborative relationships between EO nodes in different stages. First, the relative network density and collaborative depth of EIRCNs showed the trend of decreasing first and then rising, which was formed by the expansion of the EIRCN's network scale and the gradual tightening of the collaborative relationships. Second, the type and location of core nodes in EIRCN were gradually observable because of the clear division of functions of EOs in the EIRMs. Therefore, the network centralization of EIRCNs showed the process of increasing over time. Third, there was little difference in EIRCN network cohesion at different stages. In comparison, Stage III had the lowest network cohesion. Fourth, the average path length of EIRCNs followed the evolution path of increasing first and then decreasing because the network expansion led to an increase in coordination and communication distance, which raised the collaborative costs. Furthermore, network connectivity recovered with the continuous improvement of identity among EOs. From Stage II to III, the relative network density, collaborative depth, and network cohesion decreased, and the average path length increased. With the advance in epidemic prevention and control, the network tightness, convergence, stability, and connectivity of EIRCN were gradually enhanced after Stage III.(2) Different stages of emergency information release of public health emergencies had different governance resource requirements. Therefore, the types and locations of EOs in EIRCN evolved over time. On the one hand, with the deepening of the understanding of COVID-19 prevention and control, many industry and functional support departments joined. Meanwhile, different from the trend of gradual withdrawal of core organizations in the emergency management network, the core EOs in EIRCN continued to maintain a certain degree of activity and played a key role in all stages of epidemic prevention and control. Although the spread of COVID-19 was under overall control, it still showed the trend of sporadic outbreaks. Therefore, the core departments needed to undertake certain emergency management responsibilities and emergency information release at different times. On the other hand, because of the differences between emergency information release and emergency disposal, emergency rescue, and emergency response, core EOs in EIRCN did not show a homogenization trend compared with previous studies. This is because the emergency information in a certain field or direction can only be published by a single EO rather than by multiple EOs in the same field. Therefore, in the EIRCN of public health emergencies, the core EO nodes showed a diversified evolution trend of diversification.(3) As the key issues and focus of emergency information release were closely related to the focus of epidemic prevention and control, the types of core EO and key EIRM nodes in the \u201cEos-EIRMs\u201d 2-mode network at different stages evolved dynamically. In Stage II, the emergency information release mainly focused on epidemic prevention and control, social security, a guarantee of medical supplies, and key population groups prevention. Among them, social security included transportation, financial, and livelihood support. The guarantee of medical supplies included drug research and the production and transportation of medical supplies. In Stage III, with the initial control of the spread of the epidemic, the measures for businesses returning to work based on maintaining social stability were the vital issue concerned by emergency information release. It included the measures related to maintaining market order and stability, industrial chain recovery, industry support, employment of key groups, and fiscal and tax support. In Stage IV, concentrating on possible routes of transmission of COVID-19 was the focus of emergency management. Correspondingly, the emergency information release focused on prevention and control measures for key locations, units, and population groups. Meanwhile, because of the global spread of COVID-19, focusing on preventing and controlling imported cases also became the core content of emergency information release. In Stage V, with the ongoing prevention and control in China, the emergency information release focused on holidays, school opening, travel, transportation, and other issues. The development and vaccination of COVID-19 vaccines, imported cases, imported cold chain, and other conditions also received corresponding attention. To sum up, the dynamic adjustment of emergency information release reflected not only the government's prevention and control measures but also an intuitive response to the public's safety and protection needs.We obtained the time dynamic law of EIRCNs and EOs\u2013EIRMs 2-mode networks. We now further discuss the factors that influence network evolution in different stages. In the emergency information release, all EOs needed to pay related network resources to realize the dissemination of EIRMs. By analyzing the interaction between different EIRM nodes, resource sharing in emergency information release can be concluded from the resource and information flow perspectives. Based on the affiliation data of EOs\u2013EIRMs 2-mode networks, the minimums method was adopted to transform 2-mode networks to obtain the resource flow between EIRM nodes. On this basis, the chord diagrams of the resource sharing relationship of EIRMs in Stages II to V were drawn see . The widComparing Stages II and III, we find that although Stage III had many EOs, the resource sharing amount of EIRMs nodes is similar. This indicated that the high collaborative frequencies and the adequacy of interaction between EOs are also crucial ways to meet the resource requirements of EIRMs. In conclusion, different types of EIRMs at different stages and the different resource requirements of EIRMs for EOs promoted network evolution to a certain extent. Similarly, the driving forces for the time evolution of EIRCNs were similar, characterized by introducing new EOs or increasing the collaborative frequencies. Among them, introducing new EOs could improve the resource increment of EIRCNs, and the increase of the collaborative frequencies could tap the resource stock of EIRCNs.Emergency information release during public health emergencies is a vital part of emergency management, which involves every stage of the emergency management life cycle. As the responsible public health emergency management subject, the government connected various types of EOs in emergency information release to integrate the emergency resources of different fields and attributes. The contents of emergency information were different in different stages of public health emergencies. Therefore, various EOs also formed differentiated collaborative relationships around different emergency information issues. EIRCNs and EOs\u2013EIRMs 2-mode networks were constructed in this study by taking the response to COVID-19 from China's central government as an example. We aimed to systematically and clearly describe the coordination and interaction between EOs in emergency information release of public health emergencies. The network structure of EIRCNs and the interaction among Eos, the attributes of Eos in EIRCNs, and the relations among affiliation nodes in Eos\u2013EIRMs 2-mode networks at different stages were analyzed. Moreover, the time evolution characteristics of the EIRCNs in public health emergencies were summarized. The research concludes the following:(1) Comparing EIRCNs at different stages, we conclude that from Stage II to III, relative network density, collaborative depth, and network cohesion increased. In Stages IV and V, the network tightness, convergence, stability, and connectivity of EIRCNs are gradually enhanced.(2) With the advance in COVID-19 prevention and control, the network scale of EIRCN expanded, and the types of core organizations in the network have changed constantly because of the expanding demand for emergency resources. Over time, the identified core EOs was expected to continue to maintain a certain degree of activity in the next stage rather than withdraw from the network. Moreover, the time evolution of the core EO nodes in EIRCNs showed the trend of diversification rather than homogeneity.(3) The key issues and focus of emergency information release were closely related to the focus of epidemic prevention and control. The types of EIRM nodes in the network and their association with core EO nodes dynamically evolved. The time evolution of EIRMs in public health emergencies reflected the dynamic adjustment of the government's epidemic prevention and control measures. This also responded to the diversification of the public's understanding and protection against COVID-19 at different stages.(4) From the time evolution characteristics of the total amount of shared resources between EIRM nodes, the driving force of the time evolution of EIRCNs was the introduction of new EOs or the increase of the collaborative frequencies between EOs. The introduction of new EOs could improve the resource increment of EIRCNs, and the increased collaborative frequencies among EOs could activate the resource stock of EIRCNs.This study presents the following implications from two aspects: improving the collaborative mechanism of emergency information release and dynamically adjusting the key issues of emergency information release.(1) Improve and optimize the collaborative mechanism of emergency information release from two aspects of the overall structure and local arrangement. Regarding the overall structure, institutional arrangements such as the compilation of emergency plans, function allocation, and coordination mechanism should be strengthened to improve the standardization and feasibility of organizational collaboration in emergency information release. The emergency information release policy should be updated and improved promptly. Regarding local arrangements, heterogeneous EOs should be introduced to provide diversified governance resources according to the development law of public health emergencies and the characteristics of emergency management needs. The organization foundation and trust foundation formed in emergency information release should be fully explored to avoid or reduce the repeated allocation of resources.(2) Key topics of emergency information release should match epidemic prevention, control practices, and public safety needs. In the emergency information release of public health emergencies, EIRMs showed the time evolution feature, which revealed a high correlation with epidemic prevention and control practices. The timely and accurate release of data on public health emergencies and emergency response measures can help improve the authority and credibility of the governments and relevant departments. Furthermore, in the face of public health emergencies, the public's cognition demand for safety gradually expands. It is essential for relevant departments to timely interpret the concerning issues of public concern, such as emergency protective measures and public service information related to public health emergencies.This study analyzed the collaborative mode in emergency information release from a network perspective, which is an attempt in the cross-research field of emergency management and government information release. It clarified the difference and time evolution characteristics of the organizations and contents of emergency information release in different emergency stages. This study is the first to combine the emergency information release with the network analysis method, which enriches the research on the emergency management networks. However, this study is not without limitations. The research data were mainly based on the response of the Chinese central government to the COVID-19 epidemic. There are significant differences between the central government and the local government in the authority and mode of emergency information release. Therefore, it is necessary for future research to focus on the emergency information release of the local government and clarify the difference. In addition, because of the ongoing COVID-19 pandemic, the characteristics of emergency information release in Stage V still have some extensibility. Furthermore, the collaborative mechanism of emergency information release of multiple subjects such as the governments, experts and scholars, and opinion leaders of social platforms could be used as the main content of the next research to enrich the theoretical connotation of emergency collaboration continuously.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding authors.All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.This study was supported by the National Natural Science Foundation of China (72174044).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "Malaria, one of the deadliest infectious diseases, has been reported to infect the Italian people since the first century . AlthougAccording to the WHO, Europe is free of indigenous malaria cases . MalariaAnopheles atroparvus is one of the dominant potential vectors of malaria in Europe  and their association with the movement of population  from malaria-endemic regions to Europe may increase the risk of local transmission and re-emergence of malaria in Europe .The 2019 EU Epidemiological Report on Malaria reported 8,641 cases of malaria, with nine confirmed cases reported as locally acquired  . Vector-Indeed, the high flow of travelers, the current migration crisis, and the presence of malaria vectors in countries, such as Belarus, Bulgaria, France, Greece, Italy, Portugal, Spain, and the Republic of Moldova, would increase the risk of malaria resurgence in these countries , 18\u201324. P. falciparum and P. vivax to thrive are reached and run between April and October in southern Europe .Beyond the risk of malaria resurgence or re-emergence in Europe, the increasing number of imported malaria cases in Europe challenges us and shows that malaria is an urgent problem not only in Africa, India, Asia, Latin America, etc., but also in European countries.AV and JD conceptualized and wrote the paper. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "In recent years, the new economy has entered a phase of rapid development and upgrading China's service consumption is driving the continuous optimization of the population's consumption structure. To realize the rationalization of the Chinese household consumption structure, the ELES model is used to analyze the structure system of Chinese household consumption expenditure. This article constructs the ELES model, divides the types of Chinese household consumption expenditure structure systems, establishes consumption expenditure function, analyzes the influencing factors of the consumption expenditure structure system, and obtains the analysis results from static and dynamic aspects. Based on the statistics of Chinese household consumption expenditure data in recent years, this article obtains the analysis results of the consumption expenditure structure system: the basic consumption demand and marginal consumption tendency of food are in the first place, and the consumption expenditure structure system has gradually changed into the development-type and enjoyment-type consumption mode. Through increasing the income of rural residents, guiding reasonable consumption concept, optimizing consumption environment, and so on, we can promote the proposal and implementation of the optimization of China's household consumption expenditure structure system to improve the rationalization of China's household consumption structure system. Consumption is not only the end of social reproduction, but also the starting point of its logic. It is also one of the three main driving forces of economic growth and plays an important role in economic growth. Consumption structure is one of the key research contents in the field of current economics. It can not only reflect the living standard and quality of residents, but also reflect the development of economy. It is a very important index in economic research. The consumption structure is affected by many comprehensive factors, which in turn affect the development of these factors . ThroughAt this stage, most foreign scholars are more committed to the construction and application of demand function model in the study of residents' consumption structure, which brings a lot of innovation in research methods. At the same time, the entry point of foreign scholars' research on the consumption structure is novel and diverse. The research results of foreign scholars on consumption function and consumption system model have laid a solid theoretical and model foundation for the research on China's household consumption expenditure structure. However, most of the domestic scholars introduce new variables to innovate based on the existing models to inject new vitality into the research of consumption structure. Based on the research results at home and abroad, we can find that the AIDS model and Panel Data are mostly used in the research of the consumption structure, while VAR model, factor analysis, cluster analysis, and grey correlation analysis are mostly used in the research of influencing factors of the consumption structure. However, these methods can only rank the influencing factors of the consumption structure, so the analysis results of the consumption expenditure system are one-sided, so the ELES model is introduced.The ELES model is an extended linear expenditure system model, which assumes that people's demand for various goods in a certain period depends on people's income and the price of various goods. Moreover, people's demand for all kinds of goods is divided into two parts\u2014basic demand and demand beyond basic demand, and they think that basic demand has nothing to do with income level. After the basic demand is met, residents arrange various nonbasic consumption expenditures according to certain marginal consumption tendency . In the t as the education consumption expenditure and then adds the expenditure of cultural and entertainment supplies to other expenditures, to properly process the statistical data of the National Bureau of Statistics . Then, the form of consumption function is as follows:The consumption function is mainly used to measure the relationship between consumption and income. Assuming that consumption is mainly determined by permanent income, permanent income is the expected long-term income. The persistent income hypothesis suggests that rational consumers make consumption decisions to maximize their effects, not based on temporary income in the present period. Instead, consumption decisions are based on the level of income that can be maintained long-term, that is, the level of lasting income. The life cycle hypothesis relates consumption to lifetime income and property. It assumes that consumers are rational and able to use their income sensibly and consume. The only goal of consumer behavior is to maximize utility. The life cycle and persistent income hypotheses are highly similar, emphasizing that consumption is mainly determined by future income .There are many factors affecting the consumption structure of urban residents, which can be divided into macro- and microfactors, such as industrial structure, consumer prices, and family population; they can also be divided into economic and noneconomic factors, such as income, industrial structure, and social and cultural, scientific, and technological progress . These fUnder the ELES model, through the analysis of the influencing factors and components of China's household consumption expenditure structure system, the final analysis results of China's household consumption expenditure structure system are obtained from the static and dynamic aspects, respectively, and the basic demand and marginal consumption tendency of China's household consumption expenditure structure system are shown in the results.According to the definition of the consumption structure in the Statistical Yearbook, consumption expenditure is divided into food consumption, clothing consumption, residential consumption, household equipment and services consumption, medical and health care consumption, transportation and communication consumption, education, culture and entertainment services consumption, and other goods and services consumption, a total of eight consumption expenditures . This clThe internal structure of household goods and services consumption expenditure is shown in On this basis, the analysis results of the Chinese household consumption expenditure structure system are obtained from static and dynamic aspects.Consumption level refers to the scale and level of life consumption and services used by individual consumers or the whole society in a certain period. The level of consumption is determined by social development and people's living standards . AccordiIt can be seen from Marginal propensity to consume refers to the proportion of increased consumption in increased income. According to the annual per capita consumption expenditure, per capita disposable income, increased consumption, and income of Chinese households from 2016 to 2020, the value of marginal propensity to consume is calculated, as shown in According to the law of diminishing marginal propensity to consume, although people's consumption increases with the increase in income, the part used to increase consumption in the increased income is less and less. From 2016 to 2020, China's household marginal propensity to consume is within the limit of marginal propensity to consume (between 0 and 1), basically fluctuates between 0.5 and 1, and does not show an obvious decreasing trend, which does not conform to the law of diminishing marginal propensity to consume, indicating that China's household consumption confidence is insufficient . In 2018The change degree of consumption structure measures the change degree of residents' consumption structure every year. The larger the calculated value is, the greater the change range of residents' consumption structure in this period is. Combined with the consumption expenditure data of China in recent years, Chinese families are divided into three stages: 1997\u20131999, 2000\u20132013, and 2014\u20132020. These three stages correspond to the well-off, affluent, and richest life of Chinese families in turn. The specific statistics of structural change are shown in From the calculation results in According to the calculation principle of demand income elasticity, we can calculate the demand income elasticity of Chinese households' consumption expenditure. The demand income elasticity of food, clothing, housing, family equipment, medical treatment, transportation, culture and education, and other items are 0.763, 0.889, 0.958, 0.696, 0.721, 1.119, 0.648, and 0.842 respectively. Therefore, the demand income elasticity of residents' consumption is positive, which indicates that with the increase in disposable income, residents' consumption expenditure will increase accordingly.Based on the analysis of basic consumption demand, marginal consumption tendency, and demand income elasticity of the ELES model, the basic consumption demand and marginal consumption tendency of food are in the first place; the marginal consumption propensity and demand income elasticity of transportation, communication, and housing are the largest, and the consumption of transportation, communication, and housing is developing into a hot area of urban residents' consumption in Hebei Province; people will pay more and more attention to medical treatment, culture, and education, and gradually change into the development type and enjoyment type of consumption .Consumption is of great significance in the development of national economy, and the current economic situation makes it particularly important to promote consumption. The government should optimize the structure of Chinese household consumption expenditure from many aspects.As far as the current economic situation is concerned, measures can be taken from the following aspects: first, accelerate the reform of state-owned enterprises, accelerate the improvement of the overall efficiency of state-owned enterprises, improve their economic efficiency and increase workers' wages; vigorously develop various forms of collective economy, encourage and support the healthy development of individual economy and private economy, create more employment opportunities, and increase residents' income. Support laid-off workers and other low-income people to ensure the minimum living standard of the city; encourage secondary entrepreneurship through technical training, policy support, financial assistance, etc., vigorously develop the individual and private economy, and gradually increase their income . EncouraAs the main body of consumption, consumers and consumption environment work together and promote each other. Therefore, it is necessary to guide consumers to consume reasonably and scientifically, change traditional consumption concepts, abandon the consumption habits of comparison and extravagance, and establish a correct and reasonable consumption concept. On the one hand, we need to improve the quality of consumers and update the concept of consumption through education and guidance, so that people can correctly understand the importance of scientific consumption mode to the harmonious development of human, society, and ecological environment. On the other hand, we should pay attention to the consumption of spiritual culture . CompletAs an external condition, consumption environment determines the utility that consumer goods can bring to consumers and then has an important impact on the consumption mode and behavior choice of residents. First, improve the consumer market laws and regulations. We should strengthen legal publicity, strengthen market supervision, ensure product quality, crack down on fake and shoddy commercial fraud, establish a good and orderly market order, and purify the consumption environment. To protect the legitimate consumption rights and interests of residents. Secondly, strengthen infrastructure construction . Ensure In the process of adjusting the consumption structure of residents, in addition to the diversification and personalized supply of consumer goods in the traditional consumption field, we should continue to expand new consumption fields. According to the existing traditional market, we should find new potential consumption markets, such as information consumption and green consumption, to form new consumption hot spots and realize the sustainability of consumption structure optimization.From the national level, according to the marginal propensity to consume, income elasticity of demand, and price elasticity of all kinds of consumer goods, we can know that the marginal propensity to consume food in China's household consumption expenditure structure is gradually decreasing, the marginal propensity to consume health care and housing is gradually increasing, and the household consumption expenditure structure is gradually changing to the development-type and enjoyment-type structure. From the regional level, due to different income and prices, there are differences between different provinces. Therefore, analyzing the results of residents' consumption expenditure can optimize the structure of residents' consumption expenditure and help rationalize the system of household consumption expenditure in all regions of China."}
{"text": "The Bosnian Journal of Basic Medical Sciences (BJBMS) was founded in 1998 in Sarajevo, Bosnia and Herzegovina, by Professor Muzafer Muji\u0107, Professor of Physiology at the Faculty of Medicine, University of Sarajevo. Most of the scientific communication at that time, particularly in developing countries, took place through printed media with little access to a broader audience, and editorial communication took place via ground mail. Consequently, communication was much slower than today, and the journal\u2019s readership was primarily composed of members of the local or, at best, national scientific community.Nevertheless, the early editors of the BJBMS set high scientific standards, and this, combined with their diligence, resulted in the BJBMS being listed in PubMed/MEDLINE and Web of Science. These were the crucial initial steps in the journal\u2019s internationalization. The journal was well received by the global scientific community, and submissions from other countries soon began to arrive.A new era began with the widespread use of the Internet. The Internet changed almost every aspect of our lives, including our work. Scientific publishing underwent a revolution due to the vastly improved speed, efficiency, and number of communication channels. Following the trend, the BJBMS launched its first online edition, the website, in 2009. The journal\u2019s online edition was well received by readers and increased the journal\u2019s visibility and reputation, which was reflected in an increase in submissions from the global community. Since then, the BJBMS has experienced continuous growth in terms of quality, readership, visibility, reputation, and scientific metrics.Today, the BJBMS is included in the most relevant scientific databases and is well-known worldwide. The journal has outgrown its national and regional boundaries given that more than 90% of the articles published in BJBMS come from the international community.Because of aforesaid, the national designation \u201cBosnian\u201d in the title of the journal does not reflect the essence and global significance of the journal. Therefore, the publisher and editors decided to change the title of the journal to more accurately reflect its international character and the content of the articles published.From February 2023 , the title of the Bosnian Journal of Basic Medical Sciences will be changed to Biomolecules and Biomedicine. The new title reflects the increasing number of published research done on subcellular/molecular level as well as translational and clinical research contained in the term Biomedicine. Biomolecules and Biomedicine will continue to be published by the Association of Basic Medical Sciences of the Federation of Bosnia and Herzegovina."}
{"text": "The history of neurotrauma in Ancient Greece intertwines science with literature in an awe-inspiring and fascinating approach. There is great importance in understanding the historical context of medical and scientific progress, as it highlights excellent insight into the epidemiology, causes, and treatments of neurotraumatology. At the same time, it offers a fascinating glimpse into the world of the past. By presenting the stories and achievements of the great minds that have come before us, we celebrate their work and introduce people of all backgrounds to the history and evolution of neurotrauma.e.g., quadriplegia, loss of consciousness) [In ancient times, illness was believed to be cured and caused by the gods  . Nonetheousness) .The Greeks were farmers, athletes, and warriors, with military trauma accounting for as high as 93.68% of all traumas . AnotherThe most relevant observations in ancient Greece were in the works of Hippocrates, Celsus, and Galen, who mentioned changes in consciousness following traumatic brain injury (TBI) and significantly contributed to the advancement of medical sciences through the development of treatment methods . To illuThe Homeric Period (XI-VIII BC), named after the famous Greek poet, revealed some of the first sources of Greek knowledge on neurotrauma in the great literature classics, the Iliad and the Odyssey , 2, 5. THomer, Plato and Plutarch, along with other minds of the time, depict, in their writings, cranial trauma on the battlefields, in accidents, or during athletic games, such as chariot races and boxing (most traumatic sport) . A fasciIn ancient Greece, those affected by neurotrauma were primarily men, and the consequences mentioned included \"loss of consciousness, quadriplegia, brain, and brain stem injuries\", with trauma being directed mainly towards the faces and necks, as the heads were often protected by helmets .Some of the most notable mentions of trauma were those written by the poet Aeschylos, king Pyrrhos, and Alexander the Great. In their works, they offer insight into the causes of neurotrauma, as they describe the trauma caused by the most lethal weapons of the time: spear (58% of cases), sword 21%), and stones (15%) [1%, and sThe Hippocratic period is named after Hippocrates of Kos, who is considered the \"father of Medicine\" and contributed tremendously to the advancement of medicine and knowledge on neurotrauma by performing the first systematic approach to TBI in his work: \"On injuries of the head\" . In his Hippocrates (460\u2013377 BC) wrote the memorable treatise \"On Wounds in the Head\", a valuable source of insight into head injuries in classical antiquity and the first work in history focusing exclusively on cranial trauma . In his Another bright mind of the time, Plato (429\u2013347 BC), regarded the brain as the \"cranial marrow\" and the spinal cord as the \"vertebral marrow\" . AristotOther notable contributions in the domain of neuroscience were those of Praxagoras of Kos, who suggested the existence of neurons . FurtherThe story of neurotrauma in Ancient Greece is fascinating, as it highlights the precocity of great minds in understanding processes that would later be defined by modern medicine. Furthermore, the detailed and vivid observations of poets and writers stand as a testament that medicine and science can intertwine with art and that humanity is only going to benefit from multidisciplinary approaches to advance knowledge on neurotrauma and any other domain."}
{"text": "Depressive disorders have become an increasingly significant public health issue. This study is intended to show the trend of the incidence of depressive disorders in China, the United States, India and the world from 1990 to 2019, as well as the impact of age, period and cohort on it.Extracting incidence data from the Global Burden of Disease Study 2019, we determined trends in the age-standardized incidence rate (ASIR) using Joinpoint regression. An age-period-cohort analysis was implemented to describe the effects of age, period, and cohort, as well as the long-term tendencies.From 1990 to 2019, the ASIR of depressive disorders in China was lower than that in the United States; India is lower than the United States in the first 5\u2009years, showing a downward trend. The incidence in India and the United States is higher than the global average. The ASIR of women in the three countries is higher than that of men. In China, the elderly, early period and people born around 1954 have a higher risk of depressive disorders. In the United States, young people born around 1999 have a higher risk of depressive disorders. India is similar to China.From 1990 to 2019, the age effect of China as a whole increased, and the period became stable, and the cohort effect declined. The overall age and period effects of the United States reduced, while the cohort effect increased. The age effect in India increased, while the period and cohort effects decreased. Depressive disorders are becoming ever more serious worldwide, and we\u2019d better take measures to reduce its incidence according to the cohort effect of each age group. With the rapid development of countries, the burden of non-communicable diseases (NCDs), including mental disorders, neoplasms, cardiovascular diseases, etc., is increasing .Mental disorder is a condition manifested as cognitive disability, emotional regulation disorder or unusual behavior, which mainly reflects the underlying psychological dysfunction . Mental Depressive disorder is a worldwide shared mental disorder that has a serious impact on our physical and mental health. Symptoms mainly include low mood, negative attitude towards life, lack of passion and fighting spirit in life, insomnia, decreased quality of life, and suicidal tendency . StudiesDepressive disorder is the main cause of the burden of mental, neurological and substance use disorders worldwide, in both developed and developing regions . In 2017In recent years, as mental health has gradually come into public view, related research has also been carried out gradually. However, earlier studies have provided only a cursory analysis of trends in depressive disorders. There are few studies comparing trends in China, the US, India and globally. There are also few studies using the age-period-cohort analysis method on the incidence trend of depressive disorders, which can describe age, period and cohort effects, respectively. Therefore, we present the results of the GBD 2019 study, using age-period-cohort and Joinpoint analysis to assess the trend of depressive disorders incidence in China, the US and India and globally. Our study will help develop prevention strategies to reduce the incidence of depressive disorders.http://www.healthdata.org/)-an independent global health research center at the University of Washington. GBD 2019 uses data from a variety of sources, containing household surveys, censuses, essential statistics and civil registration, to calculate 286 causes of death, 369 diseases and injuries, and 87 risk factors roughly in 204 nations and districts. The GBD estimates the indicators of incidence, prevalence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) of each disease, which are reported by year, location, age and gender. GBD aims to establish comprehensive and comparable global health indicators  was provided by the Institute for Health Metrics and Evaluation  to extract the total incidence of mental disorders and depressive disorders from 1990 to 2019. Age is mainly divided into the following age groups: 20\u201324\u2009years old, 25\u201329\u2009years old, 30\u201334\u2009years old, 35\u201339\u2009years old, \u2026 and 85\u201389. Countries and regions were selected as China, the United States, India and the global.Using Joinpoint regression analysis, we estimated trends in the age-standardized incidence (ASIR) of mental disorders and depressive disorders over time. This model mainly uses logarithmic transformation of the rate and calculates the standard error according to binomial approximation . The modAge-period-cohort model is a log-linear regression model based on Poisson distribution. Its basic idea is to determine the value of age, period and cohort effect by fitting the regression relation between target event incidence and age, period and birth cohort. Age-period-cohort analysis is an analytical method that can simultaneously describe the impact of social development, historical change, demographic change and environmental factors on people. It eliminates the interaction between age, period and cohort effects, displaying the effect of age, period and cohort alone on incidence. In addition, due to the relationship of cohort\u2009=\u2009period-age , the AgeWhere M is incidence rate, \u03bc is intercept, \u03b1, \u03b2 and \u03b3 are coefficient of age, period and cohort effects, respectively, and \u03b5 is random error.This study extracted the incidence of mental disorders and depressive disorders in people aged 20\u201389\u2009years from 1990 to 2019 in China, the United States and India and globally from GBD. We divided patients into 19 birth cohorts . Patients were divided into five time periods . The incidence of mental disorders was age-adjusted for 14 age groups . According to the WHO  report , the popAs is shown in According to our findings, the ASIR of mental disorders declined slightly or stabilized in China, similar to global levels, but increased in the United States and decreased in India. Furthermore, women outnumber men in China, the United States, India, and around the world. This sex difference has been found and confirmed in previous studies . This isThe study on depressive disorders found that from 1990 to 2019, the ASIR of depressive disorders in China decreased or stabilized slightly, similar to the global level, but the ASIR in the United States increased, while the ASIR of India decreased. Moreover, consistent with mental disorders, the morbidity of women is higher than that of men. This is in line with previous research results . This maIn order to analyze the reasons behind the trend of depressive disorders incidence rate, we could discuss the incidence rate changes from age, period and cohort perspective.In addition to other factors, there is a fairly obvious link between age and depressive disorders. Age has a significant impact on the incidence of depressive disorders in China, the United States, and India. The overall incidence of depressive disorders in China is increasing with age. In particular, the incidence is relatively high in the 20\u201324 age group, then begins to decline until the 30\u201334 age group, and then increases with age. The high incidence of the 20\u201324 age group may be related to Chinese peers\u2019 competitiveness . People The incidence declines with age in the United States, which exhibits the reverse tendency. In the United States, the incidence of the elderly is low, probably because the pension system is more perfect and the pension model is more advanced. In 1935, the United States Congress passed the Social Security Act , the OldThe risk of disease in India increases with age. Previous studies have found that compared with the 18\u201359 age group, the elderly are 1.35 times more likely to suffer from depressive disorders . The WHORegarding the period\u2019s effect on the incidence of depressive disorders, we can see that it has a significant effect in China, America, and India. In China, RR has been falling from 1994 to 2009. From 1994 to 1999, the reduction was quick, but was gradual from 1999 to 2009. From 2009 to 2019, RR showed an upward trend, rising rapidly before 2014, and then slowing down. In the United States, from 1994 to 1999, there was an upward trend, and from 1999 to 2019, there was a downward trend. The decline was swift from 2009 to 2014, and the RR in 2019 was far lower than that in 1994. India, similar to the global, declined rapidly from 2004 to 2009 and then stabilized.Specifically, the decline in the morbidity from 1994 to 2009 was mostly because of the rapid development of China\u2019s society, the significant improvement in economic level and people\u2019s education level in recent years . In addiThe above tendency in the United States is mainly as a result of the following factors: First, the increase in the incidence rate from 1994 to 1999 was mainly because of some events in these years, the large earthquake in 1994, which affected Los Angeles, Santa Clarita, Fillmore, and many other cities have had a severe impact ; A terroIn India, the risk of depressive disorders declined sharply around 2004. According to previous studies, the rural poverty rate in India decreased around 2004 . In addiFor the cohort effect, China and the United States showed opposite patterns of change, similar to India and the global average.In China, the incidence of depressive disorders was on the rise before 1954 and the decline after 1954. The incidence in 1999 was much lower than that in 1909. The higher incidence of depressive disorders in the pre-1954 birth cohort is mainly due to the fact that they were born during the 1911 Revolution, the 1931\u20131945 Anti-Japanese War and the 1927\u20131949 Civil War, when the upheavals of these periods produced great worry and anxiety and caused great pressure which increases the risk of depressive disorders. The WHO estimates that about 10 percent of the population will undergo serious mental health problems after the war, such as depressive disorders . PreviouIn the United States, RR showed a downward trend from 1909 to 1924, and an overall upward trend from 1924 to 1999. Among them, it stabilized from 1969 to 1974. The overall trend is upward. The decline in morbidity in the 1909\u20131924 birth cohort in the United States may be due to the emergence of the modern mental health movement in 1908, which made people realize the significance of mental health. Incidence rates in subsequent birth cohorts increased year by year mainly due to the Great Depressive disorders of the 1930s, World War II in the 1940s, etc. The 1969\u20131974 leveling off may be linked to the Community Mental Health Act enacted in 1968 . IncidenBefore 1947, India had been subjected to British colonial rule. During this period, the British government\u2019s oppression of the Indian people increased the risk of depressive disorders . In addiIn addition, it is worth mentioning that this study has certain limitations. First, because this article is built on the data of GBD 2019, there is still some deviation in the completeness and accuracy of the incidence data of mental disorders and depressive disorders that we use, making the results less accurate. Second, we do not possess detailed incidence data for each country and region, and cannot analyze the spatial distribution.In conclusion, from 1990 to 2019, the ASIR of depressive disorders in China and India decreased slightly or remained the same, while that in the United States showed an upward trend, and the incidence of women in the three countries was higher than that of men. As far as the age effect is concerned, China and India are on the rise, while the United States is on the decline. As far as the cyclical effect is concerned, China has shown an upward tendency in recent years, while the United States and India have shown a downward trend. In terms of queue effect, China and India showed a downward tendency as a whole, while the United States showed an upward trend. Both period and cohort effects are related to national policies and whether there is a war. We should take the development of depressive disorders into account, and regulate coping strategies on the basis of the cohort effect of age to effectively reduce the occurrence of such diseases.http://www.healthdata.org/.The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found below: the Institute for Health Metrics and Evaluation, CY supervised the study. CY and SW designed the study. SW, TL, RL, TW, LH, and JS collected the data. SW and TL organized the data, analyzed the data, and interpreted the results. SW wrote the first draft. CY, SW, TL, RL, TW, LH, and JS reviewed and edited the manuscript. All authors contributed to the article and approved the submitted version.This work was funded by the National Natural Science Foundation of China (Grant Nos. 82173626 and 81773552) and Health commission of Hubei Province scientific research project (Grant No. WJ2019H304).The authors declare that the research was undertaken in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "Dear Editor,Mycobacterium leprae, is a chronic infectious disease, which may cause permanent damage to peripheral nerves and deformity.Leprosy, caused by To analyze the sociodemographic and clinical factors associated with MB leprosy in elimination planning areas in Northwest China, three specialized hospitals were included. The medical records of leprosy in province in northwest China from 2004 to 2020 were collected from the Leprosy Management Information System (LEPMIS).This is an observational and retrospective study, involving 305 cases of MB and PB leprosy cases, collected in the LEMPIS from 2004 to 2020. The variables included gender, nationality, occupation, and others. The statistical significance level was p\u00a0<\u00a00.05. Logistic regression analysis was used to adjust the confounding variables to determine the independent risk factors of MB leprosy cases.Significant differences in sex and some other variables (p\u00a0<\u00a00.05) were shown comparing MB and PB cases, as shown in These results showed high endemic characteristics of leprosy, suggesting that the delay on leprosy diagnosisPassive detection was a protective factor for MB leprosy, so it is necessary to increase the publicity and education of leprosy prevention and control knowledge in low-prevalence areas, and to improve the awarenessThis study was based on second-hand data obtained from the LEPMIS, so it has some limitations, such as inconsistent information, prevalence bias and the defect of cross-sectional design. Future longitudinal studies or geographical distribution are desirable to clarify factors related to leprosy.In conclusion, MB patients were the main infectious source of leprosy, so early detection and treatment can effectively block the transmission of leprosy in the infectious source control link, which is of great significance to reduce the probability of leprosy in patients with disability. This study has shown the epidemic characteristics and regional characteristics of MB leprosy in northwest China, which may be helpful in effectively preventing and controlling leprosy.None declared.Ge Li: Co-wrote the article; the corresponding author, reviewed the data and results of this article; contributed to interpretation of the data, commented on the manuscript, revised the manuscript, and approved the final version for publication.Chao Li: Co-wrote the article; contributed to interpretation of the data, commented on the manuscript, revised the manuscript, and approved the final version for publication.Qingping Zhang: The corresponding author, reviewed the data and results of this article; contributed to the interpretation of the data, commented on the manuscript, revised the manuscript, and approved the final version for publication.Hong Zhang: Contributed to the collection and acquisition of the article data; contributed to interpretation of the data, commented on the manuscript, revised the manuscript, and approved the final version for publication.Ping Chen: Contributed to the collection and acquisition of the article data; contributed to interpretation of the data, commented on the manuscript, revised the manuscript, and approved the final version for publication.Zhaoxing Lin: Gave guidance on research methods and case review; contributed to interpretation of the data, commented on the manuscript, revised the manuscript, and approved the final version for publication.None declared."}
{"text": "This article combs the present situation and future development trend of digital economy research in China by means of literature measurement. On the one hand, China's digital economy presents a framework system of industrial digitization, digital industrialization, digital governance, and data value. On the other hand, digital economics has gradually become a dominant science and is constantly challenging the traditional economic research framework. Data are no longer the traditional data, and the data-driven economic and social innovation development model is the future trend. Data privacy, data protection, data ethics, data assets, and so on will become the focus of academic research. The global economy is undergoing digital transformation. With the frequent interaction of digital trade around the world, governments, enterprises, and other subjects are facing digital upgrading. Data have increasingly become a new factor of production, which makes the operation mechanism of the world economy show new characteristics. The socialized application of digital technology has brought the rise of digital society and shaped the form of digital economy characterized by data. The development of digital economy drives the high-quality development of social economy. We should focus on the people, promote the sharing of the dividends of digital economy development among the people, and contribute to the people's sense of gain and happiness, so as to build a community with a shared future in digital space and realize a new global shared digital economy.From the perspective of the development of the theory of the digital economy, the concept of the digital economy has been deepening from the information economy to the concept of the digital economy. In the 1940s, there was a breakthrough in the field of microelectronics. In the 1980s and 1990s, digital technology and information network technologies converged to drive the development of digital economy, and traditional information technology models and business models changed. This has driven the rapid development of digital technologies such as cloud computing and big data. The concept of the digital economy was first proposed by the American scholar Don Tapscott in 1996, followed by the publication of a study on the emerging digital economy by the United States Department of Commerce. Recent years have seen explosive growth in publications related to China's digital economy, such as \u201cIntroduction to the Digital Economy: Theory, Practice, and Strategy,\u201d published in 2022 by the China Institute of Information and Communication Research and \u201cTheory and Governance of the Digital Economy\u201d (2021) by Dong Yang and Xinyu Xu. Based on this, this article focuses on the related literature on digital economy research in China through CNKI database. Based on the analysis of the whole article, author, and journal, this article will provide some references and inspiration for digital economy research, and further support the discipline construction, social application, and future trend of digital economy.This article takes CNKI database as the data source, selects unlimited time, and selects Peking University core journals, CSSCI journals, and CSCD journals according to the theme\u2009=\u2009\u201cdigital economy.\u201d As of April 29, 2022, 4060 documents have been retrieved. After literature processing, a total of 3643 literature were selected as sample data, excluding the lack of author, title, keyword, and meeting notice.This article uses CNKI database, VOSviewer, SPSS, and other software to visually analyze the research status of digital economy in China. Specifically, one is to make statistics on the annual production of digital economy papers. The second is to count the number of articles published by authors and journals. The third is to draw the systematic clustering map of high-frequency keywords and analyze the situation of related topics. Through the above research, this article combs and analyzes the development trend and theme context of digital economy.Through the time distribution of digital economy research literature in China, we can intuitively judge the development of academic research on digital economy. As shown in Using UCINET software to draw the co-occurrence chart of authors , a totalJournal of Commercial Economics (100 articles), International Taxation in China (98 articles), Taxation Research (98 articles), People's Tribune (74 articles), and China Finance (58 articles). Journal of Commercial Economics is a journal focusing on the field of commercial circulation; International Taxation in China and Taxation Research focus on the frontier of economic tax theory and practice, and pay close attention to the research progress of digital economy and digital tax; People's Tribune is a comprehensive publication, and China Finance is a financial journal, focusing on the experience of financial reform and discussing economic and financial theoretical issues.As shown in A total of 3643 literature were extracted from the keyword field and measured by co-occurrence  hereina. Use COOFor the content theme of China's digital economy research, the dissimilarity matrix of high-frequency keywords in the sample literature  is introThrough the literature keyword cluster analysis diagram of China's digital economy, the corresponding content framework system of China's digital economy research is obtained. As shown in Cluster 1 includes keywords industrial digitization and digital industrialization. Digital industrialization is the basis of the development of digital economy and the leading force of the reform of digital economy innovation system. Industrial digitization is an important part of digital economy, which brings efficiency improvement by integrating the application of digital technology into traditional industries. Du  believesThe development of digital economy relies on the digital transformation of traditional industrial structure and the construction of digital technology-related industrial systems, so as to achieve mutual synergy between the two and drive high-quality economic and social development. In particular, the convergent innovation and development of new technologies such as artificial intelligence and 5g is an important symbol of the digital economy, which has expanded various digital application scenarios, reconstructed people's production relations and lifestyle, and finally, provided a technical framework for the arrival of the digital era. For example, Internet companies such as Tencent, Huawei, Alibaba, and TikTok have become leading enterprises in the digital economy industry, driving the digital transformation of China's economy and contributing to the construction of Digital China.Cluster 2 focuses on macro policy environment research, including keywords digital service tax, international tax rules, value creation, \u201cthe belt and road,\u201d international tax, tax administration, tax governance, and value-added tax. The international and domestic dual cycle development pattern is the content of the national 14th five-year plan, which promotes the development of China's digital economy from the two-way development of supply and demand. To a certain extent, take double circulation as the starting point, actively promote the development level of digital technology, promote the digital synergy of industrial chain, and then improve the governance system of digital economy, build corresponding institutional system, and promote the balanced development of digital economy [The digital wave has become the main melody of the global economy. Especially in the post-epidemic era, governments all over the world are using digital intelligent technology to participate in the epidemic control and the allocation of people's living materials. The construction of digital innovation value system is related to international competition and national strategic development. Improving digital technology innovation capability, promoting the digital transformation of traditional industries, and strengthening platform system governance have become important directions for the construction of China's digital economy ecosystem.Data transactions create value for the digital economy and challenge the current tax collection system. China lacks corresponding tax system for data transactions, and digital tax has become a barrier to the service trade of data media to a certain extent. For data transactions with strong value creation ability but scattered distribution, through the comparison of digital economy tax systems of the United States and the European Union, provide ideas for the construction of tax system for localized data transaction . The priCluster 3 focuses on the research of digital village construction. The keywords include rural vitalization and digital village. The key to comprehensively promoting rural revitalization lies in the revitalization of rural industry, which provides a development opportunity for the construction of digital countryside. Digital technology infrastructure is the hardware foundation for the development of rural industries. Through the construction of digital logistics infrastructure, we can reconstruct the spatial pattern of urban and rural areas, accelerate the flow of urban and rural factors, enable the development of rural industries with digital technology, promote the integration of primary, secondary, and tertiary industries in rural areas, promote the diversified and comprehensive development of rural industries through the cultivation of new industries and new business forms, and attract and cultivate new rural digital farmers. Let farmers become the development subject and beneficiary subject of rural industrial prosperity, and form an endogenous driving force to promote the all-around revitalization of rural areas .China's digital village construction is an inevitable measure of rural revitalization in the new era. The \u201csiphon benefit\u201d of digital economy enables the construction of digital countryside, which lays a foundation for promoting the construction of digital countryside in four aspects: digital industrialization, industrial digitization, digital governance, and data value. We will explore four ways to promote the construction of \u201cdigital infrastructure and practice\u201d in rural areas, and build a \u201cdigital infrastructure and practice\u201d model, so as to comprehensively promote the construction of rural infrastructure and implement digital governance. We will explore four ways to promote the \u201cdigital infrastructure and practice\u201d and promote the construction of rural infrastructure and implement the \u201cdigital governance\u201d .Cluster 4 focuses on digital protection and governance. Keywords include data governance, data security, and cross-border data flow. Data elements drive the economy to produce a multiplier effect, promote enterprises' efficient decision-making, improve efficiency, drive innovation, and realize the orderly development of public governance. Data elements need corresponding mechanisms to release their potential value. Data governance system ensures that data elements drive economic development. Among them, data governance policy system includes data privacy protection, data property rights, data competition, and regulatory policies . The proThe development of digital economy drives economic and social transformation. In order to ensure that the legal system is consistent with economic and social development, the reform of the legal system should avoid rigidity, adhere to the principles of inclusiveness and prudence, pay attention to social co-governance, establish a regular evaluation system, and promote the reform of the government supervision system . From thCluster 5 focuses on digital intelligence technology, and the keywords are big data, artificial intelligence, and the Internet. Disruptive digital intelligence technology has changed the traditional social and economic structure system. Starting from technological progress and enterprise operation and development, there is an internal relationship between enterprise digital transformation and enterprise innovation. Digitization is the external motivation to promote enterprise innovation, and enterprise innovation is the internal demand to realize digital transformation. To change the management thinking mode and re-recognize the relationship between people and technology, we need to clarify the development objectives and create a good innovation atmosphere, improve the business ability of enterprises, and provide corresponding countermeasures and suggestions for the innovation of enterprise development model . The colThe analysis framework of organizational resilience looks at the development of new formats of digital economy, ensures that the retail industry has resilience in the uncertain process, presents different segmentation capabilities in different stages, and explores the development status and capacity-building of new formats of retail through live broadcasting and social e-commerce . Xiao etCluster 6 focuses on the research on the integration of digital economy into the development of traditional real economy. The keywords include new development pattern, dual circulation, digital economy, high-quality development, digital gap, common prosperity, global value chain, manufacturing, digitization, new economy, industrial structure, intermediate effect, technical innovation, total factor productivity, digital inclusive finance economic growth, financial technology, innovation, real economy, etc. The digital transformation of the economy under the epidemic provides new impetus for development, deepens reform, and promotes the construction of a community of shared destiny system. In the process of domestic and international double cycles, we use data elements as the starting point to help the high-quality development of the digital economy, meet the needs of the people, and lay the foundation for the new pattern of China's economic development . HoweverLook at the digital economy from the macro-, meso-, and micro-dimensions. From the macro analysis, the application of big data expands the boundary of resource allocation in the planned economy and contributes to the coordination between the government and the market. From this point of view, the innovative mechanism of digital economy has changed the traditional market structure and power structure, forcing buyers and sellers to trade under the mode of complete competition. From the micro perspective, the digital economy integrates economies of scale and breaks the traditional economic profit model . The shaIn the digital age, enterprise boundary breakthrough has become a development trend, and its evolution approach and theoretical logic are rooted in the fact that information and knowledge have become key core production factors in the digital age, which is very important for enterprise core competence and expansion power. Specifically, the core competence of enterprises has changed from the control of tangible resources to the sharing of intangible resources. Data driven has become the key logic for the development of innovative business, that is, enterprises cultivate the ability of data acquisition and mining, so as to contribute to their digital transformation and innovative development . The regDigital economy promotes the refinement of the global value chain division system, breaks through the original time and space constraints, and promotes the evolution of the global value chain division system . StartinCluster 7 focuses on the research of digital economy theory and specific practice. The keywords include platform economy, antivirus, Internet platform, data, production factors, digital trade, digital trade rules, electronic commerce, digital governance, digital government, digital China, Covid-19, industrial chain, digital transformation, sharing economy, digital platform, digital labor, etc. In view of the construction of discipline framework systems such as discipline orientation, research methods, and research contents of digital economics, this article views the transformation and development of discipline paradigm of digital economics from the dimension of technological innovation, attaches importance to the cultivation of digital economy talents, and then constructs the academic community of digital economy research . DigitalThe research on the connotation and discipline development framework of digital economy theory is based on the paradigm of technical economy and the theory of complex economics. The development of digital technology drives the innovation of economic research methodologies, such as machine learning and federal learning, which are applied to economic research, promotes the updating of traditional measurement methods, and deeply excavates the laws of economic activities and economic periodicity with the help of big data, thus contributing to the development of digital economics. Digital economy is a complex of various economic activities with intelligent technology group as the driving force and data as production factors, including driving force, new form structure, value creation activities, etc. The uncertainty of technological evolution, the unknownness of social development, the lag of policies and systems, and the prominence of digital sovereignty limit the development of the technological economy paradigm of digital economy. The development of digital economy will inevitably bring the iterative and phased integration of the economic development paradigm. Starting from the principles of coordination and balance, promote the breakthrough of basic theory, improve the top-level design, and accelerate the development of new economy from the construction of technical facilities and institutional adaptation .Technological revolution has shaped new forms of economy, such as intelligent economy, experience economy, sharing economy, space economy, etc., which requires not only the construction of new economic forms in theory but also the direction of transformation in practice. The new economic form is not a negation of the original economic form, but an innovative development. It is the transformation, optimization, and promotion of the old economic system by the new technology group . With thThe digital economy is the frontier of current academic research and the subject of multidisciplinary integration research. This article studies the literature on digital economy in CNKI database; draws the knowledge map with the help of VOSviewer, SPSS, UCINET, and other software; analyzes the author co-occurrence, keywords, and other maps; and combs the current situation of digital economy research in China, theme context, and other topics. Through the structural analysis of the categories of China's digital economy research, this study reflects the current research status in stages to some extent, but there are some errors in the keyword classification effect, such as the intersection of macro policies and specific practical problems to some extent. For the specific practical process, we need to summarize and predict the future development. The author summarizes the future research direction in combination with high-frequency hot words, The details are as follows.Firstly, the research system of digital economy has become a reality according to the framework of digital industrialization, industrial digitization, digital governance, and data value. To a certain extent, this reflects the current situation of digital economy research. In the future, the transformative development of digital economy innovation system will drive the qualitative change of social-spatial structure and corresponding functions. It will analyze the mechanism changes of digital technology, digital trade, digital finance, digital government, and digital security from the dimensions of economy, culture, politics, and technology, so as to provide strategic support and corresponding guidance for global economic governance .Secondly, the digital economy brings about the overall digital transformation of social and economic space, and moves toward daily, specific, and subtle. In the process of digital integration, building a people-centered digital social space and improving people's digital literacy will become an important topic for future research. For example, rural digital transformation needs to reshape the countryside in an integrated and all-around way, and drive the transformation of rural development mode with the help of digital intelligent technology. This requires not only the digital driving force of rural economic and industrial structure but also the digital reshaping of the overall rural operation system. Clarify the purpose and mode of digital transformation. While empowering urban development, the final value appeal should reflect the value appeal of the people, and finally, truly realize the sharing of development achievements among the people.Thirdly, from the perspective of discipline development, the discipline of digital economy is generating its own unique narrative paradigm, becoming a discipline, and constantly challenging the traditional economic research framework. The development framework of digital economy discipline includes the connotation, essential characteristics, evolutionary development mode, dynamic mechanism, driving mechanism, policy system, experience reference, development dilemma, and optimization path of digital economy. To a certain extent, the development of digital economy discipline will lead the development direction of economic theory in the future.Finally, digital sovereignty, digital rights, and data privacy protection have become the focus of research. Data are no longer traditional data. Data have become a factor of production in the field of production and an important part of digital economy; In the process of social transformation and development driven by digital economy, the digitization of productivity drives the overall digitization of production relations. In the field of daily life and consumption, data privacy, big data mining, and user imaging have become the focus of platform economy, ranging from individuals to enterprises and countries. Digital risks, digital ethics, and digital governance in the digital era have become the focus of academic circles, and interdisciplinary research by experts in multidisciplinary fields is urgently needed, providing constructive solutions for digital ethics and governance."}
{"text": "Society for Mycotoxin Research by several research groups from Toulouse led by Dr. Isabelle P.\u00a0Oswald and Dr. Olivier Puel and their team \u201cBiosynthesis and Toxicity of Mycotoxins\u201d at the Research Center in Food Toxicology, TOXALIM, INRAE, in cooperation with the Chemical Engineering Laboratory, the Purpan Engineering School and the Pharma-DEV laboratory. The 43rd Mycotoxin Workshop took place at the H\u00f4tel-Dieu Saint-Jacques, which is an ancient hospital from the twelfth century beautifully situated on the left bank of the Garonne River.After 2 years of COVID restrictions, with no Mycotoxin Workshop in 2020 and an online only workshop last year, around 180 scientists from 21 countries met in person at the 43rd Mycotoxin Workshop in Toulouse, France, from May 30 to June 1, 2022. The workshop was organized on behalf of the Society for Mycotoxin Research, Prof. Dr. Hans-Ulrich Humpf, welcomed all participants and emphasized that the Society is a non-profit organization focusing on scientific exchange in the field of mycotoxin research and supporting particularly young scientist. Members benefit from a free print subscription of the official journal of the Society, Mycotoxin Research, and are entitled to a discounted registration fee for the Mycotoxin Workshop. The head of the Research Center in Food Toxicology, Isabelle P. Oswald, also warmly welcomed all participants with some information about Toulouse, details about the scientific and social program, and great thanks to the local organizing team as well as all sponsors supporting the Workshop.During the opening ceremony, the president of the During the scientific program, especially, young scientists presented their latest mycotoxin research results directly from the lab bench in 37 lectures and 83 poster presentations. The following research topics were covered in 8 sessions: (1) occurrence and analyses of mycotoxins in food, feed, and physiological samples; (2) genetics, biology, and new secondary metabolites of toxigenic fungi; (3) effects of mycotoxins on human and animal health; (4) toxicity and risk assessment; and (5) food and feed safety. The scientific program covered new challenging topics, such as the contamination of new feed material, the health aspects of mycotoxins on salmon due to grain-based feed, human biomonitoring, and co-exposure scenarios of mycotoxins with other contaminants such as acrylamide. Other presentations addressed metabolomics approaches to assess toxic effects of mycotoxins, insights into JECFA risk assessment, and mimicking the influence of climate change scenarios on aflatoxin production. In a frame of the scientific tradition, the analytical methods for the determination of mycotoxins in various matrices were a key topic. It was demonstrated that approaches with sensitive mass spectrometry techniques might answer complex questions, such as the mode of action of mycotoxins and their precursors in various cell culture models. Along with in vitro techniques, several in silico methods were presented and discussed. Computational tools have much evolved in recent years and could be successfully used not only for toxicokinetic studies but also for genotoxicity investigations. Besides the major \u2014 and well known \u2014 negative aspects of mycotoxins on human and animal health, new research fields aiming at the use of mycotoxins (and derivatives thereof) as new, future therapeutic agents were also presented.Society to provide a platform for deepening scientific discussions, creating new contacts between researchers from different countries, and initiating new scientific collaborations. Besides the excellent French finger food for lunch, a walking tour in the city of Toulouse, a boat trip on the Canal du Midi, and an outstanding gala dinner at H\u00f4tel-Dieu Saint-Jacques were provided by the local organizers. During the closing session, all participants thanked the organizers with standing ovations and long applause for the excellent conference and some splendid days in Toulouse.The scientific programme was accompanied by several, really great social events. These have a long tradition in Mycotoxin Workshops, in accordance with the aim of the Society for Mycotoxin Research, the president, Hans-Ulrich Humpf, gave a report on the recent activities of the Society, including the proceedings of the meetings of the board of directors during 2021 and 2022. The scientific highlight last year was the 42nd Mycotoxin Workshop, first ever online conference of the Society, organized from the Institute of Food Chemistry at the University of Muenster, with around 300 participants from 31 countries  of the Society\u2019s own scientific journal Mycotoxin Research, Prof. Dr. Ewald Usleber, informed the board that he would like to step back from his position after holding it for 15 years. Finding a new EiC was a demanding task, but after intensive internal and external discussions, Hans-Ulrich Humpf agreed to take over this position from January 1, 2023. At the same time, he then will step back from his current position as president of the Society. According to the bylaws of the Society, the board decided that the current vice-president, Prof. Dr. Madeleine Pl\u00f6tz , should take over the position of the president of the Society. The board of the Society is happy to have Dr. hab. Magdalena Twaru\u017cek, university professor , as a new vice-president, until the next official election in 2023, and hopefully beyond that . As this is a major change of the board, the members of the Society were asked for their vote, and they unanimously supported the suggested composition of the new board.During the regular meetings of the board of the Society, Prof. Dr. habil. Manfred Gareis was elected as an honorary member of the Society by the board for his long-lasting activity in the board, acknowledging his outstanding support of the Society.Furthermore, the president reported that the former president of the Society did not fulfill current standards, for example with regard to safety, a new homepage was brought online with the great support of Dr. Carsten Krischek. The new internet portal of the Society can be found at https://www.mycotoxin.de/ and for the Mycotoxin Workshops: https://www.mycotoxin-workshop.eu/. The websites are still under construction and will be continuously improved.As the homepage of the Society, Dr. Benedikt Cramer, gave a short report about the financial situation, which overall developed positively, thanks to reductions in personal costs and a significant gain at the last Workshop.The treasurer of the Mycotoxin Research, gave a short report about the current situation of the journal. Mycotoxin Research and its impact on the scientific community continue to develop very well. In its 38th year of continuous publication, the Society can proudly claim that Mycotoxin Research enjoys an increasingly well reception within the scientific community. For example, the current impact factor  for 2021 is now 4.082. Mycotoxin Research is covered by all major scientific databases worldwide, and online access is guaranteed by our publisher, Springer/Nature. Ewald closed his final report as the EiC with thanking the authors, editorial board members, reviewers, and the publishers of Mycotoxin Research. Without their perseverance, and without the continued support from the membership of the Society, the success story of Mycotoxin Research would not have been possible.Ewald Usleber, the current EiC of Society for Mycotoxin Research. Further information will be available at the website of the Society for Mycotoxin Research (www.mycotoxin.de).The next and 44th Mycotoxin-Workshop will take place on June 5\u20137, 2023, in Hannover, Germany, and will be organized by the group of Madeleine Pl\u00f6tz from the University of Veterinary Medicine Hannover in cooperation with the"}
{"text": "From 24 February 2022 to 29 March 2022, Poland has taken 2,377,000 refugees fleeing Russia's invasion of Ukraine. They are mostly women, children, and the elderly. In this article, we present all activities and types of medical resources provided and organized in Poland for refugees from the first days of the conflict. Information has been compiled from the data available on the Polish Ministry of Health, other governmental and non-governmental organizations, foundations, and medical societies. From 24 February 2022 to 29 March 2022, due to the attack of the Russian Federation on Ukraine, thousands of Ukrainian citizens began to travel to Poland in search of shelter and support. By the tenth week of the conflict, 2,377,000 refugees had crossed Poland's borders , mostly Aim: We seek to identify characteristics of all activities and types of medical resources that are provided and organized in Poland for refugees from Ukraine territory affected by the war from the first days of the conflict.Online resources were systematically searched using the following terms: \u201cUkrainian refugees\u201d and \u201cPolish medical aid.\u201d Information was obtained from the Polish Ministry of Health and other governmental and non-governmental organizations, foundations, and medical societies. This analysis was supplemented by a review of Polish law acts.Organizing medical points at Ukrainian-Polish border crossings and reception areas in each voivodeship.In these areas, first aid is provided by doctors, nurses, paramedics, and volunteers.Government relased an act for assistance to Ukrainian citizens in connection with armed conflict in Ukrainian territory on 12 March 2022.The special act, in force from 24 February 2022, grants the right to medical benefits, reimbursement for drugs, and the supply of medical devices to Ukrainian citizens who came to Poland due to aggression from Russia on the same terms as for all insured Polish citizens  for the injured/wounded because of military actions, young patients with cancer patients, patients in palliative care, pregnant women, women with toddlers, and children and/or orphans from Ukraine.Each train can carry up to 160 patients, including 80 patients lying down. In such cases, medical assistance is provided by highly specialized medical centers. The National Hospital in Warsaw is prepared to receive the wounded. Moreover, 120 hospitals are deemed ready to accept the victims of the war.Organization of oncological treatment for young Ukrainian patients with cancer.To coordinate the activities, a transfer center was established in Bocheniec\u2014the \u201cJednoro\u017cec\u201d clinic of Marian Wilemski (Unicorn Clinic). More than 500 Ukrainian children with cancer have been evacuated to a Unicorn Clinic. The facility adopts medical triage. Children and their families receive medical assistance and shelter there. Then, they are transported to specialized clinics in Poland and abroad . St. Jude Children's Research Hospital has set up a command center to help manage information and coordinate treatment worldwide.Provision of targeted, highly specialized medical assistance, such as oncology, hematology, nephrology, diabetes, and neurology treatment, at departments and clinics in Poland.Launch of a 24-h crisis hotline dedicated to border services and staff of reception points accepting refugees from Ukraine to aid disabled people.Proxy of the Minister of Health for transfer and continued treatment outside the Republic of Poland for Ukrainian patients staying in the territory of the Republic of Poland in connection with the ongoing war in the territory of Ukraine.Launch of the Teleplatform of First Contact with permanent medical service provided to Ukrainians.Launch of a free helpline in Ukraine for people in need of psychological support.Launch of a free search engine for medical entities, in which communication in Ukrainian, Russian, or English language is possible. The search engine enables automatic location on a map and indicates the nearest units. One can also enter a specific city or address.Glossaries and medical translators.In the first days of the war, the Naczelna Izba Lekarska  prepared translations of medical interviews and glossaries for medical staff to communicate with refugees from Ukraine.The war and humanitarian crisis in Ukraine brought about a significant exodus of the inhabitants of Ukraine mainly to Poland. The armed conflict in Ukraine and the wave of refugees flowing into Poland pose a particular challenge for the Polish public health system in terms of providing these people with medical, social, and economic care. Medical assistance in response to health threats accompanying mass migrations, organization of education, labor market, and risks related to the destruction of the migrants' social lives and environment are some of the problems and challenges related to the humanitarian catastrophe caused by war; the effects of which are being and will also be borne by Poland.The implementation of each of the abovementioned tasks related to medical assistance requires an efficient system for monitoring incoming refugees to identify their needs, including medical needs. Thanks to this, it will be possible, among other things, to direct those in need of help to the appropriate medical centers and to implement appropriate prophylactic, diagnostic, and treatment processes, which in the long run, will have a positive impact on both the assisted and interests related to the health security policy of Poland.It is important, however, that every citizen of Ukraine in Poland benefits from free hospital care, specialist treatment, dental services, outpatient treatment or first aid from a family doctor, and diagnostic tests (as directed by a doctor). Services provided to Ukrainian citizens are settled by the Polish healthcare payer, the National Health Fund. The situation remains very dynamic, and the range of needs will evolve over time.EF, MM-W, and SD-G analyzed the data, did critical discussion and reading, and wrote the paper. All authors contributed to the article and approved the submitted version.This work was supported by the Grant of Medical University of Silesia in Katowice, Poland.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "Firmicutes, Bacteroidota, Actinobacteria, Proteobacteria, Fusobacteria, and Verrucomicrobia. Among the African population, the typical members of the microbiota are Bacteroides and Prevotella. The gut microbiome of Asians is very diverse and rich in members of the genera Prevotella, Bacteroides Lactobacillus, Faecalibacterium, Ruminococcus, Subdoligranulum, Coprococcus, Collinsella, Megasphaera, Bifidobacterium, and Phascolarctobacterium. Among Buddhists and Muslims, the Prevotella enterotype is characteristic of the gut microbiome, while other representatives of religions, including Christians, have the Bacteroides enterotype. Most likely, the gut microbiota of people of different nationalities and religions are influenced by food preferences. The review also considers the influences of pathologies such as obesity, Crohn\u2019s disease, cancer, diabetes, etc., on the bacterial composition of the guts of people of different nationalities.High-throughput sequencing has made it possible to extensively study the human gut microbiota. The links between the human gut microbiome and ethnicity, religion, and race remain rather poorly understood. In this review, data on the relationship between gut microbiota composition and the nationality of people and their religion were generalized. The unique gut microbiome of a healthy European  is characterized by the dominance of the phyla  Bacteroidota, Firmicutes, Proteobacteria, Actinobacteria, Fusobacteria, Verrucomicrobia, and Cyanobacteria, and they are represented in different proportions . As a result, the fasting microbiome is characterized by several features ,91,92,93Firmicutes and Actinobacteria were dominant in pre-fasting Pakistanis compared to the Chinese, who showed an increase in Bacteroidota. At the end of the fast, the Chinese group showed increased levels of Dorea, Klebsiella, and Faecalibacterium. The Pakistani group was characterized by enrichment with Sutterella, Parabacteroides, and Alistipes [Prevotella type was the characteristic enterotype of the intestinal microbiome. The Bacteroides type was characteristic of the Chinese microbiota. Based on these studies, a conclusion was drawn regarding the correspondence between enterotypes and religions; i.e., for Buddhists and Muslims, the Prevotella type is characteristic, while for representatives of other religions, the Bacteroides type is characteristic [It has also been found that fasting promotes a change in the beta diversity of the gut and some taxa . The stulistipes . Similarlistipes . A groupteristic .The study of the microbiome of the Slavs is of great scientific interest. This is due to the fact that representatives of this ethno-linguistic group are widely settled in the territories of Southern, Northern, and Eastern Europe. This geographical factor contributes to the features of culture and lifestyle, including nutrition, which is directly related to the characteristics of the human microbiome . ScientiThe bacterial composition of the gut is directly dependent on lifestyle, diet, and diseases of various origins, including obesity, diabetes mellitus, pyelonephritis, hypertension, etc. ,112,113.Studies of the microbiome of the Slavs living in Western Europe, in countries such as Poland, the Czech Republic, Slovakia, and Hungary; in Southern Europe, including Slovenia and Macedonia; and in Eastern Europe, namely in Ukraine, mainly aimed to investigate the bacterial composition in regard to the pathological processes in the body and the norms ,115,116.Firmicutes, Bacteroidota, Actinobacteria, Proteobacteria, Fusobacteria, and Verrucomicrobia. At the same time, about 90% of the gut microbiota are Firmicutes and Bacteroidota [It is important to note that studies of the gut microbiomes of healthy people are rarely found in scientific journals. However, a few studies that have been presented to date play a significant role in understanding the relationship between the human microbiome and factors of the external and internal environment . The maieroidota .Actinobacteria were the most abundant members of the microbiome in summer, and Bacteroidota were much less common in the samples, while the content of Firmicutes did not depend on the season.It is known that the dietary habits of people often directly affect the composition of the gut microbiome. For example, it has been suggested that the features of the microbiome composition of the Ukrainians may be associated with the consumption of rye bread and pork fat . The depFaecalibacterium, Bacteroides, and Roseburia were regular components of the microbiomes of all research objects [Actinobacteria and Firmicutes in the intestine increased, while Bacteroidota steadily decreased, with age. An increase in the Firmicutes/Bacteroidota ratio was correlated with age [Enterococcus faecalis in the microbiome depended on the mode of delivery, and the Bacteroides/Prevotella ratio was correlated with birth weight and the baby\u2019s weight at the end of the first month of life [The microbiome of Slovenians was also studied . It is k objects . Studieswith age . The dev of life .Firmicutes and a lower level of Bacteroidota were found in obese people [One of the goals of studying gut microbiota is to discover the role of the microbiome in the development of diseases of various origins, including obesity. Currently, the gut microbiota is perceived by the scientific community as a separate \u201cmetabolic organ\u201d ,119. ThuFirmicutes and Bacteroidota were found to be the predominant components of the microbiome, Clostridia and Bacteroidia were also common classes, and Clostridiales and Bacteroidales were the most numerous orders inhabiting the intestine [Firmicutes/Bacteroidota ratio in the gut microbiota of obese people, specifically.Recent studies have shown that gut bacteria play an important role in maintaining normal body weight. For more than a decade, a significant increase in the prevalence of obesity in adults and children has been recorded ,125. Polntestine . Similarntestine . There wLactobacillaceae and Enterobacteriaceae.Work by Czech researchers was devoted to the study of the microbiome in short bowel syndrome, which described the effects of the intestinal microbiome on clinical outcomes of patients with this disease . A charaBacteroidetes , coupled with a decrease in Firmicutes  [It has been proved that the bacterial composition of the gut directly depends on the state of human health ,127. AccLactobacillus in people with autism [Bacteroidota/Firmicutes in the gut and the existence of a correlation between the severity of autism and the severity of gastrointestinal dysfunction.As noted earlier, the composition of the gut microbiome is associated with the functioning of the brain . The assh autism . In addiRikenellaceae, Clostridiaceae, Christensenellaceae, and Ruminococcaceae.A similar relationship between dysbiosis and neurological and mental illness was found in the Czech Republic . The resClostridia and Bacteroidia classes are involved in inflammation of the mucous membranes. Increased contents of Proteobacteria and Actinobacteria were revealed, while the contents of Bacteroidota and Verrucomicrobia were reduced in comparison with the control group. Similar studies were carried out in the Czech Republic [Akkermansia muciniphila, Butyricicoccus pullicaecorum, and Clostridium colinum were decreased in the gut. In studies on the microbiomes of the population of people living in the central part of Russia, an increase in the bacteria Haemophilus, Olsenella, Prevotella, Cedecea, Peptostreptococcus, Faecalibacterium, Lachnospira, Yersinia, and Leuconostoc was shown [Changes in the intestinal profiles of Polish patients with ulcerative colitis were shown . It was Republic . It was as shown .Prevotella, Bacteroides, Clostridium, and Faecalibacterium as such indicators [Prevotellaceae family compared to patients with subclinical atherosclerosis.In addition to obesity, cardiovascular diseases, particularly atherosclerosis, are common and dangerous diseases in Europe ,134. BacBacteroides, Bifidobacterium Veillonella, and Lactobacillus in the intestine, while the number of Staphylococcus and Pseudomonas is increased significantly.It is known that a pathological immune response can be initiated in the intestine and that it can cause the development of multiple sclerosis . This diBacteroidota, Firmicutes, and Actinobacteria, accompanied by an increase in Proteobacteria, including the prevailing members of the family Enterobacteriaceae. For example, it was shown that, during the period from June to the end of November, there was a decrease in the bacteria typical of inflammation, such as Eggerthella lenta, Fusobacterium spp., Bacteroides spp., Helicobacter spp., etc. The numbers of Pediococcus spp., Clostridium spp., and Escherichia/Shigella spp. increased.A team of scientists from the University of Bratislava examined the microbiomes of patients with inflammatory bowel disease . IntestiBifidobacterium content and an increased Candida content in contrast to a healthy group of children [Bifidobacterium and Lactobacillus increased compared to those children whose diet was not changed [In a study of the microbiome, the state of the intestines of patients of different age groups, including children, was assessed. The intestinal condition of children with stable idiopathic nephrotic syndrome was characterized by a decreased children . Changes changed .Bacteroides, and a higher abundance of Prevotella. The authors explained this finding by the fact that the inverse correlation of the Prevotella bacteria was associated with the consumption of sucrose.It is not only the cases of changes in the microbiome under the influence of a particular disease but also cases of changes under the influence of other factors, such as lifestyle, that attract the interests of researchers. For example, an interesting study examining the gut microbiome in athletes was carried out in Poland . In contFirmicutes and Actinobacteria, which are associated with a healthy gut) and underrepresented communities rich in Bacteroidota [Firmicutes and Actinobacteria, which nutritionally specialize in starch [R. bromii and E. rectale) showed an increase when resistant starch was introduced into the diet [The microbiota of the Russian population is of particular interest to researchers since Russia includes a wide range of environmental conditions and ethno-geographic cohorts. In one of the studies, the geography of the sampling covered a significant part of the densely populated zone of the territory of Russia, including regions of Europe and southern Siberia. The urban-type settlements were represented by four of the ten most populous cities in Russia , and the rural centers by eleven villages and towns in Tatarstan, Omsk, Tyva, and Khakassia. New features of the Russian microbiomes included gut microbial communities . The subgroups of Tatarstan and Tuva differed in their composition; both were formed by similar metagenomes based on butyrate-producing Firmicutes , while the latter also contained high proportions of the Firmicutes. The rural subtypes found were especially interesting because of the strong associations of these bacteria with the health of the host. It was found that the composition of the microbiota profiles of the rural population was similar within each region and was represented by the taxa of bacteria associated with a \u201chealthy\u201d gut. The composition of the microbiota profile in the urban population was less diverse than in the rural population. This difference is most likely associated with the diets of the people [Another large-scale study also showed significant differences between the microbiomes of the populations of Russia, the United States, Denmark, and China. Most genera of the Russian microbiome belonged to  samples ,142. Theobserved . Other uSince some of the identified communities are mainly composed of species associated with a healthy gut, microbiome research is of significant interest for identifying local configurations of the human microbiota and altering the microbiota functions regarding to health and disease.Proteobacteria was found, due to the prevalence of the classes Betaproteobacteria and Gammaproteobacteria in allergic asthma, and in patients with the non-allergic phenotype of the disease, mainly due to the class Gammaproteobacteria. In bronchial asthma, a disturbance of the metabolic function of the intestinal microbiome was revealed: the proportion of taxa producing butyrate  and acetate (Alistipes) decreases [Moreover, studies of the intestinal microbiomes of the Russian population were carried out about various pathologies. The intestinal microbiota of people suffering from bronchial asthma is characterized by the same diverse taxonomic composition of metagenomes as the microbiota of healthy people; however, some differences were found. In patients with bronchial asthma, an increase in the proportion of ecreases .Lactobacilli, which form the basis of a normal intestinal microbiome, were detected in only 53.3% of the examined children. The most pronounced dysbiotic manifestations in adult patients with tuberculosis were those of Enterococcus spp. and E. coli, with normal enzymatic activity [In children with respiratory tuberculosis, the intestinal microbiota has some characteristic features. activity .Gemmiger sp. And unclassified Ruminococcaceae was associated with this disease. The most significant change associated with multiple sclerosis was a relative abundance of some members of the phylum Firmicutes, such as Acidaminococcaceae, Eubacteriaceae, and Christensenellaceae, as well as some unclassified Firmicutes and Clostridia. The family Desulfovibrionaceae, with the genera Bilophila and Desulfovibrio, represented by one OTU of Bilophila wadsworthia and seven OTUs of unclassified Desulfovibrio, turned out to be more numerous in the cohort with primary progressive multiple sclerosis. Although Desulfovibrio piger is found in the intestines of some healthy individuals, higher numbers of this species may be associated with certain gastrointestinal diseases, such as inflammatory bowel disease or autism [The gut microbiota largely shapes human health by contributing to the development of various autoimmune diseases, both intestinal and non-intestinal, including multiple sclerosis. Altered composition of gut bacteria was found in patients with primary progressive multiple sclerosis compared to healthy subjects. A marked increase in the relative abundance of the two dominant OTUs , r autism .Firmicutes sequences, which are the dominant component of the gut microbiota of healthy people in Russia, was lower in patients with ulcerative colitis, while the proportion of Proteobacteria sequences was higher. In some samples, significant sequence contents of the pathogenic representatives of Firmicutes and Proteobacteria were also found, including Acinetobacter spp., Enterococcus spp., K. pneumoniae, P. mirabilis, S. aureus, St. maltophilia, Streptococcus spp., and C. difficile [The proportion of ifficile .Bifidobacterium spp., Bacteroides spp., and Lactobacillus spp. In addition, a large number of E. coli, including the enteropathogenic strains, was detected in the bile of the patients. Enterococcus isolated from the gallbladder of patients with cholelithiasis was characterized by a wide range of pathogenicity genes. Moreover, in the microbiocenosis of the gallbladder, a strain of E. faecium with a gene providing resistance to the antibiotic reserve vancomycin was found [In Russian patients with cholelithiasis, a wide range of bacteria localized in the gallbladder were revealed, mainly representatives of the genera as found .All races and nationalities are distinguished not only by their genetic potentials but also by the living conditions in which they are formed. The concept of the multifactorial action of the environment provides a special contribution to the process of the formation, growth, and development of gut microbiota. These factors are, first of all, the geography of residence, social status of a person, religion, health, and socio-cultural environment, as well as food habits and preferences. These factors leave an imprint on the composition of the bacteria inhabiting the gut and their numbers. Therefore, we can discuss a direct relationship between the gut microbiome and ethnicity.Firmicutes, Bacteroidota, Actinobacteria, Proteobacteria, Fusobacteria, and Verrucomicrobia, with Firmicutes and Bacteroidota dominating (90%). To date, several studies have been carried out that can provide generalized information about the features of the intestinal microbiomes of people living in different countries and with different income levels, cultural and religious statuses, dietary habits, and diseases. Thus, the Prevotella enterotype of the intestinal microbiome is characteristic of Buddhists and Muslims, while the rest of the representatives of religious movements, including the peasantry, have the Bacteroides enterotype. It is important to understand the lifestyle of a person. For example, among athletes, unlike sedentary people, the bacterial taxon Prevotella predominates in the gut microbiome. In terms of disease, the dominance of Firmicutes over Bacteroidota is a characteristic pattern of the gut microbiomes of obese people.The dominant bacterial taxa of the intestines of any healthy person are Firmicutes, Actinobacteria, Bacteroidota, Proteobacteria, Fusobacteria, and Verrucomicrobia over the rest of the bacterial taxa, while only Firmicutes predominate in the guts of Americans. Among the African population, the characteristic microbiota is Bacteroides and Prevotella. The gut microbiomes of Asian residents are very diverse and rich in members of the genera Prevotella, Bacteroides, Lactobacillus, Faecalibacterium, Ruminococcus, Subdoligranulum, Coprococcus, Collinsella, Megasphaera, Bifidobacterium, and Phascolarctobacterium. In general, it can be assumed that the Asian type of gut microbiome is the healthiest. This can partly be explained by the food preferences of the inhabitants of this region. Regarding the healthiest microbiome in terms of religion, it is difficult to draw any conclusions about the healthiest microbiome due to the limited publications on this issue.The uniqueness of the healthy intestinal microbiome of a European  lies in the dominance of the phyla Further detailed large-scale studies of the bacterial diversity of the intestines of various peoples and races will provide clear information about the distinctive and unique components of the microbiomes inherent in each of them."}
{"text": "David Hunter Hubel was one of the most outstanding neuroscientists of the twentieth century Fig. . Born onAfter graduation in 1951, he did three years of hospital training plus a year of clinical neurophysiology at the Montreal General Hospital, under the mentorship of Herbert Jasper, for whom Hubel was reading electroencephalograms , and wasAfter a year, he was drafted by the army and assigned to the Walter Reed Army Institute of Research, Neuropsychiatry Division. Hubel had no experience in electrophysiology or animal research  but coulJournal of Physiology [It was in 1958 that Hubel started his collaboration with Torsten Wiesel, who had experience with retinal cell recording, having worked with Ken Brown . Hubel aBy performing experiments on cats (and then monkeys) with the microelectrode mentioned above, an advancer and an ophthalmoscope, Hubel and Wiesel explored a region that hardly anyone else was focusing on . They weBrain and visual perception: the story of a 25-year collaboration [Their collaboration, portrayed in the book boration , culminaboration . Their fAmong the many other accolades, Hubel, who was the John Franklin Enders University Professor of Neurobiology, was elected to the National Academy of Sciences (1971), awarded the Louisa Gross Horwitz Prize from Columbia University (1978), was a founding member of the World Cultural Council (1981) and was elected as a Foreign Member of the Royal Society (1982). He won the Golden Plate Award from the American Academy of Achievement and the Ralph W. Gerard Prize in Neuroscience from the Society for Neuroscience (1993). He was also the President of the Society for Neuroscience between 1988 and 1989.David Hubel was innovative, enthusiastic, and witty , yet worOn the 22nd of September 2013, seven months after his wife Ruth passed away, he died from kidney failure in Lincoln, Massachusetts, survived by three sons and four grandchildren. In addition to his breakthrough discoveries and beautifully crafted papers, David Hubel\u2019s scientific legacy includes his passion for fundamental, discovery-based research , which h"}
{"text": "Victor Chee Wai Hoe is not included in the author byline. Victor Chee Wai Hoe should be listed as the ninth author, and his affiliation is 1: Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. The contributions of this author are as follows: Conceived and designed the experiments, contributed reagents/materials/analysis tools, and approved the final version to be published."}
{"text": "With limited medical resources, it is of great significance for countries all over the world to explore architectural design methods to enhance the value of medical facilities. Therefore, it is very necessary to carry out an extensive international comparison. In order to grasp the research trend of healthcare facilities in the world, this paper conducts co-occurrence analysis, cluster analysis, and trend analysis of the keywords of 334 English articles and 153 Japanese articles related to healthcare facilities published in important academic journals in the USA and Japan in the past 15 years. We not only compare the similarities and differences in healthcare facility research between the USA and Japan, but also explore the reasons for these differences. It is found that by introducing three kinds of value variables, such as time, space, and behavior, we can not only well explain the difference in the solution of healthcare facilities in the USA and Japan to reduce medical costs but also provide new ideas for architectural design to enhance the value of hospitals. Based on the above analysis, a conceptual framework of value-based design of healthcare facilities that combines the advantages of the USA and Japan is proposed in this paper. Healthcare systems all over the world are facing the problem of both improving the quality of healthcare and controlling medical costs. Thanks to the booming medical technology, the average human life expectancy has increased rapidly from the 40s before World War II to nearly 80 years at present over the past three-quarters of a century. However, due to the infinite increasing characteristics of healthcare services, medical costs all over the world might increase faster during this period. For example, healthcare costs in the USA reached 16.7% of GDP in 2019  survey, has played an increasingly important role in healthcare design, and the currently popular evidence-based design (EBD) approach was formed under such a trend , which was founded in 2007  Journals, which include the Journal of Architecture Planning, Journal of Structural and Construction Engineering, Journal of Environmental Engineering, and AIJ Journal of Technology and Design, are the top academic journals in the field of architecture in Japan  patient safety, fall, risk, sleep, and activation; (2) patient-centered care and family-centered care; (3) infection control, contamination, and transmission; (4) human factors, efficacy, and quality improvement, which are important issues for the research-based design of healthcare facilities.Cluster 1 labeled as Users' Perspective mainly includes the following aspects: (1) satisfaction, particularly patient satisfaction; (2) preferences; (3) health, particularly mental health; (4) stress, anxiety, depression, burnout, pain, and mood; (5) nature, art, music, positive distractions, and social support.Cluster 2 labeled as Healthcare Providers' Perspective mainly focuses on the environmental design of efficient and effective care in the nursing unit, emergency department, and so on. The main research topics include the following aspects: (1) impact, efficiency, outcomes, and quality; (2) communication, teamwork, and collaboration; (3) security, safety, visibility, and mortality; (4) work and workflow.Cluster 3 labeled as Design mainly includes the following aspects: (1) noise, sound, lighting, and light; (2) perception, way-finding, and behavior; (3) ergonomics and errors; (4) nurse satisfaction, exposure, and fatigue; (5) management, performance, reliability, etc., which are the important issues for the general design of healthcare facilities.Cluster 4 labeled as Healthcare Providers' Perspective are still important even in the patient-centered era.As shown in Cluster Set I labeled as Community-based Integrated Care includes cluster 1 and cluster 9. It mainly focuses on environmental design that contributes to the quality of life for the elderly  the way to promote the widespread use of healing arts in the hospital  reducing nurse burden and walking distance through the reasonable layout of ICU and acute care unit in Cluster set III; and (4) optimizing the design of medical aid stations and improving the initial action system of disaster base hospital by careful preparedness in Cluster Set IV.As shown in hospital  in ClustThe 4 cluster/cluster set labels and the most frequently occurring keywords in the articles selected from HERD and AIJ Journals are shown in Users' Perspective and Healthcare Providers' Perspective, respectively, and the two sides of the horizontal axis in Patients' Perspective and Nurses' Perspective, respectively. The research objects of the USA and Japan on the horizontal axis are similar, indicating that both users and healthcare providers are key research topics in healthcare facilities in different countries.First, the two sides of the horizontal axis in Design and EBD, respectively. The Design cluster focuses on general design issues, while the EBD cluster focuses on design issues that require in-depth study. The upper and lower sides of the vertical axis in Emergency and Disaster Preparedness and Community-based Integrated Care, respectively, because Japan is prone to many disasters and has an aging population.Second, the longitudinal axis in care unit design is taken as an example to further discuss the similarities and differences in healthcare design research between the USA and Japan, which is described in detail in the following section.The As one of the main means of reducing medical costs, the USA has paid great attention to research that can shorten the length of stay. The results published in HERD articles suggest that factors that can shorten the length of stay include sunlight , views o2 (11.2 m2), 160 ft2 (14.9 m2), and 250 ft2 (23.2 m2), respectively , 8584, 8Studies on nurse activities have always been concerned in Japan . EspeciaOnly the decentralized nurse stations equipped with HIS , 88 and Unlike the traditional follow-up survey, many new technologies have been applied in the study of nurse activities in recent years. For example, ultrasound positioning technology has been used to collect data on nursing activities consecutively for 1 week , and BIMOverall, the USA studies of care units focus on the healthcare environment that could shorten the length of stay and improve patient and staff satisfaction, while Japan focuses on the spatial layout to improve the efficiency and effectiveness of nursing care. Taking patient satisfaction as an example, there have been 90 related articles in HERD since 2007, accounting for 26.9% of the total, while there are only two related articles in AIJ Journals, accounting for 1.3% of the total.Research goals are also significantly different between the USA and Japan. In the case of studies related to the physical environment, such as indoor environment or view outside the window, most Japanese studies just stay at the level of reducing patient or staff stress and anxiety, while American studies will even achieve the level of performance, such as healing effects or length of stay .As for research methods, EBD occupies a central place in the USA, while Japanese architectural planning mainly refers to POE analysis or computer simulation based on field surveys.As shown in As mentioned above, the research topics and solutions for the healthcare environment with limited medical resources are quite different in the USA and Japan. Through further comparative study between the USA and Japan, we found that time variables such as length of stay, space variables such as bed area and the number of care units per floor, and behavior variables such as nurse activities and nurse system play key roles in care unit design. In this paper, these variables are defined as value variables .First, we discuss the length of hospital stay. The average length of hospital stay in acute beds has fallen from 8.3 days in 1969 to 5.4 days in 2019 in the USA and from 34.4 days in 1994 to 16.0 days in 2019 in Japan in order to cut medical costs , and it 2/bed in Japan, which is only half of the AIA standard  to balance safety, efficiency, comfort, and economy in healthcare facilities with limited medical resources.As shown in As shown in The comparative study of the keywords of HERD and AIJ articles can help researchers and designers to grasp the research system of health facilities in the USA and Japan as a whole and to clarify the position of one research topic in the system and the relationship with other research topics.The USA and Japan have their own strengths in the study of healthcare facilities. EBD occupies a central place in the USA, focusing on revealing the micro-mechanisms between environmental variables and healthcare outcomes. The architectural planning approach adopted in Japan focuses on the relationship between hospital layout and improving care processes, increasing medical efficiency, and reducing health care costs.The differences reflected in the solutions of American and Japanese hospitals in controlling medical costs can be well explained by introducing three kinds of meso-level value variables of time, space, and behavior. Value-based design that combines the advantages of healthcare design in the USA and Japan can largely bridge the gap between macro master plans and micro evidence, which can help architects select, integrate, and absorb the most appropriate research results in healthcare design.Through the coordination between different types of value variables, the concepts and methods of value design help to achieve the balance of safety, efficiency, comfort, and economy of healthcare facilities under limited medical resources.The differences in the value of value variables in different countries reflect the different cultural concepts and value orientations behind them, and the understanding of this point can help architects in developing countries to learn from the experience of developed countries.The limitation of this paper is that it only discusses the value variables of the inpatient department, and further study is required for the outpatient department and the medical technology department. The authors also hope to take this study as an opportunity to trigger more discussions in the academic community.YZ and YS conceived and designed the analysis, collected the data, performed the analysis, and wrote the paper. YX contributed to figure preparation. HY collected some data. All authors contributed to the article and approved the submitted version.This research was supported by the National Natural Science Foundation of China (Grant No. 51978143) and the Healthy Building Industry Technology Strategic Alliance.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "In the published article, there was an error in the affiliation. Instead of \u201cDivision of Life Sciences and Medicine, Department of Radiotherapy Oncology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China,\u201d it should be \u201cDepartment of Radiotherapy Oncology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.\u201dThe authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "The declaration of the conflict of interest is as follows:The authors have informed the Publisher that a conflict of interest was missed in the above-mentioned article published online on September 22, 2021. DOI of the article isDr. Shishir Shetty declares that he received consultation fees from Faron Pharmaceuticals, and the payment was managed by his institution, University of Brimingham, Birmingham, United Kingdom."}
{"text": "In \u201cmHealth Intervention to Improve Treatment Outcomes Among People With HIV Who Use Cocaine: Protocol for a Pilot Randomized Controlled Trial\u201d :e28332) the authors noted two errors.First, in the originally published article the affiliation for author Archana Krishnan appeared as follows:Department of Social Scienes, University at Albany, State University of New York, Albany, NY, United StatesThis has been corrected as follows:Department of Communication, University at Albany, State University of New York, NY, United StatesSecond, in the originally published article a footnote appeared below the affiliations as follows:*all authors contributed equallyThis was deleted in the correction, as it is not applicable.The correction will appear in the online version of the paper on the JMIR Publications website on April 7, 2022, together with the publication of this correction notice. Because this was made after submission to PubMed, PubMed Central, and other full-text repositories, the corrected article has also been resubmitted to those repositories."}
{"text": "Dear colleagues,To keep pace with the dynamism of the evolution of medical knowledge, the journal that transmits it must be equally dynamic and, as an example, prioritize articles that deal with emerging diseases, such as monkeypox, adverse events, or the impacts of anti-SARS-CoV2 vaccines. or even endemic diseases that show high sanitary impact.In addition to the important structural change described above, there are adjustments to the text of the other sections, guidelines, and useful links to help authors. The link to a checklist of summarized reports on each section and its rules, specifications regarding images, tables, and requirements regarding documentation is highlighted.We remain fully committed to the quality and dissemination of ABD, not only within the national and Ibero-Latin American scientific community but also in the dermatological academic world as a whole. We move forward with the common objective of reporting the best science, for the improvement of dermatology, and, as a result, the best care for the patient. Come along, ABD reader, and be a part of this effort.None declared."}
{"text": "The Western Pacific and the Southeast WHO regions of Asia have a variety of economies, from middle-income India, Laos, and Myanmar to high-income OECD countries, such as Japan and South Korea. These regions are home to a sizable population and act as an epicenter of global manufacturing and industrial capacity .While most of Asia was under colonial rule before World War II, it became the fastest-growing economic region of the world in recent decades, manifesting some of the world's longest economic booms, starting from Japan in the 1950s, to South Korea, China, and recently to India and the Tiger Cub Economies, such as Singapore and Malaysia . In contIn addition to these ups and downs, a meager proportion (approximately 4\u20137%) of total GDP has been invested in the health sector in most Asian countries, in comparison to approximately 12% or more of that in European countries, the United States, and other high-income countries. Increased health awareness leading to increased health demand has, directly and indirectly, pressurized the ruling governments in the region to invest in the health sector, leading to multiple and mixed avenues of different opportunities and challenges for health sector growth.Of the total 17 manuscripts accepted for this Research Topic, 14 are original research papers, two are reviews, and one is a perspective article. The manuscripts and total numbers are found under the following six themes: Primary Health Care (PHC) and Health Systems Development (HSD) (four manuscripts);  insurance, governance, and universal health coverage (UHC) (four manuscripts); public health screening (two manuscripts); urban and green economics, and sustainability (two manuscripts); health care profession, ethics, and leadership (three manuscripts); and health tourism and migrants' health (two manuscripts). Geographic coverage is as follows: seven and two manuscripts are from China and Nepal, respectively, and one each represents Asia, the Middle East and North Africa (MENA), Mongolia, Malaysia, South Korea, Japan, and Indonesia .The editors observed that shifting infrastructure development to less developed regions, focusing on women's empowerment, and guiding the referral system may enhance access to PHC and thereby advance health and social development (HSD); for which the non-state actors should work in close collaboration with the state. In order to achieve UHC, the health sector in the next decade is expected to grow and move beyond HSD. For this, in addition to financial and non-financial barriers to health insurance, alternative strategies to existing insurance schemes are crucial, including social health insurance (HI), as some Asian and African countries are moving closer to UHC by HI reforms , 8; imprThe editors believe these valuable and diverse topic contributions might open new horizons of knowledge. Last but not least this is a unique opportunity to open the floor for a public debate on the Asian challenges through the lens of the Global South's health sector growth . The maiMJ and CA prepared the manuscript draft while MJ, CA, and LW revised it for important intellectual content. All authors fulfill ICMJE conditions for full authorship. All authors contributed to the article and approved the submitted version."}
{"text": "Virginia M. Bowden, MSLS, PhD, AHIP, FMLA, director emeritus of the Briscoe Library at the University of Texas Health Science Center at San Antonio  passed away on May 2, 2022, at the age of eighty-two. She was at her home in San Antonio surrounded by her daughters, Sharon and Ellen, and her beloved cat Al. Her husband of sixty-one years, Dr. Charles Bowden, passed away just two months before her on March 1, 2022.Virginia was valedictorian of her class at Stephen F. Austin High School in Houston, and at the University of Texas at Austin, she majored in math and education and took some of the first classes in computer programming. After graduating Phi Beta Kappa in just three years, Virginia worked as a computer programmer for organizations as diverse as Texaco and Bamberger's Department Store. In 1960 she married Charles Bowden, who went to medical school at Baylor University College of Medicine in Houston and did his internship and residency in Chicago and New York City. Virginia earned her master's degree in library science in 1970 at the University of Kentucky in Lexington, Kentucky, while Charles served in the US Public Health Service there.After later settling in San Antonio, Virginia accepted a position at the very new University of Texas Health Science Center at San Antonio (UTHSCSA) as a library systems analyst. She was soon appointed assistant to the director and then associate library director before being selected as library director in 1985, a position she held until her retirement in 2003.Virginia earned a doctor of philosophy degree in library and information science from the University of Texas at Austin in 1994. Her dissertation, entitled \u201cCurrent Monograph Collections: Patterns of Ownership and Use in Four Academic Health Sciences Libraries,\u201d combined her interests in collection development and computers and made use of collection and circulation data from four similar health sciences libraries.Her passion for computers and library automation was apparent throughout her career. In 1971, she managed the library's adoption of PHILSOM , a computer-based serials control system developed by the Washington University School Medicine Library. In 1978, she directed the implementation of the Computer Library Systems, Inc. (CLSI) circulation system, shared with another San Antonio institution, Trinity University. Under her direction, the UTHSCSA Library in 1983 became the second library, after Georgetown University, to implement Georgetown's Library Information System (LIS), an early integrated library system designed for health sciences libraries. The switch to an online catalog, locally called the Biomedical Library Information System (BLIS), coincided with the move to a new, larger library building, and when that move was made, the card catalog was left behind [In 1990, the Medical Library Association (MLA) awarded Virginia the third Louise Darling Medal for Distinguished Achievement in Collection Development in the Health Sciences, recognizing \u201cher creative approaches, publications, and innovating use of machine-readable files for collection decision making and cooperative collection development\u201d . VirginiVirginia's mentorship and love of libraries extended beyond health sci-ences including service as president of the Friends of the San Antonio Public Library from 1989-90. In 2003, she was awarded the Julia Grothaus Award by the Bexar Library Association for her dedication to library service in Bexar County, where San Antonio is located. Virginia also served on the Advisory Council of the University of Texas School of Information.In 1992, Virginia and Charles established the Bowden Massey Foundation, which has funded several library-related projects, including the Virginia and Charles Bowden Professor of Librarianship at the University of Texas at Austin, the Bowden Conference Room at the Briscoe Library, and MLA's David A. Kronick Traveling Fellowship. Later in her career, Virginia focused on access to health information, particularly in the Lower Rio Grande Valley at the southernmost tip of Texas. This included surveying physicians on their use of MEDLINE and other databases; introducing health care professionals to Grateful Med, the floppy disk-based predecessor to PubMed; and promoting MedlinePlus to health care professionals and consumers. Under Virginia's leadership, the UTHSCSA Library developed a robust circuit librarian program in South Texas. Two of the circuit librarians were recognized with the Michael E. DeBakey Library Services Outreach Award for serving rural or underserved populations: Mary Jo Dwyer in 1993 (the first year it was awarded) and Greysi Reyna in 2009.Virginia was especially proud of her six grandchildren and always looked forward to family gatherings. She and Charles enjoyed skiing, spending time in the Colorado mountains where they owned a vacation home, and traveling together to over fifty countries on six continents."}
{"text": "Employing edge and fog computing for building IoT systems is essential, especially because of the massive number of data generated by sensing devices, the delay requirements of IoT applications, the high burden of data processing on cloud platforms, and the need to take immediate actions against security threats. By pushing processing and storage closer to IoT devices, it is possible to reduce the number of data sent to the cloud while also reducing communication delay. To this end, new data aggregation and processing methods are required to distribute computation across the edge-to-cloud continuum. Edge and fog computing can also be used to facilitate communication and resource discovery and enhance the security of IoT devices. New architectures are required to facilitate the communication between IoT devices and servers, depending on the type of application. From the data analytics point of view, efficient and scalable data processing at the edge or task offloading to trustworthy edge/fog nodes is critical to avoid significant delays and network congestion. Meanwhile, the massive and rapidly increasing number of resource-constrained IoT edge devices has significantly extended the attack surface, creating new challenges to ensuring data privacy and communication security against emerging threats and establishing trust among multiple communication parties.This Special Issue has accepted nine papers and presents contributions to various aspects of the design, implementation, and evaluation of edge and fog computing architectures and systems in a wide variety of application domains, such as deep neural-network-based computation, ultra-dense networks, intelligent buildings, medical information systems, smart agriculture, and air quality monitoring. It showcases the challenging research issues and the promising future of the edge and fog computing era.In , the autDue to the resource constraints of edge clouds, edge servers are less reliable. The authors of  focus onThe authors of  propose In , the autIn , the autIn , the autIn , the autThe authors of  propose In , the autFinally, we would like to thank all the authors for their outstanding contributions and the reviewers for promptly providing their insightful review comments. We also sincerely appreciate the excellent support by the Editorial Board and Editorial Office of the MDPI Sensors journal."}
{"text": "Rhodococcus and Acinetobacter degraders and for their relative abundance in the microbiome for the functional zones of Moscow. The opposite effect was observed in the Murmansk leaf dust for the Rothia and Pseudomonas degraders and in the Moscow road dust for Microbacterium. The PCA and linear regression analyses showed that the Micrococcus degraders in the dust were sensitive to anthropogenic pollution, so they can be used as a tool for monitoring anthropogenic changes in the biosphere. The data on the degraders\u2019 and microbial communities\u2019 diversity suggest that minor degrading strains can play a key role in PAH degradation.We performed a comparative study of the total bacterial communities and communities of cultivable polycyclic aromatic hydrocarbons (PAH)-degrading bacteria in different functional zones of Moscow and Murmansk that were formed under the influence of the PAH composition in road and leaf dust. The PAHs were determined by high-performance liquid chromatography (HPLC); the bacterial communities\u2019 diversity was assessed by metabarcoding. The degraders were isolated by their direct plating on a medium with the PAHs. The PAH total quantity declined in the leaf dust from the traffic to the recreational zone. For the road dust, a negative gradient with pollution was observed for  Betula pendula Roth, thereby making it a good indicator of the anthropogenic load pyrene or phenanthrene, which represented 39.3% and 32.3% concentrations, respectively. The degrading bacteria that was grown on the individual substrates were additionally tested for the degradation of the other PAHs that were used in the work. In addition, salicylate, a key metabolite for the degradation of naphthalene, phenanthrene, and anthracene , was useA cross-check of the substrate specificity revealed that the majority of the strains that were isolated in this work were capable of oxidizing one of the most toxic PAHs, benz[a]pyrene (95.7%). This effect demonstrates the adaptive capacity of the microbial community to the key pollutants of the urban ecosystem.Rhodococcus, Bacillus, Micrococcus, Methylorubrum, Acinetobacter, Arthrobacter, Pseudomonas, Microbacterium, Paenibacillus, Rothia, Pantoea, Phyllobacterium, Pseudarthrobacter, Stenotrophomonas, Nocardioides, Exiguobacterium, Methylobacterium, Brevundimonas, Staphylococcus, Streptomyces, Leifsonia, Dermacoccus, Gordonia, Rhizobium, Cellulomonas, Curtobacterium, Kocuria, Deinococcus, Rahnella, Enterobacter, Moraxella, and Shinella. In the Murmansk dust samples, the diversity of the genera to which the isolated PAH degraders belong was two times higher than when it was compared to the samples from Moscow  and recreational  zones in the different Murmansk and Moscow biotopes. No common genera of degrading bacteria were identified for the traffic zone dust between the cities. We carried out a parallel analysis of the taxonomic diversity of the microbial communities from the two biotopes (road dust and leaf dust) of the three functional zones  in Moscow and Murmansk. The range of the total relative abundance of the PAH-degrading genera varied from 2.72% to 10.89% for the dust samples from Murmansk and from 2.51% to 7.12% for the dust samples from Moscow. The relative abundance of each of these genera in the microbiomes of the dust samples from Moscow ranged from 0.01 to 4.00%; for samples from Murmansk, this ranged from 0.01% to 4.20% ; in the recreational zone, these were M GP8BP and M GL1PH (Micrococcus). This indicates the movement of bacteria between the biotopes within the same functional zone. No such effect was detected for the dust samples that were collected in Murmansk.To establish the phylogenetic relationship between the strains that were isolated from the road and leaf dust and to study their diversity, we performed the REP-PCR with the primer (GTG)5 . The phyIxora spp. growing on the roadsides in Thailand were the bacteria of the genera Pseudomonas, Microbacterium, Rhizobium, and Deinococcus [Acinetobacter, Pseudomonas, Pseudoxanthomonas, and Mycobacterium which were isolated from the ornamental plant phylloplane in Bangkok accounted for 1\u201310% of the microbial community. These bacteria possess a high ability to degrade PAHs, including low-molecular-weight  and high-molecular-weight  compounds [Phyllosphere bacteria can be active degraders of the gaseous and deposited PAHs that are on leaves ,47,48. Tompounds . An analThe isolated strains of the PAH degraders from the leaf dust belonged to the following genera: Rhodococcus, Bacillus, Micrococcus, Acinetobacter, Pseudomonas, Microbacterium, Paenibacillus, Rothia, Pantoea, Stenotrophomonas, Exiguobacterium, Methylobacterium, Brevundimonas, Staphylococcus, Rhizobium, Kocuria, Rahnella, Enterobacter, Moraxella, and Shinella. Rhodococcus, Bacillus, Micrococcus, Methylorubrum, Acinetobacter, Arthrobacter, Pseudomonas, Microbacterium, Paenibacillus, Rothia, Phyllobacterium, Pseudarthrobacter, Nocardioides, Streptomyces, Leifsonia, Dermacoccus, Cellulomonas, Curtobacterium, and Deinococcus. An analysis of the relative abundance of the identified PAH-degrading microbial genera in the road-dust of the functional zones in Moscow and Murmansk is shown in To date, extensive research has been carried out on degrading bacteria and the microbial communities of roadside soils and air ,49. StudArthrobacter were found only in the road dust of all of the functional zones in Moscow. The strains of the genera Phyllobacterium, Pseudarthrobacter, and Methylorubrum were revealed only in the Moscow traffic zone . This is clustered into a separate subgroup. The sample (U TL) is characterized by it having the highest total content and diversity of the composition of the studied PAHs in comparison with that of the other samples of the dust from the leaf surfaces. This is indicative of a strong pollution of atmospheric air and, consequently, of both of the biotopes in the traffic zone of Murmansk. Probably, such a strong pollution of the leaves is because the dust sampling point in the traffic zone is located in the immediate vicinity of the Murmansk Thermal power station ,60.It should be noted that the leaf dust samples from the three functional zones of Murmansk  vary greatly in their composition of PAHs and belong to three different clusters, with the traffic zone being the most polluted. In the case of the leaf dust samples from Moscow, the pattern is different: the dust from the traffic zone (M TL) and the residential zone (M RL) belong to the same subgroup, and the samples from the recreational zone (M GL) are attributed to another cluster. Moreover, the dust samples from the roads of the recreational areas of Moscow and Murmansk (M GP and U GP) are allocated to one subgroup, as are the dust samples from the leaves (M GL and U GL). This suggests that there is a similar pattern regarding the PAH pollution in the recreational areas of Murmansk and Moscow.The hierarchical clusters of both the PAH concentration A and theTo detect the relationship between the isolated degraders, the studied PAHs, and the biotopes of the functional zones of the cities, a PCA and a linear regression were used.Paenibacillus content, and it was negatively correlated with naphthalene  are apparently present in the green zone biotopes which contribute to a higher relative abundance of these degraders\u2019 genera.The PAH-degrading bacteria of the genus Micrococcus, based on their relationship to the level of the PAH pollution in the ecosystems, enables researchers to choose them as a tool for monitoring the anthropogenic changes in the biosphere.The data that were obtained suggest that the degrading strains of the genera which were identified in this work are minor representatives of these genera in the microbial community, and they may play key roles in PAH degradation. These results expand our views of the PAH degraders\u2019 distribution in different functional urban zones. The high indicative capacity of the degrading bacteria of the genus The logical difficulties that are caused by the constant change in the intensity and characteristics of the technogenic load, the variation in the size and configuration of negative anthropogenic influence zones, and the management and natural changes in the phytocenoses and soils as a result of urban redevelopment arise when one is monitoring the distribution and accumulation of the organic pollutants in natural objects under urban conditions. An important aspect of monitoring the urban ecosystem is the assessment of the PAHs\u2019 impact on the changes in the microbial communities of various biotopes. Bacteria with a huge variety of enzyme systems and high lability of their metabolism are mainly responsible for the self-purification of natural ecosystems, including urban ecosystems, and they are capable of carrying out the biodegradation of natural and synthetic xenobiotics, thereby returning the main nutrients to the global cycle. This research is a groundwork for understanding the extent to which the microbial community of a particular biotope has a pool of degrading bacteria that contribute to the purification of the system. Seasonal long-term studies would be required to deepen our knowledge of the capacity of the urban ecosystems for the self-cleaning."}
{"text": "The cauFrom 1st January to August 8th, 2022, the Centers for Disease Control and Prevention (CDC) received reports of 30,189 laboratory-confirmed cases of monkeypox and 5 deaths from 75 countries across all six regions. United States of America  had the most cases overall, followed by the Spain, Germany, and the UK . Asia reVaccine hesitancy is one of the WHO's top ten global health challenges  and if wTherefore, more well-organized public health programs and educational strategies are needed by the government of Pakistan to disseminate accurate information about the treatment and immunization against the monkeypox virus, and this might significantly affect the resolution of vaccine hesitancy problems. Given that many patients infected with the monkeypox virus have a moderate, self-limiting disease course, the prognosis for monkeypox may vary based on factors such as prior baseline health state, immunization status, and co-morbidities. Consequently, it seems acceptable to personalize therapies depending on each patient's probability of contracting a serious illness.This article did not involve patients; therefore, no ethical approval was required.There was no source of funding for this article.Zobia Ansari: conception of the study, drafting of the work, final approval and agreeing to the accuracy of the work. Hurriyah Ramzan: conception of the study, drafting of the work, final approval and agreeing to the accuracy of the work. Ramsha Shakeel: conception of the study, drafting of the work, final approval and agreeing to the accuracy of the work.1.Name of the registry: Not applicable2.Unique Identifying number or registration ID: Not applicable3.Hyperlink to your specific registration (must be publicly accessible and will be checked): Not applicable.The Guarantor is the one or more people who accept full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.Zobia Ansari, Ramsha Shakeel.This study was not done on patients or volunteers, therefore no written consent was required.None."}
{"text": "Education is one of the most important components of the advanced world and human life. Virtual education can help increase learning motivation. Since the number of drownings is significant in Iran, this study was conducted to determine the challenges of using new technologies (online education) in the education of drowning prevention in the country.In this research, library resources were reviewed and Iranian databases related to the purpose of the study were searched.The most important challenges related to the topic of the present study include internet restrictions in different parts of the country, broadband disruption, the newness of online education, weak management, poor teamwork, poor infrastructure in online education, insufficient number of experienced and interested teachers, etc. Using new technologies, especially online education to teach drowning prevention in Iran has faced many challenges which can be resolved. Therefore, it is necessary to plan on eliminating these problems and strengthening drowning education.Education, Online Education, Immersion"}
{"text": "Evaluation of scenic resources is imperative in national park planning, and 3S technology has been applied for this purpose because it effectively leverages modern geo-informatics technology. We investigated the scenic resources in the Yesanpo National Park based on 3S technology. The Nearest-Neighbor Index, Kernel density estimation, imbalance index, and geographical concentration index in modern geography were introduced into the spatial distribution evaluation of scenic resources, and here, for the first time, the spatial combination index of scenic resources was proposed as one of the quantitative analysis indices of spatial distribution of scenic resources. Moreover, the spatial combination distribution characteristics of scenic resources were analyzed quantitatively and graphically. The characteristics of the spatial distribution of scenic resources in the Yesanpo National Park were as follows: The spatial distribution type of scenic spots in the Yesanpo National Park is a clustered type. The spatial distribution of the scenic resource groups in the Yesanpo National Park was extremely imbalanced and highly concentrated. Based on the identification of scenic resources, we evaluated the scenic resources of each area and propose sustainable development plans for each area. This evaluation method can be applied to similar national parks to promote the quantitative and graphical evaluation of the spatial distribution of scenic resources and provide support for the decision-making processes related to national park planning and management. In the 1980s, national parks, such as Huangshan and Yesanpo, began to develop tourism\u2014the Yesanpo National Park is a typical representative of tourism development in northern China. Since its official opening for tourism in 1986, the economic development of the national park and surrounding areas have been promoted, and Yesanpo has been awarded the \u201cChina Environmental Protection Ecological Demonstration Zone, National Agricultural Tourism Demonstration Site, and National Cultural Industry Demonstration Base, 2018 Chinese brand tourist attractions TOP20\u201d and many other awards. In recent years, the coordinated development of tourism in the Yesanpo National Park has received a great deal of attention. The national park is located in the Yanshan-Taihang Mountain contiguous and extremely poor area. However, these impoverished areas have rich and diverse natural scenic resources and great potential for tourism development. The national park actively explores the tourism poverty alleviation idea of \u201cnational parks drive village development,\u201d and regards tourism as an important measure to promote the development of poverty-stricken areas. It has been selected in the \u201cWorld Tourism Alliance Best Practice in Poverty Alleviation through Tourism,\u201d which is a typical area for tourism to promote poverty alleviation and rural revitalization. With the rapid development of the tourism industry, understanding the spatial evaluation of scenic resources has also developed. How to assess the spatial distribution of scenic resources scientifically and accurately is helpful to select suitable areas to develop tourism products, formulate reasonable and effective national park planning, and promote the sustainable use of scenic resources, which is an important basis for the sustainable development of national parks.The spatial evaluation of scenic resources needs scientific and reliable technical support. The advantages of evaluating the spatial distribution of scenic resources based on 3S technology are apparent and the application prospects are broad. Furthermore, 3S technology includes Remote Sensing (RS), Geography Information System (GIS), and Global Positioning System (GPS) . In receWhen identifying and evaluating scenic resources, RS technology is less affected by terrain, traffic, weather as well as other conditions, while it has wider identifying and evaluation range than traditional visual observation; therefore, it can comprehensively evaluate scenic resources in national parks. High-resolution RS images, such as GF-2, have the advantages of rich information, high definition, intuitive images, strong real-time performance, fast image formation, and fast data acquisition, which greatly reduce the difficulty of scenic resource evaluation and have apparent advantages in resource evaluation.The use of GIS technology to establish a scenic resource database can be used for digitization, standardization input, and storage of various data, such as scenic resource spatial data, texts, and charts. It can also perform operations such as spatial analysis, data supplementation, and update, and result output on scenic resource data, which can improve the efficiency of the use and management of scenic resource data and improve the systematic and scientific nature of spatial evaluation.The use of GPS technology can provide accurate spatial positioning information for the evaluation of scenic resources. It has the advantages of fast positioning, high accuracy, and all-weather operations, and can help to verify spatial evaluation results.Therefore, it is urgent to study scientific and operational evaluation of the spatial distribution of scenic resources based on 3S technology. However, to date, in-depth and systematic research on the evaluation of the spatial distribution of scenic resources based on 3S technology has not been conducted in academia.Scenic spots specifically refer to independent scenic resources developed for tourism and have independent viewing or utilization value. Research on the spatial structure of scenic spots in academia started relatively late, mostly focusing on empirical studies of tourist attractions. Research on the spatial structure of tourist attractions can be summarized as follows: the spatial structure of tourist attractions on different scales ; the influencing factors of the spatial structure of tourist attractions; and the analysis methods of the spatial structure of tourist attractions , 8.The systematic study of the spatial structure of tourist attractions began in the 1960s . Deasy aAfter the 1990s, research on the spatial structure of tourist attractions matured. Through the study of literature, the following characteristics were found.In terms of research theory, it focuses on related disciplines, such as urban geography, economic geography, and tourism geography \u201313, and In terms of research objects, the focus is on the planar spatial structure of a single tourist attraction, multiple tourist attractions, or scenic urban spots. In recent years, large-scale research has gradually decreased, and meso-microscale research has continued to increase . HoweverIn terms of research content, it mainly focuses on the spatial structure distribution characteristics, spatial mutual relations, spatial influencing factors, spatial structure evolution, and spatial structure optimization of the scenic area , 16.As a research method, the nearest-neighbor ratio R, connectivity index , geographic concentration index, accessibility index, average path length, compactness index, fractal theory, and network analysis method have been applied \u201321. In rIn research related to the spatial identification and evaluation of scenic resources, previous studies mostly focused on individual analysis and evaluation, and rarely on the identification and evaluation of scenic resources from the perspective of spatial combination and structure. However, in actual planning, spatial combinations are more important. Effective areas exhibiting a better spatial combination are often areas where scenic resources are concentrated, and they are also key areas for national park development and planning . TherefoThis study applies the GIS spatial analysis method to the spatial combination and distribution analysis of the Yesanpo National Park, and combines the requirements for the sustainable development of national parks. The \u201cspatial combination index of scenic resources (SCISR)\u201d is proposed for the first time. Taking the Yesanpo National Park as an example, combined with the thematic map of the spatial distribution of scenic resources, we analyze the scenic resource groups and their distribution characteristics from the perspective of three-dimensional space. The results are verified with field survey data in the study area, and the method is proven to be scientific and feasible. The method provides an objective, accurate, and visual way for national park managers and planning units to analyze the combination of scenic national park resources and the characteristics of their distribution from a spatial perspective. The evaluation system helps to improve the science and rationality of the evaluation of the spatial distribution of scenic resources. It is also helpful for identifying areas with relatively concentrated scenic resources and high development potential, and providing a theoretical basis and technical support for the spatial combination and structural analysis of national parks, as well as data support for sustainable development.2. It is located in the northwest of Laishui County, Baoding City, Hebei Province, China, in the deep mountain area at the junction of Taihang Mountain and Yanshan Mountain. The Yesanpo National Park is spread over a large area with a complex terrain, diverse types of scenic resources  under a CC BY license, with permission from , original copyright [2018]). Through quantitative and graphical analysis, we found that Haitang Valley, Shixuan Gorge, Xiezi Ditch, the west, east, and surrounding areas of the Juma River Basin in the Baili Gorge area, the northeast and western Dalongmen Castle, cliff carvings, and waterfalls in the Longmen Tianguan and surrounding areas, Daze Reservoir, Beiyu Tower, Nanbian Bridge and surrounding areas in Baicao Pan, and the four regions in the middle and southwest of the Jinhua Mountain area showed a higher SCISR (SCISR \u2265 10), and the viewing or utilization value of scenic resource groups was higher, along with the developmental value.The SCISR was used to quantitatively analyze the scenic resource space combination. The expert scoring method was used to score the spatial combination value of scenic resources; 20 questionnaires were issued. The corresponding scores of each scenic resource and its combination type were determined through two rounds of surveys, and the scores were recorded in the scenic resource GIS database . The SCIThe KDE map of existing scenic spots was superimposed on the SCISR map, and the pattern between existing scenic spots and the spatial combination of scenic resources was analyzed. Look for areas with a low degree of development, but with a high value for the spatial combination of scenic resources. The results showed there are currently fewer developed scenic spots in the Xiezi Ditch and Juma River basins in the Baili Gorge area, northeast of the Longmen Tianguan area, middle of the Baicao Pan area, and central and southwestern regions of the Jinhua Mountain area. The developmental degree was low, but the SCISR in these areas was relatively high, and the spatial combination value of the scenic resources was also relatively high, which showed high developmental value and great potential, as shown in According to the spatial distribution of scenic resources, scientifically determining the sequence and measures of its protection and development is the basis for sustainable development of national parks, and is important for integrating and using regional scenic resources, enhancing the overall attractiveness of regional tourism. Evenly distributed scenic resources reflect social equity in tourism development, ecological protection, sustainable development, whereas clustered scenic resources are more conducive to the development of scenic resource groups and connecting tourist routes. However, excessive clustering will inhibit the development of the same type of scenic resources , and becWe analyze scenic resources from the perspective of three-dimensional space, determine the spatial distribution types of scenic spots and their spatial clustering areas, determine the balance and concentration of scenic resource groups in spatial distribution, and use the SCISR to quantitatively evaluate the value of the spatial distribution combination of scenic resource groups. The spatial evaluation system of scenic resources constructed in this research can be used to guide national parks to expand tourism space, and integrate internal scenic resources to optimize the layout of tourism space . It provWe overlaid the SCISR on the existing scenic spot data to produce the SCISR maps of six scenery areas, evaluated the scenic resources of each scenery area in the Yesanpo National Park from the perspective of the SCISR, and analyzed the existing problems of scenic resources, finally providing ideas for the sustainable development of each scenery area.The area is located in the southwest of the Yesanpo National Park. The surrounding SCISR in the central part of the area, the west and east of the Juma River basin, is 10\u201312, which indicates a higher SCISR. It is the area with the most abundant and rich scenic resources and the best combination in the national park, such that its viewing and utilization value is high. The area is characterized by several resources, such as canyons, mountains, water sources, forests, deep valleys, peaks, forests, cliffs, streams, and waterfalls. The typical scenic spots are the surroundings of the Haitang Valley, the Shixuan Gorge, and the Xiezi Ditch. There are rich scenic resources, a good combination of views with a high developmental value, and high development potential. This is the core area of Yesanpo.The main existing problems are as follows:Because the main scenic resources are located in the canyon, the scope of viewing and recreation is small, and during the peak period of the tour, it is easy to cause congestion.The scenic resources in the Xiezi Ditch, the west and east of Juma River basins and the surrounding areas are concentrated and the developmental value is high; therefore, they must be reasonably developed.Some development ideas include the following:Theme of the area: Strange gorge, deep valley, geological wonders.Protect scenic resources and highlight the characteristics of a canyon. The area is characterized by canyons, mountains, water, forests, and other landscapes. The canyon has a peculiar structure, which belongs to the typical landform of a narrow gorge. It is rich in scenic resources in the canyon area and has high developmental value. It is suitable for sightseeing, mountaineering, scientific examination, exploration, leisure, and vacation. The next step should strengthen the protection of existing scenic resources and show each scenic resource one by one, expressing its broad landscape.Scientifically development of the area with a better combination of scenic resources to enhance tourist experience. To date, the development of the area is concentrated mainly around Shixuan Gorge and Haitang Valley, which is the most concentrated area for tourists in the Yesanpo National Park. During the peak period of the tour, congestion likely affects the tour experience, and the area is prone to danger. The next step is to develop Xiezi Ditch, which has a good combination of scenic resources, while extending the tour area to the south and east, developing the southeast mountain area, increasing mountaineering, scientific research, leisure, and other projects, and improving the utilization value of the combination of scenic resources.Pay equal attention to the development and protection of scenic resources. To promote the sustainable utilization of scenic resources, the management department of the scenery area should start an ecological restoration project to renovate the area and stop the destruction of mountains and vegetation caused by constructing roads and disorderly development.The area is located in the northeast of the Yesanpo National Park. The SCISR of Daze Reservoir, Beiyu Tower, Nanbian Bridge, and the surrounding scenic resources is 10\u201312. This is an area with a higher SCISR, with rich scenic resources and a better combination of views. Its viewing and utilization value is high. It is mainly characterized by high mountains and plant resources. The scenic resources are mainly concentrated in the middle altitude in the east, the ecological environment is relatively fragile, the developmental value is high and the development potential is large. This is the core scenery area of Yesanpo.The main existing problems are as follows:The Daze Reservoir, Beiyu Tower, Nanbian Bridge, and surrounding scenic resources in the central part of the area are relatively concentrated, with high developmental value, which require reasonable development.The types of scenic resources are single and seasonal.There is a single route to and from the area, which is prone to congestion during peak seasons.There is a lack of links to other areas.Some development ideas include the following:Theme of the area: Forest meadow.Protect forest vegetation resources and highlight natural scenery. The main peak of the area is at the top of the monoclinic mountain. This is the highest peak in the Yesanpo National Park. It stands side by side with the neighboring sister peak, Baihua Mountain (1991 m) in Beijing, the highest peak in the west of Beijing. The natural vertical band spectrum of vegetation is evident and rich. The vegetation landscape of the original forest and the original secondary forest is apparent. The next step should be to strengthen the protection of existing scenic resources, especially forest vegetation resources, highlighting birch forests, rhododendrons, Syringa reticulata, alpine meadows, and other plant landscapes, embody the distinctive characteristics of the four seasons, and gradually develop Daze Reservoir, Beiyu Tower, and Nanbian Bridge area.Improve infrastructure and link surrounding areas. Improve the scenic tour system and upgrade service facilities. Strengthen the linkage with other scenery areas of Yesanpo, Beijing Baihua Mountain Scenic Area, and Shangfangshan National Forest Park by increasing comprehensive slow-moving roads and public transportation, promoting the regional linkage development of the Yesanpo National Park.This area is located northwest of the Yesanpo National Park. The SCISR is 10\u201312 in the northeast, western Dalongmen Castle, cliff rock carvings, waterfalls, and the surroundings, which belong to an area with a high SCISR. It is an area with a good combination of scenic resources, featuring high mountain waterfalls, strange rocks, canyons, and forest landscapes, rich in scenic resources, with high viewing, utilization and developmental value, and great development potential.The main existing problems are as follows:The scenic resources in the northeast of the area are relatively concentrated and the developmental value is high; the resources need sustainable development.Natural resources, especially the combination of high mountains and waterfalls, are fragile and vulnerable to damage.The cultural image of Great Wall is not clear enough and publicity is insufficient; it has not yet become the core tourist attraction of the Yesanpo National Park.The following are some development ideas:Theme of the area: Tianguan waterfall, cultural corridor.Protect scenic resources and create natural scenery features. Protection of scenic resources in the Caishu\u2019an area and surrounding touristic areas. Appropriate expansion of the scope of the core tourist area, better excavation and presentation of the unique natural landscape, and use of the rich natural scenic resources, such as waterfalls, strange rocks, canyons, and forests. Advantages include highlighting natural scenery with high mountains and waterfalls as the core.Highlight wild interest and rationally develop river scenery resources. With the characteristics of the nature and wild, the Xiaoxi River should be reasonably developed, and the protection of water resources should also be considered during development.Relying on the culture of the Great Wall to create high-quality humanistic scenic resources. Strengthening the protection of key cultural relics of the Dalongmen Ancient Castle, conducting more in-depth and textual research, exploring the culture of the Great Wall, and developing cultural tourism and research travel markets.Scientifically setting up tour routes to organically connect natural and cultural scenic resources. The area has many types of natural and human scenic resources, a high degree of combination, a concentrated spatial distribution, and a high developmental value. Through a reasonable setting of tourist routes, the western Dalongmen Castle, cliff carvings, and high mountain waterfalls can be organically connected with the northeast scenic resources to improve the quality of the scenery area and build it into one of the main scenery areas in Yesanpo.The area is located in the northern part of the Yesanpo National Park. The SCISR of Qingquan Temple, Zhuangli Reservoir, Cypress House, and surrounding scenic resources in the middle and southwest of the scenery area is 10\u201312, which indicates an area with a higher SCISR, featuring mountains, waterfalls, and forests, with high viewing, utilization, and developmental value.The following are the main existing problems:The scenic resources in the central and southwestern parts of the area are relatively concentrated, and the developmental value is high; they need to be reasonably developed.Insufficient protection of cultural resources in villages.The overall development level is not high, the tourist service facilities are obviously insufficient, and there is a lack of connection between scenic resources.Some development ideas include the following:Theme of the area: Rolling peaks and valleys, Xanadu.Priority protection and rational development of scenic resources. Most of the area to the west of the Provincial Highway S236 belongs to the Jinhua Mountain-Henglingzi Brown-Eared Pheasant Nature Reserve. Ecological protection and cultivation should be prioritized here to reduce the negative impact of human activities on scenic resources and make this area a natural green barrier for the entire area. The Zhuangli Reservoir and surrounding scenic resources in the central part of the scenery area are relatively concentrated, with high developmental value, and can gradually be developed for leisure, sports, water tourism, and other projects.Protect humanistic scenic resources and explore traditional culture. Strengthen the protection and development of the Qingquan Temple in the southwest and the ancient residential buildings of Lingnantai in the north. Excavate the culture and folklore of Sanpo mountain dwellings, and achieve rural tourism.Connecting greenways to strengthen the link between scenery areas. Scenic resources are further developed in the central and southwestern parts of the area, connecting the Zhuangli Reservoir, Qingquan Temple, and Lingnantai ancient residential buildings through highways and comprehensive slow-moving roads, as well as the Longmen Tianguan scenery area in the southwest with the corresponding service facilities, which form a special tour with a leisure theme, water sports, and traditional culture experience.The area is located in the southeast of the Yesanpo National Park. The SCISR of the scenic resource groups in the scenery area are 3\u20135, indicating a low value for viewing or use. The central, southern, and eastern combination indices are relatively high, with the Juma River and its tributaries as the core landscape, the type of scenic resources is single, and the river and its shores have a certain developmental value.The main existing problems are as follows:Scenic resources are mainly single type rivers, lacking representative landscapes with a single-tour structure.Some buildings along the river are inadequately set back and are located within the planned river regulation line, which affects the waterfront landscape.There are few types of plants and a lack of characteristic views.Some development ideas include the following:Theme of the area: Green hill, green shadow, Water Rhyme Gallery.Renovate the river and coastal environment to build the Beijing West Gallery. The area stretches along the Juma River and its tributary Xiaoxi River. The riverside is an important external traffic source that passes through the entire area, and most towns, villages, and other residential areas are concentrated along the river and the road. Therefore, the focus of the construction was to create landscapes along the river. Protecting the ecological environment of the mountains and forests along the river should be strengthened, the landscape should be improved, and the damaged landscape should be ecologically restored. By strictly adhering to the \u201cHebei Province Blue Line Management Regulations\u201d within the river regulation line and prohibiting illegal construction, the river bank should maintain its ecological and natural nature. Simultaneously, wild flowers and color-leaf plants that reflect local characteristics can be used to create a botanical landscape with four seasons, colorful, and local characteristics.Build riverside greenways to meet leisure needs. A slow-moving greenway along the riverside can be constructed along the entire Juma River, connecting various scenery areas, creating an aesthetic and leisure road.Relying on scenic resources and facilities along the road, water tourism, strolling, cycling, and other excursions can be conducted.The area is located in the middle of Yesanpo National Park. Most areas in the scenery area have an SCISR of 3\u20135, indicating a low SCISR, but the viewing and utilization value of the scenery area is not low. The reason for this phenomenon is that the most distinctive Yugu Cave and Yugu Spring are karst caves and spring scenery resources in the scenery area. They are located underground and cannot be identified using RS images and DEM data. Therefore, the score of the SCISR is low.The following are the main existing problems:The types of scenic resources are single and there is a lack of connection among various scenic resources.The protection and utilization of war relics, such as egg tuo and the historical relics of the Buddha Cave Tower and other scenic resources are insufficient and they have not been included in tourist attractions.Damage to the mountain caused by road construction is evident, and ecological restoration is urgently needed.Some development ideas include the following:Theme of the area: Enjoyable cave, clear pond, and unique spring.Strengthen the protection of Yugu Cave and Yugu Spring, highlighting the characteristics of \u201cspring\u201d and \u201ccavity.\u201d Increase the protection of Yugu Cave and Yugu Spring, conduct scientific investigations, highlighting their cultural connotations and scientific value.Exploit humanistic scenic resources and highlight the local culture. The battle site of the Pingxi Base Area was excavated based on the deeds of the five warriors of the egg tuo.According to the comprehensive evaluation results , the spaBy summarizing the related studies on the evaluation of scenic resources in the Yesanpo National Park, it is found there are few related documents\u2014less than 10 papers. Furthermore, most previous studies used data collection and sorting, the field survey method , questioTherefore, we proposed a comprehensive spatial identification and evaluation system for scenic resources based on 3S technology. This study used multisource data  and multiple platforms  to identify and evaluate scenic resources. Based on the evaluation model of the evaluation criteria, such as the NNI, KDE, imbalance index and geographic concentration index models, and the spatial characteristics of scenic resources, an SCISR evaluation model is proposed. The SCISR is regionally more specific than the previous landscape or geographic evaluation standards. It can graphically present the spatial combination evaluation results, and the results obtained are more objective and accurate. After verifying the results of the Yesanpo National Park field survey as well as previous studies, it was found that the identification and evaluation results of this method better reflect the actual situation of the scenic resources, have high consistency, and prove the feasibility and reliability of the method. They can provide a scientific reference basis for the sustainable development and utilization of scenic resources and related planning work.We have explored and improved the field of research on the spatial distribution of scenic resources, and our innovations are reflected in the following three points:In terms of research theory, previous studies were mainly based on theories of geography \u201313. ThisIn terms of research objects, previous studies mostly focused on the planar spatial structure of tourist cities and tourist attractions . AccordiIn terms of research content and methods, previous studies have mainly focused on a single platform and a single data source to evaluate the planar spatial structure of scenic resources \u201321. ThisChina\u2019s existing national park planning policies do not require the evaluation of the spatial combination of scenic resources. However, as the government and the public are paying increasing attention to the sustainable development of national parks, one of the important tasks for the planning and management departments is the comprehensive and accurate identification and evaluation of scenic resources. The identification and evaluation system proposed herein can provide a scientific basis and an easy-to-implement evaluation system for improving the planning and management of national parks, meeting the actual needs of planning and management departments and rendering them easy to operate and promote. Furthermore, the rapid development of 3S technology has facilitated big data collection and analysis. Using multisource data and multiple platforms for conducting spatial evaluation research of scenic resources is a key topic that requires comprehensive studies, and this study can provide a reference basis for this research field.This study has primarily three limitations. First, the time dimension was not added while evaluating the spatial distribution of scenic resources. In future research, it is necessary to consider the influence of time factors, such as annual and seasonal changes, on the spatial distribution of scenic resources. Second, the identification and evaluation system needs to be supplemented and improved. The different types of spatial combination and evaluation indicators of the scenic resources need to be further supplemented, refined, and improved. For example, a combination of scenic resources, such as weather landscape, animal resources, and human landscapes, needs to be added. Moreover, comprehensively integrating the results in the fields of landscape architecture, geography, ecology, aesthetics, history, and art can supplement and improve the spatial evaluation indicators of scenic resources. Third, the data sources used in this study can be further expanded and optimized. In the future, we can attempt to introduce technologies such as higher-resolution RS images and drone tilt photography for the identification and evaluation of scenic resources to meet the requirements of national parks with different precision, different planning, and sustainable development management requirements.Social and economic developments have increased problems with the sustainable use of scenic resources, which has now become one of the research hotspots in this field. The key is to identify and evaluate the spatial distribution of scenic resources and conduct their scientific planning and management. We used GPS field measurements, RS image recognition, GIS spatial analysis, mathematical methods in geography, based on multiple data sources and platforms, to identify and evaluate scenic resources, which is technically difficult and highly comprehensive. Moreover, SCISR was proposed for the first time to evaluate the value of scenic resources from the perspective of spatial combination. The NNI, KDE, imbalance index, and geographic concentration index models were used as indicators of the spatial distribution characteristics of the scenic resources, which promote the quantitative and graphical evaluation of the spatial distribution of the scenic resources, helping units and related departments to understand the spatial distribution of the scenic resources more comprehensively, identify areas with relatively concentrated scenic resources, high developmental value, and greater development potential, and provide data support for decision making in national park planning and management. On-site verification was consistent with the actual data. Therefore, several indices can be considered important indicators for the evaluation of the spatial distribution of scenic resources and planning of national parks. This study provides the theoretical foundation and technical support for high-precision digital and systematic evaluation of scenic resources.The multisource data used in this study are multiperiod and digitized data with characteristics such as stability and high accuracy, which can reduce the workload and difficulty of field investigations and improve the efficiency of planning and management of scenic resources. The methodology and system are easy to popularize and apply, and thus, can be incorporated into the national park planning and management system. In addition, based on previous studies, this research has contributed to the identification and evaluation system of the spatial distribution of scenic resources. However, with continuous technological development, future research should attempt to combine scenic resource identification and evaluation systems with advanced technologies, such as big data, artificial intelligence, and three-dimensional virtualization, to improve the automation and intelligence of scenic resource identification and evaluation.S1 Appendix(TIF)Click here for additional data file.S2 Appendix(TIF)Click here for additional data file."}
{"text": "Policymakers, practitioners, and researchers need a balanced, thoughtful, and analytical resource to meet the challenge of global aging at a rate that\u2019s historically unprecedented. The Journal of Aging & Social Policy (JASP), which was founded in 1989, serves this role by drawing contributions from an international panel of policy analysts and scholars who assume an interdisciplinary perspective in examining and analyzing critical phenomena that affect aging and the development and implementation of programs for older adults from a global perspective. Study settings extend beyond the United States to include Europe, the Middle East, Australia, Latin America, Asia, and the Asia-Pacific rim. This presentation will document the scope, content, and focus of JASP, including the rise of international submissions, which now account for approximately half of articles published. Opportunities for publishing in JASP will be discussed; so too will strategies for navigating the peer-review process successfully."}
{"text": "To better explain the cause of gas explosion accidents, based on the existing accident-causation theory, this paper proposes an accident-causation model of gas explosion accidents based on safety information transmission. Based on this, a new method for the prevention of gas explosion accidents can be developed. By analysing the connection between safety information transmission and the causal factors of gas explosion accidents, it is inferred that the loss of safety information transmission is the key factor leading to accidents. Safety information transmission is a process chain in which information is transmitted between the information source and information subject. This process involves the stages of information generation, conversion, perception, cognition, decision-making, and execution. Information loss is inevitable during the transmission process. When the information loss of the degree of safety affects the judgment of the information subject on the current situation and decision making, the possibility of accidents increases. Therefore, in this study, we constructed an accident-causation model for gas explosion accidents based on the three elements and six stages of safety information transmission. Subsequently, the DEMATEL-ISM method was used to quantitatively analyse the causes of gas explosion accidents. Through a multilevel hierarchical structure division of the accident causes, the cause, result, and root factors affecting accidents were identified, and countermeasures were proposed to provide a theoretical basis for the prevention of gas explosion accidents. Various types of accidents occur in coal mines, including gas and coal dust explosions, coal and gas outbursts, suffocation accidents, fires, floods, roof falls, and haulage accidents. Gas explosions are undoubtedly the most serious type of accidents ,2,3. OncThe coal mine production system is a complex adaptive system, and the working environment is complex and dynamic . There aUnderwood and Waterson 2013) concluded that factors, such as information loss, have a major effect on system safety, and a high proportion of accidents are caused by information loss . Zhao an concludeTherefore, based on the three elements of the source\u2013channel\u2013information subject and the six stages of information generation, conversion, perception, cognition, decision-making, and execution of safety information transmission, an accident-causation model was constructed in this study. Subsequently, the Decision-Making Trial and Evaluation Laboratory (DEMATEL) combined with the interpretive structural modelling (ISM) method was used to study the relationship between complex system factors. The causal factors of gas explosion accidents were analysed qualitatively and quantitatively, and the logical relationship between the causal factors was discussed to provide a theoretical basis for the effective prevention and reduction of gas explosion accidents in coal mines.Li and Chen 2007) stated that safety information is a specific form that reflects the differences between safety features and their changes, including warning information, production status information, and safety instructions . Zhao an07 statedAt present, the definition of safety information is not unified, but the essential attributes are consistent. It is mainly intended to protect the physical and mental safety of people, eliminate potential accidents, reduce accident losses, and ensure work safety. The relevant dataset reflecting the system safety state, such as safety warning signs, alarm information, and operation guidelines, are all safety information. The classification of safety information differs according to different classification standards. From the state of safety information, information can be divided into static and dynamic safety information. The safety information involved in underground production systems in coal mines includes safety signs, monitoring data, safety reports, rules, regulations, and daily records. Safety information is a specific representation of system safety. The identification of system hazards, occurrence of emergencies, development trends of the mastery, and intervention are all realised through the acquisition, analysis, and utilisation of safety information.Research on safety-information loss has mainly focused on safety-information asymmetry, missing safety information, and uncertainty in safety-information perception . The essSafety information loss primarily occurs during information transmission. The entire process from information generation to information reception and use causes information loss, which includes information error, missing information, dislocation, and delay. Safety information transmission mainly involves transmission between the information source and subject as well as transmission between the information subject and subject. Among these, there is a large amount of signal noise in the transmission process between the information source and information subject. At the same time, owing to the chaotic crossover of channels, conflict, and collision, confusion can easily occur when people receive information, which affects the accuracy and timeliness of information transmission. In addition to poor channel capabilities and other reasons, the information transmission rate is low, resulting in the distortion of the information transmission. In the process of information transmission between information subjects, owing to differences in the cognitive ability, understanding, and environment of people, they may selectively receive information, which inevitably results in information loss. The degree of information loss directly affects the possibility of accidents. Information transmission and subject responses are key links to ensure the spread of original information. Information distortion is more serious when the information transmission link is longer. For higher comprehension quality of the information-receiving subject, the utilisation rate of the information is higher.A gas explosion can occur if the three following conditions are met simultaneously: (1) The gas concentration must be within the explosive limit , (2) the oxygen content in the air must be higher than 12%, and (3) a high-temperature ignition source  must be present. In underground places, except for blind lanes, the oxygen concentration reaches 20%. Therefore, the prevention of gas explosion accidents must be controlled based on two aspects: the gas concentration and ignition source. Claus postulated that information is the product of data processed by human consciousness. Gas concentration data is used as safety information to prevent gas explosions. Once the limit is exceeded and not detected in time, safety information is lost. Gas concentration monitoring involves tile inspectors, workers, safety supervisors, etc. Gas concentration overrun is the direct cause of gas explosion accidents, and the causes of overrun mainly include ventilator failure, insufficient air volume, chaotic ventilation systems, and inadequate implementation of tile inspection systems. The fundamental reason for this is deviation in safety-information acquisition, monitoring, and transmission. Missing information and information asymmetry, caused by deviations in the transmission of system safety information , are the main causes of gas explosion accidents.Through a large number of accident cases and theoretical analyses, it can be correctly stated that safety information is the specific manifestation of the mechanism and influencing factors of gas explosion accidents. The essential phenomenon of the accident evolution path and logical relationship is the transmission of safety information. This includes gas concentration monitoring, oxygen content, and ignition sources, which are categorized as dynamic, explicit, and objective safety information. These is also key safety information to prevent gas explosion accidents. Critical information loss is the root cause of such accidents. Based on the accident mechanism, the reasons and factors that cause critical information loss are analysed at the macro and micro levels. The macro level is mainly at the organisational level, including the social environment and coal mine management. The micro-level is mainly at the individual level, including the behaviour of miners and the state of objects.Considering the macro-level of coal mine production systems, gas explosion accidents are reduced with the progress of society and technological innovation, strengthening of government regulation, social supervision, and enterprise management. According to on-site research and interviews, there are differences between the implementation documents issued by the government and the actual conditions of the coal mines. The phenomenon of mismatch of technical measures, unequal information, and simple rote writing is common. There are many problems in the information transmission process, and information quality is the basic condition to ensure the effectiveness of information transmission. If the information is misinterpreted or the original information is incorrect, the accident risk can increase from the root.Considering the micro-level of coal mine production systems, human factors cause fire source and gas accumulation that leads to coal mine gas explosions. Unsafe behaviour by miners is the main cause of gas accumulation and the presence of fire sources. From the perspective of informatics, gas concentration is the source of information, which is obtained through equipment detection. The information loss in this stage mainly involves two aspects: the frequency of the concentration detection and the accuracy of the detection equipment. However, regarding concentration prediction, once gas accumulation occurs, if the concentration is not detected in time to make a judgment, there can be potential explosion hazards.In the entire process of safety-information generation, conversion, perception, cognition, decision-making, and execution transmission, the information source, channel, and subject are the key constituent elements of information transmission. In the process of information flow, information carrier defects or limited function, information conversion, external interference, insufficient information stimulation intensity, and time duration cause information loss, distortion, delay, and dislocation. Information loss ultimately affects the behavioural response of workers. Therefore, information loss in the process of information transmission can directly or indirectly lead to the occurrence of gas explosion accidents and affect their further expansion. Avoiding crucial safety information loss is key to preventing the occurrence and expansion of accidents.There are many types of safety information in underground coal mine production systems, and dynamic information is complex and changeable. Safety information is the key connection point to ensure the orderly and stable operation of the system. In the entire process from information generation to decision transmission, the factors and causes of safety information loss can be analysed from three constituent elements of information transmission  and six main processes . The constituent elements of information transmission are the basic elements that ensure the authenticity of information. Once a certain element fails or has defects, it leads to information loss, thus affecting the normal operation of the system. The six main processes of information transmission are key links that affect the degree of information loss. A critical point in the degree of information loss that leads to an accident is called crucial safety information. Crucial safety information refers to the minimum amount of information required to ensure safe operation of the system. Once crucial safety information is transmitted with error, missing data, delay, dislocation, and other losses, it can affect the safety prediction, decision-making, and other follow-up links of the information subject. Decision-making errors can lead to unsafe behaviour by workers and unsafe state of equipment, which can cause accidents.By analysing the information sources, channels, and subjects involved in the entire process of safety information transmission, it is evident that the defects in safety information sources develop into faults under the influence of the outside environment, resulting in inaccurate and false information release. Channel failure due to external influences results in poor channel and channel interruptions, and safety information cannot be transmitted normally. Information subjects cannot receive accurate safety information, and cannot make correct predictions, decisions, and execution behaviour, resulting in increased possibility of accidents.From the perspective of the entire process of information transmission, changes in the safety information quality, safety information dissemination environment, and safety information subjects all affect the effectiveness and reliability of information, which are the main factors causing information loss, as shown in Safety information quality is the basic condition for the effective transmission of information, including the reliability of information sources, clarity of purpose, normative information, and timeliness. If the information itself contains errors or is invalid, it can directly affect the decision-making behaviour of people, which can lead to accidents. In the process of effective information transmission, owing to the impact of untimely dissemination, signal-to-noise destruction, channel diversity, and other environmental influences, there is deviation or loss in the information transmission process. Therefore, the information-dissemination environment significantly affects the transformation and transmission of safety information. The carrier, manifestation, and time of information transmission mainly include dissemination timeliness, signal-noise destructiveness, diversity expression, system complexity, and channel diversity. The perception, cognition, and decision-making process of information receivers for safety information are affected by the level of personal safety awareness, emergency response ability, safety knowledge and skills, physical and mental conditions, and work experience. This is closely related to the overall quality of an individual.Studies have shown that unsafe behaviour is the root cause of accidents, and the loss of safety information is the main factor that causes unsafe behaviour, which plays a decisive role in the occurrence of accidents ,23. TherThe occurrence of gas explosion accidents is accompanied by the whole process of information transmission. Safety information loss, such as inadequate information transmission, neglect of safety (danger) information, deviation of information perception, and incorrect or untimely information responses, are the key factors that lead to gas explosion accidents. This includes the actions of neglecting safety information, such as the failure to take response measures in time when the gas exceeds the limit, failure to obtain timely gas concentration information, the chaotic nature of the ventilation system, and the wrong operation process. The essence of accident prevention and control is to control, regulate, and manage the material, energy, and information flow in the system through the identification, guidance, monitoring, warning, and regulation of safety information (positive effect). Safety information that wrongly reflects the state of material flow and energy flow in the system can lead to accidents or expand the impact of accidents (negative effect). Therefore, it is necessary to give maximum importance to and correctly use the guidance and control effect of safety information flow on material flow and energy flow to ensure the efficient transmission and timely and correct response to safety information.The DEMATEL method is a methodology for solving complex problems proposed by American scholars Gabus and Fontela. It calculates the degree of influence of each factor on other factors by determining the size of the direct influence relationship between the factors in the system. It obtains the centrality and causation degree of each factor to determine the cause and result factors . The ISMThe construction of the accident-causation model of gas explosion accidents, is based on the influencing factors of safety information loss. These include hidden danger information leading to gas explosion accidents, and the impact of the external environment, including gas concentration overruns, ignition sources, government regulations, and social supervision. The causal factors of gas explosions based on safety information transmission are listed in Eight experts in the field of coal mine safety and emergency management were invited to participate and assess, according to the scale 0\u20133 . The scoring method was used to quantitatively evaluate the direct influence relationship and degree of influence among various factors of gas explosion, and the direct influence matrix is shown in K to form the standardized direct influence matrix N.\u2460 Standardize the direct influence matrix T is constructed based on Equation (4).I indicates the unit matrix of the same order as N.\u2461 To further analyse the indirect influence relationship and degree of influence of the causal factors of gas explosions, a comprehensive influence matrix T, and the degree T; The influence degree It is evident from As shown in L was constructed according to the comprehensive influence matrix T, and the adjacency matrix L was added to the unit matrix I to form a new matrix H based on Equation (6). Then, according to the operation properties of Boole, MATLAB software was used to perform multiple Boolean operations on matrix H until the formula Z was obtained, as shown in L. T.The adjacency matrix Z, and this process was repeated to divide the accessibility matrix Z into structural levels [Z, Z, Z.According to the hierarchy principle, the factor satisfying l levels . By consThrough hierarchical division, the hierarchical structure and correlation characteristics of the factors influencing gas explosions were clarified. Regarding the causal factors of gas explosion accidents, more attention should be paid to higher hierarchical structure levels. As shown in (1)The information subject is not only the recipient of safety information, but also the transmitter of information. Work experience, safety awareness level, and the physical and mental state of information subjects have a significant impact on information transmission, which directly affects the accuracy and effectiveness of information transmission and use. Therefore, coal mining enterprises need to improve the safety awareness level, information cognition, and processing ability of their employees through daily safety training and assessment. In addition, signal noise, dissemination channels, and information expression forms in the information transmission process have a certain impact on information loss. It is necessary to consider the ways and manifestations of information transmission from the perspective of information types, the needs of the information subjects, and understanding. This can help avoid the homogenization of information transmission and further improve the effectiveness of information transmission.(2)Owing to the complexity of underground production systems, there are many types and structures of safety information in the coal mine production process. There are problems in the quality assurance of the source, the transmission environment is complex and changeable, and the comprehensive quality of the information recipients is uneven, which leads to problems in the process of information transmission. Different degrees of loss result in gas accumulation or the emergence of fire sources, which leads to gas explosion accidents. Therefore, in view of the complexity of the system, it is necessary to comprehensively analyse the information types, characteristics, attributes, and target states. Additionally, the safety information should be divided according to the urgency, manifestation, and response needs. The information transmission efficiency and information utilisation rate must be improved, and the role of safety information must assume full importance.In this study, we analysed the entire process of safety information transmission and postulate that the loss of critical safety information is the main reason for accidents. Therefore, improving the quality of the source, improving the information transmission environment, and strengthening the comprehensive quality of the information recipients can ensure the accuracy and timeliness of safety information transmission and avoid the loss or misuse of critical safety information. In this study, we provide a new idea and method for the prevention of gas explosion accidents.(1)Loss of safety information is a key factor in gas explosion accidents. Based on the entire process of safety information transmission, the factors affecting safety information loss were extracted, including safety information quality, safety information environment, safety information subjects, three first-level indicators, and fourteen second-level indicators.(2)The three elements  and six stages  of safety information transmission were analyzed. This was combined with the case of gas explosion accidents to develop an accident-causation model of a gas explosion accident based on safety information transmission, which has a certain guiding significance for the prevention of gas explosion accidents.(3)Eighteen causal factors were extracted according to the accident-causation model of a gas explosion, based on safety information transmission. The DEMATEL-ISM quantitative analysis method was used to determine ten cause factors and eight result factors. Among them, C8, C14, and C17 were the root factors affecting the occurrence of gas explosion accidents, and C2 and C16 were the surface factors.The loss of critical safety information is the fundamental factor leading to accidents. This paper analysed the causes of gas explosion accidents based on the whole process of safety information transmission, but lacks a quantitative assessment of safety information loss. In the future, we will continue to classify and extract the safety information of various types of accidents in coal mines, and quantify the loss in the transmission process, and conduct further in-depth research on coal mine accidents from the perspective of the amount of safety information loss."}
{"text": "Global temperature change is related to the destiny of all mankind, and carbon mitigation, as well as greenhouse gases control, are key points. In order to explore the basic knowledge, research hotspots and trends in global carbon mitigation research, this paper, based on 15,304 carbon mitigation articles from Web of Science, from 1991 to 2021, conducts spatio-temporal distribution, country distribution, research hotspots and cooperation network analysis, and draws frontier knowledge graphs of carbon mitigation by using CiteSpace, Gephi and other scientific knowledge mapping and literature analysis software. The key scholars, important literature, main contribution institutions and countries/regions in the field of carbon mitigation research were extracted, and the research basis and evolution law were displayed. The study found that: (1) The research on carbon mitigation is increasing every year, which can be roughly divided into four stages: germination, low-speed development, medium-speed development and high-speed development. (2) The spatial distribution of carbon mitigation research is unbalanced, mainly showing a characteristic of \u201cone super and many strong\u201d centered on the United States. (3) The research hotspots of carbon mitigation have gradually evolved from phenomenon analysis, policy guidance, method exploration to mechanism improvement. Further research might focus on ocean carbon sink, carbon trading and carbon-negative technology. Garcia, Lewis and Griscom suggest that photosynthetic carbon capture by trees may be one of the most effective strategies to limit the rise of global COntration ,4,5. Asuntration ,7. Woolfntration ,9. Marshntration ,11. Withntration ,13, the ntration ,15, carbntration , ecosystntration ,18, forentration ,20 and ohttps://www.webofscience.com/, accessed on 4 January 2022), uses dynamic network analysis and visual techniques and tools to analyze the research structure, research hotspots and future development trends of carbon mitigation, which provide an important reference for research in the future. The aim of this study is to analyze the intellectual structure, hotspots and trends of global carbon mitigation.To sum up, in addition to carbon mitigation methods, relevant research also involves agriculture, ecosystems, land use and other aspects. Particularly, research panorama, spatial distribution, regional disparities and hotspots are important for promoting carbon mitigation. In order to grasp the panorama of carbon mitigation research, regional disparities and other research status, this study, based on the global literature data of Web of Science (WoS)  covers the world\u2019s most influential research findings. Based on the WoSCC information retrieval platform, this study extracted the global carbon mitigation research literature with the theme of \u201ccarbon mitigation\u201d, covering the period from 1991 to 2021, and retrieved a total of 18,314 articles. The data of English literature from the WoSCC database was retrieved on 4 January 2022 through a search by \u201cTS\u201d = (carbon mitigation) for all years of the collection span. After duplication screening with CiteSpace, a total of 18,314 articles were found, spanning from 1991 to 2021. After data normalizing and filtering , a total of 15,304 papers were retained as research samples for trend analysis of global carbon emissions research.CiteSpace is an information visualization software developed by Professor Chen Chaomei, School of Computing and Informatics, Drexel University, USA, based on White and Griffith\u2019s  author cCiteSpace has the most comprehensive functions to process and analyze the documents in WoS database, mainly including national/regional cooperation network, institutional cooperation network, author cooperation network and co-occurrence or co-word analysis based on references, keywords, subject headings, etc. This paper mainly analyzes the knowledge base, discipline structure and research frontier in the field of carbon mitigation through CiteSpace. The co-citation network composed of the cited literature can clearly reveal the knowledge base of a certain academic topic; keyword co-occurrence network can clearly show the disciplinary structure of a certain field; the citation groups and references cited by the citation groups can show the frontier characteristics of the research in this field. This paper analyzes the co-citation network, keyword co-occurrence network and emergence words of literature on carbon-mitigation-related research topics published from 1991 to 2021 in the WoSCC database to clarify the progress of carbon mitigation knowledge Graph.The scientific knowledge graphs from CiteSpace analysis are mainly presented in the form of nodes and links. The size of nodes reflects the frequency of the analysis objects ; the thickness of links reflects the strength of cooperation, co-occurrence or co-citation; the color of nodes represents different years; the color of the line corresponds to the time of the first co-occurrence or co-citation of the node . In CiteThe interannual variation in the number of published papers in a certain field can reflect, to some extent, the attention that researcher pays to the field, which is helpful to the overall research and analysis of the development status and trend of a certain field. The number of publications in a country/region in a certain field usually represents the degree of activity in that field, which helps to analyze the relationship between countries/regions. In this paper, CiteSpace is used to map the national/regional cooperation network in the field of carbon mitigation , to analFrom the analysis of China\u2019s nodes and statistical data, China\u2019s scientific research participation in this field was relatively low in the early stage of carbon emission reduction research and the period of low-speed development. In recent years, as more and more Chinese scholars have joined carbon emission reduction research, China\u2019s publication volume in this field has increased sharply. Since 2018, it has surpassed the United States to become the country with the highest number of publications in this field. It can be seen that China is paying more and more attention to the research on carbon mitigation.Distribution of Research and Funding Institutions for Carbon Mitigation ResearchNational scientific research institutions represent strategic scientific and technological strength, and funding institutions reflect the degree of attention. 2 Emissions. Climate Change 2013: The Physical Science Basis [The knowledge base of carbon emission research can be explored from the co-citation network constructed by the cited literature. ce Basis , publishce Basis . In 2008ce Basis . In the ce Basis , which lThe scientific knowledge map constructed by the key words of the cited literature can more intuitively reflect the discipline structure from the micro level. 2 have been studied for the longest time, indicating that the relationship between global warming and atmospheric CO2 has been widely considered by scholars. From 2000 to 2012, the main emerging words in the reduction research are carbon sequestration, ecosystem, agriculture and clean development mechanism. This depicts that scholars have not only carried out long-term research on agricultural ecosystems and carbon sequestration, but have also gone deep into clean energy and other fields. From 2012 to 2021, the emerging words in this research field focus on carbon footprint, life cycle assessment, carbon dioxide emission and consumption, which reveals that carbon mitigation research has entered the phase of innovation system construction. Energy structure and its efficiency are the key factors affecting carbon emission reduction. Efficient renewable energy technology requires continuous innovation and accelerated docking with the carbon market, while technological innovation and market promotion are inseparable from strong support in policy and financial guarantees.In this paper, Burst Detection  is used to analyze the keywords of the cited literature on carbon emission reduction, which can clearly show the scientific frontier and trend of carbon emission reduction. From 1991 to 2021, the research literature related to carbon mitigation increased year on year, generally showing four stages of germination, low-speed development, uniform medium-speed development and high-speed development, and the number of papers published in various countries/regions is parallel to the overall trend. Among the developed countries, the United States, Britain, Germany, Australia, Canada, the Netherlands, Italy and France have made great contributions to carbon mitigation. Among the developing countries, besides China, India has also made great efforts to reduce carbon emissions. Although a latecomer in this field, China has surpassed the United States to become the country with the largest number of publications since 2008. From the analysis of the national/regional cooperation network, the United States has the most extensive cooperation in this field, despite the fact that China has published more articles than the United States. However, it is still essentially necessary to expand the network of international cooperation with wider and deeper impact. From the analysis of the institutional cooperation network, the Chinese Academy of Sciences has the largest number of publications and plays an important role among the global scientific research institutions.Carbon mitigation is a public issue at the global level. In the context of the unbalanced spatial distribution of carbon mitigation research, it is necessary for all countries in the world to mobilize their efforts more actively to jointly respond to the challenges brought by carbon emissions, and to put forward requirements and measures for carbon mitigation based on the actual situations by different countries/regions.In the process of carbon mitigation research, scholars, including Searchinger, Smith, Fargione and other scholars, have provided new branches and directions, laying the disciplinary foundation in this field. The research in Soil Science, Agricultural Economics and Policy, Oceanography, Ecology and other related fields provides a basis for the knowledge system, technology realization and industrial transformation of carbon mitigation. The discipline structure of carbon mitigation research can be divided into four aspects: concept and carbon source exploration, policy formulation, technical methods and carbon mitigation measures. It is worth noting that policy formulation plays a positive role in promoting the research in this field. The initial research on carbon mitigation focused on the status quo of global warming and the release of relevant international policies, such as the Kyoto Protocol and the Paris Agreement. Countries around the world have begun to explore carbon mitigation methods and the corresponding mechanisms from the aspects of carbon mitigation, such as renewable energy, clean development, land use and so on. At present, carbon mitigation has formed a mature institutional mechanism, which has been gradually improved in terms of methodology, such as LDMI and BECCS, and technical support, such as solid oxide electrolysis, life cycle assessment and carbon footprint.The formulation of carbon mitigation policy has effectively promoted the relevant research, but the innovation of technical methods and the implementation of carbon mitigation measures cannot be separated from the support of the government and the guarantee of funds.From the overall analysis of the emerging keywords, the current research hotspots include carbon capture and storage, biomass energy, clean energy and other new technologies, new materials related to emission mitigation technologies, and emission mitigation measures.At present, scholars mostly focus on the research of land use, farmland ecosystem and other carbon sinks. However, the global ocean area accounts for about 70%, which has a huge potential for carbon sinks. With the development of economy and the shortage of land resources, marine carbon sinks will be more widely considered by scholars. Low-carbon-oriented economic development will provide a new development model for the global economy. The development, trading and related activities of low-carbon projects will be conducive to promoting low-carbon economic development. To achieve carbon neutrality, negative carbon emission technology will be conquered sometime in the future, which would make it possible to control carbon emissions and absorption.Although carbon mitigation has attracted global attention and countries have responded positively and taken measures, it is still necessary to combine carbon mitigation with economic development in the future.Based on the WoSCC data platform, 15,304 carbon mitigation research studies were retrieved, with the time, countries/regions and institutional distribution of the literature being studied using scientific knowledge graphs and bibliometrics. Meanwhile, the main research countries/regions and institutions in the world were also analyzed. Through analyzing the cited literature by the keywords, the prominent words and the prominent papers, this paper discusses the discipline foundation, research hotspots and future trends in this field. The following conclusions are drawn:From 1991 to 2021, the research literature related to carbon mitigation increased year on year, and its development process can be roughly divided into four stages. From 1991 to 2002, it was in the embryonic stage, with a small number of articles and focusing on phenomenon analysis. From 2002 to 2007, although the number of published articles increased compared with the previous stage, the growth rate was slower. From 2007 to 2016, the number of published articles increased linearly and was in a state of uniform development. From 2016 to 2021, the number of published articles grew exponentially and is now in a high-speed development trend.The spatial distribution of carbon mitigation research is unbalanced, mainly showing one super with multi-strong distribution. The United States is in a dominant position, in terms of the total number of papers, cooperation networks and research history, while China, Britain, Germany, Australia, Canada, the Netherlands and other countries are evenly matched in carbon mitigation research. Overall, developed countries have invested a lot in carbon mitigation research and made great contributions to this field. Except for China and India, other developing countries have a lower research input and contribution in this field. Institutional research also shows a similar trend. Carbon mitigation, as a public issue facing the world, needs to more actively mobilize countries around the world to jointly respond to the challenges posed by carbon emissions.Carbon mitigation research has gradually evolved from phenomenon analysis, policy guidance, technical methods to emission mitigation measures, and the current research hotspots include carbon capture and storage, biomass energy, clean energy and other new technologies, new materials-related emission mitigation technologies, and emission mitigation measures. In the future, it may develop towards marine carbon sink, carbon trading, carbon-negative emission technology and so on. This paper reveals the development status of carbon mitigation research, and analyzes the hot research directions and development trends in this field, which can provide basic support for global carbon mitigation policy formulation and researchers in this field.In this paper, only the English literature was analyzed, and there was a lack of analysis on carbon-mitigation-related research in the Chinese literature. In addition, there are differences in carbon mitigation studies in different regions, and the reasons for the length of the paper are not fully discussed. Due to the different parameter settings and data processing of CiteSpace software, the knowledge graphs obtained in this paper are slightly different, but the overall analysis and conclusions are reliable."}
{"text": "The authors wish to add the following information to their Research Paper:In the original published version of this article, one of the affiliations for Prof. G. Santulli was incomplete; the correct affiliation is reported below: Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Einstein Institute for Aging Research, Institute for Neuroimmunology and Inflammation, Albert Einstein College of Medicine, New York, NY, USA. Moreover, a declaration concerning the competing interest of one of the authors was not included. This issue has now been rectified; the corrected Declaration of Competing Interest can be found below.Prof. B. Trimarco reports personal fees for speaker bureau, outside the content of the current manuscript, from Malesci, Damor, MSD, and Fidia.The authors would like to apologise for any inconvenience caused."}
{"text": "Nevertheless, although the area of trench and lakes only occupies 1.67\u20133.16% of the total area of land, its ecological value accounts for an astonishing 23.80\u201350.70% of the total ESV. At the district level, the primary decline in eco-system services value was noted in the Chongming District in the north and Pudong New Area in the east of Shanghai. However, due to the overall planning of the city and the advantages of its resource endowment, Qingpu District and its surrounding areas in western Shanghai have witnessed improvements in terms of the values of hydrological adjustment, water supply, and environmental purification. This study presents a deeper and more comprehensive understanding of issues regarding ESV in rapidly urbanized areas, thereby providing an important reference for decision-makers regarding the rational layout of cities, sustainable use of land, and management of natural ecosystems.Land resources are foundational for human survival and development. In contrast, land use/land cover (LULC) dynamics drive considerable changes in ecosystem services. Recently, China witnessed a new stage of rapid urbanization. Therefore, investigating the relationships between ecosystem services value (ESV) and LULC in these areas is highly relevant. Based on the data of land use and socioeconomic development in Shanghai from 2000 to 2020, we adopted a land use/land cover dynamics analysis method and established the ESV per unit area at the city scale, discussed the impact of LULC on ESV spatially and quantitatively, and tested the research process based on the sensitivity analysis of the ESV coefficient. The results show that from 2000 to 2020, the LULC pattern in Shanghai rapidly changed. In particular, the area of cultivated land has shrunk by 123.96 thousand hm The ecosystem is composed of plants, animals, microbial communities, and the abiotic environment. The ecosystem itself and the services provided by its species are the conditions and processes needed to meet and sustain human production and life. These provide a wide range of direct and indirect services for human survival and contribute significantly to improving human well-being ,2,3,4,5.From an economic perspective, measuring the impact of LULC on various ecosystems is an effective way to assess the environmental costs and benefits of different land-use plans and decisions. Based on the evaluation model of ecosystem services value established by Costanza et al., scholars from home and abroad have conducted extensive empirical studies ,38,39. MCompared with other parts of the world, LULC dynamics in China are substantially more complicated. With the rapid development of China\u2019s economy and its increasing urbanization, land resources in China have undergone huge conversions and occupations, resulting in a drastic transformation of land-use types and areas, which have significantly impacted the value of regional ecosystem services ,51,52,53There are many studies have been conducted regarding LULC in China, including its dynamics in urbanized areas ,71,72,73In the 20 years from 2000 to 2020, Shanghai\u2019s economy grew more than 15 times. Simultaneously, Shanghai\u2019s rapid development has also been accompanied by resource consumption, environmental deterioration, and transformation of land use patterns. From this perspective, land use/land cover in Shanghai has significantly changed, both temporally and spatially, which needs special attention. In recent years, documents emphasizing the optimization of the systematic structure and balanced development of the city, strengthening urban land use, and promoting the coordinated development of industrial layout, spatial structure, and ecological environment have been issued, such as the Shanghai City Master Plan (2017\u20132035), Shanghai Land Use Master Plan (2010\u20132030), and other documents have been issued. In this study, we derived the multi-period LULC monitoring dataset of China from Landsat MSS, TM/ETM, and Landsat 8 satellite remote sensing data and combined it with relevant statistical data. Based on this, we selected the representative city of Shanghai to study LULC and its influence on ESV. The degree of land-use dynamics, ecosystem services value, contribution rate, coefficient of sensitivity, and other indicators were used to objectively reflect the influence of LULC on ESV in Shanghai from 2000 to 2020. The purpose of this study is to provide a deeper and more comprehensive understanding of the issues related to ESV in rapidly urbanized coastal areas, thus providing theoretical and methodological support for promoting the sustainable development of land resources and social economy in Shanghai. Specifically, our study aims to answer three main questions: (1) How did the LULC dynamics occur in Shanghai from 2000 to 2020? In this regard, we will analyse and discuss the specific changes of the LULC dynamics in Shanghai; (2) How did the total and individual ESV change in response to the LULC dynamics during this period? This is the key issue of this study, and we will try to explore and reveal the impact relationship between them; (3) Regarding LULC dynamics, what management strategies should Shanghai adopt? In summary, this study aims to address these issues and assumes that LULC dynamics play a key role in the degradation of natural ecosystem services over time.2. Situated in a humid subtropical region, Shanghai has a typical subtropical monsoon climate. It features four distinct seasons, and is rainy and hot during the same period . As the economic, financial, and commercial centre of China, Shanghai is a region that boasts the strongest comprehensive and economic strengths in China. In 2020, the GDP of Shanghai was 3870.058 billion yuan, ranking first among the cities in China . In recent decades, Shanghai has undergone intensive land use dynamics owing to rapid urbanization, which has aroused public and academic attention on the need to study changes in ESV caused by LULC in Shanghai. As shown in Based on the National Resources and Environment Database and Landsat remote sensing image data of the United States as the main information source, the Chinese Academy of Sciences (CAS) established the national 1:10 scale multi-period LULC dataset, namely the China Land Use and Cover Change (CNLUCC) through artificial visual interpretation, and adopted a conical projection of Albers positive axis equi-area double standard parallels as the data projection system. In this study, the data used to analyze the impact of LULC on ESV in Shanghai are based on five land-use maps generated by the Institute of Geographic Sciences and Natural Resources Research, CAS, which are from 2000, 2005, 2010, 2015, and 2020. In this study, Landsat Thematic Mapper (TM), Enhanced Thematic Mapper Plus (ETM+) remote sensing image data were mainly used for remote sensing interpretation of data from 2000, 2005, and 2010, while Landsat 8 remote sensing image data were used for updating the LULC data from 2015 and 2020.2), and the consumer price index (CPI) used in ecosystem services value calculations were obtained from the Shanghai Statistical Yearbook (2001\u20132021) and the China Statistical Yearbook (2001\u20132021).Based on the national standard stipulated in China\u2019s Land Use Classification in 2017 (GB/T 21010-2017), land use types in Shanghai, after comprehensive consideration of the characteristics of its land resources, were classified as cultivated land, forest land, grassland, trench and lakes, wetland pits, and construction land in ArcGIS10.2, which can highlight the characteristic land-use types of coastal areas . Based oLand use dynamic degree (LUDD) describes the change rate of land use in a certain period. The comprehensive LUDD is often used to measure the change rate of land use over an entire area, whereas the individual LUDD is used to calculate the change rate of a certain land type. The calculation method for LUDD is as follows: the ratio of the total area transformed from one land type to another to the initial area of the land type transformed in a certain period . The laribLU is the final value of land type i in period m, iaLU is the initial value of land type i in period m, while ib\u2019LU is the final value of land type i in period n, ia\u2019LU is the initial value of land type i in period n, and mnM is the ratio of the change in period m to that of period n. iLUDD is the dynamic degree, and T is the study period, the unit of which is set as year in this study; hence, the iLUDD in the formula represents the average annual change rate of a certain land type, and the comprehensive LUDD equals the sum of iLUDD.In the formula above, 2) in Shanghai from 2000 to 2020 were used to estimate the economic value of food crops (yuan hm\u22122) in Shanghai. The ecosystem services value equivalent factor is used to represent the relative contribution rate of the potential ecosystem services value. Without considering human input, the economic value provided by natural ecosystems is approximately 1/7 of the economic value produced by existing food crops per unit area [\u22122) was modified. To make the raw data comparable, the CPI was used to adjust the ecosystem services value of different years to the level based on data from the year 2000  and the sown area of food crops  of each land use type in Shanghai can be obtained as shown in Based on the ecosystem services value coefficient determined by Costanza et al. and combined with the equivalent conversion method of Chinese ecosystem value proposed by Xie et al. ,60,61, tiA refers to the area of land use type i, and ijV represents the value per unit area produced by ecological services j of land use type i. m refers to the sum of all land use types, and n represents the sum of all ecosystem service categories.Based on existing studies, in the formula for calculating ecosystem services value, ESV represents the total value of the regional ecosystem services. iCR is the ratio of the value of ecosystem service i to the total value of ecosystem services, whereas jCR equals the ratio of the value of ecosystem type j to the total value of ecosystem services.To facilitate the analysis of changes in ecosystem services value and the comparison of ESV in different regions, this study, based on the research of traditional calculation methods of ESV conducted by Zhang et al. ,77, intrVi1 and Vi2 represent the ESV per unit area produced by land use type i before and after adjustment, respectively, while ESV1 and ESV2 represent the total ESV before and after adjustment, respectively. If the ESV is inelastic relative to V, then CS < 1, meaning that the ESV is insensitive to the ESV coefficient. Conversely, if ESV is elastic relative to V, then CS > 1, indicating that ESV is sensitive to the ESV coefficient. As CS increases, its ESV becomes more dependent on the ESV coefficient, indicating that the accuracy of the ESV coefficient matters.The coefficient of sensitivity is a type of elastic coefficient, which is used to show the dependence of ecosystem service value on the ESV coefficient. That is, the degree of change in ESV is caused by a 1.0% change in the ESV coefficient ,79. In tFrom 2000 to 2020, the main types of land use in Shanghai were cultivated land, trench, lakes, and construction land, and the sum of the three areas in the five years accounted for over 90% of the total area of Shanghai, as shown in 2 of cultivated land. Meanwhile, the net increase in construction land ranked first, reaching 141,260 hm2. The increase in construction land is approximately equal to the decrease in cultivated land, forest land, trench, and lakes, as shown in From 2000 to 2020, Shanghai witnessed rapidly changing LULC patterns and a significant decline in the area of cultivated land, trench, and lakes, with a net decrease of 123,960 hmIn the Shanghai Main Functional Area Planning issued by the Shanghai government, the development strategy for the vast area in the west and south of the city is divided into new areas, whose development focus is intensive and efficient, with improved functions, a friendly environment, a harmonious society, and the integration of urban and rural areas. In other words, the increase in lakes in Shanghai is probably due to the promotion of relevant policies. This study will further explain this point.Ecosystem services values of Shanghai in 2000, 2005, 2010, 2015, and 2020 were 11,458.78 million yuan, 10,269.72 million yuan, 10,539.58 million yuan, 11,148.40 million yuan, and 10,320.38 million yuan , respectThe change in ESV caused by LULC can also be analyzed from the perspective of conversion between various land use types . First, Meanwhile, the shift from wetland pits to trench and lakes contributed to increasing the ESV of the entire city from 2000 to 2020, especially from 2005 to 2010. Similarly, by virtue of the ecological civilization construction strategy advocated by the Chinese government in recent years, the shift from construction land to other land use types greatly facilitated the increase in ESV in 2015\u20132020. During this period, Shanghai conducted a large number of ecological restoration and environmental protection projects, such as the development of the Chongming ecological island, construction of the Huangpu Riverside greenway. Efforts have also been made to further develop the Shanghai Jiuduansha Wetland National Nature Reserve, Shanghai Chongming Dongtan National Nature Reserve, and other regional projects related to ecological environmental protection. Therefore, great strides have been made regarding ecological restoration and environmental protection in Shanghai in recent years, controlling the scale and mode of urban construction to a certain extent, especially adjusting, and optimizing the structure of urban land use, and controlling wetland pit contraction.According to For the convenience of analysis, we selected seven districts: Huangpu, Xuhui, Changning, Jing\u2019an, Putuo, Hongkou, and Yangpu as the city center. In general, choosing the seven districts west of the Huangpu River as the core area was based on the geographical characteristics and historical evolution of Shanghai. After the signing of the Treaty of Nanjing between China and Britain in 1842, Shanghai officially opened as one of the five trade ports. Since the 1990s, large-scale renovation of infrastructure has been performed, rendering this region one of the most prosperous areas in Asia, which is also the core area of Shanghai.The calculation results for the total ESV based on the analysis of each district in Shanghai are shown in The rate of change of the ecosystem services value in Shanghai from 2000 to 2020 is shown in 2. It is rich in natural resources that can provide high values for hydrological adjustment, water supply, and environmental purification. Qingpu District and its surrounding Jiading District, Jinshan District, Songjiang District, and Fengxian District are all classified as new urbanized areas in the Shanghai Main Functional Area Planning issued by the Shanghai Government. The development strategy for this area is intensive and efficient, with improved functions, a friendly environment, a harmonious society, and the integration of urban and rural areas. Therefore, the increase in the ESV of Qingpu District also benefits from the support of relevant policies.It should be noted that, located in the lower reaches of Taihu Lake and the upper reaches of the Huangpu River, Qingpu District boasts 1817 rivers, stretching 2155 km, and 21 lakes, covering a total area of 59.3 kmBy adjusting the ESV coefficient per unit area of each land use type by \u00b150.0%, the CSs of ESV in Shanghai in the corresponding years can be obtained through calculation . We can Existing studies clearly show that in large cities such as Shanghai, the most evident temporal and spatial change in land use type can be attributed to the expansion of construction land and diminishing natural vegetation . Based oTo a large extent, the change in land-use type from 2000 to 2020 in Shanghai has led to a decrease in the overall urban ecosystem service supply, especially regarding the reduction in the value of biodiversity (\u2212407.65 million yuan). In fact, similar situations have been witnessed worldwide ,88,89. AIn fact, the policy is also an important factor that affects the change of urban LULC and leads to the difference of ESV. For example, in the Shanghai Main Functional Area Planning issued by the Shanghai Government, the development strategy for the vast area in the west and south of the city is divided into new areas, whose development focus is intensive and efficient, with improved functions, a friendly environment, a harmonious society, and the integration of urban and rural areas. In other words, the increase in lakes in Shanghai is probably due to the promotion of relevant policies, this change of LULC in turn led to the improvement of ESV in Qingpu District. Overall, while working to improve urban economic development and adjust the structure of urban land use, decision-makers and administrators should recognize the relationship between different land use types and the ecosystem services provided by them, which contribute to the rational layout of cities, sustainable use of land, and management of natural ecosystems.Based on the land use classification (GB/T 21010-2017) and relevant calculation rules of ESV and combined with the characteristics of land types in Shanghai, this study focused on the land use types that can highlight the characteristics of the study region, such as cultivated land, forestland, grassland, trench and lakes, wetland pits, and construction land. Construction land with ESV equivalent to less than 0 was excluded from this study. However, considering the expanding area for construction land in Shanghai year by year in recent years, it can be known that the actual loss of ESV in Shanghai may be higher than the research results, which is comparable to previous research results . MeanwhiAccording to the rule that the value of an equivalent factor is equal to 1/7 of the market value of grain output per unit area in the same year, the value change caused by different prices in different periods of time is eliminated by using the CPI index to revise the ESV coefficient of land use types in Shanghai, which makes the calculated results closer to the actual ESV and improves the accuracy and comparability of value evaluation, thus properly preserving and developing the traditional methods. In general, this study selected Shanghai as a representative city to consider land use/land cover and its influence mechanism on ecosystem services value, and used TM remote sensing image data and relevant statistical data to objectively indicate the impact of LULC on ESV in Shanghai from 2000 to 2020 through indicators such as dynamic degree of land use, ESV and its contribution rate, and CS. It provides theoretical and methodological support for promoting the sustainable development of land resources and the social economy in Shanghai by enhancing a deeper and more comprehensive understanding of issues related to ESV in rapidly urbanized areas, thus providing an important reference for decision-making regarding the rational layout of cities, sustainable use of land, and management of natural ecosystems.Since its reform and \u2019opening up\u2019, China has made remarkable achievements in economic and social development. With rapid economic growth and urban development, capital, labor force, land, and other traditional elements continue to gather in cities for urban development in all aspects, rendering an increasingly limited use of urban land and thus enhancing the impact of land use change on the ecosystem. Based on existing research results and the characteristics of LULC and ESV in Shanghai, this study comprehensively considered the actual situation of the city, calculated the equivalent factor of ESV in Shanghai, and then measured the ESV and its changes in Shanghai from 2000 to 2020.2, while the construction land has expanded by 141.26 thousand hm2, which led to a decline in ESV of the entire city, especially regarding hydrological adjustment and biodiversity, which were reflected in the declining trend of the value generated by various ecosystem services. In particular, the contribution of wetland pits to the overall ecosystem of Shanghai cannot be ignored, and trench and lakes are essential for improving ecosystem services: although the area of trench and lakes only occupies 1.67\u20133.16% of the total area of land, its ecological value accounts for an astonishing 23.80\u201350.70% of the total ESV. As such, they cannot be ignored despite the small fraction they occupy in the entire area. In the future planning of land use in Shanghai, we should heed to the ecological service function of land types, such as trench, lakes, and wetlands pits, and clarify the key role they play in maintaining the balance and healthy development of urban ecosystems. At the district level, barring Chongming District, the value of water supply has increased in all other districts, especially Qingpu District (+118.65 million yuan) in the west of the city. Meanwhile, the main reason for the decrease of ecosystem services value from 2000 to 2020 was the decrease of ecosystem services value in Chongming District in the north and Pudong New Area in the east, which experienced the most severe loss of ESV. However, by virtue of the overall planning of the city and the advantage of its resource endowment, the value of hydrological adjustment in Qingpu District has risen significantly (+1011.45 million yuan) and that of environmental purification has also increased (+30.87 million yuan). We believe that the scale of urbanization and industrialization should be set and controlled in terms of time and space to prevent the pollution and destruction of wetland pits, trench, and lakes during urban development. However, the results of the sensitivity analysis demonstrate that ESV is inelastic to the ecosystem services value coefficient (V), which is consistent with the realities of Shanghai, indicating the reliability of the ESV coefficient determined in this study.As a representative of China\u2019s rapid urbanization, Shanghai has undergone significant changes in land use structure during the process of urban expansion, which is mainly reflected in the encroachment of the expanding construction land on cultivated land, forest land, trench, and lakes, as well as other land types. The LULC pattern in Shanghai rapidly changed from 2000 to 2020, in particular, the area of cultivated land has shrunk by 123.96 thousand hm"}
{"text": "The rapid spread of the COVID-19 pandemic in early 2020 has impacted the politics, economy and society of countries around the world. The public health diplomacy system through which developed countries in Europe and America used to provide vertical one-way assistance to developing countries faces huge challenges. How emerging economies can cooperate to fight the pandemic on the basis of mutual trust and mutual benefit has become an urgent issue. In this paper, we examine the impact of political mutual trust on the effectiveness of pandemic prevention and control from the perspective of establishing strategic partnerships between emerging economies. Furthermore, taking into account the huge differences between emerging economies, this paper explores institutional distance, cultural distance, and geographical distance\u2014the adjustment effect of the control effect. Studies have shown that the improvement of political mutual trust is conducive to the formation of a community of shared futures between countries and has a positive effect on curbing the spread of the pandemic. The increase of the three-dimensional distance of institutions, culture, and geography will weaken the effect of establishing strategic partners for pandemic prevention and control. This paper explores a new model of horizontal international cooperation among emerging economies, and provides a reference for emerging economies to deal with common globalization issues in the future. Since the beginning of 2020, the rapid spread of COVID-19 has brought a great impact on the world's politics, economics, and society. Different from the major public security incidents for human beings, in the face of this COVID-19 pandemic, there are huge differences in the prevention and control strategies of the world's major economies. U.S. states have introduced different pandemic prevention policies, such as issuing stay-at-home orders, closing schools and public places, canceling public events, and others  increased in real terms by 4.9% in 2020, well above the average annual growth rate of 2% between 2017 and 2019, and Canada's per capita COVID-19 spending was as high as $602 . AccordiInternational cooperation is critical in addressing global health and public health security concerns, and is key to the response to the COVID-19 pandemic . The essPrevious studies have explored how to prevent and control the spread of the epidemic from multiple perspectives, including public health management , clinicaThe unique urgency and uncertainty of major public emergencies have not only impacted the global public health system, but also provided opportunities for countries to cooperate. This paper takes into account the large number and wide distribution of emerging economies and the huge institutional and cultural differences between countries, which may lead to differences in their stressors, responses, and priorities . These dStrategic cooperative partnership between countries means mutual trust, more channels of interaction and institutions established to solve problems at the governmental and non-governmental levels. In the face of global crises and challenges, countries can transcend bilateral issues, seek common ground while reserving differences, and seek international cooperation for common solutions . TherefoH1: Establishing cooperative partnership plays a positive role in pandemic prevention and control.The dimensions of differences between countries are diverse, and the institutions, cultures, and geographical distances between countries may have an impact on the international cooperation carried out under the partnership, which in turn makes the establishment of strategic partnerships have different influences on the effect of pandemic prevention and control.Institutions include formal institutions  and informal institutions  , and insOn the one hand, the existence of institutional distance makes it difficult for countries to reach consensus on divergent issues, which may increase political tensions and make international cooperation in prevention and control more difficult . Mutual H2: Institutional distance negatively regulates the positive effect of establishing strategic partners on pandemic prevention and control.There are cultural differences between different countries , and culH3: Cultural distance negatively regulates the positive effect of establishing strategic partnerships for pandemic prevention and control.The difficulty of national cooperation is increased by increasing geographical distance, which is challenging to interrupt the rapid spread of COVID-19 around the world. On the one hand, geographic distance is a negative factor affecting state relations and is also seen as a proxy for transportation and communication costs , which nH4: Geographical distance negatively regulates the positive effect of establishing strategic partners on pandemic prevention and control.There is not yet a consistent definition of the concept of emerging economies, and a common practice is to classify countries other than developed as emerging economies , 46. FirWe collected China's strategic partnership with 164 emerging economies in 2019, and cross-sectional data on the pandemic, economy, population, and medical care of these countries in 2020. We mainly considered two aspects. One is the availability of data. In 2020, the COVID-19 virus spread widely around the world and was identified by the World Health Organization as a public health emergency of international concern. In addition, some indicator statistics in the World Health Organization and World Bank databases are only updated to 2020. Second, the impact of close strategic partnership on the effectiveness of COVID-19 prevention and control has a lag. The data for each indicator used in this article is taken from the Johns Hopkins University Coronavirus Resource Center, the website of the Chinese Ministry of Foreign Affairs, the public data of the Hofstede team, the CEPII database, the World Bank, the World Health Organization, and the United Nations Comtrade Database.The number of confirmed cases is one of the important indicators to reflect the effectiveness of a country's pandemic prevention and control . The fewThe independent variable of this paper is the strategic partnership, which is measured by the closeness of the bilateral partnership. The value is 0 for unestablished partnerships, one for partnerships, two for comprehensive partnerships, three for strategic partnerships, and four for comprehensive strategic partnerships. The higher the value, the stronger the partnership.IkCH represents the index value of the k-th institutional dimension of China, Ikj represents the index value of the k-th institutional dimension of emerging economies j, and Vk represents the variance of the index value of the k-th institutional dimension. The data of each institutional dimension comes from six aspects of the Worldwide Governance Indicators (WGI) provided by the World Bank . The second is cultural distance, which reflects the degree of cultural difference between China and emerging economies. The cultural distance between China and various emerging economies is measured according to the cultural distance measurement index proposed by Kogut and Singh . One can obtain a score for each cultural dimension of the economy by entering a country's name. The third is geographical distance, which reflects the geographical proximity between China and emerging economies, measured by the straight-line distance between Beijing, the capital of China, and the capitals of emerging economies.There are three moderator variables in this paper. The first is institutional distance, which reflects the institutional environment differences between China and emerging economies. The measurement method refers to the formula of Kogut and Singh , that isnd Singh . That isIn this paper, five variables are included as control variables from the three aspects of economy, population, and medical care. The first is the closeness of bilateral economic ties, which is measured by the total import and export trade between China and emerging economies; the second is the level of national economic development, which is measured by the GDP per capita of emerging economies; the third is the age structure of the country's population, which is measured by the proportion of the population aged 65 and over to the total population; the fourth is the health status of the national population, which is measured by the incidence of tuberculosis per 100,000 people; the fifth is the national medical and health level, which is measured by the coverage of health services in the infectious diseases index.The variable definitions and measurement methods in this paper are shown in Descriptive statistics and correlations of the variables are shown in In order to test the impact of strategic partnership on the effect of pandemic prevention and control (H1), we employ the following linear estimation model.Furthermore, in order to study whether different institutional environments, cultural backgrounds and geographic distances between the two countries have different effects on epidemic prevention and control, we expand model (2), (3) and (4) on the basis of model (1), and explore the moderating effect of institutional ,cultural and geographic distances, respectively:Among these, the independent variable lnincidence  represents the effect of pandemic prevention and control. The independent variable lnrelationship  represents the closeness of the bilateral partnership. lnid, lncd, and lngd are three moderator variables, which are geographic distance, cultural distance, and institutional distance. CV represents the set of control variables that affect the impact of pandemic prevention and control, including lntrade, lngdp_per, lnelderly, lntuberculosis, and lnsci_infectious, and \u03b5 represents the random disturbance term.p < 0.05), which suggests that the closer the partnership between China and emerging economies, the lower the incidence of COVID-19 in emerging economies. Therefore, the establishment of strategic partnerships will help emerging economies to achieve better pandemic prevention and control effects. Hypothesis 1 is supported.Hypothesis 1 of this paper is that the establishment of strategic partnership is conducive to improving the effect of pandemic prevention and control, and the incidence of COVID-19 is used as a reverse indicator to measure that effect. p < 0.05), indicating that the estimated result is still robust. In addition, in the subsequent moderating effects test  to replace the original incidence (lnincidence), thereby measuring the effectiveness of pandemic prevention and control, and use the number of visits (lnvisit) between state leaders as the proxy variable of the partnership (lnrelationship), while other variables remain unchanged. It can be seen from cts test , after t*lnid is significantly positive , the coefficient of lnrelationship*lncd is significantly positive , and the coefficient of lnrelationship*lngd is also significantly positive . The signs of the three interaction terms are all opposite to the independent variable, indicating that institutional, cultural, and geographical distance have negative moderating effects on the relationship between the establishment of strategic partnerships and pandemic prevention and control in emerging economies. When the institutional, cultural, and geographical distances between countries are relatively far, the positive impacts of establishing strategic partnerships on prevention and control in emerging economies will be weakened. Thus, hypotheses 2, 3, and 4 of this paper are supported.Hypotheses 2, 3, and 4 in this paper respectively assume that the positive effect of establishing strategic partnerships on COVID-19 prevention and control may be influenced by differences of institutional, cultural, and geographical distance. In this paper, we constructed the interaction terms of one independent variable (lnrelationship) and three moderator variables . Moreover, in this paper, we have constructed the independent variable lnrelationship and the interaction terms of the three moderator variables. Model (5), (6) and (7), respectively incorporate moderator variables and interaction terms based on model (2), to investigate the effect of differences in multiple distances on the impact of establishing strategic partnerships for pandemic prevention and control. From the regression results in In this paper, we find that the establishment of strategic partners is positively correlated with the effectiveness of pandemic prevention and control. There are three main reasons for this. First, close partnerships between countries reduce the likelihood of public health securitization. Securitization occurs when a threatening issue is sufficiently prominent to allow authorities to take approaches that they deem most appropriate to deal with the issue . The strFrom the perspective of different dimensions in distance, we find that multiple distances\u2014institutional, cultural, geographical\u2014have negative moderating effects on the relationship between the establishment of strategic partnerships and the effect of prevention and control. It is not surprising that these multiple distances have significant moderating effects. On the one hand, despite the many similarities among countries during the pandemic, measures to deal with the spread of COVID-19 and priorities in prevention and control may differ due to differences in countries' geographical locations, cultures, and institutions , which wIn this paper, we have examined the impact of strategic partnerships among emerging economies on the effectiveness of COVID-19 prevention and control. We have studied the relationship between incidence and strategic partnership among 165 emerging economies. The results indicate that a good relationship in political cooperation is of great importance for countries to work together to fight the pandemic and slow down the spread of the virus. On this basis, we further examine the adjustment mechanisms of institutional, cultural, and geographical distance between emerging economies on this driving effect, and the results show that all three distances will weaken this driving effect.Based on the above research conclusions, we put forward the following suggestions for the urgent needs of pandemic prevention and control:(1) Political mutual trust and strategic mutual trust are the cornerstones of cooperation among countries. We should take the joint prevention and control of the pandemic situation as an opportunity to promote coordination and cooperation among countries. By establishing a solid foundation of political mutual trust among countries, such as strategic partnership and high-level leaders' visits for exchange, strengthening cooperation based on the purpose of mutual benefit and win-win, adhering to the principles of openness, tolerance and seeking common ground while reserving differences, and promoting pragmatic cooperation on major issues of difference.(2) Governments should establish high-level systems and mechanisms, explore effective anti-pandemic cooperation mechanisms and extend them widely. Countries can try to establish bilateral cooperation first, then gradually move toward multilateral cooperation, regional cooperation, and global cooperation, and improve the global system for the governance of public health safety.(3) Governments should also promote multi-level collaboration among non-governmental organizations in various countries. They should strengthen the cultural exchange mechanism, carry out non-governmental cultural exchange activities, enhance cultural identity, and promote people's communication. In terms of cooperation on scientific research, universities and research institutions are encouraged to conduct academic exchanges and project cooperation, establish a joint training mechanism for medical talent, and accelerate the research and development of vaccines and anti-pandemic drugs. Countries should give full play to the role of enterprises. Whether it is the supply and transportation of materials for prevention and control or the production of vaccines, enterprises need to participate. Enterprises need to build pandemic bases for the production of prevention-related material such as masks, vaccines, and protective clothing in local areas, thereby reducing the shortage of these materials caused by insufficient production capacity and inefficient transportation.The development of today's world is inseparable from emerging economies. According to IMF statistics, emerging economies have contributed nearly 50% of world economic growth in the past 10 years. A global multi-polarization system is taking shape. It is foreseeable that the official development assistance from developed countries to developing countries will gradually weaken, and emerging economies need to further strengthen open cooperation in the fields of politics, economy, science and technology, get rid of excessive dependence on developed countries, and improve their international voice.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "In October 2014, the Pan American Health Organization/World Health Organization (PAHO/WHO) and its Member States adopted the Strategy for Universal Access to Health and Universal Health Coverage, which defines universal access as the absence of geographical, economic, sociocultural, organizational, or gender barriers; and health coverage as the capacity of the health system to serve the needs of the population, including the availability of infrastructure, human resources, health technologies (including medicines) and financing. The Universal health strategy advocated for a robust health system, supported by motivated, well-distributed health personnel with an appropriate set of skills, to provide quality services based on the needs of the populationIn September 2017, PAHO and its Member States approved the Strategy on Human Resources for Universal Access to Health and Universal Health Coverage. The lines of action of the Strategy are: strengthen and consolidate governance and leadership; to develop conditions and capacities to expand access to health and health coverage, with equity and quality; and to partner with the education sector to respond to the needs of health systems in transformation toward universal healthIn September 2018, the Plan of Action for Women\u2019s, Children\u2019s, and Adolescents\u2019 Health 2018-2030 was approved by PAHO/WHO Member States. The plan calls for the promotion of universal and equitable access for women, children, and adolescents to quality and comprehensive health services. Proposed actions under this objective include the development and implementation of comprehensive adolescent-responsive care, and systematic analysis and addressing of the barriers faced by adolescents in conditions of vulnerability in accessing health services.Since 2020, the COVID-19 pandemic has impacted health services and health outcomes in the Americas, particularly in vulnerable populations and highlighted the inextricable connections between health, the economy, the environment, and social protection policies and mechanisms.Given the impact of COVID-19 in the region, advancing, and implementing a primary health care (PHC) approach is urgently needed now more than ever. Within this context, PAHO and Global Affairs Canada initiated a project in 2021 focused on interventions to strengthen the first level of care to ensure the continuity of priority health programs, planning for the recovery of health systems over the mid-to longer term. Its actions will contribute to increasing access to and coverage of sexual and reproductive and maternal health services for women and adolescent girls by identifying and overcoming barriers to address their health needs through the provision of gender responsive, culturally sensitive, people centered, comprehensive, and quality interventions focused on the life-course approach. A sub-project is targeting the role of nurses in the improvement of health of adolescents in conditions of vulnerability.curricula and identification of content related to adolescent health in undergraduate nursing courses was conducted. Among the results found was the need to improve the capacity of the faculty and the identification of themes related to adolescent health that need be incorporated into the training of nurses, such as behavior (decision and attitude), gender identity and sexual orientation, bullying and cyberbullying, use of digital technologies, violence in relationships, parenthood in adolescence, and pubertal delay.With the collaboration of the schools of nursing of the Universidad Nacional de Colombia - Colombia, Universidad de Guayaquil - Ecuador, and Universidad Nacional Mayor de San Marcos - Per\u00fa, an analysis of Adolescence is an important stage of human development, in which adolescents, neither old children nor young adults, deal with physical, hormonal, sexual, emotional, cognitive, moral and relationship factors. Although they are generally considered a healthy group, the incidence of preventable or treatable health conditions and the barriers of access are identified as important issues affecting their healthSince 2020, this group has been affected by the direct effects of COVID-19, but also in their daily lives, with the interruption of critical health services, including mental health and sexual and reproductive health services, the disruption of education and reduced social environment and exchanges, the loss of family income, and increased exposure to violenceGiven the insertion and role of nurses in health services and systems, strengthening the nursing workforce involves prioritizing policies that focus on actions in the areas of education, employment, leadership and maximizing the contributions of nurses in service delivery, as recommended in the WHO Global Strategic Directions for Nursing and Midwifery 2021-2025The investment in nursing professionals, in their various spheres of action and decision-making, will respond to problems such as shortages, inequitable distribution, and insufficient qualification, with a specific impact on populations in vulnerable conditions.Salud integral de los y las adolescentes\u201d, available in the Virtual Campus of Public Health, and the realization of webinar series, workshops and other capacity building activities focused on the training needs identified. Additionally, analysis of policies related to adolescent health, participation of nurses in leadership positions, advocation for expanding the role of nurses in school health and primary health care and disseminating nursing practices on adolescent health will be conducted. This special issue of this journal is one of the achievements of this project.The Pan American Health Organization in order to overcome the need to update the knowledge of faculty and nurses in regard to adolescent health is planning several activities in the next years, such as the promotion of the course \u201cIt is expected that the articles published here will assist in the dissemination of best practices and roles of nurses in different countries, especially those countries in the project such as Bolivia, Ecuador, Colombia, Guyana, Honduras, Per\u00fa, and generate subsidies for governments, policy makers, educational institutions, professional associations, and researchers to support effective actions related to adolescent health."}
{"text": "New media has gradually become the mainstream media that college students rely on, and new media has also brought about subversive changes and has become an essential medium for college students to receive and disseminate information, such as learning, interpersonal communication, and entertainment. Young college students have become the most enthusiastic recipients and users of new media. College students need to have the ability to recognize, understand, and criticize new media. New media literacy has become the basic quality that every college student living in modern society must have. This paper takes 826 college students as the research object with deep neural network (DNN), and then analyzes their media selection tendency, media usage time, positive influence, and the relationship with new media literacy. The formation of good new media literacy has a positive effect and influence on the work and study after the university, making it the main force of the media society. The media is the medium of dissemination of information \u20133. It reWith the development of the Internet, new media has been updated and upgraded. So far, considering different research perspectives and levels, the definition of new media in academia has not been unified. New media is a relative concept. New media can be regarded as the product of new technologies. The latest technologies such as digitalization, multimedia, and network are all necessary conditions for the emergence of new media. After the birth of new media, the form of media communication has undergone earth-shaking changes, such as subway reading, large screens in office buildings, and so on, all of which have transplanted the communication content of traditional media into a new communication space.New media can be divided into four types , 5: mobiMedia literacy  is the aNew media literacy is divided into functional access and critical access . Each diWith the continuous development of new media technology, new media is no longer concentrated in a few elite groups, and the general public has become the main user group of new media, which has also brought earth-shaking changes to the media industry. At this time, individuals play the roles of information transmitters and producers, and the connotation of new media literacy should be further enriched and improved.When people use new media correctly and efficiently, new media can better serve people's work and life. With new media to actively participate in social interaction, constantly improve yourself in social interaction, and gradually enhance the awareness of concentric circles, responsibility awareness, civilized online awareness, and network security awareness. In general, new media literacy mainly includes the ability to acquire and understand, to think and question, to participate and create, and to use and produce.Sun Yat-sen University first opened a new media literacy course for college students on the MOOC platform in 2014. The course has successfully completed 12 rounds, each of which is divided into 9-week lesson plans, focusing on the Internet revolution and its impact, future journalism and future audiences, and online public opinion. The course outline displayed on the official MOOC ."}
{"text": "Formerly Professor of Psychiatry, University College London, and Director of the Division of Psychiatry, University College London, UKProfessor Michael King, who died on 10 September 2021 aged 71, made numerous important contributions in primary care psychiatry, including risk prediction and the evaluation of complex interventions for mental disorders. However, his research interests went much further than this. Always curious and with an insatiable intellectual appetite, he was an academic polymath, often drawing on approaches from other fields and applying them to psychiatric research. He was particularly fascinated by subjects that were difficult to study, such as improving mental health at the end of life for people with cancer, the role of spiritual beliefs in mental well-being, and the mental health and stigma experienced by people from sexual minorities. Michael was a brilliant methodologist and a prolific researcher, producing almost 800 peer-reviewed publications, attracting over \u00a345 million in grant income and supervising 30 PhD students over the course of his career. He was also tremendously generous and effective in supporting the development of junior clinical and non-clinical academics, many of whom are leaders in their fields today.Michael believed that visibility was key in addressing homophobia in society and, as an out gay man, he was also a courageous advocate for the rights of LGBT people, drawing on the scientific evidence to make his case. In the 1990s he was instrumental in changing how the cause of death was recorded for victims of AIDS, to mitigate the associated stigma without compromising the collection of accurate statistics. His research into male victims of sexual violence influenced the current legal definition of male rape. He was often called as an expert witness in cases of child custody involving lesbian and gay parents. He also gave expert evidence to the Church of England Synod on same-sex marriage and the ordination of LGBT ministers. In 2001, with Annie Bartlett, he co-founded the Royal College of Psychiatrists\u2019 LGBT special interest group (now the Rainbow SIG). Michael contributed hugely to the work of this group, presenting at numerous conferences and providing wise counsel to the College on relevant, often contentious, matters of policy. He was able to remain calm, even when seriously provoked, always presenting his arguments in an empathic, open and assured way. At the time of his death, he remained the foremost expert in LGB mental health in the UK and an international leader in this area. He also weathered a number of attacks on his reputation as a consequence of his courage in speaking up for sexual minorities. Although he was not someone who sought accolades or prizes, he was honoured to be invited to give the prestigious Beattie Smith lecture at the University of Melbourne in 2017, in recognition of his immense contribution to this field.Michael was one of two brothers born in Christchurch, New Zealand on 10 February 1950, to Bruce, a farmer, and Patricia King. He completed his medical studies at the University of Auckland in 1976 before moving to the UK to train in family practice. In 1981 he began his training in psychiatry at the Maudsley Hospital, remaining firmly invested not just in psychiatry but in medicine and primary care throughout his career. He was awarded Membership and Fellowship of the medical Royal Colleges of all three specialties. He trained in psychiatric epidemiology at the General Practice Research Unit of the Institute of Psychiatry and gained both an MD (University of Auckland 1986) and PhD (University of London 1989) prior to his appointment as senior lecturer in the Department of Academic Psychiatry at the Royal Free Hospital School of Medicine in London. He became the Head of Department in 1995 while he was still only a Reader and, under his energetic and inspiring leadership, the Department rapidly expanded. Later, when the Medical School became part of University College London (UCL), he became Director of the UCL Division of Psychiatry, a role he retained until 2014.As an adult, Michael learnt Spanish, French and German and developed a number of long-standing international collaborations, particularly in South America, Europe, India and Australasia. He was also an excellent clinician, setting up the psychosexual service at Camden and Islington NHS Foundation Trust for which he was the consultant psychiatrist for 30 years.www.ntmpatientcare.uk). Michael is survived by Irwin, two nieces and a nephew. He is very much missed by his family and by his many friends and colleagues across the world.Michael met his life partner, Professor Irwin Nazareth, in 1984 at the Gay Medical Association. They celebrated their civil partnership in 2006 and married in 2017. In 2019 he contracted a rare non-tuberculous mycobacterium (NTM) infection, later found to be connected to the extremely rare lung condition pleuroparenchymal fibroelastosis, from which he died. As was typical of his approach to life, finding that no patient support group existed, he established one, NTM Patient Care UK ("}
{"text": "The purpose of this article is to highlight the history of Hospital Agios Dimitrios, the General Hospital of Thessaloniki. During the early 20th century, many refugees settled in the Greek city of Thessaloniki. To address the growing public health needs of the city\u2019s inhabitants, the Greek government established a health agency to offer medical care and respond to infectious disease outbreaks and epidemics. This initiative resulted in the construction or renovation of various hospitals. The Hospital Agios Dimitrios in Thessaloniki was completed in 1903. Its innovative architecture includes kiosks and wards designed to provide better ventilation and prevent the transmission of infectious diseases. This article highlights the history of Hospital Agios Dimitrios, the General Hospital of Thessaloniki. Thessaloniki has great historical and strategic importance in Greece and is the capital of the geographic region of Macedonia. It has been home to thousands of refugees who fled to Greece during conflicts in the nineteenth and twentieth centuries . To addrHistory of ThessalonikiThe history of Thessaloniki dates back to 316 BC, during the reign of \u039aing Cassander of Macedonia 350-297 BC), who was appointed regent by King Philip III (359-317 BC). After the death of Philip III, Cassander settled in Macedonia and married princess Thessalonike (352-295 BC), daughter of King Philip II (382 BC-336 BC) and half-sister of Alexander the Great (356-323 BC), with the aim to become king of Macedonia ,5. \u039aing 0-297 BC,Thessaloniki became a junction connecting the Adriatic Sea with the Hellespont and Asia Minor, allowing it to quickly develop into one of the most wealthy and populous cities in the region Figure . In 168 During the Byzantine era in 330 AD, around the time that Constantine the Great (272-337 AD) founded Constantinople, cities such as Thessaloniki began strengthening their commercial, military, and economic influence to maintain their roles as important crossroads between the West and the East ,8. AfterIn the aftermath of the Balkan Wars, Thessaloniki received a large wave of refugees from Serbia, Russia, the Caucasus, Bulgaria, and Anatolia . ThousanThessaloniki again served as an important strategic location during World War I (1914-1918), with British, French, and Serbian troops relying on its harbor for shipping supplies . After RNewcomers who settled in Thessaloniki were attracted to its multiculturalism, housing, and employment opportunities. Several Muslim neighborhoods comprising approximately 9,000 properties had been deserted after the Treaty of Lausanne on July 24, 1923. During the first months after the Asia Minor Catastrophe (August 1922 - May 1923) about 117,000 refugees from Thrace and Asia Minor arrived in the city . By 1932Other hospitals in the regionAs early as the 17th century, the Turkish chronographer and traveler Evliya \u00c7elebi 1611-1682) mentioned the existence of a Greek Hospital in the city of Thessaloniki . By the 11-1682 mAfter the turn of the 20th century, several more hospitals were built in Greece, including the Jewish Hirsch Hospital (1908), Hagia Sophia Russian Hospital (1910), Hospital for Special Diseases or \"Smallpox House\" (1912), Hospital for Venereal and Skin Diseases (1917), and Sanatorium of Asvestochori (1920). Another notable facility, Red Cross Hospital (1919), is still operating today as the Georgios Gennimatas General Hospital of Thessaloniki ,18.Agios Dimitrios HospitalGureba Hastahanesi) was inaugurated [2), was later converted to a Municipal Hospital (Belediye) and renamed Hamidiye Belediyesi in honor of Sultan Abdul Hamid II (1876-1909) [Agios Dimitrios Hospital was built in an area that the Greek community used for the burial of the dead . Construugurated   .In 1929, the daughter of famous Greek architect Lysandros Kaftantzoglou, Eleni Zografou 1872-1937) , electric room, massage room, disinfectant room, baths and cold showers, laboratory, restaurant, kitchen, and laundry. The second floor included a men's operating room with 25 beds, two women's operating rooms with five beds each, two men's ward rooms with 15 beds each, a women's ward with 20 beds, a tuberculosis room with five beds, two ophthalmology wards with five beds each, and doctors' offices and dormitories. An adjoining room housed the furnaces for sterilization of tools, cotton, and bandages, as well as machines for sterilizing the water and heating patients' clothes .Adelfato (Brotherhood), an administrative council appointed by the Central Administration of Macedonia. Adelfato was chaired by the mayor, and its members were elected by the Municipal Council. Over the next several years, a radiology laboratory, a department of pathology and ophthalmology, and a tuberculosis clinic were established, and the number of beds increased to 200 [After the liberation of the city in 1912, the Hellenic Municipal Hospital of Thessaloniki was managed by the d to 200 .During World War II (1939-1945), the hospital supported the Greek army, which used much of the main hospital building as medical and storage facilities . The hosAdrias after a poorly regulated firing. The shell destroyed part of the patients' wards and seriously injured doctors, nurses, and patients. All the windows of the hospital were broken, and the machines of the chemistry were destroyed [On January 20, 1949, the hospital was bombed by the destroyer In 1971, the hospital became the property of the state as a Legal Entity under Public Law, and it was officially renamed the Hospital Agios Dimitrios in honor of the patron and protector of the city, Saint Demetrius ,16,19. ISince 1980, the following departments have been added: audiometry, electroencephalography, nystagmography, neurochemistry, hematology and blood banking, and neuroradiology. The kitchen building was also expanded to increase the size of the restaurant and food storage. A prefabricated building was delivered to the hospital to accommodate more outpatient treatment and administrative services . In 1982In the 1990s, doctors' locker rooms and gynecology offices were added to the ground floor, and a pathology clinic, kitchen, and new lavatories to the second floor. A new building was constructed to house the outpatient clinics, administration offices, library, and amphitheater. Outpatient clinics for autoimmune diseases, diabetes, lipidemia, headache, rheumatology, and fatigue testing also were added. Since the 2000s, social work, community outreach, breast health and mammography, sleep and apnea, orthopedics, pulmonary health, and diode laser services have been established .Thessaloniki has been a strategically important city from the time of Philip II until World War II. Under the rule of its many conquerors, the city also has been a major refugee settlement and multicultural center in the region. Overcrowding in the city has led to many disease outbreaks, such as malaria, tuberculosis, dysentery, and typhoid. Yet, until 1917, Thessaloniki had no organized public health policy. Soon after Eleftherios Venizelos established the Ministry of Health, the construction of hospital structures began. Hospital Agios Dimitrios in Thessaloniki, which was first erected in the 1850s and completed around 1902, was originally intended as a burial ground. The building has undergone numerous renovations in the last century and now serves as one of the most important public hospitals in the city."}
{"text": "To estimate the temporal trend of the incidence rates of accidents with venomous animals in children and adolescents in Brazil.Sistema de Informa\u00e7\u00e3o de Agravos de Notifica\u00e7\u00e3o \u2013 SINAN). The time series of incidence rates of accidents with venomous animals were stratified by age group (children aged 0 to 9 years and adolescents aged 10 to 19 years), Brazilian macro-regions , and type of accident . For trend analysis, the Prais-Winsten model and the Annual Percent Change (APC) were used.An ecological time-series study was carried out between 2007 and 2019. Data were obtained from the Brazilian Information System on Diseases of Compulsory Declaration (The time series of the incidence rate of accidents with venomous animals in children and adolescents from the North, Northeast, Midwest, and Southeast macro-regions and in children from the South region showed an upward trend. The average annual incidence rates were higher in the age group of 10 to 19 years, except for the South macro-region. Accidents with scorpions, snakes, and spiders, in this order, were the most frequent; the trends in the time series stratified by type of animal varied according to the geographic macro-region.There was an upward trend in the incidence rate of accidents with venomous animals in children and adolescents in Brazil, except for adolescents in the South macro-region of the country. In Brazil, accidents involving venomous animals are compulsory notification events since 2010, and those caused by snakes, scorpions, spiders, and caterpillars are of priority interest for the epidemiological surveillance system. Overall, these accidents are more serious in children than in adults, considering that the amount of injected venom is independent of the victim's age and the unbound fraction concentration in organs is higher in the pediatric population.Accidents with venomous animals are those caused by animals that produce toxic substances and provide specific mechanisms for inoculation. This type of accident is frequent and represents a serious public health issue in tropical countries.Bothrops genus are the most frequent among snakebites in Brazil. The North and Midwest macro-regions, especially rural areas, account for the highest incidences. Most accidents are clinically classified as mild; however, the delay in medical assistance and in the beginning of serum therapy can increase the fatality rate. Conversely, accidents caused by scorpions are predominantly urban, and an increase in cases in the states of the Northeast and Southeast macro-regions has been observed in recent years. Most cases present a benign clinical course; nevertheless, in the pediatric age group, there is a greater risk for severe clinical manifestations, especially when the accident is caused by the species T. serrulatus.Regarding accidents with snakes, those by snakes from the Loxosceles (brown spider), Phoneutria (Brazilian wandering spider) and Latrodectus (black widow). The occurrence of accidents with each type of spider varies according to geography and time of the year. In turn, accidents with caterpillars, which are more common in the South and Southeast macro-regions of the country, occur in urban areas, with the exception of lonomic accidents, which are more frequent in rural areas. The severity of the accident is associated with the amount and intensity of contact with the caterpillars, factors that are worthy of attention when dealing with pediatric patients.As for spider bites, there are three genera of spiders in Brazil that cause severe symptoms:  Thus, periodic epidemiological studies are necessary to know their temporal characteristics and assist in decision-making when developing control and prevention strategies aimed at risk areas and groups. Specifically, ecological time-series studies are an important tool for formulating explanatory hypotheses at the population and regional level, and contribute to the improvement and effectiveness of care. In this context, the objective of this study was to estimate the temporal trend of the incidence rates of accidents with venomous animals in children and adolescents in Brazil.In a large and heterogeneous country such as Brazil, regional and temporal variations are expected in the occurrence of accidents with venomous animals. The environmental and habitat transformations of these animals, which result from irregular deforestation, population migration, socioeconomic changes, and diverse climate changes, potentially modify the incidence rates of these accidents.Sistema de Informa\u00e7\u00e3o de Agravos de Notifica\u00e7\u00e3o \u2013 SINAN), and the population of each macro-region, according to age group, was obtained from the Brazilian Institute of Geography and Statistics (IBGE).An ecological time-series study on the incidence of accidents with venomous animals was carried out in children and adolescents residing in Brazilian macro-regions, from 2007 to 2019. All data were obtained from official secondary sources of the Brazilian Ministry of Health, which can be accessed on publicly available websites. Data on reported cases of accidents with venomous animals were obtained from the Brazilian Information System on Diseases of Compulsory Declaration , Brazilian macro-regions  and type of accident . Incidence rates were estimated by dividing the number of cases by the number of the population and multiplied by 100 thousand, according to the stratification of interest. The base 10 logarithmic transformation of the incidence was considered as the dependent variable (log[y]) and the centralized-year, as the independent variable (x). Subsequently, the annual percent change (APC) of the incidence and its respective 95% confidence intervals (95%CI) were estimated. The trend was considered statistically significant when zero was not contained in the 95%CI of APC; in this case, the positive APC value represented an upward trend, and the negative APC value, a downward trend. When zero was contained in the 95%CI of APC, the trend was considered stationary. All analyses were performed using the R software version 3.6.3.For trend analysis, the Prais-Winsten model was used. this study did not require evaluation by the Research Ethics Committee, as it used secondary, anonymized, and publicly available data.According to Resolution No. 466 of 2012, of the National Health Council of the Brazilian Ministry of Health,Between 2007 and 2019, 597,447 cases of accidents with venomous animals were reported in Brazil in children and adolescents. During this period, there was a 122.5% increase in the annual number of records, from 31,926 cases in 2007 to 71,048 cases in 2019. As for the age group, 55% of the victims aged between 10 and 19 years. Regarding the geographic distribution, 36% of the cases were from the Northeast; 32.5% from the Southeast; 16% from the South; 10.4% from the North; and 5.1% from the Midwest of the country.Of the total number of cases in which the involved animal was known , 51% were caused by scorpions; 16.2% by snakes; 14.4% by spiders; 3.3% by caterpillars; and 15% by other animals. The average annual incidence rates of accidents with venomous animals and the trend analysis, according to macro-region and age group, can be observed in Regarding snakebites, the North macro-region had the highest incidence rates in both age groups analyzed. The average annual incidence rate was higher in the age group of 10 to 19 years in all Brazilian macro-regions. The time series of the North and Northeast were stationary, whereas those of the Southeast and South showed a downward trend in the incidence of this type of accident; in the Midwest, a mixed pattern was observed .As for accidents with spiders, the average annual incidence rate during the study period was higher in the age group of 10 to 19 years, except in the South macro-region. The units of analysis showed an upward trend, with the exception of the South macro-region, in the age group of 10 to 19 years, whose time series was stationary. The average annual incidence rate was significantly higher in the South macro-region .Finally, the average annual incidence rate of accidents with caterpillars was higher in the age group of 0 to 9 years in all macro-regions. North, Northeast, and Midwest showed an upward trend, whereas in the Southeast and South stationary time series were observed. The average annual incidence rate was higher in the South macro-region for both age groups .The present study verified an upward trend in the incidence rate of accidents with venomous animals in children and adolescents in Brazil, except for adolescents in the South macro-region. The average annual incidence rates were higher in the age group of 10 to 19 years, except for the South macro-region. Accidents with scorpions, snakes, and spiders, in this order, were the most frequent in this population; incidence and distribution rates varied according to the geographic area of the country. In addition, stationary time series and those with a downward trend were verified, such as those observed in accidents with snakes, which reinforces the idea that, in fact, there is an increase in the number of accidents with venomous animals, especially those caused by scorpions.In Brazil, there has been a progressive improvement in the registration of diseases of compulsory notification in recent decades. Thus, the gradual increase in the incidence rate of accidents with venomous animals during the analyzed period may reflect the increase in notifications by epidemiological surveillance services, without necessarily having had a real increase in the number of cases in the population of children and teenagers. Nevertheless, the environmental imbalance with extensive areas of irregular deforestation and the acceleration of the urbanization process, which several Brazilian cities have undergone in recent decades, are factors that may be related to the increase in the number of cases. During this period, the constant numerical increase in cases caused by all animal species was attributed to several factors, including the increase in the human population, the gradual improvement of the epidemiological surveillance system, and, probably, environmental and socioeconomic factors differently affecting the incidence of accidents per each zoological group and region..A previous study on accidents with venomous animals in the Brazilian population, which analyzed the period from 2001 to 2012, showed that most accidents were caused by scorpions, snakes, and spiders, whose occurrence showed great regional variations., by analyzing the period from 2003 to 2012, had already found a stationary trend in the historical series for the country altogether.Regarding snakebites, the estimated trends were stationary or downward in children and adolescents residing in Brazilian macro-regions. Matos et al. However, in the present study, this indicator showed to be increasing in the North, Northeast, and Midwest macro-regions, which raises an alert for the possible emerging nature of this type of accident, already evidenced in other countries.The highest incidence rates of accidents with caterpillars have been traditionally found in the South and Southeast of Brazil.As limitations of this study, the authors highlight the use of secondary data, which involves the quality of records and is directly associated with the organization of health services in each location. About 86% of the reports of snakebites and 90% of the reports of spider bites presented ignored and/or unfilled information in the field concerning the genus of the involved animal, considering the age group of 0 to 19 years, in the period from 2007 to 2019, which made the analysis unfeasible. This is an essential piece of information to support preventive and health promotion actions, considering that there are specificities in the habits of different types of animals, in addition to providing indications that help in the therapeutic conduct according to the region where the accident occurred. which may contribute to the increase in notifications, at the expense of snakebites, for example, which are more common in rural regions and away from urban centers and their health services.Another point worth reflecting on is the more urban nature of most scorpion accidents, Finally, the stratification of the data also allowed the authors to use the crude incidence rates of accidents with venomous animals rather than the standardized incidence rate.It is also worth mentioning that, although ecological studies are useful to formulate hypotheses, it is necessary to point out the main limitation of this study design: the ecological bias, which consists of attributing inferences about individuals based on aggregated data from groups. In this study, the authors carefully used smaller units of analysis, stratifying the study population according to age group and Brazilian macro-region. Thus, it is believed that the groups became more homogeneous in relation to exposures, contributing to the minimization of this type of bias. the present study used data from the entire national territory, collected over a long period. In view of the vast geographic area and population size of Brazil, an ecological approach potentially and quickly identifies the existence of vulnerable groups, which require priority actions.Conversely, unlike other Brazilian studies that analyzed specific locations,Although there is an upward trend in the incidence of accidents by venomous animals in children and adolescents in most regions of Brazil, these diseases can be prevented through educational actions and health policies aimed at protecting this population. Furthermore, the improvement of strategies to ensure diagnosis and institution of early treatment is necessary to reduce the severity and, consequently, the number of fatal outcomes associated with these diseases. Within this context, the authors believe that this study contributed with updated and substantiated information about accidents by venomous animals in children and adolescents in Brazil."}
{"text": "People living with HIV/AIDS not only suffer in terms of physical and/or psychological health, but also frequently experience violations of human rights and fundamental freedoms. Although there are international treaties and a regulatory framework that legally protects people with HIV/AIDS, it is essential to determine the effectiveness of the regulatory framework in Colombia. Therefore, our main goal was to examine the legislation on HIV/AIDS in Colombia with the purpose of understanding the decrees and laws, and describing the main obstacles and barriers that people with HIV/AIDS encounter. For this purpose, we employed the method of legal interpretation and reviewed the legal regulations on HIV/AIDS, as well as the judgments of guardianship of the Constitutional Court. It is verified that there is a specific regulation on HIV/AIDS, specifically decree 559 of 19,991, decree 1543 of 1997, Law 599 of 2000, Law 972 of 2005, and Law 1220 of 2008. Although at the legislative level Colombia shows an evolution in the norm, patients with HIV/AIDS continue to be victims of human rights violations. As a result, and through the analysis of tutela judgments, it was found that the Constitutional Court recognized the violation of rights and ordered the necessary measures to be taken to guarantee the human rights and fundamental freedoms of the defendants. The human immunodeficiency virus (HIV) attacks the immune system and, if left untreated, can cause acquired immune deficiency syndrome (AIDS). Despite the fact that there is no cure, in the case that a person who contracts HIV will have it chronically, both adequate medical care and adherence to treatment are essential for people to have long, healthy lives, and to prevent the development of AIDS .According to the most recent data from the Joint United Nations Program on HIV/AIDS, in Colombia in 2020, 180,000 people were living with HIV/AIDS . HoweverUNAIDS proposed the global goal of \u201c90-90-90\u201d for 2020, i.e., that 90% of people living with HIV should have been diagnosed, 90% of those diagnosed should receive treatment, and 90% of those receiving treatment should have achieved viral suppression . HoweverAs well as physical health problems, such as well-known opportunistic diseases  and psycTherefore, the legal framework for HIV/AIDS is supported by general international instruments pertaining to the protection and guarantee of human rights and fundamental freedoms. The international instruments that recognize and guarantee the fundamental rights of all people are as follows: The Universal Declaration of Human Rights of 1948 , InternaFurthermore, the legal framework is supported by specific international guidelines for HIV/AIDS. Some of the most important guidelines, in chronological order, are as follows: The Declaration of Helsinki of the World Medical Association of 1964 , ProgramIn accordance with the various binding instruments, Colombia, among other countries, must respect, protect, and comply with the following. First, they must respect human rights norms, and thus must not directly or indirectly violate the fundamental rights of people living with HIV/AIDS. Second, they must protect and adopt the necessary measures to prevent the human rights and fundamental freedoms of people living with HIV/AIDS from violation violated. Third, they must comply with the established norms, and develop and implement all necessary legislative, financial, administrative, and judicial measures.Despite the existence of international treaties and specific guidelines, no previous study has examined the effectiveness of the regulatory framework designed to legally protect people with HIV/AIDS in Colombia. Therefore, the main objective of this research is to examine the legislation on HIV/AIDS in Colombia. The specific objectives are to (1) analyze the decrees and laws on HIV/AIDS, and (2) describe the main obstacles faced by people with HIV/AIDS according to the tutela rulings of the Colombian Constitutional Court.We use the method of legal interpretation in this study, since it is the most appropriate method for analyzing and interpreting the law according to our particular objectives . It is iThe materials in this study were decrees and laws pertaining specifically to HIV/AIDS in Colombia, in addition to the five most recent tutela judgments by the Constitutional Court. First, we examined the laws that establish rights and guarantees for people with HIV, as well as the Criminal Legislation on HIV/AIDS in Colombia. Next, we searched for and analyzed tutela judgments related to the violation of rights of patients with HIV. The judgments were obtained from the website of the Constitutional Court of Colombia. All these study activities were carried out in April and May 2022.Decree 559 of 1991 was the first legal document regulating the management of HIV/AIDS . This deDecree 559 was repealed with the introduction of Decree 1543 of 1997 , a new lDecree 1543 of 1997  compriseLaw 972 of 2005 is the first law in Colombia governing the adoption of regulations to improve the state care of populations suffering from ruinous or catastrophic diseases, especially HIV/AIDS . Law 972HIV/AIDS has also been considered under criminal legislation in Colombia. In Law 599 of 2000 , in the Following this initial law, another new law that reformed the Penal Code, Law 1220 of 2008, was introduced . The purSince records began on the website of the Constitutional Court in 1992, more than 500 tutela rulings directly or indirectly related to HIV/AIDS have been issued. In these rulings, whether fundamental rights have been violated is verified, such as discrimination in the workplace, military or place of learning due to having HIV/AIDS. Whether rights to the disability pension, health, liberty, privacy  or a decent life have been violated is also verified, for both Colombian citizens and foreigners.In the following, the five most recent Constitutional Court tutela judgments on HIV/AIDS are analyzed to understand the judicial obstacles faced by HIV/AIDS patients in Colombia.Judgment T-077 of 2022 . One manJudgment T-415 of 2021 . A foreiJudgment T-229 of 2021 . A couplJudgment T-221 of 2021 . A womanJudgment T-031 of 2021 . A man wPeople with HIV/AIDS not only suffer poor physical and/or psychological health, but are also victims of violations of human rights and fundamental freedoms. Although international treaties with the force of law have been ratified in Colombia ,13,14,15After analyzing the legislation on legal assets protected by two decrees ,32, the First, it is necessary to discuss the factors that led to the introduction of these rules. Decree 559 of 1991 was the first legal document regulating the management of HIV/AIDS in Colombia . The devSecond, to understand the evolution of the regulations, it is necessary to highlight differences in the decrees ,32. The Third, it is important to discuss laws that have modified the Penal Code in relation to HIV/AIDS. Although Law 599 of 2000  stipulatDespite the rights established in relation to regulatory norms in Colombia, people with HIV/AIDS still encounter obstacles and barriers that violate their fundamental rights. An example of this can be seen in the tutela rulings reviewed and resolved by the Constitutional Court ,39,40,41This research had some limitations. First, the results of the analysis of law and sentencing cannot be generalized to all people with HIV/AIDS in Colombia. Second, only the five most recent Constitutional Court rulings regarding HIV/AIDS cases were analyzed. Therefore, further investigations are recommended, in which the judgments of guardianship on HIV/AIDS should be systematically analyzed from a historical perspective, including rights violations as well as the final results of all sentences passed by the Constitutional Court.HIV/AIDS is a pandemic that, despite beginning several decades ago, continues to spread and cause chronic disease, which sometimes leads to death and human rights violations of infected people. The International Conventions and Treaties on fundamental rights have been essential for establishing, promulgating, and modifying regulatory norms on HIV/AIDS. The specific decrees and laws guaranteeing the rights and duties of people with HIV/AIDS have been very important to improve the quality of life of these people, and represent progress toward addressing the obstacles and barriers that they encounter in various spheres of life. In addition, these regulations provide legal certainty and protect human rights and fundamental freedoms. Although the legal framework formally guarantees the rights of people with HIV/AIDS in Colombia, this population still suffers violations of protected rights. Among the violated rights, the following stand out: The right to health and life, the right to non-discrimination, the right to human dignity, and the right to privacy, as well as due process. The violation of these rights is confirmed in the tutela judgments analyzed, since the Constitutional Court concluded the violation of these rights and expressed the obligation to take the necessary measures to restore the violated rights. Moreover, it is important to highlight the role of the Colombian Constitutional Court, which has not only established rights through tutela rulings, but also declared an article stating that specific punishment of HIV transmission is unconstitutional. In short, despite the fact that the regulatory framework on HIV/AIDS in Colombia is adequate and guarantees the fundamental rights of those affected, infected people still suffer violations of their human rights and fundamental freedoms."}
{"text": "Due to the changes in the domestic and international economic situation in the post-pandemic era, the economic development of the Guangdong-Hong Kong-Macao Greater Bay Area has become unstable in many aspects. The paper adopted the Pressure-State-Response (PSR) model to build a regional economic resilience evaluation system from the perspective of public health emergencies. Then, the spatial and temporal evolution of the economic resilience of the Guangdong-Hong Kong-Macao Greater Bay Area and the influencing factors were explored by using entropy weight method, GIS and gray correlation method. The conclusions show that: (1) Temporally, the economic resilience of the Guangdong-Hong Kong-Macao Greater Bay Area has generally increased from 2010 to 2021, and is divided into three main stages: rapid development, adjustment to fluctuations and stable development. (2) Spatially, the overall pattern of economic resilience in the Guangdong-Hong Kong-Macao Greater Bay Area is high in the middle and south and low in the northwest, and shows a \u201cstochastic\u2014equalized\u2014polarized\u201d pattern of transformation. (3) In terms of influencing factors, economic status and economic response are the main dimensions affecting the resilience level of the economic system in the Guangdong-Hong Kong-Macao region. The level of scientific research and innovation, medical governance, government regulation and the rationalization of the industrial system are the key factors. The COVID-19 epidemic swept the world in 2020, which caused a number of problems including disruption of international trade, price fluctuations, increased unemployment, and increased pressure on government spending on health care, thereby impacting the economic stability of countries. The intensification of globalization has made the world economy a mutually integrated organic whole, but at the same time, the economic development of cities and regions is inevitably influenced by the external environment. With the increasingly frequent flow of products, resources, and human resources between countries, the threat of global epidemics will be a problem that cities and regions must deal with in their economic development, and economic resilience has also become a strategic issue that countries must pay attention to in their economic development  model to build a regional economic resilience evaluation system. Moreover, the entropy power method, GIS and gray correlation method are combined to explore the spatial and temporal evolution and influencing factors of the economic resilience of Guangdong-Hong Kong-Macao Greater Bay Area, so as to provide suggestions for the economic transformation and upgrading of the Guangdong-Hong Kong-Macao Greater Bay Area under the post-pandemic era.The PSR model was originally proposed by Canadian statisticians David and Tony to address ecological and environmental issues . It reveAt present, most of the processes of economic resilience evaluation still decompose the regional system into parallel vertical subsystems such as industrial structure, technology level and economic scale, but the positive and negative feedback processes between the front-end and the regional subject are still less emphasized. If the PSR model is used, it is possible to describe more accurately the process properties of the economic resilience of the system by using the logical thinking of mutual regulation of the region from the subject system and the stress risk input to the system and the three-way feedback of the system's own state changes.Therefore, based on the above understanding, the economic system process can be divided into three stages: riskiness before the shock, stability and resistance during the shock, and resilience and evolutionary power after the shock, which correspond to the three process elements of \u201cpressure-state-response\u201d in the PSR model, respectively. In this study, three dimensions of the resilience process are proposed for the regional economic system to cope with the disturbance, namely, economic pressure, economic status, and economic response as shown in Economic pressure refers to the pressure on the system during the outbreak of public health emergencies and its aftermath, and is characterized by its own potential riskiness. It can be interpreted as the low exposure of the system to the risk of public health emergencies and its negative effects, reflecting the external disturbances and endogenous perturbation dynamics of the regional economic system. Economic vulnerability can be used as a measure of the relative loss value of the regional economy, usually manifested as employment decline, trade pressure, and financial risk, that is, risk vulnerability .Economic status refers to the stability of the system's own structure and its resistance to disturbances, while it is constantly changing in the process of negative effect of \u201cpressure\u201d and positive feedback of \u201cresponse.\u201d Economic status consists of economic stability and economic resistance. Economic stability can spontaneously maintain the ability of its own structural system to function as an internal stabilizer; economic resistance refers to the ability of the regional economic system to withstand shocks. It usually operates in the form of consumption level, economic base, industrial structure and capital input.Economic response refers to the ability of the subjects of the urban economic system to respond and take actions in response to disturbances, reflecting the ability of the subjects of the regional economic system to deal with risks, learn from shocks and disturbances and optimize their own organizational structure. Economic recovery capacity means that the speed and extent of recovery from shocks can be achieved through rapid and diversified response measures. Economic evolutionary power is the ability to renew and reorganize internal structures and functions, generating new development models and paths for the purpose of strengthening the development of economic agents.For the connotation of economic resilience, Martin proposed four dimensions of regional economic vulnerability, resistance, stability, and resilience to break down the operation process of economic resilience. Zeng  also conIn order to eliminate the influence caused by data units and subjective determination of index weights, this paper adopts the extreme value entropy method to dimensionlessly process and assign weights to the selected indexes. The greater the index dispersion, the greater the entropy value, and the greater the effective information reflected. It means that the greater the influence on the evaluation, the more significant the weight is. On the contrary, the smaller the index dispersion, the smaller the influence and the smaller the weight , 33. The(1) Building the original matrixn (year/city) * m (index). Let the value of the jth index for the ith year (city) be Xij.Build the matrix of (2) Standardizing the dataXj is a positive index or negative index, the following can be derived:Assuming that the evaluation index Xj is a suitability index, the following can be derived:If the evaluation index Pij of the ith city/year to the jth index(3) Calculate the ratio ej of the jth index(4) Calculate the entropy value dj of the jth index(5) Calculate the co-efficient of variation wj of the jth index(6) Calculate the weight Based on the data samples, the gray correlation analysis uses the geometric similarity between the parent sequence and the signature sequence to identify the closeness of the association, and obtains the gray correlation between the parent sequence and each signature sequence. The greater the correlation, the closer the relationship between the signature sequence and the parent sequence, and vice versa. The formula is as follows:i(j) denotes the gray correlation co-efficient, Qi denotes the parent sequence, where, \u03b6n denotes the number, Wj denotes the weight. The greater the value of the correlation co-efficient rj, the higher the impact of the index on the comprehensive resilience level.where, Located in the south of China, the Guangdong-Hong Kong-Macao Greater Bay Area now covers Guangzhou, Shenzhen, Foshan, Dongguan, Zhuhai, Huizhou, Zhongshan, Jiangmen, Zhaoqing, as well as Hong Kong and Macau as shown in The time span of this study is 2010\u20132019, and the data sources include the fourth national economic census, statistical yearbooks of each region, statistical yearbooks of the Pearl River Delta city cluster, statistical yearbooks of cities in China and national economic statistical bulletins. Since the statistical standards vary from city to city, the number of registered unemployed in Hong Kong and Macau in this study is the unemployed population, the total retail sales of social consumer goods in Hong Kong is the total value of retail sales, and the total retail sales of social consumer goods in Macau is the total sales of retail trade. The total volume of imports and exports in Hong Kong and Macao is the total volume of trade; at the same time, all of them are converted into RMB at the current exchange rate of the year.* index, and the results are shown in The economic data of the Greater Bay Area from 2010 to 2021 are used to construct a matrix of yearFirst, the period from 2010 to 2013 represents the period of rapid development of the Greater Bay Area. During this period, the Greater Bay Area advocated a model of rapid economic construction, thus maintaining a high rate of economic resilience development, with economic pressure, economic status and economic response all making improvements to varying degrees. After the 2009 H1N1 and 2008 financial crisis, economic pressure, economic status and economic response maintained a dynamic equilibrium relationship that promotes each other. At this time, the economic pressure risk is high, the economic status foundation is weak, and the economic response capability is insufficient. If one of them fails, the whole system will be affected. Therefore, they are developing more in a relatively \u201cconservative\u201d way. In terms of a single index, fixed asset investment and the deposit-to-loan ratio have a short-lived mini-peak, which caters to the massive tides of economic development in the early stages and a huge amount of capital is needed to promote the economic vitality of the Greater Bay Area.Second, the period from 2013 to 2017 represents the period of fluctuations and adjustment of economic resilience. It is the transition period of industrialization in the Greater Bay Area, where economic pressure and economic status underwent rapid changes and adjustments, and then the three converged in 2014, and then became differentiated. Economic pressure, economic status, and economic response became distant from each other, and the economic system of the Greater Bay Area regulated itself mainly in the form of status-response. From a single index, the value added of tertiary industry witnessed explosive growth, the economic structure of the Greater Bay Area was upgraded, entrepreneurship and scientific research vitality emerged in the budding stage of development, and the industrial structure tended to be diversified and intelligent.Third, the period from 2017 to 2021 represents the period of stable development of economic resilience. At this point, the industrial transformation of the Greater Bay Area matured, from the original high-speed development mode to high-quality development mode, and the industrial structure was gradually adjusted from labor-intensive to knowledge-intensive industries. Economic pressure gradually decreased, while economic status and economic response slowly increased, and the distance between the three gradually expanded, with the economic system in a high-exposure development model. The fall in economic pressure means that the economic system is more likely to face high-risk shocks. However, the economic system is less likely to collapse even after a public health emergency by continuously strengthening the substrate of economic status, increasing the threshold of economic resilience against the maximum risk intensity, and establishing an economic response at the same time. Furthermore, the rapid response and regulation allows the economic system to return to its original stage of development, as exemplified by the COVID-19 epidemic in 2020. The economic resilience of the Greater Bay Area declined briefly when the crisis occurred, but soon rebounded and continued to grow. In terms of a single index, the rapid rise in entrepreneurial innovation and R&D vitality signifies the beginning of a massive renewal of the industrial structure based on technological innovation. The spike in the loan-to-deposit ratio could easily cause a payment crisis in banks, which would spread further to lead to a financial crisis.* index is constructed from the economic data of 11 cities in the Greater Bay Area of Guangdong-Hong Kong-Macao, and the results are shown in A matrix of yearFirst, the cities with rapid development include Zhuhai, Foshan, Huizhou, Zhongshan, and Shenzhen. Among them, Zhuhai has the fastest growth in economic resilience in the past 12 years, with an average growth rate of 30.61% as shown in Second, the cities with slow development include Zhaoqing, Jiangmen, Dongguan, Guangzhou, Macau, and Hong Kong. Among them, Hong Kong is the slowest in building economic resilience, with a rate of 10.95% as shown in * index is constructed by counting the panel data of each city in the Guangdong-Hong Kong-Macao Greater Bay Area from 2010 to 2021. Taking the average value of economic resilience of the cities in the Greater Bay Area from 2010 to 2021 as the criterion, four representative nodes were selected in 2010, 2013, 2017 and 2021. With the help of natural breaks classification method in GIS . Once the economic crisis strikes, Macau will be subject to a series of economic chain reactions and the credit crisis will be further aggravated. Although Foshan and Zhongshan do not have as many economic advantages as Guangzhou, Shenzhen, and Zhuhai, they both have their distinctive strengths. Foshan has achieved a good balance in terms of the loan to deposit ratio, and the development model of specialized towns in Foshan has been the unique feature of its economy. Nowadays, Foshan has been trying to diversify the risk by transitioning the original specialization model to a non-related diversification model through banking, scientific and technological innovation and financial means . In receFourth, the space with low resilience is basically in the periphery, such as Jiangmen, Zhaoqing, and Huizhou. Except for 2017, when Huizhou rose to a relatively low resilience, it has been in low resilience for the rest years, with poor performance of various economic indexes. Huizhou suffers from a lack of capital and a large population outflow from Huizhou, resulting in a serious aging population, sluggish economic development, and slow recovery in times of economic crisis. Jiangmen's industrial structure is still being shifted from agriculture to industry, and its economic resilience is low due to its low per capita income, unstable economic base, and delayed industrial restructuring. Zhaoqing suffers from low fiscal revenues and inadequate health personnel, and its industrial base is weak, making it extremely difficult to respond to public health emergencies if they occur.The economic resilience value of the Greater Bay Area calculated is used as the parent sequence of the gray correlation analysis, and the other 18 indexes are used as the signature sequence to analyze the fitting effect of the economic resilience with each index, so as to determine its influencing factors. According to As shown in As shown in As shown in The economic resilience of the Guangdong-Hong Kong-Macao Greater Bay Area continues to grow, with most cities experiencing an increase in their resilience levels. From 2010 to 2021, the economic resilience of the Greater Bay Area has generally improved, mainly divided into three main stages: rapid development, adjustment in fluctuations and stable development. The regional economic structure has been evolving steadily, showing a healthy development of a pressure-state-response pattern, in which the economic resilience indexes regulate, circulate and influence each other. Among them, the pressure resilience increases in the fluctuations, and the external disturbance of the system decreases. The status resilience increases rapidly, and the robustness level of the system continues to grow. The response resilience increases in fluctuations, and the response capacity is constantly enhanced. In the development of resilience of cities within the region, except for Hong Kong and Macau, where the level of resilience is decreasing, there is a steady increase in the resilience of most of the other cities, reflecting the strong resilience of the Greater Bay Area as a whole. However, under the disturbance of changes in the global economic environment and public health emergencies, it is necessary to pay close attention to the dynamics of the Greater Bay Area's economic resilience and its forecast.It develops in an imbalanced way, high in the central and southern parts and low in the northwest. The spatial pattern of the high-resilience areas is stable, mainly concentrated in the first-tier urban areas. Benefiting from the degree of economic development, industrial structure optimization and economic innovation capability, these high-resilience cities play an essential role in enhancing the resilience of the entire Greater Bay Area through economic connectivity. The space with relatively high resilience has shifted, mainly in Jiangmen and Zhongshan in the west wing of the Greater Bay Area, Hong Kong, and Zhuhai in the south of the Greater Bay Area. These cities have a sound industrial base, but have a high economic risk , and are vulnerable to the global economic crisis and their economic resilience fluctuates heavily. The space with relatively low resilience continues to expand, such as Dongguan, Foshan, Zhongshan, and Macau. The industrial structure of these areas is relatively homogeneous, which restricts their economic activities and diversified development, so they need to upgrade and adjust their industries, increase the economic evolutionary power, and improve the level of resilience. The space with low resilience is basically in the periphery. These cities have a poor economic foundation, are lagging behind in industrial restructuring, and are slow to recover from economic crises and public health emergencies once they are hit. Therefore, these cities are the priority target for enhancing the economic resilience of the Greater Bay Area.The economic resilience of the Guangdong-Hong Kong-Macao Greater Bay Area is significantly correlated with the economic status and economic response, while it is less correlated with the economic pressure resilience. Economic evolutionary power is the key, with a correlation co-efficient of 0.7474. Economic stability and economic recovery capacity are the main focus, while the changes in economic resistance and economic risk should be paid attention to. As for the subfactors, local GDP, industrial value added and urban per capita income have contributed significantly to the increased economic resilience of the Greater Bay Area, reflecting the importance of regional social and economic development, industrial construction and market consumption. At the same time, the positive effects of general public budget revenue and the number of patents applied or granted per 10,000 persons also indicate that the government's ability to manage public health emergencies and the technological means in the epidemic also play a crucial role in the socio-economic operation. Therefore, the foundation of economic development, industrial structure, government regulation and control capacity, and technological innovation capacity are of vital importance to the economic resilience of the Greater Bay Area, and are also important elements in the future resilience enhancement path of the Greater Bay Area.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.YZ and BT contributed to the topic selection, development of the framework and writing of the manuscript, and figures and the literature review. ZC contributed to the data analysis, drawings and the tables. HS contributed to the revision of data analysis and drawings. All authors contributed to the article and approved the submitted version.We are grateful for the financial support from project of the 14th five year plan for the development of Philosophy and Social Sciences in Guangzhou in 2021 (No. 2021GZYB22); College students' innovative entrepreneurial training program: Resilience assessment of urban agglomerations in the Guangdong-Hong Kong-Macao Greater Bay Area based on the PSR model (No. S202013902038); School level scientific research project of Guangzhou Xinhua University (No. 2018KYQN001); Study on the spatial pattern, mechanism and management of innovation in the Guangdong-Hong Kong-Macao Greater Bay Area from the perspective of regional synergy. Project of special innovation classes for regular universities in Guangdong Province  (No. 2020WTSCX136); College students' innovative entrepreneurial training program (No. 201913902171); School level scientific research project of Guangzhou Xinhua University (No. 2018KYZD002); Special research on industry in Longjiang Town, Huilai County (2015HX001).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "Taking advantage of the nature of games to deal with conflicting desires through contextual practices, this study illustrated the formal process of designing a situated serious game to facilitate learning of information ethics, a subject that heavily involves decision making, dilemmas, and conflicts between personal, institutional, and social desires. A simulation game with four mission scenarios covering critical issues of privacy, accuracy, property, and accessibility was developed as a situated, authentic and autonomous learning environment. The player-learners were 40 college students majoring in information science and computer science as pre-service informaticists. In this study, they played the game and their game experiences and decision-making processes were recorded and analyzed. The results suggested that the participants\u2019 knowledge of information ethics was significantly improved after playing the serious game. From the qualitative analysis of their behavioral features, including paths, time spans, and access to different materials, the results supported that the game designed in this study was helpful in improving participants\u2019 understanding, analysis, synthesis, and evaluation of information ethics issues, as well as their judgments. These findings have implications for developing curricula and instructions in information ethics education. The process and scope of information dissemination are expanding along with the rapid development of media and technology. While the access and accessibility to information are improved, in this unique information age, the literacy and ethics of utilizing information have gained importance, especially in the development of information services. Information ethics not only influences people\u2019s behaviors in the production, intermediation, and use of information but also establishes principles for information services governing business and professional practices . Relatedpost hoc survey instruments, as in Ethics is defined as inquiry into the nature and grounds of our moral judgments, standards, and rules of conduct  which foAs information ethics involves field practices and interactions with others for common well-being, practical concerns have placed great emphasis on issues related to information ethics in the contexts of different professions, types of information, and rapidly changing technologies. Since the 1980s, several professional societies of informaticists, such as the Association for Computing Machinery , InstituAlthough the codes of ethics promulgated by the abovementioned professional societies have often been criticized as oversimplifications of information ethics and therefore as being of little help in solving the practical problems or dilemmas in field practices , the devTo address the gap between principle and practice, educational content, resources, and strategies were therefore investigated to supplement learners\u2019 understanding through contextual applications and examples . Albeit According to recent reviews of university information and technology ethics courses , the curGame-based learning meets the learning needs of contextual practices in information ethics education . The higMotivated by the aforementioned issues, this study intended to design a serious game focused on information ethics for pre-service information professionals\u2019 learning of ethical judgments. To transform the acquisition of ethics theories and professional ethics issues into implicit understanding, analysis, and evaluation, a simulation game was developed as a standalone knowledge acquisition mechanism to support the aforementioned situated learning of information ethics. The instructional effectiveness of the game was investigated based on participants\u2019 learning outcomes, i.e., making well-reasoned ethical decisions. A specific theoretical model of ethical decision-making in the domain of informatics  was adopvia changes in quantifiable metrics of their temporal and spatial use logs. The game also recorded participants\u2019 uses and instances of accessing every element as the representations of their decision-making process for further analysis.After the simulation game was developed, an experiment with pre-service information professionals, namely, college students majoring in information and computer science, was conducted. In the designed game, the player-learners assumed the role of an Internet of Things (IoT) company employee in four mission scenarios of information ethical dilemmas and took responsibility for acting out their roles within the narrative through a structured decision-making process. The game was designed with the Unity engine, and players\u2019 ethical decisions were tied directly to the game simulation In the following sections, the detailed design of the simulation game and the setup of the experiment are described.This study designed a story-driven, first-person role-playing game based on the four major issues of privacy, accuracy, property, and accessibility (PAPA) , which aAs shown in Participants experienced the four mission scenarios of privacy, accuracy, property and accessibility in identical sequences see  of encouTaking the mission scenario of privacy issues as an example, This study simulated the ethical decision-making process in game-based ethical analysis training to assist informaticists in coping with new ethical dilemmas presented by information technologies and services. To ensure a comprehensive ethical decision-making process, the theoretical model of the General Theory of Marketing Ethics, or GTME , was adoAs the original model  suggesteMore importantly, GTME  identifiThe subjects for this study were pre-service information professionals, namely, college students majoring in computer science (CS) or library and information science (IS), randomly sampled based on the local statistics of the distribution of majors . The numIn addition to the game metrics see , which rAll 40 participants completed the four mission scenarios of the game designed in this study. Exactly half of them were IS majors from the departments of library and information science and information management science, and the other half were CS majors from the departments of computer science, computer engineering, and electrical engineering. The sample sizes for graduate and undergraduate students were similar, with 22 graduate students and 18 undergraduates participating. The following sections present the analysis of the participants\u2019 behaviors and learning performances from the perspective of the efficiency and effectiveness of their ethical decision-making processes.The total playtime of all participants spent on the designed game was about 50 min . The players spent the most time on the mission scenario of privacy , and the least time on the mission scenario of accessibility issues . Participants\u2019 uses of different elves indicated their references to different evaluation methods, and the players spent more time on teleological evaluation with the Elf of Utility (57.2 s), which provided consequence-based information for assessment. Regarding the quality of the ethical decisions, Interestingly, the game invited every participant to indicate the most decisive theoretical viewpoint in each mission scenario by selecting the most valuable elf, and the results of this subjective selection differed from the above-described behaviors exhibited in the actual decision-making processes captured by the game. t = \u22124.891, p < 0.01), it was found that IS-majors were more aware of ethical issues and considerations due to the human-centered nature of their discipline and professional conduct , at the end of the game, all participants were asked to respond to four short-answer questions about their understanding of the four theoretical viewpoints. The qualitative analysis of the participants\u2019 answers showed that the majority of the participants established a basic understanding of the four major ethics theories, and they were able to make well-reasoned arguments and see multiple perspectives to approach information ethics issues. Specifically, 97.5% of the participants correctly described consequence-based evaluation based on utilitarianism, and 80.0, 75, and 65% appropriately interpreted rights-based, duty-based, and virtue-based viewpoints, respectively.The player-learner participants gave high appraisals on the simulation game in terms of its interactions and interface. As shown in This study simulated the ethical decision-making process in game-based ethical analysis training to assist informaticists in coping with new ethical dilemmas brought about by information technologies and services. Taking advantage of the nature of the game to deal with conflicting desires, this study designed and developed a simulation game as an authentic and autonomous learning environment for teaching pre-service information professionals about information ethics, a subject that heavily involves decision making, dilemmas, and conflicts between personal and social desires. Using the theoretical framework of GTME  as the sMethodologically, this study contributes to the field studies of decision science by adopting the mechanism of a simulation game to represent the complex situational elements and consequences of the ethical decision-making process, which in the past was a challenge due to the limitations of the survey instruments . The desThe raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. The patients/participants provided their written informed consent to participate in this study.WL: conceptualization, methodology, visualization, investigation, and writing\u2014original draft. J-YW: software and investigation. H-PY: methodology, funding acquisition, and writing\u2014reviewing and editing. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "Health  is determined by multiple factors: social class, educational background, income, occupation, and race/skin color. Racism can directly impact physical and psychological illnesses, with an effect on social conditions of health. This paper discusses: (1) racism as a root cause of health inequities in Brazil and elsewhere, and (2) how students at the University of Brasilia School of Medicine respond to an anti-racist curriculum. We emphasize that an environment of profound exchanges in the teaching\u2013learning process, adopting anti-racism praxis as a competency in the medical curriculum, is a paradigm shift in medical education and future practice. Health  is determined by multiple factors: social class, educational background, income, occupation, and race/skin color ,2. ConteRacism can directly impact physical and psychological illness ,5, with Even after 134 years of the abolition of slavery in Brazil, slavery had and still has fundamental implications for social inequalities. The black population tends to be born and raised in families with less economic and cultural resources. They face disadvantages that impact school and occupational results, and wage conditions . Black pIn light of those principles and of this reality, this work comments on the incorporation of an anti-racist praxis  in medicThis is a descriptive and qualitative study designed as a narrative report of an undergraduate teaching experience on Black People Health Policies at the Medical School of the Brasilia University. The path taken in one discipline of the reviewed curriculum of the Medical School  is conteThe discipline applies an anti-racist focus to medical teaching, bringing contents such as neglected illnesses  and health of deprived populations . The discipline was created in 2018 and is offered every semester. Each semester, approximately fifty new medical students are enrolled in the discipline, which is mandatory in the medical course. Three professors of Family Medicine are responsible for teaching the health of the black population in this discipline for fifteen weeks, every Wednesday morning for four hours, in the 3rd year of the medical course. When teaching about the health of the black population, professors give lectures and provide content in various formats, such as scientific articles, reference texts on national policies, books, podcasts by jurists and leaders of the black movement, among other audiovisual resources. From the presentation and debate of the content, the students carry out critical reviews in which they evaluate the learning experience, as well as the inclusion of new content in the teaching\u2013learning process.The last course week is used for students and professors to provide and receive feedback interactively. The experience of training participants is captured by interactions during the class and in the final exam. The impressions are contrasted with the challenges of struggling against structural racism in Brazil, especially in Brazilian medical education.In Brazil, the Black and the Health Reform movements fought for universal social rights for the black population and equitable access to health. They achieved the creation of the Unified Health System ,14. HoweIn the case of the black population, special conditions of vulnerability are determined by the environment, such as disqualified and devalued social inclusion , and by the invisibility of their real needs in assistance, health promotion, and disease prevention actions and programs (programmatic vulnerability). This way, black women and men live in a constant defensive state, which collaborates with inappropriate behavior, and psychic, psychosocial, and physical illnesses  .In this country, black skin color is associated with lower levels of education and income, occupational activities with higher risks, and disparity in the access of and difficulties in health care ,5,14. ThDespite institutional pressure for public policies aimed at confronting racism, it took decades for authorities to materialize health and educational initiatives focused on race/color ,14. RaciMedical education centered on the traditional biomedical model removes the psychic and social dimensions of education, limiting the future professional\u2019s tools for care . TeachinThe National Curriculum Guidelines for the Medical Course (2014) incorporate the humanistic view of the patient into the technical\u2013scientific aspects, contributing to the transition from an anatomo-clinical and hospital-centered model to the paradigm of continuous and comprehensive care for the individual . They esThe changes in the National Curriculum emphasize that general practitioners training in primary care and urgency/emergency settings should meet the health needs of the population. For this purpose, the Guidelines are centered on three major areas: Integral Health Care, Health Education and Health Management. These areas are intended to contribute to the development of skills that allow for greater aptitude in dealing with the problems of Brazilian society and public health, with an emphasis on adapting to the demands of the Unified Health System .In this context, it is essential that teaching methodologies promote criticality, reflection, and humanistic skills and attitudes in students . TeachinRacism is widely spread in society, and that is not different in education. From basic to higher education, in public or private sectors, it pervades students and teachers\u2019 relations, curricula, and institutional infra- and superstructure. It, thus, contributes to maintaining an elite-dominated and prejudicial social status quo .The ethnic\u2013racial issue must be widely debated, beyond curriculum components that discuss deprivation, as in the case presented in this paper. The academic universe is poor of popular universities that promote views of liberty and anti-racism as well as an ethnic/racial responsibility. It is urgent that knowledge production stop reproducing the coloniality of knowledge and start promoting the cultural and academic respect to and valuation of indigenous and black ancestry .In health, students and professionals, with an antiracist education and attitude, contribute to break through access barriers, reduce maternal and neonatal mortality, reduce violence, and mitigate other conditions that lead to illness in that population. When well-trained physicians understand the needs and priorities of the black population, they act for the sake of attention, care and health rights .The University of Brasilia School of Medicine reformulated the medical curriculum guided by competency domains: Knowledge, Skills, and Attitudes. Those domains cover themes of black population health, with the objective of discussing racism as a health condition; epidemiology of health problems in the black population; role of the family and community doctor in confronting inequities; and anti-racist practices in health .The experience of the University of Brasilia School of Medicine has shown that students, when provoked to reflect on structural racism, manage to produce critical reviews of excellent quality, in which they articulate the content of classes with health system policies, ethical and existential issues of the doctor\u2013patient relationship, plus aspects of clinical communication and subjective experiences.From the professors\u2019 point of view, the main focus in the training of health professionals is to deal with the racial issue in health. Since 2018, professors have observed that during the classes and in the final exam, the students show that they understand the influence of black race issues in the environmental, organic, and genetic domains. In addition, they incorporated the race\u2013color category in clinical reasoning during the clinical interview. All professors participated in deeper discussions about what the curriculum entails, and they suggested that pedagogical investments should focus on the dialogue between medicine and social sciences. This can expand the students\u2019 theoretical framework, generating new questions and exchanges among professors from medicine and social sciences, as well as expanding critical perspectives in medical training and in life in society.The experience of training participants and the students\u2019 feedback on teaching can be summarized in two points: (1) training was important to understand how to incorporate racial issues in health and (2) the pedagogical investment in different types of teaching materials  was an important stimulus for the study of content.The incorporation of the anti-racist lens in clinical reasoning represents the integral care of the patient and the confrontation of inequities, valuing their epidemiological context and their life narrative . The cliChanging the curriculum, infrastructure, and institutional superstructures for the incorporation of anti-racist practices in health education is a challenge. At the University of Brasilia, we want the ethnic\u2013racial issue to permeate all curricular components of medical education.Finally, pedagogical investments aimed at the dialogue between medicine and social sciences can broaden the theoretical framework of students, as well as critical perspectives in medical education and in life in society. An environment of profound exchanges in the teaching\u2013learning process by adopting anti-racism praxis as a competency in the medical curriculum is a paradigm shift in favor of reducing and combating racial inequities."}
{"text": "Microfluidics is a powerful tool to precisely control fluids as well as to manipulate suspended small particles in a micrometer-sized space. Numerous efforts have been made to develop this technology in interdisciplinary fields including physics, engineering, medicine, biology and chemistry. The efforts in these fields have enabled us to perform automated, high-throughput, and precisely controlled assays to treat micro-objects such as microdroplets, microparticles, and single cells, even with extremely small amounts of samples. Owing to the advantages of microfluidics, clarifying the mechanisms of the microscopic biological phenomena has been one of the central topics in these fields. In this Special Issue, we focused on recent microfluidic approaches that shed light on the biological mechanics and transport phenomena, especially on the deformation and transportation of passive micro-objects exposed to shear stress and behavioral dynamics of bacteria as active microswimmers. This Special Issue contains seven research papers covering different subjects related to cell mechanics and biotransport. Three of the research papers report the experimental approaches, and four of the papers focus on numerical investigations.Lee et al.  reportedOkuyama et al.  experimeSugihara-Seki and Takinouchi  conducteTakeishi et al.  numericaA = b: long side width; h: short side width), and elucidated the variation of the inertial focusing depending on the Reynolds number of 50 to 400. Simulations covered blockage ratios d: a particle diameter). The authors accurately estimated the particle trajectories based on the lift map and Stokes drag, and identified the particle-focusing positions that appeared in the cross-section.Yamashita et al.  numericaOtomo and Kira  theoretiMoreau and Ishimoto  theoretiIn summary, the seven original papers in this Special Issue highlight the recent advances on the deformation, transportation, and behavioral dynamics of passive and active micro-objects, towards the clarification of biological mechanics and transport. We, the Guest Editors, believe that further understanding and the clarification of mechanisms of the microscopic biological phenomena will be provided through the cooperation of experimental, theoretical, and numerical efforts such as those included in this Special Issue. We hope that the Special Issue will be a good starting point for future studies in this field. Finally, the Guest Editors would like to acknowledge all the researchers who contributed their original papers, reviewers who provided fruitful comments, and the members of the editorial office for their valuable time and efforts."}
{"text": "Esophagogastroduodenoscopies and colonoscopies are the main diagnosticexaminations for esophageal, stomach, and colorectal tumors. This study aimed to evaluate the estimates of the incidence of esophageal,stomach, and colorectal cancer; population growth; andesophagogastroduodenoscopies and colonoscopies performed by the UnifiedHealth System (SUS), from 2010 to 2018, in the five regions of the country,and to analyze the relationship between these values. The colorectal tumor had a significant elevation, while the esophageal andgastric maintained the incidences. In the five regions, there was asignificant increase in the number of colonoscopies; however, this increasedid not follow the increase in the population in the North and Northeastregions. There was no significant increase in the number ofesophagogastroduodenoscopies in the North, Northeast, Midwest, and Southregions, and in the North region there was a decrease. In the Northeastregion, there was a decreasing number, and in the South and Midwest regions,the number of examinations remained stable in the period. The Southeastregion recorded an increase in the number of examinations following thepopulation growth. The current number of esophagogastroduodenoscopies and colonoscopiesperformed by the SUS did not follow the population growth, in order toattend the population and diagnose esophageal, stomach, and colorectaltumors. Therefore, the country needs to have adequate and strategic planningon how it will meet the demand for these tests and serve the populationwell, incorporating new technologies. They are also the first option for the diagnosis of gastrointestinaldiseases ,,,,,Both EGD and CLN examinations are performed widely by the Unified Health System(SUS), both in an outpatient clinic and in public and university hospitals. EGDoffers an excellent view of the mucous surfaces of the esophagus, stomach, andproximal duodenum, and CLN allows the examination of the entire colon and rectum andoften the terminal ileum. Both examinations allow diagnostic and therapeuticprocedures, including polypectomy, mucous and submucosal resections, dilation ofstenosis, placement of stents, removal of foreign bodies, gastrostomy,gastrointestinal bleeding treatments with injection of hemostatic solutions,placement of metal clips, electrocoagulation, laser, sclerotherapy, and elasticbandages of esophageal-gastric varices, in addition to other endoscopic therapies.They are mainly performed on an outpatient clinic, since they are safe procedures,with low morbidity and less complication The Brazilian Institute of Geography and Statistics (IBGE) is a government agencyresponsible for the population control and statistical data. It is also responsiblefor the organization and execution of the demographic census, which consists of asurvey of the national population, by states, and by regions, accumulating data onthe number of inhabitants; people\u2019s lives condition; numbers of men, women, adults,and children; and others social and economic information of the country. The lastBrazilian census divulged was in 2018 The National Cancer Institute (INCA) is the Ministry of Health\u2019s organ responsiblefor the development and coordination of integrated actions for the prevention andcontrol of cancer in Brazil. Not only it provides medical and hospital assistanceactivities to cancer patients, as part of the services offered by SUS, but it alsooperates in strategic areas, such as prevention and early detection, specializedprofessionals training, and development of research and epidemiological information.Therefore, it is the main responsibility for cancer statistics in the country toprovide detailed information on incidence, occurrence, and mortality of differenttumors The objective of this study was to conduct a survey on the websites of the INCA,IBGE, and Government Health Department, to obtain, respectively, the estimates ofthe incidence of esophageal, stomach, and colorectal cancer; the population growth;and the number of EGDs and CLNs performed by the SUS, from 2010 to 2018, in the fiveregions of the country , andto analyze the relationship between these values.,,,,The INCA published every 2 years, respectively, in the years 2010, 2012, 2014, 2016,and 2018, reports of the estimated incidence of cancer in the country, in all organsof the human body, as well as by regions The number of the Brazilian population, by regions, were obtained from the IBGEwebsite The number of EGDs and CLNs performed by the SUS, recorded in the site of theGovernment Health Department, in each of the Federation States, from 2010 and 2017(divulged in 2018), were obtained ,Statistical analysis was performed using the computer program SAS System for Windows, version 9.4 . The Jonckheere-Terpstra (JT) test was used to verify the tendency of anincrease in the resident population and outpatient production over the years. Toanalyze the relationship between population growth and outpatient production in eachregion, the analysis of the cross-correlation function (CCF) was carried out The analysis in The analysis in The analysis in The analysis in The analysis in The analysis in Therefore, these results show that in all regions of the country, there was astatistically significant increase in population, between the years 2010 and 2018.The colorectal tumor had a statistically significant increase in the country;however, in the same period, esophageal and gastric tumors did not increase. In thefive regions of the country, there was a significant increase in the number ofcolonoscopies performed from 2010 to 2017; however, this increase did not follow theincrease in the population in the North and Northeast regions.The statistical analyses performed showed that there was no significant increase inthe number of EGDs in the North, Northeast, Midwest, and South region. In the Northregion, there was a decrease in the number of these examinations in the same period.In the Northeast region, a decreasing number has been recorded since 2010. In theSouth and Midwest regions, the number of examinations remained constant. Therefore,in these regions, the number of examinations performed has not followed the samepopulation growth, which has been increasing year by year. On the contrary, in theSoutheast region, there was an increase in the number of EGDs, followed by thepopulation growth, with a statistically significant relationship.The number of endoscopic examinations per 100,000 habitants, in each region, in 2018,varied in the country, as shown in Therefore, the number of EGDs per 100,000 habitants varied from region to region, indecreasing order, respectively, in the Southeast, Midwest, South, Northeast, andNorth regions. The number of CLNs per 100,000 habitants per year also varied fromregion to region, in decreasing order, respectively, in the Southeast, South,Midwest, Northeast, and North regions.,,The incidence and statistics of malignant tumors of the esophagus, stomach, andcolorectal in the Brazilian population are high and significant The most frequent malignant gastric tumors are adenocarcinomas (95%), and in Brazil,13,360 new cases are awaited in men and 7,870 in women for each year of the2020-2022 triennium, with an estimated risk of 12.81 for every 100,000 men and 7.34for every 100,000 women. Among men, in the North , it isthe second most frequent, followed by the Northeast occupying the third position, while in the South ,Southeast , and Midwest (9.38/100.000 habitants), it is thefourth most frequent among the other tumors. Among women, in the North  and South  regions, it is the fifth mostfrequent; in the Northeast  and Central-West regions, it occupies the sixth position; and in the Southeastregion , it occupies the seventh position. In Brazil, in2017, there were 9,206 deaths from gastric cancer in men and 5,107 deaths in women,corresponding to the risk of 9.12 and 4.93 per 100,000 habitants The most frequent colorectal malignancies (divided into colon and rectum) areadenocarcinomas, and in Brazil, it is estimated that for each year of the 2020-2022triennium, 20,520 cases of colorectal cancer in men and 20,470 in women will bediagnosed, corresponding to an estimated risk of 19.63 new cases per 100,000 men and19.03 for every 100,000 women. Among men, in the North  andNortheast  regions, they occupy the fourth position; in theSouth region , it is the third most frequent tumor; and inthe Southeast  and Midwest regions, it is the second most incident. For women, in the Northeast , North , and Midwest regions, it is the third most incident; and in the Southeast  and South  regions, it is the second mostfrequent. In Brazil, in 2017, there were 9,207 deaths from colon and rectal cancer,respectively, in men and women, to the risk of 9.12 and 9.33 per 100,000 habitants,,,Both EGDs and CLNs have many indications among gastroenterologists, digestivesurgeons, general surgeons, proctologists, and general practitioners. They are safeprocedures with low morbidity and are used for the diagnosis of benign and malignantdiseases and for therapeutics The Unified Health System (SUS) records the number of examinations performed in thecountry, state by state. Consulting the online available records, it was possible toconstruct the figures shown in this study, comparing and statistically analyzing thenumber of endoscopic examinations performed, with the population growth recorded byIBGE in the geographic regions and the regional incidence of these malignant tumors,recorded by INCA, year by year.The Brazilian Constitution considers health as a universal right and a governmentalresponsibility to every citizen, through an SUS, created in 1990, as a healthservice, throughout the country, for everyone. Thus, SUS allows the population toaccess the outpatient and hospital health system, from primary care to highlycomplex treatments The population senses, performed by the IBGE, recorded population growth in the fiveBrazilian regions between 2010 and 2017 -5. In coThe results showed that the number of EGDs performed in the North, Northeast, South,and Midwest regions did not increase significantly during the period of this study.In the Northeast region, the number of examinations decreased year by year.Therefore, the number of examinations did not follow the population growth. Only inthe South region, did the number of examinations increase, following the populationgrowth .The number of CLNs increased year by year in the five regions of the country.However, in the North and Northeast regions, population growth was more significantand the number of CLN examinations performed did not follow the population growth and 2.Although malignant gastric tumors have decreased in some countries, in recent years,such as Japan, Korea, and China, their incidence remains high, requiring healthactions for screening in the population, based on encouraging EGDs. In Japan, therewas an increase in the number of examinations per year, by more than 2 million from1996 to 2014. And from 2016, the government started to encourage the requesting ofan increasing number of EGDs in clinics and hospitals, achieving an increase of 8.6%per year, and that a total of 12 million examinations be performed annually, for anestimated population in 2019, of 126 million habitants In China, with 1.4 billion habitants in 2019, it was estimated that approximately 2million Chinese people had malignant gastric tumors, and of this total, 42.7%(40.3-45.0%) remained without diagnosis, due to patients\u2019 delay in seeking medicalhelp and difficulty in performing EGDs. In addition, without systematic screening,it is projected to occur about 10 million cases and 7 million deaths, due to thistumor, in the next 30 years. The authors concluded that the triennial screening,performing periodic EGDs in the population at risk, would gradually reduce by 38.8%(36.9-40.7%), 25.5% (23.4-27.6%), and 17.8% (16.0-19.6%) by 2049, respectively, theproportion of undiagnosed cases of gastric cancer In Germany, 36.6% of deaths from colorectal cancer are estimated to be attributed tothe failure to perform CLNs, this percentage being compared to what also occurs inthe United States, where it is estimated that 38.2% and 33.6%, respectively, betweenthe years 2008-2009 and 2010-2011. The authors concluded that the proportion ofdeaths theoretically that could be prevented in 10 years would be 30.7% and 29%,respectively, in Germany and the United States, in these cited periods ,The cost-effectiveness for detecting malignant esophagogastric junction and gastrictumors in the United States, in a high-risk population, using EGDs, was consideredadvantageous, in relation to the cost of surgical and oncological treatment of thesetumors when diagnosed in advanced phase Hamashima emphasized that endoscopic examinations are the main methods for diagnosinggastric tumors, and the sensitivity and specificity of endoscopic screeningevaluated in South Korea and Japan. Although the reduction in mortality employingendoscopic screening was recorded in several studies, the results remaininsufficient to confirm its effectiveness, and so new screening methods should beintroduced in future ,,,The literature has recorded high rates of colorectal cancer in several countries,including Brazil, and evidenced colonoscopy is the best and most effective screeningtest. Therefore, maximizing its effectiveness and encouraging its performance inadults over 50 years of age is the best way to detect the tumor early and provide anopportunity for appropriate treatment for the patient Taveira et al. calculated the number of EGDs per 100,000 inhabitants per year, forthe period from January 2008 to December 2009, analyzing the total Brazilianpopulation according to IBGE data and the population, in the respective states andregions. The authors concluded that the regions that performed the most EGDs inabsolute number per year, in decreasing order, were Southeast, Northeast, South,Midwest, and North. On the contrary, in these 2 years of study, calculating thenumber of examinations per 100 thousand inhabitants per year, the regions thatperformed more examinations, in decreasing order, were Northeast (654 examinations),Southeast (590 examinations), Midwest (451 examinations), South (409 examinations),and North (323 examinations), with the median being 550 examinations per 100,000habitants per year. By comparing this national average with countries like Ireland,Holland, and England that have health systems similar to SUS and performed 1,322,1,137, and 950 examinations per 100,000 habitants per year, respectively, they foundthat Brazil performed half of the examinations than these countries. The authorsconcluded that adequate planning is necessary to incorporate new diagnostictechnologies in order to serve the population of all regions of the country wellComparing the results obtained by Taveira et al. ,,Patients looking for medical help present these tumors in an advanced form; so it isimportant to implement specific health actions to provide orientations to thepopulation, encouraging the early search for Medical Services and requesting theseendoscopic examinations, for the diagnosis the tumors in early stages. The diagnosisof these tumors in early and non-advanced stages allows greater chances of surgicaland oncological treatments, making possible better disease control and increasedsurvival and quality of life Therefore, it is of great importance to know quantitative data of these examinations,to plan health actions, mainly in the malignant tumors of the digestive system,because of what they represent in the Brazilian population.The current number of EGDs and CLNs performed by the SUS did not follow thepopulation growth, to attend the population and diagnose esophageal, stomach, andcolorectal tumors. Therefore, an adequate and strategic planning of how to attendthe demand for endoscopic examinations is important, in all regions, incorporatingnew technologies, in the diagnosis of these tumors, in future."}
{"text": "A vivid example of art and science intertwining and reflecting across generations.A clear demonstration of beauty and motion in biological iterations.Angiogenesis and stars, the bringers of light and elegance to a dark sky.Interspersing/intermingling collagen, moving clouds in the wind, not to denySheets of collagen, a stable platform over the City of the Valve providing protection."}
{"text": "The field of sex and gender research in health and medicine is growing, and many early- and mid-career researchers (EMCRs) are developing skills in this area. As EMCRs specialising in sex and gender research, we aim to better understand sex- and gender-based determinants of human health, challenge long-standing and pervasive gender biases, and contribute to improving the evidence base upon which clinical guidelines and policy interventions are developed. To effectively achieve these goals, we believe that EMCRs would benefit from understanding the challenges of working in this space and participate in driving change in three key areas. First, in creating greater links between the goals of sex and gender research and addressing systemic bias against women and gender minorities, to effectively translate knowledge about sex and gender differences into improved health outcomes. Second, in expanding the reach of sex and gender research to address women's health in an intersectional way and ensure that it also benefits the health of men, transgender and gender-diverse people and those who are intersex. Third, in working with others in the scientific community to improve methods for sex and gender research, including updating data collection practises, ensuring appropriate statistical analyses and shifting scientific culture to recognise the importance of null findings. By improving focus on these three areas, we see greater potential to translate this research to improve women's health and reduce health inequities for all. There is a well-acknowledged bias against, and underrepresentation of, women in health and biomedical research , 2. To aIn conducting our own research, encompassing different therapeutic areas and sex and gender policies, we visualise sex and gender research as situated inside a complex system including: (i) wider systemic issues of gender bias and health inequities,  (ii) greSex and gender research generally aims to expose, understand, and address health inequities. In particular, this research area focuses on the underrepresentation of women in research studies and the gaps in our understanding of the impact of sex and gender on health and disease. However, researchers, including ourselves, are investigating sex and gender, and their relationship with disease, in systems that reflect broader society's biases against women and gender minorities. This has consequences for the effective translation of research findings into sex- and gender-sensitive approaches to reduce health disparities, and so it is equally important to consider and address gender bias in other areas.First, we must consider that our research is being disseminated to readers that may hold biassed views on women and gender minorities. As a result, there is the potential for findings from sex and gender research in health to be misinterpreted, by researchers, the public and the media , 16. In st century, with 1 in 6 people expected to be 60 years and older by 2030 . The need for large sample sizes in sex and gender research is why large-scale population databases such as the UK Biobank,  and National Health and Medical Research Council of Australia (NHMRC) investigator grant (APP2009726).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "In the knowledge economy, the process of knowledge sharing and creation for value co-creation frequently emerge in a multi-agent and multi-level system. It's important to consider the roles, functions, and possible interactive knowledge-based activities of key actors for ecological development. Makerspace as an initial stage of incubated platform plays the central and crucial roles of resource orchestrators and platform supporter. Less literature analyses the knowledge ecosystem embedded by makerspaces and considers the interactive process of civil society and natural environment. This study constructs a multi-agent and multi-level knowledge ecosystem from macro, meso, and micro perspective based on Quintuple Helix theory and designs four evolutionary stages of knowledge orchestrating processes. This study finds that the symbiosis, co-evolution, interaction, and orchestration of multiple agents in the knowledge ecosystem should be merged with each other for value co-creation, which helps to take a systematic approach for policymakers, managers, and researchers. The knowledge ecosystem is a non-linear and complex system that focuses on the knowledge interaction between major systems and subsystems  in the knowledge ecosystem should be analyzed for value co-creation at all levels of the knowledge ecosystem. Therefore, makerspaces require for the continuous attention of governments, scholars, business, citizens to make China's innovation and entrepreneurial strategy into an important engine to promote economic development and technological progress.Our work has some implications for policymakers, managers, researchers. Makerspaces have strong linkages to governments, universities, businesses, citizens, and the natural environment. The activities of knowledge exchange, cooperation, collaboration, and orchestration are reinforced in the knowledge networks embedded by makerspaces. The implications from three aspects are consistent with the three levels of our conceptual framework. At the macro-level, makerspaces are elements of the knowledge ecosystem as a whole. The long-term run of makerspaces could structure the relationship of symbiosis, commensalism, intergrowth, and orchestration. The not-for-profit business model is ubiquitous and communal to the sustainability of the sharing economy. At the meso-level, makerspaces play the role of community, embracing diverse populations of makers, startups, and entrepreneurs. Makerspaces need a systematic approach based on the support by multiple agents to provide disparate services to new projects. At the micro-level, makerspaces provide the economic and social environment suitable for interactive knowledge-based activities. Makerspaces should construct more multiple and mature platforms for knowledge exchange and flow among the maker individuals, incubated startups, and the maker culture.For further research, the case study should be extended to other countries, which may be more representative of all types of nations. Further research could compare our findings and practices with different contexts. Furthermore, some empirical data could be collected to verify our conceptual model.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.This work was supported by the National Social Science Foundation of China (19BGL031).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "This paper analyzes the environmental performance, spatial and temporal characteristics, and optimization paths of key polluting industries, represented here by the power industry, using the super-efficient MinDS model. The study shows that the environmental performance as a whole presents the characteristics of an inverted U-shaped and then a U-shaped trend; each region presents an asymmetric state of convergent development followed by differentiated development, with 2014 as the structural change point; the development trend of environmental performance in each region is divided into three categories  and four types of spatial clustering ; and input\u2013output indicators of environmental performance in China and across regions have varying degrees of redundancy, with labor input redundancy being the greatest, followed by capital input, technology input, and pollution emissions. On this basis, we propose to improve the monitoring and inspection mechanism of the implementation process of pollution control in key polluting industries and to improve the level of environmental performance of key polluting industries by optimizing the combination of labor, capital, and technology input factors in each region according to local conditions and adopting differentiated strategies. The main contributions of this paper are threefold: first, we incorporate technological inputs into the environmental performance evaluation index system of the electric power industry, which can better reflect the real inputs of the electric power industry and measure the results more accurately; second, we adopt the MinDS model for measuring the environmental performance level, which can quantitatively analyze the gap between each indicator and the optimal level; and third, we propose a redundancy index, which can be used to compare the redundancy of each indicator and then judge the main efficiency levels of the different factors. Among them, global CO2 emissions from the power sector reached 13 billion tons, accounting for 38% of total energy-related CO2 emissions. China is the world\u2019s largest producer of electricity and the country with the largest increase, accounting for 26.70% of the world\u2019s total power generation capacity. According to the data provided by the 13th Five-Year Plan for Electricity Development (2016\u20132020), the carbon emissions of coal-fired units in China are as high as 890 g/kWh, while those of the United States and Japan are 433 g/kWh and 544 g/kWh, respectively. Thus, it can be seen that there is some room for decarbonization in China\u2019s electric power and that it is the \u201cfront-runner\u201d in terms of controlling carbon emission reduction [At present, China\u2019s economy is in the transition stage from stable growth to high-quality development, and the coordinated development of the economy and the environment is an inevitable requirement for high-quality development. However, the problem of carbon emissions in China is still serious, and environmental problems have seriously restricted the high-quality development of China\u2019s economy. According to relevant statistics, industries with large energy consumption, such as electricity, transportation, construction, and industry, are the main sources of carbon emissions in China, and the sum of their carbon emissions exceeds 74% of the total national carbon emissions ,2,3,4. I by 2060 ,6,7. In  by 2060 ,9,10. Aceduction ,12,13,14Environmental performance, also known as environmental efficiency or eco-efficiency, was first introduced by Schaltegger and Sturm in 1990 . EnvironIn recent years, with the increase in public concern about the environment and the successive introduction of government policies, people have been paying more and more attention to the environmental effects of enterprise production activities. Many scholars have started to pay attention to the environmental governance of heavily polluting industries ,17,18. TLooking at the previous literature on the selection of environmental performance indicators in the power industry, it is difficult to find studies with identical indicators. Peng selected sulfur dioxide emissions , nitrogeFor the measurement methods of environmental performance, researchers have mainly used life cycle analysis (LCA), stochastic frontier analysis (SFA), and data envelopment analysis (DEA) methods. The LCA method mainly focuses on a specific product and measures the environmental efficiency of the product throughout its life cycle, which makes it difficult to evaluate the environmental efficiency of enterprises or industries. The SFA method is a parametric method that requires the determination of efficiency when setting a specific production function and using statistical methods to estimate the parameters, which may result in large errors. Fare and Lovell  first prPrevious studies on the construction and measurement of environmental performance index systems in the power industry have provided us with many insights, but there are also certain problems. First, there is no uniform standard for the selection of environmental performance indicators. For the input indicators, previous scholars have considered three aspects: asset input, labor input, and fuel consumption input; in addition, there are a large number of technical inputs in the power industry, such as power plant consumption rate, line loss rate, and transmission line length ,50,51,52The super-efficient MinDS model combines the super-efficiency model and the minimum distance to strong efficient frontier (MinDS) model. Andersen and Petersen  first prThe first step is to establish the super efficiency SBM model and determine the effective DMU set, which is composed of a DMU with an efficiency level greater than 1; that is, i-th input indicator of the k-th DMU; r-th output indicator of the k-th DMU; i-th input indicator of the j-th DMU other than r-th output indicator of the j-th DMU other than In the above equation, (1) represents the objective function, and (1a)\u2013(1c) represent constraints. The second step is to establish a mixed integer linear programming model under the constraints of the effective DMU set, calculate the super efficiency minds value, and solve the objective function and constraints of the super efficiency minds value model as follows:It can be seen from Equation (2) that the minds model is composed of three parts: objective function (1), constraint b, constraint c, and constraint d. In the above equation, the meanings of We comprehensively consider the ISO14031 environmental performance evaluation system and WBCSD eco-efficiency index system to select the input\u2013output indicators, and the selection of the index system follows the principles of scientificity, validity, measurability, comparability, and systematization. Since the electric power industry is mainly divided into three sectors\u2014the power generation sector, the transmission sector, and the distribution and sales sector\u2014we should include each of them as much as possible in the selection of indicators in order to reflect the environmental performance of the whole electric power industry comprehensively. The basis for the selection of the input and output indicators of the power industry is shown below, and we summarize all the input and output indicators into a table to constitute the environmental performance indicator system of the power industry, as shown in Capital input: This reflects the resource input of electric power enterprises. Since it is difficult to measure the input capital of the power industry, this paper selects the installed capacity indicator, i.e., the overall power of the enterprise\u2019s generating units, to reflect the scale of production capacity input in each region.Labor input: We usually use three methods to measure labor input in the power generation industry: labor time, labor income, and labor headcount. However, due to the residual administrative monopoly in China\u2019s power generation industry, the labor income of employees in the power industry is not a reflection of the value of labor under market conditions. As we do not count the labor time data, we finally chose the number of laborers to represent the labor input. Since it is difficult to obtain the number of employees in the electric power industry in each province, city, and autonomous region directly, we used the number of employees in the heat and power production and supply industry, which is highly related to the electric power industry, to represent the number of employees.Fuel input: This refers to the fuel consumed by power industry enterprises in the process of power generation, which can reflect the degree of fuel utilization. At present, China mainly focuses on thermal power generation, and the energy input required for thermal power generation is mainly coal and fossil energy such as oil, natural gas, and coke. In order to make these energy inputs comparable with each other, we need to convert these energy sources into standard coal consumption uniformly, and finally we express the energy inputs in terms of standard coal consumption for power generation.Technical input: We measure the technical input of the region through power consumption rate in the power plant, line loss rate, and transmission line length. The power consumption rate in the power plant refers to the percentage of electrical energy consumed by the power plant in producing electrical energy of the total amount of electrical energy generated, which reflects the rate of power consumption in the generation chain. The line loss rate refers to the percentage of electrical energy lost in the transmission and distribution process to the electrical energy supplied by the power network and measures the economy of power system operation. The length of transmission lines is directly proportional to the voltage, so there is also a particular influence on line losses.Electricity generation: This refers to the amount of electrical energy produced by a power plant, which is the value of the main product or service of the power industry.Gross regional product: Electric energy, as an essential secondary energy source, provides power for all fields of social production, and electricity consumption shows a strong positive correlation with economic growth; therefore, it is feasible to measure the economic output of the regional power industry using the regional GDP.2 emissions, SO2 emissions, and nitrogen oxides; so, we chose these three environmental pollution indicators.Environmental pollution: According to the principle of conservation of matter, fuel consumption causes environmental pollution. The pollutants produced by the power industry are mainly COSince data from Tibet, Hong Kong, Macau, and Taiwan are difficult to obtain, this paper analyzes data from the remaining 30 provinces, autonomous regions, and municipalities under the direct control of the central government in China. According to the availability of data, we selected the data of the last ten years, i.e., 2010\u20132019, for the study. The data on labor force and gross regional product were obtained from the China Statistical Yearbook and all other data were obtained from the China Electricity Yearbook. For the few missing values, interpolation and extrapolation methods were used to obtain them. In order to eliminate the influence of price factors, the data of gross regional product were calculated in constant prices with 2010 as the base period.We obtained data on fuel coal consumption and nitrogen oxide emissions in the thermal power industry from the Annual Report of China Environmental Statistics. Currently, the Chinese Yearbook does not contain data on pollution emissions in the power industry by region for all years. Some literature directly uses industrial emissions instead of power industry emissions, which is likely to affect the accuracy of the results. To make up for this deficiency, we based this analysis on the results of the first national pollution source survey of the State Council in 2008 and the emission coefficient of major pollutants in the thermal power industry calculated by the State Grid Group of China and the State Grid Institute of Environmental Protection of China. The determination methods of pollutant emissions of thermal power plants include the measurement method, material balance algorithm, element balance method, production and emission coefficient method, etc. The production and discharge coefficient method has the advantages of simplicity, clarity, and easy operation. Therefore, this method is the most general and effective technical means of determination at present. We estimated the carbon dioxide emissions based on the changes in three driving factors, namely, power generation, coal consumption for power supply, and carbon emission intensity, as shown in Equation (3). We estimated the sulfur dioxide emissions based on the power generation, the sulfur content of coal combustion, the emission factors of different combustion equipment, and the efficiency of pollutant treatment, as shown in Equation (4).In Equations (3) and (4), Considering that the DEA model should make the input\u2013output indicators as concise as possible when it is applied in practice, we use the entropy value method to downscale the three indicators of technological inputs and the three indicators of environmental pollution emissions and synthesize a total input technology indicator and a total environmental pollution emission indicator, respectively. The descriptive statistical results of the input\u2013output index system of environmental performance of the power industry are shown in The software used in this study was MaxDEA 8 Ultra. The first version of MaxDEA was developed by ChengGang in 2009, and then ChengGang released more versions of MaxDEA one after another, including MaxDEA Basic, MaxDEA Pro, and MaxDEA Ultra. MaxDEA Ultra is an optimization of MaxDEA Basic and MaxDEA Pro. MaxDEA Ultra contains all the functions of MaxDEA Basic and MaxDEA Pro, and the measurable DEA models included in this version are more comprehensive, faster, and support multi-core CPU parallel computing; so, this paper uses MaxDEA 8 Ultra software for measurement . In thisFrom To reflect on the degree of variation in the environmental performance of the power industry in each region, we plotted the standard deviation of the environmental performance of the power industry in each region from 2010 to 2019 in We believe that the possible reason for the above results is that, in 2011, the State Council issued the Opinions of the State Council on Strengthening Environmental Protection Priorities and the Notice of the State Council on the Issuance of the National Environmental Protection 12th Five-Year Plan, which proposed measures to control the total emissions of sulfur dioxide and nitrogen oxides in the power industry. The State Council\u2019s \u201c12th Five-Year Plan\u201d notice proposed to control the total emissions of sulfur dioxide and nitrogen oxide in the power industry. Since 2011, power companies in all regions have raised their awareness of environmental protection and environmental pollution emissions in the power industry have been decreasing year by year; thus, environmental performance has begun to increase. Since in the initial stage, the sensitivity to environmental regulation was higher in regions with small power scales than in regions with large power scales, this led to the gradual reduction of individual differences between regions and the rate of reduction slowed down. Starting from 2014, the State Council issued the \u201cGuidance on Further Promoting the Pilot Program of Paid Use and Trading of Emission Rights\u201d, which proposed the establishment of a paid use system of emission rights. According to Wang and Liu , it is kConsidering the change and ranking of the environmental performance of the electric power industry from 2010 to 2019 in each region, we roughly classify the trend of change in the environmental performance of the electric power industry into three types, including rising, falling, and smoothness. The regions and characteristics included in each type are as follows.(1) Rising type. This includes relatively economically developed areas such as Beijing, Hebei, Shanghai, Jiangsu, Fujian, Shandong, Sichuan, Yunnan, Jiangxi, Liaoning, Xinjiang, and Hainan. This is basically consistent with the conclusion reached by Peng . The bet(2) Declining type. This includes Qinghai, Shanxi, Guizhou, Zhejiang, and Hubei. This is basically the same as the conclusion of the study by Guo et al. . The dec(3) Smooth type. This includes Gansu, Guangxi, Hunan, Jilin, Shaanxi, Henan, Tianjin, Anhui, Heilongjiang, Inner Mongolia, Chongqing, Ningxia, and Guangdong. This is basically the same as the findings of Peng  and Guo The natural interruption point grading method is a map grading algorithm proposed by Chen et al. . This is(1) Ultra-high-level regions. From (2) High-level regions. As we can see from (3) Medium-level regions. From (4) Low-level regions. As shown in In the super-efficient MinDS model, the slack variable represents an optimization quantity, which indicates the \u201cdistance\u201d of the DMU from the effective frontier, which reflects the input redundancy and output deficiency of the DMU. In order to measure the relative redundancy level of each input\u2013output indicator, we define the redundancy index. The redundancy degree is expressed as the ratio of the absolute amount of the slack scalar of each indicator to the original value of the input or output indicator. In this study, we first screened out the regions with efficiency values less than 1 from 2010 to 2019; i.e., the inefficient regions that needed improvement. Then, the redundancy of each indicator in these regions was calculated. Using the redundancy degrees of these indicators, it is possible to analyze both the gap between each indicator and the optimal level of environmental performance of the power industry nationwide and in each region, as well as their trends. It provides a clear guiding direction for the enhancement and improvement of the environmental performance of the power industry nationwide and in each region.We used the average of each indicator in the inefficient regions from 2010 to 2019 to represent the redundancy of each input\u2013output indicator of environmental performance of the national power industry from 2010 to 2019. We use histograms to represent the redundancy of each indicator of the environmental performance of the electric power industry in China in 2010 and 2019, as shown in From In order to explore the gap between each indicator and the optimal level of environmental performance in the power industry in each region and the trend of change, we drew bubble diagrams, as shown in Based on previous studies, this paper constructs an environmental performance evaluation index system based on the electric power industry as an example, by which the environmental performance level of key polluting industries in China is evaluated, the spatial and temporal characteristics of the environmental performance level of each region in China are explored, the gap between the current environmental performance level and the optimal level is quantitatively analyzed, and the path to improve the environmental performance level of key polluting industries in China is proposed. The main contributions of this paper are threefold. First, we incorporate technological inputs into the environmental performance evaluation index system of the electric power industry, which can better reflect the real inputs of the electric power industry and measure the results more accurately. Second, we adopt the MinDS model for measuring the environmental performance level, which can quantitatively analyze the gap between each indicator and the optimal level. Third, we propose a redundancy index, which can be used to compare the redundancy of each indicator and then judge the main efficiency levels of different factors. The main conclusions drawn in this paper are as follows.(1) The overall environmental performance of China\u2019s electric power industry shows the characteristics of an inverted U-shaped first and then a U-shaped trend. The environmental performance of the electric power industry in each region presents an asymmetrical state with 2014 as the structural change point, with convergence development coming first followed by differentiation development.(2) The trend of environmental performance changes in the electric power industry in each region can be roughly divided into three categories: rising, falling, and stable. The rising type includes Beijing, Hebei, Shanghai, Jiangsu, Fujian, Shandong, Sichuan, Yunnan, Jiangxi, Liaoning, Xinjiang, and Hainan. The falling type mainly includes Qinghai, Shanxi, Guizhou, Zhejiang, and Hubei. The stable type mainly includes Gansu, Guangxi, Hunan, Jilin, Shaanxi, Henan, Tianjin, Anhui, Heilongjiang, Inner Mongolia, Chongqing, Ningxia, and Guangdong.(3) The spatial clustering effect of the environmental performance of the power industry in each region is divided into four types: ultra-high level, high level, medium level, and low level. The ultra-high-level regions are Beijing, Shanghai, Jiangsu, Hainan, and Qinghai. The high-level regions are Inner Mongolia, Tianjin, Anhui, Fujian, Guangdong, Yunnan, Hubei, Sichuan, and Ningxia The medium-level regions are Shanxi, Shaanxi, Chongqing, Guizhou, Jiangxi, Zhejiang, and Shandong. The low-level regions are Heilongjiang, Jilin, Liaoning, Hebei, Henan, Hunan, Gansu, Xinjiang, and Guangxi.(4) The input\u2013output indicators of environmental performance in China\u2019s power industry have different degrees of redundancy. The redundancy of labor input is the largest, followed by capital input, and finally technology input, power generation, regional GDP, and fuel input. There is redundancy in capital inputs in Gansu, Guizhou, and Henan; redundancy in technology inputs in Hebei, Henan, Heilongjiang, Hunan, Jiangxi, Shanxi, and Shaanxi; and excessive non-desired outputs of environmental pollution emissions in Guangxi, Jiangxi, Liaoning, Shaanxi, Zhejiang, and Chongqing.(5) The inefficient provinces are not invariant across regions. During the analysis period, Guizhou, Shanxi, and Zhejiang moved from efficient provinces to the ranks of inefficient provinces, and Jilin, Shandong, Sichuan, Xinjiang, and Yunnan moved from inefficient provinces to the ranks of efficient provinces; the redundancy degree of most indicators in each inefficient province has improved to different degrees, among which the labor input redundancy has improved the most.This paper argues that efforts should be made in the following aspects to promote the improvement of the environmental performance level of key polluting industries in China.(1) Improve the supervision and inspection mechanism of the implementation process of pollution control in key polluting industries. From the previous analysis, it can be seen that the release of environmental pollution control-related documents can greatly enhance the environmental awareness of environmental pollution subjects, but the results of the implementation process vary greatly from region to region. The implementation process should be concretized and involve the development of emission reduction standards, regular publication of the list of exceedances, proposed corrective measures, and tracking implementation. This is the only way to fundamentally improve the environmental performance of key polluting industries.(2) Each region should adopt differentiated strategies to improve the environmental performance of key polluting industries according to local conditions. Regions with a high level of economic development should make full use of their economic base to develop carbon emission reduction technologies and actively export them to maximize the technology spillover effect. For western regions with inherent advantages, they should make full use of their own advantages to build photovoltaic power parks to serve the national strategy of \u201cwest\u2013east power transmission\u201d. For areas with mainly thermal power generation, it is difficult to realize the transformation of the power industry structure in a short period of time; so, the production efficiency of the original power generation method should be improved. In short, the whole country should play to the strengths of each region to complement each other\u2019s weaknesses and optimize the environmental performance of key polluting industries as a whole.(3) Optimize the combination of labor, capital, and technology input factors and improve the efficiency of factor inputs. Labor, capital, and technology inputs are important factors that limit the level of environmental performance of key polluting industries in China and in each region. Today, when the demographic dividend no longer exists, improving labor efficiency is a necessity. The excessive redundancy of labor should be reduced by streamlining personnel, improving the intellectual quality and skill quality of labor, and establishing an effective wage-restraint mechanism. Key polluting industries tend to invest more, and the excessive investment of capital is a serious waste of resources, which should be eliminated by replacing outdated equipment, accurate measurements, and updating as needed. The excessive investment of technology is mainly caused by high plant electricity rates and excessive consumption of line loss rates, which should be vigorously targeted via research on and development of low energy consumption wind and smoke systems, desulfurization systems and powder making systems, power grid transformations, and sound line loss management systems. The inputs of labor, capital, and technology cannot be considered in isolation; only by optimizing the quantity and quality of labor, capital, and technology can we fundamentally improve the environmental performance of key polluting industries in China and its regions.This paper analyzes the environmental performance, spatial and temporal characteristics, and optimization paths of key polluting industries, represented here by the electric power industry, using the super-efficient MinDS model. In the future, we can use the super-efficient MinDS\u2013Malmquist combination model to further analyze the changes in environmental technology in the electric power industry and reveal the sources of environmental performance changes. According to our analysis, the environmental performance of China\u2019s electric power industry shows a rising\u2013declining\u2013rising trend, and the standard deviation shows a declining\u2013rising trend, indicating that the individual differences between different regions first decreased and then expanded, which may be related to the scale of the electric power industry and environmental regulation. There may be a threshold effect, which should further be explored in the future."}
{"text": "The problem of environmental pollution caused by the abuse of antibiotics has received increasing attention. However, only in recent years have antibiotic pollution and its risk assessment to the environment been deeply studied. Although there has been a large number of reports about the input, occurrence, destination, and influence of antibiotics in the past 10 years, systemic knowledge of antibiotics in the groundwater environment is still lacking. This review systematically expounds the sources, migration and transformation, pollution status, and potential risks to the ecological environment of antibiotics in groundwater systems, by integrating 10 years of existing research results. The results showed that 47 kinds of antibiotics in four categories, mainly sulfonamides and fluoroquinolones, have been detected; antibiotics in groundwater species will induce the production of resistance genes and cause ecological harm. In view of the entire process of antibiotics entering groundwater, the current antibiotic control methods at various levels are listed, including the control of the discharge of antibiotics at source, the removal of antibiotics in water treatment plants, and the treatment of existing antibiotic contamination in groundwater. Additionally, the future research direction of antibiotics in groundwater is pointed out, and suggestions and prospects for antibiotic control are put forward. Antibiotics are a class of secondary metabolites with antipathogen or other activities produced by microorganisms  in the process of life, or synthetic chemicals used to antagonize a specific pathogenic microorganism. Due to selectively inhibiting or affecting biological functions, antibiotics have been widely used in the fields of medicine, agricultural production, and livestock farming and aquaculture, mainly including tetracyclines (TCs), macrolides (MLs), sulfonamides (SAs), chloramphenicols (CPs), and fluoroquinolones (FQs) . The halAccording to statistics, the annual consumption of antibiotics in the world can reach 100,000 t~200,000 t . In receIn order to understand the occurrence status of antibiotics in the groundwater of Chinese water systems, this paper reviews the relevant literature in the past 10 years, and identifies the source, migration, and harm of antibiotics in groundwater in China, so as to provide a reference for the prevention and control of antibiotic pollution and the establishment of relevant laws and regulations. The review framework of this paper is shown in Mass production and widespread use are the main reasons for the long-term existence of antibiotics in groundwater. Antibiotics form a variety of metabolites after continuous migration and transformation in the groundwater environment, posing potential threats to the ecological environment. Therefore, the qualitative and quantitative analysis of antibiotics and metabolites in groundwater is becoming more and more important. After decades of development, the detection of antibiotics has developed from a simple observational method to an accurate qualitative and quantitative method, using sophisticated instruments. The commonly used methods at this stage are : chromatAntibiotics in the surface water and soil directly affect the groundwater environment. Among them, the sources of antibiotics in surface water mainly include domestic sewage, the medical and health industry, the antibiotic production industry, and livestock farm and aquaculture wastewater; the main sources of antibiotics in the soil environment are the use of poultry and livestock manure and landfill disposal. After the antibiotics in the surface water and soil enter the vadose zone, they eventually migrate to the groundwater through a series of complex physicochemical reactions and biological actions, such as leaching, infiltration, and groundwater\u2013surface water interactions . This arDomestic sewage is one of the main sources of antibiotics in the environment . Sewage As a producer of antibiotics, the industrial wastewater from antibiotic manufacturing plants and some chemical plants contains pollutants such as raw materials, precursors, and noumenon and their metabolites, which are the first source of antibiotic pollutants in the environment. Compared with domestic sewage, the residual antibiotic concentration in antibiotic production wastewater is much higher , and it About 50% of hospital outpatients in China used antibiotics to treat their diseases, of which about 74% received one antibiotic and 25.3% received two or more antibiotics. Overuse of antibiotics has become a common phenomenon, especially in poor areas . The excAntibiotics have been widely used to prevent or treat human and animal diseases and are also used in livestock farms as growth promoters. Due to the difficulty in being absorbed by the intestine, most antibiotics are excreted, causing a health crisis . It has With the rapid growth of the population, the demand for aquatic products is increasing, resulting in the continuous expansion of the aquaculture industry . To incrReclaimed water irrigation, landfills, and livestock feces will introduce antibiotics into the soil, and the concentration of antibiotics in the soil is related to its source, with the highest concentrations of antibiotics in the soil near a feedlot. Zhou et al.  detectedGroundwater is the final destination of antibiotics in the environment, and its pollution levels and sources have received extensive attention at home and abroad, but systematic investigations did not begin until the end of the 20th century . AccordiBecause groundwater is harder to sample than surface water, and antibiotics are difficult to detect , the curBased on reports of antibiotics in the groundwater in China in the past 10 years, this paper reviews the discovery and distribution of TCs, SAs, FQs, and MLs . The areDue to its larger population and larger area of arable land, China is a major producer and user of antibiotics . The detSAs are the longest-serving synthetic antibiotics in history , and areFQs are one of the newest antibiotics for clinical use and are widely used in the treatment of human and animal diseases . In the MLs are widely used in the clinical treatment of respiratory and skin infections due to the advantages of strong penetrating power, shortening the course of disease, and a significant bacteriostatic effect . As showAntibiotics have been detected in underground environments such as soil and groundwater. It has been reported that the main processes involved in antibiotics entering groundwater include sorption, hydrolysis, and microbial degradation, and that they are affected by various environmental factors and physical and chemical properties . AlthougThe content of antibiotics in groundwater is related to the hydrological source and the geological characteristics of the aquifer . AntibioThe migration of antibiotics in groundwater mainly depends on the sorption to soil and sediment. Generally speaking, antibiotics with strong sorption capacity do not easily migrate in the environment, are relatively stable, and easily accumulate, while antibiotics with weak sorption capacity are easily washed and migrated into groundwater with the water cycle. Sorption is mainly affected by various environmental factors such as various physicochemical properties of antibiotics, pH values, the content of soil and sediment organic matter, and cation exchange capacity. Sorption is critical for antibiotics entering groundwater . The sorHydrolysis is an important environmental behavior for the degradation of antibiotics in the groundwater environment. During the reaction, the parent structure of the antibiotic is broken, and then, one or more degradation products are generated. The hydrolysis process of antibiotics in the groundwater environment is affected and restricted by water environment factors and the physical and chemical properties of antibiotics . Through laboratory biodegradability testing with sewage sludge, L\u00e4ngin et al.  found thAlthough the number of microorganisms in groundwater is very scarce, biodegradation is still an important pathway for the transformation of antibiotics in groundwater. When antibiotic-contaminated water seeps through soil profiles and reaches aquifers, biodegradability is slowed by limited microbial populations, oxygen, and nutrients. The degradation of antibiotics in groundwater is affected by environmental factors, microbial properties, and the molecular structure of antibiotics. For example, SMZ is less biodegradable than other antibiotics in microcosm studies . Maki etConcentrations of antibiotics are lower in groundwater than in surface water , but in This article reviews the emergence of ARGs in the groundwater of China, as shown in The ecological harm of antibiotics in the water environment is mainly reflected in two aspects: the impact on aquatic organisms and the disturbance of element circulation in the aquatic ecosystem. There are different types of microorganisms in groundwater. When the residual concentration and time of antibiotics exceed the tolerance limit of microorganisms, they will inhibit the growth of microorganisms or even kill microorganisms, significantly affect the number and types of microorganisms, make the microbial community resistant, disrupt the balance of the ecosystem, and interfere with element circulation.The impact of antibiotics on the ecosystem is mainly reflected indirectly through the relationship between microbial individuals, populations, and ecosystem functions, including the number, activity, community structure, and toxicity effects of microorganisms . Chen etThe cycle of elements in the water ecosystem usually requires the participation of microorganisms. For example, the processes of biological nitrogen fixation, ammoniation, nitrification, denitrification, anaerobic ammonium oxidation, and nitrate dissimilatory reduction to ammonia involved in the cycle of N in water are inseparable from the action of microorganisms. Both the phosphorus cycle and carbon cycle in water are driven by microorganisms. Since antibiotics have the effect of killing or inhibiting microorganisms, antibiotic residues in the water environment will inevitably affect the circulation of elements. Many studies have confirmed that antibiotics in the water environment can interfere with nitrogen cycling  and affeZhang et al.  calculatThe abuse of antibiotics not only pollutes the environment, but also poses a potential threat to human health and the ecology. To alleviate and control the problem of antibiotic pollution, the most important thing is to control the source discharge of antibiotics, and the control and management of antibiotic pollution should also be conducted from the perspective of sewage treatment and groundwater restoration.As a prominent country in livestock farming and agriculture, China faces greater challenges than other countries in terms of antibiotic pollution. Actions have been taken so far in China, which have regulated the use of antibiotics in animal feed since 1989 . RegulatMore than half of the antibiotics that have not been fully utilized enter sewage treatment plants in China. Due to the lack of effective treatment technology, some antibiotics will enter the environment. In order to reduce the pollution of antibiotics in the environment, a variety of economically feasible antibiotic wastewater treatment technologies have been developed . The actAlthough measures have been taken at the source discharge of antibiotics and treatment of wastewater containing antibiotics, antibiotics still enter groundwater with improperly discharged sewage, so groundwater contaminated by antibiotics should also be treated. At present, the common remediation technologies for treating pollution in groundwater are divided into ex situ remediation technologies and in situ remediation technologies, according to different technical means . EctopicThis paper reviews the occurrence characteristics of antibiotics in the groundwater systems of major provinces and cities in China in the past decade. The results show that a total of 47 antibiotics in four categories have been detected, and SAs and FQs have the most types and the highest cumulative concentrations.The problem of antibiotic residues has become a global public health problem. As a major producer and user of antibiotics, China\u2019s antibiotic contamination problem cannot be underestimated. However, at present, there are few reports on antibiotics in groundwater in China, and research on the pollution status and prevention methods of antibiotics is even rarer. Therefore, the research and prevention of antibiotic pollution in groundwater can be carried out from the following aspects. Researchers can develop the most suitable method for the effective, rapid, and low-cost detection of antibiotics to establish a database of antibiotic contamination in groundwater in China, and reveal the migration and transformation rules of antibiotics, which can provide data support for the research and prevention of antibiotic pollution in groundwater in China. Based on the survey results, the government can formulate standards for the content of antibiotics in various media in China, and improve corresponding laws and regulations to manage and strictly control the use of antibiotics. In addition, the contamination of antibiotics in groundwater can be controlled from another important aspect: developing new and effective methods for treating antibiotic-contaminated wastewater."}
{"text": "Depression is a leading cause of disability, affecting approximately 300 million people globally . In the Similarly, notions of depression and depression care, including gender and contextual norms, vary across cultures ,9. HegemAdditionally, the full impact of the COVID-19 pandemic, including the loss of loved ones, family conflict, job loss, and isolation due to transmission mitigation efforts in addition to overall uncertainty on depression has yet to be determined . NonetheNotwithstanding the unknown impact of the pandemic on the prevalence and incidence of depression, there is a lack of up-to-date data on mental health. In the United States, the most recent national data on behavioral health prevalence were collected in the early 2000s via the Collaborative Psychiatric Epidemiologic Surveys (CPES) ,13. In tInternational Journal of Environmental Research and Public Health (IJERPH) entitled \u201cPerceptions of Depression and Depression Care\u201d includes papers from scholars who are grappling with these questions in different contexts and across different cultures. Taken together, it is critical to improve our understanding of depression and how to improve the provision of depression care. Furthermore, it is imperative to account for the effects of cultures and contexts on how depression as a condition is framed and how depression care is received. These are major challenges that span the globe. The papers in this issue of the"}
{"text": "The World Health Organization (WHO) acknowledges the importance of preschool children taking part in comprehensive physical activities supporting, among other things, their motor development, and competencies. A growing number of children attend early childhood education and care (ECEC), and expectations that this will support the development and learning of the youngest children are high. ECEC are governed by different policies embodied in both laws and curricula, and the framework of a curriculum plays a key role in ensuring the quality of ECEC services. The documents represent the content society wants the ECEC institutions to disseminate, and set out the values, objectives, and content of the work of pre-school teachers and serve as a point of reference for ECEC teachers and schools. The purpose of this study was to examine the values of movement and physical activity (MoPA) using government policy documents ECEC from Denmark, Finland, Iceland, Norway, and Sweden.This descriptive, comparative study was designed based on curriculum theory and used word count and content analyses to examine values of MoPA and to identify similarities and differences in the ECEC policies of Nordic countries.Seven terms were identified as MoPA related; body, motor, move, physical activity, physical education, coordination, idrott/liikunta. These terms occurred in various content contexts: development, environment, expression, health and well-being, learning and play, albeit sparsely and were referred to as both a goal in itself and as a mean of achieving other goals . Formulations dedicated to MoPA as a goal were present in the Danish and Finnish curricula and, to some extent, also in the Norwegian, while the Icelandic and Swedish curricula mentioned MoPA only as a mean.Findings indicated that MoPA, which are important for children's development, health, and well-being, is a low-priority value, to varying degrees, in the ECEC policies enacted by the Nordic countries. Thus, the guidance provided to educators and stakeholders therein is inexplicit. The low priority of the MoPA domain in the ECEC policies might negatively affect the possibility for young children to be physically active in preschools."}
{"text": "Lennox-Gastaut syndrome (LGS) belongs to the group of severe childhood epileptic encephalopathies and represents 1 to 2% of all childhood epilepsies.It is characterized by the occurrence of generalized epileptic seizures, characterized by a particular pattern of the electroencephalogram; slowed mental development and personality disorders.This syndrome appears between the ages of 2 and 7 years, and its management remains difficult, as it is generally refractory to conventional treatment.The long-term prognosis of this syndrome is poor, marked by the presence of periods of regression of cognitive functions, the appearance of frontal or even psychotic signs and extrapyramidal and cerebellar signs.We will try trow a clinical case, to discuss the evolution of Lennox Gastaut syndrome towards schizophrenia, which remains an infrequent complication, and to determine what would be the adequate management of these patients?We report the case of a 16-year-old patient,followed for Lennox Gastaut syndrome since the age of 03, who presented to the psychiatric emergency room for psychomotor agitation, geophagia and altered general condition. The admission interview showed a patient with motor instability, disorganized speech, delusional persecution syndrome, auditory and intrapsychic hallucinations, suicidal ideations in the context of mental automatism, impaired judgment and insight, and insomnia.The blood tests and the brain CT scan came back without any particularities.The patient was put on Risperidone, Valproate sodium, Lamotrigine and Clobazam, with good clinical evolution.The cognitive consequences are catastrophic, 85 to 92% of the patients have a progressive cognitive deterioration, in spite of the reduction of the frequency of the seizures and the improvement of the paroxysmal EEG anomalies.No significant relationships."}
{"text": "The study of human settlement environment, especially the complete study of human settlement environment in mountainous region, is a huge systematic project, which involves almost all aspects of human knowledge system at the semantic level. It is an important task to establish a systematic cognitive model of human settlement environment and carry out practical verification. In recent years, due to the rise of tourism real estate, mountain tourism real estate, as a type of tourism real estate, has attracted people's attention, and its hidden economic, social, and ecological benefits make it develop rapidly. The purpose of this study is to improve the theoretical system of tourism real estate landscape planning and mountain landscape resource protection system with 3D image technology, which has important theoretical and practical significance for exploring the sustainable development method of mountain tourism real estate landscape. This study locates the research type of mountain tourism real estate, and it is the first time to study mountain tourism, explores the specific planning of mountain tourism real estate development measures, and preliminary establish the theoretical system of mountain tourism real estate development. It brings a new idea for the development of mountain tourism real estate and puts forward the direction and method of planning. With the development of the economy and the improvement of people's living standards , many buyers are simultaneously turning to the tourism industry, which has rapidly spread from large- and medium-sized cities to small-sized cities. Therefore, vacation has become the main form of tourism in a short time . In orde Mountainous area is a terrain with uneven surface distribution and elevation difference reaching a certain threshold. However, from the perspective of human social attributes, mountain characteristics are actually an important cause of spatial differentiation . 6, 7]., 7.6, 7]With the continuous development of tourism real estate, how to carry out the construction of landscape environment of tourism real estate, to achieve the harmonious balance and sustainable development of economy and social culture by landscape ecology, is a problem that we are facing at present and need to solve. Tourism real estate development is a collection of landscape environment and the combination of tourism real estate planning cross domain . For nowWith the development of tourism real estate, the infrastructure of tourism resort is constantly built and improved, and a large number of construction are poured into coastal, lake, mountain, and other landscape tourism areas, resulting in the destruction of many original landscape environment. At the same time, due to the over-development of tourism real estate in the local area, the local traditional social culture gradually declined or even disappeared. Therefore, to maintain continuation and development of landscape culture resources, we must first consider the future development of tourism real estate is the problem; only through reasonable and sustainable development of protection principles can we make our eternal vitality and unique tourism real estate landscape. In the 1990 s, China began to tourism real estate in 1992. The State Council approved the construction of 12 state-level tourist resorts, and so far, various types of tourist real estate have developed rapidly across the country. However, compared with developed countries such as Europe and the United States , tourism real estate in China started late; the related theoretical system is relatively backward; in order to establish perfect theory system, we must combine landscape science, environmental, ecology, and other related theory, to explore suitable for China's national conditions of tourism real estate development real principles and methods, so as to promote the perfection of the theory on tourism real estate development in China . The development of tourism real estate will certainly promote the development of local economy, which is of course beyond doubt. However, we also want to scientifically use of reasonable planning and improve the utilization rate of resources, to maximize the local resource advantage to tourism as today's popular industry, not only brought the rapid development of economy but also benefits the local people, and a more solid foundation has been laid for the construction of socialist avenue , 18.New theories promote the development and evolution of new technologies, and new technologies often, in turn, promote the development and innovation of theories. The main technology platform of this study is based on 3D image processing technology, which is a beneficial attempt to innovate the discipline methodology of architectural planning. This study tries to find a new scientific research model of human settlement environment and supports the scientific and expansibility of human settlement environment with new methods and solid scientific logic. As far as the current situation is concerned, 3D image technology has been applied in the field of urban planning, but this kind of research lacks an integrated, systematic, and theoretical research perspective, especially the research on the cultural tourism of famous ethnic groups in mountain areas, which makes it possible for this research to achieve some original results. The research significance of this study is summarized as follows:Tourist real estate in the south of France and Naples, Italy, had its earliest forms before the nineteenth century. In 1839, Lord Brougham, the British Prime Minister, built his own villa on the Bay in southern France and praised it, thus arousing the great interest of most British people in the bay. In 1858, the French poet, Conneau, sent a letter to the wife of Napoleon III and once again made the southern coast of France a holiday hot. Due to the establishment of villas and hotels and various entertainment facilities, the most famous leisure and health resorts are made here in Europe, thus attracting many nobles to gather here. After World War I 1918), before the advent of the Great Depression, the traditional Puritan morality collapsed and the hedonism of the jazz age became popular. The value of this land on the south coast of France was once again favored by Americans, and American jazz culture replaced the original aristocratic coastal vacation culture [18, beforIn the early 1980s, the concept of timeshare vacation exchange began to spread all over the world, mainly developed capitalist countries in Europe. During this period, a large number of investors and developers in this area, due to the increasing product, make product business model more clear, relevant law also constantly improves and forms a complete set of services, and management industry and exchange industry also developed rapidly mature; according to relevant data, in 1999, the global timeshare property sales was as high as 6.72 billion dollars, and the United States accounted for 55%, among which the sale of rooms accounted for 50.4%. The world's largest resort, Condominium International (RCI), is an American company founded in 1974. Headquartered in Indiana, USA, the company is the first in the world to introduce the concept of timeshare exchange. As one of the global vacation rental market leader, RCI has more than 3 million members worldwide and covers 73,000 resorts worldwide , 21. In China's tourism real estate started late, starting with timesharing resort hotels in Hainan in the 1990s. With the development of China's reform and opening up, Hainan has its unique tropical never winter island, beautiful scenery, pleasant climate, and fresh air, which attracts a large number of real estate developers and presents the real estate demand in Hainan. During this period, Hainan's tourism real estate accounted for 40% of the national market share. Hainan's real estate development mode integrating leisure, and vacation tourism is overturning the traditional real estate development mode. Hainan has always been regarded as a paradise for tourism and vacation. Tourism real estate started earlier . However Parallel: the first is environment science and the information mapping theory of parallel; so far, the living environment of scientific research achievements of theory and practice has widely appeared, geological information of map-related research also gradually prospers . Object discretization: at present, the outstanding problem of human settlements environment-related research is object discretization, and there is lack of effective integration. The research methods are flat and descriptive, and there is no effective methodology and technical model for the study of human environment system. The object discretization is mainly manifested by the fuzzy definition of the object of human environment system or the semantic repetition and logical crossover in the definition of research objects. Mountain plains: the main problem is the lack of summary of the characteristics and rules of living environment; just the plain human settlement environment model and the design method to are used to study mountain problems . The griOn the contrary, while the theory and practice of human settlement environment science are flourishing, as a cross-sectional methodology, the related theory and empirical research of 3D image technology is also flourishing in the geoscience, although the research of 3D image mountain tourism is also in a stage of exploration and research. It can be noted that, so far, the relevant research on mountain tourism is mainly focused on the natural field . From the perspective of semantic model, the object and category of mountain cultural tourism research are quite different from that of human settlement environment research, which can only be used for reference in methodology . TherefoImprove the theoretical system of tourism real estate landscape planning and mountain landscape resource protection system with 3D image technologyThis work has important theoretical and practical significance for exploring the sustainable development method of mountain tourism real estate landscapeThe contribution of this study is as follows:The research is a typical cross-cutting research, which has the following key issues to be solved at the theoretical and technical level: (1) semantic  composition and logical relationship sorting (object) of (mountain) human settlement environment system; (2) the constitution and internal contradiction of human settlement system (structure); (3) identification and expression model of human settlement environment system (mountain) (technology); (4) index system and numerical modeling (method) of (mountain) human settlement environment; (5) (mountain) regional verification of spatial information Atlas of mountain human settlement environment (test); (6) law condensing and model innovation (summary). To analyze and express the living environment through the spectrum of spatial information graph of the living environment, its key logical order is as follows: clear the research object, analyze the object structure, establish the expression model, establish the analysis model, establish the empirical model, and propose the planning model.Among the six key links, the most important problem is the living environment of semantic model because when the former human settlement environment still stays on the concept description, it is an open system; combined with the related discipline, each holds one word and is not easy to use unified agreed to the key words to describe key logic structure of living environment. As a result, the solutions to these key problems are largely subjective. In the practical process, it is necessary to combine theory with practice, in order to carry out comprehensive research and analysis on the basis of the existing theoretical and practical achievements. At the technical level, the study takes 3D image technology as the platform, comprehensively integrates various research methods, and forms a research framework of mountain culture tourism.Convolutional neural network is one of the important branches of deep learning. The super-resolution technology based on convolutional neural network mainly relies on the rich operations of neural network such as convolution, deconvolution, pooling, and activation. Convolutional layer is the basis of neural network. Through the convolutional kernel , input signals can be extracted from different levels, depths, and even different frequency bands of information. The convolutional kernel is similar to various operator templates in traditional algorithms, such as gradient operator and smoothing operator. However, traditional template operator values are fixed, and specific features can only be extracted according to specific settings. Different from this, convolutional templates in neural networks only need to be initialized and then automatically updated through the iterative optimization of the network. At present, the convolutional kernels are divided into 2D convolution and 3D convolution, and their sizes are generally odd.\u03b3 and offset parameter are also introduced. This can not only make the output data of the upper layer conform to normal distribution but also keep the characteristic structure of the output of the upper layer unchanged. The following is the derivation of the specific formula:In the network design architecture, in addition to the linear or nonlinear processing of data, there are many specialized normalized layer operations that are helpful for network training convergence. For example, the layer normalizes data in channel direction, and the group norm divides channels. The most effective method is Batch Norm (BN), which refers to subtracting the mean and dividing by the variance in the ordinary sense, while BN is to normalize the data of eachbatch. In addition to subtracting the mean and dividing the variance, scale transformation parameter The above super-resolution method is to build some basic layers through the network, based on these basic operational layers. At present, convolutional neural networks, used to achieve image super-resolution, can be roughly divided into series and parallel networks, residual network, pyramid network, recursive network, dense connection network, and generative adversarial network and the combination between them. The structure of series and parallel networks is relatively simple and the input of low resolution rate graph. For example, the serial convolutional structure of the network should not be too deep through the direct output of stacked convolutional layers. It is an efficient structure and has significant advantages over other structures, whether used for classification tasks such as recognition or regression tasks such as super-resolution reconstruction. The selection of network training optimizer mainly includes batch gradient descent (BGD), stochastic gradient descent (SGD), minibatch gradient descent (MBGD), and momentum optimization algorithm. The momentum learning method weighs the importance of the previous gradient and the current gradient on the basis of SGD, and the formula is expressed asThe RMSprop optimizer can adaptively adjust the learning rate by using the gradient accumulation of previous training, and its updating formula isAdam optimizer combines a compromise version of momentum optimization and RMSprop optimization, which is the most stable among all optimizers at present. Its optimization strategy can be summarized asBased on equations \u201312), Fi, Fi12), This study mainly adopts the method of corpus research and combines quantitative statistics with qualitative analysis. First of all, we collected news texts from People's Daily for consecutive months and established a large database. Then, according to the research purposes of different chapters, we extracted samples from the main corpus and built a secondary corpus. For some chapters, we also classified and collected them according to the needs. Then, we sorted all the subcorpora in each chapter of the newspaper into text documents to establish a pair of subcorpora.There are many kinds of tourism resources, including viewing and recreation resources, ecological environment resources tourism services, facilities and service level, hotel catering, leisure entertainment, etc. All kinds of tourism resources are leisure tourism areas developed by vacationers or tourists and are the material basics for entertainment, sports, fitness, and other activities. The type, quality, and scale of tourism resources directly determine the attraction and development potential of the resort. Through the transformation of buildings, vegetation, and water bodies in Shinan Water culture tourism zone, the efficiency of water-bearing forest is improved. The dust-holding capacity of rivers is conducive to the degradation and dilution of concentration of some pollution sources and the improvement of water ecosystem function and water environment quality. The comparison before and after the transformation is shown in The size of the derived agents  of the corresponding human settlements also increases. In a long period of history, the suitability state of mountain tourism area is approximately unchanged, that is, during this period, the adaptability of human settlement environment is mainly passive adaptation. If the object of human settlement is simplified as topographic and geomorphic environment, the suitability of the object of human settlement can be approximately regarded as a fixed value. With the development of human society, especially after the arrival of industrialization process , the characteristics of the subject and object of human settlement environment have undergone tremendous changes. The focus on hotspot distribution before (right) and after (left) mountain water resource rehabilitation design project is given in From In addition, from Due to the unique tourism resources and huge development potential of tourist resorts, it is of great significance to study and explore the development of famous cultural tourism in mountain areas for a hundred years. On the basis of not damaging local landscape resources, this study designed a conceptual effect map, as shown in Mountain landscape attraction is mainly manifested in the following three aspects, Firstly, the mountain landscape environment is different from Binhai lakeside hot spring tourism real estate of another type, such as relying on the unique mountain natural ecological environment to attract tourists. Secondly, mountain villa holidays, especially in scorching summer, became the most suitable resort mountain. Thirdly, culture and entertainment are the soul of mountain tourism real estate. In order to make the development of mountain tourism real estate obtain lasting attraction, there must be a certain cultural environment, such as folk customs, temples, and historical sites. Entertainment mainly refers to the supporting facilities of tourism sites, such as commercial streets, hotels, and ski mountain bike races, which make tourism real estate sufficiently attractive and serve tourists better and drive the development of local economy. Exhibition of water culture tourist destination before (b) and after (a) reconstruction is given in Through consulting a large number of books and literature, in the comprehensive use of landscape ecology, tourism, geography, biology, and other multidisciplinary theoretical knowledge, based on the research of 3D image technology, the study explores the related technologies and theories of combining mountain water cultural tourism real estate development with landscape planning and design and makes relevant explorations and studies on the problems existing in related concepts, content, technology, environmental conditions, and other aspects of planning. The research of this study will expand the research scope of mountain culture tourism and has great theoretical value and potential application prospect."}
{"text": "To analyze the contributions of the Brazilian Nursing Association and the Federal and Regional Nursing Councils in the literature for the professionalization of nursing in the light of Eliot Freidson\u2019s theoretical conceptions.Integrative review of the literature, of socio-professional historical interest, carried out from June to November 2021, through the question: How did professional associations contribute to the professionalization of Brazilian nursing according to the literature from 2010 to 2020? The evidence were organized in a synoptic table, which allowed the construction of a conceptual map.In the 23 selected studies, the professional associations presented scientific, social and political contributions, which shape the professional field of nursing, enabling knowledge/expertise, autonomy and self-regulation.The efforts of these institutions reaffirm nursing as an academic and consulting profession, capable of exerting control over the essence of nursing work. They strive to consolidate nursing as a legitimate professional field of health in Brazil. The central idea of the sociologist\u2019s proposal is that the most productive method for analyzing professions is based on focusing on the way in which they achieve or lose control over the terms, conditions and content of the work.In the scope of the sociology of professions, the American theorist Eliot Freidson states that a profession is distinguished from an occupation by the control it exerts over work.Furthermore, Freidson characterizes a profession by three aspects: knowledge/expertise, self-regulation and autonomy. Professions share a specialized body of knowledge and qualifications which have jurisdiction, whose credentialing occurs through institutionalization in schools and universities, and occupational control of practice in the labor market, by requiring credentials to perform licensed and state-backed actions. It is through autonomy that the profession controls what is its own. When considering these aspects, it is noted that class institutions become bases for profession, discipline and work. They also support professionalism, a set of characteristics specific to professionals; and professionalization, characterized by interdependent elements, specialized work based on specific knowledge and ethics, when applying and performing professionally.Credentialism is consolidated in the specific knowledge/expertise of the profession, indispensable to legitimize the achievement of autonomy.Class institutions act effectively in favor of the category and society when they defend a political project of training and qualification that meets the interests of professionals in this class and social demands. They promote the dissemination of knowledge about and for the profession, representing these professionals in the different fields of activity in which they are inserted-7.In Brazil, the vanguard of the organization of nursing and the representation of the categories took place in 1926, with the graduation of the pioneer group of the Anna Nery School of Nursing. Created on August 12 of that year, the National Association of Graduate Nurses (NAGN), currently the Brazilian Nursing Association (ABEn), promoted the improvement of professionals and training programs, with a commitment to growing and consolidating scientific development, social and political aspects of nursing, and its history is permeated by the articulation with other organizations, based on ethical principles and on the attributions that were incumbent upon them. Thus, the creation of the Federal (Cofen) and Regional Nursing Councils (Coren) has an intrinsic relationship with the history of ABEn. Many efforts were made to implement the creation of the body that would supervise the practice of nursing professionals. The first efforts took place in the period from 1943 to 1947, but only on July 12, 1973, law 5905 was enacted, which provided for the creation of the Cofen/Coren System, an autarchy linked to the Ministry of Labor and Social Security, which has the Disciplinary function of the professional practice of nursing-9.ABEn started other nursing organizations and boosted their development in Brazil-11. Among other Cofen actions, we mention the approval, through Cofen resolution 564/2017, of the new Code of Ethics for Nursing Professionals. In this process, the Cofen Code of Nursing Deontology, from 1976, and the Code of Ethics of Nursing Professionals, from 1993, reformulated in 2000 and 2007 were considered.After Cofen and Coren were installed, the discussions on the new Professional Practice Law project, which would replace Law 2604/1955, stood out. Thus, law 7498/1986 was approved, regulated by decree 94406/1987In this context, the design of the contributions of class institutions to the professionalization of Brazilian nursing makes it possible to understand their influence and relevance to the conformation of nursing as a profession and field of scientific knowledge in health. It also reinforces, through historical facts, the importance of associative life for the construction and strengthening of professional identity.To analyze the contributions of the Brazilian Nursing Association and the Federal and Regional Nursing Councils in the literature for the professionalization of nursing in the light of Eliot Freidson\u2019s theoretical conceptions. The bibliographic survey, data collection and analysis took place from June 4 to November 29, 2021. The study adopted the recommendations of The PRISMA 2020 Statement: an Updated Guideline for Reporting Systematic Reviews (PRISMA).Integrative literature review, of socio-professional historical interest for nursing, carried out through the following steps: formulation of the problem and the research question; literature search and application of eligibility criteria for the study; selection of articles; reading and extracting relevant data; analysis and interpretation of data; organization of data into categories and presentation of the synthesis of the knowledge produced: strategy: class institutions constituted the problem (P); contributions to professionalization, the phenomenon of interest (I); and nursing, the context (Co). Thus, the guiding question was elaborated: How did class institutions contribute to the professionalization of Brazilian nursing according to the literature from 2010 to 2020? This strategy enabled the identification of controlled and uncontrolled descriptors, which were selected by consulting the terms in the Descriptors in Health Sciences (DeCS), Medical Subject Headings (MeSH) and List of Headings of the Cinahl Information Systems.To select the studies, the research question was formulated based on the PICoThe bibliographic search was carried out by consulting the electronic databases Cumulative Index to Nursing and Allied Health Literature (Cinahl), Digital Nursing Library (BDENF), Latin American and Caribbean Literature in Health Sciences (Lilacs), Medical Literature Analysis and Retrieval System online (MEDLINE\u00ae via PubMed\u00ae) and Web of Science. The Boolean operators \u201cOR\u201d and \u201cAND\u201d were used to combine the search terms and intensify the reach of the number of articles that answered the research question, which generated the search strategies  for each. Dissertations and theses, case studies, biographies and experience reports were excluded. Also, the articles captured in duplicate were considered only once, keeping them in the specific bases for nursing, followed by the multidisciplinary ones.Original studies were included, published in English, Portuguese or Spanish, from January 2010 to December 2020. 2010 was established as the initial year due to the creation of the Scientific Department of Nursing History (DHE) by National ABEn. The DHE is linked to the Center for Studies and Research in Nursing (CEPEn), which has the function of encouraging the development and dissemination of historical research in nursing. The year 2020 was adopted as the final cut, as it has historically impacted society and the profession, professionalism and professionalization of nursing, considering the 2019 coronavirus disease (Covid-19) pandemic. In addition, the World Health Organization (WHO) established this year as the International Year of Nursing and Midwifery, for screening, eligibility and inclusion of studies. The Rayyan QCRI allows the evaluation of studies with the blinding of the auxiliary reviewer, which favors reliability in the selection of information and methodological precision. In the eligibility stage, there was disagreement in 16 studies, which were sent to a third reviewer to issue an opinion on the inclusion or exclusion of the article.It should be noted that two independent reviewers performed the identification, screening, eligibility and inclusion steps. The EndNote reference manager was used to set up the database, identify and eliminate duplicates. Then, the resulting database was exported to the Rayyan Qatar Computing Research Institute (Rayyan QCRI) instrument was used to extract and record the pertinent information. The evidence of the selected articles was presented in a synoptic table, which enabled the construction of a conceptual map, in order to favor the understanding and discussion of the contributions of class institutions in the professional conformation of nursing. The conceptual map was developed by the American Joseph D. Novak, in the 1970s, and is characterized by the hierarchical or schematic structuring of concepts immersed in a network of propositions, which favors the construction of knowledge. It can be considered as a visual representation to share meanings.The form adapted from the Occupational Health Nursing Network (RedENSO)For that, we used the free concept mapping software Cmap Tools 6.03 for Windows, due to the ease of handling and construction of interactive diagrams, whose completion occurred with the use of PowerPoint. The conceptual map construct was based on the concepts of knowledge, autonomy and self-regulation, aspects of a profession by Eliot Freidson, placed at the center of the map and highlighted in bold. The dashed box highlights the ABEn entity with contributions to the development of expertise.Given the methodology used, which was restricted to the use of published data, there was no need for submission to the Research Ethics Committee. The ethical and legal aspects, with regard to authorship, were preserved, and the study did not involve participating subjects at any time.-42, presented in the synoptic table ,32-33,35 and the Revista Brasileira de Enfermagem (REBEn),28-31,41 stand out, with about 30% and 26% of production, respectively. All studies used a qualitative approach, of which 78.2% have a historical-social focus.The available evidence on class institutions resulted from the final sample of 23 articlesic table . Of thes. Publications were classified in Level of Evidence VI, resulting from a descriptive or qualitative study.Each article was evaluated to identify the Level of Evidence (LE), according to the concepts of Melnyk and Fineout-Overholt, classified into six levels: I for systematic review, meta-analysis or studies from guidelines based on randomized controlled clinical trials; II for at least one randomized controlled clinical trial; III for controlled studies without randomization; IV for case-control or cohort studies, as long as they are well designed; V for systematic review of qualitative and descriptive studies; VI for a single qualitative or descriptive study; VII for the opinion of authorities and/or expert committee reports-33, and the Cofen/Coren in 30%-40; 9% of the articles dealt with these nursing institutions-42.The ABEn entity was present exclusively in 61% of the studiesThese evidence were schematized in a conceptual map , in orde, considering the criteria that distinguish a profession from an occupation, namely: own knowledge and skills, autonomy and self-regulation and especially reliable members,3. In this context, it is clear that the publications from 2010 to 2020 reinforce the contributions of ABEn and the Cofen/Coren system in professional conformation. The grouping of scientific capital, as proposed by the DHE, promotes and preserves the history of nursing in different contexts, contributing to the dissemination of knowledge that permeates the historical process of the profession and its professionalization.Class institutions aim and mobilize the strengthening of nursing-30,31,42.The construction of nursing as a science and a profession result from the constitution of its own field of knowledge and a scientific framework to support and sustain professional practice. This constitution is permeated by the trajectory of different subjects in different contexts, whose appreciation of history, encouraged by the DHE, contributes to the construction of professional identity. Historically, ABEn is the principle behind the design and production of this knowledge for nursing, with initiatives that involve issues related to nursing education and training, scientific research and its propagation among professionals,29,42. These facts show efforts to establish and dominate ownership over a specific field of knowledge, the acquisition of which needs to be taught and perfected, through the structuring of a curriculum that includes the know-how of the profession.Concerning nursing education and training, in the 1940s, ABEn created the project that subsidized law 775/1949 and institutionalized nursing education in Brazil. At the end of the 1960s, she discussed the implications of the University Reform for the training of nurses,32, ABEn, in the 1946 Statute, created state and regional sections,25,30,33. The initiative to form these sections reinforces not only the maintenance of the Brazilian nursing unit, but also the expansion and mastery of decision-making spaces in nursing education and training, being present in the most diverse Brazilian regions. Maintaining the nursing unit was important for its strengthening, since ABEn was the only existing entity with the power to represent Brazilian nursing until the creation of Cofen.In the context of expanding nursing schools in Brazil and in the proposal to form another affiliated association (in the 1940s). In the midst of this process, ABEn held the National Seminars on Guidelines for Nursing Education (SENADEns),29,31, which discussed and encouraged the elaboration and approval of the National Curriculum Guidelines, approved at the turn of the 21st century, in 2001. From then on, ABEn turned to its own implementation and consolidation.Still in the field of education, the 1990s registered two important historical moments for nursing with the involvement of ABEn: the participation of the Education Boards, providing subsidies to the Federal Council of Education, for the approval of the new minimum nursing curriculum, in 1994. In the context of the educational reform that defines the approval of the most important Brazilian law, with regard to education, the Law of Directives and Bases of National Education (LDB), in 1996, in which ABEn undertook strategic efforts in struggles related to to political-expansionist, political-legal and political-organizational guidelines.The process of professionalization of an occupation mainly involves the political processes which occupations obtain the State to grant them the exclusive right to perform certain tasks, to recruit and educate members, to delimit the field of action in relation to other occupations and to define in which the work will consist. The State plays a decisive role in the success of a profession, formally granting it the right to monopolize professional practice in the labor market, inhibiting unfair competition and imposing boundaries of competenceABEn, working together with the Ministry of Education and the Federal Council of Education in the context of the Brazilian educational reform, plays a leading role in directing and reinforcing the formation of expertise necessary for the performance of nursing. Once directed to the production of knowledge and the domain of qualification, there is control of work and ownership of a body of formal knowledge learned in higher education institutions, in other words: the knowledge and qualification necessary for the exercise of the work for the profession.. In this regard, the dissemination of knowledge produced through the publication of the Revista Brasileira de Enfermagem (REBEn),29-30,42, created in 1932 under the name Annaes de Enfermagem, stands out. It is configured as a space for the formation of the scientific community, as well as for the structuring of the scientific field. Therefore, it reveals the scientific thinking of Brazilian nursing and ABEn\u2019s associative life policy. REBEn is the materialization of the desire to solidify nursing science knowledge for the collective.Other efforts by ABEn to appropriate the knowledge necessary for nursing and the improvement of this knowledge are recognized, such as the movements for the development of research,29,42, which permeates the organization of spaces for discussion and scientific dissemination of nursing in the national and international scenario-29,31,42 and immortalizes memories, through the preservation of the material and symbolic heritage of nursing. This is the Brazilian Nursing Memory Center, a place where a dense mass of documents accumulated over time is kept, which reveals the preservation of the memory of those who make the association. The exchange of scientific knowledge and nursing practices is also provided by the agenda of the Brazilian Nursing Week, a heritage of ABEn,29,42.The development of scientific activities is also noteworthy as shown in the conceptual map. It begins with the production itself of the first research on the numerical and qualitative situation of Brazilian nursing. This is the case of the specific themes discussed at the Brazilian Nursing Congresses (CBEn). Among these, psychiatric nursing is mentioned, which addresses aspects of the field of practice, professional qualification, as well as conceptual bases for the teaching of psychiatric Nursing.Professional knowledge establishes the authority to have control over one\u2019s work, as described by the sociologist Freidson: \u201cauthority of imputed expertise\u201d, that is, professionalization requires the establishment of an authority of expertise, a professional knowledge that is so complex and incomprehensible by lay people, which lends relevance to the work, as well as the recognition of the superiority of knowledge and competence, guaranteeing technical autonomyIt is observed that ABEn contributes to the scientific knowledge of nursing, in order to favor the development of competences for the profession. Thus, it makes it possible to ensure that, in addition to increasing expertise, these professionals have autonomy in their professional practice.. It is understood that nursing is a characteristically autonomous profession, capable of independently exercising its own work in different scenarios. Its object of care is related to human responses and processes of adaptation to situations of health problems, not just compliance with the prescriptions of other professionals who make up the multidisciplinary team.Thus, nursing autonomy is legitimized by the implementation of theories, as well as care based on the systematization of nursing care. Professional autonomy is not obtained by the profession, but results from a political and social process of legal concession, which is conferred on the profession by society. From this perspective, in many of the immense care voids in the Brazilian territory, nursing is present in society. It autonomously performs the care, aiming at the promotion, protection and recovery of the population\u2019s health. The growth of entrepreneurship in nursing and the increase in nursing offices are also emphasized, which reaffirms the autonomy of this profession. Therefore, it cannot be detached from social transformations to reinforce its autonomy and necessity.It is up to nurses to achieve this autonomy, supported by their own knowledge and recognition of the positive value of the profession for societySistema \u00danico de Sa\u00fade (SUS), of quality health care for citizens, of laws and public social and health policies, of the consolidation of nursing as a social practice. It is present in municipal and state councils and health conferences,26.In this context, ABEn engages in the most different movements of society. It participates in the fight in defense of the Unified Health System - . It is believed that the articulation of ABEn with other institutions in the world of nursing makes the mission for Brazilian nursing even more expressive. The involvement, under the responsibility of the International Council of Nurses, in the creation of the International Classification of Nursing Practices (ICNP\u00ae) and the International Classification of Nursing Practices in Collective Health (CIPESC\u00ae), both instruments aimed at support the systematization of nursing care and, consequently, the autonomy of the profession.In addition to social movements, ABEn maintains national and international relations to represent Brazilian nursing. Thus, it participates in the International Council of Nurses (ICN), the Asociaci\u00f3n Latinoamericana de Escuelas y Facultades de Enfermer\u00eda (Aladefe) and the Federaci\u00f3n Panamericana de Profissionales de Enfermer\u00eda (Feppen) and 3780 of 1960, which include the nurse at the technical-scientific level. In addition, there are efforts to build a Nurse staff, hire a nursing professional to replace people without specific training, initiatives to prohibit the misuse of the nursing title and discussion of private actions for nurses. These facts show the concern to regulate and regulate the exercise of the profession by those who possess the necessary expertise.In order to have control over its own work, in addition to investing in knowledge and technical-scientific improvement, ABEn fights to obtain appreciation and regulation of the profession, which has already resulted in laws 2604 of 1955,29,42. Cofen/Corens were created, which granted legitimacy and autonomy to the exercise and specific practice of the profession, in addition to valuing assistance based on ethical and moral principles-40,42.ABEn actively participated in the formation of the legal provisions of the profession, with the creation of a body that self-regulated the practice of nursing and, consequently, protected members and society by guaranteeing the aptitude of those who performed it.Thus, contributions from Corens, such as Minas Gerais, where there was an effort to develop the Technical Chamber of Obstetrics (CTO), in 2007, aim to guarantee autonomy. The creation and mobilization of the CTO has a social and political impact on the valorization of obstetric nursing by bringing professional recognition of obstetric nurses, not only in the service in which they work, but also for the whole society. Thus, the councils help society to trust and feel secure with the work offered. Thus, they safeguard and protect the members and the population. In this context, the current movements of Cofen/Corens and ABEn are emphasized to ensure dignified conditions for professional practice, having as the agenda for discussions and actions the law of the minimum wage for nursing and the 30-hour working day. In addition, the movements seek to guarantee quality training and committed to the development of professional skills, by rejecting undergraduate nursing courses in the distance modality.Recognition comes from the autonomy necessary to achieve professional status. The reach and maintenance of this status depends on the protection of society, which is convinced of the special value of work. The institution of this inspection body was important for the nursing profession, as ABEn has a representative role, but does not have the legal rights to carry out professional registration.The protection granted to members and the population results from the profession\u2019s ability to carry out self-regulation, understood as control of the exercise of expertise carried out by professional associations that hold legal and formal authority granted by the State. In addition, it guarantees power over work, in addition to organizing, regulating and ensuring the quality of the practice of the profession, through professional registration,37-39,41, legislation,41 and inspection activities-40,42. These actions allow it to be practiced by those who have specialized, qualified knowledge and qualifications granted for the exercise, that is, the credential, defending it regarding the quality of care and ethical standards, which favors visibility and recognition-39.Therefore, through the Cofen/Corens system, nursing obtains control of a specific work domain, necessary to achieve autonomy-41. Thus, the existence of an institution that regulates the exercise is essential for the credentialism and self-affirmation of the profession.Cofen and Corens work in the development of this professional class at a local and regional levelThe achievements historically built by nursing class institutions become even more evident in the year 2020, considering the pandemic context of Covid-19. In the midst of the health crisis, nursing once again reaffirms its protagonism, professional practice through knowledge/expertise, self-regulation and autonomy. Professionalism is highlighted in the health scenario and clearly confirms the social need for nursing.In this review, the searches were carried out in databases directed to the area of health and nursing. However, the lack of research in databases in the area of history and cross-search may not have covered all articles on the subject.In addition, the study did not cover the analysis of historical facts implemented by all sections of ABEn, which could also represent a contribution to the conformation of specific or specific knowledge of nursing in a certain region, considering the plurality of the population and Brazilian regions.Class institutions must be strengthened by knowledge and recognition of the contribution to the credentialism of nursing as a profession. From this perspective, many achievements permeate ABEn and Cofen/Coren, and it is important to socialize them. The findings can serve as an incentive to carry out studies that individually address regional nursing sections. Thus, they will highlight, deepen the specificities and expand the knowledge and expertise of each region, so that the actions result in the valorization and professional recognition of autonomy, considering that Brazil is a continental country.Furthermore, making these contributions visible is a relevant agenda to awaken nursing professionals to the importance of associative life, to increase the status quo and understanding of nursing as a practice and social need. The institutions provide an opportunity to expand the debates about the monitoring of professionals in the transformations of the country\u2019s political and social processes, mainly in the guarantee of universal rights to health.The studies included in this review, supported by Fredsonian conceptions, revealed that the nursing institutions Brazilian Nursing Association and Federal and Regional Councils of Nursing contribute to the professionalization process, supported by their own knowledge and the demarcation of expertise, linked to institutionalization, autonomy and self-regulation.The Brazilian Nursing Association was categorical in the struggles and actions that configure the development of expertise through acting in nursing education/education, in the increment of research and in the dissemination of this knowledge through the various forms of socialization. The conformation of this expertise strengthens the delimitation of the areas of necessary competences and skills, differentiating them from other professions. Through the efforts of the Brazilian Nursing Association, the council was created. Thus, there is the emergence of a body that regulates and supervises the exercise of the profession and its self-regulation, supporting the credentials for professional autonomy.It is concluded that the continuous efforts undertaken by these class institutions reverberate in the year 2020 when nursing, in the international year by the World Health Organization, stands out in the leading role in facing the pandemic. It shows itself with technical, scientific, ethical, humanistic and professional competence, confirming its function as an academic and consulting profession, whose practice for the community is based on scientific knowledge produced by peers. Thus, nursing is reinforced as a qualified profession, capable of exercising control over its own work, autonomously. Thus, in different historical contexts, these institutions legitimize Nursing as a health profession in Brazil."}
{"text": "Based on the sixth round of the 2018 Chinese Household Income Project family income survey (CHIP) data, this study made use of the OLS estimation and transfer matrix method to measure and test the problem of obesity intergenerational transmission, analyze whether there is obesity intergenerational transmission as well as between urban and rural areas, gender, and the parental education level and income level on the suppression of the obesity intergenerational transmission effect. The empirical results draw the following main conclusions: obesity intergenerational transmission in Chinese families, the degree of parental obesity has a significant positive impact on the degree of offspring obesity; the higher the degree of parental obesity, the more it can promote the degree of obesity in the offspring. Moreover, the degree of obesity intergenerational transmission is heterogeneous in urban and rural areas and gender. At the same time, the degree of rural obesity intergenerational transmission is higher than that of urban areas, and the degree of male obesity intergenerational transmission is higher than that of women. With rapid economic development, people are pursuing high-quality living standards, from meeting material quantity to improving the quality of life. In this regard, the word \u201chealth\u201d has thus become one of the popular social words frequently appearing, and people have become deeply concerned about and discussed it in recent years. According to the World Health Organization\u2019s definition of health, health is a state of physical and mental perfection and good adaptability, and not just a state of the absence of disease and weakness. This is what people refer to as physical and mental health. That is to say, a person is completely healthy in his physical health, mental health, good social adaptation, and moral health, and he is a completely healthy person. Obesity is the focus of modern people, which has the potential harm to human physical health, mental health, social adaptation, and other aspects. Obesity refers to a certain degree of obvious overweight and fat layers being too thick, and is caused by high body fat, especially excessive triglyceride accumulation. Due to excessive food intake or changes in body metabolism, excessive body fat accumulation causes excessive weight growth and in human pathology, causes physiological changes that may also be latent for some time . The folBased on the global prevalence of obesity and the harm to human health, how to suppress the risk of obesity diseases is worth further study. Therefore, this paper analyzes the mechanism of inhibiting obesity intergenerational transmission from the two aspects of education and income and makes use of OLS to estimate the validity of education and income to inhibit obesity intergenerational transmission, which is of great significance for personal health promotion and China\u2019s health strategy, and also provides a certain basis for the precise health promotion policies in China.Galton  first proposed the concept of intergenerational transmission. After this concept was put forward, many scholars have conducted a lot of research on the existence of the intergenerational transmission of income, occupation, education flow, and health, and have achieved fruitful results. In recent years, many scholars have begun to pay attention to the intergenerational transmission of obesity. These studies found that both innate endowment and acquired environment play their own important roles in the intergenerational transmission of obesity. In terms of innate endowment, many scholars believe that parental obesity has a strong positive relationship with offspring obesity. For example, ref.  studied At the level of acquired environment, many scholars believe that the acquired environment, such as education, economic income, and living habits, plays an important influence in the intergenerational transmission of obesity. Some scholars believe education is considered the most important health-influencing factor . This isOn the other hand, the higher the health cognition level of fathers, the richer their health knowledge and the better their understanding of health publicity materials and medicinal instructions to improve the health production efficiency of themselves and their offspring . StudiesSome scholars can analyze the problem of obesity from the perspective of gender and urban and rural residents. Kong Guoshu and Qi Yaqiang  confirm According to the review and combing of the existing literature, it is known that from the research perspective, most existing studies use obesity as the basic measure of healthy intergenerational transmission, and the dynamics of intergenerational transmission of obesity itself are insufficient. In terms of research content, the existing studies mainly focus on the relationship and mechanism of obesity intergenerational transmission and innate inheritance, and few studies explore the extent and mechanism of acquired environmental factors to inhibit obesity intergenerational transmission. In view of this, this paper is based on the complexity of obesity congenital genetic and postpartum obesity innate genetic factors, which is not discussed, mainly from the perspective of the acquired environment, and explore two aspects of education and income to suppress the obesity intergenerational transmission mechanism, and use OLS to estimate education and income to suppress the validity of obesity intergenerational transmission.Education will play an increasingly important role in the Outline of the Healthy China 2030 Plan, the Opinions, and the Healthy China Initiative (2019\u20132030) . Higher The family ecosystem model believes that there are similar living habits and norms in the family system, with a homegroup effect among family members in the same ecosystem. The parental health behavior will bring a demonstration effect on the offspring . GeneratA healthy diet is an important means to restrain physical obesity. In the period of the extensive economic development mode, Chinese residents mainly need physical labor. They need a lot of energy to support the consumption of physical labor, but due to their low income, they can only choose affordable rice, flour, and other high-sugar and fatty foods. With the rapid development of China\u2019s economy and the transformation and upgrading of economic structure, the production form has changed from physical labor to mental labor, and physical energy consumption has been relatively reduced. The original diet structure of residents will lead to excess energy and substances in the body, and a large accumulation of fat cells, resulting in physical obesity . TherefoExercise not only promotes health and disease prevention but also is an important means of weight regulation . With ChThe data of this study were obtained from the sixth round of the China Household Income Project (CHIP) in 2018, which is regarded as the most comprehensive and rigorous public database on micro-incomes in China. The China family income survey is organized by the National Bureau of Statistics, the Institute of Economics of the Chinese Academy of Social Sciences, and other units. It aims to measure and estimate the income distribution of urban and rural residents in China and generates samples through secondary samples from a large sample of urban survey teams and agricultural survey teams of the National Bureau of Statistics. Six rounds of surveys have been conducted: 1988, 1995, 2002, 2007, 2013, and 2018. By 2018, the CHIP covered information on personal physical characteristics, self-rated health, education, work, and income of 160,000 residents in 31 provinces, which is very suitable for studying issues related to the intergenerational transmission of obesity. Considering that in the vast majority of families, fathers occupy a dominant position in family income and decision making, the relevant information of fathers was selected as the parental sample, and the children\u2019s data were selected to match, data were then combined, duplicate observations were processed for multi-child families, and samples such as missing and inapplicable key variables were eliminated, and finally the overall effective sample size was 3055 pairs.In this paper, the dependent variable was the obesity status of the offspring, with BMI and values as a measure. BMI (body mass index), or BMI index, also known as body mass index, is an important measure of obesity and standard weight. The criteria set by the World Health Organization (WHO) are divided into seven grades: thin (<18.5), normal (18.5~24.9), overweight (\u226525), obese (25.0~29.9), obese (30.0~34.9), severe obesity (35.0~39.9), and extremely severe obesity (\u226540.0). The independent variable is the obesity status of its parent. At the same time, the income level and education level of the parent generation were selected as the control variables.On the measure of the intergenerational transmission of obesity, this study draws the concept of intergenerational income elasticity (IGE) in economics and proposes intergenerational obesity elasticity. Intergenerational obesity elasticity is regarded as the main measure of obesity intergenerational transmission, mainly by examining the correlation between the degree of offspring obesity and the degree of paternal obesity, to determine how far the level of offspring obesity is determined by the level of paternal obesity. The higher the correlation between the offspring obesity levels and the paternal obesity levels means that the greater the extent the offspring obesity level is determined by the paternal obesity levels. This also means that the paternal obesity gap is transmitted with intergenerational obesity, affecting and even determining the obesity gap between offspring. Therefore, the use of intergenerational obesity elasticity can measure the degree of intergenerational obesity transmission in a relative sense.(1)Benchmark Model of Obesity in Intergenerational TransmissionCovIntergenerational Obesity Transfer MatrixjX and Y in ] are the obesity distributions of the parent and the offspring, respectively, and X- -Y indicates the obesity distribution to transition from X of the parent to Y of the offspring, and each element P in the matrixij. Parent represents the probability of offspring in the i-th group and offspring in the j-th group.The intergenerational obesity transfer matrix is able to describe the position of the offspring of different obese groups in their peers, intuitively describing the degree of the intergenerational transmission of obesity. Intergenerational obesity transfer matrix The intergenerational obesity transfer matrix was calculated as follows. First, the paternal population and offspring population samples were divided into five BMI index levels according to their obesity levels, marking the level of paternal obesity and offspring obesity in each family sample. Then, using the parent obesity as the benchmark, the calculation results of each obesity level were calculated in the matrix form to obtain the intergenerational obesity transfer matrix, The specific form is as follows:(3)Correlation model of obesity intergenerational transmission inhibition pathwayX is the control variable , Correlation models of obesity intergenerational paths look at identifying the role of different classes of intermediate variables in intergenerational transmission. It is mainly to place the corresponding intermediate variables in the simple regression to construct the conditional obesity elasticity, and to obtain the importance of the conditional obesity elasticity by examining the importance of the corresponding intermediate variables on the intergenerational transmission of obesity. The specific model is as follows:The ratio of changes in conditional intergenerational resilience relative to intergenerational resilience calculated by analyzing each proxy variable According to the statistical analysis of each variable, the lowest value of BMI in the offspring was 15.241, the highest value was 28.354, and the mean value was 20.514. The lowest parent BMI value was 15.242, the highest value was 28.345, and the mean value was 23.255. In terms of the level of parental education, the subjects differed greatly, with the highest years of education being 22 years, the lowest years being only 5 years, and an average years of education being 9.268 years. In terms of the economic income of the father generation, the differences between the main subjects were also relatively large. The highest annual income was 1 million yuan, the lowest annual income was 0, and the average annual income was 43.929. Household type and gender were binary variables, assigned 1 for city and 0 for rural areas; 1 for men and 0 for women. See also those listed in  for detaAccording to the BMI index standard formulated by the World Health Organization (WHO), this study selected four grades of thin, normal, overweight, and obesity to provide evidence of analysis for the intergenerational transmission of obesity in China. As shown in p = 0.000, indicate that offspring obesity and paternal obesity were significantly correlated, indicating that there was intergenerational transmission of obesity in China. The intergenerational transmission coefficient of obesity was 0.328, indicating that paternal obesity had a significant positive effect on offspring obesity, that is, the higher the degree of parental obesity, the higher the degree of offspring obesity. The intergenerational transmission coefficient of obesity was 0.328, indicating that for every 1 increase in the BMI coefficient of the parent, the BMI coefficient of the offspring increased by 0.328.The results of full-sample regression, as shown in p = 0.000, indicating that offspring obesity and paternal obesity were significantly correlated, indicating that there was intergenerational transmission of obesity in rural China, and paternal obesity had a significant positive impact on offspring obesity. The intergenerational transmission coefficient of urban obesity was 0.318, p = 0.000, indicating that offspring obesity and paternal obesity were significantly correlated, indicating that there was intergenerational transmission of obesity in Chinese cities, and paternal obesity had a significant positive impact on offspring obesity. At the same time, it also shows that there are differences in the intergenerational transmission of obesity between urban and rural areas, and the degree of intergenerational transmission of obesity in rural areas is higher than that in cities.From the perspective of urban\u2013rural differences, as shown in p = 0.000, indicating that son obesity was significantly related to paternal obesity, indicating that there was intergenerational transmission of obesity between father and son, and paternal obesity had a significant positive impact on son obesity. The intergenerational transmission coefficient of obesity between father and daughter was 0.270, p = 0.000, indicating that daughter obesity and paternal obesity were significantly correlated, indicating that there was intergenerational transmission of obesity between father and daughter, and paternal obesity had a significant positive effect on daughter obesity. At the same time, it also shows that there are differences in the intergenerational transmission of obesity between men and women, and the degree of intergenerational transmission of obesity in sons is higher than that of daughters.From the perspective of sex differences, as shown in According to In addition, after controlling for the economic income level of the parent, the benchmark regression coefficient of obesity intergenerational transmission decreased from 0.328 to 0.312, that is, for every 1 increase of the parent BMI coefficient, the added value of the offspring BMI coefficient decreased from 0.328 to 0.312 see . This shThis paper focuses on the intergenerational transmission of obesity in Chinese residents, paternal obesity on offspring obesity, and the greatest impact on fat, further measuring education and income on the intergenerational transmission of obesity in Chinese residents . The resThe degree of obesity intergenerational transmission varies between urban and rural areas, with higher intergenerational transmission in rural areas than in urban areas. This result may be due to the large differences in medical and health conditions, and infrastructure and living environment between urban and rural China, all of which can affect the intergenerational transmission of obesity. For rural residents, the restriction of medical infrastructure makes rural residents more likely to fall into the poor transmission of intergenerational obesity. Urban residents themselves have a high health level, and have innate advantages in the utilization of medical resources. Therefore, there is little room for urban residents to improve the intergenerational transmission of obesity. On the other hand, due to the low income in rural areas, low-income families constrained by income invest less in the health of their offspring, and the paternal level of education of rural residents is relatively low, which will ignore the health education of their children to some extent, and it is more likely to lead to the intergenerational transmission of adverse obesity. This also shows that the degree of obesity intergenerational transmission is related to the income gap and the education level. Improving the economic development level of rural areas, increasing the per capita income of residents, improving the medical and health conditions, and the popularization of high education are effective means to curb the intergenerational transmission of obesity.There are gender differences in the degree of obesity intergenerational transmission, with a higher degree of obesity intergenerational transmission in men than in women. Specifically, boys\u2019 BMI values tend to be higher, which may be more pronounced in traditional Chinese family parenting culture, especially in rural societies or intergenerational parenting families. In addition, in Chinese social culture, women hold the concept of thin beauty as a dominant position in society. Therefore, women will actively take some behaviors to control their weight and maintain a slim and symmetrical body shape. On the other hand, women are in a weak position in the labor market and are vulnerable to discrimination in the labor market. In order to avoid the negative effects of obesity, women pay more attention to their own health investment and healthy lifestyle, and increase exercise time to control the obesity index.Based on the sixth round of the 2018 Chinese family income survey (CHIP), using the variable method tool of empirical test of Chinese residents\u2019 obesity intergenerational transmission problems, the following main conclusions can be drawn:1. Improving the parental education level can effectively inhibit the intergenerational transmission of obesity. First, with the improvement of parental education level, parental health cognition level also increased simultaneously. The improvement of parental health cognition can have a more comprehensive understanding of the harm of obesity on physical function and the negative impact on career development, social communication, psychology, and other aspects. Promoting parental scientific intervention of the offspring, such as healthy diet, regular physical activity, and behavior, standardized living habits, and the input of healthy ideas, can effectively avoid the occurrence of offspring obesity. Second, the improvement of parental education level, its learning ability, information literacy ability, and knowledge application ability, knowledge is relatively high, relatively rich, and can closely be linked to health promotion practice, and combined with offspring health characteristics of age and gender, and targeted offspring health promotion, it is more efficient in achieving health goals and avoid the risk of offspring obesity. Finally, the improvement of paternal health cognition can have a more comprehensive understanding of the importance of health in the life cycle process, stimulate the motivation of self to pursue health, and consciously regulate health behavior . In the 2. Increasing the parental income level can effectively inhibit the intergenerational transmission of obesity. At present, healthy diet, regular sports, and perfect health care services are the common ways to control and prevent overweight and obesity . These wDespite the valuable results of the investigation, the paper has a few limitations. Thus, it would be better to extend the sample for analysis (by number and geography) which allow obtaining more reliable conclusion."}
{"text": "In order to explore the public administration and resource allocation based on blockchain and structured occupational therapy, this paper takes the public affairs in the prevention and control of the Corona Virus Disease 2019 (COVID-19) epidemic as an example to conduct research. On the basis of summarizing and analyzing the previous published literatures, this study expounded the research status and significance of public administration and resource allocations; elaborated the development background, current status and future challenges of blockchain, and structured occupational therapy; introduced the methods and principles of data quality collaboration model and multiparty collaboration standard management; analyzed the case background of public administration and resource allocation in the prevention and control of the COVID-19 epidemic; discussed the public administration mechanism based on blockchain and structured occupational therapy; established a resource allocation method based on blockchain and structured occupational therapy; fathomed the role of the distributed ledger established by blockchain to increase the information symmetry of public administration activities; proposed a blockchain-established special machine trust for resource allocation; and finally, anatomized the data security sharing and access control mechanism based on blockchain and structured occupational therapy. The research results show that the public administration and resource allocation in this paper can effectively realize the data integration of the whole process and all departments and show the whole data and realize the traceability of the whole process. The blockchain revolutionizes the hierarchical leadership method of traditional resource allocation, shortens the distance between superiors and subordinates, makes information dissemination more fluent, and handles things more efficiently, making resource allocation ultimately form a flatter organization structure. In the original trust system of resource allocation, the blockchain and structured occupational therapy realizes the reconstruction of the trust system by preventing information tampering, using information encryption technology, and using information traceability technology. The results of this paper provide a reference for further research on the public administration and resource allocation based on blockchain and structured occupational therapy. The institutional design of public administration participation includes the disclosure of public administration affairs, the improvement of participation channels, the promotion of community autonomy, and the formulation of relevant participation laws. Through these efforts, more and better information sources, participation tools, participation carriers, and legal guarantees can be provided for resource allocation and participation in urban public administration . ImplemeBlockchain technology is a data structure that links data blocks in chronological order and uses cryptographic algorithms to ensure that the data stored in this way cannot be tampered with and cannot be forged and can be easily verified. The use value of blockchain is that organizations can track ledgers, and organizations can jointly create, develop, and track an immutable history of transactions and determine continuous events . As the In order to explore the public administration and resource allocation based on blockchain and structured occupational therapy, this paper takes the public affairs in the prevention and control of the Corona Virus Disease 2019 (COVID-19) epidemic as an example to conduct research. On the basis of summarizing and analyzing the previous published literatures, this study expounded the research status and significance of public administration and resource allocations; elaborated the development background, current status and future challenges of blockchain, and structured occupational therapy; introduced the methods and principles of data quality collaboration model and multiparty collaboration standard management; analyzed the case background of public administration and resource allocation in the prevention and control of the COVID-19 epidemic; discussed the public administration mechanism based on blockchain and structured occupational therapy; established a resource allocation method based on blockchain and structured occupational therapy; fathomed the role of the distributed ledger established by blockchain to increase the information symmetry of public administration activities; proposed a blockchain-established special machine trust for resource allocation; and finally, anatomized the data security sharing and access control mechanism based on blockchain and structured occupational therapy. The detailed chapter arrangement is as follows: In the face of the global epidemic of the COVID-19 virus, the epidemic prevention and control work involves typical public administration and resource allocation; therefore, this paper takes the COVID-19 epidemic prevention and control as an example to carry out public administration based on blockchain-structured occupational therapy on resource allocation methods. Epidemic prevention and control are faced with a new organizational system, new tasks, new environment, and new requirements. Its planning and design, organizational leadership, system construction, business instructions, communication and coordination, material preparation, as well as the collection, identification, and archiving need to start from scratch, and the preliminary work seems rushed and passive. Public administration and resource allocation are coordinated and coordinated by multiple systems, departments, departments and professions, and joint prevention and control, and group prevention and group governance are required. Since the outbreak of the new coronavirus, according to the needs of local epidemic prevention and control work, many leading groups of epidemic prevention and control have been quickly established in various regions to undertake important professional functions of epidemic prevention and control in the region. Its member units include publicity, health, public security, civil affairs, emergency management, big data management, transportation, commerce, economy and letter, market supervision, airports, railways, civil aviation, and customs.The blockchain can effectively realize the data integration of the whole process and all departments, show the whole picture of the data, and realize the traceability of the whole process. In the process of traditional material access and dispatch, the logistics, warehousing, distribution, and delivery of materials flowing from the distribution end to the end user have not been effectively integrated. Due to the limitations of the development stage, the diversity of needs, and the imperfect information resource governance mechanism, it is difficult to trust each other between departments, the scope of information sharing is not wide, the update of information resources is not timely and inconsistent, and business collaboration is difficult, etc. The problem has been difficult to solve effectively, so it is necessary to find a more reasonable operation mode for the governance of basic information resources of public administration departments. The asymmetric encryption technology in the blockchain can meet the needs of information ownership verification and information security. Its distribution effect can be imagined by combining this fragmented resource allocation process with a public organization . HoweverWith the help of this blockchain technology, the dissemination of various information and events in the process of public administration can cross the middle layers and quickly reach the decision-making layer and the grass-roots level, so that information can be quickly reflected. With the application of blockchain technology, all information on resource allocation will be recorded in the chain, and any changes made by anyone will be directly known to everyone, thus effectively forming a restriction mechanism. In addition, due to the point-to-point transmission, there is no distortion, distortion, change, and other problems in the information transmission process. In a word, blockchain revolutionizes the hierarchical leadership of traditional resource allocation, narrows the distance between superiors and subordinates, spreads information more smoothly, and handles things more efficiently, making the final formation of resource allocation more flat. For the internal relationship of resource allocation, applying the empowerment function of blockchain technology to allocate the corresponding rights to the corresponding stakeholders can significantly reduce the cost of collaboration and management within resource allocation. For example, the system bill of resource allocation can be updated synchronously through blockchain technology, and any changes in the account will be known to stakeholders. This makes the accounts more open and transparent, protects the interests of stakeholders, and reduces the possibility of insiders tampering with the accounts .  FigureThe transformative significance of blockchain technology is that, as a general technology, it must obtain the unanimous consensus of relevant parties before it can be widely used in different fields based on the inapplicability of the governance system. The rise of blockchain has raised new governance requirements and challenges for open and distributed resource allocation, and diversified consensus mechanisms have become new rules and new ways to solve coordination problems. The identity credibility system can authoritatively record and evaluate the credibility of the subjects and their behaviors of data sharing, opening, access, and use. A data sharing and open application achievement supervision platform can build a basic industry transformation situation system driven by data users, data value output, and data value distribution. As a combined innovation of a series of technologies, the release of its value depends more on the specific needs of the application environment, and the related cross-domain collaboration and the degree of digitization of the application environment have become the prerequisites for the realization of change. Furthermore, for organizational change, blockchain still has limitations in reducing transaction costs and improving transaction efficiency under complete contracts. Incomplete contract objectively requires the application of blockchain to sacrifice a certain degree of uncertainty in order to constitute the application premise of complete contracts.Blockchain structured occupational therapy refers to the combination of resource allocation and blockchain, and the use of blockchain technology to solve various specific problems such as incomplete information, soaring transaction costs, and the existence of intermediaries in the development process of resource allocation. The goal of blockchain structured occupational therapy is to upgrade and transform resource allocation, so as to transform resource allocation from low-added value to high-added value, from high energy consumption to low energy consumption, and from extensive to intensive. In the original trust system of resource allocation, state agencies or large enterprises provide mutual trust endorsements, so that the trust system within resource allocation can be maintained, but it is subjective and relatively fragile. As shown in Based on blockchain technology, the following changes will occur in the resource allocation process: first, before the start of business, public administration can negotiate various treaties for allocation and sign allocation agreements, agreeing on the type, quality, price, and delivery of allocated resources, methods and dates, offers, insurance, returns, liability for breach of contract, etc. Then, the public administration writes the agreed contract into code, uploads it to the blockchain, and completes the node verification of the entire network. Once the object places an order for a certain resource, the triggering conditions are met, and a series of subsequent outbound, delivery, and financial accounting processes are carried out and can be executed automatically by smart contracts . In thisAs an embedded programmed contract, a smart contract ensures that both parties can reach a transaction without a centralized organization. As a set of automatically executed code programs, smart contracts can be entered, executed, and ended on the blockchain platform as long as the two parties to the transaction reach a consensus on the program content. This avoids the possibility of disputes arising from the modification of the contract by one of the two parties at the technical level. As long as the electronic contract retained by both parties is processed and then proofread, if it is inconsistent, it proves that the contract has been modified. In the bureaucratic system, higher-level organizations and decision-makers expect their own instruction to be effectively communicated, which includes two meanings: one is the efficiency of instruction transmission. Of course, they expect that grassroots agents can fully implement their own instructions, truly upload and issue them, exert the effect of instructions, and realize policy expectations. However, in the process of uploading and releasing, how to ensure that the will of the upper level is fully understood by the lower-level organization, and the effective implementation and execution are not out of shape, but also to strengthen, and even to prevent the phenomenon of policy idling. In other words, the existing communication system to a large extent only improves the transmission efficiency of information instructions and does not effectively supervise the execution quality of information instructions.The three main subjects of social resource allocation have their own functions in different social fields, and at the same time, they learn from and penetrate each other. Where the functions of government, market entities, and private entities all play a role to a certain extent at the same time, but the effect of any one entity acting alone is not significant enough, the three entities will be combined according to a certain way of division of labor. Therefore, the government takes financial subsidies, while market entities invest in shares, or social entities provide professional services and charge appropriate fees to form government guidance, supervision, and financial subsidies, which are responsible for managing the three-dimensional cooperation model. Different social resource allocation subjects use different ways in social resource allocation . Market The blockchain stores data through a chain block structure with internal timestamps to generate time series for data, and any two blocks are associated with cryptographic methods, which can be traced back to the data information of any block; thus, it has strong traceability and verifiability. Suburbs with vast administrative areas undertake more tasks of infrastructure and public services than central urban areas, such as rail transit, municipal roads, rural roads, bridges, water conservancy facilities, sewage treatment facilities, garbage treatment facilities, large-scale greening, environmental governance, financing, construction and operation management of water supply facilities, power supply facilities, and gas supply facilities . The ideAny subject in the system can verify the public ledger, and there is no single subject in the system that can specifically control the public ledger. In contrast to traditional centralized or centralized public decision-making, the public ledger of such management and decision-making activities provided by blockchain technology has distributed data storage and point-to-point transmission and consensus mechanisms in the precise poverty alleviation system. The blockchain-structured occupational therapy uses the point-to-point transmission mode and utilizes the characteristics of decentralization to speed up the turnover of funds and commodities and strengthen the resource allocation chain. The mechanism of this information symmetry lies in the fact that scientists use mathematical principles to establish machine credit in the system, which fundamentally subverts the information asymmetry drawbacks of the traditional centralized and centralized management model . This inIn the blockchain technology environment, the parties to the transaction automatically input data through the Internet of Things, mobile terminals, or artificial intelligence devices, etc. and record and save the data with the cryptographic technology of the blockchain. If party A generates a pair of keys and discloses one of them to other parties as a public key; party B who obtains the public key uses the key to encrypt the confidential information and then sends it to party A; the encrypted information is decrypted by another private key. Different from the usual client-server network architecture, in the network environment, thousands of computers connected to each other are in a peer-to-peer position. In the field of public administration, since public power assumes the function of authoritatively distributing the value of the whole society, if the public manager in charge of public power lacks the restraint of public spirit and external institutions, it may use various public resources to form own vested interests. Facing the temptation of interests, the public character and self-interest motives of public managers are always in a state of intense competition. The public managers whose self-interest motives prevail, the driving force of their actions is the maximization of personal interests. This is the most fundamental reason for the formation of vested interests of public managers, and it is also the most difficult motivation for public managers to overcome and prevent.Based on a distributed peer-to-peer network, blockchain allows participants to join freely or authorized, thereby establishing a social governance system of collective participation and collective maintenance. Through the consensus mechanism, all participating nodes on the blockchain can reach a consensus on transactions or behaviors, thereby establishing a new order in the digital society. As shown in Integrity supervision of public administration is not only an institutional project but also a technical practice. The technical characteristics of blockchain, such as decentralization, data transparency, security and reliability, privacy protection, nontampering, traceability, and detrust, are very important to the improvement of the system and mechanism of promoting clean government supervision and the improvement of technical governance efficiency provide important support, and the two are closely related in internal logic. The blockchain can incorporate the supervision power of citizens and society into the integrity supervision system, so that the supervision of power can evolve from single-center supervision to multicenter supervision, and all public powers can be supervised. Second, the essence of blockchain is a distributed ledger, which ensures the sharing and disclosure of information and data. Third, the public key of the blockchain plays the function of information disclosure in the determination, display, control, and regulation of power, which helps to open the black box of major public affairs and major project decision-making. Therefore, blockchain technology is logically related to the democratization of clean government supervision. The blockchain data layer and network layer technology jointly ensure that the transactions cannot be tampered with. Once the information is tampered, it will broadcast and notify all participants and will lead to the failure of information tampering.An important application of the antitampering feature of blockchain in the social governance of data is to ensure the security and reliability of historical data. The traditional center-periphery structure, the center enjoys the convenience of observing the entire structure due to its central position, and this convenience also provides the center with a unique global perspective. The center of the structure can see all the transactions in the structure and then master the complete ledger, which is generally believed that one of the advantages of this model is that it is convenient to provide sufficient evidence for dispute arbitration. However, the advantages are also disadvantages. Since the center enjoys the absolute right to process data, this right will be changed due to the opaqueness of the central organization and its data processing process . It is mPublic administration big data governance has always been the main content of public administration construction. Its purpose requires the management of big data to be centered on the service object and to achieve complete and timely information flow and cross-platform cross-department, cross-field, and cross-platform public administration at all levels and types. Public administration big data is an important part of public administration big data governance, the core content of data governance, and plays an important role in cross-departmental collaboration. Blockchain-established special machine trust for resource allocation based on blockchain and structured occupational therapy is shown in The blockchain-based open network model for government data sharing can build a consortium chain of government functional departments, a government-oriented public chain for the public, and a public security system based on the sensitivity of the data carrier. It can form a blockchain rope network structure for government data sharing and openness, create a credible government data sharing and open platform, ensure the openness and security of data sharing among various functional departments of the government, and solve the risks associated with big data . It shouThe core feature of the blockchain formed based on the above mechanism is that all transaction information is stored on the chain. It is theoretically impossible to achieve; at the same time, any participant in the network can store the entire blockchain, thus forming a distributed storage, and the collapse of any node will not affect the normal operation of the entire network. With the help of the decentralization and nontampering characteristics of blockchain technology, which is easy to trace back, a public decision-making responsibility mechanism for the self-organized operation of the government service platform under the assistance of the government is constructed . This reCredit-based resource allocation mostly requires credit endorsement from third-party institutions. In the traditional state governance system centered on the government, bilateral or multilateral interactions rely on government departments as trusted intermediary organizations for coordination and are constrained by this administrative system . As a hiThe decentralization of the blockchain is conducive to building an open, transparent, green, fair, and efficient cross-departmental and cross-level emergency management collaboration platform. Any relevant government department can rely on the platform to obtain high-credibility data in real time, and synchronously record, upload, and store work information on the platform, providing an information foundation for collaboration and cooperation between government departments. The decentralized management collaboration platform can realize cross-departmental and cross-regional maintenance and utilization of government data, promote business collaboration, achieve clear instructions, orderly systems, smooth and efficient execution, and improve the integration efficiency of internal government resources. The responsibilities of each department are managed through relevant electronic programs. The algorithm code of the program contains conditions that will trigger the automatic execution of the contract. When the smart contract is uploaded to the blockchain platform, the program will automatically check the relevant events and trigger conditions and meet the conditions. The work will be directly assigned to the relevant departments, and the progress of the work will be monitored in real time. Smart contracts use algorithm code as the standard for responsibility delimitation, which can effectively prevent buck-passing and overcome laziness. At the same time, the automatic triggering and execution of algorithms can reduce manual approval and can also improve the degree of automation of government work and the quality of public services .The essence of social governance is the government's service and management of the society. The government improves and protects people's livelihood through social governance, achieves a trust relationship between the government and society, and forms a social consensus, thereby promoting social development. Therefore, social public trust is a major issue in social governance. Blockchain can use its advantages of information sharing, data traceability, authenticity and reliability of data, and immutability to improve the transparency of public information to the public, so that the public sector can get rid of the crisis of public trust . StructuIn order to explore the public administration and resource allocation based on blockchain and structured occupational therapy, this paper takes the public affairs in the prevention and control of the COVID-19 epidemic as an example to conduct research. This study discussed the public administration mechanism based on blockchain and structured occupational therapy, established a resource allocation method based on blockchain and structured occupational therapy, fathomed the role of the distributed ledger established by blockchain to increase the information symmetry of public administration activities, proposed a blockchain-established special machine trust for resource allocation, and finally, anatomized the data security sharing and access control mechanism based on blockchain and structured occupational therapy. Blockchain can use its advantages of information sharing, data traceability, authenticity and reliability of data, and immutability to improve the transparency of public information to the public, so that the public sector can get rid of the crisis of public trust. The asymmetric encryption technology in the blockchain can meet the needs of information ownership verification and information security. The consensus mechanism urges each governance body to abide by a unified agreement and without a strong third-party organization to coordinate, supervise, and highly decentralized decision-making powers, reach agreement or consensus on the validity of data, and perform their own responsibilities and spontaneously coordinate. The blockchain revolutionizes the hierarchical leadership method of traditional resource allocation, shortens the distance between superiors and subordinates, makes information dissemination more fluent, and handles things more efficiently, making resource allocation ultimately form a flatter organization structure. In the original trust system of resource allocation, the blockchain and structured occupational therapy realizes the reconstruction of the trust system by preventing information tampering, using information encryption technology, and using information traceability technology. The results of this paper provide a reference for further research on the public administration and resource allocation based on blockchain and structured occupational therapy."}
{"text": "Rapid urbanization and industrialization have brought about regional prosperity and pressure on the ecological environment, and the disorder of development has led to competition among the production-living-ecology functions. How to build livable cities, optimize the spatial layout of land, and promote the coordinated development of the production-living-ecology functions in various regions has become an important issue in the sustainable development and utilization of land space. In order to study the spatiotemporal conflict and coordination of the production-living-ecology functions with respect to the dramatic developments associated with the 21st century, this study took Hubei Province, which is the top-ranking economic region in China in recent years, as the study area and adopted the global entropy value method, triangle model, and coupled evaluation model to delineate an index system to measure the degree of conflict and coordination of the production-living-ecology functions in Hubei Province from 2000 to 2020, and also delineate zoning management based on statistical yearbook data. The results showed the following: (1) With respect to the time scale, the indices of the production-living-ecology functions in Hubei Province increased year by year, and the degree of coordination also increased yearly, from the stage of disorder with certain conflict to the stage of coordination with a high level of coupling. (2) On the spatial scale, the development of production-living-ecology functions in Hubei Province was unbalanced, which may be related to the overall development strategy of \u201ctwo circles and one belt\u201d in Hubei Province, with the eastern part of the province having a higher degree of coordination of the production-living-ecology functions and the western part having a lower degree of coordination. (3) Among the production-living-ecology functions, the ecological function of Hubei Province as a whole exhibited minimal change and maintained stable development, while the living and production functions underwent considerable development, indicating that Hubei Province has protected the orderly development of the ecological environment in the process of urbanization and new industrialization. (4) According to the development and coordination of the production-living-ecology functions in each region of Hubei Province, four development management zones were created: high-quality development zone, secondary development zone, balanced development zone, and development potential zone. Finally, policy suggestions are given for each zone. China is a vast country with uneven regional development; as a result, its resources are not evenly distributed over the national space . With thThe living function, production function, and ecological function, referred to as the production-living-ecology functions, are the basic manifestations of the spatial functions of a region\u2019s land and the products and services provided by the land under the combined influence of natural conditions and human activities. The ecological function provides ecological products and services for other functions, maintains ecological security and stability, and is the material source and environmental basis for the realization of the living and production functions ,7. The pBoth domestic and foreign scholars have conducted multi-faceted and systematic research related to production-living-ecology functions. Academics outside of China do not have a clear definition of the concept of these functions, and the relevant research has mainly focused on the connotation, definition, and derivation of multifunctional land ,17. The Current research on the production-living-ecology functions has made considerable achievements; however, there are still some shortcomings, including the fact that the majority of research has depended on the national space and not on provincial administrative regions. Moreover, few studies have explored the interrelationship among the production-living-ecology functions\u2014 most focus on the assessment of individual functions, and no in-depth research has been conducted on the interaction among the production-living-ecology functions. Hubei province, as the strongest province in central China, has become one of the fastest growing provinces in recent years due to its own geographical and humanistic advantages and policy factors, such as the shift of China\u2019s center of development from the coast to the interior. The study of the differentiation and evolutionary characteristics of production-living-ecology functions in recent years is of great significance and has positive implications for territorial spatial planning, rural revitalization, ecological civilization construction, etc. It is also of great importance for the functional optimization of Hubei administrative regions, coordinated regional development, and policy orientation. This study took Hubei province as subject, and through analysis of the spatial and temporal conflicts and the degree of coordination among the production-living-ecology functions in this region during the period from 2000 to 2020, the relationship among the production-living-ecology functions was explored and the zoning was delineated according to the current situation in Hubei province. The results of this study will provide a reference and basis for the coordinated development of production-living-ecology functions in Hubei province.Entropy, a term originally coined by the German physicist Clausius in 1850, is used to denote the degree of uniformity or disorder of an energy distribution in space; it is a physical concept of thermodynamics and a measure of the disorder (or order) of a system . Later, (i) Construct a global evaluation matrix. For (ii) Standardize the indicators. Different indicators will have a positive or negative influence on the system: the larger the value in positive indicators, the better; and the smaller the value in negative indicators, the better. Due to the differences between different indicators, they must undergo dimensionless standardization as follows:Positive indicators:Negative indicators:(iii) Calculate the percentage of indicators, the first (iv) Calculate the information entropy value of the first (v) Calculate the information utility value of the first (vi) Calculate the indicator weights. The weight of the first indicator value (vii) Calculate the comprehensive evaluation value of the first In this study, the relationships among the production-living-ecology functions were examined, and three first-level indicators\u2014the production function index (PFI), living function index (LFI), and ecological function index (EFI)\u2014were used to represent the development of production, living, and ecological functions, respectively. The index system was determined due to the relevance and difficulty of data acquisition, referencing the papers of De Zhou et al. ,57, baseThe production function index consists of three secondary indicators, including the agricultural production function (F1), which represents the level of agricultural development; the economic growth function (F2), which represents the level of economic development; and the traffic function (F3), which represents the traffic-carrying capacity. The life function index consists of the employment security function (F4), representing the social working population and income; the social security function (F5), representing social input and guarantee per capita; the habitat function (F6), representing the input and construction level of the living environment; the entertainment function (F7), representing the spiritual, material, and cultural supply of the people; the science and education function (F8), representing social science and education input; and the medical security function (F9), representing the medical care level of the region. The ecological function index is composed of two secondary indicators: the resource security function (F10), which represents the human living environment and resource-carrying level, and the ecological balance function (F11), which represents the land output and environmental pollution level. Each secondary index is composed of corresponding tertiary indices.The corresponding objective weights of all the indices and the production-living-ecology function indices were calculated according to the global entropy value method, as shown in The triangle model is a qualitative classification tool in soil science known as the international system of soil texture triangulation, which determines the types of soil by the ratio of the content of three particles: sand, powder, and clay . This model has recently been applied in several other fields, such as economics, geography, environmental science, etc. ,59,60. IThe coupled evaluation model is used to test the level of coordinated development between multivariate systems and includes two indicators: the coupling degree and coupling coordination degree ,63,64,65The coupling coordination degree is calculated as follows:Wuhan, the capital of Hubei Province, is located in the middle reaches of the Yangtze River in the central hinterland of China. It is north of Dongting Lake and adjacent to six provincial administrative regions\u2014Anhui Province, Chongqing Municipality, Shaanxi Province, Jiangxi Province, Hunan Province, and Henan Province\u2014between 29\u00b001\u203253\u2033\u201333\u00b06\u203247\u2033 N and 108\u00b021\u203242\u2033 E. Its total area is about 186,000 square kilometers, accounting for about 2% of China\u2019s total land area. Hubei Province is surrounded by mountains from the east to west and north to west, and the central part is a low and incomplete basin with many rivers and lakes, whose geographical location and elevation distribution are shown in http://www.gscloud.cn/; accessed on 1 January 2020). In this study, EvaGear (Version 2.4) was used for processing the global entropy method, the triangle model was calculated in Grapher (Version 16), and the figure processing was performed in ArcMap (Version 10.2) and Visio (Version 2019).The main socioeconomic data used in this study were obtained from the Hubei Provincial Statistical Yearbook 2000\u20132020, Hubei National Economic and Social Development Statistical Bulletin 2000\u20132020, Hubei Rural Statistical Yearbook 2000\u20132020, Hubei Urban Statistical Yearbook 2000\u20132020, and Hubei Ecological Environment Bulletin 2000\u20132020. Carbon emission data were obtained from a study by Xiao Pengnan et al. , and eleBased on calculations using the global entropy value method, an index system was constructed and the three functional indicators and corresponding weights of Hubei Province were obtained, as shown in Because the LFI, PFI, and EFI values obtained by the global entropy weighting method varied greatly, in order to visualize the relative changes in the characteristics of the production-living-ecology functions in Hubei Province from 2000 to 2020, these values were linearly normalized to obtain NLFI, NPFI, and NEFI values see . From FiFrom From The characteristics of the changes in the interaction of the production-living-ecology functions in each municipal administrative district in Hubei Province were roughly the same as those in Hubei Province, where the developmental stages roughly showed development from a low level to a high level and development exhibited an upward trend that showed certain differences in time and space. Based on the final level of the interaction of the production-living-ecology functions in each municipal administrative district, they were divided into three categories\u2014Zone C, Zone D, and Zone E\u2014and As can be seen from As can be seen from As can be seen from By referring to the levels shown in The coupling coordination degree reflects the degree of benign coupling among the production-living-ecology functions in Hubei Province, that is, the degree of mutual promotion of development. From the spatial perspective, the overall coupling coordination degree of Hubei Province improved from 0.342 to 0.694, developing from mild disorder to primary coordination; the coupling coordination degree of the eastern region, mainly Wuhan, was relatively high, followed by the central region, while that of the western region was relatively low. From the perspective of time, the spatial difference in the coupling coordination of the production-living-ecology functions in Hubei Province in 2000 was small, with an overall range of 0.226\u20130.487 and with three degrees, from moderate disorder to near disorder, dominated by disorder. Near disorder dominated in eastern Hubei, mild disorder in central Hubei, and moderate disorder in western, northern, and eastern Hubei, where the area with the lowest coupling coordination was Enshi and the highest coupling coordination was Ezhou. In 2005, the coupling coordination of the production-living-ecology functions in Hubei Province was slightly improved compared to 2000. The overall range was 0.247\u20130.497, but still showed degrees from moderate disorder to near disorder (mainly disorder). However, the number of areas with moderate disorders decreased in Enshi in the southwest and Huanggang and Ezhou in the east, while the number of areas with near disorders increased in the east and central/western parts of Hubei. The area with the lowest degree of coordination was Enshi, and the area with the highest degree of coupling coordination was Wuhan. In 2010, the spatial differences in the coordination of the coupling of the production-living-ecology functions in Hubei increased compared to previous years, a coordination stage appeared, and the overall range was 0.341\u20130.625, with four stages in total from mild disorders to primary coordination. In 2010, the highest degree of coupling coordination of primary coordination was distributed in Wuhan in the east, and barely coordinated was distributed in the central and western part of Hubei Province, while the area with the lowest coupling coordination was Ezhou. In 2015, the overall coordination of the coupling of the production-living-ecology functions in Hubei Province increased, with an overall range of 0.495\u20130.793 and with four stages, from near disorder to intermediate coordination, mainly in the coordination stage. Intermediate coordination was distributed in Wuhan in the east and Yichang in the west, where the highest coupling coordination was Yichang, while near disorder was found only in Enshi, which had the lowest coupling coordination degree in the western part of Hubei Province. In 2020, the overall coordination of the coupling of the production-living-ecology functions in Hubei Province increased again, with an overall range of 0.553\u20130.779 and with three stages, from near disorder to intermediate coordination, mainly in the coordination stage. Intermediate coordination was distributed in the east, central, and western parts of Hubei Province, while primary coordination was distributed throughout most of Hubei Province, where the region with the lowest coupling coordination was Enshi, and the region with the highest coupling coordination was Wuhan.In terms of the comprehensive coupling degree and coupling coordination, the degree of coordination of the production-living-ecology functions in Hubei Province increased at an average rate from 2000 to 2005, increased at a rapid rate from 2005 to 2015, and slowed down from 2015 to 2020. The degree of coupling and coordination of the production-living-ecology functions in Hubei province evolved toward a high level, and there were significant differences in the degree of coupling and coupling coordination in different regions, among which the higher regions were Wuhan, Huangshi and Yichang, and the lower regions were Enshi and Shiyan.Combining the global entropy value method, triangle model, coupling coordination model evaluation, and the actual situation in Hubei Province, the division levels were determined, as shown in The current research on the production-living-ecology functions suggests that all rely on the national land space or multifunctional land . In addiIn this study, we investigated the degree of coupling and coordination of the production-living-ecology functions in Hubei Province from 2000 to 2020 and constructed an index system. The results of the study showed that since the beginning of the 21st century, Hubei Province has entered a high-speed development stage, characterized by an increasingly rapid development rate from 2000 to 2015 and a slower growth rate in 2020. In addition, the production-living-ecology functions gradually entered a coordinated development stage.According to the production-living-ecology function development status of different areas in the province, zoning management divisions were laid out and targeted to achieve overall coordinated development and promote the sustainable use of national spatial resources. This study has the following shortcomings: the data were not easy to obtain, only a five-year period was selected, and the years were not continuous. The data used in subsequent studies should ideally be more accurate, the weights of the objective differences in the index system should be calculated in a normalized way, and a better optimization calculation method should be utilized. In addition, in this study, only Hubei Province was selected as the research region; we hope that future studies can be conducted at the macroscopic national scale, the world scale, and the microscopic town and village scale. Finally, the production-living-ecology function theories have not been studied deeply enough; we plan to construct a recognized theory and index system in follow-up research.For the high-quality development area, measures should be taken to maintain its development advantages and enhance its ecological functions, with the Wuhan area in eastern Hubei Province focusing on optical core screen end networks, biomedicine, and other fields to lead the high-quality development of emerging industries, continue to become the most important growth pole of cities in the middle reaches of the Yangtze River, and drive the development of other surrounding areas, such as Xiaogan, Ezhou, Huanggang, Xianning, Xiantao, Tianmen, and Qianjiang. Wuhan needs to continue to develop the modern service industry based on the \u201cfour banks of the two rivers\u201d concept; concentrate on the development of the national financial center; and take advantage of local industry, including the national leading transportation advantage, the export of talents from the university city, the centralized distribution of various industrial parks, etc., in order to develop new industrial centers and build intelligent industrial clusters, such as the automobile industry, electronic and electrical industry, etc. At the same time, the construction of the Yangtze River ecological corridor, the Han River ecological corridor, many ecological wetlands such as East Lake and South Lake, and ecological green areas, such as Mulan Grassland, guarantee the steady development of ecological functions.For the secondary development areas, measures should be taken to optimize development and give full play to regional advantages. For the Xiangyang area, these measures should focus on new energy vehicles and equipment manufacturing. The northern core of western Hubei province, to undertake the north\u2013south corridor of western Hubei province, can take advantage of railroad and highway transportation hubs to drive the development of Shiyan, Suizhou, etc., while building ecological barriers, such as ecological protection forests to protect the ecological function area of Qinba biodiversity Ecological balance. For Yichang and Jingmen in the northern core of Hubei province, these measures should focus on bio-agriculture and advanced chemical materials. The southern core of the western part of Hubei Province, to undertake the east\u2013west channel in the western part of Hubei Province, can use the convenience of the Yangtze River waterway and the Han River waterway for traffic to drive the development of Jingzhou, Tianmen, Qianjiang, Xiantao, Enshi, and other areas. At the same time, the southern core and the northern core will achieve synergistic development.For balanced development areas, such as Xiaogan, Ezhou, Jingzhou, Suizhou, Xianning, Xiantao, Qianjiang, and Huangshi, measures should be adopted to find regional advantages and characteristics, promote industrial radiation from high-quality living areas and secondary development areas, build provincial strategic emerging industry clusters with distinctive characteristics and staggered development, become the backbone of the province\u2019s development, and enhance the production-living-ecology functions in all aspects. Qianjiang, for example, combined with two high-speed systems , two railways (Hanyi passenger high-speed railroad and Qianjiang freight rail spur), two waterways , and two ports (Qianjiang Port Zekou port area and Hongqi port area) as the support of the public, rail, and water intermodal modern integrated transportation system, combined with the local characteristics of the water garden, and the advantages of the crayfish industry, to create the crayfish with rice industry as the representative of the industry Cluster, the use of its own oilfield resources, to create local characteristics of new energy, new chemicals, new materials industry clusters.For development potential, areas, such as Enshi, Shiyan, Huanggang, and Tianmen, while giving play to their own ecological characteristics, such measures should create cultural and tourism industries, strengthen the construction of transportation, and promote the radiation of living and production functions from surrounding areas to improve the living level and production level, create livable ecological cities, attract people from other areas for recreation and tourism, and achieve overall regional balance. Enshi, for example, can take advantage of the local situation and the junction of Hubei Province, Hunan Province, and Chongqing City to develop transportation, become a major transportation route of three provinces, combine local selenium-rich characteristics, build the world capital of selenium industry, vigorously develop selenium-rich tea and selenium-rich recreation tourism, etc.The overall approach should be multi-core-driven and multi-influential, forming an integrated and interactive development system in Hubei Province, ultimately realizing the full development and coordination of the production-living-ecology functions. The development management zoning is conducive to the realization of rural revitalization, the reduction of the differences among the geographical areas of Hubei Province, and the realization of common prosperity under the coordination of the production-living-ecology functions.(1)With respect to the time scale, along with the shift of China\u2019s development center, Hubei Province  has undergone considerable development. The indices of the production-living-ecology functions have improved year by year, and the degree of coordination of the production-living-ecology functions has increased year by year, from the stage of dysfunction with a certain degree of conflict to the stage of coordination with a high level of coupling.(2)At the spatial scale, the development of the production-living-ecology functions in Hubei Province has been unbalanced, which is likely related to the overall development strategy of \u201ctwo circles and one belt\u201d in Hubei Province. The eastern part of Hubei Province has a higher degree of coordination of the production-living-ecology functions, while the western part has a lower degree of coordination of the production-living-ecology functions. Centering on the Yangtze River Economic Belt in Hubei Province, Wuhan City Circle with Wuhan City as the center and the West Hubei Ecological and Cultural Tourism Circle have been formed(3)Among the production-living-ecology functions, the ecological function of Hubei Province as a whole has undergone minimal changes and maintained stable development, while the living and production functions have developed greatly, indicating that the balance of the ecological function has not been destroyed by the development of the living and production functions in Hubei Province during the period from 2000 to 2020 and the orderly development of the ecological environment has been protected in the process of urbanization and new industrialization.(4)According to the development and coordination of the production-living-ecology functions of each region in Hubei Province, they were divided into high-quality development areas, secondary development areas, balanced development areas, and development potential areas, and development suggestions were provided to give full play to the advantages and make up for the shortcomings of these regions according to their own characteristics to achieve a balance of the production-living-ecology functions across the province.Taking Hubei Province of China as an example, an indicator system was constructed and the global entropy value method, triangle model, and coupled coordination degree model were applied to analyze the degree of conflict and coordination among its production-living-ecology functions from 2000 to 2020. The results showed a dynamic change, and the four main conclusions are as follows:"}
{"text": "In this symposium we present papers from four key stakeholders on a Michael Smith Foundation for Health Research (MSFHR) Implementation Science Team (IST) that is investigating the application of an emerging approach, the non-adoption, abandonment, scale-up, spread, and sustainability (NASSS) framework , to help predict and evaluate the success of technology-supported health and social care programs in British Columbia (BC). Specifically, our team\u2019s intention is to apply the NASSS framework to answer the following research questions: 1) Can the NASSS framework be used to enhance the effectiveness and impact of innovative ATs through improving the equitable scale-up, spread, and sustainability of these technologies for older adults? 2) What are the most important factors in the technology development and implementation process that contribute to equitable scale-up, spread, and sustainability of ATs for older adults? And 3) How can we improve transdisciplinary and intersectoral collaborations to enhance and improve the equitable implementation of ATs for older adults? Based on discussions from team, advisory, and expert panel meetings, a Rapid Realist Review (RRR) of the literature, and an analysis of data collected to date, the speakers will respond to these questions."}
{"text": "In the context of the coronavirus disease 2019 (COVID-19), people\u2019s social mentality and mental health have been severely affected, which has hindered or even reversed the achievement of the United Nations Sustainable Development Goals (SDGs). However, there is a lack of investigation into the potential relationship between social mentality and health, as well as of the comparison between different databases worldwide and in China, in the current context of COVID-19. Hence, the aim of this paper is to explore the research hotspots and development trends of social mentality and health in China and worldwide, while improving people\u2019s health, building a sustainable society, and facilitating the achieving of the SDGs. A bibliometric method is employed in this paper from a macro-quantitative and micro-qualitative perspective to explore the research hotspots and trends of social mentality and health in the world and China from the two databases, namely the English-language Web of Science (WOS) and the Chinese-language China National Knowledge Infrastructure (CNKI). The results indicate that: (1) By using keyword co-occurrence and clustering analysis via the CiteSpace software bibliometric tool, 11 current research hotspots have been identified and studies are increasing in terms of using the Chinese language and the English language. (2) The current studies in the CNKI database mainly focus on the macro social environmental factors affecting social mentality and population research, while the studies in the WOS database pay more attention to social mentality and health in the context of the COVID-19 epidemic situation and a variety of professions. Hence, future research could explore the influencing factors and cultivation methods toward a healthy social mentality from the perspective of methodology and toward achieving SDG 3, providing healthy lives and promote well-being for all at all ages, and SDG 11, building sustainable cities and communities in the post-pandemic COVID-19 era. At present, the coronavirus disease 2019 (COVID-19) has already affected mental health worldwide and a number of effects are likely to persist . HoweverIn addition, sustainability is one of the most important goals on the world policy agenda . The citSocial mentality is the social state of mind in the whole society or in social groups in a certain period of social development, which is also the sum of the feelings, social emotional tone, social consensus, and social values of the whole society . Social Furthermore, current research believes that social mentality has both positive and negative effects on progress of social development, and a great significance to social stability . A positA bibliometric method has been adopted for this study to explore the research hotspots and development trends of social mentality and the potential relationship between social mentality and health from macro quantitative and micro qualitative perspectives via two knowledge databases, namely the China National Knowledge Infrastructure (CNKI)  and the As shown in In this paper, the CNKI academic journal database has been used as the data source and the themes were \u201csocial mentality\u201d and \u201chealth\u201d. The time span of the literature retrieval was set to all years. The SCI, EI, Peking University Core Journals, CSSCI, and CSCD were selected as the sources. A total of 120 articles have been obtained, of which 117 related articles were selected for bibliometric analysis.As shown in 1.Keyword co-occurrence analysisIn the setting part, Years Per Slice was set to \u20181\u2019and Node Type was set to \u2018Keywords\u2019, resulting in 191 nodes and 329 connections, and we selected \u2018Timezone view\u2019 in Layout to get the time zone diagram, as shown in As shown in 2.Keyword clustering analysisThe CiteSpace software provides two indicators, i.e., the modularity Q value  and the mean silhouette value , in line with the network structure and clustering clarity, which can be used as a basis to evaluate the mapping effect . After tAfter macro quantitative analysis, micro qualitative analysis was conducted according to the results of macro quantitative analysis, from which further classification has been carried out to reveal the development status and future development trend of social mentality and health. In the macro quantitative analysis, as shown in 1.Social mentality and social mental healthA healthy body, a well state of mind, and a sound personality are the important signs of physical and mental health for people and are the internal premise to form a harmonious society . Hence, The research on social mentality and social mental health mainly focuses on the current research status of social mentality, current social psychology, and social mentality, as well as the cultivation of a healthy social mentality. The cultivation of a healthy social mentality needs to be carried out from five aspects: culture, sports, public opinion, mental health, and a system of public psychological services (SPPS). There are nine studies that have explored the background of the development of social mentality from various perspectives such as social transformation, while 17 studies have showed the current status of social mentality, especially in the context of the epidemic, and the remaining 49 studies have revealed the cultivation methods of a healthy social mentality from different perspectives. As shown in Current research status of social mentalityWang et al.  employedCurrent social psychology and social mentalitySocial mentality can not only reflect various social problems in the process of social change, but also help to understand the social situation, public opinion, social hotspots, and social emotions, so as to achieve a positive and healthy social mentality and promote the operation of society . AdditioWith COVID-19, people\u2019s levels of stress, anxiety, and depression have risen further . In a fuCultivation of healthy social mentalitySocial mentality can influence people\u2019s behavior and social development to a certain extent . The cul(1)Cultural perspectiveFrom the perspective of cultivating a healthy social mentality, Ding  conducts(2)Sports perspectiveBian et al. adopt a series of cutting-edge empirical analysis methods in the field of computational sociology, such as time-series analysis, emotion analysis, panel data regression, and mediation effect tests, and reveal that online fitness can significantly increase positive attitudes even when online social interaction is controlled . Interes(3)Public opinion perspectiveFrom the perspective of public opinions, emotions among groups are more likely to infect each other and form a diffusion effect because of sensibility rather than the rationality of social mentality , in whic(4)Mental health perspectiveFrom the perspective of mental health, the goal of improving the social mental health education and service system is to cultivate a good social mentality . At pres(5)The perspective of the system of public psychological services (SPPS)The creation of a healthy social mentality is about establishing the SPPS, of which the formation of a good social mentality is an important goal . By usinThe main contents of the service system include three modules: mental health service, cultivation of social mentality, and construction of community identity, the main functions of which are, respectively, the prevention and treatment of psychological diseases, improvement of the mental health levels across China, and cultivation of self-esteem, rationality, positivity, and a healthy social mentality, as well as shaping the unified cultural identity of the Chinese nation and the identity of a community with a shared future for mankind . The ChiThrough text analysis on network text data of the actual work in the construction of the SPPS, Chi et al.  find thaSocial psychology and social mentality are closely related, and a change of social psychology will affect the social mentality. The cultivation of a social mentality can be carried out from the aspects of culture, sports, public opinion, and mental health. The SPPS is also an important approach to cultivate a healthy social mentality. However, relevant theories are still under construction at present, and there is a gap of relevant talents, which leads to a deficiency in constructing the SPPS. This is a research direction that needs to be further explored and supplemented in the future.2.Population and healthy social mentalityThe absorption, internalization, and reaction of various social groups and classes to the same social reality are not exactly the same . Thus, iThe social mentality of youthAs the backbone of social development and the reserved force of national construction, the healthy development of a social mentality for youth is particularly crucial. It is a great practical significance for the development of the whole society and national governance to understand the current social mentality of young people and to explore the effective approaches to cultivate healthy youth in terms of social mentality , which a(1)The social mentality of small-town youth and college studentsYouth is a huge group, and current studies have carried out in-depth analyses on the various youth groups. Wang et al.\u2019s  study on(2)The social mentality of teachersCollege teachers, who are not only disseminators of knowledge but also shapers and leaders of the students\u2019 values, are closely related to the construction of a healthy social mentality in young college students . The hea(3)The social mentality of young medical workers and the new generation of migrant workersIn the current studies on other youth groups such as young medical workers and the new generation of migrant workers, Bi  studies The social mentality in ethnic minority areas and border areasThe construction of a healthy Chinese national mentality of border nationalities is of great significance to the construction of a community consciousness of the Chinese nation . La 129129 conduThe social mentality of soldiers, cadres, and laid-off workersFeng et al.\u2019s  researchThe current crowd is mainly focused on the youth group, but the construction of a harmonious society needs the guarantee of a healthy social mentality of all people; as such, it is necessary to explore more social groups and classes, especially vulnerable groups and groups with weak discourse voices.A literature search was conducted for all years with the themes  in the core collection of the WOS database, resulting in the seven relevant articles that have been listed in In terms of research methods, the studies in the WOS core collection database mainly employ questionnaires ,169,171 The results of Furthermore, the results of Among the five aspects to cultivate a healthy social mentality in the results of The construction of the SPPS still faces the practical dilemma of outdated ideological cognition, insufficient talent reserve, poor service mode, unclear division of power and responsibility, and lack of financial support . For indYouth is a very important population group for the current studies on social mentality to assist health, especially in the current aging background for youth development city construction. Since young people are the most active manpower in the whole social force, the hope of the country, and the important force of social development, it is crucial to understand and cultivate young people\u2019s healthy social mentality . HoweverResults in This paper is the first attempt to employ a bibliometric method to explore the research hotspots and trends of social mentality and health in the world and China from two databases, namely the Chinese-language CNKI and the English-language WOS, with the following contributions: (1) from the macro and micro perspectives, the social mentality and health in the world and China is explored and identified, in which studies are increasing in terms of using the Chinese language and the English language. Qualitative analysis is mostly used in the studies in the CNKI database, and few quantitative analyses have been used, such as questionnaires. Whilst the studies in the WOS database have all implemented quantitative methods including questionnaires, scales, and comparative study, (2) the CiteSpace bibliometric tool software has been used for keyword co-occurrence and clustering analysis for the macro quantitative investigation of social mentality and health, from which 11 identified current research hotspots, namely social mentality, mechanism, college students, detection rate, social mentality, Chinese youth, under the new normal, leading, civilization entity, socialism, and Chinese characteristics, and future research trends of social mentality and health, are revealed. Subsequently, the studies in the CNKI database and WOS database, respectively, have been compared for micro qualitative analysis; and (3) in terms of research results, the current studies in the CNKI database mainly focus on the macro social environmental factors affecting social mentality, aspects to cultivate a healthy social mentality, namely culture, sports, public opinion, mental health, and SPPS, and population research, such as on young people , and ethnic minority areas and border areas, as well as soldiers, cadres, and laid-off workers, while the studies in the WOS database pay more attention to social mentality and health in the context of the COVID-19 epidemic situation and a variety of professions.In the future, it is necessary to use multidisciplinary research methods based on artificial intelligence and big data technology to comprehensively study social mentality and health from the macro and micro perspectives, and to make more accurate countermeasures, especially in the context of COVID-19, based on the need of SDG 3. In addition, the research on social mentality and health will continue to develop, and the application of art and the improvement of the SPPS will be the direction for investigation, based on which the diversified approaches to cultivate healthy social mentality could be explored in the post-pandemic era. In the research on a healthy social mentality and population, it is necessary to refine the study on the same group and the comparative study between different groups. Hence, future research could explore the influencing factors and cultivation methods for a healthy social mentality from the perspective of methodology and of achieving SDG 3, providing healthy lives and promoting well-being for all at all ages, and SDG 11, building sustainable cities and communities in the post-COVID-19 era, as well as the comparison and integration of social mentality between different countries with similar populations and contexts.However, the bibliometric method using quantitative analysis based on CiteSpace software in this paper relies on the CNKI and WOS databases. As such, the follow-up research could conduct quantitative analysis of multiple and multi-language databases, including Scopus and ScienceDirect, and explore a practice approach for social mentality to assist health in the context of COVID-19."}
{"text": "Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social impairment, restricted interests, and repetitive stereotyped behaviors. At present, its pathogenesis has not been fully understood. Various methods are used for clinical treatment and intervention, among which physical activity (PA) intervention also has an obvious effect. This study has used bibliometric methods and visual analysis methods to analyze 885 studies of PA intervention in ASD from 2003 to 2022 in the Web of Science (WoS) database in order to provide theoretical support for the follow-up research on the effect of PA with ASD. The main findings of this study are as follows. First, the literature on PA interventions in ASD research showed a growing trend. The leading institution in this field is the University of Delaware, forming a core group of authors represented by authors such as Sean Healy and Carol Curtin et al. Second, the research focus of this research area mainly includes PA interventions for children and adolescents with ASD. PA can improve symptoms such as stereotyped behaviors and motor function in patients with ASD as well as can reduce childhood obesity rates and improve quality of life. Third, skill, youth, prevalence, and meta-analysis systematic reviews were found. It is the long-term concern and focus of researchers. In conclusion, the current research is only a short-term analysis, and it is not possible to verify the long-term effect; thus, future data analysis should evaluate and explore the long-term effects of PA interventions on ASD including cohort and longitudinal study types focused on the rehabilitation of patients with ASD. Moreover, testing the sustainability of benefits for children with ASD and constructing a multidimensional exercise integrated intervention model are the main directions for future research in this field. Autism spectrum disorder (ASD) is a lifelong neurodevelopmental disorder that limits or impairs daily functioning characterized by social communication, social interaction disorders, narrow interests, and repetitive stereotypes  to brain structure and cognitive development in recent years  are a hot topic in the field of ASD research in recent years and believe that genetic information is an important research trend in the field of ASD research. Shekarro et al.  database. Understanding the structure, status, and future direction of the current PA intervention in ASD research will stimulate scholars to discover new problems and lay a further foundation for exploring intervention methods.The data in this study were derived from the core collection of WoS, an interdisciplinary comprehensive academic information database of the American Institute for Scientific Information (ISI), which were collected and screened through the WoS database. Based on the relevant prior studies . These brain programs have not only promoted the innovation of imaging technology but also enabled humans to overcome unresolved brain diseases, indirectly increasing the number of publications in the field of PA intervention in ASD research.The trend in publication volume shows that many researchers are gradually paying attention to the impact of PA on ASD. The reason for the increase in retrospective literature is largely related to the development and implementation of research measurement tools and research projects. In this study, although the rapid update of research measurement tools has made it difficult to track their specific time, the reason for the rapid increase in the number of studies since 2014 is closely related to brain programs implemented in countries around the world, such as the Human Brain Project (HBP), BRAIN Initiative, Brain/Minds Project, Brain Science and Brain-Like Intelligence Technology (China Brain Project), and other research projects oriented to tackling brain diseases. It has contributed to a significant increase in the amount, form, and latitude of data generated by new neuroscience instruments using imaging and activity recording, as well as an increased reliance on new technologies and analytical methods that utilize neuroscience data. For example, consider the HBP that aims to summarize the knowledge currently available to the human brain and gradually build models through supercomputers to simulate the human brain. The integration of neuroscience, medicine, and computer technology will enable humans to finally understand brain and brain diseases and offer new perspectives for future computers and robotics . Overall, the network size of the PA intervention in ASD research is small, the connection density is low, and most of the cooperation is mainly intra-regional cooperation. Consider, for example, the University of Delaware, the University of Florida, the University of Virginia, McMaster University, Oregon State University, and Texas Woman's University, there is a high density of intra-regional cooperation between universities in the United States. Similarly, the Chinese University of Hong Kong, the Education University of Hong Kong, Shenzhen University, and National Cheng Kung University in China have a high density of intra-regional cooperation at the core. After 2016, the overall density of the institutional cooperation network in the field of PA intervention increased, forming a large subnet, and the degree of cooperation was greatly improved, and cross-regional cooperation also appeared, such as a collaboration between the University of Toronto, Deakin University, University College London, McMaster University, and Yangzhou University. In addition, observing the overall high-frequency issuing agencies, Australia, North America, and Europe are more frequent, the remaining continents are small, and the cooperation density is also small. It can also be concluded that there is still a large space for cooperation between local institutions, and it is necessary to establish a more in-depth cooperative relationship of research institutions to promote the development of PA intervention in ASD research.By analyzing the author, the cooperative relationship with others could be investigated. We ran CiteSpace, generating networks as usual: 2003\u20132022; Slice length: 1 year; Select the node type: Author; Top N = 50; Selection Criteria Thresholding : 1, 1; and Choice: Pathfinder and Pruning the merged network, and other parameter settings were likely to institutions. This study found knowledge mapping of the co-author with N = 129 and E = 165 (density = 0.02). The higher the frequency of the occurrence of keywords, the higher the probability of the keyword appearing in the research field, then the direction involved in the keyword may be more concerned by scholars, and the more likely it is that it is a hot issue in research. Combined with keyword frequency, children, adolescents, exercise, intervention, and obesity were relatively high with frequencies over 100 times. It shows that these keywords are more concerned by scholars in this field, reflecting that the research direction related to these keywords is the core research content of the PA intervention in ASD research field, and the study finds that PA interventions and PA in children and adolescents with ASD improve symptoms such as stereotyped behavior and motor function in patients with ASD, as well as reducing childhood obesity rates and improving quality of life may be an important research direction in this field. In addition, inconsistencies in centrality and frequency were also found in this study, such as motor skill, prevalence, individual, participant disability, and other keywords with higher centrality but lower frequency. It reflects that although these research contents have an important bridging role in the research hotspots in this field, the degree of attention needs to be strengthened.The CiteSpace generated a network as usual: 2003\u20132022; Slice length: 1 year; Select the node type: Keyword; Top N = 10; and Pruning choice: Pathfinder, Pruning sliced networks, and Pruning the merged network. Given the co-occurrence of keywords, the nodes were revised, and the log-likelihood (LLR) algorithm was adopted for clustering calculation. The visualization map obtained in which N = 55 and E = 83 (density = 0.0559), the Modularity Q score was 0.7069, and the Mean Silhouette score was 0.7284, as presented in Clusters #0 high functioning autism and #2 autism: It is a high-functioning ASD group, as a class of disorders with higher IQ and function in ASD and milder autism symptoms; because it has obvious PA intervention effect, it is easier to integrate into the general population. It has become the preferred target for most researchers to carry out autism PA interventions (Kosari et al., Cluster #1 stereotypic movement disorder/therapy: Stereotyped behavior is a major feature of patients with ASD in all groups, manifested as aimless repetition of single actions, which seriously affects the acquisition of functional behaviors and social skills in patients with ASD, and easily leads to self-harm, emotional, and other problems. Interventions in stereotyped behavior are significant for the ASD research field. In this regard, scholars have conducted a series of studies on the effect of PA intervention on stereotyped behavior in patients with ASD based on brain imaging technology (Sorensen and Zarrett, Clusters #3 motor skill, #4 motor development, and #5 prevalence: The development of motor function in patients with ASD is highly correlated with their language, cognitive, and social development abilities. Studies have found that regardless of the IQ level of patients with ASD, there are a variety of motor function defects, including fine movements, coarse movements, postural control, imitation, or operation. Motor deficits limit social activity, affect the development of language, behavioral, and cognitive function in people with ASD, and increase ASD with long-term decreased levels of PA risk rates for overweight and obesity in patients (Healy et al., Cluster #6 cerebellum: From the perspective of the role of PA in promoting the development of the cerebellum in individuals with ASD, studies have shown that individuals need the participation of the cerebellum in the process of motor control and movement; in addition, the cerebellum can also help individuals obtain and identify sensory information and has the function of coordinating muscle movement and maintaining balance in the body (Desmond and Fiez, To obtain the research frontier and development trend of PA intervention on ASD, the strongest keywords cited in the literature were analyzed. Keyword burst refers to keywords appearing suddenly in a short period or which usage frequency increases sharply. Overall, it reveals the evolution of the Research Topic in different periods. In this study, 7 keywords highlighted by citations are obtained through analysis, as listed in de novo syndrome, intellectual disability, and other keywords with higher centrality but lower frequency. It reflects that although these research contents have an important bridging role in the research hotspots in this field, the degree of attention needs to be strengthened. During 2020 to 2022, sedentary behavior became a hot keyword. With the development of the society, the application of electronic products is more and more widely, greatly influenced people's life. The popularity of electronic products reduces the time of physical activity of children with ASD, and increases the sedentary behavior of children with ASD. Studies have shown that PA can significantly improve sedentary behavior in children with ASD (Thompson et al., According to This study systematically analyzed the research literature in the field of PA intervention in ASD from 1 January 2003 to 1 March 2022, using bibliometric analysis and visual analysis. The results are summarized as follows. First, the literature on PA interventions focused on ASD research shows a growing trend. It is speculated that the literature in this field will continue to grow for some time in future; in this field, the leading institution in this field is the University of Delaware; many authors have formed a network of collaborators in the field, such as Sean Healy and Carol Curtin. Second, the focus of this research area mainly includes PA interventions for children and adolescents with ASD and PA to improve symptoms such as stereotyped behaviors and motor function in patients with ASD as well as to reduce childhood obesity rates and improve quality of life of PA intervention in ASD. Third, the hotspot analysis of PA intervention in ASD research found skill, youth, prevalence, and meta-analysis systematic reviews. It is the long-term concern and focus of researchers.In summary, as the current research status is only of short term, it is not possible to verify the long-term effect. It is a future trend to explore the long-term effects of PA interventions on ASD and to bring the best rehabilitation means to patients with ASD. Moreover, with the rapid development and mature application of brain imaging technology, brain imaging technology has become an important means to explore the underlying neural mechanisms of ASD psychology and behavior and to reveal the structure and functional characteristics of the human brain. Using brain imaging technology to analyze the mechanism of PA intervention for ASD, conducting more studies to replicate and expand the existing findings, testing the sustainability of these benefits for children with autism, and constructing a multidimensional exercise integrated intervention model are the main directions of future research in this field.In this study, the CiteSpace software was used to analyze current studies on PA intervention in ASD. It provides some thinking for scholars in the field of ASD to have a comprehensive understanding of the characteristics, hotspots, and development trends of the current research field and to explore intervention methods. However, there are some limitations to this study. For example, CiteSpace cannot process documents in multiple databases at the same time, and only the documents in the WoS database can be processed. Moreover, the literature of research and analysis in the English language may cause the conclusion to service because of a lack of relevant literature materials. Therefore, future research should consider analyzing a variety of databases, and multiple languages, to increase research conclusions.The original contributions presented in the study are included in the article/AC and SW: conceptualization. SW and DC: methodology, writing\u2014original draft preparation, investigation, data curation, and visualization. SK, AC, and IY: writing\u2014review and editing. AC: funding acquisition. All authors have read and agreed to the published version of the manuscript.This research was funded by the National Natural Science Foundation of China [Grant number 31771243].The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "Cassady and Finch), Mental Health and Academic Performance , Coping Strategies and Self-Efficacy , Philosophical Inquiry and Students Engage in Learning (Leng), the Perception of Support in the Classroom and students' Motivation and Emotions , and the resilience and creativity .Current research in achievement emotions, as a topic in Educational Psychology, has meant a paradigm shift, broadening the research panorama to include different motivational-affective variables, going beyond the prevailing research paradigm with an exclusively cognitivism-based focus. It has therefore stimulated analysis and inquiry into different issues which had not formerly been analyzed with rigor. Six manuscripts have analyzed this problem, providing diverse evidence of the different relationships: Cognitive Test Anxiety, Motivation, and Self-Regulation Through Curvilinear Analyses , the preventing stress among undergraduate learners, and the importance of emotional intelligence, resilience, and emotion regulation (Thomas and Zolkoski), and the role of active coping in the relationship between learning burnout and sleep quality among college students .On the one hand, current research now addresses meta-motivational and meta-affective processes, through analyzing the effects of achievement emotions on classic cognitive processes of learning. On the other hand, this domain has helped point research into the role of individual differences in the achievement emotions experienced, based on how they relate to powerful, classic variables of personality and cognition. Three research reports have analyzed these relationships between some of them: the relationship with emotional problems and adaptation to the university, in cyberbullying , strategies for coping with academic stress , the factors and symptoms of academic Stress , the learning approaches, academic achievement, and satisfaction , and academic behavioral confidence and procrastination .Moreover, the analysis of achievement emotions is being contextualized within academic teaching-learning contexts, where these emotions are commonly produced, so that they can be assessed and improved. In addition, this research paradigm does not overlook the importance of explanatory, predictive models of students' wellbeing and their psychological health, given that the university context is highly predictive of academic stress. Six manuscripts have provided evidence regarding the relevance of the teaching-learning process in various variables, based on the In conclusion, in this Research Topic was presented theoretical and empirical-based studies, and evidence-based proposals. The submitted manuscripts aim to minimize university students' experience of stress and to promote their wellbeing and psychological/emotional health through psychological assessment and intervention.All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.This work was supported by R&D Project PGC2018-094672-B-I00, University of Navarra  and R&D Project UAL18 SEJ-DO31-A-FEDER, University of Almer\u00eda, Spain .The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "The 2019 coronavirus pandemic (COVID-19) has been very stressful, but more so for those with cancer. Patients with cancer experienced more pandemic-related stress and psychological distress than those without a cancer diagnosis. This case report, about a breast cancer patient, is presented in order to emphasize (1) the importance of the management of psychological care in oncology, (2) the need for a thorough understanding of the efficacy of the role of the psycho-oncologist and related interventions in a breast care unit for the health of both patients and professionals to improve clinical outcomes, and (3) the emerging health concerns of breast cancer patients in the context of the COVID-19 pandemic. Patients suffering from cancer reported experiencing significantly more stress linked to the COVID-19 pandemic as well as greater psychological symptoms compared to those without cancer [Local health services identify and prepare paths and spaces dedicated to the oncological patients;Healthcare professionals wear appropriate personal protective equipment;Identify specific strategies to already guarantee the diagnostic-therapeutic path initiated for patients in case of potential exposure of a cancer patient to subjects infected with SARS-CoV-2 [In relation to the reorganization of patients during the COVID-19 pandemic, it is useful to divide them into two groups: patients who have completed the therapeutic path (off-therapy) and those who are still being treated. In this case, the guidelines of the Ministry of Health state the following: During the COVID-19 period, cancer patients experienced clinically significant levels of psychological distress , pain, and insomnia ,4,5,6. IElevated distress levels of patients with cancer compared to the general population have been attributed to the diagnosis itself, which can be more or less serious, including treatments such as surgery, radiation therapy, chemotherapy, and hormone therapy, which are often destructive and harmful to patients\u2019 body image and cause disruptions in relationships and work as well as variation in their ability to cope with stress. Research has shown that, prior to the COVID-19 pandemic, about 30\u201340% of breast cancer patients suffered from depression, anxiety, or adjustment disorders ,10, and Therefore, it is critical to assess the psychological symptoms in patients suffering from cancer in order to mitigate symptoms and increase their quality of life. In the context of the COVID-19 pandemic, the goal of diagnosing and treating anxiety and depression is also to optimize the effects of medical treatments and adherence to medical regimens. The role of the psycho-oncologist is to support the cancer patient in accepting the disease, searching for psychological and existential meaning , and treSense of vulnerability;Sense of helplessness and physical suffering associated with COVID-19 that can cause generalized fear and anxiety;Sense of loneliness, increased by constraints on family members, with a possible reduction of adherence to therapy;Experience of dependence on therapies, with consequent fear of not receiving adequate treatment;Perception of responsibility for the risk of contagion;Fear of physical contact with health professionals.Patients and caregivers experience the following:Intensification of psychological distress, in particular, increased anxiety symptoms;Existential and psychological uncertainty, with consequent demoralization;Decrease in self-efficacy and confidence in one\u2019s coping strategies with the disease.Compared to cancer patients under treatment, a recent Italian study  reports Thus, there are a variety of psychological interventions available to help the patient to manage the therapeutic treatments as well as the psychological symptoms caused by cancer and its treatments .Furthermore, it is important to make consideration with respect to health professionals: COVID-19 also increased symptoms of anxiety, psychological distress, emotional burden, clinically significant depression, and a higher perceived risk of infection, leading to cognitive, emotional, and behavioral disturbances , for heaIt is fundamentally important to pursue the following objectives when intervening in the lives of patients with cancer: foster a recognition of one\u2019s own needs, help process trauma, help to rebuild body image, and shift attention to individual  and social resources ,19. MorePrevent and contain the fear of contagion, which can compromise the management of cancer treatments and patient adherence to them;Identify and manage the level of psychological distress and related symptoms experienced by patients and their family in this emergency situation;Promote the expression of emotions;Increase active coping strategies, self-efficacy/empowerment attitudes, and better adaptation to the situation;Support healthy lifestyles and precautionary behaviors;Provide correct information to patients and make known the support systems available.The purpose of this case report is to emphasize the importance and value added by psychologists in medical oncology care and, in particular, to describe the critical role of psychological interventions and support in typical breast care service during the COVID-19. Moreover, this psychological management has the following aims:Sofia (pseudonym) is a 40-year-old female who is married and has two children as well as a supportive family and social network. She has no personal or family history of psychiatric illnesses and had no other comorbid diseases. In November of 2019, she noted swelling and a sensation of heat in her left breast. Then in June of 2020, she felt focal thickening in the upper-external left quadrant. Shortly after that, in July of 2020, Sophia scheduled her first consultation at the Cancer Institute in Padova, at which time imaging showed the presence of a heteroplastic lesion in a large part of the upper-external quadrant. On her first visit to the oncologist in August 2020, the diagnosis was infiltrating breast cancer. The patient was in good general condition and concurred with the oncologist that treatment should be initiated. The treatment involves a series of chemotherapy cycles in association with hormonal therapy. As for the follow-up, the patient will also perform radiotherapy sessions. At the end of the treatment, for the purpose of prognosis, the oncologist will perform specific tests aimed at identifying the disease state.During adjuvant chemotherapy treatment, on the recommendation of the oncologist, Sofia asked for a psychological consultation. In January 2021, Sophia also had mastectomy and axillary lymphadenectomy surgery. The last operations were performed in September. Then Sofia underwent a mastectomy and status post six-cycle chemotherapy because of the presence of a tumor on her left breast.Our approach, as a strategic plan, was patient-centered: it was based on therapeutic strategies, on the evaluation of symptoms and side effects of therapies , on a coThe pattern of sessions included an initial intervention with the whole family and some only with Sophia. Cancer has the potential to transform the family system of the development of adaptive processes connected to the dynamic equilibrium of the patient-family-care team system. The disease breaks family homeostasis, and it is, therefore, possible to evaluate the oncological sickness not only as an individual\u2019s illness but also as a family disease. Distress, burden, and strain, related to cancer, are the main indicators of the psycho-social impacts on family members . It has been shown that there is an important reciprocity of emotional influence with the patient: when the latter presents a psychic disorder (anxiety or depression), the caregiver shows an increased risk of developing a similar emotional disorder ,26. Family support aims to promote adaptive coping, experiencing the disease event more positively in the family context; therefore, this maintains more positive coping from the patient .We have always proceeded towards the promotion of self-efficacy and empowerment strategies with the aim of encouraging active and functional coping methods for adaptation, improving future planning. In the first session, Sofia came to the psycho-oncology clinic with her family, husband, and children (a 13-year-old son and an 8-year-old daughter). The request she made was for family and individual support for the management of emotional experiences related to the illness and related treatments. The patient and the family members narrated their experience of the disease, from the moment of diagnosis to the current day, focusing on their emotional experiences over that period of time. Later, family support was conducted through telehealth sessions in order to process the relational dynamics and promote familial support and active coping strategies for managing the emotional experience. The following sessions were conducted with only Sophia, focusing on the management of the disease and her emotional reactions, particularly in the context of the COVID-19 pandemic. Thus, the therapeutic process included emotional (trauma) processing as well as building support for the patient by analyzing and fostering positive family dynamics and also promoting active, agentic coping strategies. Sophia presented psychological symptoms such as distress, depression, and anxiety related to the loss of a sense of control in the management of roles and self-image in the transformation of planning and short- and long-term aims. She also reported distress focused on fear and the trauma of the diagnosis. In this first phase of treatment, the defense expressed by Sofia was denial. She was conversant, but the clinician observed mood swings, emotional changes, and the absence of a positive attitude. Sofia reported significant physical symptoms, such as fatigue, weakness, fragility, insomnia, dyspnea, pain, and a lack of appetite. The patient appeared to be exhausted by the therapy process as she shared negative emotional experiences related to having cancer and concerns for her children. Sophia reported significant distress as a result of the COVID-19 pandemic situation, during which she experienced greater isolation even within the family, including isolation from her children at times to reduce the risk of COVID-19 infection. During this period of greater isolation, psychological support was important to sustain in therapy and in the family to help mitigate Sophia\u2019s tendency to focus on the feeling of emotional loneliness linked to the uncertainty of a global health emergency. Due to COVID-19, specific strategies were performed, such as relaxation techniques that are able to contribute to the management, control, and containment of physical and psychological symptoms. In fact, during some sessions, body mediation techniques were performed, such as autogenic training, for global therapeutic purposes . Schultz defines them as \u201ca series of rational physiological exercises, intended to put the body and the psyche at rest\u201d ,28  and well-being. Sofia began to adapt and maintain good psycho-emotional relaxation, supported by the coping strategies that gradually appeared during the psychological path. The outcomes of the psychotherapeutic treatments increased an adequate internal locus of control in the psychological adaptation to the oncological disease, favoring combative coping in the patient and promoting a proactive experience towards the disease, which was experienced as a challenge to be actively faced. The improvements due to the therapies allowed the patient to learn to have greater confidence and manage the discomforts related to the treatments, which are experienced with optimism and a better level of adaptation. The patient developed the skill of managing anxiety about the future and the fear of recurrence in an adjustment and functional way in the pandemic context.Neoplastic pathology can have profound repercussions on the psychological setting of the patient and her family, negatively affecting quality of life, adherence to medical care, the perception of side effects, the doctor\u2013patient relationship, and the duration of hospitalization and rehabilitation.The impact of cancer affects many dimensions of a person\u2019s existence: physical, psychological, social, and spiritual . One-thiDifferent scientific evidence indicates that people with serious or critical health conditions, including cancer, due to their immunosuppressive status, experience an increased risk of contagion to COVID-19 and any related complications .The condition of greater \u201cvulnerability\u201d establishes in patients an increase in psychological symptoms such as anxiety, anger, anguish, fear, and a sense of loneliness . Furthermore, the pandemic has created the need to combat the infection by imposing social distancing and numerous health restrictions that affect access to places of care and the regular use of oncological therapies ,35.This circumstance causes concern about treatment for their disease . PatientReturning to our clinical case, the cure and treatment of carcinoma are approached with a multidisciplinary approach with adequate attention to the physical, psychological, self-efficacy, and well-being of the patient as well as their own social network to increase the best adaptation strategies to the disease. Sofia, once she has overcome the initial shock of the disease, has to live with COVID-19, which bursts and complicates her therapeutic path, making it even more difficult to distance herself from her family and her social network: experiences of uncertainty and loneliness that arise and increase exponentially. The event of illness in a pandemic context requires an important path of adapting to the disease deriving from the COVID-19 pandemic, restoring psycho-physical balance and strengthening. Counseling represents the first step in taking care of patients and their families through an initial emotional, psychological, and cognitive assessment related to the management of the critical situation. This allows a first clinical picture of psycho-social needs and the level of psycho-emotional distress experienced, deepening the internal psychic resources and the presence of any internal coping methods related to the lived experience of the disease. The consultancy aims to capture, analyze, and elaborate doubts, perplexities, and expectations in order to promote adaptation by encouraging the integration of the disease event within the patient\u2019s personal life story ,36.Feeling depression, anxiety, and fear is very common, and it is a normal response to one\u2019s life-changing experience . People In the subsequent interviews, psycho-oncological support aims to deepen the existential meanings experienced and expressed by the patient and the family.The emotions of concern, fear, and disorientation are related to the diagnosis and the disease path. Patients may be afraid of uncontrolled pain and death, including what might happen to loved ones. It is important to share these feelings and fears.The importance of social support, even for the patient\u2019s family, is proof of this. In fact, it is observed that patients with greater social support tend to feel less anxious and depressed and report better quality of life, helping with cancer management.Depression and sickness cause great distress, impair functioning, and can even make the patient less able to follow the cancer treatment plan .During the treatment phase, the psycho-oncologist validates the patient\u2019s experience, elaborating emotional problems in order to bring out the appropriate coping modalities, which favor adjustment and adherence to the therapeutic path.During hospitalization, the psycho-oncologist has an important role in the pain, which impacts quality of life. The clinician encourages adequate management strategies and promotes communication between the patient and care team; this increases compliance and favors the treatment path\u2019s adherence .Each disease and treatment phase has internal and specific aspects. This opens up a new clinical context, accompanying patients through the path of care. The psycho-oncologist processes emotions, increasing communication with the family and supporting the patient\u2019s social network. Oncological patients often express feelings of despair, loss of meaning, uncertainty and helplessness, pessimism, and difficulty in adapting, which underline the presence of an affective state of demoralization. Consequently, psycho-oncological support is focused on the therapy\u2019s treatment of cancer-related symptoms , and it promotes adjustment linked to the specific disease stage. Sofia\u2019s case explicitly deals with hospitalization (inpatient) and the outpatient clinic.Finally, the role of the psychologist is also very important during the end-stage of the disease, where perspectives are based on a greater awareness of the personal relationship with life and death.In this phase, the clinician promotes the possibility of human and professional growth through the path of approaching the most intimate part of the personal meaning of life.Death education teaches patients to become more aware and sensitive companions to themselves and those around them on the difficult path of death. In this phase, the patient is invested with anxieties and questions that require sensitivity, attention, and even human competence. The psycho-oncologist endorses patients\u2019 disorientation, preparing the person for the prospect of \u201cletting go\u201d. This attitude is a very useful approach because it supports the person in the death process towards a peaceful welcome .Sofia\u2019s case demonstrates the experience of a traumatic event, such as cancer, during the pandemic, causing severe rejection, non-acceptance, and destabilization.Sofia\u2019s story illustrates the psychological, existential, and social complexity of the experience of a young breast oncological patient during the particular historical context of COVID-19. The findings of the present case report suggest that psychological support is essential at every stage of the disease on the path of care in order to relieve depressive symptoms and distress and strengthen coping strategies."}
{"text": "Cleft lip and palate can be treated as one of the most common craniofacial congenital malformations in humans. Such disease influences tens of millions of patients all over the world. Cleft lip and palate deformity affects many important physiological functions, including breathing, swallowing, speech, chewing, and aesthetics. This work focuses on investigating the morphology and airway volume of oropharynx patients with unilateral complete cleft lip and palate after palatopharyngeal closure. In addition, this work evaluated the similarities and differences between patients with cleft lip and palate and those without such an issue. The employed data, selected from the Department of Stomatology of Xuzhou First People's Hospital, are based on the conical beam CT images. The study sample was divided into two groups: the selected experimental group, who confronted the cleft lip, cleft palate, and velopharyngeal closure surgery, and the selected control group, who are healthy children at the corresponding age. The parameters, including the airway volume, the airway volume of velopharyngeal and oropharyngeal segments, the minimum cross-sectional area of the pharynx, the horizontal plane airway area of the hard palate and soft one, the horizontal airway area of the hyoid bone, and the vertical distance between the hard palate and soft palate, can be measured by Dolphin. These parameters were analyzed with a statistical approach. The analysis of the above-mentioned parameters reveals that the airway volume, the minimum cross-sectional area of the pharynx, the horizontal cross-sectional area of the hyoid, and the distance between the hard palate and soft palate tip in patients with complete unilateral cleft lip and palate show significant differences between the experimental group and the control group. Meanwhile, other parameters, including the horizontal cross-sectional area of the airway in the horizontal plane of the hard palate and the horizontal plane of the soft palate, did not show noticeable differences in the two groups. The patients, who confronted the unilateral complete cleft lip and palate, can improve with the velopharyngeal closure surgery. Furthermore, the length and vertical distance of the soft palate and the volume of each segment of the airway exhibit differences between the experimental group and the control group. Cleft lip and palate (CLP) is the most common congenital maxillofacial deformity, whose morbidity rate can reach more than 0.1%  , this kind of CT is the most promising and practical equipment in oral skull imaging equipment. This approach, which shows a high spatial resolution, has been widely utilized in the field of stomatology. The amount of radiation released by CBCT is very low, which is only equivalent to 1/30\u20131/40 of the traditional CT. CBCT has been extensively used in planting, teeth, orthodontics, orthognathic, periodontal, and other related issues. During the CBCT, all the patients should sit up straight. Their orbital ear planes should be parallel to the ground. The upper and lower dentitions of patients should be bitten in the median bite position. Moreover, these patients should keep quiet breathing without swallowing. All patients have been photographed using the same procedures and parameters. The whole CT images can be analyzed by Dolphin Imaging software, and the mark points were determined. The same doctors completed all the above-mentioned procedures. The measurement issues, including the airway volume and measurement plane of the oropharynx, airway volume segments and airway area at different levels, are demonstrated in During this work, the main measurement issues, including airway volume, airway volume of the palatopharyngeal segment, airway volume of the glossopharyngeal segment, minimum airway area, horizontal airway area of the hard palate, horizontal airway area of soft palate tip, horizontal airway area of the hyoid bone, and distance between the hard palate and soft palate tip, can be demonstrated. Considering these issues, the reconstruction of the airway is shown in p-value can be evaluated by the method of a significance test. When the p-value is lower than 0.05, the difference in error probability between the two groups is < 0.05. In this work, the SPSS 20.0 statistical software was employed to analyze the data of these patients  between the experimental group and the control group. The control group's measurements, including total airway volume, airway volume of the palatopharyngeal segment, and airway volume of the glossopharyngeal segment, were higher than the control ones. In addition, the control group's measurements, including the cross-sectional area, the minimum cross-sectional area of the airway, and the airway area at the tongue level, were significantly larger than in the experimental group. It was noted that there was no significant difference in the horizontal cross-sectional area of the hard palate and the horizontal cross-sectional area of the soft palate between the experimental and control groups. Therefore, the measurements, including the distance between the hard palate and the soft palate, are statistically significant between the two groups. The detailed information is presented in Hypothesis testing is an important concept in the field of statistics. Such issue is an important evidence to determine the original hypothesis is correct. The From Velopharyngeal closure means that when pronouncing non-nasal consonants, the soft palate is in contact with the posterior wall of the pharynx, separating the oropharynx from the nasopharynx, so as to facilitate normal pronunciation  the extension of the soft palate is still insufficient, and the distance from the hard palate to the tip of the soft palate is relatively short; (2) insufficient maxillary length and vertical growth deficiency due to the bone defects. Therefore, we expect to find an operation that can better extend the length of the soft palate, and increased orthodontic treatment in the growth and development of children can better promote the development of maxillary anterior and posterior, and vertical teeth.By measuring the shape and volume of the oropharyngeal airway, we found that the cross-sectional area of the horizontal airway in the cleft lip and palate group was significantly smaller than that in the control group, and the oropharyngeal volume was also significantly reduced, which was similar to previous efforts  and Xuzhou Science and Technology Plan Project (KC19142 and KC20117).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "The development of the times, the advancement of technology, and the innovation of the Internet have formed the soil for the growth of network literature and art. At present, there are still problems in the network literature and art, such as mixed fish and dragons, low quality, emphasis on entertainment, and weak responsibility, but its development is expected. Network literature and art is the product of the combination of literature and art and the development of science and technology. Meanwhile, network literature and art are an important part of social and economic development. It needs to seize the new opportunities of mobile digital technology to empower the creation, production, and dissemination of online literary and artistic works. Control the quality of online literature and art, guide its positive dissemination, and make it contribute to the prosperity of the entire Chinese literature and art. The development and prosperity of network literature and art is one of the most eye-catching cultural scenes in the new century. Especially in recent years, with the development of new media technology and the popularization of mobile digitalization, network literature and art have ushered in a broader space for development . Not onlIn 2014, General Secretary Xi Jinping pointed out at the Symposium on Literature and Art Work that Internet technology and new media have changed the form of literature and art. It gave birth to a large number of new types of literature and art and also brought profound changes in the concept of literature and art and the practice of literature and art . Due to Opinions on the Prosperity and Development of Socialist Literature and Art in October 2015, which for the first time clearly proposed to vigorously develop online literature and art. General Secretary Xi Jinping pointed out that \u201cCyberspace is the common spiritual home of hundreds of millions of people. Cyberspace is in line with the people's interests with clear sky and good ecology. Cyberspace is smoky and ecologically deteriorating, which is not in line with the interests of the people.\u201d In order to give full play to the leading role of socialist ideology, it is necessary to strengthen the active and correct guidance of network literature and art. Not only is it of great significance to purify cyberspace and make online literature and art better benefit the people, but it is also a new topic for building a socialist ideological discourse system in the new era [In order to do a good job in the construction of online literature and art, the Central Committee of the Communist Party of China issued the  new era \u20136.In 2018, at the National Propaganda and Ideological Work Conference, General Secretary Xi Jinping further emphasized that \u201cthe improvement of quality should be the lifeline of literary and artistic works, and more healthy and high-quality online literary and artistic works should be launched.\u201d As a new thing, online literature and art has been highly valued by the party and the state in recent years and has increasingly become the research focus of the academic circles .Therefore, actively research and judge the new changes, new characteristics and new trends of online literature and art in the new media field, accurately control the communication characteristics and laws of online literature and art, and actively and effectively regulate and guide it. It is of great significance for expanding and deepening the theoretical research of network literature and art, cultivating a good network literature and art ecology, and promoting the healthy development of network literature and art.At present, there are still big differences in theoretical understanding and evaluation of network literature and art. There is still no clear consensus on its conceptual analysis. Therefore, it is necessary to cut into the two categories of \u201cnetwork\u201d and \u201cliterature and art,\u201d respectively, and carry out an ontological interpretation of network literature and art from the aspects of connotation, extension, and characteristics.\u201cNetwork\u201d refers to the use of modern computer technology and physical electronic pulse technology. Through the mutual conversion between digital signals and electronic pulses, a virtual platform for information transmission, reception, and sharing is achieved. Using the network can connect any information terminal equipment that is openly associated with it to realize the sharing of information and resources among points, lines, surfaces, and bodies. With the introduction of electronic products such as computers, smartphones, and tablet computers into thousands of households, people can easily read words with the help of the Internet, and it is becoming more and more difficult to separate them.The concept of \u201cliterature and art\u201d is still controversial in the academic circles. One view holds that literature and art are collectively referred to as literature and art. Another point of view is that literature and art refer to literature, which is a parallel relationship with art . In 2011The main body of creation is based on the mass netizens. Although there are some traditional literary and artistic workers in the main body of online literature and art, the main source is still ordinary netizens with \u201cgrassroots.\u201d They come from different social classes, with different occupational backgrounds, and the number of groups is huge.The content of the works is expressed as \u201cmore than good.\u201d Compared with the orthodoxy of traditional literature and art, online literature and art tend to be more entertaining. Although there are many excellent works, under the influence of consumerism and market economy, the production of online literature and art is inevitably mixed with some vulgar and vulgar content, resulting in uneven quality of their works.The means of communication is digital media. Only when complex information such as words, pictures, images, and data in online literary and artistic works are transformed into digital models, and then into computer binary codes, can the dissemination process of works on the Internet be completed. This is the most essential difference between network literature and traditional literature and art.The audience is mainly the younger generation. Compared with traditional literature and art, which is \u201csuitable for all ages,\u201d the audience of online literature and art is mainly concentrated in the young generation of \u201cpost-80s\u201d and \u201cpost-90s.\u201d Among them, the number of readers of online literature alone is as high as more than 200 million, and most of them are young people. This makes online literature and art closely related to the daily life of young people, has a wide impact on their thoughts and behaviors, and is manifested as a \u201cfan\u201d culture.As a new style of literature and art, \u201cInternet literature and art\u201d refers to the collective name of various literature and art forms that are published and disseminated through network platforms after informatization processing. In terms of its extension, it not only covers new art forms created by netizens such as online animation, online performances, online dramas, micromovies, online music, talk shows, and jokes. It also includes networked works of traditional literature and art such as literature and drama, music, dance, art, calligraphy, photography, folk art, acrobatics, and film and television. Compared with traditional literature and art, network literature and art mainly have the following four characteristics:Network literature and art is a new type of art form that is generated and developed relying on network technology. As far as its \u201cconnotation\u201d is concerned, \u201cInternet literature and art is endowed with Internet artistic thinking under the influence and influence of Internet technology, new media, and social changes. It represents the life of the times and expresses modern experience and thoughts and feelings with new artistic production methods. In essence, it is mainly reflected in three aspects: Internet artistic thinking, new art production methods, and aesthetic art.From the perspective of the development of online literature and art, it mainly includes text-based online novels, online poems, video-based online dramas, online variety shows, online movies, online animations, online games, online performances, audio-based online music, and mobile phone value-added. In terms of development trend, it is mainly characterized by scale and industrialization, technologicalization and mobilization, and the integration and innovation of network literature and art and traditional literature and art.Data show that as of March 2020, the number of netizens in my country has reached 904 million, and the Internet penetration rate has reached 64.5%. Among them, the number of mobile Internet users reached 897 million, and the proportion of Internet users using mobile phones to access the Internet reached 99.3%. The proportion of using TV to surf the Internet was 32.0%. The proportions of using desktop computers, laptop computers and tablet computers to access the Internet were 42.7%, 35.1% and 29.0%, respectively [In terms of user scale and utilization rate, online literature and art have shown a dual trend of huge numbers and further growth. As of March 2020, the scale of online music users was nearly 635 million, accounting for 70.3% of the total netizens, and the scale of mobile phone users was nearly 633 million, accounting for 70.5% of mobile netizens. The scale of online literature users reached 455 million, accounting for 50.4% of the total netizens, and the scale of mobile phone users reached 453 million, accounting for 50.5% of the mobile netizens. The scale of online game users is nearly 532 million, accounting for 58.9% of the total netizens, and the scale of mobile phone users is nearly 529 million, accounting for 59.0%. The number of online video users reached 850 million, accounting for 94.1% of the total netizens, of which the number of short video users was 773 million, accounting for 85.6% of the total netizens. These data show that the huge number of users, diverse forms of expression, continuous growth scale, and positive development trends have created the basic style of online literature and art.From the perspective of industrial development, network literature and art not only enrich the social and cultural life of the public but also become an important part of the cultural industry and network economy in the new era.At present, the network literature and art industry has many subdivisions, forming the basic pattern of \u201cone superpower, many strong.\u201d Data in 2019 show that online games have occupied \u201chalf of the country\u201d in the online literature and art industry in terms of total volume, and its total output value of 133.96 billion yuan accounts for half of the entire industry scale. Online live streaming ranked second, reaching a scale of 64.92 billion yuan, which has surpassed the market size of Chinese cinema movies . The industries that have reached a scale of 10 billion yuan include online literature (15.73 billion yuan), online dramas (12 billion yuan), online animation (15 billion yuan), and short videos (14.01 billion yuan). The industrial scale of other online literature and art segments, including online variety shows (6.7 billion yuan), online movies (3 billion yuan), online music (6.26 billion yuan), and online audio (4 billion yuan), has also reached dozens billion scale.It can be said that many subfields have achieved large-scale and industrialized development. It should be noted that due to the \u201csavage growth\u201d of Internet literature and art . As a reThe overall promotion of digitization and networking is complementary to the personalized diversification of the emerging online literature and art market. This is of great significance for improving the supply capacity of network cultural products and services and improving the quality of cultural services. At the same time, it also promotes the healthy development of network literature and art.Benjamin believes that \u201cevery form of art has gone through a critical stage in its development history, and it can only be effective under the change of new technologies. In other words, it needs to rely on new forms of art to require breakthroughs.\u201d The advancement of technology promotes with the evolution of network art form and the development and change of art style. In the development of Internet literature and art, the trend of integration of Internet technology and art has become increasingly prominent. It promotes the continuous dissolution of the boundary between art and technology and affects people's artistic aesthetics and technology through the media and wider means and channels of the Internet.Online literature, online games, online movies, online short videos, and online animation are all based on new network technologies. Combined with the integration of artificial intelligence and other aspects across technical levels, rich works of art have been created. And in the blending of modern media and multiculturalism, a new artistic concept is constructed. For example, the use of special effects in online movies can bring the ultimate visual pleasure to the audience, and virtual reality (VR) technology has broken through the traditional art aesthetic method of \u201ccontemplation.\u201d By creating an immersive multidimensional dynamic sensory world, it extends the audience's senses and brings an \u201cimmersive\u201d aesthetic experience to the audience.With the popularization and wide application of smart large-screen mobile phones, the user scale and penetration rate of mobile network video, online music, online games, and online literature continue to grow . The mobIn recent years, the development forms of online literature and art have become increasingly rich, and at the same time, the integration and innovation with traditional forms of literature and art has also been deepened. Its remarkable performance is that with the improvement of quality, the distinction and boundary between online literary and artistic works and traditional literary and artistic works are increasingly blurred. Especially in the field of online audio-visual, excellent online variety shows, online dramas, and online movies are difficult to completely distinguish from TV variety shows, TV series, and cinema movies. Not only that the play mode of \u201cfrom network to station\u201d program interpenetration and location transfer further makes up for the differences and boundaries between the two.Looking at the production of online literature and art in recent years, on the one hand, mobile Internet communication with mobile phones as the main carrier occupies a dominant position. New forms of communication such as WeChat, Weibo, Weibo, Weibo, Internet TV, and digital newspapers and periodicals have become the main channels for the public to obtain information and relax and entertain.Network literature and art have different characteristics and laws from traditional literature and art because of the evolution of language and thinking. With its distinctive personality and innovative power, it has changed the pattern and trend of traditional literary and artistic creation and production and has increasingly radiated, driven, and even led in enriching practice. On the other hand, the advantages of historical resources and development experience of traditional literature and art cannot be ignored. The interaction, mutual influence, and mutual cooperation between online literature and art and traditional literature and art have become an important trend of media integration and have also profoundly changed the pattern of media and literature and art.Therefore, in the in-depth transformation of \u201cInternet\u2009+\u2009literature and art,\u201d on the one hand, the characteristics and advantages of traditional literature and art are further exerted, and at the same time, it is also reversed to learn from and absorb the new experience of network literature and art. On the other hand, in terms of development trends, if we say that the \u201ctransformation\u201d of online literature and art has already begun, the \u201cchange\u201d of traditional literature and art has been latently growing. Then, the fusion and innovation of the two is essentially the transition of aesthetic discourse from transition to transfer in the intersection of \u201ctradition and modernity.\u201d And make the new laws of literature and art precipitate and condense in the field of literature and art, and then move towards the process of \u201cnew normal\u201d and \u201cnew common name.\u201dUnder the background of the Internet, the network literature and art communication show remarkable characteristics such as the entertainment of the communication target, the diversification of the communication subject, the younger of the communication audience, the flattening of the communication content, and the digitization of the communication form.As we all know, the practice and exploration of online literature and art are carried out in the context of the prevalence of consumerism culture. From the perspective of the dissemination goal of online literature and art, the creators of online literature and art initially created with an entertainment attitude to meet the public's pleasure needs.In the context of the consumer society, the theme of art in online literature and art has become relaxed and casual. Art no longer undertakes serious missions of enlightenment, encouragement, and criticism, but like a string of beautiful and ugly bubbles appearing rapidly, but broken again in an instant. This is an era of loud noises. Although the spirit of enlightenment, encouragement and criticism is no longer serious, the expression of ideas through works of art is still popular. It is just that this expression often takes on a strong, uncondensed emotional tone.Therefore, to satisfy people's leisure and relaxation spirit as the main purpose, to entertain themselves and share entertainment as the goal, and to promote and realize the flow of capital logic for the purpose of consumerism is wrapped in it. Behind this consumerist approach is the advent of the era of national entertainment, and the cultural concepts of \u201centertainment until death\u201d and \u201chappy is good\u201d are rampant. People's pursuit of daily spiritual life and the improvement of spiritual quality make online literature and art meet people's inner needs. As a result, it becomes people's way of life, way of life and communication, and shapes the world in which people live. Changes and even subverts the experience history, thinking logic and aesthetic concepts handed down in people's daily life and traditional society.With the prosperity of consumerism and entertainmentism, the development of online literature and art gradually tends to be \u201cfashionable, commercialized, and profitable.\u201d The phenomenon of \u201cdemoralization, dehistoricalization, and devaluation\u201d in the process of online literature and art dissemination has attracted people's attention.At present, the main body of online literature and art communication consists of four types: UGC (User Generated Content), PGC , PUGC , and OGC . UGC is the most common dissemination subject. Weibo, live broadcast, Douban, and forums can all be regarded as UGC.Xiao Shuo and Wu Xiaobo's Wu Xiaobo Channel.With the opening of various network platforms to users, users upload and share content, which further promotes the development of UGC. PGC is a communication subject that is developing rapidly at present. For example, Youku, Tencent, iQiyi, and Himalaya all focus on professional content production. Through a professional content production team, a unified standard and normative form can be established, so as to ensure the quality of the content and satisfy the user's good experience. PUGC is a new model which is a fusion of UGC and PGC. Generally, it is a platform organization such as a studio or company that produces professional content. Well-known celebrities in the industry generally adopt this model, such as Gao Xiaosong's OGC is based on some specific content such as news hotspots, financial comments, artistic aesthetics, and works appreciation. This is a form of content production created by a group of experts to meet the needs of a specific group. From the development history of major video websites, we can see that their communication subjects are increasingly diversified.Taking Bilibili as an example, the early Bilibili was mainly based on user-uploaded videos, which contained a lot of UGC content. For example, secondary creations such as mixed cutting of original works, and with the transformation of the website ecology, a large number of professional institutions have settled in Bilibili, and PGC content is increasing day by day. In recent years, Bilibili has grown into a website with a high viscosity community culture and user increment with the help of PUGC content. In addition, NetEase Cloud Music integrates UGC, PGC, and PUGC modes. On its APP, there are not only the works of independent singer-songwriters but also the singings of singers from major music companies, as well as songs by fans and other music enthusiasts.These all indicate that the main body of communication of network literature and art presents the characteristics of diversification. Inject new vitality into the production and development of online literature and art. It also brings many problems such as plagiarism of works, the proliferation of piracy and the protection of literary and artistic copyrights and rights protection, which need attention and effective management.Data show that as of March 2020, my country's netizens are still dominated by young people. The 20- to 39-year-old group accounted for 52.3% of the total netizens, and the 20 to 29-year-old group accounted for the highest proportion, reaching 21.5%. Young people are the main audience of online literature and art. Therefore, the content, subject matter, form of expression, language structure, ideological concept, and spiritual expression of online literary and artistic works all need to grasp the psychology of young audiences and are more in line with the tastes and needs of young people and online generations . At the Different online literature and art communication platforms have different audience groups. The core users of Bilibili are two-dimensional animation enthusiasts and radiate the majority of young people. Douban's audience is mainly literary youth. Kuaishou and Douyin also have fixed audiences. These users show the characteristics of \u201cnet generation,\u201d the virtual cyberspace is their common memory of growth, and the social attributes between users also show a certain virtuality.Bilili's partitions show differences in their communities, and each individual user may have attributes of different communities at the same time. Fan opera area, game area, entertainment area, and film and television area have gathered a large number of fans. They communicate and communicate through various methods such as \u201cbarrage\u201d and text comments, showing a certain degree of sociality. The fans of each community have a certain amount of expertise in the community's field, as well as a deep understanding of the subcultural terminology and social principles of their group.From this perspective, the audience of online literature and art is increasingly showing the characteristics of community and circle. These characteristics, in turn, guide the main body of online literature and art to fully consider the desires, interests, and preferences of the audience, especially young people, when carrying out literature and art production and dissemination . It may Online literature and art in the form of online music, online TV, online movies, online games, and online short videos enable interpersonal \u201ccommunication\u201d to easily transcend the walls of time, space, and even power and class and achieve \u201ceveryone to everyone.\u201d In terms of dissemination content, it basically shows the characteristics of flat, perceptual, and daily life. In recent years, \u201cshort videos\u201d such as Douyin, Kuaishou, and Volcano have sprung up as short video programs or \u201cminiaturized\u201d light variety shows. The short video is 15 seconds to 3 minutes in length, short and concise, fast-paced, strong in social networking, and highly topical. Coupled with the vertical subdivision of themes, it is deeply welcomed by young users and respected by major platforms.This \u201csimple and fast\u201d communication method also meets the needs of people's daily entertainment. The dissemination content presents the characteristics of flat and intuitive, classified presentation, massive time-sharing, personalized customization, precise orientation, and unlimited links to similar works. In essence, it reflects the characteristics of daily life narrative, realistic narrative, individualized narrative, and liberalized narrative. This dissemination of content that focuses on flat, perceptual, real-time, and life-like content makes people gradually adapt and get used to replacing text reading by electronic reading pictures. Sound, color, light, and shadow replace understanding and imagination, and visual pleasure melts rational thinking, resulting in the phenomenon of subject dissolution or sinking , 14.Since the new era, online literature and art have paid more attention to the three-dimensional effect, emphasizing emotional rendering and atmosphere creation, striving to achieve a whole-hearted immersive experience, and do their best to provide audio-visual entertainment. Especially driven by digital imaging technology, network hypertext technology, and multimedia technology, the production of network literature and art increasingly relies on digital \u201csimulacrum.\u201d Digitization, audio-visualization, simulacra, and intellectualization have become the dominant trends in contemporary online literature and art dissemination. Digital new technologies such as virtual reality (VR), augmented reality (AR), and cloud gaming platforms are gradually entering the homes of ordinary people. Their large-scale popularization has played a role in promoting the dissemination of literary and artistic works.The application of new technologies such as artificial intelligence, big data, cloud computing, and blockchain has greatly freed the communication of literature and art from the constraints of time and space. To further enrich personal aesthetic experience, the forms of online literature and art communication are also more diverse. The popularization of 5G networks in the future will bring the speed of information dissemination to a new level. Its application will expand the breadth and depth of network communication channels and make online communication of high quality, high-quality audiovisual works a reality. It also enables the realization of a cross-time, cross-regional art appreciation mode, and you can use 5G networks and VR equipment to visit art galleries and museums at home .The large-scale application of new technologies, new equipment and new media will diversify the forms of online literature and art dissemination. The rich communication channels will also continuously improve the viewing experience of users and meet the needs of different types of cultural consumption.It should be noted that the digital production and dissemination of online literature and art has also made contemporary spiritual culture sharply inclined to focus on feelings, desires, and bodies. Replacing humanistic connotation and aesthetic inner discipline with technicalism is likely to lead to the disappearance of literary and artistic nature. The proliferation of virtual images and the origin of information worship will lead to the degradation of aesthetic experience and the passivation of aesthetic rationality. As a result, the liberating power of technology has been alienated into the shackles of the development of network literature and art.Through the current creation and dissemination of new experiences, new features, and new trends, we can see the rapid development of network literature and art. On the one hand, the rapid development of online literature and art shows the great power and vitality of \u201cInternet +.\u201d At the same time, it also has a profound impact on people's daily life, aesthetic taste, cultural psychology, values, as well as the fashion of the times, ideology, and social development , 16. On The problem of copyright protection of online literature and art is prominent, and the fast-food, flat, and superficialization of online literature and art consumption has gradually become a trend. The economic and social benefits of Internet literature and art dissemination are separated from each other, the technologicalization of Internet literature and art development has eliminated the human nature of literature and art, and so on. All these require us to face up to the cultural guidance and management norms of network literature and art, improve the network literature and art governance system, purify the network literature and art ecology, and promote the healthy development of network literature and art.\u201cKeeping the righteousness\u201d is the basis for the creation and production of online literature and art. This includes two main aspects: adhering to the development direction of socialist literature and art with Chinese characteristics and following the laws of network literature and art development. From the perspective of the former, socialism with Chinese characteristics is the institutional soil for the survival of the majority of the people. The socialist core values are closely related to the people's living conditions and spiritual aspirations. It reflects the basic moral ideals and value orientations that people should uphold when integrating into social life.Adhering to the development direction of socialist literature and art with Chinese characteristics requires that online literature and art must strictly distinguish the boundaries between popular and vulgar, vulgar, and vulgar, and online literature and art should not become synonymous with \u201cthree vulgar\u201d cultures . It cann\u201cInnovation\u201d is based on a firm and correct political orientation and value orientation. Actively promote the innovation of the concept, content, and form of online literature and art, so that the production of online literature and art can closely follow the pulse of the times, be close to real life, and reflect the spirit of the times. Face up to the entertainment, flat, diversified, youthful, digital, and other characteristics of online literature and art communication. Give full play to the features and advantages of new media in terms of interactivity, mobility, and immediacy. Innovate the theme discovery, narrative paradigm and artistic skills of online literature and art, and develop and innovate in related fields such as technology, industry, and communication.Pay special attention to the large number of young audiences, and carry out artistic innovation according to their youthful, socialized and personalized characteristics. Create a youth culture in the new era and make young people the pioneers of the progress of the times. Teenagers are not only the inheritors of China's excellent traditional culture but also the ones responsible for the great rejuvenation of the Chinese nation.Administrative Measures for Internet Information Services as the basic regulations and special management measures for online audio-visual, online publishing, online literature, online live broadcast, and online games as the main content.The report of the 19th National Congress of the Communist Party of China pointed out that it is necessary to \u201cstrengthen the construction of Internet content, establish a comprehensive network governance system, and create a clear and clear cyberspace.\u201d In recent years, in response to many chaos and problems in the field of online literature and art, relevant departments have promoted the application of traditional laws to the Internet and established special legislation in the Internet field. A multilayer law-based Internet governance system has been established, with the Laws such as the Cybersecurity Law, the Film Industry Promotion Law, and the Criminal Law Amendment (IX) have been passed, and the Measures for the Administration of the Internet and Other Information Network Dissemination of Audio-Visual Programs, the Regulations on the Administration of Internet Audio-Visual Program Services, and the Internet Provisions on the Administration of Publishing Services, \u201cInterim Measures for the Administration of Internet Advertisements,\u201d \u201cRegulations on the Administration of Internet Live Streaming Services,\u201d \u201cNotice on Strengthening the Copyright Management of Online Literary Works,\u201d \u201cRegulations on the Administration of Internet Forum Community Services.\u201d It provides an institutional guarantee for correcting the ecological imbalance and chaos of online literature and art, creating a clean and positive cyberspace, and promoting the healthy development of online literature and art.Notice on Further Strengthening the Planning and Management of Original Audio-Visual Programs on the Internet. In response to the problems of too many film and television stars, star chasing, pan-entertainment, high-priced film remuneration, and fraud in ratings (click-through rate) in some literary and artistic programs, it is emphasized that we must firmly grasp the correct political direction and strengthen value guidance. Adhere to the people-centered creative orientation and resolutely curb bad tendencies such as star chasing and star speculation and pan-entertainment. Encourage high-quality content to win, constantly innovate program forms, and strictly control the remuneration of guests. Strengthen the governance of TV dramas and online dramas (including online movies) to promote the sound development of the industry. Strengthen the use and management of ratings (click-through rate) survey data, and resolutely crack down on the fraudulent behavior of ratings (click-through rate).In 2016, the State Administration of Press, Publication, Radio, Film and Television issued the Notice on Further Strengthening the Management of the Creation and Broadcasting of Online Audio-Visual Programs, putting forward further requirements for the creation and broadcasting of online audio-visual programs. The notice pointed out that all kinds of online audio-visual programs must adhere to the aesthetic bottom line of civilization and health. Entertainment reports must respect morality and art and must not use the hype of scandals and privacy scandals as gimmicks to gain click-through rates.In 2017, the State Administration of Press, Publication, Radio, Film and Television issued the Online variety shows, online dramas, and online movies must resolutely oppose unhealthy trends such as sky-high star chasing, boring games, and luxurious feasts and avoid promoting the game life mentality and exaggeration . In addiIt is worth noting that for network platforms and operators, supervision measures still need to be further improved. For example, user identity verification is enabled for short video platforms, and content is selectively displayed to minors. The online platform is obliged to review and deal with online works and punish those works that are shoddy for rubbing hot spots and IP, works with vulgar and vulgar content, and works that spread obscenity, pornography, bloody violence. Effectively restrict minors' access to online games to prevent teenagers from indulging in online games.In March 2019, General Secretary Xi Jinping pointed out: \u201cA country and a nation cannot be without a soul. Culture, literature and art, philosophy and social sciences belong to Bacon's soul-building work, occupying a very important position in the overall work of the party and the country, and insist on and develop Chinese characteristics in the new era. It plays a very important role in socialism.\u201d In the era of all media, establishing the awareness of \u201cquality is king\u201d and promoting the quality of online literature and art production is the only way for the development, transformation and upgrading of online literature and art, and it is also the meaning of the title of realizing the function of \u201cbacon casting the soul\u201d of online literature and art.The connotation of \u201chigh-quality products\u201d of online literature and art includes two levels. One is the boutique in the sense of \u201cproduct.\u201d At the \u201cproduct\u201d level, quality means the intensive cultivation of online literature and art in terms of production, dissemination, and service. For example, in terms of production, the industrialized production process of online literature and art has become increasingly clear, the division of labor has become increasingly refined, and the application of technical means has become increasingly mature. This is the basic guarantee for the production of high-quality products. In terms of dissemination and service, accurate dissemination of literary and artistic works, finding suitable audiences, meeting the spiritual needs of audiences, and providing good postservice services are all elements and awareness of online literary and artistic works. The second is the fine product in the sense of \u201cwork.\u201d At the level of \u201cwork,\u201d quality means the improvement of online literature and art in terms of content and value.High-quality content is the decisive factor for the sustainable development of the online literature and art industry. Therefore, online literature and art should reflect the life of the times, demonstrate the spirit of the times, take truth, and tell Chinese stories. As emphasized in the report of the 19th National Congress of the Communist Party of China, \u201cto prosper literary and artistic creation, adhere to the unity of profound thinking, exquisite art, and excellent production, strengthen the creation of realistic themes, and constantly launch masterpieces that praise the party, the motherland, the people, and the heroes.In terms of value goals, the development of online literature and art should take \u201cBacon casts the soul\u201d as its value appeal. Consolidate hundreds of millions of netizens with Xi Jinping Thought on Socialism with Chinese Characteristics for a New Era and actively cultivate and practice socialist core values.In terms of formal requirements, online literature and art must not only be \u201cdown-to-earth\u201d but also \u201cpopular.\u201d \u201cGrounding Qi\u201d means to truly express the feelings, thoughts, hopes, and wishes of the people living on our land. \u201cGathering popularity\u201d means that the form is popular, and it should warm people, infect people, educate people, unite people, inspire people, carry forward the truth, goodness and beauty, and transmit positive energy.In the context of the continuous development of digital, intelligent and networked emerging technologies, it has had a profound impact on the creation and dissemination of online literature and art. But at the same time, we should keep in mind that culture is the foundation of the lasting innovation and development of network literature and art. Network literature and art should grasp the laws of digital and new media communication development and build a comprehensive and three-dimensional Chinese-style strategic communication system. In order to meet the spiritual and cultural needs of the people and the mission of spreading Chinese culture to the outside world, we will continue to create high-quality, high-standard masterpieces that can stand the test of the international market and the test of people around the world."}
{"text": "With the ongoing expansion of tourism, a conflict has arisen between economic growth in the tourism industry and environmental preservation, which has attracted the interest of government and academic groups. Because it enables the adaption of tourist activities and buildings in the tourism area in order to protect the natural resources of the scenic area while seeking economies of scale, the tourism environmental carrying capacity system is an essential tool for resolving this conundrum. It also enables tourist sites to grow sustainably while understanding their limitations and carrying capacity. This study uses Citespace 6.1.2 and VOSviewer 1.6.18 analysis software to conduct a bibliometric analysis and review of 297 articles on tourism environmental carrying capacity. This analysis includes early warning studies, assessment models and management tools, and analyses of keyword co-occurrence and emergent word co-occurrence. The article\u2019s conclusion makes recommendations for further research, including the division of each interest group, improved dynamic forecast and early warning of tourism environmental carrying capacity, and the development of an objective, scientific model of tourism carrying capacity. The effects of tourism have been more and more prominent in conversations and studies about development during the last few decades. The tourism industry has a huge potential to spur economic development in destinations. However, its expanding effects have resulted in a number of current and potential issues, as well as environmental, social, cultural, economic, and political problems in destinations and systems that call for alternative, more environmentally and destination country-friendly approaches to development, planning, and policy. In the early stages of tourism growth, there is a far more supply of newly created destination regions\u2019 resources, facilities, etc., compared to the demand from travelers, who can make use of the destination\u2019s many tourism resources and surroundings. While the growth of tourist destinations, commercial advertising, word-of-mouth marketing, and other methods to increase the popularity of the destination, its development into an upward stage, followed by a significant influx of tourists, although during this period, the destination will also strengthen the corresponding supporting facilities and improve the upgrade, etc., the supply measurement end of the increase may be significantly less than the demand side. Additionally, some tourists\u2019 moral character may lead them to litter, paint on the walls, destroy display cabinets and signage, and other actions that are not suited to the development of tourism sustainably, such as the depletion of resources, pollution of the environment, damage to facilities, and customer dissatisfaction. The measurement of tourism environmental carrying capacity (TECC) is a potent tool to achieve this goal and will be crucial in scenic areas and tourist destinations. Thus, it is vital to increase the control and dynamic monitoring of the destination.Our Common Future was adopted and subsequently published, pointing out the importance of sustainable development for the common destiny and common future of humankind and the concept of sustainable development was then introduced into tourism research and policy [Journal of Sustainable Tourism, which now has an impact factor of 9.37.The TECC, initially known as tourism volume, refers to the threshold of the intensity of tourism activities that the natural, economic, and social systems of a tourism destination can withstand, and it is essentially a comprehensive reflection of the structural characteristics of the tourism environment system. In 1964, American scholar J. Alan Wagar published his academic monograph \u201cCarrying Capacity of Wildlands for Recreation\u201d ; then, sd policy , and susAt the UN Sustainable Development Summit held in New York on 25 September 2015, the 193 member states of the United Nations formally adopted 17 Sustainable Development Goals (SDGs), abbreviated as SDGs . The SDGThe TECC has been the subject of numerous theoretical and empirical studies , but theIn this study, the Mapping Knowledge Domain (MKD) was used  to analyAs a cutting-edge method in the field of scientometric analysis technology, knowledge domain mapping combines the theories and methods of applied mathematics, information science, computer science and graphics with the methods of co-citation analysis and co-occurrence analysis in bibliometrics, using knowledge mapping to demonstrate the core structure, development history, frontier areas and knowledge framework of the discipline. It solves the problems of traditional literature research methods, such as difficult data screening and heavy workload and has the advantages of being scientific, comprehensive, standardized, accurate and simple . In thishttp://www.scopus.com, accessed on 10 September 2022), which now uniquely combines a comprehensive, expertly curated abstract and citation database with enriched data and linked scholarly literature across a wide variety of disciplines. In Scopus, scholars can quickly find relevant and authoritative research, identifies experts, and get access to reliable data, metrics, and analytical tools. Boasting the largest pool of author profiles available (17 million and counting), Scopus easily outmatches the competition [Scopus is a multidisciplinary abstract-indexed database launched by Elsevier  in 2005 petition . It is opetition .First, in order to obtain as much relevant literature as possible, \u201cTourism Carrying Capacity\u201d, \u201cTECC\u201d, and \u201cTCC\u201d were used as keywords in the \u201cTopic\u201d of the literature search, including title, abstract, and keywords; second, the time span was set to \u201c1982\u20132022\u201d, and then the search code was set to  and Language: (English) and Time range: (1982\u20132022). The search was conducted on 25 July 2022, and the database was last updated on 5 August 2022. A total of 862 results were collected and carefully checked . In the first round of screening, monographs, conference proceedings, and book reprints were excluded, and only journal articles and reviews in English-language were collected, as these are generally considered more influential and reputable than the formers. In the second screening round, results that did not involve tourism, travel, or leisure studies and were not related to environmental carrying capacity were excluded from this study. Finally, 297 valid re-study results were retained as the literature sample.To address the objectives of this study, the article uses analysis methods such as keyword co-occurrence and bursty analysis and analyzes the volume of publications and journal trends.Co-word analysis uses the co-occurrence of word pairs or noun phrases in a collection of literature to determine the relationship between topics in the discipline represented by that collection. Keywords are the core summary of a paper, and analysis of keywords in a paper can provide a glimpse into the topic of the paper . SeveralBursty words are keywords with low frequency but increasing growth momentum . This inCiteSpace and VOSviewer software can be used to analyze a large number of keywords for co-occurrence and burst detection and to identify hot spots and trends in a scientific field more objectively and effectively.The network construction in CiteSpace is based on time slice. In this study, the unit of the time slice is set to 5 years . Note types are selected as Author, Institution, Keyword and Reference for analysis. The network construction in VOSviewer is based on the whole, and in this study, the Type of analysis selects Co-occurrence and Bibliographic coupling, respectively, and the Unit of analysis selects All Keywords and Sources, respectively.Our Common Future at the 8th World Commission on Environment and Development in Tokyo, Japan, the concept of sustainable development was introduced into tourism research and policy at this point, and the theme of TECC received significant attention. Along with environmental issues or overload issues in some tourist destinations, etc., many empirical studies of TECC were conducted at this time. The third stage is the booming stage from 2015 to the present, with the official adoption of 17 Sustainable Development Goals (SDGs) at the United Nations Sustainable Development Summit held in New York in 2015; as all sectors pursue SDGs, researchers also work toward sustainable development, and since the travel and the tourist industry is a key component, sustainable tourism development has become a hot topic. They tend to focus on projects that are relevant to the TECC. The number of articles published has reached a peak in the last two years. Conceptual studies, assessment model studies, management tools, and early warning studies, as well as empirical studies on the TECC of various types of destinations, have been flourishing and appearing in various journals.The annual distribution of literature is a mapping of the quantity of literature in the time dimension. It is a quantitative basis for understanding the research progress and classifying the research stages and can reflect the development level of TECC research to a certain extent. As is shown in From the results of the keyword co-occurrence analysis presented in As a complement to the keyword co-occurrence analysis, the bursty word analysis demonstrates how the study hotspots for TECC have changed over time .. Since Neo-Malthusianism gave rise to the idea of TECC, which later developed into a comprehensive system that includes physical capacity, tourist thresholds, growth management estimates, etc. Numerous research on the environmental impact of tourism has been conducted, but their development has not been systematically sorted out. Various assessment models have been developed from the first descriptive and straightforward data used in these studies. However, it is debatable if various models can adapt to various settings and circumstances. Additionally, there are multiple kinds of tourist destinations, and these destinations exhibit different characteristics and experience varying degrees of overload issues. In order to address these issues and support the tourism destinations\u2019 sustainable development, management tools and early warning systems must be used. As a result, the conceptual analysis of the TECC, the study of assessment models, the empirical analysis of categorized destinations, and the analysis of management tools and early warning systems constitute the four main components of this chapter\u2019s literature review. According to these four results, we further conclude 4 characteristics of current research and put forward 4 prospects regarding the future research agenda.Carrying Capacity of Wildlands for Recreation. He argues that recreation capacity is the amount of recreation used in a recreation area that can sustain tourism quality over time. Research on tourist capacity has developed since Wagar. The term tourism capacity was formally introduced by the World Tourism Organization in its work report in 1978\u20131979, marking the beginning of tourism capacity into the scope of international research. Hovinen (1982) [The concept of recreational carrying capacity evolved from a neo-Malthusian perspective of resource limitation. The concept of carrying capacity was originally developed in the field of range and wildlife management, based on the notion that organisms can only survive within a limited range of physical conditions, i.e., \u201cthe availability of suitable living conditions determines the number of organisms that can exist in the environment\u201d , the pron (1982)  defined n (1982)  defined n (1982)  describen (1982)  also poin (1982) , in discn (1982) , on the n (1982)  proposedn (1982)  argued tn (1982)  pointed n (1982)  conducten (1982)  determinIn the early studies of TECC, scholars mostly used descriptive and simple statistical methods. However, with the development of tourism, science and technology, these methods have become outdated. Currently, there are two types of TECC prediction: quantitative studies and qualitative studies, of which the former is the most commonly used research method. Han  establisIn the empirical study of TECC-categorized destinations, it presents a shift from initially fragmented point-like to tourist routes and county-based tourist destinations, etc., from point to line and surface, and the research scope coexists with micro-scale, mesoscale and macro-scale. Scholars have explored TECC based on different theoretical perspectives, including DEPSIR , PSR 7070 and EEWhile foreign scholars call for national laws to guarantee the role of management tools, domestic scholars place more emphasis on improvement-oriented management initiatives in tourism destinations. Common management tools include the limits of acceptable change (LAC) , visitorThe research on TECC early warning system is in the preliminary exploration stage, and current research mostly focuses on wetland parks , marine From the current research results, the study of TECC generally presents the following characteristics: (1) The differentiation of conceptual research. The scholars have different interpretations regarding the concept of TECC and make its research content very different, including but not limited to the measurement of the natural environment, resource space, social-economic, cultural and psychological aspects, but reach a consensus on its purpose, including promoting the sustainable development of the destination and enhancing the satisfaction of tourists and residents. (2) Continuous enrichment of assessment models and deepening of research methods. Assessment models have shifted from qualitative descriptions and simple statistical methods to modeling analysis and related methods, including non-causal time series models, causal relationship models, artificial intelligence models and combination models, and quantitative measurements with BP neural networks, fuzzy hierarchical analysis, set-pair analysis, input-output analysis and area method, etc., and research results have become more objective and reasonable. (3) Gradual expansion of research scale. The initial empirical research of TECC focused on some micro-regions such as Colorado Grand Canyon National Park , Red SeaBased on the characteristics summarized in the above discussion, this paper puts forward the following outlook for the subsequent research on TECC: (1) strengthen the growth management and optimal decision target research of TECC. TECC is a complex system, and it being measured based on different dimensions shows that natural resources, economic and social, cultural and psychological subsystems are all factors involved in TECC, and future research should focus on the dynamic evolution of TECC and can simulate and predict TECC through the neural network, machine learning and other methods to reduce the measurement model in subjective factors to achieve the goal of optimal dynamic decision-making. In addition, it is necessary to adjust according to the empirical object and carrying capacity management objectives and combine the relevant theories of sociology, psychology and economics to build a scientific and objective TECC model. Secondly, subdividing each stakeholder and conducting comparative research according to the needs of each stakeholder can be done with the help of coupling theory in order to achieve balance or maximize the comprehensive benefits of each interest subject. (2) Combined with the software of related disciplines for comprehensive analysis. TECC involves ecology, environmental science, geography and sociology and other disciplines, and the existing research only focuses on the use of a discipline of software for a single aspect of the measurement, which weakens the overall systemic TECC. Subsequent research can focus on integrated software such as Ansys Fluent, ENVI and ArcGIS for simulation prediction, forward inversion and spatial analysis to scientifically study the overall system of TECC. (3) Focus on the expansion of TECC research. Although the research on the TECC of various types of destinations is rich, the articles are almost all based on the characteristics of the destination for adaptive quantitative research. The corresponding comparative research is relatively small, and its extension and expansion are weak, weakening the systemic nature of TECC theme research. Future research should take into account the extended adaptive range of TECC while focusing on the ontological self-adaptation of case sites, which will make the research more theoretical and practically meaningful. (4) Research on succession management tools and early warning systems. In terms of time series, the existing research is increasingly inclined to find some reasonable and effective capacity management tools on the basis of a specific understanding of environmental capacity conditions so as to achieve the goal of capacity control and the development of capacity management tools has become a new hot spot for research. At the same time, on the basis of time interface analysis based on experience and historical data, deepen the research on geographical differences and time series changes of environmental carrying capacity to better realize the role and significance of management tools and early warning systems, future research can introduce neuro-tourism simulation experiments, scenic spot management simulation and tourism safety simulation experiments, etc., to strengthen the simulation for tourism places and TECC in order to realize dynamic control.In this paper, a bibliometric analysis of 297 articles retrieved from the Scopus data platform, including volume data, journal distribution, keyword co-occurrence and bursty word co-occurrence analysis, was conducted in Citespace and VOSviewer analysis tools, and the study found that.Before the 21st century, the topic of TECC received less attention because most tourist places were in the early initial development stage. Since entering the 21st century, with the booming tourism industry and the emergence of some negative impacts in some tourist places, the research on TECC has increased greatly, especially in the last 5 years.Sustainability, Wit Transactions on Ecology and The Environment, Tourism Management, Asia Pacific Journal of Tourism Research, Wit Transactions On Ecology And The Environment, Tourism Management, Asia Pacific Journal of Tourism Research and Ocean and Coastal Management are the international journals with the most articles on the topic of TECC, with 24 articles on Sustainability. In contrast, the Tourism Management journal was early to focus on the topic of TECC and has been published annually since the 1980s, although only about 1 article per year in the early years.Early studies on TECC mostly focused on measuring TECC in natural tourism destinations, including areas such as global geoparks, national parks, recreational wetlands and independent islands, while subsequent studies focused on elements of tourist satisfaction and residents\u2019 perceptions, with an eye on social carrying capacity and economic carrying capacity. In 2015, with the UN Sustainable Development Summit held in New York, marine sustainability became an important topic, especially in Catalonia, Spain, where the study of environmental carrying capacity has become a recent hot topic. In addition, the European region  and the Asian region have been the main regions of TECC studies in the last 20 years.The concept of TECC originates from environmental carrying capacity, but in comparison, TECC contains various socio-economic and psychological factors, which is more complex, and a unified definition of this content has not yet been formed; the measurement methods of TECC have shifted from the initial descriptive and simple statistical methods to computers , GIS and integrated models. However, the research on early warning and management tools of tourism carrying capacity is relatively less.The study of TECC generally presents four characteristics, i.e., The differentiation of conceptual research, continuous enrichment of assessment models and deepening of research methods, gradual expansion of research scale and the improvement of the management tool system.Although the study reviewed articles on TECC and used literature data from the Scopus database for the bibliometric analysis to remedy some of the shortcomings of previous studies, there are some limitations in the article, such as the study only selected journal articles and review articles for the analysis, which may ignore some important and relevant literature. In addition, in the bibliometric analysis, only English-language literature was selected for the analysis, while regions such as Provence, Brazil, and Japan, which are some recent tourism hotspots, are non-English speaking areas, which can make the analysis results somewhat limited. Plus, TECC research in Western and Central European countries, especially in France, Germany, Italy, and Poland, started earlier than in North America, but those findings were most published in their national languages and are usually ignored. Nevertheless, this study provides a systematic review of TECC studies in the Scopus database for the period 1982\u20132022 to provide references for subsequent empirical studies and tourism destination management practices. Future studies could include conference articles and other language sources for analysis  to compensate for the limitations of the current study and pay more attention to the early studies in Western and Central European countries to better close the knowledge gap.Based on Citespace and VOSviewer analysis software, this paper conducts a bibliometric analysis and literature review on 297 articles screened from the Scopus database on TECC, including keyword co-occurrence and bursty word co-occurrence analysis and research on concepts, applications, assessment models and management tools and early warning, followed by a review of existing research, including the divergence for conceptual research, the continuous enrichment of assessment models and the deepening of research methods, the gradual expansion of research scales and the continuous improvement of management tools, and proposes four future research directions, namely, strengthening the growth management of TECC and optimal decision-making objectives, combining software from related disciplines for comprehensive analysis, focusing on the expansion of TECC research, and continuing the research of management tools and early warning systems. Finally, the findings of the bibliometric analysis and literature review are discussed, and the limitations of the paper are pointed out as well as the directions for remediation. Notably, early TECC studies were primarily published in non-English languages in Western and Central European nations, particularly in France, Germany, Italy, and Poland, and this may have led to a knowledge gap to some extent. Future studies should find an approximate solution to this challenge, either by making comparisons or by doing research on these corresponding national languages."}
{"text": "The Internet of Things (IoT) is one of the most important and widely used technologies in the world. It has improved processes, reduced costs, and increased safety, and productivity. The use of the IoT in the control of electronic equipment, industrial factories, farm centers, and agricultural fields has been very successful leading to an increase in the amount of production and improved quality of products. Drowning is one of the most important issues in safety and health topics, and many studies and technologies have been designed to reduce the death rate caused by drowning.Using the IoT in drowning by designing sensors and creating a communication platform-based internet in swimming pools, entertainment centers, ships, submarines, etc. through increasing the control and accuracy of safety systems can significantly reduce deaths due to drowning. This technology is important in the following aspects of drowning:i) It improves the performance of safety systems (increasing accuracy and ease of prevention)ii) It reduces the costs iii) Creating income for knowledge-based companies (creating a market and producing new equipment)This study was based on the national drowning registry system of Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran.IoT in drowning refers to the development and use of IoT in drowning prevention equipment and programs. With a strong focus on machine-to-machine communication, big data, and machine learning, it enables control centers to achieve better efficiency and reliability. By using this technology, you can get more accurate information about air quality, water quality, risks, and climate changes to prevent drowning. IoT devices in this application typically span a large geographic area and can also be mobile. The development of IoT-based equipment in the marine transportation system, seashores, swimming pools, etc., especially in developing countries, can reduce drowning-related deaths. Drowning, Technology, Internet of Things (IoT), Guilan"}
{"text": "Osteoarthritis has the characteristics of degenerative changes in articular cartilage and secondary osteoporosis, and it is a common chronic irreversible joint disease. In addition to affecting articular cartilage, subchondral bone, joint capsule and synovial membrane also undergo pathological changes during the development of the disease. Multiple studies have revealed that patients with osteoarthritis were found to have a significantly increased risk of osteoporosis, which also contributes to the progression of osteoarthritis. However, in the current existing studies, we found that no scholars have used bibliometric analysis in the study of the relationship between osteoarthritis and osteoporosis. From the perspective of bibliometrics, this study summarizes in detail the degree of cooperation between countries, research institutions, authors, and related journals in the field of osteoarthritis and osteoporosis research and their respective influence. In this way, the evolution of knowledge structure, the change of research focus and the hot topics with research potential in the future can be further visualized and analyzed.Search the Web of Science core collection in Science Citation Index Expanded for articles and reviews of research on osteoarthritis and osteoporosis from 1998 to 2021. Bibliometric tools such as VOSviewer, CiteSpace, were be frequently used in our study. They are mainly used to analyze collaborations between countries, research institutions, and publication authors. Meantime, co-citation analysis of journals, co-occurrence analysis of keywords and subject categories will also be reflected in the study.According to the search strategy, 1,078 publications were included during the period 1998\u20132021. And the number of annual publications on the relationship between osteoarthritis and osteoporosis is on the rise. The United States has achieved the most and contributed the most in this field and the Boston University was the most prolific institution. For the statistical analysis of published publications, Reginster JY had the highest number of publications, while Felson DT had the highest co-citation frequency. Respectively, Osteoarthritis And Cartilage was the most productive journal in this area of research. The keywords \u201cinflammation,\u201d \u201cexpression,\u201d and \u201cmesenchymal stem cells\u201d may also be the development trend and research hotspot of the future research direction in this field.In our study, the relationship between osteoarthritis and osteoporosis was analyzed by using literature measurement. These analysis results can lead researchers to learn more directly about the trend in this area and provide guidance for determining popular research directions. Osteoarthritis (OA) is the most common degenerative joint disease. It may affect one or more joints at the same time, including the small joints of the hands and feet and the large joints such as the hips and knees . The iniMost past studies have focused on the inverse relationship between the two diseases because they are thought to rarely coexist in a single individual , 8. But In view of the above aspects. The relationship between OA and OP has attracted the attention of many experts and scholars in this field. At the same time, as mentioned above, some scholars have noted that some common factors influence the development of the two diseases, so these insights may also contribute to the research and development of new therapeutic methods . On the Bibliometrics is an interdisciplinary subject that uses mathematical and statistical methods to quantitatively analyze the knowledge carriers of research. It is a body of knowledge focused on quantification, integrating mathematics, statistics, and documentation. At present, bibliometrics analysts such as Vosviewer  and CiteThe Web of Science Core Collection (WoSCC) is one of the important data sources for obtaining authoritative academic information around the world. It contains more than 20,000 authoritative and high-impact academic journals, more than 200,000 conference proceedings, and abstracts of more than 100,000 scientific and technological books, The Science Citation Index Expanded (SCI-Expanded) of the WoSCC has been used in the scientometric analysis because this platform provides the most comprehensive information needed for bibliometric analysis tools . To avoiThe datasets were imported into CiteSpace software first to remove duplicate data. Then relevant data including publication frequency and citation frequency, distribution of countries and institutions, all authors, funding agencies, publications, and journals, cited articles, and keywords are extracted. The journal information including impact factor (JIF) and Quartile in category  was obtained from the 2021 Journal Citation Reports. Statistical analysis was performed using SPSS20  and Microsoft Excel 2019 .Bibliometric and visualization analyses were conducted by three bibliometric tools. CiteSpace, free Java-based software developed by Chen , was vishttps://bibliometric.com/) for the country collaboration analysis.VOSviewer, another bibliometric software developed by Professor Van Eck and Waltman , VOSviewOne of the main components of Microsoft Office, Excel is a spreadsheet program [a software program that performs numerical and budgetary calculations]. It was the first Office component. Excel has built-in functions that can classify, sort and even chart large amounts of data. We used Excel to calculate the number of publications and citation frequency every year, and made the results into statistical charts to present. Meanwhile, all the tables in this study were also completed by Excel.According to the retrieval strategy, from 1998 to 2021, there were 1078 publications on the relationship between OA and OP, including 935 original articles and 143 reviews. The changes in the annual number of published articles and the frequency of cited articles reflect the development trend and the degree of research focus in this research field . As presthousand five hundred twenty six academic institutions from 66 countries have published papers in the field of research on the relationship between OA and OP. As we could see in the Scholars working in different fields have unique perspectives in their respective fields, and collaboration in this area can facilitate communication between disciplines and unleash new productivity. In addition, the analysis of co-authors helps other scholars understand existing partnerships. The same discovery of relevant contributions by influential researchers can provide authoritative information on certain research areas to help other researchers discover new directions and guidelines. 5527 authors and 19,163 co-cited authors were associated with the relationship between OA and OP. Co-citation analysis is an important part of bibliometrics, which refers to two authors/literature works that appear simultaneously in the reference list of the third literature . Co-citeFor a long time, journals have been an important platform for scientific communication among scholars in various fields. Therefore, the analysis of journal source distribution helps researchers to find the most suitable journals for their articles in a short period. According to preliminary statistics, a total of 318 journals have publications that study the relationship between OA and OP. In 1973, Small and Mashkova proposed that co-citation analysis should be used as a way to assess links between articles , 34. It In the study of scientific knowledge structure, keyword co-occurrence was an efficient bibliometric analysis method, because it can relatively accurately capture the hot areas. We used VOSviewer to extract keywords from the titles and abstracts of 1,078 papers for analysis, and 2,495 keywords were extracted, among which 167 keywords appeared more than 10 times and 22 keywords appeared more than 50 times. As we can see from In this study, we analyzed the research field of the relationship between OA and OP through bibliometrics and visualization, and comprehensively understood the change of the global research trend in this field, including countries, institutions, funding institutions, journals, authors and keywords. It is clear that the field of study has grown rapidly over the past two decades, with the number of publications increasing year by year. We retrieved 1,078 articles in WoSCC according to the designed retrieval strategy. Based on currently available information, we can infer that, as the ceaseless improvement of living levels, the increase of the average life expectancy of the world's population and in turn affected the population increase of OA , that atAs for the spatial distribution of countries and institutions, the United States, China, the United Kingdom, and Australia have played a major role in the study of the relationship between OA and OP. These four countries are the top four most prolific countries, producing more than half of all publications and leading the rest of the world. Among them, the United States, China, the United Kingdom, Australia, and Japan were the first countries to do research in this field, followed by the Netherlands, France, and Belgium. The number of articles published in Western Europe accounted for more than half of the total, 1.41 times that of North America, 2.08 times that of East Asia, and 5.37 times that of Oceania. These data indicate that Western Europe is the most active region in this field. But separately at the national level, the United States has been particularly prolific. In my opinion, the USA as the only superpower in the world has superior conditions in basic and clinical trials, and is ahead of other countries in terms of science and technology, with its professional technology and equipment, full-time researchers, and sufficient scientific research funds, so that it firmly occupies the leading position in the field of research. Of course, as the economies of Asian and European countries continue to grow, interest in this area of research increases, and research led by these countries increases, the gap with the United States will gradually narrow. In 1978, Freeman, an American sociologist, and professor, first proposed intersex centrality as an index to measure the degree to which a point is located in the \u201cmiddle\u201d of other \u201cpoint pairs\u201d in the graph . It is mIn the visualization analysis of funding agencies, in vitro. Strontium ranelate reduces the expression of biomarkers of cartilage degradation, thereby reducing the progression and clinical symptoms of spinal OA, which revealed the potential of strontium ranelate in the treatment of knee OA. Reginster JY's greatest contribution is a very detailed review of OA in disease management (For the analysis of the authors with the largest contribution in the field of OA and OP, we ranked the number of published publications and evaluated them in combination with other indicators to provide a more comprehensive perspective on the contribution of these authors , 50. Regnagement , 54, thenagement , treatmenagement \u201359, and nagement , carriednagement , 62, mannagement , evaluatnagement \u201366. The nagement \u201369. But Additionally, the analysis of journals and co-citations can provide information about the journals which are friendly to certain fields of study . This inThe visual analysis of co-citation can be seen in In this study, 2,495 keywords were extracted from all publications and analyzed by VOSviewer. Through the extraction and analysis of keywords, we intuitively conclude from the visualization results that keywords have diversity and variability over time. By analyzing their essence from the surface phenomenon, keyword diversity reflects the complexity of the disease mechanism. Single keywords cannot perfectly summarize the relationship of OA and OP, which indicates that the connection between them is not the connection between a single disease, and they may affect each other and form cause and effect in different development processes through various mechanisms. Mostly we found early keywords at the same time around the disease itself, from a macro level analysis of the relationship between the two, while the late keywords more and more attention to the root cause of the disease-related information, it shows that with the deepening of the research, we are no longer mere attention to appearances, gradually will focus on inflammation causes, inflammatory factors and cellular and molecular levels. As observed in Through visual analysis of bibliometrics, the structure and temporal dynamics of this field can be understood to some extent, but this study also has some limitations that are difficult to eliminate. First, the data set we included only includes data from the WoSCC database, which may leave out some relevant studies from other large databases. However, as the most used dataset in the field of bibliometrics, WoSSC also has sufficient data to illustrate the current status of the research field on the relationship between OA and OP. Second, Second, we excluded non-English language literature, so some contributions to the field using non-English language regions were overlooked. Third, since we set the search strategy until 2021 and the database is constantly updated, the impact of recent publications on the field may be underestimatedWith the help of CiteSpace and VOSviewer, we have a deeper understanding of the current status, cutting-edge hotspots, and future trends of the research on the relationship between OA and OP during 1998\u20132021. The United States and China are in the leading position. However, there is a lack of cooperation and communication among countries, institutions, and authors, and it is necessary to strengthen the cooperation and communication among them. According to the time variation of hot spots, inflammation, expression, mesenchymal stem cells will be the focus of future studies on the relationship between OA and OP.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.XWan and XWang designed, data analysis, interpretation, and manuscript writing. RP, CX, and WS collected the data. HZ, ZL, and HL revised and approved the final version of the manuscript. All authors contributed to the article and approved the submitted version."}
{"text": "The prevalence of autism spectrum disorder (ASD) increased rapidly in the last 20 years. Although related research has developed rapidly, little is known about its etiology, diagnostic marker, or drug treatment, which forces researchers to review and summarize its development process and look for the future development direction.We used bibliometrics to analyze papers of ASD in the Web of Science from 1998 to 2021, to draw the network of authors, institutions, countries, and keywords in the ASD field, and visualize the results.A total of 40,597 papers were included with a continually increasing trend. It turns out that the research on ASD is mainly concentrated in universities. The United States has the largest number of ASD studies, followed by England and Canada. The quality of papers related to ASD is generally high, which shows that ASD research has become a hot spot of scientific research. The keywords of ASD etiology and diagnostic markers can be classified into at least 7 aspects. The detection of keywords shows that ASD research is mostly based on its subtypes, takes children as the study population, focuses on neurodevelopmental imaging or genetics, and pays attention to individual differences. And ASD research has changed greatly under the impact of Corona Virus Disease 2019 in the past 2 years.We consider the future development direction should be based on the improvement of case identification, accurate clinical phenotype, large-scale cohort study, the discovery of ASD etiology and diagnostic markers, drug randomized controlled trials, and telehealth. Autism spectrum disorder (ASD) is an early-onset, chronic, and heterogeneous neurodevelopmental disorder characterized by social and communication disorders, a narrow range of interests, and restrictive, repetitive, or stereotyped behavior . It inclNearly three-fourths of ASD patients have more than 16 medical, mental, or neurological diseases, such as attention deficit hyperactivity disorder, intellectual disorder, self-injurious behavior, and sleep disorder, making it the main cause of mental disability in children under 5 years old , 10. In Although the prevalence of ASD is increasing gradually, ASD is still one of the frontier problems in scientific research, especially etiology research.Quantitative analysis of ASD research results, combing the historical development of ASD research, analyzing the research hotspots of ASD, and exploring the high studied etiology and diagnostic markers of ASD have some enlightenment for predicting its research trend. At present, bibliometrics, combining mathematical and statistical methods, can evaluate the current situation and future research trends in a field and can guide the follow-up research work . The CitThe article data comes from the science citation index expanded (SCI-E) database on WoS. We searched the WoS with the method: TS = , and the time is from the establishment of the database to December 31, 2021 . As for the types of articles, we include reviews and articles and exclude meeting abstracts, letters, book reviews, etc. We used the CiteSpace 5.8.R3, and set link retaining factor = 2; Look Back Years = 8; Year Per Slice = 3; Selection Criteria = Top50; Prunning method: pathfinder, pruning sliced networks, and pruning the merged network. We used the VOSviewer 1.6.18 to analyze the keywords, and we selected the first 1,000 keywords as our analysis objectives to study the etiology. And we analyzed the diagnostic markers with the same method. The bibliometrics research process is shown in Analyze the change in the number of articles published in the ASD field over time, which represents the degree of attention in this field to a certain extent;From micro to macro, analyze the authors, institutions, and countries in the field of ASD, which reflects the research characteristics of individuals, institutions, and countries in this field to a certain extent;Analyze the journals and references published in the ASD field, which reflect the quality or attention of research articles in this field to a certain extent;Keywords were carried out to analyze the key research directions in this field since 1998, and we focused on the etiology and diagnostic markers of ASD. Keywords with the strongest citation bursts detection were carried out, which can reflect the changes in research hotspots in a certain period;Based on the above analysis, this paper attempts to predict the trend of follow-up autism research.A total of 40,597 articles were included in this study, including 33,489 articles and 7,108 reviews. According to the publication of ASD-related papers The CiteSpace can analyze the cooperation network among authors, institutions, and countries. In the network, each node represents an individual, the size of the node represents the number of individual papers, the connection between nodes represents the cooperation relationship between individuals, different colors of nodes or connections represent different years, and the color from cold to warm represents the year from far to near. The purple nodes in the outer circle of the network represent the most important nodes, which have centrality > 0.1 .molecular psychiatry, biological psychiatry pediatrics, proceedings of the national academy of sciences of the united states of , pediatrics, autism research, etc. The average impact factor is 6.2. We screened all the keywords and got 239 keywords related to the etiology of ASD. We tried to classify these keywords, and found that the etiology of autism involves genes, structural and functional of brain, neurons and related neurotransmitters, immune inflammation, metabolism and nutrition, environmental and social psychological, prenatal exposure, and others The research papers on ASD have increased by more than 20 times in the past 20 years. There is a large amount of financial support and social attention for ASD. For example, since the 21st century, the USA has promulgated several bills to protect the rights and interests of ASD patients. In 2000, The Children's Health Act of 2000 mandated and the National Center on Birth Defects & Developmental Disabilities was established to promote the etiology, diagnosis, and treatment of ASD. In 2006, the Bush administration promulgated The Combating Autism Act, the first law for ASD patients, and spent $945 million on ASD research, treatment, and education within 5 years, which ended after The Autism CARES Act in 2014. In 2007, Congress promulgated a bill on expanding commitments to ASD patients, proposing to provide $83 million for services for ASD and their families in 2008. From 2007 to 2010, many states in the USA successively legislated to require insurance companies to include the treatment and intervention of ASD into the insurance liability, and some states legislated to make sure ASD patients were protected by the mental health laws on a non-discriminatory basis. In addition, the USA has stipulated the rights and interests of ASD patients in many laws, such as the American with Disabilities Act. The network analysis of countries/regions also shows that the USA has the largest number of outstanding published papers in the field of ASD, which is inseparable from the huge financial support of the USA for ASD. Legal support related to ASD has also been provided in China. For example, the China Disabled Persons' Federation included ASD patients in the category of disabled persons and let them enjoy corresponding rights and interests in 2004. The State Council of the People's Republic of China (SCPRC) stressed the rights and interests of ASD patients to receive education in 2009. The Guidelines for Diagnosis, Treatment, and Rehabilitation of ASD were issued to improve the level of diagnosis and treatment for ASD in China in 2010. In 2014, the SCPRC asked each city to help ASD patients with clinical diagnosis and treatment, infrastructure, and education. For the research on ASD, the National Natural Science Foundation of China has funded more than 3,000 projects since 2010, with a total amount of more than 1.6 billion Chinese Yuan.Science elaborated on the dilemma and frontier of ASD etiology research, which attracted the attention of society and researchers. The famous professor Zheng Yi from China was also invited to interpret it and put forward deep opinions on its future development direction  underlie Fragile X Syndrome, which is the most known genetic monogenic cause of ASD . TherefoAccording to the detection results of keywords with the strongest citation bursts , the resBefore 1998: As early as 1926, Grunya Efimovna Sukhareva  from theThe theoretical explanation of ASD etiology also experienced a long development before 1998. In 1949, Kanner described the parents of children with ASD as compulsive, perfectionist, and lacking a sense of humor. He pointed out vaguely that the severe stress suffered in the early stage, such as parental discord, separation, or mothers' depression, is related to autism. Bruno Bettelheim also believed that autism was not born but caused by the mothers' estranged based on his experience in Nazi concentration camps . This th1998\u20132009: Since Leo  put forw2010\u20132018: This stage is different from the research before 2010 in all aspects. The generalization of new ASD diagnostic criteria in 2013 reduced the research on ASD subtypes to a certain extent, which can also be seen in After 2019: ASD patients usually suffer from comorbidities including insomnia, anxiety, depression, attention deficit hyperactivity disorder, self-injury behavior, etc. . During ASD patients generally have gastrointestinal symptoms such as diarrhea, abdominal distension, abdominal pain, and constipation , and theThe treatment of ASD is still based on education and behavior training, but there are many candidate drugs for the treatment of ASD in recent years. In 2010, Lemonnier and Ben-Ari  reportedSince Leo Kanner published the case report on early-onset infantile autism in 1943, ASD research has a history of more than 70 years. Although we still know little about its etiology, diagnostic markers, and drug treatment, the increasing ASD research and the introduction of new research methods such as gene research and intestinal flora still make the ASD research develop gradually and have a promising prospect. Combined with the development track of ASD research and the analysis of CiteSpace, we believe that ASD will have such a development trend in the future:a. Improvement of case identification and accurate clinical phenotype: there is no doubt that the diagnostic criteria of ASD are gradually improved from DSM-II to DSM-5. ASD is a pedigree disease rather than a continuum of severity is undoubtedly the result of an in-depth understanding of ASD, which leads to more cases being included in the clinic. However, this diagnosis increases the heterogeneity of the ASD population to some extent, so it also hinders the study of ASD. At present, some researchers  try to ib. Carry out cohort research in combination with genomics and neuroimaging: it is necessary to prospectively adopt larger-scale sequencing technology, behavior, and MRI research for high-risk people with ASD with early medical risk (such as premature birth) or specific genetic background. For example, the Autism Phenotype Project. These measures are of great significance for the study of its etiology and diagnostic markers.c. Treatment: Although there are many disputes about ASD candidate drugs such as oxytocin and bumetanide, as Professor Daniel pointed out , studiesd. Telehealth: In view of the influence of the COVID-19 on ASD patients and caregivers, it is necessary to consider continuous isolation management or public health emergencies. When telehealth becomes the necessary choice, we need to objectively evaluate its reliability, effectiveness, and acceptability in ASD diagnosis and treatment guidance.This study conducted a comprehensive bibliometric analysis of articles in the field of ASD and analyzed the changes in ASD research in three stages. However, this study has some limitations that need to be solved. Firstly, Because of the limitations of the software, we only analyze English articles in the WoS database, which may lead to language and publishing bias. Secondly, the software is mainly used for statistics and visualization, and our discussion on the future may be insufficient.The original contributions presented in the study are included in the article/PR and RM contributed to the conception and design of the study. XZ, HL, and SZ collected data from the database. PR, QF, and XS wrote the first draft of the manuscript. PR, QF, and PG wrote sections of the manuscript. All authors contributed to manuscript revision, read, and approved the submitted version.This work was supported by the National Natural Science Foundation of China (No. 82174439) and the Program for Qi Huang Scholar (RM) in State Administration of Traditional Chinese Medicine.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "He was one of three co-editors of Baja's Principles and practice of surgery, including pathology in the tropics\u201d, which is popularly referred to as \u2018BAJA\u2019 after the initials of the editors' surname Professors EA Badoe, EQ Archampong and MOA Jaja. This textbook is a pre-eminent source of information for generations of medical undergraduates, postgraduates and surgeons, especially in the tropics. He was the Dean of the University of Ghana Medical School from 1984 to 1994 and President of the West African College of Surgeons from 1997 to 1999.He was the Editor-in-Chief of the Ghana Medical Journal from 1973 to 1979. Before this time, he was the Assistant Editor from 1969. These years were difficult in Ghana's history, with military coups, uprisings, and social and economic challenges. This period also witnessed tension between professional groups and the military government of the day over the concept of \u201cUnion Government\u201d, which proposed to make Ghana a non-party state. Professor Archampong managed the journal successfully and achieved regular publications. During these difficult times, he was promoted to Associate and Full Professor in 1976 and 1978, respectively. In addition, he obtained a Master of Surgery degree (M.S.) from the University of London (1974) by thesis and was awarded the Fellowship of the International College of Surgeons (USA) in 1975.Professor Archampong excelled in his many spheres of endeavour, receiving academic, national, and international awards.He was a recipient of the National Honours of the Republics of Ghana and Senegal. He was considered an astute administrator with a friendly posture.Professor Archampong will be remembered as an icon in the medical profession, a great teacher, an example of dedication to duty, family, and a Christian gentleman.th December 2021 after a well-attended burial service that included the President and Vice-President of the Republic of Ghana.Professor Archampong was laid to rest on 16May he rest in peace.Editorial OfficeGhana Medical Journaleditor@ghanamedj.org"}
{"text": "With a year\u2019s delay caused by the Sars-CoV-2 pandemic, the conference series produced by the International Society for Applied Biological Sciences  is reaching its first quarter-century -5. DurinMayo Clinic Short Course in Epigenomics. Here experts, mostly from the Mayo Clinic College of Medicine and Science in Rochester, Minnesota, cover the essentials of epigenomics: fundamental mechanisms underlying the regulation of gene transcription, the molecular basis of epigenetic control, epigenetic states and inheritance, epigenetics in the laboratory, and epigenetics in medicine. This is followed by the pre-conference practical Interdisciplinary Session of the American Academy of Forensic Sciences and ISABS 2022 and ISABS and The Ministry of Interior's Training Course: \u201cMystery on the Ship \u2013 Investigation of Water-Related Crime Scene.\u201d The American Academy of Forensic Sciences and ISABS 2022 session focuses on standards development and progress of the Academy Standards Board, application of ancient DNA methodology in degraded forensic samples, forensic training in crime scene investigation, and aquatic death and dive accidents.The conference is preceded by the In keeping with tradition, the inaugural morning of the conference on June 22 starts with keynote lectures representing the fields covered by the conference: medicine, anthropology, and forensics. Subsequently, yielding to the urgent issues of the time, an afternoon parallel session deals with anthropology and global health in the time of crisis. It focuses on integration of global health, effects of the pandemic on global development, and data management for evidence-based response to the Sars-CoV-2 pandemic and other topics. The other parallel session covers selected topics on the role of genetic variation in disease, forensics, and anthropology.The second day continues with anthropological aspects of global health in the time of crisis covering dietary adherence, the role of sex and geography in COVID-19 variation, etc. A parallel session covers issues of integrated high-definition omics: role of machine learning and artificial intelligence in therapy development, single-cell transcriptomics, and others. This is followed by the already traditional session where Nobel laureates address major issues of our time. This year the speakers are Aaron Ciechanover , Sir Richard John Roberts , and Thomas S\u00fcdhof . They will address the ethical issues inherent in curing and preventing of pandemics (Ciechanover), the use of biotechnology in combatting hunger and climate change (Roberts), and biological aspects of Alzheimer\u2019s disease (S\u00fcdhof). This year, the third \u201cNobel Spirit\u201d will provide the forum to the three Nobel laureates to stimulate public discussion on the role of science in solving global health issues, acute regional problems such as brain drain, demographic decline, as well as cultural and social change.The third-day morning is dedicated to topics from anthropological genetics such as studies of ancient DNA preserved in sediments, a new development in Neanderthal genetics, and others. A part of the day is dedicated to the advancements in osteoarthritis. The second part of the day presents the talks on multi-omics of common and rare diseases as part of the program on individualized medicine.The morning of the fourth day of the conference investigates forensic genetics cases from the one of the notorious Kaspar Hauser to the Romanov family, 9/11 victims, and more. The afternoon revisits individualized medicine through topics from epigenetics to sensitizing cancer cells to DNA damage-inducing agents, anti-tumor immunity, and others. The day ends with the evening address on creativity and artificial intelligence by Gary Kasparov, the unsurpassed former world chess champion and prominent human rights leader.The final day of the conference returns to epigenomics in its interdisciplinary applications. Examples include the use of multi-omics in revealing therapy targets, circadian rhythm, and impact of disordered metabolism in diabetes, epigenetic signatures of psychosocial stress and trauma, and more. The conference will end with the session on the genetics of COVID-19 and pandemics such as the Black Death, as well as other topics.This year\u2019s conference is the first without Moses Schanfield, whom we lost last year . TogetheThis year again, program directors Tam\u00e1s \u00d6rd\u00f6g and Manfred Kayser invested their creative energy, effort, and time to compile a stellar program. Kudos should be addressed to them; shortcomings and complaints should be addressed to us."}
{"text": "Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, studies have shown that this disease has affected the male population on a significant scale in various parts of the world, making men one of the main risk groups. To analyze the clinical and epidemiological characteristics and experiences of illness in men with COVID-19. A mixed sequential-explanatory study with cross-sectional and exploratory-descriptive approaches. Data was collected from a small municipality located in the central-north region of the state of Bahia, Brazil. Primary quantitative data was extracted from compulsory notification forms from 598 men. Qualitative data from individual interviews of 30 men was analyzed by the Discourse of the Collective Subject method. The findings identified the characterization of reports of suspected and confirmed cases of COVID-19 in men, the organization of the healthcare system, and strategies for the control and combat of COVID-19 directed towards the men of the investigated municipality. They revealed the clinical characteristics based on the collective discourse of men with COVID-19. In men, the individual experience of disease explicitly explains the clinical markers of COVID-19 expressed by the self-reported syndromic approach. Additionally, this understanding also explains the behaviors observed in their search for health care, as well as the adoption of prevention and control measures and therapies recommended by health professionals. Among the population that progressed to a picture of severe acute respiratory syndrome (SARS) caused by COVID-19, until the epidemiological period from February 21st to 27th, 2021, 62,613 cases were registered, with 54.5% of these cases comprising men. The most affected age group from this population was between 60 and 69 years, with a total of 24,775 cases (21.6%). Regarding deaths caused by SARS due to COVID-19 in Brazil, during this period, 16,444 (54.3%) were men, with the most affected age group between 70 and 79 years old, with a total of 7,717 (25.5%).,Several reasons have been suggested in the literature for the difference between sexes in the presentation of COVID-19, which indicate that being male is a risk factor for the new disease. Among these reasons, the influence of hegemonic patterns of masculinities was highlighted. This legitimizes the dominant position of men in society, which can contribute to the neglect of health care, and the disregard and disrespect for measures to prevent and control the transmission of SARS-CoV-2.,There are also factors related to habits such as smoking, abusive consumption of alcohol and other drugs, sedentary lifestyle, and clinical conditions, such as the presence of chronic diseases which occur more often in men. Moreover, new causes have been recognized with the arrival of the pandemic, namely hormonal factors related to testosterone,,Another relevant aspect to be considered that has also been occurring in the context of the pandemic, is that a large proportion of the male population delays searching for healthcare services.When considering the presence of a gap in scientific knowledge in the difference in disease presentation based on sex and gender, and given the clinical and epidemiological context of men with COVID-19, the combination of quantitative and qualitative approaches used in this study is justified. A joint study may contribute to a broader interpretation of the investigated problem, providing better evidence for best practice care for men with COVID-19.To analyze the clinical and epidemiological characteristics and experiences of illness in men with COVID-19.A mixed methods study, with sequential-explanatory type from a transverse and analytical study, and an exploratory-descriptive research with a qualitative approach. In this study design, the quantitative approach was developed first and had the greatest weight; that is, it is the priority stage of the research. Next, a qualitative approach of secondary weight and complementary character was developed. Quantitative data were extracted from COVID-19 compulsory notification forms. Individual interviews were conducted at the qualitative stage. Thus, the data collected in the quantitative stage led and directed the data collection of the qualitative stage,The study population consisted of suspected cases of infection with the COVID-19 in men, notified to the municipal epidemiological surveillance, from February to December 2020.Suspected cases of COVID-19 infection were individuals with an acute respiratory condition, characterized by at least two of the following signs and symptoms: fever (even if referred), chills, sore throat, headache, cough, runny nose, olfactory disorders, or taste disturbances.The study excluded males who passed through the city, were suspected, or were assisted/notified during the data collection period.The quantitative sample consisted of 598 men, notified as suspected cases of SARS-CoV-2 infection from February to December 2020. The qualitative sample consisted of 30 men with a confirmed diagnosis of COVID-19 presenting with symptoms. The men included exclusively accessed the Municipal Center for Coping with COVID-19 and sought care. In addition, we sought participants who only accessed the service to ensure greater sample specificity, considering that it is a rural municipality, with habits, customs, and health behaviors that may have influenced the way they experienced the disease. The municipal health department, epidemiological surveillance sector, and participants agreed to access the data contained in the medical records.Data were collected in the municipality of Quixabeira, Bahia, Brazil, from October to December 2020. During this period, the municipality had 598 notified cases, diagnosed using reverse transcription polymerase chain reaction (RT-PCR) (311 cases) or rapid tests (87 cases). At the end of that period, seven cases were still under monitoring, awaiting test results. Of these, 121 cases were positive: 77 (63.6%) were women and 44 (36.4%) were men. The municipality registered three cases of clinical admissions in a reference emergency care unit, one case of hospitalization requiring assistance in the intensive care unit, and no confirmed cases of death during the investigated period.Excel spreadsheet, and manipulated for structuring the bank, checking for incompleteness and duplication. In the second stage - the qualitative stage - individual in-depth interviews were conducted with the participants.Data collection was conducted in two stages. The first - the quantitative stage - was based on data from the Municipal Epidemiological Surveillance, obtained via access to primary data from the Ministry of Health records of \u201ccompulsory notification forms of suspicious of coronavirus disease 2019 - COVID-19 Flu-like Syndromes.\u201d The data were exported from the Google Forms application to an The interviews were conducted by a single interviewer researcher and were audio-recorded in a single meeting, with an average duration of 30 minutes. They were previously scheduled under the support of the Epidemiological Surveillance service and the team of the COVID-19 Combat Center of the investigated municipality. Interviews adhered to health protocols and ensured the safety of the participants and the research team. Additionally, patients were later re-evaluated by a medical professional and given a diagnosis and cure for the disease. Participants were intentionally selected based on the indication of professionals from the Epidemiological Surveillance Service and the municipal COVID-19 Combat Center. An unstructured script was used for the following open questions: Tell us how you experienced the impairment caused by COVID-19? How does COVID-19 manifest clinically? This management was conducted using data surveys in the quantitative stage.For data collection, notification forms were accessed from the health surveillance department after prior authorization. Then, data from the forms were read, organized, and encoded in a spreadsheet in Microsoft Excel application, version 16.0, developed by Microsoft , and submitted to processing in the Statistical Package for Social Sciences (SPSS) software, version 23.0, developed by the International Business Machines Corporation (IBM) .After collecting the qualitative data, the narratives were read line by line, and the data were systematized and coded with the support of NVIVO12 software developed by QSR International . COREQ guidelines were followed to ensure the quality of the qualitative data. The analysis of narrative data was performed using the Discourse of the Collective Subject (DCS) technique,DCS is a category of exposure to the results of qualitative research, with testimonies as raw material, in the form of one or more synthesis speeches written in the first person of the singular. This method consists of pointing out, from each answer, the KEs, which are the CIs of the discursive content expressed by the interviewees.After the analysis of the quantitative and qualitative data, a combination of the data was conducted through the connection and integration of the results. Thus, additional information on the study objectives was identified.Since this research was conducted in the context of the still-in-progress COVID-19 pandemic, ethical requirements in research were fulfilled, which involved biosafety to preserve the participants and researchers. The interviews were carried out with the researchers duly dressed in compliance with social distancing. The application of the Free and Informed Consent Term was associated with the dispensing of alcohol gel and disposable tissues to access the pens made available by the researchers.The study was approved by the Research Ethics Committee (CEP) of the Universidade Federal da Bahia (UFBA) under Opinion No. 4,087,611 on June 15, 2020. Furthermore, we obtained authorization from the Municipal Health Department and Municipal Health Surveillance Department of Quixabeira to access notification forms and patient records.The first part of the results, derived from notifications, describes the clinical and epidemiological characteristics of men with COVID-19. The second part presents data from patient records, relating to clinical and epidemiological features and the control and combat strategies for COVID-19. Finally, the third source of data presents the clinical characteristics from the collective discourse of participants, retrieved from interview audio..This study included 515 reports of suspected COVID-19 infections in men living in the municipality. As shown in ..As shown in ..Data analysis showed that 20.6% of cases were notified eight days or more after the onset of symptoms, causing delays in the surveillance process and possibly in the medical care of these patients. As shown in ..The results also showed that death occurred in older men (\u2265 60 years). The men kept in home care, who were negative for COVID-19, had an average age of 19-24 years. Reports of young teens and adult men who had confirmed COVID-19 infections predominantly progressed to cure .The secondary Qual stage of the study involved data from 30 interviews with participants in the first quantitative stage, which was explained in the form of discourse synthesis. Its respective CIs were framed, theoretically, from the fields/variables that make up the \u201ccompulsory notification forms of suspicious of coronavirus disease 2019 - COVID-19 Flu-like Syndromes.\u201dNarrative qualitative data presented in the form of DCS of participants were retrieved to further investigate the clinical and epidemiological male health from the perception of users. The following illustrates a Discourse-Synthesis composed of a CI of representation of the collective as a whole regarding the clinical characteristics and experience of COVID-19.The male collective discourse revealed that the clinical characteristics of COVID-19 are demarcated by the presentation of nonspecific symptoms. However, the disease presented its course with clinical characteristics of classic symptomatologic evolution, progressiveness, and worsening of the health status and clinical picture.The clinical trajectory of participants involved access to diagnostic and therapeutic intervening resources used by health professionals, such as nursing technicians, nurses, and doctors, of specialized units for the treatment of disease and subsequent obtention to improve and present complications and/or sequelae. To illustrate the integration of the results of the study, The analysis of clinical and epidemiological characteristics is essential for the planning and execution of strategic and programmatic actions to promote men\u2019s health and prevent diseases and conditions, especially in critical and complex contexts, such as pandemics. Although the clinical findings have indicated satisfactory clinical outcomes - reduced mortality and high cure rate, assuming mild forms of the disease in the investigated period, the data indicate a growing number of investigated cases. This represents the Brazilian and international scenario and indicates that men are more vulnerable to infection and suffering from COVID-19 and are worthy of attention from health professionals and managers.Understanding the clinical and epidemiological characteristics of the male public in research on COVID-19 contributes to the early identification and overview of the reasons that indicate why men are getting sick. The discursive findings reported by men strengthen the understanding of health and disease, the experiences of the patient, the clinical pathways, the therapeutic itineraries, barriers and critical routes adopted by men, and weaknesses in healthcare in the pandemic context, which makes it an effective integration methodology to be employed in the production of evidence for the planning and management of healthcare.-Unlike the findings in our study, the clinical profile of the male population with COVID-19 has indicated a high number of complications resulting from impairment by severe forms of the disease, greater need and length of hospital stay, development of SARS, and death. In our study, young adult men and those with self-reported mixed race/color were the most affected by COVID-19. In the investigated period, vaccination had not yet started in the city, which implies greater exposure of the target population, mainly because in Brazil, the vaccination schedule for COVID-19 includes the young adult population at non-priority levels. Regarding this difference in the clinical-epidemiological profile, epidemiological bulletins in Brazil pointed out in 2020 the impairment of older men, especially in cases of SARS.However, a focused study had already shown a growing number of severe infections in younger men with an average age of 40 years The work environment and occupational relationship of men who were diagnosed with COVID-19 showed a significant relationship with infection. According to the qualitative findings, this may indicate weaknesses in the adoption of individual and collective protection measures, the low quality of personal protective equipment in work environments, and vulnerabilities in access to work, such as in the use of public transport, in addition to failure of institutional protocols for disease prevention and control, as indicated in the literature on the subject.Regarding compulsory notification of the disease, the full completion of notification forms is extremely useful in the assessment of groups at higher risk, which could be prioritized in actions to combat and control the epidemic in states and municipalities. Such professional action in health is legally required throughout the Brazilian territory and, through the Epidemiological Surveillance Service, allows the monitoring and follow-up of cases. In addition, it presents a panoramic status of active, suspected, under treatment, cured, and death profiles.Many small municipalities have greater difficulty carrying out epidemiological surveillance actions because of structural limitations and the small number of professionals involved in the health surveillance system. This can compromise the quality of notifications or lead to underreporting of cases, especially in high-demand situations such as the COVID-19 pandemic.These potential failures in notification systems may occur at the local or national level, and directly impact the conduct of combating actions and delay the collection of knowledge of epidemics. Whether failures occur as a result of the government, or the management and operation of occupational health teams, they can result in episodes of severe disease proliferation, such as what was seen with the COVID-19 pandemic. The exponential increase in new registrations observed corroborates the high number of new clinical cases, giving COVID-19 the status of high transmissibility, even if the estimates of the basic reproductive number reported in the literature vary widely.,The direction of COVID-19 prevention and epidemiological control strategies among the male population must consider the sociodemographic profile, such as race/color, social class, and occupation, and clinical profile related to signs and symptoms, complaints, complications and infection pattern.The increase in the number of home deaths, especially among the elderly, as cited in this study, requires attention from health care managers. It reinforces the importance of ambulatory control of chronic diseases and the need to clarify the safety measures to be adopted by the population regarding the clinical complications unrelated to COVID-19 during the pandemic.,The use of combat strategies focused on health promotion, health education, and communication can be decisive factors in preventing and controlling the spread of SARS-CoV-2 among the male population, considering the pattern of behaviors of greater exposure to the risk of infection, for various reasons. These include construction of masculinity, kind of occupational activity, largest social life in the public environment, incorporated concepts of health and health care, beyond personal beliefs about the health and disease process, social and economic vulnerabilities, level of literacy and health literacy, and difficulties in accessing health services.Government efforts must be directed towards ensuring the reach of COVID-19 epidemic control, with focal investments that reach men more precisely. For this, actions with an impact on health in the workplace are necessary, massive testing drives in places with larger male populations, expansion of opening hours of health services, and investment in social communication, with a gender focus.Finally, with satisfactory effects of the use of these joint efforts, it is possible to reduce the economic impact on the national health system, ensuring greater sustainability of the system before a crisis context. In addition, this will guarantee increased survival and a reduction in male mortality by COVID-19 and secondary complications to the disease, reducing the burden of services and health professionals and will in turn ensure an early and safe return of non-essential daily activities and promotion of social welfare, with positive effects influencing the culture of health care.As a limitation of the study, some of the cases had incomplete information documented in the medical records, and the clinical documentation of the patients was not homogeneous. However, this is a common limitation in analytical studies, considering that data generation is clinically oriented and not systematically oriented.The clinical and epidemiological characteristics of men in the investigation of suspected and confirmed cases of COVID-19 were designed for adult men aged 25 to 29 years, mixed race/color, and who did not work in health care. Compulsory notifications were carried out in the municipality of their residence, with an increase in the period from April to August 2020, representing a peak in notified cases. Fatality and maintenance of home treatment were higher among elderly men, and a progression to cure predominated among adolescent, young, and adult men.The findings in the data pointed to the causal relations of the COVID-19 infection, contagion and transmission, secondary complications generated by the disease, and combat strategies aimed at the male population in the municipal health network. The individual understanding of the disease explains the clinical markers of COVID-19 expressed by the self-reported syndromic approach as well as the search for healthcare in the public service, the adoption of measures to prevent and control illness, and adoption of the recommended therapies by health professionals."}
{"text": "In a recent issue of this journal, we read with great interest the experimental report by Yao and coworkers , focusinIntestinal microecology has been a research hotspot in the field of gut-associated diseases, especially digestive system tumors. Intestinal dysbiosis is the main cause of the formation of hypoxia, low pH, inflammatory and even interstitial high pressure environment, which promotes the formation of tumor microenvironment and provides conditions for tumor generation, progression and metastasis .in vitro and in vivo studies is complementary and necessary. However, it must be mentioned that human studies related to the gut microbiota are often limited. In addition to collecting feces, sampling of small intestine, ascending colon, transverse colon and other parts is limited for normal people. Based on the difficult sample collection process and the tremendous inter-individual variability between samples caused by confounders such as genetic background, diet, health status, lifestyle and environmental conditions , small intestine (digestion process) and large intestine, namely the ascending, transverse, and descending portions of the colon. The first two reactors use fill and draw principles to simulate the different steps of food intake and digestion. The peristaltic pump allows the addition of defined amounts of SHIME nutrient medium, pancreatic enzymes and bile in the small intestine to achieve gastric content transfer. Retention time and the pH of different vessels are carefully controlled to obtain complex and stable microbial communities that are highly similar to those in different regions of the human gastrointestinal tract in structure and function.In intestinal flora research, the integration between nditions , as an anditions , Readingnditions , Simulatnditions , PolyFernditions , etc. Amin vitro model, the SHIME system has certain limitations. First, the SHIME system suffers from the lack of the physiological environment and host responses, such as the absence of oxygen gradients that is released from the blood to the mucus layer in the body. Furthermore, movement and mixing along the gastrointestinal tract is carried out by pumping and stirring rather than by peristalsis (However, it must be pointed out that, like any other istalsis . Meanwhiistalsis , and theIn summary, we completely agree that Yao et al. used the SHIME reactor device to study the important effects of TCM compounds on gut microbial ecology. These data innovatively transforms the research of complex TCM ingredients into the representative of intestinal flora, and are the creative experimental results of using the SHIME system to study the regulation of human intestinal microbiota by TCM compounds. This innovative study mediated by the SHIME model provides a new understanding of the mechanism of TCM compound intervention in the intestinal microenvironment, which is an interesting, encouraging attempt to promote multidisciplinary integration."}
{"text": "The literature reports some experiences regarding the design of integrated healthcare Performance Evaluation Systems (PES) applied in Low- and Middle-income Countries (LMIC). This study describes the design of an integrated and bottom-up PES aimed at evaluating healthcare services delivery in rural settings. The analysis involved four hospitals and their relative health districts in Ethiopia, Tanzania, and Uganda. The evaluation process was undertaken for those indicators that could be evaluated using the same reference standard. The evaluation scores were determined through the international standards identified in the literature or through benchmarking assessment. Both administrative and health data were extracted from the hospitals\u2019 registers and District Health Information Systems (DHIS) from 2017 to 2020. We defined 128 indicators: 88 were calculated at the hospital level and 40 at the health district level. The evaluation process was undertaken for 48 indicators. The evaluated indicators are represented using effective graphical tools. In settings characterised by multiple healthcare providers, this framework may contribute to achieving good governance through performance evaluation, benchmarking, and accountability. It may promote evidence-based decision-making in the planning and allocation of resources, thus ultimately fostering quality improvement processes and practices, both at the hospital and health district level. Health systems in Low- and Middle-income Countries (LMIC), compared to High-income Countries (HIC), are faced with somewhat different intrinsic challenges, which are, in large part, due to interrelated issues of poverty, education, lack of resources, as well as weak leadership .Nevertheless, health systems in all countries, irrespective of income availability, put in place similar policies that aim to improve accessibility, quality of care and equity of healthcare ,3.A wide array of interventions has been implemented so far in order to increase accessibility to healthcare across LMICs, and to guarantee that \u201cindividuals that can potentially benefit from effective healthcare do in fact receive it\u201d , thus acDespite crucial differences between health systems in HICs and LMICs, the need to ultimately improve similar aspects of these systems implies that a substantial level of complexity is present across all health systems, irrespective of epidemiological, social and economic context ,8.The last two decades saw an extensive effort to design, develop and implement Performance Evaluation Systems (PES) in HICs to manage such a high level of complexity and improve the performance of health systems ,10. InteThe literature reports only a few experiences regarding the design of PES framework applied to LMICs. When available, they refer to specific services or geographical settings ,16,17, aGiven this premise, the primary objective of this article is to answer the following research question:RQ: What are the features and challenges of designing and developing a bottom-up and integrated approach of PESs in LMICs?For this purpose, the paper describes the development of a PES in four selected settings from three Sub-Saharan African countries, namely Ethiopia, Uganda, and Tanzania. In particular, the PES aims to evaluate and compare the performance of healthcare services delivery of four different healthcare settings, providing policy makers and healthcare managers in LMICs with a specific and scalable framework that can contribute to improving efficacy when assessing performance of healthcare services at hospital and district level.Nowadays, it is common practice for HICs to measure and evaluate the performance of their healthcare systems. Health system assessments have been developed to address the need to face the common challenges of health systems in HICs, such as demographic changes and population aging, limited resources, and rising costs, along with the need to improve quality of care delivery and guarantee equitable access to healthcare services, while ensuring the financial sustainability of the whole system itself ,24. AsidIn this scenario, over the last few decades, the international literature on performance measurement proposed several conceptual frameworks and taxonomies. In 1988, Donabedian developed the first model to assess health services and evaluate quality of care by including three domains: structure, process, and outcomes . This frPartially based on the Donabedian model, a framework developed by the WHO and OECD was created at the beginning of the new century ,27. NeveHowever, it is worth noticing that countries and organisations also adopted different approaches that depend on the specific context, intended use and acceptability . MoreoveEmbedded in this research field is the experience of the PES developed and implemented in a number of Italian regional healthcare systems  and adopMore generally, this generation of \u201cintegrated\u201d PESs  is charaTo the best of our knowledge, there are few integrated PESs specifically applied to LMICs, and research and publications are limited ,36. MoreThis paper is based on a constructivist research approach. The approach is widely used in technical sciences, mathematics, operations analysis and clinical medicine, management research ,42,43 asThis approach highlights the principal issues involved in the measurement and evaluation of performance in African hospitals and healthcare districts. It is based on a continuous interaction between the research team (RT) and healthcare managers and professionals of the hospitals and healthcare districts to build up a PES according to their specific needs and requirements.The RT includes four experts in healthcare management from the Management and Health Laboratory (MeS Lab) of the Institute of Management of the Sant\u2019Anna School of Advanced Studies and two medical doctors employed by the NGO Doctors with Africa CUAMM (CUAMM). The constructivist approach entailed a series of meetings and workshops, which took place either virtually or in person, and two site visits in the selected African hospitals and healthcare districts between September 2019 and March 2020. Overall, the design and development of the system involved 5 researchers, 3 public health experts, and 15 professionals on the field. In addition, a panel of 20 experts and professionals was involved in the phase of validation of the PES, as better clarified in As previously mentioned, the methodology used here was inspired by the approach adopted for the design, development, and implementation of the PES of Tuscany Region and the Inter-Regional Performance Evaluation System (IRPES) in place in Italy to measure and evaluate the multidimensional performance of public healthcare organizations across Regional Healthcare Systems ,45. The With regard to the development of the PES system in Ethiopia, Uganda, and Tanzania, The pilot study involved four hospitals and their respective healthcare districts, which are supported by CUAMM through clinical and administrative activities both at hospital and district level.The analysed contexts are embedded within three distinct National Health Systems with specific governance, financing, services delivery models, and different levels of per-capita expenditure ,47,48. FIn all these contexts, the four hospitals analysed have the same institutional setting: they are private, faith based, and not for profit. These private hospitals act in the name and on behalf of the public health system according to specific Private Public Partnerships (PPP) with the Local Health Authorities. Indeed, these hospitals are mainly funded by the regional governments that bear some of the recurring expenses, such as costs of personnel, utilities, and drugs and consumables. The other two main sources of funding are represented by out-of-pocket payments from the patients and refunds from insurance companies. Alongside the hospitals, the health districts are managed by the regional government and are characterized by similar organizational models, featuring a wide variety of healthcare providers at different levels. Primary and secondary care is offered at dispensaries and health centres, which are spread within the reference territory and intended to provide mainly outpatient services, e.g., prevention, health promotion, maternity, and some in-patient curative services. Tertiary care is provided by regional hospitals, which offer more specialized services, including consultation, emergency, and surgical services. These hospitals serve as referral hospitals for the districts. The distribution of facilities across levels of care reflects the healthcare needs of the population, with most cases treated at the district level and more complex cases referred to reference hospitals.The Wolisso catchment area is in the Southwest Shoa Zone, one of the eighteen zones of Oromia Region in central Ethiopia. The catchment area includes five health districts (referred to as a \u201cworeda\u201d in Ethiopia) inhabited by around 633,000 people. In the reference area, primary care is offered by a total of 22 health centres that refer to the St. Luke Hospital\u2014Wolisso Hospital, a private, not-for-profit institution established in the early 2000s. In Tanzania, the Iringa District Council is one of the 158 health districts of the country  and is lAlthough the hospitals and health districts are located in different countries with different environments and epidemiological contexts, they all aim to pursue the three main goals of the healthcare system: better-quality care delivery, guaranteeing equitable access for the entire population, and maintaining the overall financial sustainability of the system ,52.To better realize the relevance of some phenomena and the assessment of the performance indicators, the RT collected data for the years 2017, 2018, 2019, and 2020. As recommended by the literature on the multidimensional character of healthcare performance ,34,45,53The indicators were calculated both at hospital and district level. Hospital-level indicators were extracted from the registers of hospitals\u2019 departments, whilst district-level indicators were retrieved from the District Health Information System (DHIS) of Ethiopia, Uganda, and Tanzania . With reHospitals and health districts datasets were used to collect aggregated data on pre-defined variables (per year of study) and subsequently elaborated into an Excel spreadsheet , which consists of five coloured strips spanning from red to dark green, each of which corresponds to one of the five evaluation bands. The evaluated indicators are represented in the dartboard as white dots. The closer they are to the centre of the dartboard, the higher the performance of the hospital or the health district is .In order to overcome a static representation and provide an integrated and continuous view of the performance across different settings , we alsoAll indicators that could not be evaluated were included in the final list to observe specific and relevant context-related phenomenon.The work illustrated in the present paper produced a total number of 128 indicators over 8 different dimensions and 24 areas. While a total of 88 indicators were calculated at the hospital level, 40 were calculated at the district level. Among these 128 indicators, 48 were evaluated using the abovementioned process, corresponding to around 38%.As already mentioned, the indicators selected for evaluation were indicators that the Tuscany Region was considered feasible evaluate using the same reference standard. All sources of evaluation standards, alternative in terms of dimensions of evaluation to the IRPES standards and benchmarking assessment, were identified through a review of the international literature.For example, bar charts were used in To provide an overall picture of the multiple dimensions of the healthcare services, the RT used the visualization tool of the dartboard, as seen in other studies conducted in Europe ,30,33. FThe dartboard shows the weaknesses and strengths of each catchment area. The dartboard of Wolisso Catchment Area presents a very disperse configuration of indicators, although with a prevalence of indicators scored in the red band as counter to the green and dark green bands. There are very positive performance results relative to all the indicators of vaccination coverage at residence level. On the other hand, there are opportunities for improvement with regard to areas related to Malaria, Tuberculosis, and HIV.Concerning the dartboard of Iringa District Council, the observation of data suggests the need to keep the indicators relative to the vaccination coverage of polio under control. In addition, it is possible to observe a certain degree of inefficiency regarding hospital management, showing potential for improvement in both the Average Length of Stay (ALOS) and the Bed Occupancy Rate (BOR).The dartboard of Napak District shows a high dispersion of performance scores, with a wide prevalence of indicators that fall in the external evaluation bands of the dartboard, and a quite small number of indicators located in the centre of the dartboard. Main criticalities are noteworthy concerning all infectious diseases areas, with particular emphasis on the management of tuberculosis and malaria, while an ups-and-downs trend emerges by observing the areas related to gastroenteritis and HIV.With respect to the dartboard of Oyam District, the graph shows a quite good balance between indicators presenting a good or excellent performance and those presenting poor performance levels. Indicators regarding vaccination coverage reveal poor performance outcomes for all the indicators analysed.Regarding the care pathways, we selected four care pathways based on the relevance of health-related issues in LMICs: the maternal and childcare pathway; the infectious diseases care pathway for two of the most common infectious diseases in Sub-Saharan Africa (tuberculosis and gastroenteritis); and the chronic diseases (HIV/AIDS) care pathway.As mentioned above, each care pathway is represented by a stave  that conThe stave of Wolisso Catchment Area shows quite poor performance in the pregnancy phase, and average and excellent performance scores in the last phase of the care pathway. Regarding the childbirth phase, the results are hybrid, as positive performance is found with respect to the percentage of caesarean sections and the percentage of peri/intra-partum asphyxia, while a quite poor performance can be observed with regard to the percentages of episiotomies and assisted deliveries performed.The stave of Iringa District Council illustrates a high concentration of indicators with excellent and good performance scores in all phases of the Maternal and Childcare pathway. Contrary to the overall excellent performance reported in the Maternal and Childcare pathway, an element of weakness in the hospital performance is represented by the high percentage of caesarean sections performed.In the Napak District, there are potential areas for improvement pertaining to the antenatal care and childbirth phases, with the percentages of supervised deliveries and assisted deliveries at residence level and episiotomies at hospital level performing slightly better than the indicator relative to the peri-/intra partum asphyxia and percentage of caesarean sections. Moreover, there is a weak capability of ensuring care continuity in the first year of new-born\u2019s life and positive evaluation scores relative to the indicators of vaccination coverage.Finally, with regard to the Oyam District, the stave shows difficulties, especially during the antenatal care and care in the first year of new-born\u2019s life. This represents one of the domains that deserve greater attention from the hospital and district managers. However, the indicators relating to the childbirth phase score slightly better, especially the percentage of assisted deliveries and the percentage of peri-/intra-partum asphyxia.This paper is embedded in a stream of the literature which has been enriched by scholars for a long time: healthcare performance evaluation. The contribution of this paper is proposing, with a constructivist approach, a system of hospital and residential indicators for four different African settings. To the best of our knowledge, this is one of the first examples of integrated PES aimed at benchmarking the performance of hospitals and health districts at local level in different LMICs. This PES focuses on the evaluation of the performance of healthcare services delivery within the local health system, which includes several residential health centres and their relative reference hospitals. It also came into existence as the result of a bottom-up and voluntary-based initiative . It was The framework developed in this study resembles the core principles and features of performance evaluation that were mentioned in the theoretical background. In addition, the indicators are reported through three peculiar graphical representation tools, i.e., evaluation bands, dartboards, and staves ,33, whicIf used from a system viewpoint, comparing results in data benchmarking among closer realities may allow the identification of unwarranted geographical variation areas and, in turn, measure horizontal equity at local level . Indeed,In the contexts in which the PES has been already implemented and used, it has proven that the potential use of benchmarking data can be achieved when publicly disclosing performance results, thus making policy makers and managers accountable for their management. Additionally, the experience in using this methodology suggests that the systematic use of benchmarked performance data, paired with effective data-visualization tools, can stimulate local staff motivation by the leverage of reputation. As stated elsewhere, raising professionals\u2019 awareness leads to a \u201creputational competition\u201d that, in turn, contributes to promote change, and hopefully improvement ,62,63.Additionally, as emerged from the feedback provided by the group of public health experts working in the field  and the performance results do not consider all providers within the same target territory. Therefore, in the hypothesis of extending the analyses to other realities, estimation errors should be considered while defining and calculating indicators.Another main limitation of this research is related to data quality, which depends on the level of development and availability of digital recording systems. The reliability of available data can influence the credibility and robustness of the defined indicators. However, the use of data for evaluation purposes may leverage the progressive improvement of data quality and, in general, the digitalization of information systems. Moreover, since the system has been designed and developed for four different environments, the set of indicators defined are necessarily linked to the data available in these specific contexts. Therefore, as already pointed out by the group of experts, the set of indicators defined does not comprehend all aspects and dimensions that could influence the performance of healthcare delivery in LMICs, e.g., the fees become a barrier preventing access to hospitals\u2019 services. However, this limitation does not invalidate its underlying innovative approach, which can be adapted and adjusted in a fine-tuning process to fit the hospitals and health providers involved, thus respecting the contextual peculiarities evolving within the system.This study investigates the results of a constructivist research study related to the development of a system aimed at evaluating the performance of healthcare services delivery within the local health system.The added value of this study resides in the fact that, to the best of the authors\u2019 knowledge, this is the first experience of this kind found in the literature concerning the design, development, and implementation of an integrated performance evaluation system, aimed at assessing the performance achieved by either the hospital or the health district in rural areas of Sub-Saharan Africa, with a bottom-up approach, using systematic benchmarking to leverage on professionals\u2019 reputation, and by considering the multidimensional nature of healthcare performance.The performance evaluation system presented in this paper represents a useful framework to be shared with actors and professionals involved in the design, implementation, and use of PESs in LMICs. In settings characterised by multiple healthcare service providers, this framework may contribute to achieve good governance through performance evaluation, benchmarking, and accountability. Additionally, thanks to its great potential to strengthen culture of data collection and monitoring, this framework may promote evidence-based decision making in the planning and allocation of resources, thus ultimately fostering quality improvement processes and practices both at hospital and health-district level.From this perspective, future research should explore how the developed PES has been adopted by local decision makers and healthcare managers and the impacts of its use with respect to the improvement of healthcare performance in the long run.There are also opportunities for further research related to the progressive amelioration of the system developed so far. Particularly, there should be systematic and continuous involvement of health professionals in the selection of new and refinement of currently existing indicators. On the other hand, existing indicators should be risk adjusted according to the socio-demographic characteristics of the population and epidemiological and institutional contexts should be observed so as not to neglect possible discrepancies among the analysed settings.These considerations should be undertaken in managerial as well as strategic terms, to provide hints for cooperation programs and NGOs, to identify specific potential areas for improvement for each setting in addition to the individual view of health professionals and, eventually, to make the system scalable in other LMICs."}
{"text": "Your Name from the angle of interest-related community interaction through utilizing online text analysis and Grounded Theory analysis. Based on the interest-related community interaction, we analyzed the elements of interest-related community interaction in cultural tourism triggered by the film, including tourist hotspots, tourism resources, the tourist experience, sightseeing expectations, tourism evaluation and information dissemination, and formulated the orientation pathway of film-enabling cultural tourism. In this study, we aimed to enrich cultural tourism research and provide a reference point and theoretical support for film-enabling cultural tourism in the Internet era by introducing the concept of interest-related community innovation to the scene of film-enabling cultural tourism.The importance of media-induced tourism has increased in the latest decade. The integration and collaboration of film elements is an especially effective pathway for the innovative development and upgrading of the experience of the cultural tourism industry. Existing studies on the mechanism of tourism destinations and cultural tourism development, mainly from the perspective of tourism destinations and tourist experience, have rarely explored the cultural tourism development mechanism from the perspective of interest-related community interaction in the film-enabling context. In this study, we conducted high-frequency word analysis and element category analysis of the online text data of the Japanese animation film  Film caYour Name released in 2016 won a warm response from Chinese consumers. With the continuous upsurge of film popularity, the tourism industry derived from it developed rapidly. After the original filming location of Your Name, Nagano in Japan, was successfully selected as one of the top 10 best tourism destinations by the United States news channel CNN, a vast number of film lovers became fascinated with the place, and the cohesion of the interest-related community was also improved greatly. According to Japanese media reports, Hida City of Gifu-ken in Japan, one of the shooting places, despite its remote location, witnessed an influx of Chinese tourists after the film was released. The number of foreign tourists doubled, and about 80% of them came for the holy land tour mentioned in Your Name. As the data provided by the Hida Tourism Association indicated, the number of tourists in Hida City exceeded 1 million in 2016 (April 2016\u2013March 2017) and reached 1.13 million in 2017, creating an economic benefit of 18.5 billion yen for Gifu-ken where Hida City is located in a short time. There were 6,984 foreigners out of the 1 million tourists in 2016 who stayed for accommodation, up 27.3% year on year. Among them, Hong Kong, China\u2019s Mainland and Taiwan were the top three regions where the tourists came from. Data released by the Japan National Tourism Organization showed that a total of 30 million foreign tourists visited Japan in 2018, 14 percent of whom went to Japan because of the attraction of the anime . Furthermore, in line with the characteristics of tourism activities between China and Japan, combining the film-enabling tourism characteristics from the perspective of the tourist destination hosts and the tourists, this study proposed the elements of the interest-related community interaction of cultural tourism triggered by the film Your Name, namely, tourist hot spots, tourism resources, tourist experiences, sightseeing expectations, tourism evaluation and information dissemination, and finally a film tourism enabling pathway was generated based on the interest-related community interaction, thus providing theoretical support and reference for the exploration of film-enabling tourism mechanism in the Internet era.Given the above consideration, the current study applied online text analysis and element coding of Grounded Theory to conduct high-frequency word analysis and element category analysis toward the text data of the Japanese animation film 2.2.1.Cultural tourism can be defined as \u201cthe movement of persons to cultural attractions away from their normal place of residence, with the intention to gather new information and experiences to satisfy their cultural needs\u201d  and invoThe literature has emphasized that earlier cultural tourism emerged from the development and operation of cultural resources, such as heritage tourism, religious tourism, and folklore tourism , p. 680 Cultural tourism has been a core element of the tourism industry for destination marketing and promotion . However2.2.The term \u201cfilm tourism\u201d originated from the United Kingdom and the United States in the 1990s, originally referring to a new type of tourism formed by combining film and television bases with characteristic tourism , p. 922.In the literature on film-induced cultural tourism, extant research has been dominated by locational shoots in either the U.S. or UK. The early highlight of the western market is partly explained by the dominance of Hollywood in filmmaking , p. 367.Film tourism activities include reenacting scenes, tasting the food and beverages that appeared in the film, and experiencing the culture represented therein , p. 389.2.3.The idea of community is predicated on a collective sense of common interests and purpose. Members of a community are bound together through comradeship and a desire to seek one another out. In the past, communities were based, at least in their conception, on proximity: members lived near one another . The former was finally classified into seven secondary subcategories, which were animation attraction, cultural expression, industrial form, geographical elements, characteristics of the starting place, tourism experience and demand stimulation, and three core categories, which were tourism hotspots, tourism resources and experience demand, as shown in Your Name shows the beautiful scenes of streets, stations, buildings, intersections, mountains, and lakes in Tokyo, Suga Shrine, Gifu-ken, etc., which gives the audience an immersive experience when watching the film and also stimulates the audiences\u2019 intention to travel to the location for sightseeing and other experiences. The improvement and development of Internet platforms have also improved the interaction effect between modern film and television works and scenic spots. The online publicity of scenic spots and interactive communication of tourists have built a community of interest for the supply and demand sides. Tourism destinations should constantly improve the settings of scenic spots, improve the service capacity of the destinations, attract more tourists, and improve the economic benefits of tourism destinations. In such a way, a coupling development mode for film and television industry and tourism industry will be achieved.Given the above analysis of high-frequency words and element categories, the development of film and television tourism should pay more attention to the construction and development of the value chain of the film and television tourism industry from the perspective of the tourist destination hosts. The film and television works are closely related to the shooting locations. When the film and television works show the unique cultural elements of the locations, they will attract social attention and extend the audiences\u2019 demand of watching the film to field visit demand, thus stimulating a series of tourist behaviors. For example, the film Your Name won the popularity of consumers after its first release in the cinema. With the further rendering of social media, the number of tourists going to the location will surge, thus forming a new phenomenon of film and television tourism in the new era. When tourists complete their tour of the tourist destination, they will communicate and share their own tour experience and cultural gains through WeChat, microblog, and other personal social media platforms. A new interest-related community will be formed, and information sharing and dissemination in the community will again spread to a wider range of interest-related communities. As a result, interest-related communities gradually come forth from the perspective of the destination tourists, thus realizing cultural enabling and benefit improvement that films can bring forth to tourism destinations.From the perspective of tourists, the form of \u201cfilm and television tourism\u201d generated by the interaction between film and television works and tourism destinations can be better spread to attract tourists\u2019 attention. As a new form of tourism, film and television tourism has a strong flow aggregation capacity, aiming to transform film and television audiences into destination tourists. For example, 5.5.1.Your Name for online text analysis and Grounded Theory analysis and explored the film-enabling cultural tourism mechanism based on the interest-related community interaction. According to the research, in the new era of rapid development of the Internet, the emergence and interaction of interest-related community has exerted a positive impact on the sharing of film and television tourism experience and film-enabling tourism and the community effect has been greatly improved. Based on the Grounded Theory analysis, the current research generated the film-enabling tourism characteristics from the perspective of the tourist destination hosts and tourists, demonstrating that under different perspectives of destination hosts and tourists, the focuses of the film and television tourism are different. Specifically, from the perspective of the destination hosts, the focus is put on the driving force mechanism of tourist destination development and the construction and development of the value chain of the film and television tourism industry, namely, the stimulation of tourism hotspots, the excavation of tourism resources, the stimulation and satisfaction of experience demand; Whereas from the perspective of tourists, attention is paid to the guidance of the topic flow brought by the interaction between film and television works and tourism destinations based on the interest-related community, namely, the stimulation of viewing expectation, the guidance of tourism evaluation direction and the improvement of information dissemination effect. In view of the above two perspectives, the overall characteristics of the film-enabling tourism mechanisms are concluded.Overall, with a focus on the topic of \u201cfilm-enabling tourism,\u201d the current study selected the Japanese animation film Your Name, namely tourism hotspots, tourism resources, tourist experience, sightseeing expectations, tourism evaluation and information dissemination. In such a manner, the current research has directed the pathway of cultural tourism enabled by the Japanese film Your Name based on the interest-related community interaction as shown in Based on the above analysis, and in consideration of the geographical location characteristics of the source of interest-related community discourse, it is revealed that most tourists are from Beijing, Shandong, Shanghai, Zhejiang, Guangdong and Sichuan, and the main tourism destinations are Nagano, Tokyo, Izu Islands and Gifu. Based on the characteristics of film-enabling tourism from the perspective of the destination hosts and tourists, this study has proposed six elements of interest-related community interaction of cultural tourism triggered by the film 5.2.In obtaining the text data with the data crawling software, and adopting the analysis paradigm of Grounded Theory, this study has explored the film-enabling tourism mechanism based on the interest-related community interaction, analyzed the elements of the interest-related community interaction, and put forward relevant measures and suggestions. The current research has broken the limitations of previous studies based on tourism motivation and marketing perspective, innovatively introduced the concept of \u201cinterest-related community\u201d into the research of film-enabling cultural tourism, and expanded the research perspective of film-enabling cultural tourism exploration. Previous studies discussed primarily the cultural tourism model of tourism destinations from the perspective of tourism destinations , and rar5.3.This study provides important practical value for the creation of film and television works and image building of tourism destinations in the future. First of all, film-enabling cultural tourism itself is an innovative application of tourism resources, and it inspires us to strengthen the in-depth interaction between film and tourism in the future, tap into the \u201celement resources\u201d in film and television works, highlight the profound cultural heritage of local tourism resources in film and television works, fully use the Internet media platforms to display unique tourism culture, and create the advantages and characteristics of tourism brands, not only to attract tourists to watch films, but also to drive their strong desire to travel to the shooting locations. Moreover, it should be noted that the construction of interest-related community is the key to promoting film-enabling cultural tourism. Therefore, it is necessary to actively build interest-related community, make use of the universality of the community to further promote the film-enabling effect to cultural tourism, and achieve a significant increase in the number of film and television audiences and tourists in the interaction between the film interest-related community and tourism interest-related community. Additionally, it is also inevitable to make full use of tourism destination resources and regional resources to realize the flexible allocation, combination and expansion of tourism resources combined with film elements, open up all-round interaction mechanism between film and tourism industrial chain, and provide tourists with the whole process, full time and space experience to comprehensively cater to tourists\u2019 demand for all-round experience and achieve innovative development.5.4.Your Name and the Chinese tourists traveling to Japan, however, interest-related communities formed by tourists and local residents during the tourism process are not considered. Therefore, future research can attempt to collect data texts including local residents from international social media platforms to further analyze the discourse structure of interest-related communities formed by tourists and local residents to reflect the characteristics of a more comprehensive film-enabling cultural tourism mechanism. In addition, the latest studies in marketing encourage using multiple data sources and methodologies (This study still has deficiencies that need further exploration and improvement. For instance, the data collected are from social media platforms in the Chinese context, and the interest-related communities formed are mainly the audiences of the film dologies , therefoThe original contributions presented in the study are included in the article/supplementary material; further inquiries can be directed to the corresponding author.YL contributed to the empirical work, the writing of the first draft, and the analysis of the results and supported the total work. JZ contributed to the revision and development of the research framework. JL contributed to the overall quality and supervision of the literature organization and empirical work. Authors discussed the results and commented on the manuscript. All authors contributed to the article and approved the submitted version.This work is supported by the Natural Science Foundation of China, Fund No: 72064003, project name: Study on the Regional Dynamic Evolutionary Mechanisms of Intelligent Technology, Factor Substitution and Industrial Synergistic Agglomeration.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "The creation of OHHLEP represents a recognition at the highest level of the urgency and complexities surrounding One Health and the intent to take this concept forward into policies and concrete actions.The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic once more demonstrated the close connection between humans, animals, and the shared environment. Although still under investigation, the closest relatives of this virus exist in animals, and the factors leading to spillover remain to be fully understood. This interconnectedness again highlighted the need for a One Health approach. Although the One Health concept is not new and has been at the forefront of interdisciplinary and multisectoral discussions for years, there is now an increased interest for this approach to be applied and translated into action. Following a proposal made by the French and German Ministers for Foreign Affairs at the November 2020 Paris Peace Forum, 4 global partners, the Food and Agriculture Organization (FAO), the World Organization for Animal Health (OIE), the United Nations Environment Programme (UNEP), and the World Health Organization (WHO), in May 2021 established the interdisciplinary One Health High-Level Expert Panel (OHHLEP)  are closely linked and interdependent.The approach mobilizes multiple sectors, disciplines, and communities at varying levels of society to work together to foster well-being and tackle threats to health and ecosystems, while addressing the collective need for healthy food, water, energy, and air, taking action on climate change and contributing to sustainable development.equity between sectors and disciplines;parity  and inclusion and engagement of communities and marginalized voices;sociopolitical and multicultural equilibrium that seeks a harmonious balance between human\u2013animal\u2013environment interaction and acknowledging the importance of biodiversity, access to sufficient natural space and resources, and the intrinsic value of all living things within the ecosystem;socioecological stewardship and the responsibility of humans to change behavior and adopt sustainable solutions that recognize the importance of animal welfare and the integrity of the whole ecosystem, thus securing the well-being of current and future generations; andtransdisciplinarity and multisectoral collaboration, which includes all relevant disciplines, both modern and traditional forms of knowledge and a broad representative array of perspectives.The newly formed operational OHHLEP definition aims to be comprehensive, to promote a clear understanding across sectors and areas of expertise, and to support the Partners and their Member States in framing their One Health strategies, programs, and implementation plans. This includes the forthcoming Joint Plan of Action for One Health (2022 to 2026), the key strategic framework that will guide the cross-sectoral collaborative activities of FAO, OIE, UNEP, and WHO. The definition should be considered as an overarching set of guiding principles that can be further tailored to specific stakeholders. It is intended to assist in orienting the general outline and considerations for a One Health approach and the opportunities for innovation, cooperation, and collaboration among all relevant sectors and disciplines. While food and water security, energy, and environmental/ecosystem health are wider topics with sector-specific and specialist concerns that may extend beyond the scope of One Health approaches, their interface is where multiple sectors have shared responsibility and relevance in protecting health and addressing health challenges. This One Health approach is not just focused on zoonotic disease or antimicrobial resistance but can address the full spectrum from prevention, health improvement, and health promotion to the detection, preparedness, response, and recovery from health crises. The approach is applicable at community, subnational, national, regional, and global levels. It relies on shared and effective governance, communication, collaboration, and coordination to understand co-benefits, risks, trade-offs, and opportunities for equitable and holistic solutions.Political commitment and leadership, including prioritization and allocation of resources that are distributed in equitable ways, are essential for the successful implementation of the integrated One Health vision. However, we need to recognize that there are substantial political, legal, ethical, financial, capacity, and societal barriers and complexities in developing and implementing a unified One Health approach. The commitment of political, sectoral, organizational, and individual societies to implement it successfully will address human, animal, and ecosystem health, including other issues like biodiversity loss, clean air and energy, the impact of climate change, food and water security, and social inequalities. This approach has clear advantages to improve health for all, embed social and environmental protection, and support sustainable economic development and resilience."}
{"text": "One Health is an emerging research area that has received increasing attention globally. In this study, we aimed to explore the global research trend and hotspots of One Health and provide a reference for potential future research and practices.This was a bibliometric descriptive study of publications on One Health in four directions, including zoonotic diseases, antimicrobial resistance, food safety, and vector-borne infections. Publications from 2003 to 2021 were retrieved using the Scopus database on One Health, which were screened based on the PRISMA guidelines. Keywords were analyzed and visualized using VOSviewer software.n = 312; 1%). The main research directions within the area of zoonotic diseases included viral, bacterial, parasitic zoonotic diseases, and vector-borne diseases, with a small amount of antimicrobial resistance research. The major research interests within antimicrobial resistance were Enterobacteriaceae drug-resistant bacteria, methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, and antimicrobial resistance gene detection; research on food safety clustered around agronomy research, aquaculture research as well as a small amount of antimicrobial resistance research in food; and research on vector-borne diseases focused on mosquito-borne infectious diseases, tick-borne infectious diseases, and vectors.A total of 12,815 publications were included. The annual number of publications and those on each topic showed a gradual increase from 181 in 2003 to 1,647 in 2020, with an average annual growth rate of about 20.2%; the top three countries in terms of the number of publications were the United States of America , the United Kingdom  and China ; the major research subjects were mainly in the natural sciences, with fewer social sciences subjects involved (The scientific literature on One Health has witnessed a rising global trend. Most research has focused on the human-animal health interface, while environmental health is often neglected. Research subjects mainly fall within natural science disciplines, with less social science research. More support needs to be given to interdisciplinary and intersectoral cooperation and research in the future. Continuous outbreaks of emerging and re-emerging infectious diseases are now rampant, threatening human health and wreaking havoc on socioeconomic development . The WorHealth is an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals, and ecosystems. It recognizes that the health of humans, domestic and wild animals, plants, and the wider environment (including ecosystems) are closely linked and interdependent. The approach mobilizes multiple sectors, disciplines, and communities at various levels of society to work together to foster well-being and tackle threats to health and ecosystems while addressing the collective need for clean water, energy, and air, safe and nutritious food, taking action on climate change, and contributing to sustainable development  defined One Health as follows: One elopment . In receBibliometrics is a statistical method used to analyze a body of literatures and its bibliometric characteristics, evaluate the development of a specific field, and predict its future trends . In partFollowing the PRISMA guidelines, this study used the bibliometric approach to analyze the research trends on One Health by (a) time and number of publications; (b) countries of publications; (c) most active journals; (d) subject areas; (e) citation of publications; (f) keywords of publications.We used the Scopus database as the data source for this study. Scopus is one of the largest bibliometric database that contains the metadata necessary for a bibliometric analysis , 13 and *)] AND TITLE-ABS-KEY . The retrieved publications represent research conducted at the human-animal-environment interface on the four priority topics of One Health.According to the Centers for Disease Control and Prevention (CDC), zoonotic diseases, antimicrobial resistance, food safety, and vector-borne infections are the four priority topics of One Health . AccordiThe term \u201cOne Health\u201d was first coined in 2003 by William Karesh, DVM . Hence, In the Scopus database, the Full Record and Cited References were exported in 7 steps of with 2,000 records each and imported into VOSviewer 1.6.15. In the software, we set the Type of analysis as \u201cCo-occurrence,\u201d the Unit of analysis as \u201cAuthor keywords,\u201d and the threshold value as 10 to draw the keyword co-occurrence clustering analysis map.In this study, we used VOSviewer, a visualization tool, to perform keyword clustering analysis on the collected literature. The software constructs and presents bibliometric maps with differences in distance, size, and density between references based on the co-citation principle of literature, which can be used to form a clustered view of the literature to assess its research directions and hotspots . ClusterOverall, the number of publications related to the four research topics on One Health has steadily increased over the past 18 years with varying rates among years . The numAmong the four topics, the number of zoonosis-related publications has been on a steady rise; the growth of antimicrobial resistance publications has accelerated since 2014 and has reached the same level as zoonosis publications in 2019; the number of food safety publications has only started to show an accelerated growth in 2017, while the number of vector-borne disease publications has remained in a slow-growth phase with a low number of publications.The 10 countries producing the highest number of papers on One Health are the United States of America (USA), United Kingdom (UK), China, France, Italy, Germany, Brazil, Australia, Canada, and India . The US PLoS ONE was the most prolific journal with 343 publications followed by PLoS Neglected Tropical Diseases with 212 publications. The top 10 active journals included three journals in the field of zoonoses, three in the field of environment, and two in the field of vector-borne diseases. PLoS ONE received the highest normalized citation per publication. Half of the journals in the top 10 list were ranked by Scopus as Q1 and all of them were affiliated with countries in the top 10 list for the number of publications, mainly with the US, UK, Switzerland, and the Netherlands. In addition, two specialized journals - One Health and International Journal of One Health, did not rank in the top 10 due to the smaller number of publications.The top 10 active journals are listed in The top 10 cited papers were listed based on Scopus databases. Among the top 10 cited publications, most were published between 2004 and 2015 on antimicrobial resistance  Table 3Table 3.Keyword analysis was conducted on the four key topics of One Health, and keywords with a frequency >10 were extracted to generate a keyword co-occurrence map, which reflects the current direction of attention for each of the four topics. The size of the circle reflects the frequency of the keywords, and the thickness of the link represents the strength of the association. The following are the results of keyword analysis.Zoonoses are divided into five research hotspots - (1) virEnterobacteriaceae resistant bacteria such as Escherichia coli and Salmonella (blue area); and 3) methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa (green area).Antimicrobial resistance is divided into three research hotspots - (1) theFood safety is divided into three research hotspots - (1) agrVector-borne diseases is divided into three research hotspots - (1) mosThis study used a bibliometric approach to examine the trajectory, bibliometric characteristics, and research hotspots of the four priority topics in One Health. The results show that the number of publications in these four areas has continued to grow since 2003, with acceleration starting in 2008. The US ranks in the top tier in One Health research with close international cross-institutional collaboration. Research disciplines dealing with One Health are mainly natural science disciplines, with less research conducted in social science disciplines. Keyword analysis reveals that the studies mainly focused on human and animal health, while less attention was paid to environmental health.The number of publications is an important indicator in bibliometrics that reflects the amount of attention on a research field is receiving and whether the field is growing over time. This number has continued to grow in the field of One Health in recent years, with an acceleration starting in 2008. This is probably related to the multi-institutional collaboration between WHO, the World Organization for Animal Health (OIE), the Food and Agriculture Organization of the United Nations (FAO), the United Nations International Children's Emergency Fund (UNICEF), the World Bank, and the United Nations System Influenza Coordination (UNSIC) in 2008 . The steZoonotic diseases have long been a key research area of One Health and its publications continue to grow, reaching a brief peak in 2020 possibly due to COVID-19 pandemic. The number of antimicrobial resistance-related publications has started to grow rapidly since 2014, which is likely spurred by the publication of WHO's first global report on antimicrobial resistance in 2014 based on data from 114 countries worldwide . The pubThe US, UK, and China have a relatively high number of publications on One Health. US and UK have established several One Health government agencies, international organizations, educational and research institutions, and research funds. UK and US universities are also actively collaborating on One Health training programs. However, most of the programs are established only for veterinary specialties . In ChinAnother interesting finding is that there is no correlation between The use of a multidisciplinary approach mentioned in the past definition of One Health has been expanded to a transdisciplinary approach in the latest CDC definition of One Health . TransdiOne Health represents a systematic approach that combines human, animal, and environmental health. However, our findings indicate that the current studies on One Health focus on human and animal health, while little attention is paid to environmental health. Meanwhile, due to the impact of COVID-19 pandemic, the tendency to concentrate on wildlife studies and neglect environmental health may be further reinforced. There is thus a need to fill the research gap between environmental health and human-animal health in order to improve the framework and implementation of One Health apporach .Zoonoses with wild animals as hosts  have increased in recent decades and focus on One Health research, while the role of One Health approach applied in parasitic diseases has also been discussed . ResearcEscherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus in the order of decreasing frequency, and the detection of antimicrobial resistance genes was one of the hot spots, which is consistent with the results of this study , more and more research in this emerging field has shifted focus to the application of One Health approaches at the human-animal-environment interface to address complex global public health problems. In order to generate an integrated solution to challenges posed collectively on humans, animals, and the environment, it is necessary to promote cross-sectoral, trans-disciplinary, and cross-regional cooperation and advocate an integrated human-animal-environment management strategy. Finally, as most of the disciplines involved in One Health with medicine-related issues only, there should be more interdisciplinary exchanges with non-medical disciplines such as politics, law, economics, and management.LM contributed to the study design, manuscript writing, literature search, analysis, and visualization. HL, WD, DW, XG, and XZ contributed to draft review, editing, and validation. SP and SL participated in language editing. All authors contributed to manuscript revision, read, and approved the submitted version.This study was supported by China Medical Board [Grant No: 20-365] and the programme of the Chinese Center for Tropical Diseases Research [Grant No: 131031104000160004].The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "Dear Editor,Erythrodermic psoriasis (EP) is a rare condition characterized by a generalized and desquamative erythema that involves >75% of the body surface.In conclusion, our case has shown that apremilast may be effective in long\u2010term treatment of EP, highlighting it as a precious therapeutic opportunity for patients with contraindications to other treatments. More data are needed to draw updated guidelines.The authors declare no potential conflict of interest.Matteo Megna gave substantial contribution to conception and design of the work, acquisition, analysis and interpretation of data, draft and critical revision of the article for important intellectual content, final approval of the version to be published. Sonia Sof\u00eca Ocampo Garza gave substantial contribution to conception and design of the work, acquisition, analysis and interpretation of data, draft and critical revision of the article for important intellectual content, final approval of the version to be published. Gabriella Fabbrocini gave substantial contribution to acquisition, analysis and interpretation of data, draft and critical revision of the article for important intellectual content, final approval of the version to be published. Eleonora Cinelli gave substantial contribution to acquisition, analysis and interpretation of data, draft and critical revision of the article for important intellectual content, final approval of the version to be published. Angelo Ruggiero gave substantial contribution to conception and design of the work, draft and critical revision of the article for important intellectual content, final approval of the version to be published. Elisa Camela gave substantial contribution to conception and design of the work, acquisition, analysis and interpretation of data, draft and critical revision of the article for important intellectual content, final approval of the version to be published.Table S1. Review of the literature: EP cases treated with apremilast. BSA, body surface area; CsA, cyclosporin; MTX, methotrexate; PASI, psoriasis area severity index.Click here for additional data file."}
{"text": "It is worth noting that, on the world stage, preventive treatment has been making timid progress since it was launched in 2018, and with the COVID-19 pandemic, there has been practically a stagnation, which worries health authorities around the world.Brazil, ranking 19. According to the Centers for Disease Control and Prevention (CDC), case management by nurses in the context of TB refers to follow-up of cases, both in active disease and in infection, from diagnosis, treatment to completion of therapy, in which the necessary resources for the control and elimination of TB are provided.Among the various international initiatives aimed at expanding the coverage of preventive treatment among vulnerable groups, there is the articulation and involvement of nurses through the case management strategy. It is worth noting that there is consistent evidence of the effectiveness of case management by nurses in the context of TB and HIV comorbidities, by expanding care for vulnerable groups, better compliance, positive/favorable clinical outcomes, low risk of iatrogenic events, greater coverage of preventive treatment, equity and a people-centered approach,4.In case management by nurses, all individuals with active disease become non-infectious upon completion of treatment, all individuals with TB infection remain non-infectious, and all individuals without TB infection TB do not be infected,4.Nurses\u2019 autonomy in TB diagnosis and treatment is revealed to be one of the main bets for advancing access to the health system and for overcoming geographic, economic, cultural and organizational barriers between people living with HIVFrom a legal perspective, it is important to highlight a favorable environment for the intervention of case management by nurses, by investing in these professionals\u2019 autonomy, whether for requesting diagnostic tests or prescribing treatments, according to Professional Practice Law 7.498/1986, which regulates the practice of nursing, the Resolution of the Federal Nursing Council (COFEN) 564/2017, which approves the Code of Ethics for Nursing Professionals, and Resolution (RDC) 471 of February 23, 2021, which provides for the criteria for prescription, dispensing, control, packaging and labeling of drugs based on substances classified as antimicrobials for prescription use, alone or in combination.In the light of international policies, and from the perspective of the autonomy of nurses and their leadership, to reduce disparities and inequities in access to health services, the movement in Latin America and the Caribbean for Advanced Practice Nursing is essential for the inclusion of nurses in the prescription of preventive treatment for TB, as countries participating in the IMPAACT4TB project are already doing. In these places, the inclusion of shortened treatments, combined with the expansion for nurses\u2019 prescription, was responsible for doubling the number of treatments offered in the services.Considering that nursing is the largest contingent of human resources in the health system and that, in TB control services in Brazil, they are responsible for care management, the inclusion of nurses in the strategy of prescribing preventive treatment will make considerable progress towards achieving the goals of ending TB as a public health problem and alleviating suffering, illness and deaths resulting from TB.It is time to take a step ahead of the disease, an opportune moment for the Ministry of Health to institute a strategic policy for TB prevention by nurses, supported by specific protocols and adequate qualification for the mission to eliminate TB in Brazil."}
{"text": "Gender equality leads to better health and mental health for women and girls as well as to better public health and mental health for all. Inequality, discrimination and social exclusion are both cause and consequence of mental health problems for all and affecting women and girls in specific and substantial ways. Equality through the realization of non-discrimination, respect and enablement of autonomy as well as full inclusion in all spheres of life are demands of gender equality legislation as well as human rights obligations for persons with mental health problems. Essentials of non-discrimination laws concern key areas, including health, family planning, marriage and parenthood, employment, housing, education, standards of living and social, political and cultural participation, along with the right to be free from exploitation, violence and abuse. Gender-specific attention to the risks, rights and needs of women and girls and their families are legal obligations as well as clinical and scientific responsibilities. Because of the cumulative and interacting gender-based and other forms of discrimination, regulations such as those following the adoption of the UN-Convention on the Rights of Persons with Disabilities include specific provisions for women with psychosocial disabilities. Other examples for the urgent necessity of a gender-sensitive approach are \u2013 among many others - safety and gender-responsiveness of community and hospital settings, humanitarian crisis response, working with family carers, and of course, mental health teaching and research, including efforts towards gender parity in academic psychiatry.No significant relationships."}
{"text": "In China, border cities are developing in the direction of trade, investment, tourism, and regional diversification and becoming crucial for the national opening-up strategy and inter-regional exchange. In this study, we construct a comprehensive system for measuring and evaluating the resilience of border cities in China that also reveals the spatial and temporal characteristics of resilience. Three representative sample zones  are selected within the three major regions of China to analyze the regional differences in border city resilience and propose targeted coping strategies. The findings of this study are as follows. First, the spatial distribution of resilience in Chinese border cities varies significantly, with the overall resilience decreasing in the following order: Northeast China > Southwest China > Northwest China > North China > Tibetan China. Higher resilience of border cities is predominantly related to better economic foundations and advantages in border trade. Second, the resilience of China's border cities has increased significantly over the past decade, with highly resilient border cities concentrated in the northeastern part of China, the northern part of Xinjiang, and Guangxi Province. Moreover, high resilience generally spreads to surrounding low-resilience cities over time. Third, the spatial distribution and development trends of resilience levels differ among the three sample zones. Therefore, it is crucial to improve urban resilience according to the regional characteristics of each border city and its specific developmental stage. With further globalization of the Chinese economy, urbanization, industrialization, and informatization are increasingly spreading to the country's border areas. Thus, frontiers that served as barriers in earlier times no longer exist. Cities that have evolved from settlements based on their unique locations, typically considered border cities, now take on the dual functions of national security barriers and economic and cultural links . Since tResearch on border cities has long been a key issue in political geography \u20137. Most Collectively, little research has been conducted on the development quality and status of China's border cities, with most studies on urban resilience focusing on national or regional scales, such as cities in the central-eastern and coastal regions of China; thus, border cities have long been neglected . MoreoveOriginally conceived in the field of physics as the ability of an object to return to its initial state, the concept of resilience was introduced to ecology by Holling in the 1970s and has since been cited in psychology, engineering, and socioeconomic research . After IThe concept of border city resilience encompasses the state and degree of adaptation of the border city territorial system in overcoming the adverse disturbances caused by the interaction between changes in the natural environment and human activities, based on the advantages of its own structural characteristics and functional attributes. As location conditions carry all the elements necessary for the creation and development of a city, dynamic changes in location conditions inevitably affect the economic, social, and planning development of a city in multiple ways . The borChina has the longest land border  and the largest number of neighboring countries in the world. The geopolitical development of China's border areas is complex, with widely varying locational conditions. China has 14 land neighbors and 45 prefecture-level border cities in nine border provinces and regions, including Liaoning, Jilin, Heilongjiang, Inner Mongolia, Gansu, Xinjiang, Tibet, Yunnan and Guangxi .http://www.mohurd.gov.cn/xytj/tjzljsxytjgb/jstjnj/), statistical yearbooks of the border provinces and regions, and statistical bulletins of the cities (http://www.tjcn.org/tjgb/) for data supplementation. Data on government-issued policies were obtained from the Ministry of Commerce of the People's Republic of China, the Office of Port Management of the General Administration of Customs, and a list of key border areas in the Opinions on Several Policy Measures to Support the Development and Opening of Key Areas along the Border issued by the State Council. The Country Vulnerability Index was obtained from the Fund for Peace website. The UN Human Development Index is based on the United Nations Development Program. Geographical distances were measured using the Baidu map pickup co-ordinate system and ArcGIS10.2 software. Missing data were interpolated to complete the dataset.Forty-one prefecture-level cities in the border areas of China were selected as the study objects, of which Daxinganling, Tacheng, Ali, and Shannan were excluded from the study owing to serious data deficiencies. The three time points chosen for the study were 2010, the first year of the 12th Five-Year Plan; 2015, the closing year of the 12th Five-Year Plan; and 2020, the end of the 13th Five-Year Plan. The data were mainly obtained for the period 2010\u20132020 from the China Urban Statistical Yearbook 2010\u20132020, the Urban Construction Statistical Yearbook of the Ministry of Housing and Construction  Urban system layerAccording to the urban resilience measurement method, we consider the harmonious symbiosis between production, life, and ecology for three urban spaces. The economic base, resource allocation, and production structure are the basic conditions for the resilience of urban systems. The effectiveness of living space is a fundamental function of a city and a measure of the resilience of the \u201cpeople\u201d in the city. As a key physical element, the city infrastructure is a direct and real factor influencing the quality of life of its inhabitants. Ecology builds the green barrier of a city, and the creation of a livable ecological city is crucial for preventing flooding and mitigating pollution. Indicators referring to each of these three spatial layers were used to measure the role that each element of the urban system layer in the border city has on its level of resilience.(2) Border system layerFrom its birth to its development, a border city cannot be separated from the geography of the border area, which is connected to the interior and exterior of the city, forming the basis on which cross-border trade is conducted, with the economic prosperity of the city as the carrier. The degree of openness to the outside world in a border economy oriented toward trade at ports has always been a key concern for the state. According to the law of distance decay in geography, the distance between a border city and its neighboring important cities affects the ease of transmitting its resources. In addition, border areas are bordered by neighbors in a complex and volatile environment, where political and social conflicts and the economic level of other countries can become factors of vulnerability that threaten the country according to the openness of its borders. Therefore, we used a three-layer sub-system of openness, strength of ties, and neighboring environment to measure the role that each element of the border system layer in border cities has on the level of resilience.As each evaluation index has different levels and orders of magnitude, we adopted the z-score standardization method to process the data in a dimensionless way and eliminate the influence of data with different levels of magnitude on the resilience evaluation. The TOPSIS evaluation model, which is based on entropy weights, was used to measure the resilience of Chinese border cities. Specifically, the standardized data were normalized, the weights of each indicator were determined by the entropy weighting method, and the TOPSIS model was applied to calculate the positive and negative ideal solution distances of the target vector for each year by defining a measure in the target space, where the closeness of the evaluation target to the ideal value was calculated for ranking. Finally, we calculated the resilience evaluation value of each border city. The advantage of the entropy-TOPSIS model is that it is operational and the results are reasonable . The levThe BCR was calculated using the above evaluation model. Then, ArcGIS10.2 was used to spatially link the BCR values to the study area in vector format and visualize the spatio-temporal geographic information. The natural breakpoint method takes into account the range and number of elements in each group, as close as possible, and can be used to divide subjects into groups with similar attributes. Based on Jenks' natural breakpoint method, the BCR was divided into five categories based on its magnitude, i.e., lowest, lower, medium, higher, and highest resilience . The valThe sample zone is a collection of continuous linear study sites that represent a series of sites that vary regularly or show significant differences in geographical gradients owing to dominant factor drivers . To reveThe BCR of the 45 prefecture-level cities, states, or regions in China's border areas was measured for the three study years  according to the model described in Section 3.3.2. The average BCR of border cities was 0.3174, 0.3323, and 0.3397 in 2010, 2015, and 2020, respectively, showing a gradual increase in resilience over time, the average resilience of China's border cities in 2015 was 4.694% higher than that in 2010, and in 2020, it was 2.227% higher than that in 2015. When comparing individual BCR values across the 3 years, Xinjiang Changji Prefecture had the highest BCR of 0.5048 in 2015, whereas Kashgar, Xinjiang, had the lowest BCR of 0.2449 in 2010 . Figure In 2010, the resilience levels of most border cities in China were generally low, with minimal regional differences. According to the five major regions , and Tibetan China), the average resilience level of border cities in 2010 decreased in the following order: North China (0.3222), Northeast China (0.3128), Southwest China (0.3053), Northwest China (0.3043), and Tibetan China (0.2604) . In termThe BCR values of border cities in 2015 were significantly different from those in 2010, with all cities showing an overall increase in resilience and more pronounced spatial differences, specifically in the northeast and northwest regions and in eastern Inner Mongolia. That is, cities in northeast and eastern Inner Mongolia showed significant increases in BCR values, whereas the southwest and Tibetan regions showed no significant improvement in resilience. During this year, border cities began to make a breakthrough in terms of resilience quantity and quality, transitioning from only one highest-resilience city and two higher-resilience cities in 2010 to three highest-resilience cities and six higher-resilience cities .The resilience level of border cities in 2020 showed a relatively small change from that in 2015, except in the southwest region. The highest-resilience region was dominated by eastern Northeast China, northern Xinjiang, and western Guangxi, whereas the lowest resilience region included southwestern Xinjiang and Tibet, which showed no notable improvement effect. In Yunnan Province, the resilience level of border cities was significantly increased, with a transition from lower resilience to highest resilience and significant regional differences overall. The northern region had the largest average BCR of 0.3514, showing an increase of 0.011 from that in 2015, with the best overall regional resilience quality and the fastest rate of resilience improvement in Tibet, followed by the southwest region, with BCR values showing an increase by 11.4 and 5.52%, respectively, from 2015. In 2020, there were five border cities with the highest resilience and nine border cities with higher resilience. In the northeast, the cities of Jixi, Mudanjiang, Yanbian Korean Autonomous Prefecture, and Dandong had an average resilience index value of 0.3868. The northern region had the most balanced resilience level, with Baotou exhibiting the highest intra-regional resilience level of 0.447, which was decreased from that in 2015. The greatest variation in city resilience levels was found within the northwest region, with the highest resilience level in Yili at 0.4345 and the lowest resilience level in Kizilsu Kirgiz Autonomous Prefecture at 0.299, with a difference of 0.135 between the two, reflecting the huge gap in development between the north and south of Xinjiang. The resilience index of Yunnan border cities in the Tibetan and southwest regions is rising slowly, whereas cities in Guangxi Province have improved significantly, with the emergence of Chongzuo as a high-resilience border city , 2.Regarding the evolution of border city resilience from 2010 to 2020 in more detail , the resIn this study, three sample zones of border cities in Northeast China, Xinjiang, and Yunnan\u2013Guangxi, which are located in three key development directions of China's border area, were selected to draw a trend line of the resilience level of each zone in 2010, 2015, and 2020 using the geostatistical trend line analysis method in ArcGIS 10.2 . This an(1) Northeast China: Northeast Asia sample zoneThe BCR values of northeast border cities, which span the three provinces of Heilongjiang, Jilin and Liaoning, were approximately arranged in an inverted \u201cU\u201d shape, i.e., BCR values were higher for the western side, mainly Heihe, the northeast side, including Jixi, Mudanjiang and Yanbian Korean Autonomous Prefecture, and the southern side, Dandong, than for the other cities. However, the three cities on the northeastern side have maintained high levels of resilience over time, increasing their differences from their neighbors and becoming more structurally prominent. Subject to the influence of the urban base and international environment, the northern side of Heilongjiang Province, as the border river between China and Russia, has convenient transportation and serves as a good basis for cooperation between the two countries. Jixi City and Mudanjiang City have their own urban volumes, which are greater than those of the surrounding cities, and have relied in recent years on the advantages of transportation, population, and national policies to improve the quality of development, in addition to port trade, foreign investment, and border tourism to optimize the economic structure, which has accelerated the resilience of these cities. The border cities in the north and east, as traditional forest and agricultural areas in the northeast, have good basic conditions for the development of agriculture and animal husbandry but a weak foundation for secondary and tertiary industries and face the dilemma of industrial structure defects and difficulties in transformation. Moreover, this part of the region has long belonged to the labor export outflow area and faced the pressure of negative population growth, with a high degree of aging and a high unemployment rate, relative to the cities in the northeast and Dandong City in the south, where the export of trade-oriented industrial development is constrained. Intra-regional development disparities have accelerated factor flows, with resources from cities with differing infrastructure flowing more to developed regions, large provincial cities, and the parts of neighboring countries that border China far from their own economic and political centers, which makes it difficult for Northeast China's border cities to prosper. In addition, the long-term population exodus, the existence of social problems such as aging urban infrastructure, low income of residents, and employment difficulties, as well as the low degree of openness of the neighboring Russian Far East and North Korea to the outside world, which reduces the development potential of border cities on the Chinese side, have led to large spatial differences in resilience of the border cities and unstable development trends in this sample zone.(2) Xinjiang province: Central Asia sample zoneThis zone includes border cities with high levels of resilience, consisting of various regions, cities, states, and leagues in northwest China, as well as those bordering Central Asian countries and Mongolia, including Xinjiang, Jiuquan in Gansu, and the Alashan League in Inner Mongolia. The difference in resilience between cities in the east and west of the sample zone was not significant, and its trend line is approximately a smooth curve, characterized by a \u201cconvex\u201d structure with low levels in the east and west and high levels in the center. The difference in resilience levels between cities was greatest in 2010 and least prominent in 2015; in 2020, the curve became more pronounced, reflecting an increased difference in resilience levels between cities. This phenomenon is primarily caused by constraints of the natural environment. The northwest region straddles arid and semi-arid zones, with large areas covered by grasslands, deserts, the Gobi, and other land cover types that are relatively harsh. However, Xinjiang, Gansu, and Inner Mongolia rely on their rich resources of livestock, minerals, oil, and gas, coupled with increasing openness toward Central Asian countries, four of which joined the SCO as early as 2001 and have a high degree of political mutual trust. Moreover, closer economic cooperation under the Belt and Road Initiative will, to a certain extent, make better use of the city's proximity to the border and make up for the inherent shortcomings of its natural geographical environment. Furthermore, the ecological environment of the southern border region and western Inner Mongolia still deserves protection, as overgrazing and reclamation of pastureland has led to ecological fragility and consequent severe weather conditions such as sand and dust storms, which directly threaten the normal functioning of the city. In addition, the economic development of the northern border region has long relied on mining mineral resources and petrochemical processing, resulting in pollution and a fragile industrial structure. We recommend that the region as a whole should restore its ecology while developing tourism and that multiple initiatives should be taken to improve the resilience of the city and achieve healthy and sustainable development of northwestern border cities.(3) Yunnan\u2013Guangxi: Myanmar\u2013Laos\u2013Vietnam sample zoneThe sample zone extends from the Nujiang Lisu Autonomous Prefecture in Yunnan to Fangchenggang City in Guangxi and includes 11 cities bordering the Southeast Asian countries of Myanmar, Laos, and Vietnam. The resilience level of border cities in this sample zone increased from west to east, with an overall trend line of double smooth curves in parallel. The region covers three water systems, namely the Nujiang, Lancang, and Duijiang Rivers; cities in the Nujiang River Basin showed the lowest level of resilience, followed by cities in the Lancang River Basin, with cities in the \u201cYoujiang\u201d River Basin in Guangxi Province exhibiting the highest resilience. The Yunnan\u2013Guangxi border area has good water and temperature conditions, high forest cover, and complex topography. Unlike the two sample zones mentioned above, the Yunnan\u2013Guangxi sample zone lacks large areas of flat land conducive to urban-scale development, which limits the carrying space for urban production and living. In this environment, the inconvenience of geographic location becomes a challenging factor that hinders the comprehensive resilience of the city in terms of accessibility and the quality of life of residents. The trend line in 2020 was flatter than that in 2010, with the overall gap narrowing as the resilience of border cities in the southwest region increased across the board. Notably, the strength of national policy support for Yunnan and Guangxi provinces has reinforced the effective functioning of border cities across the border. We found an obvious role of each city in trade with Myanmar, Laos, and Vietnam. Moreover, these cities have attracted increasing attention in terms of good prospects for radiating ASEAN countries, as well as investment in talent, investment environmental management, and other related elements. This has led to an improvement in the quality of urban construction while actively promoting comprehensive construction of border cities with high levels of resilience.This study makes two major contributions to the research field. First, regarding theoretical knowledge, we construct a comprehensive, focused, and visual system for exploring the resilience and healthy development of border cities in China. This study differs from existing research in relation to the location conditions and development of border cities in China. Most existing studies start from macro-scale countries (regions), meso-scale cities , and micIn this study, we summarize the methods and processes of these four categories of research, which represent studies of \u201ccities in the border\u201d  and \u201ctheThe second major contribution of this study is to provide guiding suggestions for the development of Chinese border cities in combination with government policies. The national government provides policy support to border cities, and local governments take measures to formulate effective development models according to local conditions. In this study, we explored the weaknesses of regional border cities through resilience measures and spatial differences in recent years and proposed measures to improve urban resilience. These measures include maintaining high-resilience border cities to optimize the urbanization structure, reasonably optimizing the urbanization quality, building a border area growth pole, actively undertaking the industrial transfer of developed areas, introducing emerging industries, paying attention to technological innovation, improving the product market and competitiveness, creating a good market investment environment, developing a series of investment promotion preferential policies to enhance city vitality, encouraging scientific and technological innovation, and promoting the development of border city transformation measures . For borThe limitations of this study are predominantly related to data collection limitations and the complex factors affecting the resilience of border cities. As border cities are far less comprehensive than mainland capital cities and coastal cities in terms of data disclosure, the lack of data is a serious issue. Moreover, the reality of China's border cities is complex. China's border areas are vast, and border cities in different regions are faced with different levels of economic development and resource endowments; therefore, it is difficult to identify a unified development pattern. Although we deconstructed the concept and analytical framework of the resilience of China's border cities and then analyzed their spatio-temporal patterns and regional differences, we did not further explore the factors influencing the resilience of border cities because of objective factors such as the complexity of the main body of border cities and the difficulty of obtaining some data. We aim to conduct further research on this aspect in future. The development of China's border areas has attracted substantial attention from the international community and Chinese government. Various international, national, and local incentive policies have been introduced to encourage development , 43. In In this study, we collected urban panel data for 2010, 2015, and 2020, as well as data used to characterize internal and external city linkages, to analyze the spatio-temporal characteristics and evolution of resilience in border-level cities in China at the national scale. A city resilience system was constructed from the perspective of border city relationships, and the main interannual variations and spatial differences in the resilience of China's border cities were summarized by quantifying their resilience levels. The main findings are as follows:We observed significant spatial divergence in the level of resilience in Chinese border cities, with overall resilience decreasing the following order: Northeast China > Southwest China > Northwest China > North China > Tibetan China. Coastal border cities such as Dandong and Fangchenggang had greater resilience than inland border cities. The spatial differences in BCR values were consistent with the economic level of border regions as well as the construction of ports and export-oriented trade orientation. Moreover, the spatial difference coincides with the level of economic and trade development of border areas, which directly influences investment in urban infrastructure and environmental management. The economy is not only an important component of the border system but also the basis for increased resilience of the urban system at border locations. However, gaps in the resilience level of border cities are inextricably linked to factors such as physical geography, historical foundations, population movements, and policies. Most border cities in China still rely on their geographical location and geopolitical advantages. In addition to forming an economic development model that focuses on foreign trade, close links between the main body of the city and the border crossing and its surrounding areas are strengthened. By ensuring the healthy and high-quality development of highly resilient cities, the quality of resilience in small- and medium-sized cities can be improved, and the geographical gap in resilience between cities can be gradually reduced.From 2010 to 2020, the overall resilience level of China's border cities showed an upward trend, with spatial disparities gradually increasing. In particular, 2010\u20132015 was a critical period for the resilience of border cities nationwide, and by 2015, the combined resilience of northeast China and the northern border region of northwest China had reached its highest level, becoming the most resilient areas of China. In 2020, the number of cities with medium and high levels of resilience dominated; however, concentrated contiguous areas of cities with medium to low levels of resilience still existed. For border cities, the elements between the border and urban systems cannot be separated, and the integration and matching of elements between systems is key to improving the resilience of border cities.According to its geographical proximity, the northeastern sample zone showed an inverted \u201cU\u201d shape, with western, northeastern, and southern parts exhibiting high and continuously increasing resilience and all other cities in the zone exhibiting reduced resilience. The Xinjiang sample zone showed no significant differences from east to west, and the resilience trend line was approximately a smooth curve, characterized by a \u201cconvex\u201d structure with low levels in the east and west and high levels in the center and a \u201cgentle to prominent\u201d trend over time. The Yunnan\u2013Guangxi sample zone showed an increasing level of resilience from west to east, with a double smooth curve parallel structure. Cities in different sample zones and stages of development face significantly different risks and shocks. The construction of a resilient city at the border must be tailored to the local conditions, that is, the regional nature of the border and the stage of urban development. Simultaneously, refined and dynamic coping strategies that consider the general environment and future urban development potential of border areas should be developed.The original contributions presented in the study are included in the article/LS: form analysis, topic research, method proposal, progress management, and article writing. FP: fund acquisition, conception, supervision, review, and editing and modification suggestions. SW: conceptualization, methodology, theory proposal and verification, software application and visualization analysis, article writing, and data management. All authors contributed to the article and approved the submitted version."}
{"text": "Each index of the system was obtained by sorting analysis of radar chart. The weight table of evaluation index was calculated by analytic hierarchy process. Therefore, the evaluation index system of training quality of high-level tennis team constructed in this study aims to provide reference for real-time monitoring, comprehensive evaluation, and diagnostic evaluation of each link of high-level tennis team training.The paper established the evaluation index system of training quality of high-level tennis team, which comprising five first-class indexes: work planning evaluation index ( Training quality is an important factor to measure the improvement of athletes' competitive ability and affects not only their comprehensive performance, which is the core content for diagnosing and evaluating athletes, but also a comprehensive concept, which is composed of the coaches \u201ccoaching ability, training conditions, athletes\u201d enthusiasm to participate in training and other elements. In the process of constructing and developing high-level sports teams, scientific and systematic training is the key link to change athletes' competitive ability and improve training performance, which plays a supporting and leading role in the cultivation and development of sports reserve talents. Since the scientific evaluation system can reflect the development of sports and the implementation effect of relevant policies, relevant workers can grasp the development process of training at any time. Many developed countries have studied this from the perspective of athletes, coaches' evaluation, and sports team management. The quality evaluation of sports team training includes three aspects: first, the perspective of athletes, including the physical condition, technical and tactical ability, pre-game state adjustment ability, and self-analysis of sports performance; second, the perspective of the coach, including the evaluation of teaching ability; and third, the angle of the sports team, mainly involving the team management  education, the all-round development of young people is of great concern. The construction of a high-level tennis team training quality evaluation system, from the dimension of scientific and technical literacy, has laid a good development space for the promotion of physical and mental health and the improvement of competitive ability of this special group of young athletes, and broadened the reserve of competitive reserve talents.The purpose of this article is to provide a comprehensive evaluation method for the training quality of high-level tennis teams and to provide a theoretical basis for the scientific and reasonable regulation and control of the training work of high-level tennis teams.In the research of training quality evaluation, experts and scholars mainly focus on the process of mathematizing the evaluation contents of different sports with multiple objectives and criteria, and then obtain accurate and scientific evaluation results, which can be used as a guide and reference for improving athletic ability of athletes.In the study of athletic ability of athletes, experts and scholars mainly focus on the characteristics of sports, highlighting the characteristics and complexity of competitive ability.In the research on the evaluation index system of sports teams, Chinese scholars mostly discuss both subjective and objective aspects, and some studies present the analysis of a certain aspect, but it is not common to analyze the whole aspect of sports team training. Foreign scholars' research on the training of high-level sports teams mainly focuses on a particular aspect of the components of sports teams, such as sports techniques and tactics, athlete psychology, and other perspectives, and analyzes the problems related to the training of the whole sports team. As the rapid development of modern competitive sports has put forward higher requirements for sports team training, further research on systematic training of high-level sports teams is needed in order to make the training of sports teams develop in an efficient and refined way.Through consulting and sorting out the literature on the quality of tennis team training, including journal papers, master's thesis, books, and relevant policy documents, the key words of \u201ctennis team\u201d and \u201ctraining quality\u201d were searched, summarized, and analyzed. Based on this, relevant experts' research of training quality of high-level tennis team are determined and divided into training work planning, training work implementation, training work monitoring, tennis team work management, and sports competition results.Exploring the components, connotation, evaluation principles, methods of Training Quality of High Level Tennis Team, we have interview some experts through the way of face to face talk, telephone interview, and E-mail. The experts are mainly come from experts and scholars in sports colleges, front-line coaches work in provincial team and management personnel of all kinds of sports team. Based on the investigation of the current training situation of China's high-level tennis teams, the actual development of training planning, training implementation, training work monitoring, tennis team work management, and sports competition results are summarized and refined in According to the information in According to the first two parts, sorting out the primary selection indexes of training quality evaluation of high-level tennis team and designing the questionnaire \u201cscreening table of training quality evaluation index of high-level tennis team.\u201dThe degree of authority of the experts is an indication of the reliability of the questionnaire, which is expressed by the familiarity of the experts with the selected indicators and the basis of their judgment. The quantitative values of the familiarity and judgment basis are shown in A coefficient of authority value of \u22650.70 is generally considered to be within the acceptable range. In this study, The degree of coordination of experts' opinions reflects the variability of the selected experts' evaluation of the index, which can be expressed by calculating the coefficient of variation and the coordination coefficient. The coefficient of variation is a statistical measure of the degree of variation of different experts' opinions, and the smaller the coefficient of variation, the higher the degree of coordination of experts. The formula is: CV = I/V, and CV represents the coefficient of variation, I represents the standard deviation, and V represents the mean. The expert coordination coefficient reflects the degree of consistency of experts' opinions on the index. In this study, the coordination coefficients and chi-square values of experts in the first and the second rounds were calculated based on the results of the first and the second rounds of expert consultation and the related formulae , 6.In the form of written and online questionnaire survey, two rounds of survey were conducted among sports training experts, representative senior coaches, scientific research personnel, and training management personnel in the tennis industry. The final result was based on the second survey. According to the screening results, the importance degree (average score \u22654 points) is taken as the evaluation index of training quality of high-level tennis team.The questionnaire was sent to 20 experts, and testing the validity of the questionnaire  shows thr = 0.835, p < 0.1 of the two questionnaires was calculated, indicating that the questionnaire issued in this study has high reliability.In this study, we adopted the method of retest. After formally distributing the questionnaire for 15 days, 50% of the respondents were randomly selected to reissue the same questionnaire, and the data were processed. By comparing the results of the two surveys, the According to the requirements of analytic hierarchy process (AHP), this article designed a \u201cquestionnaire on the weight of elements in the hierarchical structure of training quality of high-level tennis teams.\u201d SPSS25 was used for statistical analysis on the collected questionnaires, determining the weight of training quality indicators of high-level tennis teams, and analyzing the evaluation indicators.At present, there is no specific standard for judging the level of sports teams. In China, it is mainly used to implement athlete technical grading system .At the present stage, the skill level of Chinese tennis players is mainly evaluated according to their competition level and ranking, which generally can be classified as elite athletes, first-class players, etc. But usually, due to the different recruitment standards and training conditions of sports teams in different provinces and cities, the overall competitive level is not judged by the individual performance of athletes, that is, the level of athletes themselves, but by the level of the competition and ranking of sports teams.Some experts think that the \u201chigh level\u201d is a relative concept. The training of high-level athletes should be divided into at least two levels: one level is the high level relative to the average student, where these athletes should have a high level of special sports skills, and this part of the sports team group with a certain foundation and skills is called \u201chigh level;\u201d and another level is the high level relative to professional athletes, who have a good athletic talent and athletic foundation, professional athletes can be achieved through scientific training, and these athletes belong to the competitive type of \u201chigh level.\u201d These two \u201chigh levels\u201d play an indispensable role in the process of sports development, and they are also the embodiment of the training of sports talents at all levels  training work planning, (2) training work implementation, (3) training work monitoring, (4) network team work management, and (5) sports competition results.To reflect and measure the research object comprehensively, the evaluation system is to reflect the characteristics and rules of high-level tennis team training, and the training quality evaluation index system can more comprehensively reflect the actual situation of high-level tennis team training. To ensure that the selected indexes can objectively and accurately reflect the training quality of high-level tennis teams, according to the relevant literature and existing research basis, preliminarily constructing the evaluation index system of tennis team training quality. After the screening, determining the evaluation index system of the training work of the high-level tennis team  is focusCompetitive ability includes five elements: physical fitness, skill, tactical ability, mental ability, and intelligence. Systematic training is a decisive factor for the steady improvement of athletes' competitive ability , important (four points), general important (three points), unimportant (two points), and very unimportant (one point). According to the results of expert questionnaire, the mean value and coefficient of variation of the indicators can be calculated. Among them, the mean value refers to the concentration degree of experts' opinions. The higher the value, the higher the importance, and the average value mean value is required to be not <4.0. The coefficient of variation is the coordination degree between experts on a certain index; the smaller the coefficient, the higher the coordination degree of the index  and the coefficient of coordination (W). The smaller the variation coefficient, the higher the consistency; when the value of the coordination coefficient is between 0 and 1, the greater the value, the higher the degree of consistency.Coefficient of variation formula: b is the number of experts; k is the number of evaluation indexes).Coordination coefficient formula: p < 0.01. Therefore, it is considered that the experts have a good consistency in the evaluation indexes of the training quality of high-level tennis teams, and the evaluation result is credible.The results of expert questionnaire survey: using SPSS25 to analyze the expert evaluation results, the results show that the consistency coefficient of the first-level index is 0.688, the second-level index is 0.479, and the third-level index is 0.744; According to experts' opinion concentration and coordination degree to eliminate, merge, modify, and delete indicators, the average index score above four points, expert opinion concentration and overall coordination degrees below 0.2 shall be preserved. Finally, the evaluation indexes of training quality of high-level tennis teams, including five first-class indexes, 17 second-class indexes, and 75 third-class indexes is determined .In this study, the AHP was mainly used to determine the weight coefficients of the evaluation indexes, which is not only a multi-objective evaluation decision-making method suitable for complex structure but also an evaluation method combining qualitative and quantitative analyses. It is decomposed into general objective layer, sub-objective layer, and criterion layer according to the leading relationship of factors, divided into general target layer, sub-target layer, and criterion layer, constructing the multi-target and multi-level model to form a progressive hierarchical structure. By calculating the importance of the low-level evaluation matrix, one yields the importance ranking of the low-level evaluation matrix Satti, .From the perspective of high-level tennis team training quality evaluation, through consulting a large number of studies at home and abroad, it can be found that it mainly includes five parts: training work planning, training work implementation, training work monitoring, sports competition results, and sports team work management /(n \u2212 1)Calculate consistency index CI: CR = CI/RI , the index weight of training quality of high-level tennis team is as shown in The secondary index weight of training quality of high-level tennis team is sorted from large to small according to the normalized processing results  compreheTraining planning is a process in which a high-level tennis team formulates training contents and plans according to the players' actual state and phased training objectives. Scientific and systematic training plan is not only the blueprint of tennis team training, but also the main carrier of the whole training work implementation (National Strength Conditioning Association, The implementation of training work is the concrete display of the whole training work. which should not only consider the intricate internal factors, but also consider the operability of the actual situation (Nicola and Keith, Training work monitoring is not only the real-time supervision and feedback of training effect, but also the action guide for dynamic adjustment of coaches' strategies. Whether the training work planning is appropriate, the training work is scientific, the sports team management is comprehensive, and the sports competition results meet the expectations, etc., need to be fed back according to the training work monitoring, so as to provide scientific and effective reference for the player training work Yu, . From thThe work management of tennis team is the premise and foundation to improve and guarantee the training work, and is a systematic project to establish and maintain the implementation of the work Nancy, . In the Sports competition performance is a characteristic symbol reflecting the result of training work, but also an important symbol of evaluating the quality of training work Vescovi, . The traThe concept of \u201ctraining quality of high-level tennis team\u201d is preliminarily defined, which mainly includes five aspects: training work planning, training work implementation, training work monitoring, sports competition results, and sports team work management.Constructing the evaluation system of training quality of high-level tennis team included 5 first-class indexes, 17 second-class indexes, and 75 third-class indexes. In addition, formulating the weight table of training quality evaluation indexes for high-level tennis teams.This study analyzed the main components of the training quality of high-level tennis team as follows: training work planning is not only the blueprint of tennis team training, but also the main carrier of the implementation of the whole training work. The implementation of training work is the concrete display of the whole training work, which should not only consider the intricate internal factors, but also consider the operability of the actual situation. Training work monitoring is not only the real-time supervision and feedback of training effect, but also the action guide for dynamically adjusting coaches' policies. Sports competition performance is a characteristic symbol of reflecting the result of training work and an important symbol to evaluate the quality of training (Gema et al., The evaluation index system of training quality of high-level tennis team constructed in this research can help the coaches to improve and adjust the training control factors and to promote the comprehensive and coordinated development of high-level athletes. At the same time, the evaluation criteria for the follow-up training work promote the sustainable development of China's competitive tennis industry and ensure the realization of the overall development goals of China's competitive sports.In the follow-up work, based on the index system and weight of this study, the comprehensive evaluation standards will be formulated and then applied in some high-level tennis teams. In order to provide theoretical and practical guidance for the development of high-level tennis team guidelines, forming a set of high-level tennis team training quality evaluation system by screening and repairing the problems in the actual operation is essential.In the future research, comprehensive analysis and evaluation model of training quality will be built through which we can realize the quantitative analysis, diagnosis, and evaluation of various types and constituent factors of training quality of high-level tennis teams. According to the analysis and evaluation results, the work quality composition chart of high-level tennis team will be established, so as to carry out scientific monitoring on the sports training process to achieve the purpose of \u201cpromoting quality by evaluation.\u201dThe original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.This study was supported by Scientific Research Project of Hubei Provincial Department of Education, project name: Study on Quality Monitoring and Evaluation of Training of High-level Professional Young Female Tennis Team in China.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "Building on the experience and results of important European initiatives like the TO-REACH Action, the new European Partnership on Transforming Health and Care Systems aims to accelerate the sustainable transformation of European health systems. By means of multidisciplinary research with a focus on improving the uptake of innovative solutions by health system actors, including organisational, service, and overarching policy innovations, the partnership plans to achieve access to high quality, sustainable and innovative health care for European populations. This presentation will explore current and upcoming plans for the Partnership, as well as discuss some of the lessons learnt from past initiatives and how these, combined with the experiences from the pandemic, have contributed to shaping the new Partnership's agenda. Inputs from stakeholders in the audience will be collected to inform the Partnership's ongoing learning process.A country perspective from SloveniaVesna-Kestrin PetricSlovenian Ministry of Health, Ljubljana, SloveniaHealth system strengthening and transformation \u2013 Current priorities of the European CommissionIsabel de La MataDG SANTE, European Commission, Brussels, Belgium"}
{"text": "The Maxwell A. Pollack Award for Contributions to Health Aging Lecture will feature an address by the 2021 Pollack Award recipient Namkee G. Choi, PhD, FGSA, of the University of Texas at Austin. This session will also include the presentation of the 2022 Maxwell A. Pollack Award to recipient Nancy Morrow-Howell, MSW, PhD, FGSA, of Washington University in St. Louis. The Maxwell A. Pollack Award for Contributions to Healthy Aging Award recognizes instances of practice informed by research and analysis, research that has directly improved policy or practice, and distinction in bridging the worlds of research and practice."}
{"text": "Farmland abandonment is one of the most important land use changes in the world today and crucial to the sustainable development of the global environment. The authors carried out extensive research on farmland abandonment from many perspectives, but, due to the variety of the research contents, rich research perspectives, and complex research objects, the current research in this field lacks comprehensiveness, objectivity, and systematization. In this study, the bibliometric R software packages bibliometrix and biblioshiny  were used to analyze the development history and current situation of 896 articles on farmland abandonment in the Web of Science core collection database from 1980 to 2021, revealing their research hotspots and predicting the future development trends. Over the past 40 years, the number of published papers on abandoned farmland has continuously increased. Research mainly focused on the ecological environment, with natural succession, biodiversity, and vegetation restoration being high-frequency keywords in this field. Research on the social aspects of farmland abandonment has developed rapidly in the past 6 years. Based on these findings, this paper put forward four future research directions: the data source for the extraction of abandoned farmland should transform to high spatial-temporal resolution and hyperspectral remote sensing images; the method should pay more attention to the time series change detection and the application of the model; future research should focus on the economic costs of the reclamation of abandoned farmland and the ecological consequences of such reclamation; and the global ecological impact of vegetation succession after the abandonment of farmland should be further discussed from a broader perspective. Land use change seriously affects the sustainable development of the global environment ,2, especThe term \u201cfarmland abandonment\u201d has different definitions, depending on the method and content of the study . The JoiPrevious studies reviewed numerous aspects of research in the field of farmland abandonment. For example, the impact of farmland abandonment on the ecosystem and biodiversity  could beGenerally, literature reviews on farmland abandonment only cover a certain country or region ,46, therBibliometrics is an alternative approach to analyze the distribution structure, research topics, and changing trends of a large number of academic publications via mathematical and statistical methods and visualizes the results through visual and intuitive charts ,48. CompBibliometrix has been widely used to quantitatively analyze the literature in geography-related fields. For example, Soler et al.  retrieveHere, we used the bibliometrix and biblioshiny R language packages to comprehensively analyze the literature in the field of farmland abandonment, considering studies published in the Web of Science core database between 1980 and 2021. First, the development process, current situation, and trend of the research period in the field were identified through the statistical analysis of the annual output of related publications, citations, journal sources, and the main research countries and regions. In addition, collaborative network analysis and clustering of authors, keywords, and topics determined the research hotspots and future frontiers in this field. Based on the above analysis, the problems to be addressed are as follows: (1) What is the trend of article production and citation in the field of farmland abandonment? (2) What are the fluctuation trends regarding the authors, journals, and countries in the field of farmland abandonment? (3) What are the main research directions in the field of farmland abandonment? (4) What is the future research focus in the field of farmland abandonment?To improve the representativeness and usability of the data, the data were collected from the Web of Science core collection database , which iUsing the bibliometrix and biblioshiny software packages, the research status and trends in the field of farmland abandonment were reviewed and analyzed. Data analysis included a quantitative analysis of annual scientific production, citations, and journal sources, a collaborative network analysis of authors, countries, and regions, a clustering analysis of document keywords, and the evolution analysis of thematic trends and monitoring methods in abandoned farmland areas during the research period . The pre(1) Problems and spans of design research: This paper identified farmland abandonment as the research topic and searched the core database of the Web of Science for articles from 1980 to 2021 by determining search terms, search time, and document types. (2) Data collection: An article database was built  by exporTo analyze the general situation and development trend of the research field, the number of published articles  and the From 2001 to 2015, the number of published articles on farmland abandonment showed an upward trend, albeit with fluctuations, with an average of 25.13 articles per year, accounting for 42.1% of the total published volume. Mean citations peaked in 2003, 2008, and 2015. During this period, sustainability issues, such as climate change and food security, became major concerns. With increasing population size, urbanization, and farmland intensification, the migration of the rural population to cities has led to the large-scale abandonment of farmland. In this period, the contribution of the rational use of abandoned farmland to sustainable development was recognized, and the administration of abandoned farmland has become a hotspot ,79. For From 2016 to 2021, the number of articles on farmland abandonment increased dramatically, especially in 2020 and 2021, with 80 and 93 articles, respectively. The papers published during this period accounted for 46.99% of the total articles published. In this period, in addition to a change from the traditional ecological perspective to a more modern approach, the research perspective was more diversified, involving the driving factors of farmland abandonment ,87,88, sLand Use Policy over the entire period accounted for 3.6% of the total published articles, followed by those published in Sustainability, with 2.9%. In terms of total citations, Land Use Policy was the most-cited source, followed by Catena with 1642 citations; the ninth-ranked journal, Remote Sensing, had the lowest number of citations (165). Taking into account the H index, Remote Sensing was again at the bottom of the list, whereas the seventh-ranked journal, Forest Ecology and Management, had an H index of 17, which was the same as the first-ranked journal Land Use Policy.To study the development of the research area in different journals, the sources of journals were ranked considering the number of publications, the H index, and TC  . The H iLand Use Policy had the largest production volume and the fastest growth rate during the research period. (2) Forest Ecology and Management had a significant production volume before 2014, with a decrease thereafter. (3) Catena published the first papers on farmland abandonment in 1999, with stagnation in the middle part of the research period and a significant increase after 2016; Land Degradation & Development showed a similar trend. In general, over time, farmland abandonment become the focus of several journals.According to the journal source dynamics, the evolution curve of the cumulative number of published articles for the 10 most productive journals was plotted over time , obtainiWe first ranked the most relevant authors in the field of farmland abandonment, along with several bibliometric metrics , and subThe results in the Author Collaborative Network  were divThe first group examined farmland abandonment in eastern Europe and the former Soviet Union after the disintegration of socialism. Different land policies, economic development, and reform strategies led to large differences in the abandonment rates among different countries ,95. DuriThe second author group mainly studied the effects of farmland abandonment on soil and hydrological conditions in the Mediterranean region ,98. For The third group of authors focused on the effects of farmland abandonment on the Loess Plateau of China, such as the effects on soil carbon sequestration  and the The fourth group of authors mainly analyzed the factors driving and influencing the abandonment of rural farmland in China. In this country, more areas are abandoned in mountainous and hilly areas than in the plains . Xu et aSimilar to the second and third groups, the fifth group of authors also discussed the relationships between farmland abandonment and vegetation and species diversity but paying more attention to the afforestation on abandoned farmland in eastern and northern Europe. For example, hybrid aspen plantations planted on abandoned farmland in Estonia were monitored, and their impacts on understory vegetation and species numbers were discussed , as wellThe sixth group of authors focused on abandoned farmland in the mountainous areas of Nepal, such as the Himalayan mountains ,109 and The seventh group of authors studied the changes in species distributions after farmland abandonment, focusing on birds. The main study area was Hokkaido, Japan, where abandoned farmland and wetlands coexist. The authors assessed the landscape patterns of the abandoned farmland  and compAt least five of these clusters were interested in ecological issues, whereas the remaining two clusters reported social concerns. Based on different natural conditions, policies, and systems, studies on farmland abandonment showed obvious regional differences.Considering the authors\u2019 production over time , TeodoroTo identify the key countries and regions in terms of publication number and impact, the cooperation network between countries and regions was analyzed . BetweenBased on the national collaboration network , the mosThe top 10 cited articles  reflecteIn addition, the paper ranked No. 2  used theAfter the collapse of the socialist system in eastern Europe and the former Soviet Union, under the dual impact of the system and the economy, farmland abandonment differed among different European countries. The article ranked No. 8  studied The third-ranked article mainly studied the driving mechanism of grassland abandonment on forest expansion. Although the total citation number was high, the local citation rate (LCR) was 0, indicating that the article was not correlated to the field of farmland abandonment. The fourth-ranked article estimated the abandoned global farmland area via land use data from the global Environment 3.0 historical database and MODIS satellite images, demonstrating the bioenergy potential of the global abandoned farmland  using thBy comparing the top 20 author keywords (DE) and keywords-plus (ID) most related to the field of farmland abandonment , farmlanUsing the functions of cluster analysis and multiple correspondence analysis, biblioshiny could reflect the hotspots, themes, and writing directions in the field of farmland abandonment. Cluster analysis was used to cluster complex keyword\u2013network relationships into several relatively simple groups . The keyThe first cluster category focuses on the study of biodiversity, species richness, and plant communities after farmland abandonment. There are obvious regional differences in the ecological and environmental consequences of farmland abandonment. For example, most studies in European regions show that the encroachment of vegetation on bare land and original farmland after abandonment will have a negative impact on lizards, birds, and other animal species . One stuThe second cluster category mainly contains studies on vegetation and species restoration over time after farmland abandonment. Zhang et al.  studied The third category contains publications on the impacts of natural succession on forests, soils, and microbial communities, mostly in the mountainous areas of Europe and on the Loess Plateau of China. Cojzer et al. , in SlovThe fourth category focused on methods to extract abandoned farmland, studying the mode, driving force, and spatial determinants of abandoned farmland. The commonly used method identified abandoned farmland by analyzing the inter-annual land use change in a given study area. Subsequently, the driving factors and spatial determinants of farmland abandonment ,152 wereThe fifth category was similar to the third and fourth categories. However, this category not only constructed the extraction method of farmland abandonment but also focused on the bioenergy potential abandoned farmland , estimatIn Europe, with the highest number of publications on farmland abandonment, studies on the distribution, patterns, consequences, and impacts of farmland abandonment formed a separate cluster. The causes of farmland abandonment in Europe are various, depending on the region and period under consideration. Due to natural conditions, historical development, and economic, social, and demographic backgrounds, agricultural conditions vary from region to region. For example, Terres et al. established a unified indicator of the driving factors of abandonment through a comprehensive analysis of farmland abandonment in different regions of Europe, including the aging population, the low population density, the low farm income, the small scale, and the poor implementation of agricultural plans. This indicator covers the possible drivers of abandonment in all EU countries and can be flexibly applied according to the background of different regions ,157,158.Theme evolution analysis can explore the changing laws, relationships, paths, and trends of the content, and intensity and structure of the research topic over time. Here, the study period was divided into three stages, with strategic coordinates being drawn . OverallDuring the development stage from 2001 to 2015 , the theDuring the active phase of 2016\u20132021 , studiesThis study reviewed the abandoned farmland monitoring methods used in the database. The representative methods in this field changed over time  and can (1) Field survey. The largest advantage of this method is that it can explain the mechanism behind farmland abandonment, although it is difficult to obtain a complete view of all abandoned farmland areas in a given region due to the lack of spatial details. Therefore, the extraction of abandoned farmland often uses field survey data coupled with other models. For example, Florian et al. distributed the survey data of European Russia, Ukraine, and Belarus to the remote sensing image data through the spatial allocation model, obtaining an accuracy of 65% . Raymond(2) Classification of remote sensing images. Visual interpretation methods are mostly applied to Mediterranean mountains ,42,81, a(3) Change detection method. Some authors took more than 30 countries in central and eastern Europe as the research area and used MODIS NDVI time series products to extract abandoned farmland. This product has a high time resolution, and the characteristics of abandoned farmland can be compared with the growth cycle characteristics of vegetation types. However, the spatial resolution is low (250 m). This study also combines SVM classification, obtaining an accuracy of 50.7% . Estel eWe conducted a quantitative analysis and visualization of articles published in the field of farmland abandonment from 1980\u20132021 at the macro-scale by using the bibliometrix and biblioshiny software packages, based on the Web of Science core collection database. From this, we determined the current status and future development trends of scientific production in this field, overcoming the shortcomings of previous literature reviews that rarely comprehensively analyzed the research results from multiple perspectives and revealed the potential changes.The annual scientific output results showed that the number of articles in the field of farmland abandonment fluctuated and increased rapidly, especially after 2016. According to the number of articles issued, the research period can be divided into three stages: budding stage, development stage, and active stage. Judging from the average number of citations of papers, the years with the strongest development in the field of farmland abandonment were 1987, 2003, 2008, and 2015. Over time, more attention was paid to abandoned farmland as such, with most papers being published from 2007 to 2017; however, the overall quality of the publications declined after 2018.Land Use Policy was the most productive journal in the field of farmland abandonment from 1980 to 2021, with the highest number of citations and the highest H index. In terms of research strength, China was the country that published the most articles, although countries in Europe were more influential. Cooperation between countries suggested that some countries in Europe, such as Germany, the UK, and the Netherlands, focused more on collaborative research. When considering both the number of papers published by independent authors and international cooperations, papers published by countries such as China and the United States through independent research were more common.Journal source analysis showed that Studies on farmland abandonment were two-branched: one branch mainly analyzed the social factors, such as policies and trade, which may promote or inhibit the abandonment of farmland; the other focused on the ecological impacts of farmland abandonment, such as impacts on soil quality, carbon sequestration, and biodiversity. The same trend was found in the authors\u2019 collaborative network, with five of the seven most productive research groups focusing on ecological aspects and the other two on social factors.The most common keywords were farmland abandonment, land use, vegetation, dynamics, forest, and management. Analysis of the theme evolution of abandoned farmland showed that vegetation, landscape, dynamic degree, and management were the most commonly used keywords in the first stage. The influence of the most used keywords in the second stage was weakened; in this stage, the focus was on the improvement of the extraction technology. The last period was related to the driving forces and determinants of farmland abandonment, in addition to vegetation succession and biodiversity. The theme that remained constant throughout the study period was the succession of vegetation after farmland abandonment.This study has two limitations. First, it relies more on dynamic databases that are constantly updated as the number of indexed journals increases or decreases. Therefore, the bibliometric analysis of farmland abandonment may change in the next few years. Another limitation is that this study largely relies on the results obtained from visual charts. However, the display of results lacks a richer global perspective. The global perspective can, however, be improved by incorporating other databases, such as Scopus.Overall, the results obtained can help researchers determine the specific research areas and contents of farmland abandonment. The analysis of the cooperation between the author and the country may facilitate the investigation of the authors in the field of farmland abandonment or the formulation of policies at the national level. In addition, this study provides a database and analyzes the different topics and methods for future researchers, assisting in the selection of research areas and topics.According to the results, farmland abandonment research needs to be further expanded in the following aspects:(1) In terms of data sources, farmland abandonment experienced a process from the traditional family survey data to the remote sensing image data; the latter underwent a transformation from low to high spatial resolution. However, the high-resolution images used for farmland abandonment generally have a low temporal resolution. In the future, the use of multi-source remote sensing data to combine high temporal resolution and high spatial resolution for farmland abandonment extraction may become the mainstream of research. Nowadays, there are more and more applications of hyperspectral images, and improvements in spectrum number and spectral resolution can significantly enrich spectral information, revealing more details of ground objects. Such an approach would greatly improve the accuracy of remote sensing in the identification of ground objects. In the future, this direction can be explored with the use of hyperspectral images to extract abandoned farmland.(2) To extract abandoned farmland, change detection methods are mostly used. The extraction accuracy largely depends on the classification accuracy, and the classification error of each temporary phase will be accumulated, affecting the final result. Moreover, the classification of heterogeneous images is independent and does not consider the correlation of time, making it easy to ignore vegetation changes in the growth cycle, resulting in unreasonable change detection results. Classification time series data can effectively avoid this problem, and models such as the Landsat-based detection of trends in disturbance and recovery (LandTrendr), breaks for additive season and trend (BFAST), and continuous change detection and classification (CCDC) can demonstrate this. Today, only the LandTrendr model is used for the extraction of abandoned farmland. With the rise of deep learning, the remote sensing time series change detection research based on deep learning has attracted the interest of many researchers. Deep learning is an automated learning based on the end-to-end mechanism. It does not rely on prior knowledge, but it is still difficult to automatically mine data and acquire the spatiotemporal features of images. In the future, how to use these models to effectively extract abandoned farmland may be an important development trend.(3) Since the 21st century, the impact of global climate change on ecology and the social economy has been an important topic. In recent years, the global outbreak of COVID-19 and regional armed conflict have caused unprecedented crises in the world, seriously affecting agriculture, the economy, human health, and food security. It is, therefore, of great significance to meet the global food crisis by rationally reclaiming abandoned farmland to rapidly increase food production and the global grain supply. However, there is still controversy about the economic cost of abandoned farmland reclamation and the ecological consequences of such reclamation. Should the abandoned farmland be reclaimed, continue to expand, or be subjected to intensive farming? Research around this area may be a future focus.(4) According to the results of this study, future studies will still focus on the ecological impacts of abandoned fields, such as vegetation succession, carbon sequestration, and impacts on biodiversity. However, most of the current studies focus on a certain country and region, with conflicting ecological impacts along with different geographical locations and environmental conditions. At present, the ecological impact of abandoned farmland is still controversial among scholars. In the future, further discussions on this impact are: Is this a threat or an opportunity? Is this negative or positive? The formulation of policies according to local conditions when facing farmland abandonment may be an important research topic in the near future."}
{"text": "To analyze Taiwanese ecotourism with international standards, this research employed the social learning theory (SLT) to identify the determinants of Taiwanese community ecotourism with the international standards. This basic theory of social psychology comprehensively assays the interplays and interconnections among the three analytical perspectives , the four essential issues  of the Global Sustainable Tourism Council, the six assessed dimensions of ecotourism resolution from the WCC, and the twenty-nine assessed indexes of the KES ecotourism evaluations. It was then possible to comprehensively explore the sustainable determinants of Taiwanese ecotourism with the international standards through the FA of quantitative and qualitative analyses in combination with the highest research validity, reliability, representativeness, and accuracy. After analyzing the evaluated measurements, the empirical and valuable conclusions and findings are (1) these analytical perspectives, appraised attitudes, evaluated criteria, and sub-criteria positively advance Taiwanese ecotourism with the international standards (PITEEICIS); (2) the sustainable determinants of Taiwanese ecotourism with the international standards include the Support for Capacity Building of the Local Community (SCBLC), Cooperation with the Local Community (CLC), Supports for the Local Enterprises (SLE), Local Participation and Benefits Sharing Duties (LPBSD), Tourist Management (TM), and Responsible Tourist Behaviors Inducement (RTBI). Importantly, the majority of ecotourism industrialists and experts still focus on the economic benefits, such as supporting the local community and enterprises, rather than tourist behavior inducement to stimulate ecotourism participation in order to promote and advance the Taiwanese ecotourism to the international standards; (3) in order to promote Taiwanese ecotourism to the international conventions, the Taiwanese government and organizations in ecotourism should contribute toward the local welfare and create and design various training programs and courses to enhance local community\u2019s awareness and capability of ecotourism development in order to establish a complete system that stimulates the ongoing planning and decision making of local community participation and regularly monitors, records, and reflects their opinions, based on the area\u2019s history, culture, and natural attributes, to develop and sell sustainable local products by creating fair trade principles and valuable products. With the rapid increase in global Gross Domestic Product (GDP) and swift development of transportation technology, domestic and international tours have increasingly become entertainment for contemporary people. The majority of people would like to discover novel news, information, and life experiences through a series of tours. In addition, many local regions, areas, and communities also utilize tourism to expose their news, information, and culture to the public in order to attract more people to visit, which then develops the regional economy and reputation. In the wake of the booming tourism development, each ecological environment has confronted a bulk of unpreceded and irreversible destruction and hyper-pollutions . In ordeThrough the higher transmission speed of wireless technology, the sources used to surf and download local information, such as local news, local real-time video, local transportation information, local on-time announcements, local festival schedules, etc., can also be used by local organizations to expose the local news, messages, and statements in real-time without time and space restrictions. Furthermore, people now would like to easily visit anywhere in the world, which depends on the swift development of transportation technology and convenient infrastructure . TherefoTourism, ecotourism, and protected areas, by the International Union for Conservation of Nature (IUCN) International Union for Conservation of Nature (IUCN), ecotourism is defined as \u201cthe environmentally responsible travel and visitation to relatively undisturbed natural areas, in order to enjoy and appreciate nature  that promotes conservation, has low visitor impact, and provides for beneficially active socio-economic involvement of local populations\u201d [In the book, lations\u201d . \u201cAs thelations\u201d .For this reason, the WCC of IUCU has unanimously passed a resolution on the international standards for sustainable ecotourism in association with the 17 Sustainable Development Goals (SDGs) of the 2030 agenda for the sustainable development of the United Nations (UN) Department of Economic and Social Affairs. As for the Eco-friendly Development (ED) in ecotourism resolution from the WCC, the eleventh (sustainable cities and communities with decent work and economic growth), twelfth (responsible consumption and production), and fourteenth (life below water) SDGs are the measures recommended for sustainable economic growth, consumption, and production practices and the conserved and sustainable use of nature and natural heritage. In detail, the eleventh SDG aims to expedite, maintain, contain, and increase economic sustainability in order to advance the establishment of safe residential sections with disaster prevention for each individual. The twelfth SDG was created to ensure sustainably consumed and productive models and the fourteenth SDG was promoted for the sustainable development of ocean and water natural resources. In regards to the Responsible Management (RM) ecotourism resolution from the WCC, the fifth , eighth (decent work and economic growth), ninth , and seventeenth  SDGs are effective approaches for ecotourism organizations. The ecotourism organizations are supposed to have the responsibility of advancing gender equality in each employee to facilitate the efficient production of sustainable economic growth in order to expand the sustainable global collaboration relationship. Importantly, organizations in ecotourism should further establish safe, tolerant, innovative industrialization with disaster prevention [In terms of the Environmental Conservation (EC) in ecotourism resolution from the WCC, the thirteenth (climate action) and fifteenth (life on land) SDGs are effective goals for ecotourism organizations. Ecotourism organizations have to take aggressive actions to confront and diminish the impact of global climate change through a series of actions such as sustainable terrestrial ecosystem utilization and the sustainable management of forests as well as the avoidance of desertification, soil degeneration, and loss of biodiversity. With respect to the Genuine Ecotourism Experiences Provision (GEEP) in ecotourism resolution from the WCC, the fourth  and sixteenth  SDGs establish the effective magnanimity of ecotourism organizations. Ecotourism organizations have to provide empirical experiences and provisional tour activities and programs to advance inclusive and equal quality education to establish the environmental conservation lifelong learning mechanism in order to strengthen an inclusive, equal, and sustainable society . In regaEcotourism organizations are necessary to conduct the tourists in such a way as to maintain and protect the natural water, resources, energies, and sanitation structure throughout tourism activities. Ultimately, in reference to the Local Participation and Benefits Sharing (LPBS) ecotourism resolution from the WCC, the first (no poverty), second (zero hunger), third , and tenth  SDGs indicate effective structures for ecotourism organizations. Ecotourism organizations have to plan for the diminishment of poverty through the accomplishment of food security and improvement of nutritional status in order to achieve good public health and well-being. Hence, ecotourism not only focuses on the expedition of environmental protection but also emphasizes cultural conservation as well as benefits the local economy by the presence of tourists to continuously achieve the sustainable triple-bottom balance between the earth\u2019s environment, social humanities, and economic benefits .Therefore, the World Tourism Organization (UNWTO) and United Nations Statistics Division (UNSD) have started to collect exhaustive ecotourism data to understand the complete performance and development of global ecotourism to construct the evaluated international standards and evaluated indicators of development of the suitability of global tourism from the economic, environmental, and social dimensions of the sustainable tourism information diagram in 2017, the year of international sustainable ecotourism . SubsequSubsequently, the WCC has officially announced the One Program to request the director general, commissions, and members to support an initiative for the international standards in ecotourism at its session in Hawai\u2018i, United States of America, 1\u201310 September 2016 that (1) practically expands the sustainable tourism guidelines to cover the best ecotourism practices, including an updated IUCN definition of ecotourism, relevant standards and indicators for culturally sensitive community engagement and welfare, environmental learning, and appropriate infrastructure and tourist behaviors, to seek the prevention of a negative anthropogenic influence on species and ecosystems, (2) empirically implements, in existing national, regional, and international certification schemes, standards and guidelines focused on ecotourism in order to improve and promote conservation outcomes by encouraging the uptake of the best practices and adherence to and strengthening of globally accepted international standards, and (3) systemically designing, creating, and delivering a series of training opportunities for ecotourism governance, auditing, and certification as well as the implementation of the best practices for ecotourism development and management.In regard to the development of Taiwanese ecotourism, the Tourism Bureau of the Executive Yuan officially established the Taiwan Ecotourism Association (TEA) in 2001 by organizing the government, civil powers, and resources to facilitate the ecotourism development in Taiwan with the aim of promoting the sustainable and wise use of Taiwan\u2019s natural, cultural, and ecological resources in ecotourism. Based on the fundamental goals of the TEA, there are five main purposes: (1) conducting training courses and workshops covering multiple aspects of ecotourism; (2) promoting ecotourism by partnering with industries; (3) setting up a platform to consolidate efforts from all parties for ecotourism development, (4) establishing an evaluation and certification program to enhance the quality of ecotourism, and (5) reinforcing international cooperation and coordinating demands from international markets. In order to empirically elaborate on tourism operations, community development, biodiversity, geodiversity, geological heritage, places of geological interest, wildlife, and the natural environment, Taiwanese ecotourism must explore its sustainable determinants with the international standards.However, the driving business contents and organization framework, the critical demand for contemporary Taiwanese ecotourism, and the evaluation indicators and certificates with international standards are the current severe shortages in the TEA. Therefore, after making a comprehensive survey of the research on ecotourism development in Taiwan, there was no one official study able to focus on detecting the sustainable determinants of Taiwanese ecotourism with international standards. In order to realistically provide the research evaluations and assessments of the sustainable determinants of Taiwanese ecotourism with the international standards of the Taiwanese government, parastatal ecotourism organizations and associations and ecotourism researchers, developers, and tourism industry professionals, as well as the national, regional, and international certification schemes, standards, and guidelines on this research topic were used to concentrate on ecotourism to encourage the adoption of international standards and norms with the updated IUCN definition and guidelines to be analyzed in-depth and discussed.For this reason, these sustainable determinants are able to promote and seek auditing and certification for Taiwanese ecotourism in landscapes and seascapes of conservation value, according to international standards. In order to empirically explore the sustainable determinants of ecotourism with the international standards, the ecotourism destinations, accommodations, and tours have been defined as the analytical perspectives because the tours focus on the individual\u2019s feeling, accommodations depend on the organizations in ecotourism, and the destinations assemble the local natural and cultural resources and assets. Then, the four creditable dimensions  of the GSTC were classified as the appraised attitudes. Lastly, the six assessed dimensions of ecotourism resolution from the WCC, in association with the seventeen SDGs of the 2030 agenda for sustainable development and the twenty-nine assessed indexes of the KES ecotourism evaluations in connection with the six assessed dimensions of the ecotourism resolution from the WCC, were extensively discussed and considered as the evaluated criteria and sub-criteria in this research. Therefore, this research has innovatively employed the social learning theory (SLT)  to form The core reason the SLT was created was to extensively discuss the dependences and influences among individual behaviors, organizational operation, and performance as well as social development and tendency ,15. The In statistical measurements, the Factor Analysis (FA) of quantitative analysis  was applCurrently, over two hundred green certificates and certifications in the world have been created to offer to the various tourism-related industries and companies to apply based on each of their specific demands which have instituted their ecological certificate recognition and mechanism. These green and ecological certificate recognitions are able to assist tourism-related industries to concretely strengthen their comparison and sustainability in regard to their operational costs and corporate images in order to contribute to environmental protection and cultural preservation. Focusing on the evaluated indicators and certificate and ecotourism development, the Korea Tourism Organization (KTO) of the Korean Ministry of Culture and Tourism (KMCT) has instituted the Korean Ecotourism Standards (KES) since 2010 furthermore, the KES has been proofed and recognized by the global ecotourism certificate system of the Global Sustainable Tourism Council (GSTC), which means any tourism organizations can obtain the accreditations of the KES and CSTC if they can respect regulations and pass the KES ecotourism evaluations. In detail, the destinations , accommodations (organizationism), and tours  have been identified as the three core perspectives from the KES ecotourism evaluations . FurtherFirst of all, there are two assessed sub-criteria in the EFD evaluated criteria  which inSecondly, there are eleven sub-criteria in the RM evaluated criteria and which are 1. Compliance with Laws (CL): the tourism organizations have to respect national and international laws associated with ecotourism development, management, and regulations covering public health, safety, labor, cultural, and environmental aspects. 2. Financial Insurance (FI): the tourism organizations have to plan and implement insurance contracts to protect tourist destinations, residents, facilities, and visitors. 3. Sustainable Management Strategies (SMS): the tourism organizations have to establish and administer multi-year (destination) management strategies. These strategies cover environmental, economic, social, cultural, quality, health, safety, and aesthetic issues in order to publicly develop and increase public participation and the appropriate financial funds and subsidies. 4. Management Units (MU): the tourism organizations must have effective staff and individual social responsibility for a coordinated approach to reach sustainable ecotourism. The effective staff is supposed to be appropriate for the ecological conservation scope and deal with environmental, economic, social, cultural, quality, health, and safety issues .They establish an efficient system for equal employment, equal training, fair wages, fair evaluation, and periodic guidance and training (including advanced levels) regarding staff roles and responsibilities for sustainable ecotourism in collaboration with the stakeholders in the ecotourism system. 5. Monitoring (M): the ecotourism organizations have to establish a periodically reviewed, improved, and monitored proclamation system to monitor, publicly report, and respond to environmental, economic, social, cultural, tourism, and human rights issues, including both direct and indirect ecotourism impacts annually, at least . 6. StraThirdly, there are nine sub-criteria in the EC evaluated criteria which are 1. Active Environmental Management (AEM): the ecotourism organizations have to possess a regular system to comprehensively review, evaluate, and improve the practices, with stakeholders\u2019 involvement, in order to administer to the total numbers of tourists and tour activities based on the environmental, economic, socio-cultural, and managerial carrying capacity of the local natural resources . In addiFourthly, there are three sub-criteria in the GEEP evaluated criteria which are 1. Nature and Cultural Experiences (NCE): the ecotourism organizations are supposed to supply tourist activities with consideration to the individual enjoying, experiencing, and understanding the nature and culture of the destination. 2. Interpretation Services (IS): the ecotourism organizations have to offer accurate interpretive information at natural and cultural sites. The local information is comprehensive, culturally appropriate, developed with community collaboration, and communicated in languages pertinent to tourists. 3. Interpretation Planning and execution (IPE): the ecotourism organizations have to design a series of plans and manuals for interpretation service and review and regularly improve these plans and manuals .Fifthly, there is one core sub-criteria in the RTBI evaluated criteria which is the Tourist Management (TM): the ecotourism organizations have to plan and design a strong tourism system, developed with the consent of and in collaboration with the affected community, to strictly protect natural and cultural assets and sites and take into account the cumulative impacts of interactions with wildlife, regarding the sale, trade, display, or gifting of local assets and in consideration of historical and archaeological artifacts.Sixthly, there are four sub-criteria in the LPBS evaluated criteria which are 1. Local Participation and Benefits Sharing Duties (LPBSD): the ecotourism organizations should contribute to the local welfare of the ecotourism stakeholders. 2. Support for Capacity Building of the Local Community (SCBLC): the ecotourism organizations have to create and design various training programs and courses to enhance the local community\u2019s awareness and capability of ecotourism development. 3. Cooperation with Local Community (CLC): the ecotourism organizations have to establish a complete system that stimulates planning and decision-making on an ongoing basis of local community participation and regularly monitors, records, and reflects their opinions. The local community access to natural and cultural sites is also monitored, protected, and, if necessary, rehabilitated or restored. 4. Supports for the Local Enterprises (SLE): the ecotourism organizations have to construct a cultural preservation system, based on the area\u2019s history, culture, and natural attributes, to develop and sell sustainable and valuable local products through fair trade principles .In order to comprehensively evaluate the interplays and interconnections among the three analytical perspectives , the four essential issues  of the GSTC, the six assessed dimensions of ecotourism resolution from the WCC, and the twenty-nine assessed indexes of the KES ecotourism evaluations must be analyzed. To comprehensively explore the sustainable determinants of Taiwanese ecotourism with international standards, the SIT behavioral theory was applied to estimate the interactive dependencies and relationships among individuals, organizations, and society. The reason is the SIT was able to be selected to comprehensively assess the in-group favoritism and out-group discrimination as well as the intergroup conflict appearance due to direct group competition from people who have recently become part of the group.Ref.  used theIn the current social science research, the FA of quantitative analysis has been the mainstream quantitative methodology for administering large-scale questionnaires by detecting the interplays and dependencies among each evaluated criterion. It is able to comprehensively assay a bulk of complicated research questions and issues, according to its theoretical concept, analytical design and structure, and statistical method. For this reason, this research employed the FA of quantitative analysis to handle the assessments of 247 valid large-scale questionnaires. The entire commonalities among the three analytical perspectives , the four essential issues  of the GSTC, the six assessed dimensions of ecotourism resolution from the WCC, and the twenty-nine assessed indexes of the KES ecotourism evaluations were explored in-depth by the FA of quantitative analysis . AccordiSuch that, 1: K numbers of common potential factors were defined from the L numbers of general influenced factors.2: the M numbers are more than the K numbers.W .If maximization: , In order to enforce the research reliability and exactness, the ANP of qualitative analysis was further applied for dealing with the expert questionnaires to construct an analytical hierarchy in order to systematically analyze the entire cause and effect among each appraised attitude, evaluated assessed criterion and sub-criterion, and candidate. In view of the theoretical inducement of ANP of qualitative analysis,  mentioneIn the interactive pairwise compared matrix, the measured weights were defined as W (W = [w (eigenvector) were able to be measured through a succession of assessments of the vector quantities method (AW = nW) by calculating the inductive principle .Importantly, the consistency index (C.I.) was able to be calculated in each interactive pairwise compared matric and then, the consistency ratio (C.R.) was further able to be estimated through the numbers of C.I. and random index (R.I) computed from the estimated table of random index figure in Equation (4)In terms of the verification of ANP of qualitative analysis, the numbers of the C.R. in each pairwise compared matric need to be lower than 0.1 in the evaluated measurements of each pairwise compared matric.The initial concept-concertizing research step: Originally agglomerating the behavior perspectives of SIT theory and marketing elements of holistic marketing to comprehensively solve the research question in order to achieve the research topic and goal.The second theory-organizing research step: Concretely integrating the behavior perspectives of SIT theory and marketing elements of holistic marketing , middle region , southern region , and eastern region . The descriptive statistic of the FA of quantitative analysis is expressed in With reference to Equation (1) of the FA approach of quantitative analysis, The entire commonalities of each appraised criterion of FA of quantitative analysis are shown in After administering the FA of quantitative analysis, the evaluated model was established to identify the sustainable determinants of Taiwanese ecotourism with the international standards by verifying the interconnections among the appraised perspectives and attitudes, evaluated criteria and sub-criteria, and the following candidates: Negative Impact on the Taiwanese Ecotourism with the International Standards (NGITEIS), No Impact on the Taiwanese Ecotourism with the International Standards (NITEIS), and Positive Impact on the Taiwanese Ecotourism with the International Standards (PITEIS), as shown in In association with As a result, (1)The three analytical perspectives , the four essential issues  of the GSTC, the six assessed dimensions of ecotourism resolution from the WCC, and the twenty-nine assessed indexes of the KES ecotourism evaluations positively advance Taiwanese ecotourism with the international standards (PITEEICIS), empirically closing the research gap in the current related Taiwanese ecotourism research fields and effectively providing the political recommendations for the sustainable ecotourism development for the Taiwanese government.(2)The top five synthetically comparative weights in the PITEEICIS are the sustainable determinants of Taiwanese ecotourism with the international standards and these are the Support for Capacity Building of the Local Community (SCBLC), Cooperation with the Local Community (CLC), Supports for the Local Enterprises (SLE), Local Participation and Benefits Sharing Duties (LPBSD), and the Local Participation and Benefits Sharing (LPBS) as well as Tourist Management and Responsible Tourist Behaviors Inducement (RTBI). Importantly, the majority of ecotourism industrialists and experts still focus on sharing the economic benefits, such as supporting the local community and enterprises, rather than inducing tourist behaviors to stimulate ecotourism participation in order to promote and advance Taiwanese ecotourism with the international standards.(3)In order to promote Taiwanese ecotourism to the international conventions, the Taiwanese government and organizations in ecotourism should contribute to local welfare and create and design various training programs and courses to enhance the local community\u2019s awareness and capability of ecotourism development in order to establish a complete system that stimulates the ongoing planning and decision making of local community participation and regularly monitors, records, and reflects their opinions, based on the area\u2019s history, culture, and natural attributes, to develop and sell valuable and sustainable local products through the fair trade principles.(4)In particular, taking the Taiwanese government in line with international practices, the Taiwanese government and organizations in ecotourism need to plan and design a strong tourism system, developed with the consent of and in collaboration with the affected community, to strictly protect natural and cultural assets and sites and take into account the cumulative impacts of interactions with wildlife regarding the sale, trade, display, or gifting of local assets in consideration of historical and archaeological artifacts.This research employed the SLT in the basic theory of social psychology to comprehensively assay the interplays and interconnections among the three analytical perspectives , the four essential issues  of the GSTC, the six assessed dimensions of ecotourism resolution from the WCC, and the twenty-nine assessed indexes of the KES ecotourism evaluations. It was able to comprehensively explore the sustainable determinants of Taiwanese ecotourism with the international standards through the FA of quantitative and qualitative analyses in connection with the highest research validity, reliability, representativeness, and accuracy. After administering a succession of the evaluated measurements, the empirical and valuable conclusions and findings are:With reference to the sustainable development of ecotourism in Taiwan, the internationalization of ecotourism has been imperative. Hence, Taiwan has to develop and establish a comprehensive sustainable ecotourism institution and system with the international standards. However, to the best of our knowledge, there is not any available research that comprehensively analyzes and develops a complete model to detect the sustainable determinants of Taiwanese ecotourism with international standards. To academically fill this gap, this research employed the SLT and was able to discover the correlations among the four essential issues  of the GSTC, the six assessed dimensions of ecotourism resolution from the WCC, and the twenty-nine assessed indexes of the KES ecotourism evaluations in the main analytical hierarchy and concept.In terms of future directions, evaluated results, and measured consequences, this research was able to explore the sustainable determinants of Taiwanese ecotourism with the international standards in order to create an evaluation mechanism which adopts the international practices and accreditations of the WCC and CSTC.Specifically, with respect to the research limitations, this research may be restricted to Taiwan; however, this research originally focused on the sustainable determinants of Taiwanese ecotourism with the international standards. In addition, although this research employed the SLT of the basic theory of social psychology to fill the current research gap in the sustainable determinants of Taiwanese ecotourism with the international standards with quantitative and qualitative analyses, there are still multiple decision-making methods and theories to be used in order to detect more key sustainable determinants for completing the Taiwanese ecotourism development and certifications with the international standards."}
{"text": "Background: In addition to searching for effective methods of treatment, interventions are sought to support well-being, quality of life, mental health, and recovery. Sailing has its specific features, including task orientation, challenges, contact with people, and nature. This specificity may be treated as a potential therapeutic factor, but it is also likely that people with certain psychological characteristics are involved in it. Therefore, the study aimed to assess some psychological features of women with cancer experience who decided to take part in the Onco-Cruise (Polish: Onko-Rejs). Methods: Participants were 56 women . We used NEO-FFI, the Zimbardo Time Perspective Inventory, and The Multidimensional Health Locus of Control Scale. Results: Onco-Cruises participants were characterized by a high level of extraversion , openness , low neuroticism , predominance of present hedonistic  and future time perspective , and the internal health locus of control . Conclusion: Group sailing can be favorable for broadly understood health and cancer recovery, but people who choose this activity have certain psychological predispositions, especially indicating high needs for stimulation. Permanent features should be taken into account when proposing various interventions for oncology patients to best suit them to their natural possibilities and preferences and, thus, make them most effective. According to reports by the World Health Organization, in 2020, one in six people in the world died of cancer, which was a total of 10 million people . Depending on the characteristics of the cancer and its stage, specific therapeutic methods are used, including cytoreductive surgery, radiation treatment, targeted endocrine/molecular therapy, and chemotherapy . AggressOne of the commonly used methods of actively coping with stress is physical activity . ScientiRegarding sailing, our information shows that there is currently one pilot study available for cancer patients, involving 19 breast cancer women. The results show a reduction in the level of anxiety and distress and an improvement in the quality of life in the study group. As part of the intervention, in addition to sailing theory and practice, the patients had sessions with a psychologist and a physical exercise specialist . In PolaSailing, apart from sports and the recreational aspect, is closely related to nature. It helps build a sense of security, relieves anxiety related to diagnosis and treatment, and promotes self-reflection, including understanding life changes . In addiAccording to the Big Five Theory, the universal structure of personality consists of the following features : extravePublished studies on the health benefits of sailing interventions focus on the clinical aspects of participants ,25,26,36Women who qualified to participate in a week-long sailing cruise on the Mediterranean, organized by the Onco-Cruise Foundation-I Choose Life, were invited to participate in the study. The inclusion criteria were: consent to participate in the study, age from 18 years, female gender, diagnosis of oncological disease (current or in the past), oncological treatment (current or in the past), and qualification for participation in an Onco-Cruise. The exclusion criteria were: withdrawal of consent to participate in the study. Initial consent to participate in the study was expressed by 102 persons, to whom research questionnaires were sent. A total of 56 sets of questionnaires were received in return, all of which could be included into the analysis.The study was carried out by the method of a diagnostic survey, with the use of four questionnaires. Three of them were standardized tools:NEO-FFI. The Personality Inventory by Paul T. Costa Jr. and Robert R. McCrae in the Polish adaptation of Zawadzki et al.  was usedThe Polish Short Version of Zimbardo Time Perspective Inventory, PS-ZTPI , was useMultidimensional Health Locus of Control Scale (MHLC) by Kenneth A. Wellston, Mitchell J. Stein, and Craig A. Smith  in PolisWe also used our own questionnaire, consisting of 28 questions divided into three parts. The first part included questions about age, education, occupation and current professional activity, place of residence, relationship, and attitude to faith/religion. The next one contains questions about the health status: year of cancer diagnosis, type of cancer(s), number of cancer diseases diagnosed so far, type of cancer treatment , chronic diseases, mental disorders, medications taken on a regular basis, and assessment of the frequency and satisfaction with social relations. In the third part, there were questions related to sailing and concerned: past sailing experiences, including participation in previous editions of Onco-Cruises, sailing certification, reasons for the decision to participate in an Onco-Cruise, and expected results.The data were collected in two periods, before the Onco-Cruise in 2019 and 2021. The declared Onco-Cruise participants were invited and informed about the possibility of taking part in the study through the Onco-Cruise-I Choose Life Foundation. People who gave their informed consent to participate in the study received a complete set of questionnaires. Anonymous questionnaires were filled in by themselves, with unlimited response time, and then returned via the Foundation. The respondents\u2019 answers were placed in a database and then analyzed using STATISTICA 14.0 software. At this stage, we did not have a control group, but we wanted to capture not only the average intensity of the studied features, but above all, their most common prevalence and the overall specificity of the mental functioning of the surveyed women. In such a situation, we believed that a useful approach would be to compare the results to the sten scores in the case of research tools with Polish standardization (NEO-FFI) and the results of Polish adaptations , and, in the case of ZTPI, to compare the profile with a Balanced Time Perspective (BTP), i.e., optimal distribution of the intensity of individual traits .The study group consisted of 56 women aged 25 to 72 years . The vast majority lived in the city (82.14%), had higher education (76.78%), was currently professionally active (71.42%), and was in a relationship (71.42%). Details are presented in The diagnosis of breast cancer dominated (62.50%) in the study group. Most of the respondents have so far been treated with several methods, most often surgical (89.28%) and chemotherapy (69.64%). Almost half of the respondents did not currently have any therapeutic recommendations, and only control examinations (48.21%). This procedure was also recommended for the majority in the near future (62.50%). Some of the respondents declared the presence of a chronic disease other than cancer. Arterial hypertension (25%) and depressive disorders (23.21%) were the most frequently mentioned. The respondents also declared taking medications on a permanent basis, most often Tamoxifen (23.21%) and Levothyroxine (21.42%). Details of the clinical characteristics are presented in The descriptive statistics of the analyzed psychological variables are presented in Dividing of person\u2019s scores obtained in each scale by 3 ,42 made In our study, we focused on describing the relatively constant psychological characteristics such as personality, temporal orientation, and the health locus of control. We assumed that the respondents would be dominated by people with a high level of extraversion, agreeableness, conscientiousness, and openness to experience, but not neuroticism.The results of our study showed that the level of extraversion of the surveyed women is high, which means they tend to focus their energy, orientation, and attention on the outside world, including social contacts, having fun, and seeking stimulation ,43. ReseAnother result obtained in our study indicates an average, and most often, low level of neuroticism in the respondents. Previous studies have shown that high levels of neuroticism are associated with negative health behaviors , also leAgreeableness is most associated with positive interpersonal behavior . InteresWhen we were designing the study, we assumed that the participants would have both a strong future orientation and a present hedonistic and would be convinced of the possibility of influencing their health and well-being. Indeed, in terms of temporal orientation, the participants of our study obtained the highest results in the present hedonistic and future. However, due to the low reliability of the scale of the present hedonistic, we treat the results with great caution. It is imperative to check them in future research. The combination of a strong present hedonistic and future perspective may seem surprising. Most often, these two features are presented as two poles of involvement in each area of time: involvement in the present steals the layers of attention directed toward the future . HoweverThe last feature analyzed in the study was the health locus of control. We assumed that the respondents would be convinced of the possibility of influencing their health and well-being, despite the fact that their treatment was largely based on the medical intervention. The examined women obtained the highest result in the internal health locus of control. Previous studies have confirmed that the sense of control over their own health in cancer patients is associated with better mental adjustment , as wellSummarizing the results of our study on relatively constant psychological features, such as personality structure, time perspective orientation, and the locus of health control, it can be assumed that they are significant for making a decision about participation in an Onco-Cruise. It can be concluded that in the studied group, many psychological features have pro-health values and may constitute an important element of planning secondary health prophylaxis. Onco-Cruises most likely fulfill their pro-health role as declared by the participants and the Foundation, but it is naturally selected for this type of activity\u2014it is chosen by people with specific psychological characteristics. Most likely, the key may be an individual need for stimulation, manifested inter alia by a high level of extraversion and openness and low neuroticism. However, considering the potential invariability of these features, future research should also take into account more factors that build motivation to participate in such endeavors as the Onco-Cruise. Undoubtedly, the combination of fixed features with factors influencing motivation could allow for more effective psychological help, which is needed in the face of cancer.There are some limitations to this study. First, it was a pilot study without a control group. Our main goal was the initial understanding of the characteristics of psychological traits, but also the collection of demographic and clinical data, in order to be able to adequately select the control group in the next stages of the project.A serious limitation is the low reliability of the ZTPI present hedonistic scale obtained in the present study. Similarly, in the Polish adaptation of the tool, this scale obtained the lowest reliability rates \u03b1 = 0.45 . In our Due to the lack of standardized norms for MHLC without a control group, it is difficult to interpret the results based solely on measures of central tendency.Women experiencing oncological disease who participated in Onco-Cruises were characterized by a high level of extraversion, agreeableness, openness, and conscientiousness, and low level of neuroticism, predominance of a present hedonistic and future perspective over time, and an internal health locus of control. The pilot study had several goals. The essential element was the initial recognition of the constant psychological characteristics of women participating in Onco-Cruises. We also wanted to obtain information on the demographic and clinical characteristics of participants. This will enable us to better plan further studies on the impact of participation in Onco-Cruises on the mental and emotional state . Due to the wide scope and length of future surveys, we wanted to distinguish such constant features that are particularly expressive and can potentially be associated with the reception of the cruise experience in order to control them at a later stage of the research. In the pilot study, we chose well-known and popular psychological tools, which makes it possible to compare our results to other research. We wanted to check if they would be appropriate in the context of the specificity of the group and the nature of the further study. Therefore, taking into account the intensity of individual features, their potential importance for further research in relation to other already available results and the research economy in relation to the psychometric values of the tools, we decided to control time perspective and personality traits in the Big Five concept at a later stage. However, due to the planned extensive scope of the study and individual comments on the length of the current survey, we considered the study with a shorter Big Five measuring tool, e.g., the Polish version of the Ten Item Personality Inventory . We deciThe study also allowed us to use current experiences and results for further research in the field of relatively constant psychological traits associated with different forms of activities undertaken by patients with chronic diseases that differ in intensity, duration, and nature. This, in turn, can be used to learn about the preferences of patients and to create various adequate forms of activity proposals, tailored to personal characteristics. Regarding this option, we suggest that it is worth staying with the tools used in the pilot study."}
{"text": "I) and total joint faulting cumulated per km (TFAULT) were the highest for the IRI of JPCP.The international roughness index (IRI) can be employed to evaluate the smoothness of pavement. The previously proposed mechanical-empirical pavement design guide (MEPDG), which is used to model the IRI of joint plain concrete pavement (JPCP), has been modified in this study considering its disadvantage of low prediction accuracy. To improve the reliability of the prediction effect of the IRI for JPCP, this study compares the prediction accuracy of the IRI of JPCP by using the machine-learning methods of support vector machine (SVM), decision tree (DT), and random forest (RF), optimized by the hyperparameter of the beetle antennae search (BAS) algorithm. The results from the machine-learning process show that the BAS algorithm can effectively improve the effectiveness of hyperparameter tuning, and then improve the speed and accuracy of optimization. The RF model proved to be the one with the highest prediction accuracy among the above three models. Finally, this study analyzes the importance score of input variables to the IRI, and the results show that the IRI was proportional to all the input variables in this study, and the importance score of initial smoothness (IRI Joint plain concrete pavement (JPCP), using shrinkage to control the cracks, is a common form of concrete pavement without any reinforcement . It is wLong-term Pavement Performance (LTPP) is the most comprehensive study of pavement performance data collection, covering about 900 roads in the United States, Canada, and other countries with various influencing factors, including general information, climate data, material test data, traffic data, and pavement inspection data . It is oI is initial smoothness measured as IRI, m/km, TC is the percentage of slabs with transverse cracking , SPALL is the percentage of joints spalled, PATCH is the pavement surface area with flexible and rigid patching  as a percentage, TFAULT is the total joint faulting cumulated per km, mm, SF is the site factor, and AGE is the pavement age in years, FI is the freezing index, days, and The Mechanical-Empirical Pavement Design Guide (MEPDG) is a common method for predicting the smoothness of pavement ,27. The It is clear from the figure that the predicted value of the IRI of JPCP by the MEPDG differs greatly from the actual value, that is, the fitting effect is poor. Therefore, it is of great practical significance to propose a more accurate and efficient model to predict the IRI of JPCP. Gulfam-E-Jannat et al. conducted a regression analysis to evaluate IRI models by comparing the predicted distress to observed distress . SoulimaWith the development of machine learning, the application of machine-learning models to predict the performance of pavement has become a research hotspot for architectural engineering researchers ,45,46,47I), pavement age in years (AGE), percentage of slabs with transverse cracking  (TC), percentage of joints spalled (SPALL), pavement surface area with flexible and rigid patching  (PATCH), total joint faulting cumulated per km (TFAULT), freezing index (FI), percentage of subgrade material passing the 0.075-mm sieve Extraction of the sub-training set. By the Bootstrap method, N samples are randomly extracted from data set D, put back to form K sub-training data sets, and K decision trees are established.(2)Construction of decision tree. The construction of subclassifies mainly uses a classification regression tree. Firstly, K features are randomly selected from M features at each node of the decision tree as the segmentation feature set of corresponding nodes. The optimal segmentation feature and segmentation node are determined according to relevant criteria. The segmentation node is divided into two nodes, and the corresponding data is also divided into two nodes. The above process is repeated until the stop condition is met.(3)Construction of random forest. Step (2) is repeated, and stops when K decision trees are generated, and then these are combines into a random forest (4)K decision trees in the random forest are used to classify the test data set DT, and K prediction results ((5)The mode in the prediction result of the decision tree is selected as the final prediction result of each sample in the prediction data set.Tuning the hyperparameters of the model before the model training is beneficial in improving the prediction effect of the model. In this study, BAS was selected to optimize the hyperparameters of SVM, DT, and RF. The relationship between the RMSE values of the three models and the number of iterations is shown in This study evaluated the prediction effect of the above three models on the IRI of JPCP by comparing and analyzing the fitting effect of the predicted value and the actual value of SVM, DT, and RF tuned by BAS. The comparative analysis of the predicted value and actual value of the training set and test set of the three models is shown in I, TFAULT, FI, AGE, TC, SPALL, and PATCH were 2.2460, 1.4710, 1.1685, 0.5864, 0.5385, 0.3458, 0.2626, and 0.2416, respectively. That is, the IRI of JPCP was proportional to IRII, TFAULT, FI, AGE, TC, SPALL, and PATCH, and the importance of variables on the IRI of JPCP decreased according to the above order. IRII and TFAULT were the most important variables on the IRI of JPCP. It should be noted that IRII is an objective parameter that cannot be artificially designed during road maintenance. Therefore, road engineers should pay attention to TFAULT when designing JPCP, as it is of great significance in improving the IRI of JPCP. The effect of SPALL and PATCH on maintaining road surface smoothness was weak, indicated by the low important scores.To further analyze the importance of the input variables selected in this study on the IRI of JPCP, the importance scores of eight input variables were analyzed, as shown in To address the issue of the reliability of the IRI prediction for JPCP being low, this study proposed the idea of using a hybrid machine-learning model to predict the IRI of JPCP. Firstly, this study used BAS to tune the hyperparameters of SVM, DT, and RF. Then, by comparing the prediction effect of SVM, DT, and RF optimized by BAS on the IRI of JPCP, the machine-learning model with the highest accuracy prediction was selected. Through the study of the above analysis, the following conclusions are drawn. (1)I, TFAULT, FI, AGE, \u03c1200, TC, SPALL, PATCH) in the database had a reasonable distribution, wide coverage, and low correlation. Therefore, using this database to predict the effects of the models, the prediction effect of the IRI of JPCP will not be affected by unreasonable data distribution and a high correlation between variables.The data of the input variables (IRI(2)IRI of JPCP in general among the three machine-learning models. In addition, the RF model had no fitting phenomenon due to the introduction of two randomness variables; DT had a poor-fitting effect on the predicted value of the IRI of JPCP.BAS had a good hyperparameter tuning effect on SVM, DT, and RF, indicated by the fact that RMSE values could quickly converge in the process of machine learning. By comparing and analyzing the predicted value and actual value of the IRI of JPCP from the three models in the training set and test set, it was found that RF had the best prediction effect  on the (3)I and TFAULT were the two most important parameters for maintaining the roughness of the road surface. Considering that IRII is an objective parameter of road surface, road engineers should pay more attention to the influence of TFAULT on road surface smoothness in the design process. The effect of SPALL and PATCH on maintaining road surface smoothness was weak, indicated by the low important scores.IRIRegarding future development, it is possible to consider using the present hybrid machine-learning model to predict the IRI of both JPCP and jointed reinforced concrete pavement (JRCP). In addition, the results obtained can be applied to the mixture design of cement concrete pavement by considering the IRI development of the pavement."}
{"text": "Nature Communications 10.1038/s41467-020-14367-0, published online 05 February 2020Correction to: In the published version of this paper, the members of the Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium were listed in the Supplementary Information; however, these members should have been included in the main paper. The original Article has been corrected to include the members and affiliations of the PCAWG Consortium in the main paper; the corrections have been made to the HTML version of the Article but not the PDF version. In the PCAWG Drivers and Functional Interpretation Group, the affiliation for Erik Larsson has also been changed from \u2018Computational Biology Center, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA\u2019 to \u2018Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden\u2019. Additional corrections to affiliations have been made to the PDF and HTML versions of the original Article for consistency of information between the PCAWG list and the main paper."}
{"text": "Physical ergonomics has established itself as a valid strategy for monitoring potential disorders related, for example, to working activities. Recently, in the field of physical ergonomics, several studies have also shown potential for improvement in experimental methods of ergonomic analysis, through the combined use of artificial intelligence, and wearable sensors. In this regard, this review intends to provide a first account of the investigations carried out using these combined methods, considering the period up to 2021. The method that combines the information obtained on the worker through physical sensors  or biopotential sensors , with the analysis through artificial intelligence systems (machine learning or deep learning), offers interesting perspectives from both diagnostic, prognostic, and preventive points of view. In particular, the signals, obtained from wearable sensors for the recognition and categorization of the postural and biomechanical load of the worker, can be processed to formulate interesting algorithms for applications in the preventive field , and with high statistical power. For Ergonomics, but also for Occupational Medicine, these applications improve the knowledge of the limits of the human organism, helping in the definition of sustainability thresholds, and in the ergonomic design of environments, tools, and work organization. The growth prospects for this research area are the refinement of the procedures for the detection and processing of signals; the expansion of the study to assisted working methods , and to categories of workers suffering from pathologies or disabilities; as well as the development of risk assessment systems that exceed those currently used in ergonomics in precision and agility. Ergonomics deals with the design of work environments so that they are suitable for humans, and aims at the objectives of health and safety, and productivity at work . ErgonomPhysical ergonomics is concerned with human anatomical, anthropometric, physiological and biomechanical characteristics as they relate to physical activity. Relevant topics include working postures, materials handling, repetitive movements, work-related musculoskeletal disorders (WMSDs), workplace layout, physical safety, and health . High exTechnological innovation, and in particular wearable devices ,12, offeworker-activity-environment]. Ideally, the combination of wearable sensors and AI could help ergonomics in identifying the factors that promote occupational well-being, directing the targeted use of economic resources to implement ergonomic design that contributes to the primary prevention of health issues in the workers. Secondly, the use of wearable sensors and AI could help to verify the long-term tolerability conditions of work, through an accurate recognition of the exposure conditions, integrating the strain aspects developed by the worker, and comparing them with the work requirements.In current and foreseen employment contexts, characterized by the complexity of the work organization, the absence of exactly decodable tasks\u2014as well as the aging of the workforce, and the emergence of situations with exposure to multiple risk factors \u2014it is ofInnovations in AI  have been shown to increase productivity, and could potentially improve the safety and health of workers in the workplace . TherefoPhysical ergonomics related to physical activity concerning human anatomical characteristics;Cognitive ergonomics related to mental processes;Organizational ergonomics related to optimization of socio-technical systems.As reported by Karwowski , the conTo the best of the authors\u2019 knowledge, no systematic reviews consider the potential combined use of wearable devices and AI algorithms in physical ergonomics applications. Some reviews have focused on the potential use of wearable devices in ergonomics ,23,24,25The systematic review is a method of selecting, evaluating, and summarizing studies based on a specific topic . Our sysThe literature search was conducted on Scopus and PubMed databases, and it was limited to English documents. Each database was queried using the following keyword structure: (\u201cwearable\u201d OR \u201csensors\u201d) AND  AND (\u201cAI\u201d OR \u201cML\u201d).Conference reviews, reviews, book chapters and erratum;Papers not available;Papers duplicated.In order to simplify our research, the exclusion criteria were:Papers proposing human-machine interface solutions without wearable devices, and not explicitly related to occupational medicine ;Papers proposing wearable devices for cognitive ergonomics ;Papers proposing only a wearable device solution without AI ;Papers proposing wearable devices for other purposes .Concerning the screening by title, abstract, and full text, the following exclusion criteria were defined:Documents were screened evaluating, firstly, title and abstract contents and, in case the documents did not meet the inclusion criteria, secondly the full text. The systematic review includes 25 papers divided into journal articles (16 out of 25), and conference papers (9 out of 25).Most of the papers were published between 2018 and 2021, peaking in 2020 as shown in The papers were analyzed according to several categories: aim of the study; people involved, and task performed by the subjects; type of wearable device and its positioning on the human body; signal acquired by the sensor and features extracted; principles, methods, standards and/or guidelines underlying the ergonomic assessment; AI strategy (ML and/or DL); results of the studies. Wearable devices have developed exponentially through novel sensors and technologies, and the long-term monitoring of vital signs and other principles, as described in . The verOf these studies, 3 out of 25 articles tested a prototype device on healthy volunteer subjects. Akanmu et al.  developeOther prototypes were tested on healthy worker subjects. Specifically, Aiello et al.  developeSome authors tested commercial devices on healthy volunteer subjects. A potential approach is described in ; the autThe Equivital EQ02 Life Monitor system consists of a multi-parameter body worn sensor . Other eFinally, Fridolfsson et al.  used a cThe majority of the studies (18 out of 25) used inertial wearable sensors. Inertial sensors refer to accelerometers, gyroscopes and magnetometers that measure linear acceleration, angular velocity and magnetic fields. Typically, three orthogonal gyroscopes, three orthogonal accelerometers, and three orthogonal magnetometers are contained in an IMU . Eight sIn particular, Matijevich et al.  found thOne of the applications of inertial sensors is the recognition of human postures in several environments, i.e., during activities in the workplace . PostureThe diagram in Furthermore, a substantial minority of articles used only biopotential sensors, namely devices that convert a biological response in an electrical signal. In the current study, examples of biopotential wearable sensors were used by Mudiyanselage et al.  and UmerFinally, other studies ,52,56,57Manual material handling is an important risk factor for the development of WMSDs in construction workers. Ergonomic criteria allow the quantification of risk levels during manual handling activities , such asOne of the ergonomic criteria quoted in the systematic literature review is the Revised NIOSH Lifting Equation (RNLE). The RNLE is a manual material handling risk assessment method associated with lifting and lowering tasks in the workplace ,72. MudiTwo papers ,42 classAnother ergonomic criterion found in the review, and which was used to prevent ergonomic risk factors, is the Occupational Safety and Health Administration (OSHA) . On one A total of 9 out of 25 studies used different principles, methods, standards, and/or guidelines for ergonomic risk, in particular: International Organization for Standardization (ISO) 5349 and 11226 ,53, Job Finally, 10 out of 25 articles did not mention a specific ergonomic criterion. For instance, Estrada and Vea  classifiML and DL are two branches of AI that can help to prevent WMSDs, as studied in . In the Ensemble classifiers combine a set of several ML algorithms, named base learners, to obtain a single classifier that outperforms the others . In the In terms of accuracy, several classifiers showed high values. Among the ensemble classifiers, RF was the best algorithm showing accuracy values above 90%. Antwi-Afari et al.  achievedFeature extraction is a useful process of dimensionality reduction and/or redundant data reduction that avoids the loss of important information. The extracted features refer to the signals acquired from sensors placed on a specific body part . These fTwo studies ,41 out oSensor features could be analyzed to identify an ideal wearable system . MatijevIn some articles ,54,80,82Differently from the above-mentioned articles, Mudiyanselage et al.  extracteThe ergonomic analysis technique that makes use of sensors and AI is mainly aimed at the prevention of WMSDs, and particularly affects the body sectors of the upper limbs and back, widely treated in ergonomics. Through this approach, aspects related to the posture of the whole body have also been partly explored, addressed in ergonomics only recently, and for which, in the literature, there are still no clear thresholds of sustainability or indications of optimal levels of variability over time. The application of this approach provides useful information on the needs of ergonomics to improve the conditions of safety at work, and the comfort of the worker; to design suitable work environments and equipment; or to set up work organizations that avoid the onset of phenomena of accumulation of fatigue or overload. Above all, this approach can be advantageous for the analysis of complex or difficult to observe work situations.As the diffusion of this approach progresses, the wealth of knowledge could help improve the prevention of WMSDs, both associated with acute and cumulative load. This could provide useful information for setting up working methods that are well tolerated, even during the entire working life\u2014an important aspect especially for professions with high biomechanical wear, such as for construction operators or healthcare professionals.This approach assists not only in the study of the characteristics of force, repetitiveness, and posture , but also in the kinematic traits of the worker\u2019s behavior. Specific kinematic traits could be useful as indicators to control and predict the appearance of any alterations capable of endangering the integrity of the worker, but also to monitor the critical phases during the return to work for people with dysfunctions, disabilities or previous pathologies.Furthermore, the data detectable through sensors can enrich the value of the ergonomic intervention of evaluation and design, attracting interest also on aspects properly investigated by other disciplines, such as engineering, psychological, organizational, medical, but also economic ones. The technological approach can be all the more innovative the more it uses prototypes , often made with open-source resources, and not pre-deterministically channeled towards a single aspect of interest. Considering some variables detectable through sensors, the design of optimal work situations can be addressed to specific categories of workers, such as the elderly, in order to be able to implement targeted adaptations of the workplace that guarantee the expected levels of productivity and safety.In addition to the purposes of monitoring, evaluation, and design, the combined technique that uses sensors and AI opens up new scenarios for ergonomic interventions of an educational and participatory prevention type; this provides a contribution for workers to explore new ways of carrying out work, possibly also with the adoption of technological aids and devices, such as exoskeletons. The illustrated approach also opens the way to analysis and consideration of multiple conditions of exposure to physical, chemical, environmental, organizational factors at work, for which neither consolidated methodologies for risk assessment are currently available nor is evidence of association available, with the motor, physiological or biomechanical functions of the human operator.Further studies may make improvements to the illustrated technique, specifying the optimal positioning of the sensors, defining the best AI system, but also proposing the elaboration and development of other methods of ergonomic analysis, different from those already used and accepted by classical ergonomics. An interesting aspect of the study related to the topic presented here, and mainly focused on WMSDs, concerns the interpretation of worker well-being as an integrated construct that includes physical, psychosocial, and organizational aspects . As it has, in fact, been demonstrated by various studies, these aspects act with reciprocal influence on the conditions of the human operator, and the intervention on one of the risk factors could have repercussions on the other dimensions. This broadening of perspective also affects the long-term benefits that can be prepared for, and guaranteed by, short-term investments in improving occupational safety and health. Furthermore, given the multifactorial nature of the underlying causes of WMSDs, a future study perspective could concern the assessment of exposure associated with prolonged low-intensity static work, typical of teleworkers and the increasing digitalization of work.This article presented a systematic review of the combined use of wearable devices and AI for ergonomic purposes, selecting 25 relevant studies from the scientific literature. The analysis highlighted a deep interest, which has grown in recent years, for the use of wearable sensors coupled with AI algorithms (both ML and DL) to monitor the biomechanical risk to which workers are exposed to during their activities. The review provides the researcher with an overview of the latest uses of AI and wearable sensors in the context of physical ergonomics. Additionally, this review could be useful to support professionals in selecting the most suitable wearable technology and AI strategy for ergonomic assessments and improvements in industrial and non-industrial settings."}
{"text": "While there have been increased calls for strengthening community health systems (CHSs), key priorities for this field have not been fully articulated. This paper seeks to fill this gap, presenting a collaboratively defined research agenda, accompanied by a \u2018manifesto\u2019 on strengthening research and practice in the CHS. The CHS research agenda domains were developed through a modified concept mapping process with a team of 33 experts on the CHS including policy-makers, implementers and researchers from institutions in six countries: Uganda, Guatemala, South Africa, Sweden, Tanzania and Zambia. The process began remotely with brainstorming research priorities and concluded in a one-week workshop that was held in Zambia where priorities for strengthening CHS were discussed, grouped into domains, interpreted, and drafted into a collective declaration. Eight domains of research priorities for CHSs were identified: clarifying the purpose and values of the CHS, ensure inclusivity; design, implementation and monitoring of strategies to strengthen the CHS; social, political and historical contexts of CHS; community health workers (CHWs); social accountability; the interface between the CHS and the broader health system; governance and stewardship; and finally, the ethical methodologies for researching the CHS. By harnessing a set of diverse and rich experiences and perspectives on CHS through a structured process, a multifaceted research agenda and manifesto that transcend context, disciplines and time were developed. We posit this as an entry into greater debate and diversity in the field as we continue to find ways to strengthen research and practice in the CHS. As a relatively new and contested area of research, there is great potential to engage this growing interest and develop the field through initial research agenda setting. This is critical in generating dialogue and debate that can inform both inform both practice and further research.Community health systems (CHSs) are the subject of growing interest based on their potential to leverage different community resources and advance population well-being. However, CHSs are understood in quite varied ways across the health systems\u2019 research fraternity. These variations range from a restricted view of community health workforce endeavours or other local community volunteer programmes aimed at social accountability, to more generally understood concepts that encompass all of society\u2019s efforts aimed at improving population well-being. Research agenda setting is approached in several ways including: the commissioning of small research activities; literature reviews; and convening of conferences, among others. Generally speaking, input from subject experts, engagement of a wide scope of stakeholders, building consensus and sharing of the research agenda to foster further debate are typical steps or processes in this endeavour. While some of these agenda-defining processes are aimed at to arriving at more inclusive research agendas, some are more focused on specific interests, often short-lived and limited in scope by disciplines and geographical reach. The latter often result in specific research questions that can easily be answered within a specific period of time and with resources that are usually readily available. For example, a recent literature and consultative review on global research agenda for CHSs largely focused only on community health worker (CHW) programmes. While this agenda is important, it does not adequately represent the scope of the field of CHSs, given that CHWs are just one of the components. Inclusive research agendas are more dynamic and create a stimulus upon which more long-term or enduring human interests are sustained is the kind of vision that our CHS research agenda setting is based on.Policy agendas such as the Millennium Development Goals and Sustainable Development Goals are implemented through research agendas among other ways. Research agendas are therefore essential in directing resources and coordinating efforts towards achieving set policy goals by creating logical frameworks through which channel scarce resources and actions can be used. In this paper, we aim to share a collaboratively defined agenda of CHS research priorities, crowned by a manifesto statement that emerged from the process. The participants in the agenda-defining process consisted of researchers from seven institutions, as well as front-line workers, managers and senior policy-makers from the Zambian Ministry of Health. Over the course of a one-week workshop, this collective leveraged their diversity  to undertake a multidisciplinary exploration and mapping of research priorities for the CHS. This is envisioned to spiral into a more enduring and dynamic debate of shaping and reshaping CHSs that are responsive and accountable.In this section we present the process by which we developed the priorities that formed the basis for defining domains of the CHS agenda and the manifesto. A group of public health and health system players engaged in thinking, researching, policy-making and advocacy on CHSs met for a week (10\u201314 June 2019) at the Chaminuka Lodge in Lusaka, Zambia to collate our collective understandings of the CHS and generate a research agenda. The group of 33 participants included junior and senior health systems researchers from institutions in Zambia (8), South Africa (8), Sweden (4), Uganda (1), Tanzania (1), and Guatemala (1), as well as stakeholders from the Zambian Ministry of Health (4), community health workforce (3), and international partner organizations (3) see . Our implementation of the method was guided by the steps outlined by Trochim and Kane with some adjustments in an effort to ensure that the process was inclusive and representative of the group\u2019s collective ideas. Below are the steps we undertook  to gain an integrated view of how participants saw the statements fitting together in overarching themes. The idea statements were plotted on a point map (or distance matrix), where the statement points\u2019 proximity to each other was based on the frequency with which they were grouped together. The point map was then partitioned into clusters of statements using hierarchical cluster analysis, and the team of facilitators examined how the points were grouped together into 6 to 15 clusters of ideas. At each level of clustering, the team assessed the coherency of the ideas that composed the clusters and whether the successive splitting of clusters added a valuable distinction for making sense of the themes represented in the ideas. They found that a 10-cluster solution was a good base for presenting the general domains and the ideas they contained to the broader group of participants . On the third day, the participants were engaged in reviewing the concept map of the 10-cluster solution. Interpretation took place in small group discussions and a designated notetaker in each group recorded participants\u2019 suggestions on how to make sense of the thematic domains that the clusters represented, and if they might be combined or divided to better capture important conceptual domains in CHSs research. The facilitator team reviewed the small groups\u2019 interpretations of the clusters and found general consensus about the domains that were judged to be coherent and adequately capturing an important theme, and also significant overlap in the suggestions for modifying domains. Integration of the small-groups\u2019 interpretations led to the identification of eight thematic domains organizing the statements. On the fourth day, participants were engaged in further interpretation of the integrated list of thematic domains that emerged from the previous day\u2019s discussions. In this step, the groups were charged with refining the definitions of the domains, developing a visual representation of how the domains fit together in a model or \u2018landscape\u2019 of CHSs, and a written declaration of how to strengthen CHS, drawing on their interpretation of the domains. Each of the four groups shared its visual model of the CHS domains and its declaration during a world cafe session later in the day. The lead workshop organizers later met with a small group of participants to synthesize the definitions of the priority research domains, reflect on the visual models and declarations coming out of the process, and draft an overall manifesto on research and practice for strengthening the CHS. The domains and the manifesto statement were then circulated to workshop participants for feedback.The initial concept map in  Further conceptual interpretation of these domains in small groups was based on the same eight thematic domains, but participants employed different visual and metaphorical devices to depict their interrelationships. One model depicted them as elements of a self-sustaining ecosystem, another as systems within systems, while another arranged them as components of a building with a foundation of values and purpose and an overarching roof of governance. In another model, the domains were organized into micro-, meso- and macro-levels. Variations across the small-groups\u2019 interpretations reflected varying mental models of the function of CHS and complex ideas surfaced about how domains of research priorities should fit together to strengthen them.The CHS Chaminuka Manifesto, named after the venue of the workshop in Zambia , represe We believe that communities are complex social systems with long histories, imbued with power relations that play out between people, families, neighbourhoods, committees and health workers. We understand CHSs as embedded in these community social systems and in broader health systems, with porous boundaries between them. The CHSs represent a significant health system asset or resource comprising both hardware elements, such as human resources, drugs and technologies, as well as software elements such as values, relationships and trust. Health systems typically engage the CHS through CHW programmes. CHWs are mandated to provide primary and preventive health services, but both their mandate and their capacity to carry it out effectively are impacted by factors such as motivation, training, degree of embeddedness in communities they serve, and the disjuncture between their role as described on paper, and what is expected in practice. It is therefore vital that the research takes seriously the lived realities of CHWs, and seeks to establish effective strategies for identification, selection and recruitment of CHWs and best practice for training and continuous development of CHWs, enhance their agency, motivation and job satisfaction, and remove barriers to effective retention of CHWs in, and relationships with, the health system. We believe that the CHS is also a site for the empowerment and participation of communities within broader health systems, allowing communities to hold government to account. This is to be achieved by strengthening community participation mechanisms that shift power relations, ensuring responsiveness of health systems to community needs, and actively pursuing strategies for collective action. This entails:Building capacity for collaborative governance and accountability, understood to include oversight, direction and stewardship to enable and strengthen the CHS, promote intersectoral collaboration, overcome fragmentation, ensure allocation of resources and build trust; Strengthening the interface and relationships between CHSs and their broader health systems, as well as between the community and health services; Recognizing the importance of addressing imbalances in power and building trust in relationships between stakeholders in strengthening the CHS.  We also believe that it is the responsibility of governments to support and strengthen the CHS, which includes:Working to overcome health system fragmentation Ensuring equitable resource allocation to CHSs Coordinating partnerships between actors within CHSs, and monitoring the impact of external partner actions on CHSs Ensuring balance of power between formal sector health workers and volunteer CHWs Recognizing the importance of boundary spanners, which mediate relations between CHSs and broader health systems Building trust between the formal health-care system and the CHS Strengthening the capacity of communities to hold government to account for maintaining their responsibility to the CHS.  We are explicit in positioning the values and principles underpinning our understanding and conceptualization of CHSs, and therefore our research in, on and for the CHS. Core to our values is the need to foreground marginal and vulnerable populations, and to fight to make those who are invisible, visible. The values and principles we believe should be taken into account when designing, implementing, monitoring and evaluating the CHS are:A focus on reducing inequalities by acknowledging and striving to meet the intersectional needs of individuals as members of complex communities A concern with the health and well-being , rather than a disease-focused approach A commitment to locally driven solutions A whole-of-society perspective that seeks to harness the social determinants of health to promote well-being.  As such, we believe that research on, in, for and with CHSs should:Be inclusive Be locally driven and embedded in communities and societies Generate new knowledge through co-production Centre around community engagement through non-hierarchical participatory methodologies that foreground trust, balance of power, and strong and sustained interpersonal relationships Acknowledge the complexity and context-sensitive nature of CHSs, through a whole-of-society perspective Always be conducted with the intention of contributing to real-world social change Shift the centre of knowledge generation on the CHS to countries themselves, and in ongoing dialogue with policy-makers and practitioners.  In conducting this research, it is crucial to take account of, and research, the history, political-economy, and social and gendered contexts of the CHS, from global to local, including local knowledge beliefs and cultural practices. We understand this complex context not only as the context in which CHSs are embedded, but also as the context in which researchers conduct their work. In doing so, we recognize that global imbalances in knowledge generation may allow for certain ideas, interests and discourses on the CHS to dominate in ways that silence others. The participants of the Chaminuka workshop resolve to continue building collaborations, research partnerships and community engagement platforms to strengthen CHSs. We further commit to conducting ethical, emancipatory research for and with all stakeholders towards inclusive empowered communities, while acknowledging the importance of histories, power and relationships, and using critical perspectives to understand the impact of these contextual factors on our daily work and relationships. Abbreviations: CHS, community health system; CHWs, community health worker. This paper presents priority research domains and a manifesto declaration produced through a collaborative process to articulate an agenda for strengthening CHS. The process was enhanced by participants\u2019 varied positionalities, which encouraged us to consider more carefully our starting points and assumptions on the CHS. For example, some of us were senior, others junior, others have focused on the role of CHWs in health systems, others on citizen mobilization and advocacy; some of us on health systems and their management, others on multisectoral development; some on macro-level policy and design, others on front-line action; some of us are researchers, other practitioners, and policy-makers. However, in terms of country level representation, the participants were largely from low- and middle-income countries and only country was represented from the high-income category of countries. While this posed a potential limitation to the priority and agenda setting process, the whole process was never made context specific, participants generally reflected on all their experiences in either context. A significant number of the participants had experiences with CHSs in high income countries through collaborations and lived experiences. In this application, the software-generated map of the thematic cluster solution served as a jumping-off point for further engaging participants in dialogue and interpretation, thereby raising contestation and generating an opportunity to find coherence and resolution through collective sense-making. By explicitly raising and harnessing different perspectives, we were able to stimulate rich thinking and a variety of representations of the CHS . Such an approach nonetheless is limited by the wealth of experience, depth and critical nature of the participants and dialogues undertaken.The process was facilitated by a modified concept mapping approach, which provided a structured and participatory tool for integrating our collective ideas about what is important for CHSs. During the workshop, we challenged the idea of a single narrative on the CHS and emphasized the development of a multifaceted research agenda that could accommodate multiple perspectives and starting points cutting across generations, disciplines and context. We consider that the process was rich and robust enough to stimulate richer discussions around the development of the CHS field of research and practice, an iterative end that we welcome all to engage in as we build more responsive health systems around the world. We acknowledge the funders of this study. In addition, we are grateful to all the workshop participants who freely shared their knowledge and CHSs experiences that enabled us to write this paper. All participants of the brainstorming and workshop sessions consented to participating the process and having their views shared through this publication. Authors declare that they have no competing interests. MT led the drafting of the manuscript, AKH, HS, FJ, and AH supported MT in the drafting of the manuscript. In addition, AH provided overall technical oversight to the manuscript writing process. FJ, EW, and AH were a part of the lead team in the concept mapping process that was used to develop the content of the manuscript. JZ reviewed and provided technical guidance to the drafting of the manuscript. The Chaminuka collective actively participated in the priority setting process and their views are well captured in the manuscript. All authors reviewed and approved the manuscript for submission.1School of Pharmacy, University of Waterloo, Waterloo, ON, Canada. 2Department of Epidemiology and Global Health, Ume\u00e5 University, Ume\u00e5, Sweden. 3Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda. 4School of Public Health & Family Medicine (SPHFM), University of Cape Town, Cape Town, South Africa. 5School of Public Health, University of the Western Cape, Cape Town, South Africa. 6South African Medical Research Council Health Services to Systems Unit, University of the Western Cape, Cape Town, South Africa. 7Centre for the Study of Equity and Governance in Health Systems, Guatemala City, Guatemala. The Chaminuka Collective consists of the following members, displayed with their affiliations:Isabel Goicolea; Department of Epidemiology and Global Health, Ume\u00e5 University, Ume\u00e5, Sweden. Charles Michelo; School of Public Health, University of Zambia, Lusaka, Zambia. Paul MalizganiChavula; School of Public Health, University of Zambia, Lusaka, Zambia. Adam Silumbwe; School of Public Health, University of Zambia, Lusaka, Zambia. KasapoChibwe; School of Public Health, University of Zambia, Lusaka, Zambia. Doreen Sitali; School of Public Health, University of Zambia, Lusaka, Zambia. Chama Mulumbwa; School of Public Health, University of Zambia, Lusaka, Zambia. MargarateMunakampe; School of Public Health, University of Zambia, Lusaka, Zambia. Wanga Zulu; School of Public Health, University of Zambia, Lusaka, Zambia. Miguel San Sebastian; Department of Epidemiology and Global Health, Ume\u00e5 University, Ume\u00e5, Sweden. Uta Lehmann; School of Public Health, University of the Western Cape, Cape Town, South Africa. Tumelo Assegaai; School of Public Health, University of the Western Cape, Cape Town, South Africa. Leanne Brady; School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa. Lance Louskieter; School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa. Jill Olivier; School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa. Marsha Orgill; School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa. SiriliNathaneal; School of Public Health and Social Sciences, Muhimbili University, Dar es Salaam, Tanzania.Supplementary file 1. The Workshop Participants List.Click here for additional data file.Supplementary file 2. List of 98 Statements of Research Priorities Needed to Strengthen CHS.Click here for additional data file."}
{"text": "The multidimensional impact of hearing loss on the various demands of life in children using cochlear implants is represented by variables that can influence the hearing, language and quality of life outcomes of this population.To evaluate the factors influencing the quality of life of children with cochlear implantation, considering age, hearing age, age at evaluation, hearing skills, spoken language, family degree of receptiveness, schooling and socioeconomic status of the parents.Participated 30 children using cochlear implants, aged 6 to 12 years and their respective parents. The children were evaluated by the categories auditory performance, by language category, and by the children with cochlear implants: perspectives parents questionnaire. Parents were assessed by the family involvement scale.The cochlear implant impacted the quality of life of the children, with more significant results on the increase of the social relations domain and the decrease of the family support domain. Overall, the increase of the age in the evaluation, better hearing and language skills, the mother's level of schooling and the family receptiveness correlated with the quality of life of children with cochlear implants.The influencing factors that correlated with the quality of life of the implanted children were the child's older age at the evaluation, the better hearing and language skills, the mother's level of schooling and the family receptiveness. The benefits of a Cochlear Implant (CI) in children are well known. The success related to spoken language recognition and comprehension skills are well-established in both national and international literature.12The use of specific tools to assess the quality of life of children with CI allows the assessment of the impact of hearing loss and the device use in everyday situations, beyond the evaluation of the hearing and spoken language skills provided by the formal clinical measures. The information acquired through the opinion of the parents, or in some situations, by the patients themselves, has the potential value of guiding conducts during the intervention process.14Thus, greater investments in the investigation of these other life demands of the child with a CI are necessary and may result in greater benefit, in addition to guiding the speech therapy, family counseling and guidance during the therapeutic process with a more individualized approach for each child.Therefore, the aim of this study was to evaluate the factors influencing the quality of life of children with cochlear implants, considering the age at surgery, hearing age, age at evaluation, hearing skills, spoken language, degree of family receptiveness, the parents\u2019 level of schooling and socioeconomic level.This was a cross-sectional, descriptive, quantitative study, approved by the Research Ethics Committee of Hospital de Reabilita\u00e7\u00e3o de Anomalias Craniofaciais of Universidade de S\u00e3o Paulo (HRAC/USP), Retirar under CAAE no. 61753416.0.0000.5441.Thirty children of both genders, aged between 6 years and 12 years, who were CI users enrolled in the Cochlear Implant Section (SIC) of HRAC/USP, and their respective parents participated in the study. The participants signed the Free and Informed Consent Form (FICF) and Assent Form. The sample consisted of a convenience sample, with parents and children attending the CI follow-up routine between March and August 2017.The inclusion criteria of this study were: having a minimum of six complete years of age (72 months) to 12 incomplete years (144 months), having severe and/or profound bilateral sensorineural hearing loss, having undergone CI surgery according to the multifactorial criteria for cochlear implant surgery indication proposed by the interdisciplinary team of the Cochlear Implant Section (SIC-HRAC/USP), with total electrode insertion and during the sensitive period of auditory neural plasticity, up to three years and six months of age,The children's auditory performance was determined based on the Categories of Auditory Performance (CAP) scaleThe Family Involvement Rating scale,http://resource.isvr.soton.ac.uk/audiology/Software/ParQ120.htm.The children's quality of life assessment was measured using the Children with Cochlear Implants: Parent's Perspectives (CCIPP) questionnaire,The more positive the answer, the greater the association between quality of life and the CI use from the parents\u2019 perspective.st quartile, median and 3rd quartile values were used for the representation of variables: age at surgery, hearing age, age at evaluation, auditory skills, spoken language skills, degree of family receptiveness, level of schooling, and socioeconomic level of the parents. The inferential correlation analysis between the influencing variables and quality of life was performed using the non-parametric statistical dependence test between two variables, Spearman's rho Correlation Test. The level of significance was set at p\u00a0\u2264\u00a00.05%.The statistical analyses were carried out using the software SPSS, version 18. Percentages, mean, standard deviation, minimum, maximum, 1Quality of life assessment involves several factors, such as physical and emotional well-being, self-esteem, family, friends, school, satisfaction with the CI, social aspects, mobility, self-care, pain, telephone use, speech comprehension, environmental sound perception, communication, self-sufficiency, use of electronic devices, other peoples\u2019 attitudes, self-confidence, preferences, interests and ethical and moral values.8In this sense, measuring the quality of life in the pediatric population requires the use of sensitive measures to assess these aspects. The use of specific evaluation tools is highly advantageous, because it allows the assessment of parents\u2019 perceptions and provides information about auditory and speech language development and expresses significant changes in the perception of the family regarding the CI user's satisfaction. These data help professionals in the intervention process.24In the last 10 years, four studies31The results of the present study are in agreement with previous findings. From the parents\u2019 perspective, the CI improved the quality of life in all domains related to the child and in one of the domains related to the family. The subscale of social relations showed a more significant impact, followed by communication, functionality, autonomy, education, well-being and happiness, of the effects of CI on the family, and of the support and assistance given to the child .The fact32Among the evaluated domains, the subscale support and assistance to the child recorded the lowest indexes of quality of life scores in relation to the other scales. The same was observed in other studies14In the analysis of the CCIPP subscales , autonomEven with overall good quality of life results, the minimum and maximum response values and the standard deviation between the subscales showed the variability of results, distancing some children from the group's mean values, due to the different perspectives shown by some parents . Researc36For children who did not reach the highest percentages of quality of life after the CI use , the impConsidering the multidimensionality and multifactorial aspects of the implantation and development process of children with cochlear implants that occur at different temporal scales, it is natural that in some studies, certain variables have a strong effect on one group of children but not on others, explaining the variability of results found in this and other studies.Because of this, variables related to the family nucleus such as the socioeconomic level, parental level schooling and family receptiveness in speech therapy are also receiving attention from the literature due to the fact that small children usually spend most of their time interacting with their parents and depend on them for the full rehabilitation process. In this study, the mother's level of schooling was positively correlated with the domain of communication and social domain, and more receptive parents had an impact on the child's communication and education. No statistically significant correlations were found between quality of life and socioeconomic aspects . In the Overall, the quality of life was influenced by five of the investigated variables. When analyzed individually, family receptiveness appeared as one of the most significant variables, acting as a strong predictive marker of development and better quality of life in these children. Considering the different variables that involve the development of children with CI, it is evident the complexity that includes the control of all influencing factors involved in the CI indication, adaptation and monitoring of this population. The desirable balance between the investigated variables alone does not guarantee the full performance of auditory skills, language skills and quality of life.The influencing factors that correlated with the quality of life of the children with CI were the older age at the evaluation, the better hearing and language skills, the mother's level of schooling and the family's receptiveness.This knowledge can guide the speech therapist in charge of the rehabilitation to promote improvements in the planning of specialized speech therapy, consistent with the individuality of the child and his/her family, contemplating personalized guidelines aimed at different socioeconomic and instructional realities, guaranteeing to the families the same possibilities of access to information and opportunities for development. Moreover, this evidence can help the interdisciplinary teams at the stage of cochlear implant indication and when evaluating the progress of the results, guiding the postoperative follow-up based on the specific characteristics of each child and family regarding these factors.The authors declare no conflicts of interest."}
{"text": "Successfully launching a sustainable EHDS requires a clear understanding of the current situation in Member States, taking into account the existing diversity. With this in mind, country visits are being carried out in a group of 12 countries: Denmark, Belgium, Hungary, Netherlands, Estonia, Ireland, Portugal, Finland, Czech Republic, Slovenia, Sweden, Germany. The aim of the country visits is to map the state-of-play of health data management in different countries and explore their preparedness to join the EHDS. The topics explored include: the health data sources available, the health data infrastructure , data quality assurance mechanisms, data governance, as well as resource and training needs and opportunities. Another aim of the country visits is to explore needs and expectations at national level, and how the EHDS can respond to them. This presentation will include an overview of the health data management systems of the 12 countries mapped, providing a snapshot of the situation across Europe. It will then present the findings on their preparedness to join the EHDS. Preparedness takes into account a variety of factors, including political will, as well as legal and technical factors. The presentation will further share the lessons learnt and best practices highlighted from the country visits. Finally, based on these findings, the presentation will close with an overarching view on the preparedness across Europe to deploy the EHDS for the secondary use of health data, EHDS2, as well as planned actions that would facilitate the implementation of the EHDS2 in different member states."}
{"text": "Health assessment data assists the well-being and patient care teams' process in drawing up a care and assistance plan and comprehending the requirements of the patient. Comprehensive and precise data about the Quality of Life of cancer patients play a significant part in the development and organization of cancer patient care. Quality of Life has been used to mean a variety of various things, such as health situation, physical function, symptoms, psychosocial modification, well-being, enjoyment of life, and happiness. Chronic diseases such as cancer are among the disorders that severely affect people's health and consequently their Quality of Life. Cancer patients experience a range of symptoms, including pain and various physical and mental conditions that negatively affect their Quality of Life. In this article, we examined cancer and the impact that this disease can have on the Quality of Life of cancer patients. The cancers examined in this article include head and neck, prostate, breast, lung, and skin cancers. We also discussed health assessment and the importance and purpose of studying patients' Quality of Life, especially cancer patients. The various signs and symptoms of the disease that affect the Quality of Life of patients were also reviewed. People's health is a goal of common, financial, conservational aspects, and personal aspects. Besides additional issues, health knowledge is one of the most significant causes of well-being . A healtThe idiom Quality of Life is extensively used to evaluate quality of life and well-being matters . The purThe head and neck are two of the most significant vital diagnostic parts of the body of their complex structure and many physical procedures . Head anProstate cancer morbidity and fatality measures often diverge. The second most common reason for cancer death in men is prostate cancer . There aAfter skin cancer, breast cancer is the most common cancer among women and is the second greatest cause of cancer death in women after lung cancer . Some kiLung cancer is the most common cancer incidence and cause of cancer mortality in men, while in women, it is the third most frequent cancer . AlthougSkin cancer is the most common cancer, and its occurrence is growing as young people expose themselves to vast amounts of ultraviolet radiance (UV) and use minimal skin defense, increasing their danger \u201390. MelaWe assess and compare the data in the figures of HNC and PC, according to the figures, head and neck cancer affects the role and cognitive function more than prostate cancer. Prostate cancer patients have less appetite than head and neck cancer patients, and affording to the figures, dyspnea is more common in prostate cancer patients than in head and neck cancer patients. The social and emotional function is more affected in prostate cancer, and pain intensity is felt more in head and neck cancer patients than in prostate cancer patients. In both diseases, patients develop diarrhea, but in patients with head and neck cancer, there is more than in patients with prostate cancer. Based on prostate and lung cancer figures, we compare the quality of life of prostate and lung cancer patients. The effect of prostate cancer on the social, cognitive, and emotional functioning of patients is also greater, the severity and amount of pain in prostate cancer patients are higher than in lung cancer patients. Sleep disturbance is seen in both diseases, but they are almost more elevated in prostate cancer patients. Also, in both disorders, the appetite is decreased. Comparing the quality of life of patients with these two cancers, we concluded that the severity of pain that skin cancer patients suffer is much higher than that of head and neck cancer patients. However, skin cancer patients who have not yet had surgery have better mental health, but comparing the data, we concluded that physical function is almost the same in both diseases, but the social part of head and neck cancer patients is better than skin cancer. In patients with prostate cancer, gastrointestinal disorders such as constipation and diarrhea are observed, and even the patient's sleep is disturbed. Prostate cancer has a more negligible effect on functional scales such as social and emotional than skin cancer. Comparing the quality of life of skin cancer with lung cancer, we found that the impact of lung cancer on the patient's physical, social, and emotional functioning is more significant than skin cancer. On the other hand, the severity of body pain in skin cancer patients is higher, although, by comparing breast cancer with other cancers, we found that the intensity of pain that breast cancer patients endure is lower than that of patients with head and neck and skin cancer. According to the data in the figures, nausea and vomiting are lower in breast cancer patients than in head and neck cancer patients. The severity of dyspnea in breast cancer patients is less than that of head and neck cancer. Sleep difficulties experienced by lung cancer survivors and prostate cancer patients are greater than those experienced by breast cancer patients. Comparing the figures, it was concluded that appetites in breast cancer patients in the first 3 months of the disease were reduced more than in patients with head and neck, prostate, and lung cancer. According to the information in the tables, we examined the dimensions of physical functioning and role functioning, social functioning, and emotional functioning among the cancers mentioned in this article, namely head and neck cancer and prostate cancer, breast cancer, lung, and skin cancer, and came to this conclusion. We found that the physical functioning dimension in head and neck cancer is more favorable than other cancers and the physical functioning of head and neck cancer patients is better than other cancers, and this dimension is less affected in head and neck cancer patients. Role functioning among prostate cancer patients is better than other cancer patients in this article. Also, among cancers, lung cancer has the most significant impact on physical functioning and role functioning. Examining the dimensions of emotional function and social function, it can be said that these two dimensions are more affected by head and neck cancer than other cancers, while the social role of lung cancer patients and the emotional function of skin cancer patients were better than the others.We have added four more cancers to this article to expand the research results, and they are shown in the table below. According to the information in the tables, we examined the dimensions of physical functioning, emotional functioning, social functioning, cognitive functioning, role functioning, nausea and vomiting, appetite loss, fatigue, pain, dyspnea, and diarrhea among cancers mentioned in this article, namely head and neck cancer, prostate cancer, breast cancer, lung, skin cancer, cervical cancer, colon cancer, stomach cancer, and esophageal cancer, and concluded. Regarding the four additional cancers added to the table, the patients studied in colon cancer are patients who have undergone 3 months of rehabilitation program . But in Reviewing and researching the Quality of Life of patients can give us essential information about patients' responses to cancer and cancertreatments, and in the communication of diverse responses and the general Quality of Life, the data gained can also affect the care options chosen. As a result, the most critical cancers encompassing breast, head, neck, prostate, lung, and skin cancer were the topical parameters and important items discussed in this article. It can be found that side effects of treatment procedures affect quality-of-life parameters efficiently. Symptoms of cancer can significantly impact the quality of life, which substantially impacts physical, emotional, social, and spiritual health. In general, emotional and physical anxiety and fear of cancer, changes in the patient's appearance, and loss of the patient's ability to perform daily tasks can significantly impact patients' Quality of Life.SJ proposed the main idea and gathered data and RG revised the article. Both authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "Nature 10.1038/s41586-020-1965-x Published online 5 February 2020Correction to: In the published version of this paper, the members of the Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium were listed in the Supplementary Information; however, these members should have been included in the main paper. The original Article has been corrected to include the members and affiliations of the PCAWG Consortium in the main paper; the corrections have been made to the HTML version of the Article but not the PDF version. Additional minor corrections to affiliations have been made to the PDF and HTML versions of the original Article for consistency of information between the PCAWG list and the main paper. An additional affiliation has been added for Husen M. Umer . The affiliation for Erik Larsson has been changed from Computational Biology Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA to Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden."}
{"text": "The Donald P. Kent Award lecture will feature an address by the 2021 Kent Award recipient Luigi Ferrucci, MD, PhD, FGSA, of the National Institute on Aging. The Kent Award is given annually to a member of The Gerontological Society of America who best exemplifies the highest standards of professional leadership in gerontology through teaching, service, and interpretation of gerontology to the larger society. The Robert W. Kleemeier Award lecture will feature an address by the 2021 Kleemeier Award recipient Kenneth F. Ferraro, PhD, FGSA, of Purdue University. The Kleemeier Award is given annually to a member of The Gerontological Society of America in recognition for outstanding research in the field of gerontology."}
{"text": "Aging has become a universal concern of the world, and its process is accelerating, which leads to the shortage of the care resources and increased burden of social development. Based on this problem, The concept of time banking has been gradually applied to geriatric caring, forming a model of mutual support for older people, which has been practiced in different countries. However, there is no consensus about the effect of time banking for older person. Thus, the aim of this review was to integrate research on the application of time banking to summarize the benefits for older people and challenges faced in different countries. Moreover, the review put forward solutions to provide references for the localization of time banking in China. PubMed, Wiley Online Library, Web of Science, SAGE Journals Online, Science Direct, EbscoHost, SpringerLink and CNKI databases were searched to include 22 eligible studies. Qualities of included studies were assessed, evidences about the benefits for older person and challenges regarding time banking was synthesized. Although the overall study quality was medium, consistent evidence was existed to indicate that time banking has beneficial effects which containing social values and personal values on the older people. Furthermore, the comprehensive evidences also showed that time banking would be improved in the following four aspects: diversity of volunteers, improvement of service quality, variety of incentives and scientific management. Additional well-designed and high-quality studies are needed for us to better understand the opportunities and challenges of time banking."}
{"text": "Based on the theme of sports risk prevention and control in colleges and universities, the connotation and classification of sports risk in colleges and universities are recognized and screened, the theoretical basis of sports risk prevention and control in colleges and universities is interpreted, and the needs of sports risk prevention and control in colleges and universities are analyzed. On the basis of questionnaire and expert interview, the analytic method is used to construct the evaluation index system of sports risk prevention and control in colleges and universities, including 5 first-level indexes, 9 second-level indexes, and 27 third-level indexes in colleges and universities, teachers, students, parents, and communities, in order to find out the characteristics and occurrence rules of sports risk in colleges and universities in Changsha, Zhuzhou and Xiangtan, Hunan Province. We find out the loopholes and shortcomings in the risk management of sports in colleges and universities and provide theoretical reference for reducing the risk of sports in colleges and universities in the region and improving students' physical quality. Physical exercise, as an important way to improve and consolidate college students' physical and mental health, plays an important role in promoting college students' physical health, training their will quality, regulating emotional pressure, and developing healthy exercise methods. However, sports always have different degrees of sports risks, which have an impact on college students' physical and mental health and even life safety. Especially in recent years, the frequent occurrence of sudden death cases in campus sports has become an embarrassment and a challenge that universities have to face \u20133. AlthoSports risk is derived from sports science and risk management. At present, many experts and scholars have different cognitive perspectives on sports risk, and the concept of sports risk is also different. Wang  believesThe risk prevention and control of college sports is an important way to ensure the personal safety of college students' participation in sports. The personal safety of college students' participation in sports is mostly caused by human factors, which has the characteristics of complexity, diversity, and suddenness. According to Hou , the preHuman factor management theory was put forward by the American Safety Engineer Heinrich in the 1920s through the study of American industrial safety accidents, also known as Heinrich causal chain theory or domino theory . AccordiThe theory of energy destructive release was founded in Harton in the 1970s . StartinThe new public service theory was proposed by the Danharts in the 1970s. Taking the \u201cthree E\u201d as the basis of their own value, this paper puts forward the principles of public interest as the goal rather than by-product, democratic action, serving citizens rather than customers, responsibility is not single, serving rather than steering, paying attention to people rather than just productivity, strategic thinking, and exceeding entrepreneurial identity . It consThe polycentric governance theory was proposed by the American Ostroms in the 1960s. With the help of multiple power centers and organizational systems to provide public services, governance of public things, emphasizing the interactive process of participating groups and active creation of governance rules, governance forms, with the choice of diversity, reduce free-riding behavior and reasonable decision-making characteristics . For theSystem security theory was founded by Johnson in the 1950s. The security theory and method system formed by this theory in order to solve the problem of \u201csystem accidents caused by management negligence and errors\u201d is a comprehensive system security management method and system security engineering to comprehensively identify potential risks of the system. Targeted control measures are adopted for the system to bear the lowest risk, and the system security is the best and runs through the whole life cycle of the system . The sysAs the last station of school education, college physical education shoulders the responsibility of cultivating and consolidating college students' sports habits and lifelong fitness consciousness. However, for a long time, due to the influence of the state, society, and family on the excessive emphasis on college entrance examination and the change of life style in the Internet age, students lack exercise consciousness and exercise habits, and their physique is not optimistic \u201321. AccoAt present, the physical problems of college students are still more prominent, and the campus sports safety is frequent, which has brought negative effects to college students' physical exercise. In 2016, a senior student in Wuhan University suddenly fainted in the process of physical fitness test and died after rescue . In 2016The diversity of sports events in colleges and universities, the immobility and complexity of sports venues, the personalization of college students, and the special sports equipment or equipment of many sports events must be considered comprehensively when constructing the risk prevention and control evaluation index of sports in colleges and universities .The sources of sports risk in colleges and universities mainly include the level of colleges and universities, teachers, students, parents, and communities. The types of sports risk in colleges and universities are divided into direct factors such as sports itself, facilities and equipment, and students themselves and indirect factors such as management, climate environment, and society. Therefore, the construction of university sports risk evaluation index should be comprehensive analysis of risk sources and classification .Sports risk in colleges and universities has the characteristics of objectivity and sociality, suddenness and measurability, variability and invisibility, inevitability and uncertainty, contingency, and controllability. In addition, it also has the characteristics of damage and potential, multifactor and behavior correlation, and the process of risk generation, development, and damage. University sports risk is a collection of various risk factors and dynamic changes. Effective prevention and control should be implemented on the basis of full analysis of risk characteristics and processes in the construction of risk prevention and control evaluation indexes of university sports.The theory of system security and human factor management believes that \u201cmanagement negligence and errors lead to accidents in the system\u201d and \u201cquantitative changes cause qualitative changes,\u201d and the world is constantly changing. At present, there may be very small hidden dangers. With the accumulation of quantitative changes to qualitative changes, the consequences may be unthinkable. With the extensive development of sports in colleges and universities, the attention of the state and society to the physical health of college students and the development of high technology the rapid development and improvement of sports in colleges and universities is inevitable, and the accompanying risks are also developing and changing. Whether the risk prevention and control evaluation index system of sports in colleges and universities can adapt to the changes and continuously improve and develop is crucial to reduce the risk.Because the university sports risk prevention and control involves the university, the teacher, the student, the parents, and the community and each level contains many domains, therefore, in the setting of evaluation indexes for the prevention and control of sports risks in colleges and universities, we should not only comprehensively consider the factors of colleges and universities, teachers, students, parents, and communities, but also focus on covering the whole picture of the prevention and control of sports risks in colleges and universities from an overall perspective, which can not only focus on reflecting the basis of the prevention and control of sports risks in colleges and universities, but also comprehensively control the dynamics of the prevention and control of sports risks in colleges and universities.(1) Principles of objectivity and operability: the evaluation index system of sports risk prevention and control in colleges and universities should not only be widely adapted to and serve the practical needs of sports risk prevention and control in colleges and universities, but also fully consider the particularity of the current development of sports in colleges and universities, and according to the current policies and spirit of sports risk prevention and control in colleges and universities, the established evaluation index system of sports risk prevention and control in colleges and universities should try to select indicators that are easy to quantify, obtain, and are less disturbed by human factors, which is conducive to convenient, fast, and accurate implementation of data collection and statistics, so as to speed up the process of sports in colleges and universities and improve service levels. (2) The principle of division and cooperation and keeping pace with the times: the risk prevention and control of sports in colleges and universities is managed by many relevant functional departments. The screening of evaluation indexes for risk prevention and control of sports in colleges and universities must adhere to clear division of labor, mutual cooperation, and unified coordination. And because the risk prevention and control evaluation of college sports in China has just started, although some scholars have constructed the evaluation system, the rapid development of new technology and culture and the extension and connotation of college sports are constantly enriched. Therefore, the construction of university sports risk prevention and control evaluation index system should be based on the current, focusing on the principle of keeping pace with the times in the long run. (3) Principles of systematicness and comparability: when determining each index, the evaluation index system of sports risk prevention and control in colleges and universities cannot simply consider the problem from the index itself. Instead, this index should be placed in the overall environment of the research object of sports risk prevention and control in colleges and universities, reflecting the main characteristics and conditions of the sports risk prevention and control system in colleges and universities and making vertical and horizontal comparisons as far as possible.According to the overall goal and decision-making plan of the construction of the evaluation index system of sports risk prevention and control in colleges and universities, it is divided into three levels: goal, criterion, and scheme. Referring to the construction model of the evaluation index system of sports risk prevention and control in primary and secondary schools of Zhang and Wang , using fThe specific operation process is as follows: first is the use of analytic hierarchy process theory to grasp the university sports risk prevention and control research problems, construction of university sports risk prevention, and control hierarchical structure; secondly, the judgment matrix of college sports risk prevention and control is constructed to compare the relative importance of a certain factor at the previous level and all factors at this level. Again, determine the scale using AHP theory to determine the weight calculation and consistency test. The weight of university sports risk prevention and control index is based on the Ministry of Education \u201cInterim Measures for School Sports Risk Prevention and Control\u201d . ThroughA, the maximum  eigenvalue \u03bbmax of the judgment matrix A is obtained, and then the corresponding eigenvector W is solved by using its corresponding characteristic equation AW\u2009=\u2009\u03bbmaxW, and then its eigenvector W is normalized. Then test the consistency C of the judgment matrix is C\u2009=\u2009\u03bbmaxn\u2212/n\u22121. When C\u2009=\u20090, the judgment matrix is consistent. The larger the value of C is, the more serious the inconsistency of the judgment matrix is. The inconsistency degree of the judgment matrix can still be used in a certain range, so the random consistency index R\u2009=\u2009\u03bbmaxn\u2212/n\u22121 is introduced. When the random consistency ratio CR\u2009=\u2009C/R\u2009<\u20090.1, the inconsistency of A is still acceptable; otherwise, the judgment matrix must be adjusted.After constructing the judgment matrix In the university sports risk prevention and control classification index, the weight of the first-level index is in the top three: students, teachers, and universities. Universities are the platform and guarantee for sports risk prevention and control, teachers are the backbone of sports risk prevention and control, and students are the main body of sports risk prevention and control. From a macro perspective, the prevention and control of sports risks in colleges and universities should make use of the platform and resources of colleges and universities, give full play to the subjective initiative of teachers, effectively act on students, and realize the closed-loop control of sports risks.Among the secondary indexes of sports risk prevention and control in colleges and universities, students' safety awareness, learning attitude, teachers' sports practice, and risk education in colleges and universities occupy a large weight, which indicates that cultivating students' sports risk awareness and correcting students \u201clearning attitude, teachers\u201d scientific implementation of extracurricular sports practice and sports risk education in colleges and universities are the key. From the medium level, risk prevention and control in colleges and universities should be scientifically planned, focus on, and prevent and control the occurrence of sports risks.In the three indicators of college sports risk prevention and control, the top seven factors are self-security awareness, group awareness of prevention and control, emotional level, cognitive level, training preparation, sports risk education platform, and sports risk training and certification. From a microperspective, how to improve college students' safety awareness, awareness of prevention and control, and emotional level needs more detailed planning and design of teaching and training by universities and teachers. This means that teachers' teaching and extracurricular sports training design should fully take into account the above elements. In the arrangement of teaching and training content, the use of teaching methods and the control of exercise intensity should fully consider the initial state of students, so as to meet the current situation and needs of students. Colleges and universities should be responsible for building sports risk prevention and control information and training platform, cultivate students' awareness of prevention and control, improve students' knowledge reserve of prevention and control, and improve students' ability to prepare for sports training.According to the situation and characteristics of sports risk prevention and control in colleges and universities, through the research on the related theories and models of sports risk prevention and control in colleges and universities, the guiding ideology of the evaluation index system of sports risk prevention and control in colleges and universities is established. Based on the principles of constructing the evaluation index system of sports risk prevention and control in colleges and universities, the evaluation index system of sports risk prevention and control in colleges and universities is established. Through questionnaires and interviews with experts and then according to expert advice using analytical methods such as qualitative and quantitative analysis, we determine from colleges and universities, teachers, students, parents, and community five first-level indicators, nine second-level indicators, and 27 third-level indicators to build college sports risk prevention and control evaluation index system see :In the uIn the college sports risk prevention and control indicators, students, teachers, colleges, and universities have higher weight, which is the focus of college sports risk prevention and control factors. Student factors, which are self-security awareness, group awareness of prevention and control, emotional level, and cognitive level, are the key points of student sports risk prevention and control. Teacher factor, which is training preparation, is an important part of college sports risk prevention and control; university factors, which are sports risk education platform, sports risk training, and certification, are the key parts of university risk prevention and control.Sports risk prevention and control as a grand and complex system engineering needs close cooperation between universities and society, parents, and individual college students. (1) For colleges and universities, firstly, in addition to making rules and regulations such as \u201csports risk prevention and control plan\u201d and \u201cemergency and accident handling mechanism,\u201d it is necessary to strengthen the construction of sports venues and facilities and the improvement of teachers' skills to meet the individualized needs of college students' sports needs; second, it is necessary to strengthen the publicity and training of campus safety. Through lectures and training such as health and safety knowledge, safety management, and emergency rescue, the \u201ccollege students' campus sports safety manual\u201d is prepared. Health and safety education is carried out by means of \u201conline\u2009+\u2009offline\u201d methods such as propaganda columns, radio stations, WeChat, SMS, and the Internet, so as to improve college students' understanding of the risks of college sports and master the methods to avoid sports risks. (2) For teachers, first of all, they should timely and correctly obtain the current school sports risk information, so as to have a good mind. Second, according to students' physical ability and practical needs, select the appropriate extracurricular sports training content, take reasonable teaching methods, and set up personalized training programs step by step for the implementation of training intensity and quantity arrangements. (3) For students, they should fully understand the importance of physical health and the risks existing in sports, consciously learn and master sports risk prevention and control knowledge, improve sports risk awareness, and strengthen the ability to avoid sports risks."}
{"text": "Since October 2017 till 2019 the project of Psychosocial Care for internally displaced persons and the war affected population in Ukraine has been in place . In 2020 this project continuing for counselling pandemic affected persons.The counsellors are professional psychologists who were trained within the scope of the project. Sessions may be held in Russian or Ukrainian, according to the user\u2019s choice.Analysis of protocols of online counseling sessions and supervisions.The key and most frequent issues mentioned by the clients are loneliness, the loss of the sense of life, fear, uncertainty, anxiety, difficulties in family relations, in particular, with children, job insecurity, addictions, psychosomatic disorders and so others. They are closely related to the situation in the country . The above issue is in potential clients\u2019 inadequately high suspicion level (in some cases on the border of paranoid fantasies), which is manifested in the fear of the possible infringement of confidentiality, over-listening, surveillance, recording of talks etc.The online counseling is the way to provide professional, accessible, free for the users and fully anonymous psychosocial care. Most frequent issues mentioned by the IDPs and the war affected population peoples has been indicated. When presenting the project service, the focus is always made on the high level of data protection and strict confidentiality.No significant relationships."}
{"text": "Martin C. Mihm, Jr. (15 March 1934\u201319 July 2022), Professor of Dermatology, Pathology and Dermatopathology, Harvard Medical School, Boston, MA, USA .Dr. Martin C. Mihm, Jr. passed away on 19 July 2022, and the whole dermatopathology community is deeply saddened by this sudden loss. Dr. Mihm, a world-renowned international consultant for melanoma, other skin tumors and cutaneous inflammatory diseases, was one of the greatest names in dermatology and dermatopathology, and he made countless contributions to these fields.Dr. Mihm graduated from the University of Pittsburgh, School of Medicine and joined the Massachusetts General Hospital (MGH) at Harvard Medical School as a trainee in Dermatology in 1964. He was board-certified in Dermatology, Pathology and Dermatopathology. However, it was his passion for dermatopathology that led to an appointment as the Chief of the MGH Dermatopathology Unit in 1974, where he served for the next two decades. Within the Department of Dermatology at the Brigham and Women\u2019s Hospital and Dana-Farber and Brigham and Women\u2019s Cancer Center, where he remained the Director of the Mihm Cutaneous Pathology Consultative Service, a second opinion dermatopathology service and the Director of the Melanoma Program, Dr. Mihm consulted on more than 350,000 cases, nationally and worldwide, and offered accurate diagnosis, prognosis and treatment recommendations for routine and challenging cases in dermatology and dermatopathology. He also served as an associate director of the Center for Melanoma Oncology at Dana-Farber and Brigham and Women\u2019s Cancer Center, as a co-director of the Melanoma Risk and Prevention Clinic at Dana-Farber and Brigham and Women\u2019s Cancer Center and as a Professor of Dermatology at Harvard Medical School. Dr. Mihm was also active internationally; he was a co-founder of the Rare Tumor Institute of the WHO in Milan, Italy, and acted as an external coordinator for five years. He was also the co-director of the Melanoma Pathology Program of the European Organization for the Research and Treatment of Cancer (EORTC).New England Journal of Medicine [Since the beginning, he was interested in melanoma pathology, and with his mentor and friend, Wallace Clark, he published a paper in 1969 entitled \u201cThe histogenesis and biological behavior of primary human malignant melanoma of the skin\u201d [Medicine . In thesJournal of Cutaneous Pathology to honor Dr. Mihm\u2019s 75th birthday and his achievements [Dr. Mihm was the first director of the Harvard Dermatopathology Training Program, founded in 1975. His precise and revolutionary approach to the practice of cutaneous pathology led to the birth of modern dermatopathology, and thanks to his inexhaustible academic energy, he trained countless dermatologists and dermatopathologists all over the world. In 2010, a special issue was published in the evements .Dr. Mihm loved giving lectures worldwide; he accepted numerous invitations nationally and internationally. He had been in Geneva, Switzerland many times to give his great lectures for clinicopathological meetings and to train dermatopathologists in different courses organized by the University Hospital of Geneva Dermatopathology.Dr. Mihm published more than 400 original manuscripts, more than 100 reviews and chapters and more than a dozen textbooks and monographs. Among the very long list of his substantial contributions to dermatopathology, we can cite the following: the recognition of melanoma tumor progression: radial and vertical growth; the identification of different clinicopathological types of melanoma; the recognition of immunologic variants of cutaneous necrotizing vasculitis; the identification of syngeneic human graft-versus-host disease; the definition of the specificity and clinical utility of the lupus band test; the discovery of CD1a expression on human Langerhans cells and the demonstration of the utility of CD1a immunophenotyping for Langerhans cell histiocytosis; the recognition of borderline/minimal deviation melanoma variants; the introduction of classification schema for conjunctival melanocytic lesions; the development of a grading system for cytologic atypia in dysplastic nevi; the characterization of nevoid melanoma; the significance of tumor infiltrating lymphocytes in melanoma nodal metastases; the description of osteogenic melanoma; the establishment of guidelines for histological reporting of melanoma excisions; the clinicopathological insights into animal-type melanoma; the description of pigmented epithelioid melanocytoma; the description of use of MITF in melanoma diagnosis; the key contributions to AJCC melanoma staging; the discovery of a new marker (GLUT1) for juvenile hemangiomas; the contribution to the development of engineered melanoma vaccines based on dendritic cells; the setting of an EORTC melanoma policy; the identification of tumor lymphangiogenesis as a novel indicator of melanoma prognosis; the identification of the biology of desmoplastic melanoma; the elucidation of lentiginous subtype melanoma; the discovery that Prox-1 promotes the invasion of kaposiform hemangioendotheliomas .Dr. Mihm was an outstanding physician, scientist and dermatopathologist; however, he also had great humanistic qualities. Despite his huge medical and scientific knowledge, he was humble, eternally optimistic and always wanted to help people around him. He was a hero, a father figure and a spiritual guide for many colleagues. He was a rare intellect, spoke several foreign languages, including German, French and Italian, had a great culinary taste and loved classical music. He always said that if he were not a physician, he would want to become the Chief Conductor of a Symphony Orchestra.Marty, as we, your close friends call you, wonderful friend, educator, and mentor, you have been the Chief Conductor of Dermatopathology; we have been fortunate to experience your teaching, brilliance, kindness and generosity. Thank you for what you have done for dermatology and pathology. Rest in peace. We will never forget you!"}
{"text": "Rehabilitation must be based on the individual needs and specific goals of the person and must be adapted to his abilities. According to the recommendation of the World Stroke Organization, the team involved in conducting rehabilitation should be multidisciplinary. One of the treatments that are applied within the multidisciplinary approach to a neurological patient is educational-rehabilitation treatment, which is multi-component in nature. Before starting educational-rehabilitation treatment, an educational-rehabilitation clinical assessment is necessary, which aims to detect difficulties caused by impairment; identify potentials and constraints in these areas; determine the specifics, course, and forecasts of difficulties; formulate clear treatment recommendations; form a watch list that will be available to all team members in the process of diagnosis, treatment, education, and to evaluate the effectiveness of treatment; and continuously monitor the ability and adaptive behavior of the person. Educational-rehabilitation clinical treatment includes treatment of cognitive abilities, treatment of motor skills, relaxation, treatment of adaptive skills, as well as informing the person about the disease and counseling.This review focuses on some aspects of rehabilitation such as treatment of cognitive and motor disorders, treatment of adaptive skills, relaxation issues, and informing and counseling patients from the perspective of an educational rehabilitator with practical experiences in this area of rehabilitation. An individual and holistic educational-rehabilitation approach in the rehabilitation of stroke patients, with a multidisciplinary team of experts, covers the complex motor and non-motor consequences of the disease, which affect the functional recovery and quality of life of the patient.Educational-rehabilitation treatment is based on a bio-psycho-social model in which biological, psychological, and social factors must be observed simultaneously, and rehabilitation must be focused on the person as a whole to achieve optimal physical, mental, and social potentials.Educational-rehabilitation clinical treatment includes treatment of cognitive abilities, treatment of motor skills, relaxation, treatment of adaptive skills, as well as informing the person about the disease and counseling.1According to the World Health Organization, rehabilitation is \u201ca set of measures that help individuals, who have or are likely to have a disability, to achieve and maintain optimal functioning in interaction with their environment\u201d.2 Treating a chronic patient does not only mean treating the disease but also all aspects that the disease affects, especially economic and social factors.3 Approaches to the treatment of patients should be holistic because without working on the cognitive, emotional, and physical aspects, the healing process is slowed down as well as the desired effect of medication.5Rehabilitation must be based on the individual needs and specific goals of the person and must be adapted to his abilities.6 Functional recovery is based on the restitution of brain tissue and on the relearning of, and compensation for, lost functions.9 An important concept in rehabilitation is that of brain plasticity, which implies that it is possible to modulate or facilitate reorganization of cerebral processes by external inputs.10 Stroke rehabilitation is a process; its objectives are to prevent deterioration of function, improve function, and achieve the highest possible level of independence  within the limits of the persistent stroke impairments. During this process, treatment and training are provided to stroke survivors to help them return to normal life. By regaining and relearning skills of everyday living through rehabilitation, many stroke survivors obtain greater independence in activities of daily living and improved functional capacity. Hallmarks of effective stroke rehabilitation practice include multidisciplinary/interdisciplinary team work, team work coordinated by regular meetings, goal-focused activities and individualized goals, emphasis on functional activities, involvement of patient and family in rehabilitation process, education provision to patients and families, and staff with specialized skills and interest in stroke.11Stroke is the largest single cause of severe physical disability, and rehabilitation to reduce functional deficits is the most effective treatment.12 The team involved in conducting rehabilitation should be multidisciplinary to include professionals such as a neurologist, physiatrist, nurses, physiotherapist, educational rehabilitator, speech therapist, neuropsychologist, occupational therapist, and social worker. Communication and coordination among these team members are paramount in maximizing the effectiveness and efficiency of rehabilitation.13The World Stroke Organization has for the past 2 decades emphasized the importance of a multidisciplinary approach in providing recovery and rehabilitation services after stroke.14 It is divided into stimulative treatment (encouraging the development of various abilities and skills), corrective treatment , and compensatory treatment (based on the development of compensatory strategies). The methodology and organization of work should be flexible, guided by the characteristics and capabilities of the person and his environment, and not by some pre-given criteria for adapting to the requirements of the environment. The general approach to treatment is ecological, aimed at developing the potential and alleviating the limitations of the person in specific life circumstances and in light of the unique requirements of these circumstances.15One of the treatments that are applied within the multidisciplinary approach to a neurological patient is educational-rehabilitation treatment (ERT), which is multicomponent in nature. Educational-rehabilitation treatment is based on a bio-psycho-social model in which biological, psychological, and social factors must be observed simultaneously, and rehabilitation must be focused on the person as a whole and on achieving optimal physical, mental, and social potentials.Before starting ERT, an educational-rehabilitation clinical assessment is necessary, which aims to: detect difficulties caused by impairment; identify potentials and constraints in these areas; determine the specifics, course, and forecasts of difficulties; formulate clear treatment recommendations; form a watch list that will be available to all team members in the process of diagnosis, treatment, education and to evaluate the effectiveness of treatment; and continuously monitor the ability and adaptive behavior of the person.Educational-rehabilitation clinical treatment includes treatment of cognitive abilities, treatment of motor skills, relaxation, treatment of adaptive skills, as well as informing the person about the disease and counseling.16 The basic cognitive functions are attention, long-term memory, perception, while the higher cognitive functions are speech, language, decision-making, and executive functions.17 Frith and Dolan18 state that the difference between higher and lower cognitive functions is that the lower ones are automated and do not require special effort, while higher cognitive functions are under conscious control. However, as some higher cognitive functions, such as reading and understanding language, may become automated, the most important feature that distinguishes them is the fact that higher cognitive functions require more cognitive effort than lower cognitive functions. Cognitive training conducted by an educational rehabilitator has 4 levels.Cognitive functions are intellectual processes by which we become aware of something, perceive, and understand ideas. Therefore, they refer to the processes by which we receive and process information.19 Sensory stimulations of impaired central nervous system functions, with appropriate series of stimuli, chart a new path for collaterals of weakened or lost neurons and participate in their connection.20 The program of sensory stimulations includes visual, auditory, tactile, olfactory, gustatory, proprioceptive (sense of movement), and vestibular stimulation (sense of self-awareness\u2014body position and movement in relation to gravity).The first level includes the treatment of cognitive functions that provide observation and input of new information, selection, and sorting of relevant information, as well as information maintenance, planning, organization, and control of activities. Namely, our sensory organs accept information from the environment and the body, and the process of sensory integration enables the brain to organize them and give them meaning. The brain can use only organized and integrated sensations for movement, learning, and behavior.The ERT of visual functions include eye movement and focusing exercises, visual shape perception exercises , spatial relationships , spatial orientations , visual-motor integrations , visual memories , and speed of visual information processing .21 They also affect information processing speed, perceptual speed, as well as visual search .22 Achtman et al23 proposed computer games as part of vision rehabilitation because of their impact on neuroplasticity of the visual system and visual learning. There is a large selection of vision exercises for impaired motility, binocular vision, and accommodation, for example, brock String, exercises with eccentric circles, Marsden ball, space fixator, McDonald field recognition exercise, Wayne Saccadic Fixator, and the like. Visual exercises primarily exercise visual functions but they also affect the functions of visual perception, such as visual-motor integration, visual-spatial organization, reaction speed, etc.24 Although the bulk of the voice of stroke rehabilitation is on the recovery of motor and communication functions, visual impairment is slowly beginning to receive the same amount of attention.25 The research indicates the need for vision rehabilitation to achieve maximum possible recovery in comprehensive rehabilitation and more successful performance of daily life activities.27 Vision rehabilitation has a positive effect on visual field width recovery,28 and visual field function can be compensated by increasing visual search field29 and increasing perception speed during visual search.22 The results confirmed the impact of vision rehabilitation on visual functioning in daily activities.30Difficulties in visual perception cause difficulties in the area of higher visual functions and cognitive difficulties in terms of visual agnosia, alexia, prosopagnosia, achromatopsia.39There are numerous reliable sources on visual perception of patients with stroke.Difficulties in auditory information processing can be manifested by difficulty focusing on auditory stimuli, limited ability to listen continuously in the presence of noise, difficulty in understanding verbal information, limited ability to directly reproduce auditory information and follow orders of varying complexity, poor recognition and interpretation of different voices, reading and writing difficulties, poor speech, and lower academic achievement. Difficulties in the speed of processing auditory information can be reflected in understanding longer instructions and completing tasks related to reading and writing in a limited time . The treatment of auditory functions includes speed of auditory information processing, auditory discrimination, auditory sequencing, and auditory integration.44 Namely, after the somatosensory training, the somatosensory and functional changes of the upper extremities improve in terms of improving the ability to interpret bodily sensations and the feeling of control over one\u2019s hand. Somatosensory training eases the use of the hand in daily life activities which is essential for continued brain and arm recovery.45Treatment of sensory problems includes increasing tactile awareness, discrimination, and stereognosy through various tactile sensations . The program of kinesthetic perception includes differentiation of body scheme in gestural space, differentiation of facial mimicry, somatic stimulation of body and its parts, perception exercises in deep sensibility, and exercises for building and restoring body scheme. Several authors in their clinical research report that somatosensory training can lead to sensory improvement after stroke.Attention is a means by which limited mental processes are directed to the information and cognitive processes that are most important at a given moment. The most common manifestations of attention difficulties are forgetting instructions, difficulties in organization of materials and activities, and difficulties in solving tasks. Disorders in the domain of visual and auditory attention can make it difficult to adopt and perform complex activities of everyday life, primarily due to difficulties in processing information or directing attention to relevant aspects of information. Educational-rehabilitation treatment contains 4 components of attention: focusing, maintaining, alternating, and sharing attention. The first group of exercises that are used are auditory attention range exercises . The second group of exercises is focused on the development of strategies for processing and storing auditory verbal information . In the treatment of the range of visual attention, exercises are used, which consist of a series of visual thymuses  of increasing complexity, which a person should separate from a larger group and reproduce. Selective attention is practiced by applying tasks that require search, monitoring, rapid activation and inhibition of responses, and coordinated motor activity. In the domain of auditory attention, tasks are given in which the respondent should react  to the target word or sound in a series of auditory stimuli.46 Memory difficulties can occur in the areas of encoding , consolidation , and recollection . The treatment should focus on metamemory, the creation, and the application of memory strategies. Exercises are of increasing complexity in different sensory modalities\u2014auditory , visual , and tactile-kinesthetic. In the field of auditory memory, exercises for direct and delayed reproduction of verbal and nonverbal information are applied. The skills that the client will stimulate through exercises are visual-auditory-kinesthetic strategies, associations, tracking orders, and recalling information. After memory-based cognitive rehabilitation, stroke patients reported fewer memory problems in everyday life immediately after treatment compared with control groups; however, there was no evidence that these beneficial effects persisted over a longer period.47The second level of cognitive treatment includes memory treatment. Memory allows us to retain and find in our experience the information we use in the present.The third level of cognitive treatment refers to information processing and thinking that are responsible for the mental organization and reorganization of information: classification and organizational skills . The skills that the client will stimulate through exercises from this level are verbal and visual reasoning, thought organization, convergent reasoning, logic, comprehension, integration, reasoning, and problem-solving.The last level includes the treatment of functions that ensure the expression and output of information  and the treatment of difficulties in the field of academic skills .48 suggest that rehabilitation programs, for persons with stroke, should concentrate on increasing attention, concentration, information processing skills, memory, and patients\u2019 judgmental ability to improve social cognition.Kim et al49 and exercises aimed at the functional use of the hand and arm.Treatment of motor skills includes reeducation of motor skills, exercises for the development of basic and higher motor skills,50 Reeducation of motor skills uses movement as a sensorimotor and psychomotor activity which summarizes the entire developmental course of the relationship to oneself and others that was formed during the sensorimotor and psychomotor relationship between a person and the world. In case of increased anxiety or other psychosomatic disorders, certain forms of motor reeducation significantly contribute to the reduction of physical and mental difficultiesMotor reeducation is a multidimensional therapeutic approach in working with children and adults with motor disorders. Psychomotor reeducation is a specific field in educational and rehabilitation practice that focuses on the development of motor and motor skills, dexterity, balance, movement coordination and speed control, development of perceptual and gnostic abilities, and cognitive functions and contributes to the enrichment of sensory-motor and psychomotor experience.52 Motor reeducation treatment includes general reeducation exercises and specific reeducation exercises.The goal of reeducation is to stimulate, facilitate, or substitute dysfunctional cognitive mechanisms with more functional mechanisms to improve the client\u2019s performance in those domains of behavior in which dysfunction or deficit is manifested.53General motor reeducation exercises include massage, hydrotherapy, exercises with passive movements, exercises for defining the experience of body integrity, exercises for defining the experience of gestural space, exercises for independence of movement, exercises for equalizing muscle tone, observation exercises, stabilizing lateralization, exercises of experience and mastering the rhythm, exercises of experience, duration and orientation in time, exercises of coordination of movements, exercises for control of impulsivity, exercises for knowing the shape and weight, and exercises for noticing the presence of another. Exercises of specific reeducation of motor skills are directed toward individual and specific clinical pictures and are classified as follows: exercises for agraphia, exercises for alexia, exercises for acalculia and agnosia, exercises for apraxia, and exercises for motor speech disorders caused by neurological damage to nerves that participate in shaping voice with specific speech therapy treatment.15 Upper extremity apraxia is a common stroke-related disorder that can reduce patients\u2019 levels of independence in daily activities and increase their level of disability.54 The treatment of apraxia that has been studied in the literature,57 especially in stroke patients,58 proved effective. An adequate apraxia rehabilitation program can improve independence in daily life activities and accelerate the natural recovery process.59Exercises for the development of basic motor abilities and skills are used to achieve better posture in different positions and activities, for better maintenance of balance at rest and movement, for more successful coordination of movements, for achieving greater precision of movement, and for more successful bimanual activities. The goals of treatment of higher motor abilities and skills are more precise execution of voluntary non-transitive and transitive movements, more harmonious organization of transitive movements in space and time, better organization of elements in 3-dimensional, 2-dimensional, and graphic space, and more successful coordination of movements with verbal or nonverbal orders. The following exercises are applied: exercises of melokinetic practice, ideomotor practice, ideational practice, construction exercises in 2-dimensional and 3-dimensional space, according to reproduction model or independent construction, exercises of graphomotor activities and visual-motor coordination (copying geometric shapes and drawings and drawing), and non-verbal movement regulation exercises.The educational-rehabilitation program also includes motor skills exercises , exercises aimed at functional hand and arm use by performing coordinated activities required to move and handle objects using fists and hands , and exercises aimed at improving fine motor skills by performing coordinated activities of handling objects, lifting, handling, and releasing by using 1 hand, fingers, and thumb .62 In stroke patients, the upper extremities recover more slowly functionally than the lower extremities.63Damage to the upper extremities after a stroke most often involves difficulties in moving and coordinating arm, hand, and fingers and often causes difficulties in performing daily activities such as eating, dressing, and washing. Dysfunction of the upper extremities, after stroke is the biggest reason for limitations in the functional use of hand in the daily activities of patients and their socialization.64 and influence muscle relaxation, and improve concentration and attention.65 Some of the common methods for achieving a state of deep relaxation are: guided imagination, meditation, progressive muscle relaxation, self-training, yoga, abdominal breathing, soothing music, and the like.64 Guided imagination is the process of imagining objects, spaces, people, and situations, that is, stimulating visual, auditory, olfactory, taste, and proprioceptive sensations that are complementary to the sensory and aesthetic criteria of an individual. In this way, in addition to encouraging pleasure and satisfaction, more adequate imaginary systems of dealing with reality can be encouraged.66 Imagination also affects almost all important physiological mechanisms, such as respiration, pulse, blood pressure, sexual function, and the immune response, and can be used to relieve anxiety, depression, and stress symptoms.69 Breathing exercises are the basis of techniques used in different relaxation techniques with different therapeutic effects.72Relaxation refers to a specific physiological state that is completely opposite to the way the body reacts when under stress or during a panic attack. Regular practice of deep relaxation can alleviate generalized anxiety and frequency and intensity of panic attacks, prevent stress accumulation, increase energy and productivity, improve concentration and memory, reduce insomnia and fatigue, reduce a number of psycho-somatic disorders75 regardless of the severity of the stroke.76 Assessing and diagnosing adaptive skills are of great importance because adaptive skills help a person in performing everyday life activities.77 The treatment of adaptive skills aims to achieve an optimal level of independence in everyday life. In order for people with neurological diseases to have a better quality of life, it is very important to enable the acquisition of practical skills and to focus rehabilitation on strengthening independence and autonomy.Adaptive behavior is a set of conceptual , social , and practical skills (activities of everyday life), which a person learned to function in everyday life. The level of adaptive behavior is conditioned by a number of personal and environmental factors, so when considering the approach to treatment, it is necessary to assess all potential factors that could be important for the development and modulation of various adaptive skills. As a result of impaired body structures and functions, after a stroke, a person may have difficulty performing basic activities of daily living which can lead to limitations in participation ,78Information about the disease and counseling of patients are carried out with the aim of changing health behavior and raising the level of motivation of the individual in order to increase his desire for cooperation in rehabilitation and readiness to achieve goals aimed at successful rehabilitation. Motivation means the mental readiness of an individual to accept information. It depends on the relationship with the person conducting the education (information) and has the ability to convey the message in an understandable appropriate way. The most important for informing and educating patients is the interaction-communication relationship between educators and patients. At the very core of the relationship is empathy, as the educator\u2019s ability to enjoy the role of the patient, to provide and enable support to the patient to make his or her own decision. Information and learning depend on the characteristics of the patient, such as his prior knowledge of the disease, resistance to the disease or its acceptance, and the support of the family and social environment. Positive transfer and countertransference are prerequisites for the success of the transmission of educational messages. Counseling as a 2-way relationship of patient training is essential for independent and successful solving of individual problems. It can be used in agreement on behavior change  and agreement on change of attitudes .79People react differently to the realization that they are seriously ill: they become disoriented, confused, their emotions numb, they distance themselves from the environment, and things that used to make sense become irrelevant. Therefore, support in coping with the disease is important, sometimes crucial for building a constructive response to the new situation. The patient is encouraged to think only about the next step, about small shifts, but special attention is paid to each achievement.80Providing information to patients and caregivers improves their knowledge of stroke and increases patient satisfaction with some of the information they have received about stroke. An effect on reducing patients\u2019 depression was also found. Providing information in a way that it involved patients and caregivers more actively, for example, when given more opportunities to ask questions, had a greater effect on patients\u2019 mood than 1-time provision of information. There is little evidence that providing information has effects on independence or social activities.81 All these disorders should be included in the comprehensive rehabilitation process, which implies the multidisciplinarity of the team, which must have a physiotherapist, speech therapist, neuropsychologist, and occupational therapist in addition to the educator-rehabilitator.Since stroke carris with it two types of conseauences (motor and non motor) and rehabilitaion program should be focused equally on both areas, motor and non motor, respectively. Today, rehabilitation is more focused on the treatment of motor consequences, while non-motor ones are not given enough attention although they are an integral part of the clinical picture with a high prevalence and significantly incapacitate patients with stroke. The non-motor consequences of stroke, in addition to the cognitive ones we talked about, include speech, reading, writing, arithmetic disorders, neglect phenomena, anosognosia, agnosia, dysphagia, sleep disorders, as well as anxiety, depression, post-traumatic stress disorder, etc.Rehabilitation of patients with stroke should be focused on the person as a whole and on achieving optimal physical, mental, and social potentials. An individual and holistic educational-rehabilitation approach in the rehabilitation of stroke patients, with a multidisciplinary team of experts, covers the complex motor and non-motor consequences of the disease, which affect the functional recovery and quality of life of the patient.In this review, the focus is only on some aspects of rehabilitation such as treatment of cognitive and motor disorders, treatment of adaptive skills, relaxation issues, and informing and counseling patients from the perspective of an educational rehabilitator with practical experiences in this area of rehabilitation."}
{"text": "According to the current international consensus , bruxismTemporomandibular disorders (TMD) can be defined as a set of clinical problems involving the masticatory muscles, the temporomandibular joints, and related structures, and is related to alterations in the structure, function, or physiology of the masticatory system and may be associated with other systematic and comorbid medical conditions . TMD is Therefore, we encourage reading the important and novel articles published in this Special Issue, entitled \u201cTemporomandibular Disorders Related Pain among Sleep & Awake Bruxers: A Comparison among Sexes and Age\u201d. The articled are related, but not limited, to: the assessment of SB intensity in tobacco smokers and alcohol drinkers, assessment of masticatory muscle electromyographic (EMG) activity in both children diagnosed with pain-related TMD and AB and in children without TMD, symptoms of sleep masticatory muscle activity among women and their association to OSA, assessment of the effect of the current COVID-19 pandemic on the prevalence of bruxism, oral parafunctions and painful TMD among dental patients and to evaluate the influence of the pandemic on both sexes, testing the association between a single observation point self-report and ecological momentary assessment (EMA) of AB, cardiovascular implications of SB, and others. It is worth noting that readers can probably find, for the first time in the literature, research about the prevalence of TMD and bruxism among sex workers ."}
{"text": "In recent years, with the development of wind energy, the number and scale of wind farms have been developing rapidly. Since offshore wind farms have the advantages of stable wind speed, being clean, renewable, non-polluting, and the non-occupation of cultivated land, they have gradually become a new trend in the wind power industry all over the world. The operation and maintenance of offshore wind power has been developing in the direction of digitization and intelligence. It is of great significance to carry out research on the monitoring, operation, and maintenance of offshore wind farms, which will be of benefit for the reduction of the operation and maintenance costs, the improvement of the power generation efficiency, improvement of the stability of offshore wind farm systems, and the building of smart offshore wind farms. This paper will mainly summarize the monitoring, operation, and maintenance of offshore wind farms, with particular focus on the following points: monitoring of \u201coffshore wind power engineering and biological and environment\u201d, the monitoring of power equipment, and the operation and maintenance of smart offshore wind farms. Finally, the future research challenges in relation to the monitoring, operation, and maintenance of smart offshore wind farms are proposed, and the future research directions in this field are explored, especially in marine environment monitoring, weather and climate prediction, intelligent monitoring of power equipment, and digital platforms. Owing to concerns over the global energy crisis and air pollution, the development and utilization of wind energy, solar energy, and other renewable energy sources have been given increasingly more attention all over the world ,2,3. WinWith the growing emphasis on clean energy, the installed capacity of offshore wind power has been increasing faster than ever. However, due to the particularity of the offshore wind farm environment, offshore wind farms are usually accompanied by high temperature, high humidity, high salt fog, typhoon, lightning, and so on; thus, the probability of power equipment failure is higher . MeanwhiAt present, many scholars have studied the construction, monitoring, operation, and maintenance of smart offshore wind farms ,11. CompAround the world, governments are vigorously developing offshore wind power and have accomplished a lot in many fields. As shown in The remainder of this paper is organized as follows. With the rapid development of offshore wind power, only offshore wind farms in coastal waters have had difficulty in meeting the requirements for wind energy development; these offshore wind farms have a greater impact on the marine environment ,24. TherSea\u2013sky monitoring mainly includes the climate, meteorology, floating pollutants, wind information, and some bird species, and can provide experience and optimization strategy information for the construction and operation of smart offshore wind farms in the future . Sea\u2013skyThe machine noise, light, and magnetic field produced by offshore wind farms will have a certain impact on the foraging, breeding, and migration of birds ,27. For It is not only necessary to protect the local ecological environment, but also to monitor the local weather, wind speed, and other information in order to provide effective historical data for better operation and production in the future. Trombe et al. ,37 perfoMonitoring of the sea surface mainly includes the measurement and evaluation of offshore wind energy resources, marine ecological protection and construction planning, global marine environmental protection, maritime search and rescue, emergency monitoring for red tide and sea ice, and other measures in disaster prevention ,44,45,46Wind energy resource is an important factor affecting the economy of offshore wind farms, and the measurement and evaluation of wind energy resources is the key to the success of wind farm construction ,48. Sea The monitoring of marine natural disasters and environmental pollution is of great significance to the construction of smart offshore wind farms, especially of storm surges, red tide, oil spills, sea ice, and so on ,67,68,69The offshore wind farms may damage the sea floor environment and cause the death of benthos. This section will discuss the advanced monitoring equipment for the sea floor environment, earthquake monitoring, benthos monitoring, large marine organism monitoring , and other advanced technologies ,88,89,90Some researchers have found that offshore wind turbines do cause some damage to marine organisms ,92. For Although the harsh marine environment brings a lot of inconvenience to the operation and maintenance of smart offshore wind farms, the application of underwater robots and unmanned aerial vehicles (UAVs) improves the convenience of operation and maintenance activities as well as reduces the safety risk for workers. Therefore, a robotic system is also a key part of smart offshore wind farms. The underwater environment is dangerous and complex, and robots can stay in the water for a longer time or work in a deeper environment as compared with human beings . Figure Since the offshore wind farm environment is harsh and complex, the equipment fault rate of offshore wind farms is significantly higher than that of onshore wind farms ,103,104.The structure of an offshore wind turbine is basically the same as that of an onshore wind turbine, which is mainly composed of a foundation, tower, nacelle, hub, wind wheel, drive train system, gearbox, generator, brake system, pitch system, yaw system, sensors system, electrical system, control system, communication system, and so on . As showThe monitoring data source is composed of all kinds of sensors installed on the equipment, and the main signals monitored are the vibration, acoustic emission, generator speed, stress, torque, temperature, oil, electrical signal, SCADA data, and so on ,112,113.The gearbox is an important part which often causes the downtime of wind turbines, and the fault diagnosis of gearboxes has been a concern of many scholars. Cheng et al.  proposedGenerator fault is one of the main factors that lead to the wind turbine shutdown, which is why generator fault diagnosis has been a hot research topic ,127. TheIn addition, some scholars have studied condition monitoring and fault diagnosis for towers, blades, foundation, sensors, and so on ,144,145.With the development of large-scale offshore wind power, AC transmission technology will be limited by the transmission distance. DC transmission technology will become the development direction of offshore wind power long-distance transmission, especially the flexible high-voltage direct current transmission, which can automatically adjust the voltage, frequency, power, and so on . For exaAlthough there are various means to improve the reliability of the power electronic converter system, the fault is still difficult to avoid ,155. In The short-circuit fault is mainly caused by overheating, over-voltage breakdown, wrong driving signal, etc. Moreover, it is destructive and easy to burn other components of power electronic devices. The hardware protection methods for IGBT short-circuit faults mainly include the desaturation detection method , inductaGenerally, the main causes of IGBT open-circuit faults are device fracture, binding wire fracture or welding off, poor wiring, circuit faults, etc. . AccordiWith the development of the smart grid, the data-driven fault diagnosis technology of power electronic converters has become a research hotspot in the industry ,168,169.Submarine cables are key components of offshore wind power transmission and play an important role in the development of offshore wind power . The conIn order to ensure their safe operation, many scholars have studied the online monitoring of submarine cables . Zhu et In addition to offshore wind turbines, power electronic converters, and submarine cables, some scholars have studied offshore booster stations, sensors, uninterruptible power supply (UPS), offshore wind power structures, and so on ,189.The offshore booster station , fault repair, equipment spare part management, etc. Therefore, wind power operation and maintenance ships, helicopters, and so on are essential for the daily maintenance of offshore wind farms (as shown in In order to reduce the cost of operation and maintenance and improve the availability of offshore wind farms, it is necessary to scientifically and reasonably plan the operation and maintenance work for offshore wind farms so as to improve the quality and efficiency of operation and maintenance as well as reduce the attendance times and the cost of operation and maintenance .Compared with onshore wind farms, the operation and maintenance of offshore wind farms are more affected by the environment and climate, and the operation and maintenance efficiency are lower. The operation and maintenance of offshore wind farms need to meet certain marine meteorological conditions. For example, when the wind speed is too fast or the waves are too high, operation and maintenance tasks cannot be completed. Martini et al.  analyzedThe operation and maintenance strategies for offshore wind farms mainly include preventive maintenance and post repair; preventive maintenance mainly includes regular maintenance and status maintenance, and post repair mainly includes fault repair and emergency repair . Li et aThe harsh environment makes operation and maintenance more difficult in offshore wind farms, but also brings great challenges to the operation and maintenance personnel. Offshore wind power maintenance personnel are usually scattered across different wind turbines or ships, and there are some potential risks such as falling from height, drowning, asphyxiation, poisoning in semi-enclosed spaces, electric shock, and so on. Therefore, it is not only necessary to strengthen the ability and quality of operation and maintenance personnel before taking posts, but attention should also be given to the state of operation and maintenance personnel during operation and maintenance, and human errors should be avoided as much as possible in the operation and maintenance process of offshore wind farms .In order to improve the rescue efficiency and reduce loss due to marine accidents, many scholars have studied the search scope, rescue methods, etc. As shown in The smart dispatching system, the offshore wind power radar multi-source detecting and tracking system, the boundary warning system, and the operation supervision system of offshore wind turbine platforms were used to ensure the safety of ships, operation and maintenance personnel, wind turbines, and submarine cables. As shown in 1.During the construction of offshore wind farms, it is necessary to monitor the marine environment and marine organisms for a long time, and to try to avoid or reduce the impact on the habitats and migration routes of birds, fish, and other marine organisms. At the same time, the integration of offshore wind farms and marine ranches can be considered to realize the efficient output of clean energy and safe aquatic products, which will be an important industrial mode and future development direction.2.Due to the high cost of operation and maintenance helicopters and ships, the advanced data analysis platform, model display platform, and visualization platform should be considered, which can make full use of the accumulated operation data to predict and analyze the state of the offshore wind power equipment so as to scientifically carry out the operation and maintenance of offshore wind farms, to fully realize predictive maintenance and intelligent maintenance for offshore wind power equipment, to optimize the frequency of operation and maintenance, and to reduce the operation and maintenance cost.3.In the power equipment intelligent monitoring field, the current intelligent monitoring method relies too much on data samples. In addition, the domain knowledge-driven method can be employed, which can reduce the dependence on data samples. In particular, some expert experience and knowledge can be used for feature extraction, which can effectively reduce the dependence on data samples of different operation conditions.4.In a long-distance sea voyage, the special operation and maintenance ship is likely to be affected by the weather and sea conditions. For example, when the operation and maintenance ship sets out, the sea state is still calm, but it has to turn back due to the sudden change in weather halfway to the operation site, which creates unnecessary operation and maintenance costs. Therefore, it is necessary to strengthen the prediction capabilities for regional climate and weather at the offshore wind farms and to provide real-time weather information for the reasonable planning, operation, and maintenance of offshore wind farms so as to reduce unnecessary operation and maintenance times and costs.This paper summarized the research on the monitoring, operation, and maintenance of smart offshore wind farms. The environmental monitoring technologies, some advanced equipment and technologies, some power equipment monitoring methods, and the operation and maintenance strategies for smart offshore wind farms were discussed in detail. In order to improve the stability of offshore wind farms, to improve the quality and efficiency of operation and maintenance, and to increase the revenue of offshore wind farms, this paper puts forward the following research points and trends:"}
{"text": "Dear Editor,Due to the relevance of cutaneous melanoma to the health system and the scarcity of large series of cases with longitudinal follow-up in samples from the Brazilian population, we read with great interest the article by Castro e Souza et al.,There is consistent evidence of an increase in melanoma diagnoses worldwide in recent decades; in parallel, there is an intense discussion about factors associated with this phenomenon, such as population aging, increase in sun exposure during leisure time, use of immunosuppressants, greater population awareness, greater access to the health system, and even greater diagnostic accuracy by dermatologists and pathologists. Nevertheless, the population-specific mortality did not show any signs of decrease, further alluding to the possibility of overdiagnosis.3Shorter survival in men with melanoma have also been identified in other countries; however, the tumor biological behavior considering the hormonal differences, as defended by the authors, may not fully justify this fact, especially since the greatest divergence of mortality between the sexes occurs in old age, when sex hormones are less active.4vs. 73.1 years), undergo fewer hospital admissions (except for obstetric ones), and have a greater perception of their own health care, such as adherence to vaccination, regular examinations and routine outpatient consultations. In the meantime, behavioral aspects related to masculinity should be considered as possible determinants of delay in the diagnosis of melanoma, contributing to its worse prognosis.It is considered relevant to mention that all diseases have biological, environmental and sociocultural dimensions. In Brazil, women have a life expectancy that is 9.6% higher than men (2019: 80.1 To corroborate this hypothesis, the data from Castro e Souza et al. was reanalyzed regarding the Clark and Breslow levels \u2013 considering such variables as ordinals. When analyzing them using the Chi-Square test of tendency, which considers the influence of the effect by the variable order,In conclusion, the results of Castro e Souza et al. should be seen from the perspective of primary and secondary prevention, aiming to substantiate policies that promote early diagnosis, especially in groups at higher risk and mortality, such as men and the elderly, since the worse melanoma survival in men may also reflect the socio-cultural determinant associated to gender, leading to late diagnoses in groups less aware of the importance of the disease.None declared.Anna Carolina Miola: Design and planning of the study; statistical analysis; drafting and editing of the manuscript; critical review of the literature; critical review of the manuscript; approval of the final version of the manuscript.Juliano Vilaverde Schmitt: Design and planning of the study; statistical analysis; drafting and editing of the manuscript; critical review of the literature; critical review of the manuscript; approval of the final version of the manuscript.H\u00e9lio Amante Miot: Design and planning of the study; statistical analysis; drafting and editing of the manuscript; critical review of the literature; critical review of the manuscript; approval of the final version of the manuscript.None declared."}
{"text": "Green finance, as a major policy innovation under the guidance of high-quality economic development, can optimize the economic development mode and structure through green investment to enhance the rationalization and advanced level of industrial structure, and ultimately enhance the level of high-quality development of China\u2019s economy. Based on the panel data of 30 provinces and cities in China from 2009\u20132019, this study examines the impact of green finance on economic high-quality development and its transmission path using the intermediary model. Based on this, a model with moderated intermediation effects is constructed to explore the mechanism of green finance on an economic high-quality path based on the intermediation path of industrial structure advancement and industrial structure rationalization and the moderated effect of environmental regulation. Finally, regional heterogeneity analysis is conducted. The study found that, firstly, green finance significantly contributes to high-quality economic development, and there is a positive mediating effect of both advanced and rationalized industrial structure. Secondly, environmental regulation positively regulates the positive impact of green finance development on industrial structure upgrading and strengthens the role of industrial structure upgrading in promoting economic quality development, as well as playing a significant positive regulating role in the direct effect of green finance on economic quality development. Finally, there are regional differences in the impact of green finance on high-quality economic development. With China committing to peak carbon dioxide emissions before 2030 and achieving carbon neutrality before 2060, the Central Economic Work Conference urged quicker steps to present an action plan that enables the peaking of emissions. Green development is the core key element of high-quality economic development, and the development of green finance is urgently needed to practice green development. China is one of the countries that has established a systematic green financial policy framework, and improving the framework of the green financial system has been elevated to the national strategic level. In 2021, the balance of green credit in China has reached 15.9 trillion and the stock of green bonds has reached 1.16 trillion. Green finance is the \u201clubricant\u201d and \u201cbooster\u201d of green development, which can guide the flow of funds and enhance the level of resource allocation to promote the development of green industries [Research in the area of the relationship between finance and economic development started early, with Goldsmith  having sIn the research related to green finance, since the emergence of green finance theory in the 1980s, some scholars have conducted more research on the connotation and development necessity of green finance ,11,12. HIn summary, on the one hand, finance can promote economic development. However, in the field of green finance, although some studies have been conducted to explore the relationship between green finance and economic development, there is still insufficient research on the mechanism of action and transmission mechanism of the relationship between green finance and high-quality economic development. In addition, there is no literature specifically based on the intermediary effect of industrial structure upgrading and the regulatory effect of environmental regulation to study the effect of green finance on economic development. On the other hand, most existing studies focus on the impact of green finance on economic aggregates, with insufficient research on regional heterogeneity. Based on this, the incremental effect of this study is reflected in: first, constructing a comprehensive index system through multiple dimensions, comprehensively examining and evaluating the level of green finance and high-quality economic development in China, and enriching and improving the definition measurement and theoretical research system of both; second, constructing a model with regulated intermediary effects, and exploring the transmission path of green finance to promote high-quality economic development based on the intermediary path of industrial structure upgrading and the regulation effect of environmental regulation; third, the total effect of green finance on high-quality economic development, with the direct effect and the indirect effect through the rationalization and upgrading of industrial structure analyzed under different levels of environmental regulation, and the moderating effect of environmental regulation explored in depth. Finally, we analyze the regional heterogeneity of the promotion effect of green finance to explore the regional development differences in China, with the findings providing a basis for promoting high-quality economic development with green finance.Green finance provides a financing path for green development and is an important tool for achieving high-quality economic development. Cowan points out that green finance can be regarded as a special service industry, which can efficiently promote green economic development through financial support strategies . Green fFirst, the capital formation function. Green finance allocates a variety of innovative financial instruments and their combinations to facilitate the transformation of savings into investment. This will enable the green industry to obtain sufficient funds to expand the scale of production and innovative green technology development, furthering the process of economic sustainability. Second, the resource allocation function. Green finance reduces the amount of credit financing for traditional polluting industries, forcing them to introduce green labor and production technology innovation, promoting green transformation and upgrading of industries, and promoting green development. Third, the information transfer function. The implementation of green financial policies can transmit the implementation of the country\u2019s commitment to sustainable economic development, which in turn can change and optimize corporate behavior, innovative green technology upgrades, and production efficiency, thereby promoting the green development of the economy. Fourth, the factor guidance function. Green finance can guide the flow of funds through the role of market mechanisms, through interest rate policies, subsidy mechanisms, differential loan amounts, and other policies to reduce the risk of environmentally friendly projects, promote the establishment of green projects and the development of green industries, the formation of economies of scale, and ultimately achieve high-quality economic development. Based on this, this study proposes Hypothesis 1.Hypothesis\u00a01.Green finance has a direct role in promoting high-quality economic development.Green finance is a key policy to achieving low-carbon economic development, which is of great significance to improve environmental quality, optimize the economic development model, and adjust the economic structure.First, green finance concentrates capital in green industries. Green finance can pool capital through financial intermediaries and financial markets via various financing mechanisms, and guide the flow of capital to green industries such as energy conservation and emission reduction, ecological maintenance, resource conservation, and recycling through green financial tools and services, as well as differentiated credit policies, to meet the capital needs of enterprises with market competitiveness, and support the creation, production and operation, investment, and technological research and development of enterprises. At the same time, it raises the investment and financing costs of the highly polluting and energy-consuming enterprises or a series of projects, inhibits their development, and overall promotes the development of the industry to environmental protection, both rational and advanced. This is especially so with the efficient allocation of resources and the transition of the industrial structure to technology-intensive, with the highly polluting and energy-consuming enterprises gradually starting to adjust to low energy consumption and low emissions. The ecological model of green finance has been adjusted.Second, green finance has the function of industrial integration. In the implementation of green concepts and financial policies, highly polluting and energy-consuming enterprises conduct research and development of green technologies due to the pressure of survival, reduce enterprise energy consumption and promote product upgrading to green transformation and upgrading, and improve enterprise production efficiency. In addition, Zhou  indicateBased on the above analysis, this study proposes Hypothesis 2.Hypothesis\u00a02.Green finance effectively promotes the upgrading of industrial structure, and then enhances high-quality economic development.In summary, the mechanism of green finance\u2019s effect on high-quality economic development is shown in Combining the \u201cnegative externality\u201d of ecological pollution and the theory of market failure in economics, it is impossible to achieve the Pareto optimum by relying only on the market mechanism to allocate resources, but also must rely on government intervention, i.e., corresponding environmental regulation to ensure the reasonable allocation of resources. At the macro level, the current high quality of economic development requires, firstly, that economies increase financial investment in green environmental capital, including renewable energy and the circular economy and, secondly, that environmental policies are disciplined so that highly polluting and energy-intensive industries can green their production. All of these require the financial sector to actively guide and allocate funds between industries in order to facilitate the transformation and upgrading of industries. When green technology innovation achieves breakthroughs and green industries rise, benefiting from the realization of positive externalities of green industries, a positive feedback mechanism will be formed within the economy where economic and environmental benefits co-exist, thus achieving a win\u2013win situation for both high-quality economic development and environmental protection. Based on the existing research, this study innovatively introduces environmental regulation as a moderating variable to analyze the impact of its moderating effect on the three paths, and then optimizes the external path boundary, in order to examine the level of economic quality development in a comprehensive way.Firstly, concerning the regulatory effect of environmental regulation between green finance and quality economic development, green finance can be complemented by market regulation and mandatory government control, optimizing the previous paths of environmental regulation, promoting green transformation, and improving the quality of economic development . SecondlHypothesis\u00a03.Environmental regulation positively regulates the relationship between green finance and quality economic development.Hypothesis\u00a04.The relationship between environmental regulation positively regulates both green finance and industrial structure upgrading.Hypothesis\u00a05.The relationship between environmental regulation positively regulates industrial structure upgrading and high-quality economic development.We summarize the moderating effect of environmental regulation between green finance development, industrial structure upgrading, and high-quality economic development, as shown in Economic quality development level (EQUA): In the 13th Five-Year Plan in China, the concept of \u201cgreen development\u201d was introduced for the first time, and the social development goal of \u201cInnovation, Coordination, Green, Openness, and Sharing\u201d was established, which indicates that high-quality economic development has become an important feature of socialism in the new era.On the basis of following the above development concept, the research idea of Cheng  is referGreen finance (GF): In 2016, the People\u2019s Bank of China (PBOC) and others released the \u201cGuiding Recommendations on Building a Green Financial System\u201d, which optimized and improved the green financial system, indicating that green finance is a national strategic policy to promote the process of sustainable development through green credit, bonds, stock indexes, insurance, and carbon finance. Therefore, by analyzing the above guiding recommendations and referring to Zhou et al. , this stAs can be seen from The main reason for the gap between China\u2019s high-quality economic development and the growth rate of green finance is that since the reform and the country opening up, China\u2019s economy has continued to grow at a high rate. However, in recent years, China\u2019s society has transitioned from a production-based society to a consumption-based society, and the goal of economic development has gradually changed from high-speed development to high-quality development, with the slowdown of China\u2019s economic growth rate in line with the basic laws of economic development. The 2007 release of \u201cOpinions on Implementing Environmental Protection Policies and Regulations to Prevent Credit Risks\u201d was the beginning of the development of green finance in China. Based on the continuous development and efficiency improvement of financial institutions and markets, China has a huge potential to develop green finance and has made a series of achievements: in 2021, green credit in China accounted for 10% of the domestic loan balance, the system of green finance is tending to be perfected, the scale of products and instruments is continuing to rise, and the results of international cooperation are becoming more and more abundant. As a result, the level of green finance development has grown significantly in recent years, both nationally and in all regions.Industrial structure upgrading: The difference of industrial structure affects the pattern and process of economic development, and is an important discerning feature of high-quality economic development. Along with the development of green finance, China\u2019s industrial structure has been undergoing transformation. In order to concretely show the current situation of and the level of industrial structure upgrading in China\u2019s economy, this study divides industrial structure upgrading into two levels, industrial structure rationalization (TL) and industrial structure advancement (TS), based on the structuralist viewpoint .The rationalization of industrial structure (TL) reflects the level of coordination among industries, the degree of industrial structure agglomeration, and the rationality and efficiency of production factor allocation. Referring to Gan et al. , the indIn Equation (1), The advanced level of industrial structure (TS): In the process of the economy tending toward service, in the background that the growth rate of the tertiary industry is faster than that of the secondary industry, and the society gradually transitions from production-oriented to capital-intensive and then from capital-intensive to technology-intensive, this study uses the ratio of the output value of tertiary to secondary industry as a measure.Environmental regulation intensity (ER): Environmental regulation intensity can limit the polluting behavior of enterprises and influence economic development through the rational allocation of resources and enhancement of enterprise innovation capacity. In the measurement of environmental regulation indicators, scholars have put forward different views. These include Ren , Shen 3, ShangGuFirstly, the standardized value of j in province i; j in province i for the whole country; i and the whole country, respectively. After obtaining In Equation (2), Finally, based on the standardized values and average weights of each indicator, the environmental regulation intensity of each province is obtained in Equation (3) as:There are many factors that affect the level of high-quality economic development, with the main factors controlled with reference to existing studies. The control variables selected in this study are as follows: (1) Trade dependence (TRA): The ratio of total regional import and export to total regional GDP. (2) Size of foreign investment (FI): The ratio of foreign investment amount to local GDP. (3) Human capital level (HC): The rate of general higher education graduates in this study. (4) Information level (Infor): The ratio of the number of Internet users in this study.The above data were obtained from China Statistical Yearbook, China Science and Technology Statistical Yearbook, WIND database, CSMAR database, and provincial statistical yearbooks from 2009\u20132019. In the process of data acquisition, the missing data were estimated by the exponential smoothing method. The descriptive statistics of the above variables are shown in This study takes high-quality economic development as the explained variable and green finance as the explanatory variable. To specifically analyze the impact of green finance on the qualitative development of the economy, this study conducts an empirical analysis based on panel data for 30 Chinese provinces from 2009\u20132019. The panel model is able to overcome the time series analysis being plagued by multiple cointegration and is able to provide more information, more variation, less cointegration, more degrees of freedom, and higher estimation efficiency. The constructed panel model (1) is built as follows:i = 1, 2, 3, \u2026, N represents each province; t = 1, 2, 3, \u2026, N represents each year; In the model, Based on the analysis of the impact of green finance on economic quality development, we then explore whether green finance can have an impact on the level of economic quality development through industrial structure upgrading. Therefore, referring to Wen , we estai and t denote provinces and years, respectively, with the above analysis dividing industrial structure upgrading into industrial structure rationalization (i.e., In the model, To further test the moderating effect of environmental regulation on the mediating effect, referring to Wen , based oThe regression results of green finance on high-quality economic development are shown in The reason: green finance helps to share information among enterprises, government and financial institutions, which enables them to enhance the efficiency of capital factors\u2019 utilization and rationalization of resource allocation. In addition, with the effective regulation of the market mechanism, green enterprises have multiple paths to obtain credit funds, achieve efficient allocation of production factors, and gradually realize economies of scale, which will strongly improve the development of green finance and realize its effective integration with economic development to improve the quality of economic growth. Therefore, the development of green finance has a positive effect on the improvement of economic growth rate, which is consistent with H1.In the basic regression analysis, the coefficients of green finance are significantly positive, so the intermediation effect test can be conducted. The regression results of the mediating effects of industrial structure upgrading are shown in The reasons: First, for industrial structure upgrading, green finance can inhibit the capital inflow of polluting industries; promote the factor gathering of green industries; promote the gradual transformation of industrial structure from labor-intensive to capital-intensive, and then from capital-intensive to technology-intensive; enhance the degree of coordination among industries; and improve the industrial production through the functions of capital orientation, resource allocation, information transfer, and factor integration. It enhances the coordination between industries, improves the allocation efficiency of industrial production elements and resources, and raises the level of industrial rationalization and industrial advancement. On this basis, green finance has an impact on economic growth in terms of both structure and efficiency: in terms of industrial structure, due to the continuous growth of green finance and the gradual expansion of the share of green industries in China, the highly polluting and energy-consuming enterprises are shrinking, and the industrial structure shows the development trend of ecological greening, thus driving the high-quality growth of China\u2019s economy; in the area of comprehensive efficiency, under the comprehensive influence of the risk mechanism, all types of enterprises have been able to improve their competitiveness. In the area of comprehensive efficiency, under the comprehensive influence of risk mechanism, all types of enterprises take the initiative to implement green technology innovation, thus further optimizing the capital efficiency and improving the quality of economic growth.In order to enhance the robustness of the mediation effect test, both Sobel\u2013Goodman and Bootstrap tests are used to validate this study. In the regression results of the mediating effect model with regulation in In this study, we use the Bootstrap method to test the mediating effect model with regulation: the mediating effect of industrial structure upgrading under the moderating effect of different environmental regulation levels, i.e., low environmental regulation level, mean environmental regulation level, and high environmental regulation level, respectively, with the results shown in First, for the conditional direct effect, we can see that with TL as the mediating variable, the conditional direct effects of green finance are 0.2091, 0.3554, and 0.5017 at low-to-high ER levels, respectively; with TS as the mediating variable, the conditional direct effects of green finance are 0.2403, 0.3945, and 0.5487, all gradually increasing, and all with confidence intervals not containing 0. This indicates that the direct effect of green finance on high-quality economic development increases significantly as the ER rises.Second, for the conditional mediating effect, we can see that when TL is the mediating variable, the conditional mediating effects of TL are \u22120.007, 0.0628, and 0.1764, respectively, and the confidence interval does not contain 0 and the coefficient is significant only when ER is the mean and positive one standard deviation of the mean; with TS as the mediating variable, the conditional mediating effects of TS are \u22120.0151, 0.0208, and 0.1461, respectively, and the confidence interval does not contain 0 when ER is positive one standard deviation of the mean. The confidence interval does not contain 0 until the ER is one standard deviation, which shows that the mediation effect of TS is only highlighted when the ER is large.Third, for the conditional total effect, we can see that the total effect of green finance on economic quality development is 0.183, 0.4273, and 0.6715 with the confidence interval not containing 0. This indicates that the promotion effect of green finance on economic quality development increases significantly with the increase of ER level.The regression results plot the moderating effect M \u00b1 1SD and J-N, as shown below. From The above analysis shows that an increase in the intensity of environmental regulation is conducive to the further realization of high-quality economic development. At present, the most common environmental policy in China is directive environmental regulation, the main means of which is to force enterprises to meet the emission and technical standards set by the environmental protection authorities through relevant policies. The government should use environmental regulation to force polluting enterprises to take the path of low-carbon and green development. On the other hand, the government should guide green finance to support the research and development and promotion of new technologies and products that are green, energy-saving, and emission-reducing, in order to realize the vision of environmental regulation and green financial innovation. The government should also guide green finance to support the research, development, and promotion of new technologies and energy-saving and emission-reducing products, in order to realize the vision of environmental regulation and green financial innovation to enhance high-quality economic development.In this study, China is divided into East, Central, and West according to the geographical location and economic development for regional heterogeneity analysis, and a regression analysis is conducted to test the regional heterogeneity of the impact of green finance development on economic quality development based on the selection of control variables such as foreign trade dependence, foreign investment scale, and human capital. and the regression results are shown in In order to ensure the robustness of the findings on the impact of green finance on economic quality development, this section conducts robustness tests through the lagged effect of green finance, panel quantile model, and sequential elimination of control variables.High-quality economic development is influenced by both green finance and changes due to the time lag of green finance development. To ensure the robustness of the above findings in this study, green finance with a lag of one period is treated as an explanatory variable and thus subjected to panel regression. As can be seen from the regressions in In the previous paper, the traditional least squares method was used to estimate the mean impact of green finance on economic quality development; quantile regression can reflect the overall distribution level of economic quality development, i.e., the degree of green finance impact under economic quality development in different quantiles. The results in Since the regression results and the obtained conclusions may vary depending on the control variables, this study excludes the control variables of foreign capital scale, foreign trade dependence, informationization level, and human capital level in turn and then conducts the robustness test.The regression results are shown in With the transformation of China\u2019s economy from high-speed development to high-quality development, which makes higher requirements for the country\u2019s economic development model and economic structure, China urgently needs to implement green development, and green development requires vigorous development of green finance. Based on economic phenomena and the frontier literature, this study explores the intrinsic mechanism of green finance to promote high-quality economic development based on the mediating effect of industrial structure upgrading and the regulating effect of environmental regulation based on panel data of 30 provinces in China from 2009\u20132019. The study finds that, firstly, green finance has a significant positive direct contribution to high-quality economic development in China. Secondly, there is a positive partial mediating effect of industrial structure rationalization and industrial structure advancement between green finance and high-quality economic development. Thirdly, for the moderated mediation model, environmental regulation positively moderates the relationship between green finance, industrial structure upgrading, and high-quality economic development, and the positive relationship between the two is enhanced as the intensity of environmental regulation continues to increase. Fourthly, in the heterogeneity analysis of the regional panel regression model, there are regional differences in the impact of green finance on high-quality economic development between the eastern and central and western regions. However, in the above-mentioned process, factors such as the level of green finance development, the rationalization of local industrial structure, and the level of advanced industrial structure, as well as the intensity of environmental regulation, influence and determine the effect of green finance. Therefore, it is necessary for the state, local governments, financial institutions, and enterprises to work together to improve the green financial system in order to promote China\u2019s high-quality economic development. Accordingly, the following policy recommendations are proposed.First, a national coordinated design and improvement of green financial system to promote sustainable development of green finance. In recent years, the National Development and Reform Commission, the Ministry of Finance, and the Ministry of Environmental Protection have launched a series of green financial reform initiatives one after another, and have achieved certain results. However, it is difficult to achieve the goal of high-quality economic development with the existing green financial policies and fragmented measures. Therefore, the first step is to strengthen the top-level design of the green financial system and enhance the intensity of policy implementation. A unified standard system for green finance must be developed and improved in conjunction with market practice, and needs to be gradually refined, clarified, and made operable, in order to gradually expand the scope of standards for the green financial system in building a universal and unified green financial system. Innovation in green financial products and services should be encouraged to provide diversified green financial products, and the enthusiasm of market players to innovate green financial business models needs to be fully mobilized in order to effectively improve the performance of green financial business.Second, accelerate the upgrading of industrial structure and assist high-quality economic development. Research findings show that the upgrading of industrial structure provides a key intermediary path for green finance to drive China\u2019s high-quality economic development. On the one hand, China\u2019s industrial structure should be optimized by vigorously developing emerging enterprises, breaking through the strategic layout of core technologies, and not making massive cuts to highly polluting and energy-consuming enterprises, instead adopting a guiding and incentivized approach to promote them to complete their green transformation. On the other hand, China should enhance the suitability of green financial and fiscal policies, minimize the cyclical fluctuations of policy effects, and ensure the long-term sustainability of policy effects, in order to provide stable financial subsidies and preferential policies for enterprises\u2019 green transformation.Third, optimize the environmental regulation policy channel and enhance the efficiency of environmental policy implementation. China should flexibly exert the influence of environmental regulation on green finance and industrial structure upgrading, and adopt an approach that encourages and regulates both according to the characteristics of different industries. Each region should adopt reasonable environmental regulation measures, according to the characteristics of their respective industrial structures and resource endowment conditions, in order to give full play to the reversing effect of environmental regulation on industrial structure optimization and promote regional industrial transformation and high-quality economic development.Finally, adhere to local conditions and implement differentiated regional policies. China is a vast country, and the level of green finance and high-quality economic development in different regions exhibits regional heterogeneity due to economic, geographical, cultural, and policy conditions. The eastern region should adhere to and improve the existing green financial system, vigorously promote innovation in the green financial system, and continue to maintain the determination for green and high-quality development. For the central and western regions, efforts such as fiscal transfer payments should be increased to find regional advantages, combine regional resource advantages with green finance, achieve differentiation in positioning, and take a leapfrog development path to further narrow the regional gap."}
{"text": "Redes de Aten\u00e7\u00e3o \u00e0 Sa\u00fade) in order to meet their health needs-2.Care lines (CL) refer to proposals for articulating resources and health production practices, based on the most relevant epidemiological needs. This allows defining a care flow through which users must travel through Health Care Networks  and Acute Myeloid Leukemia (AML) has increased considerably in most countries and the incidence of HL cases increased by 38.6% between 1990 and 2017.Hodgkin\u2019s Lymphoma (HL), Non-Hodgkin\u2019s Lymphoma (NHL) and Multiple Myeloma (MM) represented, respectively, about 1.4, 7.0 and 2.3 million lives affected by these types of hematological malignancies. In this context, there is a need to systematize the care provided to these patients.Such diseases require specialized attention, rapid diagnosis and effective treatment, given their rapid evolution, such as AML, which, although the prognosis has improved in recent decades, only one in four patients survives five years or moreTherefore, it is essential to sum up the elements for the care provided to patients with hematological malignancies to elaborate and propose a CL for such a specific audience, in order to support a safe, quality and assertive care. Moreover, this compilation of knowledge can support clinical decisions and conduct taken, as well as the performance of professionals and the follow-up of patients between health services, therefore, with triggering and improvement of clinical itinerary, in order to ensure the provision of care based on the best available evidence.Given the above, this study sought to answer the following guiding question: what are the elements for assistance to patients with hematological malignancies that can support the proposition of a CL?To identify the elements for assistance to patients with hematological malignancies to propose a CL.As it was research that used public domain materials and did not involve human beings, it was not necessary to be appreciated by the Research Ethics Committee. However, it is important to highlight that the copyright was respected with correct citation and referencing.-13. The research protocol is registered in the Open Science Framework (https://doi.org/ 10.17605/OSF.IO/VCGPQ).This is a scoping review, based on the method proposed by the JBI Reviewer\u2019s Manual and conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR): Checklist recommendations. It was developed through five stages: I- definition of research question; II- search for relevant studies; III- selection of studies; IV- data extraction and analysis; V- gathering, synthesis and presentation of results.This type of review aims to investigate scientific evidence, identify and map existing gaps in a given area of studyThe first stage included the elaboration of the research question through the PCC strategy .To complete the second stage, the descriptors that encompassed the largest number of studies related to the research topic were identified, through consultation in the Medical Subject Headings (MeSH), for descriptors in English, and in the Health Science Descriptors (DeCS), for descriptors in Portuguese. This process, added to the employment of the Boolean operator AND, culminated in the development of the following search strategy (with its respective descriptors in Portuguese): (Patients AND Patient Care Planning AND Hematologic Neoplasms).Initially, as a way to ensure that there are no studies with the same theme registered in the OSF or published, a broad search was carried out on the platform and in databases to identify protocols or reviews with similar themes. From this diagnosis, it was followed with the steps to consolidate the scoping review.Study selection consisted in identifying texts in the databases and repositories of theses and dissertations by reading title and abstract, for screening the works according to eligibility criteria and reading full text for data extraction. The analyses were performed by peers of reviewers independently and, in case of disagreement, there was discussion for reaching consensus. In cases of doubts and disagreements, the opinion of a third reviewer specialized in the area of the object of study was requested.For the step of separating, summarizing and reporting the essential elements found, a structured instrument specifically designed for this purpose was used. This tool allowed data synthesis, interpretation and basic numerical analysis of the extent, nature and distribution of studies selected to compose the final sample.Reposit\u00f3rios Cient\u00edficos de Acesso Aberto de Portugal).The searches were carried out in April 2021 in the following databases and repositories of theses and dissertations: U.S. National Library of Medicine (PubMed), Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Science Direct, PSYCHINFO, EMBASE, Latin American and Caribbean Literature in Health Sciences (LILACS), The National Library of Australia\u2019s Trobe (Trove), Academic Archive Online (DIVA), Electronic Theses Online Service (EThOS), The Education Resources Information Center (ERIC), Theses Canada, DART-Europe E-Theses Portal, National ETD Portal, Theses and Dissertations from Latin America, CAPES Theses and Dissertations Portal and Portuguese Open Access Scientific Repositories  to five (V).From the studies included in the final sample, the following variables were extracted: year of publication, country of study, language, methodological design, level of evidence, level of health care, type of hematological cancer, the area of health professionals and CL used for assistance to patients with hematological malignancies. The studies\u2019 level of evidence was classified according to JBI proposal, which enabled the identification of essential information from the studies, which made it possible to synthesize and interpret data, in addition to generating the basic numerical analysis of the extent, nature and distribution of the studies incorporated in the review.Data mapping occurred through the use of a structured instrument, proposed by JBI ReviewersThe collected data were organized in Microsoft Excel 2016\u00ae spreadsheets, analyzed using simple descriptive statistics and presented in graphs, figures, charts and/or tables, as appropriate, to compose the results of this study.Searches in the databases resulted in a final sample consisting of 93 studies, based on the selection process described in Study characterization included in the final sample is described in There are productions from 1978 to the present day, in which an increase in the last decade stands out, with emphasis on the year 2019 . The language of publications was English . Most publications are from the United States of America (USA) .The most developed study design was systematic review  and cohort . Thus, the level of evidence that stood out was II . The assistance provided to people with hematological malignancies stands out due to the levels of health care of high complexity  and medium complexity . The types of hematological malignancies most addressed in the studies were leukemias  and lymphomas . Moreover, the most approached type of care was treatment , followed by diagnosis .It is noteworthy that some studies portrayed more than one type of care, more than one type of hematological malignancy and the care is applied at different levels of health care, as shown in link available in the second paragraph of the method.Article references in the sample of data selected in this research are found in a file attached to the OSF and can be consulted from the access to the platform, through the ,10,17-18.The epidemiological relevance of hematological cancer and the interest in improving care for patients affected by this disease are confirmed by the specific care needs, the quantitative of the final sample of this research, the growing number of scientific productions carried out in the last decade and the increase in rates incidence of this type of cancer-20.The most frequent place of studies was the USA and European countries; on the other hand, it is observed that the African continent had no representation, which is possible to correlate with the investment in the technological apparatus and development of scientific productions in these countries-22 in this group of countries, given that North America has the second highest incidence of NHL cases and Europe ranks third in terms of diagnosis of this disease. Moreover, CLL and AML were more commonly diagnosed in countries located in Europe and North America between 1997 and 2017.Similarly, this relationship may be associated with the magnitude of hematological cancer,24,25,26.Furthermore, the most discussed malignancies in the studies were leukemias and lymphomas, in line with the need to provide care to patients, given that these are the types of hematological cancer most distributed among the population-28.Regarding the level of health care, the findings of this study reveal that onco-hematological care is concentrated at medium and high complexity levels, since cancer is a type of disease that requires adequate equipment and human resources to provide specialized care.However, Primary Health Care (PHC) plays a fundamental role in health promotion, focusing on cancer protection factors, disease screening, early diagnosis, regulation of patients for other levels of care and training of teams, in addition to coordinating and maintaining the care of users with cancer. Thus, it is necessary to improve actions at this level of health care, to minimize the delay in diagnosis, in the provision of care and in the use of resources, in order to guarantee comprehensive care for patients with hematological malignancies.However, it is observed that there are difficulties in providing care to cancer patients in PHC services, due to the need for qualification of professionals involved in the process of identifying signs and symptoms, referral to early diagnosis and treatment, users\u2019 unequal access to available services and delays in carrying out tests and returning for consultations-31, where primary prevention is not possible, related to modifiable factors, often recommended to adults, such as smoking, alcoholism, sedentary lifestyle and other lifestyle habits, the importance of identifying the various technologies developed for the investigation of the disease is emphasized.In this regard, early diagnosis increases success in treatment and chances of cure. Nevertheless, in pediatric leukemia, since it minimizes complications, such as high risk of infections, cachexia, mucositis, depression, loss of social function and other side effects of treatment and impairment caused throughout cancer,37,38,39. In addition, it enables the experience of the cancer coping process with better quality of life and better response to malignancy treatment-41.Another aspect of remarkable relevance is supportive care.From this perspective, it is still necessary to infer a greater focus of the studies in the curative process, to the detriment of the detection and care directed to post-treatment. With this, there is a growing increase in cancer survivors, from the development and success of anticancer therapies,43-44. Thus, palliative care aims to improve care during the final life trajectory and should be integrated in a timely manner in standard oncological care. Nevertheless, the implementation of intensive care until the end of life and frequent hospital deaths,45-46is still observed.However, the mortality rate for hematological malignancies is still high.This is associated with the complex nature of hematological malignancies and their treatment, delays in end-of-life discussions, lack of integration of palliative care services and barriers at home for the patient to experience the end of life at home,47-48.On the other hand, increased survival has implied a new demand for post-treatment care that is not yet met by health services, as studies reveal a high prevalence of unmet needs in this population, such as concerns about changes in concentration and memory, fatigue, change in sexual activity, anxiety, depression, and change in body image.Thus, there is a need for changes in the care of patients with hematological cancer. The determination of a CL that systematizes the therapeutic itinerary of these patients can minimize the existing gaps in the RAS and promote a safe, quality and timely care delivery that can provide a longer survival timeA limitation of this study is the difficulty in accessing articles that are unavailable in full because they do not meet this criterion, a fact that may have led to the loss of publications that could enrich the findings of this study.The present study brings relevant contributions to health, especially in the field of onco-hematology, by highlighting the particularities of the elements that can compose a CL to systematize the services and care provided to patients.It is worth emphasizing the importance of the multidisciplinary team, especially nursing, within this context, as it is the most present professional category throughout the care process. and, thus, with greater opportunities to identify patients\u2019 health-disease needs, outline and make the best decisions and conducts for the implementation of CL, when considering the particularities of each case.In view of the findings, this research achieved the proposed objective and presented the main elements that can support the proposition of a CL for assistance to onco-hematologic patients, when it summarized important aspects about diagnosis, treatment, supportive care, palliative care and post-treatment assistance.Overall, these patients face several obstacles to achieving specialized care, given the complexity surrounding the diagnosis and treatment of hematological malignancies, as well as difficulties that are imposed in relation to access and continuity of care in the network, which often implies an unfavorable outcome and death.To this end, this issue needs to be addressed in new research, seeking to raise evidence to base the practice of health professionals and the dynamics of health services, based on the needs presented, associated with the updating and training of health professionals with new knowledge."}
{"text": "African American communities are frequently depicted as victims of urban conditions. However, a rich culture of grassroots community development and organizing, often led and stewarded by Black women, exists. Many of these efforts involve enhancing economic, political, and educational opportunities and centering ethics of care and caregiving. This is the notion of Black placemaking, which is explicitly community-focused, shaping the social fabric of everyday life and allowing for the development of Black vernacular spaces that became vital to African-American culture. This paper examines how Black older women engage in placemaking by presenting three select case studies. Using a narrative inquiry approach, we conducted secondary data analysis of interviews drawn from larger qualitative studies about aging in communities that took place in San Francisco and New York City. Black feminist spatial imagination, embodiment, and intersectionality theory were our guiding frameworks. Our analysis revealed how the aging Black body is a site that is subjected to socio-political regulation and violence and illuminates how Black women are agents of community resilience, creativity, and transformation. Creating and holding space  with bodies and physical structures that center the Black community is an act of care, self-determination, and resistance to white supremacy. These embodied processes of placemaking have wide-ranging implications for the ways Black neighborhoods are framed and discussed in popular media, empirical research, and policy. Furthermore, they invite a shift in our current approach to placemaking in later life, one that centers the strengths, history, and traditions of the Black community."}
{"text": "Dr. C. Richard Conti, a legendary cardiovascular educator, researcher, and mentor, died suddenly on February 21, 2022, in Gainesville, FL.Dr. Conti was born in 1934 in Bethlehem, PA, graduated from Lehigh University Phi Beta Kappa in 1956 and from the Johns Hopkins University Medical School in 1960. After service in the US\u00a0Army Medical Corps, Dr. Conti returned to Johns Hopkins for residency in Internal Medicine and Fellowship in Cardiology. His interest was in ischemic heart disease, and he was among the pioneers in interventional cardiology. He chaired the National Heart Lung and Blood Institute (NHLBI) first national randomized trial of medical versus surgical intervention in patients with unstable angina and chaired the Asymptomatic Ischemia Pilot Trial comparing medical therapy with revascularization in patients with stable angina. In 1974, Dr. Conti was recruited to become Chief of Cardiology at the University of Florida in Gainesville.\u00a0There, as Professor of Medicine, he guided the university, to become nationally and internationally recognized as a center of excellence in cardiovascular research and training. Dr. Conti was a lifelong teacher and learner, chairing the American College of Cardiology (ACC) Self\u2010Study Education Materials Committee, which served to create the ACC Self\u2010Assessment Program (ACCSAP). As well, he contributed as Editor in Chief of ACCEL, the audio journal of ACC. In 1989\u22121990, Dr. Conti served as President of the American College of Cardiology.A passionate educator, he was involved in the early efforts of the American College of Cardiology and ESC international programs, guiding the development and growth of the annual Great Wall International Conference in Cardiology in Beijing. After serving as Chief of Cardiology for 24 years, Dr. Conti relinquished this role in 1998 but remained active directing the Ambulatory Cardiology section at the University of Florida.As well, Dr. Conti served on the subspecialty board of Cardiovascular Disease of the American Board of Internal Medicine and the Cardiology Advisory Committee of the NHLBI. He was recognized for his skill as a teacher and scholar by the British Cardiac Society, the French Cardiac Society, the European Society of Cardiology, the College of Medicine South Africa, and the Venezuelan Cardiac Society among others. He took particular pride in his daughter Jamie, a cardiologist and electrophysiologist at the University of Florida as she progressed to lead the Division of Cardiology. He received the Docteur Honoiris Causa from the Universite de Marseilles in 2000. Dick was a devoted husband, father, grandfather, and great\u2010grandfather. He was a marathoner and loved to golf, to ski, and to travel, taking his family on cruises worldwide. My husband Julius and I were privileged to join Dick and his lovely wife Ruth on a number of international teaching trips, where he was always the center of vibrant discussions and masterful teaching. Dick mentored many of the current leaders in cardiovascular medicine worldwide and was a personification of the concept of lifelong learning.Dr. Conti authored or coauthored over 600 scientific manuscripts and book chapters and was editor of Clinical Cardiology from 1988 to 2011. He took a strong and enduring interest in the journal, working with Willis Hurst and Bob Schlant and many other giants of cardiology. All of us who joined with him at the editorial board meetings that he hosted every year at the American College of Cardiology will always remember these wonderful occasions."}
{"text": "Pesticides are chemical substances used to control, prevent, or destroy agricultural, domestic, and livestock pests. These compounds produce adverse changes in health, and they have been associated with the development of multiple chronic diseases. This study aimed to present a detailed review of the effect of pesticides on the oral cavity and the oral microbiome. In the oral cavity, pesticides alter and/or modify tissues and the microbiome, thereby triggering imbalance in the ecosystem, generating an inflammatory response, and activating hydrolytic enzymes. In particular, the imbalance in the oral microbiome creates a dysbiosis that modifies the number, composition, and/or functions of the constituent microorganisms and the local response of the host. Pesticide exposure alters epithelial cells, and oral microbiota, and disrupts the homeostasis of the oral environment. The presence of pesticides in the oral cavity predisposes the appearance of pathologies such as caries, periodontal diseases, oral cancer, and odontogenic infections. In this study, we analyzed the effect of organochlorines, organophosphates, pyrethroids, carbamates, bipyridyls, and triazineson oral cavity health and ecosystems. Oral diseases are considered early indicators of the general health of a population, and their prevalence is higher in developing than in developed countries . GloballIn the agricultural environment, it has been projected that by 2050, there will be a need for an 80% increase in food production, leading to a predicted increase in the use of these anti-pest chemicals ,5. InforTo assess the risk to oral health from exposure to pesticides, it is necessary to take into account several key factors such as chemical characteristics of the pesticide, characteristics of the oral cavity, and oral microbiota . HoweverPesticide contamination has been linked to many diseases in humans . ContactTo know the degree of risk of an individual due to exposure to pesticides, there is a need for classification of these pesticides based on chemical structure .OC are chlorinated hydrocarbons, classified as aromatic, alicyclic, cyclodienic, and terpenes, with oxygen or sulfur molecules A. They aOther key characteristics are described in A study has revealed that the most widely used pesticides worldwide are OC, OP, P, C, and triazines . Most ofThe main routes of disposal of pesticide presidencies depend on their release by feces or urine. To a lesser extent, it can be removed by sweat, maternal milk, tears, and hair ,25.In oral and inhalation exposure, the oral cavity is the first line of contact with agrochemicals . Therefo2. Homeostasis in the oral cavity depends on factors such as mucosal integrity, saliva, microbial balance, and its response to chemical exposure . Th. Th60]. No reports of damage to the oral cavity were found as a result of triazine exposure. However, other studies on the gastrointestinal (GI) tract epithelium demonstrated that triazine exposure increased oxidative stress levels, decreased antioxidant responses, and altered the structures and metabolism of nucleic acids . SimilarFrom another perspective, the effects of pesticides with mutagenic potential on the oral cavity were analyzed. A study on 29 workers exposed to pesticides showed a high population of micro-nucleated cells in the oral epithelium . In anotStudies have shown that pesticides inhibited muscarinic and nicotinic receptors, resulting in xerostomia, a risk factor for the development of dental caries, oral infections, and mucosal inflammation ,32,34,53The effects of pesticides on the oral cavity were described mainly for OP and B. The most relevant results for these pesticides are described below.Lactobacillus [Exposure to chlorpyrifos (OP) is related to changes in the host microbiome . Oral exbacillus . In contbacillus . Increasbacillus ,55,56,75Glyphosate (OP) has a chelating property. Thus, it was bound to the allosteric site of the microbiota enzyme UDP-N-acetylglucosamine enolpyruvyl transferase (MurA), resulting in changes in its functionality and interference with the synthesis of peptidoglycan which is vital in bacterial growth ,66. ExpoLactobacillus and Granulicatella and their gene expressions [Streptococcus and Halomonas [A study on the effect of azinphos methyl (OP) on the oral microbiota of exposed farmers showed that the pesticide altered membrane permeability and decreased some bacterial communities such as ressions . Moreovealomonas .Exposure to paraquat (B) enhanced the development of periodontal disease by limiting the proliferation of the epithelium of the oral cavity, thereby enhancing its thinning . It shouThere are no extant studies on the effects of OC, P, C, or N, especially on the oral cavity microbiome. Therefore, the results of the evaluation the effects of pesticides on the microbiota of different tissues and organisms are described below, with respect to their impacts on bacterial colonies of the oral cavity, and on biofilm.Streptococcus spp., Lactobacillus spp., Granulicatella, Corynebacterium, and Bifidobacterium  modifies the pH of the oral cavity, thereby altering the homeostasis of the microbiota and favoring the bioaccumulation of the pesticide in the lipophilic zone below the lamina propria.Lactobacillus and increased the count of LPS-carrying bacteria, which disrupt TJ junctions. Analysis of various studies on exposure to pesticides in the microbiota of various tissues and organisms revealed a decrease in Firmicutes and an increase in Bacteroidetes, a finding which, if extrapolated to the oral cavity, would have repercussions on its microbial balance. Furthermore, it was observed that exposure to diazinon and IM increased colonization by Fusobacterium spp., which favors the expression of mesenchymal markers and therefore may account for the development of metastasis. Overall, exposure to pesticides is related to the development of pathologies such as caries, periodontitis, and oral cancer.It is important to note that pesticides impact balance in the oral microbiome, and they influence proinflammatory activities that lead to the weakening of TJ junctions, and also increase the vulnerability of adherens junctions in the wall of the gingival sulcus and the gums. Exposure to OP and B decreased the count of"}
{"text": "The dual problems of the public crisis from the global epidemic and the deterioration of the ecological environment constrain the economic development in the Yellow River Basin. To promote the sustainable and balanced development in the Yellow River Basin, this paper takes public health, ecological environment, and economic development, as a whole, to study the coordinated development of the Yellow River Basin. Based on coupling coordinated theory, we use the SMI-P method to evaluate the coordinated development index of public health, the ecological environment, and economic development in the Yellow River Basin. Moreover, we use the coordinated regulation and obstacle factor diagnosis to identify the main influencing factors and design regulation methods to optimize the coordinated development index. The results found that (1), during the research period, there is spatiotemporal heterogeneity in the coordinated development level in the Yellow River Basin. From 2009 to 2019, the overall development index increased steadily, while the regional disparity in the coordinated development level was obvious. (2) The ecological environment indicators contribute more to the relevance and obstacle factors, such as the average concentration of fine particulate matter, per capita arable land area, afforestation area, etc. (3) After regulating the overall development level of the Yellow River Basin, we prove that Path 4, which comprehensively considers the relevance and obstacle factors, performs better. Since the outbreak of the global epidemic, COVID-19, there has been an increasing concern about public health issues ,3. MeanwUnder the background of ecological protection and high-quality development of the Yellow River in China, we explore the synergistic relationship among public health, the ecological environment, and economic development, which aims to provide effective suggestions for the high-quality development of the Yellow River Basin. Existing studies have shown that there is a close and complex causal relationship among the economic development system, public health system, and the ecological environment system . RelativFor the relationship between public health and economic development, the US Special Administrative Committee on Occupational and Environmental Medicine Health emphasized the impact of health on the economy from the perspective of health productivity and health care crisis . Nichol In terms of the relationship between public health and the ecological environment, about 1.6 million deaths each year can be attributed to the unhealthy air, which accounts for about 17% of all deaths in China . GrossmaFor the relationship between the ecological environment and economic development, existing studies verified that the inverted U-shaped relationship between economic growth and environmental degradation is based on the empirical framework of the Environmental Kuznets Curve (EKC) ,29. In r\u201cCoupling coordination\u201d originates from the field of physics and refers to the close connection between each internal and external element of two or more systems. It is mainly used in the field of climate change. As the research moves along, coupling coordination has been introduced to measure the nonlinear interactions between the ecological environment and economic development, as well as public health and economic development. Liao et al. measured the degree of coupling and coordination between economic development and the ecological environment in the Beijing-Tianjin-Hebei region of China, and they made policy recommendations for local coordinated development . Wu et ac); the optimal value (e) represents the maximum value of the indicator increased by 10%; the worst value (a) is the minimum value of the indicator reduced by 10%; the worse value (b) represents the interpolation of a and c; the better value (d) represents the interpolation of c and e.The evaluation method of \u201csingle index quantification-multi-index synthesis-multi-criteria integration\u201d , as shown in According to the established evaluation index system for the coordinated development of the public health, ecological environment, and economic development in the Yellow River Basin, we use the Compared to Using the coordinated development index of the upstream, midstream, and downstream, from 2009 to 2019 in From the perspective of each province, the development index of public health, the ecological environment, and economic development in nine provinces is mainly concentrated as 0.1~0.7, involving four levels of basically uncoordinated, less uncoordinated, close to coordination, and more coordinated. Specially, the coordinated levels of Qinghai, Gansu, and Ningxia are less coordinated, and Inner Mongolia, Shaanxi, Shanxi, and Henan are close to coordination. Furthermore, Sichuan has developed from close to coordination to more coordinated, and Shandong is more coordinated, which reaches the highest level of coordination. From the perspective of upstream, midstream, and downstream, the coordinated development level of the downstream is the highest, which is close to coordination, while the level of the midstream has changed from less coordinated to close to coordination. However, the level of the upstream is less uncoordinated, which demonstrates the massive gap among upstream, midstream, and downstream. The coordinated status of each subsection of the basin is consistent with the actual situation. There are, indeed, certain gaps and barriers in the coordinated development index between provinces, as well as the upstream, midstream, and downstream ,52.On the whole, the coordinated development index of each province and upstream, midstream, and downstream have shown an upward trend, which indicates that the coordinated development of the three subsystems of the Yellow River Basin shows a positive rising trend in the future.We used the coordinated development index of each province in k)) and the Based on the calculation of The degree of contribution to the three-subsystem coordinated development, of each indicator in the nine provinces, can be seen in We use Obstacle Factors Diagnosis to calculate the obstacle degree of each index of the nine provinces in the Yellow River Basin, in 2019, and select the eight indicators with higher obstacle degree rankings in each province as the main obstacle factors, which is shown in According to the coordinated development results calculated by the The original data are regulated through the coordinated behavior regulation path, and then, the coordination development index of each path is calculated by the On the whole, the results in In terms of the specific paths, Path 4 has the best coordinated regulation effect from the holistic watershed perspective, which integrally considers the correlation and constraints. The overall coordinated development index increases by 0.42. Moreover, the adjustment effect of other paths, from high to low, is Path 3, Path 1, and Path 2. From the adjustment effect of each province, the Path 4 is still the best one, while Path 1, Path 2, and Path 3 have their own advantages in the adjustment effect when applied to different provinces. In summary, the optimal adjustment method for the optimal set of coordinated regulatory behaviors should be comprehensively considering the correlation and constraints that affect the overall development index. For the indicator\u2019s adjustment, it is necessary to comprehensively consider its own relevance and obstacle factors, and finally, Path 4 is used as the optimal adjustment method in the paper.Existing studies have already developed several methods to quantitatively evaluate the overall coordinated development of the Yellow River Basin. Among them, the coupling coordination method is widely used. The coupling coordination method can measure the close relationship between systems and the influence of one thing on the others . Table 1ogeneity , which iogeneity ,57, but At present, the coupling coordination degree method is mainly used to evaluate the coordination development level . Comparein China . Zuo usein China .In addition, we considered the research scope. We chose the entire province of the watershed as the study area, instead of the prefecture-level cities, because it is difficult to form a relatively complete index system due to the inaccessible data in prefecture-level cities.(1)EEDI) has a higher base value but the slowest growth rate compared with the ecological environment index and economic index [PHDI) and the growth rate are in the middle level. The index of each subsystem in the Yellow River Basin tends to be consistent. However, the overall development index level is not prominent, and each subsystem still has a huge space for ameliorating the development level.The coordinated development index of the public health, ecological environment, and economic development, during the study period, shows an increasing trend ,49. The ic index . The bas(2)During the study period from 2009 to 2019, the overall coordinated development index kept growing steadily from 0.352 to 0.486. The level of coordinated development also has promoted from less coordinated to close to coordination. When discussing the coordinated development level of the upstream, midstream, and downstream, the upstream comes last, followed by the midstream, with the downstream topping the table . As for (3)In terms of correlation, the indicators that have a general impact on the overall coordinated development index of the Yellow River Basin, including the average concentration of fine particulate matter, the per capita arable land, the effective utilization coefficient of farmland irrigation water, the number of people engaged in scientific and technological activities, the number of higher education graduates, the number of beds in health care institutions, the number of travel agencies, and the number of medical institutions . In termBased on the coordinated development of the three subsystems of the ecological environment, economy, and public health, we research the nine provinces in the Yellow River Basin and construct the evaluation system for the public health, ecological environment, and economic development as a whole. In addition, the correlation degree and obstacle degree of the system indicators that affect its coordinated development index are calculated. Furthermore, the coordinated regulation method is adopted to regulate the index system. Based on the above processes, we draw some conclusions:Based on the above research results and conclusions, the following policy recommendations are proposed for the high-quality development in the Yellow River Basin.(1)In terms of the ecological environment, strengthen the intensity of sewage treatment, increase investment in sewage treatment facilities, ameliorate sewage treatment standards to reduce pollution of ecological water, and ensure water safety for residents. In addition, treating agricultural equipment, improving the utilization rate of agricultural irrigation water, and reducing the use of agricultural fertilizers and pesticides can reduce the burden on land and make land sustainable. Moreover, promote the transformation and upgrading of heavily polluted enterprises, use clean energy, develop new technologies, and improve the efficiency of resource utilization and the recycling rate of waste, thereby reducing solid particulate matter and harmful gas emissions and improving air quality. Furthermore, strengthen afforestation, increase the coverage rate of forests and wetlands in the Yellow River Basin, and promote the restoration of the ecological environment on both sides of the Yellow River and the prevention and control of river basin pollution to enhance the environmental carrying capacity and the ability to restore the ecological environment, and the ecological barrier function of the Yellow River Basin can be stably played.(2)In terms of economic development, consider the actual situation of the region, optimize the industrial structure, attach importance to technological innovation, increase investment in research and development, use the actual policy to introduce talents in order to transform the local industry into technology-intensive industries and enhance the local economic creativity. Furthermore, policies guide the increase in the share of the tertiary industry structure, and they increase the disposable income of residents to stimulate economic growth to achieve the purpose of stimulating residents\u2019 consumption and economic growth. Besides, regions should strengthen cooperation with neighbors, so provinces with better economic development can play a leading role in promoting the development of surrounding regions, accelerate economic development in poor regions, and narrow economic regional differences. At the same time of economic development, properly balancing the relationship with other industries enables the formation of a new regional economic pattern with complementary advantages and characteristic development, which realizes the sustainable development of the regional economy.(3)In terms of public health, raise the concept to guide population growth, improve the working welfare of medical personnel, and strengthen policy subsidies for drugs to reduce the degree of aging, improve the motivation of medical staff, and reduce the personal health consumption expenditure of residents. In addition, increase care for the elderly, strictly monitor drinking water resources, improve urban infrastructure and emergency facilities in provinces, and prevent public health crises caused by emergencies, so the lives, health, and safety of residents can be guaranteed, and the happiness and satisfaction of living can be improved. Furthermore, developing fitness and entertainment venues, travel agencies, and other venues for physical exercise and spiritual entertainment can improve the health of residents and achieve the goal of the Healthy China.(4)Promote the comprehensive management of the public health, ecological environment and economy subsystems. The economy can drive the improvement of ecological environment protection and public health, while the high quality of the ecological environment and public health can also promote economic development. Moreover, by breaking administrative barriers, promoting regional open cooperation, market cooperation, brand development, and benefit sharing, establish cooperative and mutual aid relationships and, ultimately, realize the overall high-quality development of the Yellow River BasinFrom an application point of view, the above suggestions may be helpful for policy design. In addition, the scientific and reasonable policies can improve the level of coordinated development of public health, the ecological environment, and economy in the Yellow River Basin, and they promote the high-quality development of public health in the Yellow River Basin, which is in line with our research purposes.Academically, the paper can effectively make up for the relative insufficiency of the current studies on the regulation method of the main factors affecting the overall coordinated development index, and it can also provide auxiliary reference for further research by other scholars. In the future, we will conduct more detailed research on the Yellow River flowing through prefecture-level cities. In addition, this study assigns one-third of the weight to each subsystem of public health, the ecological environment, and economic development, and future research will assign weight to each system in a more rational manner."}
{"text": "Synergistic development is the only way which must be passed and a key point to achieve high-quality economic development. This paper regards regional synergetic development as a composite system, builds up the evaluation indicator system, and calculates the level of economic synergetic development of Guangdong-Hong Kong-Macao Greater Bay Area Urban Agglomeration, by using the collaborative degree model of composite system. The results show that each subsystem of the composite system has a high degree of order from 2007 to 2019, but compared with Beijing-Tianjin-Hebei urban agglomeration and Yangtze River Delta urban agglomeration, the level of economic collaborative development of Guangdong-Hong Kong-Macao Greater Bay Area urban agglomeration in 2008\u20132019 is relatively low and has large spatial differences. The main reason is that under the background of \u201cone country, two systems\u201d policy, the institutional differences between Guangdong, Hong Kong, and Macao have not been effectively linked up and synergetic, Greater Bay Area urban agglomeration has not yet formed an organic whole, and the synergy effect of mutual support and promotion is relatively weak. Based on this, we should seize the great historical opportunity of the construction of Guangdong-Hong Kong-Macao Greater Bay Area, accelerate the construction of the mechanism for the synergetic economic development of the three areas, accelerate the establishment of an integrated market, build a reasonable division of labor system and collaborative innovation system, and jointly promote the synergetic economic development of Greater Bay Area. Outline Development Plan for the Guangdong-Hong Kong-Macao Greater Bay Area was released, marking that this national strategy, which was personally planned, deployed, and promoted by General Secretary Xi Jinping, has entered the stage of full implementation. In the Outline, \u201cpromoting the synergetic development of regional economy\u201d and \u201cexploring a new model of synergetic development\u201d are clearly defined as the guiding ideology and strategic positioning. The synergetic development here is a way to fully explore the potential advantages of various regions through efficient and orderly integration, promote the orderly flow and optimal allocation of factor resources to the greatest extent in space, and promote the formation of more effective and rational division of labor and cooperation, so as to release the development mode of the growth potential of new economy , the greater the value is, the greater the contribution of the subsystem to the composite system is. \u2202ij and \u03b2ij are the critical upper limit value and lower limit value of the order parameter, respectively. In the paper, the minimum and maximum values of the order parameter in the research period are selected as representatives. From the perspective of the whole composite system, the contribution of each order parameter component to the subsystem is closely related to its combination form and weight, namely, it needs to be realized through their own integration of \u03bc(bij). The paper adopts the linear weighting method to calculate the order degree of subsystem.\u03bc(bi) is the order degree of the subsystem, \u03bc(bi) \u2208 . The larger \u03bc(bi) is, the higher the order degree of the subsystem is, and vice versa. \u03c9jis the indicator weight which is determined by entropy method. First, assuming that there are m cities and n evaluation indicators, the order degree probability distribution of order parameter component isAmong them, \u03bc(bij) \u2208 , the entropy value of the jth indicator of the subsystem Ai isAs mentioned in equation (3), k=1/ln\u2009m, then, the entropy weight \u03c9j of the jth indicator can be defined asAmong them, Ai of the composite system of regional economic synergetic development in the period t0 is \u03bc0(bi), and the order degree in the period ti is \u03bc1(bi), then the synergy degree E of the regional economic synergetic development system isAssuming that the order degree of the subsystem At the same time\uff0c E is . The higher the value is, the higher the level of regional economic synergetic development is, and vice versa. Parameter u measure the synergy direction of each subsystem. When the value of u is 1, the synergy degree E is positive, which indicates that the order degree of each subsystem is in the rising stage, and the composite system is in the synergy and order stage; When the value of u is -1, E is negative, indicating that the order degree of at least one subsystem declines, and the composite system is in the unstable or unsynergetic stage.The value of Guangdong Statistical Yearbook, China Urban Statistical Yearbook, Hong Kong Statistical Yearbook, and Macao Statistical Yearbook over the years.The paper takes the panel data from 2007 to 2019 of the 11 cities of Guangdong-Hong Kong-Macao Greater Bay Area urban agglomeration, namely Guangzhou, Shenzhen, Zhuhai, Foshan, Zhongshan, Zhaoqing, Dongguan, Huizhou, and Jiangmen, as well as Hong Kong and Macao as the main research samples. The data sources of each indicator include Considering that the currency units used by cities in the Pearl River Delta, Hong Kong, and Macao are not the same, in order to facilitate the unification and calculation of indicators, the exchange rates of each year are converted into RMB for indicator statistics and analysis.For the missing original data, the mean method is adopted for processing. The indicator data that are not directly published in the statistical yearbook or annuals is obtained by calculation.According to the calculations of formulas to 5), t, t5), thBased on Referring to the method of Guo Shipping , the papChina Statistical Yearbook and China Urban Statistical Yearbook over the years, as well as the statistical yearbooks of provinces and cities. As shown in In order to further objectively and accurately grasp the economic synergetic development of Guangdong-Hong Kong-Macao Greater Bay Area urban agglomeration, the paper also measures the economic synergetic development level of Beijing-Tianjin-Hebei urban agglomeration and Yangtze River Delta urban agglomeration, using the same method as before. Beijing-Tianjin -Hebei urban agglomeration and Yangtze River Delta urban agglomeration are two regions except Guangdong Hong Kong Macao Great Bay Area in China that are expected to become world-class urban agglomerations, with relatively large economic development scale, relatively high speed, and relatively high population density. The statistical data of these cities are mainly from the From the perspective of the principle of synergetics, only when there is a close relationship between subsystems that promote and depend on each other can the composite system produce a synergistic effect in which the overall function is greater than the simple summation of local functions. Although the subsystems of the composite system have a relatively high order degree, the overall level of the synergetic economic development of Guangdong-Hong Kong-Macao Greater Bay Area is at a low level, lagging behind the Beijing-Tianjin-Hebei urban agglomeration and the Yangtze River Delta urban agglomeration, and there are large spatial differences. This shows that the degree of synergy between the urban agglomerations in Greater Bay Area is low, and the relationship of \u201cmutually beneficial symbiosis and win-win cooperation\u201d has not yet been formed. The reason for this situation mainly comes from the institutional differences between Guangdong, Hong Kong and Macao under the background of \u201cone country, two systems\u201d policy .Different from other urban agglomerations, Guangdong-Hong Kong-Macao Greater Bay Area is a cross-border cooperation of three independent tariff zones within the same sovereign country under the background of \u201cone country, two systems\u201d policy, and implements different political and social systems. This institutional framework ensures that the Pearl River Delta, Hong Kong, and Macao share the same fundamental and long-term interests, and lays a solid foundation for the synergetic development of the economies of the three places, but many institutional differences have also been produced, bringing many imbalances and asymmetries to the economic cooperation among the three regions. For example, Hong Kong and Macao are free ports with a high degree of internationalization and rule of law, perfect market economy rules, and little government intervention in the economy. However, the Pearl River Delta has not been formally integrated with the world economic system, the level of opening to the outside world and the development of market economy need to be improved, and the government-led characteristics are still obvious. At the same time, Guangdong-Hong Kong-Macao Greater Bay Area belongs to three independent tariff areas, so the circulation of goods in the Greater Bay Area faces different trade policies, tax arrangements, and regulatory systems; people from the three places need to apply for visas, so the number of visits is limited, and there are also restrictions on academic qualifications, quotas, duration of stay, social welfare, professional qualification recognition, and so on; the financial supervision systems of Guangdong, Hong Kong, and Macao are independent, the financial markets are isolated from each other, and the three currencies are not circulating with each other; the mainland has opened up to Hong Kong and Macao in the fields of telecommunications and Internet with conditions. The residents of Hong Kong and Macao need to switch networks and pay roaming charges to and from the Pearl River Delta. In order to adapt to or overcome these institutional differences, the market entities of Guangdong, Hong Kong, and Macao need to pay additional institutional transaction costs, resulting in that business activities cannot be carried out on the principle of profit maximization, which reduces the willingness to cooperate across regions. These institutional transaction costs may also cause market segmentation and monopoly, breed local protectionism and departmentalism, form intra-regional trade barriers, and reduce the efficiency and quality of resource allocation in the entire Great Bay Area, which is not conducive to the formation of an integrated market.Since the return of Hong Kong and Macao to China, in order to solve the problem of inclusiveness under the \u201cone country, two systems\u201d policy, a multi-level institutional arrangement from the central government to local levels has been carried out for many years, which helps to promote the in-depth cooperation among Guangdong, Hong Kong, and Macao, but the connection and synergy of the systems among the three places have never achieved a major breakthrough. Driven by a series of institutional arrangements including CEPA and Guangdong Pilot Free Trade Zone, the division of labor and cooperation in the service industry among Guangdong, Hong Kong, and Macao has achieved certain results. However, as the market opening and access conditions, and business environment of the three places have not been effectively connected, the division of labor and cooperation in the service industry among Hong Kong, Macao, and the Pearl River Delta still remains in the traditional fields such as transportation service, tourism service, and business service. Hong Kong's advantageous fields such as insurance, law, accounting, and construction have not really achieved effective connection and complementary advantages with the manufacturing industry in the Pearl River Delta. In addition, with the convergence of the economic development structure of the Pearl River Delta, Hong Kong, and Macao, as well as the improvement of the mainland's infrastructure, the three places have launched homogeneous competition in the fields of finance, logistics, exhibition, and scientific and technological innovation. Such a division of labor has not only prevented Guangdong, Hong Kong, and Macao from becoming an economic community and interest community with shared risks and interests but also brought too much internal friction to the construction of the Great Bay Area, which reduces the overall effect of economic development.Constructing a mechanism for synergetic economic development and uniting the awareness of common development of all parties: giving full play to the advantages of \u201cone country, two systems\u201d policy, constructing a common framework across the institutional gap, planning and laying out the development of Greater Bay Area as a whole, and promoting the three regions from complementary advantages to integration of advantages are important guarantees and top priority for the synergetic economic development of Greater Bay Area urban agglomeration. It is suggested to establish a \u201cLeading Group for the Synergistic Economic Development of Guangdong-Hong Kong-Macao Greater Bay Area Urban Agglomeration\u201d as the organization for overall planning, decision-making and synergy, which is responsible for promoting the synergy among the cities in the Greater Bay Area at the national level; the \u201cSynergy and Management Organization for the Synergistic Economic Development of Guangdong-Hong Kong-Macao Greater Bay Area Urban Agglomeration\u201d should be established as the daily leadership and executive organization for the synergetic economic development of Greater Bay area to be responsible for the implementation and implementation of various plans and designs, the formulation of supporting supplementary agreements and implementation rules, and the guidance of specific work; the \u201cSupervision and Management Organization for the Synergistic Economic Development of Guangdong-Hong Kong-Macao Greater Bay Area Urban Agglomeration\u201d should be set up to supervise the implementation of synergetic policies and measures, and restrict the behaviors of all partners according to the agreement. In addition, we should also construct a multi-level interest compensation mechanism in Greater Bay Area, coordinate the overall interests and local interests of the urban agglomeration in Greater Bay Area, and improve the motivation and willingness of the synergetic development of the three places.Constructing an integrated market in Greater Bay Area and accelerating the connection of business environment and rules: it is suggested that the duty-free policy for products originating in Hong Kong and Macao under the CEPA agreement should be extended to all products from Hong Kong and Macao, including imports from Hong Kong and Macao. We should continue to deepen the implementation of the measures for the opening of service trade under the CEPA agreement, try to cancel the restrictions on the share ratio and access conditions for the investors of Hong Kong and Macao to enter the finance, telecommunications, culture, and other fields of the Guangdong Pilot Free Trade Zone, relax the approval of investment fields and qualifications, cancel the foreign exchange management system, and construct an integrated financial market among the three regions. We should also encourage the telecommunication companies in the three places to cooperate in a win-win way and construct an interconnected, convenient and smooth Internet and communication network in Greater Bay Area, promote the electronization and automation of endorsement and customs clearance in the three places, speed up the construction of self-service customs clearance and inspection channels, and realize \u201cone endorsement, multiple trips.\u201d In addition, it is necessary to accelerate the formulation of unified industry service standards, professional qualifications and professional titles in Greater Bay Area, carry out pilot work of mutual recognition of professional qualifications in Greater Bay Area, explore the establishment of a list of professional qualifications of Guangdong, Hong Kong and Macao talents, and study and carry out mutual recognition of academic qualifications in the three places. We need to increase efforts to replicate and promote the successful experience of the reform in the areas of commercial registration, in-process and after event supervision in the free trade zone to other cities in the Greater Bay Area, and gradually improve the legal, international, and convenient business environment. Finally, we should reform the customs management system and the setting of layout, speed up the realization of the goal of \u201cLiberalizing the First Line and Managing the Second Line\u201d in Greater Bay Area, and promote the innovative models such as \u201cone place, two inspections\u201d and \u201ccooperative inspection\u201d .Constructing a reasonable division of labor system and form a regional community of interests: based on the existing two-wheel drive model of the advanced manufacturing and the modern service industry, a division of labor system of Greater Bay Area urban agglomeration with complementary advantages and misplaced competition will be formed to comprehensively improve the overall competitiveness. Guangzhou should play the central role as the \u201cheadquarters,\u201d maintain its radiation and diffusion capacity to the Pearl River Delta, and promote the upgrading of industrial structure by cultivating strategic emerging industries such as biomedicine, new materials, new energy, and marine biology. Shenzhen can make use of its high-tech industrial characteristics to improve the scientific and technological content and innovation level of manufacturing industry, realize the strong combination of technological innovation and financial industry, and form complementary advantages with Hong Kong. Foshan, Dongguan, and Zhongshan can accelerate the landing and transformation of high-tech achievements from Guangzhou and Shenzhen, and accelerate the transformation and upgrading of traditional manufacturing industries. Huizhou, Jiangmen, and Zhaoqing should actively undertake the transfer of relevant industries to achieve dislocation development. Hong Kong and Macao should actively integrate into the overall development situation of the Greater Bay Area, and take advantage of their service industry advantages to drive the transformation and upgrading of the manufacturing industry and the development of modern service industry in the Pearl River Delta. At the same time, we should consolidate and enhance the status and functions of Hong Kong as an international financial center, shipping center, and trade center, continue to give full play to the unique advantages of Hong Kong and Macao as \u201csuper contacts,\u201d and build the Great Bay Area into a high-level opening-up platform.Constructing a synergetic innovation system and creating a first-class science and technology bay area: innovation is the driving force for the synergetic development of the regional economy. We should strengthen the integration of innovation resources in the three regions, optimize the innovation environment, and construct a synergetic innovation system for Greater Bay Area. The major universities and scientific research institutes in Guangzhou can strengthen the research and exploration of basic frontier fields and the education and training of innovative talents. Tianhe High Tech Development Zone, science city, and other advantageous strategic platforms should strengthen the joint innovation with advanced manufacturing industries in Foshan, Dongguan, and Zhongshan. Shenzhen should focus on the development of high-tech industries and strive to achieve breakthroughs of the core technologies in the fields of new energy, new technology, biomedicine, energy conservation, and environmental protection. Many well-known universities and scientific research institutions in Hong Kong should strengthen their cooperation with universities and enterprises in the Pearl River Delta to accelerate the implementation and transformation of scientific research achievements while improving research and development capabilities. The three places should jointly construct a technological innovation service platform for Greater Bay Area, especially for small and medium-sized enterprises, to promote the smooth implementation of enterprise innovation activities and technological upgrading. The financial institutions should be encouraged to introduce capital into the process of industrial incubation and transformation of innovative technologies, and provide targeted financial products and services. The connection of intellectual property protection mechanisms among the Pearl River Delta, Hong Kong, and Macao should be accelerated to optimize the external environment for scientific and technological innovation. Finally, we should take advantage of preferential policies in registered residence, taxation, customs clearance, and other aspects to attract innovative talents and innovative enterprises to gather and flow freely in Greater Bay Area.The paper constructs an evaluation indicator system of regional economic synergetic development, applies the synergy degree model of the composite system to calculate the economic synergy level of Guangdong-Hong Kong Macao Greater Bay Area urban agglomeration from 2008 to 2019, and compares it with Beijing-Tianjin-Hebei urban agglomeration and Yangtze River Delta urban agglomeration. The following conclusions are drawn: (1) The economic synergy development level of Guangdong-Hong Kong-Macao Greater Bay Area has changed significantly in different periods, showing a gradual upward trend on the whole from non-synergy stage to primary synergy stage; (2) There are large spatial differences in the level of synergetic economic development of Guangdong-Hong Kong-Macao Greater Bay Area urban agglomeration. The level of synergetic economic development of sub-core cities is the highest, followed by core cities and non-core cities; (3) Through the comparison, the synergetic economic development of Guangdong-Hong Kong-Macao Greater Bay Area urban agglomeration has the roughly same trend as the Yangtze River Delta urban agglomeration and Beijing Tianjin Hebei urban agglomeration, but it is still at a low level. The main reason for these current situations is that the institutional differences under the background of \u201cone country, two systems\u201d policy in the urban agglomeration of Guangdong-Hong Kong-Macao Greater Bay Area have not been effectively connected and synergetic, resulting in loose cooperation among the three places, and the synergistic effect of mutual and joint cooperation is still relatively weak. Based on this, the paper puts forward the following countermeasures:"}
{"text": "Maternal and child malnutrition is a worldwide public health problem with short, medium, and long-term adverse consequences for both mother and child. In Mexico, maternal and child malnutrition represents a serious public health problem that must be urgently addressed. In this context, Primary Health Care (PHC) plays an important role in the prevention, detection, monitoring, and treatment of the different forms of maternal and child malnutrition. Assessing the quality of nutritional care offered at this level of care is necessary in order to improve it; however, there are no indicators for the evaluation of this quality. Therefore, this study aimed at developing a set of indicators to assess the quality of maternal and child nutritional care at PHC.We developed indicators for different stages of life: preconception, pregnancy, infancy, and preschool age. A systematic review of the literature on clinical guidelines for the prevention, diagnosis, and treatment of the different forms of malnutrition was carried out; the recommendations of the guidelines evaluated with good quality were extracted.Based on these recommendations, 22 indicators were constructed. A pilot study was carried out to validate the indicators and 16 indicators were selected to assess the maternal and child nutritional care at PHC. Maternal and child malnutrition remains a global health problem. The coexistence of undernutrition and obesity increases not only the risk of maternal morbidity and mortality but also impacts the fetal growth and development with short and long-term consequences . As repoIn Mexico, based on the 2020 National Survey of Health and Nutrition about COVID-19 , 76% of Primary health care (PHC) aims to ensure the highest possible level of health and wellbeing of an individual and populations; it ranges from health promotion, prevention, treatment, rehabilitation, and palliative care . It has Currently, there are essential nutritional actions addressed to eradicate maternal and child malnutrition in all its forms. Despite the proven knowledge, most countries have failed to reach their targets, sometimes due to the lack of coverage but also for neglecting specific goals. The nutritional interventions that are cost-effective and group-focused must be prioritized, considering the social context and the economic resources of each entity. In addition, for the improvement of the quality of care, it is necessary to reduce the gap between the scientific evidence, the politics and governance, and the resources destined to the centers of primary care \u201311.According to the World Health Organization (WHO), the quality of care is defined as the degree to which health services for individuals and populations increase the likelihood of desired health outcomes, and this must be according to the best evidence-based professional knowledge . In the Currently, there is limited information about the description and development of indicators for quality of nutritional care during preconception, pregnancy, postpartum, and infancy. In Mexico, all the efforts are focused on quality of care to identify obstetric risk factors without regard to nutritional care . It is iTherefore, we aimed to develop and validate quality of care indicators for maternal and child nutritional care on PHC in the environment of the Mexican Health System. Having indicators that allow us to evaluate the quality of nutritional care in the aforementioned stages of life will allow us to identify improvement areas in the quality of care offered in PHC in Mexico.The development of the indicators to evaluate the quality of maternal and child nutritional care at PHC was carried out by following six steps. In A systematic literature search was carried out in PubMed and websites for clinical practice guidelines, guidelines and position statements related to the prevention, diagnosis, and management of all forms of malnutrition during preconception, pregnancy, postpartum, and infancy and preschool children. To assess the quality of these documents, the methodology of the Appraisal Of Guidelines For Research and Evaluation II (AGREE II)  instrumeThe recommendations, based on the results of the systematic literature search, were reviewed by two researchers with experience in medical care at PHC. Recommendations whose measurement required information sources other than those existing in health units and those that involved care at a higher level than PHC were eliminated.In order to reduce the number of recommendations while maintaining those with the highest degree of recommendation and measurement feasibility, a prioritization matrix was constructed. For this, we used the scoring system according to compliance with criteria based on the degree of recommendation, the feasibility of application, and ease of obtaining the sample necessary for measurement and relevance .The review was conducted in pairs by experts in quality of care and the disagreements were resolved through discussion and consensus. The values of each criterion were added to obtain a total score ranging from 0 to 12 points, considering the recommendation to be more useful when the score was higher. The highest scores were selected for each step of the care process  at each stage .The selected recommendations were reviewed by a group of experts in nutrition and quality of care to reduce the set to a manageable number for collecting information in the field and to be valid for the context of care in health services in Mexico.For the development of the indicators, the methodology suggested by Saturno-Hern\u00e1ndez  was follBased on the structure of the indicators and their formulas, a data collection instrument was designed using Excel spreadsheets to facilitate its use in any electronic device.A pilot study was carried out to evaluate the reliability of the 22 indicators and the feasibility of their application. This study was performed in five PHC rural and urban units belonging to the Mexican Ministry of Health in the State of Mexico.The clinical records and nutritional control cards were the inputs to obtain the necessary information to evaluate the indicators. Each indicator was evaluated by two independent researchers by reviewing a systematic random sample of 30 clinical records and nutritional control cards for each life stage .The sampling was carried out through patient records on the Child Nutrition Status Control cards (SINBA-SIS-18-P) and Comprehensive Care for Pregnancy, Puerperium, and Lactation Period (SINBA-SIS-38-P)  from 202The reliability of the indicators was evaluated by inter-rater agreement based on the results of the kappa adjusted for prevalence and inter-rater bias (PABAK). Indicators with a result equal to or greater than 0.4 were considered reliable, taking into account the Benchmark scale .Feasibility was established based on the possibility of being measured through the available data sources in the medical units, recording the difficulties that arose during measurement.Based on the reliability and feasibility results, the group of experts carried out a second prioritization exercise to keep a feasible number of indicators that would be manageable by health personnel.Of the 922 recommendations identified in this work, 124 were excluded  since they were related to the second level of care or required information other than the available in health units. With the selected recommendations, 22 composite indicators were constructed and tested in the pilot study. The reliability of the indicators obtained in the pilot study is shown in Considering the aspects mentioned in \u201cMaterials and methods\u201d section, we selected 16 indicators to assess the quality of nutritional maternal and child care at health units at PHC . We deciWe carried out, for the first time in Mexico, a systematic and validated process for the development of indicators to assess the quality of maternal and child nutritional care at PHC that can be implemented within the Mexican health system.The activities evaluated by the 16 selected indicators coincide with the recommended evidence-based nutrition actions over the life course by WHO  for imprIt is important to consider that the validation of indicators took place in a period in which Mexico and the entire world were in a pandemic due to SARS-CoV-2. The pandemic conditioned, on the one hand, the low demand for services due to confinement measures, the difficulties in transportation, or the fear of getting infected; and on the other hand, the decrease in the supply of health services. The health services that were the most affected by this situation were family planning, prenatal, obstetric, and postnatal care, newborn care, child care, adolescents, sexual, and reproductive health, chronic diseases, and nutrition programs. The latter were completely interrupted in some cases . As a reThe principal limitation identified during the validation process was the inability to measure the feasibility of all indicators due to the lack of clinical records. Clinical records are the source documents for most studies on the health care process; however, it is important to be aware of the deficiencies that prevail in these records in clinical practice in general. Some authors point out that the lack of adequate clinical records is not incompatible with good clinical practice . NeverthIn the pilot study, neglect or even lack of clinical records was observed; this did not allow the evaluation of relevant aspects of the care process for the different forms of malnutrition. This lack of clinical records may be due to an omission of care activities carried out by health personnel, which could cause problems in monitoring the health status of health service users. The absence of clinical records is also evidence of the quality of the care process.In addition, for some indicators, the number of medical records necessary to be able to estimate the reliability statistics was not completed. However, it was considered necessary to maintain some indicators that presented difficulties for their measurement, due to the relevance indicated by the scientific literature and the experts. For example, regarding the indicators of the preconception stage such as \u201cFolic acid supplementation,\u201d no records were found about patients who were planning a pregnancy; therefore, to assess the care provided to this group, alternative sources must be used, such as the registry of pregnant patients. Even though feasibility and reliability could not be evaluated in the indicators belonging to preconception, we decided to keep them in the group of the 16 final indicators due to the importance of the nutritional status at this stage in the course and outcome of pregnancy in both the mother and the offspring.Despite the limitations, to our knowledge, this is the first effort to design and validate a systematic set of indicators to evaluate the quality of maternal and child nutritional care. We consider it relevant to have indicators that allow evaluating the quality of maternal and child nutritional care that make it possible to highlight areas of opportunity, variability of care, and progress in the improvement of care. This study provides a path to focus on quality-improvement initiatives within PHC. The 16 indicators developed were used to assess the quality of maternal and child nutritional care in health units of PHC in six states in Mexico. The results of this evaluation will be published shortly.The systematic use of the 16 indicators at the PHC to monitor and evaluate the quality of maternal and child nutritional care could contribute substantially to improving the nutritional status during preconception, pregnancy, postpartum, infancy, and preschool stage at the individual and population level.The original contributions presented in this study are included in the article/MA-M, SH, IO-G, and SB-M: conceptualization and design. MA-M, IO-G, SH, AB-M, OA-R, MV-C, EM, CP, SB-M, MK-H, CM-M, MM, BS, MB, MS, and FC: investigation. MA-M, IO-G, AB-M, OA-R, CP, MV-C, MB, MS, AC, BS, and FC: supervision of the investigation. MA-M, IO-G, SH, AB-M, OA-R, MV-C, EM, MK-H, CP, SB-M, MB, MS, and FC: methodology. IO-G, SB-M, AC, BS, and AT-D: data curation and organization of the databases. EM, AB-M, and OA-R: formal statistical analysis. MA-M, IO-G, AB-M, OA-R, MK-H, CM-M, MM, and FC: review and edition of the manuscript. All authors contributed to manuscript revision, read, and approved the submitted version."}
{"text": "Food Security, Sustainability, and Food Policy, and these journals focus on the publication of comprehensive views from interdisciplinary perspectives. (2) Studies on food security cover 138 countries or regions. The top three countries in terms of the number of published articles are the United States, the United Kingdom, and China. Among the top 20 countries in terms of the number of published articles, European countries are highlighted. (3) Climate change, food security, agriculture, policy, and management are the other high-frequency keywords in the field of food security; climate change occurred 321 times. The word sub-Saharan Africa also occurred more frequently, indicating that food security in sub-Saharan Africa has attracted wide attention. (4) The food security theme mapping clearly showed the research status and future development trends of various topics in the field. Currently, food production, climate change, and sustainable development are the most popular themes. Research on food sovereignty, ecological agriculture, child obesity, and other aspects is an emerging field. (5) We predict that in the future, the field of food security may focus on the expansion and improvement of the food security evaluation system, the balance between sustainable development and food security goals, the improvement of agricultural production and management efficiency, and the research on government policies and strategies. Our results provide a reference for grasping the current situation, key research direction, and development trend in the field of food security.Food security is related to human wellbeing and sustainable development and an important guarantee for world peace. In the context of global climate change, increased food demand, resource depletion, conflicts, and frequent public health emergencies, food security is widely seen as one of the top challenges. Food security research has obvious interdisciplinary characteristics, involving a wide range of fields. We analyzed the literature on food security in the Web of Science core collection from 1991 to 2021, using bibliometric methods with the aid of the Biblioshiny software package. By collecting, screening, analyzing, and visually expressing the literature data, the following conclusions were drawn: (1) In the past 30 years, the annual number of publications on food security increased. The period can be divided into three stages: 1991\u20132003 as the budding period, 2004\u20132012 as the development period, and 2013\u20132020 as the high-yield and active period. The top three journals discussing food security issues are  Food security concerns the stability of the international community and human wellbeing and plays an important role in sustainable development. The 2030 Agenda for Sustainable Development lists hunger eradication, achieving food security, and improving nutritional status as high-priority areas in the 17 Sustainable Development Goals , highligCurrently, research on food security mainly includes the connotation of food security, the influencing factors, and how to guarantee food security. In 1974, the UN Food and Agriculture Organization first defined food security as \u201cwe should ensure that anyone anywhere can get enough food for survival and health in the future\u201d  Which topics containing food are the most popular in academia?(2)What is the current state of global cooperation on food security?(3)How do the keywords in food security research cluster together?(4)What areas of food security need further research?Research in the field of food security involves multiple disciplines and the comprehensive analysis of food security-related research from an interdisciplinary perspective to obtain an in-depth understanding of the current research situation. After Pritchard proposed the term bibliometrics in 1969, bibliometrics attracted global attention, which was most evident in the late 1970s. Bibliometric research mainly focuses on three fields: methodology, scientific information, and scientific policy, of which the first is the basic research field [Web of Science is the largest and most comprehensive collection of information resources in the world and contains more than 12,000 authoritative and high-impact academic journals in the fields of natural sciences, engineering, and biomedicine. We used the Web of Science core collection from the Web of Science database as the data source; the search method was the Topic Subject (TS) search, and the language was English. The search formula is TS = (\u201cFood Security\u201d or \u201cGrain Security\u201d). After deduplication and screening, 3734 documents in the field of food security, published between 1991 and 2021, were obtained, including 2832 research papers; 64 conference papers; 402 review articles; and 436 books, book chapters, letters, and other types of documents.Bibliometry, a traditional quantitative analysis method in the field of library and intelligence science, originated during World War II. After a long development period, it has been used in many disciplines and has become an important analysis method in scientific research. We combined bibliometric and other measurement research methods to process the retrieved literature information. The resulting data were further explored and analyzed using the software packages Bibliometric and VOS viewer and finally visualized for expression. This paper mainly observed and interpreted the overall literature data in the field of food security based on the publication volume evolution trend analysis, historical citation analysis, popular journal analysis, high-yield author analysis, main research country/institution analysis, keyword analysis, and theme analysis.The first step in a research review is conducting a research design, including raising research questions, clarifying research objectives, and identifying research methods . The secThe number of documents is an important indicator of the development stage of a certain field and a reference standard to predict the future trend. Food Security in 2009, on the issues of \u201chow to define food security\u201d and \u201chow to measure food security\u201d [By analyzing the local and global citation rates of the articles in the field of food security, we found that most of the top-cited articles were published around 2010, indicating that the research results in the field of food security during this period were more influential . The artecurity\u201d . The sececurity\u201d . The estecurity\u201d . Dana [2ecurity\u201d  called fecurity\u201d , the conecurity\u201d , and theecurity\u201d ,25. In aecurity\u201d ,27 also Food Policy, entitled \u201cFood security: a post-modern perspective\u201d [Global Environmental Change, revealed the possibility of a phosphate shortage in the future, emphasizing the importance of scientifically managing the phosphorus resources in the global food system.In Biblioshiny, 20 nodes were selected, representing seminal work within the domain and some classical studies . The earpective\u201d , with thpective\u201d , publish2. The core area was composed of seven journals; the journal with the largest number of articles was Food Security, and that with the highest H-index was Food Policy , with 119 articles. It is an international organization dedicated to providing research on food security, hunger eradication, and poverty and is a benchmark research institute in the field of food security. It is followed by Cornell University and Wageningen University, with 75 and 70 papers, respectively . The foritations . The ageKeywords are a high-level summary of the topic of the article, and analyzing keywords in the field can quickly and accurately capture research hot-spots. Regarding the field of food security, the frequency of individual keywords represented the number of research findings. Climate change was the most frequently encountered keyword and was detected 321 times. Climate change directly affected the four pillars of food security  and had the most extensive impact on food security. The second most frequently occurring keywords were agriculture, policy, management, poverty, and insecurity, indicating that these aspects were highly related to food security. Sub-Saharan Africa (68 times), China (50 times), and India (27 times) appeared as keywords, showing that these countries were the focus of food security research . For a lTheme mapping is a method that combines the advantages of traditional indexing and artificial intelligence, with keywords as the core of the data model to efficiently analyze its centrality and density, with the aim of exploring and reasoning about research topics. Theme maps can solve the problems caused by a large amount of disordered information. The horizontal and vertical axes indicate centrality and density, respectively, representing the workload and importance of the subject, respectively . The theFood production, climate change, and sustainability are currently the most popular themes, with high research density and centrality in the field of food security. The topics related to water security, energy security, water footprint, and the environment, whilst receiving a lot of attention, are not closely integrated with food security. The number and centrality of studies on food sovereignty, ecological agriculture, and childhood obesity were not high, indicating that these are emerging fields. In recent years, due to the impact of international conflicts and the COVID-19 pandemic, the issue of food sovereignty has received extensive attention . ResearcResearch on food security concerns various areas, and the content of such research has been constantly enriched, with significant progress in recent years. Studies in this field are of great significance for judging the development trend of food security scientifically and rationally. The development and evolution of the concept of food security have obvious stage and historical characteristics. The understanding of the connotation of food security has been constantly enriched and improved, and the results have gradually changed from theoretical to applied results. At first, food security mainly emphasized the sufficiency of food production and supply. After that, studies in food security began to pay equal attention to the total amount of food and quality safety and to the balance of food supply and demand ,6. In reThe whole research and development process in the field of food security can be understood through the analysis of article references, high-frequency keywords, countries and institutions, and thematic maps. At present, the mainstream view is that the countermeasures and suggestions for food security should be discussed mainly based on the four pillars, availability, access, utilization, and stability. Climate change, food nutrition and security, and sustainable agricultural development are hot issues in the field of food security research. From the perspective of disciplines, the interdisciplinary trend of food security research is obvious, and a growing number of scholars in environmental science, demography, and geography are paying attention to food security. Some research fields focus on ensuring food security and putting forward corresponding countermeasures and suggestions. Scientists construct the evaluation index system of food security from the perspective of food production, distribution, consumption, and food reserves . Among tThe goal of food security research is to achieve food security in quantity, quality, and nutrition. Although the grain output still maintains a steady upward trend, and the nutritional level continues to improve, guaranteeing food security still faces enormous challenges, and the food security situation is still severe. Climate change poses many food security issues. Studies have shown that rising global temperatures and more extreme weather events will reduce the production of major food crops such as wheat, corn, and rice. To adapt to future climate change, adopting improved varieties, changing planting dates, and optimizing irrigation systems are important measures. Considering the productivity and sustainability of food and achieving the dual goals of food security and sustainable development are crucial topics. Agriculture accounts for 34% of greenhouse gas emissions, with the majority of them coming from land-use changes caused by agricultural activities and the rest from the food production supply chain . AchieviAgro-ecosystems are heavily dependent on water resources, and an increase in food demand will inevitably lead to an increase in water demand . Many scAccording to our analysis of the existing research results, we believe that the following issues in the field of food security will receive attention in the future:(1) Improvement of the evaluation system for the food security level: The global food security measurement requires a complete indicator system. Demographic, climate, financial , and policy factors combined influence food security. In 2000, the Committee on World Food Security comprehensively considered consumption, health, and nutrition and formed seven monitoring indicators: (a) the incidence of undernourished population; (b) per capita dietary energy supply; (c) the proportion of grain and rhizome food calories in the per capita dietary energy supply; (d) life expectancy at birth; (e) mortality rate of children under 5 years; (f) proportion of underweight children under 5 years; (g) proportion of adults with a body mass index >18.5. Although the developed countries have sufficient access to food as a whole, local food insecurity is the main problem. For many developing countries, the root cause of food security is still food insufficiency caused by poverty. Numerous publications related to the indicator system have also been produced at national and regional levels, but the current evaluation indicator system is still not comprehensive enough and can only reflect part of the food security level. Food security at the micro-level has gradually become a hot topic, and the measures at the family and individual levels need to be further improved.(2) Balancing sustainable development and food security: In the early stage, the degradation of natural resources, the decline in farmland production potential , and wat(3) Research on improving agricultural production and management efficiency: There are still defects in grain production, sales, and management, along with an unreasonable allocation of resources and an untimely market supply. Improving the quality of agricultural products , adjusti(4) Research on government food security policies and strategies: Currently, there are more severe food shortages in the world\u2019s hunger hot-spots. In the context of intensive agricultural development, the rapid development of high-tech fields and the formation of technical barriers have widened the gap in the level of food security among countries. In the case of insufficient policy and institutional guarantees, along with the development of technology, the agricultural technology gap between developed and undeveloped countries will widen increasingly, making the poor population face a more serious food crisis. In the face of conflicts and disputes, natural disasters, and public health emergencies, the type of food security policies should also be the focus of sustainable food security research.The comparative analysis of relevant studies helps to determine differences, make up for deficiencies, and enrich research results. At present, research on food security involves factors such as concept, population, production, circulation, trade, policy, and the environment. The research perspective is multi-dimensional, and it can deeply discuss some specific issues. The literature is fruitful, and this research field is receiving increasing attention. However, the discussions on food security are scattered, ignoring the systematic characteristics of the research object, and it is difficult to form a unified logical main line connecting different research perspectives. We understood the development of food security research from a macro-perspective and noted the correlation between major research groups and countries as well as the distribution of research topics; we also analyzed the research results of major articles and authors. Our research attempts to clarify the cognitive context of academic circles on hot issues of food security help scholars understand the latest content of food security and can provide a reference for in-depth research on food security issues.This paper only used the core dataset in the Web of Science database as the data source. According to the retrieval conditions, the publications were from 1991 to 2022. Undeniably, there were some important research achievements before 1991. In addition, to exclude the interference of non-whole years with the research results, our research includes studies published before 31 December 2021. Therefore, we only analyzed the research results related to food security in the past 30 years. Our research is based on a single database, ignoring articles included in Scopus, CNKI, and other databases. In our following study, we will therefore explore how to incorporate other databases according to the current discussion, with the aim of expanding our research horizon.Food Security, Sustainability, and Food Policy published the largest numbers of articles and are dedicated to the discussion of food security issues, focusing on the publication of comprehensive views from interdisciplinary perspectives. Food security research covers 138 countries or regions, and the United States is at the vanguard in both quantity and quality. China is the developing country with the most significant contribution to food security research. Food security in sub-Saharan Africa, India, and other regions has received extensive attention. It is worth noting that most mature countries and institutions studying food security are located in Europe. Therefore, strengthening international cooperation in food security is the key to solving the world food problem. Climate change is the most frequently occurring keyword in the field of food security, followed by agriculture and management. The food security theme mapping shows that food production, climate change, and sustainable development had the highest research centrality degree and densities in the field of food security. Poverty in sub-Saharan Africa and India is an important theme for food security. At the same time, it is predicted that ecological agriculture, nutritional security, and food sovereignty will be research topics with good prospects.In this study, we quantitatively analyzed the current state of research in the field of food security, based on the literature related to food security in the Web of Science database and combining the advantages of different bibliometric software packages. The results show that in the past 30 years, food security has experienced three stages of development, namely the initial stage, the development stage, and the high-yield and active stage; scholars\u2019 understanding of the connotation of food security has been enriched and improved; and the research results have gradually changed from theory to application and are more practical and operable. The journals To realize the world food security vision, the increasingly complex context of the global economy, including global climate change, production factors, technological progress, and international cooperation, needs to be considered. Maintaining and developing food security under the premise of sustainable development is the core of food security. Improving the food security index system, balancing the relationship between sustainable development and food security, improving the efficiency of agricultural production and management, and research on government food security policies and strategies will be the focus of the future."}
{"text": "Over the years, the Mexican population in the United States has faced high prevalence of health-related inequalities and disadvantages and represents one of the most vulnerable migrant groups in the country. To help reduce the gaps in health care for the Mexican population, the Mexican government, in collaboration with strategic allies from various sectors, launched the Ventanillas de Salud (VDS) strategy, which was subsequently reinforced through the Mobile Health Units (MHU) care model. Both the VDS strategy and the MHU care model are intended to contribute to the development of initiatives, projects, and actions in health that will benefit the Mexican community living in the United States, which lacks or has difficulty accessing health services. This article provides a descriptive, analytical analysis of the VDS strategy and the MHU care model, as unique collaborative models, which can be replicated, and have achieved a positive impact on the health of Mexican and other Hispanic communities in the United States, at both the individual and community level. According to data from the Current Population Survey 2020, the Hispanic population in the United States (62.1 million people) represents 18.6% of the total population (331 million), while the community of Mexican origin (38.5 million) accounts for 11.5%. Within this Hispanic community, the majority have American citizenship (80.2% Hispanics and 81.2% Mexicans), either by birth or naturalization; one in 10 obtained Legal Permanent Resident status and one in 10 lacks documents for their legal stay in the United States. In absolute numbers, 10.8 million of all Hispanics lack medical coverage, of which 7.2 million are of Mexican origin . This annual event takes place in October when health is promoted and access to various medical services and prevention activities is facilitated  strategy was implemented as a pilot project in the Mexican Consulates in San Diego and Los Angeles, California, with the support of the United States-Mexico Border Health Commission (USMCB), the United States-Mexico Health Initiative , the University of California and The California Endowment .To fulfill its mission, VDS has over six hundred allies which include health institutions such as hospitals and federal health centers, community clinics, government organizations and educational institutions, which contribute to providing screening services, delivery of printed educational material, and help with navigating the health system in the United States, among others. These collaborative partners comprise a broad and valuable network that provides comprehensive preventive health services including health education, screening, and referrals.To strengthen the VDS, the Mobile Health Units's (MHU) care model was created to provide preventive health services to remote communities with difficult access to health services. Eleven MHU currently operate in cities with a large concentration of Hispanic populations: Chicago, Dallas, Denver, Las Vegas, Los Angeles, Miami, New York, Orlando, Phoenix, Raleigh, and Tucson .The VDS strategy was initiated in response to the success of the Binational Health Week and its acceptance by the community. During this event, preventive and health promotion services are offered annually to Hispanics who typically experience barriers to accessing such services in the United States. Such improved access and acceptance led community leaders and local organizations to request long term continuity of these services. In 2003, the VDS strategy was implemented as a pilot project at the Mexican Consulates in San Diego and Los Angeles, California, with the support of the United States-Mexico Border Health Commission and the United States-Mexico Health initiative , from the University of California and The California Endowment. In 2004, the VDS strategy was formally launched and extended to other consulates. With the aim of strengthening and expanding the coverage of preventive health services for the Mexican community in the United States to remote communities unable to access health services, in 2016, the first phase of the MHU care model was implemented in Dallas, Los Angeles, New York, Phoenix and Chicago. Its services were subsequently extended to Denver, Las Vegas, Raleigh, Orlando, Miami, and Tucson .The VDS strategy is an example of government and institutional collaboration with strategic allies in Mexico and the United States. The resources, both monetary and in kind, required to provide basic preventive services, are contributed by the following actors:Seed moneyInstitutional collaboration- Mexican govermentSpace on their premisesTechnology and support officeAlliancesTraining- Consular networkManage and operate the VDSSelect and hire staffGenerate intervention projectsOrganize fairs and events- Lead agenciesProvide specialied personnelPerform screening tests and administration fof vaccinesCarry out workshops and deliver educational materials and workshopsParticipate in health fairs and training- Network of associated agenciesThe VDS strategy has an advisory board comprised of nine members, including leaders in the health and migrant assistance sectors, who represent different sectors: government, academia, the non-government sector, and international organizations, from Mexico and the United States. The purpose of the Advisory Board is to provide advice on management, innovation, and binational managerial strengthening processes with the various sectors to improve strategy .In general, VDS and MHU focus on conditions with the highest incidence rates among the Mexican population living in the United States, grouping services into five categories:Counseling on prevention and health promotion issues through advice on priority health issues, such as nutrition, obesity, diabetes, women's health, child health, mental health, addictions, HIV/AIDS, and access to services, among others.1) Timely detection of various ailments, using measurements such as body mass index, cholesterol and glucose tests, and HIV/AIDS and COVID-19 tests.2) Referrals to health services available in their locality (community clinics), related to cultural and language particularities, to receive medical care if necessary and/or establish a medical home.3) Administration of flu and COVID-19 vaccines and for other illnesses.4) Advice on health insurance alternatives in the United States.5) Activities undertaken by VDS and MHU are based on training health promoters in priority health issues to strengthen their skills and provide comprehensive preventive health services for users . During In addition, these activities were supported using culturally adapted educational materials in Spanish focusing on health promotion and disease prevention. Between 2020 and the first semester of 2021, technical content was developed on various priority health topics , which subsequently allowed the design of 301 educational materials. The material is disseminated in community events and through social media networks: Facebook, Twitter, Instagram, YouTube, and the VDS strategy website.Likewise, in 2018, the Mexican Section of USMBHC launched the mental health initiative. In collaboration with the Pan American Health Organization (PAHO), it implemented training in the Mental Health Gap Action Programme (mhGAP) Intervention Guide designed to help health personnel and community health workers  reduce gaps in mental health. The training covers issues such as risk factors and warning signs of mental illness and information on depression, anxiety, trauma, and psychosis either to help a person cope with the mental health problem and/or to refer them in a timely manner to professional help .SICRESAL-MX, the data collection system previously described in the methods section, is the official mechanism for registering users of VDS and MHU services and for generating real-time quantitative data describing the sociodemographic and health conditions of users and the VDS and MHU services received by users. The database is a rich source of information with about 283 variables. Its importance lies in the fact that the capture of such data through the registration process enables its analysis through descriptive statistics for decision-making and the strengthening of preventive health services.The VDS strategy has met the needs of their users by providing comprehensive health services through culturally adapted preventive health promotion actions, by contributing to disease control, and preventing the use of emergency service through timely detection.The MHU care model has taken these services to remote communities that are unable to access health services, thus, reaching a sector of a vulnerable community and broadening the scope of services.According to data from SICRESAL-MX, between 2019 and 2021, the VDS and MHU served approximately 6.4 million people and provided 20.7 million services, of which 88.2% corresponded to counseling or advice, 8.1% to screening, 3.1% to vaccination services, 0.2% to information on other issues, and 0.1% to referrals. This level of care has achieved a favorable impact on the health of Hispanic VDS service community in the United States by offering preventive services that enable identifying ailments and raising health issue awareness. In addition, it contributes to disease control and prevents the use of emergency services through timely detection, service availability advice, and aiding in the establishment of a medical home. Likewise, because of the COVID-19 pandemic, services were expanded to adapt to the new context.Of those receiving screening services for specific conditions at the VDS and MHU, the most important data are presented below :Glucose screening showed that two out of every 10 people screened at VDS and three out of 10 at MHU displayed high levels.An alarming piece of data is that around three-quarters of people screened in VDS and MHU have overweight and obesity problems, especially men.In general, three out of 10 users attended VDS and MHU had high cholesterol levels. Once again, a higher percentage of men experienced this condition compared with women, especially among those who attended VDS.While six of every 10 persons had high blood pressure, women experienced a higher prevalence than men.During the period of analysis (2019\u20132021), data from the SICRESAL-MX related to family history of illness of 41,000 people receiving either VDS and/or MHU services showed that 55% have a family history of diabetes and 20% have a family history of obesity. In addition, 452 mental health screenings were performed during this period indicating the prevalence of the following: depression (40%), anxiety (16%), psychosis (14%), violence (8%), sexual problems (8%), and other more rare conditions (14%).During the period of analysis, just over 154,000 people were served at VDS and MHU and provided information on their medical coverage . These dThe services provided by VDS and MHU in the United States are crucial for several reasons:First, there is a large and growing size of Hispanic population living in the United States. According to data from the most recent Census conducted in 2020, the total Hispanic population living in the United States amounted to 62.1 million, of whom approximately 62% were of Mexican origin (38.5 million people).Second, it addresses the predominant characteristics that act as barriers to medical care among this population such as their economic status, limited command of the English language, and limited access to health services that result in them suffering from poorer health.Third, the VDS and MHU address conditions that stem from a history of chronic-degenerative illnesses and diseases among the Mexican population, such as obesity, diabetes, and hypertension, documented both in Mexico, through the National Survey of Health and Nutrition , and theFourth, in recent years mental health has become a major concern in offering preventive and holistic care and giving it the same level of care as physical health problems receive. VDS and MHU began an initiative to approach healthcare among Mexicans in the United States to detect mental health signs and symptoms, and to refer them to access local or online services.Fifth in the face of the COVID-19 pandemic, VDS and MHU adapted its services and system and type of care offered to continue providing in person preventive services, such as administering vaccines, also, providing remote services, showing their ability to adapt and respond to emerging needs.Given these characteristics and based on the results of the quantitative analysis, both VDS and MHU are considered successful models in managing to detect the specific needs of their users and adapting to the context where they are implemented. They have also been strengthened over the years, thanks to their network of strategic allies in each consular district, which in turn manifests their perseverance, coordination, and institutional commitment.VDS and MHU have proven to be an important model of collaboration. Through alliances with institutions from different sectors, VDS and MHU have managed to direct outreach to a vulnerable sector of the Hispanic population to reduce the gap in access to health services. It is a unique care model, serving co-nationals in another country, contributing not only to the benefit of the health and wellness of Mexicans in the United States, but also to the health and wellness of other neighboring Hispanics.The ability of the VDS/MHU to effectively organize and manage health outreach services and to connect clients to these services, particularly in the area of COVID-19 and mental health, is a testament to the strength of its diverse network of collaborators in Mexico and the United States.In conclusion, we would like to suggest the following actions to strengthen the VDS and MHU services and ensure the continuity of the strategy. First, VDS and MHU should identify and formalize collaborations with strategic allies to promote the supply and distribution of the COVID-19 vaccine and others vaccines to the neediest and most vulnerable migrant communities. Second, it is also important to strengthen the mental health module. The relevancy of this module was highlighted by the COVID-19 pandemic and the detrimental impact on mental health related to social distancing and sheltering in place. Third, the VDS and MHU requires greater dissemination of the work carried out to strengthen their actions and give continuity to the strategy.The VDS strategy has been instrumental in providing much needed health-related preventive services to hard-to-reach populations and communities which they would otherwise have been unable to obtain.The datasets generated for this study are available on reasonable request to the corresponding author.IL and SS first draft and data analysis. MR, AL, AR, MC, LG, and CR revision and final draft. All authors contributed to the article and approved the submitted version.Initial funding for the project provided by the Mexican Government.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer KD declared a past co-authorship with the authors MG and CR to the handling editor.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "The growing pressure of anthropogenic activities on ecosystems and the ongoing climate change, as well as natural phenomena, influence the set of organisms organized in communities and ecosystems. Among the stressors that affect organisms are (among others): global warming and the resultant increase of temperatures of water and terrestrial habitats, the spread of pollutants e.g., metals, pesticides, persistent organic pollutants, or drugs. All organisms, subjected to the influence of these agents, react in altered metabolism, malfunctions of physiological processes, or behavioral alterations. If not balanced, these changes may lead to significant changes in populations and whole ecosystems. Importantly, the human-derived negative stimuli are often sudden, which disturbs the homeostasis in organisms.2-acidification and desiccation. The papers deal with the important groups of invertebrates: insects and crustaceans. Also, the range of the levels of biological organization, tested within the studies was wide: a transcription factor p53, heat shock proteins (Hsp70 and Hsp90), enzymatic activity, cellular studies, metabolism, reproduction, locomotion, morphology, and survival. As one can notice, the authors of the present Research Topic focused on the global-change threats. Among the most important findings, we may find the results indicating the importance of p53 proteins, which take part in the regulation of cell cycle, for the survival in the altered salinity of water as a habitat, significance of Hsp proteins in response to the environmental stress, relation between altered physical properties  and development of representatives of invertebrates.The importance of responding to the growing anthropo-pressure has repercussions in scientific literature. There is a growing interest of the scientific community in the effects of anthropogenic activity on living organisms. A brief analysis of the number of papers published on this topic shows the increasing trend of publications concerning pollutants, the environment, and invertebrates . These aRen et al for the first time reported that the expression of p53 mRNA and p53 protein levels are increased in case of altered salinity. Moreover, apoptosis and activity of antioxidant enzymes in the gills of arthropods exposed to stress varied significantly. The prooxidant-antioxidant balance is crucial for the homeostasis of organisms, and the imbalance may lead to numerous important diseases within organisms and play an important role in various pathological conditions, leading to cell damage. Next, Glyphodes pyloalis, based on studies of Hsp proteins. They also highlighted these proteins\u2019 role in response to stressors. On the other hand, Leiva et al. presented a set of data showing the classical toxic effects: survival, biomass, development, and morphology. Interestingly, they integrated the abovementioned effects with the metabolic rate and antioxidant-enzyme activity. Their results clearly show the thread caused by anthropogenic changes in the biosphere of living organisms, including endangered species, and a wide range of levels of biological systems. Engell Dahl and Renault showed the effects of desiccation\u2013which may coincide with the effect of global warming\u2013on a beetle, Alphitobius diaperinus. They also focused on the similar effects on the level of organisms: survival, locomotion, and reproduction. The tenebrionid beetles are quite resistant to the lack of water, as they often live in crop and food stores. However, the stress led to reduced fertility. Together with the previously mentioned research of The presented results show the complicity of the effects of stressors, as well as the importance of keeping homeostasis at all levels of biological organization. Taken together, the papers presented in this research topic show complexity of effects caused by environmental stressors on invertebrates. The imbalance of homeostasis can be observed at all levels of biological organization, from biomolecules, through suborganismal levels, up to the levels of individual organisms and populations. This, in consequence, may lead to drastic changes within ecosystems. The results indicate the importance of multi-level research on the effects of stressors on invertebrates."}
{"text": "Nature Communications 10.1038/s41467-019-13929-1, published online 05 February 2020Correction to: In the published version of this paper, the members of the Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium were listed in the Supplementary Information; however, these members should have been included in the main paper. The original Article has been corrected to include the members and affiliations of the PCAWG Consortium in the main paper; the corrections have been made to the HTML version of the Article but not the PDF version. In the PCAWG Drivers and Functional Interpretation Group, the affiliation for Erik Larsson has also been changed from \u2018Computational Biology Center, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.\u2019 to \u2018Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden\u2019. Additional corrections to affiliations and author names have been made to the PDF and HTML versions of the original Article for consistency of information between the PCAWG list and the main paper."}
{"text": "Infectious Diseases of Poverty [Global Report for Research on Infectious Diseases of Poverty [Infectious Diseases of Poverty.Exactly 10\u00a0years ago, on 25 October 2012, a group of scientists, policy-makers, and practitioners undertook an ambitious project to launch a new open-access journal, named The aim of the new journal was to publish a blend of original research articles and more empirical work, the latter embracing different types of articles, including scoping reviews, case studies, opinion pieces, and policy briefs. Its focus was to be on infectious diseases of poverty, coinciding with the launch of WHO\u2019s first roadmap to overcome the global impact of neglected tropical diseases (NTDs) earlier that year , and undInfectious Diseases of Poverty, provides a juncture to review the relationship between the scope of publications and the journal\u2019s impact. During the last decade, the journal has endorsed and promoted the One Health discipline, which has evolved from concept to practices [One World, One Health Conference formulating the Manhattan principles in 2004, to the action plan that has been formulated by four international organizations, namely the Food and Agriculture Organization of the United Nations (FAO), the World Organisation for Animal Health (WOAH/OIE), the United Nations Environmental Programme (UNEP), and WHO. Over the years, the number of publications and their citations of One Health research has grown considerably [The event to celebrate the 10th anniversary of continuous publication of the journal, ractices , and froiderably . In paraInfectious Disease of Poverty has been climbing up as well, exceeding 10 in 2021 with an H-index of 47, according to the Web of Sciences (accessed on 6 October 2022). Importantly, the journal continues to engage participants from the low- and middle-income countries (LMICs) in the leadership, management and dissemination of its outputs. These developments are complemented by a series of remarkable milestones  fora.Thirdly, the journal has made efforts to disseminate seminal research findings by 18 international channels, such as e-mail campaigns, editor picks, landing pages, cross-journal promotion, among others. This has substantially improved the visibility of the journal, the articles, and\u00a0the authors of the\u00a0respective papers. Multidisciplinary topics and promotional efforts have made the journal a reputable and valued academic platform for scientists, policy-makers, professionals, and students in the field of infectious diseases and One Health. As of September 2022, the journal has published 1060 papers by 5298 authors from 108 countries, that were downloaded over 4.7 million times. Such a huge amount of dissemination has facilitated collaboration between scientists worldwide. Yet, an analysis of authors\u2019 cross-country collaborations has shown that the People\u2019s Republic of China, the United States of America, the United Kingdom, Switzerland, and European countries still constitute most of the research-centres of collaboration in the field of infectious diseases of poverty, and that much more remains to be done to foster key competencies to conduct programmes from tropical and sub-tropical regions (Fig.\u00a0As programmes to prevent, control, and eliminate infectious diseases of poverty have considerably been hampered by the COVID-19 pandemic with an estimated delay in the realization of the SDGs by 2030 , the jou"}
{"text": "Pavlov and Cajal were two influential scientists who developed their work in the late nineteenth and early twentieth centuries. Both won the Nobel Prize in Physiology or Medicine. The authors analyze the similarities between their life and work, delving into a single aspect: the Nobel prize obtained by both with only two years of difference: Pavlov in 1904 and Cajal in 1906, shared with Camilo Golgi. Both belonged to two declining empires when nationalism was still of some importance. The theories proposed by them more than 115 years ago are still valid in much of what they contributed in their respective disciplines. Both won the Nobel Prize in Physiology or Medicine with a short chronological difference: Pavlov in 1904 and Cajal (shared with Camilo Golgi) in 1906,There are similarities between their life and work. Since it is impossible to cover the work of both, the authors have decided to delve into only one aspect: the Nobel Prize won by both with only two years of difference, Pavlov:1904, and Cajal:1906th century and in the first half of the 20th century, which tragically unleashed the First and Second World Wars. Nationalism impacted on the scientific field, as a source of competition in achievements between countries, for example, the Nobel prizes in science: Physiology or Medicine, Physics, Chemistry, to their creditThe historical context of these two characters was marked by a strong nationalism in Europe, both in the second half of the 19,Pavlov and Cajal both belonged to empires in decline; Russia, the home country of Pavlov, and Spain of Cajal. These two scientists, their Nobel prizes, and other distinctions obtained by them, were also of the most significant importanceCajal published in 1899 the first edition of his masterpiece \"Texture of the nervous system of man and vertebrates\" only a year before the \"Disaster of 98\" occurred, caused by the war between the United States of America and Spain. After a few naval battles, all lost by Spain, the decadent empire asked to sign a peace treaty, yielding independence to Cuba, and the cession of Puerto Rico, the Philippines, and Guam to the United States, which became a colonial powerIvan Pavlov's extensive and productive investigative career took place in Tsarist Russia and post-October 1917 Soviet RussiaRegarding the Nobel Prize, the juries had difficulties awarding it to Pavlov in 1904, his main competitor being Cajal,The controversy also had another ingredient. Many researchers worked alone, and Pavlov was the first to research with his Ph.D. students at the St. Petersburg Institute of Experimental Medicine. Some jurors had doubts about the originality of his work,Pavlov went to Stockholm to receive the award, becoming the first Russian scientist to obtain it. At 55, the scientist peaked his career: international recognition for his work and financial compensation of 73,000 gold rubles . He assigned it to his laboratory and future research,,Cajal, in turn, had become the leading exponent of the \"neuronal doctrine,\" in opposition to the \"reticularists,\" who did not accept the existence of unicellular structures in the nervous systemJones (1998), cited by GrantFinally, it would be the neural doctrine that ended up being accepted and the one that prevails, in almost all its aspects, to this day."}
{"text": "Throughout history, technologies have been created to increase the health of society. In general, technologies have been developed to improve processes and reduce costs. One of the most important issues is the development of new health technologies. Today, the use of nanotechnology, biotechnology, intelligent electronic systems, artificial intelligence, etc. to increase the health of society is very noticeable.In the present study, using the data obtained from the Iran National Registry of Drowning (INRD), new methods and technologies in drowning prevention have been studied.The proposed technologies for drowning are important in three ways: i-To improve processes (increase accuracy and ease of prevention), ii-To reduce the costs , and iii- To generate income from new methods (creating a market and producing new equipment). For example, a robotic detector from Coral Detection Systems that scans the pool for drowning activity is a high-tech system for the reduction of mortality. Finally, it can be said that the development of new equipment and methods in preventing drowning and launching startups in this area is very important to increase not only the level of community health but also the income of the swimming industry.Advanced Technologies, Drowning, Prevention, Iran"}
{"text": "Smart cities are the future development direction of cities and are a comprehensive expression of the development of the organic life body of cities. The organic life form of a smart city relates to viewing the city as an organic life self-organizing system based on the wholeness and systemic nature of the smart city life form itself, to construct a holistic spatial linkage of the functions and mechanisms of the city life system, and to enhance the overall vitality of the space. This study is based on the literature of \u201csmart city\u201d research in the China National Knowledge Infrastructure (CNKI) database, and the current situation and related themes of smart city research in China are discussed through co-word analysis and cluster analysis using software such as SPSS and VOSviewer, among which there are four themes in co-word cluster analysis, namely, intelligent technology supporting smart city research; research on the integration of the social system of a smart city; research on the top-level strategic design and planning and construction of a smart city; and research on the development, evaluation, and concrete practice of smart city construction. Four conclusions are drawn from the development of smart city research in China: Firstly, smart city research has attracted the attention of multiple disciplines, and the research themes are scattered and integrated across disciplinary systems. Secondly, smart city construction, development rules, and characteristics need to be further explored, and the problems, future trends, and policy support for the modernization of China\u2019s cities and towns have been focused on engineering and technology, with a lack of practical research in non-technical areas such as humanities and ethics. Thirdly, the philosophical humanism and ecological ethics of smart cities need to be systematized, and their construction and development needs to be humanistic, systematic, and comprehensive, thus contributing to the sustainability, livability, ecology, and wisdom of future urban development. Fourthly, the development of the smart city system is supported by theories related to global cities and innovative cities, and the world city, a product of globalization, is undergoing a transformation into a digital and intelligent organic urban life form. Since International Business Machines Corporation (IBM) put forward the concept of a \u201csmart earth\u201d in 2008, with the spatial application of information and intelligent technology, the term smart city has gradually become synonymous with the future development of the city. In 2012, China promulgated the Notice on Carrying Out the National Smart City Pilot Work, which marked the beginning of the specific practical work of China\u2019s smart city construction. China\u2019s smart city construction has experienced more than ten years of development. At present, the relevant themes need to be grasped as a whole, so as to summarize the development law, enrich the theoretical framework, and provide corresponding guidance for specific practical problems. Smart city construction promotes the optimization of urban ecosystems with intelligent perception and interconnection integration from five aspects: concept strategy, social development, economic development, spatial planning, and infrastructure, so as to provide corresponding methods and strategies to solve the problems faced by urban development [It is clear that smart cities are of significant value to the current problems and challenges encountered in urban development, and a large number of research results have emerged. The technological revolution has led to changes in traditional production and lifestyles, profoundly altering the way society is organized and the way urban space operates, shaping a whole new pattern of human urban social systems. Smart cities driven by digital and intelligent technologies have emerged, and the development of smart city construction relies on the interaction process between modern intelligent technologies and urban development needs. However, the specific objectives and action plans of smart city construction are applied piecemeal in the field of urban construction and rely excessively on the technical sphere, forcing people to experience unsatisfactory results and other real problems that need to be addressed accordingly. Based on this, this paper analyzes the state of smart city research in China, further explores the evolution of smart city research paradigms, tracks research frontiers and research hotspots, and provides reference and guidance for future smart city practice and theoretical research.From the specific practice of smart city development, it has become mainstream to build and develop smart cities around technology support. Governments around the world are focusing on smart city projects to achieve diverse goals such as sustainability, citizen engagement, and improved services . The devFrom the perspective of the theoretical development of a smart city, the theoretical connotation of a smart city and its technical support framework have undergone changes in specific practice. Smart City Version 1.0 is a smart urban solution promoted by technology companies; Smart City Version 2.0 is a local government solution leading the improvement of residents\u2019 lives and sustainable lifestyles; Smart City Version 3.0 is a community collaboration model, which includes the best strategic solutions for citizens, policy makers, enterprises, and other subjects . The devBased on smart cities as a global issue involved in local practice, the issue of how to develop rationalized standards and norms for smart cities and the dynamic competition between world cities and second and third tier \u2018follower\u2019 cities have become globally engaged issues. To some extent, the global character of smart cities and the transformative governance issues they represent point the way to future research and policy practice . ThroughAlthough international research on smart cities started earlier, Chinese smart city research has just begun. In terms of research content, Chinese smart city research is more focused on technological innovation and infrastructure development, while international research is broader, covering technology, policy, and humanities; at the same time, international research is more concerned with the economic value derived from smart city construction, while Chinese research is more concerned with its public value. Many studies have addressed the conceptualization of the smart city itself, with one illuminating definition being that a smart city is a system integration of technological infrastructure that relies on advanced data processing with the goals of making city governance more efficient, citizens happier, businesses more prosperous, and the environment more sustainable . In viewBibliometrics is a cross-cutting science field that uses mathematical methods of mathematical statistics to analyze the literature in a field of interest. VOSviewer is commonly used in bibliometrics as visual mapping software to structure and visualize the knowledge domain of the literature by extracting data units and constructing a visual spectrum of the relationships between data. The SPSS statistical analysis process includes descriptive statistics, general linear models, regression analysis, log-linear models, cluster analysis, time series analysis, multiple responses, etc. COOC software is mainly used for literature database de-duplication, co-occurrence matrix, two-mode matrix, similarity matrix, etc. Bibliometric tools are commonly used in various disciplines of social and natural sciences to achieve a holistic grasp of trends and the current state of research in related disciplines through the processing of large amounts of data from relevant literature. This study is a bibliometric approach to data analysis of the literature related to \"smart cities\", and the research design is broadly divided into the following sections : (1) RetThe data used in this paper were obtained from the CNKI database. As of 31 March 2022, the title, key words, and abstract containing \u201csmart city\u201d were selected. The source categories of journals were searched, i.e., Peking University core, CSSCI journals, and CSCD journals, and a total of 2236 documents were retrieved. After the literature was processed , 1976 documents were finally obtained as sample data.Co-word analysis uses SPSS, COOC, VOSviewer, and other software to analyze the degree of association between words, such as keyword clustering, second mock examination co-occurrence analysis, hierarchical clustering, and so on, to outline the current situation of smart city research. Co-word analysis shows the relationship between the research objects through data and images, then summarizes the relevant literature, and discusses the research status and future development trend of smart cities.In this study, the year, author, journal, and high-frequency keywords were analyzed through bibliometric metrics. Specifically, (1) the annual publication of China\u2019s smart city research was analyzed, (2) VOSviewer, COOC, and other software were used to analyze co-appearing authors and keywords and journals and keywords, and then the two-model co-occurrence relationship between related authors, journals, and keywords was excavated, and (3) multi-level clustering analysis and keyword clustering co-occurrence analysis were carried out for high-frequency keywords.According to the time distribution map of smart city research literature , China\u2019sThere were 54 authors whose frequency was greater than or equal to five times, and 51 keywords whose frequency was greater than or equal to 10 times. The second mock examination of the co-occurrence of authors (54) and keywords (51)  represenThe 41 journals have published 10 or more articles. In addition, the 51 keywords had a frequency of 10 or more times. Visual analysis of the second mock examination of the co-occurrence between journals (41) and keywords (51) was carried out, and the results are shown in The keyword fields of the 1976 documents were measured by COOC  softwareThe 51 keyword dissimilarity matrix  in the CThe co-occurrence matrix of 51 keywords from the CNKI database  was impoKeyword clustering in According to The application of the latest technology in the Internet of Things era has accelerated the construction of urban infrastructure and has realized human\u2013computer interaction and human\u2013human interaction through network transmission, bringing convenience to human production and life. Unfortunately, however, the contradiction between user privacy and forensic investigation is inevitable. How to protect privacy and security based on forensic services requires corresponding solutions to provide a reasonable framework to ultimately ensure the security of data flow across domains . Data drThere is an \u201cinnovation alienation trap\u201d in the science and technology innovation cycle. The irrational perception of the science and technology innovation cycle, the purpose of innovation, and the relationship between the city and society has led to problems in the process of using science and technology for smart city construction. It is necessary to understand the characteristics of the science and technology innovation cycle and its value objectives, to accurately grasp the scale of innovation, to create a good innovation space, to stimulate innovation, and to achieve a sustainable model of smart city development . The conThe \u201ctrue wisdom\u201d of smart city construction in the new crown epidemic period needs to be people-centered, and it needs to turn \u201ccrisis\u201d into \u201copportunity\u201d, \u201cindividuality\u201d, and \u201ccollectivity\u201d integration and to create an intelligent governance model of multi-subject co-governance . Major pResearch on specific practice areas of smart city society: The concepts of \u201cIndustry 4.0\u201d, \u201cSociety 5.0\u201d, and \u201cConnected Industry\u201d have gradually become the consensus of modern social development, promoted the construction of the national strategic extension framework system of smart cities, taken suitability, technology, comprehensiveness, and systematization as the basic requirements for improving the development of smart cities, and explored strategic docking and cooperation such as science and technology strategies and industrial enterprises . From thUrban planning and design, construction, development, evaluation systems, and other related research: Smart city construction is inseparable from digital infrastructure, and competitive advantages should be ensured in the fields of top-level design and core technology research and development. Compared with latecomer countries, the US digital infrastructure does not have an advantage , and theSustainable urbanization and informatization have become the trends of urban social development, and the use of informatization means to promote the sustainable development of urbanization and realize a low-carbon and sustainable urbanization ecological resilience system . Urban gWe need to promote the construction of smart cities and explore the realization path of smart governance based on four dimensions: governance concept, model, system, and mode . We needWe need to promote the construction of smart cities, the digital layout of global scenarios, and realize the construction of standardized systems for digital society and digital community infrastructure. We need to promote urban digitalization and refined governance, solve the problem of community governance application scenarios, and drive the development of science and technology industries related to urban construction . EnterprIn this paper, the selected literature data were limited to the CNKI database, and international databases were not comparatively studied, which makes the research data sample too localized and does not truly reflect the international value of China\u2019s smart city research. In the next step of our research, we should strengthen the use of international databases to promote the international integration of China\u2019s smart city research discourse system. Smart city research has attracted extensive attention from many disciplines, including urban science, management science, geographic science, urban sociology, economics, and other multidisciplinary fields. China\u2019s smart city research focuses on the essential connotation, historical development, influential factors, logical framework, industrial application, and other fields of smart cities. In the future, the research on smart city construction should focus on the practical exploration of interdisciplinary system integration, urban digital simulation, dynamic mechanisms, and so on . ThroughFirst, the research theme of China\u2019s smart city shows a tendency of scattered fragmentation. To a certain extent, there is no unified framework for domestic smart city research, which shows that smart city theory is in the initial stage of exploration, and its connotation essence has not reached a consensus, and the smart city framework under different theoretical frameworks is also different. Among them, the construction of smart cities from the perspective of system theory generates a holistic intelligent system through the coupling of three major systems: physical city, social city, and digital city, so as to realize digital, sustainable development and creative city construction . From thSecond, the law of smart city construction and development needs to be further explored. For example, urban governance, especially the governance of megacities, needs to explore a social governance path that conforms to the characteristics of the development laws of megacities, pay attention to the construction of a digital and intelligent urban governance system, improve the level of urban services, and make cities more agile, intelligent, ecological, and livable. At present, population aging has become a development trend in China. How to use big data to drive the precise and intelligent development of the traditional pension model has become a real problem. The big data platform can accurately meet the needs of the elderly and guarantee that the flow of data, capital, and service is coordinated and unified, the allocation of resources is optimized, and the healthy and orderly development of the aging society is realized .Third, the philosophical humanism and ecological ethics of smart cities need to be systematized. The risks encountered in urban governance in the digital era need to be considered from the overall nature of urban society, and issues such as technical risks and the nature of human practice should be examined from the perspective of urban ethics to provide reasonable space for the innovation of the co-construction system of smart city construction . The coaFourth, the organic life form of a smart city needs to be nourished by theories related to global cities, innovative cities, and urban innovation. The world city, a product of globalization, is undergoing a transformation into a digital, intelligent organic city life form, a process that will inevitably bring about structural changes in society, which will in turn affect the industrial system of the urban space and issues such as citizen participation. The organic and innovative smart city is a system in which innovation agents, mechanisms, and environments interact with each other, with intrinsic dynamic mechanisms driving the sustainable economic, social, and cultural development of the city.Finally, smart cities may reshape the future of urban development, and the technocratic-induced critique of smart cities will become a new model for the vision of neoliberal urban governance. With the rise of the critical discourse on smart cities, the framework of the smart city vision needs to be redefined and combined with a case study of the smart city in Cologne, Germany, to demonstrate social innovation and the future changes of sustainable cities that are \u201cgenuinely\u201d smart . Smart c"}
{"text": "Cognitive decline is a gradual neurodegenerative process that is affected by genetic and environmental factors. The doctor-patient relationship in the healthcare for cognitive decline is in a \u201cshallow\u201d medical world. With the development of data science, virtual reality, artificial intelligence, and digital twin, the introduction of the concept of the metaverse in medicine has brought alternative and complementary strategies in the intervention of cognitive decline. This article technically analyzes the application scenarios and paradigms of the metaverse in medicine in the field of mental health, such as hospital management, diagnosis, prediction, prevention, rehabilitation, progression delay, assisting life, companionship, and supervision. The metaverse in medicine has made primary progress in education, immersive consultation, dental disease, and Parkinson's disease, bringing revolutionary prospects for non-pharmacological complementary treatment of cognitive decline and other mental problems. In particular, with the demand for non-face-to-face communication generated by the global COVID-19 epidemic, the needs for uncontactable healthcare service for the elderly have increased. The paradigm of self-monitoring, self-healing, and healthcare experienced by the elderly through the metaverse in medicine, especially from meta-platform, meta-community, and meta-hospital, will be generated, which will reconstruct the service modes for the elderly people. The future map of the metaverse in medicine is huge, which depends on the co-construction of community partners. By 2050, the global population over the age of 60 will be about 210 million, and more than 130 million may suffer from Alzheimer's disease (AD) , which lAt present, the relationship established between patients with cognitive decline and their doctors is still in a \u201cshallow\u201d medical world, and the service for the healthcare for cognitive decline needs to be improved. First, the ordinary medical archives did not fully cover the information about the patient's daily life and their environmental conditions. The diagnosis and treatment were based on insufficient participation of the patients lacking data on life logging. Second, scientific management in life, sports, and entertainment for the elderly was lacking. Third, trust and effective communication between doctors and patients were lacking. To effectively solve the above problems, establishing a new medical world with deep empathy among doctors and patients is urgent. This article technically analyzed the application scenarios and paradigms of the metaverse in mental health and proposed that people in the related fields around the world work together.Telehealthcare has been used in the treatment and research of intellectual developmental disorders , which pThe metaverse technology applied in the field of education and teaching is called the Metaverse in Education, and applied in the field of healthcare and medicine is called the Metaverse in Health and the Metaverse in Medicine. The International Association and Alliance of Metaverse in Medicine (IAMM) released an Expert Consensus, defining 2022 as the 1st year of \u201cMetaverse in Medicine,\u201d and defining the Metaverse in Medicine as the medical internet of things (IOT) practiced through augmented reality (AR) technology using AR glasses or virtual reality (VR) glasses . Kye et The metaverse in medicine supports immersive senses and has a wide range of application scenarios. It can be applied in medical education and training, diagnosis, prediction, prevention, delay progress, supervision, elderly companionship, life assistance, and recovery for patients at risk or suffering from cognitive decline.Under the outbreak of COVID-19 pneumonia, the paradigm of non-face-to-face detection, self-healing, and self-healthcare will be generated through the metaverse platform, metaverse community, and metaverse hospital. \u201cMeta-hospital\u201d is a cloud platform of the metaverse in medicine serving cloud doctors, cloud patients, and educators, in which education, training, consultation, diagnosis and treatment, popular science publicity, home testing, and clinical research are carried out.The digital twin technology in the metaverse is used to construct the digital scenarios of the hospital. A digital twin is a virtual form of a physical entity, with dynamic, bi-directional links between the physical entity and its original twin in the digital domain . DigitalArtificial intelligence technology has obtained reliable results in genetic diagnosis and neuropsychological diagnoses of neurodevelopmental diseases, such as intellectual disability, autism, and depression , 14, whiThe clinical diagnosis of cognitive decline needs clinical evaluation and psychiatric test data, as well as neuroimaging and neurophysiological data. Brain neuroimaging and neurophysiological data provide important information on the changes in brain structure and function. In view of the gradual development of AD, full-time lifelogging, at-home motion sensor, multi-mode environment monitor, wearable monitor, and handwriting computer analysis were used to continuously record the activities, so as to obtain the dynamic data that could not be obtained before . Sensor *c) dimensions, where m represents the size of pixel blocks * pixel blocks in the image, and c represents the number of pictures. The input text data are treated by natural language processing and recognized by the model in the form of (m*c) dimension. In the cross attention layer of the model, Q(uery), K(ey), and V are used to split the input vector into a series of < key, value > data pairs. By calculating the similarity and correlation between Q and each element, the weight coefficient of V corresponding to each k is obtained, and the weighted sum of V is calculated. Since the flattened image data have a large m value, to reduce the dimension, the dimension-reduced Q is obtained through the asymmetry projection, and then enters the attention layer, which greatly reduces the calculation time and training complexity. The obtained hidden features were input into the transformer to get the feature results, and this process is repeated for 48 layers, and then the average results and final feature judgments are obtained.To realize the fusion of the above multimodal data, a transformer-based attention iteration model is introduced. In this model, data of different modes can be input. The input image is flattened into  and depression, relieving pain, improving amblyopia, coping with traumatic brain injury, and Parkinson's disease. Consultation and treatment by the man-machine dialog of mental disorders were realized in 2015. VR is an efficient rehabilitation tool for stroke, Parkinson's disease, and other neurological diseases .With the development of the metaverse in medicine, more products with the function of lifelogging and with games and sports elements for the elderly will enter their lives. By 2022, the number of connected wearable devices in the world is estimated to exceed 1.1 billion. The Vidicon revenue and auto-cameras are designed for patients with severe memory loss. All the images, sound around them, and experiences were captured and stored, so as to help them recall where they have been and what they have done at any time. AI intelligent speakers accompanied the elderly to chat. A social robot named Elli Q could gradually get to know the elderly and help them with online social networking and online games. An alcove immersive social software solved the problem of spatial distance and could experience the reality of offline social interaction. With VR and AI technology, all-around immersive global travel, shopping, fitting, and exploration can be experienced without leaving home. With the microchips implanted in the human brain, human consciousness was digitized. It is expected to be used for reconnecting the patient with the outside world who suffered from injury to the brain and nerves. Combined with nano-robot targeted therapy, brain-computer interface (BCI) will give more exciting medical application prospects.The metaverse is the next stage of internet mode to break the limitation of the real world. The physical world, the spiritual world, and the knowledge world are connected, and the human-machine and the spirit-machine are combined to give the elderly unlimited super ability and freedom, and bloom their lives and realize their dreams again.Metaverse is used in some time-dependent first aid processes, such as sudden death, stroke, myocardial infarction, fall, shock, asthma, choking, epilepsy, acute abdomen, and other sudden diseases of the elderly. There are two main stages: the pre-hospital stage and the treatment stage in the hospital. All the processes can be mimicked in fine-grain by digital twin technology. The time flow and information flow of life of the patients can be intelligently replayed, helping to identify the abnormalities and respond quickly. Using digital twin technology, a twin script based on the real ambulance and emergency environment using various sensors was digitally reconstructed, which highly restored the details of emergency facilities and equipment, integrated rendering and seamless roaming. The digital pre-judgment in the pre-h stage is very important for deciding what level of rescue action the rescuers trigger in the second stage. According to the patient's condition, decide whether the first aid team is triggered and the hospital needs to make preparations during the transfer. Virtual services make the physical world more efficient, more convenient, more secure, and lower cost.The metaverse requires the support of computing power and underlying technology, engine, platform, and APP. Among them, underlying technologies include digital twin, extended reality (XR), and internet of things (IoT) . It was launched by the international cooperation team in 2020 and promoted in the community. The brief structure is as follows.The project module includes four components: decentralized application (DAPP), gateway, donor networks, and distributed autonomous corporation (DAC). The SINSO DAPP component can quickly match the experts for consultation. Based on the smart contract of the distributed autonomous company (DAC), users uploaded data through the API interface of the Gateway component. The data were labeled and classified on the Gateway component and preprocessed to protect privacy. On the Donor networks component, users' data assets were converted into non-fungible token (NFT) assets and automatically matched the purchasers. Authorized inquirers find files through the address in the blockchain, using the public key and private key to generate encryption keys to re-encrypt the files and feed them back to the inquirer. Data sharing was realized and value flowed on the premise of maximizing privacy and data security. On the DAPP components, the members were continuously expanded and encouraged from pilot area to large-scale demo area, from many micro metaverse to decentralized medical infrastructure, such as metacommunity and meta hospital.The periphery of SINO needs to be largely improved at this stage. A considerable part of the work is still similar to the process of road and bridge construction. Anonymous sharing of the medical data all over the world is a huge project for the medical industry, and the construction work is always on the road.We tried to plan the foreseeable blueprint of the metaverse in medicine through the existing applications. Although the current technology has not kept up with the imagination, at least what we can predict is that the market demand and application scope will increase continuously with the maturity of the technology. The metaverse will stimulate medical innovation and upgrade in a new way. It will make medical diagnosis and treatment more accurate, fast, and convenient, and its position will develop from auxiliary to dependent and indispensable function. In particular, the metaverse will break the rule of geriatric diagnosis and treatment habits. The proportion of self-service and remote diagnosis and treatment will increase. The management role of hospitals will be weakened, and hospitals will become a distributed node and lose their central position.On the other hand, because the world is facing uncertainty risks , in the short term, aging medicine is also subject to uncertainty pressures, such as shrinking internal demand, supply shocks, and weakening expectations, and the development and application of geriatric metaverse products are also restricted. Furthermore, the technology has its own limitations. For example, a 3D experience is not ideal since the digital twin is still at an early stage. The construction cost is high. The small metaverse established dispersedly without a unified standard will face problems when integrating later. The research and development of methods for multimodal technology integration lag behind. The XR equipment access to the metaverse is not convenient. With more and more clients accessing, the problems caused by large concurrent network connections need to be solved. Therefore, it needs to be deeply integrated with different industries to form a unified standard for sharing data, and finally can be integrated. Although the prospect is not very clear at present, in the long run, the metaverse is the way to the future of medicine.The world will be at the peak of aging. Long-term and unremitting efforts should be made to improve this social problem. It is necessary to take population-based AD prediction and mental healthcare as long-term goals. Fortunately, with the advent of population aging, we are entering the fourth industrial revolution triggered by AI technology, which brings hope to solve many aging-related problems. As an innovative medical environment, the metaverse in medicine represents a milestone of intelligent medicine. People from all fields actively seize positions in the metaverse. In particular, with the global epidemic, a growing need for uncontact medicine and healthcare for the elderly has emerged, which put forward the demand for non-face-to-face social communication. Through the platform of the metaverse in medicine, the elderly users will activate their own strength, reshape the elderly health system and lifestyle, and experience the paradigm of self-monitoring, self-diagnosis, self-healing, and self-care. It may help the elderly from a consumer group to a self-service group with the ability of sustainable development. As more data are added to the metaverse in medicine, this new paradigm will become an important preventive tool for the diagnosis and treatment of cognitive decline and AD.HZ is responsible for drafting some contents of AI and metaverse. J-YG is responsible for literature retrieval. YC is responsible for the conception, drafting, and revision of the thesis. All authors contributed to the article and approved the submitted version.This work was supported in part by the funds of the Collaborative Education Project of Industry-University Cooperation of the Ministry of Education of China (202102100053); the Key Talents Project of Maternal and Child Health Care in Jiangsu Province (SFY202103); and the Top Medical Expert Project of Tai Hu Ren Cai Plan (2021-9).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "According to the World Health Organisation goals of treatment of drug addiction are: reducing of drug use and craving, improving of health, well-being and social functioning of the affected individual, prevention of future harms by decreasing the risk of complications and relapse. Wellness means a sense of overall well-being incorporating numerous aspects of an individual\u2019s life. These include physical, mental, emotional, intellectual, occupational, and spiritual aspects. For those who suffer from mental and substance use disorders, wellness means feeling a sense of purpose in life, being actively involved in work or play that is satisfying, finding happiness, having joyful relationships, and having a healthy body and living environment. .We will present different dimensions of wellness and describe how to incorporate these dimensions into drug addiction treatment.Presentation of theoretical frame and description of treatment programme at the Center for Treatment of Drug Addiction Ljubljana.When each of wellness dimensions is balanced, it is easier to maintain recovery process and avoid the triggers of relapse.In the context of wellness, treatment goal is to maximize the capacity of person to feel, think and act in ways that enhance his/her ability to enjoy life and deal with the challenges he/she face. Wellness lifestyle includes a balance of health habits such as adequate sleep and rest, productivity, exercise, participation in meaningful activity, nutrition, productivity, social contact, and supportive relationships.No significant relationships."}
{"text": "Government-level ESG  institutionalization and active ESG activation in the private sector are being discussed for the first time this year in Korea, spurred by increased national interest since the COVID-19 pandemic crisis and the declaration of a carbon-neutral society by 2050, and ESG discussion in many fields is spreading rapidly. In addition, global awareness of the crisis caused by environmental pollution and natural disasters has highlighted the importance of green infrastructure (GI) as a new conceptual alternative to improve public value. Based on sustainability, which is a common goal of ESG and green infrastructure, this study aimed to examine the research targets and techniques of green infrastructure from the perspective of ESG. This study selected and analyzed 98 domestic and international academic journal papers published over the past 10 years in the Web of Science academic journal database literature collection. Focusing on the research subjects, the focus on green infrastructure, and research keywords, we examined the aspects of the green infrastructure plan that have been focused on from the ESG perspective and compared domestic and international research trends. In addition, implications for how each research topic is connected to the concept of ESG according to its function and purpose were derived. By examining the domestic and international research trends of green infrastructure from the ESG perspective, we identified the need for a wider range of research on the diversity and relationship between humans and the ecological environment; policies and systems; and technical research that does not focus only on a specific field. In this regard, we intend to increase the contribution to ESG management in the public sector through the establishment of green infrastructure plans and policies in the future, as they account for a large portion of public capital. ESG stands for \u201cenvironment, social, and governance,\u201d which are used as factors to judge a company\u2019s non-financial performance, which is linked to corporate ethical or social responsibility investment ,2, and tDiscussions on sustainability began in the 1990s, when the United Nations Conference on Environment and Development (UNCED) in Rio de Janeiro, Brazil, adopted Agenda 21, a plan for international cooperation for sustainable development. At this time, the world\u2019s three major environmental conventions, the Convention on Climate Change, the Convention against Desertification, and the Convention on Biological Diversity, which are the basis of the environmental factors of ESG, were newly established.Subsequently, the sustainable development goals (SDGs) presented by the UN at the 2015 UN Sustainable Development Summit were included in the 2030 Agenda for Sustainable Development as the 17 core sustainable development goals of the UN [The 17 goals for sustainable development are ending poverty, ending hunger, health and welfare, education, gender equality, clean water hygiene, decent and clean energy, decent jobs and economic growth, industry and innovation and infrastructure, reducing inequality, sustainable cities and communities, responsible consumption and production, climate action, underwater ecosystems, peace and justice, and partnerships .When the foundation of ESG was being laid, in 2011, Porter and Kreamer created the concept of Creating Shared Value (CSV), which seeks both social problem solving and economic value. It is a concept that suggests companies, consumers, and society should pursue shared values and form a complementary relationship through strategic social marketing beyond CSR .ESG is an investment philosophy that pursues long-term value growth as the value of sustainable and harmonious development, considering the benefits of economic, environmental, social, and governance emphases .The concept of ESG was first used in December 2004 in a report jointly produced by the United Nations and the Swiss Foreign Ministry, and details of environmental, social, and governance issues in \u201cWho cars wins\u201d are shown in As the concept of ESG becomes increasingly mainstream, ESG is widely considered, practiced, and popularized in the field of practical uses , and theFollowing the COVID-19 pandemic, sustainable and inclusive development has once again become a hot topic of discussion worldwide, and in response to increasingly serious sustainable development issues in environmental, social, and financial markets, international organizations and countries around the world have proposed sustainable and comprehensive development frameworks for human society .As interest at the national level rises in Korea, along with the 2050 Declaration of Carbon Neutralization (10 December 2020), government-level ESG institutionalization and active ESG activation in the private sector are being discussed, and they have spread to many areas since they were first conceived a year ago.The Korean government has required companies to disclose ESG obligations by 2025, and since declaring the Green New Deal policy and carbon neutrality, ESG has been promoted not only by the private sector but also by local governments . Changes are taking place in the full-scale promotion of ESG administration , and ESGIn addition, as part of this policy, green infrastructure\u2014a conceptual alternative to improve urban environmental, cultural, and economic value\u2014continues to be discussed in the domestic landscape field as a sustainable plan.The first time the term \u201cgreen infrastructure,\u201d a combination of \u201cgreen\u201d and \u201cinfrastructure\u201d, was used was in the policy report published by the Clinton administration in May 1999, entitled the President\u2019s Council on Sustainable Development ,11. The Green infrastructure creates a network of physical green spaces, the concept of greenways, to continuously utilize recreation functions in the city; it solves urban social problems by adding the concept of natural ecosystems to human ones .Various benefits exist in green infrastructure , and theFirst, contributing to the economic development of the community by improving the social, physical, and environmental conditions of the site .Second, the promotion of leisure activities, realization of community\u2019s aesthetic preference, improvement of residential environments through community regeneration and provision of comfort for human mental and physical health , and encThird, ecological network contribution through biodiversity and habitat protection, environmental quality improvement, and ecological function of adaptation and mitigation of climate change .The economic, socio-cultural, and ecological functions of green infrastructure become the basis for the introduction of green infrastructure in planning and land use by allowing them to be efficiently utilized in a limited space through the combination of functions . As suchIn this study, to pursue sustainability, we examined the research trends of green infrastructure from an ESG perspective and examined the relationship between green infrastructure research subjects and items by ESG field. In the future, research on green infrastructure in Korea needs to include various studies related to this so that ESG management that pursues social, environmental, ethical, and sustainable growth as a policy tool in the public domain can be realized. Through this, it was judged that the evaluation factors for each ESG item as a strategy for creating a sustainable community environment from various developments can contribute to progressing the green infrastructure plan.This study used a systematic literature review . ConsideAs a research method, papers from domestic and international academic journals were collected through an electronic journal database search.http://www.riss.kr/, accessed on 5 March 2022) through a total of three stages of literature extraction.The overseas database used for this study was the Highly Cited Paper Index in the Web of Science; domestic academic papers listed in the Korea Citation Index (KCI) and candidates for KCI registration were collected from RISS , Document Type , and Publication Years, which were narrowed down to the period from 2006 to 2021 in Korea, when the study started, were set as parameters , and finally, academic papers that had secured public credibility by KIC listing in Korea and highly cited papers  were selected.The second stage was the exclusion of duplicate articles , and in the third stage, after reviewing the keywords and abstracts of the searched articles, their thesis values, and effects, the classification by ESG items was pre-implemented based on the target of application.https://www.moodys.com, accessed on 12 March 2022), one of the three major credit rating agencies in the United States, was used to select 55 international and 43 domestic research papers related to E (Environment), S , and G (Governance) factors, with relevance for each category.To select studies meaningful for the analysis of the relationship between green infrastructure and ESG, first, Moody\u2019s ESG evaluation index  and domestic indicators .In line with the recent trend of emphasizing international environmental and social governance, ESG standards are being upgraded, and an appropriate foundation is being established. Although the evaluation indicators differ from institution to institution, the fundamental purpose they pursue is the same. Based on the major evaluation indicators being promoted overseas  and domestic indicators , it was reorganized in Analysis of the articles related to green infrastructure from 98 domestic and international journals showed that research has been actively conducted in Korea since 2007, and has been on a steep rise since 2016 .Green infrastructure research, according to ESG items, was published with more than 60% of the focus on the environment both domestically and abroad, which is believed to be due to the early start of the concept of green infrastructure in the academic fields related to landscaping, environment, and civil engineering . It can An analysis of the current status of research data published according to ESG evaluation indicators reconstructed by the author for domestic and international research trends showed that similar indicators were distributed in E (Environment) and G (Governance) items .The E (Environment) field showed a very similar research status in climate change response, with seven cases (16.3%) in Korea and nine cases (16.4%) overseas and in air quality management, with three cases (7.0%) in Korea and three cases (5.5%) overseas. Higher concentrations were found in water resource management  and natural capital conservation and construction  in Korea, and in water resource management  and natural capital conservation and construction  overseas.In Korea, disaster management and water cycle research were treated as important subjects: damage from wind and water due to climate change accounts for more than 90% of all natural disasters, and it is concentrated in urban areas . ResearcIn foreign countries, research was actively conducted to secure green areas such as land and forests and to establish spaces for ecological diversity, and many studies were conducted on ecosystem services (ESs), ecosystem-based adaptations (EbAs), frameworks ,55,56,57However, research has not been conducted on energy management evaluation indicators related to renewable energy with active policies worldwide .In the S  field, some studies related to housing and living environment  and community contribution  have been published in Korea, but studies related to health  and consideration of social members  were conducted abroad.In Korea, the main focus was on the level of user satisfaction ,85,86 anHowever, there was no research on indicators in the education sector, such as safety, learning, and experience, for the effects of environmental damage or crime safety .The G (Government) field showed that studies on policies and systems  were active in Korea and abroad, and that they had high expectations for urban and park development or continuation through green infrastructure.In Korea, policy improvement of green infrastructure in connection with existing systems, such as urban planning, green park plans, land use plans, and urban-based projects ,101,102,However, indicators related to participation in green infrastructure planning or policy establishment have not been studied .The highest proportion of research on green infrastructure in Korea focused on large areas, such as cities and green areas, followed by units of green infrastructure such as parks, roads, green facilities, and waterfronts, which were studied in connection with the creation of an urban ecological environment and pollution reduction .From the ESG point of view, domestic green infrastructure research mainly focused on the G (Government) area, such as policies, plans, and evaluations for green infrastructure, compared to E (Environment) and S  aspects.The contents of urban policies and plans, evaluation of green infrastructure plans, and techniques of domestic green infrastructure research were actively studied. In particular, research measures for green infrastructure, green growth, and balanced development, such as urban planning and design techniques , LID , and green growth evaluation , were extensively handled, suggesting the importance of green infrastructure as a comprehensive and future policy at the city level .In addition to policies, planning techniques, and evaluation, studies on urban biodiversity , such as ESs, EbA measures and frameworks, and NbSs occupied the largest proportion.In addition, various studies have been conducted to improve disaster management and the global environment, such as those focusing on green space and health and human well-being , urban heat islands , climate change , air quality , and water  .From an ESG point of view, various studies  were conducted on the relationship between humans\u2019 health and the ecological environment, in addition to technological studies (G), such as policies and plans for green infrastructure, compared to Korea, which had no technological studies.Comparing the published status of the analyzed green infrastructure research, the scale and expansion of research followed the order of E > G > S both in the domestic and international literature, but there were some differences in detailed ESG evaluation indicators. In the G field, only research on policies and systems was conducted in Korea and abroad, but in the E field, domestic water resources management was the main focus, while overseas, natural capital conservation and establishment were the most common subjects. In Korea, research on S aspects was conducted on housing, the living environment, and contribution to the local community, while overseas research was conducted on consideration of social members and health indicators.In terms of green infrastructure research, Korea has also heavily focused on policies and plans for cities, parks, and green infrastructure, and some research on water resource management and vegetation environment was conducted. On the other hand, research on urban biodiversity was most active overseas, followed by planning and policies for cities, green infrastructure, and green areas, and research was conducted in various fields, such as urban heat islands, climate, air quality, water resources, and greening.Korea focuses on short-term and practical utility, such as disaster and resource management, and improvement of people\u2019s living and economic help. In foreign countries, the macroscopic relationship between humans and the ecological environment is important, and thus the focus is on securing ecological spaces both inside and outside the city, expanding social services, and living a healthy life.According to the conceptual definition and planning direction of green infrastructure, it is a physical space of various scales created for ecosystem services, recreational functions in the city, and solutions to urban social problems, where\u2014in addition to space plans such as land use projects\u2014integration and collaboration plans with public policies are also needed.As a result of analyzing green infrastructure research, selected according to the evaluation index items of the ESG field reconstructed by the author, research activities in the E and G fields are expanding, but they are relatively low in the S field.Research on policies, land use, and development techniques for both domestic and foreign cities accounted for the largest proportion of green infrastructure studies, and system studies for LID and urban ecological diversity were actively conducted.This is considered as part of an effort to prepare an environmental response plan using green infrastructure targets of various scales, such as green areas, parks, roads, and green facilities, as global awareness of crisis is rising due to environmental pollution and disasters ,113. ThiFor green infrastructure to contribute to ESG management in the public sector, sufficient research evidence and data are needed to support the validity of each field. As a result of analyzing the current status of green infrastructure research using the ESG evaluation index in this study, the fields that were relatively insufficient, or evaluation indicators that have not yet been studied, are as follows.First, the subjects and contents of research that are currently biased toward the E and G fields should be further expanded to the S fields. It is clear that the implementation of green infrastructure plans or policies has a positive environmental and ecological impact. However, the social impact on human life requires long-term observation, and the amount of research and interest concerning this subject so far is not high. According to domestic and foreign research trends in the ESG evaluation index, research considering social members, health, housing and living environments, and community contribution is emerging, but there is no research on safety and education, and the transfer of research is insufficient compared to the E and G fields.Second, for the policy use of green infrastructure, indicators related to green energy for carbon neutrality should be studied. In response to global warming, various efforts are being made to establish net-zero-carbon cities, rather than simply low-carbon cities, in line with global efforts to break away from the fossil fuel era to reduce greenhouse gas emissions. To prepare for it, fuel and renewable energy materials are required, together with urban spaces, industrial structures, and a green infrastructure environment . In the Third, research on collaboration in green infrastructure plans or policies in the G field is needed. In ESG management, transparency, soundness, and value realization through communication of plans or policies are important, and must be accompanied by participation indicators. Since research on participation indicators has not yet been conducted at home or abroad, it seems necessary to study cases or measures to secure the reliability of policies through participation or communication in the planning or policy establishment stage of developing green infrastructure.As the importance of green infrastructure for combatting climate change, disaster response, and sustainable growth has expanded, related research on the applicability and effectiveness of urban planning and policies is becoming more active, and Korea\u2019s interest is similar to that found overseas.However, according to the detailed evaluation indicators or research contents of each ESG field, Korea tends to concentrate on plans, techniques, and economic effects for disaster and resource management.In the E field, research on natural capital conservation and construction indicators such as land and forests is passive, and research on urban ecological diversity has not yet been conducted.In addition, in the S field, it seems to have focused only on short-term policy effects, focusing on residential, living environments, and community contribution indicators.For Korean green infrastructure research to be consistent with the ESG management vision in the future, various considerations of the cycle of macroscopic human life and ecological environment, in addition to short-term effects and technology utilization, will be needed.Although ESG and green infrastructure are commonly oriented toward sustainability and are actively embraced by national policies around the world, no research or consideration has been dedicated to the relationship between green infrastructure and the ESG perspective.To analyze the relationship between green infrastructure and ESG, 55 research papers from abroad and 43 from Korea that meet the ESG evaluation index criteria were selected and considered among green infrastructure studies from 2006 to 2021. The selected papers analyzed the status of green infrastructure research related to ESG, green infrastructure research trends according to the ESG evaluation index, and green infrastructure research subjects and contents, respectively, and the author reconstructed and used the ESG evaluation index based on detailed evaluation items developed by domestic and foreign public and private evaluation institutions.As a result, research on green infrastructure in both Korea and abroad is expanding in the E, S, and G fields, and various studies are also distributed in the detailed ESG evaluation index reconstructed by the author. This means that the green infrastructure is largely in line with the goals and indicators of ESG management, and suggests that the establishment of green infrastructure will contribute to ESG management in the public sector in the future.This study reveals that green infrastructure is a useful environmental, social, and policy tool for realizing ESG management in pursuit of social, environmental, and ethical sustainable growth in the public domain, and it can be used to present ESG evaluation indicators in future green infrastructure plans and policies.To this end, the direction of future green infrastructure research is presented as follows.First, for green infrastructure to contribute to ESG management in the public sector, sufficient research evidence and data are needed to support the validity of each field, E, S, and G, so research in the S field, which is relatively insufficient compared to the E and G fields, should be expanded.Second, research in fields lacking in literature according to the ESG evaluation index is needed. As the E field\u2019s concern with carbon reduction, greenhouse gas reduction, and energy management, the S field\u2019s focus on safety and education, and the G field\u2019s participation indicators are increasingly important in public ESG management globally, related research will be essential in the future.Third, green infrastructure plans and policies account for a large portion of public capital, and since most of the infrastructure projects are carried out as long-term projects, sufficient validity will be provided when research on human and ecological environment diversity and relationships is supported from a macro perspective. As Korea focuses on research on short-term effects and technical aspects, studies on macroscopic human life and ecological environment cycles are essential."}
{"text": "Discussions on sustainable development were included on the agenda of the United Nations(UN) in 1972, at the United Nations Conference on the Human Environment held inStockholm, Sweden.-Also in 2015, a new global agenda was initiated, this time called the 2030 Agenda forSustainable Development, adopted by 193 UN Member States. It is a global action plan,which covers the environmental, economic and social dimensions of sustainabledevelopment, in a comprehensive and interconnected manner.In this context, this paper presents some reflections on the potential of the datasources available for monitoring the goals of the SDGs in Brazil, especially theindicators used by the Health Surveillance Secretariat of the Ministry of Health(SVS/MS).,Brazil, as a Member State of the UN, adhered to the SDGs from the moment it came intoeffect. In 2016, the National Commission for the SDGs (CNODS)In the context of the SDGs, in addition to the political component, it is necessaryto articulate initiatives in terms of monitoring and shared governance, whichencourage the active participation of the entities of the federation, the civilsociety and the private sector in monitoring the goals, including technical support,and the implementation of local, regional and national initiatives.In this sense, a structure was created in the Ministry of Health to organize theprocess of monitoring the SDGs. In 2020, a working group (WG) was created at theSVS, called GT ODS SVS, composed of representatives from all departments of theSecretariat, to work specifically on the indicators under its direct responsibility, as well as those related to the themes of thatsecretariat . This WG contributed so that the SDGs monitoringactivities, already in place in the Ministry of Health, could be better organizedand qualified. Since its implementation, the WG develops permanent activities in thefollowing areas:updating of indicators ;3 with the aim of updating them to the 'produced'status;3qualification of indicators that are in the 'analysis/construction'phasemonitoring of indicators; and the creation of networks encompassing the Federal District, state, andmunicipal governments, universities and the civil society for theincorporation of the 2030 Agenda.Faced with the need to expand the monitoring of the SDGs, in order to encompass goalsand indicators related to the SDGs throughout the Ministry of Health, in 2021,through the Advisory Committee for Monitoring and Evaluation of the BrazilianNational Health System (SUS), coordinated by DEMAS, the WG for the 2030 Agenda inthe Ministry of Health (GT ODS MS) was created, composed of the its secretariats -the Specialized Health Care Secretariat, Primary Health Care Secretariat, theSecretariat of Science, Technology, Innovation and Strategic Health Inputs, theSpecial Secretariat of Indigenous Health, the Work and Education Management inHealth Secretariat, and the Health Surveillance Secretariat -, the National HealthSurveillance Agency, the National Health Foundation, and the National CancerInstitute.The availability of quality, accessible, updated, reliable and disaggregated data,based on official national sources, is essential condition for the periodicproduction of indicators.In the Brazilian context, the following are pointed out as important data sources formonitoring the SDGs, in particular SDG 3: the Mortality Information System (SIM),the Live Birth Information System (SINASC), the Information System for NotifiableDiseases (SINAN), and the national health epidemiological surveys, such as theSurveillance System for Risk and Protective Factors for Chronic Diseases byTelephone Survey (VIGITEL), the National School-based Health Survey (PeNSE) and theNational Health Survey (PNS).,,The SIM is the official death registration system in BrazilAs they are official data recording systems and due to their scope, SIM, SINASC andSINAN make up the basis for calculating at least 15 of the indicators referring toSDG 3, consisting of 13 targets and 28 indicators, in addition to their use for theindicator 16.1.1, pertaining to SDG 16 .,In terms of national surveys as sources of data for the SDG indicators, it isimportant to highlight that in the 2019 edition of the PNS there was an importantchange in relation to the previous version, conducted in 2013. In this latestedition, the minimum age of the selected resident to answer the survey questions wasreduced from 18 to 15. This change occurred due to the monitoring of internationallyagreed indicators, especially those related to the SDGs. To demonstrate theimportance of such compliance, the SDG 3.a.1 indicator assesses the prevalence ofsmokers in the population aged 15 years and over.Broad dissemination of the produced results is part of this monitoring process. InBrazil, this disclosure is made through the Sustainable Development Goals DigitalPlatform (ODS Platform),However, in order to monitor and achieve the goals of the SDGs, it is necessary tohave intersectoral initiatives for the construction and management of networks thatinvolve the entire Brazilian society and contribute to the formulation of policies,programs and plans. With the end of the period of validity of the 2011-2022Strategic Action Plan to Tackle Non-Communicable Diseases in Brazil,The production of the SDG indicators is still a major challenge for the country, bothin terms of quantity and diversity. Although Brazil has solid data sources, of goodquality and with an adequate level of disaggregation, the 2030 Agenda requirescombinations of information beyond this sector, which increases the difficulty ofthe process. The dispersion and lack of regularity in the production of some type ofdata can be cited as central issues to be observed for the production of suchindicators and, consequently, the monitoring of the goals.Lastly, it is opportune to develop the objectives and goals of the SDGs in line withthe demands of the Brazilian National Health System (SUS). This way, possibilitiesare created for its reach and the strengthening of intersectorality,universalization and equity in health, requirements to contemplate the diversity andcomplexity of the themes of the 2030 Agenda in face of the social, political,economic, cultural and environmental health determinants."}
{"text": "Children with conditions that until a few years ago were incompatible with life currently survive due to technological advances, changing the epidemiological profile and leading to the need to reassess the healthcare.CSHCN presents quite heterogeneous conditions regarding clinical manifestations, severity, and functional limitations and, consequently, varied health care requirements, which interferes with the organization of care and adoption of programs or specific health policies.CCC involves the combination of four characteristics: (1) Presence of one or more severe chronic clinical conditions and/or association with higher morbidity and mortality rates; (2) Functional impairment and mental and/or physical limitations, often leading to compromised autonomy and/or need of assistive technology  to ensure survival; (3) Different care needs compared to the general population, such as polypharmacy, specialized therapies, and special diets, besides specific educational needs; and (4) Greater use of healthcare services, with a higher number of medical appointments, multiple professionals from different areas involved in the care, and more frequent and/or prolonged hospitalizations.In the United States, there is an estimated prevalence of 15\u201320% of CSHCN, responsible for the high healthcare costs, even though complex cases are rare.5Care coordination is a strategy of approach, with emphasis on inter-organizational relationships,5This care model has been recommended by the American Academy of Pediatrics for care to CSHCN under the denomination of Medical Home, which encompasses a broad concept of an \u201caccessible, comprehensive, longitudinal, coordinated, humanized, culturally adapted, and family-centered\u201d approach. According to these characteristics, care for these patients can be provided at any level of care. However, it should be ideally provided in primary care, usually by a general pediatrician with the joint support of other specialists and a multidisciplinary team, with care coordination being the key element.The ICR-HCFMUSP outpatient clinic for CSHCN and CCC was established in 2016 with the following objectives: (1) To provide coordinated outpatient care to patients with CCC, aiming to integrate the multispecialty assistance that these patients require; (2) To facilitate dehospitalization and support families in understanding the treatment; (3) To train pediatric resident physicians with a view to disseminate and implement the model in other locations; and (4) To contribute to the production of knowledge in this field.Since 2016, 1006 patients referred from the several specialties clinics of the HCFMUSP were examined, totaling 8,028 appointments. The main characteristic of the patients is the multiplicity of health problems. Most of them present three or more diagnoses need polypharmacy, and approximately one-third are technology-dependent and/or need assistive technology, like gastrostomy, tracheostomy, supplemental oxygen, and others.Care is provided by the pediatric resident physician under the supervision of a general pediatrician who identifies all morbid conditions and respective therapeutic proposals guided by specialists, addresses the needs of the patient and the family, establishes priorities, and shares decisions. Through dialogue with specialists and a multi-professional team, a therapeutic care plan is created, including clinical issues, aspects related to the promotion of quality of life, autonomy, and educational and social insertion of the child and adolescent.This is the profile of the service that has been characterized as a service of \u201ccomplex pediatric care\u201d. However, the proposal of an outpatient clinic for the follow-up of children with CCC encounters some barriers.The first dare is to find professionals in primary care who feel able to follow these patients, especially in aspects related to the integration of inpatient and outpatient care coordination.The dehospitalization of these patients, especially those technology-dependent, and the prevention of injuries depend on the qualification of the multi-professional team.In addition to access and technical training to assist these patients, it is necessary to overcome difficulties of integration between the health sector and others. Care coordination presupposes communication with the area of education, social assistance and non-governmental organizations, and family groups.The difficulty in offering the necessary attention to patients with CCC has been the subject of increasing attention and should be the focus of discussions on the organization of services. The experience described allows for reflection and points to care coordination by a general practitioner as a strategy to improve health outcomes, both from an individual and family perspective and on the healthcare system. However, several barriers need to be overcome.The authors declare no conflicts of interest."}
{"text": "Environmental devaluation is a major concern for European countries as they seek to scrutinize strategies for development anthropology. Germany holds diversified ties with the socioeconomic and environmental development of the region. In accordance with global obligations, Germany's research on environmental issues, protection laws and actions, and universities and scientific research institutions in the field of environmental protection are progressing toward the development of a sustainable future securing the development anthropology. However, Germany's research on environmental issues is unclear to the rest of the world. Chinese scholars also lack effective countermeasures and suggestions for implementing environmental protection cooperation between China and Germany under the Belt and Road Initiative to draw a sustainable global drain. Understanding the current situation and frontier trend of environmental research in German academic circles is essential and irreplaceable for relying on research results data and quantitative analysis theory to carry out the research process. The methodology of this paper established a quantitative analysis based on \u201cinstitutions,\u201d \u201cscholars,\u201d \u201cresearch objects,\u201d and \u201cfrequency of keywords\u201d among the research results on environmental issues in Germany. It constructs a digital portrait of the field of environmental research in Germany. Knowledge mapping is extensively used in this study as the primary research tool to show the development of environmental research in Germany. The standard deviation of social science research has roughly doubled in that time. CiteSpace, a visual tool for document statistical analysis, is used to analyze the research results on environmental protection published by German scholars from 2008 to 2018. The study results include Web of Science Network, and finally, a visual map is drawn. This study analyzes the status quo, research institutions, keywords, research hotspots, and research trends of international cooperation in environmental research in Germany. The findings are in supportive position of environment study that is the key to human existence and societal development. Leading to this Germans are in concern of human anthropology being reflected in scholarly published work. In response to practical challenges, \u201cglobal warming\u201d and \u201csustainable development\u201d became the most frequently used keywords. It provides sustainable thoughts and countermeasures to strengthen Sino-German environmental protection exchange and cooperation further. Germany is the most important European country and a sustainable engine for promoting economic growth. Germany has attached great importance to environmental protection the overall. Not only does the German government emphasize the significance of environmental preservation, but also all political parties, organizations, universities, scientific research institutions, and citizens place a high value on environmental protection as a national priority.German mainstream media such as S\u00fcddeutsche Zeitung, Der Spiegel, Frankfurter Allgemeine Zeitung, \u201creported the connectivity of environment policies in promulgating developmental roots by the means of anthropology as a key to environment and societal norms\u201d Rojas . In variMost western countries were significantly impacted after the global financial crisis broke out in 2008. To avoid relying too much on the United States for their economic development, some European countries put their main efforts into the fields of new technology development, advanced equipment manufacturing, environmental protection, and so on, hoping to bring new growth points to their own economy. As the most important engine of economic growth in Europe, Germany has also been greatly affected since the global financial crisis broke out in 2008 Rauh, . The Ger2 emissions and the ultimate costs of technologies like blockchain  of the three time periods were assigned as , , and , respectively.We selected the \u201ccountry\u201d option in the CiteSpace interface, and the visualization results showed that there were 78 effective nodes and 727 links. From 2008 to 2018, Germany made 727 contacts with 78 countries worldwide .To further analyze the cooperation network between German universities and scientific research institutions, the author chose the cluster node \u201cinstitution\u201d in the CiteSpace operation interface and set the thresholds  to , and , respectively. The Then, we selected the \u201cinstitution\u201d option, and the visualization results showed that there were 192 effective nodes and 594 links; that is, from 2008 to 2018, German universities and scientific research institutions, as well as German scientific research institutions and universities and scientific research institutions from other nations, collaborated on environmental research projects. The research status of German scientific research institutions more clearly and further highlights the research achievements of some German institutions. The author further screened out the data of German universities and scientific research institutions that participated in inter-agency cooperation research < 49 times and performed further statistical analysis on the screened-out ten universities and think tanks. According to the analysis, the data of the ten universities and research institutes with the highest frequency of environmental research in Germany are as follows:The data show that the top ten universities and research institutions engaged in environmental research in Germany are Helmholtz Center Environmental Research Center, Humboldt University, Dresden University of Technology, Berlin University of Technology, Technical University of Munich, Bremen University, Hamburg University, Bonn University, Aachen University of Technology, and Freiburg University. Among them, Helmholtz Environmental Research Center in Germany, Humboldt University in Germany, and Dresden University of Science and Technology in Germany rank among the top three in German environmental research, with a frequency of 99 times, 70 times, and 69 times, respectively, which dominates the research direction and research frontier of German environmental research, and University Bremen, University Hamburg, University Freiburg have a frequency of 59 times, 55 times, and 49 times. As a global stakeholder on the world map, academic institutions must expound on the conclusive findings to develop environmental feasibility. This reflects the joint venture of the socio-economic foundation pillars of Germany.After analyzing the cooperation between countries and institutions at the level of collaboration among scholars, the author set the cluster node as \u201cauthor\u201d and intuitively analyzed the cooperation and cited the situation of German scholars in environmental research, thus further presenting the collaboration among scholars in the field of environmental protection and essential author information in the last decade. We clicked \u201cVisualize\u201d to run CiteSpace without changing other parameters and, finally, received the following visualization diagram. The network analysis findings illustrate the authors' connectivity concerning environmental research being designated to investigate the spectrum of research that sags elements of the environment, causes, consequences, and concerns in the German circle. The results explain that the scholarly work is more concerned with the environmental domain, which is the roadmap for the German government and other institutions to design a collaborative pattern of global ecological success.German scholars engaged in environmental research mainly included Jens Newig, Hans Wiesmeth, Henner Hollert, Claudia Pahlwostl, and Stefan Sagging, created by Martin Kowarsch (Martin). The scholars mentioned above mainly formed a research team led by ten scholars. From the map distribution, it can be further seen that, among the research teams led by these ten scholars, there were not only four large-scale research teams but also several small-scale cooperation networks with cross-cooperation. It is worth noting that the scholars mentioned above are all from top universities and scientific research institutions in Germany, including Helmholtz Center Environmental Research Center in Germany, Humboldt University in Germany, Dresden University of Science and Technology in Germany, Berlin University of Science and Technology in Germany, Munich University of Technology in Germany, the University of Bremen in Germany, Hamburg University in Germany, Bonn University in Germany, the Aachen University of Technology in Germany, and Freiburg University in Germany. These scholars reflect the main scientific research forces of environmental research in Germany. The abovementioned scholars' research is mainly supported by the Council of Europe Joint Research Center, the European Union, the German Research Foundation, the German Federal Ministry of Education and Research, and other institutions and foundations.To observe the research hotspots and frontiers in German-related environmental problems, the author selected \u201ckeyword\u201d as clustering nodes in the research tool interface of CiteSpace. The time slice was set to 1 year to highlight the time changes of the analysis object in greater detail. Then, we clicked the \u201cvisualization\u201d button to run CiteSpace, and the final software statistics chart is as follows.According to the obtained analysis data, under this set of parameter setting conditions, \u201cnodes\u201d = 384 and \u201clinks\u201d = 2,432 times; that is, a total of 384 keywords were included in this statistic, and there were 2,432 contacts among the above keywords. The author filtered the keyword information with a frequency of fewer than 47 times and finally collected 20 groups of keywords with a higher frequency in this field. The keywords that German scholars pay attention to environmental problems from high to low are climate change, sustainability, management, model, system, biodiversity, influence, framework, policy, governance, protection, performance, water, environment, behavior, science, ecosystem service, energy, problems, and risks .In Germany has long been regarded as one of the countries with the best environmental protection and the most eco-environmental management experience. People attach importance to environmental issues, and the cooperation between China and Germany on environmental protection is an important starting point, whether it is for China-EU relations or for promoting the green cooperation of the Belt and Road Initiative to draw sustainable environmental gains together. It is vital for China and the European Union to jointly fulfill a big country's responsibility and promote the implementation of the global emission reduction task. To varying degrees, German and academic circles have affirmed China's emission reduction achievements as an important participant in the Paris Agreement and an important partner of the European Union. They have kept high expectations for China and Europe in the fields of global governance and environmental protection for a sustained future. With the rational use of the research tool CiteSpace, the author visually operated and analyzed the samples from the aspects of international cooperation, cooperation of scientific research institutions, cooperation networks of researchers, cited networks, research hotspots, research frontiers, and so on, based on the related research of German scholars on the environment collected by the Web of Science TM core collection database from 2008 to 2018, and finally came to the following conclusions.Firstly, the author preliminarily clarified the status of German research on environmental issues, international cooperation, and scientific research cooperation from 2008 to 2018.The second place in the German cooperation list is the United Kingdom, and the frequency of German-British cooperation is 321. However, Sino-German collaboration on environmental issues ranked 11th, and the frequency of the Sino-German association was only 126 times, which was still low. There was still much room for improvement. To better promote the economic recovery of both sides after the epidemic, China and Germany should uphold the concept of green development and strengthen green cooperation through high-level dialogue on the environment and climate. After the UK withdrew from the European Union, Germany's status as a major EU country became more important. In the European general election in 2019, Germany ranked first among the member countries with 96 seats, especially because the influence of the Green Party group is inseparable from the German Green Party. To further strengthen China-EU relations, we must improve cooperation with Germany in various aspects.Third, Germany's research on environmental issues is mainly led by German universities and research institutions, including Helmholtz Central Environmental Research Center, Humboldt University, Dresden University of Science and Technology, Berlin University of Science and Technology, Munich University of Technology, University of Bremen, Hamburg University, Bonn University, Aachen University of Technology, Freiburg University, and other universities and research institutions, including Helmholtz Central Environmental Research Center, Humboldt University, and Germany. German scholars engaged in environmental research mainly include a research team composed of Jane Newweig, Hans Weismenz, Henna Holt, Cordia Pelle Vast, Stefan Eli, Martin Kovac, Akutas Hurst, Klaus Cuomo, Connard Walter, and Alai Seza. The scholars mentioned above mainly set up four large-scale research teams and several small-scale cooperation networks with a cross. The council of Europe Joint Research Center, the European Union, the German Research Foundation, the German Federal Ministry of Education and Research, and other institutions and foundations provided corresponding financial support and funding for the scholars mentioned above, effectively promoting the research of environmental problems in Germany. In March 2019, the German Federal Ministry of Education and Research, the German Ministry of Education and Research put forward the \u201cNew Initiative of Biodiversity Conservation Research,\u201d expressing the determination to protect global biodiversity. In this regard, China has always attached great importance to biodiversity protection and has actively participated in global biodiversity governance. At the second Belt and Road Initiative international cooperation summit forum, Chinese President Xi Jinping emphasized that \u201cwe should take green as the background, promote green infrastructure construction, green investment, and green finance, and protect our common living homeland.\u201d Both sides have played important roles in promoting the realization of the post-2020 global biodiversity framework. In addition, we need to pay attention to the role of many social organizations in promoting public welfare. For example, the Sino-German Environmental Energy Center is committed to promoting exchanges and cooperation between the two sides in the environmental and energy fields. At the same time, promoting advanced environmental protection technologies and popularizing advanced European environmental protection ideas are two different things. Active participation is vital in Sino-German environmental research cooperation projects, such as the Sino-German clean water project and Horizon 2020.Fourth, regarding environmental problems, 384 keyword frequencies have been included in this statistical data. The top 20 keywords with the closest attention and frequency were climate change, sustainable development, management, mode, system, biodiversity, influence, framework, policy, governance, protection, performance, water resources, environment, behavior, science, and ecosystem services. After further adjusting the view mode to time zone view, it was found that the current frontier keywords of German environmental research mainly include water resources, biodiversity, environmental problems, urban planning, institutions, models, indices, biofuels, robustness, and international functional classification. Many studies on environmental problems in Germany are focused on the fields of water resources and biodiversity. In addition, urban planning, biofuels, and robustness have also attracted wide attention from German academic circles.To sum up, by analyzing the relevant literature data collected by German scholars on environmental issues in the Web of Science TM core collection database, the author has derived 2,714 research results. These research results have great representativeness and coverage. They can truly reflect the current international cooperation in environmental research in Germany, the collaboration of scientific research institutions, the cooperation network of researchers, cited networks, research hotspots, research frontiers, and so on. After the introduction of \u201cIndustry 4.0\u201d in Germany in 2013, environmental issues became a priority for the government and private industry alike, and significant progress was achieved toward protecting the environment in the country. In the future, there is still much room for development in the cooperation between China and Germany on environmental protection. To optimize and sustainably develop China's environmental protection policies, the country can keep abreast of the latest research achievements, research frontiers, and trends in the field of environmental protection in Germany, strengthen academic exchanges between China and Germany, increase the number of scholars and international students sent to Germany, and promote the continuous progress of China's environmental protection industry. According to the data of the German Federal Statistical Office, despite the tremendous negative impact of the epidemic, the bilateral trade volume between China and Germany increased by 3% last year to about 212.1 billion euros. In 2021, the fifteenth meeting of the Conference of the Parties to the Convention on Biological Diversity was held in Kunming, China. Both China and Germany should shoulder the responsibility of protecting the environment by strengthening innovative cooperation in climate change and enhancing the level of Sino-German collaboration on the environment and climate.First, in relation to the significance of this research, the current study compiles the global connection of environmental research knowledge supplied by research stakeholders. Second, this research is a worthy addition to the canon of knowledge, having been published in the prestigious peer-reviewed journals of academic powerhouses in industrialized nations. Third, this study has inducted five clusters of environmental research contributions into the field of research. To rethink and understand environmental concerns, we visualize the environmental pillar of sustainability, which is the very existence of human life in developed countries. The connectivity of economic and social components of sustainability is complemented by environmental sustainability. This is what this field of work considers from the well-reputed research publisher in the global arena. This study's application of a global perspective in areas such as water resources, biodiversity, environmental problems, urban planning, institutions, indicators, biofuels, robustness, and international functional classification represents a timely contribution that recognizes research concerns in Germany that are working to transform development into sustainable development. Followed by the next dimension, this study reveals critical keywords studied in the past concerning environmental research. The bilateral cooperation of China and Germany on the environment and developing new energy sources are practical steps. There is a Sino-German ecological park in Qingdao. The Chinese Ministry of Science and Technology is working with its German counterpart to advance electric bikes, electric vehicles, and hybrid vehicle R&D in Beijing and Shanghai. In terms of managerial contributions, the study urges organizational stakeholders to promote policies that would result in a greener environment to promote sustainable development. The global partnership between heavily industrialized countries must be seen in connection to environmental sustainability through shared experiences. The consideration of academic studies on environmental research must be integrated into strategic management plans to ensure sustainable development is reported in scientific literature.This study fully uses CiteSpace tools to analyze the environmental research situation in Germany and draw corresponding conclusions. The diversity of data sources, the interests or preferences of researchers, and the research methods' applicability all constitute the research process's limitations and conclusions. The limitations of the research in this paper are mainly as follows:Firstly, CiteSpace, as the research tool of this study, although it can show the relevance of the analyzed objects, cannot provide quantitative indicators of the degree of relevance. Hence, the whole research is still in the qualitative analysis phase.Secondly, the data lag of the paper mainly obtains the research data through the network and retrieval database. There need to be more current achievements to support the research. Thirdly, China and Germany have different national conditions, and the applicability of the research results is limited. Germany is a developed country that has entered the stage of post-industrialization. Its thinking and policies on green industry and green consumption are not necessarily suitable for China's current national conditions and the development stage. This means that the research conclusions and thoughts in this study are more of a useful reference for China's future green development than a means that can be directly used.In future research, comprehensive resources can be helpful in the utilization of the results of German environmental research so that it can be adapted to China's national conditions and promote in-depth cooperation between China and Germany in the fields of low-carbon development and green industry. Green practices and digital technologies are concrete measures of such collaboration. With the unprecedented high temperatures and drought in the Northern Hemisphere in 2022, people are already feeling the effects of global warming. Research and decisive action on environmental issues are urgent. Environmental research collaboration between China and Germany should also address this dire scenario. Green practice involves production and consumption to operate in developmental domain of anthropology. In production, digital technology significantly enhances management efficiency and reduces wasteful resource use and management-related waste. Green practices will transform people's eating habits, social activities, transportation, etc., in the consumer sector. These subjects can serve as future directions for environmental studies study.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding authors.WZ: conceptualization and data collection. BT: data management: FW: project administration. HT: data analysis. HZ: paper drafting. CW: validation and conducted the survey. MT: methodology and reviewing. All authors have read and agreed to the published version of the manuscript."}
{"text": "Medium and Long-term Development Plan of Comprehensive Transportation Network of Shandong Province (2018\u20132035), this paper uses the GIS network analysis method, weighted average travel time, modified gravity model and other methods to study the land traffic accessibility and economic relation intensity of prefecture-level cities in Shandong Province, China, in 2020 and 2035. The results show that the distribution of land traffic accessibility in Shandong Province, China, shows a certain regional main road pointing characteristic in 2020, and the urban accessibility level gradually decreases along the Beijing\u2013Shanghai high-speed railway and Jinan-Qingdao high-speed railway to the periphery. In 2035, the land traffic accessibility of Shandong Province, China, will be more spatially distributed as \u201cconcentric circles\u201d. From 2020 to 2035, the urban land traffic accessibility and the balance of economic contact in Shandong Province, China, will be improved significantly. The research results can provide a theoretical reference for optimizing the traffic network pattern and promoting urban economic contact in Shandong Province, China.As the basic support of regional economic and social development, land transportation is one of the important engines to promote regional development, and its construction and improvement will have an important impact on the regional economic pattern. Based on the road network of Shandong Province, China, in 2020, according to the  As the carrier of the flow of production factors, the transportation network can connect production and consumption, balance regional supply and demand, attract, multiply and integrate industries, capital and population , and proTraffic accessibility is considered a comprehensive index that can evaluate the development status of urban transportation scientifically and effectively by the academic community , which cRegional Development and Its Spatial Structure, Academician Lu Dadao of China, took Federal Germany as an example to analyze the impact of accessibility changes on regional development and put forward that the level of regional accessibility is a prerequisite for regional development [Transportation is closely related to the urban economy, and good accessibility in the urban transportation system is closely related to regional spatial integration . Cascettelopment . Mun [26elopment  concludeelopment  took theelopment  developeelopment , from thelopment , the spaelopment , and theelopment , etc. Inelopment . For exaelopment  analyzeselopment  analyzedelopment  proposedelopment  used theelopment  calculatelopment .To sum up, there are abundant research results on the connection between traffic accessibility and economy, which mainly focus on the evolution of regional transport accessibility and economic connection, the impact of different transport mode changes on regional economy and accessibility, and the impact of the establishment of a traffic channel on regional accessibility and economy . HoweverThe rest of this study is arranged as follows. In Medium and Long-term Development Plan of Comprehensive Transportation Network of Shandong Province (2018\u20132035) [Located in the eastern part of the Chinese mainland and in the lower reaches of the Yellow River, Shandong Province is rich in natural resources and has a complete industrial system, which is an important strategic resource base of China. Additionally, the transportation network in Shandong Province extends in all directions, with Beijing\u2013Shanghai, Beijing\u2013Kowloon and other railways and highway networks all over the province, which is an important transportation hub connecting the North and South of China. By the end of 2020, Shandong Province had opened 2110 km of high-speed railways and 286,800 km of highways, an increase of 6489 km over the previous year. In the 18\u20132035) , By 2035Medium and Long-term Development Plan of Comprehensive Transportation Network of Shandong Province (2018\u20132035) (hereinafter referred to as the Plan). The vector data of the planned road network were obtained by vectorization after sampling and geo-registration of the planning pictures by ArcGIS. Due to the availability and limitation of the planned road network, this study only involves the planning data of high-speed railways and expressways, and other road network data were replaced by the data of 2020. After combining relevant elements, the planned road network of Shandong Province, China, in 2035 can be obtained, as shown in In this paper, vector data of administrative divisions, expressways, national roads and provincial roads of Shandong Province, China, in 2020, were obtained through the Shandong Provincial Geographic Information Public Service platform for data visualization and processing. The railway data were derived from a 1:250,000 national basic geographic information database. The relevant elements were projected to WGS_1984_World_Mercator to obtain the road network of Shandong Province, China, in 2020, as shown in The overall theme of this paper is to explore and predict the spatial distribution of urban land transport accessibility and urban economic linkages. The method framework is shown in Traffic accessibility can reflect the difficulty of transportation between regions , and weiHighway Engineering Technical Standards (JTG B01\u20132014) and High-Speed Railway Design Code (TB10621\u20132014), the average running speeds of different types of roads are obtained, as shown in The time cost distance among prefecture-level cities was calculated based on ArcGIS 10.8.0.12790 software. Firstly, according to the Using the shortest time of inter-city land transportation to modify the gravity model, the economic contact between cities in Shandong Province, China, is measured. The equation is as follows:lue is 2 .The coefficient of variation was used to verify whether the planned road network would enhance or narrow the gap in accessibility or intensity of economic connection between cities . AccordiArcGIS network analysis method was used to calculate the shortest time cost distance between each node city. At the same time, population and economic dual indexes were taken as weights, and the results were obtained by using Equations (1) and (2). Then, the inverse distance interpolation method and natural discontinuity point classification method were used to obtain the spatial distribution of land traffic accessibility in Shandong Province, China, in 2020, and the prediction of the spatial distribution of land transportation accessibility in Shandong Province in 2035, as shown in Plan is to further optimize and supplement the transportation network in the areas with inconvenient transportation and poor transportation accessibility so that the land transportation fast track (such as high-speed rail and expressway) network can be spread throughout the province. It can be seen that by 2035, the completion and improvement in the planned road network can further solve the problems of the existing road network layout in Shandong Province, China, is not dense enough, the traffic connection is not tight enough, the urban traffic is not smooth enough, and the traffic accessibility in the marginal areas is poor. Thus, Shandong Province can realize the goal of \u201cfocusing on key points, reinforcing weak points, strong and weak items, and further optimizing and improving the comprehensive transportation network layout of the province\u201d [In order to further analyze the change difference in land traffic accessibility in Shandong Province, China, in 2020 and 2035, the spatial difference in land traffic accessibility change rate in Shandong Province, China, (2020\u20132035) was obtained from the variability analysis of urban land transport accessibility before and after the planning, as shown in rovince\u201d .According to Formula (3), the economic contact among prefecture-level cities in Shandong Province, China, is calculated, and the XY to line point-to-line tool in ArcGIS is used to draw the urban economic relation intensity in Shandong Province, China, in 2020 and 2035, as shown in According to According to Formula (5), the coefficient of variation in urban land traffic accessibility and economic relation intensity in Shandong Province, China, is calculated, as shown in This study analyzes the accessibility of urban land transportation, the level of economic links and their spatial distribution in Shandong Province in 2020 and 2035, and finds that the level of land transportation in Shandong Province, China, will be greatly improved by 2035. The accessibility level of land transportation in Shandong Province presents a \u201cconcentric circle\u201d distribution on the whole, but it also shows a certain regional main road orientation characteristic. For example, in 2020, the level of urban accessibility will gradually decrease to the periphery along the Beijing\u2013Shanghai high-speed railway and the Beijing\u2013Qingdao high-speed railway. Therefore, the construction of high-speed railways can narrow the traffic accessibility gap between the peripheral cities  and the central cities  in Shandong Province. The construction and development of high-speed railways can affect regional transport accessibility, shorten people\u2019s travel time, and make people travel more convenient and comfortable. This coincides with the concept of \u201cMobility as a Service\u201d (MaaS). The development of modern transportation technology provides people with better services  for long-distance travel, which makes people more inclined to public transportation . As a reThis study has made a spatiotemporal analysis of urban land transportation accessibility and economic connection intensity in Shandong Province, China, in 2020 and 2035, and has a macro understanding of the traffic distribution pattern in Shandong Province, China. However, the study did not involve the road delay index, traffic transfer waiting time, road congestion time, traffic costs and other factors, so the results of traffic accessibility tend to be theoretical and idealized, which will provide a direction for subsequent refined research. In addition, the transportation network contains a variety of transportation modes, and the land transportation level cannot represent the overall traffic level of the city. In the future, a comprehensive study on urban traffic accessibility will be carried out by combining land, water, air and other transportation modes.(1)The spatial distribution of land traffic accessibility in Shandong Province, China, showed a \u201ccentral\u2013periphery\u201d pattern with the provincial capital city as the core and gradually increasing to the peripheral areas. In 2020, the distribution of land traffic accessibility in Shandong Province, China, showed a certain regional main road pointing characteristic, and the urban accessibility level decreased gradually along the Beijing\u2013Shanghai Railway and Ji\u2013Qing Railway to the periphery. In 2035, the spatial distribution of land traffic accessibility in Shandong Province, China, has no obvious road direction characteristics, and the accessibility level tends to be more \u201cconcentric circles\u201d in space. From 2020 to 2035, the overall land traffic accessibility in Shandong Province, China, will change significantly, with the change rate of land traffic accessibility in 16 prefecture-level cities all exceeding 20%. Among them, the central area of Shandong Province, China, changes less, whereas the marginal area changes more. The spatial distribution of land traffic accessibility in 2020 is similar to the spatial distribution pattern of the horizontal change rate of accessibility before and after the planned road network. It shows that the planned road network greatly improves the accessibility of land transportation in Shandong Province, China, further maintains the advantage of transportation accessibility in the central areas, and reduces the difference in accessibility between the peripheral area and the central area. By 2035, with the completion of the planned road network, the land traffic accessibility of cities located in the peripheral areas of Shandong Province, China, will be improved significantly. This will bring new opportunities and development to the industries that depend on land transportation in the peripheral cities of Shandong Province, China, and then bring local economic vitality and promote urban construction and social development.(2)In 2020, the economic contact of cities in Shandong Province, China, showed a pattern of \u201cstrong in the middle and weak in the periphery\u201d, and the core edge features were significant. Among them, the strength of economic contact between Jinan and Zibo was the highest, followed by that between Zibo and Weifang. The strength of economic contact between cities in central Shandong Province, China, was about 10 times that between cities in western and northern Shandong Province. This is because the western and northern regions of Shandong Province, China, are short of rapid traffic arteries, and the social and economic foundation of some cities is relatively weak, so traffic accessibility is relatively poor compared with the central region of Shandong Province, China. By 2035, the network level of urban economic contact in Shandong Province, China, will be improved greatly, the central radiation role will be strengthened, and the marginalization will be weakened. Overall, a network of urban economic contact with Jinan and Qingdao as the core will be formed.(3)After the completion of the planned road network, the urban land traffic accessibility in Shandong Province, China, decreased to 59.65% on average, the coefficient of variation decreased to 18.31%, the urban economic relation intensity expanded to 10.60 times the original, the coefficient of variation decreased to 55.50%. This shows that the completion of the planned road network will make the urban land traffic accessibility and the balance of economic contact in Shandong Province, China, obviously improved.Based on the road network data of Shandong Province, China, in 2020, we calculated the land traffic accessibility and economic relation intensity of all prefecture-level cities in Shandong Province, China, in 2020 and 2035 according to the road network planning, and analyzed the current and future urban land traffic accessibility, economic link intensity level and spatial distribution pattern of Shandong Province, China. The main conclusions are as follows:"}
{"text": "Definitions of health in different branches of medicine are one of the key paradigms in medical sciences. Nowadays, there are two distinct definitions of sexual health and mental health. The definition of sexual health, as well as sexual rights, was proposed by the World Health Organization , and the definition of mental health was published in World Psychiatry .The analysis and comparison of these two definitions: mental health and sexual health are two main objectives of this study.The analysis was carried out in three areas: logic, philosophical aspects  and the impact of other disciplines.The definition of sexual health reveals a eudaimonistic approach, whereas the definition of mental health is based on a holistic paradigm. Regarding the main principles in the definition of sexual heath, one can identify the following values: well-being, pleasure, safety, sexual rights \u2013 compared to harmony, empathy, coping skills, universal values in the definition of mental health. Sexual rights are a constitutive part of sexual health. There is no comparative element in the definition of mental health .These two definitions can have different effects on the prophylaxis and therapy of patients. It all depends on the specific context of care (sexology or psychiatry). Sometimes universal values matter and sometimes not. This is contradictory. Consistency is needed between definitions and practices."}
{"text": "The continuous increase in the cost of feeds and the need to improve the sustainability of animal production require the identification of alternative feeds, such as those derived from the agro-industrial sector, that can be effectively used for animal nutrition. Since these by-products (BP) are sources of bioactive substances, especially polyphenols, they may play an important role as a new resource for improving the nutritional value of animal-derived products, being effective in the modulation of the biohydrogenation process in the rumen, and, hence, in the composition of milk fatty acids (FA). The main objective of this work was to evaluate if the inclusion of BP in the diets of dairy ruminants, as a partial replacement of concentrates, could improve the nutritional quality of dairy products without having negative effects on animal production traits. To meet this goal, we summarized the effects of widespread agro-industrial by-products such as grape pomace or grape marc, pomegranate, olive cake, and tomato pomace on milk production, milk composition, and FA profile in dairy cows, sheep, and goats. The results evidenced that substitution of part of the ratio ingredients, mainly concentrates, in general, does not affect milk production and its main components, but at the highest tested doses, it can depress the yield within the range of 10\u201312%. However, the general positive effect on milk FA profile was evident by using almost all BP at different tested doses. The inclusion of these BP in the ration, from 5% up to 40% of dry matter (DM), did not depress milk yield, fat, or protein production, demonstrating positive features in terms of both economic and environmental sustainability and the reduction of human\u2013animal competition for food. The general improvement of the nutritional quality of milk fat related to the inclusion of these BP in dairy ruminant diets is an important advantage for the commercial promotion of dairy products resulting from the recycling of agro-industrial by-products.  In the livestock industry, the marked volatility of the commodity prices for feeds, coupled with the need to improve the sustainability of animal production, requires the identification of alternative feedstuffs, such as those derived from the agro-industrial sector. Even though the inclusion of by-products (BP) in livestock diets is an old practice , the ideAlthough the relevant amount of agro-industrial BP is produced worldwide   whose content still remains high after the industrial process. Bioactive compounds natively present in most of the agro-industrial BP could exert many beneficial animal and human effects, which confer added value to these materials . Some ofGrape BP  are one of the most investigated, being derived from the wine industry worldwide ; among tThe industrial processing of pomegranate BP  has gained popularity for the content of several bioactive compounds, especially in peel   have also been investigated as potential nutraceutical carriers for their antioxidant activity  and for Tomato BP   are anotIn small ruminants, the carryover of polyphenols to milk has been established ,21,22. TIn addition, polyphenols are effective in modulating the biohydrogenation process in the rumen of dietary polyunsaturated fatty acids (PUFA), and, hence, in the composition of milk fatty acids. The unsaturated FA in the diet, mainly linoleic acid , alpha-linolenic acid , and oleic acid , are converted to saturated FA (SFA) by rumen microorganisms through the biohydrogenation process. During the biohydrogenation of LA, first occurs the isomerization to rumenic acid , which is subsequently hydrogenated to vaccenic acid  and finally to stearic acid (C18:0). The LNA is mostly isomerized to conjugated linolenic acid , which is then hydrogenated to VA, and finally to C18:0. The intermediates VA and RA can escape from the rumen and accumulate in the tissues and milk. The VA is also the precursor of RA in the mammary gland, due to the enzyme delta-9 desaturase that catalyzes the addition of a cis-9 double bond to the VA . Research in human and animal models evidenced the large health-promoting effects of RA, which were effective against cancer ,29, atheSpecifically, the polyphenols in the ruminant diets act indirectly, either limiting or suppressing the growth of rumen microorganisms involved in the PUFA biohydrogenation ,46. The Despite several investigations on this subject, the effectiveness of BP-containing bioactive compounds in improving milk lipid quality is still disputed. This is likely a consequence of the type of BP, the dose tested, the wide diversity of active compounds, the composition of the basic diet, and the length of the experiments.Therefore, the present study summarized the effects of widespread agro-industrial BP such as grape, olive, tomato, and pomegranate BP on milk production, milk composition, and FA profile in dairy cows, sheep, and goats. The main objective of this work was to evaluate if the inclusion of BP in the diets of dairy ruminants, as a partial replacement of concentrates, could improve the nutritional quality of milk fat without having negative effects on animal production traits.n = 12), and some of them in ensiled, dry, or pomace form. For pomegranate, only 10 articles fit our inclusion criteria. A total of thirty-eight publications from these databases were used, considering all three ruminant species. The dataset was prepared by including the results of the control and experimental groups; the extent of variation of each experimental group from the control group was calculated and expressed as a percentage.A systematic literature search was conducted in 2022 in Google Scholar, Web of Science, and PubMed by using the following keywords: grape, olive, pomegranate, winery, by-products and milk yield, milk composition, and fatty acids. This research was repeated by including the terms sheep, goat, cow, and ruminant, as well as bovine, ovine, and caprine. The inclusion criteria, for each by-product, were the measurement of intake, the level of by-product supplemented, the measurement of milk yield, and the main components (fat and protein) and/or the fatty acid profile of milk. For grape by-products, the initial search yielded 18 articles, and among them, only 13 have been selected because they include relevant data of interest; most of the publications used grape pomace or marc. For olive by-products, we selected 15 articles; most of them used olive cake  for pomegranate BP.The inclusion of different kinds of BP in the diets of dairy cows, dairy sheep, and dairy goats did not give univocal results in terms of voluntary intake, DM and nutrient digestibility, and ruminal fermentation parameters. The wide variability should be associated with differences among species, experimental conditions, source of BP, and doses. In general, high doses of polyphenols reduce feed intake, as evidenced by the strong negative correlation between these variables , the cis-9,trans-11,cis-13 octadecatrienoic acid, also called punicic acid PnA; . The PnAon of VA . The VA The positive effect on milk quality of the animals fed pomegranate BP was evidenced by the reduction in SFA content and the enhancement of MUFA and PUFA contents.The inclusion of olive BP in ruminant diets did not significantly modify the milk production and composition in dairy cows , except Similarly, in dairy sheep and goats, the use of olive BP did not significantly modify milk yield and its main components if used in doses below 300 g/kg of DMI . Olive cOlive BP had a significant influence on the proportions of the main FA in milk fat . In all The high LNA content in olive leaves makes this by-product an attractive and cheap source of n-3 PUFA in animal diets to improve the FA profile of milk.Concerning the groups of FA, univocal results were highlighted for MUFA content, which increased in all species supplemented by olive BP. However, in sheep milk, the extent of the MUFA increase was higher compared to cow milk . This result could be partially explained by the higher level of inclusion of olive BP in the diet of sheep in some of the considered studies ,138.The effect of the inclusion of tomato BP in ruminant diets is reported in S. aureus, including antibiotic-resistant strains [Naringenin is one of the most abundant polyphenols in tomato BP . This po strains .Regarding the FA profile, the trials that investigated the inclusion of tomato pomace in ruminant diets are limited to small ruminants and showed increases in the concentrations of VA and RA in both sheep and goats . The conThis paper demonstrates that the use of widespread agro-industrial BP, such as grape pomace, pomegranate, olive cake, and tomato pomace, as a substitution for part of the ratio ingredients, mainly concentrates, in general, does not affect milk production or its main components, but at the higher doses tested, it can reduce the milk yield within the range of 10\u201312%. However, the general positive effect on the milk FA profile was evident by using almost all BP at different tested doses.The inclusion of these BP in the ration, which ranged from 5% up to 40% of DM without depressing milk, fat, or protein production as a rule, demonstrates the substitution power of concentrates of these feeds in terms of both economic and environmental sustainability, as well as the reduction in human\u2013animal competition for food.Furthermore, the general improvement in the nutritional quality of milk fat is an important advantage for the commercial promotion of dairy products resulting from the use of these BP.Finally, the possible animal health benefits of ingesting substances with a generally well-documented anti-inflammatory effect, which would be in addition to the benefits mentioned above, i.e., improvement in animal health and welfare, remain to be evaluated."}
{"text": "The purpose of this article is to demonstrate the design and validation of a questionnaire, to study the importance of vaccines in the health of children. It is based on the analysis of a complete conceptual framework, considering the factors that show the current situation of vaccines, in the context of education for health and coexistence on the international scene. One thousand subjects from 76 countries participated in the study. The validity of the questionnaire was carried out with 15 experts, resulting in a content validity index (IVC) for each high dimension, with the mean IVC being the questionnaire with a Fleiss\u2019 kappa result of 0.96. The process led to a final design consisting of 12 items. The statistic used to identify the degree of consistency in the estimates and calculate the value of the match between the evaluators was the index Fleiss\u2019 kappa, which yielded an overall result of 0.57, which was considered moderate. The results obtained make it possible to conclude that the VACUNASEDUCA questionnaire is valid for understanding the status of vaccines, the importance of teacher training on health prevention, and the influence of student vaccination on the health of peers and teachers, from a gender perspective. Currently, in the face of the COVID-19 pandemic, social interest has been stoked and research on vaccines has increased. The debate has transcended the context of the experts and flooded the public space, and has been amplified by activism on social media. All this has revealed some contradictions of the experts, confusion of the population, and, in many cases, a decrease in the credibility of vaccines that are affected by a crisis of confidence. It is also being considered whether, in certain cases, they should be mandatory, as well as the administrative and judicial procedure for imposing compulsory vaccination, and the cases in which the courts and tribunals may require it.It should be specified that this study is based on the fact that health, as indicated in 1946 by the World Health Organization . It shouReasonably, it is essential to analyze the advantages and effectiveness of vaccines, concerns about their safety, and how they are perceived in the educational community. As Matesanz points out , having It is clear that vaccines save millions of lives every year, and are one of the safest and most effective public health interventions, providing benefits on disease control and prevention, as well as social and economic benefits. Indeed, since the creation of the Expanded Program on Immunization by the WHO in 1974, the benefits have been expanding, and proof of this is the explicit recognition of the importance of vaccination and its great impact on social good, developing a Global Vaccine Action Plan (GVAP) for 2011\u20132020 [Vaccines are antigenic preparations consisting of microorganisms or by them, which are modified, so that they lose or attenuate their pathogenic capacity, and their purpose is to stimulate the defense mechanisms of the individual against infectious agents. The advances in molecular biology, specifically in the development of recombinant DNA technology and bioinformatics, have been essential tools for the evolution of vaccines. Likewise, the advances in the knowledge of immunity and in biological therapies cannot be forgotten . It is iAt present, we live immersed in a situation of continuous virological risk. We are immersed in the pandemic caused by COVID-19, with new infectious challenges and high mortality rates, exacerbating with more virulence diseases, such as malaria, acquired immune deficiency syndrome (AIDS), tuberculosis, etc. This new global framework has brought together and strengthened the role of international bodies. In fact, as it is a public health issue that affects everyone, from the United Nations (UN) and the WHO, strategies and initiatives are being introduced to combat COVID-19, and, at the same time, to be able to continue the work of education, information, monitoring, prevention, and medication worldwide .It must be recognized that, although there is no 100% effective vaccine, nor are all vaccines equally effective, the advantages of vaccines focus on their proven effectiveness, which manifests itself in their behavior in practice and depends, in particular, on the immune capacity of the recipient, the type of vaccine, established schedules, and its availability, tolerance and stability. In the interest of public health, the Spanish Agency of Medicines and Medical Devices (AEMPS) may subject each batch to prior authorization and make the placing on the market conditional on its conformity. Consequently, vaccines are administered in order to stimulate the specific defense mechanisms of the individual against certain infectious agents .The European Union (EU) carries out public health policies in the member states; however, there is no common prevention model. This situation generates inequality in the access to immunization among community citizens, which has been evidenced by the pandemic caused by COVID-19. Each country designs its vaccination strategy, with regard to its epidemiological situation; however, WHO, EU and UNICEF develop prevention and immunization strategies and plans at the global and European level .It is important to emphasize that the WHO designs long-term immunization strategies and carries out specific advocacy work with a global impact, such as World Immunization Week or the European Vaccine Action Plan 2015\u20132020.The EU also has a global health strategy involving the AEMPS, the Directorate-General for Health and Food Safety (DG SANTE), and the European Centre for Disease Prevention and Control (ECDC). Thus, the third European action program on health 2014\u20132020 and the \u2018joint actions\u2019 stimulate the collaboration of the member states to solve public health problems at the European level, focusing on the following objectives: to contribute to innovative, effective and sustainable health systems; improve the citizens\u2019 access to better and safer health care; promote health and disease prevention; and protect citizens from cross-border health threats .Our research aims to design and validate a questionnaire to study the importance of vaccines in the health of the child population, to know the influence of vaccines, analyze their development, assess their situation in the twenty-first century, and examine the need for the mandatory nature of certain vaccines.Reasonably, it was proven that there is no questionnaire that is adequate to what is intended to be measured in our research, so it was essential to create a new questionnaire, VACUNASEDUCA , followiThe analytical descriptive design adopted by the questionnaire validation process has been developed in several phases in which quantitative strategies and the application of different statistical techniques have predominated through the IBM SPSS26 program, for the calculation of descriptive statistics, reliability indices through Cronbach\u2019s alpha model and the exploratory study of the factorial structure through the factor analysis of principal components. The results of these analyses have been the subject of quantitative assessments by 15 experts  using anThe sample of this research, given the subject matter studied, has been worldwide. It has been considered as the subset of individuals who agree to undergo an investigation, where it is taken as a reference to meet several criteria of representativeness of the total population. The selection has been in the interest of the researchers. Indeed, the sample consists of 1000 participants from the following 76 countries: Albania, Germany, Andorra, Angola, Saudi Arabia, Algeria, Argentina, Australia, Austria, Bangladesh, Belgium, Bolivia, Bosnia-Herzegovina, Spain, Botswana, Brazil, Bulgaria, Cape Verde, Cameroon, Canada, Chile, China, Cyprus, Colombia, Ivory Coast, Cuba, Denmark, Ecuador, United Arab Emirates, Spain, United States, Estonia, Philippines, Finlandia, France, Gabon, Gambia, Georgia, Greece, Guatemala, Equatorial Guinea, Haiti, Honduras, India, Ireland, Iceland, Israel, Italy, Jamaica, Japan, Jordan, Latvia, Lebanon, Liberia, Luxembourg, Morocco, Mauritius, Mauritania, Mexico, Montenegro, Mozambique, Paraguay, Peru, Poland, Portugal, United Kingdom, Russia, South Africa, Sweden, Switzerland, Thailand, Tanzania, Turkey, Ukraine, Uganda, Venezuela, Zimbabwe.Regarding the characteristics of the sample, in relation to gender, it is made up of 694 women (69.4%) and 306 men (30.6%). The age of the sample members is mostly between 18 and 44 years .n = 554) belong to the health sector, 32.9% (n = 329) to the educational field and 11.7% (n = 117) to the economy sector.As for the work performance of the sample members, 55.4% (The socioeconomic level of the sample members has been established based on the country of origin through the human development index (HDI) .As indicated, the conceptual framework of the VACUNASEDUCA questionnaire focuses on vaccines, being configured in the main variable of research, its structure is reflected in The research has been developed in the following phases: (a) delimitation of the construct to be measured and analysis of the state of the matter; (b) pilot design of the questionnaire, taking into account the objective, population, sample and format; (c) expert judgement who will assess the validity of the content of the questionnaire and make the relevant proposals for improvement and its incorporation; (d) statistical analysis of the data; (e) final proposal for the questionnaire. The study was carried out in 2019 and 2020, guaranteeing at all times the confidentiality and anonymity of the data obtained .The statistical results obtained in the calculation of the content validity, the construct validity, and the reliability of the final instrument are shown.In order to determine the validity of content, the Lawshe\u2019s content index  has beenThis verifies the extent to which the questionnaire actually measures what you want to measure, and thus assesses the consistency of the questionnaire, debugging its initial structure.The affirmative answers given by the participating experts, as reflected in As can be seen, high content validity ratios were found in all the items, with no value below 0.51 appearing, so there was no need to remove any item from the initial questionnaire. It should be noted that 10 items, 83.3% of the total of the 12 items, achieved a perfect content validity ratio; a value of one and only two items, 16.7% of the total, obtained a ratio of 0.73, which was indicative of a high content validity [The value of the agreement between the evaluators was also calculated, in order to know the degree of consistency in the estimates made. The kappa coefficient, originally proposed by Cohen , is usedThe preliminary tests of the factor analysis allow us to verify the adequacy of the factorial technique, these being the following: the Kaiser\u2013Meyer\u2013Olkin test (KMO) and the Bartlett Sphericity test ,22,23,24After validation by expert judgment, the instrument was configured by 12 items that were included in the factor analysis.The results of the extraction method, by analyzing the principal components, are reflected in The analysis in Most of the factors studied in the social sciences are interrelated, so externally imposing a criterion of non-correlation between factors, such as orthogonal rotations, may be artificial and not respond adequately to reality. Consequently, it has been chosen to use oblique rotations that increase the realism of the factorial solution, so the Oblimin factorial rotation method is used, with Kaiser normalization , obtainiThe matrix of components did not come out totally \u201cclean\u201d, with items three and eight correlating in two factors.The factors, F1, F2, F3 and F4, coincide with the dimensions and their items described preliminarily before the factorial analysis procedure: D1, awareness and regulation; D2, education and teachers; D3, regulation and mandatory; and D4, consequences and risks. Although item three correlates with factors F1 and F2, and item eight correlates with factors F3 and F4, in general, a factorial structure that is very similar to that initially designed can be observed.The descriptive statistics for each of the items are shown in For each of the dimensions, its descriptive statistics are collected in With the calculation of reliability, we tried to analyze the stability of the results for future administrations of the questionnaire, using Cronbach\u2019s Alpha coefficient (\u03b1).The reliability analysis for the instrument reached an index of 0.64 for all the items on the questionnaire. The mean value for the four dimensions was 0.64, which is close to the limit of 0.70 that Kerlinger et al.  set for In health education, it is evident that the use of reliable and validated questionnaires is a very common methodological instrument that requires adequate elaboration, as it is a fundamental part of the research design and conditions the results obtained ,21,27. RIt should be noted that the work began before the pandemic caused by COVID-19, being topical and highly applicable to the new challenges in vaccination in the educational context, especially in the first levels of schooling. There is no doubt that, today, one of the most worrying challenges is global health security. In addition, it is becoming clear with COVID-19 that disease outbreaks can develop faster and travel farther than ever before. Emerging threats are not limited to a single place or country, so investing in health security must be a global priority.It should also be noted that we live in a healthier, safer, and more prosperous world than 20 years ago; however, the progress made is fragile. Indeed, more than one and a half million people die each year from vaccine-preventable diseases, and fifteen million children are still missing out on the benefits of vaccination in the least developed countries. Along these lines, the Vaccine Alliance (GAVI) has planned that, in the strategic period 2021\u20132025, the launch of the most complete package of vaccines in the history of the Alliance will take place, expanding the portfolio of vaccines. Logically, the introduction of new vaccines, including boosters against tetanus, diphtheria, and pertussis (Tdap); the birth dose of hepatitis B; multivalent meningococcal conjugate vaccines; routine oral cholera vaccine; and vaccines against respiratory syncytial virus (RSV) and rabies will help protect people throughout their lives, not just during childhood [There is no doubt that global health security and the fight against COVID-19 depend on the early implementation of health systems around the world. Likewise, actions, treatments, and efforts are needed to combat this pandemic, where health education from the earliest age is of vital importance.It must be recognized that, in order to motivate the realization of work on the subject at hand, and to be able to develop solid and effective research, it is essential to have valid tools that make it possible for the results obtained in the research to be useful to intervene in the effective improvement of the situation studied. There is no doubt that knowing what their political, social and human factors are allows us to investigate in a little-known field, promoting the study of the concerns and opinions of the human factors involved in a more direct way, such as teachers at university and non-university centers, scientists, parents and mothers, teachers in training, students, political representatives, and managers. Consequently, the researchers prioritized designing a questionnaire that was very easy to complete, in order to optimize the response of potential participants.The VACUNASEDUCA questionnaire can be a very valuable tool in today\u2019s society, and, as has been shown, it is easy to apply and requires few prerequisites. It is justified that it is very valid to know, in a given context, the awareness of society regarding vaccines, the assessment of their mandatory nature, the regulation by the administrations, the initial training and awareness of teachers, gender influence, information and involvement of parents, need for a vaccination register/card, and the consequences and risks of non-vaccination. It is a questionnaire of great interest not only in the educational and health fields, but it also affects the whole of society, because vaccines are an important measure, due to their high effectiveness and tolerance profile, making it possible to save millions of lives and eradicate some diseases. There is no doubt that vaccines are an investment not only because they improve the quality of life, but they also constitute an economic and social value of great importance.It offers an original and innovative proposal that, based on the training offered to teachers on health prevention, plans to design a training plan for prevention and education for health, and reflect on the influence of the vaccination of students on the occupational health of teachers. In addition, from a gender perspective, it is possible to analyze how the effects of the inappropriate application of vaccines could affect male teachers, differently from female teachers. It should be noted that one of the strengths of the VACUNASEDUCA questionnaire has been the very large sample used, which covers 76 countries. It is also important to note that the process of validating a questionnaire has limitations linked to the choice of the number of experts, since their number varies substantially according to the authors consulted, without establishing a specific consensus . Thus, t"}
{"text": "Dear editor,Eccrine syringofibroadenoma (ESFA) is a rare tumor that consists of the proliferation of ductal structures that resemble the acral portion of the eccrine sweat glands. It was first described by Mascar\u00f3 in 1963, and there are just over 70 published cases in the literature.The authors report the case of a 71-year-old male, retired and without comorbidities. He reported the use of heat-generating plaster, consisting of iron powder, activated carbon, vermiculite, potassium chloride, and water (Fenaflan Patch\u00ae) to treat pain in the lateral region of the right thigh. However, there was a local reaction with burning and heat sensation, which caused the patient to remove the plaster before the indicated time. In the following days, he developed erythematous papules and a vegetating plaque, sometimes friable and bleeding, with mild pruritus. It progressed for three months, reaching the size of 4\u202fcm . A 5-mm Clobetasol in 0.05% cream was administered with occlusive application once a day for 20 days, with a fully effective response. The post-inflammatory residual erythema resolved completely within a few months.The most current classification of ESFA includes five subtypes: solitary; multiple without skin changes; nevoid associated with ectodermal dysplasia; multiple associated with Sch\u00f6pf syndrome; and the reactive subtype, associated with neoplastic or inflammatory dermatoses.The reactive type is probably triggered by tissue damage and, in the process of repair and remodeling, there is hyperplasia in response to the damage.Histopathology assessment is necessary for diagnostic confirmation, the eccrine ducts may or may not be demonstrated. Immunohistochemistry can help in difficult cases, with cells often positive for keratin 6 and 19, as well as filaggrin.There is no consensus regarding treatment. The literature presents reports of etretinate therapy, surgery, radiotherapy, and laser; however, there are no reports of treatment with clobetasol or other topical corticosteroids.None declared.Roberto Rheingantz da Cunha Filho: Approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; effective participation in research orientation; intellectual participation in propaedeutic and/or therapeutic conduct of studied cases; critical review of the literature; critical review of the manuscript.Lucas Jos\u00e9 Quioca: Approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; critical review of the literature; critical review of the manuscript.Graziela Junges Ascending Rastelli: Approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; critical review of the literature; critical review of the manuscript.Jos\u00e9 Fillus Neto: Approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; effective participation in research orientation; critical review of the literature; critical review of the manuscript.None declared."}
{"text": "In the original article, we neglected to include the funder the National Natural Science Foundation of China, 81971573 to HD, the Suzhou Gusu Medical Youth Talent, GSWS2020019 to HD, and the 13th Five-Year Science and Technology Project of the Education Department of Jilin Province, JJKH20190064KJ to MZ.In the published article, there was an error regarding the Affiliation for Hui Dai. Instead of \u201cChina-Japan Union Hospital of Jilin University, Changchun, China\u201d, it should be \u201cThe First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China\u201d.The authors apologize for these errors and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "Purpose: Based on the Nippon Color & Design (NCD) system, this study aims to accurately discover the color preferences and image positioning of different female groups in China and, thus, to establish a color reference system, which is suitable for the packaging of beauty products.Methods: We first selected middle-aged women in the rural area of northern China as the studied group. Then, we conducted an extensive questionnaire survey on their color preferences focusing on their psychological characteristics and perception rules of emotional needs for colors. After that, we extracted colors from samples and classified them using the NCD system research method. Finally, we conducted a systematic analysis and verification to determine the color emotional preference of this group.Conclusion: We investigate the color preference of targeted customers to establish the image space of beauty product packaging. By applying SPSS for the factor analysis, we study the rural women in northern China, who are less concerned about fashion. We focus on the accurate positioning between the interaction of color, women, and environment throughout the color design process. We have conducted a series of comparative analyses of popular beauty products among the rural women. The results can accurately reflect the brand definition and positioning of color semantics and, thus, provide invaluable information for future beauty packaging designs and marketing promotion strategy. Due to the rapid development of the economy of China in the past two decades, the per capita disposable income of Chinese residents has been growing swiftly, which has led to a substantial increase in the beauty product market. According to the report of China's National Bureau of Statistics in 2020, the sales in the cosmetics market of China have increased from 204.9 billion yuan in 2015 to 340 billion yuan in 2020. Currently, China is the second largest cosmetics consumption country in the world after the United States. In order to compete in the fast-growing market, many researchers start to study the purchasing behaviors of customers and their psychological states. How to lure customers to purchase their products becomes their top priority. Hence, emotional designs have become the primary concern in the design industry.A study about package design and color elements of digital products by Koh, Seon, the colors of the product packaging design have a great impact on the purchase desires of consumers; 78% of the survey participants said the color would affect their purchase desires. The outcome of the survey shows that the color of the product packaging design is essential to sales. As the primary element in visual impression, the color of packaging design directly affects the physiological response and psychological cognition of people. Relevant theoretical foundations include, for example, A Study of Color Emotion and Color Preference. In this study, three color preference models for single colors were developed , soft and hard axis (S\u2013H), and clear turbidity (K\u2013G), and the image system is established on this basis. The NCD semantic system is color-matching of a semantic coordinate system, which is formed by analyzing the perspective of color image based on the three basic attributes of color . The NCD semantic system converts the perceptual psychological needs of users, such as sensory impressions and aesthetic preferences, into semantic symbols, matches the design of cold, warm, soft, and hard colors to meet the perceptual needs of users, and finally proposes solutions to meet the color emotional preferences of different users.This research investigates, analyzes, and classifies the color status of beauty packaging at home and abroad. We try to explore an accurate and effective color design method to design the color of beauty packaging to enhance the emotional experience of customers. Combining the research theme of color imagery, the practical color coordinate system (PCCS) is used to refine and abstract the color of selected beauty packaging samples, and to conduct statistical and visual analysis of color distribution and visualization of the color style positioning and emotional tendency of beauty brands at home and abroad. Based on the NCD semantic system, its essence is to achieve the consistency of the mapping between color semantics and user perception on the premise that color image positioning is consistent with the perceptual needs of the user. A consistent quantitative basis is established, and the perceptual engineering and quantitative color systems is applied to complete the quantitative research of matching objects at both ends of the mapping, which provides the feasibility for establishing consistency in orientation.1) The hue and tone distribution of beauty packaging at home and abroadAfter preliminary investigations, we selected basic skin care products as the subject of this research. Contemporary women are very demanding on their own appearances, 78% of women are not satisfied with their skin conditions, and their requirements for beauty are getting higher and higher. Among them, anti-aging has become their main demand. CBNData research shows that from the consumption of different effects in the online female skin care industry in 2020, the demand for anti-aging skin care accounted for 34%, exceeding the long-term concern of most women for moisturizing and moisturizing needs (33.4%). The significance of choosing this type of beauty product research lies in three aspects. First, basic skin care products are the most representative products in the current beauty industry. Second, the purchase frequency of skin care products is relatively fixed, and their seasonal characteristics are strong. The main purchases are quarterly basis, with one to two times a quarter being the mainstream purchase frequency. Third, the consumption level of skin care products tends to be even, and there are a considerable number of consumer groups in the middle, high, and low categories.The survey collected 200 samples of beauty packaging at home and abroad. The main containers and packaging of skin care products are usually plastic bottles, glass bottles, hoses, and airless bottles. Factors such as different painting processes and reflective surfaces of the outer packaging are excluded, and the final color application situation is shown in 2) Color distribution of cosmetics packaging in image spaceThe distribution of the packaging colors of basic skin care products at home and abroad in the image space is shown in This research is based on the collection and selection of color image adjective pairings of beauty packaging. First, after determination of the representative color test samples of beauty packaging in the previous steps , 4, we wOn this basis, we perform a detailed analysis of the specific meaning of each group of adjectives, and deleted the adjective groups with similar meanings, similarities, and unclear expressions. We also search relevant literature, referring to the cognitive suggestions of cosmetic design practitioners on the color of beauty packaging, and then obtain the semantic description related to the color image of beauty packaging. Finally, we select 30 sets of color image adjective pairs as the final test vocabulary, as shown in The female consumer market in China is huge, and the rapidly growing market has led to changes in the market structure. The growth of female users will stimulate the overall market. Exquisite product packaging and unique emotional experience often tend to arouse the consumer psychology of this group and stimulate consumer impulse. Therefore, studying the color preferences of female consumer groups has great potential and value for the market. White collar workers are the mainstream consumers of skin care products. They will choose first- and second-tier mid- to high-end products. As far as the development of domestic brands is concerned, the market value of domestic brands is that they are better at developing channels in second- and third-tier cities than international brands, and quickly seize the mass market in second- and third-tier cities and rural areas.In this case, the middle-aged female consumer group of about 30\u201355 years old is selected as the study subject. There are three main reasons for studying the northern rural women of this age group:The consumption behaviors of northern rural women under the age of 30 have not yet been fixed, and they are mostly seeking differentiation and have a strong sense of group imitation consumption;Among the northern rural woman consumers who are over 55 years of age, consumption behaviors and consumption habits have reached a fixed pattern in the middle and young ages, and their personal purchasing intentions have weakened, and new consumer products will be purchased by their children;Among the northern rural women, those who are 30\u201355 years of age have a leading role in daily commodity decision-making and purchasing activities. They are not only the decision-makers and purchasers of their own consumption activities but also of their husbands, children, and parents. Due to the influence of different consumer demand, factors such as different personalities, different regions, and different cultural education levels, female consumers in this age group have a certain degree of representativeness. When they purchase cosmetic products, they are more susceptible to the consumer psychology of product appearance and demands for aesthetic emotion.Analysis of cross-cultural color emotion by Gao et al.  and the result shows KMO = 0.913, as shown in In order to test whether the original data are suitable for factor analysis, it is necessary to pass the correlation coefficient matrix, Kaiser\u2013Meyer\u2013Olin (KMO) and Bartlett sphericity test, and the test of the common degree of variables. The variants are not irrelevant to each other  extracted from the factor analysis and the color attributes of the corresponding representative samples, the corresponding relationship and correlation characteristics between the sample color attributes and the semantics conveyed by factor axis are discussed. It can be seen from Based on the color sample statistics of 97 beauty packaging and using a Likert scale, the representative semantics of the three common factors are extracted. The first common factor (cognitive factor) extracted from the factor analysis shows that its representative vocabularies are delicate/coarse, intellectual/progressive, and fashionable/old-fashioned. The most remarkable samples of negative axes  on this factor are: YR/B, Y/B, G/L, BG/L, B/L, G/S, BG/S; the most remarkable samples of positive axes  are R/DGR, YR/DGR, and Y/DGR. By analyzing the color attributes of typical sample colors, we observe that the color features corresponding to approximate sensory images such as delicate, intellectual, and fashionable, are mainly as follow: the color has a visual perception of weak brightness, and the change in chromaticity is also inclined to increase the content of white. In terms of hue, blue-green color is the most remarkable, and there are also some colors of orange and yellow, which show the psychological feelings of visual cognition and prefer soft colors, while the color brightness and purity of main-tune tendency prefer stable color combinations with little fluctuation. It shows that women of this age group with a natural sense of closeness to rural life prefer neutral and cold colors in hue, and turbid colors, which have low color purity and tend to gray system. The women in northern China are reserved, and the colors they prefer have the characteristics of low brightness and low purity, and basically form the conservative and cautious semantics, which is consistent with their personalities.The second common factor (activity factor) extracted from the factor analysis shows that its representative vocabularies are youthful/mellow, agile/sedate, and speedy/smooth. The most remarkable samples of negative axes  on this factor are: RP/V, R/S, B/S; the most remarkable samples of positive axes  are: PB/B, PB/GR, B/GR. By analyzing the color attributes of typical sample colors, we observe that the color features corresponding to approximate sensory images such as mellow, sedate, and smooth, are mainly as follow: the color has a visual perception of weak brightness, and the change in chromaticity is also inclined to increase the content of black. In terms of hue, blue-purple color is the most remarkable; chromaticity also tends to the middle gray scale of achromatic colors. Colors of gray and blue-gray are the main hues, which show the reserved and conservative characteristics of the group. The tone is mainly cloudy and gray, which is closer to the quiet and calm inner feelings, contrary to the semantic characteristics such as being open and enthusiastic.The third common factor (attributive factor) extracted from the factor analysis shows that its representative vocabularies are luxurious/rustic, gorgeous/plain, and western/eastern. The most remarkable samples of negative axes  on this factor are R/DP and YR/DP; the most remarkable samples of positive axes  are GY/Lgr, G/Lgr, BG/Lgr, P/P, and N8. By analyzing the color attributes of typical sample colors, we observe that the color features corresponding to approximate sensory images such as plain, eastern, and rustic, are mainly as follow: in terms of brightness, it is better to choose middle brightness, and the change in chromaticity is also inclined to increase the content of white. In terms of hue, the colors of blue, purple, and gray, which can provide the best visual experience by reflecting the oriental life, also reflect the color emotional experience of the group in the specific cultural background.Nowadays, perceptual engineering and color psychology are both emerging fields in the design industry. They explore the relationship between rational thinking and perceptual impression of humans, how aesthetic experience of people is formed, and how to construct the relationship between human emotions, environment, and objects. A good communication bridge between the participants and finding effective emotional design methods are issues worthy of further investigation. NCD color image positioning, as the front-end system of color design, is the scientific color theory basis for fashion product designers. This study constructs a complete color reference system by investigating and positioning the color image of middle-aged women in the rural areas of northern China, focusing on exploring the co-existence of the color design process on color, women, and the environment. The proposed color-oriented design method conforms to the development trend of scientific design, clarifies the color logic relationship of \u201ccolor impression and emotional semantics,\u201d and is oriented to enhance the emotional experience of the user, which is conducive to accurately creating aesthetic characteristics of the local market. The product color with cultural connotation highlights the application value. At the same time, the construction of the color system meets the aesthetic needs of the Chinese population, and has the commercial practice value of more optimized design and more scientific structure.www.wjx.cn, https://www.wjx.cn/mobile/statnew.aspx?activity=111860856&reportid=#1, https://www.wjx.cn/vm/tU4Ai4A.aspx.Publicly available datasets were analyzed in this study. This data can be found here: All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "Shu-szi Sin \u8f9b\u6811\u5e1c, 1894\u20131977)  referral, Mr. Sin became a professor and Director of the Department of Biology of the Sun Yat-Sen University. Influenced by Dr. Diels, Sin Shu-szi presided over the scientific investigation of the Dayao mountain in Guangxi together with his colleagues in May 1928, where they collected more than 30,000 specimens. In november of the same year, he and his colleagues conducted a larger field study at the Dayao mountain, which lasted until February 1929. Soon after, Mr. Sin led a third scientific investigation of the Dayao mountain, opening a precedent for large-scale scientific investigation and biological collection in China. The scope of its investigation and collection far exceeded the Yaoshan area, involving the Yunwu, Doupeng, and Fanjing mountains in Guizhou; the Jintong mountain in southern Hunan; Beijiang, Yongchang, and Yaoshan in the Guangdong Province; and the Hainan province.Shinisaurus crocodilurus, the Sinia rhodoleuca, and the Corybas sinii etc. Based on their investigations and collections, a relatively complete animal and plant specimen room was established in the Sun Yat-sen University, which became an important basis and resource to cultivate and attract a large number of specialized personnel engaged in animal and plant research, enhancing the academic influence of China in the international biology community.Mr. Sin and his colleagues collected more than 60,000 specimens, including 30,000 specimens of plants, over 100 specimens of 40 species of mammals, about 4,000 specimens of 210 species of birds, around 500 specimens of 40 species of reptiles, and more than 2,000 specimens of birds. Apart from revealing the treasures of flora and fauna in southern China, he also identified nearly 20 new species, such as the Yaoshan Two-Month Inspection Record, the Zheng Yao Dance Song, the Ki Zi Ge, and the Yaoshan Collection Schedule. Thanks to their efforts, the people and the life of the Yao minority were introduced to, and accepted by, the outside world.In the Dayao mountain study, Mr. Sin and his colleagues broke the barriers between science and humanities, by using breakthrough scientific research methods in the humanities to investigate and report the life and customs of the Yao minority. Based on field visits and interviews with villagers, a map of the village was drawn. In addition, Mr. Sin also produced a considerable quantity of notes on local customs and habits, and compiled a large number of ethnic folklore materials such as the In 1932, Mr. Sin served as the head of the editorial department of the Ministry of Education of the National Government. The next year, the editorial office was expanded as the National Translator-Editor Center, of which Mr. Sin was the first director. He believed that standardizing the scientific terminology was an important foundation for the development of natural sciences in China. Accordingly, the National Translator-Editor Center began to translate and edit the terminology in chemistry, astronomy, geology, medicine, physics, and other fields. In order to facilitate this work, Mr. Sin and his colleagues also enrolled a number of experts and organized a series of academic conferences. The standardization of the scientific terminology in the first years of 1930 gave a crucial contribution to the development of science in China.Realizing the importance of building a scientific community, Mr. Sin built good relationships with other scholars. He was one of the founders and sponsors of the Botanical Society of China, whose preparation and initiation began in mid-summer in 1933. As one of the initiators, Mr. Sin attended the inaugural meeting in Chongqing, when the Constitution of the Chinese Botanical Society was adopted, and Mr. Sin was recommended as a key member Sun, . The estIn 1932, Mr. Sin visited Luoyang and other cities of northwest China, where he found the absence of higher agricultural schools. Therefore, he felt that he should do something to improve the situation in that region. Mr. Sin believed that Wugong, a city in the Shaanxi province, was an important birthplace of ancient Chinese agriculture; for this reason, he advocated the establishment of agricultural colleges in that city. At the end of 1932, he participated in the founding of the Northwest Agriculture and Forestry College in Wugong. In July 1936, the preparation work for the Northwest Agriculture and Forestry College was over. In spite of the harsh conditions in the northwest, he resigned from the position of Director of the National Translator-Editor Center, serving as President of the Northwest Agriculture and Forestry College and, later, as Dean of the Northwest Agricultural College. During that time, he regularly held lectures with teachers and students every week, listening to opinions, and insisting on doing exercises with students in the morning. Therefore, he was not only familiar with the teaching situation, but also knew well teachers and even most students. Many of his students later became the backbone of the agricultural field. The teachings of the old Dean were appreciated.In 1940, Mr. Sin left Shaanxi and became professor and Director of the Central University in Chongqing. He was also elected as member of the National Political Participation. Due to the illness of his mother, he resigned his various duties and returned home village to take care of his mother. During his stay in the countryside, he was deeply impressed by its economic and cultural backwardness. He persuaded the government to support education, and participated in the preparation of the Hunan 14th Middle School, the Xuwu Middle School, and the Jiuli Middle School in the Hunan Province. In 1945, Mr. Sin was elected as President of the Hunan Provincial Education Association.On March 26, 1946, Shu-szi Sin was appointed by the government of the Republic of China as principal, responsible for the preparatory work of the Lanzhou University. He believed that running a comprehensive university, composed of five colleges, in Lanzhou was crucial to improve the education of the whole northwest. To make Lanzhou University the capital of northwest education, he first focused on the establishment of the faculty, emphasizing the need to run the veterinary college, the Tibetan language department, and the Russian department, among others, and to train qualified graduates that were urgently needed for the development of the northwest economy and culture. Secondly, he managed to attract scholars at the Lanzhou University. Due to the poor transportation and living conditions of northwest China at that time, few scholars were willing to move to Lanzhou. Mr. Sin visited some scholars in Beijing, Shanghai, and Guangdong, and invited them to the Lanzhou University as visiting professors or short-term lecturers. Thanks to his good reputation and good relationships with other scholars, the Lanzhou University attracted a number of scholars around China. His third contribution was the purchase of a large quantity of books and teaching equipment. With his recommendation, a large number of Chinese and foreign books and academic journals  were collected in the Lanzhou University Library, which in just three years jumped at the top of the northwest colleges and universities.After the founding of the People\u2019s Republic of China, Mr. Sin returned as Dean of the Northwest Agricultural College. He deeply felt the importance of investigating the agronomic heritage of China. In 1952, he established the ancient agronomy research team, which included scholars such as Shenghan Shi (\u77f3\u58f0\u6c49), Weiying Xia (\u590f\u7eac\u745b), Yao Zhou (\u5468\u5c27), and Yunti Cui (\u5d14\u5141\u8906). Although there was no funding support at that time, all team members were working hard. In 1965, their efforts were recognized by the government, and the Ancient Agricultural Research Laboratory was established at the Northwest Agricultural College. They studied and sorted the ancient agricultural literature, and addressed the issue of soil and water conservation. They gained experience in studying the ancient agricultural literature, especially in aspects such as the identification of authenticity, the examination of the origins of the literature, and the punctuation, subsection, annotation, and translation (Zhang and Pu, Study of Chinese Fruit Trees History; the New Analysis of Yu Gong; the Study on the\u00a0Book\u00a0of\u00a0Change; and the Preliminary discussion on 159 cultivated plants in the book of agricultural administration. The Study of Chinese Fruit Trees History systematically analyzes and compares the achievements of the earliest fruit trees cultivation in China, according to the records of fruit trees from the Western Zhou Dynasty to the end of the Tang Dynasty, and carefully examines the types and names of fruit trees during this period. In the New Analysis of Yu Gong, Mr. Sin conducts a scientific investigation of \u201cwater and soil\u201d and \u201ctribute\u201d such as comb and bag which recorded in Shang Shu \u00b7 Yu Gong, an ancient article describing the geography, establishing an example of ancient agronomy research. In his later years, Mr. Sin paid great attention to the issue of soil and water conservation in China, especially in the northwest region. He published the Historical Research on Soil and Water Conservation in China, and presided over the preparation of the Introduction to Soil and Water Conservation. In order to collect first-hand information on vegetation damage and soil erosion, he conducted field studies in Shaanxi, Yunnan, and other places. Having reached the age of eighty, he was overworked. When he returned from the Yunnan investigation, he fell ill. He passed away on October 24, 1977.Mr. Sin\u2019s research outcomes include: The As a biologist, ancient agronomist, and educator, Mr. Shu-szi Sin was always passionate in his work and research. His work was visionary and groundbreaking. He loved his motherland, and devoted all himself to the development of science and education, especially in northwest China."}
{"text": "Background: In China, there are severe unmet medical needs of people living with rare diseases. Relatedly, there is a dearth of data to inform rare diseases policy. This is historically partially due to the lack of informatics infrastructure, including standards and terminology, data sharing mechanisms and network; and concerns over patient privacy protection.Objective: This study aims to introduce the progress of China's rare disease informatics platform and knowledgebase, and to discuss critical enablers of rare disease informatics innovation, including: data standardization; knowledgebase construction; national policy support; and multi-stakeholder participation.Methods: A systemic national strategy, delivered through multi-stakeholder engagement, has been implemented to create and accelerate the informatics infrastructure to support rare diseases management. This includes a disease registry system, together with more than 80 hospitals, to perform comprehensive research information collection, including clinical, genomic and bio-sample data. And a case reporting system, with a network of 324 hospitals, covering all mainland Chinese provinces, to further support reporting of rare diseases data. International standards were incorporated, and privacy issues were addressed through HIPAA compliant rules.Results: The National Rare Diseases Registry System of China (NRDRS) now covers 166 rare diseases and more than 63,000 registered patients. The National Rare Diseases Case Reporting System of China (NRDCRS) was primarily founded on the National Network of Rare Diseases (NNRD) of 324 hospitals and focused on real-time rare diseases case reporting; more than 400,000 cases have been reported. Based on the data available in the two systems, the National Center for Health Technology Assessment (HTA) of Orphan Medicinal Products (OMP) has been established and the expert consensus on HTA of OMP was produced. The largest knowledgebase for rare disease in Chinese has also been developed.Conclusion: A national strategy and the coordinating mechanism is the key to success in the improvement of Chinese rare disease clinical care and drug accessibility. Application of innovative informatics solutions can help accelerate the process, improve quality and increase efficiency. Rare Diseases refer to diseases with a very low incidence, often chronic and progressive, and life-threatening . The rarThere is no single, widely accepted definition for rare diseases. Three elements to the definition as used in various countries are as follows: the total number of people having the disease, its prevalence, non-availability of treatment for the disorder . In the Rare diseases are a global public health challenge. In China, people living with rare diseases have severe unmet needs. Health for All is China\u2019s national healthcare strategy and the improvement of clinical care and drug accessibility for rare disease patients is a key issue to meeting its target. Epidemiological and clinical data for most rare diseases, which provide a foundation for policymaking at both the regional and national level, are missing in China . This isThe Healthy China 2030 Planning Outline was issued by the Communist Party of China (CPC) Central Party Committee and the State Council in 2016 . The Outwww.nrdrs.org.cn)  has developed the National Rare Diseases Registry System  . An init.org.cn) . The aimMeanwhile, with the endorsement of the National Health Commission of China, the PUMCH serves as the national rare diseases center, which is mainly responsible for taking the lead in establishing and improving the working mechanism of the collaboration network, formulating a national plan for doctor training, and treating the most critically ill patients with rare diseases, provides planning, coordinating, management, and technical support, and coordination of a national network of 324 hospitals for conducting direct case reporting on the 121 rare diseases included in China\u2019s First List of Rare Diseases. An online registry updated manually and available to all member hospitals, is complemented by automatic reporting by the member hospitals to integrate their electronic medical record systems with the case reporting server provided by the national center. With the coverage of 324 medical centers designated as the national (1), and regional (323) rare disease centers, the statistician inside each center report weekly all the diagnosed cases of the rare diseases included in the first list of rare diseases. The annual report of the data will be published by the national rare disease center.International standards, including Human Phenotype Ontology (HPO) and Logistic Observation Identifiers Names and Codes (LOINC) were applied to ensure interoperability and to support future multi-national studies. Privacy issues were addressed through HIPAA compliant rules. To ensure alignment to the needs of the rare diseases community, increase coverage and population representativeness, a multi-stakeholder involvement strategy was incorporated.The NRDRS now covers the registry of 166 rare diseases and 63,470 registered patients in 185 case reporting forms (CRF)  . A regioIn February 2019, 324 hospitals, representing all the provinces in mainland Chinese provinces, were selected based on their capacity and experience in treating patients with rare diseases to form the National Network of Rare Diseases (NNRD) . This coBased on the data and real-world evidence available in the two systems, the National Center for Health Technology Assessment (HTA) of Orphan Medicinal Products (OMP) has been established. Members of the center are widely representative, including rare disease research experts, HTA research experts, policymakers, clinical therapists, representatives of pharmaceutical companies, payers, and patients\u2019 rights and other stakeholders. And the expert consensus of HTA on OMP has been produced and published . This sethe Diagnosis and Treatment Guidelines for 121 Rare Diseases , genetic sequencing, and other technologies are enabling for the collection, storage, transmission, and analysis of health data. Biomedical and clinical data are being generated by the terabyte, and even petabyte. The importance of the application of real-world evidence in medical decision-making is gaining increasing acceptance, especially for rare diseases . WorldwiPhenotypic information, which is key to the accurate diagnosis of rare diseases , is not Solid and sustainable funding from the central government is key to the success of this registration and case reporting system. The initial funding from the Ministry of Science and Technology of China was an important stimulus for research on rare diseases . Multi-sA national strategy and coordinating mechanism is key for improvement of clinical care and drug accessibility in the treatment of rare diseases in a country with a large population. The application of innovative informatics solutions can help accelerate the process, improve quality, and increase efficiency. With the registry system for scientific research, case reporting system for public health service and policymaking, direct patient and family data ascertainment and the related data-driven systems and services, China has built a data infrastructure for rare diseases research and management to address the unmet medical needs of patients with rare diseases and to achieve the national goal of Health for All."}
{"text": "Research, understanding, and prediction of complex systems is an important starting point for human beings to tackle major problems and emergencies such as global warming and COVID-19. Research on innovation ecosystem is an important part of research on complex systems. With the rapid development of sophisticated industries, the rise of innovative countries, and the newly developed innovation theory, innovation ecosystem has become a new explanation and new paradigm for adapting to today\u2019s global innovation cooperation network and the scientific development of complex systems, which is also in line with China\u2019s concept of building an innovative country and promoting comprehensive innovation and international cooperation with scientific and technological innovation as the core. The Innovative Research Group at Peking University is the most representative scientific and technological innovation team in the frontier field of basic research in China. The characteristics of its organization mechanism and dynamic evolution connotation are consistent with the characteristics and evolution of innovation ecosystem. An excellent innovative research group is regarded as a small innovation ecosystem. We selected the \u201cEnvironmental Biogeochemistry\u201d Innovation Research Group at Peking University as a typical case in order to understand and analyze the evolution of cooperation among scientific and technological innovation teams, improve the healthy development as well as internal and external governance of this special small innovation ecosystem, promote the expansion of an innovation team cooperation network and the improvement of cooperation quality, promote the linkage supports of funding and management departments, and improve their scientific and technological governance abilities. Through scientometrics, visual analysis of knowledge maps, and an exploratory case study, we study the evolution process and development law of team cooperation. It is found that the main node authors of the cooperation network maintain strong cooperation frequency and centrality, and gradually strengthen with the expansion of the cooperation network and the evolution of time. Driven by the internal cooperative governance of the team and the external governance of the funding and management departments, this group has gradually formed a healthy, orderly, open, and cooperative special innovation ecosystem, which is conducive to the stability and sustainable development of the national innovation ecosystem and the global innovation ecosystem. Global warming, the COVID-19 epidemic, earthquakes, ecological destruction, sudden and extreme events, and their accompanying social and economic disasters pose severe challenges to the sustainable development of mankind. However, due to the complex structure of the Earth system and the many nonlinear interactions, there are significant difficulties and obstacles for individuals aiming to understand and to predict emergencies and disasters under these complex systems; nevertheless, research on complex systems in the scientific community has not stopped ,3. The NWith regard to the rise and development of research on innovation ecosystem, because of the rise of Silicon Valley and the success of high-tech companies such as Apple Inc., Cupertino, CA, USA, marked by two scientific and technological innovation and research reports of the President\u2019s Committee of Advisors on Science and Technology (PCAST) in 2004, some researchers believe innovation ecosystem has been formally put forward as the core concept and normative content, and therefore have focused their attention on innovation ecosystem. It is believed that the leading position of the United States in science and technology, economy, and politics in the world mainly depends on an \u201cinnovation ecosystem\u201d which is dynamic, evolving, and has a good top-down design ,9,10. SuIn the 21st century, China pays special attention to the construction of an innovative country. Recently, China has been focusing on the innovation-driven development strategy, accelerating the overall innovation with scientific and technological innovation as the core, and constantly advancing the modernization of the national governance system and governance capacity. Facing the changes in international trade and economic situations and the impact of the COVID-19 epidemic, China, as a big economy and complex innovation ecosystem, has achieved relatively good and stable responses and development. Some scholars believe that the development and connotation of innovation ecosystem theory are highly consistent with China\u2019s innovation-driven development strategy and the concept of accelerating comprehensive innovation with scientific and technological innovation as the core ,21,22,23The source and production of scientific and technological innovation are basic research. Most basic research requires promotion of the state, inclination of science and technology policies, and support of science funds. Systematic and cooperative innovation needs to be completed through a scientific and technological innovation team. From a macro perspective, the national innovation system and innovative country are large innovation ecosystems, while from a micro perspective, industries, organizations, enterprises, and innovation teams are also small- and medium-sized innovation ecosystems. Some studies on innovation ecosystem have focused on regions and regional perspectives, such as the global innovation system, national innovation system, and regional innovation system ,15,24. TAccording to existing studies, the innovation ecosystem has time series, self-organization, and community characteristics ,6,7,8. FScholars from various countries have many definitions and discussions on the connotation of \u201cinnovation ecosystem\u201d ,21,22,23According to the relevant regulations of the National Natural Science Foundation of China (NSFC), an \u201cInnovative Research Group\u201d refers to \u201ca research group with excellent middle-aged and young scientists as academic leaders and the backbone of research, jointly carrying out innovative research around an important research direction, and cultivating and bringing up a research group that occupies a place in the forefront of international science . An innoAn innovative research group takes universities, scientific research institutes, and other institutions as supporting units, and the academic leaders, research backbone, and formal team members must belong to the supporting units, which are regional, interval, and community to a certain extent; meanwhile, the assessments of an innovative group advocate interdisciplinary research, frontier exploration, and international cooperation, and the team is also open and innovative. The members of an innovative research group have information communication and close cooperation; in addition to the formal internal cooperation network, they also cooperate with other high-level scholars or groups, which will gradually evolve into an increasingly expanding cooperation network and ecosystem during the progress of a project and subsequent development and evolution. Therefore, an innovative research group has the basic characteristics of an innovation ecosystem, which is itself an innovative cooperation network and an open and complex system that is constantly evolving in time sequence. It is of necessary theoretical and practical significance to explore the regular contents of its cooperation network and time-series evolution from the perspective of innovation ecosystem.According to many scholars\u2019 studies and research on the development and evolution of innovation ecosystem ,18, reseAs the case study and evolution analysis involve the period presentation and analysis of innovation cooperation network, as well as the cooperation frequency and network centrality of the main node authors, these all need to be analyzed with the methods of scientometrics and visual analysis of knowledge maps. Scientometrics (Scientific Metrology) has a wide connotation and scope, including citation analysis, bibliometrics, etc. that were widely used in the early stage, and visual analysis of knowledge maps, knowledgometrics, altmetrics, etc. that were developed in the later stage ,40. A knIn order to deeply analyze the cooperation mechanism and time sequence evolution of an innovation group cooperation network from the perspective of innovation ecosystem, we selected the excellent Environmental Biogeochemistry\u201d Innovation Research Group of the Earth Sciences Department of the NSFC for the exploratory case analysis, supplemented by scientometrics and visual analysis of knowledge maps, and therefore clearly show the process and connotation of the cooperation network and time sequence evolution.According to our previous research on innovative research groups ,41,47,48During the research period of the project, from 2001 to 2006, 183 SCI documents were retrieved from the academic achievements of the main backbone members. Three years after the completion of the project, from 2007 to 2009, 116 documents were retrieved. Through scientometrics and knowledge map visual analysis, using CiteSpace software, we describe the time sequence evolution of cooperation, distribution, and clustering of main node authors ,43,44,45With the support of the NSFC, the innovative reasearch group invested eight researchers during the project implementation period from 2001 to 2006, with S. Tao as the academic leader and J.-H. Fang, J.-Y. Hu, and X.-J. Wang as the research backbones. The eight members of the team included two academicians of the Chinese Academy of Sciences (one member was selected during the project implementation and one member was selected after the project conclusion) and five members were winners of the National Science Fund for Distinguished Young Scholars (three members were funded before the project was launched and two members were funded after the project was completed), two members were selected into the New Century Excellent Talents Plan of the Ministry of Education of China (one member during the project implementation and one member after the project was completed). It can be seen that this group, as an innovation ecosystem, has achieved good research results and cultivated and expanded the team of research talent in the expansion and time evolution of the cooperation network.According to the interview, report materials, and previous studies ,41,47,48Science, Nature, and Environmental Science & Technology, which has made the group an internationally renowned academic group engaged in environmental biogeochemistry research [During the implementation of the project, this group made a series of breakthrough achievements in the related attributes of the terrestrial ecosystem carbon cycle and its response to climate change, the regional environmental process of persistent organic pollutants, and the environmental fate and ecological effects of endocrine disruptors, etc. For example, the research group perfected the application of the \u201cContinuous Biomass Conversion Factor Method\u201d proposed earlier in a regional scale carbon assessment and studied the carbon budget of Japanese vegetation by using this method, which solved the dynamic change problem of the Japanese carbon budget that Japanese scholars had not solved for many years. The ecological risk assessment method with the expected loss of population sustainability as the evaluation endpoint was established, and the ecological risk of the Taihu Lake Night Heron population caused by DDE exposure was evaluated. Many original achievements have been published in the world\u2019s top journals such as research .We drew the paper cooperation network knowledge maps (node map and timeline map) of the main group members during the project implementation period, as shown in Nature and Science journals, were completed by cooperation with team members and foreign scholars during the project research. Other backbone members, such as F.-L. Xu and J.-Y. Hu, also have high cooperation frequency and network centrality, and each member has their own subgroup and network cluster.It can be seen from During the research period of the project, the five representative papers of this group are shown in 2 absorbed by China\u2019s land could offset the share of CO2 emissions from industrial sources, providing a relevant reference and a basis for China\u2019s relevant departments to formulate energy conservation and emission reduction policies and for China\u2019s international negotiations on climate change. By cooperating with botanists from all over the world, the team members have established a distribution database of Chinese woody plants containing more than 11,000 species. It was found that the number of species in China and North America was indeed limited by energy, as predicted by the \u201cmetabolic theory\u201d, but the size of spatial scale greatly affected the relationship between energy and diversity. The first global inventory of PAHs emissions was established and published. The concept of gene susceptibility was quantitatively introduced into exposure and risk simulation, which quantitatively confirmed that polycyclic aromatic hydrocarbons were an important pollutant inducing lung cancer in Chinese residents. A multicomponent method for the determination of trace estrogen, androgen, progesterone, glucocorticoid, and mineralocorticoid in the environment was established. It was found that there were serious deformities in the juvenile of wild Chinese sturgeon in the Yangtze River, and it was proven that triphenyltin was the main substance causing the distortion of wild Chinese sturgeon.On the basis of the results achieved during the implementation of the project, the group members carried out further research after the conclusion of the project and achieved remarkable results . For exaThe five representative papers in the three years from 2007 to 2009 after the project completion are shown in We drew the knowledge maps of the SCI papers cooperation network of major members of the \u201cEnvironmental Biogeochemistry\u201d Innovation Research Group from 2007 to 2009, as shown in It can be seen from Science, reported it. The \u201cContinuous Biomass Conversion Factor Method\u201d, which was proposed to calculate regional forest biomass, has been used as a general method and is widely used. The multi-media source analysis method established by the research group has been praised by peers as \u201can important contribution to our understanding of pollutant sources and environmental behaviors, and represents \u201cculmination\u201d in the aspects of source characterization of polycyclic aromatic hydrocarbons, analysis of a large number of samples, application of fugacity model, statistical analysis and sensitivity, and uncertainty analysis. Papers on the county-level resolution emission list of polycyclic aromatic hydrocarbons in China were listed as the highest cited papers of the year after Environmental Science & Technology was published. The quantitative research results of lung cancer risk caused by respiratory exposure to polycyclic aromatic hydrocarbons in China are listed as important articles in the current period by the PNAS. The direct evidence of fish distortion caused by environmental pollution has become an important reference for explaining fish distortion in wild ecosystems. The research results on steroid pollution in municipal wastewater have become an important basis for peers to carry out research on new persistent pollutants.According to the interview, report materials and previous studies ,41,47,48The research group has a certain international influence in relevant research directions. At present, many people have served in international academic organizations  working group, \u201cSETAC Asia Pacific chairman, etc.) and served as the editorial board of foreign academic journals.Through the exploratory case analysis of the cooperation network and time sequence evolution process of innovation groups, it can be found that as a small innovation ecosystem, excellent innovation groups have formed a good cooperation structure and the innovation network for their scientific research teams and research communities, academic leaders as \u201chead geese\u201d, and other research backbone structures is reasonable. On the basis of young scientists, combined with other researchers and postgraduates, an innovative ecosystem community was formed; at the same time, the community exchanged and cooperated with other community members individually or as a whole, and gradually expanded into a larger cooperative network, forming an open, complex, and dynamic ecosystem in the time sequence evolution.As an innovation ecosystem, the innovative research group is also supported and funded by the National Natural Science Foundation of China (NSFC), managed and reviewed by the foundation committee and the expert review committee, and supervised and managed by the supporting units, and therefore organically combines external governance with internal cooperation of the team . At thisIn the typical case report materials submitted to the National Natural Science Foundation of China (NSFC) and National Center for Science & Technology Evaluation (NCSTE), the group thinks that: (1) For the members of the group, the project provides relatively sufficient research funds and condensed the research direction of the team. The implementation of the talent funds has high flexibility, is not strictly limited by specific research programs, and is easy to exert initiative and creativity, which provides important conditions for young scientists to become talents. (2) For the group, the implementation of the project provides better conditions for cooperation among members, enabling them to freely cooperate, innovate, grow, and evolve . TherefoThis study is based on the perspective of innovation ecosystem and uses a case study, as the mainstream method of related research, to explore the process and connotation of the evolution of a cooperation network and time sequence of an outstanding innovation group as a special type of innovation ecosystem. It is considered that the innovative research group conforms to the connotation and characteristics of the innovation ecosystem, and has the characteristics of interval, openness, innovation, dynamics, and complexity. In the evolution and development of the cooperation network, through the guidance and drive of academic leaders and research backbones, it continues to coordinate integration and cooperative innovation, and therefore achieves a series of important research progress and talent training objectives. It has also formed an innovation ecosystem of symbiotic evolution.Specifically, at the level of practice and case study, we select the \u201cEnvironmental Biogeochemistry\u201d Innovative Research Group, organize its development and governance context according to relevant materials and timeline, draw the knowledge maps of the scientific research cooperation network in the periods of the project implementation and completion, and analyze the characteristics of cooperation among the main node authors of the network . According to the materials, we summarize the external management of the Science Fund for Innovative Research Group, the National Natural Science Foundation of China, team cooperation, and internal governance of innovative research groups, which can promote the expansion of the innovative research group cooperation network and time sequence evolution, and promote it to form an open and complex innovation ecosystem.From the Earth and the country, down to organizations, teams, and individuals, in the face of routine changes and emergencies, the concepts and methods of complex network systems help to achieve stability and sustainable development. From a macro perspective, in the period of COVID-19, China\u2019s economic development, technological innovation, international cooperation, health of people, and stability of working life all benefited from the construction of a good innovation ecosystem. At the same time, China has actively strengthened international cooperation in scientific and technological innovation and public health, actively integrated into the world innovation cooperation network, nested and integrated the national innovation ecosystem with the global innovation ecosystem, and symbiotically evolved.Meanwhile, at the micro level, as a special small innovation ecosystem, science and innovation teams such as innovative research groups also need to form an open and expanded innovation cooperation network and ecosystem that is nested, linked, and integrated into larger science and technology organizations and innovation ecosystems of industry, country, and the world under the collaborative promotion of internal cooperation governance of the team and external governance of relevant departments. As a result, from the micro to macro level and from the inside to outside multi-layer linkage, science and innovation teams could truly achieve comprehensive innovation, and promote the development of global innovation ecosystem, to effectively respond to global warming, economic crises, COVID-19, and other major challenges and unexpected events."}
{"text": "This supplement contains seven revised and extended papers selected from CIBB 2018 and CIBB 2019, the 15th and 16th editions of the international conference on Computational Intelligence Methods for Bioinformatics and Biostatistics. CIBB is a venue that embraces researchers with different backgrounds, ranging from mathematics to computer science, from materials science to medicine, and from engineering to biology, all interested in the investigation and application of computational intelligence methods to open problems in bioinformatics, biostatistics, systems biology, synthetic biology, and medical informatics.CIBB 2018 was held at Faculdade de Ci\u00eancias e Tecnologia, Universidade NOVA de Lisboa, Caparica, Portugal, from 6th to 8th September, 2018 [CIBB 2019 was held at the Department of Human and Social Sciences of the University of Bergamo, Italy, from the 4th to the 6th of September 2019  collecteCIBB dates back to 2004, and it was organized as a special session of different Italian conferences up to 2007. In particular, CIBB was part of WIRN 2004 in Perugia, WILF 2005 in Crema, FLINS 2006 in Genoa, and WILF 2007 in Camogli. Afterwards, the Steering Committee of CIBB planned the 2008 edition in Vietri  as an independent conference. From that moment onward, by relying on the increasing support of the community, CIBB has been organized as a conference, first held only in Italian venues\u2014Genoa (2009), Palermo (2010) and Gargnano (2011)\u2014then, starting from 2012, with an international scope. CIBB 2012 was organized in Houston (TX), then in Nice (France) in 2013, Cambridge (UK) in 2014, Naples  in 2015, Stirling (UK) in 2016, Cagliari  in 2017, Lisbon  in 2018, and Bergamo  in 2019.Thanks to the synergistic effort of the Organizing, Program and Steering Committees, and to the support of sponsors and participants, the success of CIBB conference series is still growing."}
{"text": "The characteristicsof this expansion are discussed, as well as the socio-political settingwhere such movement occurred, and the quality of education available basedon the data collected.this is a descriptive and cross-sectional study with a quali-quantitativeapproach, with the use of secondary databases.an accelerated and disordered growth of Nursing undergraduate courses wasidentified, as well as the number of vacancies, especially due to theparticipation of the private sector, especially since the year 2000.Geographical inequalities in the distribution of these courses and vacancieswere also identified.the strong expansion of higher education in Nursing, along with other healthprofessions, resulted in the strengthening of private higher educationinstitutions associated with economic groups, regional concentration, aswell as the excessive offer of distance learning without adequate evaluationof its quality or repercussions. The educational system responds both to thedemands of the health system and to the dynamics of the health labor market. In thissense, educational institutions are recognized as vital in the transformation of thehealth system and in economic and social development.stcentury. Its trends of expansion are especially related to the public policies,which influence, and even encourage, the increase of these institutions.The phenomenon of privatization in higher education in health has been characterizedas a marked dynamic and accelerated growth in education in the 21itutions.. Privatization also presents as a characteristic a strong appeal ofprivate HEI brands, competition, the exploitation of niche markets with sociallyprestigious professions, aggressive marketing, and profit-oriented pricingpolicies.In this study, the term \u201cprivatization\u201d includes the expansion of private highereducation institutions which offer Nursing degree courses, directed by individualsor companies, and no longer by the State. In this process, there is a tendency toperceive the student as a consumer and education as a product. Privatpolicies.(-). In July 2019, the number of schools and actual vacancies were 1,348and 197,995, respectively.In Brazil, the first Nursing school appeared in 1890, in Rio de Janeiro and, in 1939,the first private Nursing institution was created in S\u00e3o Paulo. Until the end of the1950s there were only 33 Nursing courses in the country, of which 36% were of aprivate nature, in its immense majority confessional institutions-. In Julper inhabitant, on the other hand, it has producedinequalities in the distribution of institutions and questions on the quality ofeducation. Additionally, Nursing training in Brazil started to strongly contemplatethe Education at Distance (EaD) modality, with 82.000 vacancies offered by 9 HigherEducation Institutions (HEIs), all private.While the increase in the number of schools and vacancies can be considered positive,since it has increased access to higher education and improved the proportion ofprofessionals  private.. However, 80% of these professionals are located in countries with halfthe world\u2019s population, a very unequal distribution especially in the poorest andlow- and mid-income countries. Despite this growth, until 2030 a shortage of 5.7million Nursing professionals is estimated, especially in countries with the highestburden of diseases.Nursing is the largest professional category in the health sector. Recent data fromthe World Health Organization (WHO) indicate a growth of 4.7 million professionalsin the period from 2013 to 2018, currently corresponding to approximately 59% of theworkforce in the sector worldwide. Recent WHO analyses indicate the need for growth in the mean number ofNursing graduates around 8% per year, but stress the importance that this expansionmust be linked to greater employability, strategies for the retention of theseprofessionals, development of competencies and skills associated with the needs ofhealth systems, and strengthening governance and leadership in Nursing.There is no evidence on how the increased number of vacancies and schools could solvethe problem related to the lack of health professionals. Recent.Currently, in Brazil there are 1,241 Nursing courses in the face-to-face modalityunder activity, that offer 193,217 vacancies, the immense majority being in privateHEIs, whose participation is of 87.8% in the offer of courses. The increase in theparticipation of the private sector, inherent to the global trends of the economicmodel, in the offer of services and in health education, also created opportunitiesin the measures that aimed at the expansion of the Universal Coverage of Health andthe flexibilization of laws and norms regarding the participation of private andinternational capital, besides reducing the inefficiency of regulatorystructures. In this sense, it is crucial to understand how universities operate inthe process of training human resources in market terms, since this reality does notalways appear in the public description of their function and often receives anegative connotation. Moreover, it is urgent to understand the factors affecting the size ofthe future health workforce to plan and propose more effective actions adjusted toeach reality.The understanding of workforce training is intrinsically linked to economicdevelopment and has important social, economic and political consequences. It isdifficult to assume that large economies reach advanced stages of developmentwithout high levels of innovation and quality in education, for example, which canbe considered basic components for placing a country at the forefront of the\u201cinformation society\u201d. In thinotation. Moreov reality.Thus, this article intends to describe, analyze and characterize the expansionmovement of Nursing undergraduate courses in Brazil, emphasizing the participationof the private sector, its role, impact and trends in Nursing training in thecountry., nurses, nursing assistants and technicians, obstetricians and midwivesare defined as Nursing professionals. Training takes between one and five years,varying according to the degree and the title. In this article, only the informationreferring to the professional qualified in higher level Nursing courses is analyzed,whose undergraduation varies from 4 to 5 years.In Brazil, in accordance with the Law No. 7,498/86, nursesIt is a study of the descriptive type, cross-sectional and with a quali-quantitativeapproach, whose analysis setting is Brazil. The quantitative data of this study werecollected in the period going from July 2019 to May 2020. The population of thisstudy is the higher education institutions with Nursing training courses, selectedwith the following criteria: i) higher education institutions with undergraduateNursing courses; ii) the administrative category of IES; iii) active course; and iv)teaching modality, if face-to-face or distance learning. All the institutions withundergraduate courses in activity were selected as Participants.The following variables of the study were selected: number of active Nursing courses,modality of the activity, if face-to-face or at distance, administrative category ofthe institution that offers the graduation course (if public or private), number ofauthorized vacancies, and the geographic location of the course or of theinstitution that offers it. As the variables were easily located, it was notnecessary to use any particular instrument for data collection.Data collection was carried out at the e-MEC websites, the An\u00edsio Teixeira NationalResearch Institute (INEP) and the Workstation of the Observatory Network of HumanResources in Health of the Institute of Social Medicine of the State University ofRio de Janeiro (ObservaRH-IMS/UERJ). Regarding data treatment and analysis, wehighlight that, at the e-MEC website, we obtained the listed data referring to theperiod in force and effect, and that it was not possible to access data fromprevious years, which were obtained from the ObservaRH-IMS/UERJ database. Themicrodata from the 2017 and 2018 Higher Education Census were obtained from theAn\u00edsio Teixeira National Research Institute (INEP) website. The entire collectionwas conducted by a single researcher, with supervision and review by anotherresearcher. Subsequently, the data were compiled and organized into a table andgraphs, using Office Microsoft Excel resources.nursing education, nursing schools,private and privatization. Relevant articles published since the year2000, in English, Portuguese and Spanish, dealing with similar research studiesand/or the historical context of the development and expansion of Nursingundergraduate courses were considered. The search of the texts was made by aresearcher, with the participation of the other researchers in the analysis, in aqualitative manner, with emphasis on the content of the selected articles, in orderto complement the information of the research, as well as to compare them to otherstudies. Finally, regarding the ethical aspects, this study waives the approval ofany Ethics and Research Committee.The literature review was carried out in the PubMed, SciELO and Google Academicdatabases, in such a way to become aware of the existing production of the educationof nurses and of the expansion of private higher education in this area. For this,the following search terms were used: . By permeability we can understand the effects of the meeting oroverlapping of the State and the private sector in the various stages of productionand delivery of public policies. The effects can assume different outlines depending on the relationalpattern established at a given time, under certain historical, social, political andeconomic conditions.Changes in the education systems have expanded permeability to the privatesector. By perpolicies. The efnditions..The purchase and sale of services is no stranger to the state activity; however, thespeed and the characteristics of privatization in the last decades had much properaspects, especially in the educational sector. In this sense, there are no servicesexempted from the participation of the private sector; there are those where theprivate sector operates with less or very little expression.This section initially presents the profile of the privatization process in Brazil,highlighting some elements of the historical context and its characteristics. Thefollowing describes the growth trend of the private sector over the past few yearsand its geographical distribution across states and regions of the country..As far as Brazilian higher education is concerned and from a legal point of view,the State can and has transferred resources to private HEIs. In the case of thepublic policies that influence and even contribute to the expansion of privatehigher education institutions, there is a tendency to increase theexpressiveness of the private sector in the health sector globally.campi of existingfederal institutions, such as in the increase of the number of institutions orthrough restructuring programs, such as the Support Program for Restructuringand Expansion Plans of Federal Universities (Reuni); 2) expansion ofpost-graduation and knowledge entrepreneurship; 3) intense diversification ofcourses, institutions and teaching modalities, especially distance learning(EaD); and 4) expressive increase of private for-profit HEIs.The expansion of Brazilian higher education covers four categories: 1) expansionof vacancies, enrollments and courses in the federal HEIs by the Union, whichcan be observed both in the multiplication of fit HEIs.. Another interesting aspect is that, although political scenarioshave alternated between different political groups and parties with supposedlydifferent ideals of conformation, orientation and militancy, their leaders havemaintained a favorable direction for the expansion of private HEIs.From 1960 to 1970, a lucrative sub-sector of higher education businesses wascreated, when the establishments were still considered formally as non-profitinstitutions. AnotheLei de Diretrizes e Bases,LDB) is considered by most authors to be the basis of theprivatization process of higher education in Brazil. However, the participationof private for-profit HEIs, explicitly or not, already existed since the1960s.The 1996 Guidelines and Bases Law .Until the end of the 1940s there were 20 Nursing courses in the country, four inprivate HEIs. Since 1949, the Brazilian State stimulated the creation of newschools, by making the Nursing course compulsory in all the universities orheadquarters of medical schools. Law Noospitals. Only iAfter the 1968 University Reform, the Nursing degree finds again fertile groundfor expansion. If in the 1960s only three new courses were created, and the1970s saw the appearance of 39 new courses, 28 in public HEIs and 11 in privateinstitutions. From 1980 to 1990, 62 Nursing schools were created, 42 in publicinstitutions. The participation of private HEIs remained stable until the 1990s,when the enactment of LDB in 1996 promoted an alignment of the country\u2019seducational policies with flexibilization, liberalization, diversification offinancing, and redefinition of the role of the State in education. So it is fromthe late 1990s that growth in the private sector surpassed that of the public inthe supply of courses and Nursing positions, as shown in .The public sector held more than half of the enrollment until 1998 but, in thefollowing year (1999), private course enrollment represented 54.5% of the totalin the country, continuing to grow over the years. Several factors contributedto the substantial expansion of Nursing courses and vacancies in the countryand, consequently, in the number of graduates: i) legal and normative documentsrelated to the allocation of Nursing professionals in services; ii) labor marketflexibility; iii) public policies that corroborated the expansion of the labormarket in the health sector; and iv) educational policies that make HEIs moretolerant and autonomous.Between 1991 and 2004, the number of available vacancies increased tenfold, from7,460 to 70,400, of which only 8% were in the public sector. The number ofactive courses in this period also increased expressively, going from 108 in1991 to 415 in 2004, with a total increase of 291,5%, confirming the leadingrole of the private sector with a growth of nearly 616%. The LDB contributedstrongly to this expansion, because in the period from 1991 to 1996, forexample, the growth percentage of higher education in Nursing was only 4.71%,while between 1996 and 2004 it was approximately 287%. The same trend wasnoticed in the following years. In 2003 there were 243 Nursing degree coursesoffered by the private sector and 89 by the public; in 2004, these numbers were322 and 93, respectively. The vacancies offered in 2003 totaled 41,937 in theprivate sector and 5,410 in the public sector; in the following year, thenumbers jumped to 64,803 and 5,597, respectively, an increase of 154.5% ofvacancies in the private sector. . The worst percentages of vacancies were recorded in the years2002, 2003 and 2004, with the equivalent of 18% in the private sector.However, although the number of vacancies for Nursing undergraduate students hasincreased considerably, the number of graduates has not followed the sameevolution; on average, the evasion percentage of Nursing vacancies ishistorically higher in private courses than in public courses and corresponds to38% in public institutions and to 62% in private ones. The woIn 2006, the first distance Nursing courses were created. In 2019, 130 courseswere offered by 9 institutions, distributed in 14 poles, totaling 82.000vacancies available in the EaD modality. Today, this modality represents 28% ofthe total vacancies offered for Nursing under-graduation in Brazil. In theprivate sector, compared to the face-to-face modality, distance learningrepresents 30,8% of the vacancies offered.The growth in the number of courses has not been uniform throughout the country\u2019sregions, presenting inequalities between states and cities and concentrationsmainly in the capitals and metropolitan regions, where, in general, there is ahigher Gross Domestic Product (GDP) and, consequently, greater economic powerand greater concentration of income of the population, in addition to a previousinstalled capacity, both of human resources and of physical structure. Thelargest fraction of public investment has also occurred in these locations.The Southeast region, followed by the South, remained the epicenter for expandingcourses and vacancies. However, considering the proportion of expansion in theperiod from 1991 to 2004, it was the Midwest that had the most expressiveincrease, 480%, although in absolute figures the number of schools (n=29 in2004) was much lower than in the Southeast and South regions . Table 1 shows the current geographicdistribution of courses and vacancies in Brazil.Regarding the enrollments, in 2018, the private institutions received 91.5%, mostof them distributed throughout the Southeast region (37.8%), and followed by theNortheast region (31.1%). The Midwest and North regions had an index of justover 10%  and the South had a lower enrollmentrate (9.7%). The Southeast region stands out for having the highest enrollmentrates in recent years, as seen in Nine IES offer nursing courses in the modality EaD, with poles in almost all theBrazilian states. Two HEIs based in the state of S\u00e3o Paulo concentrate almost80% of all vacancies offered, as observed in Training in health is a vital component for the sustainability and effectivefunctioning of any health system. The responsibilities and roles of nurses asclinical professionals, leaders, policy makers, researchers, scientists andprofessors are fundamental to the effective and practical functioning ofeducation.. In Bahrain, Middle East, there is a strong incentive for students toenter the private sector, where they are offered a written guarantee of employmentin the private sphere, for when they graduate.The trend towards privatization of health education seems to have a global dimension.In China, with government encouragement, private institutions for the education ofhealth professionals developed rapidly, exceeding what public institutions were ableto offer, but with unbalanced geographical distribution and questions on technicaland educational capacity. In Bahgraduate.. Data from 2010 already signaled a large participation of the privatesector in Kenya, with 51% of 68 Nursing EAD courses(-). In India, in this same year, 88% of all the Nursing educationinstitutions were private, producing 95% of the total Nursing workforce. In 2017,the total of private institutions already reached 90.3%. In Saudi Arabia, in 2017,of the 39 HEIs, 13 (33%) are private.In Thailand in 2006, 19.6% of all the nurses trained in the country were graduatesfrom private institutions; in 2010, this percentage rose to 24.1%, confirming theimportance of the private sector in the training of these professionals. Data fwith 51% of 68 N courses-30. I private..The participation of the private sector in Nursing qualification around the world isvery expressive and raises questions, which in general orbit around four topics: i)the contribution of the private sector in the training of Nursing professionals; ii)concentration/distribution; iii) the trend to also be linked to the private sector;and iv) teaching quality.In Brazil, this expansion movement can be associated with two factors: a reduction infunding in the public sector and a flexibilization and relaxation of regulations,including the emergence and increase of distance learning courses, which brings todiscussion the component of quality of training., for example, and is also identified for medical schools. Similarly, in Brazil private hospitals are concentrated in cities withbetter economies and so are private medical schools, most of them located in theSoutheast (41.4%), especially in S\u00e3o Paulo and Minas Gerais, where most of theprivate hospitals are for-profit (57.8%). The concern with the imbalance in the geographical distribution alsooccurs in China, where 97 private HEIs are located in Western and Central China,economically more advantageous regions, while only 26 are in EasternChina.Despite the distribution/concentration of the Nursing schools in the country, it isclear that the argument that the expansion of the private sector would serve to fillthe gaps in the public sector corresponds to an opportunity for market expansion.This urban-centered pattern of distribution of private HEIs is also perceived inIndia, Kenya, South Africa and Thailand, for ex schools. Simila (57.8%). The cornChina.. Although the supply of nurses has grown, it coexists with low rates ofabsorption of these professionals by the public sector, often due to recruitmentinefficiencies or to poor working conditions. A similar setting has been describedin Kenya and India, where the imbalance between production (supply) and labor marketabsorption (demand) has strongly favored the migration of nurses in these countries. Recent analyses of the WHO projections estimate that the effectiveglobal demand for nurses would increase by nearly 33% between 2019 and 2039, yetmore than 220,000 professionals would not be absorbed either by the public sector,nor by the public sector.The disparities indicate how the interaction between the education system and thehealth system has been mediated by the Nursing labor market, taking into account thechallenges of governance and regulation. The results revealed imbalances andcritical mismatches in the demand and supply of nurses, especially in locationsoutside the major urban centers. In India, for example, only 9% of the Nursingschools are in locations with shortages of such professionals. Althouctively). Recentc sector.Although Brazil is not traditionally a \u201cNursing labor exporter\u201d country, the growingtrend in the number of schools and the high supply of vacancies, coupled with theinability to employ these professionals, suggest a powerful space for migration. Inthe richest countries, the existence not only of a workforce mostly older and closeto retirement, but also of international recruitment companies that, besidessubsidizing the language course, offer good employment conditions and socialbenefits, has increased the interest in Nursing professionals from poor and low- andmid-income countries (PLMICs).. Another aspect is the reduction or freezing of the Nursing wages,increasing the number of worked hours and/or of multiple jobs in searching toguarantee personal/family income. In this context, the possibility of migrating abroad with theguarantee of a work contract can indicate a trend in the Nursing labor market. Inthe Philippines, for example, most private nursing schools have the participation ofinternational groups, especially British and European, which contribute financiallyto the opening and operation of these institutions, in addition to drawing up theguidelines and curriculum guidance for the training of these professionals, so thatthey are compatible and equivalent to the standards required in their countries,strongly encouraging the migration of this workforce.At the same time, contexts of economic recession, widely seen in these countries,affect all sectors of the economy, including health professionals. Being the largestprofessional group in the health sector, nurses are strongly affected by theattempts to balance the budget, whose simplest and quickest alternative foradjustment is the reduction in the supply of workers. Anothey income. In thi. Also in the field of teaching quality evaluation, it is worthhighlighting the existence of a gap in studies on the quality of the teaching staffin public and private educational institutions and the comparative percentage ofphysicians and masters, for example. It is known, however, that the vast majority ofprivate HEIs in Brazil do not direct the curriculum to research and, generally, theleading role in the scientific field of research is centered on the publicinstitutions.The exponential growth of the private sector alerts to the lack of qualifications ofthe teaching staff, which in general, in these institutions, presents higherturnover and less rigorous and more flexible criteria for the selection ofprofessors. Another important point is that the increase in the number of schoolsincreases the competitiveness of the most qualified university professors not onlyamong private HEIs, but also with public institutions. Also i requirements, in terms of aligning student admissions and trainingprograms with changes in the sociodemographic profile and population needs,maintaining health standards, establishing training schools in rural areas, andcollaborating with the public health system, as internship settings duringgraduation. However, more current studies are urgently needed.Internationally, some studies suggest that public institutions, in general, are in abetter position to respond to the countries\u2019 FTS requireaduation,33. H. Although the regulation of higher education is monitored by theMinistry of Education, this institution lacks mechanisms and tools more adjusted tothe reality of the expressive quantity of HEIs and, in the specific case of Nursing,of the massive number of vacancies offered, especially in the at-distancemodality.The absence of an effective regulation mechanism by the State in Brazilian privatehigher education can be considered an incentive for expanding thissector,35. AThus, although the present study presents some limitations and difficulties, derivedfrom the use of different nomenclatures and modality of courses in the area and,despite the great amount of collected data, the analysis, paradoxically, is stillexploratory. Due to the inconsistencies and knowledge gaps on these processes, itsubstantially contributes to the scientific knowledge of Nursing research in thearea of management and evaluation of health education, whose production between theyears 2006 and 2015 was limited to 11%. At the same time, this study seeks tobroaden and enhance the discussion of the health workforce through the labor marketlens, proposing an analysis on the growth of the private education sector and itsimpact on the health systems.This study examines three major questions on Nursing schools: The first relates tothe strong expansion of higher education in Nursing alongside other healthprofessions, which has resulted in the strengthening of private higher educationinstitutions associated with economic groups and regional concentration. The secondrefers to the geographical distribution of the courses and vacancies, which isunequal in the country. And finally, the existence of the distance learningmodality. It is still a controversial method and very questioned in courses in thehealth care area, since the training does not do without personal interaction,especially for the end-object of the Nursing exercise, that is, care. Concerns onthe quality relative to the expressive increase in the number of courses andvacancies and the quality of Nursing training and of other health professions arefundamental for an effective planning of the health workforce.The growing number of schools and vacancies does not seem to be linked to articulatedstrategies to solve the problem of the growing demand for a sufficient and qualifiedhealth workforce. This situation is similar to that of many developing countriesthat have failed to establish an organic relationship between multi-professionaleducation and the health system. Innovative strategies to address this issue must bedeveloped to contribute to achieving universal health coverage and access.In the current context of the new coronavirus pandemic (COVID-19), distance learninghas become a priority in the HEI agenda, even without much information on itsdevelopment or its impact on the quality of training of the professionals and on thehealth labor market, except for the tendency to concentrate the educational offer ina few HEIs. This is a necessary and urgent research agenda in the context ofteaching health professions.The study sought to demonstrate the relevance and scope of the privatization processfor Nursing education, reflecting on the implications of this process in meeting thedemands of the health system in Brazil.Furthermore, it is expected to contribute to the development of a more practical andparticipatory research agenda involving different actors from the government,academic settings, civil society, private sector and associations, among others, aswell as to the process of evidence-based decision-making and political choices."}
{"text": "The SARS-CoV-2 pandemic in Brazil has grown rapidly since the first case was reported on 26 February 2020. As the pandemic has spread, the low availability of medical equipment has increased, especially mechanical ventilators. The Brazilian Unified Health System (SUS) claimed to have only 40,508 mechanical ventilators, which would be insufficient to support the Brazilian population at the pandemic peak. This lack of ventilators, especially in public hospitals, required quick, assertive, and effective actions to minimize the health crisis. This work provides an overview of the rapid deployment of a network for maintaining disused mechanical ventilators in public and private healthcare units in some regions of Brazil during the SARS-CoV-2 pandemic. Data referring to the processes of maintaining equipment, acquiring parts, and conducting national and international training were collected and analyzed. In total, 4047 ventilators were received by the maintenance sites, and 2516 ventilators were successfully repaired and returned to the healthcare units, which represents a success rate of 62.17%. The results show that the maintenance initiative directly impacted the availability and reliability of the equipment, allowing access to ventilators in the public and private health system and increasing the capacity of beds during the pandemic. In December 2019, an outbreak of viral infection was first reported in Wuhan, China, when several patients presented symptoms of pneumonia with unknown etiology ,4. In thBy the beginning of March 2021, a total of 120,002,856 cases of COVID-19 were confirmed worldwide, including 2,655,755 deaths, with confirmed numbers reaching 11,483,370 cases and 278,229 deaths in Brazil [Common symptoms of SARS-CoV-2 infection include respiratory symptoms, fever, cough, shortness of breath, and dyspnea. In cases where there is a moderate to severe clinical course, the infection can cause pneumonia, severe acute respiratory syndrome, renal failure, and even death ,11. PatiIt is already well established that respiratory failure is the most prevalent and feared complication of pneumonia caused by SARS-CoV-2, usually causing hypoxemia. In this case, 10 to 20% of cases become difficult to control, necessitating the use of frequent mechanical ventilation for weeks or months ,19. The The growing daily increase in the number of cases of COVID-19 and the need for intensive care have led to resource limitations in meeting the demand for mechanical ventilators for the treatment of severe acute respiratory syndrome worldwide. This has increased the search for new alternatives, including efficiently increasing production capacity ,20. TherSeveral countries, particularly those with fewer resources, had many difficulties in acquiring equipment, reflected in falling assistance and increased mortality, as was the case in Brazil ,25, wherThis context demanded fast, assertive, and effective actions to minimize the health crisis in Brazil, which quickly became the epicenter of the pandemic in Latin America ,31. ThusIn April 2020, estimates of Ministry of Health of Brazil indicated that the country would need about 20,000 additional ventilators, and at the peak of the pandemic, 2000 new ventilators would be needed per week . AccordiIn this work, we provide a brief overview of the rapid structuring of a collaborative network for the maintenance of mechanical ventilators during the SARS-CoV-2 pandemic. This network was named Initiative + Maintenance of Ventilators (I+M). In addition, we present the main results obtained and the social contribution of allowing access to this equipment in the public health system in Brazil, consequently increasing the bed capacity during the pandemic. This work has very important social relevance for Brazil in the context of the epidemic caused by COVID-19, which is still creating a high demand for respiratory care. Although the I+M represents a national network, this work presents specific results achieved by SENAI CIMATEC . This institution was the first and the main site of the I+M and was considered a reference for the entire Brazilian network, and therefore is the so-called Reference Unit in this work. A mechanical ventilator is considered an artificial external organ, originally designed to provide oxygenation and respiratory support for patients who cannot breathe enough on their own due to impaired lung system functions , a condiBased on the cycle between the inspiratory and expiratory phases of breathing, ventilators can are classified as follows: (i) volume cycled, where the ventilator cycles between inspiration and expiration once a preset tidal volume is achieved; (ii) pressure cycled, where the ventilator cycles between inspiration and expiration once a preset inspiratory pressure is reached; and (iii) time cycled, where the ventilator cycles between inspiration and expiration once a preset inspiratory and expiratory time has elapsed .Mechanical ventilators have the following elementary units : (i) InlA block diagram of a basic ventilator is shown in The reference unit received a total of 29 different ventilators models from 16 different manufacturers. These numbers show the complexity of the operation and of the standard procedures implemented in an emergency way to repair the ventilators.The voluntary network is composed of 39 maintenance sites distributed in 21 states of Brazil and is supported by the Ministry of Health, Ministry of Economy, Ministry of Defense, Brazilian Agency for Industrial Development (ABDI), and Brazilian Association of Clinical Engineering (ABEClin). The network was formed by 24 institutes of SENAI; 20 private companies , Globo Studios, Ford Motor Company, General Motors, Honda, Hyundai Motor Brazil, Votorantim Institute, Jaguar Land Rover, Mercedes-Benz Brazil, Moto Honda, Renault, Scania, Toyota, Troller, Usiminas, Vale, Volkswagen Brazil, and Volvo Brazil); 3 universities and technology institutions , University of S\u00e3o Paulo (USP-POLI), and Federal University of Espirito Santo (UFES)); and 1 federal foundation ).Located in the state of Bahia, the Reference Unit was the first maintenance site to start operation and led the implementation of the network through the design of protocols, establishment of procedures, and provision of training for all teams around the country. The aim was to transfer knowledge and accelerate the structuring of the network. In order to disseminate the methods and procedures, a series of national and international events were carried out through online platforms. The maintenance at the Reference Unit was performed mainly in two working spaces, as shown in The second workspace b was strIn addition to the equipment and infrastructure, it was also essential that the areas allowed for organization of the material and information (data) flow to ensure reliability and efficiency in the maintenance process. The guidelines also included flowcharts of the processes, an organization chart of the team, procedures for pickup and delivery operations, traceability tools for each ventilator during its stay at the maintenance site, external and internal logistics, purchasing process, and stock management and dashboards to facilitate communication with the team.In all areas, rules, guidelines, and materials related to health, safety, and environment (HSE) were also in place. The use of protective equipment, such as masks, face shields, coats, and gloves, as well as daily HSE meetings and scheduled reverse transcription polymerase chain reaction (RT-PCR) tests were mandatory.The administration and technical teams included employees of the maintenance site and volunteers, including specialists and technicians in medical and hospital equipment, clinical engineers, mechanical and electronic engineers, logistics engineers and analysts, project managers, safety technicians, purchase specialists, and communication and marketing analysts.Although results from the whole network are referred to in this section, this work focused on specific results achieved by the Reference Unit maintenance site located in Bahia state. The challenges faced and results achieved were quite similar for most maintenance network sites.The launch of the maintenance line was strategic planned by the Reference Unit based on the serious concern that most countries would experience a shortage of mechanical ventilators  and to p2, and its road network is 119,639 km long. In total, the Reference Unit received 536 ventilators for repair between 3 March and 25 September 2020 and supported 58 cities and 7 mesoregions in Bahia state.The first step was to establish a process and a team to map and get in contact with healthcare units that needed ventilator maintenance assistance, and plan the logistics to collect the equipment and generate a service order to control and ensure the correct return once the maintenance was completed. In the case of Bahia, according to the Bahia State Health Secretariat (SESAB), the service network involved in battling COVID-19 relied on 123 healthcare units. In terms of territorial extension, Bahia is the fifth largest state in Brazil, with 567,295 kmOnce the ventilator arrived at the maintenance site, a cleaning and disinfection protocol was initiated to allow the maintenance process to take place. The flowchart helped to standardize the protocols and procedures to be implemented around the country in order to ensure a safe and efficient maintenance process. All documents generated were distributed and used for training of all people involved. Here, a business continuity plan (BCP) was formulated to establish important rules and protocols following WHO guidelines , includiTechnical support was provided to every new maintenance site incorporated in the network. Training materials, operational ventilator manuals, and video classes were available to all members of the I+M. Different sorts of training were held; the initial training represented the beginning of the journey, so the dynamics necessary to carry out maintenance at the new sites could be understood, as well as the minimum infrastructure necessary to perform the project. There were 8 sessions that reached an audience of 100\u2013160 people per session. The initiative sparked interest in other countries, thus it was adapted for Latin America, Africa, and WorldSkills member countries.Another sort of training was live broadcasts from specialists and clinical engineers to present specific ventilators and answer technical questions from the members of the network. The \u201cConversation with a Specialist\u201d training sessions had a total live audience of 187 participants and all the videos were made available on YouTube, with more than 5900 viewers. The nationwide events were carried out using an online platform. The international trainings were broadcast via the Reference Unit\u2019s official YouTube channel. All documents, procedures, and protocols generated were made available on a communication platform so that the technical teams at the maintenance sites could have access to implement the information in their processes during the I+M period. The open-source operation manuals are also available on the ANVISA website . DetailsThe training sessions proved to be a fundamental strategy to quickly empower the maintenance sites, contributing to increasing the number of ventilators successfully repaired. In total, 2516 ventilators were successfully repaired and returned to healthcare units, from 4047 ventilators received by the maintenance sites, which represents a success rate of 62.17%.The videos and technical live sessions discussing critical cleaning and disinfection protocols and procedures proved to be essential in creating a safer and heathier environment for all participants. In addition, the strategy to centralize all technical information in a hub allowed the network to have updated documents and technical information, crucial for the success and feasibility of the initiative.Besides all of the effort to rapidly launch the network, another challenge was to finance the new parts and components needed to replace damaged ones. Technological advances in the manufacture of mechanical ventilators with the incorporation of microprocessors and advanced features have led to significant improvements in this kind of equipment . Along wAs new members joined the I+M initiative, the project received more attention from additional companies/institutions for funding. As already mentioned, the last network report already counted 39 maintenance sites present in almost all states of Brazil, mobilizing in 53 institutions among SENAI units, companies, universities, foundations, and institutes. Additionally, another 18 companies and institutions, both private and government participants, supported the initiative with further funding. Their names have not been released for confidentiality reasons.The I+M initiative mobilized more than 800 people directly involved in the maintenance activities. Among these were mechanical, electronic, and clinical engineers, as well as technicians and specialists. The I+M initiative presented its final report on 15 December 2020. The numbers of mechanical ventilators received and repaired are presented in The Reference Unit maintenance site received a total of 536 ventilators from five states, 439 ventilators being sent only by the state of Bahia (279 recovered) , 41 fromIt is important to emphasize that this was an unprecedented initiative with regard to the maintenance of ventilators and no similar initiative, whether public or private, was carried out. Thus, without the support of this maintenance network, it is believed that it would not be possible to achieve this number of repaired ventilators.As already mentioned, the initiative received mechanical ventilators from public and private healthcare units. In the case of the Reference Unit, the majority of ventilators came from public healthcare units, as shown in The lead time to repair the ventilators, considering pickup, cleaning, disinfection, screening, spare parts acquisition, maintenance, tests, calibration, and returning to the healthcare units, was one of the biggest challenges for the maintenance sites. As presented in Although the Reference Unit produced a relevant number of repaired ventilators, as presented in In addition, due to contract rules, some manufacturers were only able to supply specific parts and components directly to the health units, which also affected the progress of the activities of the maintenance sites. For the 324 mechanical ventilators repaired by the Reference Unit, a total of 508 spare parts were used, resulting in an average of two items exchanged by equipment. The average expenditure per piece of equipment was USD 662.52.According to a report by CGU, a Brazilian public financial office that regulates the use of public resources, published in May 2020, states and cities spent an average of USD 16,000.00 for every new mechanical ventilator . DespiteSince the beginning of the pandemic, there have been concerns by health authorities that the amount of mechanical ventilators available for the treatment of COVID-19 was less than the demand for these devices, as the virus spread rapidly . The shoIn Brazil, ANVISA is responsible for the registration of ventilators, which considers, among other steps: viability and regularization of the company; control and project development; the conformity certification and the product registration. This is a bureaucratic and time-consuming process in normal times. Due to the pandemic scenarios, ANVISA has been adopting measures to flexibilize the ventilators registration, such as the technical note 356/2020, which simplifies and streamlines the medical equipment regularization processes .Another aspect that influenced the complexity of maintenance was the great diversity of manufacturers and models available in the Brazilian healthcare system. Despite their general similarities, each model has specific characteristics that, in many situations, demands a longer time to diagnose the defect and repair the equipment.During the period of the I+M initiative, the Reference Unit set up one workspace to receive, clean, and disinfect the mechanical ventilators and three maintenance laboratories, thus increasing its capacity to receive and recover more ventilators, so it also expanded the team dedicated to the project. The low availability of specialized technicians and engineers with knowledge of mechanical ventilation systems and equipment was an important bottleneck that the I+M initiative had to deal with.Despite the restrictions brought about by the pandemic, the initiative counted a representative number of professionals who volunteered to participate. In the case of the Reference Unit, at its peak, it had 37 people on the technical team focused on equipment repair, in addition to the logistics, management, and purchase teams.This productivity performance was also the result of applying tools from the lean philosophy, the principle of which is to do more with less waste, time, and resources . AdoptinIn total, the I+M initiative successfully repaired 2516 ventilators and returned them to healthcare units. Considering a theoretical number calculated at the maximum continuous capacity and assuming that, on average, a patient will require the continuous use of a mechanical ventilator for 15 days, in 6 months of use, the I+M initiative helped medical doctors and hospitals to support 30,192 human lives with mechanical ventilation.It is important to emphasize that, in an unprecedented way, other initiatives were observed around the world, such as the development of new ventilators that were easy to manufacture ,69; the In this work, an overview of the rapid deployment of a network for maintaining disused mechanical ventilators in public and private healthcare units is presented. The data show that the maintenance I+M at the Reference Unit had a large positive impact, covering more than five Brazilian states and directly affecting the treatment of a great number of patients. Many technological and logistical challenges were overcome. The implementation of the first line of ventilator maintenance in three days, meeting the protocols and norms, in partnership with clinical engineering professionals was a great challenge. Logistical structuring, from collecting ventilators to returning them to health units and developing procedures for cleaning and disinfecting equipment, was another great issue, in addition to the training of specialized labor for this type of action.The first maintenance unit was launched in three days with all required protocols and safetyThe engagement of SENAI institutes in the initiative allowed quick setup of new units once the institutes were present in all states in Brazil. Additionally, the interest of volunteers and industrial companies in supporting the initiative allowed knowledge transfer and financial support.The 2516 ventilators the initiative returned to healthcare units supported 30,192 human lives in the worst situation of the COVID-19 pandemic, considering a theoretical number calculated at the maximum continuous capacity.There was support in improving the infrastructure of the state hospital network and training of specialized labor for this type of action.The biggest challenges were the logistics, specialized manpower, and availability of spare parts to perform the maintenance.It is of fundamental importance to establish complementary criteria for the routine maintenance and management of spare parts for ventilators in public and private health networks, to ensure that ventilators remain usable for a long period of time. These aspects have a direct impact on the availability and reliability of equipment, and consequently on the ability to assist patients in treatment. In summary, the report provides the following information:"}
{"text": "Introduction: As of March 2020, coronavirus disease 2019 (COVID-19) has been declared a \u201cpandemic\u201d by the WHO. This has led to the need for governments around the world to implement restrictive containment and isolation measures to stem the spread of the virus; these measures have included social distancing, isolation, and quarantine. The fear of contagion has been indicated as one of the causes of stress, anxiety, depression, and insomnia in the general population. With respect to the response of young people to the pandemic, the category of University students deserves further attention. The sudden change in \u201cUniversity\u201d habits , the consequent loss of a social network, and the economic problems in their families have seriously affected the psychophysical well-being of University students. The aim of this study was to explore, in a sample of Italian University students, the relationships among anxiety, perceived vulnerability to disease, and smartphone use during the COVID-19 pandemic.Methods: A sample of 194 volunteer college students  aged between 18 and 30 years  were recruited to participate in this study. Participants were recruited through an online questionnaire sent to students of the University of Catania, Italy, and distributed from September 2020 to January 2021. The volunteer participants were given an online protocol that included the Fear of COVID-19 Scale (FCV-19S) for the evaluation of fear, the Perceived Vulnerability to Disease (PVD) for the evaluation of perceived vulnerability to disease, the State-Trait Anxiety Inventory (STAI) for the evaluation of trait and state anxiety, and the Smartphone Addiction Scale Short Version for Adolescents and Young Adults (SAS-SV) for the evaluation of use, abuse, or addiction of smartphone use.Results: The fear of COVID-19 did not reach an intensity such as to be defined as serious  in the whole sample. Both men and women showed a high risk of smartphone addiction  in SAS-SV. University students showed moderate trait and state anxiety  in STAI. In addition, students showed moderate perceived vulnerability to disease  in PVD. The results showed that fear of COVID-19 and trait anxiety appear to be the predictors of SAI and PVD but not the predictors of risk of smartphone addiction (SAS-SV).Conclusions: The data highlighted the presence of a perception of vulnerability to infections in subjects in which there was also a moderate anxiety, both state and trait, associated with the fear of the COVID-19 pandemic. It is hoped that a large part of the population will soon be vaccinated, including University students, and therefore, it would be desirable to carry out further assessments in the post-vaccine phase to highlight any differences in the state of anxiety and the perception of vulnerability to infections. The possible positive role of the use of smartphones in maintaining social contacts should also be emphasized. Coronavirus disease 2019 (COVID-19) has rapidly expanded in Europe, North America, Asia, and the Middle East. Based on the alarming levels of prevalence and severity, the Director-General of the WHO on March 11, 2020 called the COVID-19 situation a pandemic  axis and has shown how dangerous this is for the public, especially for pregnant women and disabled people  and emotional distress, individuals can cope better with the psychological and social threats of the pandemic if they can manage anxiety and depression, despite the high levels of fear of the pandemic infection , the consequent loss of a social network, and the economic problems in their families have seriously affected the psychophysical well-being of University students  were recruited to participate in this study. Participants were recruited through an online questionnaire sent to students of the University of Catania, Italy, and distributed from September 2020 to January 2021. The survey was also shared on the Facebook page of the Department of Educational Sciences of the University of Catania. All participants provided online informed consent and answered the questionnaire anonymously.A sample of 194 volunteer college students  aged between 18 and 30 years  for the evaluation of fear, the Perceived Vulnerability to Disease (PVD) for the evaluation of perceived vulnerability to disease, the State-Trait Anxiety Inventory (STAI) for the evaluation of trait and state anxiety, and the Smartphone Addiction Scale Short Version for Adolescents and Young Adults (SAS-SV) for the evaluation of use, abuse, or addiction of smartphone use.The FCV-19S  using SPSS software version 26.t-test of independent samples , and SAS-SV scales calculated through the  samples . There wThe Pearson's correlations are shown in The data from this study did not show significant differences regarding gender in the various assessment tests performed, except in the fear of COVID-19, in which women showed greater fear. Both male and female students showed a significant score for a high risk of smartphone addiction at SAS-SV, while the fear of COVID-19 did not reach a level to be defined as severe. Both state and trait anxieties showed a level of moderate severity, as well as a moderate perception of vulnerability to infections. Although the fear of COVID-19 cannot be defined as serious in the examined students, the correlations showed how, as the fear of the pandemic increased, both the aversion to germs and the perception of infections increased.Furthermore, the same variables  were also positively correlated with trait anxiety . We hypothesized that the trait anxiety highlighted in the examined subjects could have encouraged preventive and control behaviors toward the fear of contagion. It is significant to note that, although the use of smartphones can be defined as having a high risk of addiction, no significant correlations emerged between the latter and the other dimensions examined. Among other things, the PSU did not appear to depend on the fear of COVID-19.This seems to be in line with some other studies carried out on student samples during the COVID-19 pandemic. For example, the study by David and Roberts  conducteMoreover, some other studies on young adults showed that, although depression and social anxiety were the determinants of the risk for a greater PSU, particular categories of technological applications were positively correlated with psychophysical well-being (De Pasquale et al., Another significant finding that emerged from this study concerns the predictive value of fear of COVID-19 and trait anxiety on the perception of vulnerability to infections. Therefore, knowing in advance the psychological traits of the subjects, it is possible to intervene in time, preventing the negative influences of a particularly stressful event from becoming serious.This study has some limitations. In particular, the study reveals some methodological shortcomings, as the perception scales of vulnerability to disease have not typically been designed for clinical diagnostic purposes, diminishing their suitability for clinical research. Further study needs to be conducted to explore further phenomena that could be predicted by the constructs evaluated by the PVD. Furthermore, the sample of subjects examined is relatively small and concerns only a portion of University students in the city of Catania, even if the results of the study are quite consistent with the study carried out so far on University students in other countries during the COVID-19 pandemic. Another important limitation to consider concerns the fact that the state of the emotional well-being of these subjects is not known before the pandemic period, and therefore, we do not know for sure if the moderate state of anxiety found depends only on the effects of the pandemic or also on other variables. It is not possible to exclude states of anxiety and the presence of a certain degree of perception of vulnerability to infections preceding the pandemic due to the absence of evaluation.The data highlighted the presence of the perception of vulnerability to infections in subjects with moderate anxiety, both state and trait, to be associated with the fear of the COVID-19 pandemic. It is hoped that a large part of the population will soon be vaccinated, including University students, and therefore, it would be desirable to carry out further assessments in the post-vaccine phase to highlight any differences in the state of anxiety and the perception of vulnerability to infections. The possible positive role of the use of smartphones in maintaining social contacts should also be emphasized.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by Italian Association of Psychology. The patients/participants provided their written informed consent to participate in this study.CD: conceptualization, methodology, data curation, writing\u2014original draft preparation, writing\u2014review and editing, supervision, and funding acquisition. MLP: methodology, investigation, and writing\u2014original draft preparation. FS: methodology, validation, formal analysis, investigation, and writing\u2014original draft preparation. ZH: writing\u2014review and editing, visualization, and supervision. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "Dear Editor,Sweet Syndrome (SS) is the most frequent of neutrophilic dermatoses.We present a case of subcutaneous SS and BD in the same patient, given its extremely rare association.Mycoplasma pneumoniae serology, autoimmunity studies all negative. A skin biopsy revealed neutrophilic dermohypodermitis, mixed panniculitis, with vasculitis of the medium-small vessels (A healthy 72-year-old woman consults for painful erythematous nodules in the extremities of two weeks\u2019 evolution, associated with fever and arthralgias. Physical examination reveals erythematous subcutaneous nodules on the extremities, arthritis, and oral ulcers . Laborat vessels . With thSubcutaneous SS fulfilled the same spectrum of neutrophilic panniculitis.There are few reports on the association of both dermatoses.We think that the relationship between both diseases is more than a mere coincidence. SS might represent a marker for Beh\u00e7et\u2019s activity, as in the majority of reported cases it presents in the acute phase or prior to an exacerbation, which is correlated to the clinical evolution of our patient.Future studies are needed aiming at the wide clinical variability of both diseases and the way they relate to each other, which is probably in a continuum within the spectrum of the still poorly understood neutrophilic dermatoses.None declared.Pablo Vargas-Mora: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; obtaining, analyzing, and interpreting the data; effective participation in research orientation; critical review of the literature; critical review of the manuscript.Fernando Valenzuela: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; obtaining, analyzing, and interpreting the data; effective participation in research orientation; critical review of the literature; critical review of the manuscript.Viera Kaplan: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; obtaining, analyzing, and interpreting the data; effective participation in research orientation; critical review of the manuscript.Laura Carre\u00f1o: Approval of the final version of the manuscript; conception and planning of the study; obtaining, analyzing, and interpreting the data; effective participation in research orientation; critical review of the manuscript.None declared."}
{"text": "Science diplomacy is a fast-growing field of research, policy, and practice dedicated to understanding and reinforcing the connections between science and international affairs to tackle national, regional, and global issues. By aligning science and diplomacy, countries can attract talent, strengthen their national research ecosystems, provide avenues for participation of scientists in policy, and coordinate integrated solutions to challenges with technical dimensions. While Latin America has a long tradition of bilateral and regional cooperation, science still plays a marginal role in foreign policy, as has become evidenced by the response to the COVID-19 pandemic. With few exceptions, Latin American nations have a relatively immature science, technology, and innovation ecosystem, compounded by low public and private investments in research, coexisting with profound socio-economic inequalities, and large vulnerable populations. Such challenging conditions have created barriers to a fluid relationship between science and diplomacy, fundamentally characterized by inefficient communication between scientists and policymakers, weak collaboration channels, and duplicated roles, which altogether perpetuate siloed mentalities and a lack of trust between the two communities. Over the last decade, a first influential wave of Latin American scientists, diplomats, and other professionals, including five of the co-authors, have undertaken science diplomacy training provided by specialized organizations. Through these experiences, we recognized the need to elevate awareness and build capacities in science diplomacy in our respective countries and overall, across Latin America. Here, we describe emerging efforts and mechanisms to bridge the gap between scientists and policymakers at the national and regional level. Furthermore, we offer recommendations to amplify the impact of those pioneering initiatives toward consolidating a robust science diplomacy practice across the region. The national experiences described from Costa Rica, Mexico, and Panama can serve as a roadmap for other Latin American nations in the early process of developing a science diplomacy strategy, so they can also align themselves to a collective pathway. Most critically, we propose a way forward so that Latin America can leapfrog beyond disjointed training of individuals into integrated institutional strategies that can harness the tools of science diplomacy to enhance science-informed multilateral cooperation and enable more effective science-informed policymaking. Although science and diplomacy have been intertwined throughout modern history, the term was only coined in the early twenty-first century  ecosystem IDB, , compounSuch challenging conditions, along with deep ideological fractures, have created complex barriers to connecting scientific and diplomatic structures , The World Academy of Sciences , the European S4D4C project, the SciTech DiploHub (in Barcelona), the International Network for Government Science Advice , and the Innovation and Science Diplomacy School (InnSciDSP in S\u00e3o Paulo) , Mexico , and Panama (SLV) met at the 2017 edition of the Science Diplomacy and Leadership Workshop of the AAAS Center for Science Diplomacy, organized by MGS, then Senior Project Director at the AAAS Center for Science DiplomacyUpon our return from the program, we engaged with key science and policy stakeholders in our respective countries to help build and strengthen their science diplomacy ecosystems. Here, we present the journey of our countries\u2014Costa Rica, Mexico, and Panama\u2014in science diplomacy and document some of the advances and transformations we have contributed to and their impacts to date. Based on our experiences, we conclude by proposing suggestions for scaling capacities in science diplomacy across Latin America and provide recommendations to better integrate these pioneering initiatives into the sustainable development strategies of individual countries and the region as a whole.In Costa Rica, close collaborations between the scientific and diplomatic spheres have been ongoing for decades. As one of the first countries to demilitarize, Costa Rica prioritized resources for education, culture, healthcare, and environmental conservation, championing diplomacy, and peaceful engagement over hard power. Back in 1997 Costa Rica  proposed a model Nuclear Weapons Convention, in 2013 chaired the first Open-Ended Working Group on nuclear disarmament and eventually marshalled the Treaty on the Prohibition of Nuclear Weapons (TPNW) negotiation conference, which was adopted in 2017 Uma\u00f1a, . Not surNevertheless, all these efforts only began to be labeled and recognized as \u201cscience diplomacy\u201d after 2014, with the appointment of a scientist (Dr. Rom\u00e1n Macaya) as Costa Rican Ambassador to the United States. In this role (a first for a scientist to be named ambassador), Dr. Macaya implemented an unprecedented agenda of scientific cooperation between the two countries, resulting in highly impactful collaborations in water, public health, disaster prevention, and remote sensing. In 2015, one such collaborative project linked researchers from the United States Geological Survey (USGS) with the Ministry of Environment and Energy (MINAE), leading to the production of high-resolution, country-scale remote-sensing mapping of underground aquifers  signed between the University in Costa Rica (UCR), the Costa Rican Social Security (CCSS), and George Mason University, originally designed to produce collaborations on infectious diseases such as zika and dengue, facilitated joint work in the formulation and testing of potential Covid-19 treatments during the 2020 pandemicOther science diplomacy efforts have leveraged strengths in local scientific production to shape diplomatic agendas. For example, research results from the Clodomiro Picado Institute were used as a basis for a 2016 proposal before the World Health Assembly, in pursuit of integrated global action to reduce deaths and disability caused by snake bites. This diplomatic initiative culminated in the 2017 declaration of snakebite poisoning as a priority neglected tropical disease by the World Health Organization (WHO) , began institutional efforts to link diplomats with researchers through regular convenings. Among the strengths in domestic scientific capacity, that could be leveraged to address relevant regional issues are the prevention of natural disasters through collaboration with the Volcanological and Seismological Observatory (OVSICORI), the conservation of marine biodiversity through the Center for Research in Marine Sciences and Limnology (CIMAR), and biotechnological development through the National Center for Biotechnological Innovations (CENIBiot). At the bilateral level, a recent example of transboundary science-based collaboration between foreign ministries is the joint submission of Costa Rica and Ecuador, requesting to extend their maritime boundaries over the continental shelf between the oceanic islands of Cocos (Costa Rica) and the Galapagos (Ecuador), with the added goal of jointly protecting pelagic species along the migratory passageway, which are threatened by illegal fishing in the areaIn order to formalize these interactions, which so far have been largely More recently, with heightened public awareness about the urgency to integrate science into foreign decision making, prompted by the Covid-19 pandemic, a series of virtual webinars were focused on science diplomacy. Last August, the UNESCO office in San Jos\u00e9 convened the first ever high-level panel in Costa Rica dedicated to the topic, featuring top representatives from the Ministry of Science and Technology (MICITT), the Ministry of Foreign Affairs, and other public entities. A more informal platform called Halo Sessions, geared toward informing the general public, also organized a webinar on science diplomacy in June 2020. Both of the Costa Rican co-authors (MG and ECA) participated in these events. And in early 2021, co-author MGS was invited by the Ministry of Foreign Affairs to present the results of her UNESCO report on science diplomacy in Latin America and the Caribbean to Costa Rican diplomats and invited scientists.Slowly, these incremental efforts are permeating into the institutional structures. However, many barriers still remain for early-career scientists to follow in Dr. Macaya's footsteps: just like in most countries STEM graduates are not traditionally exposed to science diplomacy curricula nor are there frequent spaces of interaction with diplomats. On the other hand, the Ministry of Foreign Affairs is currently developing a science diplomacy strategy, which would be formalized into the Process of Economic Diplomacy. Furthermore, they are actively seeking cooperation opportunities with science diplomacy e-training platforms that could provide courses on this topic to their personnel.Panama has a young science, technology, and innovation system, even if science and technical advances have been crucial since its early national development. Historical scientific institutions, such as the Smithsonian Tropical Research Institute (STRI) and the Gorgas Memorial InstituteIn 2017, the National Secretariat for Science, Technology, and Innovation (SENACYT), the science funding agency responsible for developing and strengthening the country's research and innovation systems, selected two young scientists from Panama (co-author SLV was one of them) to participate in the AAAS Science Diplomacy and Leadership Workshop. During our time in Washington DC, we met with a representative of the Panamanian Embassy and the discussion revealed the lack of communication between the diplomatic and the scientific spheres in Panama. It also manifested that most governmental institutions in Panama did not know much about the small but rapidly growing scientific community in the country, nor the breadth of domestic expertise in different scientific fields. Upon our return to Panama, we began conversations to raise awareness about science diplomacy among different stakeholders and institutions. SENACYT and the Ministry of Foreign Affairs (MOFA) approached the scientific community and international partners, including AAAS, UNESCO, and the Inter-American Institute for Global Change Research (IAI), to organize the first science diplomacy workshop in the country as a side event of the Latin American Open Science Forum (CILAC 2018), with the objective of raising awareness among scientists, diplomats, decision-makers, and journalists about the benefits and potential of science diplomacy to support the science system in Panama as well as the role of science to help meet the UN Sustainable Development Goals. Other Panamanian diplomats and scientists, many belonging to the Panamanian Association of the Advancement of Science (APANAC)In 2018 Panama became the first Latin American country to launch an official national strategy for science diplomacy, championed by former Vice President and Foreign Minister Isabel de Saint Malo, in coordination with SENACYT. The strategy establishes that the new diplomatic cadres must be familiar with science, technology, and innovation, and new institutional capacities must be created within Panama's foreign policy structures to align national and international policies with the 2030 Agenda. The action plan included the establishment of a Science Diplomacy Committee to foster dialogue and collaboration between the government and the scientific community. One of the key elements of the strategy was to incentivize the recruitment of STEM professionals to diplomatic careers, so Parliament updated the rules regarding the requirements for entry into the foreign service to open it to graduates from any background As the governance requirements of the science, technology, and innovation ecosystem grew, there was a need to create a dedicated office within the Mexican Government that would link the scientific community with policymakers more effectively. In 2013, the Science, Technology, and Innovation (STI) Office was established within the Office of the Presidency, elevating science advice to the highest political level.At this point, there was enough momentum within the scientific and policy communities, and opportunities to work between these two worlds started to materialize. Between 2012 and 2018, a new wave of young scientists interested in policy and diplomacy began to emerge, including co-authors AH and LM. We too participated in the 2017 AAAS Science Diplomacy and Leadership Workshop in Washington DC, where we connected with other scientists and diplomats from around the globe and joined a powerful network of collaboration and support. Back in Mexico, we started building bridges between our national research institutions and the international community, by fostering collaboration between the CCC, the President's STI Office, the National Council of Science and Technology (CONACYT), and international organizations such as AAAS1st Mexican Congress on Science-Informed Policy: Enhancing the Science-Policy InterfaceIn 2017, the STI Office, the CCC, and the AAAS Center for Science Diplomacy co-organized the The efforts to strengthen science-policy interfaces in Mexico were not limited to the Executive Branch. In the Federal Legislative Branch, an Office of Scientific and Technological Information for the Congress of the Union (INCYTU) was established and operated by the Scientific and Technological Consulting Forum (FCCyT) between 2016 and 2018. However, as it was external to Congress and financially dependent on the Executive, it had a modest impact and disappeared early 2019. In 2021, a new proposal has been passed to create an internal Office for Science Advice in the Chamber of the Deputies, which will depend on the Congress both financially and structurally. Additionally, the Federal Law of Science and Technology will be updated as a consequence of a Constitutional amendment. The objective of this law must include mechanisms for strengthening the institutional frameworks for the long-term development of science and technology, to consolidate the role of advisory bodies and research organizations such as the CCC, and to recommend the creation of new structures dedicated to science diplomacy and science advice not only in the executive and legislative branches, but in other levels of governance. An example at the sub-national level is a science policy fellowship program hosted by the Government of Mexico City (CDMX), led by AH and inspired in the AAAS Science Technology and Policy Fellowship (STPF), to place Ph.D. scientists in government offices for 1 year to develop knowledge and skills to navigate the science and public policy nexusThe COVID-19 pandemic response has manifested the divide between science, policy and society in many countries, and Latin America is no exception. Despite the promising advances presented here, our countries are still reactive, rather than anticipatory, to the challenges that require robust scientific input and regional and global cooperation. Governments must adopt this new vision of development and prosperity based on strengthening their science, technology, and innovation systems, and connecting knowledge to policy and society. Much more needs to be done to foster local and international cooperation to strengthen communication channels between scientists, diplomats, and policy makers. We show how the leadership of young pioneers, the co-authors being only few examples, supported by and trained in international programs have been a crucial first step to create a group of champions of science diplomacy in the region.First, national and regional institutions should take the lead in establishing regular capacity development in science diplomacy for scientists and diplomats, from junior to senior, rather than relying on external training opportunities in places like the United States or Europe. For science diplomacy to have a lasting impact in the development of the region, in resolving societal, environmental and health issues, it needs to go beyond one-off workshops, seminars, and conferences. Capacity development goes far beyond trainingOne national capacities are established, the next step will be the creation of a regional network of institutions dedicated to building science-policy interfaces, to collectively identify and tackle shared problems in the Latin American region. A pioneer effort in this direction is the Inter-American Institute for Global Change Research (IAI)'s Science, Technology, Policy (STeP) Fellowship ProgramWe must caution, however, against a too idealized vision of science diplomacy and recognize its limits and even potential negative consequences. Over the last 5 years, nations retreating from multilateralism, trust in science and expertise in decline, and increasing technological competition between major powers has challenged the \u201cromantic view\u201d that has dominated the mainstream discourse on science diplomacy (Rungius and Flink, All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "The prevalence of obesity, and its comorbidities, particularly type 2 diabetes, cardiovascular and hepatic disease and certain cancers, continues to rise at an alarming rate worldwide ,2. This Appetite and energy intake are modulated by a diverse range of factors\u2014the latter are both \u2018central\u2019 and \u2018peripheral\u2019 ,6. The rDuring meal ingestion, the oral cavity is exposed to the texture, taste and smell of the food . As foodGiven the major advance in knowledge in the field, this Special Issue is timely, providing a comprehensive overview of the gastrointestinal mechanisms underlying the regulation of appetite and energy intake, as a series of definitive reviews by international authorities. These reviews address gut-related mechanisms, including nutrient sensing, gut hormones, gastrointestinal motility, gut-brain communication and the roles of the vagus, diet and the microbiota, as well as the abnormalities associated with eating disorders, specifically obesity and the anorexia of ageing. The reviews are divided into two sections; the first focuses on preclinical research, and the second on knowledge derived from studies in humans, including the implications for the management of metabolic diseases and eating-related disorders. The reviews are complemented by a number of important original papers.Lu and colleagues  discuss The subjective sensory experience of food, including its appearance, smell, taste and texture, is recognised to play an important role in the regulation of energy intake. Lasschuijt and colleagues  discuss The composition of a meal is detected in the oral cavity and throughout the lumen of the gastrointestinal tract. In addition to the four basic taste qualities, sweet, sour, salty and bitter, there is now evidence for the existence of additional tastes, including fat, umami, kokumi and carbohydrate. Keast and colleagues provide an overview of these tastes, their sensing in the oral cavity and gastrointestinal lumen, and their implications for food consumption . As a reObesity is characterised by dysregulations in the mechanisms controlling energy balance, including energy intake. Farhadipour and Depoortere review the evidence that gut hormone secretion is altered in obesity, reflecting changes in the functionality of gastrointestinal nutrient receptors and the effects of different weight loss strategies . That baThe review articles are accompanied by eight important original articles\u2014the latter attest to the diversity of the work in this field. Preclinical studies investigated the effect of dietary supplementation with the amino acid isoleucine on body weight and blood glucose in lean and obese mice ; the effWe believe that this Special Issue provides a comprehensive overview of the gastrointestinal mechanisms contributing to appetite and energy intake regulation. Over the last decade, there have been substantial advances in our understanding of a number of areas\u2014from the sensing of meal content, texture and palatability, signal transmission to the brain, signal processing and the translation into behavioural responses, through to the characterisation of dysfunctions in eating-related disorders, specifically obesity and the anorexia of ageing. Hence, while classically, the brain was viewed as the centre of appetite control mechanisms, it is now clear that many of the signals that activate the pathways involved in appetite control originate in the gastrointestinal tract. The powerful effects of bariatric surgery on gut hormone release, appetite suppression and sustained weight loss attest to this. The challenge for the next decade is to translate this knowledge, particularly that relating to the cellular mechanisms underlying nutrient sensing and gut hormone release, into effective dietary and pharmaceutical approaches for both the prevention and management of eating-related disorders."}
{"text": "The light-addressable potentiometric sensor (LAPS) is an electrochemical sensor based on the field-effect principle of semiconductors. It is able to sense the change of Nernst potential on the sensor surface, and the measuring area can be controlled by the illumination of a movable light. Due to the unique light-addressable ability of the LAPS, the chemical imaging system constructed with the LAPS can realize the two-dimensional image distribution detection of chemical/biomass. In this review, the advantages of the LAPS as a sensing unit of the microelectrochemical analysis system are summarized. Then, the most recent advances in the development of the LAPS analysis system are explained and discussed. In particular, this review focused on the research of ion diffusion, enzymatic reaction, microbial metabolism, and droplet microfluidics using the LAPS analysis system. Finally, the development trends and prospects of the LAPS analysis system are illustrated. The microfluidic chip is an emerging and powerful analysis technology, which has been widely applied in the development of microanalysis systems. In other words, based on the micro-electro-mechanical system (MEMS) technology, a variety of microstructures such as microchannels, micromixers, microreaction chambers, and micropumps are fabricated on glass, silicon wafers, organic polymers, and other materials. A series of discontinuous processes in biochemical analysis, including sample collection, processing, reaction, and detection, are integrated on a chip to achieve miniaturization and integration of the analysis equipment, which realizes lab-on-a-chip. Therefore, it has the advantages of fast analysis speed, less pollution, parallel processing, etc., and has gradually attracted more and more attention and has been applied in many fields such as clinical examination and environmental monitoring .The detector is one of the core components of a microfluidic chip. Since the advent of microfluidic chips, the research on detectors suitable for integration with microfluidic chips has been a hot spot. Among many microfluidic detection technologies such as electrochemical, titration, fluorophotometry, and colorimetry, electrochemical detection has shown many advantages such as a simple structure, small volume, no pollution to samples, and compatible with the micromachining technology, which have incomparable advantages in integration with chips , especiaScience, which pointed out that the LAPS can sensitively detect the weak change of the solid\u2013liquid interface potential on the surface of the LAPS  how to improve the spatial resolution of LAPS records. The possible solutions may come from using novel semiconductor materials to manufacture LAPS chips, introducing more focused light spots, and laterally suppressing the movement of carriers in semiconductors. 2) How to speed up the imaging system. To solve this problem, it is necessary to utilize a high-speed scanning system, which allows rapid recording of data and rapid imaging from the sensor surface. 3) How to improve the measurement accuracy of the LAPS under microfluidic conditions. Since the measurements in the microscale or nanoscale solutions require very high accuracy, it is, thus, highly essential to improve the measurement accuracy of the LAPS, especially in the cases of high-throughput measurement. The possible solution to this problem may rely on the improvement of the peripheral circuits and data processing algorithms. In summary, it is necessary to further improve the spatial resolution, measurement speed, and accuracy of the LAPS to promote the wide applications of the microchannel analysis system in many fields such as biomedicine , food sa"}
{"text": "Few scientists had the breadth and depth of scholarship, the keen interest in interdisciplinary scientific collaboration, and the commitment to mentoring the next generation of scientists as Dr. James Jackson. His passing remains a tremendous loss for the field. This symposium, organized by members of the Michigan Center for Urban African American Aging Research (MCUAAAR), which was founded by James over 20 years ago, reflects on the impact of transdisciplinary team science, of the importance of research networks and resource sharing, of the need to center research within practice and community, and of the scientific innovation that comes from integrating conceptual models, data sources, and methodological approaches from seemingly disparate fields. The session is co-chaired by Dr. Robert Taylor, longtime faculty member and current PI of MCUAAAR. The talk by session chair Dr. Briana Mezuk will discuss the ways in which the training approach of Analysis Core has inspired new training programs on integrative methods focused on minority health and disparities. The talk by Dr. Tam Perry will describe the innovations of the Community Liaison and Recruitment Core, including how COVID-19 impacted the activities of the Healthier Black Elder Center. The third talk by Dr. Rodlescia Sneed, a MCUAAAR early-career scientist, provides an example of how this Center supports interdisciplinary minority aging research through her project focused on older adults who have a history of incarceration. Finally, Discussant Dr. Roland Thorpe, a member of the MCUAAAR Advisory Board, will reflect on Dr. Jackson\u2019s legacy of mentorship and collaboration."}
{"text": "Cardiovascular diseases, including myocardial infarction, are among the most common diseases worldwide. Markers associated with the diagnosis of myocardial infarction have been in the spotlight for many years. The most commonly used markers of myocardial infarction are cardiac troponins. However, insufficient understanding of the biology and metabolism of cardiac troponins does not allow us to fully unlock the full diagnostic potential of these cardiomarkers. In this article, I summarized and discussed in detail the features of the metabolism of cardiac troponins. I conducted a comprehensive review of current literary sources and presented my point of view. The format of the manuscript includes a consistent description of the biology and stages of the metabolism of cardiac troponins, starting from the release and circulation, and ending with the features of elimination of cardiac troponins. The possible influence of the biology of cardiac troponins on the diagnostic value of cardiac troponins is analyzed. Based on the analysis of the literature, I found a close relationship between the diagnostic value of cardiac troponins and their biology/metabolism. Further research is needed to increase the diagnostic value of cardiac troponins, and to fully unlock their diagnostic potential.Understanding of the biology of endo- and exogenous molecules, in particular their metabolism, is not only of great theoretical importance, but also of high practical significance, since many molecules serve as drug targets or markers for the laboratory diagnostics of many human diseases. Thus, cardiac troponin (cTns) molecules have long been used as key markers for the confirmation of diagnosis of myocardial infarction (MI), and with the introduction of contemporary (high sensitivity) test methods, many of our concepts related to the biology of these cardiac markers have changed significantly. In current clinical practice, there are opening new promising diagnostic capabilities of cTns, the understanding and justification of which is closely connected with the theoretical principles of the metabolism of these molecules. However, today, the biology and metabolism of cTns have not been properly investigated; in particular, we do not know the precise mechanisms of release of these molecules from the myocardial cells (MCs) of healthy people and the mechanisms of circulation, and the elimination of cTns from the bloodstream. The main purpose of this manuscript is to systematize information about the biology of cTns, with an emphasis on the metabolism of cTns. The format of this paper, starting with the release of cTns in the blood and concluding with the metabolism/filtration of troponins, provides a comprehensive yet logically easy way for the readers to approach our current knowledge in the framework of understanding the basic mechanisms by which cTns are produced and processed. Conclusions. Based on the analysis of the current literature, the important role of biology and all stages of metabolism  of cTns in laboratory diagnostics should be noted. It is necessary to continue studying the biology and metabolism of cTns, because this will improve the differential diagnosis of MI and i a new application of cTns immunoassays in current clinical practice. Troponins (troponin I (TnI), troponin T (TnT), troponin C (TnC)) are proteins that are parts of the troponin complex, which is bound to the protein tropomyosin (TPM). TPM, in its turn, together with actin, forms thin filaments of myocytes\u2014the most important component of the contractile apparatus of striated muscle cells  ,2. All tThe molecules of troponins have different amino acid structures depending on their localization in muscles, on the basis of which troponin isoforms are distinguished. Thus, TnI has three isoforms: cardiac troponin I (cTnI), TnI of fast-twitch skeletal muscle fibers, and TnI of slow-twitch skeletal muscle fibers. TnT also has three main isoforms: cardiac troponin T (cTnT), the TnT of fast-twitch skeletal muscle fibers, and the TnT of slow-twitch skeletal muscle fibers. According to molecular genetic studies, the amino acid sequence of cTnI and cTnT differs from the amino acid sequences of the corresponding isoforms of skeletal Tns localized in skeletal muscle fibers by approximately 40\u201360% ,8. This Notwithstanding the solid achievements in the study of etiopathogenesis, diagnostics, and treatment of acute coronary syndrome (ACS), it still remains one of the leading reasons for disability and mortality in all the developed countries of the world. All patients with ACS have a higher risk of developing myocardial infarction (MI) and death ,16,17,18Although the regulatory documents concerning the diagnostics and treatment of different forms of ACS and MI contain clear recommendations on the time of troponin testing and decision-making levels, and the sensitivity and specificity of most immunoassays approximate 100%, there still remain a number of unsolved problems and issues relating to the application of these markers in clinical practice. Some of these problems are connected with the variety of troponin diagnostic agents, their unequal sensitivity and diagnostic accuracy, and different susceptibility to cross-reactive substances (molecules), i.e., with different analytical characteristics of test systems ,20. AnotDue to modern ultra-sensitive tests, medical practitioners have the opportunity to diagnose MI early (within the first two hours from the admission of the patient) through the evaluation of the dynamic changes of cTns. The changes (increases) in the concentration of cardiac troponin molecules within the first two hours are very small , and cannot be detected by moderately sensitive test systems. It should be noted that, due to a number of multicenter studies, algorithms of the early diagnostics  of non-ST-segment elevation MI (NSTEMI) have been validated for the ultra-sensitive test systems of various manufacturers  33]..33].According to the data of modern (ultra-sensitive) troponin test methods, the molecules of cTns are detected in blood and a number of other biological fluids in all healthy people ,40,41,42One of the significant problems of both moderately sensitive and modern highly sensitive immunoassays is the lack of their standardization ,63,64. TIt should be noted separately that the molecules of cTns can be affected by the very numerous proteolytic enzymes present in the blood, which thereby can indirectly affect the levels of cTns in the blood of patients. For example, due to an increase in the activity of proteases that cause the fragmentation of troponin molecules, the duration of the circulation  of cTns in the bloodstream will decrease, which can potentially lead to false-negative results when using those test systems that have diagnostic antibodies directed against the fragmented epitopes of troponin molecules ,66. A deA very interesting direction in studying the diagnostic value of cTns is the assessment of the possibility of using other biological fluids as biomaterials for the detection of troponin molecules. This direction is developing due to an increase in the sensitivity of immunoassays (the creation of highly sensitive and ultra-sensitive test systems), which can detect very low concentrations  of cTns that circulate in many biological fluids, including non-invasively obtained fluids  ,71,72,73The main biological fluids in which the molecules of cTns are detected and their diagnostic value are summarized in Conventionally, three main stages of the metabolic pathway of cTns can be distinguished : (1) theEach of these stages of metabolism can play a decisive role in the regulation of the concentrations of cTns in blood, i.e., their diagnostic value. In addition, there are a number of factors that can have a potential and hypothetical influence on these stages of the metabolic pathway of cTns. These factors can be physiological conditions; for example, gender, age, and circadian characteristics, which have a certain effect on the degree of release of troponin molecules from the myocardium of healthy people, or changes in the activity of the proteolytic enzymes that target cardiac troponin molecules. The activity of proteolytic enzymes can also change under pathological conditions and/or in the case of taking certain medications. Renal failure can be noted as an example of a significant factor affecting the removal of cTns from the bloodstream. It is important to emphasize that there may be an extremely large number of such factors, and some of them are probably still unknown.Furthermore, in the course of this manuscript, I will sequentially consider each of the stages of the metabolic pathway of cTns, and note the main known and assumed factors that may affect these mechanisms and the diagnostic value of cTns.The introduction of highly sensitive test systems into practice made it possible, with high accuracy , to detect very low concentrations of cTns, ranging from 0.001 to 0.01 ng/mL, and below the values corresponding to the 99th percentile (upper limit of the norm). As a result, cTns molecules were found in almost 100% of healthy people, and instead of a clear borderline level typical of MI, a smooth scale appeared, capable of reflecting the subclinical myocardial pathology associated with structural (non-ischemic) damage, stable coronary artery diseases, and other pathological conditions that negatively affect MCs ,88,89. CBelow, I will consider each of the above mechanisms of cTns release, sequentially and in more detail.14-labeled DNA molecules in MCs. A long-term observation of people with the inclusion of a radioactive isotope of carbon (C14) in the DNA of cardiomyocytes, which occurred as a result of nuclear weapons tests, was carried out. The authors calculated the rate of renewal of cardiomyocytes by studying the rate of DNA synthesis, which was calculated by investigating the rate of accumulation of C14 in MCs. A renewal of cardiomyocytes, the intensity of which decreased annually\u2014from 1% per year at the age of 25 years to 0.45% per year at the age of 75 years\u2014was found. In general, about 50% of cardiomyocytes underwent renewal throughout life [Evidence of the fact that MCs can regenerate/renew has been obtained by studying the metabolism of Cout life ,106. Theout life , howeverIn accordance with the data of other researchers, the average rate of cardiomyocyte renewal in mammals is 0.5\u20132.0% per year, and can vary depending on the influence of certain factors, such as physiological conditions , trauma, and concomitant diseases ,109,110.However, the assessment of the degree of regeneration and the rate of renewal of MCs can be significantly influenced by inflammatory processes, the proliferation of non-myocyte cells, and the formation of a connective tissue scar in the myocardium, which often complicates and/or distorts investigation results ,116. FurTo date, a large number of factors have been discovered that can trigger the processes of the apoptosis of cardiomyocytes ,118. TheAn experimental study led by Weil et al. has shown that the short-term ischemia activates apoptosis of MCs in experimental animals, and the apoptosis of cardiomyocytes is accompanied by an increase in the serum levels of cTns. Short-term myocardial ischemia was simulated by means of the balloon occlusion of a branch of the left coronary artery, and the fact of occlusion was confirmed by coronary angiography. The duration of ischemia was 10 min, after which reperfusion was carried out by deflation of the balloon. To confirm the apoptosis of MCs, the TUNEL method was used, according to the results of which, the number of cardiomyocytes in the state of apoptosis was significantly increased . At the same time, no histological signs of myocardial necrosis were observed. This suggests that short-term  ischemia does not cause the ischemic necrosis of cardiomyocytes, but enhances apoptotic processes in the myocardium. However, the levels of cTns began to rise rapidly: 30 min after reperfusion, the cTnI concentration approached the upper limit of the norm (38 ng/L), and after 1 h, exceeded it (51 \u00b1 17 ng/L). Two and three hours after reperfusion, the serum levels of cTnI were 148 \u00b1 88 ng/L and 180 \u00b1 117 ng/L, respectively, which indicated the continuing release of troponin molecules from the myocardium. Finally, 24 h after reperfusion, the cTnI concentration reached its peak and amounted to 1021 \u00b1 574 ng/L . Thus, tThe literature also describes other situations when the apoptosis of cardiac myocytes is induced by other mechanisms that are not associated with the reversible (short-term) ischemia of cardiac muscle tissue. The authors identify the following mechanisms of apoptosis that can promote the release of cTns from MCs: the stretching of the myocardial walls, increased preload on the heart, and the increased activity of the sympathoadrenal system ,100,123.In another experimental study, Weil et al. concluded that an increase in preload on the heart triggers apoptosis, and causes an increase in the concentration of cTnI in the blood of experimental animals. To increase the preload on the heart, the experimental group of animals received an intravenous drug\u2014phenylephrine (300 \u03bcg of the drug per minute)\u2014for one hour. After the simulation, echocardiography was used to confirm myocardial overload, and to verify apoptosis and determine cardiac troponin levels, histological methods were used, including the TUNEL method and a moderately sensitive immunoassay, respectively. As a result of the histological examination of the myocardium of the experimental group of animals, a significant increase in the number of cardiomyocytes in the state of apoptosis was noted, as compared to the control group. At the same time, no histological signs of myocardial necrosis were recorded. Moreover, 24 h after the simulation, the number of cardiomyocytes in the state of apoptosis decreased to the level of the control group, which indicates the reversibility of apoptotic changes. The cTnI concentration exceeded the upper limit of the norm 30 min after the simulation, and then the cTnI levels continued to rise sharply, and reached a value of 856 \u00b1 956 ng/L one hour after the simulation. The serum levels of cTnI remained elevated throughout the study period (24 h) and peaked at 1462 \u00b1 1691 ng/L . Since sThe degree of release of cardiac troponin molecules from MCs as a result of apoptosis induced by myocardial overload depends on the strength and duration of exposure. For example, relatively small myocardial overload is observed on mild to moderate exertion, in hypertension and non-massive pulmonary embolism, so the increase in serum levels of cTns in these conditions is also relatively small. However, for example, on high-intensity exertion, or in massive pulmonary embolism, myocardial overload becomes much more significant, and therefore, these conditions are accompanied by relatively higher serum levels of cTns ,130,131.Another very interesting mechanism for the initiation of apoptosis is an increase in the activity of the sympathoadrenal system. A research group led by Singh et al. found that the stimulation of beta-adrenergic receptors (\u03b2-AR) regulates intracellular apoptotic signaling pathways in cardiomyocytes. Moreover, the stimulation of \u03b21-AR enhances the apoptosis of MCs, while the stimulation of \u03b22-AR has the opposite effect ,133. It Considering the above, the apoptosis of cardiomyocytes should be considered as a significant mechanism for the release of cardiac troponin molecules from MCs. This mechanism is not associated with the necrosis of cardiomyocytes, and contributes to a very significant increase in the serum levels of cTns. Thus, the apoptosis of MCs can be of great diagnostic value in conditions such as prolonged and intense physical activity, arterial hypertension, pulmonary embolism, heart failure, and, probably, in old age. Further research is needed to clarify the exact role of apoptosis in the release of cTns in physiological and pathological conditions.This mechanism of release of cTns from MCs was first described in an experimental study a relatively long time ago. A research group led by Schwartz reported that, on the plasma membrane of MCs, membrane vesicles (blebbing vesicles) are formed ,138. MorThe size and location of intracellular molecules are two key factors that affect the transport (release) of molecules across the cell membrane. Low molecular weight biomarkers are much more intensively released across the plasma membrane, which plays a role in the diagnostics of many diseases, including cardiovascular pathologies. So, for example, with the development of MI, the concentration of low molecular weight cardiac markers (myoglobin) in blood serum increases much earlier than the concentration of high molecular weight cardiac markers (lactate dehydrogenase-1) ,144,145.The most important factor that can affect the size of a molecule (biomarker) and, accordingly, the possibility of its release, is the degree of activity of enzymes that cause the proteolysis (fragmentation) of this molecule ,147. TheIn addition to the enzyme calpain, the cleavage of cTns molecules can be catalyzed by some types of matrix metalloproteinases (MMP 2 and MMP 14) ,149,150 Changes in acidity (pH) can also modulate the activity of intracellular proteolytic enzymes ,157. So,The membrane permeability of MCs is an important factor that plays a role in the release of cardiac marker molecules from MCs into the bloodstream. Based on the analysis of the results of existing experimental data, two main mechanisms can be distinguished that underlie the change (increase) in the membrane permeability of MCs: (1) an increase in the membrane permeability of MCs as a result of an increase in the load on the myocardium and stretching of its walls; (2) an increase in the membrane permeability of MCs as a result of myocardial ischemia, and the activation of proteolytic enzymes that can damage the cell membrane.The first mechanism for the release of cTns was studied by Hessel et al. . In theiThe second mechanism for increasing membrane permeability is associated with membrane damage during the ischemia of MCs. As already described above, myocardial ischemia initiates changes in the metabolism of cardiomyocytes and the acidification (acidosis) of the intracellular space of MCs, which, in turn, will lead to the activation of proteolytic and proapoptotic enzymes. These enzymes have many targets, and in addition to the specific action (fragmentation of cTns), they can obviously catalyze the proteolysis of proteins that make up cell organelles and membranes ,162,163.A possible mechanism underlying the release of cTns is small-scale necrotic processes, which can be caused by both ischemia and inflammatory-toxic processes, imbalances in the neurohumoral system.So, according to some researchers, regular heavy physical exertion, myocarditis, and stressful situations can cause subclinical damage to myocardial tissue (death of single cardiomyocytes), which can subsequently be associated with the formation of relatively small areas of fibrosis and an increased risk of sudden cardiac death . So, forSome studies registered extremely high levels of cardiac markers, including cTns in the blood serum of athletes, after serious and prolonged physical activity ,169,170,Although, during psycho-emotional stress, the level of troponin increase is relatively small (rarely exceeds the levels of the 99th percentile in the isolated effect of stress), it cannot be considered a safe process ,173. TheOne of the controversial but hypothetically possible mechanisms underlying the increase in serum levels of cTns is the release of these molecules from non-cardiac cells. Several experimental and clinical studies indicate the expression of cardiac troponin molecules in skeletal muscle cells ,176,177 A second potential non-cardiac source of cardiac troponin release is the walls of large veins (venae cavae and pulmonary veins). Some studies report only the presence of the expression of cTns in the walls of these veins, but do not describe the possible role of these troponins in diagnostics ,179. HypThus, due to the fact that data on extracardiac expression are either insufficient or contradictory, further research is needed to validate this mechanism.The mechanisms of cardiac troponin release described above, and their diagnostic values, are summarized in The second major stage of the metabolic pathway of cTns is circulation in the bloodstream. At this stage, the molecules of cTns are influenced by a number of factors , which can affect the serum levels of cTns and, therefore, their diagnostic value. The molecules of cTns released into the bloodstream are represented by a heterogeneous fraction (a significant variety of different forms of troponin molecules): free cTns; combined complexes consisting of several free forms of cTns , and small fragments of cTns ,186,187.Clear evidence that cardiac troponin molecules can pass (filter) through the glomerular filter has been presented in several recent clinical studies due to the use of highly sensitive troponin immunoassays ,71,73. AThe search for specific mechanisms of proteolytic cleavage of cTns in the bloodstream is of great practical importance, since it will optimize laboratory diagnostics: in particular, there is a possibility of developing antibodies directed against individual fragments of cTns, or introducing inhibitors of the main proteolytic enzymes that catalyze troponin proteolysis into diagnostic test systems to reduce interference and more thoroughly interpret the test results, taking into account comorbidities that affect the activity of enzymes breaking down cTns, etc. Unfortunately, the number of fundamental studies devoted to the investigation of the processes of proteolytic cleavage of cTns in the bloodstream is extremely small. To date, only one specific mechanism is known, described in the study by Katrukha et al. ,152. AccIn general, a number of research groups studying the processes of proteolytic cleavage in the bloodstream report the presence of a very large number of fragments  of cardiac troponin molecules, which have different sizes , stability, half-lives in the bloodstream , and conditions of formation  ,186,187.Very interesting data are presented by the researchers Zahran et al., who studied the degree of proteolytic degradation of cTnI in patients with varying degrees of ischemia and damage to cardiac muscle tissue . The res(1)Study of the fundamental specific mechanisms of proteolytic degradation of cTns in the bloodstream, both under normal conditions and under the conditions of simulated concomitant pathologies. This requires a targeted and thorough study of the potential effect of individual serum proteolytic enzymes .(2)Search for specific fragments of cTns, which are released at the earliest possible time after the onset of myocardial ischemia and the creation of antibodies to them, which will increase the sensitivity and specificity of troponin immunoassays.(3)Search for specific fragments of cTns, which have a small molecular weight and are able to pass through the glomerular and blood-salivary barriers. The creation of antibodies to these fragments will make it possible to develop specific highly sensitive test systems for the analysis of non-invasive biological fluids  and for the introduction of new methods of non-invasive diagnostics and monitoring of cardiovascular pathologies, including MI, into routine clinical practice.(4)Study and identification of potentially possible specific mechanisms of proteolytic cleavage of cTns under the action of other (non-ischemic) factors. This will allow the development of specific troponin immunoassays to identify those fragments that, for example, will increase exclusively with the stretching of the myocardium or exclusively with an increase in the activity of the adrenergic nervous system and an increase in \u03b2-AR stimulation, etc. Thus, it will be possible to carry out a more specific diagnosis of non-ischemic myocardial damage in some physiological and pathological conditions not associated with ischemia of the cardiac muscle tissue.Summing up the role of the stage of cTns circulation, we should once again emphasize its potentially high diagnostic value in practical medicine. At the moment, this stage is a relatively poorly studied area of the biology of cTns. The main directions of further work in this area, in my opinion, should be as follows:The final stage of the metabolic pathway of cTns in the bloodstream is as important as the other two stages (release and circulation). Both of these stages are closely related to the terminal stage of the metabolic pathway of cTns. So, for example, when small fragments are released from cardiomyocytes (as a result of the intracellular proteolytic cleavage of cTns), they will obviously be almost immediately removed from the bloodstream by filtration through the glomerular and blood\u2013salivary barriers. When larger fragments of cTns and/or binary and ternary complexes are released, the filtration of these molecules is unlikely due to their large size (molecular weight).The circulation of cTns is equally closely related to the removal of these molecules. So, for example, with a higher activity of serum proteolytic enzymes, the process of degradation of cardiac troponin molecules will be more active, which will lead to the more rapid formation of small troponin molecules and their filtration  from the bloodstream.In general, today, the mechanism of filtering cTns through the glomerular barrier is one of the main and definitively proven ways to remove cTns from the bloodstream. The inferential (indirect) evidence is that when the filtration rate decreases , cardiac troponin molecules accumulate in the bloodstream and their serum levels begin to rise sharply in those patients who do not have any signs of cardiovascular pathology and damage of MCs. The more the renal function is suppressed , the higher the concentration of cTns in the bloodstream rises ,197,198.Recent clinical studies by several research groups can be considered as valuable evidence of the existence of a mechanism for the elimination of cTns across the filtration barrier ,71. A keOne of the key and very labile factors affecting the glomerular filtration rate  is blood pressure. So, with a decrease in blood pressure, the filtration rate will slow down and the degree of removal of cTns from the bloodstream will decrease. This mechanism, in particular, can contribute to the fact that the molecules of cTns will increase much more and circulate in the bloodstream for longer in pathological conditions, accompanied by a sharp drop in blood pressure. This can be typical for large focal myocardial infarctions, which are often accompanied by a sharp decrease in blood pressure (cardiogenic shock), and the degree of increase/duration of circulation of cTns in the bloodstream can be considered as a prognostically unfavorable sign . With anAnother method of cTns removal is associated with the activity of the reticuloendothelial system, the cells of which capture the protein molecules of cardiac markers from the bloodstream, and cause their intracellular proteolytic cleavage ,202,203.As noted earlier, the proteolytic cleavage of cTn molecules in the bloodstream is an extremely understudied mechanism for the elimination of cTns. As a result of this mechanism, a large number of small fragments of cTns are formed, which can be immunoreactive (can interact with antibodies and be detected by immunoassays) and non-immunoreactive fragments (which will not interact with antibodies). From the point of view of laboratory diagnostics, non-immunoreactive fragments of cTns can be considered to be already removed from the bloodstream, since they will not bind to antibodies, and thus will not have an effect on the result of the laboratory diagnostics of MI or any other pathology. To elucidate the mechanism of cTns removal by proteases, well-controlled basic research is needed to thoroughly investigate the role of individual serum proteolytic enzymes in the degradation of cTn molecules in the bloodstream.Thus, three main mechanisms of elimination of cTns from the bloodstream can be distinguished: (1) the elimination (filtration) of cTns through the glomerular barrier, (2) the removal of cTns from the bloodstream by cells of the reticuloendothelial system, (3) the proteolytic cleavage of cTns molecules and/or their fragments in the bloodstream to non-immunoreactive forms. Taking into account the analysis of the literature, the main mechanism for the removal of cTns, in my opinion, is the elimination of cTns through a three-layer filtration (glomerular) barrier. This mechanism can have a significant impact on the diagnostics of cardiovascular diseases, including MI, since the impaired removal of cTns from the bloodstream is often accompanied by a significant increase in the serum levels of cTns. In addition, many patients have comorbid pathologies, among which kidney damage  is relatively common. Many other common diseases, for example, diabetes mellitus and sepsis, are also often complicated by renal failure. Thus, they may increase the serum levels of cTns in patients with no signs of cardiovascular diseases.The removal of cTns from the bloodstream by glomerular filtration may have an important impact on rapid algorithms for the diagnostics/exclusion of MI. Thus, the research group led by Kavsak reported that the currently established upper threshold levels of cTns (99th percentile) for the diagnostics/exclusion of MI can be used only for patients with an optimal glomerular filtration rate (\u226590 mL/min) . In patiFinally, the filtration of troponin fragments through the blood\u2013brain barrier into the cerebrospinal fluid and through the blood\u2013salivary barrier into saliva can be considered as additional potential mechanisms for the removal of cTns. As evidence of the existence of these mechanisms, one can consider studies ,78,79,80The activity of many systems  of our body changes cyclically during the day (with the change of day and night), commonly called circadian or diurnal rhythms. Circadian rhythms are an evolutionarily developed mechanism necessary to maintain the optimal functioning of the body and adapt to changing environmental conditions .Due to the fact that the tissues and cells of our body change, there is a change in the concentration of a number of molecules , which are produced or metabolized by these tissues and cells. Many of these molecules are laboratory biomarkers, the concentration of which is used to diagnose diseases ,207. ThiRecent clinical studies have reported that the bloodstream levels of cTns are dependent on circadian rhythms. These studies used highly sensitive troponin immunoassays able to detect small fluctuations in the concentration of cTns in the bloodstream  ,209,210.The precise mechanisms of the formation of circadian rhythms of cTns are unknown, however, it can be assumed that they will be associated with changes in the functional activity of those organs, tissues, and cells that can somehow affect the metabolic pathway of cTns, in particular, the stages of their release into the bloodstream, the stage of circulation , or the elimination stage . Among the most probable mechanisms for the formation of circadian rhythms of cTns, in my opinion, there are circadian fluctuations in the activity of the cortex and medulla of the adrenal glands, of the thyroid gland, and the activity of enzymes of the hemostatic system ,217,218.A possible explanation of the reason for the fact that the circadian rhythms of cTnT are more significant than the circadian rhythms of cTnI is their biochemical features, in particular, the fact that the volume of the cytoplasmic fraction of cTnT is almost twice the volume of the cytoplasmic fraction of cTnI (approximately 7\u20138% versus 3\u20134%) ,58. ThusThe metabolic pathway of cTns includes three main stages , each of which can have a very significant effect on the serum levels of cTns, i.e., on their diagnostic value. The format of the review, starting with the release of troponin in blood, and concluding with the metabolism/filtration of troponins, provides a comprehensive yet logically easy way for the reader to approach our current knowledge in the framework of understanding the basic mechanisms by which troponins are produced and processed.Based on the analysis of the current literature, the important role of biology and all the stages of metabolism  of cTns in laboratory diagnostics should be noted. It is necessary to continue studying the biology and metabolism of cTns, because this will improve the differential diagnosis of MI, and create a new application of cTns immunoassays in current clinical practice.It should be noted that many new views on the biology, metabolism, and diagnostic value of cTns  were formed as a result of an increase in the sensitivity of troponin immunoassays.Unfortunately, today, many stages of the metabolic pathway of cTns and factors influencing the metabolic pathway of cTns are extremely poorly understood, and are hypothetical and/or contradictory. In particular, the specific mechanisms of the release of cTns from the myocardium into the bloodstream, as affected by physiological conditions and characteristics  and non-ischemic pathologies, which are often accompanied by an increase in the concentration of cTns in the bloodstream, are not very well known. Moreover, factors affecting the circulation of cTns molecules in the bloodstream, in particular, enzymes involved in the metabolism (fragmentation) of troponin molecules, remain unknown. The mechanisms of filtration (transport) of cardiac troponin molecules from the bloodstream to other biological fluids are not investigated, and, accordingly, these possibilities of non-invasive diagnostics have not been validated. Thus, the study of the biology and metabolism of cTns and potential factors influencing it is a relatively large and poorly studied area for further research, which is needed to optimize diagnostics and validate new diagnostic capabilities."}
{"text": "Chronic non-communicable diseases (NCD) account for 72% of the causes of death in Brazil. In 2013, 54 million Brazilians reported having at least one NCD. The implementation of e-Health in the Unified Health System (SUS) could fill gaps in access to health in primary health care (PHC). Objective: to demonstrate telehealth strategies carried out within the scope of the Institutional Development Support Program of the Unified Health System (PROADI-SUS) and developed by Hospital Alem\u00e3o Oswaldo Cruz, between 2018 and 2021, on evaluation, supply, and problem-solving capacity for patients with NCDs. Methodology: a prospective and descriptive study of three projects in the telehealth areas, using document analysis. The Brasil Redes project used availability, implementation, and cost-effectiveness analysis, TELEconsulta Diabetes is a randomized clinical trial, and Regula Mais Brasil is focused on the waiting list for regulation of specialties. All those strategies were developed within the scope of the SUS. Results: 161 patients were attended by endocrinology teleconsultation in one project and another two research projects, one evaluating Brazil\u2019s Telehealth Network Program, and another evaluating effectiveness and safety of teleconsultation in patients with diabetes mellitus referred from primary care to specialized care in SUS. Despite the discrepancy in the provision of telehealth services in the country, there was an increase in access to specialized care on the three projects and especially on the Regula Mais Brasil Collaborative project; we observed a reduction on waiting time and favored distance education processes. Conclusion: the three projects offered subsidies for decision-making by the Ministry of Health in e-Health and two developed technologies that could be incorporated into SUS. With the change in the epidemiological and demographic profile of the population, in addition to the growing increase in chronic pathologies and people in vulnerable situations, the need for an integrated approach to the individual concerning health care emerges ,2,3. ChrDigital health, or e-Health, can be defined as \u201cthe safe and cost-effective use of information and communication technologies in support of health and health-related fields\u201d, with the World Health Organization considering making e-Health a global priority for health systems development . The impWe Are Social in January 2020, identified 150.4 million internet users in Brazil [The distribution of income and access of the Brazilian population to technological resources is characterized by geographical and social inequality. Even so, the report \u201cDigital 2020\u201d, published by n Brazil , accountn Brazil . Considen Brazil . That wan Brazil ,15.This article aims to describe telehealth strategies carried out in the years 2018 to 2021 by the Hospital Alem\u00e3o Oswaldo Cruz, in partnership with the Brazilian Ministry of Health through the Support Program for Institutional Development of the Unified Health System (PROADI-SUS) ,17.Between 2018 and 2021, Hospital Alem\u00e3o Oswaldo Cruz, in partnership with the Ministry of Health, through PROADI-SUS, developed projects and actions in Telehealth aimed at improving management in various spheres of the SUS. Of these, we review three strategies aimed at reducing the impact of CNCD on health using different strategies in e-Health for this purpose. As these are three different projects, we will describe the methodology of each one separately.The Brasil Redes Project aimed to carry out a diagnostic evaluation of the National Telehealth Brazil Networks Program (PNTBR\u2013in Portuguese), which completed 10 years of existence in 2017 . This prFive studies were carried out for this evaluation: evaluability study, implementation evaluation, and cost-effectiveness evaluation of two services offered in the list of activities foreseen by the program and program cost analysis . The evaRegula Mais Brasil Collaborative  is a proMotivated by the COVID-19 pandemic , the MinThis project\u2019s main objective, until in recruitment phase, is to conduct clinical research to test the hypothesis that teleconsultation is non-inferior to the face-to-face care of patients with diabetes mellitus (DM) type II referred from primary health care (PHC) to specialized care in SUS .This is a randomized, pragmatic, phase-2, single-center, open, non-inferiority clinical trial, with central randomization, allocation confidentiality, and data analyst blinding, to assess the efficacy and safety of specialized care by teleconsultation compared to face-to-face care. A total of 250 participants of both sexes over 18 years old, with type 2 diabetes mellitus, will be included. This sample size will allow evaluating the non-inferiority of up to 0.5% between groups, assuming a standard deviation of 1.30.The outcomes that will be analyzed in this study are: the mean difference in the percentage of glycated hemoglobin (HbA1c) post- and pre-intervention in patients diagnosed with type 2 DM in 3 and 6 months, fasting blood glucose measurements and blood count, measurements of serum urea and creatinine, lipid profile measurements, systolic pressure measurements, in-office measurements, in-office diastolic pressure measurements, measurements of body weight and body mass index (BMI), the incidence of any adverse events, and quality measurements of patients\u2019 lives using the diabetes quality of life measurement questionnaire (DQOL) .In the micro-costing analysis , this stThe main target audience of the Telessa\u00fade Brasil Redes National Program is primary health care teams, and with that many of the actions offered by the centers were focused on caring for people with CNCD. In this sense, the project results highlighted opportunities for improvement of the telehealth program for CNCD at the federal level. In Brazil\u2019s public health system, there is a necessity to homogenize the financing values considering the production potential of the centers, mainly for telediagnosis, and monitoring and evaluation methods of results. For the spheres of state centers aiming to value their actions, there is a need to reflect on challenges in the use of these services by health workers and on regional partnerships. The set of methods offered a broad vision of the program and articulated more detailed analyses of certain services offered by the telehealth centers. The purpose was to offer subsidies to the Ministry of Health in improving the telehealth program and using the expertise of certain centers as inspiring the formulation of procedures used to be offered by SUS.Since the creation of the Brazil Redes program in 2007, 33 telehealth centers have been identified in various regions of the country , with veIn this sense, the centers sought to articulate different fronts of activities to contemplate permanent education and the improvement of primary care professionals, whether through courses, virtual lectures, teleconsulting, production of training second opinions, and telediagnosis. Regarding the processes evaluated in the economic component, the two studies carried out with the Telehealth Center at Clinic\u2019s Hospital from the Federal University of Minas Gerais clarify the cost and budget impact forecast for the implementation of telecardiology services in the public service network, which can greatly contribute to the improvement of care for people with CNCD.The Hospital Alem\u00e3o Oswaldo Cruz carried out consolations in the Regula Mais Brasil Collaborative Project via teleconsultation of users, in the specialties of neurology, endocrinology, orthopedics, and mental health, totaling 1097 teleconsultations in this period. Specific actions for CNCDs are concentrated in the specialty of endocrinology, in which 161 teleconsultations were carried out, all with SUS users in the city of Recife, city located in the state of Pernambuco, in northeastern Brazil . The resDepending on the prevalence of endocrinological diseases, diabetes mellitus appears as the most prevalent reason for teleconsultations performed. Regarding the technology used for contact between the doctor and the patient, video calling (audio and video) was mostly used, since it represents the best possibility of remote interaction. The exclusive audio resource was only used when it was not possible to use video calling.The outcomes of the last teleconsultation were performed to allow an assessment of the resolvability potential of this assistive technology. The follow-up outcomes in PHC (40.3%) represent cases in which the specialist, based on the assessment in teleconsultation, considers that, based on the complexity of the case, the patient can be followed up in the PHC, close to their residence, avoiding unnecessary referral and displacement of the patient to the specialized center. In addition, he receives the first guidance and conduct by the specialist via teleconsultation. Likewise, the reassessment in teleconsultations (23.4%) also represents the cases in which digital technology allows for adequate follow-up with a specialist, without the need to travel. On the other hand, cases in which the outcomes indicate the need for a face-to-face consultation with the specialist, whether immediate or elective, represent the limitation of teleconsultation in the assessment or follow-up of cases. It is worth mentioning that all cases evaluated did not have a first face-to-face consultation which, in some cases, limits a better diagnosis.What corroborates the potential of teleconsultations is the result of the Net Promoter Score , which aRegarding the results of the teleconsultation diabetes research project, it was not yet possible to demonstrate aspects of the research results related to the results of complementary exams, questionnaires measuring the quality of life in diabetes (DQOL), and satisfaction assessment with telemedicine, due to the small number of participants included so far. Of the patients included in the study, the mean age was 59.4 years, with a predominance of 78% of white people, followed by black (12%) and mixed race (10%), and a slight predominance of males (54%) of the included participants.In addition, within the scope of the teleconsultation project, the time-driven activity-based costing (TDABC) micro-costing methodology, or costs based on time and activity, was adopted because it allows the identification of the unit cost of the service within the expected efficiency conditions, also acting as a comparison metric. In this scenario, the first hypothesis considered the duration of the teleconsultation and the face-to-face consultation to be identical, as well as the duration of the pre-consultation activities. This is a preliminary conclusion, considering that recruitment, until this period, was minimal and with low statistical power to detect differences in times. The second hypothesis considered that the costs with materials and structure of the UBS\u2019s and the Polyclinic are also identical since the Health Department of Joinville is in the middle of the process of changing the methodology for this type of cost and must provide these data in a manner more accurate by mid-2021. In this hypothetical scenario, the cost of teleconsultation was 5% higher than that of a face-to-face consultation. As in both cases, the consultation is responsible for more than 90% of the total cost, the difference in duration between the two types of consultation will be the determining factor for the difference in costs between them. More details that relate the methodologic and statistic description are outlined in the design paper published before .Teleconsultation is a medical act and must abide by the Brazilian Medical Code of Ethics (MCE) ,28,29. ACritics of telemedicine approval warn that the possible overuse and careless use of telemedicine could turn doctors into \u201ctelemarketing operators\u201d, which could lead to poor quality in appointments, medical errors, and unemployment by reducing the number of face-to-face doctors . AlthougThis whole context evidences the lack of alignment between the federal government, the Brazilian Medical Federal Council, health plan operators, medical associations, and medical professionals, especially concerning teleconsultations. The challenge is how to expand access to medical services mainly to specialists for populations in remote regions, reduce healthcare costs and the displacement of patients, and on the other hand, minimize the fear of damage to the medical profession . Other cThe Brazil Redes program showed the presence of decentralized and disseminated strategies throughout the national territory, with actions in telehealth, focused not only on CNCDs but also other health promotion strategies. The actions of teleophthalmology with identification of diabetic retinopathy based in Mato Grosso ,35 confiThe Regula Mais Brasil project, through the implementation of teleconsultation in the Unified Health System, demonstrated, in an unprecedented way, how strategies that allow the population\u2019s access to different medical specialties can be feasible, in addition to allowing the capillarization of care, through the strategy to take the specialist wherever the patient is and not the other way around. Especially in the period of the SARS-CoV-2 pandemic, this project can maintain access to health care, especially for users with diabetes and sequelae after a stroke, ensuring the maintenance of care .Regarding the teleconsultation diabetes research project, if the efficacy and safety for patients assisted by teleconsultation are confirmed, once the normative issues are resolved by the Federal Council of Medicine (CFM), this will be able to effectively contribute to the promotion access of patients to the public health system, including specialist physicians. Likewise, there may be an increase in the resolvability of the population\u2019s health needs, breaking the geographical barrier that a country with continental dimensions, such as Brazil, imposes on the provision and standardization of health, in addition to the potential savings for health systems, which may be used safely and with quality.This paper has several limitations: one of then is the fact we make a compilation of three different strategies implemented at SUS in a tentative way to delivery medical assistance to the general population. As the initial projects were not designed to analyze the impact on outcomes, for example, the incidence of myocardial infarct or stroke, the authors only could initiate a discussion, showing that e-Health strategies can be performed in a public health system.Although there is evidence in favor of the use of telehealth strategies to deal with CNCDs, in Brazil, due to difficulties in accessing technology in addition to important care gaps and legal impediments, we observe a lack of strategies in this area for health promotion within the scope of the SUS.Therefore, given the above, there is a need to generate reliable scientific evidence of the effectiveness and safety of applicability within the context of regulation and access to the SUS. In this article, the authors demonstrate how specific initiatives in telehealth, through partnerships between the Ministry of Health and Hospitals of Excellence, can foster the development of new research and assistance strategies within the scope of e-Health in Brazil."}
{"text": "Premature ovarian insufficiency (POI) is defined as a decline in ovarian function before the age of 40 and is one of the leading causes of infertility in women. The etiology is complex, and the pathogenesis is not clear. The main treatment is hormone replacement therapy, but a growing body of data confirms that such treatment can increase the risk of endometrial disease and cardiovascular disease. Complementary and alternative medicine (CAM) has been widely used in patients with POI due to its limited adverse reactions and high efficiency. According to literature reports, CAM therapy for POI mainly includes traditional Chinese medicine, acupuncture, psychotherapy, dietary supplements, and exercise therapy. This article reviews the application of CAM in the treatment of POI and attempts to determine the therapeutic effects and the mechanisms behind these effects based on existing clinical and experimental studies in order to provide theoretical support for the treatment of POI. Compared with traditional acupuncture, it has the advantages of no trauma, less pain, and easy operation. TEAS can increase the number of antral follicles, improve basic endocrine indicators, and improve ovarian reserve function in POI patients, and it has a similar treatment effect as artificial cycle treatment . The mecPsychological stress is one of the main causative factors of POI , while, Pseudostellaria, and Rehmannia glutinosa, (2) Curculigo orchioides Gaertn, Epimedium brevicornu Maxim, ginger, and mutton, and (3) medlar, green beans, and Rana dybowskii. All three diets can tonify the liver and kidneys, improve ovarian function, and relieve the clinical symptoms of POI [A Chinese medicated diet is a rational combination of different Chinese drugs taken with food under the guidance of TCM theory and is devised using traditional and modern scientific processing technology. The theory of \u201cmedicine and food homology\u201d has been known since ancient times in China, and the medicated diet embodies medicine in food, and it increases not only the efficiency of the medicine but also the nutritive value of food, and it can be used to prevent and cure diseases, build up health, and prolong life , 120. Chs of POI .\u03baB signaling pathway to inhibit immune responses and reduce the risk of immune-induced POI [Vitamin D, a precursor of several lipid-soluble steroidal hormones, is involved in the regulation of the female reproductive system in addition to its well-known role in regulating the calcium-phosphorus balance of the blood and bone tissues. Its receptors are widely distributed in the reproductive tissues, including the ovary , 123. Stuced POI . It has uced POI . In addiuced POI .\u03b1-tocopherol as the major form, and it can effectively reverse the adverse effects of oxidative stress on the reproductive system [Vitamin E is a lipid-soluble antioxidant with e system . Increase system \u2013129, ande system . Ma et ae system , and a re system .Vitamin C (ascorbic acid) is an essential nutrient with an antioxidant effect and can reduce the risk of chronic diseases, and it must be consumed regularly to prevent deficiency . An expeExercise is a type of physical activity that uses planned, structured, and repetitive limb activities to improve the function of the body as well as the mental health of women with POI. The application of exercise and psychotherapy in POI patients is of great value and can improve the level of sex hormones and clinical symptoms , 137. WoPOI refers to a decline in ovarian function before the age of 40 and is characterized by menstrual disturbances, infertility, and varying degrees of menopausal symptoms. CAM for POI mainly includes herbal products, acupuncture and moxibustion, psychotherapy, dietary supplements, and exercise therapy. Through these therapies, the levels of sex hormones in POI patients can be improved, menstrual cycles can be resumed, menopausal symptoms can be alleviated, pregnancy rates can be improved, and anxiety and depression can be relieved, thereby improving the quality of life of these patients. In conclusion, the active principle of CAM therapies has a strong scientific foundation, and researchers have shown increased interest in this area of medical treatment. Due to the small sample sizes of most studies, however, it is currently difficult to make clear recommendations for clinical guidance. Larger samples and RCTs are needed in the future to verify the efficacy and safety of CAM for the treatment of POI and to provide new strategies for treating POI."}
{"text": "Philip Ciunkiewicz was not included as an author in the published article. The corrected Author Contributions Statement appears below.KS and PC collected data, extracted features, deployed and evaluated machine learning algorithms, interpreted and visualized results, and drafted the manuscript. MR and PM conceptualized the project and participated in the study design, analysis and interpretation of results, and drafting of the manuscript. RB and SY provided expert guidance throughout the study and interpretation of results. All authors contributed to the article and approved the submitted version4Department of Biomedical Engineering, University of Calgary, Calgary, AB, Canada.In the published article, there was an error regarding the affiliation for Philip Ciunkiewicz. They should have The authors apologize for these errors and state that this does not change the scientific conclusions of the article in any way. The original article has been updated"}
{"text": "In the original article, there was an error in affiliation 2 as published. Instead of University of the Chinese Academy of Sciences, Beijing, China, it should be University of Chinese Academy of Sciences, Beijing, China.The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated."}
{"text": "Policymakers, practitioners, and researchers need a balanced, thoughtful, and analytical resource to meet the challenge of global aging at a rate that\u2019s historically unprecedented. The Journal of Aging & Social Policy (JASP), which was founded in 1989, serves this role by drawing contributions from an international panel of policy analysts and scholars who assume an interdisciplinary perspective in examining and analyzing critical phenomena that affect aging and the development and implementation of programs for elders from a global perspective. Study settings extend beyond the United States to include Europe, the Middle East, Australia, Latin America, Asia, and the Asia-Pacific rim. This presentation will document the scope, content, and focus of JASP, including the rise of international submissions, which now account for approximately half of articles published. Opportunities for publishing in JASP will be discussed; so too will strategies for navigating the peer-review process successfully."}
{"text": "Dear Editor,I began my school life in a white institution thanks to the good socio-economic status achieved by my parents after years of hard working. At the school, I was always the only black girl in the classroom. For this reason, at the age of 6-years, I became aware of the perverse racism presented in our society.However, in my multiethnic and multiracial family environment I was gifted with loving relationships and mutual commitment. For this reason, I developed mechanisms to sustains my ideal of healthy interethnic and interracial relationships.My dual ethnical background (white Christian and black Yoruba) and my dual nationality (Brazil-Nigeria) determined my personal, educational and professional paths. In addition, these were responsible for my entering in medical school at the age of 18, without ever questioning whether that was my place. As a black woman, I occupied and continue to occupy this space under questioning eyes related to my deservingness to be there, intellectual capacity, and under frequent microaggressions from colleagues, professors, and users of the health systems. Since the 1980s, new approaches in the historiography of slavery have made possible more accurate analyses of the Brazilian slave process, which was not enough, however, to overcome the reductionism of the history of blacks to the history of slavery.In the history of Brazil, serious misconceptions, which reduce a human condition to legal condition, were provoked by the synonym between \u201cblack\u201d and \u201cslave\u201d. This misunderstanding was fed by researchers who rely on sources produced by foreigners incapable of discriminating between the conditions of enslaved and freed blacks. The latter, associated with tradictions, religion and geographical origin that make up the so-called \u201ccultural racism\u201d.The action of racism is perverse and shows how negatively stereotyped representations of Africans, African descendants, and their religions are related.The notion of race functions from two basic and complementary registers: the biological and the ethno-cultural.The psychosocial effects of racism shape behaviors, thoughts and feelings, on the basis of which discriminators and discriminated are differentiated. The victims, transformed into defendants, and solely responsibles for the suffering imposed on them, are conditioned to feel inferior or subhuman. The damage to psychological health includes anguish, panic, anxiety, insecurity, guilt, self-censorship, rigidity, loneliness, chemical dependencies, and syndromes. The promotion of equity, inclusion and recovery include factors related to socioeconomic and educational indices, and processes of reconstruction of subjectivities.Sistema \u00danico de Sa\u00fade -SUS), defends equity in health for the black population, and has as the main guideline the \u201cinclusion of the topics related to Racism and Health of the Black Population in the processes of training and permanent education of health workers and in the exercise of social control in health area.In Brazil, in the health field, the National Policy for Integral Health of the Black Population aims at fighting ethnic-racial discrimination in the Brazilian Public Health System ( Even more concerning are the invisibility of racism as a social determinant of health, the opportunity that is lost to prepare medical professionals for a humanized care that takes into consideration the biopsychosociocultural contexts in which patients are inserted, and the process on how these contexts affect the processes of health, disease, treatment, cure or death.Today, graduated for almost 10 years, I witness the intensification and spread of the Black Lives Matter Movement, which has expanded around the world, and also reached the Brazilian academic elite as a wave of collective awareness about racism. I had the opportunity to talk to medical students about this subject, which, although so necessary in our historical and social context, is still faces serious difficulties of consolidation in the curricula of training courses for health professionals, and seldom appear in the medical school curriculum.Clearly, the issue of racism will not be completely solved through medical education adequate to the Brazilian reality, but for the first time, I noticed a promising concern of young black and white future physicians engaged with racial/ethnic inequities in health area. I witness, for the first time in medicine, the impulse for the creation of strategies capable of reducing or even annullate ethno-racial inequalities in this country.Currently, more than ever, the time has come for higher education health institutions to act in a concrete and precise manner in the implementation of disciplines, courses, and undergraduate, and graduate programs of sufficient quality to deal effectively with the theme of Afro-descendant citizenship. are useful for the definition of strategies and tactics to achieve the desired goal.To achieve this goal, it is necessary to create, in the health field, a space for qualified debates on the African presence in the multicultural and multiracial composition of the Brazilian society. Some recommendations by Monteiro establishes five thematic axes to be considered in the continuing education of health professionals: racism, African and Afro-Brazilian history and culture, health of the black population, the body, and affirmative action practices. The articulation of themes and sub-themes around these axes results in a complex network of knowledge. Many of these knowledge come from ethnomedicine, an indispensable field for the dialogue between medicine and anthropology, between health and spirituality/religion, and between contemporary Western medicine and Afro-diasporic health care practices.Our first task is to identify the health needs and potentialities of the black population and, to accomplish this, it is necessary to articulate knowledge and methods from several areas of knowledge. For pedagogical purposes, MonteiroTotally aware of the history of humiliations experienced by black people, and due to my special condition as a black physician and of the commitments and responsibilities associated with my profession, I am trying to put my strength and my will at the service of justice and peace in human relations, and to the service of the health and well-being of the people with whom I share steps on my journey."}
{"text": "Urban rail transit is an important transportation infrastructure that mitigates the congestion of the central city and realizes compact city space development. However, the literature on the spatiotemporal coupling of urbanization and rail transit from the urban scale and its influencing factors is still uncommon. Taking Beijing as an example, based on the theory of coupling coordination, we have constructed a comprehensive indicator system for regional urbanization (hereafter RU)  and rail transit (hereafter RT). On this basis, we use the entropy method, coupling coordination degree model, and spatial autocorrelation analysis method to explore the spatiotemporal characteristics of the overall and pairwise coupling coordination between population, economy, spatial urbanization, and rail transit. Finally, we analyze the spatial correlation and standard deviational ellipse analysis of the coupling coordination degree between RU and RT. The results indicate the following: (1) In addition to population urbanization, the other urbanization indicators and the RT level all show a downward\u2013rising\u2013falling trend from 2006 to 2017, among which the level of economic urbanization is the highest. The degree of coupling coordination between RU and RT is unbalanced development and shows a trend of first rising and then falling. (2) The degree of coupling coordination between RU and RT presents an imbalanced distribution in various regions, and the coupling coordination degree in the central urban areas is significantly higher than that in the outer suburbs. (3) From 2006 to 2017, the spatial correlation of the coupling coordination degree between the various systems has a similar changing trend. Moreover, the distribution of the spatial agglomeration points of the coupling coordination degree between RU and the RT is similar, showing a decreasing trend from the central urban area to the surrounding urban area. Therefore, relevant departments can rationally plan the construction of urban rail transit according to the coordination relationship between RU and RT and the spatial aggregation degree to realize the benign and sustainable development between urban especially suburbanization and rail transit. In recent years, with the rapid development of the economy, urbanization and motorization have further accelerated, the urban population continues to increase, and the scope of urban scale is expanding. As of the end of 2020, China\u2019s urbanization level exceeded 60%. However, with the speed of urbanization, it is a series of urban issues, such as road traffic congestion, unreasonable urban spatial structure, and waste of resources. The traffic problems of the city have always existed, but urban traffic contradictions are becoming more serious, and the unreasonable structural defects in the large urban spatial layout are more fully sufficient. For example, according to data statistics, Beijing\u2019s annual traffic congestion is direct; indirect economic losses reaches tens of thousands of RMB, which probably accounts for 5% of Beijing\u2019s GDP. The problems caused by air quality and friction disputes have also affected the quality of life of thousands of people, which has become a social problem that cannot be ignored. To support urban development and construction as well as the convenient travel of residents, many cities have begun to plan rail transit networks. As an important part of the urban public transportation system, urban rail transit is an important part of its shipping, speed, convenience, and punctuality, which solves one of the important tools of the city mayor. At the same time, the economic role of rail transit is also very significant, with the rail transit-oriented urban development model being an important trend in many world cities. Vigorously developing fast, environmentally friendly, economical urban rail transit has become the key to accelerating urbanization processes and resolving traffic contradictions in major cities. According to the data released by the Ministry of Transport, as of 31 December 2020, there were 44 cities in China to operate urban rail transit, which accounts for 6.29% of China\u2019s total cities. This also depends to some extent on China\u2019s urban rail transit systems still needing further rapid development. Among them, the planning and construction of the comprehensive transportation hub are strengthened, and the urban rail transit is axial, thereby achieving a comprehensive improvement of urban traffic congestion, improving working efficiency and the quality of urban life.On 19 January 2021, the National Development and Reform Commission of China held a press conference, indicating that China will focus on \u201ctwo new\u201d and shortboard weaknesses. It stated that China should speed up the construction of rail transit, gradually improve the urban rail transit network, and strive to establish a modern urban comprehensive transportation system with public transportation network as the main body and rapid rail transit as the backbone, which is in line with the process of urban development. Within the city, there is also a significant uncoordinated issue between rail transit and regional urbanization. For example, the urban rail construction in the central city is perfect, while in the outer suburbs, it is relatively deficient. In 2000, only Beijing, Tianjin, Shanghai, and Guangzhou had urban rail transit lines. The urban rail lines are mainly distributed in the city center, and there are relatively few in the outer suburbs. For example, the urban rail lines in Beijing only cover 11 administrative regions, and there are at least six urban rail lines in the central city, while in the outer suburbs such as Huairou, there are fewer than two. Therefore, in the process of urban construction, the coordinated development of urbanization and urban rail in different regions is important.The coordination and sustainability of urbanization have always been the focus of scholars. In the process of urbanization development, rail transit construction and urbanization development are mutually promoting, so the coordinated development between them is important. The existing research can be divided into two categories: qualitative research and quantitative research. For the former, scholars mainly take the perspective of whether the rail line optimization, rail station optimization, and comprehensive hub transfer mode are coordinated with urbanization. In addition, quantitative analysis mainly uses the quadrant graph, coupling degree model, Theil coefficient model, and spatial analysis method to analyze the coordination between rail transit and urbanization-related factors.Rail transit planning has gradually become an important part of urban construction, and rail transit construction has a significant promoting effect on urban economic growth . FirstlyPrevious studies mainly focused on the influence of rail transit construction planning on urbanization development, but they did not analyze and study from the direction of coordination between the two. Urbanization development is a complex process that we need to analyze from different angles. This paper studies the coordination between rail transit and urbanization and the related influencing factors from three perspectives of economic urbanization, population urbanization, and spatial urbanization, so as to provide some theoretical support for the healthy development of urban track and urbanization.Firstly, scholars have carried out multi-dimensional studies on the relationship between rail transit and urbanization development. For example, Hou has analyzed the coordination relationship between rail transit and land use based on multivariate data through data envelopment analysis (DEA) and the clustering method, finding that the relationship between rail transit capacity and land use of rail transit stations with high population density is unbalanced . Liu hasSecondly, scholars also have studied the factors influencing urbanization from the aspects of urban functional mixing degree, population, land, and so on. Based on information entropy and coupling coordination degree, the coordination relationship between urban function mixing state and urbanization development level and its influencing factors are analyzed from the perspective of urban spatial structure development . Cao hasMost of the existing studies focus on one aspect of the system elements in the process of urbanization from a certain perspective, and all of them are from the perspective of the city as a whole. Few studies have quantified and measured the coordinated development relationship between urban orbit and urbanization from the perspectives of economic urbanization, population urbanization, and spatial urbanization by taking different regions of a city as research units. The specific synchronization research comparison can be shown in To sum up, previous studies on the relationship between rail transit and urbanization mainly focus on the degree of mutual influence and promoting effect, and the coupling relationship between rail transit and urban population, space, and industrial structure. However, most of the previous studies have studied the causes of the imbalance between rail transit and urbanization development in different cities from the perspective of the city as a whole, and studies on the factors of the imbalance between rail transit and urbanization development from the perspective of urban internal regions remain rare. Compared with similar previous studies, our innovation is mainly reflected in the following two aspects. First, based on the coupling coordination model, we measure the coordination relationship among the economic, spatial, and population urbanization and rail transit as a whole, as well as pairwise. Second, we explore the internal reasons that affect the unbalanced development of urban regions by looking at the coordination relationship between rail transit and the urbanization level. Based on the data of rail transit and urbanization development level from 2006 to 2017, we construct a comprehensive indicator system of regional urbanization  and rail transit, and we calculate the coupling coordination degree between the urbanization and rail transit of each region in Beijing. Finally, based on the spatial autocorrelation model, the associated characteristics of the coupling coordination in space are analyzed. According to the research results, relevant departments can make corresponding decisions on urban rail line planning, reasonably plan the urban space layout, and provide theoretical support for urban optimization management and sustainable development.Beijing has a certain representation as China\u2019s political, economic, technology, and transportation center. Taking Beijing as an example, we analyze the coordination relationship between regional urbanization and rail transit. With the rapid development of rail transit in China, the subway is not only the main form of urban rail transit but also the focus of urban rail transit construction in the future. As of January 2017, Beijing has a total of 19 subway lines covering 11 municipal districts, mainly including Dongcheng, Xicheng, Haidian, Chaoyang, Fengtai, Shijingshan, Changping, Fangshan, Tongzhou, Shunyi, and Daxing. Based on the actual operation of the Beijing subway, the research area of this paper is shown in Referring to the indicators of urbanization and rail transit at home and abroad, the indicator system of this paper mainly includes two aspects: regional urbanization and rail transit. According to the relevant regulations and description of urbanization by the Institute of Urban Environment, Chinese Academy of Sciences, urbanization is a multidimensional concept, including population urbanization, economic urbanization, and spatial urbanization. Since urbanization is a complex process, demography defines urbanization as the process of rural population transforming into urban population, economics defines urbanization from the perspective of economic model and mode of production, and geography defines urbanization as the process of rural areas or natural areas transforming into urban areas. Therefore, we select the corresponding indicator data from three aspects of population urbanization, economic urbanization, and spatial urbanization to measure the RU. Firstly, we construct the indicator system of regional urbanization from the three criteria layers of population urbanization, economic urbanization, and spatial urbanization . SecondlThe coupling degree refers to the phenomenon of two (or more) systems that affect each other by various interactions, including the promotion system from disordered ordered processes, which describes the interaction between systems or elements. The coupling coordination refers to the high and low level of the interaction between the two systems or the multi-system, as well as the uniformity of the benign association between the various elements within the system, indicating the tendency between the system from disordered to order. To study the coordination relationship between regional urbanization and urban orbit, we selected four systems with population urbanization, economic urbanization, spatial urbanization, and rail transit. Then, based on the coupling coordination model, we measure the coupling degree and coupling coordination between the four systems, and the specific calculation steps are as follows:Step 1: Measure the levels of each system. We integrate various types of evaluation methods, considering the lack of objective basis in the determination of the weight in the subjective empowerment evaluation method. In some cases, the subjective judgment may have a certain deviation. As an objective evaluation method, the entropy method can not only avoid the subjective judgment of the researcher but also solve the information overlap problems between multiple indicators ,46. Ther(1) Standardized processing. This type of processing is used to eliminate the inconsistency of the measurement units of each indicator, the size of the measurement units, and the direction of the positive and negative direction. Therefore, the data are standardized before calculating the comprehensive indicator, we homogenized the indicators of different qualities, and their value ranges are . Standardization of the forward indicators and negative indicators is shown in Equations (1) and (2), respectively.Positive indicator:Negative indicator:(2) Measure the level of each system. Firstly, we calculate the information entropy Here, Here, Step 2: Calculate the coupling degree between urbanization and urban orbit in region To further explore the coupling relationship between population urbanization, economic urbanization, spatial urbanization, and rail transit in region To judge the coupling degree of the three systems or two systems, the coupling degree is divided into four levels based on previous research results, as shown in Step 3: Calculate the coupling coordination degree between RU and RT in the region terature ,45, eachSimilarly, there are pairwise coupling coordination relationships among population urbanization, economic urbanization, spatial urbanization, and rail transit. The calculation formula is shown in Equation (8):Here, terature ,45, the The classification is based on the degree of coupling coordination, and the specific classification criteria are shown in The relation , and furFor If By calculating the At the same time, there are corresponding standardized statistics \u03b8, the standard deviation of the long axis, the standard deviation of the short axis, and the center point. Among them, the long axis represents the direction of the data distribution, the short axis represents the range and dispersion of the data distribution, and the center point represents the center of gravity of the space element layout. The standard deviational ellipse method can identify the direction and distribution trend of data. We analyze the spatial evolution of the coupling coordination between RU and RT, which can understand the evolution of coordination between urbanization and rail transit. The calculation steps of the standard deviational ellipse method are as follows.The standard deviational ellipse method proposed by Professor Lefever in 1926 is one of the classical methods to analyze the directional characteristics of spatial distribution. This model takes the mean of x and y coordinates of all elements to calculate the mean center, which is taken as the starting point. Then, it calculates the standard deviation of x and y coordinates to define the axis of the ellipse containing the distribution of all elements . The calStep 1. Determine the ellipse center :Step 3. Determine the length of the elliptic length axis We use the standard deviational ellipse tool provided by ArcGIS  to conduct standard deviational ellipse analysis on the coupling coordination degree between RU and RT and the spatial aggregation degree of the coupling coordination degree. The output size was selected as \u201cone standard deviation ellipse surface\u201d (covering the point element set containing 68%) . The staUrban rail transit is the key to promoting urban economic development, optimizing the urban spatial structure, and realizing sustainable urban development. At the same time, with the continuous acceleration of urbanization, the construction of urban rail transit is also constantly improving. According to Equation (4), we have obtained the levels of population urbanization (PU), economic urbanization (EU), spatial urbanization (SU), and rail transit (RT), as shown in On the whole, from 2006 to 2017, except for PU, the changing trend of other urbanization indicators and the level of RT is consistent, which shows a downward trend from 2006 to 2008, a relatively stable rise from 2008 to 2015, and a downward trend from 2015 to 2017. In contrast, the level of PU has the highest value in 2010 but presents continuous decreasing trends from 2010 to 2017. The reasons mainly include the following three points: First, China was affected by the global financial crisis in 2008, and the economic development of Beijing showed a downward trend from 2006 to 2008. However, the 2008 Beijing Olympic Games promoted the city\u2019s urban construction and economic development, resulting in a rising trend of urbanization indicators in Beijing from 2008 to 2015. Second, before 2008, Beijing\u2019s urban rail construction was not perfect. In 2008, the mileage of Beijing\u2019s rail transit reached 200 km, and 26 fast links between the new urban area and the city center, and between the city center and the suburbs were built. Therefore, urban rail transit has been on the rise since 2008. However, there has been no further development of the urban track since 2015. Third, with the removal of non-capital functions from Beijing and the construction of an \u201cadvanced and sophisticated\u201d economic structure, employment in some traditional labor-intensive industries has decreased. According to the Blue Book of Beijing Population, Beijing\u2019s permanent population is on the decline. For example, the number of permanent migrant residents in 2016 and 2017 dropped by 1.84 percent and 1.63 percent, respectively, compared with the previous year.It can also be seen from According to Equations (7) and (8), we can obtain the distribution of coupling coordination degree between RU and RT, as shown in According to Equations (5) and (6), the coupling relationship between each system is obtained, and the results are shown in As can be seen from From According to the spatial evolution pattern of the standard deviational ellipse of the coupling coordination degree between RU and RT in According to Equation (8), we obtain the pairwise coupling coordination degree of PT, ET, and ST and make spatial visualization with ArcGIS. The results are shown in On the whole, the pairwise coupling coordination relationships have a significant regional imbalance, which is mainly reflected by the continuous decrease from the central city to the outer suburbs. In addition, from 2006 to 2017, the coupling coordination degree of each region shows a trend of increasing first and then decreasing. The standard ellipse of the coupling coordination degree has no obvious change, which is mainly concentrated in the central urban area, Changping, and Shunyi. This indicates to some extent that the central urban area, Changping, and Shunyi are the main areas of coordinated development between urbanization and rail transit, and there are obvious differences in the coordination relations among different regions.From the perspective of each region, except ET, the pairwise coupling coordination relationship of PT and ST in each region is basically in a state of disorder, and the coordination relationship in the outer suburbs is almost in a state of extreme disorder or serious disorder. Firstly, the urban rail in the outer suburbs is built late, and the improvement is not as good as that in the central urban. According to data, the coverage rate of 750 m rail transit stations in the central urban reaches more than 90%, while that in Huairou and the other outer suburbs is not. Secondly, the permanent population of the central urban area has always been much higher than that of the outer suburbs. Thirdly, the construction of spatial facilities in Beijing has always been in a state of regional imbalance. For example, the spatial urbanization level of the central urban area is about 1.44 times that of the outer urban area. As can be seen from The distribution of spatial elements is mainly divided into three modes: agglomeration, dispersion, and enrichment. To further study the spatial distribution pattern and evolution law of On the whole, from 2006 to 2017, the spatial correlation of the coupling coordination degree among all systems shows a similar trend, which decreased first and then increased. In addition, we can find that except for ST, the From To further understand the spatial aggregation between the pairwise coupling coordination degrees, we use ArcGIS to carry out regional visualization, as shown in From the perspective of each region, Dongcheng, Xicheng, Haidian, and Shijingshan are high-value dispersion areas and high-value clustering areas, which belong to the region with a high coupling coordination degree and agglomeration of urbanization and rail transit. However, the coupling coordination degree of Chaoyang, Fengtai, Daxing, and Tongzhou are within the general area; Changping, Shunyi, and Fangshan are the low-value dispersion areas and low-value clustering areas of coupling coordination degree. This regional imbalance between urbanization and rail transit is mainly because the center urban development speed is higher than that in the outer suburbs. For example, the number of subway lines and subway stations in the central urban area is about 3.23 times that in the outer urban area, and the GDP of the central urban area is about 3.32 times that in the outer urban.According to Equations (11) and (12), we can get the spatiotemporal distribution of high\u2013low value clustering points with different pairwise coupling coordination degrees, as shown in Overall, from 2006 to 2017, the high-value dispersion and clustering areas of PT and ST are increased from four to six, and the high-value dispersion and clustering areas of ET are four and five, which means that the coupling coordination degree of rail transit and urbanization has a significant regional imbalance.In various regions, Haidian, Dongcheng, Xicheng, and Shijingshan are high-value clustering and dispersion areas, which are the areas with a high degree of coupling coordination of RU and RT. Daxing, Chaoyang, Fengtai, and Tongzhou are general areas of coupling coordination degree, Shunyi, Changping, and Fangshan are low-value dispersion and clustering areas of coupling coordination degree. This regional imbalance results from the following: First, the urban rail construction in the central urban area is perfect, while the rail construction in the outer suburbs is relatively backward. By 2018, a total of 22 subway lines had been opened in Beijing, while there were only two subway lines to Fangshan. Second, the urbanization development level of the central urban area is significantly higher than that of the outer suburbs. For example, the GDP and per-capita disposable income of the central urban area is about 1.62 times and 1.12 times that of the outer suburbs.As the standard ellipse spatial evolution distribution of the coupling coordination between RT and RU  shows a consistent trend of change, we take the ellipse spatial evolution distribution of the overall coupling coordination as an example for analysis and use ArcGIS for visualization, as shown in According to the standard deviation ellipse spatial evolution distribution of coordination degree between RT and RU, the coordination degree of RT and RU generally presents a northwest to southeast evolution pattern from 2006 to 2017, and the distribution area is mainly in the six districts . It can be seen that the outer suburbs of Beijing will become the main body of improving the coordination between RT and RU.From From 2006 to 2017, the ellipse center shows a trend of developing from northwest to southeast, and the distribution area is mainly concentrated in the central urban area. Specifically, the ellipse coverage area is also shrinking, and the distribution center and coverage area of the coordinated degree of RT and RU are gradually spreading to the southeast. In terms of spatial distribution, Dongcheng, Xicheng, Haidian, Chaoyang, Shijingshan, and Fengtai have the highest coordination degree between RT and RU. This is because from 2006 to 2017, the coordination degree of RT and RU in this region is the highest, and the spatial pattern evolution characteristics also show a relatively unstable trend, which is manifested as northwest to southeast. Meanwhile, from 2006 to 2017, Changping, Shunyi, Fangshan, Tongzhou, and Daxing are the low-value distribution areas of the coordination degree between RT and RU, so they are always outside the coverage range of the standard deviation ellipse. This is because these regions are an exurb urban area, the urban rail opening is late, and the rail line is relatively imperfect, so the coordination degree of RT and RU in these regions is low, so the coverage of the standard deviation ellipse is relatively small.Compared with previous studies, our innovations mainly include the following three aspects. Firstly, based on the coupling coordination degree model and spatial autocorrelation model, we study and analyze the coordination relationship between rail transit and urbanization . Previous studies mainly focused on the relationship between urban spatial structure and rail transit, or the influence of population, land, and other factors on urbanization, but there were few studies on the relationship between rail transit and population, economy, and spatial urbanization. From the perspectives of population urbanization, economic urbanization, and spatial urbanization, we study the coordination relationship between them and rail transit respectively, and we analyze the causes of imbalance among different regions. Finally, based on the spatial autocorrelation model and standard deviation ellipse model, we study and analyze the spatial correlation and spatial evolution characteristic of coupling coordination degree among rail transit, population urbanization, economy urbanization, and spatial urbanization, thus further understanding the imbalance of rail transit and urbanization in different regions.Secondly, based on the urbanization and rail transit data of 11 administrative regions of Beijing from 2006 to 2017, we measure the coupling coordination degree and spatial correlation between rail transit and urbanization in different regions. Most of the previous studies on urbanization have studied the causes of imbalanced urbanization development among different cities from the perspective of the city as a whole. Few studies have analyzed the factors affecting the imbalance of urbanization and the coordination relationship between rail transit and urbanization from the perspective of the urban inner region. The results show that the coupling coordination degree between urbanization and rail transit presents an imbalanced distribution in various regions, and the coupling coordination degree in the central city is significantly higher than that in the outer suburbs. By studying the coupling coordination between rail transit and urbanization in different regions, we find the relationship between rail transit and urbanization. For example, the coupling coordination degree of suburbs is low, so it provides theoretical guidance for the suburbanization of rail transit, the development of commuter rail, and the development of suburban railway.Thirdly, we explore the internal causes of the imbalance of urban regional development from the coordination between rail transit and urbanization. From the perspective of time, different urbanization indicators and rail transit are in different trends. For example, from 2006 to 2017, the level of economic urbanization, spatial urbanization, and rail transit all showed a downward\u2013upward\u2013down trend, and the level of economic urbanization is the highest. From the perspective of space, the coupling coordination degree between rail transit and urbanization in different areas of the city is in an unbalanced state, but the spatial correlation of coupling coordination degree between each system has a similar trend. The coupling coordination degree of the central urban area is significantly higher than that of the outer suburbs, and the clustering points of high and low values are decreasing from the central urban area to the surrounding urban area. Therefore, it is necessary to strengthen the construction of suburban rail transit, develop the subcenter of the city, build a new suburbanization development model of urban space structure, and guide the orderly and compact expansion of urban space to achieve sustainable development of the city.The coordination relationship between rail transit and urbanization development level is related to the sustainable development of the whole city, among which the imbalanced development of urban regions has gradually attracted attention. Taking Beijing as an example, we use the data of rail transit and urbanization from 2006 to 2017 to build a coupling coordination degree model. Finally, based on the spatial autocorrelation model, we analyze the spatial aggregation of coupling coordination degree. The specific conclusions are as follows:Firstly, except for population urbanization, economic urbanization, spatial urbanization, and the rail transit system level have the same trend, and economic urbanization is at the highest level. On the whole, the coupling coordination degree between RU and RT is in a state of disorder, and the coupling coordination degree between various systems presents a consistent trend of change. The coupling coordination degree between EU and RT is at the highest level, while the coupling coordination degree between SU and RT is at the lowest level.Secondly, the coupling coordination degree between RU and RT is imbalanced in each region, and the coupling coordination degree in the central urban area is significantly higher than that in the outer suburbs. On the whole, from 2006 to 2014, there is no significant change in the overall coupling coordination degree in the central urban area, but the coupling coordination degree in the outer suburbs  shows an obvious upward trend. In addition, the degree of coupling coordination in all regions significantly decreases in 2017. In addition, from the perspective of the spatial evolution pattern of the standard deviational ellipse, the distribution of the overall coupling coordination degree between 2006 and 2017 is consistent, mainly in the central urban area, Changping, and Shunyi.Finally, on the whole, from 2006 to 2017, the coupling coordination degree between RU and RT has a similar trend in spatial correlation, and the Moran\u2019s I values show a trend of decreasing first and then increasing. The high-value and low-value aggregation points of coupling coordination degree among the population, economy, and spatial urbanization and rail transit are similar, which shows a decreasing trend from the central urban to suburban areas.In summary, it is found that the coordination relationship between urbanization and rail transit has an obvious regional imbalance. Relevant departments can formulate corresponding urban development planning strategies and urban transportation policies according to the urbanization development level of different regions and the coupling coordination degree and spatial aggregation degree between RU and RT to realize the healthy, green, and sustainable development of urban transportation.Our research has some limitations at present. Firstly, the selection of evaluation indicators for RT and RU mainly relies on the previous literature indicator system and the existing statistical data of Beijing. Therefore, our selection of the indicators of RU and RT is not comprehensive; we need more open source data to support the selection of other indicators: for example, rail transit lines in different areas of the range, a single line of rail passenger flow data and residents\u2019 commuting times, the total number of passengers, the train service quantity and train departure frequency, and so on. Secondly, limited by the availability of data, the multi-source data used in this paper are not perfect, such as the number of passengers in each rail line. Moreover, some social factors, such as local policies and data openness, make it difficult to obtain and quantify some data. As the city is a complex system, the data of the urban development level are formed by the interaction of complex data of multiple dimensions, which has the characteristics of multiple heterogeneity. Therefore, this paper only studies the coordination relationship between RT and RU from 2006 to 2017, and it does not expand the research period, which is not conducive to a more accurate and comprehensive grasp of the interaction between urbanization and urban rail and its change law. In the future, we can try to make innovations in the research factors, use multi-source data to supplement the research on the relationship between urbanization development level and rail transit, and analyze the factors affecting urbanization development and urban transportation from multiple dimensions and dividing scales. In addition, the influence of different public transport systems on urbanization is also worth further exploration."}
{"text": "The Donald P. Kent Award lecture will feature an address by the 2020 Kent Award recipient, David Ekerdt, PhD, FGSA, of the University of Kansas. The Kent Award is given annually to a member of The Gerontological Society of America who best exemplifies the highest standards of professional leadership in gerontology through teaching, service, and interpretation of gerontology to the larger society. The Robert W. Kleemeier Award lecture will feature an address by the 2020 Kleemeier Award recipient, Matt Kaeberlein, PhD, FGSA, of the University of Washington. The Kleemeier Award is given annually to a member of The Gerontological Society of America in recognition for outstanding research in the field of gerontology."}
{"text": "Last year, there was an increase in the amount of manpower in Malaysia, especially in terms of the numbers of neurosurgeons, cognitive neuroscientists and clinical psychologists. One way to increase the number of cognitive neurotechnologists in the country in 2021 is to allow neuroscientists to register as neurotechnologists with the Malaysian Board of Technologists (MBOT). The Malaysian Brain Mapping project has risen from its humble beginnings as an initiative of the Universiti Sains Malaysia Brain Mapping Group in 2017. There is currently a proposal for its entry into the national arena via the Precision Medicine Initiative with the Academy Science Malaysia, the Ministry of Science, Technology and Innovation, Ministry of Higher Education and Ministry of Health. The current Malaysian Government\u2019s Science, Technology, Innovation and Economy (STIE) plan was launched in 2020, leading to the establishment of neurotechnology as one of 10 STIE drivers. On 14 July 2020, the Prime Minister of Malaysia, Tan Sri Muhyiddin Yassin, chaired the National Science Council with the Ministry of Science, Technology and Innovation\u2019s Minister Khairy Jamaluddin, Deputy Minister Ahmad Amzad Hasim and Secretary-General Datuk Ir Dr Siti Hamisah Tapsir and launched 10 Science, Technology, Innovation and Economy (STIE) drivers in accordance with the Malaysian National Policy on Science, Technology and Innovation (DSTIN) 2021\u20132030. One of the STIE drivers was neurotechnology  Study. Then, in December 2020, the 10\u201310 MySTIE framework, which trailblazed a path for prosperity, societal well-being and global competitiveness, was published and officiated by Minister Jamaluddin with the New Science Policy: DSTIN 2030  as part of its efforts to provide additional assistance for small medium enterprises (SMEs) affected by COVID-19. SME project participants in key government programmes involved in research, development and innovation for critical technologies identified under national blueprints from IR 4.0-related technologies, green technology and biotechnology to ensure continuity and the completion of existing projects. These technologies included blockchain, artificial intelligence, big data analytics, internet of things, addictive manufacturing (3D/4D/5D/6D printing), cybersecurity, system integrators, augmented reality, advanced materials, drones and manufacturing systems as well as bioscience technology and neurotechnology  has risen from its humble beginnings as an initiative of the Universiti Sains Malaysia Brain Mapping Group in 2017. There is currently a proposal for its entry into the national arena via the Precision Medicine Initiative with the Academy Science Malaysia, the Ministry of Science, Technology and Innovation, and the Ministry of Health in a recent meeting with the Academy of Science Malaysia in early 2021. This is a Malaysia\u2019s parallel initiative of the successful Cuban Brain Mapping Project which was published recently .Thus, Malaysia must have a Centre of Excellence for Clinical Neuroscience, Psychiatry and Psychology services that, at least, represents the cluster of hospitals and teaching institutions with clinical neurosciences as well as psychiatry and clinical psychological services situated in the east coast of West Malaysia in the 12th Malaysia Plan that emphasises the use of neurotechnology in healthcare. It is also important to consistently build the younger generation of neuroscientists, neurologists, neurosurgeons, neurorehabilitation specialists, clinical psychologists and clinical neuropsychologists since it takes nearly 11 to 16 years to train them to address the needs of the country using neurotechnology to diagnose and cure diseases."}
{"text": "We live in complex times in the health, social, political, and energy spheres, and we must be aware of and implement new trends in intelligent social health systems powered by the Internet of Things (IoT). Sustainable development, energy efficiency, and public health are interrelated parameters that can transform a system or an environment for the benefit of people and the planet. The integration of sensors and smart devices should promote energy efficiency and ensure that sustainable development goals are met. This work is carried out according to a mixed approach, with a literature review and an analysis of the impact of the Sustainable Development Goals on the applications of the Internet of Things and smart systems. In the analysis of results, the following questions are answered about these systems and applications: (a) Are IoT applications key to the improvement of people\u2019s health and the environment? (b) Are there research and case studies implemented in cities or territories that demonstrate the effectiveness of IoT applications and their benefits to public health? (c) What sustainable development indicators and objectives can be assessed in the applications and projects analyzed? Today, technological advances must be accompanied by their applications and implementation in human-inhabited environments, in which public health and energy efficiency play an important role ,2. The sSmart grids and smart cities should facilitate people\u2019s access to environments, facilitate healthcare services, and promote the safety and happiness in our society. Technologies such as the IoT, the Internet of Energy, artificial intelligence, and the installation of sensors in human environments are used to optimize infrastructures, services, and the strategic planning of communities.We must design and implement advanced facilities, equipped with sensors and devices that promote the safety and health of people while maintaining a balance between energy use and efficiency. We must train professionals in the technological and engineering sectors, in universities, to keep humans and sustainability at the heart of their designs and projects.It is essential that the incorporation of intelligent systems is efficient from a technical, safety, and economic point of view. Sensor devices, the Internet of Everything, together with reliable and safe electrical installations and comfortable human environments will lead to cost reduction, higher productivity, and health and safety for people, companies, and institutions.We cannot forget that the implementation of energy audits in environments inhabited by people is based on a reduction in greenhouse gas emissions, which will have direct effects on the improvement of people\u2019s health, the protection of the environment, and profitability. All these parameters that directly or indirectly affect IoT platforms, energy control, and health should be analyzed as a part of all human health research ,10,11,12IoT applications and their multiple developments and advances are unstoppable; sensors, intelligent devices, systems, and advanced technological architectures offer great prospects for development in cities and communities in the present and in the near future .The digitization and application of intelligent systems and IoT devices in urbanized environments and in communities inhabited by people is carried out in blocks of analysis, structured in different disciplines, but all of them have a common center of gravity, the trilogy: human\u2013technology\u2013sustainability. We will analyze this trilogy and its main applications, as an introduction to the research carried out .Cities and human-inhabited environments have come under great digital and technological pressure in recent years, and this has been exacerbated by the global pandemic caused by COVID-19 ,16,17. TIn the analysis of human environment systems, such as cities or communities, it is necessary to carry out an in-depth study of the conflicts and systems in which an advanced society is involved. These systems and environments must also be involuted as an active part of a whole that brings together, for example, waste management, the measurement of environmental pollution ,22,23, eSociety needs efficient and healthy resources and everything depends on their management, improved governance, and projects that stimulate the implementation of advanced technological systems to facilitate the path to sustainable development. The management of water, transportation, and agriculture must be taken into account for social growth and human health, since these fields directly involve healthy food and better air quality ,30,31,32One of the parameters to which we must pay special attention in this study is that of IoT applications for the improvement of people\u2019s health. It will be one of the parameters that we will explore as a common thread throughout the work, in which we will interrelate sustainable development and energy control as necessary elements for its evaluation. Social and public health aspects are at the forefront of the research and work on intelligent systems ,34,35.Many intelligent systems applied to human environments will be developed in the next decade, serving to improve the health and quality of life of our societies. They will be ubiquitous, applied in homes, elderly care facilities, hospitals and health centers, schools, and universities, and many institutions will request sensor devices and IoT systems to be implemented for health management ,37,38.Governments and political management strategy around intelligent devices, technology, sensors, and IoT systems must be effective and take into account sectors and disciplines such as engineering, computer science, architecture, healthcare, etc. There are multiple cities and territories that are applying the Smart City and Smart Human City strategy to address the future and implement technological advances in cities ,41,42,43Smart, sustainable, and efficient cities must be designed with sensor systems and IoT applications; the so-called \u201csensory city\u201d is an integrative model that will enhance people\u2019s lives, management processes, and, with energy efficiency, environmental sustainability and people\u2019s health as the three main pillars ,47,48,49IoT applications and systems aim to make the Internet even more immersive and integrated into our environment in a natural way. It must be easy to access and interact with any of the devices around us\u2014for example, traffic lights, security cameras, telephones, computers, tablets, vehicles, signs, stores, sensors, health centers, etc. ,51.The analysis and location of intelligent systems within urban, rural, and generally human spaces is complex. Sensors, actuators, and devices are located and move with people; they can be fixed but are increasingly mobile\u2014for example, in cell phones or vehicles. However, there are organized architectures and levels of design around how intelligent systems should or can be arranged in human environments, e.g., in cities, communities, or in any other environment . Figure IoT applications, according to , can be In the most common architecture of IoT systems and their applications, it is usually broken down into layers of performance or system implementation. For example, the following main layers ,15: applEach of these sub-architectures or working layers integrate the different technologies, devices, sensors, systems, etc., which will be interconnected by means of electrical\u2013electronic and wired or wireless connections. The range of connection elements is very wide and each field of action will have its own specific systems.Specifically, speaking of systems applicable to people\u2019s health, we can choose and differentiate some of them. In some cases, research is focused on simple, low-cost, ubiquitous devices for monitoring people\u2019s health ; in otheTechnological systems in the smart human home: environmental systems, personal systems, data management systems and interfaces, actuators electrical systems and protections, energy efficiency controllers, software, automation systems, augmented reality, etc.Applications to people\u2019s health: smart healthcare, monitoring of activities of daily living, monitoring for medical management, robotic personal assistance devices, fall monitoring and control devices, telecare for social interaction and leisure, automation for human\u2013machine interaction, implantable medical devices, sensors, microsensors and general-purpose devices, intelligent materials, etc.The different existing technologies and systems can be listed, also providing an update and preview of those to come in the future:Innovative projects based on the realization of patents, prototypes, and technological applications using IoT, sensors, and intelligent systems can come from research centers with public or private funding, companies, or public or private institutions, among others. For example, there are large technology companies, such as Telef\u00f3nica Koa Health , which aThe 2030 Agenda of the United Nations (UN) established the Sustainable Development Goals (SDGs) in 2015. This Agenda is an action plan for people, the planet, and prosperity. The 17 goals are comprehensive and indivisible, balancing the three dimensions of sustainable development: economic, social, and environmental . This paIt is necessary to propose working methods and protocols to implement the SDGs in smart cities, taking into account citizen participation, governance, energy systems, and technological developments . There aThere is no doubt that the systems that will make technological change and progress in sustainable development possible will be the IoT, sensors, communications networks, and all the electrical, electronic, computer, and intelligent material devices that will be flexibly integrated into cities and territories. These advances will also bring major energy savings, which are fundamental to the SDG indicators and criteria and essential for energy efficiency and environmental sustainability .The interrelation of IoT systems, health, and energy efficiency has a common nexus that we want to discuss in this paper: the need to design and implement smart technology projects for cities and human environments in which the welfare and quality of life of people coexist in a sustainable and efficient system, which will inevitably lead to substantial benefits for the planet . This paThere must be clarity, transparency, and efficiency in the mass implementation of technological devices, IoT, and sensors, since society may not be prepared for this great change. Fear and ignorance and the digital divide will be important hurdles in the mass installation of systems unknown to a large majority of people. The use of technology for health and energy efficiency must be approached as an unstoppable process that will affect all areas of life. While the general public will become more acquainted with it, their doubts and fears must be addressed.The pandemic caused by Sars-Cov2 has boosted the research and implementation of useful biosensors and systems capable of obtaining reliable information to prevent, detect, and mitigate the effects of the disease , and theThis work aims to improve knowledge about existing applications and future trends in the implementation of intelligent devices and systems that improve the health of people and communities, from the perspective of energy efficiency and sustainable development. To do this, we will analyze high impact research that is being developed and its effectiveness and whether it really will benefit the health of people and the environment. We will examine its productivity, energy, and economic efficiency and we will address a question that many projects do not take into account: are the sustainable development objectives met in this research?Our aim is to analyze the technology-health-ODS trilogy and prove that it is effective and will lead to a near future in which sustainability and environmental health are achieved hand in hand with technology. A mixed research approach will review the studies and research offered by the literature on IoT solutions, sensors, smart cities, and smart grids and their importance for public health, energy efficiency, and environmental sustainability. Some of the sources and their implications in different territories will be X-rayed through institutions and technology companies and how they implement the SDG indicators.The manuscript is structured as follows: The work followed a mixed approach , in whicFollowing the recommendations of the existing literature in the literature review and case study processes, known as a mixed review ,65,66,67To achieve the objective, we performed a systematic literature review (SLR) in various databases, as set out in In this work, in addition to an SLR, a mixed method was used, so that in the analysis of the results obtained in the database search, we added research and real case studies implemented by companies or institutions, and we analyzed the most notable of these projects, providing a comprehensive range of knowledge to conduct our review .All the answers to the research questions were analyzed through a qualitative analysis of the documents extracted from the literature search and review, as well as a selection of research of international relevance that, due to its origin or good results, we found interesting for our work.In this section, we will analyze the results obtained in the literature search using keywords and filters and also include the selected case studies of the main technology giants, specified in Following the percentages and quantitative parameters, we will begin to evaluate the manuscripts and their main contributions and discussions from a qualitative perspective. We will begin the analysis by following the research questions and examining which of the selected and filtered manuscripts provide answers to the questions. It is interesting to note the main areas of study in the selection of keywords, among which Engineering and Computer Science stand out above the rest, as shown in Sometimes there are conflicts in the definitions given for smart environments and the systems applied to them and in sustainable environments, when both are complementary and necessary and, in this context, we will address the importance of linking both concepts in all aspects. Sustainability and the SDGs, together with energy efficiency protocols, must be applied to the research of intelligent systems and IoT applications, regardless of the field in which it is carried out. We shall make sure to do so in our case, with our emphasis on health protocols and people\u2019s well-being .IoT Applications for Health Improvement;Energy Efficiency Indicators analyzed in research;Projects or case studies analyzed;Sustainable Development Goals.Among the sources in 1.Block 1: Industry 4.0, health at work, carbon emissions, solid waste management.There are a large number of research studies that deal with the health of people from the point of view of industry, occupational health, waste management, and, in general, health research from an industrial and occupational perspective. According to Oztemel , robots Analysis and evaluation of energy efficiency at work: Yes.Analysis of Sustainable Development Goals: Scarce.2.Block 2: E-health, elderly adults, environmental resources.In this block, there are several research studies that focus their analysis on e-health, health, and mobility and focus on the study of elderly people, home care, and disability, among others ,78,79. IAnalysis and evaluation of energy efficiency at work: Yes.Analysis of Sustainable Development Goals: No.3.Block 3: Cybersecurity, health, and privacy.Most of the papers explain the problem of security and privacy of people in studies on IoT and sensors applied to health; however, there are some specifically devoted to this issue, such as Hamamreh  and KoroAnalysis and evaluation of energy efficiency at work: No.Analysis of Sustainable Development Goals: No.4.Block 4: AI, smart cities, governance, urban health, energy efficiency, green IoT.In this block, different studies have been grouped together, some very similar and others different, but they all have the theme of energy efficiency or sustainability in common, which is why we will group them together for analysis ,86,87,88In the field of Artificial Intelligence (AI), Allam  reviews Tuysuz  presentsAnalysis and evaluation of energy efficiency at work: Yes.Analysis of Sustainable Development Goals: Scarce.5.Block 5: Data mining, health systems, wearable biosensors.In this set of research, diverse but all related to the IoT and its applications to health and sustainability, we found some works where the subject matter does not really specify the role of energy efficiency at work clearly, nor relate to any of the SDGs. For this reason, the following studies have been grouped into this block: ,94,95,96Analysis and evaluation of energy efficiency at work: No.Analysis of Sustainable Development Goals: No.6.Block 6: Big Data, cyber-physical systems, mobile health, public health.Rachad Atat  presentsAnalysis and evaluation of energy efficiency at work: No.Analysis of Sustainable Development Goals: No.7.Block 7: Smart buildings, healthcare, health monitoring.In this block, we have grouped research studies that focus on health indoors, in buildings and homes, responding to the needs of people in controlled environments ,104. HimDetailed discussion has been carried out on different factors contributing to thermal comfort, visual comfort and air quality comfort . MahmoodAnalysis and evaluation of energy efficiency at work: Yes.Analysis of Sustainable Development Goals: Scarce.8.Block 8: Computing architectures.We detected in the analysis of the sources that there are some studies on computer architectures  that revAnalysis and evaluation of energy efficiency at work: Yes.Analysis of Sustainable Development Goals: No.9.Block 9: Smart city applications architecture, 5G, circular economy.This block emphasizes the relationship between IoT and its application to health, taking into account the smart city strategy and the circular economy ,113,114.The circular economy in smart cities and related IoT applications is a field of work and analysis that stands out as a novel vision of activity sensorization in business, social, and health applications and many more. However, in the cases studied in this work ,112, no Analysis and evaluation of energy efficiency at work: Yes.Analysis of Sustainable Development Goals: No.10.Block 10: Drones, smart cities, security.We cannot forget the role that drone technology plays in this era where data and location provide crucial information in all fields of study. In , a studyAnalysis and evaluation of energy efficiency at work: Scarce.Analysis of Sustainable Development Goals: No.11.Block 11: Electronic waste, Sustainable Development Goals (SDGs).In all the sources analyzed, we found only one in which the involvement of SDGs in IoT research and applications and the impact on health is referred to and studied in depth  through Analysis and evaluation of energy efficiency at work: Scarce.Analysis of Sustainable Development Goals: Yes.12.Block 12: Energy management, wireless sensor networks.Anjum  studies Analysis and evaluation of energy efficiency at work: Yes.Analysis of Sustainable Development Goals: No.13.Block 13: Mobile health applications .This book  addresseLiu  applied Analysis and evaluation of energy efficiency at work: No.Analysis of Sustainable Development Goals: No.14.Block 14: Waste management, logistics.In this block, we have grouped several research papers related to waste management and logistics, as necessary elements for the preservation of health and closely related to energy and the SDGs. However, we found few references in them to energy efficiency or to any sustainability indicator. In , hybrid Another work integrated LoRaWAN communication network (network developed using the Internet of Things) with waste sorting equipment to create a system that provides automated garbage can operation, environmental monitoring, and graphical interface monitoring. The system uses electrostatic capacitance-type proximity sensors to determine the types of waste deposited in the trash cans .Regarding logistics,  reviews Analysis and evaluation of energy efficiency at work: Scarce.Analysis of Sustainable Development Goals: No.15.Block 15: Academia.In this last block, we have reviewed a research paper where the academic field is merged in IoT systems, in which experiences from different educational systems are shared. It discusses digital transformation in academic society and innovative ecosystems in the world .Analysis and evaluation of energy efficiency at work: No.Analysis of Sustainable Development Goals: No.The Millennium Development Goals  led to improved health and well-being through the collaborative efforts of United Nations (UN) agencies and their constituent Member States. In 2015, the 2030 Agenda for Sustainable Development proposed 17 Sustainable Development Goals (SDGs) . The UniThe impact of smart systems on public health is clear, but it is also important to analyze the impact of the SDGs. Therefore, in In In the presented work, a literature review has been carried out taking into account the applications of IoT, its impact on people\u2019s health, and the environment in which we live. Several research questions have been analyzed and examined in the study of the sources investigated, as well as their relationship with the SDGs and their main targets and indicators. We are pleased to observe how a large number of studies and research efforts take into account the SDGs; however, this is generally not done intentionally, as they are not commented on or analyzed in the content of the papers. Therefore, several studies and projects strive to implement IoT designs, installations and applications for people\u2019s health, environmental improvement, environmental protection, and energy efficiency, but not explicitly within the framework provided by the SDGs.Among the blocks and categories that we have proposed in this work, several can be considered essential to people\u2019s health. They correspond to the SDG indicators that take into account the protection of public health, digital health, autonomous energy systems associated with the maintenance and care of healthcare equipment, and educational and training systems needed to train of healthcare staff in all territories.Industry, infrastructures, Smart Communities, Smart Human Cities, and, in general, digitalization in all areas will substantially improve people\u2019s health, which inevitably entails the implementation of IoT systems.We have detected some of the challenges to be addressed by our societies and have put forward proposals for future research, which could bring attention to and increase interest in sustainable development and related goals through the SDGs, as a working protocol for research on IoT applications to protect the health of people and their environments, as well as improve energy efficiency. The first proposal would be the development of a protocol or work methodology in which any research on intelligent systems and IoT applications in all areas and fundamentally in health would pursue a goal or objective within the framework given by the SDGs. For example, if an application is being developed to improve the mobility of the elderly or people with disabilities at home , this coThe second proposal would be the detection of non-compliance with the SDGs in research; in this sense, any research or work that is subsidized by any government institution, through research projects, grants, contracts, etc., must be shown to comply with any of the SDGs and their main goals, in order to ensure that research of the highest quality and related to sustainable development, efficiency, and protection of people and the environment in line with the SDGs is prioritized. In the engineering research required for an energy installation, the technical\u2013economic feasibility study of the project is no longer enough \u2014it must The third proposal and challenge that is yet to be met, and that we have observed in the analyzed literature, is that many of the research studies pay little or no attention to energy efficiency ,99, whicThe fourth challenge proposed is to establish the European Union\u2019s strategy on taxonomy for sustainable activities. The EU taxonomy is a classification system that establishes a list of environmentally sustainable economic activities. The EU taxonomy is an enabler that will increase sustainable investment and to implement the European Green Pact. It will provide a tool for businesses, investors, and governance to formulate policies on economic activities that can be considered environmentally sustainable. This system will be a major step towards improving the implementation of IoT applications in all disciplines and primarily in energy and health .For all the above, from what has been analyzed in the literature review, both from a quantitative and qualitative point of view and in the process of reviewing the SDGs and energy efficiency parameters, we consider that these three proposals could considerably improve future research and work in the field of sustainability and drive progress in the health, social, economic, and environmental spheres.For the implementation of all projects and work in less developed countries through low-cost means, renewable energy systems should be a further objective and indicator, to be considered essential in the research on IoT applications in all fields, especially in public health.The deployment of IoT applications and sensors in our lives is inevitable, and every day there are more connected devices and a greater number of systems that require the implementation of these technologies, especially to improve quality of life, health, safety, and in many other applications. Technology in general and the interconnectedness of different elements integrated in our homes, at work, or in the environment, parks and gardens, street furniture, traffic lights, vehicles, etc., are part of our daily lives and are increasingly essential. IoT technology and applications must be low cost and accessible to a large number of people and environments, so that the implementation of devices and their benefits to society will be enhance equity and, ultimately, will be unstoppable. The tools needed to improve the health of people and their environments, as we have analyzed in this work, are multiple and have no limit: we are developing more and more novel and original systems that are adaptable to any situation and any territory.The fact of being able to demonstrate that IoT applications benefit public health and sustainability by undergoing verification according to the indicators and goals of the SDGs would represent progress in our commitment to integrate technology in all corners of the planet and achieve universal impact, without distinction between countries, races, environments, or populations.At the beginning of this article, we proposed a bibliographic review to examine the research on IoT systems and devices, their applications and their benefit to public health and sustainability. To this end, we posed several research questions, which we have analyzed in the various sections of the work. On this basis, we conclude that there are multiple and very different works, sensor devices, and intelligent systems aimed at promoting and protecting people\u2019s health and, in turn, the territories and the environment they inhabit. Therefore, by including a more detailed analysis of the SDGs and the implications of their goals and objectives on these devices, in Artificial intelligence and its applications in the IoT and integration in society will be essential for the fulfilment of a large part of the SDGs, so it must be integrated extensively. Meanwhile, awareness should be raised on all of the social, health, and environmental benefits that the implementation of AI projects and developments will entail. There are studies and reports that endorse this, such as ,232.To conclude, some of the highlights we have observed are: (a) the proposed analysis offers us filtered information on the research on IoT systems and applications in the field of public health and their benefits to sustainability; (b) to achieve a comprehensive social and institutional system for the protection of public health in different communities and territories, it is necessary to innovate and continue research on sensor technologies and IoT applications, since these offer information, data management, and continuous improvement of healthcare solutions, often at low cost and deployable within people\u2019s family circles and homes; (c) the data obtained from the multiple applications implemented will allow greater control of the security of the population, for the improvement of society and its territories, which will lead to an improvement in institutional management and governance; (d) security will be important and therefore should be taken into account for the management of intelligent systems and applications geared at improving public health and efficiency; (e) the SDGs should be a vehicle for IoT development, offering its goals and objectives as a framework for the design, installation, and management of the technology to be implemented."}
{"text": "The nursing practice environment (NPE) has been analysed and is now recognised as a variable that influences the results of nursing care, since the promotion of favourable environments is fundamental to the quality of care optimisation . The devWe conducted a scoping review, according to Joanna Briggs Institute\u2019s approach . A threeWe retrieved 289 records and selected 12 papers, including quantitative and qualitative studies. Our analysis revealed that positive NPE improves nurses\u2019 satisfaction and, consequently, improves QNC. Additionally, some characteristics of the NPE should be improved, such as the participation of nurses in management decisions, leadership, education, guidance, support and recognition of the work developed by nurses. Autonomy, control over the environment and collaboration between health professionals and managers improve teamwork and QNC.A positive NPE culture in PHC is highlighted as one of the key factors for the satisfaction, retention and recruitment of nurses and is associated with the improvement of the QNC. Concurrently, the development of a teaching-learning culture between managers and the nursing team develops and improves professional skills, with the consequent improvement of nursing practices."}
{"text": "In the context of clinical risks, infectious risk, i.e., the probability of contracting an infection during healthcare facilities stays, is the most serious and common adverse effect and/or complication of healthcare. Hospital infections, and more generally, healthcare-associated infections (HAIs), are in fact one of the main problems in terms of morbidity, mortality, and costs that public health is currently facing ,2.The ever-increasing knowledge of the risk factors associated with hospitalisation has undoubtedly improved our ability to control HAIs, but the frequency with which they occur has remained more or less constant over the years. This is also due to an increase in the population that is particularly susceptible, which is in turn attributable, at least in part, to positive factors. Indeed, the progressive ageing of the population and the increased survival of patients with highly debilitating pathologies (made possible by the refinement of diagnostic and therapeutic techniques) means that many of today\u2019s patients requiring care are individuals with reduced immune defences and are therefore more exposed to the risk of infection ,4.Escherichia coli and Klebsiella pneumoniae), but subsequently, as a result of antibiotic pressure and the increased use of plastic medical devices, an increase in infections with Gram-positive bacteria and fungi has been observed. Moreover, HAIs are now increasingly caused by microorganisms that are resistant to first-line drugs and are often also multi-resistant, such as MRSA (Methicillin-Resistant Staphylococcus Aureus), VRE (Vancomycin-Resistant Enterococci), and CPE (Carbapenemase-Producing Enterobacteria) [Like all infections, HAIs are the result of the interaction of three elements: the host, the infecting agent, and the environment. In particular, the habitus of the patient has an important influence on the infectious risk. Consequently, those patients most at risk are mainly the elderly, premature, and immunocompromised. The habitus also partly accounts for the type of microorganisms primarily involved. Those responsible for HAIs are not usually conventional pathogens, but mainly saprophytic microorganisms that find ideal conditions for propagation and development in the characteristics of the patients and the care environment. Until the early 1980s, HAIs were mainly caused by Gram-negative bacteria  ,6. In paacteria) ,8.Like all infections, HAIs have different modes of transmission: direct, interhuman, and indirect. Of critical importance are the cleanliness of workers\u2019 hands, the use of medical devices and diagnostic and/or therapeutic manoeuvres, contaminated instruments, objects, and solutions, as well as other vehicles and vectors.facies of the air, leading to the inhalation of microbial aerosols and the deposition of contaminated particles.Among the various vehicles, air plays a particularly important role. Air is the vehicle through which microorganisms move through the environment, reach surfaces, and settle there, resulting in the risk of exposure through inhalation, contact with contaminated surfaces/objects or ingestion. It has been estimated that about 10% of HAIs are attributable to microbial contamination of the air, i.e., the presence of pathogenic and/or higher-than-acceptable quantities of microorganisms. Furthermore, inappropriate microclimatic conditions can affect the microbial Legionella spp., non-tubercular Mycobacteria, amoebas) [The environment\u2019s structures and plants can also play an important role. In this context, water distribution systems and aerosols released from cooling systems, for example, should be considered, as here, microorganisms of purely environmental origin may be present, which find an ideal habitat in man-made water systems  ,9,10.It is clear that control, prevention, and surveillance measures are the best strategies to contain the spread of HAIs . HoweverNational authorities play important leadership roles in developing policies, recommendations, and guidelines in order to provide the necessary qualified personnel, facilitate the implementation of prevention and control practices in health facilities, monitor progress, and give feedback. In this regard, the identification and implementation of elements that characterise an optimal plan for HAI control and prevention are essential. Such elements include: (i) standard precautions (hand hygiene and the use of barrier measures), (ii) the monitoring of environmental microbial contamination and control of environmental sanitisation procedures, (iii) the disinfection and sterilisation of reusable equipment and devices, (iv) the availability of resources ; (v) the constant monitoring of plant structures ; (vi) the promotion of educational initiatives, as well as specific training, aimed at cultural and behavioural change on the part of health and social service providers and citizens, making best use of the scientific evidence ,13,14,15More generally, given that one of the main responsibilities of the mission of healthcare institutions is to provide quality care while guaranteeing the safety of patients and healthcare workers, the surveillance and control of all risk factors present in healthcare facilities must be an essential aspect of care ,16,17,18The in-depth examination of these issues in a dedicated Special Issue, through a multidisciplinary overview, may represent a further tool available to the scientific community to identify the best practices of proven effectiveness in the field for the implementation of decisive strategies aimed at tackling this crucial phenomenon for public health.Healthcare, primarily aims to increase the international literature evidence and observations in the field regarding the implementation of standard precautions, the adoption of specific infectious disease precautions, the improvement of staff education and responsibility, environmental monitoring, facility audits, and the appropriate use of antimicrobials.With this in mind, the Special Issue \u201cAntimicrobial Resistance, Healthcare-Associated Infections, and Environmental Microbial Contamination\u201d, published in the journal"}
{"text": "The combination of physical sensors and computational models to provide additional information about system states, inputs and/or parameters, in what is known as virtual sensing, is becoming more and more popular in many sectors, such as the automotive, aeronautics, aerospatial, railway, machinery, robotics and human biomechanics sectors. While, in many cases, control-oriented models, which are generally simple, are the best choice, multibody models, which can be much more detailed, may have applications, for example, during the design stage of a new product.This Special Issue sought to attract works dealing with the many challenges that must be overcome when developing multibody-based virtual sensors. These challenges include the selection of the fusion algorithm and its parameters, the coupling or the independence between the fusion algorithm and the multibody formulation, the magnitudes to be estimated, the stability and accuracy of the adopted solution, optimization of the computational cost, real-time issues and implementation on embedded hardware. Studies of the application of multibody-based virtual sensors to, for example, vehicles, heavy machinery, mobile or humanoid robots, assistive orthotic and prosthetic devices or the measurement and analysis of human movement were also welcome.In the next paragraphs, a brief description of the content of each contribution forming the Special Issue is provided.The first work  focuses The second work  addresseThe objective of the third work  is to avThe fourth work  is not cThe fifth work  foreseesThe sixth work  deals wiThe field of application of the seventh work  is machiThe eighth work  looks atThe ninth work  intends The tenth work  is a spaIn summary, it can be seen that the papers gathered in the Special Issue contributed either by proposing solutions to the general problem of state, input and/or parameter estimation ,5,7,8,9,Finally, we wish to thank the authors, reviewers and journal staff for their commitment and effort, which made it possible to complete this Special Issue on time."}
{"text": "Co-authors Feiyun Huang and Jialing Tang were unintentionally omitted as authors in the original published article. The corrected author list and Author Contribution Statement appears below.The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.1\u2020, Feiyun Huang2\u2020, Yinan Ma3*, Jialing Tang4*Lin Feng1Sport Hospital Affiliated to Chengdu Sport University, Chengdu Sport University, Chengdu, China2Key Laboratory of Bio-Resources and Eco-Environment (Ministry of Education), College of Life Sciences, Sichuan University, Chengdu, China3Department of Physical Education, Yili Normal University, Yining, China4Department of P.E., Central South University, Changsha, ChinaLF, FH, and YM contributed to the conception of the study; performed the experiment; LF and FH contributed significantly to the analysis and manuscript preparation; LF, FH, YM and TJ performed the data analyses and wrote the manuscript. All authors contributed to the article and approved the submitted version.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "Until recently, studies of precarity have overlooked aging and late life. This poster presents a snapshot of conceptual work in progress on a Canadian Social Sciences and Humanities Research Council (SSHRC) Insight Grant on precarity and aging. The poster outlines existing definitions and theoretical perspectives, key results, a current evolving conceptual model, and a working definition of Precarious Aging. It situates existing knowledge and definitions of precarity, highlights crucial intersectional locations of gender, im/migration and (dis)ability, and clarifies the concept of precarity in later life. Results at this point in the study are based on conceptual reviews, reviews of literature on precarity and aging, and the consideration of allied concepts. In conclusion, the concept of precarity offers a promising lens to guide research in the field of social and critical gerontology, providing a foundation for an enhanced understanding of the lives and realities of older people with regards to aging, disadvantage, and inequality."}
{"text": "Risk-taking behaviors of adult bedridden patients in neurosurgery are frequent, however little analyzed. We aimed to estimate from the literature and our clinical experience the incidence of the different clinical pictures. Risk-taking behaviors seem to be more frequent than reported. They are often minor, but they can lead to death, irrespective of the prescription of physical or chemical constraints. We also aimed to contextualize the risks, and to describe the means reducing the consequences for the patients. Two main conditions were identified, the loss of awareness of risk-taking behaviors by the patient, and uncontrolled body motions. Besides, current experience feedback analyses and new non-exclusive technological solutions could limit the complications, while improving prevention with wearable systems, neighborhood sensors, or room monitoring and service robots. Further research is mandatory to develop efficient and reliable systems avoiding complications and saving lives. Ethical and legal issues must also be accounted for, notably concerning the privacy of patients and caregivers. Agitated, confused, and also moderately disabled in-hospital patients can injure themselves, even if they are bedridden. Indeed, as soon as a patient cannot manage wide-amplitude movements, purposeful or not, and either during motion or control of body stability, of the head, the trunk, and limbs, there is a risk of injury and even death. In neurosurgery, a large population of patients is potentially concerned because of the large typology of diseases such as traumas, tumors, strokes, neuralgia, and functional disorders. The risks are all the more important and frequent as the population accessing the care increases inevitably as patients get older and are more vulnerable and frail, whatever the causes. As a result, the number of neurological diseases increases regardless of the symptoms at admission. This in turn affects the risk of developing neuropsychological disorders during primary care.. The magnitude of the risk, however, should be limited  the loss of awareness of risk-taking behaviors by the patient, and (ii) uncontrolled body motions. The loss of awareness of risk-taking behaviors is typically observed with confused patients or patients suffering from disorders of consciousness. Loss of consciousness is a common feature, at least partially, of the self and the environment, without coma, that leads to a confusion fluctuating state with a dream-like experience. The anosognosia, or the loss of awareness of deficit, can be associated with confusion. Hence the clinical pictures can be very different and complex, all the more, when the patients are agitated. This condition of loss of awareness of risk-behaviors is caused or worsened by a lot of acquired and preexisting pathologies, such as pain, mood fluctuations, biologic disorders, neuropsychiatric disease, or sequelae of head injury. Uncontrolled body motions can also lead to risk-taking behaviors. Of course, this is always the case for loss of awareness risk-taking behaviors, but also for conscious patients who move their body, head, trunk, and limbs where the motion is not controlled, whether by clumsiness, or because of restraining systems or any kind of obstacle , or due to neuro-orthopedic troubles. In neurosurgery, a particular condition is the cranial traction of a patient with instable cervical fractures, where hazardous mobilization, whatever the cause, can be dramatic.There are different ways to anticipate and to monitor risk-taking behaviors of bedridden patients, in general, and notably in neurosurgery. The challenge is ambitious and should include all the actors from the ground to the decision-makers and biomedical companies.Everyone has the right to respect for his private life.\u201d However, the patient can sign an authorization allowing the hospital to film or take a picture for a purpose that must be determined. Indeed it should be noted that to be operational and enforceable, the authorization must define the terms of dissemination of the image with regard to duration, medium, and geographic area. For research and future medical monitoring aiming to protect patients, such as those bedridden with risk-taking behaviors, filming should become legal provided that the patient or the representative has been able to consent to the use of a device. The images should of course not be used for any purpose other than prevention of risks and will therefore only be used by the healthcare and medical team in charge of the patient in strict compliance with the General Data Protection Regulation (The prevention relies on the awareness of such behaviors, and the deep analysis of the conditions that can generate them, as from the level of care teams. There are different ways to optimize the risk in the context of risk-taking behaviors of bedridden patients, for instance, following an International Organization for Standardization risk approach, by reducing the likelihood of falls, reducing the consequences of such falls, losing the minimum of benefits for the well-being of a patient, and preventing the introduction of new risks because of the treatment of the first one. The aim is to minimize and optimize all elements, from those which can be seen as insignificant such as clearing the bed and its surroundings of all unnecessary objects and checking the efficiency of the alarm systems, to more evident parameters such as optimal pain treatments, optimization of sedative drugs and restraints systems, and appropriate organized schedules of visits, either nurses or relatives. These elements can be improved directly in the frame of experience feedback forms  and withgulation . Neverthgulation , 32. To gulation \u201335. Thergulation , to imprgulation .estimate that monitoring could also be useful to assess the impact and efficacy of physical and chemical restraints, like for any treatments (There is no doubt that the monitoring of risk-taking behaviors of bedridden patients will emerge in the very near future, enabling health care providers to save lives and avoid severe complications. In the meantime, besides the technical issues, ethical and legal concerns must be solved, according to each country. It is also reasonable to eatments , 38, andeatments . Legal, eatments .J-JL, RC, and FB: conceptualization. J-JL, FB, RC, M-AC, AS, JC, KA, and LM: writing\u2014original draft. CD, MS, CM, SR, AU, BP, and YE: writing\u2014substantial review and corrections. J-JL and FB: supervision. All authors have read and agreed to the submission of the manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "Purpose: To analyze how individual characteristics and the social context are associated with mental distress symptoms in the Brazilian population.Method: A multilevel cross-sectional study with data from the 2013 National Health Survey. There were two dependent variables: (a) decreased vital energy and somatic symptoms, (b) the presence of depressive thoughts. The independent variables were biological characteristics, education and income, habits and lifestyle, and context variables. Bivariate analysis was performed, and Prevalence Ratios calculated in a Poisson Regression (95% CI). A multilevel Poisson Regression was performed to verify the effect of individual and contextual variables.Results: Regarding depressive thoughts, young and middle-aged individuals, low education, women, absence of partner, smokers or former smokers, and absence of health insurance were the categories at highest risk; belonging to classes D-E and living in states with lower expected years of schooling proved to be protective factors. Similar results were found for the second outcome.Conclusions: Symptoms of mental distress were associated with the individual characteristics and contextual aspects of the federation unit. These findings indicate the importance of strengthening psychosocial care aimed at vulnerable groups. Characterized by depressive symptoms, anxiety state, and a set of non-specific somatic complaints , in the period from 2005 to 2015 there was an increase of 18.4% in the number of people with depression, and the prevalence of this health condition in Brazil is 5.8%, being the highest rate of Latin America. Regarding anxiety disorder, the worldwide prevalence is 3.6% and Brazil has the highest number of cases among all countries in the world, affecting 9.3% of the population  are characterized by depressive symptoms, states of anxiety, irritability, fatigue, insomnia, memory and concentration problems, and somatic complaints , is part of the Unified Health System (SUS), is an articulated and effective network that assists different levels of health care, qualified to meet people in distress or presenting demands arising from mental disorders or chemical dependence. It works based on a territorial perspective, with emphasis on community-based services aimed at meeting the needs of users and their families, highlighting care centered on people's needs Brasil, .In 2013, in order to monitor these themes, Brazil conducted the National Health Survey (NHS) with a national scope and at domestic level, which aims to produce data about the health situation and lifestyles of the Brazilian population in the country. The NHS was conducted in partnership with the Brazilian Institute of Geography and Statistics (IBGE) and the Ministry of Health of Brazil, and estimated that 7.6% of people aged 18 or older had been diagnosed with depression by mental health professionals, accounting for 11.2 million of people  database of Brazil of the year 2013. This nationwide research was conducted to know and characterize through a household-based survey the Brazilian population profile in terms of the health situation, lifestyle, surveillance of chronic diseases, risk factors, access, and use of health services. The NHS uses an instrument designed specifically for the survey, consisting of three questionnaires: the household, the one related to all household residents, and the individual. All methodological details of the NHS are described elsewhere  and on the nomenclature of symptom classes described in the Self-Reporting Questionnaire (SRQ-20), already validated in several countries .The \u201cBrazil Criteria for Economic Classification\u201d is based on the possession of goods, such as a car, computer, refrigerator, TV, washing machine, DVD player, microwave, motorcycle, and cell phone. There is also a bathroom, a maid, and the head of the family's educational level. Each item has different weights, and the variable represents the family's purchasing power. The score is defined between 0 and 100 points and divided into five classes  in which class A represents the highest socioeconomic level while class E the lowest level.This set of variables ensures the inclusion of individual characteristics, lifestyle, and socioeconomic conditions.For the contextual level, socioeconomic variables that can influence self-perceived health were selected. The variables included were Gini index, Human Development Index (HDI) and expected years of schooling for individuals over 18 years old related to the Federation Units.p \u2264 0.20) were inserted in the multivariate model. In the first step, the contextual effect was evaluated based on a null model using the likelihood ratio test to verify significance. Two models were then tested, the first one with the individual level only, and the final model with the individual and contextual levels, with variables that remained significant in the model. Analyses were performed using the Stata 13 statistical software.Prevalence rates were presented in absolute and relative values in each category, and the effect was estimated through Prevalence Ratios (PR) and their respective confidence intervals (95% CI). Variables with significant associations in bivariate analyses  and the Gini index were not associated with the studied outcomes. It was thus demonstrated that these context variables have little explanatory power over the prevalence of mental suffering in the Brazilian population.One of the limitations of this study has to do with the response bias, since the theme is surrounded by ethical, moral and cultural issues, and these factors strongly influence the responses of people. There may have been omission of information on mental distress when individuals were questioned directly, out of fear or embarrassment of exposure. However, population surveys provide us with representative samples of the population from all regions of the country and can serve to compare these results with those of other countries, as well as support the organization of public policies aimed at minimizing the problem. The prevention of these events represents a major challenge because of the need for the response to articulate different areas, requiring interdisciplinary action, as well as the involvement of various sectors of civil society and governmental organizations.Recognizing the magnitude of common mental disorders in Brazil through population-based researches and a methodology that takes into account each individual's context is invaluable for assessment and planning of the health system, contributing to the advancement of knowledge and improvements in health care policies.The present study reveals that symptoms of mental distress were mainly associated with individual characteristics such as young and middle-aged adults, women, low education, absence of partner, smoking habit, and absence of health insurance. Belonging to income classes D and E and living in states with lower expected years of schooling proved to be protective factors for the outcome variable \u201cdepressive thoughts.\u201d Context variables lost their significance after the final multilevel analysis model.The present findings indicate the importance of strengthening the health care network, especially in psychosocial care services aimed at the most vulnerable groups, and thus develop preventive strategies for these groups in order to reduce the incidence rates of mental illnesses. Therefore, the present research is of fundamental importance for the area of collective public health because it stimulates a reflection on mental health policies in Brazil, influencing their re-evaluation and restructuring. It is necessary that further studies be developed on this theme in Brazil and in other countries in order to seek innovations and other relevant findings in this area.The original contributions presented in the study are included in the article, further inquiries can be directed to the corresponding authors.HSB and RMA contributed to the conceptualization, data curation, formal analysis, and methodology. IRB contributed to the conceptualization, data curation, formal analysis, methodology, supervision, and validation. TAS and AAM contributed to the data curation, formal analysis, and methodology. All authors contributed to the writing and final approval of the manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "Alexander Gaskov, Prof., Dr. Sci., 1944\u20132021.Professor Alexander Gaskov, our dear colleague, friend and teacher, passed away on 18 January 2021, from COVID-19. He was a brilliant scientist in the area of chemistry of semiconductor materials for physical and chemical sensors. He spent his entire research career, which began in 1966, in the Division of Inorganic Chemistry of the Department of Chemistry, Moscow State University. During all his career, he kept generating new ideas, seeking new directions in research and the application of results in practice. He generously shared his knowledge with students and staff, resulting in the emergence of dozens of talented new researchers. The publications produced by the laboratory achieved international recognition. Alexander Gaskov is an Eastern Siberia-born scientist. While at school, he showed an aptitude for physics and chemistry. He graduated from high school with a gold medal. In 1961, as the winner of the School Chemistry Olympiad, he was awarded a grant for a trip to Moscow, which he used to enter the Moscow State University (MSU). The entire life of Prof. Alexander Gaskov was inextricably linked to the MSU, at which he has passed all the ranks from a Junior Researcher to the Chief Researcher and Professor of the Moscow State University. In 1966, he was awarded a Ph.D. in Chemistry. The beginning of his research activity was devoted to the development of materials for IR photodetectors and emitters based on single crystals and epitaxial heterostructures of lead and tin chalcogenides. In 1988, he successfully defended the thesis \u201cDirected synthesis of three-component solid solutions of lead and tin chalcogenides for optoelectronics\u201d and was awarded the Advanced Doctoral Degree in Chemistry, which is the highest academic award of the USSR/Russia. In 1993, he received the title of Professor in Inorganic Chemistry. In 2008, Prof. Gaskov was appointed to lead the newly established Laboratory of Chemistry and Physics of Semiconductor and Sensor Materials.In the 1990s, Prof. Gaskov began exploring a new area of research of the synthesis of nanocrystalline semiconductors with high gas sensitivity. Comprehensive experimental studies of the wide-band semiconductor metal oxides allowed determining an innovative strategy for a direct synthesis of nanocrystalline materials for the chemical gas sensors [Later on, the focus of research in the laboratory was placed on active centers located on the surface of nanocrystalline semiconductor oxides ,3,4. ThiResearch of Alexander Gaskov\u2019s lab in the field of nanocrystalline semiconductors, in addition to oxide materials, involved the binary compounds based on chalcogenides, the so-called quantum dots . These mIn the past decade, Prof. Gaskov\u2019s laboratory has been exploring the issues of reliability, stability and power-consumption of semiconductor gas sensors, which are crucial for the successful functioning of sensors in real operational conditions. These areas include the development of synthesis methods that allowed producing the highly dispersed materials in high-temperature processing conditions, as well as the creation of sensitized and hybrid materials with photo-and gas sensitivity for the light-activated gas sensors . The useAlthough Prof. Gaskov was a strong proponent of fundamental science, he always sought ways of practical implementation of the experimental results. The highly sensitive selective semiconductor sensors created in his lab are the key elements of the Foxy-lab gas analyzer specially designed for detecting highly toxic organophosphorus substances as well as for automatic continuous determination of rocket fuel components. These gas analyzers were installed at Baikonur and Vostochny cosmodromes in 2016 and remain operational.Alexander Gaskov was a genuine scientist, passionate about his work, with a vision of the global picture, but very strict regarding the accuracy of details. In this vein, he taught his graduate students and this he demanded from colleagues. His enthusiasm and passion for results influenced the people around him, making them achieve and accomplish. As a professor of the MSU, he trained dozens of graduates and post-graduates who opted for specialization in inorganic chemistry, solid state chemistry, and materials science. In recent years, he lectured on the fundamentals of the chemistry of semiconductors, principles of inorganic synthesis, and chemistry of new materials. He was also the organizer and head of the interfaculty course \u201cFunctional materials of the XXI century\u201d. Under his supervision, 23 Ph.D. graduates successfully completed their studies. He provided guidance for the two dissertations of the Advanced Doctoral Degree in Chemistry.Alexander Gaskov was a member of the Academic Council of the Chemistry Department and a member of the Dissertation Council for Chemical Sciences of Moscow State University. In 2009, he was awarded the title of the \u201cDistinguished Researcher of Moscow University\u201d, and 2020, the title of the \u201cHonorary Worker of Science and High Technologies of the Russian Federation\u201d from the Ministry of Science and Higher Education of Russia.Above all, Alexander Gaskov loved life, his work, his laboratory, and his family. In the \u201csensor community\u201d, he will be remembered as a genuine scientist who made an important contribution to the understanding of the chemical foundations of the nature of semiconductor materials. By his colleagues, he will be remembered as a leader, teacher and a dear friend. With sadness for our common loss, but with vivid memories and gratitude for Alexander\u2019s precious time lived with us, we will continue our work, bringing his ideas and plans further."}
{"text": "Resilience is usually defined as one's ability to \u201cbounce back\u201d from adversity and is a salient indicator of the quality of life and psychosocial functions of patients facing chronic diseases, for instance, cancer, hypertension, irritable bowel syndrome, and heart failure, etc. , 2. ThusResilience in Chronic Disease received a great response. The collection consists of 12 studies with a total of over 7,100 participants from different countries. A diversified array of populations including the general population in the COVID-19 pandemic , patients with chronic pain , cancer , irritable bowel disease , cardiovascular disease , neurocognitive disorders , renal transplant , and rheumatoid arthritis , as well as caregivers for children with chronic illness , patients with liver cancer , and maintenance hemodialysis , were examined. Findings derived from the current collection echo the existing positive-psychology literature emphasizing the importance of psychological and social resilience in the move forward with chronic disease. Scientists from multi disciplines have contributed to this collection, providing contributions that raise awareness, educate, and reduce the impact of different chronic diseases on patients and their caregivers. However, several limitations should be emphasized here. First, most articles used observational designs , describing resilience and its associations with other aspects of the psychological, social, and physical well-being of patients with chronic disease. Our specific aim was first, to recognize distinct resilience trajectories during diagnosis, treatment, and survivorship throughout the course of chronic disease, which was not achieved in the current collection , the Humanity and Social Science Youth Foundation of the Ministry of Education of China (No. 19YJCZH227), the Humanity and Social Science Foundation of Department of Education of Guangdong Province (No. 2020WTSCX009), the Humanity and Social Science Foundation of Guangzhou (No. 2021GZGJ57), and the Humanity and Social Science Foundation of Guangzhou University of Chinese Medicine (Nos. 2020SKXK01 and 2021SKYB07).The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "The accurate identification of urban functional areas is of great significance for optimizing urban spatial structure, rationally allocating spatial elements, and promoting the sustainable development of the city. This paper proposes a method to precisely identify urban functional areas by coupling Open Street Map (OSM) and Point of Interest (POI) data. It takes the central urban area of Hangzhou as a case study to analyze the spatial distribution characteristics of the functional areas. The results show that: (1) The central urban areas of Hangzhou are divided into 21 functional areas . (2) The single functional areas and the mixed functional areas show the geographical distribution characteristics of the looping stratification, which means \u201cCore-periphery\u201d differentiation is obvious, and the comprehensive functional area is relatively scattered. (3) The mixed degree of regional function with ecological function and production function is low while comprehensive functional areas are usually associated with higher potential and vitality. (4) The identification results are in great agreement with the actual situation of Hangzhou central urban area, and the method is feasible. Therefore, this paper can provide a reference for urban development planning and management. The functional area is the basic unit of urban planning, management and resource allocation. Urban functional areas are important geospatial attributes of urban land, in which people carry out various socio-economic activities, which are usually determined by two perspectives of land use type and human activities, including residential land, industrial land, commercial and business facilities land , 2, 7. AThe traditional urban function zoning is mainly based on remote sensing images, land use data, panel data and so on . Zhong eCompared with the above studies, the POI data is a kind of point-shaped geographic space big data of real geographic entities. The results of this research could finely characterize the dynamic and real-time nature of urban land functions, and reflect the diversity and mixed degree of various facilities , 23. ZhaTherefore, this paper takes Open Street Map (OSM) road network data and POI data as the main data source, and proposes a method for accurate identification of urban functional areas based on kernel density estimation, functional area identification, mixed degree calculation and other technical means. Taking the main urban area of Hangzhou as a case, this paper further identifies urban single functional land, mixed and comprehensive functional land, and analyzes the distribution characteristics of the functional structure in the research area. The improvements of this study are shown as follows: 1) Taking the irregular grid formed by the road network as the research unit, the segmentation of urban functional areas is more reasonable. 2) The kernel density method reduces the noise effect of POI data, improves the recognition accuracy of mixed functional areas and weakens the discretization of results. 3) The recognition model considers the mixed functional areas and comprehensive functional areas to make the results more in line with the real situation. 4) The mixed degree calculation and accuracy verification of the identification results of urban functional areas are conducted to make the results more convincing. In terms of literature, it is expected to provide a typical case and research methods for the research of urban spatial structure in China driven by spatial big data. In practice, it provides the reference for urban managers to understand the urban spatial structure, accurately grasp the development status of urban functions, and formulate reasonable urban planning schemes.2. It is and one of the central cities in the Yangtze River Delta. In 2019, the city\u2019s GDP reached 222.85 billion US dollars, with a permanent population of 10.36 million. The central urban areas are located in the northeast of Hangzhou, including Xihu District, Gongshu District, Shangcheng District, Binjiang District, Jianggan District, and Xiacheng District, with a total area of 706.27km2. The central urban areas are concentrated areas of business, population and services in Hangzhou. The urbanization process of Hangzhou is the epitome of China\u2019s rapid development. At the same time, the urban development mode of Hangzhou, which takes into account science and technology, industry, humanities and ecology, represents the development direction of the future city. Moreover, the rapid change of urban functions of such cities brings challenges to urban management and operation. Therefore, this area is selected as the research area. An overview of the research area is shown in Hangzhou, the capital city of Zhejiang Province, is located in the northern part of Zhejiang Province, the lower reaches of the Qiantang River, and the southern end of the Beijing-Hangzhou Grand Canal. The central geographical coordinates are E120\u00b019\u2019, N30\u00b026\u2019. The city governs 10 districts, 2 counties and 1 county-level city, with a total area of 16853.57kmhttp://www.ngcc.cn/ngcc/html/1//391/392/16114.html), the satellite map data comes from Auto Navi Map (https://www.amap.com/), and they all can be obtained free of charge. The urban road network data of Hangzhou comes from the Open Street Map (OSM) geographic data platform (https://www.openstreetmap.org/). OSM aims to provide users with free and easy-to-access digital map resources, which is currently the most popular spontaneous geographic information platform. We preprocessed the collected OSM road network data: select highways, railways, township main roads, urban main roads and roads, delete sidewalks, residential lanes, chaotic road network and other lines which are less important and do not affect the analysis results, delete duplicate lines. Filter to delete other redundant paths and broken paths and paths below 100 meters, and finally, fill the broken paths. POI (Point of Interest) data comes from AutoNavi Maps Open Platform (https://lbs.amap.com/). AutoNavi Maps is China\u2019s leading provider of digital map content, navigation, and location services. This research uses the open API interface provided by AutoNavi Maps to obtain 168607 POI data of six districts in Hangzhou in December 2020, and each POI data contains attribute information such as geographical entity name, address, affiliation type, longitude, and latitude, administrative region and so on. There are many problems in the original POI data, such as various classifications, the repeated crossover between different classifications, classification errors, information missing, and inconsistent coordinate system. Moreover, some types of POI have low public awareness, such as public toilets, newspaper pavilions, and bus stations. These types of POI are not significant in the identification of functional areas and are not convenient for research and discussion. Therefore, it is necessary to unify the coordinate of POI data, clean the data, delete wrong POI points, delete repeated abnormal values, screen and delete low public awareness points, and reclassify them. According to the \"Code for classification of urban land use and planning standards of development land\" (GB_50137\u20132011) and combined with the actual conditions of Hangzhou, we divided POI into six types: residential, administration and public services, commercial and business facilities, industrial, green space, science and education [Before collecting the open source data required for the article, we have carefully examined all relevant platform service terms to ensure that our research is fully compliant with the agreement. The administrative division data is from the 1:250,000 basic geographic database provided the National Geomatics Center of China , n is the number of research objects j within the bandwidth R.In the formula, r is the bandwidth, SD is the standard distance value, Dm is the median of the distance between the average center of the point and all points, n is the number of points, xi and yi are the coordinates of points, respectively, and The result shows that the choice of bandwidth R has a critical impact on the result of kernel density analysis , 32. GenThe above formula is used for calculation in GIS to obtain the search radius of POI data of various functional areas. Among them, the residential area is 1095 m, the administration and public services area is 1102 m, the commercial and business facilities area is 745 m, the industrial area is 970 m, the green space is 1224 m, the science and education area is 1013 m, and the overall search radius of POI data is 837 m. Hinnerburg et al. researched the relationship between the bandwidth and the number of density-attractor and found that there are a certain number of bandwidth intervals that keep the density-attractor stable, and it is reasonable to choose the bandwidth in these intervals . Based oIt is not only the distribution density of POI but also the size of geographical objects represented by POI and the degree of public recognition to affect the function of the plot. In this paper, the occupied area of POI points is selected as one of the weights , and theFi, di, and Wi are the frequency density, sum of nuclear density, weight of the POI of class I in the unit, respectively. Due to the complex and diverse urban functional structure, there are both single-use functional areas and areas with two or more mixed functions. Therefore, this paper further compares the frequency density of POI in the functional area: When the frequency density of POI in the unit is more than or equal to 50%, the functional area is a single function area. When the two kinds of values of higher frequency density of POI in the unit are between 20% and 50%, the unit is defined as a mixed functional area with two types of POI. When the frequency density of all kinds of POI in the unit is 0, it is defined as no data area, and the rest of the unit is the comprehensive functional area.According to the weight calculation of each POI, the frequency density of each POI in the land use unit is calculated, which can be used as the basis of functional zoning . The calpi is the proportion of class I POI kernel density value to the total value of each class of POI kernel density in the functional area unit, and n is the number of POI classes. If the kernel density of some POI in the unit is 0, it does not participate in the calculation.According to the mixed index of land use, the mixed degree of functional areas in the research area is further evaluated . The for2), residential land , administration and public services land , green space land , industrial land , science and education land . The mixed functional areas include the combination of commercial and business facilities land, and administration and public services land , the combination of commercial and business facilities land, and residential land , the combination of commercial and business facilities land, science and education land , the combination of commercial and industrial facilities land , the combination of commercial and business facilities land, and green space land, the combination of administration and public services land, and residential land , the combination of administration and public services and green space land , the combination of administration and public services and industrial land , the combination of administration and public services land, and science and education land , the combination of industrial and residential land , the combination of residential and green space land , the combination of science and education, and residential land , the combination of science and education, and industrial land , the combination of science and education, and green space land . There are 103 comprehensive functional areas, covering an area of 39.801km2. The remaining units are no data areas . Because of the small statistics of various POIs in this block, the kernel density value is small too.Through OSM network grading and buffer operation, the central urban area of Hangzhou is divided into 1542 block units. After calculating the weight and frequency density of various POI in each block unit, the identification result of functional areas in the Hangzhou central district is obtained . It can The single functional areas in the central urban area of Hangzhou are mainly commercial and business facilities land and residential land . Among t2, accounting for 55% of the total area of the research area, which indicates that the mixed degree of urban functions in the downtown area of Hangzhou is relatively high. Mixed functional areas are mainly the combination of commercial and business facilities land and administration and public services land, which occupy the largest area, accounting for 25% of the total research area. In terms of spatial distribution, the central part is more and concentrated, while the periphery is less and scattered. Specifically, they are primarily concentrated in Shangcheng District and Xiacheng District, the south of Gongshu District, the east and west of the Xihu District, and the west of Jianggan District. Next is the combination of commercial and business facilities land and residential land, accounting for 14% of the total research area, intersperses in various functional areas. The number of other mixed functional areas is 223, accounting for 14% of the total area of the research area, and the area of other mixed functional areas accounted for 16% of the total area of the research area. The layout of other mixed functional areas is more dispersed. Among them, the number of the combination of residential and green space land and the combination of science and education and the industry land are the least, with 1 each. The area of the combination of industrial and residential land is the smallest, accounting for only 0.04% of the total area of the research area. The overall layout of the comprehensive functional urban areas in the central city area of Hangzhou is scattered , making research in this field not detailed enough. With the development and popularization of computer technology, remote sensing technology and big data are applied in the research of urban functional area recognition, but there are still problems such as tedious classification methods and the result precision cannot be guaranteed. Based on the kernel density estimation algorithm, this paper proposes an urban functional area identification method that combines OSM and POI data. It has a high reference value for the analysis of urban overall patterns and spatial optimization. At the same time, the availability of OSM and POI data makes this method can be easily used in other cities.Firstly, POI data can provide a spatial location and attribute information of various urban facilities. Real-time and efficient data acquisition methods simplify the cost and uncertainty of traditional identification methods such as remote sensing, field research and questionnaire survey. The application of big data breaks through the problems of poor timeliness and a small sample of traditional data, improves the accuracy of urban functional area identification, and is convenient for larger-scale research.Then, the OSM road network is used to generate road space, and the research area is divided into independent block units so that the segmentation of urban functional areas is more reasonable. The kernel density estimation method is used to realize the influence diffusion of POI in the adjacent location, weaken the discrete phenomenon of POI points, and identify the functional areas through the optimal bandwidth selection. The results are basically consistent with the actual situation. Through the calculation of the mixed index of urban functional areas, it is convenient to express the mixed degree of land use in the central urban area of Hangzhou. Although in the process of urban planning and construction, urban land use layout planning emphasizes functional zoning, mixed land use planning should also be adhered to promote economic development and facilitate the lives of residents.Finally, compare the identified functional areas with the image of AMap, the verification of the results shows that the method has a high degree of recognition for urban functional areas, which can make up for the disadvantages of the traditional method and has certain feasibility. It can support the spatial layout research of urban functional areas, so that the decision-making organs can find the shortcomings of the existing urban planning, and can coordinate the development direction of the existing planning functional areas, improve the vitality of urban space, and carry more human activities.However, this method also has some shortcomings. For example, the verification of the results is only carried out through the comparison of typical regions, and there is no true value as a comparison. Therefore, it is hard to determine the accurate identification accuracy of this method. In addition, this method is based on the OSM road network to divide urban units, and the basic road network data have the problems of low density and the lack of data in suburban and rural areas, which leads to the excessive division of functional units in such areas, resulting in poor local recognition results.The urban functional area projects each element of the city in space and forms a closely related organism. The identification of Hangzhou urban functional areas based on big data is not only beneficial to the adjustment of urban spatial layout and the creation of good conditions for the development of urban economy and society but also can improve the efficiency of urban land use  through On the whole, the single functional areas are mainly distributed in the periphery of the city. For example, the single residential areas are mainly distributed in the north and south of West Lake District, the east of Jianggan District, and the southern edge of the Binjiang District. The single industrial areas are mainly distributed in the eastern part of the Jianggan District and the southern part of the Xihu District. The single areas for science and education are mainly distributed in the northern part of the main urban area of Hangzhou. In general, the more single functional land, the more it affects the mobility of the city . For exaThe mixed functional areas are distributed in the whole research area and nested with single functional areas, which indicates the rationality of the spatial structure of the main urban area of Hangzhou. For example, residential land forms residential-industrial zones around enterprises, commercial-residential lands around businesses, and public service-residential lands around public services. From the perspective of different administrative regions, each administrative region has an area with a higher degree of mixed, as well as an area with a lower degree of mixed. In line with the law of urban growth and development in urban areas, it revolves around multiple economic activity centers , 47. HowThe comprehensive functional area means that there are three or more urban functions in the plot, reflecting the organic integration of different urban functions. For example, the southernmost comprehensive functional area of Binjiang District is the location of China Network Writers\u2019 Village and the core for the development of China\u2019s network literature industry. Meanwhile, the high-quality environment and supporting facilities attract more writers. Similarly, in the easternmost comprehensive functional area of Jianggan District, there are enterprise platforms with functions of scientific research and industrial incubation, such as ABO Biopharmaceuticals (Hangzhou) Co., Ltd., Sanhua Academia Sinica, as well as high-grade residential areas, the supporting facilities are relatively complete. These regions are very typical innovation areas in Hangzhou, and the mixing of functions is also the most prominent feature of high-quality urban innovation space , 51.In the research area, the mixed degree of some areas is deliberately controlled, mainly in the areas that undertake ecological functions, such as the Qiantang River, Xixi Wetland, West Lake Scenic Area, and the areas that undertake production functions, such as Zhejiang Qiosi Farm in Jianggan District. This is because the strategy of ecological civilization and the protection of cultivated land both are China\u2019s basic state policies , which rThe rapid evolution of cities and the promotion of China\u2019s urbanization policy have brought many new challenges to urban planning and management. The spatial division of urban functional areas and urban zoning management of the city could provide a new idea for planners and managers to a certain extent. The government could plan different functional areas of the city according to the social, economic and natural geographical conditions, and realize the change from the traditional \" unitary and extensive \" management mode to the modern \" diversified and refined \" management mode , 54.Based on the above analysis of the comprehensive judgment of the current situation, we believe that the current urban functions of the central city area of Hangzhou are becoming diversified and individualized. However, with the continuous evolution of urban spatial structure, there are many potential problems . First oTherefore, in the future, the urban land use function of the central urban area of Hangzhou should be optimized from the following aspects: (1) Developing mixed-use areas based on actual needs, guiding the optimization of urban mixed areas to improve the efficiency of land use. (2) Reducing single-use land types and promoting the transition from single-use land to mixed-use land. (3) Adhering to the construction of the multi-center distribution pattern of urban spatial structure and promote the fair distribution of social-spatial elements . (4) WhiThis article takes the central urban area of Hangzhou as the research area and proposes a method of city functional area identification based on the kernel density estimation algorithm that integrates OSM road network and POI data: Firstly, the OSM network divides the urban area into research units with the same social and economic functions. The influence diffusion of POI facilities is realized based on the kernel density estimation algorithm, which weakens the discretization of POI. At the same time, kernel density bandwidth and POI weight are set to identify the functional urban areas and projected to different plots. Finally, the land-use mixed index is calculated. The results show that: (1) There are three types of urban functions in the central urban area of Hangzhou: single, mixed, and comprehensive. The central urban areas of Hangzhou are divided into 21 functional areas and the commercial function land is the dominant function of the research area. (2) The single functional areas and the mixed functional areas show the geographical distribution characteristics of the looping stratification, which means the \u201cCore-periphery\u201d differentiation is obvious. Mixed functional areas are widely distributed, but the areas with ecological and production functions have a low degree of mixed. Comprehensive functional areas are widely distributed and with higher potential and vitality. (3) The results of identification are in good consistent with the actual situation of the central urban area of Hangzhou. Therefore, the kernel density weighting method which considered public awareness and general area has high accuracy and feasibility, which can provide a reference for urban development planning and management. (4) The real-time and high efficiency of OSM and POI data acquisition methods and the scientific accuracy of big data application make the method of identifying urban functional area which combined OSM and POI data available. This method can be easily used in the identification of other urban regional functional areas to help people to understand the urban spatial structure more intuitively. And this method has high potential in assisting government departments and researchers in the scientific analysis of urban planning and land use.There are some deficiencies of this paper: Because of the data defect of POI, the identification ability of areas such as small building density, unused land in cities and farmland is weak. At the same time, the integrity of POI data, the rationality of data cleaning and the accuracy of reclassification need further research. In view of the defects of the results test in research methods, a variety of verification methods can be added to future research for a horizontal comparison of results. Finally, due to the lack of historical POI, the evolution characteristics of urban functional areas cannot be identified. So combining mobile signaling data, sharing vehicle (bicycle) data, social media big data and other multi-source data to analyze the evolutionary logic and driving mechanism of urban functional areas will be the direction of future research."}
{"text": "In the original publication, the name of the fourth author should be: Takafumi Sangai and his affiliation should be:Department of Breast and Thyroid Surgery, Chiba University Hospital, Chiba, JapanThe corrected name and affiliation are given in this correction."}
{"text": "In Japan, there are key healthcare professionals for home nursing care for elderly people called Care Managers. The care manager coordinates the service while adjusting the family situation and the user's intentions. The purpose of this study was to examine the practical structure of support for adjusting the intentions of family members and users regarding care service use. Data from seven cases, where family members and users have different intentions regarding care service use, were analyzed using the grounded theory approach. The phenomenon of \"confirmation of discrepancies\" was discovered with six sub-categories: adjusting the intentions of users and their families, effort to restore relationships, expression of intention to refuse involvement, expression of desire for adjustment, arrangement of opportunities for adjustment of intentions, and appropriate service adjustment. Four patterns occurred in the process of \"confirmation of discrepancies\": smooth adjustment, restoration and promotion of mutual relationships, failure to reach an agreement, and negative feedback loops. These patterns were based on a combination of the care managers' degree of understanding strength, the managers' degree of insistence, the managers' degree of representation of mutual feelings, the degree of managers' prediction of life prospects, the degree of trust in care managers, and the degree of expression of family anxiety."}
{"text": "Based on the interdisciplinary concept of One Health, EcoHealth, and Planetary Health, this paper focuses on participatory knowledge-to-action approaches by relating one decade of environmental disasters in Brazil with the action of veterinary rescue teams, aiming to give support to future disaster preparedness. This paper will present the historic actions of teams rescuing animal that are victims of environmental disasters, in addition to addressing the need for contingency plans and response management in these types of events. The main events in Brazilian states where veterinary rescue teams participated were, chronologically, as follows: 2011 flood and landslide (Rio de Janeiro); 2012 flood ; 2015 dam break (Minas Gerais); 2017 flood (Minas Gerais) and forest fire (Minas Gerais and Goi\u00e1s); 2019 dam break and evacuation (Minas Gerais) and flood (Bahia); 2020 flood (Esp\u00edrito Santo and Minas Gerais) and forest fires (Mato Grosso and Mato Grosso do Sul). The Brazilian disasters that had a large global repercussion were the ruptures of the ore dams in Marina (2015) and Brumadinho (2019), both in the State of Minas Gerais. The role of veterinarians in these events was recognized by the Federal Council of Veterinary Medicine (CFMV) after their performance in Mariana, Minas Gerais (2015), and in 2020, the CFMV approved the National Mass Disaster Contingency Plan Involving Animals. The work of veterinarians in interaction with other professionals in environmental disasters proved to be effective and necessary for the rescue of animals and for planning and giving support to disaster preparedness in the future. The term \u201cdisaster\u201d has different concepts, but the concepts invariably refer to at least one of these factors: threat, vulnerability, risk, exposure, and responsiveness . DisasteIn general, disasters devastate homes, establishments, and properties, destroying livelihoods and deteriorating essential services, damaging the individual and collective health of humans and animals, reflecting on injured individuals and a variable number of deaths, in addition to leading to damage to a greater and lesser extent and also to mental damage that may be transient or long-lasting .Depending on the type of disaster, different demands are faced by the communities and teams responsible for providing support in the post-tragedy. For this, the professionals of these teams must have multidisciplinary skills from previous training, as well as adequate resources for proper support , 5. In sAdverse events, mainly of climatic origin such as droughts and forest fires, of hydrological origin such as runoffs and floods, and of meteorological origin such as heat waves and tropical cyclones, currently affect populations worldwide and particularly in Brazil. According to data from the United Nations International Strategy for Disaster Reduction (UNDRR), more than 200 million people are affected by disasters of different origins every year .This paper will present a brief overview of the historic actions of volunteer veterinarians in rescuing animal victims of environmental disasters, in addition to addressing the need for contingency plans and response management in these types of events.In Brazil, the occurrences of disasters, especially those of natural origin, coincide with the deterioration of living conditions in cities, with the occurrence of many damages and losses . It is eThe main events with participation of veterinary rescue teams in Brazilian states were, chronologically, as follows: 2011 in Rio de Janeiro (flood and landslide); 2012 in Acre and Par\u00e1 (flood) and Minas Gerais (flood); 2015 in Minas Gerais (dam break); 2017 in Minas Gerais (flood and forest fire) and Goi\u00e1s (forest fires); 2019 in Minas Gerais (dam break and evacuation) and Bahia (flood); 2020 in Esp\u00edrito Santo and Minas Gerais (flood) and in Mato Grosso and Mato Grosso do Sul  .In January 2011, heavy rains triggered what would be considered the worst Brazilian natural disaster of recent times: the floods and landslides in the mountain region of Rio de Janeiro, an event that caused 905 deaths in seven cities and affected more than 300,000 people, which corresponded to 42% of the population of the affected municipalities, that is, 4.46% of the population of the State of Rio de Janeiro at the time. Total losses were estimated at US$3 billion; however, these omit relevant impacts in sectors such as education and health, which could not be considered due to unavailability of detailed information  and Brumadinho (2019), both in the State of Minas Gerais, with is the state with highest number of disasters and consequentially rescue team actions . In the Laborat\u00f3rio de Aplica\u00e7\u00f5es de Sat\u00e9lites Ambientais da Universidade Federal do Rio de Janeiro [LASA/UFRJ]). Burnt areas increased by more than 100%, compared to the same period at the year previous to the disaster. Fire affected almost all conservation units and indigenous lands in the Pantanal region  was officially created in 2019. Before the dam burst in Brumadinho, several professionals and volunteers that operate in disasters were included in the group. Important work fronts were developed and technologized, such as contingency plans, autopsies, vaccination and health of the team, and veterinary medicine from catastrophe animal shelters, in addition to the field rescue fronts. With the constant performance of veterinary professionals in catastrophes and with the insertion of a team in the Regional Council of Veterinary Medicine of Minas Gerais, a new line of professional activity originated, the veterinary medicine of disasters , receiving support from civil society and from the Federal Council of Veterinary Medicine (CFMV), being nationally recognized for its experience in response to fauna affected by disasters . The maiIn view of this scenario of the last decade, there is a clear need to prepare veterinarians to work in this area, so that they can be recognized, respected, and inserted in an official way in disaster management operations, acting in parallel with the actions developed for the rescue of human lives. It is essential to recognize the role of animals in the family nucleus and human health and include them in disaster contingency plans, with a view to preventing and reducing the health risks arising from these disasters . BiosafeIn mass disasters, it is essential that there is articulation between several federal, state, and municipal institutions that can contribute to situations involving animals, such as environment, agriculture, public health, police, public ministry, civil defense, firefighter, education, and civil society organizations. It is essential that contacts and partnerships between institutions and support bodies begin even before the occurrence of a disaster, to harmonize contingency strategies and plans and to promptly implement them, correctly and at the right time . There iIn Brazil, the National Civil Protection and Defense Policy (PNPDEC), established through Law 12608/2012, provides that civil defense and protection actions are organized by prevention, mitigation, preparation, response, and recovery actions. Thus, for each of them, there are specific responsibilities, while they are part of a systemic and continuous management. However, this policy does not detail the actions related to animals as among the main actions to assist victims of disasters; it mentions only the management of domestic animals and the burial of animals in appropriate places, according to zoonosis rules  and Brumadinho (2019), in Minas Gerais; and the fires in the Pantanal (2020) .The National Contingency Plan for Mass Disasters Involving Animals brings together the experience of professionals from various segments of activity, considering the particularities of the species and the potential disasters expected for Brazil. The plan considered aspects of approaching the scenario and making decisions involving the care and rescue of the various species; their habits, food, accommodation, transportation, and health; and all the spheres that need to be understood so that prevention, response, and/or recovery are successful, ensuring the rescue of animals and guaranteeing their well-being and quality of life, with clear and concise guidelines. It is believed that the plan will be an important marker of activities related to the theme in future situations, which cannot be predicted, but for which one must be prepared .Technical preparation, hierarchy, and communication in the context of a disaster are essential for the safety of professionals, people, and animals, as well as for planning and decision making. However, to make effective and assertive conducts feasible in handling these situations, the accurate compilation of information and data by the situation diagnosis team is vital, helping to mobilize efforts and adequate resources for the operation . PreviouTechnical rescue of animals in disaster scenarios involves planning and, at the same time, requires speed. To facilitate the conduct of professionals, the National Mass Disaster Contingency Plan Involving Animals highlights eight steps to be observed, aiming at the health and well-being of animals and specifying plans to rescue and welcome oxen, horses, pigs, rabbits, dogs, cats, birds, fish, and domestic rodents. It involves everything from on-site assistance, with water, food, medication, and animal preparation (some even require sedation), to transportation and disembarkation at the destination, in temporary shelters. In the operational part, in addition to providing guidance on initial diagnosis, action plans, composition, and team meetings, the plan also defines priorities and strategies for assisting animals. The document addresses cases subject to euthanasia provided for in legislation and guides the conduct of crime scene investigations, which includes collecting corpses and biological and chemical remains, preserving the chain of custody, and maintaining the suitability of the remains from their recognition and collection until its use by the justice department as an evidence element .The plan also addresses aspects pertinent to legal veterinary medicine, forensic necropsy, biosafety measures and personal protective equipment, immunization of workers and volunteers, health service waste management plan, and work zones. It also deals with a hierarchical structure for organizing the responsibilities of official bodies and their actions during the response to a disaster. The plan also describes what the documentation system for veterinary medical care should be in the routine of temporary shelters for rescued animals and indicates how to deal with the destination of domestic animals for temporary home, adoption, or reintegration with the guardian .Like people, animals are also victims of disasters, and they need to receive due attention, following ethical, legal, sanitary, social, and environmental protocols. Over the course of one decade, rescue efforts were improved, and rescue techniques and procedures were developed for different animal species in different types of catastrophe situations, as well as standard operating protocols, first-aid protocols in the field, protocols for use of anesthetics in the field, and vaccine and medication protocols for each type of species affected, in addition to training teams to work on different fronts.The disaster veterinary medicine is an emerging area with a strong humanitarian bias and requires social motivation because there are several situations that professionals face in these occurrences that require preparation and continuous training. In addition, emotional intelligence is needed to face the realities encountered in disaster situations, such as environmental destruction, extreme contexts of crisis, dangerous situations, and vulnerability involving the homeless, missing, and dead. In times of disaster, the teams involved are faced with a chaotic and complex environment, which requires coordinated and integrated action by multiple agencies, aimed at mitigating suffering and damage.Another point to be highlighted is that after the occurrence of a series of disasters and the work of voluntary rescue teams, there has been a greater appreciation of the veterinary medicine class by society and companies, especially companies that provide services for the systemic monitoring of fauna in affected areas and are thus considering hiring veterinarians to be integrated into multidisciplinary teams.The environmental disasters that occurred in Brazil showed the importance of professionals that act in disasters. In contexts such as large fires, landslides, floods, ruptures of tailings dams, and natural disasters (such as tornadoes and storms), veterinarians work mainly in the rescue and clinical and surgical care of animals of different species of domestic and wild fauna. However, these professionals can also form activities in the field of food security for the affected population, in pest control, and, in action planning, in integrated work of several teams involved in the affected regions, which emphasizes the interdisciplinary profile of the veterinary medicine in the concept of One Health.The work of veterinarians in interaction with other professionals in environmental disasters proved to be effective and necessary for the rescue of animals, not only because they are part of the affected families and because animals are sentient beings but also because they are important characters in the epidemiological scenario before, during, and after a disaster has occurred. We consider that this information is essential to influence scientific priorities in this approach and give support nationally and internationally for public policies and decision-making at local and global levels for disaster preparedness in the future with a focus on the approach of EcoHealth and Planetary Health.With the content of the National Mass Disaster Contingency Plan Involving Animals, in Brazil, it is expected that the actions of rescuing animals in situations of mass disasters can be officially recognized and incorporated into the activities of the agencies and institutions responsible for responding to crisis scenarios.CS and GC contributed to the conception and design of the paper and organized the information of the presented data. GC organized the paper text. All authors revised and contributed with their professional and personal experience in the actions on the rescue of animals in the environmental disasters in Brazil, in different regions and years.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "The WLS is a study of Wisconsin high school class of 1957 graduates, with follow-ups in 1964, 1975, 1993, 2004, 2011, and 2020. The data reflect the life course of the graduates (and their siblings), initially covering education, switching to family, career, and social participation in midlife, and physical and mental health, cognitive status, caregiving, and social support as respondents age. The WLS is linked to multiple administrative data sources including: parent earnings from state tax records (1957-60) and Social Security earnings and benefits for respondents; 1940 Census data; characteristics of high schools and colleges, employers, industries, and communities of residence; voting records from 2000-2018; Medicare claims; and the National Death Index. Efforts are underway to expand the racial/ethnic and educational composition of the WLS by supplementing the original sample with a new cohort of age-matched adults drawn from Wisconsin\u2019s Black, Hispanic, Asian-American, and Native American communities."}
{"text": "The COVID-19 pandemic and increasing frequency and severity of environmental disasters reveal an urgent need for a robust health observing/surveillance system. With the possible exception of Brazil, we know of no such comprehensive health observing capacity. The US should create a national system of linked regionally-based health monitoring systems similar to those for weather, ocean conditions, and climate. Like those for weather, the health observing system should operate continuously, collecting mental, physical, and community health data before, during, and after events. The system should include existing cross-sectional health data surveys, along with significant new investment in regional longitudinal cohort studies. The recently described framework for a Gulf of Mexico Community Health Observing System is suggested as a potential model for development of a nation-wide system. Our objectives in this short communication are to illustrate the overarching need for a national human health observing system, provide an example of what such a system might encompass, and outline two steps, one near-term and one medium- to long-term, that could be taken toward its development.More than any previous disaster of the twenty or twenty first centuries, the COVID-19 pandemic, and the increasing likelihood of more emerging diseases in the future, have highlighted an urgent, overarching need for comprehensive health surveillance at local to national scales . The conhttps://www.nih.gov/news-events/news-releases/all-us-research-program-launches-covid-19-research-initiatives). Unfortunately, the sampling being done by the All of Us study lacks a statistically-based approach, thus limiting the epidemiological utility , could provide a nation-wide health observing system of unparalleled capacity.The Gulf of Mexico Health Observing System (GoM CHOS) framework design is based, in part, on the atmospheric and oceanic observing systems that underlie modern weather, climate, and marine forecasting capabilities, upon which hundreds of millions to billions of people depend daily. These environmental observing systems enable society to mitigate effects of extreme weather events and resulting costly health and socio-economic impacts at local to global scales. Using the GoM CHOS as a model for pilot studies and building out to a regional framework, as employed by the US Integrated Ocean Observing System (IOOS) .1) Short-term: As a first step, the Federal Government or Congress should authorize a Federal agency (or group of agencies) to undertake a health observing system pilot program and it could be in the Gulf of Mexico region to take advantage of the Gulf of Mexico Community Health Observing System framework. Wherever and however conducted, the purpose of the pilot would be \u201cto learn by doing,\u201d to establish a strong base of information for designing and building a national network of regional health observatories. Although cost estimates were not a part of the original study, a rough \u201cguestimate\u201d of funding required for a Gulf region health observing system is ca. $10 M/year. Better estimates will depend on implementation decisions . Almost 2) Medium to long-term: The Federal Government, with leadership of the CDC, NIH, and NSF and participation of the NASEM, should establish a Commission or Committee to make recommendations to the President and the Congress for creation and long-term funding of a national system of regional health observing systems focused on pandemics and disasters. The Commission or Committee should comprise public health and biomedical experts with relevant expertise from Federal Government health agencies, State Health Departments, public health and medical experts from academic institutions, public and private health care providers, computational data specialists, and others as may be required.The COVID-19 pandemic and the increasing frequency and severity of environmental disasters make obvious the urgent need for a robustly operational health observing system for the U.S. A comprehensive health observing capacity does not exist and should be developed. A regionally based, nationally linked system, as outlined in this communication, can serve to gather the health information, including mental, physical and community health data, in a representative sampling of the nation's population, including the susceptible or vulnerable, with respect to effects of pandemics and other disasters. The database would be available to public health officials, medical practitioners, disaster preparedness planners, biomedical researchers, and others to improve health preparedness and response. Multiple health observing systems would create comparable, ongoing health data streams that could improve targeting of investments for disaster preparedness, response, and prevention, there by reducing future expenditures for long-term health care related to disasters. Also, such systems could provide earlier and stronger warnings of impending epidemics, as well as tracking of possible long-term effects and contacts, allowing more targeted and possibly less severe responses, which would reduce economic and other societal impacts. Although aspirational at present, a national health observing system is feasible. Considering the high annual costs of disasters and the massive cost of the COVID-19 pandemic, not taking action to improve health monitoring will be far more expensive.PS, BS, and RC were responsible for concept formulation. PS had primary funding and writing responsibilities. All authors contributed ideas, reviewed, and approved the manuscript.The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the Gulf of Mexico Alliance, the Gulf of Mexico Research Initiative, the National Institute of Environmental Health Sciences, the College of Charleston the National Science Foundation, or the University of Maryland College Park.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "Carbon nanostructures are important nanomaterial with interesting physical and chemical properties. These nanostructures have been assessed for application in different fields of medicine, such as cancer detection and treatment, Parkinson disease, reproductive medicine, etc. This nanomaterial can be used in reproductive medicine as a drug delivery system, antifungal, antiviral, and antibacterial agent, condom-coating agent, enhancer of sperm fertilizing ability, ectopic pregnancy treatment, trophoblastic diseases, endometriosis, uterine fibroids, and Assisted Reproduction Techniques (ART) improvement. The other side of this coin involves various side effects of carbon nanostructures, especially negative effects on reproductive systems. All carbon nanostructures showed toxicity on the reproductive system by producing reactive oxygen species and oxidative stress. Less attention has been given to the unique properties of carbon nanostructures, except for their practical attractiveness, the other side of this coin, namely the risks and side effects of these compounds - especially in the case of a reproductive system that supports the survival and health of future generations. Therefore, we suggest paying particular attention to the negative aspects of the increasing use of carbon nanostructures. Application of different nanostructures  has been developed in different fields over the past years, especially in medicine ; 2020. COne side of the coin, e.g. the use of carbon nanostructures in reproductive medicine, has been the subject of many studies. Effective and positive mechanisms of these nanostructures in various fields of reproductive medicine, such as increasing sperm fertility, prevention of unplanned pregnancy, increasing sperm and egg retention in culture medium, preventing the transmission of sexually transmitted infections, increasing the effectiveness of genital health drugs such as chemotherapy in the treatment of reproductive system cancers, and etc., has been well studied and proven, and the most detailed topics related to these positive effects have been discussed in many papers The use of carbon nanostructures in ART include delivery system for increase bioavailability and permeability of sexual hormones, gametes and embryos selection, and gene transfer. In the field of embryogenesis, these nanostructures can be used for labelling pre-implanted embryos, Nano nutrition, and gene therapy. Carbon nanostructures have been used in reproductive oncology for treatment and diagnostic purposes. Infection detection, targeted treatment, microbicides and vaccine design for prevention, are all applications of Carbon nanostructures in the field of reproductive infections. These nanostructures can be used as alternative for surgical intervention in ectopic pregnancy, trophoblastic diseases, endometriosis and uterine fibroids (However, attention to the other side of this coin, namely the risks for increasing the use and the range of carbon nanostructures, especially their toxicity on the reproductive system, has been neglected. Compared to the positive aspects of the use of carbon nanostructures in reproductive medicine, much less attention has been paid to its negative aspects  Figure . A compaDue to less attention to the negative aspects regarding the use of carbon nanostructures, we suggest that in future studies and research, more attention be paid to other aspects, namely the harmful effects related to carbon nanostructures. Due to the importance of reproductive system health for survivors and the health of born children, it is highly important to pay attention to the negative impact of carbon nanostructures on the reproductive system."}
{"text": "Health concept and zoonotic diseases are on the rise. The One Health concept, involving collaboration between veterinary and medical scientists, policy makers, and public health officials, is necessary to foster joint cooperation and control of emerging zoonotic diseases. Zoonotic diseases, which are caused by a wide range of arthropods, helminths, protozoa, bacteria and viruses, can cause severe and even fatal clinical conditions in animals and seriously affect the infected humans. The main zoonoses are related to interactions between livestock and wildlife, as well as between dogs and cats and human populations. Humans are accidentally infected in endemic areas, where animals act as reservoirs and climatic conditions favor the proliferation of vectors. The influence of other variables, such as temperature, humidity, presence of irrigated areas, introduction of new vector species, climate change, increasing human activity, travel with pets to/from endemic countries and the presence of these diseases in areas previously not described as endemic, are important factors to consider in the establishment of new zoonotic diseases in areas where, until then, were considered free of the disease. Approximately 60% of human diseases are zoonotic and at least 75% of the emerging pathogens of human infections are of animal origin. Currently, most of these diseases are neglected despite causing a potentially global problem.When Frontiers in Veterinary Science asked us to produce a Research Topic, we were aware of the importance and dissemination it could have, so we tried to address an interesting, attractive, and practical topic that would be of help to the scientific community and the general public. Themes dealing with the One Zoonotic Diseases: Their Host and Vectors was proposed with the aim of providing state-of-the-art research focused on preventing and controlling zoonotic diseases, both through the control of the vectors and their animal reservoirs. It contains a total of 16 contributions from parasitologists, immunologists, entomologists, veterinarians, virologists, and microbiologists from all continents, who have addressed the study of different zoonotic diseases, dealing with topics such as the relationship between the human population, domestic animals and wildlife, the role of invasive alien species, the epidemiology of zoonotic infections, different strategies in the monitoring and control, programmes for treatment and prevention, vector dynamics, vector life cycles, and immune response in their hosts.Therefore, this Research Topic entitled RM, RB-M, LR, and EC wrote the editorial. All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "Alzheimer's disease (AD) and all other dementia represent a global challenge, with an estimated 50 million individuals in the world living with dementia today. In low and middle income countries (LMICs), the burden of disease often is greater, and some of these countries are projected to have some of the largest increases in dementia prevalence during the next few decades. As the world's largest voluntary health organization dedicated to AD and all other dementia, the Alzheimer's Association is committed to its vision of a world without dementia and recognizes the needs, challenges, and opportunities for dementia research in all parts of the world, and especially in LMICs. Currently, the Association is devoting more than $215 million in funding to nearly 600 best-of-field projects in 31 countries, including a significant number of projects that advance and support LMIC-specific research. The innovative work in LMICs is focused on addressing unmet needs or challenges associated with the many unique cultural, demographic, and economic characteristics of these countries. The Association also is expanding leading global forums such as the Alzheimer's Association International Conference (AAIC). In an effort to create new learning and participation opportunities, the Association also has been partnering with other international organizations and collaborating with local leadership to provide AAIC Satellite Symposia (AAIC SS) in LMIC regions around the world. In 2021 and beyond, the Association is committed to continuing these LMIC-focused initiatives, identifying gaps in LMIC research and resources, and enhancing collaboration and communication among researchers in these regions. The need for global coordinated research that will reach and benefit all communities around the world has perhaps never been greater. For several decades, in response to the global challenge of dementia, the Alzheimer's Association has recognized that all countries are critical and integral components of international research efforts in the global mission to eradicate dementia. Accordingly, the Association is dedicated to ensuring complete representation of those countries with a World Bank designation of middle or lower middle income , many ofSince its founding in 1980, the Alzheimer's Association has had an increasingly global focus. This focus has included a growing awareness of the needs of low-income and middle-income countries (LMICs), as well as the importance of their inclusion in the global research enterprise\u2014an awareness initially informed in large part by the work of the 10/66 Dementia Research Group (DRG). This research group, established in 1998 as a part of Alzheimer's Disease International (ADI), brought together researchers with a special focus on LMICs and succeeded in challenging the belief, prevalent in the 1990s, that dementia was relatively rare in these countries , 5. The In subsequent years, the Alzheimer's Association has supported and joined in efforts by other international organizations, including ADI and the World Health Organization, to significantly advance our understanding of and approach to LMICs and to help inform strategies for addressing dementia by countries around the world \u20139. By 20https://iadrp.nia.nih.gov/)  . ThroughThis article contains a summary of existing Alzheimer's Association initiatives that support research in LMICs, spanning funding and partnering on research studies, as well as convening researchers both globally and regionally. While it is important to note that LMICs are not homogenous, and that funding and convening activities are unique in each country, we also provide examples in each section for illustrative purposes.Since 1982, the Alzheimer's Association has supported a wide range of projects involving basic science, social and behavioral research and clinical research through numerous investigator-initiated peer-reviewed grant programs. These programs became international in 2000, at that time reaching researchers in more than 50 countries through their applications, awarded funding and review process . Today tA significant number of these projects, some of which are funded in partnership with the Global Brain Health Institute (GBHI) and Alzheimer's Society (UK), are conducted in LMICs by researchers who reside in these regions . Though Despite the current shift toward biological definitions of AD and other dementia , for exaIn the absence of curative interventions for dementia, caregiving and the well-being of caregivers is another important focus of dementia-related care and research supported by these investigator-initiated grants. In Guadalajara, Mexico, for example, Dr. Brenda Perez Cerpa, MD, is funding the evaluation of a decision aid for families of individuals with advanced dementia . The aimThe Alzheimer's Association is devoted not only to developing but also to expanding multinational studies and projects\u2014from international clinical trials to prevention, biomarker validation, and health care utilization studies\u2014to ensure that they include genetically, ethnically, and culturally diverse populations. For some well-established studies already underway, the Association is committed to providing additional funding to ensure greater inclusion of LMICs. One such multinational study is the Dominantly Inherited Alzheimer Network Trials Unit (DIAN-TU), based at Washington University School of Medicine in St. Louis . The DIAA similarly large collaboration aimed at preventing dementia is the World Wide FINGERS network , 18, whiIn January 2020, the Alzheimer's Association also joined leaders in dementia research from Latin America, the GBHI, the Tau Consortium, and the National Institutes of Health (NIH) in forming a new multinational consortium that likewise aims to expand dementia research in Latin America. Research Dementia, Latin America, or ReDLat, is designed to identify unique genetic, social, and economic determinants of health that contribute to the development of AD and other dementia in Latin America. By collecting and analyzing neuroimaging, genetic, and behavioral data from more than 4,000 individuals in Argentina, Brazil, Chile, Colombia, Mexico, Peru, and the US, ReDLat investigators expect to broaden our understanding of the genetic and environmental determinants of dementia, particularly in diverse and underserved populations in Latin America. This large-scale 5-year project is bringing together experts in the fields of neurology, neuropsychology, geriatrics, psychiatry, neuroscience, and genetics from across Latin America.In July 2020, the Alzheimer's Association highlighted its work with researchers from all around the world, and led by the team at University of Texas, San Antonio, to support and advance critical research in response to the current pandemic crisis, with a special focus on research examining the neurological sequelae of SARS-CoV-2 following acute infection. Although much remains to be known about the long-term consequences of SARS-CoV-2 infection, several research studies suggest that COVID-19 is associated with neurological complications .The Alzheimer's Association has long been dedicated to fostering international collaboration among dementia researchers in all countries, in part by providing a range of inspiring forums and professional opportunities. The Alzheimer's Association International Conference (AAIC) is the world's largest gathering of researchers from around the world whose work is focused on AD and other dementia . As a paIn July 2020, in response to the global pandemic, AAIC was held virtually for the first time. This free, on-line conference attracted the meeting's largest audience to date, with more than 33,000 registered attendees and featuring more than 3,000 scientific presentations. The online accessibility of the AAIC experience further enabled dementia scientists from every corner of the world to share and discuss the latest research findings, and network to build new international collaborations, with over 7,000 registered attendees from 93 LMICs. A growing focus on LMICs was also evident in the many presentations that examined or highlighted issues faced by regions comprising these countries, including a plenary session led by Dr. Vijayalakshmi Ravindranath, a scientific leader from the Indian Institute of Science in Bengaluru, India. Such presentations included a systematic review of culturally tailored dementia interventions for minority ethnic groups in low- and middle-income countries, a description of a cognitive assessment test adapted and validated for use by older adults in a Brazilian indigenous community, an examination of multi-morbidity as a correlate of dementia among older people in Central Africa, an overview of socioeconomic determinants of dementia among Caribbean Hispanics, and an examination of cognitive dysfunction among middle-aged adults with type 2 diabetes in South Africa.In December 2015, AAIC launched a series of satellite symposia to extend the reach of AAIC across the globe and provide more learning and participation opportunities to people from all countries, including LMICs. When the first satellite research symposium was held in Mexico City, the prevalence of dementia in Mexico, Brazil, the Andean Area, and Central America was expected to increase by more than 400% between 2010 and 2050 . MoreoveThis first AAIC satellite symposium (AAIC SS) underscored the value of ensuring the incorporation of previously neglected LMIC cohorts in international studies, in part by highlighting unique characteristics of studies across Latin American populations, including those assessing prevalence and incidence of both risk factors and dementia . The resDuring the development of all AAIC SS, one aim has been to select locations that permit greater involvement of regions comprising LMICs. The second AAIC SS meeting, for example, which took place in Bulgaria, in collaboration with researchers at the University of Varna and the University of Pittsburgh, brought this conversation closer to Eastern Europe, provided a forum for showcasing dementia research in neighboring countries, and engaged the expertise of leading researchers in that region of the world. In 2018, an AAIC SS meeting held in Bengaluru, India provided a forum for exploring emerging dementia research in South Asia and similarly engaged leading dementia researchers throughout that region, including in LMICs.All meetings sponsored by the Alzheimer's Association, including AAIC and all satellite symposia, aim to encourage collaboration among professionals from all countries, including LMICs. In 2008, the Alzheimer's Association established a new means to support the dementia research community by creating the International Society to Advance Alzheimer's Research and Treatment (ISTAART) . This esIn line with the UN's Sustainable Development Goal number three to ensure healthy lives and promote well-being for all at all ages, the global dementia research enterprise continues to strive for effective prevention and treatment throughout the world. A critical goal will be to sustain recent efforts to ensure inclusion of LMICs\u2014where two-thirds of people with dementia reside\u2014in large-scale, multinational research studies. Another important goal will be to identify modifiable risk factors in LMICs and determine practical, cost-effective ways of addressing them . OpportuThe original contributions generated in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.HS, LC, and CS provided outline and specific details for sections of the manuscript. SW supported initial draft. MC oversight of the full manuscript and strategy development. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "The variety of material classes engaged for constructions is very wide, ranging from naturally occurring substances, such as stone materials and wood, to manufactured products such as inorganic binders, ceramic bricks, adhesives, metals, composites like concrete, bituminous or fibre-reinforced materials. Often, construction materials and ceramics are considered traditional materials with well-established compositions and manufacturing processes. Supports of this belief are the use of clay minerals as main raw materials and the presence of high-temperature treatments in the industrial manufacturing processes of bricks, tiles, hydraulic binders, pipes and refractories.In the recent years, all the above types of materials have been requested for continuous enhancement of their functional properties and performances. Furthermore, the increasing environment concerns and demand for developing sustainable and circular economy have promoted significant changes in the selection of alternative raw materials and in the development of new or improved production processes. Primary goals of the innovation have been the preservation of natural resources, the reduction of pollutant emissions and, at the same time, tailoring of the products characteristics. Much has been done but the potential for much more to be studied and developed about all the above materials is still equally wide. At his launching, the aim of the Special Issue \u201cCeramics and Construction Materials\u201d was to collect contributions from the research community illustrating the current direction and the recent advances of the search in the field of the above materials, with a special look to the new green and ecofriendly materials.The papers published in this Special Issue deal with different aspects of manufacturing, characterization and maintenance of ceramics and construction materials. They give a screenshot of the present status of the world research in the field. Contributions coming from several countries, like Australia, China, Czech Republic, Korea, Latvia, Poland, Portugal, Slovakia and UK, well illustrate how ceramics and construction materials are becoming more and more different from traditional ones and how their final properties largely depend on engineering optimization. 2O, as an alkali activator, to fly ash accelerates the formation of poorly crystallized hydrates in the hydrothermal synthesis of the cement. This, in turn, allows the formation of a good pozzolanic material even with the lower temperatures of the process. In addition, the application of a kinetic model based on the Jander\u2019s equation reveals to be appropriate for predicting the evolution of the hydrothermal process. Very interesting results were obtained by Gon\u00e7alves et al. [Several published articles are focused on binders and concrete ,4,5,6,7,As far as the properties of cementitious mixes obtained by means of innovative technologies, in article  the effeA work related to metallic construction materials has been developed by Li et al. . In thisPapers ,10 are fIn conclusion, the published papers demonstrate the scientific and technological relevance of the topics dealt with. As evidence of the readers interest, most of them have registered at the time of this Special Issue publication more than 700 readings. Furthermore, the published articles have reached on the whole 36 literature citations."}
{"text": "Patient-centered care is essential in high-quality health care, as it leads to beneficial outcomes for patients. The objective of this review is to systematize indicators for the care of patients with cardiometabolic diseases based on patient-centered care, extending from the stages of diagnostic evaluation and care planning to intervention. An integrative literature review was conducted by searching seven scientific databases, and a narrative analysis was performed. A total of 15 articles were included, and indicators related to diagnosis and care planning/intervention were extracted. In the planning of care centered on the person with cardiometabolic diseases, the individuality, dynamics of the processes, flexibility and the participation of all stakeholders should be taken into account. The needs of the person must be addressed through the identification of problems; establishment of individual goals; shared decision making; information and education; systematic feedback; case management; meeting the patient\u2019s preferences and satisfaction with care; engagement of the family; and therapeutic management. The indicators for intervention planning extracted were behavioral interventions, therapeutic management programs, lifestyle promotion, shared decision making, education patient and information, interventions with the use of technology, promotion of self-management, program using technology, therapeutic relationship, therapeutic adherence programs and specialized intervention. Patient-centered care (PCC) is defined as care that establishes a partnership among practitioners, patients, and their families to ensure that the care needs, values, and preferences of patients are satisfied . PCC is PCC is fundamental in high-quality health care and leads to beneficial outcomes for the patient, such as knowledge about their health, better skills to manage self-care behaviors, increased satisfaction, medication adherence, improved quality of life, and reduced admissions, readmissions and length of hospital stay. Regarding family members, PCC reduces the intensity of stress, anxiety, and depression, increases satisfaction, and improves relationships with health professionals. It also has beneficial effects on the health system, as services with a good cost\u2013benefit ratio are provided ,3.For care to be centered on the patient, it is essential for decision making to be shared. In this care model, health communication is central to supporting patient engagement. Shared decision making has evolved greatly in recent years in Europe and North America. It reflects attitudes, beliefs and practices that should be explicit in PCC and that differ among different regions of the world and, on a smaller scale, among the different regions of a country .One of the greatest challenges of the century is to optimize the health and quality of life of the population. The unavoidable reality of the high prevalence of cardiovascular diseases in the adult population and the aging of the population is a problem. Approximately 70% of elderly individuals have two or more chronic diseases, typically including a cardiovascular disease and a metabolic disease, which makes decision making difficult for health professionals and patients. A patient-centered approach and shared decision making can help ensure that the benefits of care decisions outweigh the harms of multiple comorbidities .Cardiometabolic diseases (CMDs) are one of the main causes of comorbidities and death worldwide, both in developed countries and in emerging and underdeveloped economies. It is estimated that approximately 25% of the global adult population suffers from CMDs. Considered by the World Health Organization as the epidemic of the 21st century, CMDs encompass, among other conditions, obesity, diabetes and hypertension, which are considered risk factors for the development of cardiovascular diseases, such as acute myocardial infarction and stroke and peripheral arterial disease .The risk factors for the development of CMDs are diverse but interrelated, such as hypertension, elevated fasting glucose, obesity and elevated triglycerides; understanding these contributes significantly to the development of clinical and/or treatment strategies . HoweverTo reduce the chances of developing CMDs across the years, it is very important to implement lifestyle changes, such as prioritizing healthy eating and reducing the consumption of simple carbohydrates, sugars, and sodium; exercising at least 150 min per week; controlling alcohol intake; reducing or avoiding smoking; adopting measures that reduce stress ; and having nights of restful sleep .In this sense, it is essential that health professionals carry out a diagnostic assessment, develop an adequate care plan that is adapted to the lifestyle and environment in which they are inserted, and implement person-centered care. However, the scientific literature is sparse and has little consensus on diagnostic assessment strategies, care planning and interventions centered on people with patients with CMDs.This integrative literature review aims to identify and systematize indicators for the care of patients with CMDs based on PCC, extending from the stages of diagnostic evaluation and care planning to intervention.The protocol for this review was registered and published in PROSPERO (CRD42021240880), including the unique characteristics of the methodological procedures, namely, the eligibility criteria and data synthesis strategies.The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols (PRISMA-P) statement ,9. Our mHow can the diagnostic evaluation of patients with cardiovascular and metabolic disease be performed, either through assessment instruments or other types of evaluation?What are the care planning strategies focused on patients with cardiovascular and metabolic disease developed with the objective of promoting health and preventing and/or reducing complications related to the aforementioned diagnoses?What intervention strategies aim to implement care processes focused on patients with cardiovascular and metabolic disease?The review was designed based on the following research questions:\u00ae Plus with Full Text; Nursing and Allied Health Collection; Cochrane Plus Collection, including Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews (CDSR) and Database of Abstracts of Reviews of Effects (DARE); MedicLatina; MEDLINE\u00ae, including International Nursing Index; PubMed via MEDLINE; EMBASE; Scopus; CINAHL; Web of Science; The Cochrane Library ; and the Virtual Health Library (VHL).To conduct the review, a broad literature search was conducted in the following databases: EBSCOhost Research Platform; CINAHLThe search strategy was adjusted to each database and was limited to finding the most recent evidence from the last 10 years, dating from 2011 to 2021, including publications in English, Portuguese, Spanish and Italian.The search involved the combination of four basic concepts in line with the medical subject heading (MeSH) terms; the search phrase was as follows: ((metabolic disease) OR (cardiovascular disease)) AND ((patient-centered care) OR (patient care planning)).First, an exploratory study was conducted without limitations. However, given the large number of results, the search was limited to the title, abstract and/or keywords in the different databases.The studies were selected in different phases. Duplicates were removed from the different search engines. Two reviewers independently analyzed the eligibility of studies to reduce bias and did so by reading the title and abstract. Studies that did not meet the inclusion criteria of the review were excluded. A third reviewer was consulted when disagreements or questions emerged. Last, the full text of the articles was evaluated following the same methodology.The reviewers who selected the studies also extracted the data independently. The third reviewer helped in cases of questions or disagreements.A descriptive evaluation of each study was performed using an instrument designed for data extraction, taking into account the defined research questions.In the evaluation of quantitative, qualitative or mixed studies, it was decided to use the instruments of the Joanna Briggs Institute (JBI), Adelaide, Australia (2020). These instruments rigorously evaluate the essential criteria of primary studies. The critical evaluation instruments were applied by two independent reviewers, with recourse to the third reviewer for consensus in case of disagreement. The result of the critical evaluation of the studies was not defined as an inclusion/exclusion criterion. All studies selected up to this stage were included.This review includes articles with different study designs. We chose to perform a structured narrative analysis of the findings to answer the research questions .The search generated 946 results accepted for reading of the title. After that, 17 were removed because they were duplicates, and 841 were removed because the title did not fit the topic. The abstracts of the 88 selected articles were read, and the full text of 25 articles was analyzed. After reading the full text and applying the inclusion criteria, 10 articles were eliminated .A content analysis was performed based on the extracted indicators and a patient-centered intervention model was built .The intervention indicators extracted from the studies were: Behavioral interventions ,21,24,25This review integrates studies that allow for performing a narrative analysis of process, outcome and improvement indicators resulting from diagnostic evaluations and care planning and/or interventions in patients with CMDs.Person-centered care models reinforce the satisfaction of the person\u2019s needs. Regarding diagnostic evaluations, we found several instruments that are conducive to this care model. Most of the studies found based the diagnostic evaluation on person-centered data collection instruments, such as semi-structured interviews with different care stakeholders, including patients, practitioners and/or family members ,15,21. TBased on the analysis of the various studies, we highlight the importance of conducting an individualized cardiometabolic risk assessment in order to implement primary and secondary prevention strategies adapted to individual risk.The planning of care and the respective intervention found in the selected studies revealed a diversity of data that mostly converge on care centered on patients and their individual conditions. The study conducted by Iturralde et al. (2019)  designedReducing cardiovascular risk is a cross-cutting goal in Western society. Lenz and Monaghan (2011)  demonstrThe guidelines issued in 2013 by the American College of Cardiology and the American Heart Association described in the study by Montori, Brito and Ting 2014)  showed i  showed PCC is associated with less uncertainty in illness than is usual care. Dudas et al. (2013)  report tThe interventions studied are highly heterogeneous and centered on recommendations for health promotion and prevention of cardiometabolic risk factors and using information and communication technologies .In general, the studies included in this integrative review show the following results: improvements in the care process, patient engagement , improveThe clinical results found in the studies were a decrease in cardiovascular risk factors, such as decreased blood pressure levels, decreased blood glucose levels, decreased weight ,14,20 anInterventions aimed at patients with cardiometabolic risk can be in-person or remote  and should be based on the principles of PCC to improve the safety and quality of care. In this sense, the approach to patients should be based on the therapeutic relationship, be holistic and individualized, in which there is empathy, respect, and patient involvement in decision-making, and communication should be clear and assertive. The studies found reported that PCC improved patient assessment, self-care, medication adherence, health and quality of life, and decreased cardiometabolic risk and mortality.These results are in line with the findings of studies in which educational interventions aimed at lifestyles were carried out with the objective of reducing cardiometabolic risk in a more cost-effective way ,30.The main limitation of this study was the decision to conduct the search in electronic databases and portals in Portuguese, English, Italian and Spanish, which may have led to the non-inclusion of publications on the subject in other languages. Another limitation is the heterogeneity of the studies that limits the comparison of findings. However, it allows us to verify the complexity of evaluating patients with CMDs and the variety of interventions in this context.We emphasize the importance of PCC models for patients with CMDs, highlighting the importance of performing a periodic evaluation of cardiometabolic risk with special emphasis on lifestyle assessment.In intervention models focused on patients with cardiometabolic risk, an approach that encompasses behavioral interventions, therapeutic management programs, lifestyle promotion, shared decision making, education patient and information, interventions with the use of technology, promotion of self-management, program using technology, therapeutic relationship, therapeutic adherence programs and specialized intervention.In care planning, some technological strategies can improve the care process and the outcomes, such as the use of e-health programs, telemedicine, follow-up through phone calls, the use of lifestyle diaries, and the use of information systems that support shared decision making.In addition, PCC are related to improvements in communication, patient\u2013practitioner relationships, shared decision making, medication adherence, engagement and responsibility for health, and self-care and care continuity. With regard to clinical outcomes, the PCC approach allows for improving health and quality of life by reducing cardiometabolic risk factors, thus translating into reduced mortality and a decreased need for hospitalization, and hence the associated costs.We find that based on the extraction of results as part of the literature review process, there are different interventions/strategies focused on patients with cardiovascular and metabolic diseases that have a significant therapeutic impact on the quality of the care process, with reductions in health complications related to the aforementioned diagnoses and health gains, thus contributing to the effective monitoring of cardiovascular risk and positive outcomes of people-centered care through coordination, collaboration and partnership."}
{"text": "This is a conceptual paper proposing a new model of Strengths-Based Interprofessional Practice and Education (SB-IPE), incorporating appreciative inquiry and narrative, and its application to improve health and social care practice and policy for older adults. Within people, families, communities, and teams are people who understand their assets and culture, hold a collective wisdom derived from their individual biographies and shared history, and are deeply invested in their success. This wisdom and experience can be mined for strengths and best practices to improve health and social care for older adults and their families. The conceptual framework of the model and relationship between concepts are explained, reviewing and synthesizing relevant literature on the strengths perspective, interprofessional practice and education, evolution of the patient voice, appreciative inquiry, and narrative to leverage the voices and experiences of older adults, their families, and interprofessional teams. Providing person-, family-, and community-centered health and social care through SB-IPE involves eliciting, listening to, and processing stories and narratives, then coalescing and co-creating person/family/team narratives throughout the trajectory of care. Appreciate inquiry and narrative can be harnessed to imagine an improved experience of care for older adults and their families. Incorporating the potential disruption of the voices and perspectives of older adults and their families offers value for health and social care delivery and policy innovation. Application of the SB-IPE model holds promise for harnessing these voices and collective experiences leading from disruption to transformation of health and social care practice, health professions education, policy, and research."}
{"text": "In this review, recent advances in the methods of pre-treatment of plant material for the extraction of secondary metabolites with high biological activity are presented. The correct preparation of the material for extraction is as important as the selection of the extraction method. This step should prevent the degradation of bioactive compounds as well as the development of fungi and bacteria. Currently, the methods of preparation are expected to modify the particles of the plant material in such a way that will contribute to the release of bioactive compounds loosely bonded to cell wall polymers. This review presents a wide range of methods of preparing plant material, including drying, freeze-drying, convection drying, microwave vacuum drying, enzymatic processes, and fermentation. The influence of the particular methods on the structure of plant material particles, the level of preserved bioactive compounds, and the possibility of their release during the extraction were highlighted. The plant material pre-treatment techniques used were discussed with respect to the amount of compounds released during extraction as well their application in various industries interested in products with a high content of biologically active compounds, such as the pharmaceutical, cosmetics, and food industries. The step of sample preparation for extraction and chromatographic analysis has attracted the attention of researchers, analysts, and companies producing analytical equipment for almost two decades. This interest shows the awareness of the importance and impact of this stage of the analytical procedure on the quality of the results obtained. Moreover, it results from the general tendency to use faster and more effective methods which are ideally more environmentally friendly .Proper preparation of material for research and many branches of industry, such as pharmaceutical, cosmetics, and food, is fundamental in extracting and analyzing complex natural materials. Proper sample preparation can increase the extraction efficiency of biologically active compounds. These preparations include weighing, volume measurement, mixing, diluting, heating, cooling, fractionation, purification, and preservation. Weighing is the first stage responsible for the final result of the analysis. The basic task is to ensure the right number of samples are taken for analysis. The volume measurement is used for liquid and gaseous samples. Mixing is one of the steps in the initial sample preparation. It must ensure the homogeneity of the sample and is also used when diluting samples. The heating of the sample is necessary when dissolving or removing water from the material, and lowering the temperature is used for preserving the sample and, e.g., during freeze-drying. Sample purification and fractionation are based on sieving, filtration, sedimentation, centrifugation, foam flotation, membrane filtering, distillation, evaporation, and crystallization. The purification process is often connected with the extraction, i.e., the isolation of analytes from the sample. Therefore, we can also distinguish the technique of solvent extraction , solid-phase extraction, or preparative chromatography. Preservation is intended to protect the sample during processing against a change in analytes\u2019 content as their loss during physical or chemical processing changes the nature of the matrix. All of these activities affect the final yield of extraction ,3.The distinguishing feature of plant material, apart from its variability and the characteristic structured cell architecture, is the abundance of compounds with different physicochemical properties which occur in a wide range of concentrations. Plant material is a very complex matrix composed of a wide variety of plant metabolites, substances with a wide range of polarity. These include waxes, terpenoids, lipids, phenolic compounds, low-polar alkaloids, polar glycosides, polar alkaloids, saccharides, peptides, and proteins. Bioactive compounds are primarily phenolic compounds (including flavonoids), saponins, cyclitols, etc. A good method of preparing a plant sample should be expected to, regardless of the location of a given compound in the matrix, its type, or the presence of other components , quickly and thoroughly isolate the volatile and non-volatile, the polar and non-polar compounds, and be sensitive and resistant, e.g., to high temperature. As a result of a well-chosen method of preliminary sample preparation, phytoactive ingredients become more available and, at the same time, easier to extract. Considering the area of use of raw or pre-processed plant material and the importance of the analysis being carried out, the lack of influence of the method used to change the qualitative and quantitative composition of the tested plant is a particularly desirable feature of the method of preparing a plant sample ,4,5.The preparation of a sample of plant material for analysis involves several important steps. The first step is pre-washing, drying or freeze-drying the plant material, and grinding for homogenization. The following steps are extraction and qualitative and quantitative determination ,2,6.When planning the pre-treatment processes of plant material, several aspects characteristic for a given type of raw material should be taken into account, which, depending on the needs, may be a disadvantage or advantage. In the course of raw material processing, its components usually undergo irreversible chemical changes such as oxidation, hydrolysis, or the condensation of components . Because the plant cell wall is a highly complex matrix, proper preparation is crucial for obtaining a high isolation efficiency of biologically active compounds. Additionally, regardless of whether the raw material was initially pre-treated, its quality will be influenced by many other factors including the way the plant was grown, the place where it was grown, weather conditions, the method of drying the biomass, temperature, the final water content of the raw material, and its storage temperature. All of these factors will influence the final chemical composition of the biomass ,8. ImporBioactive substances isolated from plant material can have antioxidant, antimutagenic, anticancer, antiemetic, antifungal, antibacterial, and many other properties. They are used to treat and relieve symptoms of many diseases. They can be used in the food, cosmetic, pharmaceutical, and agricultural industries as well as many other sectors of the economy ,10,11,12In this review, the pre-treatment techniques of plant material were described. However, method selection is very important for both analytical research at the laboratory level as well as for the industrial level where the main aim is to extract as much bioactive compounds as possible. We focused on conventional methods such as convection drying, microwave vacuum drying, and freeze-drying, as well as paying attention to the increasingly used modern methods: fermentation and enzymatic hydrolysis. We also presented the influence of the discussed sample preparation methods on the content of bioactive compounds in plant material. So far, the techniques mentioned that are currently used in the extraction industry are limited to drying or convection drying. Most of the presented works refer to a laboratory scale but their effectiveness should lead to the transfer of the presented ideas to an industrial scale.Research on medicinal plants begins with pre-extraction, i.e., the initial preparation of the raw material, which is an important stage in processing plant materials. This stage should prepare samples in such a way as to limit the loss of the bioactive ingredients contained in the plants. Preliminary raw material preparation steps such as grinding and drying can also influence the phytochemical content of the final extracts. Many authors, especially those using plants used in ethnomedicine, prepare fresh tissue extracts. However, dried plants are used more often .The drying process is primarily aimed at inhibiting metabolic processes which result in stopping changes in the plant\u2019s chemical composition. This occurs by removing water from the plant material, which is necessary for plant enzymes to function properly. The lack of water and a high drying temperature contribute to the inhibition of enzymes that can break down the active ingredients. Proper drying also reduces the number of microorganisms in the final product. It significantly reduces the weight and volume of plant material, reducing the costs of packaging, transport, and storage of plant substances ,15.The drying of the plant material may take place under natural or artificial conditions. The former includes drying in the open air or semi-open rooms, where free air circulation is used, but there is no direct sunlight. Drying carried out in natural conditions is the oldest method of preserving raw material. Nowadays, this method is abandoned because the process is long and does not allow for the adjustment of drying parameters, which means that the quality of the obtained dried material is low. Drying in artificial conditions includes ventilated rooms with various heating methods, where we can set the temperature range and air pressure ,16,17.The method of drying the plant material largely depends on the active ingredients it contains. If the plant material is a source of flavonoid compounds, drying at high temperatures can be used (even up to 100 \u00b0C and 180 \u00b0C) ,18. ApplDrying is of great importance primarily in the food industry. The quality of the products guarantees that their features will remain unchanged over a long period of time with a high level of consumer acceptance. Effective and thorough drying methods are required to guarantee the high quality of the products obtained. Drying on a laboratory scale can be carried out in laboratory dryers, and on an industrial scale in a vacuum chamber, tunnel, spray drum, tower, and shaft dryers ,17.The most common method for plant material preparation is convection drying. Convection drying is one in which a stream of drying agent  flows around the plant material bringing heat and removing moisture . The dryStevia rebaudiana) leaves decreased with increasing drying temperature, although it remained relatively high ,10095,10The mechanism that determines the efficiency of extraction is the mass transport of the extracted substance from the inside of the plant material and then from the contact surface of the phases to the solvent. The key role in the extraction process is played by the resistance to mass transfer related to the structure of the raw material and the specific location of the extracted compounds ,105. TheThe enzymatic pre-treatment techniques depend primarily on the ability of enzymes to hydrolyze components of the cell wall like cellulose, pectins, and hemicellulose. Degradation of these polymers disrupts the structural complexity of the cell wall and improves the extraction efficiency due to better mass transfer, particle size reduction, increased contact surface and enhanced solvent distribution. Moreover, enzymatic hydrolysis of the plant material results in the reduction of solvent consumption and extraction time ,108,109.Vitis labrusca L.) [The effectiveness of enzymatic hydrolysis depends on the type of enzymes and the selection of optimal conditions like pH, temperature, or ionic strength. For example, pre-treatment with cellulase was very effective in the extraction of phenolic compounds from grape marc. Cellulase and beta-glucosidase, used separately, significantly increase the efficiency of the isolation of polyphenolics from guava leaves. Enzymes can have a synergistic effect; combined pectinase and cellulase activity were very effective in extracting grape juice with high content of polyphenolic compounds from fox vine (usca L.) ,111,112.Angelica sinensis, factors influencing cellulase activity were investigated. It turned out that a pH below 5 and above 9 inhibited the enzymatic activity. The optimum pH was in the range of 7\u20138. The optimal temperature was 40 \u00b0C. The lower and higher temperatures were not appropriate for the enzyme activity [The factors that influence the reaction rate are temperature, substrate and enzyme concentration, inhibitors, and pH. As the temperature rises, the activity of enzymes increases, to a certain point, after which it decreases . As an eactivity . ExperimAn interesting example for the pre-treatment of plant material is the optimization of conditions of hydrolysis with the Box-Behnken design. In order to find the optimal conditions for hydrolysis, 27 experiments have been conducted with the use of four independent variables, i.e., pH, enzyme concentration, time, and temperature of the reaction. HPLC-MS/MS analysis showed that in the extracts obtained from the material previously subjected to enzymatic hydrolysis under optimal conditions, the total content of phenolic compounds obtained was about 2-fold higher compared to the control and 3.4-fold higher compared to the maceration extracts. It has also been shown that the initial treatment of plant material with an enzyme preparation commonly used in the agricultural industry significantly increased the efficiency of the extraction of bioactive substances. The use of enzyme-assisted supercritical fluid extraction in various industries to isolate bioactive compounds from plant material is economically effective and represents an advance in modern technological processes ,114.The pre-treatment of plant material is crucial for the extraction of bioactive compounds. On the laboratory scale, a wide range of methods and protocols are described in the literature. They involve drying, freeze-drying, convection drying, microwave vacuum drying, enzymatic processes, and fermentation. The selection of an extraction method should be based on the type of plant material and isolated compounds as well as prevent their degradation and the development of unfavorable microorganisms. Each selected method will affect the structure of plant material particles differently and subsequently alter the level of released bioactive compounds. However, an important challenge is the introduction of the described new, non-conventional methods of pre-treatment of plant material, such as freeze-drying, microwave vacuum drying, enzymatic processes, and fermentation, into the extraction processes on an industrial scale, which can significantly improve the efficiency of extraction of biologically active compounds. Therefore, further studies on the transfer of the mentioned methods into the industry, taking into account economical aspects, are still required."}
{"text": "In recent decades, high-resolution ultrasound (HRUS) has revolutionized themorphological and structural evaluation of peripheral nerves and muscles,revealing details of the internal structure of the neural fascicles and musclearchitecture. Applications range from diagnostics to interventional procedures.The anatomy of the forearm region is complex, with several muscles and anextensive network of vessels and nerves. To guarantee the success of theevaluation by HRUS, knowledge of the normal anatomy of the region is essential.The aim of these two companion articles is to present the normal anatomy of thenerves and compartments of the forearm, as revealed by HRUS, as well as therelationships between the main vessels and nerves of the region. Part 1 aims toreview the overall structure of nerves, muscles and tendons, as seen on HRUS,and that of the forearm compartments. We present a practical approach, withgeneral guidelines and tips on how best to perform the study. Part 2 is apictorial essay about compartment vascularization and cutaneous innervation. Therelationships between arteries, satellite veins and nerves, as well as therelationship between cutaneous nerves and superficial veins, are demonstrated.Knowledge of the normal anatomy of the forearm improves the technical quality ofthe examinations, contributing to better diagnoses, as well as improving theperformance and safety of interventional procedures. To guarantee the success of the HRUS evaluation, knowledgeof the normal anatomy of the region under study is essential. Familiarity with therelationships between the vessels and nerves in the forearm is important to ensuresafety in interventional procedures.In recent decades, high-resolution ultrasound (HRUS) has revolutionized themorphological and structural evaluation of peripheral nerves andmusclesThe aim of these two companion articles is to present the normal anatomy of thenerves and compartments of the forearm, as revealed by HRUS, as well as therelationships between the main vessels and nerves of the region. Part 1 aims toreview the overall structure of nerves, muscles and tendons, as seen on HRUS, andthat of the forearm compartments. We present a practical approach, with generalguidelines and tips on how best to perform the study. Part 2 is a pictorial essayabout compartment vascularization and cutaneous innervation. In this second part, wefocus on the relationships among arteries, satellite veins, and nerves, as well ason those among cutaneous nerves and superficial veins. The article is illustratedwith images obtained with a high-resolution broadband 18-5 MHz linear transducer.All individuals depicted in the images were volunteers and gave written informedconsent.There are several neurovascular bundles in the forearm region, the vessels andnerves showing greater or lesser relative proximity along their course. Thearterial blood supply is provided by the ulnar and radial arteries and theirrespective branches . Whenpr. In its initial course, the ulnar arterypasses below the ulnar head of the pronator teres muscle, which separates itfrom the median nerve , as well as the supinator muscle,and, together with the venae comitantes, form the so-called leash ofHenry, which is in close proximity with the deep andsuperficial branches of the radial nerve and can compress those structures vein, the basilic vein, and the median vein. The superficial veins do not follow thecourse of the large arteries, presenting great interindividual variability intheir course, confluence, and number. The deep veins (venae comitantes)accompany the radial and ulnar arteries  and 4. TFor evaluating the peripheral nerves and muscles of the forearm, HRUS is an excellentmethod. The analysis of the relationships between vessels and nerves, which isrelevant in intervention procedures, can be facilitated by the ancillary use ofDoppler. Knowledge of the normal anatomy of the forearm improves the technicalquality of the examinations, contributing to better diagnoses, as well as improvingthe safety and performance of interventional procedures."}
{"text": "With the growing problem of the emergence of antibiotic-resistant bacteria, the search for alternative ways to combat bacterial infections is extremely urgent. While analyzing the effect of antimicrobial peptides (AMPs) on immunocompetent cells, their effect on all parts of the immune system, and on humoral and cellular immunity, is revealed. AMPs have direct effects on neutrophils, monocytes, dendritic cells, T-lymphocytes, and mast cells, participating in innate immunity. They act on B-lymphocytes indirectly, enhancing the induction of antigen-specific immunity, which ultimately leads to the activation of adaptive immunity. The adjuvant activity of AMPs in relation to bacterial and viral antigens was the reason for their inclusion in vaccines and made it possible to formulate the concept of a \u201cdefensin vaccine\u201d as an innovative basis for constructing vaccines. The immunomodulatory function of AMPs involves their influence on cells in the nearest microenvironment, recruitment and activation of other cells, supporting the response to pathogenic microorganisms and completing the inflammatory process, thus exhibiting a systemic effect. For the successful use of AMPs in medical practice, it is necessary to study their immunomodulatory activity in detail, taking into account their pleiotropy. The degree of maturity of the immune system and microenvironment can contribute to the prevention of complications and increase the effectiveness of therapy, since AMPs can suppress inflammation in some circumstances, but aggravate the response and damage of organism in others. It should also be taken into account that the real functions of one or another AMP depend on the types of total regulatory effects on the target cell, and not only on properties of an individual peptide. A wide spectrum of biological activity, including direct effects on pathogens, inactivation of bacterial toxins and influence on immunocompetent cells, has attracted the attention of researchers, however, the cytostatic activity of AMPs against normal cells, as well as their allergenic properties and low stability to host proteases, are serious limitations for the medical use of AMPs. In this connection, the tasks of searching for compounds that selectively affect the target and development of an appropriate method of application become critically important. The scope of this review is to summarize the current concepts and newest advances in research of the immunomodulatory activity of natural and synthetic AMPs, and to examine the prospects and limitations of their medical use. Antimicrobial peptides (AMPs) are an ancient and widespread class of compounds widely-spread from prokaryotes to eukaryotes and aimed at host defense from pathogen penetration ,2,3.AMPs contain from 5 to 100 amino acid residues, including basic  and hydrophobic (often more than 50%) residues. The classic cationic antimicrobial peptides are defensins and cathelicidins.The history of AMPs began in 1939 when a peptide in soil from Bacillus bacteria showing a protective effect against pneumococcal infection in mice was discovered and called gramicidin ,5. AMPs Hyalophora cecropia and named them cecropins A and B ..27].Systematization of AMPs can be based on sources and methods of production of amino acid sequences and secondary structures  . Most AMThe main function of AMPs is bactericidal or bacteriostatic action. Antimicrobial activity of AMPs is realized via direct interaction with bacterial cell walls based on electrostatic forces. Cationic AMPs interact with the negatively charged surface of the outer membrane of the bacterium and either neutralize its charge, create pores and penetrate the outer membrane, or bind to LPS and destroy the membrane. As soon as the peptides pass through the outer bacterial membrane, they bind to phospholipids of the negatively charged surface of the cytoplasmic membrane of the bacterium and cause fatal changes in the membrane structure or create transmembrane channels. As the result, the integrity of the bacterial cell is disturbed and its death occurs .In most cases, the lytic activity of AMPs manifests itself in a destructive effect on bacterial membranes, but, in addition, a number of AMPs have the ability to affect the cytoplasmic targets of bacteria , inhibitEnterobacterales reduce the number of E. coli cells and increase the population of Bifidobacterium and Lactobacillus in the cecum .,85.MacacThe discovered ability of AMPs to prevent the appearance of biofilms ,80,86, aAMPs in humans are represented by three main families: defensins, cathelicidins, histatins. Defensins, depending on the type of disulfide bond arrangement, are divided into alpha- and beta-defensins. Alpha- and beta-defensins are constitutively produced by neutrophils, lymphocytes, and epithelial cells of the skin and mucous membranes .Human alpha defensins 1\u20134 are also called human neutrophil peptides 1\u20134 (HNPs), since they are most often expressed by neutrophils and account for up to 50% of the total protein content in these cells ,99. ThesBeta-defensins are expressed by epithelial cells of the skin and mucous membranes ,107,108.Defensin secretion is induced both by whole bacteria and by their components, for example, by LPS, lipoteichoic acid, lipid A, and muramyl peptides ,116,117.AvBD2, AvBD6, and AvBD7 related to beta-defensins and cathelicidin CATH2 both in vitro and in vivo ..265].Thus, the initially detected antimicrobial activity of AMPs in humans is not the only one, and, possibly, their immunomodulatory activity makes an equal contribution to the manifestation of effector functions. For the successful use of AMPs in medical practice, it is necessary to study in detail their immunomodulatory activity, taking into account their pleiotropy, the degree of maturity of the immune system and the microenvironment in order to prevent complications and increase the effectiveness of therapy. It should also be taken into account that the real functions of one or another AMP depend on the type of total regulatory effect on the target cell, and not only on the individual properties of the given peptide."}
{"text": "Blindness (Ensaio sobre a cegueira in Portuguese), a novel that describes the effects of a mass epidemic of blindness. Unlike Saramago's book, in which the cause of such sudden condition remained unexplained, the agent causing the most devastating human pandemic in recent history, referred to as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been fully characterized shortly after its first identification in late 2019 in Wuhan, China. Coronaviruses are relatively novel threats to public health. However, veterinarians have a long-standing experience in fighting diseases caused by this family of RNA viruses. Furthermore, mass epidemics have recently affected animals more frequently than humans and for that reason, many veterinarians have had the chance to experience the complexities associated with dealing with emergencies that resemble the challenges associated with the coronavirus disease (COVID-19) pandemic.In 1995, Nobel Laureate Jose Saramago published https://www.worldvet.org/news.php?item=465). This Research Topic by Frontiers in Veterinary Science joins that celebration, bringing together a collection of 12 scientific papers representing stories, opinions, perspectives, and research results that illustrate the impact that the COVID-19 pandemic has caused on veterinary sciences and veterinarians. Papers have been grouped into three major areas, illustrating how the pandemic has (a) impacted our perspectives for veterinary public health and one health, (b) affected animal welfare and the operation of veterinary services, and (c) promoted novel research initiatives and opportunities, respectively.In response to this health crisis, probably for the first time in history, the scientific community was in the spotlight. However, public attitudes and opinions toward science were heavily polarized and influenced by political, social, and philosophical views. While many looked at science as a source of answers and a resource for data and information that enable better understanding, and ultimately control and prevention of the disease, there was also miscommunication, skepticism, and even social revelry. In the middle of such complex social, economical, and political scenarios, and while the scientific community engaged in an unprecedented race for discovery, from the onset of the pandemic, veterinarians placed themselves at the forefront of that fight. Veterinary Clinics and hospitals were adapted to fulfill protocols and mitigate risks while still taking care of their mission, veterinary laboratories were adapted to aid with the diagnosis and molecular characterization of the SARS-CoV-2, human and financial resources were shifted to support research aimed at helping with the control and prevention of the disease. To honor the efforts of veterinarians around the globe, the World Veterinary Association (WVA) dedicated the 2021 World Veterinary Day (April 24) to celebrate the work of veterinarians to protect animal and human health during the COVID-19 pandemic . The extent and complexity of the human-animal interaction have also been affected, in some places, by an increase in the legal and illegal trade of wildlife for consumption, which, in addition to increasing the risk for disease transmission, has impaired access to resources for native communities around the world, which typically rely on wild meat to meet their nutritional requirements . However, silver bullets do not exist and solutions are difficult to design and implement; indeed, there is a risk that restrictive measures to trade, imposed in an attempt to reduce the likelihood of diseases spreading, would affect food security further, adding to the damage that the pandemic has caused to global food access .Although the benefits of the coexistence of animals and humans have traditionally exceeded the negative consequences of such interaction, in recent decades, human population growth and efforts to alleviate poverty and hunger have led to an increase in the magnitude and complexity of such interactions, affecting widespread and disparate geographies and a variety of animal species. Consequently, there was a dramatic increase in the risk for the emergence and transmission of diseases in the human-animal interface. There is an urgent need to search for, identify, and characterize potential sources of emerging pathogens at the animal-human interface and to develop strategies to prevent or mitigate the risk for future pandemics (Marchant-Forde and Boyle). In response to the crisis, in many countries, multisectoral groups were established in an attempt to mitigate the impact of the pandemic on animal welfare. For example, a group of organizations in Australia outlined recommendations aimed at protecting animal welfare in the country and promoting similar actions in other regions .COVID-19 outbreaks have had devastating consequences for some activities, particularly those conducted in confined spaces in which workers are located close to each other, such as meat processing plants. The capacity of pig processing plants in the U.S. was reported to have decreased by 45% at a given time during the epidemic, representing a daily reduction of ~250,000 animals in the country's capacity to slaughter pigs. The situation severely affected animal welfare, in the form of longer transportation times to process pigs in plants that were still active, culling of animals in farms, and the potential environmental impact associated with the disposal of those carcasses .Veterinary clinics, hospitals, and laboratories have also been affected by the pandemic, with regular function and activity disrupted in many complex ways. Challenges included, for example, partial or complete shutdowns, interrupted courier services, disruptions in workflow and diagnostic testing, and the need to adapt laboratories to new physical distancing practices, protocol development or enhancement for handling samples from high risk or susceptible species, and fulfilling requirements for pre-test permission approval from state and federal veterinary agencies (Mobasheri).On the other hand, the COVID-19 pandemic also inspired and promoted research initiatives emerging from veterinary sciences throughout the world, with the objective of aiding control of the emergency under a One Health umbrella. In the interface of animal and public health, there is an opportunity for the knowledge and experiences emerging from veterinary sciences to accelerate response and preparedness against COVID-19 and other potential emerging threats . Similarly, animal models of coronavirus infections can help understand the pathogenesis and implications of the disease in humans. For example, neurological signs have been reported in human cases of COVID-19, while, recently, there have been promising results in the use of antiviral drugs for the treatment of the neurological form of coronavirus infection in cats (Dickinson). In addition to animal models, epidemiological models originally developed for animal diseases were adapted to help explain and predict the spread of COVID-19 in human populations .One potential area of collaboration is rooted in the basic and applied research conducted for decades in the veterinary field to develop antivirals and immune modulators to help control the diseases caused by coronaviruses in animals. For example, recombinant bovine gamma interferon (rbIFN-\u03bb) was found to be effective in preventing SARS-CoV-2 infection in VERO cells . In a broad context, many lessons learned from the management of animal health emergencies could have helped and should be adopted in the future, anticipating further global failure, which has already been experienced in addressing the COVID emergency, stressing an urgent to revisit a global strategy for implementation of the One Health agenda (Enticott and Maye).Successful initiatives to support this response through a collaborative One Health approach were launched, including, for example, the parameterization of mathematical models of COVID-19 spread in Ireland, leverage of public and veterinary epidemiology resources to support the response to the pandemic in Australia, and multinational collaboration to create a platform for knowledge exchange in sub-Saharan Africa (In conclusion, similar to the character that escaped blindness, who was able to see during the epidemic described in Saramago's fictional novel, we expect that the collection here illustrates the light that veterinary sciences may bring in the form of reflection, and the generation of the foundational knowledge required to develop tools and strategies for fighting one of the most impactful health challenges experienced in our recent history, while increasing preparedness and mitigating the risk for, and impact of, future global emergencies.AP was the sole author of this manuscript.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "In the Abstract, there are errors in the second and fifth sentences of the paragraph. The correct sentences are:The Queensland Department of Transport and Main Roads (TMR) are preparing for the Ipswich Connected Vehicle Pilot, the largest Field Operational Test (FOT) in Australia to evaluate C-ITS safety benefits. As part of supporting TMR deliver this Pilot,In the planned FOT, the participating vehicles are only equipped with the vehicle C-ITS. However, we are investigating the usage of the Inertial Measurement Unit (IMU) as a second source of measurement (supporting device) based on the UAH-DriveSet dataset [26].The following information is missing from the Acknowledgements: The Ipswich Connected Vehicle Pilot is an initiative of the Queensland Department of Transport and Main Roads, and is supported by the iMOVE CRC, the Motor Accident Insurance Commission, the Queensland University of Technology, Ipswich City Council, Telstra and the Federal Department of Infrastructure, Transport, Cities and Regional Development."}
{"text": "The land development by human beings has changed from the initial small-scale and low-level transformation to the comprehensive utilization of large-scale and high-intensity implementations. The contradiction between production-living-ecology space (PLES) has become increasingly prominent while drawing land dividends. As one of the important birthplaces of Chinese civilization and the ecological barrier in the northern region, the rapid urbanization and industrialization of the Yellow River Basin (YRB) make the ecological environment very fragile, and the imbalance of land and space development is extremely serious. Therefore, according to the multifunctional characteristics of land use, this paper establishes a classification system of production space (PS), living space (LS) and ecology space (ES), and discusses the spatiotemporal evolution and conflict distribution characteristics of the PLES with the help of the transfer matrix and spatial conflict index (SCI). The results are as follows. In 1990\u20132020, agricultural production space (APS), grassland ecology space (GES) and other ecology space (OES) yielded the largest proportion of PLES in the YRB. However, compared with 1990, the area of these spatial types decreased in 2020, while the urban living space (ULS) expanded rapidly. The distribution pattern of PLES was generally consistent, and the transformation between PLES in Ningxia, central Inner Mongolia, Loess Plateau and downstream areas was relatively intense. The conflict index of PLES showed an upward trend, but it was generally in a controllable range. The stable and controllable areas were concentrated in the upstream of the urban agglomeration, and the midstream and downstream were basic out of control and seriously out of control, respectively. Territorial space is the carrier of socioeconomic development, as well as the support of human survival and development, and the evolution of its pattern and function is the result of the continuous interaction between humans and land ,2. The iSince the beginning of the new era, China has attached great importance to land planning to address a series of negative problems caused by the overexploitation of land resources. The report of the 18th National Congress put forward the overall construction goal of \u201cIntensive and efficient in the production space, livable and moderate in the living space, beautiful in the ecological space\u201d, and made optimizing the spatial development pattern of the country the first step in the construction of ecological civilization. In 2017, the National Land Planning Outline was released to make specific arrangements for regional development, the construction of the main functional areas and development goals, and in the report of the 19th National Congress, it was further proposed to carry out the delineation of three control lines, namely the \u201cecological protection red line, permanent basic agricultural land and urban development boundary\u201d.The YRB is a typical region of rapid economic and social transmutation ,17,18; hThe structure of this paper is as follows: In the 1980s, western countries launched a number of spatial planning research programs. By establishing evaluation models and using GIS and other methods, the suitability and mode of land spatial development were evaluated from the perspective of environmental protection ,21,22. TThe quantitative identification of the PLES is mainly based on the measurement of spatial quantity or quality, and the common measurement methods include land use type consolidation and the comprehensive index evaluation. On the one hand, from the existing research results, the method of land use consolidation is the most widely used, and it is based on the functions carried by each land use type to identify the pattern characteristics of the PLES intuitively and quickly ,24. HoweMost studies on the spatiotemporal evolution of the PLES have been conducted with the help of the ArcGIS platform and combined with econometric models for quantitative analysis. In the literature, most of the existing studies analyzed the spatial evolution characteristics of PLES in terms of quantity, speed and direction of change, as well as pattern, equilibrium and patch change ,31,32,33The study of \u201cconflict\u201d originated from sociology, and refers to the psychological or behavior contradictions caused by the incompatibility or opposition of different actors in goals ,35,36. WIn summary, many scholars adopt a variety of methods to carry out research on territorial space or PLES, with diverse research perspectives and rich research results. However, due to the interdisciplinary nature and diversified research standpoint, a unified research route has yet to be formed. Prominent problems such as the contradiction between humans and land caused by the continuous improvement of the utilization intensity of space resources have become increasingly prominent. Research on the spatial conflict of the basin combined with land use conflict and PLES is still rare. The contributions of this paper mainly focus on the following aspects: First, land use conflicts and PLES are combined to reclassify land use types and construct the PLES classification system. Second, taking the YRB as the research object, the spatiotemporal evolution of production, living and ecology space is described, and a conflict model is established to analyze the regional differences in spatial conflicts. Finally, this study provides a scientific basis and decision-making reference for the coordinated and healthy development of PLES, and provides a theoretical basis, technical support and typical case analysis for the management and regulation of land use spatial conflicts in the basin.2 . The Yellow River runs across the three strategic regions of East, Central and West China, and is a giant ecological corridor connecting the four geomorphic units of the Qinghai-Tibet Plateau, Inner Mongolia Plateau, Loess Plateau and North China Plain. The overall terrain of the basin is high in the west and low in the east. The average altitude of the western source region is over 4000 m, with numerous mountains and large topographic fluctuations. The elevation of the central region is 1000\u20132000 m; the geological structure is broken; and the soil texture is loose. Most of the eastern elevation does not exceed 50 m, and is mainly formed by the Yellow River sediment alluvial plain.The Yellow River is located at 31\u00b031\u2032\u201343\u00b031\u2032 N, 89\u00b019\u2032\u2013119\u00b039\u2032 E, starting from the Bayan Har Mountains on the Qinghai-Tibet Plateau and flowing eastward through nine provinces (regions): Qinghai, Sichuan, Gansu, Ningxia, Inner Mongolia, Shaanxi, Shanxi, Henan and Shandong . The totThe YRB is a complex area of China\u2019s \u201ceconomy-society-environment\u201d system. By the end of 2018, the total population of the YRB was 420 million, accounting for about 30% of the total population of China, and the regional GDP was 23.9 trillion yuan, accounting for more than a quarter of China. As the foundation and lifeblood of the development of northern China, it formed an obvious ladder development pattern of backwards upstream, rising midstream and developed downstream. In industrial and agricultural production, coal, oil, natural gas and mineral resources are abundant. Resource-based cities relying on the exploitation and processing of energy resources account for 47% of the total number of cities in the basin, and are important energy, chemical, raw materials and basic industrial bases. Agricultural and animal husbandry production also plays a pivotal role in the national economic pattern. The corresponding human living space is mainly concentrated in some river valleys in the upstream and plain areas in the midstream and downstream. Driven by natural environmental constraints and economic factors, the population distribution is dense in the middle and east, and sparse in the west. The ecological environment of the YRB is very fragile; the ecological functions of natural grasslands in the upper reaches are severely degraded; the middle reaches are faced with severe soil erosion problems; and urban life, industry and agriculture cause pollution to water resources. In recent decades, due to the rapid development of urbanization and industrialization, coupled with the complex geographical and climatic characteristics, the competition between production, living and ecology space has become an important factor restricting the sustainable development of this region.PLES is the reflection of humans\u2019 diversified demands for various products and services in daily work and life. It is the result of the interaction of different spatial environments and spatial scale elements, and is manifested in different utilization structures and ways in land use . With thPS refers to the type of land use space that provides people with various products and services. This space takes land as the carrier to serve the most basic survival needs of human beings. It is the output of production and operation activities of the land use system, providing economic sources for most human beings and achieving the long-term goal of maintaining survival and development. . Among tLS refers to the type of land use space used by human beings for living, entertainment, science, education, culture and health, and some special purposes. This space aims to provide basic living conditions and security, and further meets the spiritual and cultural needs of human beings, which is the ultimate goal of the land use system . As the ES refers to the type of land use space that regulates the atmospheric environment, protects biodiversity, maintains soil and provides ecological products. This space is the foundation and support of production and living space, and is closely related to local natural resource endowment . It can The essence of PLES evolution is a complex process of land use change. Under the influence of various driving factors such as the social economy and natural environment, it is manifested in the competition of various stakeholders for land use structure and form. In this dynamic process, PS guarantees various products and services produced and developed by human beings; LS meets the purpose of human habitation and social needs; and ES provides the basic material basis for human survival. Taking human beings as the center, various spatial types form the basic relationship of conflict and coordination with their unique functions. For example, ES meets people\u2019s ecological needs and provides raw materials for PS. However, if human activities in PS and LS exceed the ecological carrying capacity, this will lead to environmental problems such as ecological pollution. Therefore, the evolution of PLES is a complex dynamic process, and its driving factors are mainly expressed in two aspects. In terms of social factors, the level of economic development, policies and regulations, residents\u2019 life, population, industrial development, transportation and education all inevitably have an impact on the evolution of the PLES. Population factors, for example, population growth, distribution, age structure, comprehensive quality and migration will directly or indirectly promote the PLES evolution. In terms of natural factors, topography and climate characteristics are the basic factors affecting the distribution and change of PLES, such as slope, elevation and soil. In addition, the conversion of cropland to forest and grassland, land reclamation and deforestation can also affect the quantitative change of PLES.S is the land area; n is the total number of land types; and i and j are land use types at the beginning and end of the study period, respectively. In this paper, ArcGIS10.2 software is used to calculate the statistics of PLES space types in different periods, and then an Excel pivot table is used to establish the PLES transfer matrix.The transformation of the PLES type and structure is realized by a land use transfer matrix model. The transfer matrix is a two-dimensional matrix that lists the transfer area of land use change according to the status quo of land cover in the same area and different phases, which serves as the basis of structural analysis and change direction analysis. It can not only reflect the area of each space type in a fixed region and at a fixed time statically, but also describe the area transfer of each space type at the beginning of the period and the area transfer of each space type at the end of the period ,47. ThisLand use systems are complex, dynamic, and fragile, so spatial conflicts need to be considered from the three aspects of system complexity, stability and fragility . To avoii and j are the j-th spatial types in the i-th spatial unit; m is the total number of spatial evaluation units in the YRB; and n is the total number of PLES types.The PLES complexity index reflects the gradual increase in the scale and intensity of land use due to rapid urbanization, and the continuous shaping of the surface morphology, resulting in the fragmentation of patches and the intensification of contradictions in space use. The area-weighted mean patch fractal dimension (AWMPFD) reflects the degree of interference of the domain plate on the measured patch, and to a certain extent reflects the impact of human activities on the spatial pattern. The higher the value is, the greater the external pressure on the patch. The AWMPFD in the landscape ecological index is used to characterize the spatial complexity index of PLES to measure the shape complexity of spatial patches. The formula is:The PLES vulnerability index reflects the ability of space patches to withstand external pressure. At different stages, various land use types have different responses to external disturbances. The weaker the resistance is, the more vulnerable it is to external influences, and the higher the level of spatial conflict. Therefore, from the perspective of landscape ecology, using the vulnerability of various landscapes inside the space to calculate the PLES vulnerability index, the formula is as follows: results ,26. ValuThe PLES stability index refers to the phenomenon where the regional spatial pattern fragments landscape patches under the interference of external pressure; the linear patches are \u201cfishing nets\u201d, and the dot-shaped patches show an agglomeration state, with increased density and separation, resulting in a decrease in the proportion of planar patches in the spatial unit. The more fragmented and complex the spatial form, the worse the stability within the spatial unit, the greater the spatial risk and the higher the intensity of spatial conflict. Therefore, the fragmentation degree of the landscape ecology is selected to represent the spatial stability index, and the formula is as follows:Using the moving window method in Fragstats 4.2 software to measure the spatial conflict level of the PLES in the YRB, taking into account the characteristics of the research scale, data type, data volume and spatial patch conditions, comparing different size window units  and referring to related research, it is found that the 4 km \u00d7 4 km window can better express the spatial conflict distribution characteristics. If the patch in the boundary area of the study area does not cover the entire unit area, the calculation is performed based on a complete unit area to calculate the index in each spatial unit mentioned above. Finally, the spatial conflict index is standardized to . According to the inverted \u201cU\u201d-shaped spatial conflict trajectory model, the space conflict index is divided into four categories: stable and controllable  and basically controllable , basically out of control  and seriously out of control .The PLES data of the YRB evolved from the land use type. These data come from the Resource and Environmental Science and Data Center of the Chinese Academy of Sciences. Among them, land use data include grid datasets of 1 km \u00d7 1 km in 1990, 2000, 2010 and 2020. The data are based on Landsat 8 remote sensing images, generated by the human-computer interaction visual interpretation and interpretation, including 6 primary types and 25 secondary types of cultivated land, forestland, grassland, water, residential land and unused land. Using ArcGIS 10.2 software, the land use types of the YRB were extracted based on the administrative division vector file; the PLES was divided by reclassification and other methods, and this software was used for mapping and data analysis.With the help of ArcGIS 10.2 software, the area of the PLES of the YRB in 1990, 2000, 2010 and 2020 was extracted, and the changes in the spatial area of each category were calculated. The results are shown in Overall, during the study period, the APS, GES and OES showed a shrinking trend, and the other four types of land use space had different degrees of expansion. Among them, ULS has the fastest growth rate, and the rest are IPS, RLS, WES and FES. The reason is that since the reform and opening up, the rich land and natural resources of the YRB gradually entered a stage of rapid development, coupled with its large population, rapid advancement of economic, social and cultural undertakings, rural surplus labor flows to cities and towns, urban land and transportation, and industrial and mining land rapidly increased, leading to the expansion of the ULS and IPS . In addiBased on the above analysis of temporal evolution characteristics, the spatial pattern characteristics of PLES in the YRB are further analyzed, as shown in 2 and 12,439 km2, respectively, during the period, and the growth rates were 225.22% and 169.52%. In internal conversion, from the perspective of roll-in structure, in terms of PS, APS is mainly converted from RLS and GES, and IPS is mainly converted from APS and GES; in terms of LS, both ULS and RLS are mainly converted from APS; in terms of ES, FES is mainly converted from APS and GES, and GES is mainly converted from APS and OES. The WES is mainly converted from APS, GES and OES, and OES is mainly converted from GES. From the perspective of roll-out structure, in terms of PS, APS is mainly transformed into ULS, RLS and GES, and IPS is most transferred to OES. In terms of LS, the transformation of ULS to other types of space is not obvious, and RLS is mainly turned to APS. In terms of ES, FES is mainly transformed into GES; GES is transformed into APS and OES; and OES is mainly transformed into GES.To explore the internal transformation characteristics of the PLES in the YRB, based on the distribution map of the PLES in Based on the above analysis, the spatial distribution of land conversion in different periods is further discussed . OverallBy calculating the spatial conflict index of four periods in the YRB, it is found that the average values of the spatial conflict index in 1990, 2000, 2010 and 2020 are 0.41, 0.43, 0.53 and 0.57, respectively . With thThe spatial conflict index of each spatial unit was further calculated, and the spatial distribution of the conflict index of PLES in the YRB from 1990 to 2020 was visualized by using ArcGIS 10.2 software . In geneThe spatial conflict levels of the three spatial types in the YRB were calculated and statistically analyzed , and the(1)From 1990 to 2020, PS and LS expanded by 0.87% and 6.75%, respectively, while ES decreased by 0.37%. In terms of spatial distribution, the APS of PS is concentrated in the traditional agricultural production area downstream, while the APS of the midstream and upstream is scattered. The distribution of LS corresponds to the agricultural and industrial production space. The density of LS in the downstream is significantly higher than that in the midstream and upstream, while the distribution of ecology space is more in the west and less in the east.(2)APS, GES and OES decreased, and the rest of the space types showed a trend of expansion. IPS and ULS expanded rapidly. In terms of transition and transition structure, each space type has different transformation directions, but the transformation between ES and PS is the main transformation direction. In the downstream area, the transformation between PS and LS is mainly reflected in the mutual transformation of PS and LS, and the transformation distribution of ES and LS is scattered.(3)From 1990 to 2020, the intensity of conflicts in PLES gradually increased, but it was still controllable. Stable and basic controllable space units accounted for more than 70%, and basic and seriously out of control space units gradually increased. In terms of space, the basic controllable space units are mainly distributed in the upstream region and relatively concentrated, while in the downstream region, they are mainly basic out of control and seriously out of control, and their distribution is relatively fragmented. Specifically, the variation range of conflict units in PS and LS is the same, while the variation range of conflict units in ES is smaller.(1)Although most of the upstream areas are in a stable and controllable state, as China\u2019s Water Tower and ecological spatial agglomeration area, ecological protection should be considered in the first place; the relationship between the production, living and ecological environment should be correctly handled, promote the construction of water conservation capacity, strengthen regional desertification control and strictly implement the principle of ecological access. The construction of nature reserves should promote ecological restoration, adhere to local conditions, comprehensively utilize engineering measures and biological measures to manage the ecosystem, control the ecology space at different levels and scales, delimit the rigid core elements and elastic space of ecological protection, reduce the frequency of human social and economic activities and alleviate the contradiction between human activities in the ecology space and the ecological environment.(2)The midstream region should be committed to the spatial governance of soil erosion. On the one hand, it is important to protect forestland, grassland and unused land, enhance the soil and water conservation capacity, prevent the fragmentation of ecology space caused by urbanization and industrialization and take into account the economic and ecological benefits of land use. On the other hand, ecological restoration should be actively promoted to improve the management efficiency in the middle reaches. For irrigated agricultural areas, excessive consumption of water resources in agriculture and industry should be prevented; the proportion of ecological water should be increased; the intensity of land development should be strictly controlled; industries related to ecological environment protection should be developed; and the coupling and coordination level of PLES should be improved.(3)The downstream region, as the region with the most serious conflict, is densely populated and has high industrial and agricultural production intensity. First, it is necessary to improve the quality of the population while reasonably controlling the size of the population, with land efficient and intensive use as the development goal, optimize the industrial layout, focus on cultivating new industrial systems, strictly control the disorderly expansion of urban and rural construction land, improve the utilization efficiency of existing construction land and alleviate the contradiction between industrial and agricultural production and ecological protection to create a green ecological corridor in the lower reaches of the Yellow River. Second, for the vast agricultural production space, the level of agricultural mechanization should be improved, protect high-quality cultivated land resources, improve land output income and reduce dependence on land resources. Finally, the concept of green development was combined with technical means, using the theory and technology of sponge cities, green buildings and ecological materials to promote the construction of urban ecological civilizations and strengthen the positive impact of land invisible forms on the ecological environment.Based on the PLES perspective, this paper constructed a land use classification system in the YRB, and revealed the evolution characteristics and conflict index of PLES from 1990 to 2020. Strengthening spatial governance and improving land use efficiency is a complex system project that is affected by natural and human factors in various regions. Therefore, it is necessary to promote the scientific demarcation of the boundary of PLES in the YRB, strengthen the control and supervision of the boundary of various spatial types and divide the boundary of production, living and ecological spaces scientifically and reasonably according to the resource and environmental carrying capacity, spatial conflict level, spatial development suitability and social and economic development status of each region."}
{"text": "Internet of things technology began to spread to all industries of our lives; the application of medical internet of things in many hospitals highlighted its advantages and brought a lot of convenience to patients and medical staff. With the continuous progress of China's medical reform and the continuous improvement of patients' requirements for medical service quality, this paper discusses the application of medical internet of things in clinical nursing in ward, and the basic information collection, infusion, and mobile nursing were discussed and studied. Through the parallel control study of the laboratory itself, this paper evaluates whether the two different clinical measurement methods of medical internet of things technology and traditional technology are consistent in body temperature, pulse, respiration, and blood oxygen saturation. At the same time, it also deeply studies the value and advantages of internet of things technology in the application of other monitoring indicators in clinical nursing and analyses the problems in its application. The experimental data show that the two measurement methods with different principles can be completely replaced in clinical application, and the time efficiency of the new clinical nursing method under the medical internet of things technology in mapping body temperature, pulse, and respiration has been improved by 76.20% and 72.02%, respectively, surpassing the traditional information technology and realizing the intelligent, automatic, and standardized data acquisition method. It ensures the authenticity of data and the real-time of information flow and meets the needs of resource sharing and medical regional interconnection. Due to the complexity and breadth of clinical nursing work, the collection of transactional nursing information occupies a lot of manpower, material resources, and time; the computer processing process of nursing information has high requirements for information processing methods and technologies. Nursing information has different attributes and different processing methods. Highly subjective information must be collected and recorded on site by nurses with professional knowledge and stored on paper carriers or mobile devices . The objThe organic integration of internet of things and nursing activities is one of the important characteristics of nursing development in the 21st century. The advantage of the application of the internet of things in clinical nursing lies in that the information receiver with sensors replaces people to \u201cperceive\u201d the information of human body, facilities, and environment and is not limited by time and space . It can This paper aims at the current situation that the traditional methods have high labor intensity, low efficiency, high error rate, and low value embodiment, which makes the nurses in a high-tension working state for a long time, thus affecting the accuracy of clinical nursing diagnosis and treatment decision-making and effect, discusses the application of medical internet of things in clinical nursing in ward, and discusses and studies the basic information collection, infusion, and mobile nursing. Through the parallel control study of the laboratory itself, this paper evaluates whether the two different clinical measurement methods of medical internet of things technology and traditional technology are consistent in body temperature, pulse, respiration, and blood oxygen saturation. At the same time, it also deeply studies the value and advantages of internet of things technology in the application of other monitoring indicators in clinical nursing and analyses the problems in its application. The experimental data show that the two measurement methods with different principles can be completely replaced in clinical application, and the mapping efficiency of the new clinical nursing method under the medical internet of things technology exceeds the traditional information technology, realizes the intelligent automation and standardized data acquisition method, and ensures the authenticity of data and the real-time of information flow; it meets the needs of resource sharing and medical regional interconnection.The chapters of this paper are arranged as follows. With the development of technology and application, the connotation and extension of the concept of internet of things are also expanding. Its overall framework includes the following five parts, namely, community architecture, technological know-how system, preferred system, associated enterprise device, and useful resource system. The terminal sensing layer consists of sensing terminal devices, such as RF readers, electronic tags, cameras global positioning system, and various sensors, and other sensing terminals collect data information . The senThe application of internet of things technology in the hospital nursing information system is of great significance and value. First, internet of things technology can quickly evaluate patients and accurately grade patients. Based on the internet of things technology, the preinspection system is set at the same time. The preinspection system can effectively, quickly, and accurately obtain patient information and conduct triage according to the severity of patients' diseases . In addiCombined with the previous design, the internet of things network based on Wi-Fi and RFID technology is designed to realize specific applications. In this project, the medical internet of things is selected as the final technical landing point. The application environment and conditions of medical internet of things are as follows: Wi-Fi signal coverage has been realized in the ward environment, and the nurse workstation has network access to the hospital LAN. The hospital has its own database system; according to the environment and requirements, the overall structure of the designed medical internet of things network is shown in In this system, the sphygmomanometer, as a sensor node, has RFID read-write function and Wi-Fi communication function. In use, the sphygmomanometer first collects the patient's personal information in the label, then measures the patient's blood pressure data by the Coriolis auscultation method, and then connects the Wi-Fi network through the wireless access point to bind the patient information and blood pressure data and send them to the nurse station PC; the PC runs the application software to further save the data to the hospital database system . ThroughPortable Device. The sensor is concentrated in a portable device with high reliability, which meets the requirements of small volume and convenient use and has the performance of high measurement accuracy. (2) Low-Power Consumption. Due to the frequent use of sensing terminal equipment, but the amount of data collected is small and no high transmission rate is required, low-power consumption can ensure a long service time of the equipment without frequent charging [Automatic Networking. Each ward has at least 40 beds, so at least 40 sets of sensing terminal equipment shall be allocated. These 40 sets of equipment shall automatically form a network and send vital signs parameters to the server through wireless mode. (4) Expansibility. The environment of the ward is complex, there are many interference factors, and the environment and area of each ward are different. Therefore, it is necessary to ensure that the sensing terminal equipment can be used in different environments and has high expansion performance. Through the investigation of existing communication technology in the early stage and combined with the characteristics of the current hospital information system, the system structure developed is shown in According to the needs of clinical nursing and the application environment of the system, the following problems must be solved in the system design. (1) charging . (3) AutIn terms of technical implementation, the research and development of nRF905 low-power RF communication module with 433\u2009MHz communication frequency band are focused. Combined with low-power MCU and physiological signal sensing equipment, it collects, analyses, and processes three key parameters that must be measured every day in the general ward: blood pressure, body temperature, and pulse. Accordingly, wireless electronic thermometer and wireless blood pressure pulse meter are developed in the sensing layer. The network realizes the conversion of RF communication into Wi-Fi communication and enhances the functions of temporary storage and automatic networking. In the application layer, the key physiological signal nursing system based on PDA and the real-time acquisition and control system based on PC are made.The body temperature sensor is mainly composed of temperature measurement circuit, main control chip, wireless transmission module, and power management module. The temperature measurement circuit is mainly composed of chip and thermistor. The main control chip of TI company and the wireless transmission module is nRF905 module , 24. TheThe sphygmomanometer adopts a high-performance sound pressure sensor to judge the blood pressure value by extracting the Coriolis sound signal of auscultation. This method can eliminate the individual difference of the oscillography electronic sphygmomanometer and improve the accuracy of blood pressure measurement. In the design process, the Coriolis tone delay time technology is developed to further accurately determine the systolic and diastolic blood pressure and ensure the accuracy of individual measurement. High precision pressure sensor and customized Coriolis sound sensor are used to extract blood pressure related signals, and the overall performance of the system is improved through linear deflation and automatic pressure zeroing. The appearance of the mercury manometer is simulated by liquid crystal, with high scale resolution , 27. It The main functions of application layer service software are maintenance, display, collection, writing, viewing, and alarm of life parameter information. The maintenance function is mainly used for database maintenance, including adding, deleting, and updating records. The man-machine interface of the system is written based on C++ language, and the development tool is MFC application program based on VC++ 6.0 dialog box class . The bast test, correlation coefficient, and Bland Altman method.Under the condition of overcoming individual differences, the experimental research design scheme of self parallel control is adopted. With the help of traditional measurement tools and medical internet of things, the control group and experimental group are set. The same person collects four vital sign parameters, body temperature, pulse, respiration, and blood oxygen saturation at 7 different time points in a day. This experiment is aimed at healthy groups to verify the feasibility and accuracy of the new technology in clinical nursing application. For the above data management work, the personnel in charge of nursing division or above shall be invited to guide and participate in data quality control, supervision, and management. Because the data collected by the two methods of comparison have the characteristics of point and surface differences, the latter is processed by the mean method and then compared. SPSS 22.0 statistical software was used to analyse the continuous repeated measurement data collected in the experiment by analysis of variance, paired t test, and then the correlation test is carried out for the two groups of data samples to understand the degree of correlation and bias. The above analysis of variance shows that the data of two different principal measurement methods of R are completely consistent, and there is no statistical difference, while the data of temperature, pulse, respiration, and blood oxygen saturation are not completely consistent, and there are statistical differences. With the help of the plot's submenu, the mean change trend diagram of the indicators measured repeatedly for 7 times is made, and the linear correlation regression equation of temperature and pulse is calculated, as shown in After the experiment, the data stored in the medical IoT system were transferred, and the tables were counted after counting. Finally, the recorder shall fill in the comparison form uniformly and the supervisor shall check it. The experiment is started after completing the pre-experiment. First, the data are entered into excel by the double entry method and then imported into SPSS 22.0 software for statistical analysis and description. The analysis of variance is used to understand the difference between the two groups of data, and the degree of difference is statistically described by paired F\u2009=\u20098.504, P=0.005 \u2264 0.005, there is no linear correlation, and the control data of the two groups are different. The blood oxygen saturation results of control group (ECG) and experimental group  were 98.00\u2009\u00b1\u20090.52 and 98.63\u2009\u00b1\u20090.81. Due to the difference in precision between the two different methods, it is necessary to further analyse the data in combination with clinical application standards. Therefore, the Bland Altman analysis method is used to evaluate the consistency of the two different measurement methods, and the calculated results are shown in t test, as shown in The difference between the measurement results of the two different methods is described by paired Through data analysis and clinical consistency evaluation, it is concluded that these two different measurement methods can completely replace each other in the accuracy of temperature, pulse, respiration, and blood oxygen saturation measurement, and the accuracy and sensitivity of medical internet of things are higher. The medical internet of things is fully used, highly operable, highly accepted by patients, and has strong clinical practicability and popularization. Under the internet of things technology, the integration of temperature, pulse, respiration surveying, and mapping in the three nursing test sheets has improved the time efficiency by 76.20% and 72.02%, respectively, compared with the traditional surveying and mapping methods 1 and 2. Time comparison of different surveying and mapping methods is shown in Intelligent automation and standard dynamic data collection are realized in information collection, highlighting the advantages of standard collection, unified access, and transmission, data sharing, and unified service. It shortens the operation time of nurses' manual measurement of temperature, pulse, and respiration, reduces the error rate of data input system, and reduces the process links of vital signs measurement and drawing. In terms of monitoring human physiological parameters, it is more widely used and more powerful, convenient, and practical than the current ECG monitor. For example, the increased fall index, sleep index, and other more than a dozen indicators, including the noninvasive blood glucose and blood pressure monitoring channel to be opened soon, to comprehensively monitor the health status of patients, undoubtedly extend the nurse workstation to the patients and directly point the nursing safety management and nursing quality monitoring to the target of real-time dynamic management. It laid a solid foundation for realizing nursing scientific management and intelligent decision-making.The medical internet of things system in this test is seamlessly connected with NIS. Taking only one routine nursing work \u201cmapping temperature, pulse, and respiration\u201d as an example, the mapping efficiency of internet of things is about 76.2% and 72.02% higher than that of traditional methods . This result shows that the application of the new technology directly reduces the indirect nursing time. While improving the work efficiency and reducing the labour intensity, it also correspondingly reduces the office consumables. Especially, when a large number of patients are treated in the ward and temperature, pulse, and respiration surveyed, nurses will have a deeper experience in artificial intelligence mapping, which provides technical support for the transformation of the nursing workflow of collecting vital signs. In addition, compared with the traditional working mode, it highlights its strong artificial intelligence characteristics in the standardization, authenticity, correctness, timeliness, and sharing of data collection, which lays a solid foundation and rich resources for enriching the clinical nursing database system, and provides a scientific and safe guarantee for patient condition monitoring management, safety management, and high-quality service.The use of medical internet of things in the ward can greatly improve the work efficiency of medical staff and reduce work errors. At the same time, it can also make the doctor-patient relationship more harmonious and improve the patient's nursing satisfaction. Medical internet of things can concentrate all information on the same platform so that resources can be used effectively; this paper designs and implements a new clinical nursing method based on medical internet of things. Based on the design principle of improving the automatic management level of hospital ward, reducing the work intensity of medical staff, reducing cost investment, and reducing patient bed accompanying, communication technology, photoelectric detection technology, microcomputer technology, computer network technology, and relational database technology are successfully applied to the ward intelligent monitoring system based on internet of things. The use of the system provides convenience for nurses' nursing work, provides a reliable safety guarantee for patients' daily treatment, and has high application value. The trial in several clinical wards shows that the system has high accuracy, stability, and consistency in the measurement of blood pressure, pulse, and body temperature. At the same time, both the sensor end and the application end can output reliable alarm signals when the data are abnormal or reach the warning value. Finally, the system is divided into multiple functional modules in a reasonable way, which can be customized and tailored to meet the application of different levels of hospitals or wards."}
{"text": "College students are taken as the research sample, with the purpose of exploring the characteristics of physical exercise and health education path of students under artificial intelligence (AI) algorithm. First, related literature is studied to understand the physical education system of college students. Then, the current situation of physical exercise of college students is investigated through the interview survey, and the mathematical statistics method is used to analyze the survey results. Moreover, the necessity and paths to carry out health education are discussed through the analysis of the physical exercise behavior of college students. Finally, the college smart sports classroom (SSC) is constructed using AI and the big data analysis method. The experimental results indicate that more than 50% of college students can actively participate in physical exercise. Besides, boys are more likely to take dangerous coping behaviors, while girls are more prone to choose to resist coping behaviors. In addition, there is little difference in age of the distribution of different coping behaviors in physical exercise. Freshmen are more inclined to take risky coping behaviors, and the quantity of students taking resistant coping behaviors increases with the increase of grades. Therefore, relevant physical health education for college students can promote the good habit of health exercise. This study can provide a reliable experimental basis for the development of sports education in the future. With the rapid development of science and technology today, the material life of people has been greatly improved. Youths are the foundation and driving force of national development, and their healthy growth is vital to the development of the motherland . The knoAt present, the era of information technology (IT) where all things are interconnected and intelligent is coming, and many new information technologies are coming one after another, such as mobile Internet, Internet of Things (IoT), big data, and cloud computing. The Smart Sports Classroom (SSC) is a specific branch of the smart classroom (SC). There is almost no research on the SSC, and no scholars have found a clear conception of the SSC . GeneralAlthough SSC has grown mature in theory, there are few cases of its application in the actual classroom. Therefore, taking college students as the research sample, the relevant literature is first studied to understand the physical education system of college students. Second, the questionnaire survey is conducted to investigate the current situation of the physical exercise of college students, and survey results are made mathematical statistics analysis. Furthermore, the necessity and path of health education are discussed based on the analysis of the physical exercise behavior of college students. Ultimately, the university sports fitness center is built by AI and the big data analysis method. The innovation lies in the combination of AI and college physical education curriculum, which improves the quality of the college physical education curriculum and provides new research ideas for the physical and health education of college students.As an emerging force in the development of a country, it is extremely important for young people to have a healthy body. Physique is the comprehensive and relatively stable characteristics of the quality and structure, physiological functions, and psychological factors of the human body based on heredity and acquisition. Physical fitness usually includes five dimensions, including physical development, physiological function, physical fitness, and athletic ability development, mental development, and adaptability development . PhysicaThe correlation between physical fitness and physical exercise has received more research attention. In summary, there are many studies on the physical exercise of students, and most of them analyze the impacts of physical exercise on physical health. However, the research on the intervention of physical exercise from the perspective of health education is relatively rare. Therefore, the current status of physical exercise of students is analyzed, and AI technology is applied in the health education and exercise of students, which exerts an extremely important role for the healthy development of adolescents.Investigating the current status of physical exercise of college students is conducive to understanding the importance of the lifelong sports concept of college students and the formation of good daily physical exercise habits. The sports classroom can play a guiding role in the physical exercise of students. The necessity of applying AI to sports classrooms can be analyzed from multiple perspectives such as students, society, and schools .From the perspective of social development, the construction of SSC in colleges and universities is to use the Internet, big data, AI, and other technologies to intelligently transform and innovate the college sports classrooms. The innovation of technology and teaching methods can provide powerful support for digital classrooms and smart campuses, contributing to the development of the smart society of China . SSC in At present, AI technology is widely used in the field of educational technology, including learning platforms, learning environments, and learning tools. Big data, a terminology of the IT industry, refers to the data set that cannot be captured, managed, and processed by conventional software tools in a certain time range. It is a massive, high-growth, and diversified information asset that requires new processing modes to acquire stronger capabilities of decision-making, insight, and process optimization. The hot research areas are introduced as follows, including intelligent learning platforms, intelligent learning environment, and intelligent auxiliary teaching tools. (1) Intelligent learning platform: online learning platforms represented by massive open online courses (MOOC) can record massive data of the learning process of learners. Based on data analysis, the platform can accurately grasp the learning status of each learner and then provide personalized teaching diagnoses and teaching recommendations for learners. Accordingly, numerous studies based on learner behavior data have gradually become research hotspots, i.e., predicting academic performance based on learning behavior characteristics of learners. (2) Intelligent learning environment: intelligent learning environment includes smart campus, smart classroom, and smart library. Smart campus integrates teaching resources and applications through network information technology and AI technology and realizes the smart and scientific decision-making of campus management. For example, the smart campus system designed by Professor Uskov of Bradley University covers the teaching environment, teaching management, and teaching process. Smart classrooms use advanced information technology, network technology, computer technology, and AI technology to provide multiple data support for various decisions of classroom teaching activities, such as learner type identification and utility analysis of content display methods. (3) Intelligent auxiliary teaching tool: intelligent auxiliary teaching tool is an intelligent system that simulates the role of human teachers and assists learners to learn, such as an intelligent teaching system and teaching robots. Intelligent auxiliary teaching tools can continuously evaluate the learning state or learning ability of learners in the process of learning knowledge, and implement precise intervention according to their state.In general, the digital detection of SSC mainly combines intelligent bracelets and other equipment with background data software to establish the sports health records of each student. Parents can know the movement of the children through the data at any time. Besides, schools can find the shortcomings of physical education timely to make improvements and detect whether the students have discomfort during sports exercise. In addition, systematic data helps schools understand the situation of students and the quality of sports at any time. The complex date operation of the background tends to be more accurate with the continuous advancement of SSC. Different background system operation modes have their own characteristics, but in general, they have a relatively unified idea.Browser/Severe (B/S) architecture is the architecture mode combining browsers and servers, which is a transformation and improvement of Client/Severe architecture with the rise of Internet technology. In the B/S framework, the user work interface is realized through the World Wide Web (WEB) browser. A few transaction logics are implemented in the front end (Browser) while the main transaction logic is implemented in the Server, forming a three-tier structure. B/S architecture is a network architecture model after the rise of WEB, and the WEB browser is the most important application software of the client. This pattern unifies the client, concentrates the core part of the system function realization to the server, and simplifies the development, maintenance, and usage of the system. The B/S architecture simply requires a browser on the client, such as Netscape Navigator or Internet Explorer, and a database in the Server, such as Oracle, Sybase, Informix, or SQL Server. The data interaction between the browser and the database is realized through Web Server, which greatly simplifies the client computer load, reduces the cost and workload of system maintenance and upgrading, and reduces the overall cost of users. Virtual Reality (VR) is a new practical technology developed in the twentieth century, containing a computer, electronic information, and simulation technology. It is basically achieved by the simulation of the computer of the virtual environment, which gives people a sense of environmental immersion. With the continuous development of social productivity and science and technology, the demand for VR technology is growing in all walks of life. VR technology has also made great progress and has gradually become a new field of science and technology.The literature search method  is adoptThe sample data is collected through the questionnaire survey to evaluate the physical exercise of students. During the questionnaire design , the hazIn the questionnaire, the value of exercise intensity is represented by the common physiological indicators, such as heart rate. Generally, it is believed that 120 times/min represents small exercise intensity, 120\u2013150 times/min denotes medium exercise intensity, and 150\u2013180 times/min or more than 180 times/min signifies large exercise intensity. The options of some questions on the scale are based on the Likert Score Sum Scale, among which 1\u20135 reveals \u201ctotally disagree,\u201d \u201cbasically disagree,\u201d \u201cneither disagree nor agree,\u201d \u201cbasically agree,\u201d and \u201ctotally agree,\u201d respectively. This questionnaire does not involve personal privacy in the whole process of questionnaire design, distribution, and data collection. Besides, the whole questionnaire survey is conducted with the consent of participants (not less than 18 years old). This survey has been approved by the leadership of higher vocational colleges and relevant departments. The questionnaire is not open to the public and is only used for research purposes .An equal amount of sampling questionnaires is issued in three representative undergraduate universities to reduce the deviation of the survey results and improve the strictness, scientificity, and representativeness of the questionnaire. A total of 321 questionnaires are distributed and 309 are recovered, with a recovery rate of 96.26%. Therefore, the questionnaire survey is effective. After reviewing the returned questionnaire and eliminating the questionnaire with obvious defects to ensure the validity of the questionnaire, there are, ultimately, 285 valid questionnaires in total. Cronbach\u2019s \u03b1 coefficient is a statistic of the average value of the half reliability coefficient obtained by all possible project division methods of the scale, which is the most common reliability measurement method. It was first named by American educator Lee Cronbach in 1951. If a scale has n questions and the average correlation coefficient between questions is r, the standardized \u03b1 coefficient of this scale is given as follows:The questionnaire is evaluated by Cronbach\u2019s \u03b1 value to verify the reliability, stability, and index system of the physical exercise questionnaire of college students and to test the reliability coefficient of the questionnaire . The intThe characteristics of physical exercise of college students are investigated and analyzed. In the physical education class, the \u201chealth first\u201d is adhered to while implementing the teaching concept of \u201cjogging.\u201d Besides, mobile internet, Internet of Things, big data, and cloud computing are integrated to innovate the physical education model further, enhance the initiative of students in learning, improve teaching efficiency, visualize physical education data, organically integrate both inside and outside classes, and promote exchanges among students, teachers, parents, and schools .In the SSC built by universities, the overall structure of the intelligent service platform takes humanity as the core through the intelligent terminal equipment platform, the stadium intelligent platform, and the health cloud management platform. AI equipment supports powerful background data analysis, processing, storage, and extraction, and organically integrates students, teachers, parents, experts, scholars, and multiple elements, so that smart equipment terminals and stadium equipment are combined. The information platform connected to the health cloud management platform, stadium intelligent platform, and intelligent terminal equipment platform provides SSC with an intelligent, informatized, and integrated service support environment. In the university logistics center, the function of the health cloud management platform is like the brain of a person, which is the cloud intelligent database of the university logistics center. Cloud computing and other science and technology are adopted to collect, store, and control SSC data in colleges and universities. The data are collected through terminal equipment and transmitted to the cloud platform for processing and analysis. Finally, relevant information about student physical exercise is given.The process of classroom teaching analysis includes the collection, representation, analysis, and display of teaching behavior data, which needs to be realized through the application system. A logical framework of a smart classroom teaching behavior analysis system is designed to rationalize the feasibility of the research method while positioning and combing the research elements and the relationship between elements. The framework takes classroom teaching behavior analysis as the goal, covering the acquisition, storage, modeling, processing, and analysis involved in the analysis process, along with the supportive environment as an application system. The logic architecture of the system is divided into five parts: data acquisition module, data analysis module, smart service module, the system supporting technical standards, and information security module. The current status of physical exercise of students is investigated by questionnaire survey, and the results are shown in Furthermore, the correlation between the normal exercise intensity of college students and different physical exercise coping behaviors is analyzed, and the results are shown in By investigating the status quo of physical exercise of college students and the corresponding statistical analysis, the perception level, gender difference, age difference, and physical exercise habits of college students are all related to the coping behavior of the physical exercise of college students. Results suggest that girls do better than boys in haze protection, but some girls resist physical exercise to prevent haze damage. Boys are less concerned about choosing corresponding protective gears or adjusting the original planned physical exercise content based on air quality than girls, forming a typical physical exercise risk response behavior. The characteristics of boys and girls in physical exercise coping behavior choices can be judged from gender differences. The number of students who choose to resist coping behavior increases with grades. Usually, juniors and seniors no longer need to choose compulsory physical education, making daily physical exercise motivation decline. When the weather or environment is slightly unfavorable, it is easy to resist. Therefore, the physical exercise coping behavior of college students in the face of haze is also related to their usual exercise habits. It is essential to cultivate the concept of lifelong physical education for college students and to develop good daily physical exercise habits.As shown in The comparison results of physical exercise effects of different system models are shown in The path of physical education in colleges and universities is as follows. First, define the level of sports resources in colleges and universities and formulate different levels of development planning. According to the proportion of sports resources, colleges and universities can be divided into upper sports resources schools, middle sports resources schools, and lower sports resources schools. Schools with different levels should adopt different development strategies. The upper sports resource schools mainly adopt the \u201cindependent\u201d development strategy, and the education authorities only formulate various development standards and development indicators for schools to fully mobilize the enthusiasm and initiative of the school, which formulate its development planning and implementation measures independently. Middle sports resource schools adopt the development strategy of \u201cjoint promotion.\u201d The main function of the education department is to plan and regulate its strategy, provide support, and help for its insufficient sports resources, and encourage schools to actively cooperate with enterprises and communities in manpower, material, and financial sports resources.Second, exploring distinctive sports resources in colleges and universities in the region, and actively developing specific sports courses. With a vast territory, there is a huge gap in the development of various regions in China due to various reasons such as history, resources, and geographical location. Therefore, China is often divided into several different regions to facilitate the management and distinction according to different division methods. For example, by administrative region, China is divided into East China, South China, Central China, North China, Northwest China, and Southwest China. By economic zone, the country is divided into the eastern coastal area, central inland area, and western remote area. According to the six comprehensive economic zones, the whole country includes the Northeast China Economic Zone, Economic Zone of Middle Yellow River, Economic Zone in the Middle and Lower Reaches of the Yangtze River, Southeast Coastal Economic Zone, Southwest Comprehensive Economic Zone, and Northwest Economic Zone.Last, accurately grasping the sports needs and hobbies of different classes of college students and enhancing the particularity of physical education. Under the background of the growing differentiation of social classes, is there any class difference in fitness needs and hobbies among people of different social classes? According to the investigation and study of relevant information, there are certain differences in the sports life of members of all social strata. These differences are reflected in the sports population, sports activities, sports venues, and sports consumption level. Statistics based on the China Health and Nutrition Survey show that like social stratification, sports participation groups are also stratified, and people at different levels have different sports participation preferences. There are demographic differences in the sports participation of residents, such as gender, place of residence, education level, occupation type, and income level.In summary, a questionnaire survey on the current status of physical exercise of college students reveals that more than half of college students can actively participate in physical exercise under the premise of ensuring that their health is not threatened in the face of haze, but the characteristics of their physical exercise behaviors are not certainly beneficial to health. Thus, AI technology is adopted to build the SSC in colleges and universities, which can make the physical exercise behaviors of students more active and develop healthy physical exercise habits, providing experimental references for the later development of physical education. However, there are also some shortcomings that are worth noting in future research. The technologies such as the Internet, the IoT, and big data on which the development of SSC relies are also developing and improving. Therefore, the construction of SSC is a dynamic process. In addition, it is necessary to constantly update the technology, and put forward the corresponding teaching mode and construction path in different classroom construction stages. Moreover, the teaching mode can further practice SSC. The experimental intervention of the SSC control group and an experimental group can be set to analyze the teaching effect of SSC attitude and behavior, and continuously improve the physical education mode.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by the Shanghai Normal University Ethics Committee. The patients/participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.Both authors listed have made a substantial, direct, and intellectual contribution to the work, and approved it for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "Several studies have reported, in emerging economies, an incidence of congenital heart defects that is higher than average because of several factors, including genetics, high prevalence of consanguineous marriages, malnutrition, poor sanitation, and high fertility rates . CongeniJivanji et al. presented very clearly the situation in sub-Saharan East Africa: Kenya, Tanzania, and Uganda, with their commentaries on affordability, access, and awareness. They listed all challenges faced in developing a cardiac program in that region, with problems such as corruption at various levels described with a very clear narrative .Giamberti et al. presented their remarkable experience over a 17-year period of creating and developing a pediatric cardiac unit in Cameroon, central Africa, with accurate description of barriers and facilitators encountered for the set-up. This team not only organized the clinical activities but also a fruitful bilateral exchange of collaboration with the local caregivers, with continuous educational programs, and constant monitoring of the progress made. The most successful result is that this unit, the only one active in the entire country of Cameroon, is now attracting patients from surrounding countries .Cvetkovic reported her experience gained in various visits to India, Malaysia, Nigeria, Kenya, Tanzania, and Mauritius. Thanks to the opportunity of experiencing different environments, she presented her approach to improve the quality of anesthesia derived from the combination of the following: regular teaching and education sessions, careful patients selection, patients preparation for surgery with meticulous pre-operative care, individualized type of anesthesia, and structured daily team briefing (Cvetkovic). The results were very encouraging, particularly because every visit was followed by regular interaction between visiting and local teams (Cvetkovic).Howes, a specialist nurse with years of experience in Pediatric Cardiac Intensive Care Unit who was involved in many visits with different teams, presented her interesting perspective regarding the protocol of early extubation after repair of complex congenital heart defects. Advantages and disadvantages of early extubation were analyzed, balancing the potential risks  vs. the needs dictated by limited resources in terms of personnel, equipment, infrastructures. Most of these aspects can be taken into consideration in different types of environments (Howes).Zain et al., who reported the experience of the local team in a rural area of North-East Malaysia, exposed to the beginning of pediatric cardiac surgery activities from scratch, initially with a surgeon in place for a couple of years, then with regular visits of alternating teams. Their experience is another confirmation that, if a program is well-organized and sustained, it can lead to stepwise growth of the local team until reaching autonomy for surgical management of the vast majority of children born with congenital heart defects in a region without any alternative available for treatment. The visiting teams now are mostly helping the local team for assistance in the surgical management of the most complex malformations, and to continue the educational and supporting program .A relatively new perspective has been presented by The last two articles of this Research Topic reviewed the entire issue of humanitarian activities in low and middle-income countries.Novick et al. reported their approach, accomplished after mastering the assistance in pediatric cardiac surgery, starting from visiting Colombia in 1991 and since then having visited 32 countries, having completed over 560 trips of between 1- and 4-weeks in duration, with nearly 10,000 patients operated on in total. Their comprehensive approach covers many steps, including the request for assistance, a site visit, the preparation for program implementation, different types of program models accordingly with the match between the local needs and the visiting team availability , the nursing education and empowerment, and the attention to the services of interventional cardiology, anesthesia, perfusion, biomedical engineering, operating room . Because of their very extensive experience across many countries, Novick et al. also analyzed the difficulties of providing service in conflict zones, the need to provide benchmarks and indicators of improvement, as well as quality improvement and assessment, and ethical considerations on the entire matter.Murala et al. provided a detailed overview of the current global situation, with report of the current units involved in these humanitarian activities with short and long-term programs. In particular, for the short-term programs the analysis included persistence and continuity, cooperation with Non-Governmental Organizations, focus on types of congenital heart defects, on site issues, view from the host programs, and financial aspects. Then they proposed elements to consider in a model for establishing long-term programs: shared vision, spark plug , communication and coordination, training, material support, exit strategy, data collection, and analysis .Nichani and Nichani explored in a clever and original way the potential benefits of this work performed by teams from the so called \u201chigh income countries\u201d to the low-income regions of Africa and Asia to provide care for children born with congenital heart defects.In the final article, In fact, there are also advantages for those teams organizing these humanitarian activities, such as gained experience on unusual cases, team-building, and improvement. Furthermore, a deeper connection to the main meaning of the medical profession is an extremely important part of the experience.This is, to the best of our knowledge, the first time that the many benefits for the traveling medical teams, in addition to the recipients, have been considered in all the literature published on this topic.We hope that this Research Topic will help all readers and interested individuals so that in the future the diagnosis of congenital heart defects and rheumatic heart diseases will no longer be the death sentence, for the majority of children in the world, that it currently is.All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "Since the first case of the novel coronavirus (SARS-CoV-2) was reported in Wuhan, China, in December 2019, the coronavirus disease (COVID-19) has quickly spread to all the corners of the world. Amid the global public health threats posed by the COVID-19 pandemic, active cooperative governance has gradually emerged as the most powerful weapon against its spread. To facilitate international cooperation for pandemic governance, this paper applied the evolutionary game theory to analyze the factors influencing active cooperative governance and, based on the results, proposed a series of recommendations for promoting international cooperation. (1) leveraging the role of international organizations to reduce the cost of realizing the strategy of active cooperative governance, (2) promoting the international exchange of related experiences to lower the cost of active pandemic governance, (3) sustaining productive and daily activities during the pandemic in a classified and hierarchical manner to reduce the economic loss incurred by active pandemic governance, and (4) optimizing the incentive measures of international organizations to facilitate the selection of active cooperative governance. Finally, from the four aspects of resource management of pandemic treatment, supply management of living materials, population flow cooperation management, and governance fund cooperation management, this paper gives the path of international pandemic cooperative governance. Since the first case of the novel coronavirus SARS-CoV-2) was reported in Wuhan, China, in December 2019, the coronavirus disease (COVID-19) has quickly spread to all the corners of the world  and F(y) be 0. Five strategy equilibrium points for Affected Countries 1 and 2 are obtained: O , C , A , B , and D , where x* = Let x*, y*) as the saddle point. When the probability of active governance being initially adopted by both Affected Countries 1 and 2, , falls within ABCD, the two countries will lean toward the strategy profile of active cooperative governance over time. In other words, the system will converge to . However, when the said probability falls within AOCD, the two countries will lean toward passive non-cooperative governance, and the system will converge to . The details are mentioned in According to Friedman's methods, this study identifies  and  as the evolutionarily stable strategies for the two affected countries. The corresponding strategies are for both countries to choose passive and active pandemic governance, respectively, with , economic losses caused by active pandemic governance (Le1 and Le2), and the cost of realizing the strategy of active cooperative governance (Ce). The partial derivatives of Cpk, Lek, and Ce are computed with respect to SABCD. Considering that the above parameters are all above 0, Rp + Rs > Rpk \u2212 \u03b8Lpk \u2212 Ce, and Rik + Rpk + Lpk < Cpk + Lek, the following can be obtained:To enable each affected country to converge to the state of active cooperative governance, this study first observed the effects of changes in the following parameters on This implies that, if the costs of active pandemic governance, the economic losses caused by such governance, and the cost of realizing the strategy of active cooperative governance are lower, the affected countries are more likely to choose the strategy of active cooperative governance over time.In reality, first of all, in terms of the cost of controlling the pandemic, due to the differences in the economic level between countries and the ability of national financial investment, developed countries can spend more manpower and material resources to control the pandemic, while poor countries cannot afford the huge investment in pandemic prevention materials; secondly, in terms of the capacity of bearing economic loss, in order to reduce the death and spread of patients, developed countries tend to take longer-term measures of trade stop, blockade and isolation, while poor areas cannot afford long-term economic losses. Finally, in terms of the cost of cooperation strategy, if the two countries have a similar political and economic background and previous cooperation foundation, the resistance of cooperation between the two countries will be greatly reduced, thus contributing to the realization of cooperation. However, if there are huge economic differences and national contradictions, the increase of cooperation costs will hinder the realization of cooperative governance. Therefore, the lower the cost of controlling the pandemic, the smaller the economic loss and the lower the cost of achieving the cooperation strategy are conducive to the realization of the cooperation strategy.SABCD are also observed: individual returns of active pandemic governance (Ri1 and Ri2), public returns of active cooperative governance (Rp), shared returns of active cooperative governance (Rs), and losses incurred by the pandemic (Lp1 and Lp2). The partial derivatives of Rik, Rp, Rs, and Lpk are obtained with respect to SABCD. Considering that \u03b8 > 0, Rp + Rs > Rpk \u2212 \u03b8Lpk \u2212 Ce, and Rik + Rpk + Lpk < Cpk + Lek, the following can be obtained:Furthermore, the effects of the following parameters on This implies that, if the individual returns of active pandemic governance, the public and shared returns of active cooperative governance, and the losses incurred by the pandemic are higher, the affected countries are more likely to choose the strategy of active cooperative governance over time.Specifically, in reality, first of all, in the area of self-earnings, controlling the pandemic situation and reducing the number of infected persons will bring their own benefits to the national health, the credibility of the government, and the enhancement of the international image, which will promote the countries to actively respond to COVID-19. Secondly, active governance will reduce the number of domestic infections and reduce the number of domestic infections that will affect other countries' prevention of the pandemic. The prevention in own country can bring positive externalities to the prevention of other countries. At the same time, the cooperative governance will bring the partners the common benefits of the two countries' trade recovery. The improvement of public benefits and common benefits will promote cooperation. Finally, in terms of the harm of the pandemic, the more serious the economic and social harm caused by the pandemic, the more difficult it is for a single country to deal with it, and the need for other countries to cooperate, the easier the cooperation strategy will be achieved. Therefore, the greater the individual benefits, public benefits, common benefits, and the harm of the pandemic, the easier the cooperative governance strategy will be achieved.F), subsidy for active pandemic governance (Sf), and reward for forming an alliance in active cooperative governance (E), are now added to the payoff matrix shown in The above analysis is set against an unconstrained background. However, in reality, the affected countries are under constraints imposed by a variety of international organizations currently in force, including the United Nations (UN), WHO, World Trade Organization (WTO), IMF, International Labor Organization, and Food and Agriculture Organization , 34. To x*, y*), where First, this study defines the system of replicator dynamics equations and lets them be 0. Once again, five strategy equilibrium points for the two affected countries can be obtained: O , C , A , B , and D , falls within ABCD, the countries will lean toward the strategy of active cooperative governance over time. In other words, the system will converge to B . However, if the probability falls within AOCD, the countries will lean toward passive non-cooperative governance, and the system will converge to O . If the probability of the affected countries choosing the strategy of active cooperative governance is to be increased over time, it is necessary that saddle point D is moved to the origin 0, in order to expand the surface area of ABCD. Considering that the surface area of ABCD is defined as x* and y* are substituted into SABCD, the following can be obtained:Similarly, according to Friedman's method, the strategy equilibrium points  and  are identified as evolutionarily stable strategies. When the probability of active governance being initially adopted by both Affected Countries 1 and 2, (SABCD: costs of active pandemic governance (Cp1 and Cp2), economic losses caused by active pandemic governance (Le1 and Le2), the cost of realizing the strategy of active cooperative governance (Ce), individual returns of active pandemic governance (Ri1 and Ri2), public and shared returns of active cooperative governance (Rp and Rs), and losses incurred by the pandemic (Lp1 and Lp2).The previous section has already probed the effects of the following parameters on SABCD: coalition government's punishment for passive pandemic governance (F), subsidy for active pandemic governance (Sf), and reward for forming an alliance of active cooperative governance (E). The partial derivatives of E, F, and Sf are computed with respect to SABCD. Considering that Cpk + Lek > Rik + Rpk + Lpk + F + Sf, Rp + Rs + E > Rpk + \u03b8Lpk + Ce + Sf, and Rp + Rs > Cpk + Lek + Ce, the following can be obtained:In this section, the analytical focus shifts to the effects of the following parameters on This means that if the joint organization punishes the countries that choose not to actively control the pandemic, subsidizes the countries that choose to actively control the pandemic, and rewards the alliance for actively cooperate to governance the pandemic, over time, each country will be more likely to choose the strategy of active cooperative governance. Specifically speaking, first, the punishment for the countries who negatively respond to the pandemic will promote the realization of cooperation, such as the World Health Organization's public criticism of the negative attitude of the United States in the early stage of the pandemic; second, subsidies will be given to the countries with active governance, and the financial assistance, scientific research and material assistance provided by the World Health Organization to the poor areas will help them control the pandemic. Finally, on the reward for the governance alliance, the WHO thanks the EU leaders for their efforts in uniting the world to fight the pandemic and providing the EU with materials for defeating the pandemic. Therefore, punishing the countries that negatively respond, subsidizing the countries that positively governance and rewarding the cooperative governance alliance are conducive to the achievement of cooperative strategies.Summarizing the above, three conclusions can be drawn. First, if the costs of active pandemic governance, the economic losses incurred by such governance, and the cost of enabling the strategic choice of active cooperative governance are lower, the affected countries are more likely to choose active cooperative governance over time. Second, if the individual returns of active pandemic governance, the public and shared returns of active cooperative governance, and the socio-economic impacts of the pandemic are higher, the affected countries are more likely to adopt active cooperative governance over time. Third, if the coalition punishes countries for passive pandemic governance, subsidizes countries for active pandemic governance, and rewards alliances of active cooperative governance, the affected countries are more likely to opt for active cooperative governance over time. Additionally, the strategic continuity of active cooperative governance is determined by the magnitude of its returns and the constraints imposed by the coalition.This study adopts the evolutionary game model to analyze factors influencing the strategic choice of active cooperative governance, along with the ways to enable such a choice. The individual returns of active pandemic governance, public and shared returns of active cooperative governance, and the socio-economic impacts of the pandemic are some of the more objective variables. Thus, to enable the strategic selection of active cooperative governance, efforts should be made to regulate the costs of active pandemic and active cooperative governance, the economic loss incurred by active pandemic governance, and the incentives for active and passive pandemic governance. The detailed measures are as follows: (1) leveraging the role of international organizations to reduce the cost of adopting active cooperative governance, (2) promoting the international exchange of related experiences to lower the cost of active pandemic governance, (3) sustaining productive and daily activities during the pandemic in a classified and hierarchical manner to reduce the economic loss incurred by active pandemic governance, and (4) optimizing the incentive measures of international organizations to guide countries adopt the strategy of active cooperative governance.To reduce the cost of strategic selection, the UN\u2014as the most authoritative of comprehensive international organizations\u2014approved a draft resolution titled \u201cGlobal Solidarity to Fight the Coronavirus Disease 2019 (COVID-19),\u201d introduced by six countries including Singapore, Ghana, and Indonesia, during the UN General Assembly. The resolution was co-sponsored by over 180 countries. The General Assembly's call for global solidarity and concerted efforts against the pandemic marked an important step in advancing international cooperation. The approval of the draft resolution saved the costs of negotiation and contract administration and lowered the threshold and resistance against international cooperation.To reduce the cost of governance, the mortality rate of COVID-19 patients approximated to 4% in China and exceeded 6% in other regions. It is necessary for the hardest-hit areas such as Europe to draw on China's therapeutic regimens for a higher recovery rate. China has shared its experience and practices with over 10 countries including France, Portugal, and Denmark with regard to virological characteristics, anti-pandemic philosophy, and the latest research achievements in pathology. It also imparted to Europe information that is highly instrumental in clinical treatments, including information on Chinese medicine and many other clinical regimens, as well as the recommended dosage, contraindications, and efficacy of an antimalarial drug and other agents.To reduce economic losses, it is important to ensure the smooth and continued operations of the global economy and trade. On the one hand, excessive draconian measures should be prohibited. Emergency measures should not stand in the way of global trade and supply chain operations. On the other hand, countries should endeavor to enact trade facilitation policies. Measures like tariff reduction, the lifting of trade barriers, and unimpeded trade should be implemented proactively, whereas trade disputes such as trade wars and tariff wars should be avoided. In terms of pandemic prevention and economic growth, we should learn from China's experience and implement production by classification according to the costs and benefits of pandemic prevention and production in various industries. First of all, no matter how severe the pandemic situation is, it is necessary to ensure the production of enterprises supplying medical materials, water, electricity, gas, communications and other basic living materials. Basic material support is the basis of pandemic prevention and control, and only by ensuring the production of these enterprises can we better prevent and control the pandemic. Second, governments should ensure safe production among enterprises by category and in stages on the premise that prevention and control can be carried out effectively. Enterprises in which employees can be segregated during production, those where production and consumption are separable, and those that encounter less negative impact from pandemic prevention and control can carry out production with specific conditions during the outbreak. However, enterprises that are unable to meet these criteria must wait for the pandemic to ease or end before they can resume production.To optimize incentive measures, international organizations should reward countries that actively engage in global pandemic governance. They should offer them incentives such as waiving or reducing the current year's membership fees and lowering import and export tariffs.The above discussion analyzed the influencing factors and enabling mechanisms associated with strategy realization for active cooperative governance. After strategy realization, measures to exploit each country's advantages to the fullest for the sake of global resource allocation against COVID-19 also warrant further investigation.First of all, the COVAX Global New Crown Vaccine Initiative (New Crown Pneumonia Vaccine Implementation Program), jointly led by the World Health Organization and the GAVI Alliance, is currently the most effective mechanism for the equitable sharing of safe and effective vaccines worldwide, with the goal of promoting equitable global vaccine distribution. Effective vaccines should become global public goods, and first be provided to people in urgent need around the world . The ultAlthough this study scientifically expounds the view of international cooperation to respond to the COVID-19 by using game theory, it still has the following limitations. First, the game theory assumes that all subjects participating in decision-making are rational and represent their interests. However, in reality, the behavior of countries cannot keep rational all the time, which will affect the applicability of the conclusion. Secondly, although we consider the factors that affect the cooperation between countries as much as possible, there are still some factors that are difficult to consider, such as political factors, which will affect national decision-making. Third, our results have not taken into account the dynamic changes of the COVID-19. Despite the limitations, this study has important implications for international cooperation to manage pandemics.In the face of the global public health threats posed by the COVID-19 pandemic, active cooperative governance has evolved into the strongest weapon against the outbreak. That being said, some national governments have stuck to passive solutions due to an inadequate understanding of the dangers of the outbreak. To facilitate international cooperative governance, this paper studies the factors of active cooperative governance in each pandemic area based on the evolutionary game method, and based on the analysis of influencing factors, gives the policy path of how to promote international cooperation in a pandemic situation and how to carry out national cooperative governance in a pandemic situation.What factors affect the international cooperation of pandemic control? First, if the costs of active pandemic governance, the economic losses incurred by such governance, and the costs of enabling the strategic choice of active cooperative governance are lower, the affected countries are more likely to choose the strategy of active cooperative governance over time. Second, if the individual returns of active pandemic governance, the public and shared returns of active cooperative governance, and the socio-economic impacts of the pandemic are higher, the affected countries are more likely to adopt the strategy of active cooperative governance over time. Third, if the coalition punishes countries for passive pandemic governance, subsidizes countries for active pandemic governance, and rewards alliances of active cooperative governance, the affected countries are more likely to opt for active cooperative governance over time.The following recommendations are also proposed for enabling active cooperative governance among countries: (1) leveraging the role of international organizations to reduce the cost of realizing the strategy of active cooperative governance, (2) promoting the international exchange of related experiences to lower the cost of active pandemic governance, (3) sustaining productive and daily activities during the pandemic in a classified and hierarchical manner to reduce the economic losses incurred by active pandemic governance, and (4) optimizing the incentive measures of international organizations to guide countries and effectively facilitate the selection of active cooperative governance strategies. The marginal contribution of this study lies in drawing upon the evolutionary game perspective to identify the enabling mechanisms and cooperative pathways underlying international cooperative governance.How to carry on the international pandemic situation cooperation governance? First, in terms of medical material management, global allocation of medical equipment resources, collective cooperation in scientific research, and relevant assistance from medical staff; second, in terms of supply management of living materials, global allocation of food and other necessities of life, and international trade cannot prohibit or restrict exports; third, in terms of population flow and cooperation management, countries in the severely affected areas should restrict population Outflow: countries with a good pandemic situation should restrict the inflow of population, and countries close to the end of the pandemic should strictly prevent the import from abroad. Fourthly, in terms of fund management for pandemic control, through the United Nations and other international organizations, a fund pool for pandemic control should be set up to increase financial assistance to the severely affected areas, vulnerable areas, and economically difficult areas.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.HY and XZ: conceptualization. HY, SH, and YW: methodology. XZ, XL, and ZS: validation. HY, YW, and LX: formal analyses and investigation. HY, YW, XL, and XZ: writing\u2014original draft preparation. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "The study of the spatial differentiation of COVID-19 in cities and its driving mechanism is helpful to reveal the spatial distribution pattern, transmission mechanism and diffusion model, and evolution mechanism of the epidemic and can lay the foundation for constructing the spatial dynamics model of the epidemic and provide theoretical basis for the policy design, spatial planning and implementation of epidemic prevention and control and social governance. Geodetector  is a great tool for analysis of spatial differentiation and its influencing factors, and it provides decision support for differentiated policy design and its implementation in executing the city-specific policies. Using factor detection and interaction analysis of Geodetector, 15 indicators of economic, social, ecological, and environmental dimensions were integrated, and 143 cities were selected for the empirical research in China. The research shows that, first of all, risks of both infection and death show positive spatial autocorrelation, but the geographical distribution of local spatial autocorrelation differs significantly between the two. Secondly, the inequalities in urban economic, social, and residential environments interact with COVID-19 spatial heterogeneity, with stronger explanatory power especially when multidimensional inequalities are superimposed. Thirdly, the spatial distribution and spread of COVID-19 are highly spatially heterogeneous and correlated due to the complex influence of multiple factors, with factors such as Area of Urban Construction Land, GDP, Industrial Smoke and Dust Emission, and Expenditure having the strongest influence, the factors such as Area of Green, Number of Hospital Beds and Parks, and Industrial NOx Emissions having unignorable influence, while the factors such as Number of Free Parks and Industrial Enterprises, Per-GDP, and Population Density play an indirect role mainly by means of interaction. Fourthly, the factor interaction effect from the infected person\u2019s perspective mainly shows a nonlinear enhancement effect, that is, the joint influence of the two factors is greater than the sum of their direct influences; but from the perspective of the dead, it mainly shows a two-factor enhancement effect, that is, the joint influence of the two factors is greater than the maximum of their direct influences but less than their sum. Fifthly, some suggestions are put forward from the perspectives of building a healthy, resilient, safe, and smart city, providing valuable reference and decision basis for city governments to carry out differentiated policy design. The scientific response to the global novel coronavirus pneumonia outbreak (hereinafter referred to as COVID-19) is a major scientific research task in the context of global public health events. It requires a close intersection of the subjects including medicine, geography, management, sociology and economics, and a rapid breakthrough in scientific theories and methods for dynamic surveillance, precise prevention and control, accurate prediction, and effective response to the epidemic outbreak. Major epidemic diseases directly threaten the economic and social development of all human beings. Summarizing and analyzing the spatial-temporal distribution patterns and regularities of infectious diseases ,3, spatiThe development and evolution of infectious diseases are greatly influenced by the environment, so it is essential to figure out the spatial distribution characteristics and driving mechanism of COVID-19, the most serious infectious disease in recent 100 years . Since tThe first is that there is a lack of comprehensive studies with integration of economic, social, and environmental dimensions in spite of abundant research results. The main findings include that Neelon , AnderseThe second is the single research method with insufficient diversity and influenced by covariance and methodological limitations, resulting in a small number of analysis factors and a very insufficient study of the interaction between factors. The existing research results are mainly based on regression analysis methods and linear models, including geographically weighted regression ,25, GeneThe existing research has shown that the unbalanced spatial distribution of COVID-19 is common, but its driving mechanism is still unknown. Different factors vary greatly in their influence on COVID-19 , and it The study area includes 296 cities, excluding Sansha City, Hong Kong, Macao and Taiwan, as well as autonomous prefectures and county-level cities in the mainland . A totalThe 143 sample cities are typically representative from the perspective of cities, infected people, the dead, and the world with 61 of them reporting deaths. From the perspective of cities, sample cities account for about 48% of all in the study area. From the perspective of infected people, sample cities account for about 98% in the study area. From the perspective of the dead, sample cities account for about 86% in the study area. From the perspective of the world, as of 29 March 2021, COVID-19 infections were reported in 214 countries and regions around the world, totally about 130 million, with an increase of more than 500,000 new confirmed cases per day, still in a rapid growth. China\u2019s achievements in combating COVID-19 are leading in the world, and the Chinese experience is of great reference value for other countries in responding to COVID-19. The empirical study on the case of China is typical and representative.China Urban Construction Statistical Yearbook and the China City Statistical Yearbook, with some absent collected from statistical yearbooks, statistical bulletins, government work reports of provinces and cities. The COVID-19 data collected in this paper are as of 29 March 2020, while the others are as of 2019. \u2461 Discrete processing must be performed before running Geodetector, due to the fact that the independent variable data are numeric. To eliminate the human influence, nature breaks are adopted in this paper. Discrete the continuous data of independent variables by Python  and classify the 143 cities into 15 categories (3\u201317).Based on the research of relevant scholars, this study is mainly divided into three steps and eight key points  36]. Th. Th36]. The COVID-19 epidemic is still not over, and virus mutation is ongoing, resulting in a number of new variants with greater transmissibility, pathogenicity, and high viral load such as Delta and Omicron. However, limited by many factors, this paper did not include them in the research framework for the following reasons: firstly, the research of this paper ended on 29 March 2020, while new high-risk variants such as Delta and Omicron were first discovered and reported in October 2020 and November 2021, respectively, not falling within the study time range; secondly, large bodies of city-scale economic, social and environmental data used in this paper are subject to a fixed cycle for collection and counting, and the latest data available have been adopted in the study; thirdly, new high-risk variants such as Delta and Omicron have aroused great vigilance in all countries, but their impact on China remains to be observed for a longer period of time, as China has effectively controlled the spread and dissemination of the new variant of the virus in the mainland China, thanks to the world\u2019s strictest dynamic zero-case policy and the strict inspection system for all persons and substances entering China. In addition, experts such as Zhong Nanshan, Zhang Wenhong and Zhang Boli believe that China\u2019s rapid response and dynamic zero-case policy can cope with various types of virus variants, and that as long as the whole society takes active measures to prevent and control the epidemic as required by the national and local governments, Delta and Omicron will not have a great impact on China, and the actual situation is largely consistent with the experts\u2019 predictions.The second step is about Data Processing. \u2462 Use Excel to calculate the coefficient of variation and Gini index of dependent variables and analyze the spatial differentiation level of COVID-19. \u2463 Import the raw data of the dependent variable and the discretized data of the independent variable into Geodetector software and calculate the analysis results. \u2464 Select the best alternatives in \u2461, and choose the one with the largest The third step is about Data Analysis. Analyze and discuss the calculation results of \u2462 and \u2464. \u2465 Determine the strength of the explanatory power of the independent variables according to q-values. \u2466 Analyze the interaction effect between driving factors. \u2467 Average q-values for the independent variables that pass the significance test, calculate the strength of the 3 driving forces, and further reveal the driving mechanism of epidemic risk spatial distribution and its policy implications.Clustering is the process of dividing similar samples into different groups or more subsets by means of static classification or rule set, so that the member samples in the same subset all have similar properties. The standard deviation ellipse is one of the classical methods for analyzing the spatial distribution direction, with the size of the ellipse reflecting the concentration of all elements of the spatial pattern and the declination (semi-major axis) reflecting the dominant direction of the pattern. The elliptical semi-major axis indicates the direction of the data distribution, while the semi minor-axis indicates the range of data distribution. The data will have a more pronounced directionality when there is a larger difference (larger flattening) between the semi-major axis and the semi minor-axis. For the semi minor-axis of the standard deviation ellipse, its shorter length indicates a more concentrated geographical distribution of study objects and a stronger influence of agglomeration and centripetal forces on the spatial pattern ,38. ThisThe spatial autocorrelation index is an important index to measure the potential interconnectedness and dependence of study objects in a region. There are global spatial autocorrelation and local spatial autocorrelation. The former is to describe the spatial characteristics of the attribute values of spatial elements in the whole region and reflect the similarity of their neighboring attribute values, which is of great importance for the analysis and description of the distribution characteristics of a spatial attribute in the whole region; the latter is to calculate and analyze the correlation degree between a spatial object in the region and its neighboring objects, analyze the differences in the local characteristics of the distribution of study objects in space, and reflect the spatial heterogeneity and instability in the local region . The comIn this paper we use the coefficient of variation and Gini coefficient for spatial heterogeneity measures and analyze the influence factors and their interaction effects based on the Geodetector, which was established by Professor Wang Jinfeng in 2010 as a new statistical method to detect spatial heterogeneity and reveal its influencing factors ,43. The http://www.geodetector.cn (accessed on 21 April 2021)), and in this paper the first two functions are used to study the spatial differentiation of COVID-19 in China cities and its driving mechanisms. In other words, factor detection and interactive detection are conducted based on Geodetector with the populations diagnosed as COVID-19 infected and dead as the dependent variables The core idea of the Geodetector is based on the assumption that if an independent variable has a significant influence on a dependent variable, the spatial distribution of the independent and dependent variables should be similar. Geodetector offers 4 functions of factor detection, interaction detection, risk detection, and ecology detection  and dependent variables (COVID-19 infections and deaths). Geodetector has stronger power than general statistics, which is based on correlation, but has a stronger hint of causality. Since it is much more difficult to keep the geospatial distribution of the independent and dependent variables consistent than to keep the consistency of their mathematical modeling curves, in this paper we use the results of the Geodetector analysis to represent the influence of the 15 independent variables on the geographic distribution of COVID-19, with the \u201cfactor detector\u201d results used to reveal the direct influence and the \u201cinteraction detector\u201d results used to find the synergistic influence.Direct influence reveals that the geographical transmission and spread of COVID-19 infections and deaths are affected by multiple factors, and there is a large difference in the influencing factors and their influence between the two . The resFor the infections, GDP, Area of Urban Construction Land, Expenditure, and Industrial Smoke and Dust Emission have great influence, with For the deaths, the critical influencing factor is Expenditure only, unlike those for the infections, and there is a significantly reduced number of factors. GDP, Number of Hospital Beds, Industrial Smoke and Dust Emission, Area of Green are significant influencing factors, Revenue, Area of Urban Construction Land, Industrial NOx Emissions are accessory influencing factors; Per-GDP, Number of Industrial Enterprises, Population Density, Number of Licensed (Assistant) Doctors, Area of Parks, Number of Parks, and Number of Free Parks have negligible influence. The number of significant and accessory influencing factors is close in the deaths compared to the infections, but their components and forces change considerably.In terms of synergistic influence, factors are in a complex interaction relationship and have a comprehensive influence on the geographic spread and diffusion of COVID-19 . The intSpatial stratified disparities, known as the first law of geography and one of the three basic principles of ecology, is used to analyze geographic phenomena where the variance within spatial layers is smaller than that between layers. This study argues that the spatial distribution of COVID-19 in China\u2019s cities is highly heterogeneous, that is, COVID-19 varies significantly between different cities in China. It is highly concentrated in certain cities, with a high level of \u201cpolarization\u201d, and a significant \u201cMatthew effect\u201d, which is in agreement with the conclusion of Cheng . It may There are many driving factors affecting the spatial differentiation of COVID-19, with significant difference in strength and strong interaction between each other, showing a prominent trend of diversification of COVID-19 spatial spread and evolution drivers and complexity of driving mechanisms. Based on the ranking of driving forces of spatial differentiation of COVID-19 patients and death, and the mean value of the forces (0.35), the driving factors are divided into four categories, and then the driving mechanism of spatial differentiation of COVID-19 in China cities is constructed see  with theSome of the findings in this paper corroborate some viewpoints of existing papers. Previous studies have shown that there are large spatial differences in the distribution of COVID-19, and that urban medical conditions, greening and living environment quality, pollution, economic development, and other factors have an undeniable influence on the spread of the virus. This study further confirms these views. As of 29 March 2020, 214 and 199 countries (regions) across the world reported COVID-19 infections and deaths, respectively, with the coefficient of variation at the national scale of 4.20 and 3.82, and the Gini index of 0.87 and 0.88, respectively, suggesting that there is great variation in the global spread and distribution of COVID-19 virus. At the same time, Mizumoto  believesHowever, some results are different or even opposite, and these new findings are of great value to complement and refine the spatial spread driving mechanism and evolution law of COVID-19. The differences are mainly in three areas: first of all, for the economic dimension, Amdaoud , Paez 7, and LinEpidemic prevention policy and medical spatial planning are the most critical policy tools for the government to control the spatial spread and dissemination of COVID-19, and the core work of management, planning, geography, and spatial epidemiology. The driving factors of COVID-19 spatial propagation and evolution are quantitatively large, and the factor forces and interactions are significantly heterogeneous, complex, and dynamic. Therefore, this paper suggests a precise, refined, and differentiated policy design for spatial governance of COVID-19 based on the driving mechanism constructed in the previous sections with reference to the findings of Peleg  and GrzyThe first is to, in line with the ecological civilization construction requirements, increase investment in green space and park construction, make more parks free to citizens, and improve the positive shelter capabilities of public spaces such as schools, gymnasiums, exhibition halls, auditoriums, organize regular exercises and drills to strengthen the emergency isolation and storage capacity of public spaces, and enhance the comprehensive emergency response capabilities for transforming public spaces to treatment and nursing space ,83. FurtThe second is to implement the development concept of healthy and resilient cities, increase financial investment in medical space and optimize the spatial allocation of medical facilities according to supply characteristics and requirements, provide more training and supply for medical workers, expand medical staff and increase hospital beds, and enhance the emergency resilience of medical space and facilities; and implement the concept of smart development, control the size of cities in accordance with the requirements of \u201ctightening up increment, revitalizing the stock and improving the quality\u201d, and strictly control the expansion and spreading of urban construction land to achieve efficient spatial governance based on the findings of Li , Zhou 8 and WangThe third is to implement the development concept of safe cities and smart cities, promote the application of smart technology in urban construction, prepare and implement the specialized plan for urban prevention and control of infectious diseases, establish technical standards for epidemic prevention, treatment, and emergency response, and build a safety control system of \u201csource control + tailing margin\u201d for cities ,92. The Affected by the scale, there is an urgent need to strengthen multi-scale empirical research to develop a precise and scientific epidemic prevention policy for different age groups, social classes, exposure levels, and different realities such as \u201ccity closure\u201d, \u201ccommunity closure\u201d, \u201cstrict control of overseas import\u201d, \u201cresumption of production and schooling\u201d, based on different scales of geographic units such as countries, regions, cities, counties, towns and communities, and special spaces, and the potentially large differences in the level of spatial heterogeneity of COVID-19 spread and evolution and its driving mechanisms. This paper investigates the spatial heterogeneity of COVID-19 at the urban scale and its driving mechanism based on quantitative analysis and finds that the spatial distribution and spread of COVID-19 are highly spatially heterogeneous, with significant differences in the driving forces and their interactions. It further classifies the driving factors into three categories, stating that Area of Urban Construction Land, Gross Domestic Product (GDP), Industrial Smoke and Dust Emission, Expenditure are the most influential factors; the effect of Area of Green, Number of Hospital Beds, Number of Parks, Industrial NOx Emissions cannot be ignored; Area of Parks, Number of Licensed (Assistant) Doctors, Per-GDP, Population Density play indirect roles mainly by means of interaction.This study not only provides useful reference for China and other countries in the world, such as the United States, India, Brazil, France, the United Kingdom, Italy, and Turkey with more severe outbreaks, to actively explore the COVID-19 spatial distribution patterns, transmission mechanisms and dispersal models, evolutionary dynamics and mechanisms, prevention and control recommendations and countermeasures, and new approaches to spatial governance and policy design, but also offers new ideas and frameworks for the study of Middle East Respiratory Syndrome (MERS), Severe Acute Respiratory Syndrome (SARS), Avian Influenza, Dengue, Ebola, Cholera and other international and regional infectious diseases. The empirical studies based on the ideas and framework provided in this paper can reveal the spatial spread patterns and evolution laws of these infectious diseases and their driving mechanisms, which is invaluable for Middle East and African countries to formulate scientific prevention and control policies, especially with a great value of application for less developed countries such as Syria, Iraq, Afghanistan, Iran, Yemen, Libya, Sudan, South Africa, Ethiopia, Nigeria, and Angola, which are suffering from war or virus ravages.There are significant differences in COVID-19 risk and response performance among different cities and countries around the world, as well as factors influencing the spread and geographic distribution of the virus and its prevention and control strategies. The research framework and ideas constructed in this paper can be applied to the analysis of cities in the United States, India, Brazil, Iran and other countries to explain the spatial spread and geographical distribution patterns of COVID-19 and provide a basis for the design and implementation of infectious disease control policies. In addition, there are obvious inequalities between different countries in the dimensions of economic development stage, medical and health conditions, living environment and pollution, which have different impacts on the spatial transmission and distribution of COVID-19 epidemic. With multi-scale empirical studies on different countries, regions, and cities, as well as comparative analysis of multiple cases across the world by multi-methods, GIS and network analysis methods , this paThere are also some deficiencies in our study, which may have a certain impact on the accuracy and applicability of the conclusions. Due to the limitation of data acquisition, comparative studies at different scales and in different time periods are not covered in this paper, and differences in epidemic prevention policies and population attributes between cities are not included in the research framework. In the era of \u201cpost-epidemic\u201d or \u201cnew epidemic\u201d or even \u201cnew-new epidemic\u201d, we call for more international scholars to carry out cross-national multi-scale and multi-time series comparative and empirical studies to get more precise conclusions, to enable policy makers, planners, and the public to fully know the spatial distribution of COVID-19 and its driving mechanisms, and provide a theoretical basis and practical guidance to conquer the virus earlier and create a better life."}
{"text": "Professionals throughout the world have been working to assess the interdisciplinary interaction and interdependence between health and wellbeing in a constantly changing environment. The One Health concept was developed to encourage sustainable collaborative partnerships and to promote optimal health for people, animals, plants, the environment, and the whole planet. The dissemination of scientific discoveries and policies, by working directly with diverse communities, has been one of the main goals for Global One Health. The One Health concept has also been referred or related to as \u201cOne Medicine, One Medicine-One Health, One World-One Health, EcoHealth,\u201d and Planetary Health,\u201d depending on each fundamental view and approach. In Latin America, despite the concept still being discussed among health professionals and educators, several One Health initiatives have been used daily for more than decades. One Health action has been applied especially in rural and underserved urban areas where low socioeconomic status, lack of health professionals, and scarcity of medical resources may require professionals to work together. Local communities from diverse social and economic statuses, including indigenous populations have been working with institutions and social organizations for many years, accomplishing results through grassroots movements. These \u201cbottom-up\u201d socio-community approaches have also been tools for the prevention and control of diseases, such practice has preceded the One Health concepts in Latin American countries. It is strongly believed that collaborative, multidisciplinary, political, and economic initiatives with prosocial focus may become investments toward obtaining significant results in the face of global, economic and health challenges; working for a healthier world with inclusivity, equity, and equality. In this study, it is briefly presented how the One Health approach has been initiated and developed in Latin America, highlighting the events and actions taken in Brazil, Chile, and Colombia. The One Health concept is not a new idea. Although historically, there have been times when medical doctors and veterinarians have worked together , it may A scientific and multidisciplinary approach for the health and wellbeing of humans and animals in a balanced environment, which results in the promotion of Planetary Health, showing that everything has been intrinsically connected . Also coThe perception of health in humans and animals and knowledge of their interconnectedness can be long traced to the traditional knowledge of indigenous people in Latin America. Indeed, animals preceded humans in appearing in the territory by tens of millions of years, they have been deeply interconnected to the history of what is Latin America now. Human appearance has profoundly affected and shaped the health and life of native American animals, which subsequently led to a long history of the increasing human impact: from the Paleoindians, who may have caused the extinction of several Latin American megafauna species, to the Columbian Exchange that brought exotic species from the Old World, such as horses, cattle, sheep, dogs, domesticated American native species including turkeys, llamas, and alpacas, which brought extinction to several native American species. In such a similar dynamic scenario, animals have also influenced human history in an adaptive and interdependent human-animal relationship in Latin America .Montenegro and Stephens  have thoIndigenous populations were neither static nor peaceful. Survival depended on war systems, different weapons, and food strategies. Health and wellbeing were intrinsically connected to sophisticated knowledge acquired through centuries regarding the balanced use of local ecosystems. European invasions changed the culture, inter-ethnic, and ecological relationships of natives. Health was also affected by new infectious diseases. For centuries, since the time of their colonization, conquest, or occupation, indigenous populations of tropical coastal environments suffered the most from illness and poverty. The Central Andes had a demographic collapse similar to the Bubonic plague epidemic in Europe in the 14th century. Later, such native populations have been affected by the continuous spread of diseases, habitat fragmentation, and land occupation associated with the lack of modern health care and infrastructure.Although the use of animals in conventional medicine has been comparatively recent, a meta-analysis of historical and archaeological evidence indicated that animals have been used in traditional medicine in Latin America since ancient times. This was considered a \u201cfaunal drugstore.\u201d Animals, mostly wild species, were used as both raw materials for clinically prescribed therapies, and as amulets and charms in native magic-religious rituals and ceremonies . Plants Nowadays, many indigenous people still living within isolated environments have been constantly destroyed by non-sustainable agriculture and exploratory business, leading to harsh economic conditions, higher morbidity, and health risks. These populations have been connected and highly dependent on their local ecosystems for survival. Despite the accumulated knowledge and holistic understanding, One Health has much to learn about the early times of native Latin America, as the natural environment deeply influenced indigenous life, culture, and history.In 2010, the Food and Agriculture Organization (FAO), World Organization for Animal Health (OIE), and WHO collaboration officially established the One Health Tripartite . In addiOnly in June 2021, at the 168th Session of the Executive Committee that the Pan American Health Organization (PAHO) has included One Health in the official agenda, as a \u201ccomprehensive approach for addressing health threats at the human-animal-environment interface\u201d and prioritizing endemic diseases of zoonotic and vector-borne origin, emerging, and reemerging infectious diseases of zoonotic origin, antimicrobial resistance, and food safety . HoweverThe PAHO proposed analysis and mapping of health interactions in specific national contexts, the establishment of One Health governance, strengthening multidisciplinary and intersectoral aspects, emergency preparedness and response, digital technology and scientific tolls, research, and capacity building as strategies in accordance with Agenda 4.6 One Health of the General Strategic Plan of PAHO for 2020-2025 with an estimated budget of the US $1 million per biennium . In thatOne Health history and development in the last decades in Brazil, Chile, and Colombia have been summarized and presented by timelines of each country  in Jaboticabal, northeast S\u00e3o Paulo state, Southeastern Brazil, have performed animal and public health outreach in rural communities which would later be regarded as One Health. Students accompanying community health agents assessed health risk factors related to the interaction between humans, animals, and the environment in homes and surrounding areas with attention to the main zoonoses as determinants of the health and disease processes in their ecosystems. Educational actions were applied, mainly, in primary and secondary schools with an expectation that children were the messengers for their parents and their behavior to be changed. All of these activities generate research for postgraduate studies.The One Health movement in Brazil was officially introduced and recognized in 2007 when Dr. William B. Karesh, a wildlife veterinarian from the Bronx Zoo of New York, EcoHealth Alliance, and the Wildlife Conservation Society (WCS) led the first One Health Symposium in Brazil, introducing the theme \u201cOne World, One Health\u201d in which wild animals act as important reservoirs and sentinels of diseases that affect human health being correlated with environmental destruction. In 2009, the Centers for Disease Control and Prevention (CDC) and Brazilian professionals collaborated with a Leptospirosis research study through the One Health approach in Northwestern Brazil. In December 2012, the concepts of One Health, EcoHealth, and Zoobiquity were introduced in Brazil by one of the authors of this study (CPB), who is also a zoo and wildlife veterinarian, by initiating and promoting One Health and spearheading official postgraduate research interdisciplinary programs among national and international academic institutions.The Veterinary Public Health and Biotechnology (VPH Biotec) Global Consortium launched the \u201cInternational Congress on Pathogens at the Human-Animal Interface (ICOPHAI).\u201d The first edition occurred in Addis Ababa, Ethiopia, in 2011, and the second ICOPHAI was held in Porto de Galinhas, Brazil in 2013 to discuss issues related to zoonotic infectious diseases worldwide and thematic areas that necessitate One Health implementation in Latin America .Sistema \u00danico de Sa\u00fade\u201d \u2013 SUS). By this time, the One Health concept was neither widely known nor advertised nationwide. Similarly, \u201cThe One Health Summer School Brazil\u201d, which started in 2013, focuses on topics of infectious diseases, food safety, and public policies as part of an international collaboration between the School of Veterinary Medicine and Animal Sciences at Unesp, Prefeitura de Botucatu/SP, and the University of Saskatchewan, Canada. Postgraduate training was developed through international collaborations.Since 2012, many One Health events have been officially established in several states and cities in Brazil. Most of the One Health events in Brazil were neither known nor advertised nationally or internationally. The Universities already had interdisciplinary outreach programs with One Health, such as approaches working directly with rural and diverse communities through the Unified Health System (\u201cCentros de Excel\u00eancia de Sa\u00fade \u00danica\u201d) as a result of a 2014 One Health Fulbright Scholar and Ambassador Awards, spearheaded by one of the authors of this manuscript. The original Centers of Excellence at the time were held in the states of Bahia, Pernambuco, Minas Gerais, Rond\u00f4nia, Par\u00e1, Roraima, and Mato Grosso do Sul. A successful example of these \u201cgrassroots\u201d community and One Health approach movements through \u201cCentros de Excel\u00eancia de Sa\u00fade \u00danica\u201d occurred on March 5, 2015, with the First One Health Bahia Symposium held in Porto Seguro with attendance of more than 150 health professionals from different areas and institutions. Infant microcephaly that was possibly associated with the ZIKA virus was presented through the One Health concept by Brazilian physician infectologist, Dr. Antonio Bandeira, working together with Funda\u00e7\u00e3o Oswaldo Cruz (FIOCRUZ) and Hospitals. Similar activities involving directly community leaders were developed in these Centers of One Health.In 2014 and 2015, many actions were carried out in Brazil that contributed to the spread and application of the One Health approach in the country and Latin America. The first One Health Workshop was hosted in Minas Gerais State, Southeastern Brazil with national and international One Health experts . In the Meanwhile, members of the One Health Brazil Latin America Association presented their work at the One Health Forum in Davos, Switzerland at the third Global Risk Forum One Health Summit 2015 , and at The \u201cOne Health Brazil Latin America Association\u201d became an official member of the World Veterinary Association (WVA) in 2015. The association included Brazil, Colombia, Peru, and Chile collaborators. Eventually, pioneer members from the Brazilian institutions reorganized and created the One Health Brasil with a purpose to unite, collaborate, organize, and centralize a sustainable multidisciplinary network of One Health, EcoHealth, and Planetary Health in Brazil.After that, other important initiatives have been promoted, mainly by universities and professional associations like the 52nd Brazilian Society of Tropical Medicine Congress, held in Macei\u00f3, Northeastern Brazil in 2016. On this opportunity, the subject \u201cChallenges for human and animal health in transforming ecosystems in a One Health perspective\u201d was widely discussed.LeishN\u00e3o Project: A One Health approach for visceral leishmaniasis prevention in an endemic area in Brazil\u201d by Galhardo et al. , and the World Medical Association (WMA), receiving several Global One Health Awards in 2016\u20132017. The \u201co et al. , \u201cOne HeIn February 2017, the antimicrobial resistance (AMR) group from the Pontifical Catholic University of Paran\u00e1 (PUCPR), using the One Health approach, organized the round table, \u201cCurrent state of Antimicrobial Resistance in Brazil and the United Kingdom,\u201d together with the UK Science and Innovation Network and the School of Life Sciences of PUCPR. They invited 40 high-level experts from the government, academy, and private companies from the UK and Brazil to discuss the global and Brazilian state of AMR. As a result of this round table, several suggestions were made to improve the fight against AMR within the International Global Plan to fight AMR. In addition, the One Health Commission of the Regional Veterinary Council of Paran\u00e1 State (CRMV-PR), a pioneer at the National level, was formed in April 2018 to fortify Veterinary Medicine in maintaining public, animal, and environmental health under the context of One Health. In 2019, through the State Commission for One Health, a partnership was established between the Federal and the Regional (PR) Council for Veterinary Medicine, and the first International Symposium on One Health was held, addressing zoonoses, disasters, mental health, and AMR. At the opening of the event, a term of commitment was signed between government entities, PUCPR, and the Regional Council to work in One Health. Thus, the School of Life Sciences (PUCPR), in 2019, changed all the matrices of its undergraduate courses, thus starting with One Health disciplines common to all courses.After 2017, Federal and Professional Associations  have collaborated by disseminating the concept of One Health. The Preventive Medicine and Public Health sectors have always covered aspects of preventing and maintaining the health and wellbeing of animals and, by extension, of human beings. The conservation and preservation of the environment have shown great global interest in health and only in the last decades, with the new emerging diseases, and many enzootic epidemics have been proven to be associated with an imbalance in nature, destruction of habitats, and wild and domestic animals that were sentinels or reservoirs of new epidemics. An example of applying the One Health approach in endemic regions can be seen during the biggest epidemic of Yellow Fever in Brazil, which occurred in the years 2017 and 2018 due to a new cycle wave aggravated by mosquito-borne spreading, habitat encroachment, and exposure of the unvaccinated population. This occurred after almost 80 years of eradication in urban settings by vaccination in 1942. The fatality of wild primates during the epidemic demonstrated the importance of animals as sentinels for human health and the destruction of the environment associated with the reemergence of various zoonotic diseases  in the last years. This international campaign co-coordinated by the One Health Initiative, the One Health Platform Foundation, and the One Health Commission aims to bring awareness to the need for One Health interactions around the world. In 2018, an event organized by students from the Federal Rural University of Rio de Janeiro (UFRRJ) was one of the winners of the One Health Day Student Event Competition Award. The \u201cOne Health Day at UFRRJ\u201d brought professionals from different health and environmental-related fields together to sensitize attendees from different backgrounds about the indissociable connection between human, animal, and environmental health. In the last years, similar educational events were held on a local, regional, and national level in Latin America, reinforcing the need for a multidisciplinary approach in many of the contemporary and future challenges.From 2016 to 2021, other independent health groups continued in formation throughout Brazil and Latin America, such as courses and disciplines. The \u201c1st National Meeting on One Health,\u201d in Belo Horizonte, Minas Gerais State, Southeastern Brazil supported by the Federal University of Minas Gerais and Federal Council of Veterinary Medicine (CFMV) aimed to disseminate the concept \u201cOne Health,\u201d its challenges, policies to professionals in the medical, veterinary, and environmental fields. Most of the One Health groups and events in Brazil initially concentrated on wildlife medicine, species preservation, environmental conservation , and emerging infectious diseases in Brazil and Latin America. Many groups focused on sustainable agriculture, agroindustry through the One Health approach, AMR, Food Safety, theater and arts, education, anthropology, and animal and human health, while others focused on comparative medicine and human-animal bond and wellbeing. Several professionals participate in these interdisciplinary partnerships, such as medical doctors, veterinarians, nurses, agronomists, nutritionists, psychologists, historians, anthropologists, statistics, biologists, dentists, conservationists, engineers, artists, and dancers.Research groups in Brazil have also been applying One Health as a practical tool to solve problems such as zoonoses in different populations and their contact animals, taking advantage of the SUS, which allows comprehensive human-animal sampling. In such scenarios, wild boars, hunting dogs, and hunters have been surveyed in Brazil for vector-borne, waterborne, and foodborne diseases, for the first time worldwide . MoreoveThe increase in the demand for qualification due to the requirements of the labor market has led health, agriculture and environmental professionals to increasingly seek a differential in their academic training with Higher Education Institutions. This fact was specially related to the insertion of different health professional categories, starting from the enactment of Law No. 8,080 of September 19, 1990  in the aFurthermore, the experience of interdisciplinary teaching, research, and extension of Environmental Health at the School of Nursing at Ribeir\u00e3o Preto, University of S\u00e3o Paulo (SNRP-USP), began four decades ago in the training of clinical nurses. The history of this curriculum development had moments of coming and going, resulting from the institutional didactic and methodological options and trends. However, it took shape and acquired greater consistency over time despite the difficulties imposed by the traditional teaching model centered only on disciplinary practices and the hospital-centered care model. From the 1980s onward, there were important national movements with changes in health care proposals in Brazil, culminating in the promulgation of the new national constitution (1988) and strengthened by the Primary Health Care model and the SUS in 1990. The creation of an Interinstitutional Group for Studies and Research in Health Service Wastes (IGSRHSW) was strengthened by an interdisciplinary character, composed of professionals from different areas of knowledge and educational institutions, services and assistance in health, environment, sanitation, engineering, economics, and administration focused on Environmental and Planetary Health. Concomitant to the formation of this group, the Environmental Health Laboratory was created, in which an action project was established in the teaching, research, and extension to the community. Academic works were generated, including thesis, dissertations, scientific articles, manuals, books, and book chapters, among others, also offered to graduate students and postdoctoral researchers, opportunities for exchanges with relevant international institutions. Currently, the teaching of Environmental Health at SNRP-USP has been inserted in the teaching practice, in an interdisciplinary way and focused on One Health, through the proposal of building healthy and sustainable environments, aiming at training nurses and other professionals of the future for a globalized world.In addition, since 2017, the class \u201cOne Health: Human, Animal, and Environment\u201d has been offered to undergraduate students at the Federal University of Minas Gerais - UFMG, covering theoretical and practical aspects that include field visits in public parks and zoonosis control services in Belo Horizonte, Minas Gerais.As previously mentioned, the introduction of the One Health concept in postgraduate education in Brazil was introduced, which was derived from the American term \u201cOne Health\u201d and the interdisciplinary approach. The integrated and transdisciplinary training among professionals was brought to the fore among the professors of the Federal Rural University of Pernambuco (UFRPE), which was the utmost need to create and offer a outreach program that would meet the demands required by local communities and by the professionals working together in the Pernambuco State, Northeastern Brazil. Some professors realized in recent years, especially between the period of 2015 and 2018, that students entering postgraduate courses did not have the profile for training in graduate courses at the academic level because the vast majority of them already had employment in a public institution or private company linked to the health, agriculture or environment field, and were often interested in graduate programs mainly to update their knowledge and improve their performance in their professional fields or by their own need for changes in the field of activity in the companies in which they already operated.In addition to this perception and concern from the professors, and due to the lack of a specific postgraduate program in One Health in the city of Recife, capital of Pernambuco State, the Professional Master's degree in One Health from UFRPE began to be designed and idealized by some professors, who took over the elaboration of the proposal, in the field of preventive veterinary medicine in the Department of Veterinary Medicine. However, since this department did not have enough professors who would meet all the demands of the minimum program content necessary for the training of students, other professors from other departments of the Federal Rural University of Pernambuco (UFRPE) and other institutions, namely, the Federal University of Pernambuco (UFPE) and the Federal University of Agreste of Pernambuco (UFAPE), were invited to collaborate. In addition, considering practical experience and experience in management and administrative positions, professionals from public institutions, such as the State Health Secretariat of Pernambuco, were also invited to compose the teaching staff and contribute to the training of professionals in the field of One Health.Based on this demand raised by UFRPE, coordinating professors of the developing proposal have scheduled meetings with the various segments and institutions linked to the One Health field, such as municipal and state health departments and the Agricultural Defense Agency of the State of Pernambuco. The Defense Agency, in particular, readily showed interest and positively signaled support for the creation of a postgraduate course in the One Health field in addition to raising actions among their staff. This was done for training and updating, given the growing demands and needs from society for joint action of quality by the professionals who make up the staff of the respective companies. Thus, the implementation of a professional master's course in the field of? One Health at UFRPE was a demand needed not only by veterinary medicine professionals and other health professionals, given the different possibilities of performance in the professional market, but also by the society itself. This was done for technically qualified professionals to meet their needs, as food consumers and users of different health services, related to health surveillance, a better quality of life, animal health defense, environmental health, and primary health care.Currently, the accredited professional master's degree in One Health at UFRPE has two lines of action and/or intervention called Surveillance and Primary Health Care and Epidemiology and Health Planning. Teaching staff formed by veterinarians, an economist, a dentist, a speech therapist, and, occasionally, professionals from other areas were invited to interact with the students, among which included social workers, nurses, physiotherapists, veterinarians, an administrator, a pharmacist, biologists, educators, among other professionals, who develop intervention projects in their institutions of origin, whether public or private, in the field of health, agriculture, and environment, related to health education, control of communicable or non-communicable diseases, water, food, management, processing of epidemiological data, AMR, among others at the intersection human, animal, and environment.The design of shared disciplines at the post-graduate level by applying the Collaborative Online International Learning concept has also been an initiative to promote One Health among different professionals in Brazil and other countries . The FedOutreach projects in higher education institutions also support the promotion of One Health among faculty, scholars, and communities in Brazil. An interdisciplinary team from UFES, recognizing the importance of training professionals in the One Health approach, created an outreach project entitled One Health ES in 2020, which involves faculty, professionals, and undergraduate and graduate students of different areas, such as medicine, veterinary, nutrition, pharmacy, biology, biomedicine, and dentistry. Periodically, the group meets to debate publications involving One Health and to plan and develop projects to be implemented in the community aiming at the health promotion and the prevention and control of diseases by applying the One Health concept, such as publication of informative material in social media. One Health ES also organizes webinars with invited experts, improving the network for further projects. The team also conducts research using this approach working directly with communities, which has been promoted in the social media of One Health ES. The engagement in the interprofessional actions, with collaborative participation of the entire team, highlights the promising impact of this initiative in the public health system and biodiversity in Brazil.In Minas Gerais, Southeastern Brazil, the Post-Graduate Research Program (PPG) of the Federal University of Vi\u00e7osa has been a program of international research partnerships with the University of Washington and The Paul Allen Global Animal Health at the Washington State University, the USA with an official dual Doctor of Science and PhD. The UFV/UW/WSU One Health interdisciplinary post-graduate partnership program continues to support sustainable collaborative research projects in One Health approaches as well as hosting exchange of professionals, students and visiting scholars.During the COVID-19 pandemic, veterinarians in the Residency Program at UNESP Jaboticabal have been working directly in Public Health on different fronts of action both in Epidemiological Surveillance and Primary Health Care, as well as in the Coronavirus Service Center, performing telemonitoring of suspected patients. In parallel, two research projects have been developed: \u201cSeroprevalence of SARS-CoV-2 infection in the municipality of Jaboticabal - SP: serial serological surveys\u201d and \u201cMolecular diagnosis of patients infected with SARS-CoV-2 in the municipality of Jaboticabal - SP: use of a safe and low-cost protocol.\u201d Also, due to a departmental reorganization at the School of Agricultural and Veterinary Sciences, a Department of Pathology, Theriogenology and One Health has been renamed, demonstrating that One Health should be accepted as a reality that involves all disciplines related to animal health and global health, in the interface with the environment, including One Health in the curriculum, outreach, and research.As regional One Health groups were created, mainly through articulations in favor of research opportunities, but also for specific events, university professors and post-graduate students from different professional programs established a small online community in 2016 using the mobile platform, WhatsApp that would have become the most popular in Brazil and several countries. They established this community, the One Health Brasil Network, together with leaders and members of the One Health Brazil Latin America Association and several other One Health commissions and groups from all over Brazil. Initially, such a network aimed at simply sharing contacts and general information, intuitively associated with the themes of One Health, EcoHealth, and Planetary Health, from newspaper and scientific academic articles, policy reports, manuals, and regulations to advertise lectures and world events related to One Health.Growing \u201corganically,\u201d especially from the outreach promoted by its members at symposia and conferences, the community began to face one of the great challenges of a community-based organization: effective communication. Often, the dialogical space was taken by manifestations that, although relevant, clearly diverged from the One health approach and, often, conveyed ideological positions and political readings of governmental programs and actions. With the recurrence of circumstances impairing constructive and collaborative dialogue, the necessity of a group management committee became clear. This management committee then started monitoring the posts and, whenever necessary, intervening to preserve the focus on One Health and, as much as possible, the predominance of collaborative attitudes.Ecossistemas Aqu\u00e1ticos: Sa\u00fade animal, humana e Ambiental), an interdisciplinary subdivision applying One Health, EcoHealth, Planetary Health, and wellbeing of all lives in aquatic ecosystems.In 2019, the management committee decided to create a website to what was already called the Rede One Health Brasil network , as a prIn 2020, through the One Health Brasil network, investigators from different regions of Brasil received a CNPq Research Award  and have been leading the first SARS-CoV-2 research in pets in Latin America. Results have been notified to OIE-WOAH, peer-reviewed articles have been published, and education through media and internet tools have been emphasizing the importance of veterinarians as essential professionals in human health, animal welfare, and the prevention and control of pandemics through One Health.Una Salud Chile) including national universities and public services  wanted to provide education in civil society and directly in the communities, working and consolidating the resilience of the villages within Santiago. On December 4, 2018, the director of CIACHI was appointed spokesperson for Central and South America at the One Health Platform and the director of One Health Commission connected the founders of OHLAIC. The activities grew exponentially throughout the year in Chile with the participation and support of the Education and Science Foundation. The First One Health Seminar on Emerging and Re-emerging Diseases was held in Valdivia, several One Health workshops in schools, and a Scientific Fair at Higher Institute of Commerce were carried out . FurtherThe main purpose of the National One Health Network (ReNOH) has been to connect all One Health groups in Chile to work based on local, national, and global objectives, including researchers and university students working in the same areas from all regions of the country. It is currently incorporating high school students and civil society, bringing the concept to schools and civic associations such as neighborhood councils or fairs.The expansion of ReNOH has been a work in progress and discovery of new activities, in this context. Their main objectives have been to educate in One Health concepts and strategies, reaching the most remote and vulnerable communities . The maiRed Salud P\u00fablica Veterinaria\u201d (SPVet). The SPVet network was created following a recommendation made at the First Meeting of Veterinary Public Health held in Bogot\u00e1 (Colombia) in 2003 under the auspices of the Representation of PAHO-WHO. Organizations and Universities participating in this meeting included the National University of Colombia, Antioquia University, and the District Secretary of Health. During this meeting, an important dialogue related to food safety, prevention of zoonoses, poor public perception of the role of veterinarians in the wellbeing of the community, low importance of veterinary public health in higher education, and absence of guidelines for professional practices and the consequent fragmentation of the agricultural sector in the decision-making regarding the health system and the social and economic development of the country was held. The objectives of the SPVet network were the following: (1) maintaining a continuous and timely flow of information on veterinary public health topics, (2) strengthening ties of cooperation and support among specialists, create a space for discussion and consultation on topics of national interest as international, and (3) contributing to the strengthening of undergraduate and graduate academic activities in veterinary public health , a series of projects co-financed under the EU ALFA program, aimed to support an international network constituted by Faculties of Veterinary Medicine from Latin America and Europe. The projects have envisaged a series of objectives and activities aimed to promote and enhance research and training and intersectoral collaboration across Latin America and Europe. Project partners use a mail-list and distance learning platforms  to organize educational activities. Major results so far achieved have included the harmonization or development of a common curriculum, the creation of common modules on selected VPH topics, and that new teaching methodologies were used for a common training program on VPH, delivered via the Internet, using the problem-solving approach based on case studies. Challenges were experienced as a result of poor and unreliable internet connections. The use of modern communication and teaching methods in combination with written and theoretical material enabled lecturers and students at the universities involved to test, in some cases, for the first time, a problem-solving approach and a modular teaching structure in virtual format of real situations. The adoption of this innovative, flexible, less teacher-dependent mode of learning has played a key role in the activities of the network  exchanges of professors and researchers and coordinating meetings, participation in and organization of seminars, congresses, and conferences at the National and International level, and the publication of scientific and popular articles were used. The SAPUVETNET didactic tools have been tested and used by partner faculties and universities and other institutions. Didactic material can be freely circulated and distributed, used for distance learning, and be adapted to the local context of any country or geographical area, even outside Latin America and Europe   publishing academic material, (ii.) promoting the One Health concept through participation and organization of local symposiums, (iii.) institutional cooperation with the National Health authorities such as the Zoonoses Integral and Integrated National Program funded by the Colombian Ministry of Health and Pan American Health Organization, and (iv.) formation of undergraduate students within the igators) , 40.Another important network applying the One Health approach not only in the academic field but also in general communities is the University of C\u00f3rdoba in Monteria, northern Colombia. This University constituted the One Health Colombia Network (OHCol Network) being recognized nationally and internationally by One Health Commission (USA) and the International Student One Health Alliance (ISOHA). This Institution held the first One Health Colombia International Symposium in 2018 and the second One Health Colombia International Symposium in 2019. The OHCol Network has been accredited as an official member of the interdisciplinary alliance for research and international collaborative training with the Schools of Medicine and Global Health, and the One Health Research Center (COHR) at the University of Washington, USA, and have been developing curricula and outreach programs to train students and professionals with the global vision of One Health, EcoHealth, and Planetary Health approaches for conservation and human, animal and environmental health among the underserved minority communities. Colombian health professionals working with research and community leaders through the One Health approach were also members of the original One Health Brazil Latin America Association which has been officially a member of the World Veterinary Association since 2015.Since 2018, the One Health Colombia Network has held 18 \u201cOne Health and Wellness outreach sessions\u201d in different rural and underdeveloped regions. More than 1,200 animals of several species have been evaluated, vaccinated, vitaminized, and dewormed. In addition, more than 7,000 people of all ages have received medical care and educational teachings in prevention health and welfare. These outreach sessions follow a human-animal-environmental interface methodological strategy based on Human Health activities, Biodiversity, and Economics Health . From 20Uniagraria) located in Bogot\u00e1, v. CES University, Medell\u00edn, and vi. the National University of Colombia, located in Medell\u00edn and Bogot\u00e1.Under the COVID-19 pandemic, several Colombian public health research groups have published about the importance of the One Health Approach in the emergence of newer zoonotic infections like SARS-CoV-2 , 43. AutOne of the most significant contributions from the Colombian National Health Institute was the launching of the One Health Zoonotic Disease Prioritization workshop (OHZDP) in Bogot\u00e1 in August 2019, based on the methodology developed by the CDC USA and Colombia .In November 2019, the second International One Health Symposium held by the One Health Colombia and leaders from One Health in Latin America countries  signed a One Health Latin America Manifest for mutual understanding committing to work collaboratively and synergically within the One Health Latinoam\u00e9rica, Ibero y el Caribe network (OHLAIC) .Sa\u00fade \u00danica, Salud Unica, Une Seule Sant\u00e9) and \u201cHealth One\u201d , may be interchangeable in such languages.Despite the adaptation of an English-speaking concept of One Health to Spanish, Portuguese, or French of most Latin American countries, the majority of terms can be easily translated due to their link to basic words describing almost the same health issues. However, Latin languages accept the switch of substantive-adjective. For example that \u201cOne Health\u201d   and the Salmonella spp., Escherichia coli, tuberculosis, malaria, yellow fever, influenza A(H1N1), West Nile Virus, Zika, Dengue, Chikungunya, and SARS-CoV-2, have been examples in which animals, humans, and the environment have been intrinsically related. In these cases, animals were also victims of the emerging infectious diseases transmitted by vectors being sentinels for human health and a sign of an imbalance in the environment, especially by habitat destruction due to deforestation or pollution. In addition, emerging or neglected zoonotic diseases, such as hantavirus pulmonary syndrome, leptospirosis, trypanosomiasis (Chagas disease caused by Trypanosoma cruzi and other species), brucellosis, hanseniasis, treponemas, and leishmaniasis arose when human beings have invaded forest region, increasing the contact between people wild animals who might act as pathogen reservoirs. A better understanding of the type of contact between human and animal populations (domestic or wild) has been fundamental for modeling how zoonotic infections will emerge and spread. The emergence of several unidentified species of new pathogens in Latin America and co-infection with Bartonella, Ehrlichia, and Rickettsia as possible etiologic agents of anthropozoonoses and zooanthroponoses, and related diseases in pets, livestock, and wildlife have intensified the interest in neglected and emerging pathogens.To further develop the One Health concept, we must consider taking into account the accelerated advances in science and the globalization of our economies. This has been important because about 75% of emerging infectious diseases have been shared between humans and domestic and/or wild animals. Emerging zoonotic diseases that affect Latin American countries today result from interactions between natural and human-animal-plant systems. Infectious agents, such as Zika, dengue, hanseniasis, leptospirosis, leishmaniasis, yellow fever, parasitic and other neglected diseases in Brazil, and the complex nature of emerging zoonotic diseases demonstrated the need to strengthen even more interdisciplinary training and partnerships elucidating the concept of One Health in Latin America and support the work with indigenous tribes and underprivileged communities. As a result of collaborative efforts supported by Latin America's One Health, networks have developed and organized national teams for disasters preparedness through One Health. On February 11, 2021, Latin American representatives from the WHO contacted the One Health Brasil network executive members to collaborate in the submission of a proposal for the importance of One Health in Pandemics, Food Safety, Food Security, and Bioterrorism.The emergence and spread of diseases with sustained transmission from person to person have long hit humanity, representing challenges for science and public health, worldwide. Changing natural environments can modify the balance between species, increase contact between them and establish human-animal bridges. Other activities, such as wildlife trafficking, incorrect use of soil or water, urbanization without sustainability, habitat destruction, lack of basic sanitation, fires and deforestation, and the absence and/or breaking of health protocols can also contribute to the emergence of new diseases. Although governments have been responsible for public health policies, the multifactorial character in the emergence of pandemics means that the responsibility for controlling those that have been occurring, and for preventing new ones from arising, be that of all professionals, or future professionals, and of citizens living in a community. It has been the role of collaborative efforts to promote discussions and generate and disseminate knowledge, fulfilling their role in the training of professional citizens, since only knowledge can lead to changes in habits and behaviors of individuals and society.One of the challenges, foremost, in the academic scientific world is to understand the importance to work together equally with the native and minority populations of Latin America by listening to what these ancient cultures have to teach the scientists and not vice versa. Politics, years of lack of trust built among conflicting cultures, excessive bureaucracy and biased government policies from these countries interfere with collaborations and research partnerships to be developed. The One Health approach creates a unique effort to promote Unity in Diversity, cultural coexistence, human-animal-plant-ecosystem harmony, and spiritual universal values. Their Unity in Diversity concept that we share the same sky, walk the same Earth, breathe the same air, and that we are a single family might bring resolution for successful partnerships in a more holistic health vision. This unity is the essence of life from ancient civilizations and indigenous peoples which must be learned, as animals and the natural environment have deeply influenced indigenous life, culture, and history, in an adaptive and interdependent relationship throughout Latin America.The recent experience of Latin America with COVID-19 has demonstrated the importance of a more interconnected world through cooperative and less competitive collaborations. One Health may be the way for preventing future pandemics and health disparities instead, focusing on health equity, environmental and economic sustainability. Not surprisingly, through One Health initiatives, veterinarians with all professions have been associated at the front response of COVID-19 pandemics. One Health may represent the main future strategy and basis for preventive actions requesting veterinarian leadership, as potential unknown animal pathogens may still become emergent in human beings , 54. LatThere were some limitations to this review. Primarily, the review has relied mostly on personal knowledge of authors and search of main selected events instead of a formal \u201cOne Health\u201d systematic review, a relatively new concept word in Latin America which would fail to provide a comprehensive search of both indexed and non-indexed studies, experiences, and events. Although the authors have focused the review on only three Latin American countries, such an international approach has not been published to date, and it may stimulate and inspire future interactions and publications by One Health researchers in neighboring countries worldwide. Thus, the review herein has aimed to establish a starting point by rescuing the history and current efforts on One Health initiatives in only three out of the 33 countries currently established in Latin America and the Caribbean to date.Although the past topic has offered a detailed discussion about One Health experiences and conferences held at different times, the importance of One Health should be described separately. The strengthening of national and international collaborative partnerships in elucidating the concept of One Health by sharing experiences in conferences and during on-field practical actions has led to a better implementation of the One Health approach and measures to mitigate, control and prevent emerging and infectious diseases, such as Zika, dengue, hanseniasis, leptospirosis, yellow fever, antibiotic-resistant bacteria and parasitism, and the complex nature of diseases in indigenous and underprivileged communities in many Latin American countries.The One Health approach supports global health security by improving coordination, collaboration, and communication at the human-animal-plant-environment interface to address shared health threats, such as zoonotic diseases, antimicrobial resistance, food safety and security among others. Examples of potential benefits and outcomes of One Health actions are to monitor and develop standards at the local, national and global health equity, ensure adequate capacity in health including strategies to prevent, detect and respond to outbreaks of diseases, develop emergency preparedness responses, support interdisciplinary collaborative partnerships, and control of highly infected pathogens and reemerging diseases, and conduct scientific research.One Health is an inclusive collaborative, multisectoral, and transdisciplinary approach, working at the local, regional, national, and global levels, with the goal of achieving optimal health outcomes recognizing the interconnection between people, animals, plants, and their shared environment. Furthermore, the Importance of a One Health approach has increased in advancing global health security and the Sustainable Development Goals.Finally, improvement of international, national, regional and local levels of One Health networking and collaborative research studies, associated with professional training, conferences, and continuing education, has led to a better understanding of the human-animal interactions (domestic or wild) and spatial modeling on emerging, reemerging, and spreading of zoonotic infections. The advance of One Health in concepts and approaches in such a holistic way has provided key tolls for prevention and preparedness, as already presented at the discussion for tuberculosis, malaria, yellow fever, influenza A(H1N1), West Nile Virus, Zika, Dengue, Chikungunya, and recently for SARS-CoV-2.Independent of the approach used to describe the link and vision of Health of the Environment , Economics Health, Health of the Planet , and Population Health to One Health, all these concepts share the same goals as understanding their use as practical holistic tools for better and more effective solutions to address threats to the health, wellbeing and sustainability of humans, animals, plants and the environment. Above all, One Health can be used as a preventive measure for upcoming threats not only for Latin America but for the shared planet Earth as a whole.Based on local \u201cgrassroots\u201d demands, action movements and population needs, the experiences of One Health history and development in Latin America and Caribbean countries are different from other continents, from within the same continent like North America, and even among the three Latin American countries discussed herein. This review hopes to inspire other countries, regions, and continents to also share their own One Health experiences.While the One Health approach worldwide is considered crucial to address governance challenges of complex issues and is widely supported in theory, its implementation in practice remains limited, especially due to lack of financial support and the secular anthropogenic and self-centered mentality. Altogether, the world must continue working to further establish a standard system of equal assessment of health, construction of sustainable mechanisms for collaboration and communication between responsible agencies and ministries for human, plant, and animal health. Furthermore, align national, regional, and international strategies with collaboration, cooperation, and intersectoral partnership implementing the concept of environmental conservation in daily practice. Not only to learn and change the paradigms of health and diseases, of economic-political-cultural crises for the conservation of the Planet's Biodiversity with inclusion, equity, and sustainability with a holistic view, but also change our Ego into the Eco framework. Finally, there is a critical need to respect, rescue, and learn from diverse communities and indigenous peoples who have the ancestral knowledge for a balanced life on our planet. Thus, future One Health experiences in Latin America should always associate cross-disciplinarity action and concept, surpassing political, social, cultural, and linguistic differences.All authors contributed equally, approved the submitted version, and collaboratively to the written manuscript. CP-B designed the original manuscript. Figures were designed by DF, CV, NC, and AB. AM, DA, DSB, DFB, DF, AB, and CV finalized the review.The University of Washington Faculty grant 75-5324 PETTAA was applied for publication fees.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "Many scholars have conducted in-depth research on the theme of land use change and food security, and formed fruitful research results, but there is a lack of quantitative analysis and comprehensive evaluation of research achievements. Therefore, based on the relevant literature on the theme of land use change and food security in the core collection of the Web of Science (WOS) database, this paper takes the advantage of CiteSpace and VOSviewer bibliometric software to draw the cooperative network and keyword cooccurrence map to analyze the research progress and frontier. The results reveal that: (1) The research started in 1999 and can be divided into three stages: initial research, rapid development, and a stable in-depth stage. This topic has increasingly become a research hotspot in the academic community. (2) The distribution of research institutions is concentrated and forms a small cluster, and the research networks between developed and developing countries have been established, and developed countries are in the core position, but the cooperation network is not prominent. (3) The research content is becoming increasingly organized and systematic, and the research hot topics are divided into seven aspects. (4) The research area of the subject covers multiple levels, such as global, national, and specific natural geographical regions, and has formed a research system of geographic information technology and satellite remote sensing technology. It also presents the trend of cross integration with economics, land management and soil science. In the future, theoretical innovation still needs to be strengthened, and we should strengthen the research on the impact of agricultural chemical fertilizers on food security and study the impact of urban expansion on land use change. Land use change and its impact on food security have become one of the frontiers and hot topics studied by scholars worldwide ,2,3,4. WIn recent years, research related to the theme of land use change and food security has emerged in the academic community, mainly combined with issues of climate change, carbon emissions, agricultural intensification ,17,18. Fhttp://apps.webofknowledge.com, accessed on 6 September 2021) and adopt the method of group retrieval. The WOS Citation database is an information retrieval platform developed by Thomson Reuters of the United States. With the Science Citation Index, Social Science Citation Index, and Arts and Humanities Citation Index as the core, it contains more than 9000 world authoritative and influential academic journals, and the documents in the database have high authority in the academic community [The data on the relevant literature used in this paper come from the core collection of the WOS database  is a Java-based application software proposed by Professor Chen of Drexel University in 2004. It is based on the co-citation analysis theory and pathfinder, minimum spanning trees algorithm to make a quantitative analysis of the literature in specific fields, which is used to analyze and visualize the emerging trends and patterns in the knowledge field of scientific publications [https://www.vosviewer.com, accessed on 6 September 2021) is also a literature analysis and knowledge visualization software tool developed by van Eck and Waltman of the Centre for Science and Technology Studies at Leiden University [As an auxiliary procedure of bibliometrics, science mapping provides a spatial representation of network structures. Science mapping involves the interdisciplinary fields of applied mathematics, information science and computer science. It is a new development of scientometrics and information metrology. In recent years, with the rapid development of computer science, many scholars have used various science mapping tools to analyze the potential dynamic mechanism of discipline evolution ,23,24. Cications ,26. It hiversity . It can iversity .The annual distribution of the number of published articles can reflect the research level and degree of development of a certain discipline . The numThe initial stage of the research (1999\u20132008): At this stage, the number of relevant research studies was relatively small, the research topic was relatively limited, and the number of research scholars in this field was also small, mainly because there was not much research on land use change and food security. Before this stage, scholars studied the theme of land use change or food security separately. In 1999, Sporton et al. first studied the theme of land use change and food security . SubsequThe rapid development stage of the research (2009\u20132017): During this stage, scholars showed great interest in the research topic, the number of published articles continued to increase, the research questions and perspectives were further expanded, and several leading studies emerged, such as Alexander and Verburg et al. ,34. In 2Stable in-depth stage of the research (2018-present): During this stage, the literature publication trend was relatively smooth, and the research content and perspective gradually increased in depth. The research perspective has focused on both macro and micro issues, including population growth, land systems, rural development, soil organic carbon, and life cycle assessment, in the research agenda of land use change and food security, and the overall research has continued to deepen ,41.By analyzing the author\u2019s cooperation network , we can Taking the research institution as the node for visual analysis, we can obtain the cooperation network map of the research institution  and showIn According to Keywords capture the core idea of the article. Through the research on keywords in a field, we can quickly grasp the hot topics in the field . In thisTo refine the research topics more intuitively and effectively in this field, we use the unique clustering density map function of VOSviewer software to visualize the keyword cooccurrence clustering results . In the With excessive carbon emissions produced in the process of human production and consumption, global warming and abnormal climate events frequently occur, which have a direct impact on land use, especially on changes in cultivated land area, threatening global food security ,47,48. AA sustainable land management policy can help mitigate climate change, protect the land from soil erosion and ensure food security. Its core is to emphasize the resilience of management methods, that is, to seek maximum synergy through the combination of different land management policies ,60. RussIn the face of the food security crisis, although the development of marginal ecological land can improve food output in the short term, this process is mostly irreversible, and the opportunity for agricultural land expansion is limited . ExcessiResearch on agricultural intensification can be traced back to 1990. Vlek took sub-Saharan Africa as an example to explore the role of alternative soil fertility and other measures in agricultural production . There aClimate change has changed the process of surface change and terrestrial ecosystems and their composition, structure and function , triggerLand degradation seriously affects food production and distribution through soil erosion, the decline of land fertility and salinization . PaoloniWith increasing attention given to energy security and ecological security, governments worldwide are pursuing multiple goals of energy security, reducing greenhouse gas emissions, and developing rural economies. Tian and Renzaho et al. found that the government have invested much money or established tax incentive mechanisms to develop renewable bioenergy represented by fuel ethanol and biodiesel to replace nonrenewable fossil fuels  ,89. WhilFood security is a multidimensional security goal and is affected by many factors, among which food production is the most critical link in the food security system ,97,98. LIn addition, the research results of some scholars show that grain production is affected by a variety of natural and socioeconomic factors, among which regional factors, family size, farming system, land use intensity, land tenure, climate change and environmental cost have a great influence on grain productivity. The actual grain yield is affected by the quantity and quality of cultivated land, climate, agricultural technology, and planting methods ,102,103.Global land use change is affected not only by climate change, land degradation and other factors but also by economic factors such as agricultural benefits . The forIn addition, facing the problems of land fragmentation, higher agricultural production costs, lower agricultural productivity and lower grain output, most countries in the world have generally used effective measures, promoting moderately intensive land and large-scale production and management to transform and upgrade the agricultural system, to reduce agricultural production costs and to improve agricultural benefits . MoreoveAlthough the keyword clustering density map of the VOSviewer software can intuitively show the hot research topics in the field, the time factor is not considered. The time zone map of the CiteSpace software arranges keywords according to time series, which can more intuitively show the distribution of hot topics in each period . TherefoCombined with The burst detection algorithm was proposed by Kleinberg to explore the research frontier trend in a field by studying the strength and duration of keyword bursts . The resTo ensure food security, countries all over the world have generally adopted strict land use restriction measures, such as China\u2019s cultivated arable land minimum policy, Japan\u2019s land classification management system and the United States\u2019 land fallow policy. They hope to strictly restrict land use change through administrative control methods to stabilize food production and limit food risk within a controllable range ,115,116.The results of this paper show that the first research article on the theme of land use change and food security was published in 1999. Since then, the number of published articles has shown a slow-growth trend. To deeply analyze the evolution of the research field of land use change and food security, this paper divides these research studies into three stages according to the number of articles published annually and the category and frequency of keywords. The first stage is the initial stage of research (1999\u20132008), during which the number of published articles was small, the research theme concentrated on a single topic, and overall research progress went slowly. Related research mainly focuses on conceptual and technical analysis, as well as direct analysis of the impact of land use change on food security. The second stage is the rapid development stage (2009\u20132017), during which basic research knowledge increased to a certain extent. The research focused on the influencing factors of land use change, including climate change, carbon emissions, and sustainable land management, climate change and sustainability would continue to be focused on in the future. During this stage, scholars also paid more attention to improving the ability to deal with land use change and food security risks, and to explore countermeasures and governance schemes at multiple levels, such as technology and policy. The number of articles published on the theme of land use change and food security did not increase significantly until 2009, which may attribute to the theme of World Food Day in that year, which was described as \u201ccoping with the crisis and achieving food security\u201d, and emphasized the serious plight of malnutrition of 1.02 billion people in the world, as well as the need to help solve the problem of hungry people under conditions of economic crisis. The third stage is the stable deepening stage (2018\u2013present). In this stage, as the global food security problem becomes increasingly serious, scholars pay more attention to global land use change and food security, and they raise the issue of food security to a risk problem.We found that the research in this field mainly explores the impact on food security from four land use change factors: environmental change, land quality, crop planting type and agricultural production mode. First, environmental change involves climate change and carbon emissions. Excessive carbon emissions will lead to global warming and extreme climate events, resulting in changes in production factors such as moisture, heat, humidity, and temperature, which will lead to changes in land use patterns to varying degrees, eventually affecting the cultivated land area of food production and endangering food security. Second, land quality is related to land degradation. Due to the unreasonable use of land and changes in the natural environment, part of land in the world has experienced serious degradation (soil erosion), which leads to a decline in land productivity and has a serious impact on food production. Third, crop planting types involve renewable bioenergy and food production. Compared with the economic benefits of food crops, the economic benefits of other cash crops are higher, especially with the rapid development of clean energy (bioenergy), which leads to the conversion of some cultivated land originally planted with food crops to other cash crops. The reduction in the planting area of food crops will inevitably lead to a decline in total food production, then threatening global food security. Fourth, the agricultural production model involves sustainable land management policy, agricultural intensive development, food production and agricultural benefits. Facing practical problems such as land degradation, reduction of ecological land, land pollution and decline of soil fertility, people urgently need to change the extensive agricultural production model to the production model with higher overall efficiency. For example, the intensive agricultural model pays more attention to the stability of grain production and the protection of the ecological environment, which can give full play to the economic, social and ecological effects of agricultural production .At present, the research topic in this field is mainly aimed at the complex practical problems of global land use change and food security, and the research content is becoming increasingly organized and systematic. According to the clustering results, we can extract seven frontier hot topics in this field: climate change and carbon emissions, sustainable land management policy, agricultural intensive development, land degradation, renewable bioenergy, food production and agricultural benefits. These results present the trend of cross integration with economics, land management, soil science, public policy, politics, geography, and other disciplines, and indicate that the research in this field continues to expand. Meanwhile, it is worth noting that although the theme of land use change and food security has become very popular in recent years, scholars\u2019 research perspective is not limited to the direct analysis of the impact of land use change on food security but also considers climate change, carbon emissions, renewable bioenergy, agricultural intensive development models and other relevant aspects ,8,54. InThis paper also has some research limitations that can be improved in the future. Firstly, because we only selected the WOS database as the data source for the bibliometric analysis of this study, and did not choose other databases , the data used in our study cannot include all literature. However, as one of the most comprehensive databases in the world, the WOS database contains high-quality documents, it can represent the research hotspot and frontier in this field. Secondly, we can fully analyze the most influential publications in the database in the future, which will help to understand the real impact of the most important research in the scientific community.This paper comprehensively used CiteSpace and VOSviewer software for bibliometric analysis and performed a visual analysis of the knowledge map of the literature with the theme of land use change and food security in the WOS database, and explored the research status, knowledge structure and evolution context. Since 1999, the number of annual published articles in the field of land use change and food security has shown an overall upward trend, which can be divided into three stages: initial research, rapid development, and a stable in-depth stage. Although a core author group was initially formed, the overall cooperation network is still relatively scattered. The distribution of research institutions is concentrated and forms a small cluster, which shows that there are only a few cooperative relationships among research institutions, and large institutional collaborative groups have not been formed across countries or regions. In national cooperation networks, developed countries are in the core position, but the cooperation network is not prominent. Meanwhile, keywords such as food security, land use change and climate change are taken as the core issues, they exhibit a radial shape and form seven frontier hot topics in this field. Moreover, due to the complexity of the research theme of land use change and food security, the research methods in this field are in-depth and diverse, and multidisciplinary development is constantly integrated. In addition, with the emergence of factors or problems such as climate change, carbon emission limitations, the application of new land use models and technologies, and the imbalance between food production and demand, there are new opportunities and challenges to the research on land use change and food security.The research field of land use change and food security can be strengthened in the following aspects in the future. (1) Theoretical innovation still needs to be strengthened. At present, the research in this field is carried out through technology and mathematical models, which lack theoretical construction and innovation. The research perspective can also be innovated from the dimensions of land property rights systems and land management systems. (2) We should strengthen the research on the impact of agricultural chemical fertilizers on food security. Agricultural chemical fertilizer plays an important role in slowing down land use change and ensuring the sufficiency of food production, especially synthetic nitrogen fertilizer. However, the loss of active nitrogen will not only affect grain yields but also pollute the ecological environment. (3) Further research can focus on the impact of urban expansion on land use change. Due to the urbanization process of countries worldwide, a large amount of high-quality cultivated land around cities is occupied, which seriously threatens food security, especially in developing countries."}
{"text": "To address the data storage, management, analysis, and mining of ship targets, the object-oriented method was employed to design the overall structure and functional modules of a ship trajectory data management and analysis system (STDMAS). This paper elaborates the detailed design and technical information of the system\u2019s logical structure, module composition, physical deployment, and main functional modules such as database management, trajectory analysis, trajectory mining, and situation analysis. A ship identification method based on the motion features was put forward. With the method, ship trajectory was first partitioned into sub-trajectories in various behavioral patterns, and effective motion features were then extracted. Machine learning algorithms were utilized for training and testing to identify many types of ships. STDMAS implements such functions as database management, trajectory analysis, historical situation review, and ship identification and outlier detection based on trajectory classification. STDMAS can satisfy the practical needs for the data management, analysis, and mining of maritime targets because it is easy to apply, maintain, and expand. China faces an increasing demand for marine resources and ocean space along with economic and social development, bringing a variety of practical challenges to its maritime regulation and security. In the maritime regulation field, it has become more and more difficult to supervise and regulate the ships engaging in illegal fishing and maritime smuggling because these ships evade detection . In the Apart from further strengthening the maritime military forces and increasing patrols and law enforcement efforts, \u201csoft methods\u201d must also be employed to cope with these challenges, e.g., improving the automatic identification system (AIS) receiving stations and radar surveillance stations . The datIn recent years, attention has been focused on the classification and identification of moving targets using data mining technology and AIS trajectory data. Reference  studied This paper takes the AIS as a fundamental platform to design and develop a ship trajectory data management and analysis system (STDMAS) with various functions following the trajectory data management and analysis method. A ship identification method based on the motion features was put forward. With the method, ship trajectory was first partitioned into sub-trajectories in various behavioral patterns, and effective motion features were then extracted. Machine learning algorithms were utilized for training and testing to identify many types of ships. By addressing the practical needs of ship management and regulation, STDMAS can help realize the effective management of ship trajectory data, so as to effectively support and safeguard China\u2019s maritime management and maritime security.The main tasks of STDMAS include managing the storage of ship trajectory data from various sources to provide protection service for the historical data on spatial and temporal ship trajectory; assessing and analyzing the quality of trajectory data from various sources to provide the data support for evaluating the equipment performance based on the collected ship target trajectory data; and analyzing and mining the information on the hot spots and situation regularity in the waters around China to provide the technical support for the analysis and decision making in maritime supervision and management ,6. It caSTDMAS has five modules: database management module, trajectory analysis module, trajectory mining module, situation analysis module, and configuration management module. Among them, the database management module can be further divided into three sub-modules including original maritime information data management, trajectory data management, and geographical information data management. The trajectory analysis module is further divided into two sub-modules: situation review analysis and trajectory quality assessment . The traThe logical structure of STDMAS is designed as shown in Data level: As the fundamental database of STDMAS, this level is mainly responsible for cleaning, filtering, and converting the massive multi-source heterogeneous data of maritime targets. Subsequently, it puts the maritime data into storage in a unified format and provides the corresponding interface for data management, maintenance, and query. For this level, attention is mainly paid to the marine geospatial representation model, trajectory data representation model, massive trajectory fast storage method, and fast temporal and spatial query method, etc.Service level: As the business center of STDMAS, this level is responsible for the central computation service of trajectory data. It involves three modules, i.e., trajectory analysis, trajectory mining, and online analysis processing. It implements such functions as ship historical trajectory review and replay, data quality assessment of various information sources, ship identification, ship navigational regularity mining, ship outlier detection, and situation regularity mining in the waters around China .Presentation level: This level is responsible for presenting the human-computer interaction operations and the results of data analysis. After borrowing the data presentation methods from other similar platforms and soliciting opinions from maritime information supervision users, the GIS display technique and graphic user interface technique are comprehensively applied to present the results of trajectory data computation and analysis to users in the form of maps, diagrams, and data reports.(1)The object-oriented method is employed to design the system. The unified modeling language UML is taken as the analysis tool to enhance the reuse rate of code.(2)The system adopts the C/S architecture based on the Visual Studio 2013.NET development environment. It is developed with the C# programming language that is absolutely object-oriented.(3)The GIS spatial display module is developed using SharpMap. As a completely open source and lightweight GIS rendering tool, SharpMap offers a variety of underlying function interfaces.(4)The database is the open source object-relational database PostgreSQL with the PostGIS spatial module plug-in. Additionally, Npgsql dynamic link library is employed to connect the system with the database ,13.For the design and development of STDMAS, the technical route is determined according to the requirements for system construction and functions. It also ensures that the system is easy to expand and maintain.(1)The data storage cluster is the foundation of the entire system. The data from different information sources have different security levels. Therefore, physical separation is ensured in the storage of the maritime data from different sources to guarantee the absolute security and control of the data. For the efficient, stable, and expandable management of data storage, IP-SAN two-layer data storage architecture is employed, and the data storage disk array supports convenient future expansion. The storage capacity is 100 T.(2)The computation service center is mainly composed of a switch, a router, a computing server, and a management server. The management server is responsible for system configuration and user authority management. The computing server is connected by high speed Ethernet to the data storage cluster. It allows querying and sorting of the maritime data and other operations through the storage server in the data storage cluster. In this way, it can fulfill such functions as maritime and air situation data loading management, storage management, data query, system review analysis, trajectory mining, and situation analysis. Through the client, a user can send a data analysis request to the computation service center. The computing server can then extract the data from the data storage cluster for computation, and transmit the computation results to the client .(3)A client is a computer for any maritime data management user or common user in the local area network. Maritime data users can send a service request through a client to the computation service center, and obtain the corresponding trajectory data, graphic reports, or other views.(4)The network in the system is divided into three parts, i.e., the part in the data storage cluster, the part in the computation service center, and the part for interaction between the computation service center and the client user. After comprehensively considering the needs for functions and the construction cost, optical fiber connection was provided in the data storage cluster (between the storage server and the storage disk array), whereas the Gigabit Ethernet was used in the computation service center . A 100 mThe physical deployment of STDMAS, as shown in The database management module provides the basic data for the upper-layer services such as trajectory data analysis and mining . The claThe OriginalDataManger class implements the storage, query, deletion, and other management services of original maritime information data. The class mainly contains the object dbConfig indicating the database connection configuration, the object fileName indicating the file name of original maritime information data files, and the object originalData indicating the storage of original data. Among the methods used in the class, ReadOriginalData is responsible for reading the original maritime data of different formats from various sources and depends on the LogFileModel class representing the reading of files; PrepareData is used for the cleaning, format conversion, and other operations of the original maritime data after being read and relies on the OriginalDataFormat class for the unified format; Write2OriDB implements the storage of the original maritime data and depends on the DatabaseModel class for realizing the basic database services. Moreover, the OriginalDataManger class can also, upon the user\u2019s request, call the methods Update2OriDB, QueryFromOriDB, and DeleteFromOriDB for the update, query, and deletion in the original maritime database.The TrajDataManager class implements the storage, query, deletion, and other management services of trajectory data. The class mainly consists of the object dbConfig indicating the database connection configuration, the objects timeRange and spatialRange indicating the time and spatial range, respectively, selected by a user, the object trajData saving the constructed trajectory data, and other objects such as movingObject, movingTrajectory, and movingSegment. Among them, the objects movingObject, movingTrajectory, and movingSegment have their type of data depending on the MovingObject, Trajectory and Segment classes for the trajectory data model. Among the methods for the TrajDataManager class, GetOriginalData is used to extract all the original data in the time and spatial ranges given by the user from the original maritime database; TrajPrepare allows reconstructing the trajectory with all the trajectory data of a target, and IsValueble is then employed to judge the validity of the trajectory, remove the invalid points, and smooth the trajectory; ConstructObject, ConstructTrajectory, and ConstructSegment are used to construct the trajectory data model designed in this paper; Write2TrajDB, Update2TrajDB, QueryFromTrajDB, and DeleteFromTrajDB can store, update, query, and delete the data in the trajectory database upon a user\u2019s request. Like those in the OriginalDataManger class, these methods also rely on the DatabaseModel class .The GISDataManager class implements the storage, query, deletion, and other management services of geographical information data. The class is mainly composed of the object dbConfig indicating the database connection configuration, and the object gisData indicating the storage of geographical information data. In the class, readGisFile is used to read the geographical information data, and the methods ConstructSeaAreas, ConstructGrids, and ConstructCells are responsible for converting the geographical information data into the spatial grid model. The three methods rely on the SeaArea class, the Grid class, and the Cell class, respectively. The methods Write2GisDB, Update2GisDB, QueryFromGisDB, and DeleteFromGisDB can implement the storage, update, query, and deletion in the geographical information database upon a user\u2019s request. Similarly, these methods are also dependent on the DatabaseModel model .The class diagram of the trajectory analysis module is shown in The SituationAnalysis class mainly implements such functions as querying all the maritime data in the time and spatial ranges given by a user, performing the review, replay, and analysis of maritime situation, creating the sequence of events for the sea and air situation in the corresponding process, and reproducing the maritime situation evolution process of missions and events in the corresponding time and spatial ranges. The SituationAnalysis class contains the object dbConfig indicating the database configuration, the objects spatialRange and timeRange indicating the time and spatial ranges selected by a user, the object simStep determining the speed of replay, and the object trajData for the storage and query of trajectory data. Among the main methods for the class, SelectTrajs is used to check the trajectory in the trajectory database based on the time and spatial ranges given by a user, and depends on the DatabaseModel class; RunSituation calculates the location of each target at each time of simulation by calling the simulation module (the SimulationModel class) and replays the maritime situation using the simulation step simStep through the geographical information display module (the GISDisplayModel class); TargetStats is employed for the statistics of the information on various targets, e.g., quantity, and displays the information in the form of a report ,21,22.The TrajQualityAssessment class is designed to analyze and assess the quality of the selected trajectories. In the class, the object filterParameter indicates the conditions for selecting trajectories, and the object trajs stores all the selected trajectories. The method GetTrajs can extract the trajectory data from the database or from the trajectories in the replay and analysis module. It depends on the DatabaseModel class and the SituationAnalysis class. The method GetAssessment is used to analyze and assess the quality of the selected trajectories. The method DrawResult displays the results of analysis and assessment to the user in graphical form. The indicators of the trajectory quality assessment include target identification rate, average identification response time, trajectory outlier rate, continuous tracking rate, and fault tracking rate .The UML class diagram of the trajectory mining module is shown in The TargetIdentify class can construct the ship trajectory classification model based on the parameters set by a user and then use the model to determine the category of any unknown ship. The class consists of the database configuration object dbConfig, the trajectory data set targetTraj, and the classifier, etc. In the TargetIdentify class, the method GetTrajs is employed to extract the trajectory data needed from the trajectory database according to the user\u2019s request, and depends on the DatabaseModel class . The metThe PatternRecognition class is used to construct the clustering model based on the trajectory selected by a user and display the trajectory clustering results in graphical form. The class consists of the objects dbConfig, trajs, and clusterModel . The metThe UML class diagram of the situation analysis module is shown in The TDWMaker class is mainly used to construct the trajectory data warehouse. Among its methods, CreateNewTDW can create the new data mart for a new subject; FactTableConstruct can define the fact table and dimension table based on the configuration given by a user; DataLoading can extract the processed data from the trajectory database in the extraction-transformation-loading (ETL) method and then input the data into the data warehouse, but it depends on the DatabaseModel class for implementation .The DataAnalysis class is mainly intended to extract information from the trajectory data warehouse upon a user\u2019s request, and it generates the reports. Among its methods, SelectGranule is used to select the granule of time, space, and other dimensions for data analysis; Measures can further calculate and obtain the measured value of a subject  at each granule; DataReport and GraphicalReport can present the results of data analysis in the form of a data report or graphical report. However, the DataAnalysis class must rely on the GISDisplayModel class in the display of data analysis results, so as to more vividly present the changes of historical maritime situations.Presently, trajectory mining technology offers four features in terms of mission and based on temporal and spatial characteristics, that is, trajectory pattern mining, trajectory clustering analysis, trajectory classification, and trajectory outlier detection . Among t(1)Stop Mode: A ship trajectory contains a segment of continuous sub-trajectories in which the speed at all points is lower than the speed threshold. The distance between any two trajectory points must be lower than the distance threshold, and the duration is greater than the time threshold. At this time, the motion mode of the sub-trajectory is Stop Mode.(2)Turn Mode: The turn threshold is set to (3)Line Mode: In a ship trajectory, the remaining sub-trajectory is in the Line Mode after taking out those in the Stop Mode and the Turn Mode. The three motion modes of a ship trajectory are illustrated in In the studies of trajectory motion mode, many scholars divide trajectory only into Stop Mode and Move Mode. However, ships at sea may take any turn for a specified reason or purpose unlike the moving objects on the ground, e.g., vehicles and pedestrians, which are restricted by road grids. In other words, turn is also an important motion mode of ship trajectory. On this basis, this paper partitions ship trajectory into three basic motion modes, that is, Stop Mode, Turn Mode, and Line Mode ,8.(1)StFor further data mining and knowledge discovery, a ship trajectory can be partitioned in terms of these three basic motion modes in the following procedure:Step 1: Partition a ship trajectory into several continuous sub-trajectory segments;Step 2: Go through all the sub-trajectory segments. When the speed at most of the points in a sub-trajectory segment is less than the speed threshold Step 3: Go through all the sub-trajectory segments in the Move Mode. When the sum of direction changes at the points of a sub-trajectory within the time threshold exceeds the turn threshold, it is judged that the sub-trajectory is in the Turn Mode. Otherwise, it is in the Line Mode;Step 4: Use the outlier detection algorithm to rule out the outliers in the trajectory;Step 5: Add the segmented ship sub-trajectories into the corresponding sets of Stop Mode, Turn Mode, and Line Mode.For higher efficiency of the trajectory data mining algorithm, the trajectory features must be selected in terms of their contribution to ship identification. Based on the above ship trajectory partitioning algorithm, trajectory features are classified into four categories, that is, global features, stop features, line features, and turn features.(1) Global features refer to the extracted general features of the entire trajectory and its sub-trajectories and reflect the features of the trajectory holistically. There were nine global features extracted in this paper, including total sailing time, total sailing distance, total sailing sinuosity, number of sub-trajectories in the Stop Mode, Line Mode, and Turn Mode, and their respective proportion of total trajectory time. Among these global features, trajectory sinuosity represents the ratio of the sailing distance between two trajectory points and the straight distance between them and is employed to indicate the curvature of the path. Total trajectory sinuosity is the ratio of the total sailing distance of a ship to the straight distance between its departure and destination. The total trajectory sinuosity is calculated by the following formula:p1, p2, \u2026\u2026, pn}, the central point of stop C((2) Stop features are the trajectory features extracted from the sub-trajectories in the Stop Mode. The stop features extracted in this paper include two parameters, that is, stop duration and stop range. Stop duration refers to the period of time from the start to the end of a sub-trajectory in the Stop Mode. Stop range is represented by the area of circle of uncertainty for all trajectory points available in a sub-trajectory in the Stop Mode. It is assumed that the stop sub-trajectory is extracted as StopT = {Let the matrix stop error radius Sa is:Then the stop range (3) Line features are the trajectory features extracted from the sub-trajectories in the Line Mode. The line features extracted in this paper involve three parameters, that is, speed, acceleration, and heading. The \u201cglobal features\u201d for these parameters are calculated with seven statistical quantities including mean, median, standard deviation, average of three largest numbers, coefficient of variation, skewness, and kurtosis. Among them, skewness is a coefficient for measuring the deviation of data distribution from the symmetrical center and is normally represented by the ratio of three-order center distance to the third power of standard deviation. Kurtosis is a coefficient reflecting the aggregation level of data at the center and normally denoted by the ratio of four-order center distance to the fourth power of standard deviation. Skewness (4) Turn features are the trajectory features extracted from the sub-trajectories in the Turn Mode. In this paper, the extracted turn features involve three parameters in total, that is, angular speed, turn speed, and turn angle. Angular speed is the ratio of the direction difference between two trajectory points and the time. Turn speed is the ratio of the distance between two trajectory points and the time. Turn angle is the difference between the destination direction and the departure direction of all sub-trajectories in the Turn Mode.Based on the ship trajectory partitioning and trajectory feature extraction, the classification algorithm in the field of machine learning is employed to obtain a ship trajectory classification model through training. The feature extraction method proposed in this paper is taken to construct the overall framework of a ship trajectory classification model as shown in In this paper, the real AIS data of ships were taken from the ship historical temporal and spatial trajectory library to extract 1000 effective trajectories of fishing boats and cargo ships (500 each) through data cleaning, filtering, conversion, and preliminary processing, for training and testing of the ship classification model . The spaBased on the proposed ship trajectory feature extraction method, 158 trajectory features were extracted from the historical trajectories of fishing boats and cargo ships, including global features, stop features, line features, and turn features of each trajectory. Subsequently, the data sets of trajectory features for fishing boats and cargo ships were created together with the statistics and analysis of features.As shown in To verify the effectiveness of the proposed ship trajectory feature extraction method, some popular single classifier learning algorithms in the machine learning field were selected in this paper for training and testing the ship classification model, including Decision Tree (DT), Na\u00efve Bayers (NB), Logistic Regression (LR), Artificial Neural Networks (ANN), and Support Vector Machine (SVM) . The tes(1) Feature selection and dimension reduction:The principal component analysis (PCA) method  was adop(2) Classification of training set and test set:The feature data set was partitioned with hold-out. Before each test, the feature data set was randomly divided into two mutually exclusive sets, that is, 75% training set and 25% test set.(3) Model training and evaluation:Two indicators were selected to evaluate the results of model prediction, that is, accuracy and area under curve (AUC) . For thiAccuracy indicates the proportion of all predicted results as follows:TPR) and false positive rate (FPR) are as follows:The receiver operating characteristic curve (ROC) can be used to reflect the performance of model classification. The true positive rate  has implemented such functions as identification of unknown ships and ship outlier detection in the database management module, trajectory analysis model, and trajectory mining module . In thisWith the database management of the system, a user can read the original files of original maritime data, trajectory data, and GIS data, and can also convert, write, check, update, and delete the data from the database, as shown in This module can implement the fast query of radar detection or AIS target original data and trajectory target within the spatial and time ranges and analyze the variation tendency of the spatial curve, sampling time interval, and distance interval of trajectories , as showBased on the abovementioned trajectory data mining method, the trajectory mining module of STDMAS can implement the identification of unknown targets and the outlier detection of targets. However, both functions depend on the training and implementation of the trajectory classification model .To address the data storage, management, analysis and mining, of maritime targets, an object-oriented method was adopted to design the overall structure and functional modules of the ship trajectory management and analysis system (STDMAS). This paper elaborates the design and technical details of the STDMAS functional modules including logical structure, module composition, physical deployment, database management, trajectory analysis, trajectory mining, and situation analysis. A ship identification method based on motion features was put forward. With the proposed method, ship trajectory was first partitioned into sub-trajectories in various behavioral patterns, and effective motion features were then extracted. Machine learning algorithms were utilized for training and testing to identify many types of ships. The functional modules implemented for the system include database management, trajectory analysis, historical situation review, ship identification, and outlier detection based on trajectory classification. STDMAS can satisfy the practical needs for the data management, analysis, and mining of maritime targets because it is easy to apply, maintain, and expand. Efforts will be made to integrate such functions as trajectory cluster analysis and mining and trajectory situation analysis in STDMAS. Moreover, STDMAS will be connected to the real-time maritime target data receiving system, and then tested to further provide the data support and computation service for research and application personnel in the management, analysis, and mining of maritime target data. Additionally, the system can process a limited size of AIS data at present, so that big data algorithm and cloud computing architecture may be employed to improve the efficiency of mass data processing algorithms in future research."}
{"text": "The 2021 Master Plan for Aging outlines five bold goals to pursue over the next ten years, including addressing the issues of housing, health, and quality of life, finance, and caregiving, the plan also addresses public safety and emergency services, community programs and public spaces, access, inclusion, and equity. In order to prepare the workforce to meet these goals, California Community Colleges have the unique opportunity to collaborate and develop Aging Specialists in fields not traditionally age-focused. This presentation explores the possible scope and path toward curriculum development of five innovative collaborations that will prepare Gerontology specialists for the workforce that will be created through the execution of the California Master Plan."}
{"text": "Ucides occidentalis  and the environment , sampled at fifteen sites over five stations. Consistent spatial distribution of metals in the Guayas estuary was found. Nickel levels in the sediment warn for ecological caution. The presence of As in the crabs generated potential concerns on the consumers\u2019 health, and a maximum intake of eight crabs per month for adults is advised. The research outcomes are of global importance for at least nine Sustainable Development Goals (SDGs). The results presented can support raising awareness about the ongoing contamination of food and their related ecosystems and the corresponding consequences for environmental and human health worldwide.Mangrove wetlands provide essential ecosystem services such as coastal protection and fisheries. Metal pollution due to industrial and agricultural activities represents an issue of growing concern for the Guayas River Basin and related mangroves in Ecuador. Fisheries and the related human consumption of mangrove crabs are in need of scientific support. In order to protect human health and aid river management, we analyzed several elements in the Guayas Estuary. Zn, Cu, Ni, Cr, As, Pb, Cd, and Hg accumulation were assessed in different compartments of the commercial red mangrove crab  Increasing degradation of ecosystems is not only causing biodiversity loss but also affecting the quality of water-related ecosystem services. These services cover a wide range of benefits, including water purification, carbon capture and storage, natural flood protection, and provision of water for agriculture, fisheries, and recreation . For insIn recent years, pollutants have been found to end up in rivers and eventually in mangrove wetlands as a result of increasing human activities . For insMangrove ecosystems are known as environmental sinks, accumulating various types of contaminants since their sediments act as a chelating matrix for metal(loid)s  are compounds with both metal properties and non-metal properties. As arsenic was investigated in this research as the only metalloid, for reasons of simplicity, it will be included in the term metal throughout the manuscript), pesticides, petroleum, and other contaminants ,15. MoreToxic effects tend to occur when a threshold concentration is exceeded, which is strongly determined by the bioavailability of the considered metal. Therefore, insight into the occurrence, distribution, and bioavailability of different metals is crucial in assessing the toxicity of surface waters worldwide . The metUltimately, the combination of these environmental processes threatens fisheries stocks in the mangrove wetlands ,26,27. FUcides occidentalis)  and the environment , sampled at 15 stations in the Guayas estuarine ecosystem. The Guayas River Basin in Ecuador has been subjected to growing agricultural and industrial activities during the past few years, and several studies have shown the accumulation of contaminants in the ecosystem . Pb. Pb77]. Regarding the environmental compartments, apart from Ni in water and Cd in sediment, no significant differences were present between the five sampling stations . This inA useful indication of the grade of sediment contamination is given by the Igeo. Muller has defined seven classes of geo-accumulation index ranging from Class 0  to Class 6  . The indp > 0.05). In addition, no significant difference was found between the exposure results for children and adults. The results indicate that the crab-consuming population (children and adults) is exposed to the metals Zn, Cu, Ni, Cd, and Hg at levels that do not exceed the toxicological reference values  and anthropogenic sources related to domestic, agricultural, industrial, oil processing, and mining activities ,12,85. PTrace metals are known to be one of the most common contaminants bound to estuarine sediments . These eFurthermore, the Igeo index indicated a moderate contamination of As in the mangrove sediment. However, it must be observed that the Igeo index uses general background values and does not consider the high contribution of volcanic rock to the presence and concentrations of As in soils and sediment in Ecuador.Arsenic and Ni are widely distributed in nature as a result of environmental sources  and anthropogenic pollution, which is to a great extent caused by smelting of nonferrous elements, glass manufacturing, thermal power plants using fossil fuels, agriculture, and fertilizers ,93,94,95The distribution of the different metals in the crab tissue between the different stations was perceived to be significantly different for certain stations, depending on the crab tissue. On the contrary, no significant differences between the stations were observed for the metal concentrations in sediment, water, and leaves, apart from Ni in water and Cd in sediment. These metal concentrations in the sediment, leaves, and water of the Guayas mangroves were more homogeneously distributed than expected, in contrast to the different pollution inputs at each station . The resThe risk assessment exposure results indicated a potential risk for consumers of the red mangrove crab due to the presence of As. Inorganic arsenic has been classified as a carcinogenic agent by the International Agency for Research on Cancer ,103, as The assessment of metal distributions in agricultural soils and aquatic ecosystems and the identification and management of associated risks and impacts is crucial to achieve the United Nations Sustainable Development Goals and to prevent adverse environmental and health impacts ,22,30,31The dispersion of conceivably toxic metals in aquatic ecosystems and related food is a public health concern of global urgency. As metals do not degrade, the detected elements Zn, Cu, Ni, Cr, As, Pb, Cd, and Hg remain in the mangrove life cycle for a long time and end up in the red mangrove crabs. Elevated Ni concentrations in the mangrove sediments could lead to potential adverse health effects for sensible aquatic organisms. The risk assessment exposure results indicated a potential risk for consumers of the red mangrove crab due to the presence of As. It is advised to the consumers of crab meat to apply a consumption limit of eight crabs per month for adults and four crabs per month for children to protect their health in the long term. However, these recommended limits were set without considering additive exposure of As contaminated rice and/or water. As shown in this research, the assessment of metal distributions in aquatic ecosystems and management of associated risks are paramount regarding food safety and associated socio-economic aspects of fisheries. Further research is required regarding the sources of the metals, the metal uptake and accumulation mechanisms of the crab, along with the presence of inorganic as and methylmercury in the red mangrove crab, as this study is seen as a first exploration in this area."}
{"text": "A hundred and twenty years ago, the Butantan Institute was founded by the Brazilian physician and scientist Vital Brazil, combining, in the same institution, medical research, and the transfer of results to society in the form of health products. Its foundation was a reaction to the outbreak of bubonic plague in the city of Santos, S\u00e3o Paulo State of Brazil, but the Institution soon also showed its specialization in the study of venomous animals, their venoms, and the production of antivenoms. More than a century after its foundation, the Institute maintains its tradition and initial mission regarding important contributions for collective health. Today, Butantan is an outstanding biomedical research center, which integrates basic research, technological development, the production of immunobiological, and scientific divulgation, seeking the permanent updating and integration of its resources. Butantan is internationally known for its research on venomous animals, and houses one of the largest collections of snakes in the world. Butantan scientists have published countless studies on the characterization of the composition of venoms, the mechanisms of action of their toxins, and the use of toxins as lead molecules for the development of new drugs. The Butantan Institute also operates the \u201cHospital Vital Brazil\u201d, which is specialized in accidents involving venomous animals. The dissemination of scientific knowledge occurs at different levels and media; the institution is a pioneer in the training of graduate students in the field of Toxinology for MSc and PhD degrees.Toxins celebrates the 120th anniversary of the Butantan Institute, in recognition of their contribution to international Toxinology, highlighting the current production by house scientists and collaborators from other institutions. We selected 19 original articles and 4 reviews approaching several points of Toxinology. The venom of snakes was approached in different aspects as the structural and functional variability in the composition of venoms from individual snakes [This Special Issue of l snakes , the mecl snakes , metallol snakes ,7,8, andl snakes , scorpiol snakes ,12, fishl snakes ,14, and l snakes , includil snakes . The grel snakes , and thel snakes , anticoal snakes ,22 effecIn conclusion, this is a small recognition of the institute\u2019s contribution to the field of Toxinology that demonstrates its continued and relevant role in this field. I hope you enjoy reading this, and congratulations to the Butantan Institute, scientists, and collaborators, on their 120th anniversary."}
{"text": "Tuberculosis is an infectious disease that affects humans and animals. This study aimed to review the influence of economic and organizational, veterinary, and sanitary measures on the epizootic situation of animal tuberculosis and the epidemiological situation of human tuberculosis in the Republic of Kazakhstan.The epizootic situation of cattle tuberculosis in Kazakhstan was studied based on the annual statistics of allergy testing of animals with tuberculosis by the Committee for Veterinary Control and Supervision of the Ministry of Agriculture of the Republic of Kazakhstan, according to the results of allergic, clinical, and pathological studies, including laboratory studies of biomaterials from animals that reacted to tuberculin. Tuberculinization of cattle in the country is performed twice in the spring and autumn using tuberculin purified protein derivative for mammals. In addition, mass diagnosis of human tuberculosis is conducted by radiology.The authors assessed the epizootic situation of tuberculosis in cattle in Kazakhstan from 1991 to 2019. The analysis results showed that at the beginning, the epizootic situation in cattle tuberculosis was challenging. However, since 2001, there has been a noticeable decrease in tuberculosis in animals in Kazakhstan, which has had a favorable effect on the epidemic situation of human tuberculosis.According to the analysis results, the measures used in the Republic of Kazakhstan to prevent tuberculosis improved the well-being of livestock farms. The proper conduct by qualified veterinary specialists on allergy testing of animals and differential diagnosis of nonspecific tuberculin reactions allows establishing an accurate epizootic picture of tuberculosis. Furthermore, strict adherence to instructions on the diagnosis and prevention of tuberculosis, implementation of developed veterinary, sanitary, and organization, and economic measures can improve the epizootic picture of tuberculosis, reducing the risk of human tuberculosis. Mycobacterium bovis [Mycobacterium tuberculosis complex (MTC), suggest that M. tuberculosis species, Mycobacterium africanum, M. bovis, Mycobacterium caprae, Mycobacterium microti, and Mycobacterium pinnipedii, be grouped, and they used the infraspecies term \u201cvar.,\u201d for example, M. tuberculosis var. bovis. Tuberculosis is an infectious anthropozoonotic disease affecting mainly cattle and is the cause of 5-10% of human cases of tuberculosis, also being widespread in domestic and wild animals [Tuberculosis is a widespread infectious disease of animals and humans. In some regions of Kazakhstan, it causes significant economic damage and has great social significance. The bovine tuberculosis pathogen, recognized as a chronic zoonotic infection by the World Organization for Animal Health , is um bovis . Howeverum bovis , based o animals -6. Cattl animals .et al. [Due to the existence of a scientifically grounded system of measures in Kazakhstan, there has been a tendency to improve the epizootic situation of tuberculosis. However, tuberculosis remains a complex infectious pathogen of animals. It most often chronically occurs and is characterized by several specific body changes, including the formation of tuberculosis foci in the lungs and lesions of regional lymph nodes. The chronic and asymptomatic course has led to its significant spread. Tuberculosis is most common among cattle, and its increased prevalence in humans corresponds to areas of intensive cattle breeding . Howeveret al. , the relCattle tuberculosis on the territory of Kazakhstan was registered back in the 1930s, and for more than 70 years, the epizootic situation of this disease remained challenging. Infection manifestation was characterized by the stationarity of areas affected by tuberculosis in certain regions of Kazakhstan, the reemergence of infection in the previously rehabilitated farms, and the spread of the bovine tuberculosis pathogen among people. During the Soviet reign, party and economic bodies, by administrative measures, prohibited the reduction of animal population in farms and demanded the fulfillment of the plan for the supply of livestock products, such as milk and meat. Because of the untimely removal of sick animals and their overexposure in the herd, healthy animals were reinfected, and the infection spread. As a result, farms affected by a double infection (tuberculosis and brucellosis) were widespread. In some farms, cattle sick with tuberculosis were kept for a long time in \u201cisolation wards,\u201d which were not examined.The Soviet Union, including Kazakhstan, disintegrated in 1991. The Republic of Kazakhstan proclaimed its independence and began reforming its economy, which also affected agriculture. State and collective farms were denationalized, and new private agricultural formations were created. Since 2000, in Kazakhstan, one could observe the creation of small agricultural formations, including family-operated and private farms, and a significant increase in livestock in the private sector. Organizational, economic, structural, and legal transformations aimed at creating conditions for stabilizing agricultural production. Thus, a diversified economy with various forms of ownership was formed. The main problem in preventing tuberculosis in animals was the weak economic condition of economic entities and animal owners. The diversity of agricultural formations provided for a qualitatively new approach of veterinary specialists in performing special livestock events in the personal, subsidiary, family-operated, and private farm households, which contained up to 80% of cattle. However, the measures taken to eradicate tuberculosis in farm animals did not meet the requirements, aggravating the resulting complex epizootic situation. The decline in the epizootic situation caused a complication of the epidemiological situation of tuberculosis among the population. In this regard, the Government of the Republic of Kazakhstan adopted resolution No. 839, \u201cOn urgent measures to protect the population of the Republic of Kazakhstan from tuberculosis.\u201dIn connection with the change in the culture of animal husbandry, there was a shift in emphasis on the development of methods of intravital diagnostics, means of specific prevention, and improving the systems of measures to combat tuberculosis in animals. Along with improving chronic infections at farms, the isolation of animals that reacted to tuberculin continued in tuberculosis-free agricultural entities. There was a reorganization of the structure of the veterinary service and the adoption of new veterinary legislation. Diagnostic tests for tuberculosis are conducted by the veterinary service specialists of the regional offices of the Veterinary Control and Surveillance Committee twice a year, in spring, before the animals are put out to pasture and in autumn when the animals return to their stables. It is mandatory to test all cattle and, if necessary, other animal species. An intradermal allergy test with purified protein derivative (PPD)-tuberculin for mammals is used for diagnosis. If tuberculin-responsive animals are detected in a tuberculosis-free farm, they are separated from the main herd, and differential diagnostic tests are performed using a simultaneous test and diagnostic slaughter for veterinary and sanitary examination of the carcasses. If morphological changes in internal organs are detected, biomaterial samples are taken for bacteriological examination at regional divisions of the Republican Veterinary Laboratory. If tuberculin-responsive animals are detected in a diseased farm, they are recognized as infected and slaughtered within 5 days. According to official veterinary reporting, the territory of the Republic of Kazakhstan is free of animal tuberculosis. The frequency of isolation of animals with tuberculosis in Japan is 10% , 17% in , M. tuberculosis adapts to antibiotics; thus, modern medicines have a less detrimental effect on circulating populations of mycobacteria [The main reason for maintaining a challenging epizootic situation in cattle tuberculosis is the resistance of mycobacteria to adverse factors and long-term survival in environmental objects . In addibacteria .This research aimed to study the epizootic situation of animal tuberculosis in the Republic of Kazakhstan, the effectiveness of special veterinary, organizational, and economic measures in reducing tuberculosis prevalence in animals, and sanitation of farms from the infection. Furthermore, we show how the reduction in tuberculosis prevalence in animals has affected the prevalence of human tuberculosis in the Republic of Kazakhstan. In addition, we monitor the spread of tuberculosis in the different regions of the Republic of Kazakhstan and assess the strategy to control animal tuberculosis based on their research.The research protocol was discussed and approved at the meeting of the local ethical committee of the Kazakh Research Veterinary Institute of the Science Committee of the Ministry of Education and Science of the Republic of Kazakhstan on August 29, 2017.The study of the epizootic situation of tuberculosis in cattle was carried out in the Republic of Kazakhstan for the period from 1991 to 2019. Experimental studies on laboratory diagnosis of tuberculosis were carried out at the Kazakh Research Veterinary Institute in Almaty.Epizootic monitoring for tuberculosis of farm animals was conducted according to the \u201cEpizootic research methods and theory of the epizootic process\u201d . The epiin vivo diagnosis of animal tuberculosis is the allergy method . The tuberculin (PPD) for mammals produced by the BioVet Research and Production Center (the Republic of Kazakhstan) with an activity of 50,000 TU in 1 mL is used. The activity of tuberculin was harmonized with that of PPD bovine tuberculin obtained from the National Institute for Biological Standards and Control (United Kingdom). Tuberculin was injected into animals with a needleless injector intracutaneously in a dose of 0.2 mL into a preshaved and 72% ethanol-treated area of the upper third of the neck. The reaction was recorded after 72 h. A thickening of the skin fold by 3 mm or more was considered positive. The OIE recommends producing tuberculin from virulent strains of bovine mycobacteria, M. bovis [The main method of M. bovis . AccordiM. bovis , in tubeM. bovis .Studies of the selected biomaterial were conducted in the bacteriology laboratory of the Kazakh Research Veterinary Institute. During the work, bacteriological methods for diagnosing tuberculosis were used with the presowing processing of diagnostic biomaterial and biological tests. For this, the material was cut into small pieces in a mortar, covered with 5% sulfuric acid solution, and left for 20 min to suppress the growth of acid-unstable microflora. Then, the acid was decanted, and the material was washed with saline and homogenized. The resulting suspension of biomaterial samples was sown on the surface of a dense nutrient Lowenstein\u2013Jensen medium (control) and thermostated at 37\u00b0C.The mass diagnosis of tuberculosis in humans is conducted by X-ray, and every working citizen of the republic must undergo a fluorography once a year. In addition, applicants, students, job applicants, and the rest of the population must be diagnosed by X-ray when they visit a health center. If the X-ray shows signs of tuberculosis, the patient is referred to a tuberculosis clinic, where X-rays, bacteriological tests on sputum samples, and polymerase chain reaction (PCR) tests are conducted.\u00adconsidered responsive to tuberculin, and those with characteristic changes in internal organs at slaughter, isolation of the tuberculosis pathogen in bacteriological \u00adexamination of biomaterial, and the case \u00adidentifying animals responsive to tuberculin in a tuberculosis-positive farm were considered sick. As a result, 553,983 herds were handed over for slaughter, considering the store cattle. Among other infectious diseases of cattle within the decade, the proportion of animals with tuberculosis was 16.6%.From 1991 to 1999, 37,670 cattle were slaughtered or died from all infectious diseases in Kazakhstan, including 21,631 animals that died of tuberculosis, amounting to 59%. According to the results of the antituberculosis measures performed in Kazakhstan for 10 years from 1991 to 2000, 290,085 animals reacting to tuberculin and 172,925 patients with cattle tuberculosis were found, which amounted to 463,010 herds . AnimalsSince 2002, there has been a decrease in animals reacting to tuberculin, from 2231 herds in 2002 to 165 herds in 2008 . This isIn 2012, three farms were registered as affected by tuberculosis. The Ushtube-Aydin LLP located in Baktybai of the Eskeldinsky district of the Almaty region was considered to be affected by tuberculosis. Out of 440 animals studied, 54 reacting to tuberculin were found, amounting to 12.3%. Postmortem assessment of macroscopic changes, histopathology, and bacteriological research methods is the standard method for diagnosing tuberculosis in animals [M. tuberculosis cultures from biomaterial samples. In the Shokan and Co. LLP, located in Shokan, Saryozek district, Almaty region, during a planned allergy study, 124 animals that reacted to tuberculin were found  reacting to tuberculin were found, and in 719 heads (0.01%), the diagnosis of tuberculosis was confirmed during slaughter. A high percentage of morbidity in cattle was noted in the Kostanay region (0.2%). The Prirechenskoye LLP, Denisov district, Kostanay region, where 717 cows with a positive reaction were found at one farm, was declared affected by tuberculosis. During the diagnostic slaughter of animals that reacted to tuberculin, visible tuberculous changes in the internal organs and lymph nodes were established .In the Karaganda region, in the Shet district, at the Sulu Madine farm, 64 herds that reacted to the PPD tuberculin for mammals were found. At the slaughter of the reacting animals, a veterinary and sanitary analysis of carcasses confirmed the diagnosis of tuberculosis. As a result, tuberculosis prevalence in animals on average in the rural district equaled 0.015%. In the Nuftiyeva private enterprise of the Almaty region, during a planned allergic study of 78 cows, 17 reacting animals were found, during the slaughter of which we also found tuberculosis in the internal organs by veterinary and sanitary examination.M. tuberculosis were isolated from samples of the selected biomaterial.In 2014, 1690 animals that reacted to tuberculin were found in the Kostanay region. In the Karaganda region, 790 herds responded to tuberculin, including in the Abai district, the Yubileiny rural district, the Mayburnak winter farm, and the Ata family-operated farm. The diagnosis of tuberculosis was confirmed by veterinary and sanitary examination of carcasses during the slaughter of two reacting animals and bacteriological examination. In addition, cultures of In 2015, cattle tuberculosis was registered in the Karaganda region, Bukhar-Zhyrau district, Dubovsky rural district in the village of Alabas, and the Arslan family-operated farm. During the selective control and diagnostic animal slaughter and veterinary and sanitary analysis of carcasses, tuberculosis was diagnosed, and 24 herds recognized as sick were sent for slaughter.In the Almaty region, an intradermal tuberculin test was conducted on 2990 herds, and 95 (3.1%) animals that reacted to tuberculin were found. In addition, 58 herds were subjected to diagnostic slaughter. Twenty-six animal carcasses were subjected to veterinary and sanitary examination, and tuberculosis was confirmed in 100% of cases. Simultaneously, a generalized form of tuberculosis was established in five animals, and widespread tuberculosis  was noted in seven animals. In five cows, specific tuberculous lesions were found in the mesenteric lymph nodes. The bacteriological method was used to study biomaterial from seven cows. In all cases, a culture of bovine mycobacteria was isolated. Furthermore, four cows that reacted to tuberculin were found at a private farmstead, and when they were slaughtered, the diagnosis of tuberculosis was confirmed by veterinary and sanitary examinations.In 2016, in the Karaganda region in the Karkaralinsky district of the Besobinsky rural district, 281 animals that reacted to tuberculin were found in Abai during an allergy study. During the commission control and diagnostic slaughter of five cows, the veterinary and sanitary examination established the diagnosis of tuberculosis. All animals that responded to tuberculin were sick with tuberculosis and sent to meat processing institutions for slaughter. There was also a case of tuberculosis in cattle at a personal farmstead in Zhezkazgan, Karaganda region. During the veterinary and sanitary examination of the carcass, tuberculosis was established in one herd.Recently, much work has been done in Kazakhstan to prevent tuberculosis in tuberculosis-free farms and improve the health of economic entities affected by tuberculosis. As a result, there is a shift in emphasis on developing methods of intravital diagnostics, means of specific prevention, and improving systems of measures to combat tuberculosis in animals. The CVCS of MA, employing local veterinary workers, annually conducts a double allergic study of the livestock, which as of 2020 amounted to 8,800,000 herds. According to the veterinary reports of the CVCS, no animals reacting to tuberculin were found in Kazakhstan. Presently, Kazakhstan is considered free from animal tuberculosis.According to the chief state sanitary doctor in the Republic of Kazakhstan, there is a stable epidemiological situation concerning human tuberculosis. Over the past 8-9 years, about 4000 people were diagnosed with tuberculosis yearly. The diagnosis was confirmed by radiological and laboratory tests . In 25% of these people, cultures of mycobacteria of multidrug-resistant tuberculosis were detected. Over the past 3 years, the prevalence rate of tuberculosis in people in Kazakhstan has decreased by 1.1 times  and the mortality rate by 1.4 times . In 2019, the prevalence rate of tuberculosis was 34.7, and the mortality rate was 1.6/100,000 people. Thus, the yearly rate of decrease in morbidity and mortality is 7-8%. Effective diagnosis and treatment of tuberculosis have saved the lives of more than 53,000 people who had contracted tuberculosis over the past 3 years.The widespread observance of the requirements in livestock farms is described in detail in the instructions for the diagnosis and prevention of tuberculosis. Furthermore, strict implementation of the developed rules allowed the reduction of tuberculosis prevalence in animals and humans. These measurements positively impacted the epizootic situation in the republic, which ultimately decreased the prevalence of tuberculosis in people in Kazakhstan .M. bovis and M. caprae are recognized as the most relevant causative agents of tuberculosis in animal husbandry [The epizootic situation in cattle tuberculosis in Kazakhstan has significantly improved. Among the ecotypes grouped within the MTC, usbandry -25. The usbandry ,27.According to the veterinary reports, in 2011, 201 herds responding to tuberculin were found. In 2012, out of 12,369,722 animals studied, 816 animals reacting to tuberculin were found. As a result, the diagnosis of tuberculosis was confirmed at three places affected by tuberculosis in 529 herds. In 2013, 6,897,895 herds were tested for tuberculosis. Simultaneously, 1072 animals reacting to tuberculin were found. In two places affected by tuberculosis, the diagnosis of tuberculosis was confirmed in 719 herds during slaughter. In 2014, 1690 animals that reacted to tuberculin were found in the Kostanay region. In the Karaganda region, 790 herds of cattle that reacted to tuberculin were found, including in the Abay region in the Ata family-operated farm. The diagnosis of tuberculosis was confirmed when the reactive animals were slaughtered. In 2015, cattle tuberculosis was registered in the Karaganda region, the Bukhar-Zhyrau region in the village of Alabas, and the Arslan family-operated farm.in vivo testing of cattle, reducing the prevalence of disseminated tuberculosis [During the slaughter of the reacting animals, tuberculosis was confirmed, and 24 herds recognized as sick were sent for slaughter. In the Almaty region, 2990 herds were examined, and 95 (3.1%) animals that reacted to tuberculin were found. Furthermore, 58 herds were subjected to diagnostic slaughter, and 26 animal carcasses were subjected to veterinary and sanitary examination; tuberculosis was confirmed in 100% of cases. In 2016, in the Karaganda region in the Karkaralinsky district in the Abai procuring center, animals that reacted to tuberculin were found during an allergy study. During the slaughter, the animals were diagnosed with tuberculosis. Two hundred eighty-one herds were sick with tuberculosis and sent to meat processing establishments for slaughter. These results were expected because airborne transmission is the most common route of infection in cattle, resulting in damage to the respiratory tract and associated lymph nodes, and then oral transmission through ingestion of bacilli, resulting in damage to the digestive tract and associated lymph nodes. Furthermore, generalized systemic infection is associated with a terminal illness, which is rare due to periodic rculosis .Tuberculosis is an anthropozoonotic infection. The tuberculosis pathogen circulation in nature and its impact on human and animal morbidity in the Republic of Kazakhstan were studied in the last century at the Tuberculosis Institute of the Ministry of Health in Almaty under the direction of Blagodarny . ConvincIn this work, a correlation between the reduction in the prevalence of tuberculosis in animals and its impact on the prevalence of tuberculosis in humans in the country has been established. Planned allergy testing of animals for tuberculosis, timely culling of compromised animals that react to tuberculin, careful veterinary and sanitary control of livestock products, and restrictions on the delivery of livestock products to consumers from sick animals reduce the risks of tuberculosis people. Implementing special veterinary and sanitary measures to control tuberculosis in Kazakhstan allowed the recovery of livestock farms from this chronic infection. Thus, it is necessary to continue to carry out the measures stipulated in the instruction \u201cOn measures to prevent and eliminate tuberculosis in animals\u201d to maintain the achieved status.The epizootic situation of bovine tuberculosis in the Republic of Kazakhstan was studied. According to the analysis results, the measures used in the Republic of Kazakhstan to prevent tuberculosis have improved the well-being of livestock farms. Appropriate allergy testing by qualified veterinary professionals and differential diagnosis of nonspecific tuberculin reactions can establish the true epizootic picture regarding tuberculosis. Strict adherence to the instructions for diagnosing and preventing tuberculosis, implementing developed veterinary and sanitary, and organizational and economic measures can improve the epizootic of tuberculosis, decreasing the risk of tuberculosis prevalence in humans.KAT: Conception and design, acquisition of data, analysis and interpretation of data, and drafted and revised the manuscript critically. AMB: Conception and design, drafted and revised the manuscript critically. AAP: Acquisition of data, and analysis and interpretation of data. RKT: Conception and design, acquisition of data, and analysis and interpretation of data. All authors read and approved the final manuscript."}
{"text": "Due to a misunderstanding between authors, two of the original authors were not listed on this article at the time of submission and publication. All three authors have discussed this and determined that adding the two missing authors is the best solution. The two new authors are:Neha ShahDepartment of Physical Medicine and Rehabilitation, Northwestern Medicine at Marianjoy Rehabilitation Hospital, Wheaton, USAPrempreet BajajDepartment of Orthopedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, USA"}
{"text": "Social and emotional learning (SEL) has acquired great prominence in recent years, due to the skills it develops in students, influencing personal and social well-being. At the same time, society is moving toward a model in which understanding oneself and others is a fundamental aspect in order to function properly on a social level. Studies on SEL programmes have been carried out in various parts of the world, although recent reviews have focused exclusively on the Anglo-Saxon context. Therefore, the aim of this paper was to synthesize research on the efficacy and effectiveness of SEL programmes in Ibero-American contexts in early childhood, primary and secondary education. Systematic review was used as the method of enquiry, following the standards of The Campbell Collaboration. In total, 22 empirical studies of SEL programmes implemented in Ibero-America were collected. The results showed that the SEL variables with the highest incidence and significant results were self-awareness, social awareness, self-control, relationship skills, decision-making, school climate, well-being, and academic achievement. While no studies focused on sense of belonging or school safety. Finally, the establishment of programme components, duration, and integration, for each variable, scientifically evidences the keys that can ensure the success of future SEL programmes. Over the past few years, there has been a considerable increase in educational, social, and political interest in social and emotional learning (SEL), a trend that seems to have arisen from the need to address the high incidence of social, emotional, and behavioral problems among children, adolescents and young adults in today's society, and to build protective factors that enhance their well-being and performance  that have been developed in Latin American countries on this type of intervention with pre-school, primary, and secondary school students?What are the most relevant characteristics of the SEL programmes  that have been implemented in Latin American contexts with students between 3 and 18 years of age?What is the significant evidence of the studies, with respect to the variables of the SEL model, to generate socioemotional and academic improvements among infant, primary and secondary school pupils in the Ibero-American context?The first action of this systematic review, as specified in the guidelines set out by The Campbell Collaboration  and the The inclusion criteria were determined according to the general objective of the systematic review, initially establishing the definition or operational characteristics of the independent and dependent variables, and then specifying the methodological designs, the participating population and the geographical, cultural and temporal restrictions.In this sense, SEL programmes (independent variable) refer to those educational interventions that are based on the SEL model and are aimed at students acquiring and effectively applying the knowledge, skills, and attitudes necessary to develop healthy identities, manage their emotions, set and achieve positive personal and collective goals, feel and show empathy for others, establish and maintain positive and supportive interpersonal relationships, manage interpersonal situations in a constructive way and make responsible and caring decisions , as these are the educational stages in which this type of programme is most developed and recommended, especially as a preventive measure against the problems of school adjustment that students tend to present , ProQuest  and Scopus.The complementary search involved the following actions: (a) Manual searches of the reference lists of each of the studies included in this systematic review; (b) Google Scholar searches, aimed at identifying unpublished studies on the web; (c) personal contacts with national and international researchers of recognized prestige, with the aim of identifying unpublished reports and research in development or in progress; (d) searches in open access resources or gray literature: OpenGrey GreyNet International-Gray Literature Network Service, National Technical Information Service (NTIS), Directory of Open Access Repositories (OpenDOAR), Open Access Scholarly Information Sourcebook (OASIS), Bielefeld Academic Search Engine (BASE), COnnecting REpositories (CORE) y Library Hub Discover; (e) resource searches on development research: Community Research and Development Information Service (CORDIS); Economic and Social Research Council (ESRC) Regard database, Center for Reviews and Dissemination (CRD), NBER Working Papers, The Campbell Collaboration and RePEc; and (f) searches in relevant networks and institutions: What Works Clearinghouse, Evidence for ESSA, EPPI Center, Educational Evidence Portal (EPP), IZA World of Labor, Social Science Research Network (SSRN), The Campbell Collaboration, CASEL and Panorama Education.Search terms were selected using the Education Resources Information Center Thesaurus, based on the study inclusion criteria specified above, trying to strike a balance between sensitivity  and specificity .*\u201d OR \u201cprogram*\u201d OR \u201cpractice*\u201d OR \u201ctrain*\u201d OR \u201cinitiative*\u201d OR \u201caction*\u201d OR \u201cproject*\u201d) AND .The search strategy was modified according to the specifications of each platform and electronic database, as well as any other resources used . In this sense, for those resources, platforms and electronic databases with advanced search functions, the search terms (in English and Spanish) were classified into two categories , which were included in the various search engines to identify the papers under study from the title, abstract and keywords. These categories were combined using the Boolean operator \u201cAND,\u201d while the Boolean operator \u201cOR\u201d was used for the search terms in each category and their synonyms. For resources or databases with basic search functions, search terms were adjusted to the limited functionality of their search engines, so searches were conducted by keyword and/or topic-topic, combining or including separate search terms. For example, the terms and combinations used in the search of Web of Science, ProQuest, and Scopus are specified below:  AND  first level of screening, where two team members worked in parallel to identify and eliminate duplicate records; (b) second level of screening, where two team members identified and eliminated in parallel those studies that, after careful examination of their title and abstract, did not clearly meet the inclusion criteria; and (c) third level of screening, where two team members in parallel read the full text versions of the studies to determine their eligibility against the inclusion criteria. At the second and third levels, an Once the final sample of studies had been confirmed, two members of the team extracted and coded the data and information from each study in parallel around the following variables , while disagreements about it have been resolved through consultation and discussion with a third member of the working team. Finally, the approach adopted for data analysis was, considering the aim of this systematic review, a narrative content analysis Dochy, .The general process of searching and selecting records was represented graphically in a PRISMA flow chart  Page et.N = 18), Portuguese (N = 2), and Spanish (N = 2). Of the studies reviewed, all 23 were journal articles.The selected studies come from four countries: 12 from Portugal, six from Spain, two from Brazil and two from Chile. The studies were published between 2010 and 2020 . The language of publication was English (M = 777.45). The sample size ranged from 50 participants to 5,145 participants. The gender distribution did not vary between the studies, all 23 included samples composed of both males and females. The ages of the participants ranged from 5 to 17 years. The educational stage on which the studies focused was primary education (N = 13) and secondary education (N = 9).In terms of the total sample, 17,104 participants were examined in these studies  and missing in 1 study (4.55%).ad hoc instruments. Regarding the research design, all 22 studies included a quasi-experimental pretest-post-test design, all of them including a non-equivalent control group design.In relation to the assessment instruments, 21 studies used standardized scales and only one study used In terms of research context, the vast majority of experiences took place in public schools located in urban settings . However, there are studies that covered the implementation of SEL programmes from an urban and rural perspective (three with a comparative character).Regarding the characteristics of the programmes, The instruments used to measure the different constructs assessed in the experiences are also detailed. The Test of Emotion Comprehension (TEC), the Global Self-Esteem scale and the Socialization Battery 3 (BAS-3) stand out for their frequency of use.On the other hand, The purpose of this systematic review was to synthesize the main characteristics and evidence on the effectiveness of SEL programmes to improve school and socio-emotional outcomes of early childhood, primary and secondary education pupils in Ibero-American contexts. In this regard, with respect to the first research question, the results obtained show that Portugal, Spain, Chile, and Brazil have been the Ibero-American countries that have made the greatest commitment over the last decade to the application and, especially, the evaluation of this type of interventions in compulsory education . Particularly, by a systematic and rigorous evaluation, characterized by the selection of quasi-experimental evaluation methodological designs, with comparison groups, mostly non-randomly configured, but with statistical adjustments that guaranteed their equivalence in the pretest phase. In the rest of the Ibero-American countries, as in the early childhood education stage, no studies with these characteristics have been identified regarding SEL practices.In fact, the number of programmes incorporated in this review can be considered quite small, fundamentally when compared to the number of interventions included in systematic reviews developed in the Anglo-Saxon field . However, all SEL programmes, as established in the specialized literature   the literature search, both primary and complementary, was completed in February 2021, so literature published after that date has not been included in the systematic review; (b) researcher bias in selecting manuscripts may have influenced the final sample of studies, although its effects were attempted to be attenuated by the parallel development of the selection process by two researchers, resolving any dissonance with the participation of a third investigator; and (c) the amount of gray literature included in the review is limited, despite the use of the different search engines that collect this type of literature, which may have increased the threat of publication bias, although a large number of these studies were actually excluded in the selection process, mainly because they used low-quality methodological designs.As future lines of research, a meta-analysis of the studies collected should be carried out in order to find out the overall effect size of the research. It is also worth highlighting the possibility of continuing to implement SEL programmes in the Ibero-American context with the variables sense of belonging or school safety, since at present no study addresses these SEL variables. The practical implications of the work are linked to the establishment of the key implementation factors of the SEL models for each variable, in terms of programme components, duration and integration. This shows scientific evidence that can ensure the success of future programmes.The scientific production on the design, implementation, and evaluation of SEL programmes in the Ibero-American context over the last decade differs greatly from the research, practices and policies that have been developed over the last 25 years in the Anglo-Saxon context  of the University of Granada and the Tomillo Foundation (Reference: CNT4547).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "Atopic dermatitis (AD) is one of the most common chronic inflammatory skin disorders. Dupilumab, the first targeted biological drug approved for the treatment of AD, has been widely used, along with increasing ocular adverse effects (AEs).To perform a bibliometric analysis of all the qualified literature involving ocular AEs during the treatment of AD with dupilumab.Relevant studies were extracted from the Web of Science database and screened by researchers. The bibliographic analysis was performed using the VOSviewer.British Journal of Dermatology published the highest number of articles. The United States was the country with the most publications. Sanofi (France) and Regeneron Pharmaceuticals (USA) were the leading organizations with the most contributions. Conjunctivitis was the most common ocular AE. The management of AD will continue to be the research hotspot and development trend in this area. The milestone research is the first article \u201cTwo Phase 3 Trials of Dupilumab vs. Placebo in Atopic Dermatitis\u201d published in the New England Journal of Medicine. Most of the top 10 papers were mainly randomized, placebo-controlled phase 2 and phase 3 clinical trials and real-life large cohort studies.A total of 138 articles were enrolled in this study. The first study was published in 2016 by Oregon Health and Science University from the United States. The majority of publications were published in the past 3 years. This study may help better understand ocular AEs in the dupilumab treatment of AD, and grasp the research trends and most influential topics in this field. Atopic dermatitis (AD) is one of the most common chronic inflammatory skin disorders, and affects patients of all ages in all aspects, from physical health to psychological condition and economic burden , 2. The Atopic dermatitis is believed to be the result of complex interactions between genetic and environmental factors that affect the immune system and epidermal barrier function . The infIn 2014, Beck et al.  first reAND TOPIC: (atopic dermatitis) AND DOCUMENT TYPES: (Article OR Letter) AND LANGUAGE: (English).Relevant studies in relation to dupilumab in the treatment of atopic dermatitis were extracted from the Web of Science Core Collection database on August 30, 2021. The detailed search strategy was as follows: TOPIC: (dupilumab) Two researchers (QN Jia and J Qiao) further performed literature screening of the title and abstract independently, with full text downloaded if necessary. Research regarding ocular adverse events in the treatment of atopic dermatitis with dupilumab were retrieved and collected, such as research letters and case letters. Articles that meet the following criteria were excluded: (1) ocular adverse events were uninvolved in the main topic of article; (2) the article was a review, systematic review, meta-analysis, correspondence, expert opinion, retracted article, conference article, or guideline. With the guidance of a senior expert (YP Zeng), a final agreement was reached on the literature screening.For articles that met the criteria, we recorded all the available information, such as title, authors, institutions, funding organization, country/region, abstract, keywords, journal of publication, year of publication, citations, and cited references. Journal impact factor (IF) was queried from the 2020 Journal Citation Reports.The bibliographic information was analyzed using the VOSviewer (version 1.6.17). The co-occurrence analyses of authors, organizations, countries/regions, and keywords were performed with VOSviewer, as well as the analyses of reference citations, and co-citations. The related maps of the above analyses were produced.We extracted 494 articles on the topic of patients with AD treated with dupilumab from the Web of Science Core Collection database following our search strategy. After literature screening by researchers, a total of 138 articles reported the occurrence of ocular AEs and were enrolled in this study. By document type, 138 articles were categorized into 97 original articles and 41 letters. The flow diagram of the present study is shown in All 138 articles were published between 2016 and 2021. The number of publications of each year are displayed in Allergy, Journal of the American Academy of Dermatology and JAMA Dermatology) had an IF higher than 10. Eight out of the 10 journals belonged to a dermatologic field (80%). British Journal of Dermatology took the lead and had the highest number of publications , followed by Journal of the American Academy of Dermatology , Dermatologic Therapy , Journal of the European Academy of Dermatology and Venereology , and JAMA Dermatology .All the articles analyzed in this study were published in 47 journals, including 22 Dermatological journals. The other 25 journals were classified into Ophthalmology , Medicine, General & Internal , Immunology , Allergy , Pharmacology & Pharmacy , Medicine, Research & Experimental , and Multidisciplinary Sciences  . The number of publications varied from 1 to 18 in these journals. The journal IF was distributed between 0.22 and 91.245. There were 33 countries/regions reporting ocular AEs during the treatment of AD with dupilumab. The United States published the highest number of publications , followed by France , Germany , Italy , and Netherlands . The collaborative network among the major countries/regions was generated by VOSviewer and presented in In total, 326 organizations had made contributions in this study area. Regeneron Pharmaceuticals Inc. made the most contributions with 21 articles (15.22%), followed by Sanofi , University Medical Center Utrecht , Oregon Health and Science University , and Northwestern University . Oregon Health and Science University was the first to report ocular AEs in this medication field, subsequently with Oregon Medical Research Center, Sanofi, Ludwig-Maximilians-University Munchen, and Aarhus University Hospital, etc. When it comes to the cooperation network, there were 20 nodes and 158 links . The orgA total of 788 authors participated in this research field. Both Graham NMH  and Simpson EL  published the largest number of articles in this study area , followed by de Bruin-Weller M , Blauvelt A , and Chen Z . Co-authorship analysis revealed 34 nodes and 300 links . The topAs shown in New England Journal of Medicine and Lancet with an IF of 91.245 and 79.321.Of the 138 papers, the analysis of reference citations discovered 134 nodes and 686 links . The vasNew England Journal of Medicine , Lancet , and British Journal of Dermatology . Other journals were the Journal of the American Academy of Dermatology, Journal of Allergy and Clinical Immunology-In Practice, JAMA Dermatology, and JAMA. The top 2 papers were identical to those in the analysis of citations, and were undoubtedly the most co-cited papers with 87 and 82 citations, respectively. \u201cDupilumab with concomitant topical corticosteroid treatment in adults with atopic dermatitis with an inadequate response or intolerance to ciclosporin A or when this treatment is medically inadvisable: a placebo-controlled, randomized phase III clinical trial\u201d  rl trial\u201d   by Zirwas et al. .In recent years, bibliometric analysis has been gradually applied in a variety of medical fields, such as respiratory medicine, ocular disease, and cancer. In dermatology, several research fields have been analyzed with bibliometric methods, such as general dermatology, melanoma, psoriasis, psoriatic arthritis, toxic epidermal necrolysis, and Stevens-Johnson syndrome \u201325.To the best of our knowledge, this is the first bibliometric analysis focusing on ocular AEs during the treatment of AD with dupilumab. In this study, we investigated published documents involving dupilumab in the treatment of AD, identified all the related ocular AEs, and systematically analyzed the basic characteristics of literature, such as the journals, collaborative networks of countries/regions, organizations and authors, co-occurrence of keywords, and citation network.The analysis of document type showed that less than one-third of documents were case letters or research letters, and most papers were original research studies. With regard to the publication time, the earliest study was published in 2016, and the majority (89.86%) of publications were published in the past 3 years (2019\u20132021), indicating research on ocular AEs is a novel and emerging field.New England Journal of Medicine and Lancet) have higher IFs than dermatologic journals. The top 6 journals were the British Journal of Dermatology, Journal of the American Academy of Dermatology, Dermatologic Therapy, Journal of the European Academy of Dermatology and Venereology, JAMA Dermatology, and American Journal of Clinical Dermatology. All of them were dermatologic journals, and 5 out of 6 journals were world-class dermatologic journals with IFs higher than 6.The bibliometric analysis of journals found a total of 47 journals of publication. Dermatologic journals  and ophthalmologic journals  were undoubtedly the top 2 categories, followed by Medicine, General & Internal and Immunology/Allergy categories. The reason why Medicine, General & Internal journals published quite a few papers might be that some general medicine journals , followed by North America (2), East Asia (2), Australia (1), and South America (1). The vast majority (86.67%) of countries/regions were in the Northern Hemisphere. Except for Brazil, all the other countries/regions were developed countries/regions.In the bibliometric analysis of organizations, 326 organizations had made contributions in this study area. Oregon Health and Science University published the first article reporting ocular AEs during the treatment of AD with dupilumab. Most organizations were universities and research centers. However, organizations leading the way were Sanofi (France) and Regeneron Pharmaceuticals Inc. (USA), since dupilumab was jointly developed by them. University Medical Center Utrecht (Netherlands) was the leading university, followed by Oregon Health and Science University (USA), and Northwestern University (USA). Thus, the main forms of research group were biopharmaceutical companies, universities, and research centers. Regarding the cooperation network, Sanofi containing Sanofi Genzyme ranked first in the cooperation intensity with the highest total link strength, followed by Regeneron Pharmaceuticals Inc., demonstrating the dominant position in the development of dupilumab. Half of the top 10 organizations with the most citations were from the United States, reflecting the great influence on this research field.On the subject of authors, we summarized a total of 788 authors participating in this research field. Concerning first authors, Graham NMH  and Simpson EL  were the most prolific authors with the most citations. In the co-authorship network, the top 10 authors with the highest link strength mainly came from organizations of the United States, in which Regeneron Pharmaceuticals Inc. made up the largest proportion. Additionally, the contributions of ophthalmology specialists are significant in the correct classification and management of eye involvement in the treatment of AD, and several articles have highlighted the significance of the cooperation between dermatologists and ophthalmologists .With respect to the co-occurrence analysis of keywords, conjunctivitis was the most common ocular AE identified in this study. Plenty of clinical trials have demonstrated that AD patients treated with dupilumab had a higher incidence of conjunctivitis than those treated with placebo. The term \u201cconjunctivitis\u201d contained the following diseases: conjunctivitis, conjunctivitis allergic, conjunctivitis bacterial, conjunctivitis viral, and atopic keratoconjunctivitis, with all being reported as AEs in the literature. Other ocular AEs, such as dry eyes, eye pruritus, blepharitis, blepharoconjunctivitis, and cicatricial ectropion, were also reported.Notably, in our study, allergic conjunctivitis, blepharitis, keratitis, and atopic keratoconjunctivitis were also complications at baseline in some cases. Previous studies have proved that the above ocular diseases are common comorbidities occurring in nearly half of patients with AD . MoreoveFurthermore, keywords regarding the management of AD made up the largest proportion in the co-occurrence network of keywords, such as the safety and efficacy of dupilumab, quality of life and care of the patients, and daily practice. Clinical lesions of AD usually tend to be recurrent and may last for a lifetime. Moreover, topical treatments have relatively limited efficiency for moderate-to-severe AD, and systemic therapy with long-term significant efficiency and safety is required for treatment. Therefore, for a long time, the management of AD is one of the great concerns in dermatology, and remains to be a therapeutic challenge for clinicians. The occurrence network of keywords indicated that the management of AD will continue to be the research hotspot and development trend in this medical area.New England Journal of Medicine, took the lead with 741 citations, such as both citing and cited conditions. This article was the first study discovering ocular AEs of dupilumab in the treatment of AD, and thus became the milestone research in this field. The top papers with the most citations were mainly randomized, placebo-controlled phase 2, and phase 3 clinical trials. Except for clinical trials, real-life evidence and clinical reports have also provided fundamental evidence for future studies. A clinical report \u201cConjunctivitis occurring in atopic dermatitis patients treated with dupilumab-clinical characteristics and treatment\u201d  and Regeneron Pharmaceuticals (USA) were the leading organizations with most contributions; conjunctivitis was the most common ocular AE; the management of AD will continue to be the research hotspot and development trend in this area; the milestone research is the first article \u201cTwo Phase 3 Trials of Dupilumab vs. Placebo in Atopic Dermatitis\u201d published in New England Journal of Medicine; most of the top 10 papers were mainly randomized, placebo-controlled phase 2 and phase 3 clinical trials and real-life large cohort studies.In summary, the present study presented a comprehensive bibliometric analysis concerning ocular AEs during the treatment of AD patients with dupilumab. The first study was published in 2016 by Oregon Health and Science University from the United States; the majority of publications were published in the past 3 years; Our results predicted that research on ocular AEs was the frontiers and promising field, and the management of AD was the great concern and difficulty and would be the future research direction. In conclusion, this study may help better understand ocular AEs in the dupilumab treatment of AD, and grasp the research trends and most influential topics in this field.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.QNJ, JQ, and YPZ contributed to concept, design, literature search, and edited the manuscript. QNJ and KF contributed to data acquisition and analysis and statistical analysis. QNJ drafted the manuscript. QNJ, JQ, KF, and YPZ reviewed the manuscript. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "Plant enhances the capacity of the ecosystem and agricultural systems, enabling human beings to survive and multiply on the earth. Since the human being appeared, plants and their production have played a pivotal role in the development of human civilization, which is mainly reflected in four aspects, including ecological value, edible and medicinal value, ornamental value, and cultural value. In the growth process of both aquatic and terrestrial plants, we need to consider plant protection from the four following levels. 1) at the level of maintaining ecological diversity: we need to explore soil improvement and protection, ecological and supply-demand balance of precise fertilization, meteorological prediction and warning and prediction of plant pest and disease epidemic patterns, etc.; 2) at the level of agricultural production: scientific breeding and seed selection, plant phenotyping, food safety and traceability, intelligent diagnosis and control of plant diseases and pests, intelligent weeding, automatic harvesting, quality grading and division, water and fertilizer integration, quality monitoring, growth monitoring, plant nutrition maintenance, ecology, soil, fertilizer and crop resources and nutrient balance, etc.; 3) at the level of plant high standardized farmland construction: explore smart orchard, smart tea garden, smart field, smart facility farmland, etc., explore recycling agriculture, Photovoltaic Agriculture  caused by long-term labor work.Similar challenges also exist while judging whether an insect is a pest or a beneficial insect, and judging what kind of a weed it is. At present, in order to effectively cope with the grand challenges, we suggest the research on the following five aspects:Based on Internet of Things, Image Processing, and Knowledge Graph technology  management tools and decision support system could be supplied to planters to ensure the implementation of the necessary changes .In the process of biological control, it is necessary to consider the impact of various factors, e.g., environmental conditions, host plants, host pests, application methods, product batches, on natural enemies of pests and pathogenic microorganisms. It is of great importance to confirm the effect of biological control through large-area monitoring. However, the traditional manual method is time-consuming and laborious to know the whole control effect accurately, which is not beneficial for the development of biological control technology, and for the establishment of evaluation standards and systems about biological control effect.In order to effectively cope with the challenges of green intelligent biological control, we suggest the researches on the following two aspects:Based on Internet of Things, Artificial Intelligence, Satellite Remote Sensing, Aerial Image Processing, Big Data, Knowledge Graph, and other technologies, we can carry out the researches on the epidemic law, and comprehensive prevention and control for plant diseases and pests, weeds, on the treatment of degraded grassland, and on the integrated soil and water management. For example, the pest monitoring network can help cultivators anticipate problems in advance and take the initiative to solve them , Intelligent Equipment, and UAV, we can carry out researches on guiding the unmanned tractor to work on the designated path and guiding the UAV to collect plant growth information on the preset path;Based on Satellite Remote Sensing and Aerial Image Processing, we can carry out researches on evaluating forest and pasture germplasm resources, selecting breed, protecting beneficial insect, and monitoring the farmland, e.g., drought of farmland and the alien species invasion in forage grass.In the era of unmanned smart plant protection, a high level of plant science is technologically achievable with the favor of computer science.Both authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.This work was supported in part by the National Natural Science Foundation of China under (Grant 62072248), and by the Jiangsu Agriculture Science and Technology Innovation Fund under (Grant CX(21)3060).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "In recent years, with the continuous reform and innovation of the sports industry, the national training of sports talents has gradually developed into the training mode of skilled sports talents and professional talents in the field of sports. Therefore, the research on the influence of entrepreneurship education on the entrepreneurial psychology of sports majors has become the inevitable requirement of the development of the sports industry. The purposes are to understand the entrepreneurial psychology and its influencing factors of the students in sports majors after graduation and promote more suitable college students to start businesses and realize self-value. With the students in sports majors in four colleges of Y province as the research object, the typical model in psychology, planning behavior model, is taken as the basic theoretical basis. The questionnaire method combined with the data mining technology based on the decision tree model is adopted to study the influencing factors of entrepreneurial psychology of sports majors. It focuses on the influencing factors and mechanisms of the entrepreneurial drive of sports students. The results show that the three factors, namely, entrepreneurial behavior attitude, entrepreneurial subjective norms, and entrepreneurial perceptual behavior control, are different and interrelated. They are inseparable and can be transformed into each other under certain conditions. Three factors jointly drive the entrepreneurial behavior of students in sports majors. The entrepreneurial drive of students in sports majors in Y province is a dynamic system mechanism, which is analyzed using data mining technology. The entrepreneurial perceptual behavior control is the core factor affecting the entrepreneurial drive of students in sports majors. However, the success rate of entrepreneurs will be higher when the three elements play a reasonable role. The subjective factors driving their entrepreneurship will be reduced in direct proportion when entrepreneurs are deficient in one aspect. The Statistical Bulletin on the Development of National Education in 2020 presented by the Ministry of Education, in 2020, colleges in China enrolled 1,106,600 postgraduates, 9.6745 million undergraduate and junior college students in general higher education, and 3.6376 million students in higher education. Moreover, the growth rate has been rising. The national quality of China has also been improved, but it also brings some practical problems. First, the number of college graduates is increasing, and the competition is becoming increasingly greater. Second, the pulling effect of the economic slowdown of China on employment is weakened, and college students will also be limited by their conditions such as lack of work experience. The current employment situation is not so optimistic under various pressures. Facing this employment situation, more and more college students realize that only with innovative ideas and innovative thinking can they be competitive in the increasingly fierce competition and rapidly changing world. Moreover, more and more college students begin to try to start their businesses. College students have also received the attention and practical support of the government, society, colleges, and other parties.The number of college students continues to grow with the expansion of college enrollment, and more people have received higher education. According to At present, there is a huge contradiction between the growing health needs of the people and the urgently needed professionals in sports. Meanwhile, the endowing status of sports talents by employers has put forward a severe test for the employment of sports college students who are about to graduate. The development of the sports industry and sports cause is inseparable from the cultivation of talents. However, at present, the cultivation of talents in the sports industry has obvious shortcomings when the development of the sports industry has entered the fast lane. The lack of talents has become one of the obstacles restricting the rapid development of the sports industry of China. According to the 13th five-year plan of the national sports industry, the employed population of the sports industry of China reached 6 million in 2020. At present, there are only hundreds of thousands of graduates trained by national sports colleges and non-sports colleges, so there is a large talent gap, let alone many sports graduates who are not engaged in sports-related industries. To realize the employment of college students in sports majors, the state continues to encourage them to start businesses. Hence, the research of entrepreneurship education on the entrepreneurial psychology of sports majors from the perspective of pedagogy is conducive to promoting the entrepreneurship of sports talents with outstanding professional quality and strong comprehensive ability. Besides, it can realize entrepreneurship to drive employment and then fully improve the quality of entrepreneurship and employment of sports majors. Moreover, it can break the shortage of employment in enterprises and the difficult employment of students, meet the health needs of people, and effectively improve the success rate of sports talents.The research innovations are as follows. First, the knowledge of psychology, artificial intelligence, and deep learning are integrated across disciplines. Analyzing the driving factors of entrepreneurship of students in sports majors can make people deeply understand the influencing factors of their entrepreneurship psychology and provide sufficient theoretical guidance for the development of the sports industry and the cultivation of sports talents. Second, with the students in sports majors as the research object, the influencing factors of their entrepreneurial psychology are analyzed. It can make people more specifically understand and grasp the main influencing factors and specific reasons of their entrepreneurial psychology, constantly promote the employment of them by entrepreneurship, and promote the development of sports entrepreneurial talents in China. Third, the uniqueness of group entrepreneurship of college students in the process of model construction is highlighted, and the relevant influencing factors are analyzed from multiple dimensions.The relevant materials of China Academic Journal Network, Wanfang full-text database, and YALU Chinese Journal Network are considered based on the research purpose and content. Besides, they are analyzed and understood in detail by reading the related books of entrepreneurship of college students and entrepreneurship drive theory, to lay a good theoretical foundation for this exploration.The entrepreneurship research status of students in sports majors is as follows. Adi et al.  found thChen  studied Through investigation and research, Ghada  suggesteUnderstanding the cognitive infrastructure supporting entrepreneurial activities can provide a richer perspective on how to cultivate entrepreneurship. The introduction of social cognitive theory in the field of entrepreneurship is conducive to understanding the process of entrepreneurs discovering and utilizing opportunities and exploring the essence of entrepreneurship. Zhang et al.  proposedEntrepreneurship education began in 1947 when Myles Mace offered the course \u201cstart-up business management\u201d for MBA students of Harvard Business School. This course is considered to be the starting point of entrepreneurship education. Entrepreneurship education has two definitions: broad sense and narrow sense. The broad sense is to cultivate a pioneering spirit of students, which is a kind of quality education; the narrow sense is an education to train individuals to engage in industrial and commercial activities, train students from job seekers to job creators, provide jobs, and create jobs.Thereby, entrepreneurship education is to focus more on cultivating the entrepreneurial consciousness of individuals engaged in enterprises and business planning, cultivating the entrepreneurial spirit such as pioneering spirit and adventure spirit, enhancing entrepreneurial knowledge and skills, improving the comprehensive quality of individual entrepreneurship, and providing preparation and guidance for the practice of individual independent entrepreneurship.Koh  suggesteLiu  stated tBased on the above theoretical framework and some basic information required in the actual survey, the selection of research variables in the questionnaire mainly includes the following three parts.The first part is to understand the basic information of the respondents; the second part is to understand the current situation of entrepreneurial driving, attitude, and motivation of the respondents; the third part is to further understand the information of the influencing factors of the entrepreneurial driving of the respondents, which mainly includes entrepreneurial behavior attitude factors of college students, perceptual behavior control, and subjective norms. The answers of the respondents to the relevant questions including entrepreneurial behavior attitude factors, perceptual behavior control, and subjective norms reveal the specific relationship of various factors affecting the entrepreneurial drive of college students in sports majors. Ma et al.  suggesteAccording to the research purpose and content needs, 180 undergraduates and graduates in sports majors from 2016 to 2020 in two colleges in Y province and two colleges in S province were selected as the research objects to mainly explore the driving factors of entrepreneurship.Based on the research purpose and content, the relevant materials, such as China Academic Journal Network, Wanfang full-text database, and YALU Chinese Journal Network, were considered. Among them, there were 4 dissertations, 10 journal theses, 5 relevant policy documents, and 15 books on entrepreneurship and entrepreneurship driving theory of college students in sports majors. These materials were carefully analyzed and understood to lay a theoretical foundation for this exploration.This exploration was mainly to discuss the impact of entrepreneurship education on the entrepreneurial drive of sports majors. Hence, a questionnaire method was employed to study the entrepreneurial driving factors of college students in sports colleges and departments of Y province. In the second half of 2020, designed questionnaires were randomly distributed to students from two colleges in Y province and two colleges in S province. Then, 200 questionnaires were collected from graduates on the Internet. Among them, 190 questionnaires were successfully recovered, and the recovery rate was 95%; there were 180 valid questionnaires, and the effective rate was 94.7%. SPSS18.0 statistical software (Chicago: SPSS Inc.) of social sciences was adopted. The questionnaires were distributed, and the effective questionnaires were successfully recovered for necessary mathematical statistics and result analysis.In A total of 20 influencing factors of the entrepreneurial drive were randomly selected as indexes from the three dimensions of the theory of planned behavior. The total score of this questionnaire was 100 points, and the corresponding scores of each dimension were 35, 35, and 30 points, respectively. The Likert-type 5-level scoring method was adopted, with a median of 3.The actual situation of entrepreneurial drive of sports students includes three dimensions: entrepreneurial behavior attitude, subjective norm, and perceptual behavior control. The investigation of entrepreneurial behavior attitude of sports majors involves seven aspects: three views and self-cognition, entrepreneurial cognition, will quality, temper and character, belief and perseverance, entrepreneurial vision planning, and confidence and determination. The investigation of behavior control of the sports students involves six aspects: innovation ability, social skills, management ability, team cooperation ability, market foresight ability, and fund-raising ability. Rivas and Espada  suggesteRegarding the evaluation of their management ability, the number of students who choose general, good, poor, very poor, and very good is 97, 50, 20, 10, and 2, respectively. It clearly suggests that the evaluation of the current college students of their management ability is basically above average; regarding team cooperation ability, the number of students who choose good, general, very good, poor, and very poor is 90, 50, 28, 5, and 2, respectively. It suggests that the evaluation of the current college students of their team cooperation ability is basically above average, and they are more confident; for market foresight ability, the number of students who choose general, good, poor, very poor, and very good is 97, 59, 12, 3, and 2, respectively. Obviously, the current college students can identify with their market foresight ability, and about half of them have strong market foresight ability; for fund-raising ability, the number of students who choose poor, good, very poor, general, and very good is 135, 22, 3, 2, and 2, respectively. It illustrates that one of the main obstacles faced by college students is to raise venture capital, and 80% of the students think it is difficult to raise funds.Rogoza and Zemojtel-Piotrowska  suggesteThe investigation of the subjective norms of sports majors involves five aspects: the subjective attitude of their relatives and friends toward their entrepreneurship, the attitude of the public toward entrepreneurship of sports majors, the praise of local government, mainstream media and the public for entrepreneurship of students, the service awareness of government and colleges for entrepreneurship of college students, and the support of government projects for entrepreneurship. Regarding the attitude of the family and friends toward entrepreneurship of college students, the number of students who choose good, general, very poor, very good, and poor is 102, 50, 10, 9, and 2, respectively. It suggests that the respondents think that their family members and friends around them still show positive and supportive attitude toward entrepreneurship; in the evaluation of their fund-raising ability, the number of students who choose good, very good, general, poor, and very poor is 96, 68, 13, 2, and 1, respectively. Wang and Chen  indicateThe government, the media, and the public praise the typical entrepreneurial behavior. As for their fund-raising ability, the number of students who choose good, very good, general, poor, and very poor is 79, 62, 22, 9, and 8, respectively. It suggests that they praise the typical entrepreneurial behavior positively; for the service consciousness of the government and colleges for entrepreneurship of college students, the number of students who choose general, good, poor, very good, and very poor is 92, 50, 23, 7, and 6, respectively , which has a positive proportional linear relationship. The optimization of the entrepreneurial atmosphere will bring a group effect with the strengthening of entrepreneurial motivation of college students, which will raise the entrepreneurial enthusiasm of the students in sports majors  for the publication of any potentially identifiable images or data included in this article.All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.This work was supported by Research on the Governance of Henan Province Youth Extracurricular Traning Institutions in the New Era Project approval number: 2021YB0011 and Research on the Educational Standard System of Outstanding Physical Education Teachers in the New Era Project approval number: 21ATY009.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "Second, the existing innovation and entrepreneurship education in colleges and universities is investigated with a questionnaire survey (QS) and interviews to discover the challenges that college students face during innovation and entrepreneurship. The QS results provide a data basis for subsequent strategies. The results demonstrate that 19.86% of the students have a complete understanding of innovation and entrepreneurship, while only 9.93% of the students are interested in innovation and entrepreneurship activities. The technical significance of innovation and entrepreneurship activities only accounts for 41.84%. Moreover, the vast majority of students (79.67%) believe that the curriculum of innovation and entrepreneurship education is single, simple, and irrelevant to their majors. Meanwhile, some problems have been found: for example, the teaching faculty is insufficient, and there is not a sound entrepreneurial atmosphere. As per the survey results, an innovation and entrepreneurship education strategy for core stakeholders, namely, universities, society, government, university teachers, and students, is formulated to promote the sound development of innovation and entrepreneurship education in colleges and universities. Besides, a training strategy in line with the awareness of college students toward mass entrepreneurship and innovation is formulated based on the current situation of innovation and entrepreneurship education, which can serve as a reference and has practical significance for enriching and perfecting the innovation and entrepreneurship education system for college students.Against the background of economic globalization, the awareness of college student startup entrepreneurs toward mass entrepreneurship and innovation is analyzed from the perspective of educational psychology, thus responding to national development strategies. First, the  As economic globalization[0mm][-4mm] accelerates, the number of university graduates increases yearly, resulting in severe employment situations and difficulties in self-employment. Data suggest that the number of college graduates in China has increased from about 5 million in 2010 to nearly 9 million in 2019, with only about 70% employment rate  and interview method are selected to investigate college students, thereby determining existing problems of college students in the process of innovation and entrepreneurship, formulating the corresponding strategies. The results provide theoretical support for the development of innovation and entrepreneurship education in colleges and universities.Under the trend of mass entrepreneurship and innovation, many colleges and universities have included courses of innovation and entrepreneurship education. The theoretical research and practical activities of innovation and entrepreneurship education in colleges and universities are highly active, and significant results have been obtained.To contextualize entrepreneurial behaviors, Morales et al.  assessedThe above studies reveal that innovation and entrepreneurship are activities with characteristics of the times. Innovation and entrepreneurship education have become trendy educational topics. Developing innovation and entrepreneurship education has also become a focus and resonance of higher education in the world. However, the current research is relatively shallow, non-systematic, and incomplete, which singles out the innovation and entrepreneurship education of colleges and universities from professional courses. Therefore, the awareness of innovation and entrepreneurship of college students is understood from the perspective of educational psychology. Then, corresponding strategies are proposed, which are of great significance to promoting entrepreneurial awareness of college students.Under the background of economic transformation, the innovation-driven organizational mechanism is discussed. On this basis, the requirements for innovation-driven entrepreneurship education in colleges and universities are analyzed, and the corresponding strategies are explored through case analysis.Theoretically, the purposes are to enrich the theoretical system of innovation and entrepreneurship education in China, put forward systematic and innovative suggestions for innovation and entrepreneurship education courses in colleges and universities, and provide theoretical support to meet the needs of innovation-driven entrepreneurship education in Chinese universities.Practically, the purposes are to provide scientific guidance for the practice of innovation and entrepreneurship education in colleges and universities and help outstanding college students recognize innovation and entrepreneurship education, bravely innovate and start businesses, apply what they have learned, and develop an adaptable innovative and entrepreneurial thinking. Simultaneously, college students are instructed to carry out system innovation to help innovation and entrepreneurship education better interact and promote each other with the regional socio-economic environment  questionnaire  and the technical significance of innovative activities  have no significant relationship with the satisfaction of student. The results are shown in The comprehensive mechanism of various factors in the entrepreneurship education system is complex. Here, the three dimensions of the student QS and satisfaction are statistically analyzed by regression analysis. The result shows that the three dimensions have a significant impact on the satisfaction of students. Meanwhile, multiple regression analysis is conducted to test the relationship between the five dimensions and satisfaction. The result indicates that only the dimension of innovation and entrepreneurship education has a significant relationship with satisfaction, specifically, \u03b2 = 0.518, Awareness of innovation and entrepreneurship refers to desires and thoughts of people to create or explore ideas or things that they have never felt or have a deep interest in. It shows the will, aspirations, interests, reveries, attitudes, ideas, and emotions of people in creative activities, which is an aggressive, positive, and extremely fulfilling form of expressing human thinking and awareness activities. Besides, it is the premise of human creativity and, ultimately, meets needs of people for social and personal development  believe that innovation and entrepreneurship activities do not have technical significance, with a single curriculum that is irrelevant to the majors of students. Finally, strategies are formulated for core stakeholders, namely, universities, society, government, university teachers, and students, to provide a reference for the sound development of innovation and entrepreneurship education in colleges and universities. However, there are also some shortcomings. First, the scope of the survey and the scale of the sample need further expansion. College students are mainly studied here, but core stakeholders, such as universities, society, government, university administrators, university teachers, and students all are involved in the actual innovation and entrepreneurship education. Therefore, in the follow-up, subject universality should be extended, and more abundant analysis methods can be adopted to compare and analyze the situation of different survey subjects. Meanwhile, the influence of subjective factors should be minimized in QS design, the QS model should be optimized, and the results variables should be introduced for further analysis.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by Harbin University of Science and Technology Ethics Committee. The patients/participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "John Litt is not included in the author byline. John Litt should be listed as the eighth author and is affiliated with the Discipline of General Practice, Flinders University, Adelaide, South Australia, Australia. The contributions of this author are as follows: Conceptualization, Investigation, Methodology, Validation.David Edwards is not included in the author byline. David Edwards should be listed as the ninth author and is affiliated with SA Quitline, Cancer Council SA, Adelaide, South Australia, Australia. The contributions of this author are as follows: Conceptualization, Data curation, Investigation, Resources, Validation.The following information is missing from the Acknowledgments section: The authors would like to acknowledge the SA Quitline  as the organisation that provided (and employed) the Counsellors who offered the pro-active call-back smoking cessation program through telephone advice."}
{"text": "Since its foundation in 1928 at the second International Congress of Radiology in Stockholm, Sweden, the International Commission on Radiological Protection (ICRP) has continuously developed and improved recommendations for radiological protection. The aim has always been to protect people and (later) the environment from the detrimental effects of ionising radiation without unduly limiting its beneficial use.ICRP periodically issues General Recommendations that describe the overall structure of the System of Radiological Protection (\u2018the System\u2019), and more frequently develops specific publications that elaborate elements of the System in more detail or provide essential information for implementation.Publication 26  assesses and reports levels, effects, and risks of exposure to ionising radiation. Based on these and other scientific evaluations, along with ethical and practical considerations, ICRP develops the System. The International Atomic Energy Agency (IAEA) is one of the key organisations that formulates standards and guides used internationally for the protection of people and the environment from harmful effects of ionising radiation.Because ionising radiation is a ubiquitous natural phenomenon which affects everyone\u2019s daily life, and is also used in many modern technical applications, e.g., in medical imaging and radiotherapy, research, industry, and electricity generation, there are many other organisations interested in how ICRP advances radiological protection. Consequently, ICRP maintains formal relation with 30 international organisations, including, but not limited to, the IAEA, the International Commission on Radiation Units and Measurements (ICRU), the International Labour Organisation (ILO), the International Radiation Protection Association (IRPA), the Nuclear Energy Agency (NEA) of the Organisation for Economic Cooperation and Development (OECD), UNSCEAR, the World Health Organisation (WHO), the World Nuclear Association (WNA), and a number of others including international medical associations and radiation research platforms.In announcing that the next cycle of revisiting the System of Radiological Protection has started  in their field of expertise. For example, UNSCEAR has recently defined its Programme of work for 2020\u20132024 and has identified priorities evaluation of radiation-induced diseases of the circulatory system, of the nervous system, radiation-induced eye lens opacities, radiation effects on the immune systems, and other radiation-induced non-cancer effects, such as acute radiation syndrome, respiratory disease, endocrine disease, and transgenerational effects Unscear .Likewise, in recent years, various European radiation research platforms have systematically developed SRAs to identify research topics relevant in their respective fields. For example, the European Radioecology Alliance (ALLIANCE) has identified short-to-medium-term research priorities in radioecology to improve the scientific basis and reduce uncertainties in human and environmental risk assessments, increasing radiation protection of humans and wildlife ALLIANCE . The recInterestingly, an effort has just been initiated to provide recommendations on re-initiation of a low dose research program in the United States NAS . Each orThe System must cross all different orientations and questions and must draw upon not only the traditional scientific areas of inquiry, but also upon the wide range of social science and application sciences. In particular, implementation sciences can help to understand how individuals think and act, which is an equally essential part of defining the System in a way that it is truly fit for purpose. From this perspective, questions can emerge which may be usefully answered in the near term to support the current review of the System, as well as longer term areas that will contribute to the future. ICRP finds itself in a unique position of looking across the entirety of the research spectrum and recognises that while all the lines of inquiry are important, some aspects may contribute more directly to the review of the System. From this perspective, ICRP has thus found it useful to suggest areas of work, not to supplant the agendas of its partner organisations, but to help formulate a crosscutting and coherent view of work that can contribute to the revision of the System.In the present issue of Radiation and Environmental Biophysics, the ICRP paper by Laurier and co-workers , Don Cool (ICRP Vice-Chair), Christopher Clement (ICRP Scientific Secretary)."}
{"text": "Monnier, MD.Professor of Case Western Reserve University\u201cA living legend, a leader of the field of the Maillard Reaction\u201dPhoto: Dr. Vincent Monnier with Dr. Paul Thornalley, Dr. Naoyuki Taniguchi and his colleagues in Osaka University Medical School when he joined the IMARS meeting in 2001This document is dedicated to a living legend, a leader of the field of the Maillard Reaction, Vincent M. Monnier MD. Since he began his carrier, he has been in the center of the field and has dedicated himself to further innovations in this area of research. He was one of the original organizers of the International Maillard Reaction Society (IMARS) and continues to contribute to its ongoing activities. During his career, numerous postdoctoral researchers have passed through his laboratory, and many of them have continued to contribute to progress in the field of the Maillard Reaction as well as to the scientific community in general. He remains an active researcher in the field of Maillard chemistry and at the forefront of the field. We look back his achievements below.Dr. Vincent Monnier was born in Switzerland, to a family of scientists. He obtained his medical degree and diploma in chemistry from the University of Basel. From 1977 to 82, he did postdoctoral research in Anthony Cerami\u2019s lab at Rockefeller University . In 1982, he was appointed to the faculty of the Institute of Pathology, Case Western Reserve University, and since then, he has continued his research on in vivo aspects of Maillard Reaction, including studies with the Diabetes Control and Complications Trial (DCCT) group. He was awarded the Paul E. Lacy Award in 1990 and the Nathan Shock Award  in 1996, and became an elected Fellow of the American Association for the Advancement of Science in 2015.Science in 1981 with Dr. Cerami, which proposed that the Maillard Reaction is intimately involved in the aging process [New England Journal of Medicine in 1986, which described the nature of the association of Maillard Reaction and diabetic complications in Type 1 diabetes [To overview Dr. Monnier\u2019s research, we review some aspects of the history of Maillard Reaction research. The Maillard Reaction, which involves a reaction between monosaccharides and amino groups, was originally described by Maillard, in 1912 [diabetes . These pOne of Dr. Monnier\u2019s achievements is the elucidation of the molecular mechanisms by which glycation and glycoxidation leads to impaired protein function. The glycation reaction is extremely complicated, and he has been examining the precise pathways and determining the structures the glycation products, including pentosidine \u20136, LW-1 Dr. Monnier also examined the importance of glycation in aging and in age-related diseases, including diabetes, cataract formation and renal diseases, revealing that glycation theory explains the hyperglycemic memory in the pathology of diabetic complications \u201318. His Dr. Monnier has also attempted to develop methods to slow down the speed of glycation. His search for soil microorganisms that are capable of digesting Amadori-products resulted in his discovery of FAD-containing fructosyl-amine oxidases , 25, andSince his research remains ongoing, it is not possible to completely summarize his work, but it is possible for us to review his contributions to the research community. As mentioned above, he has been involved in the advanced training of numerous researchers, including many post-doctoral fellows from Japan. Among these we include Drs. Fumitaka Hayase, Satoshi Miyata, Shinji Taneda, Motoko Takahashi, Atsushi Araki, Yoko Nishikawa, Makoto Satake. Many of those post -doctoral scientists have remained in the field of Maillard Reaction and continue to contribute to the community, including Drs. David Sell, Ram Nagaraj, Monika Pischetsrieder, Marcus Glomb, Manuel Portero-Otin, Frederic Tessier, and more. Dr. Monnier\u2019s contributions toward the community is substantial.Here, I (Taniguchi) would like to introduce a brief history of the IMARS and the Japan Maillard Reaction Society (JMARS).The first symposium of IMARS was held in Uddevalla, Sweden in 1979 , the 2ndThis year, the 19th IMARS will be held in Qatar with Dr. Paul Thornalley serving as the host. Dr. Thornalley is now the president of IMARS. JMARS has continued to scientifically contribute to IMARS activity. Drs. Reiko Inagi (University of Tokyo) and Ryoji Nagai (Tokai University) are actively involved in activities related to IMARS and edit the highlights of the Maillard Reaction in the IMARS web site and in international networks as well.Dr. Vincent Monnier has made great contributions to the efforts to launch JMARS. He participated in the 3rd IMARS meeting that was held in Japan in 1985 and on the way back to the US he visited Hokkaido University, Sapporo, because he has a good friend there, Ichiro Fukushima, Professor of Physiology (Hokkaido University) who spent some time as a research fellow at a laboratory at Rockefeller University. At that time, I (Taniguchi) was an associate professor at the Cancer Institute at Hokkaido University. When Dr. Monnier gave a lecture on the campus of Hokkaido University School of Medicine, Fukushima asked me to chair the session. Many years ago, I was a visiting associate professor at the Cornell University Medical School, which is located just next to the Rockefeller University and Fukushima is also a good friend of mine. He lived in the housing at Rockefeller University, which was located on the upper east side, and I lived in an apartment complex called Sutton Terrace which is located just across the street from his apartment.In 1988, Drs. John Baynes (University of South Carolina) and Vincent Monnier organized a meeting at NIH . This meThe second research meeting was again held at the Ono Pharmaceutical Company in Osaka and was organized by Naoyuki Taniguchi. Since the 3rd meeting at Kyoto, which was organized by Dr. Yukio Shigeta , many clinicians with interests in in diabetes mellitus participated in the meeting and many additional persons with interests in clinical aspects of diabetes from various locations in Japan also attended the meeting. The meetings were the 9th meeting and, in 2000, the meeting name was changed to the 10th JMARS and was organized by Dr. Toshihiko Osawa (Nagoya University).In 2001, the 7th IMARS and 11th JMARS joint meeting at Kumamoto was organized by Drs. Seikoh Horiuchi, Taniguchi, Fumitaka Hayase (Meiji University), Tadao Kurata and Toshihiko Osawa , and theFinally, we wish to thank all those who contributed to this Special Issue on: Advances in Glycation: from food to human health and disease. We also wish to express our particular thanks to the Glycoconjugate Journal staff, Editor Prof. Sandro Sonnino and the production staff at Springer Co., for their help with publishing these proceedings. We finally wish to acknowledge Dr. Milton S Feather for his help with the review this Editorial."}
{"text": "Introduction: The Situation Room is a physical or virtual space where experts systematically analyze information to characterize a health situation, especially during emergencies. Decision-making processes are made toward solving health needs and promoting collaboration among institutions and social sectors. This paper presents the context and circumstances that led the University of Guadalajara (UdeG) to install a local health situation room (HSR) to address the COVID-19 pandemic at this institution based in the state of Jalisco, Mexico, a narrative is also made of its working processes and some of its results.Methods: The design of this situation room for COVID-19 was based on the methodology established by the Pan American Health Organization (PAHO)/WHO. This local-type situation room was installed on February 12, 2020. The health problem was characterized, and strategic lines, objectives, and goals were established; the first analysis was derived from an action plan deployed at the UdeG. The strategic lines were situational diagnosis, preventive actions, and containment strategies.Results: The situation room influenced the activities of the UdeG before the epidemic cases started in the state. One of the actions with the greatest impact was developing a mathematical model for predicting COVID-19 cases. Subsequently, new models have been developed according to the epidemiological evolution of the disease, helping manage the epidemic in the state. Another important result was the early closing of face-to-face university activities, reducing contagion risks and the mobility of more than 310,000 students, faculty, and administrative personnel throughout Jalisco.Conclusions: A consequence of the closure was that the confinement generated by the pandemic was the change to virtual meetings from April 2020 to date; but at the same time, this working format was a strength, since it influenced the decision of the university board to change all the academic activities to virtual format before other educational, economic, and social activities in the state did. By April 2020, the situation room transcended its institutional boundaries and was invited to participate at the Jalisco State's Health Committee. Its recommendations have helped to maintain the state with one of Mexico's lowest COVID-19 incidence and mortality rates. The Health Situation Room (HSR) is a term adopted from \u201cwar rooms\u201d, which refers to closed physical spaces, which were housed in some secret place during wars where the military chiefs with knowledge about war strategies, international political conflicts, specialists in political communication, and key members of the government gather to analyze and decide the actions to take during war conflicts . It has According to the WHO and the Pan American Health Organization (PAHO), epidemiology is a health science that is responsible for studying the distribution and the determinants of disease or health events and their application for the control of diseases and other health problems , 3. EpidThe situational health diagnosis later evolved to be called Health Situation Analysis (HSA). PAHO points out that HSA is the production of scientific evidence to support decisions on health issues . The genOn the other side, the HSR is defined generically as the space where the HSA takes place. Even more, HSR is understood as \u201cthe physical and virtual space where health information is systematically analyzed by a work team to characterize the Health Situation of a population, especially during emergency situations. The information is presented and disseminated in various formats, such as tables, graphs, maps, technical documents, or strategic reports to make decisions based on the evidence; in this way, the HSR becomes an instrument for institutional management, political negotiation, the identification of needs, the mobilization of resources, and for the monitoring and evaluation of health interventions\u201d . The maicampi), more than 170 high schools, and one virtual education system, distributed all over the state. This conglomerate of campi and schools conform to what is called the University Network of Jalisco. The Health Science Center integrates more than 130 educational programs in the area of health, based at the campus located in the city of Guadalajara, capital of Jalisco.The University of Guadalajara (UdeG) is the second-largest higher education institution in M\u00e9xico with more than 310,000 students and is based in the state of Jalisco, Mexico. It is organized in 16 higher education centers  was based totally on the implementation methodology of Situation Rooms established by PAHO/WHO for the Region of the Americas . AccordiThe objectives of an HSR should be (a) detecting and responding to communicable health problems on a timely, complete, and regular basis, (b) handling high-quality information, early detection, and prediction of epidemics, (c) providing an intervention plan during epidemics, and d) efficiently monitoring the planned intervention. These objectives are achieved through the implementation of four very precise actions: (1) training in epidemiology, (2) strengthening laboratories, (3) making communications more efficient in the health sector, and (4) giving special attention to health systems as a front line for health surveillance. According to these definitions, the operation of a situation room is based on three elements: the collection and processing of data, the analysis of the data, and the generation of the analysis products.Therefore, installing this UdeG-HSR followed the next procedure, based on the aforementioned PAHO/WHO recommendations:An initial request from the Provost of the Health Sciences Center was issued to the Department of Public Health, for the UdeG-HSR design and integration.Invitations to the participants that would integrate at the UdeG-HSR.Select the sources of information, the indicators that would be worked, and the databases that would be consulted.Enable the physical space and the necessary resources to access valid and reliable data and information to carry out the HSA. This implied the use of statistical analysis systems, geographic information systems, trends, and inequity analysis systems.The initial collection of the data available at the time of start-up and selection of the indicators that would be analyzed at the UdeG-HSR.Encourage the analysis process so that the members of the HSR made the appropriate decisions based on evidence, with all the computer and communication resources during the sessions at the physical space, or remotely.Constant and permanent collection of the data that would be generated and updated of the indicators subject to analysis by the participants.Generate the elements to obtain an initial diagnosis, identify its determinants and risk factors, define priorities, carry out preventive actions, and identify potential needs for technical cooperation.Generate specific prevention and effective communication actions for the entire community of the UdeG.These recommendations were set at the forefront strategy of the UdeG-HSR with only minor adjustments. Nevertheless, the authorities and coordinators imprinted their particular operative functioning due to the conformation of the University Network and the local-type configuration of this HSR.At the request of the provost of the Health Sciences Center, two meetings were held in early February 2020. During the first meeting, the pertinency for the creation of an HSR was identified, also the advantage of having that local-type HSR, according to the classification of PAHO/WHO , as a reIn January 2020, the Health Sciences Center and the whole University Network had already undertaken some prevention and sanitary actions for all the institutions, but it was not until the UdeG-HSR was formally installed that a catalog of data-based measures was communicated to all the institutional networks. To make this, the room was organized into two groups: the analysis group of the HSR (HSR-AG) and the HSA-extended group (HSA-e). The HSR-AG was integrated by a president (the President of UdeG), a general coordinator of The Provost of the Health Science center, an executive coordinator , and six more specialists, while the HSA-e group was integrated by a technical coordinator, two PhD students, and 14 more members . After bIt is worth mentioning that among the members of the HSA-e group, there were four epidemiologists, two molecular virus diagnosis researchers, three infectious diseases researchers, an expert in community nursing, one applied psychology, and one immunology researcher. During the meetings held over the first month, the pandemic problem at UdeG was elucidated and the strategic lines, objectives, and goals were established, which resulted in an Action and Execution Plan . This PlPreventive actions (information for the university community). This strategic line allowed to estimate the intended coverage of the exposed population groups of the community, applying the most appropriate prevention or control measures, such as health protection, sanitation, and epidemiological surveillance.Control strategies. Measures aimed at the prevention and protection of community health, necessary to adapt and create a culture of prevention.University's Situational Diagnosis. Analyzing the new reality in the face of the COVID-19 pandemic, for decision-making, articulation, and directionality of plans, training programs, control, and monitoring.Identification of the determinants and risk factors. Analysis of the indicators of determinants for the health status of the university community, recording vital activities and surveys for data administration.Contact and support of suspected cases. Deployment of a surveillance program for those positive and suspected cases, by analyzing the data to provide care recommendations, and presentation of a proposal to strengthen prevention and containment measures.Technical reports. Generation of analysis and results reports from the meetings, directed to the HSR-AG and the general council. Those reports contributed to the preparation of periodic messages to the university community.Epidemic monitoring. Provide health information to all the University Network, monitoring the trends of the COVID-19 cases, through the analysis, interpretation, and contextualization of national, state, and local data.Priority definition. The analysis allowed identifying priorities and offering interventions for decision-making aimed at evaluating the results and the impact it generated in the university community.Evaluation. In terms of evaluation, the UdeG-HSR undertook a combination of quantitative and qualitative methodologies in order to promote compliance with the programs for the improvement of health actions, contributing to the orientation of strategies, fulfillment of the goals, and applying the planned methods and procedures with constant monitoring of the event.These nine strategic lines guided the work of the UdeG-HSR, keeping its main objective in view and achieving the established goals. The main objective of the situation room was \u201cto define the actions that will be carried out by the UdeG to attend the COVID-19 epidemic by SARS-CoV-2, both for the prevention of contagion and the diffusion of information toward the university community and the adequate handling of suspicious cases on the part of the dependencies of the Network.\u201d Furthermore, four specific objectives were identified:Disseminate the preventive messages of COVID-19 throughout the University Network.Implement the infrastructure and resources to apply effective actions for the management of suspected COVID-19 cases.Reduce the risk of contagion by COVID-19 at the university areas.Continuously evaluate compliance with the objectives of the Action and Execution Plan.Finally, the goals established at that time were the following:An Action and Execution Plan for the prevention and management of suspected cases of COVID-19 was distributed to all the University Network on March 17, 2020.All the University Network disseminating the information material on COVID-19 as of March 16, 2020.All the University Network with access to a service area for suspected cases of COVID-19 as of March 20, 2020.All the University Network with access to trained personnel to handle suspected cases of COVID-19 as of March 20, 2020.All cases throughout the University Network with acute respiratory symptoms suggestive of COVID-19 were timely attended and adequately referred.These elements were the starting work for three consecutive meetings in the generation of the Action and Execution Plan that served as the basis for the activities and recommendations that this HSR issued to the university authorities to face the COVID-19 pandemic in a timely manner and prevent, as established in the general objective, contagion among members of the university community, and the timely dissemination of quality information for their care. As of that date, the participants met every week 26 more times, physically until March 17, and virtually through videoconference, from March 24 to date.The UdeG-HSR soon had direct involvement in the actions of UdeG. One of the elements with the highest impact was the implementation of the predictive model of COVID-19 cases, which was based on the incidence of cases and the national population parameters, to predict the possible number of cases that would occur on the following days/weeks. Section 3.4 will detail these models.As of March 19, when the University closed its doors, the UdeG-HSR continued having weekly virtual meetings through a videoconference platform. This implied that the members became familiar with these platforms but did not restrict the wealth of contributions and observations that were generated to inform the university authorities about the pandemic evolution and support them in making decisions for the community.As established in the strategic lines of the room, three technical reports were issued during 2020, which contained a series of recommendations for the management of the pandemic at the University. The characteristics of each report are:Technical Report no. 1. Issued on March 19, 2020, and recommended that university authorities recognize that COVID-19 was a real threat against which they should disseminate the appropriate information and be prepared to act; promote the active participation of the university community in actions for the prevention and containment of COVID-19 cases in accordance with the state, national, and international guidelines, and apply the guidelines of the Action and Execution Plan issued by this UdeG-HSR .campi of the University Network until the close of the 2020-A term and suspend the previously scheduled academic activities of the 2020 summer term, so that this period could be used for regularization activities of the 2020-A term, privileging non-contact modalities. Finally, integrate a Specialized University Committee to update the Institution's Educational Model that allowed to face this and other types of contingencies in a timely and flexible way, without affecting the performance of students, teachers, and administrative personnel .Technical Report no. 2. Issued on April 7, 2020, and recommended that the university authorities continued with the academic activities of the 2020-A term in a virtual format until the end date of the courses scheduled by the General Coordination of School Control. Maintain administrative activities to a minimum in all Technical Report no. 3. Issued on October 22, 2020, with the annual activity report of the UdeG-HSR, in which all the work carried out, the projects that derived from it and the communication and dissemination work of scientific and preventive information for the university community was reported .Weekly reports were carried out in which data were collected by selecting the population indicators for epidemic surveillance based on the most appropriate sources of information, through the constant updating of databases and from the information that came from the different agencies, such as the Ministry of Health  official technical communications. Subsequently, an analysis was carried out to support the management of the monitoring and evaluation of the scenario. Those reports were created based on the preparation of information sheets, in addition to carrying out the corresponding preparation of the presentations for each session. Those presentations included fundamental sections where the agenda of the day was presented.In addition, these activities were made: a series of TV, journals, and radio interviews were given by the members of the UdeG-HSR; a dissemination plan for the university community where active participation in the mass-media was carried out; on a preventive basis, information campaigns were designed and published by the Social Communication Office with prevention measures, official announcements, and news, for example, \u201ctake care of COVID-19\u201d and \u201cprotect yourself\u201d, among others. The General Provost handed nine reports and memos related to the work of the UdeG-HSR, 12 press conferences were organized by the UdeG Media office, 68 press releases highlighted by the UdeG press office, and about 200 \u201cCoronavirus, The Pandemic\u201d TV programs cast by channel 44 . The official communication website was created to publish all the information generated; in addition, Google Trends reported 873 direct searches with the word \u201cTest COVID UdeG\u201d, 384 direct searches with the word \u201cCOVID UdeG\u201d, 32,800 results associated Google with a \u201cUdeG Situation Room\u201d, and 125,000 results associated with the \u201cUdeG Situation Room\u201d, with 350 interviews in different media. All this activity occurred to sensitize the university community to maintain prevention measures and actions against the COVID-19 pandemic.campi and high schools on how to proceed to prevent the disease. This information, together with the Action Plan designed by this HSR, was implemented through the operative teams. These teams were called Operative Rooms or Auxiliary Commissions at the different centers of the University Network depending on their physical and community size.One of the actions that have had the highest response on our university community was advising the different During the execution of the Action Plan, a large number of direct and indirect results were obtained, some of the direct results are the abovementioned predictive models that estimate the magnitude of the epidemic in the state of Jalisco and the University Network, with monthly updates of the disease; the Geospatial Analysis of Jalisco and the central-western region of Mexico, through 24 presentations and 11 special reports published on the official website of the pandemic, focusing on the analysis of suspected and confirmed cases, and incidence and mortality rates at different levels of disaggregation; permanently monitoring the epidemiological panorama at international, national and state levels, and the preparation of a weekly synthesis and epidemiological report, was presented at every meeting of the HSA-e group. Another activity was the training of the University Network teams, based on the Operative Model of the University Network creating a MOOC-type course-workshop which allowed to face from the beginning any eventuality and handling of suspected cases at the university network, this activity could not be deployed without the collaboration of the Medical Unit of UdeG. The Integral Psychological Care for Well-being Clinic (CAPIB) was created offering online psychological counseling for students, free of charge, with 24/7 service; the Strategy for the Diffusion and Dissemination of Science program was created to develop the information campaigns aimed at the university's and state's community; also, the HSR-AG designed the University Epidemiological Surveillance Project, establishing the bases and guidelines for epidemiological surveillance at the return to personal classes at the university facilities; other research projects that are in process from the departments of Molecular Biology, Public Health, and Applied Psychology, these projects are detailed below.Indirect results obtained by the work of the UDG-HSR are the following: a Call-Center was established at the UdeG that, as a support for the Ministry of Health of the Government of Jalisco, which goal was to help the population to identify the risk of having the disease and, when appropriate, schedule them for the RT-PCR, antigen or antibody tests at the COVID-19 diagnostic laboratories; the COVID-19 Diagnostic Laboratories was organized in a Diagnostic System, which came into operation on April 16, 2020 and included 10 diagnostic laboratories at the University Network where they run the tests as a Drive-Thru service; this system also includes the Rapid Test Center for antigens and antibodies detection. Another indirect result is the participation at the Radar Jalisco strategy, coordinated by the Ministry of Health of Jalisco, where the laboratories of UdeG and the Civil Hospital of Guadalajara collaborated in the application of RT-PCR tests and reporting the results. Another important result is the online system that evaluates the risk of contagion, designed by a group of researchers at the Engineering Sciences Center, this system is offered on a website that is linked to the Ministries of Health  where individuals can evaluate the infection risk on recent days and make specific recommendations according to the result obtained. The project proposal \u201cAm I a COVID-19 case?\u201d with the collaboration of a group of physicians working at the Civil Hospital of Guadalajara that addresses the crisis or lack of information in the population about the symptoms and the procedures to follow in case of being virus carriers or having health complications.To estimate the magnitude of the pandemic, as described before, the HSR-AG developed several predictive models. The first model was presented on February 28, 2020, as a written report at the HSA-e group meeting, this model was based on epidemiological data from the John Hopkins University & Medicine, Coronavirus Resource Center , and theLater this year, the REPLICA model was created in collaboration with researchers from the University of California and the University of Georgia . The REPThese reports had a high influence in determining the academic activities at the university, advising to continue online classes, and keeping students and teachers at home, to avoid or reduce the risk of contagion. These reports served also as input to the Health Committee of Jalisco for the decisions and actions that took place at the state level. The main limitation of these models was the imprecision due to the different factors involved. However, they gave an overview of trends, which contributed to more informed decisions.Scientific progress during the health contingency was also essential to know the behavior and development of the pandemic. For this reason, some members of the HSR-AG along with other UdeG researchers developed a group of scientific projects that contributed to this aim, and their results have already been published or still in press. Some of these projects are:Vitamin D and COVID-19: A review on immunomodulatory effects of vitamin D in the prevention of severe COVID-19 ;Vitamin D Levels in COVID-19 Outpatients from Western Mexico: Clinical Correlation and Effect of Its Supplementation ;Association of Food Intake Quality with Vitamin D in SARS-CoV-2 Positive Patients from Mexico: A Cross-Sectional Study .Factors related to COVID-19: COVID-19 Screening by Anti-SARS-CoV-2 Antibody Seropositivity: Clinical and Epidemiological Characteristics, Comorbidities, and Food Intake Quality .COVID-19 diagnosis: RT-qPCR Assays for Rapid Detection of the N501Y, 69-70del, K417N, and E484K SARS-CoV-2 Mutations: A Screening Strategy to Identify Variants With Clinical Impact  creating an HSR based on the PAHO/WHO model to respond to health problems as other Latin American countries have done; (2) organize its members in two groups, the HSR-AG and the HSA-e groups; (3) the support to the institutional and state's governmental levels; and (4) effective communication of the results to the university network and the community of Jalisco.The PAHO/WHO model for HSRs defines a specific set of principles. According to the level of application, they can be national, state, county, or local type. In comparing the functioning and results of UdeG-HSR with other Latin American experiences we found that in Argentina, Brazil, Costa Rica, Venezuela, and Mexico, there have been similar efforts, following the same PAO/WHO model but sometimes with different objectives (not everyone attending COVID-19). In Argentina to start, the federal government installed a state-type HSR on each one of its departments, aimed to analyze the situations of departments and to generate actions according to each department's characteristics , but folA different experience took place in Brazil in 2010, when they promoted the use of data to offer dynamic diagnoses and improve the health of the population through a National-type HSR, thus making it possible to prepare plans that were compatible with the identified needs, to promote the improvement of the health care system which results allowed the application of new public health policies . In CostThe National-type HSR created in Venezuela in 2018 intended to have a better interpretation of the health and disease processes. All the administrative processes could be understood in a better way since the planning prior to the intervention at the cities and departments. Analyzing data in a more accurate way for the main causes of morbidity and mortality, health promotion, and approach to public policies to meet local, national, and regional indicators .Regarding the current pandemic, again in Argentina a COVID-19 National-type HSR was created, where an epidemiological analysis of the disease situation was carried out at the international, regional, and national levels . All theFinally, in Mexico, the response to the disease involved timely and immediate actions by various states of the Republic, operating manuals for the epidemiological and sanitary intelligence units were published by the Mexican Ministry of Health, where the implementation of Crisis Rooms and Intelligence Rooms constituting another epidemiological tool for decision-making in Public Health based on Evidence , howeverAs can be seen, these Latin American countries have implemented situation rooms at different levels, they all used the same PAHO/WHO model as the UdeG-HSR. The grounds and processes remain similar along with these countries, though some operating activities and implementation have been different. In the end, the results are very similar: a group of experts addressing a health situation based on quality data, adequate analysis, and a strong methodology and support from the authorities.The UdeG-HSR has worked under the situation room model generated by PAHO/WHO for more than 1 year. Though it followed the recommendations for its organization and operation, this HSR was organized into two groups: the HSR-AG and the HSA-e groups. This arrangement was considered to widen its scope at the university network because the first group was focused on the analysis of the evolution and impact of the pandemic, and the second was to recommend the strategies and operative activities at the institution.However, in light of the different contexts where HSR have been implemented in other Latin American countries , we idenThe University Network is ready to receive students and faculty, the return to the university has been delayed until October 15, 2021, however, the UdeG-HSR and the authorities have declared that the control of the epidemic lies in joint responsibility with the university community. A return-to-classes plan has already been prepared to keep everyone safe when the conditions are set properly in Jalisco and Mexico. At the beginning of 2021, the Provost of the Health Sciences Center authorized the continuity of the situation room for this year, with the agreement of the University's President. Both groups will continue working with minor changes and additions in their integrating members and their functions.Most of the reported projects are concluded, but there are some other research projects and publications in planning or development, they are focused on the epidemiologic, molecular biology, public health, and psychology characteristics of the disease. The internal activities will also continue and the two groups will maintain their collaboration with the state's Health Committee and with other Universities or Institutions, to support a positive Public Health impact on the population, containing or controlling the pandemic. The indirect results of the UdeG-HSR were mainly over the activities of the state, thanks to the openness of the ministry of health and the governor of Jalisco. It is clear that an institutional local-type HSR cannot limit its work for in-house benefit only; therefore, the results and impact will go beyond its boundaries and surely will affect the near society.In sum, the creation of the local-type UdeG-HSR had a positive impact as it provided data-based decisions and communication resources to issue the necessary recommendations and strategies as a response to the COVID-19 pandemic, whose main focus was monitoring and responding to a health problem with public health measures, identifying the risk factors and predicting its spread rhythm and time.One of the most evident impacts of the UdeG-HSR is the incidence and mortality rates at the state of Jalisco, reported among the lowest in the country by the time this article was written. For instance, in January 2021, the federal government reported that there were 53,810 confirmed cases and 6,254 deaths in Jalisco due to COVID-19, the fifth-highest (out of 32) in Mexico in both indicators . In spitThis study shows the actions taken by the UdeG-HSR in face of the COVID-19 pandemic. The conclusions are:This HSR was created as a local-type room, therefore, its scope was limited to the institution's boundaries. However, due to the relationship with the state government, its actions and recommendations went beyond it.The timely installation and work of the UdeG-HSR helped the state of Jalisco to maintain one of the lowest incidence and mortality rates in the country, in part because the institution maintained virtual activities since last year avoiding the mobilization of more than 310,000 students, faculty, and administrative personnel.There were direct and indirect products of the situation room, one of the most important was the mathematic models to analyze the pandemic evolution, which has evolved.Communicating campaigns and programs were effective to target the university community; the response was immediate and kept everyone at home.The evaluation of impact and effectiveness has not been done, yet it has been scheduled for late 2021. This evaluation requires a validated methodology and analysis criteria that are at a preparation phase, as mandated at the Action and Execution plan.The original contributions presented in the study are included in the article/supplementary materials, further inquiries can be directed to the corresponding author/s.JM and GM contributed to the conception of the UdeG-HSR. JM, GM, IR, DR, and AL contributed to establishing its fundament. JM is the general coordinator of the UdeG-HSR, represents it in the health group of the State Government, and has managed its relationship with different sectors. GM is the executive coordinator of the ISS analysis group and has represented it in the state government health group. IR was the technical coordinator for the expanded UdeG-HSR group. IR, DR, and AL wrote the first draft of the manuscript. All the authors contributed to critically reviewing it for important intellectual content and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The handling editor declared a past collaboration with one of the authors IR.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "Leprosy is one of the neglected diseases in the world and Brazil is the second country with more cases. A retrospective study was conducted based on the medical records of 196 leprosy patients diagnosed during the course of 13 years at a university hospital. The aim was to describe the adverse effects of polychemotherapy, as well the most prevalent and most vulnerable populations. In the study, dapsone was the most implicated drug, especially in women, and the risk increased with age. The authors conclude that with this patient profile, greater vigilance should be taken regarding possible adverse effects, especially anemia. The multidrug therapy (MDT) recommended by the World Health Organization (WHO) has dramatically changed the natural history of leprosy. It reduced the prevalence and development of antimicrobial resistance.In a retrospective study from 2002 to 2014, 371 leprosy patients were evaluated and the socio-demographic profile and adverse effects (AE) of the standard MDT were evaluated. Paucibacillary (PB) and multibacillary (MB) patients who underwent less than four and nine supervised doses, respectively, were excluded; 196 patients remained.Of the 196 patients, 97 were males and 99 females; 41.32% were treated with MDT-PB, 53.05% with MDT-MB, and 5.61% with an alternative regimen . A totalMost AEs occurred in the first few supervised doses, 33.92% in the first and 76.78% until the fourth . DDS wasIn the cohort of 196 individuals studied, most MB treatments were in male patients. Nobre et al. reported twice as much MB cases in men .DDS was responsible for the largest number of AE cases, mainly in the first trimester. Anemia was the most frequent, mainly in women. The risk of AE increases with each year of age. These findings reinforce the need for greater vigilance at the beginning of treatment, in women, and in older patients.None declared.Violeta Duarte Tortelly: Approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; effective participation in research orientation; intellectual participation in propaedeutic and/or therapeutic conduct of studied cases; critical review of the literature; critical review of the manuscript.Egon Luiz Daxbacher: Approval of the final version of the manuscript; design and planning of the study; effective participation in research orientation; critical review of the literature.Arles Martins Brotas: Approval of the final version of the manuscript; critical review of the literature; critical review of the manuscript.Sueli Carneiro: Approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; critical review of the manuscript.None declared."}
{"text": "In recent years, improvements in imaging techniques have profoundly changed the diagnosis of pathologies of the maxillofacial district. Three-dimensional radiographic diagnostic exams, with a lower dose of ionizing radiation and the same, or a higher, resolution, are frequently applied to dentistry and the maxillofacial district for the diagnosis and treatment of pathologies and conditions that, until a few years ago, required several radiographic examinations ,2,3,4. Cone Beam computed tomography (CBCT) represents the most widespread and most-used 3D exam in dentistry. This diffusion is allowed because the equipment is the least voluminous, allows extremely reduced, high-quality acquisition times compared to other tests, and has a lower cost than other diagnostics equipment, such as Magnetic Resonance Imaging (MRI) ,5,6.The ability to modify the FoV while maintaining a very high image quality and the functionality of various image management and re-processing software allow for its use in dentistry, ranging from use in the smallest FoVs for a few dental elements in endodontics to larger FoVs, for example, in orthodontics ,7. In enMoreover, this also allows for the study of the temporomandibular joint in gnathology, offering most of the indications that are useful to the clinician when completing the treatment plan, assisted by MRI . TherefoThe main and most relevant dilemma in the use of this technique is represented by the presence of ionizing radiation, the importance of which is often underestimated in the prescription of this kind of diagnostic exam . In thisConsidering the ultrasounds and their physical characteristics, their application in dentistry, considering the superficiality of the structures to be studied, is extremely valid. Vascular lesions of the tissues of the oral cavity, of the oral tissues themselves, or of the more superficial bone and alterations, with the appropriate probes, seem to be simple to apply, free of ionizing radiation, minimally invasive, and easily available in the office for constant use during daily clinical practice ,15.Recent evidence makes it possible to consider MRI as a complete dental diagnostic examination, which allows for both an investigation of the anatomy of the soft tissues at certain frequencies and the volumes and bone density . FurtherUnlike resonance, ultrasound allows for a more specific evaluation of a superficial mucous or bone site, but allows for the possibility of modifying the parameters to increase the definition of the collected images or the depth of the vision. With specific parameters, this examination also allows for the evaluation of dental hard tissues, which has not been explored with this method to date. It is non-invasive, does not cause biological damage, and avoids the use of intraoral periapical or bite-wing radiographs ,15. Further in-depth studies and in vitro studies will be required to ascertain the effectiveness and innovation brought about by the application of these techniques for a use that is not practiced today, and, subsequently, the instruments for oral use will have to be implemented, especially the probes for diagnostic examinations with ultrasound.The margins of success are wide, guided by the non-invasiveness of these procedures and the absence of biological damage caused by ionizing radiation."}
{"text": "Artificial intelligence has been applied in all aspects of cultural industry, and has affected the micro, meso, and macro level of cultural industry, accelerated the transformation of cultural industry, and changed the structural system of cultural development. Based on artificial intelligence technology, this paper studies 52 years of coastal rainfall and analyzes the characteristics of rainfall pattern by observing the latest meteorological observation data in southern China from 1969 to 2020. Based on the analysis of rain patterns in South China, it is found that only 8% of the annual precipitation in a southern region of China has a significant increasing trend. The monthly trend showed the most obvious downward and upward trend in April and November. Finally, by analyzing the results of artificial intelligence research, we can create a model of global cultural communication system based on artificial intelligence application. The logic model combines the elements of power, system, service and research framework knowledge, and puts forward the idea of system optimization based on artificial intelligence application to solve subsystem problems; For the service subsystem, artificial intelligence should be used to strengthen the supply and demand of services; For knowledge subsystem, artificial intelligence is needed to improve education and training skills, including knowledge service skills and knowledge management skills. The global cultural communication system must use artificial intelligence to improve the synergy of subsystems. Through the analysis of coastal rainfall pattern and the study of global cultural communication based on artificial intelligence, this paper applies it to cultural communication and promotes the development of global cultural communication. As an important part of weather and hydrological cycle, rainfall has changed in recent years due to the impact of global climate change. The spatial and temporal distribution of rainfall restricts the social and economic development of the region to a certain extent, and plays an important role in preventing regional floods, resisting drought, and effectively using water resources , and specific elements of meteorological humidity are used. The data covers the period from January 1969 to December 2020, with a spatial resolution of 2.5 \u00b0 \u00d7 2.5 \u00b0, East longitude 0 \u00b0 to 357.5 \u00b0, 90 n \u00b0 to 90 s \u00b0, Use 144 \u00d7 73 grid division of the world. The monthly mean data set of meteorological elements includes four dimensions: longitude, latitude, isobaric surface (from 1000 HPA near the ground to 300 HPA above sea level), and monthly dimension.Mann Kendall trend test method is widely used to determine whether meteorological data and hydrological data change significantly with time. sgn(xj-xi): In the randomized controlled study, if the sample data does not conform to the trend, then t follows the normal distribution, and the corresponding mean value is 0. The difference is calculated as follows: To calculate the statistical value of ZMK test according to the normal distribution, refer to the following contents: The value of P can be understood as the probability of a low probability event, and its value is calculated as follows: Nowadays, the precipitation models commonly used in design at home and abroad includes Chicago precipitation model and P.C. precipitation model. Because the Chicago precipitation model is based on the rainstorm formula, it is easy to determine the precipitation intensity at different times under different return time periods and maximum aspect ratio, so as to obtain the precipitation process designed for different periods, and obtain the corresponding precipitation model effect, which is more reflective  and different saturation states (unsaturated and saturated). The operation process of the precipitation model is shown in Fig. For lid measurement, three different initial saturation states are established: unsaturated, semi saturated, and fully saturated. According to different initial saturation conditions, different return time and rainy season are simulated. Under the condition of precipitation, lid measurement results compare the operation of different precipitation models with the same return value (During rainfall, the peak value of rainfall will come soon, and the rainwater from lid measures has no time to penetrate and absorb. Therefore, lid measures have adverse effects on runoff regulation of primary precipitation in semi saturated and fully saturated states.With the gradual closure of the summer water vapor channel, the summer water vapor in the southwest and south of the South China Sea gradually decreases, while the dry cold water vapor flows out from the northeast and gradually increases, resulting in the gradual weakening of autumn rainfall. Secondly, a typhoon circulation was found in the South China Sea in September. The westward flow from the Indian Ocean flows eastward through the bay of Bengal and produces a large amount of water vapor accumulation in the southern coastal area of H Province in China Fig. . This haIn order to analyze the causes, the monthly water vapor budget of each pressure layer in southern China is calculated see Fig. . It can The establishment of cultural industry can be divided into three categories: first, the establishment of cultural content and its carrier. The cultural content mainly includes words, images, audio, video, modeling, and comprehensive types. The carrier mainly consists of publications, raw materials, equipment, and facilities. The second is to provide cultural services, such as art performance, cultural creation, entertainment and cultural places, cultural fairs, cultural intermediaries, and vocational training; The third is the composition of the product, that is, the mixture of the first and second articles. In the production process of cultural industry, artificial intelligence can be competent in creating database and selecting theme, creating auxiliary or independent theme, modifying content, checking and correcting, changing operator, etc. The cultural creation of artificial intelligence has attracted the attention of the society (Ayoob and Gupta AI link applications have the following differences: first, the Internet, Internet of things, and traditional media are migrated to the network structure of intelligent media, and intelligent management is used to reduce the lack of information, poor performance, and more connections between media, as well as idle and waste resources, sharing management, sharing services, etc. The transportation cost is reduced and the transportation speed is improved. Secondly, through intelligent social interaction, entertainment, communication can become lively and interesting, can take a variety of forms and can be accepted.As the link to realize the value of cultural industry, consumption is the value of selling, trading, receiving, using experience, and feedback. The articles used are products with cultural connotation, cultural service products, and components. The AI application in this link will at least include the following contents: first, use AI technology to quickly and accurately analyze the needs of consumers, and then actively provide them with services such as content distribution, product recommendation, personal customization, and supply to meet their needs. Secondly, create a new, interesting, exciting, and practical smart grid application, such as photo editing, beauty, dubbing, karaoke, and so on, to attract many users to experiment and use (Azizullah et al. Chinese culture not only follows a single concept of communication. In order to achieve long-term development, we must adhere to the concept of communication diversity and integration, and create an environment conducive to the external communication of Chinese culture in the 21st century.Marxist ideology is not only the advanced theory guiding people to develop social life, but also the theoretical basis for people to develop culture. The main factor of Chinese culture communication is the opening of Chinese culture to the outside world. Marxist cultural thought is not only the basis of foreign cultural communication thought, but also includes doctrinal thought, in order to further strengthen the comprehensive development of culture, spread good Chinese culture and promote cooperation and cultural exchange. Marx said: \u201cthe globalization of production and communication will inevitably lead to the globalization of culture, which is the inevitable result.\u201d Marxist cultural vision has always stressed the need to maintain tolerance and develop cultural virtues, and that the world is culturally diverse, only mutual learning and improvement can maintain the exchange of world civilization (Borysewicz-Lewicka and Opydo-Szymaczek The dissemination of Chinese culture is an inevitable choice to adapt to the trend of globalization. The trend of globalization is promoting the interaction and exchange between countries and regions. Consistent with the analysis of globalization theory, globalization in modern civilization is an inevitable process of history. In a specific sense, economic globalization continues to promote the development of cultural globalization, and different countries have established their own values and world outlook in continuous exchanges (Chen et al. In the context of modern culture, the spread of Chinese culture in the outside world has been inseparable from the spirit of the Chinese nation. With the smooth progress of reform and opening up and the continuous improvement of social process, the spirit of China\u2019s times is of more and more importance, and more and more patriots are willing to add a part of their power. In the socialist modernization construction of the country, we should actively promote the socialist culture with the spirit of the times, and show the positive role of the spirit of the times in the process of cultural transmission.The spirit of the Chinese nation can promote cultural exchanges Choubisa . For exaThe national spirit of different periods also reflects the new development of Chinese culture in different periods, such as \u201cfour comprehensive\u201d and \u201cBeidou spirit in the new era\u201d (Currell et al. At the beginning of the new century, China has carried out cultural cooperation and cultural exchanges with other countries in different ways, so that the people of many countries can feel the profound cultural heritage of China. As for the existing communication effect, there are still some areas to be improved in the process of external cultural communication. Looking for new methods of cultural communication can help to improve the current situation of cultural communication (Daiwile et al. Only when we have a comprehensive understanding of Chinese culture, can we pay attention to the characteristics of Chinese culture in foreign exchanges and improve the communication ability of excellent culture. We should give full play to the advantages of different cultural communication themes, constantly study the uniqueness of Chinese culture, and establish different cultural communication channels. China\u2019s cultural departments and official media organizations give full play to various cultural and diplomatic functions, actively carry out cultural exchanges on a regular basis, emphasize the spirit of the Silk Road, and shape a good national image (Ding et al. In the process of spreading Chinese culture to foreign countries, we can also deepen cultural communication through academic exchanges, tourism projects, exhibitions of Chinese culture and history, and cooperation with Chinese and foreign education (Fallahzadeh et al. The trend of globalization promotes multidimensional cooperation and participation in the process of mutual exchanges between countries, which is also the key condition for people to carry out cultural exchanges. There are differences in history, culture, economy, and national interests between countries, which also means that \u201cusers\u201d have many differences, and their information needs, information choices, psychological acceptance, and use effects are also different (Ganyaglo et al. There are obvious differences in language communication, cultural customs and economic conditions among countries, which hinder the establishment of \u201cfive links\u201d. Language exchange is not only the most important factor in cultural exchange, but also an important bridge for international cultural exchange and an effective way to communicate with other countries (Khaliq et al. With the development of globalization, many countries also have a strong interest in Chinese culture. Every country has its own works, language and customs, so Chinese teachers, scholars, and translators have become the mainstay of China\u2019s external cultural communication. Nowadays, China mainly relies on the Confucius Institute as the main body of communication to strengthen the cooperation and exchange between countries and regions, so as to meet the needs of the world for Chinese culture. China should actively promote the construction of Chinese teachers, improve the Chinese learning system, so that people all over the world can better understand the richness and depth of Chinese culture in the process of learning Chinese.S city is located somewhere in the south of China. It is also the most populous city in the south of China. As an important city in China\u2019s modernization and high-tech development, s city is vulnerable to bad weather, such as strong winds, short-term rainstorms, and storms. In recent years, due to the continuous increase of weather disasters, huge economic losses, and personnel losses have been caused in s city. Therefore, it is very important to study the spatial and temporal characteristics of rainfall distribution in South China, which plays a key role in supporting and maintaining the local flood control and drought relief policies. This study uses the latest meteorological observation data of 63 weather stations in South China from 1969 to 2020 to study the climate characteristics at the temporal and spatial level. Finally, this paper aims to study the issues related to global cultural communication. The research on world cultural communication will not only focus on new technology, but also on the connection of many disciplines and methods, and will focus on general research. In order to further improve the development of global cultural communication theory, we can find better communication channels from the perspective of discipline integration."}
{"text": "Tamarindus indica L. in the drylands of southeastern Ethiopia; although the majority of farmland trees produced <5000 fruit year\u22121, the selection of Tamarind germplasm in its natural ranges could improve production [The Special Issue \u201cEnvironmental, Ecological and Food Resources in the Biodiversity Overview: Health Benefits\u201d wants to underline the importance of classification, cataloguing and analysis of environmental, agricultural, ecological, botanical and food sources\u2014from native species to unconventional sources and wastes\u2014which should be promoted from the perspectives of biodiversity and sustainability . In thisoduction . Anotheroduction  that shoStudies on the impact of biodiverse environments in food production and nutrition should be promoted, especially in terms of the exploitation and promotion of wild and native foods from the perspective of responsible human consumption and health outcomes.Management, modelling and the sharing of environment and biodiversity information and data are encouraged. Addressing to the promotion of diversities, to building synergies throughout food, agriculture, sustainability, nutrition and health systems and sharing of knowledge represent a future integrate and multidisciplinary direction, in the perspective of one health outcomes ,4.The production of food composition data for nutrients and biologically active compounds, as well as the definition of new biomarkers and indicators, represent key determinants in understanding the linkage and crosslinks between food, environment, nutrition and health ,6,7,8,9.The Special issue explored the developments, management, applications and utilizations of agricultural, ecological, botanical, food and environmental interoperable, multidisciplinary and multi-purpose resources, repositories and infrastructures from environmental to nutritional- and health- related fields. Current research trends are towards integrated web-based models, e-services and e-platforms in the perspective of data sharing and digital era."}
{"text": "The winking earlobe sign is a sign of tricuspid regurgitation, characterized by the movement of the earlobe coincident with the pulse. The winking earlobe sign is a sign of tricuspid regurgitation, characterized by the movement of the earlobe coincident with the pulse. A physical examination showed Frank's sign, a diagonal crease in the earlobe, and remarkable systolic pulsations of the earlobe (winking earlobe sign) and the neck with jugular vein distension Video . MoreoveThe winking earlobe sign is a sign of TR, characterized by the movement of the earlobe coincident with the pulse.None declared.RO contributed to patient management, conception, and design of case report; acquisition, analysis and interpretation of data, and drafting the article. TI, KA, and HK contributed to patient management, conception, and design of case report. YK contributed to interpretation of data and revised the article critically. All authors gave final approval of the article and have agreed to be accountable for all aspects of the work.Written informed consent was obtained from the patient.Written patient consent has been signed and collected.Supplementary MaterialClick here for additional data file.Supplementary MaterialClick here for additional data file."}
{"text": "Dear Editor,As onychocryptosis is a frequent demand in dermatological assistance, and its surgical management requires both specific training and indication criteria, we read with interest the article by Ma,Currently, there is no consensus, nor a body of evidence on the specific differences of the several surgical techniques for onychocryptosis, or on their comparison in terms of effectiveness, morbidity, infection, cost-effectiveness and technical difficulty. Therefore, the development of new methods is of scientific relevance and should be critically appreciated considering the described surgeries, especially regarding the technical differences and recurrence rates after 12 months.Despite the interesting results presented by Dr. Ma, the proposed surgical technique sequence is very similar to the classic matricectomy described by Winograd (1929),Surgical techniques for the treatment of onychocryptosis require careful systematization of the operative sequences and approach to the matrix, as well as the precise indication according to tissue hyperplasia, nail plate situation and pyogenic granuloma. Only the comparative analysis of the performance of the techniques, stratified according to the indications, can lead to criticism, aiming to maximize the performance of the procedures.Due to the peculiar anatomy of the nail apparatus, surgical approaches to onychosis require specialized training by the dermatologist. However, despite the high prevalence of onychocryptosis and impact on quality of life, there is a lack of well-conducted comparative clinical trials that favor the personalization of indications. Moreover, it is crucial to review the previously described surgical techniques, both for their historical and scientific value, when one proposes the standardization of a new surgical technique.None declared.Anna Carolina Miola: Approval of the final version of the manuscript; drafting and editing of the manuscript; critical review of the literature; critical review of the manuscript.Giovana Piteri Alcantara: Drafting and editing of the manuscript; critical review of the manuscript.Luciane Donida Bartoli Miot: Drafting and editing of the manuscript; critical review of the manuscript.H\u00e9lio Amante Miot: Approval of the final version of the manuscript; drafting and editing of the manuscript; critical review of the literature; critical review of the manuscript.None declared."}
{"text": "East African Health Research Journal (EAHRJ), a new no-fee, open-access, peer-reviewed journal that focuses on research conducted in and relevant to East Africa. Established by the East African Health Research Commission (EAHRC) of the East African Community , the primary aim of the journal is to present evidence that can be the basis for better health policy and practice in the countries of the EAC. The journal also aims to:represent the East African perspective on health and health related-issues,provide information that is relevant to the EAC,be a platform for sharing and dissemination of knowledge,enable scholarly recognition of professionals and institutions,support professionals\u2019 career development,provide forum for health professionals from East Africa to be more visible globally, andprovide direction in setting up health priorities in the region.We are pleased to present The EAHRJ will promote and facilitate the application of knowledge from research to strengthen national and regional health policy and practice; development of human-resource capacities and skills; exchange and dissemination of health-research information; and advocacy of evidence generated from health research.The Issues of the journal will include original articles, reviews, short communications, surveys, commentaries, opinions, book reviews, essays, special and supplementary issues, and reports, and cover a broad range of health and related aspects, including medicine, geo-medicine, dentistry, nursing, pharmacology, toxicology, pharmaceutical science, veterinary science, food science, environment, health-related agriculture science, and public health.EAHRJ will be published three times a year online, at www.eahealth.org, and in hard copy. Hard copies will be distributed to all relevant stakeholders, such as government institutions and organisations, research institutions, academic institutions, relevant NGOs, civil society organisations, etc.The We are publishing the first issue of the journal in conjunction with the 6th East African Health and Scientific Conference (EAHSC) taking place in Bujumbura, The Republic of Burundi, 29\u201331 March 2017. The theme of the conference is Preparedness for, and control of disease outbreaks, epidemics, and pandemics in the context of climate change, globalisation, and gaps in health systems. We have aligned the articles published in the first issue of the EAHRJ with the theme of the conference.We expect that this journal will add value to the various initiatives taken to improve health and wellbeing of the people of East Africa and the world in general."}
{"text": "Worldwide, the management of health emergencies requires a high degree of preparedness and resilience on the part of governments and health systems. Indeed, disasters are becoming increasingly common, with significant health, social, and economic impacts. Living in a globalized world also means that emergencies that occur in one country often have an international, in some cases global, spread: the COVID-19 pandemic is a cogent example. The key elements in emergency management are central governance, coordination, investment of resources before the emergency occurs, and preparedness to deal with it at all levels. However, several factors might condition the response to the emergency, highlighting, as for Italy, strengths and weaknesses. In this context, policies and regulation of actions to be implemented at international and national level must be up-to-date, clear, transparent and, above all, feasible and implementable. Likewise, the allocation of resources to develop adequate preparedness plans is critical. Due to COVID-19 pandemic, the European Commission proposed the temporary recovery instrument NextGenerationEU, as well as a targeted reinforcement of the European Union\u2019s long-term budget for the period 2021\u20132027. The pandemic highlighted that it is necessary to interrupt the continuous defunding of the health sector, allocating funds especially in prevention, training and information activities: indeed, a greater and more aware public attention on health risks and on the impacts of emergencies can help to promote virtuous changes, sharing contents and information that act as a guide for the population. The management of disasters and emergencies is a core function of Public Health. Indeed, natural or humanmade extraordinary events might constitute a public health risk that require a timely, coordinated, and efficient response from governments and healthcare systems. Disasters can be natural  or technological  , and theOf note, an important issue for Public Health at the international level is represented by microbiological emergencies, which are becoming increasingly frequent. Indeed, the World Health Organization (WHO) monitored worldwide 1483 epidemics in 172 Countries between 2011 and 2018 ,8,9, ecoIn this commentary, we present an overview of the policies, regulatory frameworks and legislation on health emergency management at global and European level. Then we focus on the Italian COVID-19 pandemic as an example of management of health emergencies. Finally, this paper concludes by proposing some directives about the management of future emergencies. The attempt to manage and coordinate the response to health emergencies at international level began in 19th century. The first International Health Conference, in fact, was organized in 1851 after the European cholera epidemy (1830\u20131847) . Then, tIn Europe, the first emergency regulation was approved in 1998 and Council Decision n. 2001/792 established the European Civil Protection, (reformed in 2013) to strengthen and coordinate disaster prevention, preparedness, and response . Then, tDuring the COVID-19 pandemic, the European Commission adopted Communication COM(2020)724 to strengthen European Union (EU)\u2019s resilience and coordination to cross-border health threats . This CoOn 2 May 2018, the European Commission presented its proposal for the next long-term EU budget and on 27 May 2020, due to COVID-19, it proposed the temporary recovery instrument NextGenerationEU (NGEU)  and the The Italian Constitution does not contain specific rules on the state of emergency. However, based on article 77, the Government can adopt decrees in the cases of extraordinary necessity and urgency, concerning the concrete management of emergencies; also, article 120 allows the Government to replace local authorities in events of danger to public safety and security. Moreover, Article 117(3) states that the state must establish health principles. Law 8 December 1970, No. 996, was the first identifying ordinary  and extraordinary (Extraordinary Commissioner) Civil Protection\u2019s bodies as well as their competences . In the Indeed, in case of emergency, a bottom-up pyramidal response mechanism is activated, starting from the level closest to citizens. Therefore, the mayor  directs and coordinates relief operations, assisting the population and organizing municipal resources . He/she Nationally, the Council of Ministers\u2019 President coordinates measures with Civil Protection Department, appoints delegated Commissioners and specific task forces, and issues emergency ordinances to avoid dangerous or damaging situations. The Council of Ministers, based on President\u2019s proposal, decrees the state of emergency indicating its territorial extension and duration  . Finally, Agencies in support of the Ministry of Health carry out technical-scientific consulting activities , drug regulatory activities , and health performance monitoring and control .The Italian Recovery and Resilience Plan was approved on 22 June 2021 by the European Commission . It respTo fight the pandemic, Italy also approved several decree laws for urgent measures that have provided for a significant increase finance in the standard national health requirement  . Cura ItItaly was the first western country affected by the COVID-19, representing the frontline against the pandemic, with a mortality rate among the highest in Europe, especially during the first wave . In thisHowever, several factors have made it difficult to implement a rapid and coordinated response. In particular, Italy has 20 different regional health care systems , and decFurthermore, Italy show several limits in capacity planning of the hospitals. In particular, the enormous pressure generated on the healthcare system during the first and the subsequent waves caused by variants (such as omicron) highlighted the need to develop models for hospital surge capacity planning ,50,51. IFinally, the constant defunding of the National Health Service in Italy in recent decades, which has led to a shortage of healthcare workers, insufficient structures and technology and the absence of integrated management, explains, at least partly, the difficulties in the management of the first wave of the pandemic ,44.The COVID-19 pandemic must represent a moment of awareness and reflection in order to improve governance processes and the ability to respond and react to disaster events. The COVID-19 emergency has confirmed that it is necessary to work more on the analysis of local contexts in order to design targeted interventions at regional and national level, improving the interaction and coordination between different settings. Planning and, therefore proper organization, represent the key to adapt and direct decision-making processes. The pandemic has highlighted how the current governance, often still anchored to laws, regulations and bureaucratic systems or apparatuses belonging to historical periods and contexts completely different from the current or future ones, is only partially able to provide a timely and coordinated response. Moreover, system resilience is a key issue in managing healthcare emergencies. In fact, the adaptive capacity of hospitals and in general of all healthcare facilities is essential to ensure rapid adaptation to an emergency. The pandemic has led to the development of predictive models and methodologies for risk assessment and quantification on which response measures to the spread and containment of the virus are developed. These models should be implemented and made feasible, not only in organizational and managerial terms but also in relation to structural, environmental, plant, engineering and technological aspects that can also be adapted to the context of other health emergencies, to ensure the presence of a resilient system capable of providing a quick, specific and personalized response as much as possible, with a major impact in terms of lives saved and reduction of social and economic damage. To make these models feasible, however, coordination and collaboration between the structures are necessary, both at a territorial and regional level, and mainly, at a national and central level, to overcome the regulatory conflicts, technical and legislative regulations that still exist and are not sufficiently corrected and updated on the basis of the current pandemic experience .In this context, the new European agency HERA represents an important step forward, although it is limited to the European Union and it still insufficient to ensure a timely, transparent, and coordinated response. It is necessary, in fact, to provide an agency not only with prerogatives of direction and control, but also with effective powers of intervention that are, when necessary, substitutive of national failures in emergency management. A control room, therefore, of rapid health intervention and civil protection, with its own budget and operational decision-making, free from the veto of a single state, which can act quickly, with consistent and coordinated measures, with the ability to collect homogeneous data, with professionally trained and constantly updated staff, with a production capacity\u2014its own or supply\u2014of tested machinery and protective devices, vaccines, and specific drugs. Thus, not only during an emergency, but also in ordinary times, it is desirable to lean on a Preparedness European Agency to share of resources and data, with harmonization of public health and social measures for response. Such a network would assure and promote accountability by synthesizing, reviewing and assessing operative information and knowledge, and for critically evaluating the effects of public health decisions. Basically, also to try to overcome the gap, which currently exists, between the time when there is awareness of a critical emergency event and the unharmonized decisions to effectively prevent, halt, or delay the consequences of this event. Considering the Italian situation, despite the health regionalism, it is necessary to identify an adequate \u201cchain of command\u201d, able to exercise a leadership role to coordinate and integrate the skills of all institutions and actors involved, on whose collaboration lies the readiness to respond and the resilience of an integrated system. Finally, the pandemic has highlighted the need to interrupt the continuous defunding of the health sector, allocating funds especially in prevention, training and information activities: indeed, a greater and more aware public attention toward health risks and on the impacts of emergencies can help to promote virtuous changes, to share contents and information that act as a guide for the population."}
{"text": "Undoubtedly, the COVID-19 pandemic is not the first and most frightening global pandemic, and it may not be the last. At the very least, this phenomenon has though seriously challenged the health systems of the world; it has created a new perspective on the value of national, regional, and international cooperation during crises. The post-coronavirus world could be a world of intensified nationalist rivalries on the economic revival and political influence. However, strengthening cooperation among nations at different levels will lead to the growth of health, economy, and security. The current situation is a touchstone for international actors in coordinating the efforts in similar future crises. At present, this pandemic crisis cannot be resolved except through joint international cooperation, global cohesion, and multilateralism. This perspective concludes that the pandemic could be an excellent opportunity for the scope of global health diplomacy (GHD) and how it can be applied and practiced for strengthening five global arenas, namely (1) International Cooperation and Global Solidarity, (2) Global Economy, Trade and Development, (3) Global Health Security, (4) Strengthening health systems, and (5) Addressing inequities to achieve the global health targets. GHD proves to be very useful for negotiating better policies, stronger partnerships, and achieving international cooperation in this phase with many geopolitical shifts and nationalist mindset among many nations at this stage of COVID-19 vaccine roll-out. The first case of COVID-19 reported in Wuhan, China, in December 2019, was declared as an international public health concern and a global pandemic by the World Health Organization (WHO) on March 11, 2020 . TherefoAccording to the WHO, GHD connects public health, law, international affairs, management, and economics, concentrating on negotiations and shaping the global policy climate for health. The central tenet of GHD is for countries to work together in international fora to address public health issues . AccordiHence, GHD is very critical and successful in addressing many of the global challenges as we have witnessed in the formulation of International Health Regulations (IHRs 2005), Framework Convention of Tobacco Control (FCTC), Universal Health Care (UHC) , SustainThis paper has highlighted the five main areas  where GHHealth is now a part of global food, environment, oil, and water agreements, and it is addressed at major global and regional summits, including the G7 and G20 summits. Every SDG that has been negotiated has shown that health is an important component and outcome. Therefore, this explains why GHD plays a central role in every subsequent round of SDG-related negotiations. Given this background, the global health agenda is now viewed as a common challenge for developing and developed nations . COVID-1In the case of previous epidemics of HIV, SARS, H1N1, MERS, Zika, and Ebola, they have mostly affected specific regions/nations or the global south more than the north, and therefore the support came in from the rich nations in Western Europe and North America. However, in the current COVID-19 pandemic, the rich nations have been affected more, with more cases and deaths resulting in global competition, lack of solidarity, and nationalist movements in addressing the domestic economic and health crises .In the United States' federalist system of public health governance, COVID-19, which is highly transmissible, crosses the borders efficiently, and impacts the economy and infrastructure, have exposed many weaknesses. Besides, the federal response was alarmingly slow to evolve, causing uncertainty about the existence of the virus and the measures taken to tackle it . DespiteIn China, following the outbreak of COVID-19 in Hubei province, China, the government imposed a lockdown on its cities. Still, the international air travel through flights was not canceled, which resulted in people traveling from outside to China and vice versa. Though China was initially seen primarily as the source of the virus, it has started to provide material and equipment such as masks, PPE to its neighbors, the Middle East, and Europe . These aWith 15.58 million confirmed cases and 434,715 deaths as of May 17, 2021 , and theThe impact of the COVID-19 pandemic, the withdrawal of the funding to the WHO by the US President, has resulted in an unprecedented situation. This, in turn, has affected the health of people living in the Americas as the Pan American Health Organization (PAHO) being a beneficiary  and the The rapid spread of the current epidemic taught us that the international environment could not be managed as an island. International solidarity and convergence and the abandonment of political games could be part of a related approach to confront neo-isolationism. However, isolationism (as long as not coupled with xenophobia) can also have benign effects from a health security perspective regarding the movement for disease vectors. Therefore, the more the global economy is affected, the greater political priority is paid to health and health diplomacy .Perhaps political leaders apply GHD as a soft tool; instead of taking impulsive actions, the fear of the global community of the spread of coronavirus could have been curbed . The decIn many recent cases, countries' officials initially denied, downplayed its severity, and even adopted a blame game strategy. The latter was represented by some leaders pointing the finger of blame at other countries for the spread of the disease and trying to bypass and downgrade the role of the WHO as the central coordinator in controlling the epidemic. The non-compliance of some countries with international health regulations (IHRs) and poor international and regional cooperation has been documented . MoreoveThe Trade-Related Aspects of Intellectual Property Rights (TRIPS Agreement) and Public Health as part of the Doha Declaration has stated key flexibilities to countries in Article 31. Furthermore, clause 5(c) of the TRIPS Agreement stated that \u201cpublic health crises, including those relating to HIV/AIDS, tuberculosis, malaria and other epidemics,\u201d can constitute \u201ca national emergency or other circumstances of extreme urgency.\u201d The clause provides countries with some flexibility in managing the patents for pharmaceuticals (public goods), especially in situations of \u201cnational emergencies\u201d and \u201cother circumstances of extreme urgency\u201d \u201335. HoweThe Global Health Security Initiative (GHSI) is an international partnership to strengthen health preparedness and response globally to biological, chemical, radio-nuclear, and pandemic influenza threats. They were launched in November 2001 by Canada, the European Commission, France, Germany, Italy, Japan, Mexico, the United Kingdom, and the United States of America. WHO provides technical support to the initiative, which is again a result of successful GHD . The gloThe health diplomacy landscape is essential if and when the multifaceted and devastating consequences of this hidden enemy subside . It is eHealth has become an issue of national security/global concern, and GHD aids in developing new bilateral or multilateral agreements to safeguard the health and well-being of people. As a result, many countries have implemented the IHRs, imposed travel restrictions, and implemented public health regulations. Some countries that enacted them in the early days of the pandemic are Canada , India , and theOnce again, the pandemic has proved that health should be placed at the center of the international agenda and considered the primary concern of countries' foreign policy strategies . The keyIn recent years, health has been something more than just a \u201cpurely humanitarian\u201d effort based on national interests in helping to achieve other functions of foreign policy . We shouWhat COVID-19 pandemic has interestingly and ironically exposed to the world is such that many European and North American countries\u2014arguably some of the best health systems of the world\u2014are crumbling and struggling to contain the widespread infections; while some of the developing countries' health systems, as well as smaller health systems in Asia , are doing much better, evidenced by the lower number of infections and lower fatality rates in these health systems. Even though the Western European and North American health systems have higher capacities and are equipped with hi-technology equipment, they all suffered a severe strain during this pandemic. Nonetheless, one can also argue that it is the initial political and policy responses adopted by different countries toward the pandemic that put them on different trajectories. The initial policy directions had a huge influence and impact on health system capacities in the context of the pandemic as witnessed by the immediate actions by the heads of the states in Asia (as mentioned above) along with Canada , India , and CarThe recommendations of the Global Preparedness Monitoring Board for pandemics and emergency public health situations requires strengthening multilateral collaborations and closer cooperation between governments and other actors of the international system as well as mutual trust : (1) fulIf well-conducted, GHD results in improved global health, greater equity, better relations and trust between states, and a strengthened commitment on the part of stakeholders to work together with stakeholders nationally and globally . Many coThe primary goal of health diplomacy should be to reduce inequalities by making diagnostics, therapeutics, and vaccinations a global public good accessible to all. GHD will serve as a bridge for international collaboration in addressing public health issues, improving health services, and rebuilding multilateral institutions by emphasizing universal health coverage for sustainable and equitable growth . The aspThe pandemic has uncovered many weaknesses of the global health systems and increased the burden on the already fragile healthcare systems in many countries. The world has witnessed many nationalistic movements in many countries to secure drugs, vaccines, and personal protective equipment with a selfish attitude, which is not the right choice. The virus has no boundaries, and unless the nations work together with solidarity and help the developing countries with fragile health systems to build their health systems, health security cannot be ensured. Countries must improve their health systems, focusing on surveillance systems, infrastructure and investing more in science and technology to solve the challenges of today and in the future in more scientific and technologically sound ways. The GHD plays a critical role as the nations have been sensitized about the importance of the health sector and their citizens' health, ultimately running the nations' economies. It is high time that the Science, Technology, and Health domains should work more closely and contribute to the development of novel technologies, vaccines, drugs, medical devices, and kits for COVID-19 and future health threats. The countries should also prioritize and create expert teams in GHD at the national level to frame their interests and negotiate at the global platforms for better outcomes. Through successful GHD, the health ministries and the global health professionals could frame health as a high priority and reemphasize the strategy of Health in All Policies (HiAP) for a safer post-pandemic world. GHD can strengthen international cooperation, health systems, improve the global economy, trade, and address the inequities to achieve health-related global targets. Therefore, GHD can deal with several complex issues in the multipolar world which have strongly linked geo-socio-economic and political determinants and pave the way for health, development, security, and peace.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.ST, VC, EJ, and SK: conceptualization and preparation of initial draft. VC and ST: literature review. VC: data collection and analysis, preparation of figures, editing, and finalizing the manuscript. All authors have approved the final version of the draft before submission.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "Study Basis: This evidence map presents a summary of studies that addressed the effects of meditation on various clinical and health conditions. Meditation is a contemplative practice that has been used for the promotion of health, and the treatment of different conditions.Method: The study is based on the search of four electronic databases for the period 1994-November 2019 and includes systematic reviews, meta-analyses, meta-syntheses, and integrative reviews. 3iE evidence gap map was the methodology of choice, and AMSTAR 2 was used for the analyses. Tableau was used to graphically display the confidence level, number of reviews, health outcomes, and intervention effects.Results: This map encompasses 191 studies, with Mindfulness being the key word that retrieved the highest number of results. Several meditation techniques were evaluated in different contexts, and the confidence levels of 22 studies were high, 84 were moderate, and 82 were low. Two 2 meta-syntheses and 1 integrative review were also included. Most of the studies reported positive effects and a beneficial potential of the practice of meditation. Health outcomes were divided into five groups out of which mental health and vitality, and well-being and quality of life stood out with the largest number of studies.Conclusions: Meditation has been applied in different areas. This Evidence Map intends to be an easy visual tool to access valuable evidence-based information on this complementary therapy for patients, health professionals, and managers. The World Health Organization (WHO) has encouraged and strengthened the inclusion, recognition, and use of Integrative and Complementary Health Practices (ICPs) in national health systems at all levels: Primary Care, Specialized Care, and Hospital Care, through the recommendations of the WHO Strategy on Traditional Medicine 2014\u20132023 , the Brazilian Ministry of Health has signed a partnership with the Latin American and Caribbean Center for Health Sciences Information (BIREME-PAHO-WHO) and the Brazilian Academic Consortium for Integrative Health (CABSIN) to develop Evidence Maps on Integrative and Traditional Health Practices , includiAccording to Johnson , meditatThe first robust evidence in the health field can be found in the late 60's. In 1970 , WallaceSince then, the number and quality of studies on meditation has increased, becoming an integrative practice that has gained a growing interest among health professionals.About 19% of the non-institutionalized adult population in the USA practices some kind of meditation . A higheThe interest in Complementary and Alternative Medicine, classified by WHO within a broader scope as Traditional, Complementary, and Integrative Medicines (MTCI), has grown not only within the general population, but also among health professionals. In general, about 80% of complementary therapies have been considered as an option of treatment during the patient-doctor discussions . DespiteTo bridge this gap, this study intends to systematize research results on the prescription and adoption of meditation in a clear and concise map to boost confidence and inform decisions taken by health professionals and public administrators.This Evidence Map includes integrative and systematic reviews, meta-analysis, and meta-synthesis, and summarizes meditation related health interventions and outcomes. Systematic reviews were performed to obtain a reliable summary of the best evidence available in this area. The analysis was carried out following the PRISMA guidelines  and the Papers published in English, Spanish, and Portuguese were selected in searches conducted on PUBMED, BVS, and EMBASE databases from 1994 to November 2019. Experts on the topic were consulted and the search strategy was jointly developed with BIREME.List of the words used in the search in Systematic reviews/meta-analysis, and meta-syntheses on meditation with adequate description of health outcomes were eligible for inclusion in the Evidence Map. An integrative review study was considered as highly relevant and was also included. The selection of systematic reviews, meta-analysis, meta-synthesis, and integrative reviews was done based on the studies that self-identified as such. Participants of all ages, regardless of their health condition, were also eligible for inclusion as well as interventions of any kind, follow-up, and duration. Studies that did not focus on meditation and/or related health outcomes were excluded.Screening and blinding procedures were carried out by two independent reviewers using Rayyan software . CitatioA spreadsheet with various descriptors was developed to synthesize the findings. This matrix included: Full text citation; Interventions; Outcomes group; Outcomes; Effect; Population; Database ID; Country of focus; Country of publication; Year of publication; Type of review; Review design; Study design; Confidence level. The Evidence Map was organized considering the outcomes, effects, and confidence level of the studies included.n = 84 studies), 82 studies had a low confidence level, and 22 studies had a high confidence level. The two meta-syntheses and the integrative review could not be evaluated by this tool , followed by mixture of techniques (93 results), mantra-focused practices (15 results), state-focused practices (8 results), and focused mindfulness practices (1 result). According to AMSTAR2 classification, most studies showed a moderate level of confidence , followed by Canada (30 studies), United Kingdom (28 studies), and Australia (23 studies). One hundred and twenty one studies did not report the country of focus.It was observed that meditation has been used as an intervention in diverse health conditions. Within the 191 studies retrieved, effects were classified into five categories of health outcomes and considered as: negative (no results); positive (246 results); potentially positive (174 results); inconclusive/mixed (74 results); and no effect (13 results), reaching a total of 507 diverse effects, as shown in The Mental Health category included 270 results involving the practice of meditation  among whThe group including Physical and Metabolic outcomes presents a total of 87 results. The effect of meditation was positive in 41 results, potentially positive in 29 results, inconclusive in 15 results, and with no effects in two results. The most common outcomes were improvements regarding high blood pressure, general cancer symptoms, and chronic pain . RegardiThe vitality, well-being and quality of life group obtained 106 results for the practice of meditation as can be seen in The number of meditation practitioners has grown in recent years. One of the main reasons is the acknowledgment of the positive effects that meditation exerts on health in general , 9. HoweA survey carried out by Andrade et al. , found oIn the map, depression, and anxiety were the disorders with the highest number of results, with 71 and 67 results, respectively. On depression, there were 11 reviews with a high confidence level of which only one effect was inconclusive, one potential positive and 9 had positive effects related to meditation. All articles with a high confidence level were systematic review studies with meta-analysis , 24 repoGoldberg et al.  also conMental health costs in China increased more than 3-fold from 2005 to 2013 and could have reached much higher values if all patients with mental illness received adequate professional treatment. Anxiety is the most prevalent mental disorder, affecting up to a third of the population at some point in life , 32, 33 In the dimension of health promotion and vitality, 7 moderate quality reviews highlight relevant effects on quality of life , 43\u201348 oThe use of meditation as a health promotion resource is growing, with positive outcomes in terms of cognitive performance \u201353 and sIntegrative resources have been increasingly used in the context of health promotion . Sarris Along the same lines, other authors propose broad intervention programs involving lifestyle changes based on meditation . Thus, tAmong the interventions of the Complementary and Integrative Traditional Medicines (MTCI), meditation is the most comprehensive in terms of results and variety of effects. Among the systematic review studies included in the evidence maps presented in the BVS/MTCI, the meditation map is the largest of them, indirectly showing the substantial number of studies published on the subject in recent decades. Meditation techniques can be used by children and adolescents , pregnanOn the physical and metabolic effects of meditation, the literature has described several relevant factors. The ability to promote neural plasticity of meditation techniques is very relevant and has important physical and metabolic impacts . Black aIn this perspective, perhaps interventions such as meditation are part of a plausible solution to deal with the challenges related to quaternary prevention in collective health , 75 mainThe creation and publication of evidence maps consists of graphically representing the best evidence found, analyzed and categorized, with the corresponding bibliographic records and full texts (when available) of the studies, in order to facilitate access to information for all interested parties .As it is not the objective of an evidence map, the calculation of the effect sizes of a meta-analysis was not performed, nor was the risk of bias assessments performed, but we tried to overcome these limitations by assessing the quality of the included systematic reviews by applying AMSTAR 2.The outcomes and effects information presented in this Meditation Evidence Map will further advance the evidence-based knowledge of MTCI as proposed by PNPIC in Brazil and promoted by WHO 2014\u20132024 and BIREME.Meditation practices can be developed by healthy individuals or individuals who have different health conditions, from chronic diseases to different mental health disorders, with positive and potentially positive effects on various low-risk health outcomes.The practice of meditation can be a safe and effective strategy for implementing programs in the field of collective health. The possibility of applying it in groups facilitates access and reduces costs in relation to drug interventions, for example in mild cases of depression and anxiety, being a potential resource to avoid chronicity and the negative impact of stress on health.https://mtci.bvsalud.org/pt/mapas-de-evidencia-2/.Publicly available datasets were analyzed in this study. This data can be found here: CS and RA did the selection of articles and quality assessment, analysis of results, and writing of the discussion. VA designed the search strategies and accompanied the filtering of results by reviewers on the RAYYAN platform, collaborated in the data analysis, methodological design of the evidence maps, and writing of the manuscript. MS and RG collaborated in the methodological design of the evidence maps, data analysis, and writing of the manuscript and conclusions. All authors contributed to the article and approved the submitted version.The study was part of a project funded by the Ministry of Health of Brazil in partnership with the Latin American and Caribbean Center on Health Sciences Information BIREME-PAHO-WHO and the Brazilian Academic Consortium of Integrative Health to develop Evidence Maps in Integrative and Complementary Practices, including meditation. The Brazilian Ministry of Health funded the project and BIREME's research partners conducted the study and performed the collection; management; analysis; interpretation of data; preparation, review, and decision to submit the manuscript for publication.The results and conclusions of this publication are the responsibility of the authors responsible for its content; the findings and conclusions do not necessarily represent the views of the Ministry of Health of Brazil and BIREME-PAHO-WHO.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "The capacity to detect, control and manage emerging and re-emerging zoonotic diseases in Africa has been limited by a lack of utilisation of available reporting structures and policies to support programmes at national and local levels. This study explored the impact of the Zambian government policies on animal and human disease reporting and management and on One Health opportunities. An in-depth review and analysis of strengths, weaknesses, opportunities, and threats in the existing policies and reporting structures in the departments responsible for Veterinary Services, Health, and Wildlife, was conducted. According to our findings, sub-optimal implementation of existing policies related to the control of zoonotic diseases was impacting disease reporting, and reporting structures play an important role in effective and sustainable reporting of zoonotic diseases. Further, the study explored capacities and strategies in trypanosomiasis control as a case study that could prompt effective adoption of a One Health approach, and as such, the study suggests measures that could help to assess the performance of a One Health system in the control of African trypanosomiasis and other zoonotic diseases. The occurrence of human and animal African trypanosomiasis is associated with the presence of tsetse flies. Mammalian wild animals such as lions, buffalos, hippos, and elephants are the main reservoirs for the tsetse-transmitted trypanosome parasites ,2. HowevWith about five-eighths (5/8) of Zambia estimated to be infested with tsetse flies, overall AAT prevalence in Zambia remains unknown. Based on trypanosomiasis studies conducted in different regions of the country, AAT prevalence in livestock ranges from 1% to as high as 90%. Over 60% of the country\u2019s cattle population is under threat from trypanosomiasis with about 80% of the livestock owned by traditional farmers. The prevalence of trypanosomiasis in livestock and particularly in cattle has continued reporting alarming figures in affected areas ,11. AccoMost developing countries in Africa are faced with poor policy support with regard to animal disease surveillance . Poor anThe global health security agenda specifically identifies One Health as an integral part of efforts to achieve health security against the threat of infectious diseases and other public health emergencies. Analysis by the World Bank suggests that given the high economic and health burden of zoonotic diseases, strengthening human and veterinary health capacity, to facilitate One Health approaches to disease prevention and control at the country level, could yield high returns on investment, averaging $30 billion per year . DespiteThis study compared and examined the policies and reporting structures in Departments of Veterinary Services, Health and Wildlife, in Zambia, in the context of the existing strengths, weaknesses, opportunities and threats, with the aim of gaining some insights into prospects for effective multi-sectoral and coordinated surveillance systems for zoonotic diseases. The study also examined existing opportunities and capacities among personnel and available operational provisions, in the Departments of Veterinary Services, Health and Wildlife, that could be used in a One Health approach to better manage and control trypanosomiasis and other zoonotic diseases.Control of animal diseases falls under the jurisdiction of the Department of Veterinary Services in the Ministry of Livestock and Fisheries (MLF). The ministry is headed by a Minister who undertakes the sourcing of funds and oversees the allocation of resources to the various programmes and activities in the ministry a. The coWithin the structure, it is the VAs and the TCAs that interact routinely with farmers and hence with livestock, and as such, it is these personnel that constitute the front-line workers and the first and most important sources of information on disease occurrence. They are also the first line of defence in the control and management of livestock diseases, i.e., they are expected to be the first to see indicators of disease , take the first possible/recommended interventions where feasible, and relay the necessary information (reports) urgently to their supervising officers (at district level) on suspected disease outbreaks and also routinely  on the general disease situation in their areas (camps) of jurisdiction . Some districts have trained Community Livestock Assistants (CLAs) who help report cases of animal disease that occur in their communities to the VAs  . Thus, tHowever, regarding animal trypanosomiasis, active surveillance is carried out intermittently by the TTCU, and this information is made available through the specific reports.The Ministry of Health (MOH) is responsible for reporting all human diseases occurring in Zambia. Just like the MLF, the MOH is also headed by a Minister b. Under The Department of Wildlife and National Parks, formally known as Zambia Wildlife Authority (ZAWA), falls under the Ministry of Tourism and Arts c. The deThe results of the SWOT analysis are as shown in In total, 21 health centres and health posts from Mambwe district were involved in our survey, namely, Kamoto, Chilanga, Mphata, Kakumbi, Airport, Masumba, Nyamaluma, Kasamanda, Ncheka, St. Lukes, Malama, Kamubaba, Chikowa, Nyakatokoli, Lupande, Lusamdwa South, Chipako, Jumbe, Chisengu, Jumbe and Mphomwa . Only heDuring interviews, responses on the availability of parasitological and molecular tools  that coup = 0.001) (p = 0.04)  . On the  = 0.04) .Type of collaboration required as indicated by the Departments of Veterinary, Health and Wildlife during the survey included the following: staff training and capacity building, disease awareness and management and disease diagnosis.The results of the review of reporting structures for the Zambian Departments of Veterinary Services, Health, and National Parks and Wildlife  indicateFindings from the survey indicate limited government financial support for the three government departments to undertake surveys/surveillance for the control of trypanosomiasis and the need to strengthen collaboration between sectors for disease control and management. A previous study  conducteGovernments of endemic trypanosomiasis areas are, however, overwhelmed with the costs attached to the sustainable control of trypanosomiasis, thus, making its control difficult . The higThe Zambian government has made efforts to control tsetse and trypanosomiasis, but due to financial limitations and other disease burdens, trypanosomiasis control programmes have not been sustained ,31. ThisCurrently, in consideration of past lessons learnt and in adopting the approach of the African Union\u2019s Pan African Tsetse and Trypanosomiasis Eradication Campaign (AU-PATTEC), Zambia has adopted the principle of an area-wide integrated pest management, which is based on interventions against trypanosomiasis . HoweverThrough review of reporting structures for the Departments of Veterinary Services, Health, and Wildlife, as shown in An analysis of reporting structures for the Departments of Veterinary, Wildlife, and Health reveals that each department had its strengths, weaknesses, opportunities, and threats, as indicated in The reporting structure for the Wildlife Department  is long,In general, the study identified levels, as indicated in The provisions in the Zambian Public Health Act, Animal health Act and Wildlife Act were evaluated in the context of providing the key elements on national policies and on animal disease reporting systems in Zambia. Organisational structures of each of the departments responsible for Veterinary Services, Health, and Wildlife, were also examined in relation to disease reporting systems . An onliIn Zambia, personnel that undertake disease diagnosis are of various training/professional backgrounds of human and animal health service providers. An interview-based questionnaire study targeting all officers based in Mambwe in Zambia was conducted within the Veterinary Department (9), Wildlife Department (15), and Health Department (21). The interviews looked at the management and control of African trypanosomiasis in their respective departments. To conduct the study, written informed consents were obtained from all respondents before administering the questionnaires. Participation in the study was voluntary, and participants were free to withdraw from the study without giving any reasons. Information sheets  were prop values < 0.05 were considered statistically significant. Fisher\u2019s exact test was used to compare proportions between districts where expected values or responses were less than five.We conducted a SWOT analysis  of policEthical clearances were obtained from James Cook University (H7226 and A2498) and the Zambian Ethics Committee (Ref. No. 2018-Oct001), and the research was approved by the Zambia National Health Research AuthorityCoordinated surveillance systems within available organisational structures could play a key role in disease reporting and have the potential to impact the reporting of emerging and re-emerging diseases. A better One Health system could be applied in Zambia and other countries in the region and beyond by strengthening links for collaboration and coordination at national, provincial and district levels between sectors  and by creating improved reporting links within available reporting structures that will promote interactions and provide a more holistic response to disease control. This can be achieved through already existing institutions such as CVRI, ZNPHI, and TDRC, as well as through epidemic preparedness committees. With a slight shift in focus to include zoonotic diseases, the ZNPHI could provide the platform for disease reporting between partnering departments.More efficient use of existing capacity by implementing a One Health approach is possible between sectors. For example, in areas where veterinary services have laboratory capacity, samples from the Departments of Health and Wildlife can be sent to veterinary facilities for analysis and vice versa. In addition, community awareness programmes for zoonotic diseases and collaborated staff training/upscaling of skills related to veterinary, health and wildlife can be collaborative to save resources. The digitalisation of records for information sharing through national, provincial and district epidemic preparedness committees could be carried out in partnership to create a more efficient response system. To support sustainable zoonotic disease control approaches that can be implemented at national, provincial and district levels, new policies will need to be developed in the future."}
{"text": "Themodel was applied in a southern Brazilian city, in the following stages:documentary, questionnaire, mapping of gaps and educational proposal. in the first stage, after documentary research, a total of 14 general corecompetences were described and a questionnaire with specific corecompetences was chosen, with confirmation of correlation among them; in thesecond stage, the importance and expression competence at work degrees wereobtained, after the questionnaires were filled out by 74 municipal publichealth managers; in the third one, a formula was adopted for the trainingpriority degree and its classification; the fourth stage presented aneducational proposal for the development of one of the competences with thehighest priority degree. the model brings contributions by describing general core competences, afterdocumentary research; carrying out the correlation between a questionnaire,containing specific core competences with the general ones; by mapping gaps;and by the proposal of learning trails for the development ofcompetences. Since the promulgation of Decree n\u00ba 5707/2006, which consolidatedmanagement by competences as one of the models to be followed by the federaladministration, there has been a search and application of new models in theperspective of management by competencies for the public sector. Competency management is relatively new in Brazil, but its importance has beenincreased, being considered synonymous with good management practice. Since . Competency management is also applied in countries that have nationalhealth systems, such as Canada, which has been working with core public healthcompetences since 2008.Competency management models are present in the public and private sectors of manycountries, but several of them are complicated and conceptually focus on the needsof the past and present. The counterpoint would be dynamic Simplified CompetencyManagement Model focused on knowledge, competences and behaviors that will beessential for managers in the future. Competnce 2008.. The Association is composed by health schools from countries such asDenmark, Belgium, Switzerland, France, United Kingdom, Netherlands, Poland, Serbia,Hungary and others, presenting the fifth edition of the European List of CoreCompetences in 2018.The Association of Schools of Public Health in the Europe Region published its firstedition of the European List of Core Competences for the Public Health Professionalin 2006. The As. Specifically in the United Kingdom, the document Public Health Skillsand Knowledge Framework 2016 addresses the need for a competence structure toaddress issues such as: result, description of activities and functions ofprofessionals, professional development, educational curriculum and description offunctions in public health.Generally, core competencies provide parameters for the execution of public healthservices, as they deal with access to health services, surveillance, disease anddamage prevention, health promotion and protection. Specifc health.Competencias Esenciales en Salud P\u00fablica: Un Marco Regionalpara Las Am\u00e9ricas (MRCESP), an instrument that defines essential knowledge, skills and attitudesfor the public health workforce. It also recognizes that the guarantee of compliancewith public health obligations depends on competent managers, even with insufficienttraining offers.In 2013, in Latin America, the Pan American Health Organization (PAHO) issued adocument named (MRCESP), an insg offers.Sistema \u00danico de Sa\u00fade (SUS)demands from its managers local and regional commitments, participation in variouscouncils, creation and compliance with management instruments, in addition to theconstant evaluation of inspection and social control bodies. However, some managersare not prepared to assume the management function, even though they have excellentacademic credentials.In Brazil, the Unified Health System - dentials.. In the development of competences, it is assumed the balance betweenthe interests and needs of the organization and the individual with their knowledge,skills and attitudes. Thus, the consequence of investment in knowledge adds value,not only in the excellence and sustainability of the organization, but also in thesocial value of the individual. Core competencies improve public health by contributing to the development ofteamwork, capacity for situational analysis, planning and improvement of healthservices based on evidence and focused on the population in an equitable and ethicalway. In thedividual.  that present how competency management can be implemented.Due to the complexity of this theme, it is considered that the presentation of modelsthat correlate specific and general competencies through a mapping capable ofpointing out their priority degree and educational strategies for the development ofpublic health manager competences, is still a gap of knowledge to be filled. Thus,it is assumed that the health system can also not only benefit from the descriptionof core competences for public health, but also develop new technologies andtools that pr to the managers of own public health services of a Municipal HealthSecretariat (MHS).Therefore, this study aimed to present the contributions of a Simplified CompetencyManagement Model (SCMM) to the . Mixed methods research, exploratory descriptive type, which combines qualitative andquantitative approaches as a classification criterion, based on itsobjectives. .In the presentation of the SCMM contributions, a qualitative approach was used duringthe documentary stage of the SCMM, in which the meaning of words and phrases weresought in the study of the official documents found, indicating the vision of thefuture, mission, strategic objectives, management reports, status of municipal civilservants and performance indicators.. In the third stage, for the internal consistency tests of datacollection, we used the Cronbach' alpha coefficient per Domain after Main ComponentAnalysis (MCA), using the statistical software Predictive Analytics Software (PASWStatistics) 18.0.0, formerly named Statistical Package for the Social Sciences(SPSS\u00ae).The quantitative approach highlighted the contributions of the SCMM with the mappingof gaps in its second stage, performed with multivariate analysis of the datathrough statistical techniques, such as the analysis of main components and internalconsistency. In theThis study was carried out between October 2017 and June 2018 at the MHS of S\u00e3o Josedos Pinhais, located in the state of Paran\u00e1, southern Brazil, with approximately atotal of 320 thousand inhabitants and its own municipal public health network,comprising 46 services , with approximately 2 300 civil servants, of which 91are managers.Managers are called directors, heads or coordinators by means of a paid function, inthe case of statutory employees, or by commissioned position, indicated by technicalor political party criteria by the Municipal Health Secretary and endorsed by theExecutive Chief. The inclusion criteria were based on the typicality of the positionthat public health managers of MHS own services exercise . We included individuals with responsibility for directing, heading orcoordinating a department, division or public health service of MHS, who exerciseddecision-making, mediation, planning, control and evaluation activities, regardlessof gender, age, education, professional training, if effective or commissionedserver, time in office or time of management experience. who proposes the following: \"competence is knowing how to actresponsibly and recognized, which implies mobilizing, integrating, transferringknowledge, resources and skills, which add economic value to the organization andsocial value to the individual\". Thus, organizational competence was disseminatedinternationally with the term core competency, which encompasses a set of skills or aptitudes that unites individualefforts (merging expertise with the new) through harmony, communication, commitmentand work organization in its various functions, which finally have positive results. The definition of competence used in this study was based on an author who prompetency, which So, it was proposed to apply a SCMM with four stages: documentary, questionnaire,mapping of gaps and educational proposal ..In the first stage of the SCMM, documentary data collection took place in October andNovember 2017. The sources were the official documents of the Municipal Governmentand MHS, which addressed attributions or job descriptions related to the institutionmanagement and organizational strategy. These documents , with potential forinterpretation and description of content, were related to the competencies ofmanagers.After studying the official documents, the general core competences of MHS weredescribed, indicating the composition of an expected performance or behavior ofaction by means of a verb or an action object accompanied by a condition and acriterion ..Then, there was a correlation between the general core competences described for MHSand the specific core or external competences, understood as valid for the localneed, choosing the document of the PAHO MRCESP., based on the MRCESP.The second stage of the SCMM was applied for data collection through asemi-structured self-assessment questionnaire, translated and adapted to theBrazilian context, based e MRCESP..The questionnaire consists of response levels of five predefined, divalent,asymmetric interval points - Likert scale of five points - presented in a total of56 questions or core competences divided into six Domains: Domain 1 - HealthSituation Analysis; Domain 2 - Risk and Damage Surveillance and Control; Domain 3 -Health Promotion and Participation; Domain 4 - Policies, Planning, Regulation andControl; Domain 5 - Equity in Access and Quality in Individual and CollectiveServices; and Domain 6 - International and Global Health.The results of the structured questions (specific core competences) are presented bymeans of a central tendency measure (arithmetic mean) and a dispersion measure(standard deviation). The averages can vary between 1 and 5, with 1 being the lowestvalue regarding the lack of knowledge of the specific core competence and 5representing that the competence is put into practice, with the possibility ofteaching the competence to others.. The number five refers to the number of points on the Likertscale.In the third stage of the SCMM, the mapping of gaps was performed, resulting from theformula PD = CID (5 - CED), adapted from the one presented by Brand\u00e3o(1), with theCompetence Importance Degree (CID) being the result pointed out by specialistmanagers(15), according to the different importance understood formanagement. The nu\u00ae electronic spreadsheet, it was possibleto generate the numerical representation of the gap between the specific corecompetencies by classifying the Training Priority Degree (PD).Thus, the Competence Expression Degree at Work (CED) was developed through theresponse of the managers participating in the study. So, when applying the formula,using the Microsoft Excel 2007.In the fourth stage of the SCMM, in March 2018, the educational proposal wasdiscussed during a meeting with four representatives of the Municipal Public HealthSchool (PHS), responsible for carrying out the educational actions, where thepossibilities for developing competences were presented as gaps through learningtrailsThe study was submitted to the Research Ethics Committee, Opinion No. 2068137 andCertificate of Presentation of Ethical Appreciation (CAAE) No. 67007517.5.3001.0100,and met the ethical recommendations for research with human beings contained inResolution No. 466/2012.As a result of the first stage, after searching the physical and digital collectionsof MHS, the Municipal Secretariat for Planning and Economic Development and the CityHall, the documentary consultation was carried out on eighteen official documents ofthe city, with possible interpretation potential and description of content relatedto the competences of managers, a survey carried out in November 2017.After a thorough reading of the eighteen documents found, it was understood that onlythree official documents stood out for their potential for interpretation anddescription of content related to the concept of competence. The selected documentswere: Municipal Organic Law, Civil Servant Statute and the Strategic Map of theMunicipal Government. In none of them the functions, attributions, qualifications,profile or responsibilities was clearly found, for any level of management. However, the three officialdocuments selected for their content served as a basis for describing 14 generalcore competences for MHS, as shown in Then, the 14 general core competences described for MHS were correlated to the sixdomains of specific  core competencies of the questionnaire based onMRCESP, demonstrating that the selected  questionnaire, with specific,selected competences holds potential for the development of the general competences described.Domain 1 (8) was correlated to General Core Competence(GCC) III. Domain 2 (Surveillance and Risk and Damage Control)(8) to GCC VII. Domain3 (8) to GCC I, II, VIII. Domain 4 (8) to GCC IX, XI, XII, XIII and XIV. Domain 5(8) to GCC IVand V; and, finally, Domain 6 (8) to GCC VI andX.In the second stage of the SCMM, a questionnaire was applied between October 2017 andJanuary 2018. Of the total of 91 managers approached, 85.71% (n=78) completed thequestionnaire between 22 and 50 minutes. Four questionnaires, which were incomplete,were removed from the study to guarantee the quality of the collected data, with81.39% (n=74) of the questionnaires being computed.The result of the mapping of gaps in the third stage, as shown in From this mapping, the gaps in Domain 2  standout - referring to risk management, health risk reduction, immediate response andreconstruction, all referring to disasters - and in Domain 6 , in which core competencies, mapped as gaps, address transnationalinitiatives, global and international health.The internal consistency of the collected data demonstrates a high coefficient forCronbach's alpha (reliability), for data collected in all domains and second orderconstructs (results above 0.75).As a result, a Classification by Score indicating the PD was also adapted, as shownin , according to As a result of the fourth stage, after meeting with the PHS team, one of the specificcore competences identified with the highest PD (DO2CO11) was selected to be used asan example in the definition of content and teaching theme, through Knowledge,Skills and Attitudes (KSA), accord, participate in risk management plans disasters in the face of natural,technological and biological threats to mitigate their effects (DO2CO11), are: As a learning proposal, options can be individualized according to the aspirationsand preferences of each manager, that is, some of the options that can composelearning trails to develop the specific core competence pointed out as agap, partic- Distance education course (Theme: Incident command system); - Face-to-face lecture (Theme: Technologies and innovations for disasterprevention); - Book (Reducing vulnerability to disasters: from knowledge to action);- Article ; - Videos ; - Internet pages ; - Mentoring ;- Forum (Disaster risk prevention); - Workshop (Comprehensive risk and disaster management); - Specialization Course (Disaster Management in protection and CivilDefense). .Finally, as a result of the study and search for evaluation techniques to perceivethe development of the specific core competence, identified as a gap after thelearning path has been covered, there is a proposal for impact indicators in thecategories: Level , Measurement Complexity (depth and orbreadth), Data Collection Instrument , DataCollection Source (manager or colleagues) and Observed Impacts (improving competenceor advances and achievements)..Depth refers to advances in the performance of activities related to the objectivesand contents taught (core competences) and impact on work. On the other hand, theamplitude refers to the positive effects in other activities not directly related tothe objectives and contents taught..In the case of Level of Assessment of the impact on the individual, a questionnaireis suggested to measure the Complexity of the Measure regarding depth (first sixquestions) and breadth (last six questions), to be applied after the manager meetsthe learning path, with a total of 12 questions with answers structured on a Likertscale of agreement.In order to measure the Level of Evaluation of the impact on the organization, theComplexity of the Measure is proposed only in depth and as a Data CollectionInstrument, the documentary analysis; the Data Collection Sources are the SUSManagement Instruments and the Observed Impacts are the advances and achievementsrelated to the competence developed registered in the management instruments, suchas the Previous Four-monthly Detailed Report (PFDR) and the Annual Management Report(AMR).Regarding the first (documentary) stage, the SCMM contribution to the finding, duringthe search for official documents, absence of a description of the functions,attributions, qualifications, profile or responsibilities of the managers stands out. The performance of themanager depends on clear specifications and provided by the organization, with anupdated job description, covering the responsibilities and duties, by department.Thus, the job description is like a road map of where they want to be andhow(19-20)..The first stage of the SCMM also provided the institution with a description of 14unprecedented general core competencies, which enhance the implementation oforganizational goals and strategies to promote motivation, monitoring, evaluation,coordination and synchrony of efforts in different services and accelerate publicmanagement decision-making processes by sharing defined objectives., a questionnaire chosen as a data collection instrument, which containsthe specific  core competences. Another contribution of the first stage is the correlation between the specificgeneral core competences described for the institution (MHS) and the six Domains ofMRCESP, a quesIt is understood that to put the SCMM into practice, you can choose any questionnairecontaining specific competences. However, it is recommended that a correlation bemade with the general core competences so that efforts are not expended, by pointingout gaps or time in educational projects, to develop external core competences,which do not add up to what is expected by the public administration..As a contribution of the second stage of the SCMM, there is the presentation of theevaluation of specific core competences by specialists, resulting in the CID. Thus,competencies receive individualized results, far from a unanimous ideal among allcompetencies for a proposition of level of acceptability, which can vary a lot orlittle between one competence and another, because without the evaluation, among thenumerous general and specific competencies that exist, it would be difficult todiscern priorities.In this same second stage, the CED is defined when the questionnaire respondentperforms a self-assessment regarding the possession of the knowledge, skills andattitudes necessary to put the specific core competence into practice. presents itself as a tool of effective contribution, because inaddition to practicality and simplicity in use, it results in the PD, providingfocus on specific core competencies pointed out as gaps, that is, with a higherscore. Still in the third stage of the SCMM, the Classification of the PDcontributes to the evaluation of the results of the applied formula, when observingthat the participating managers present satisfactory results, as they presented onlyeight gaps  with the maximum score being 10 (moderatepriority).In the third stage of the SCMM, the formula adapted from the one presented byBrand\u00e3o present. The four gaps in Domain 2 (Surveillance and Control of Risks and Damages) presentedin the third stage of the SCMM address specific core competences referring tointersectoral planning for managing natural, technological, biological andpost-disaster reconstruction, with the damage identification and immediaterehabilitation. The relevance for the city of the core competences, identified asgaps related to disasters, is confirmed by the report of the State Coordination ofProtection and Civil Defense of the State, since in 2016 the city of this study hadthe highest number of occurrences in the State: 17 disasters. .Therefore, this is not a concern only in Brazil. In Africa, the World HealthOrganization, in partnership with public health training institutions, conducted apilot study on the development of core competences and training curriculum on Riskand Disaster Management.The four gaps in Domain 6  deal with corecompetences related to transnational intersectoral initiatives to overcomeinequalities, and global health, as contrasts between public health systems andtheir influence on health, welfare, social security and fundraising reforms, whichare important to the city, which, in addition to having an international airport, islocated in a vulnerable (metropolitan) region., and a 95% confidence interval level and a 5% margin of error. However,it is emphasized that the performance of statistical analysis is not mandatory forthe use of the SCMM.Regarding the statistical analysis of main components and internal consistency of thecollected data, the reliability results  were high forall domains, even with the number of items per domain, mostly below tenquestions, and a  and that, after extracting factors with the proper rotation, sampleadequacy, sphericity and factorial model tests, parallel analysis, determinantvalue, non-redundant residue, removal of possible outliers, and if necessary,maximum likelihood, goodness-of-fit index and adjusted goodness-of-fit index, beforecalculating Cronbach's alpha coefficient.On the other hand, if data are collected for scientific research, it is recommendedthat there be at least 50 participants and tha.The fourth stage of the SCMM contributes by exemplifying how the specific corecompetence, mapped as a gap, can be decomposed into knowledge, skills and attitudes,guiding the definition of content and teaching theme for the development ofcompetence on disasters. An educational structure is a set of competencies thattakes into account performance based on educational needs, personal experience,professional role and role in planning, mitigation, response and disasterrecovery.. The permeability of higher education, which advances to the field ofprofessional development, has been of interest in Europe and the United States as itenvisions greater potential for innovation with the activation of flexible personallearning paths.Competency-Based Education (CBE) assumes that different sets of competencies arefeasible to be customized for different education needs in the health professions,favoring the flexibility of time, place or learning pace, with multiplepaths. The peng paths.. This panorama converges to the use of the SCMM, which contributes tothe systematization in sequence, from the reflection and identification of problems(identification of gaps), to the search for practical solutions after thedevelopment of specific competences.A study carried out with managers of primary health care in southern Brazil pointedout the lack of training as a reason for dissatisfaction, and permanent healtheducation as a strategy for meaningful learning, with a methodological axis in theirwork processes. This p(-), because formal education, even in public health, does not, or little,develops the core competences expected of a manager(-).The process of shifting the focus from the transfer of knowledge to the developmentof competences must result from the tuning of the theory to real work situations,seeking excellence in public health practice and reducing the distance between whatis learned and what is practiced-32, b manager-34.. This study proposes the development of learning paths for the development of any corecompetence identified as a gap. It is based on the premise that, when the expectedcompetencies are not expressed, it is possible to manage the development ofcompetences in facing complexities and evolving demands. , even though they offer conveniences for organizational learning.The proposal for learning paths for public management is still incipient and littleknown, as an alternative to training grids. As a strategy to promote the developmentof competences by combining the expectations of the organization with thecharacteristics and profile of each person, the trails can be characterized asempirical and non-systematic strategies, even t, in addition to other better known as lectures, seminars, face-to-faceand distance courses, conferences, study trip, specialization course, books,manuals, articles, movies, forums, websites, videos, coaching and mentoring.The formatting that can be chosen for the learning paths is vast and unlimited,relying on the resources of Information Science to organize and representinformation, in add. Mentoring, recognized and recommended as an innovative, low-costcompetence development, has been implemented in health institutions, with thetemporary stay of a mentor, visits by an itinerant mentor, a team ofmulti-professional itinerant mentors, a mentor for two health services or permanentmanager-mentor.As an example of a resource, mentoring has been used for more than a decade in theframework of research in the field of health, in addition to being present inteaching situations. It is also appropriate in specific cases of work and in thedevelopment of leadership competences. Mentorr-mentor..Without evaluation, the teaching-learning cycle is not closed. The contribution ofthe fourth stage is also related to the assessment techniques for perceiving thedevelopment of the specific core competence identified as a gap. It is consideredimportant to evaluate the results of the impact of learning activities by theindividual, in the feedback for the proper improvement of the model and for theorganization, in ensuring that the efforts expended are being effective to thedisposition., there is a demand for new applications of the model for continuity ofthe process, since the services, contexts and their actors are dynamic.As limitations of this study, it is pointed out that the questionnaire used does notaddress financial aspects of management, and they have not been explored. Still, dueto the determined validity period of the SCMM, possibly around sixmonths, there This study analyzed the contributions of a SCMM consisting of four stages for a MHS andappears unprecedented in Brazilian public health. In the first stage, the SCMM made contributions by noting the lack of description ofthe functions, duties, qualifications, profile or responsibilities of managers in official municipal documents;exemplified how general core competencies can be described; detailed the correlationof general core competences with questionnaires containing specific  corecompetencies.In the second stage, the SCMM made explicit contributions to the generation of theImportance and the CED through the analysis of the questionnaire results.In the third stage, the SCMM evidenced contributions on how to generate the PD whenperforming the mapping of gaps through formula and Classification of the PD.In the fourth stage, the SCMM presented contributions on how to break down a specificcore competence in Knowledge, Skills and Attitudes; proposed an individualizededucational intervention through Learning Trails to develop competences; proposedimpact assessment techniques for the perception of competence development.As a recommendation for future studies, it is suggested that the experts consulted togenerate the Competences Importance Degree are from the service, as the importanceof different competencies is based on local needs, contexts and people. Also, theperformance of the gap mapping step must be separated by the different levels ofmanagers and or by departments, which allows more specificity in the planning of thelearning trails."}
{"text": "There are errors in the Funding statement. The correct Funding statement is as follows: The grant holder is Seblework Mekonen, Award agreement No = 4500384863. This work was carried out with aid of a grant from United Nations Educational, Scientific and Cultural Organization (UNESCO) and International Development Research Centre (IDRC), Ottawa, Canada. The views expressed herein do not necessarily represent UNESCO, IDRC or its board of governors. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."}
{"text": "Urban Renaissance (UR) Agency in Japan is one of the world's largest public housing institutions. When faced with the serious aging problems in Japan, the Japanese implemented innovative reform, with the smart medical and pension service launched according to the characteristics of resident population and their variation trends. As it well mastered the actual needs of residents by establishing the intelligent medical system, the occupancy rate was increased. Meanwhile, the problem of inadequate local medical resources was solved, with the satisfaction of residents as well as the cultural exchange and integration within communities ameliorated, which hence realized the sustainable development of communities. In this study, the smart medical experience of Urban Renaissance Agency in Japan was explored in the hope of providing enlightenment for the development of smart communities in China. Relevant Chinese enterprises can draw lessons from the experience of community services in Japan, and via the cooperation among industries, governments, and universities, they can collaborate with universities, scientific research institutions, high-tech enterprises, district governments, and grassroots communities to give full play to the advantages of the platform and improve service quality. Japan is one of the countries most affected by aging in the world. According to the demographic statistics report released by the Ministry of Internal Affairs of Japan in 2019, the elderly population there had reached 35 million, with an aging rate as high as 28.4% [With the development of a super-aging society, the single elderly population without spouses or children is increasing annually, which brings serious challenges in terms of pensions . In JapaTraditional medical treatment and elderly care are usually achieved by hospitalization and nursing home. However, due to practical problems such as insufficient resources, the medical industry in Japan is striving to penetrate into communities, which has progressively realized in-community medical treatment and in-community elderly care. According to the forecasting data of related institutions, the areas with a super-aging index approximate to Tokyo Megalopolis are basically consistent with the residential communities (groups) of UR Agency in Japan , and theBased on the survey data of Mizuho Bank, by 2030, the size of Japan's housing rental market will shrink by 30% from its current size because of an aging population with fewer children. Among them, the demand for multigeneration families and young single families will be greatly reduced, whereas at the same time, the demand for elderly people, especially single elderly people, will increase greatly. Urban Renaissance (UR) Agency in Japan is one of the world's largest public housing exclusive institutions. The number of elderly people will increase from 29.24 million in 2010 to 36.85 million in 2030, while the number of people in need of care will increase from 4.91 million to 8.36 million, and the number of facilities and houses for the elderly will increase from 1.48 million to 2.5 million. Besides, the demand for a large number of age-friendly housing also stimulates government agencies and private enterprises actively to participate in the layout of age-friendly community reconstruction as well as the construction of regional medical service centers.The full name of UR Agency is \u201cIndependent Administrative Legal Person Urban Renaissance Agency,\u201d which controls 720,000 sets of rental homes across Japan. Since its establishment, the UR Urban Organization and its predecessors have solved the housing problems of millions of Japanese families and fulfilled the tasks during a certain historical period by providing houses for generations of families extensively. With the advent of a super-aging society, UR Agency has been endowed with new historical significance. Most of the rental houses of UR Agency are located in the suburbs where the super-aged population gathers. Especially, about 430,000 large group houses were constructed and supplied during the period from 1960 to 1970, which were difficult to meet the living needs of the existing residents in terms of area, pattern, and supporting facilities. Therefore, renovating communities to meet the living needs of the elderly has become the primary task for the UR Agency.Moreover, with the persistent elevation of living requirements and quality of life, the all-around environmental quality along with medical and old-age care services of residential communities are important factors for improving residents' satisfaction and happiness. Based on the existing large number of public housing, the variations of market demand, regional activation, and harmonious development of communities, UR Agency correspondingly adjusts and alters its housing products, aiming to adapt to the overall requirements of the super-aged society in Japan and improve the overall quality of communities.To adapt to the variations of Japan's super-aged society in the future, UR Agency sets up a special committee and organized Japanese experts and scholars to perform a special study in this regard and hence formulated three future-oriented reform policies according to the reality of UR and the development tendency of Japanese society.Sustainable and secure family medical and nursing services are provided for the residents in UR community. For the areas with insufficient medical and nursing resources, medical institutions and elderly care facilities are attracted by means of investment promotion. To provide medical and elderly care services on a larger scale, the cooperation with public and private institutions near the community is encouraged.Based on the analysis of the existing living conditions and community reality, the redesign and overall transformation should be implemented by taking safe, high-quality, and sustainable public housing as the target.It provides a community platform for young groups, family groups, and elderly groups to communicate and help each other and collects opinions and suggestions from different groups as far as possible, aiming to safeguard the common interests of all stakeholders in the community and promote the harmonious community development.Founded in the 1960s, Chiba-ken is not only a large-scale construction site near the JR railway station in Japan but also a typical suburb super-aging community in Japan. In recent years, as the University of Tokyo has established a new campus there, relevant scholars of the university have begun to investigate this place and put forward the idea of solving local practical problems through the cooperation between industries, governments, and the university. Under the joint efforts of the University of Tokyo, UR Agency, and local municipal governments, a new industry-government-university association, \u201cKashiwa Regional Super-Aged Society Comprehensive Research Association,\u201d has been established. Aiming at the characteristics of fewer children and aging in the local areas, a series of targeted smart medical reform plans have been launched.\u221724 hours regional medical support network through smart medical treatment to serve local communities.Due to its long distance from major hospitals in Tokyo, inconvenient travel for elderly residents, and difficulties in medical treatment, UR Agency has newly established and introduced smart medical institutions here to establish a \u201cMedical Cooperation Center,\u201d whose main functions are as follows: first of all, after leaving from medical institutions in Tokyo, patients can continue their medical treatment at home through the Internet and Internet of things devices, the corresponding attending physicians will be recommended to the patients, and corresponding medical institutions and specialized hospitals in the area will be arranged according to the patient's situation . Second,To meet the demand for medical services in a super-aged society, UR provides exclusive and personalized services for the elderly in the local community by cooperating with local private enterprises . In UR, The plan of regional comprehensive smart medical centers has been implemented in more than 100 UR agencies, which enriched the local medical resources, improved the satisfaction of local and surrounding residents, and exerted a favorable impact on promoting the sustainable development of communities . MeanwhiRelevant Chinese enterprises can draw lessons from the experience of community services in Japan, and via the cooperation among industries, governments, and universities, they can collaborate with universities, scientific research institutions, district governments, high-tech enterprises, and grassroots communities to give full play to the advantages of the platform, improve service quality, precisely analyze the resident group, and excavate residents' specific needs, so that personalized value-added services can be provided and all-round solutions can be formed. Therefore, it can be promoted in public housing communities in China. In addition to meeting the residents' needs and improving their sense of satisfaction and happiness, it can also yield value-added service benefits for enterprises while achieving certain social benefits and fulfilling corporate social responsibilities to establish favorable social images ."}
{"text": "The analysis categories were thefollowing: the creation and expansion of the Nightingalean Nursing TeachingSystem; the subsumption of the Nursing labor to capital; imperialism andinternational health; and the flexibilization of the Nursing labor.the expansion of the Nightingale Teaching System has trained nurses on aglobal scale. The capitalist system transformed the Nursing labor in thetwentieth century, culminating in the twenty-first century with precariousand intense turnover of nurses in their jobs.the Nursing labor, made professional by Nightingale, has assumed in the last200 years a dialectical relationship with capitalism in which it bothdetermines and is determined by it. New challenges, such as the Industry 4.0technologies, are constantly imposed on the profession. Inthe 1840s, Florence sparked her interest in public health, a time when a healthreform was being debated in the UK as a whole. The Nursing labor was part of herpublic health interests, including architecture and urban sanitation. Thus, the workers who left the countryside for the city in search ofwage labor found themselves in the need to subject themselves to taking on unhealthyjobs and forcing their children into equally degrading situations, such as in thecoal mines and in the workhouses.At that time, the incredible expansion of production promoted by the IndustrialRevolution increased the intensity of production and caused a relative reduction inthe amount invested in the purchase of labor power available on the market by freeworkers. Thus, rkhouses..Against her familys wishes, Florence Nightingale increased her interest in Nursing,hospital organization and architecture, and in epidemiological records. She workedin health services in England and, in 1849, visited Nursing services, among otherlocations, in Rome, Alexandria, Kaiserswerth and Paris. In 1851, she returned toKaiserswerth for observations and a three-month training in the KaiserswertherDiakonie and headed to Paris, where she completed her observations and training withthe Filles de la charit de Saint-Vincent-de-Paul. Returning to England in 1853, sheassumed the position of superintendent at the Establishment for Gentlewomen DuringTemporary Illness until October 1854, when she embarked for the Ottoman Empire toact alongside the British troops as superintendent of the Female NursingEstablishment of the English General Hospitals in Turkey in the CrimeanWar. After strong resistance from direct superiors to improve the sanitaryconditions at the Barrack Hospital, Florence Nightingale participated in thecreation of a health commission, headed by physician John Sutherland, who, afterarriving in March 1855, and with her support and that of her subordinates,transformed the health conditions of the hospital.In skdar, at the Barrack Hospital, Florence Nightingale found an environmentlacking instruments and supplies for personal and environmental hygiene, foradequate food and for the comfort of wounded and sick combatants. After hospital.. In 1859, with a collection close to 5.7 million in current values,the Nightingale Fund starts the construction of The Nightingale Home and TrainingSchool for Nurses at the newly built St Thomas Hospital in London, England.Inaugurated in July 1860, it received its first students and began a journey of deeptransformation in world Nursing towards the professionalization of the so-called artof caring.Upon returning to England in 1855, Florence was a national heroine for hercontributions to reducing mortality at the Barrack Hospital, having received severalobeisances. To honor her, her friends came up with the idea of creating a careinstitution that would be a kind of English Kaiserswerth through a fund, theNightingale Fund, established in 1857. The Nursing labor, considered regardless of any determined socialform, is characterized today by the labor act of caring for human beings that isperformed by human beings in the role of Nursing laborers. They apply esotericknowledge(-) and set up interactions with their service users in a givenenvironment.Today, there is more than one work process in Nursing administrative, teaching andresearch all of them acting in function of the Nursing labor. The Nunowledge-6 andWhen a work is subsumed to the capitalist mode of production, it ceases to be just aprocess of organic metabolism of the human being with nature in order to produceuseful effects to be also a conservative, creative and multiplying value activity.The Nursing labor was no different. and with nurses and midwives from Australia, New Zealand and the UnitedKingdom show that Nursing experiences similar situations in several countries,insufficient workdays, underwages and underemployments, showing the need forreflections on Nursing relationships in the world of labor.Studies carried out on Nursing in Brazil and witKingdom show thBearing in mind that in 2020 the 200th anniversary of the birth of the creator ofmodern Nursing is celebrated, many reflections have been made to discuss the currentstate of the discipline and profession and the necessary strategies to beimplemented in order to continue the advances and its expansion, with a betterposition in the world of labor; therefore, in this list of investments it isnecessary to analyze the development and outcomes of the profession within thedominant sociability system in most of the world, capitalism. Thus, this theoreticalessay starts from the following research question: What are the relationshipsbetween the development of the Nursing labor and capitalism over the 200 years ofFlorence Nightingale?That said, the purpose of this essay is to analyze the relationship between thedevelopment of the Nursing labor and capitalism over the 200 years of FlorenceNightingale., in which the economic categories function as ideal expressions ofhistorical relations of production and, therefore, correspond to a certain level ofdevelopment for the productive forces. The exposure method was developed aposteriori of the investigation process. The categories are the following: creationand expansion of the Nightingalean Nursing Teaching System; subsumption of theNursing labor to capital; imperialism and international health; and theflexibilization of the Nursing labor.This is an original, discursive, logical-reflective and theoretical production basedon interpretations of historical facts that represent turning points in capitalismand that determine the ways to perform the Nursing labor, as well as on Marxisttheories that assist in the interpretation of these historical facts. It isorganized into analytical categories, created from the method of scientificdialectics as described by Karl Marx, in whiKey ideas from the four analytical categories of this reflection are presented. Inthe creation and expansion of the Nightingalean Nursing Teaching System, TheNightingale Home and Training School for Nurses stands out, established in 1860 atSt Thomas Hospital. With a model that was based on pedagogically organizedscientific content and the mandatory residency of the students in the hospital, itcontributed to raising the quality of service provision and to reducing hospitalcare costs. Quality and prestige contributed to the international expansion of thisSystem.The subsumption of the Nursing labor to capital is observed when the work processtakes the form of a production process, which is constituted, at the same time, bythe work process and the valuation process. The 1929 Crisis, which hit centralcountries, such as the United States of America (USA), affected the Nursing laborthat, with the advent of private health insurance, also began to be directlyexploited by capital. The production of more value accompanied by an increase in theworkday is one of the main characteristics of the formal subsumption of labor tocapital. Concomitantly, the application of Taylorism and Fordism in Americanhospitals has intensified the productivity of the Nursing labor, characteristic ofthe real subsumption of labor to capital.The transition from the 19th century to the 20th century is marked by the developmentof Imperialism, which has had a major impact on international health. Thedevelopment of the international market has intensified the routes betweencountries, moving large intra- and international migratory flows. Such flows andpopulation growth in large urban and commercial centers have contributed to thespread of diseases, especially infectious and epidemic, generating the need forresponses from the health field to address the financial concerns of largeindustries. Within this framework, the Rockefeller Foundation stands out for itsperformance in the health field.Based on the influence of the Rockefeller Foundations scientific philanthropyactions, the Nursing labor starts to acquire new skills, such as the application ofknowledge about the social aspects of nosological events and health education aimedat the prevention of communicable diseases, and to deepen knowledge in dietetics,biology, pharmacology and other basic sciences. As a result of this influence, theNursing labor, based on specific and medicalizing public health actions, started toassume important functions in maintaining and recovering a sufficient level ofhealth for the working classes so that they could both offer their workforce and actas consumers in the market society, and was used to clean up the image of largecorporations in the oil industry and of the US imperialist interests.The many crises that marked the capitalist system have, throughout its history, ledto important changes in the world of labor. Productive restructuring, reduction ofsocial rights, precarious work, fragmentation of the working class, and weakening ofthe workers claiming forces are aspects to be considered in the debates on theflexibilization of the Nursing labor, which generates important impacts on healthcare..The creation of The Nightingale Home and Training School for Nurses on June 24th,1860, brought important new contributions, such as: the introduction of scientificknowledge discovered by physicians in the teaching of nurses; the soleresponsibility of the superintendent (matron) to control the Nursing service; theneed for apprentices to reside in the hospital; the payment of a reasonable amountto nurses after the first year of the course; carrying out manual work exclusivelyby servants; circulation of apprentices among different wards; and observation asthe main competence to be developed by the apprentices. Working class apprentices were considered to be ordinary apprenticesand the costs of maintaining them in the first year of the program were financed bythe Nightingale Fund. Upon graduation, the so-called nurses were directed to assume regularobedience positions. The apprentices of the bourgeois classes, referred to as ladynurses, paid for their maintenance costs in the first year of the program and, upongraduation, were directed to assume leadership positions on an internationalscale.The model lasted three years, as in Kaiserswerth. The first year was devoted totheoretical classes and, in the following two years, hospital and home services wereperformed. Workinale Fund. Upon galscale..In addition to the prestige of adopting an education system associated with the imageof a UK heroine, the adoption of the relatively inexpensive labor of apprentices fortwo years made hospitals of the time interested in the system. The interest inraising the level of the nurses training and decreasing costs of providing hospitalservices through the adoption of this system crossed the Atlantic Ocean and reachedthe USA and Canada.. The Nightingalean System came to be known in the USA as the BellevueSystem, as it was introduced in the country by that institution. The education systems started disconnected from the hospitals but, dueto the lack of donations to finance them, they were integrated into hospitals. InCanada, in 1874, the St. Catharines General and Marine Hospital brought two trainednurses and five or six students from England to set up a teaching system that wouldlast three years. In 1875, the Montreal General hospital sought help from FlorenceNightingale to set up her education system and five nurses were sent from St.Thomas Hospital to establish the school in the institution.In 1873, three schools implemented Nursing education systems based on theNightingalean System in the USA: The Bellevue Training School in New York City onMay 1st; the Connecticut Training School in New Haven on October 1st; and the BostonTraining School on November 1st(-). With the arrival of the education system in these countries, the timein which students were trained, on average, tripled, keeping hospitals with moreemployees on low salaries (with a mean of $10 a month in 1874 in the USA) for longertime. The result of this equation was a rapid growth in the number of nursetraining schools. Between 1900 and 1929, the number of nursing schools in the USArose from 432 to 1,885. In Canada, the number of nurses between 1901 and 1921 rose from 280 to21,385, including the students.The hospitals in these two countries did not have good working conditions for thenurses. After completing their training in the hospitals, the nurses sought to selltheir workforce to families who hired them to provide their services within theirhomes-11. W. This process begins to affect the Nursing labor in the USA with thesale of health insurance, which started in the 1920s, gained popularity in the1930s, helped in the economic recovery of the hospitals, and boosted thecapitalization of these services. From 1934 to 1938, the Blue Cross, which was selling insurance forhospital care, went from 100,000 to 1.5 million insured clients, and to 22 millionin 1946. The Nursing labor already served the capital indirectly by improvingworkers productive capacity, keeping workers and bourgeois healthy or recoveringtheir health. However, from this process of capitalization of the health services,it is also directly exploited by capital.The process of formal subsumption of labor to the capitalist mode of production ischaracterized by the conversion of the work process into an instrument of theprocess of capital self-valorization, although this conversion does not necessarilyalter the work process itself. This pservices. From 1. It is characteristic of the real subsumption of labor to capital thatthe conscious application of sciences to the immediate production process in orderto produce more relative value. Formal subsumption is a precondition for real subsumption of labor inthe capitalist mode of production, since it is necessary to accumulate a minimum ofcapital in order to invest in the development of new methods of work and in theimprovement of its means.While in the process of formal subsumption, the work process only becomes a processof self-valorization of capital, in the process of real subsumption, capital acts inthe work process, intensifying it and making it more efficient to produceprofit. It is ve value. FormalIn the Nursing labor, the real subsumption of capital happened pari passu to formalsubsumption. As soon as the hospital services were being capitalized, the productionof absolute surplus value generated by the excessive increase in daily workinghours, the technical division of labor, the loss of ownership of the means ofproduction and the production of relative surplus value generated by application ofthe Taylorist and Fordist models of work management plagued this in a short periodof time.. The ANA proposed that hospitals could hire workers without formalqualifications to perform maintenance services, secretaries for administrative tasksand attendants for routine activities, in order to rationalize the work ofregistered nurses and reduce labor costs applied to simpler tasks. In this way, the ANA promoted an intensification of the separationbetween manual and intellectual work.In the 1930s, the American Nurses Association (ANA) defended the application ofTaylorism in hospital care and the consequent technical division of the Nursinglabor. The ANer tasks. In thi, as well as the hospital architecture. During this period, Functional Nursing emerged, which acted as anassembly line with an intense division of activities into small tasks, and time andmovement studies were applied to operations performed in the Nursing labor, whichled to a significant increase in the working pace on an industrial scale.Not only was Taylorism applied to Nursing care, Fordism also influenced thestructural changes in Nursing care in the 1930s in the USA, as welitecture. Duringal scale.. Although thousands of nurses left their countries to take part in thewar, they represented a small number of the available nurses and governments andprivate hospitals refused entry to male nurses, black-skinned nurses and people over40 years old to take up positions in hospitals.Under the pretext of an alleged shortage of nursing professionals caused by theSecond World War, American hospitals reversed many previously-achieved advances.They put an end to the eight-hour workload limit; reversed the restriction on thecreation of new Nursing schools; they exerted pressure on the War Nursing Council torelease the training of 50,000 nurses a year and on the National League for Nursingto loosen the requirements for admission to the Nursing courses, so as to reduce thetraining time for Nursing students, reintroduce Nursing students to conduct directassistance in wards and regulate the position of the Licensed Practical Nurse,trained from a one-year technical program. Althouospitals..Imperialism is a phase of the development of capitalism that started at the turn ofthe 19th to the 20th century. It is characterized by the acceleration of capitalconcentration and centralization processes; by the combination; financial capital;inherently capitalist exploitation in the dependence relationships between financialmonopolies located in metropolises and their colonies/areas of influence;transformation of the old sharing of the world into sharing between capitalistmonopolies over areas of exploitation of raw materials, trade routes and consumermarkets; and submission of the international division of labor to the monopolisticinterests of the metropolises, under penalty even for using the armedforces.. In this way, means of land and sea transportation, as well ascommercial routes, were developed to move goods and workers to meet the demands ofproduction and capital accumulation, generating large intra- and internationalmigratory flows and eventual contacts for the purchase and sale of goods. Inaddition, the First World War imposed the movement of large troops in foreign lands.Such elements, combined with the growing population concentration in urban centers,contributed to the population being exposed to microorganisms, for them new, and forthe rapid spread of communicable diseases.The technologies of the First Industrial Revolution and imperialist interests deeplyexpanded the production capacity and demanded a greater supply of raw materials,labor instruments, workers and consumer markets. In thidiseases.. Therefore, general health conditions, as well as basic levels ofeducation and the lifestyle/consumption pattern of people from all nations becamefinancial concerns for large industries and philanthropic organizations such as theCarnegie Corporation, created in 1911, the Rockefeller Foundation, created in 1913,and the Ford Foundation, created in 1936, which played an important role in creatingconditions favorable to US imperialist exploitation.In the meantime, potential or actual epidemics in one part of the globe came toaffect the profits of large international corporations headquartered in otherlocations. Therefoitation.. The Rockefeller Foundation in its creation had the InternationalHealth Commission (1913-1916), later named as the International Health Directorate(1916-1927) and, finally, as the International Health Division(1927-1951).The Rockefeller familys investment in health-related scientific philanthropy startedin 1909, with the Rockefeller Sanitary Commission for the Eradication of Hookworm inSouthern USA, followed in 1910 by the Sanitary Commission, until the creation of theRockefeller Foundation in 1913. The Ron 1913-19, later n, replacing or diminishing the influence of religious Nursing assistanceand existing traditional practices where the Foundation had advanced. In Brazil, the Rockefeller Foundation played a fundamental role inNursing and Public Health as a whole, creating schools for the training of nursesand health visitors throughout the national territory and, subsequently, the Special Public Health Service.Until 1950, the Rockefeller Foundation had invested or intended to invest in Nursingeducation programs in almost 30 countries around the world, in addition to promotingthe establishment of connections between Nursing schools and universities andproposing the curricular bases of dozens of Nursing education institutions aroundthe world based on the Anglo-American version of the Nightingalean Nursing TeachingSystem, replacadvanced. In Braerritory and, su. The so-called cyclical crises, which took place every 7 or 10 years,occurred within longer periods, around 50 years, which are called longwaves.Crises are the natural mode for the existence of capitalism and, therefore, since itsinitial stage of development at the international level, the capitalist mode ofproduction has faced several crises. The songwaves.. Each was initiated from a technological or industrial revolution andall were composed of two phases: an initial expansion, marked by accelerated capitalaccumulation, and a final one with a tendency to stagnation, marked by graduallydecelerated accumulation.Until the 1950s, there were four long waves in the history of capitalism: (i) betweenthe end of the 18th century and the 1847 crisis; (ii) between 1847 and the beginningof the 1890s; (iii) between the 1890s and the Second World War; and (iv) the lastone that started in the mid-1940s. Each wmulation.. This phase was also marked by the end of the Bretton Woods Agreementin 1971, the oil crisis caused by the Arab-Israeli conflict in 1973, the neoliberallaboratory installed in the military coup in Chile in 1973 and the crash of theStock Exchange in 1973/74. This period of crisis and recession on a global scale led to the deepdeterioration of the Social Welfare State in countries that assumed a centralposition in the international labor division. In Brazil, contradictorily and due toits quality as a country with a dependent economy, the Unified Health System isbuilt as an element of a universal social security system in the midst of thisinternational setting and, consequently, suffers from pro-market reforms,underfunding and deepening competition between public and private institutions sinceits inception. The 1970s were crucial for capitalism, marking the end of the SocialWelfare State guided by Keynesianism, starting the implementation of neoliberalrationality, and marked the beginning of a crisis of another nature: the structuralcrisis of capitalism.The stagnation phase of this last long wave, called the Golden Age of Capitalism, wasmarked by recessions in imperialist economies in western Europe  andJapan between the 1960s and 1970s that culminated in the 1974/75 worldrecession. This p 1973/74. This pnception. The 19pitalism..Capital has three fundamental dimensions: production,distribution/circulation/materialization, and consumption. These dimensions,although they have relative autonomy from each other, are fundamentallyinterdependent and tended to be strengthened, expanded and made increasingly complexthrough their interactions. When one of these dimensions met a limit, anothercompensated and gave the feeling that this contradiction had been overcome. With thestructural crisis, this triad that leads to the self-expansion of capitals suffersmore and more disturbances to the point of presenting flaws in its mechanisms fordisplacing contradictions from one dimension to another.. A productive restructuring was necessary to generate a more flexiblepattern of accumulation and to be better able to overcome the contradictions withinthis crisis. This restructuring, which is still under development until the presentday, had the Toyota Production System as its main reference.Unlike the long waves that happened until the 1970s, with the structural crisis thereis a situation of cumulative, endemic and chronic crisis on a globalscale. A prods crisis. This reference.. Upon returning and discussing what he had found in Detroit withTaiichi Ohno, they understood that Fordism would not serve Japan and developed analternative that would be called the Toyota Production System and, later on, LeanProduction.In 1950, Eiji Toyoda visited Fords Rouge plant in Detroit to study the plant and itsmodes of production and management. Upon roduction.. In Lean Production, wastes are results of operations that do not addvalue to the product developed. To eliminate wastes in the Lean Production, therefore, it is necessaryto define what is and what is not value according to the view of its consumer beit the final consumer or some intermediary in the production chain , trace thevalue chain, that is, define the set of absolutely necessary actions for theproduction of a certain product or service, and ensure that the entire productionprocess of the product or service reaches the necessary fluidity to meet the needsand desires of the consumers in less time, with fewer errors and with the lowestcompetitive price(-).One of the main features of Lean Production is the search for eliminating wastesthrough processes that promote continuous improvement of the capital accumulationprocess. In Leaeveloped. To elive price-25.. Thus, unproductive work performed by assistants, such as maintenance,monitoring and quality control, are now performed by productive workers. Such modifications in the production process generated negativerepercussions for social rights, precarious working conditions, greaterfragmentation of the working class, and weakening of confrontational unionism to thedetriment of negotiating unionism.With the transformations generated by Lean Production, the intellect of the workers,previously rejected, started to function as an intellect of capital, based on thevalorization of value and on the devaluation of work. Thus,  workers. Such munionism.; the Virginia Mason Medical Center in Seattle, Washington,USA, an institution associated to the Virginia Mason Institute, thatcreated the Virginia Mason Production System inspired in Lean Production and makesconsultations with diverse health institutions, among them the NHS itself; ThedaCarein Wisconsin, USA, that created the ThedaCare Improvement System based on LeanProduction; the Institute for Healthcare Improvement in Cambridge, Massachusetts,USA; in addition to organizations in Brazil, Canada, Taiwan, New Zealand,Germany, Sweden, Italy and Holland.Lean Production has been applied not only in the automotive industry, but also inother branches of the manufacturing industry and in branches of the serviceindustry, including health care, where it takes the shape of Lean Health Care.Currently, Lean Health Care is not the sole management model that aims torestructure the health industry towards greater flexibilization of work andemployment contracts, but many health organizations and systems apply Lean HealthCare principles around the world. Some examples with higher prominence are theBritish National Health System (NHS); the Viton,USA, an insoduction; the Intts,USA; in addlland and a mentality of continuous improvement(which presupposes the understanding that the philosophy is for the long-term andtherefore is not limited to a single intervention), and that it is expressed bycarrying out Lean evaluation activities  and Lean improvement activities (such as 5S or the 6S variation whichincludes safety(33), level production, visual management and standardizedoperations).A very comprehensive and promising operational definition was developed for LeanHealth Care. The aurations)..A key concept for applying the Lean Production principles in the health field iswaste. The NHS currently recognizes eight health wastes: (i) Defects: rework causedby failed processes or lack of access to correct information in the first attempt;(ii) Waiting: when the individuals cannot perform their work due to the absence ofpeople, equipment and information at the appropriate time; (iii) Transport:unnecessary movement of materials; (iv) Over processing: performing unnecessarystages that do not add value; (v) Inventory: characterized by excess stockedmaterials and patients waiting to be discharged or waiting for procedures; (vi)Motion: when people move unnecessarily and for things that are difficult to access;(vii) Over production: the act of producing more than necessary or when it is notnecessary; and (viii) Skills: not making the best use of peoplesabilities.(-), intensive care units and coronary units, outpatient clinics, surgery centers, laboratories, diagnosis services, pharmaceutical services, gynecology and obstetrics, primary health care and ophthalmology. It is common for the Lean Health Care model to be associated with workmanagement instruments from other models, such as Six Sigma.The Lean Health Care model has been applied in several types of health services andunits, such as: emergency-36, i units,-38 anry units, outpat clinics, surgerters,-, laboraratories,37, drvices,-40, pstetrics, primaralmology. It is igma,,-42.. In this contemporary model of hiring, the employer does not settle aminimum number of hours worked, and can serve both to fill the void left by jobabandonment or by medical leave, and for hiring professionals to work from theirhomes in a situation of flexible demand for health care.Nursing laborers, mainly in England, have suffered from the so-called zero-hourcontracts. In thilth care,43.. This same report points out that the turnover of these workers ishigher in all the scenarios. In Brazil, there is currently a trend to intensify the precariousnessof the health work, either due to the deterioration of the working conditions or ofthe contractual employment ties.From 2016 to 2017, the British National Health System recorded a total ofapproximately 325,000 workers employed in the zero-hour contracts for adult care,representing almost a quarter (24%) of the entire workforce employed in this sector,with the most affected workers being registered nurses, with 55% of the workforcesubjected to this precarious hiring regime, and caregivers, with 56% of theworkforce. This scenarios. In Braent ties.. In this sense, for the Nursing labor to produce health care for thepopulation, in the light of the Nightingalean ideas, Nursing laborers need decentconditions to safely exercise their professional practices.The area still needs to invest more in studies on the increasing precariousness ofthe Nursing labor but, from what it has produced, wear out and work overload areverified as consequences, with negative impacts on the physical and mental health ofthe workers. In thiThe Nursing labor, which becomes professional under Florence Nightingales influence,has assumed a dialectical relationship with capitalism in the last 200 years, inwhich it both determines it and is determined by it. New transformations are yet tocome. The technologies of the Fourth Industrial Revolution, also known as Industry4.0, have demonstrated their ability to radically transform the international labordivision, including Nursing. Recovering the visionary impetus of the Lady of theLamp to lay the foundations of the Nursing transformation is a challenge of theagenda."}
{"text": "The National Library of Medicine (NLM) Michael E. DeBakey Fellowship in the History of Medicine is a unique program in a unique institution: the world\u2019s largest biomedical library, which is part of the National Institutes of Health (NIH). The fellowship is rooted in strong connections between its namesake and the NLM and is an expression of Dr. Michael E. DeBakey\u2019s longstanding appreciation of the library and the role of the humanities in medical education and practice. This article explains Dr. DeBakey\u2019s connections to the NLM and describes the origins, development, and structure of the NLM Michael E. DeBakey Fellowship in the History of Medicine. It also highlights research achievements of selected NLM Michael E. DeBakey Fellows, demonstrating that the fellowship is successfully carrying forward Dr. DeBakey\u2019s principles and practices of weaving science, technology, and the humanities to form holistic understanding of the human condition, inspiring well-rounded careers built on both scientific and humanistic knowledge. During his 75-year career, Dr. Michael E. DeBakey (1908-2008) transformed cardiovascular surgery, raised medical education standards, and shaped national healthcare policy. He pioneered dozens of operative procedures such as aneurysm repair, coronary bypass, and endarterectomy, which routinely save thousands of lives each year, and performed some of the first heart transplants. Dr. DeBakey\u2019s inventions included the roller pump (a key component of heart-lung machines) as well as artificial hearts and ventricular assist pumps. He was a driving force in building Houston\u2019s Baylor University College of Medicine into a premier medical center, where he trained several generations of top surgeons from all over the world.Dr. DeBakey played a central role in the establishment of the National Library of Medicine (NLM). He was a visionary supporter of the institution, serving two terms as chairman of its Board of Regents and actively participating in many of its programs, from the establishment of the National Network of Libraries of Medicine in the 1960s to launching NLM outreach initiatives in the 1990s, and promoting the digitization of its indexes to pre-1960s journal articles.Figure 1).Dr. DeBakey valued a well-rounded approach to medicine. During World War II, when he was serving as a surgical consultant to the Army Surgeon General\u2019s Office in Washington, DC, he spent countless hours in the Army Medical Library (AML), gaining an appreciation for its collections as well as its tenuous and fraught circumstances as an underfunded, often neglected part of the Army Medical Department. After the war, Dr. DeBakey was appointed as an honorary consultant to the AML, and, in this capacity, he presented a detailed analysis of the library\u2019s status  and John F. Kennedy (Democrat from Massachusetts) to draft legislation for a National Library of Medicine as part of the US Public Health Service. The senators introduced the bill in March 1956; with a push from Dr. DeBakey, it made it to the senate floor for a vote, and the National Library of Medicine Act was signed into law by President Eisenhower on August 3, 1956.Figure 2). One of the first orders of business was establishing a home for the new library, a challenge Dr. DeBakey took on with enthusiasm. The pros and cons of about 10 locations were discussed, and as part of the following meeting one month later on April 29, most of the regents went on a bus tour of several of the locations.The first NLM Board of Regents met in March 1957, with Dr. DeBakey as an appointed member .After much debate, the Board agreed with Dr. DeBakey\u2019s proposal and selected the NIH campus as the home of the new NLM. In 1959, the Board of Regents Chairman appointed Dr. DeBakey to serve on a working group to consult about the design of the new building, and less than 3 years later, in January 1962, the NLM opened to the public. Dr. DeBakey continued to serve on the board for many years, in two separate tenures. A few years later, expressing this appreciation of the NLM and other medical libraries, Dr. DeBakey stated: \u201cOur libraries are our most valuable and precise link between generations and between people working in many areas. We must protect them at any cost.\u201d3 Five years on, these programs have successfully carried forward, preserved, and made widely known the dynamic legacy of Michael E. DeBakey.In February 2016, the NLM received a generous gift from The DeBakey Medical Foundation to support development, expansion, and enhanced public access to the library\u2019s collection of Michael E. DeBakey papers and to develop related programs in the history of medicine, specifically the NLM Michael E. DeBakey Fellowship in the History of Medicine. The gift also supported free videocasting and permanent archiving of NLM History Talks so they could be widely appreciated.4 The collections include papers of Michael E. DeBakey himself, reflecting the expanse of his life, achievements, and interests as a world-renowned medical statesman, innovator, and champion of humanitarianism and life-long learning.Launched in April 2016, the NLM Michael E. DeBakey Fellowship in the History of Medicine provides selected individuals with up to $10,000 to support onsite research in the collections of the NLM, which span ten centuries, encompass a variety of digital and physical formats, and originate from nearly every part of the globe.Circulating Now. Understandably, the COVID-19 pandemic has impacted the fellowship, and the NLM expects flexibility in scheduling future visits of fellows when it reopens to support onsite research. In the interim, library staff are available to provide reference support and planning for onsite research.The fellowship is administered on behalf of the NLM by the Foundation for Advanced Education in the Sciences (FAES). Through this partnership, the NLM and FAES operate the fellowship on an annual cycle with calls for applications each spring, application deadlines each fall, and announcements of fellows each winter. FAES receives applications to the fellowship program through a dedicated online portal. Staff of the NLM History of Medicine Division and the Office of NIH History review submitted applications based primarily on the viability of the research plan, including its scholarly rigor and extent to which it engages NLM\u2019s collections, as well as the feasibility of the plan given the proposed budget. Fellowships are awarded to individual applicants, not to institutions, to help offset the costs associated with visiting and using the NLM historical collections. Anyone over the age of 18, of any academic discipline and status, who has not previously received the Fellowship, is eligible. Non-US citizens may apply. On average, the NLM has named four fellows annually. Fellows are expected to make at least one in-person visit to the NLM to undertake their historical research projects during the calendar year following their selection. Fellows are also required to author at least one guest blog post, based on their research, for the popular blog of the NLM History of Medicine Division, Figure 4). This international and multidisciplinary cohort of women and men at various stages of their careers has produced an impressive and measurable body of research work encompassing five scholarly books, four articles, and 16 essays on Circulating Now, which have been collectively viewed over 25,000 times.5Since the launch of the NLM Michael E. DeBakey Fellowship in 2016, nearly two dozen individuals have been named to the fellowship (NLM DeBakey Fellows have published on a diversity of subjects ranging from the evolution of modern surgery to the development of medical libraries and medical librarianship to the interplay between health care and urban economies. They also have produced a global history of civilian internment during wartime, the first biography of Dr. DeBakey himself along with various detailed studies of his surgical techniques and innovations, a history of the internationalization of medical education, and a study of how doctors\u2019 wives transformed American medicine and the evolution of wartime bacteriology and wound care.https://videocast.nih.gov/PastEvents?c=221. Notably, beginning in 2021, all NLM History Talks incorporate American Sign Language interpretation. Support for this expanded access to NLM History Talks is made possible in part through a gift to the NLM from the DeBakey Medical Foundation.The library presents an annual NLM Michael E. DeBakey Lecture in the History of Medicine, which complements the NLM Michael E. DeBakey Fellowship in the History of Medicine and further expands public awareness of Dr. DeBakey and his appreciation of well-rounded careers built on both scientific and humanistic understanding. Delivered by a selected fellow, the NLM DeBakey Lecture is a cornerstone of the NLM History Talks program, which promotes awareness and use of NLM and other historical collections for research, education, and public service in biomedicine, the social sciences, and the humanities. All NLM History Talks are livestreamed globally by NIH Videocasting, closed-captioned, permanently archived, and freely available at Circulating Now have been read more than 6,500 times. This data, along with that associated with the posts authored by NLM DeBakey Fellows themselves, offers a quantitative measure by which these initiatives overall have raised public awareness of the name and legacy of Dr. DeBakey.Together, the first five annual NLM Michael E. DeBakey Lectures, from 2017 through 2021, have been viewed more than 1,500 times, and their associated posts on The NLM Michael E. DeBakey Fellowship in the History of Medicine and its related initiatives are carrying forward Dr. DeBakey\u2019s principles and practices of weaving science, technology, and the humanities to form a holistic understanding of the human condition, inspiring an ever-growing cohort of scholars to embrace his perspective by pursing well-rounded careers built on both scientific and humanistic knowledge. In stewarding this program and the legacy it represents, and no less the papers of Michael E. DeBakey himself, which document his life and career, the NLM is advancing the study of history with heart\u2014and impact."}
{"text": "Recent years have brought multiple crises and global challenges to light: financial hardships, economic crises, climate change, the COVID-19 pandemic and, most recently, the war in Ukraine (to name a few). These crises are connected to biopsychosocial and societal burden, and their management requires resilient, collaborative and positive governance in a global community. The crisis management cycle identifies preparedness, response, recovery and mitigation as important stages of dealing with crises.As prevention scientists, practitioners and policy-makers, we ask ourselves how we can contribute to this process. Naturally, prevention and health promotion are connected to the preparedness of populations as they strengthen resources and build resilience. Prevention also plays a role in response, recovery and mitigation, for example by supporting adaptive coping skills, providing psychoeducation and promoting health behaviors.Moreover, these crises are an opportunity for learning and development in our discipline. As prevention professionals, we are aware of the enormous human suffering and the potential for additional environmental harm, but we also aim to create opportunities for positive and sustainable change. Reducing physical and often also social contacts during the COVID-19 pandemic, for instance, led to innovative digital solutions and digitalized behavior change interventions to support communication, health, and healthy relationships across physical distances. The field of prevention science was forced to think about new ways to interact, conduct research and implement and evaluate interventions.As another example, the shared concern about climate change fosters new opportunities for multi-sectoral cooperation and interdisciplinary and global action, for instance, in international working groups on prevention, public and mental health, cross-continental research projects and calls to action. The most recent crisis, the war on Ukraine, reveals the potential of global digital communities and their impact on social support and the prevention of violence, crime and hate. Taken together, these challenging times tell us a lot about the human condition, from extraordinary strain to exceptional bravery and endurance.What have we, as prevention professionals, learned from these crises for our personal and professional lives, and what implications do we see for the field of prevention science?How has prevention science helped us to foresee, respond, recover, and mitigate, and how can we improve the contribution of prevention science not only on an individual but also a social, societal and even global level in the critically decisive years to come?How can research on the effective ingredients of interventions and policies be applied to rapidly emerging challenges and problems, i.e. how can we contribute to the resilience of our cultures, societies and families under immediate stress or even threat?Which directions is prevention science going in, and how are more traditional approaches and topics like individual health behavior change, and substance use, connected to global issues , policies and communities?Best practices and lessons learned from these events are also among key questions of the European Society for Prevention Research (EUSPR) in its journey with the Journal of Prevention. As a society for prevention scientists, practitioners and policy-makers across Europe, we want to explore, innovate, and improve the reach and impact of prevention from a cross-sectoral, cross-cultural and interdisciplinary perspective, for instance by preserving mental health, fostering positive and healthy youth development, and creating nurturing, sustainable and safe environments. With regards to current crises, the EUSPR asks:These are some of the questions that we would like to invite you to investigate, reflect on and discuss with us in the Journal of Prevention. Apart from these topical discussions, the Journal of Prevention also covers focused research on risk and protective factors, health and risk behaviors, determinants and etiology of positive and negative individual and social health outcomes as well as the development, implementation and evaluation of preventive interventions or local policies, the synthesis of evidence , and debates on current and future directions in the field. Together, we want to examine the current state of the art of prevention science and practice, develop and discuss ways forward into an increasingly cyberphysical future, and create sustainable networks of scientists, practitioners and the public for the future or prevention science \u2013 in Europe and beyond.COVID-19 has taught us how many lives can be lost due to misinformation, pseudoscience and inefficient narratives and false claims about science. This is why the Journal of Prevention will keep high standards on what we shall call \u201ceffective\u201d or \u201cpromising\u201d interventions but also give space to debates on upcoming topics, and a forum for those who work in applied prevention so that the practical relevance and the concrete usefulness of prevention sciences can be explained and communicated as well.One of the first messages we received from our Ukrainian colleagues in the first days of the attack on Ukraine was an appeal to help them get their children out of the country into safety. The same happened when the Spanish democracy was attacked in 1936. It is an intrinsic and innate feature of human nature to first worry and think about the safety and wellbeing of children. And this is our mission and driver: the prevention sciences can provide the ideas for action, tools and necessary innovation for everybody to be able to offer a livable future to their children, with and without the help of technology. If the Journal of Prevention succeeds in communicating this clearly and understandably, we can make a positive and optimistic contribution to our societies\u2019 resilience in this gloomy period.Finally, the researchers, practitioners and policymakers gathered in EUSPR have a need for meeting each other to exchange experiences and challenge each other\u2019s studies in forum and debate, following the pandemic. The Journal of Prevention is for this society an opportunity to document, sustain and further disseminate these debates, implying a robust upgrade of the academic discourse on prevention in and beyond Europe. We invite you to share and contribute.The Board of Directors,European Society for Prevention Research (EUSPR).https://euspr.org/."}
{"text": "Background: The outbreak of novel coronavirus disease 2019 (COVID-19) has led to tremendous individuals visit medical institutions for healthcare services. Public gatherings and close contact in clinics and emergency departments may increase the exposure and cross-infection of COVID-19.Objectives: The purpose of this study was to develop and deploy an intelligent response system for COVID-19 voice consultation, to provide suggestions of response measures based on actual information of users, and screen COVID-19 suspected cases.Methods: Based on the requirements analysis of business, user, and function, the physical architecture, system architecture, and core algorithms are designed and implemented. The system operation process is designed according to guidance documents of the National Health Commission and the actual experience of prevention, diagnosis and treatment of COVID-19. Both qualitative (system construction) and quantitative (system application) data from the real-world healthcare service of the system were retrospectively collected and analyzed.Results: The system realizes the functions, such as remote deployment and operations, fast operation procedure adjustment, and multi-dimensional statistical report capability. The performance of the machine-learning model used to develop the system is better than others, with the lowest Character Error Rate (CER) 8.13%. As of September 24, 2020, the system has received 12,264 times incoming calls and provided a total of 11,788 COVID-19-related consultation services for the public. Approximately 85.2% of the users are from Henan Province and followed by Beijing (2.5%). Of all the incoming calls, China Mobile contributes the largest proportion (66%), while China Unicom and China Telecom are accounted for 23% and 11%. For the time that users access the system, there is a peak period in the morning (08:00\u201310:00) and afternoon (14:00\u201316:00), respectively.Conclusions: The intelligent response system has achieved appreciable practical implementation effects. Our findings reveal that the provision of inquiry services through an intelligent voice consultation system may play a role in optimizing the allocation of healthcare resources, improving the efficiency of medical services, saving medical expenses, and protecting vulnerable groups. In late December 2019, a cluster of pneumonia cases caused by a new severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) were firstly reported in Wuhan, Hubei Province, China , 4. As oGiven the situation of the COVID-19 pandemic, avoiding tremendous population visits to medical institutions and realizing remote healthcare consultation and triage of patients have become the important means to allocate healthcare resources optimally, which can contribute to the control of the pandemic indirectly. To date, one of the imperative tools that have not yet been fully explored is to employ information and communications technologies (ICTs) to support social distancing and quarantine, optimal healthcare delivery, and reduction of exposure and cross-infection for healthcare professionals and COVID-19 patients , 15. IntAccording to the analysis of voice messages of users, an artificial intelligence-based voice consultation system for COVID-19 can automatically identify health consultation questions of users from different distances and then provide specific answers and response opinions \u201320. As tAccordingly, to reduce the number of non-essential in-person visits at hospitals, lessening face-to-face contact among the healthy public, COVID-19 patients, and healthcare professionals, preserving already strained medical resources, increasing service capacity of medical institutions to screen suspected cases and deliver healthcare information, and eventually help reduce the spread of COVID-19, this study has developed and deployed an intelligent response system for COVID-19 voice consultation. The system would support the functions of collecting and analyzing information of users through intelligent inquiry and interaction with users, propose suggestions of corresponding mitigation measures based on the actual situations of the users, and screen suspected COVID-19 cases. According to our knowledge, this intelligent response system is one of the first tools developed and applied on a large scale for COVID-19 in China. The findings of the present study may play a helpful role in avoiding the frequent visits of healthy people to fever clinics, improving the utilization efficiency of medical resources, and preventing and controlling the COVID-19 infection among healthy people and medical practitioners.This study intends to design an intelligent response system for COVID-19 voice consultation, which can complete user self-assessment. When users access the system, the system will ask questions about the basic information of users. Through natural language processing (NLP) technology, it dynamically adjusts the follow-up questions that need to be confirmed according to the different options selected by the user and then give corresponding response opinions depending on actual situations, which can quickly screen out COVID-19 suspected cases and offer specific suggestions for further actions. Due to the incompleteness of online consultation, the system is not connected to any healthcare systems, once a COVID-19 case is suspected, she/he will be recommended to go to the nearest COVID-19 designated hospital for further confirmation and treatment immediately. To achieve the above functions, according to the requirements analysis of software engineering, the intelligent response system needs to meet the following items.Business requirements: Build an intelligent voice consultation system for COVID-19, users can complete self-assessment by accessing the system. For related workers, the chances of contact with other people should be minimized during the development, deployment, and application stages of the system.User requirements: Users only need to make a phone call to access the system. They can complete a self-assessment about COVID-19 without going to the hospital. Through real-time voice communication, individualized assessment results and suggested response measures are ultimately obtained.a) Remote deployment and maintenance: Given the high infectiousness of COVID-19, non-contact should be the first requirement of this system, and remote operation should be achievable at all stages from deployment to application of the system.b) Accurate speech understanding: Accurate and real-time speech understanding is a key to the successful application of this system. Minor mistakes in speech recognition and understanding may lead to severe errors.c) The intelligence of the system: Each epidemiological history and personal symptoms of user are different. Using a fixed process in all consultations is not appropriate, the system should be able to dynamically and intelligently adjust its contents based on the subsequent answers of user.d) Data statistics and analysis: Statistical analysis of data from system logs and routine operation can quickly identify characteristics of users and provide suggestions for improving the consultation framework, and it is also helpful for medical staff to conduct scientific research.Functional requirements:To meet the abovementioned requirements, the physical architecture of the system is designed as shown in System administrators can access the system backstage remotely through web and then design and adjust the consultation process and configure the relevant parameters of the system. To realize subdivided medical services, the web server is open with various application programming interfaces (APIs) and can also contact with a hospital information system according to actual business needs.It contains three parts: intelligent voice engine server, load balancing, and storage server. The speech engine completes interactive services, such as speech recognition, synthesis, and understanding. The system dynamically balances services through load balancing, and the recording storage server is used to store recordings of the users.Users can directly dial the phone number to access the soft-switching system. The soft-switching system interacts with the core module through the Session Initiation Protocol and transmits the data of the conversation process to the recording storage server simultaneously.The architecture of the system is shown in This layer adopts a soft-switching system to handle different types of incoming calls. It supports multiple pathways of access, such as telephone, email, short messaging service (SMS), and Web call.This layer is the core layer of the system. Key technologies, such as automatic speech recognition (ASR), prosody recognition, pragmatic analysis, and syntax analysis are employed, which can work together to achieve multiple rounds of dialogue with the system.The background business layer does not provide services directly to users, but it is open to system administrators to support related business.This layer is in charge of functions, such as user terminal management, outgoing and incoming call tasks management, call center control, API management, and security module, which provides services directly to users and engineers of system operation.Two samples were used in the present study. Firstly, sampling the voice signal, before training the model, it is necessary to sample the sound wave to convert the analog audio signal into a digital signal, which is convenient for the computer to process. This work was completed by using the following arguments: sample rate 8 kHz, bit depth 16 bit, and bit rate 128 kbps. After sampling the voice signal, Mel-scale frequency cepstral coefficients were employed to sample features of digital signals, which was able to achieve efficient modeling of the principles of the human voice, while reducing feature dimensions. Secondly, sampling the data set of speech recognition training. Before putting the speech recognition system into practical application, one of the biggest challenges is the accent problem. Actually, there are many accents in China, and the accents from different dialect regions are quite different . To dealThe core algorithm of this system is based on multiple rounds of speech recognition. The implementation process of the algorithm is shown in Complete the conversion of speech to text by constructing a speech recognition acoustic model based on long short-term memory (LSTM). Since voice is a typical timing signal, a recurrent neural network (RNN) has strong timing modeling capabilities and therefore is suitable for voice recognition. The LSTM model is a variant of RNN, which has three more gates: forget gate, input gate, and output gate. Compared to traditional RNN, LSTM can process a longer sequence of voice data through the combination of three kinds of controllers and achieve better voice recognition. LSTM has shown state-of-the-art performance on many tasks of speech recognition \u201325. To iht from the lower maxout LSTM layer is the input xt of the upper maxout LSTM layer. These Stacked maxout LSTMs networks have the power to combine the multiple levels or representations with flexible use of long-range context. The equations of the maxout LSTM layers are as follows:Maxout units can summarize a group of spatially neighboring neurons in a lower layer that is capable of achieving the property of local translation invariance. Specifically, output i, f, o, a, and c are the input gate, forget gate, output gate, cell input activation, and cell state vectors, respectively, all of which are the same size as the hidden vector h. Wci, Wcf, and Wco are diagonal weight matrices for peephole connections, G is the group size in the maxout unit.For the equations, \u03c3 is the logistic sigmoid function, and Dividing prosodic structure based on speech and text information, such as accent classification of prosodic words, pitch analysis of phrases at the boundary of prosodic phrases, and classification of tones at the boundary of intonation phrases.Based on text recognition, text phrase structure classification, short sentence type classification, and sentence category classification are performed.The information structure of phrases, the semantic inheritance relationship among dialogue rounds, and the topic of dialogue segments are analyzed.Classifying the speech act verbs firstly, and then categorizing the response type of this round of dialogue and confirming whether it is the trigger or response. In the wake of the classification, the adjacent pair category to which this round of dialogue belongs is investigated, and according to the source of the utterance, sentence category, or information structure, the corresponding answer type is determined.Based on the results of the pragmatics analysis and combined with the current logical nodes, the next logical node can be determined, and through speech synthesis technology, a new round of dialogue can be pushed to users.According to the actual experience of prevention, diagnosis, and treatment of COVID-19, and considering the guidance documents of the National Health Commission , this stIn this system, the epidemiological history includes four types. (1) People who have traveled or contacted history of the outbreak epicenters; (2) people who have been in contact with emerging epidemic areas announced by the government; (3) people who had close contact with suspected or confirmed COVID-19 patient(s); and (4) many people around occurred symptoms, such as fever, fatigue, cough, and sore throat. After completing the consultation, the system will automatically select an appropriate opinion from the four predefined guidelines to recommend to the user. The details of the guidance opinions are summarized in The system has been developed and put into operation since March 31, 2020. People in China can access the intelligent response system by dialing the telephone number 0371-96299.With the support of necessary hardware and software environment conditions, this system can be deployed remotely, docking with local telephone lines, and then provides voice consultation services. During the operation of the system, the status of the system can be monitored remotely, and the consultation process mentioned above can also be adjusted remotely, which can avoid on-site operation and maintenance, reduce human contact, and decrease potential exposure of COVID-19.The operation procedure of this system can be adjusted quickly and efficiently according to the actual needs, and nodes can be set up based on the original process. Functional modules, such as manual transfer and SMS distribution, can be added in if required, and the remote deployment of each procedure can be completed smoothly.The system can realize the statistical analysis of disconnection reasons, the dialogue data, consultation time, and geographical distribution of users. Based on the analysis, administrators can promptly identify and adjust the current existing or newly emerging problems of the system, which can help medical staff understand and count data in relation to COVID-19 well and then take more effective countermeasures.The security module is located in the basic service layer of the system, which includes the following functions: (1) metadata management: viewing and modifying the information, such as the type, description, security level, and operation authority of each field in the data table; (2) account management: through unified management of user accounts, to make the granularity of permission control as small as possible, meanwhile, set a validity period for the permissions, and automatically recover the permissions when they expire; and (3) log management: recording and auditing the logs of account management operation, permission approval, and data access operation. Based on these functions, the security module can help the system achieves effective protection of user privacy and information security.To assess the performance of the proposed intelligent response system, 100 h of telephone voice conversation from the 12,000 h corpus were extracted as the test dataset, and the comparisons of speech recognition performances of different models were conducted. The Gaussian Mixture Models and Hidden Markov Models (GMM-HMM) model was selected as the baseline model, while the KALDI toolkit was used to train the GMM-HMM model. The Stacked LSTMs model was chosen as the state-of-the-art model, in which three conventional LSTMs were stacked, and each layer had 750 LSTM cells. In the Stacked maxout LSTMs, three maxout LSTMs were stacked, each layer had the same configurations as Stacked LSTMs. These three models were evaluated based on the same dataset.Character Error Rate (CER) was employed to evaluate the different models. CER is a typical metric of the performance of the Chinese Speech Recognition System. Through comparing the output character sequence predicted by ASR with the correct reference character sequence, CER can be computed as:Where S, D, and I are the number of substitutions, deletions, and insertions, respectively, and N is the number of words in the reference.In terms of the test results listed in Since the intelligent response system was launched, the average number of user visits per day was 69 . As of SThe geographical distribution of the incoming calls users was analyzed . Total 8The proportion of different mobile operators among users was also investigated. There are three major mobile operators in China: China Mobile, China Unicom, and China Telecom. Of all the incoming calls of the system, China Mobile with the largest proportion, and its users were responsible for 66% , while China Unicom and China Telecom were accounted for 23%  and 11% , respectively .The time distribution that when users access the system for COVID-19-related voice consultation is shown in Based on ASR, text to speech, and NLP technologies, the present study developed and initiated an intelligent response system for COVID-19 voice consultation. The functions, performance, and application effect of the system were then investigated. To the best of our knowledge, this is the first time, from the provincial level real-world practice in China, that the comprehensive account of an intelligent response system for COVID-19 voice consultation was explored. The findings of the current study may provide a helpful reference for further regional, national, and even international actions against the COVID-19 pandemic.Coronavirus Diesease-2019 is a highly infectious disease, since the officially reported emergence of COVID-19 in Wuhan, China, the epidemic scale has spread rapidly, with cases arising across China and many other countries. As of February 14, 2021, in mainland China, 89,772 confirmed COVID-19 cases were reported across 31 provinces and municipalities, with 4,636 fatalities. The COVID-19 pandemic has sharply increased the demand for medical services and inevitably exceeded the maximum supply of healthcare facilities. In China, the socio-economic development gap between different regions is huge, and the distribution of medical resources is extremely uneven. For example, although 42.65% population of China lives in rural areas, ~80% of medical resources of China are concentrated in urban areas, two-thirds of which are in megacities . This geThe high levels of human-to-human transmission, asymptomatic infection, and long incubation period are the main reasons for the large-scale epidemic of COVID-19 , 35. If The intelligent response system proposed in the present study can analyze the information about consultation content of users and the response of the system. Then according to the specific situation of the users, the system dynamically provides targeted treatment opinions and action suggestions . This maRecurrent neural networks are networks with loops in them, allowing information to persist. LSTM is a special kind of RNNs, which can learn long-term dependencies. LSTM was firstly introduced by Hochreiter and Schmidhuber in 1997 and then was further developed and popularized by many researchers , 41. LSTIn the current study, the application of the intelligent response system can achieve effective triage of outpatients, reduce public gatherings, and help control the spread of the COVID-19 epidemic. Moreover, with the help of the system, users are able to visit the nearest hospital or fever clinic according to their specific symptoms and receive appropriate diagnosis and treatment in time. These findings are consistent with other similar studies , 46, 47.Our findings showed that 85.2% of the users are from Henan Province and followed by Beijing (2.5%), while for the time users visited the system, there was a peak period in the morning and afternoon, respectively. By analyzing the time and geographical distribution information of the calls of users, the system can summarize and conclude the characteristics and habits of users, which can help to optimize the allocation of medical resources and improve both the quality of healthcare services and user satisfaction. For instance, 8:00\u201310:00 am and 2:00\u20134:00 pm are the peak periods for user visits , during As one of the latest applications of artificial intelligence and ICTs in the battle with the COVID-19 epidemic, the intelligent response system for COVID-19 voice consultation proposed in the current study has both social and economic advantages. First, the system can triage and divert relevant healthcare needs of the public, thereby, alleviating the already shortage of medical resources. Second, the voice consultation services of the system can reduce the number of fearful people visiting the hospital, avoid frequent public gatherings in medical institutions, and decrease the exposure and infection risk of healthy individuals and medical staff. Third, based on the system, healthcare facilities can save and optimize the allocation of medical resources, and improve the efficiency, capacity, and quality of their services. Fourth, the system provides COVID-19-related consultation services through telephone and voice, which is appropriate and helpful for those who cannot read or use smartphones, and of course increases the coverage, acceptability, and adherence of the intelligent voice services. In addition, through advising healthy people to stay at home for isolation and observation, in addition to reducing unnecessary consumption of medical resources and the cost of healthcare services, the system can also help users avoid expenses due to hospital visits and related transportation and accommodation. The prevention and control of the COVID-19 pandemic are multifaceted, and the intelligent response system for COVID-19 voice consultation developed and applied in this study can undoubtedly play a helpful role in reducing public gatherings, preserving medical resources, increasing the service capacity of healthcare facilities, and eventually curbing the spread of COVID-19.Some limitations of the intelligent response system in practical applications also need to be acknowledged. Firstly, the intelligent voice service functions of the system are relatively simple. It can only provide suggestions in relation to the prevention and control measures of COVID-19 based on the consultation and feedback information of users, such as personal precautionary practices, self-monitoring of body temperature at home, fever clinic visits, early detection and quarantine, and COVID-19-designated hospitals treatment, which may hardly meet the additional healthcare needs of the users. Secondly, the system is designed and constructed mainly according to or adapt to the COVID-19 epidemic situations of Henan Province. Thus, the functions and contents of the intelligent voice service may not be perfectly suitable for the prevention and control of COVID-19 in other regions in China. This can be seen from the fact that the healthcare inquiries of the system were mainly concentrated in Henan Province. The plausible phenomenon suggests that to increase the coverage and capacity of the intelligent response system, there is a need to further enrich and improve its services in the future, or do some adaption and adjustment works whenever necessary, according to the actual situations and policies where it is used. Lastly, based on the epidemiological characteristics and personal symptoms, this intelligent response system can complete the preliminary screening of users and then make relevant suggestions and guidance. However, the system only provides information for the reference of users, the COVID-19 prevention and control recommendations are neither belonging to the medical category nor can they replace the hospital doctor's diagnosis and treatment. Further research and practice works are urgently needed to address these limitations.Given the general susceptibility, high prevalence, and wide distribution of COVID-19 across the world, substantial and various public health intervention and control measures involving social, economic, and healthcare sectors, especially the vital response arrangements based on the application and analysis of real-world data are continuously warranted. Based on NLP and modern ICTs, the present study designed and deployed an intelligent response system for COVID-19 prevention and control. Through identifying and analyzing the voice information of users, the intelligent response system realized functions, such as user-oriented intelligent inquiry, screening of suspected COVID-19 cases, and targeted recommendations of response measures, which achieved appreciable practical application effects. To further improve the efficiency and quality of prevention, diagnosis, and treatment of COVID-19, in the future, the improvement and application of the system should take the actual medical service activities of clinicians into consideration. For instance, through integrating different function models into the system to promote its versatility and then to increase the capacity of the system in the battle with COVID-19. Generally, in terms of the unprecedented the COVID-19 pandemic, the provision of inquiry services through an intelligent response system in this study plays a valuable role in optimizing the allocation of healthcare resources, improving the efficiency of medical services, saving medical expenses, containing the new pandemic, and protecting vulnerable groups.The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.JS, JG, JZ, and YZ conceptualized, designed, initiated the study, reviewed, and revised the manuscript. JS, JG, and YZ drafted the initial manuscript. MY, YL, XH, FC, and QM were involved in the development of methodology and discussion of the article structure. All authors have read and approved the final manuscript as submitted.This work was supported by the National Key R&D Program of China (Grant No. 2017YFC0909901), the Natural Science Foundation of Henan Province of China (202300410409), and the Joint Construction Project of the Henan Province Medical Science and Technology Research Plan (2018) (Grant No. 2018020120). The funders played no role in the design, development, or interpretation of the present work.The views expressed in the article are those of the authors and do not necessarily reflect the position of the funding bodies.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "BACKGROUND: As endpoint of cohort studies on cancer, the incidence, rather than the mortality is preferable. Of 45 areas in the Japan Collaborative Cohort Study (JACC Study), surveys for incidence of cancer were conducted in 24.METHODS: The proportion of the study subjects aged 40 to 79 years in areas of survey for the incidence of cancer  was 58.2% of the total subjects of the JACC Study . Among the 24 areas of survey for the incidence of cancer (ASI), 10 areas were combined because of similarity. Then, we present the incidence rate of cancer among 15 ASI unified from the 24 ASI by gender according to area. We also report the completeness of the survey for cancer incidence presenting the mortality-incidence ratio (MI ratio) among the ASI.RESULTS: Where a population-based cancer registry was utilized, the MI ratio deviated from 0.31 to 0.61 in the male subjects and from 0.15 to 0.53 in the female subjects. However, where a population-based cancer registry was not used, the MI ratio deviated from 0.25 to 0.72 in the male subjects and from 0.13 to 0.79 in the female subjects, and there was an area where the MI ratio exceeded 0.70 in both of the male and female subjects.CONCLUSION: Establishment of population-based cancer registries is strongly desired throughout Japan to assess risk factors of cancer development for primary prevention of cancer. Because the established population-based cancer registries did not cover all of Japan,3 some of the ASI did not utilize these registries for identifying subjects with cancer. Where established population-based cancer registries were not available, hospital-based cancer registries or inpatient records of the hospitals treating cancer patients were used for identifying the subjects with cancer.As endpoint of cohort studies on cancer, the incidence, rather than the mortality is preferable, if risk factors have been assessed with regard to cancer development. Many cohort studies make use of existing routine surveillance systems of the incidence of cancer, such as population-based cancer registries, to ascertain the outcome of interest.4 presenting the mortality-incidence ratio by gender according to area among the ASI. We not only show the crude rates and the age-adjusted rates of cancer incidence, but those of cancer mortality by gender according to area among the ASI.We report here the number of the subjects with cancer as well as the completeness of the survey for cancer incidenceOur entire study design, which comprised singular and collective use of epidemiologic data and biological materials (serum only), was approved in 2000 by the Ethical Board at Nagoya University School of Medicine, where the central secretariat of the JACC study is located.Of 45 areas in the JACC Study, surveys for incidence of cancer were conducted in 24. Among them, 10 areas were located in the same prefecture in Kyushu, and were surveyed by the same institution, utilizing a population-based cancer registry. Consequently, we combined these 10 areas, and present the data of 15 ASI unified from the 24 ASI by gender according to area in As tools to survey for cancer incidence, population-based cancer registries were utilized in 11 out of the 15 ASI, and hospital-based cancer registries or inpatients\u2019 records of hospitals treating cancer patients were used in the remaining 4 ASI. Although the tentative end of observation was in 1997 in 14 of the 15 ASI for this article, it was in 1994 in an area because of incidental interruption in the survey for cancer incidence, as shown in Excluding the subjects who had cancer before the baseline survey, we present the numbers of the study subjects, the dead subjects, the subjects dead who died from cancer, and the subjects with incident cancer during the periods of observation by sex according to area in 4,5 Ideally, completeness should be close to 100%, so that comparison of rates among areas will reflects true differences in the risk of cancer and not artifacts of the survey process. Generally, however, most ASI would have the possibility of incompleteness due to failure to identify and include incident cancers. Completeness is assessed by measuring the percentage of the subjects with cancer identified from the death certificate only (DCO%), the percentage of the subjects with cancer first notified via death certificate (DCN%), and the mortality/incidence ratio (MI ratio). Although the DCO% and the DCN% could not be estimated because of lack in relevant information, the MI ratio was evaluated as shown in Completeness of survey for incidence of cancer is defined as the extent to which all the incident cancers occurring in a target population are included for the study subjects.5 of incident cancers. As shown in If the MI ratio exceeds 0.70, it is usually a signal of under-registration67 standardized to the 1985-model Japanese population.8 The age-adjusted rates of cancer incidence varied from 344.14 to 1187.97 in the male subjects and from 216.83 to 597.00 in the female subjects. Likewise, the age-adjusted rates of cancer mortality varied from 95.66 to 607.64 in the male subjects and from 33.89 to 265.55 in the female subjects.Cancer incidence varies strongly with age. Hence, standardization of age increases the ability to compare rates of cancer among different areas by distribution of age.9 standardized to the 1985-model Japanese population,8 as well. As a result, the age-adjusted rates of cancer incidence were 751.21 and 429.77 per 100,000 in Japanese males and females, respectively. Consequently, the medians of the age-adjusted rate of cancer incidence in the males  and the females  of the 15 ASI were very much close to the above figure.For comparison to the whole Japanese population, we calculated the age-adjusted rate of cancer incidence with reference to the data for age-specific rates of cancer incidence for those aged 40 to 79 years in 1993 in Japan,10 standardized to the 1985-model Japanese population,6 as well. As a result, the age-adjusted rates of cancer mortality were 436.08 and 204.42 per 100,000 in Japanese males and females, respectively. Accordingly, the medians of the age-adjusted rate of cancer mortality in the males  and the females  of the 15 ASI were slightly lower than the above figure. Because the study subjects were not only selected from the participants of health check-up program in some areas, but also they were probably liable to examine their symptom at medical institution, earlier detection and treatment might cause relatively higher rate of cancer incidence and lower rate of cancer mortality among them.Similarly, for further comparison to the whole Japanese population, we calculated the age-adjusted rate of cancer mortality with reference to the data on age-specific rates of cancer mortality in persons aged 40 to 79 years in 1995 in Japan,6 That is, mortality rates do not meaningfully reflect incidence rates, especially, in cancers with a favorable prognosis like skin, thyroid, breast, and prostate cancer.Because death registries are available in the whole areas of the JACC Study, most of the previous reports of the JACC Study made use of the cancer mortality for the outcome. However, it is well known that mortality rates depend on prognosis or survival.6 However, only 58.2% of the study subjects were involved in the ASI of the JACC Study, and considerable variations were observed in the MI ratio of the survey for incidence. Therefore, the findings from the results of analysis of the subjects with incident cancer should be reported with the MI ratio of Incidence rates provide the clearest measure of the burden of carcinogenic exposures at the population level.The present investigators involved, with the co-authorship of this paper, in the JACC Study and their affiliations are as follows: Dr. Akiko Tamakoshi (present chairman of the study group), Nagoya University Graduate School of Medicine; Dr. Mitsuru Mori, Sapporo Medical University School of Medicine; Dr. Yutaka Motohashi, Akita University School of Medicine; Dr. Ichiro Tsuji, Tohoku University Graduate School of Medicine; Dr. Yosikazu Nakamura, Jichi Medical School; Dr. Hiroyasu Iso, Institute of Community Medicine, University of Tsukuba; Dr. Haruo Mikami, Chiba Cancer Center; Dr. Yutaka Inaba, Juntendo University School of Medicine; Dr. Yoshiharu Hoshiyama, Showa University School of Medicine; Dr. Hiroshi Suzuki, Niigata University School of Medicine; Dr. Hiroyuki Shimizu, Gifu University School of Medicine; Dr. Hideaki Toyoshima, Nagoya University Graduate School of Medicine; Dr. Shinkan Tokudome, Nagoya City University Graduate School of Medical Science; Dr. Yoshinori Ito, Fujita Health University School of Health Sciences; Dr. Shuji Hashimoto, Fujita Health University School of Medicine; Dr. Shogo Kikuchi, Aichi Medical University School of Medicine; Dr. Akio Koizumi, Graduate School of Medicine and Faculty of Medicine, Kyoto University; Dr. Takashi Kawamura, Kyoto University Center for Student Health; Dr. Yoshiyuki Watanabe, Kyoto Prefectural University of Medicine Graduate School of Medical Science; Dr. Tsuneharu Miki, Kyoto Prefectural University of Medicine Graduate School of Medical Science; Dr. Chigusa Date, Faculty of Human Environmental Sciences, Mukogawa Women\u2019s University ; Dr. Kiyomi Sakata, Wakayama Medical University; Dr. Takayuki Nose, Tottori University Faculty of Medicine; Dr. Norihiko Hayakawa, Research Institute for Radiation Biology and Medicine, Hiroshima University; Dr. Takesumi Yoshimura, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan; Dr. Akira Shibata, Kurume University School of Medicine; Dr. Naoyuki Okamoto, Kanagawa Cancer Center; Dr. Hideo Shio, Moriyama Municipal Hospital; Dr. Yoshiyuki Ohno, Asahi Rosai Hospital; Dr. Tomoyuki Kitagawa, Cancer Institute of the Japanese Foundation for Cancer Research; Dr. Toshio Kuroki, Gifu University; and Dr. Kazuo Tajima, Aichi Cancer Center Research Institute."}
{"text": "According to the World Health Organization (WHO), in June 3, 2021, there were 171,292,827 confirmed coronavirus disease (COVID-19) cases and 3,687,589 deaths. In addition, by June 2, 2021, a total of 1,581,509,628 vaccine doses had been administered worldwide , creates a predictable interval of three to four months that allows the resumption of the various activities as well as the economy of these locations, enabling companies and governments to plan within this new productive context.However, some nations and regions insist on another type of social isolation, the partial lockdown, which, unfortunately, has a greater permissiveness that produces a slight effect on the incidence, as part of the population adheres to the process, although the majority, mainly the denialists, do not comply with restrictive and protective measures such as the use of masks, prohibition of mass gatherings (parties), and others .The problem with this process is the impossibility of planning the economic recovery by the authorities  and companies because of the incidence of cases and deaths remaining in continuous flow, as in Brazil, with no quantitative reduction that allows the return of general activities in adequate safety conditions, for example, the resumption of schools for face-to-face classes.This type of measure may please companies and politicians, as it allows the economy to be in apparent operation. However, there is no way for certain segments to continue, especially if involving mass gathering, as they can generate unprecedented growth in the incidence, as has occurred in Brazil in the current context, after the various holidays at the end of the year and reduction of preventive measures adopted by some localities.p-value<0.0001, corroborating the hypothesis that non-pharmacological measures, including social distance, are fundamental for the protection of people and for the resumption of the economy.The United States  adopted In this sense, we realize the inexistence of the paradigm that national economies can fail because of the lockdown , althougUnfortunately, we need to reinforce the issue that preventive measures are important and that they do not lead to the collapse the economy if properly coordinated by the authorities.Economic collapse can occur because of the uncontrolled growth of the disease without producing herd immunity. However, the development of more contagious and lethal variants, in addition to the expenses that could be avoided, such as the treatment of patients and deaths, purchasing equipment and supplies, and days of not going to work, might not exist if there was an effective national public health policy to combat this disease.All authors affirmed that they contributed to the development of the manuscript. Fujita DM designed the study, collected data, and wrote and edited the manuscript. Nali LHS designed the study, collected data and discussed the results. Salvador FS contributed to the investigation, methodology and manuscript review. Luna EJA performed the analysis and reviewed the manuscript."}
{"text": "The last and corresponding author Saeed Amini is affiliated with institutions 4 and 5, as shown in author list of this Correction, and not with institutions 3 and 5, as initially shown in the original article.Furthermore, institution 4 is the Department of Health, Khomein University of Medical Sciences, Khomein, Iran, as shown in the \u201cAuthor details\u201d section of this Correction, and not the Department of Health Services Management, Khomein University of Medical Sciences, Khomein, Iran, as initially shown in the original article.Following the publication of the original article , it was The original article has already been corrected as above."}
{"text": "We share with great sadness that our long-time friend and colleague Prof. Dr. Hans-Dieter Klenk passed away on 1 June 2021, at the age of 82. With the passing of Hans-Dieter Klenk, the worldwide virology and infectious disease community is losing one of its most eminent representatives who has shaped the scientific landscape of these disciplines for decades.Hans-Dieter Klenk studied medicine and biochemistry in T\u00fcbingen, Vienna and Cologne. From 1967 to 1970 he started his outstanding scientific career as a visiting scientist in the laboratory of Purnell W. Choppin at the Rockefeller University in New York. In 1973, back in Germany, he was appointed as a Full Professor in Virology at the Justus Liebig University of Gie\u00dfen, and in 1985 he became the Chair of the Department of Virology at the Philipps University of Marburg. He held this position until his retirement in 2007. It did not come as a surprise to any of his colleagues, friends and family, he continued to serve science in many ways until his death.Prof. Dr. Klenk has decisively shaped Germany\u2019s virology with a strong international orientation and visibility. Under his leadership, numerous scientists not only had the opportunity to develop their own scientific careers, but were also appointed in leading positions at national and international institutions in academia, industry and government. He used the power of new molecular, genetic, biochemical, and cellular methods to study viruses and identify the functions of their specific genes and proteins. Directly associated with the name Hans-Dieter Klenk is the very successful research work on influenza viruses, in particular the role of the surface protein hemagglutinin in the pathogenesis of influenza infections. In addition, other zoonotic viruses that threaten public health as emerging viruses, such as Ebola, Marburg and Lassa viruses, were of great interest to him. He founded the BSL4 laboratory in Marburg and gave the Department of Virology a completely new infectious disease research direction, which has been highly successful and competitive and is still very actively pursued today.Prof. Dr. Klenk served as the president of the German Society for Virology from 1999 to 2005. He has been the vice-president of the von Behring-R\u00f6ntgen-Stiftung, Gie\u00dfen-Marburg, since its foundation. He coordinated numerous scientific consortia, including the highly successful Collaborative Research Center SFB 286 of the German Research Foundation (DFG), and was active on editorial boards of multiple scientific journals with specific involvement in the establishment of the journal Emerging Microbes & Infections (EMI). He served as an advisory board member for many scientific institutions including but not limited to the Georg-Speyer-Haus, the Feldberg Foundation for Anglo-German Scientific Exchange, the Institute Pasteur of Shanghai, and the Institute of Medical Microbiology, Fudan University. After his retirement, he specifically invested time supporting Chinese virologists in collaboration with leading scientists in China.Hans-Dieter Klenk was an intellectual leader in his field, in the pantheon of virologists, for many decades. He has received numerous highly respected scientific prizes for his work, among those the Robert Koch Medal, the Ernst Jung Medal for Medicine and the Emil von Behring Prize. In addition, he was awarded the Grand Cross 1st class of the Order of Merit of the Federal Republic of Germany in 2018.His death weighs heavy on our hearts and minds as we all will miss this outstanding and visionary scientist, this strong and commanding leader, this supportive and respectful mentor and advisor, and this straightforward, humorous, and generous person that he was until the very end.Our deepest and sincere sympathy goes out to his wife Ulrike, their three sons Christoph, Philipp, Alexander, and the entire extended Klenk family.Our sincere gratitude to Hans-Dieter Klenk whose science and personality has shaped our careers and lives."}
{"text": "Mindfulness journal ranked first for the most published articles and citations. \u201cThe benefits of being present: Mindfulness and its role in psychological well-being,\u201d written by Brown and Ryan, was the most cited article. Mindfulness, meditation, depression, intervention, stress reduction, stress, and anxiety are the top co-occurrence keywords. The timeline of cluster analysis discloses that before 2010, hypertension, cancer, mindfulness, generalized anxiety disorder, and other topics received great attention. In the decade since 2010, scholars have shown interest in meta-analysis, attention, and self-assessment, and keen attention to mindfulness-based interventions. These findings provide an important foundation to direct future research.This study comprehensively summarizes research in the field of meditation, especially mindfulness meditation from 1900 to 2021, by analyzing the knowledge map through CiteSpace and VOSviewer software. Using \u201cmindfulness *\u201d or \u201cmeditation *\u201d as the topic, articles included in the Science Citation Index Expanded and Social Sciences Citation Index were searched in the web of science core database, resulting in the selection of 19,752 articles. Over half a century ago, Deikman published the field\u2019s first article in the Journal of Nervous and Mental Disease in 1963, and publications have soared in subsequent decades. The USA is in the core position in terms of global collaboration, total publication numbers, and total citations. The  Meditation is comprised of a family of self-regulation practices that train attention and awareness to bring mental processes under greater voluntary control to thereby foster general mental well-being and development, and/or specific capacities such as calmness, clarity, and concentration . Among tIn recent decades, the research on mindfulness and meditation has developed rapidly, and a variety of topics have emerged ,6. For eTherefore, an analysis of the development, current status, and the relationships between key points and important events of the mindfulness and meditation literature is essential to inform the direction of future research.Bibliometrics is the cross-disciplinary science of quantitative analysis of all knowledge carriers by mathematical and statistical methods . It is nThe aim of this study was to reveal the inner structure pattern and citation landscape of mindfulness and meditation publications from a general perspective. CiteSpace and VOSviewer were used to analyze annual publication outputs, publication distributions by country and institution, author productivity, and collaboration patterns to provide an informed perspective on the evolution and development of mindfulness and meditation as a scientific discipline. Moreover, analyses of document co-citation networks, research clusters, and reference citation bursts were performed to offer insights into research topics and trend evaluations over time from different perspectives, thereby facilitating future research.Science Citation Index Expanded (SCI-E) and Social Sciences Citation Index (SSCI) articles from 1900 to 2021 (4 March 2021) were searched, with \u201cmindfulness *\u201d or \u201cmeditation *\u201d as the theme, in the Web of Science Core Collection. Considering that mindfulness is an important part of meditation classification and the focus of the current research, and there is a mixture of mindfulness and meditation concepts in some studies ,28,29, \u201cCiteSpace 5.3.R4  and VOSviewer 1.6.16  were used for knowledge mapping analysis. CiteSpace is a Java application for analyzing and visualizing co-citation networks . It suppVOSviewer is a software tool developed for constructing and viewing bibliometric maps. It constructs a map based on a co-occurrence matrix .In the visualizations, one node represents a project (such as an author or a country), the size of the node reflects its importance , and the color of the node signifies the group according to the default clustering method. Network connections denote collaborations between projects. The line width represents the intensity of collaboration. In this study, we used VOSviewer to make country collaboration, inter-institution collaboration, co-authorship, and co-citation networks.Before analyzing the results, all the inconsistencies in the bibliographic data were standardized and corrected. These inconsistencies appeared due to errors in the process of capturing the WOS data, abbreviations, and mistakes made by the authors in the references. For example, to prevent classification errors, we uniformly revised the expressions cognitive behavior therapy, cognitive behaviour therapy, cognitive behavioural therapy, cognitive-behavior therapy, and cognitive behavioral therapy to cognitive-behavioral therapy. The inconsistencies were checked by the first author. See Journal of Nervous and Mental Disease in 1963 [Meditation emphasizes mental development, such as bhavana  in Buddhism and lien-hsin (refining the mind) in Taoism. In Western definitions, meditation is a self-regulation strategy with a particular focus on training attention . The fir in 1963 . Eight sIn addition to Deikman\u2019s research, Kabat-Zinn played an important role in the promotion of meditation. Among the top 10 most frequently cited articles, Kabat-Zinn contributed 3 articles . See During the century from 1900 to 1999, only 625 meditation articles were published . Journal of Personality and Social Psychology (JPSP) by Brown and Ryan (2003) [n (2003) , was citn (2003)  and \u201cMinn (2003) , rankingPsychological Inquiry (1370 citations). Baer published highly cited articles in Assessment (2849 citations) and in Clinical Psychology-Science and Practice , while Kabat-Zinn wrote impactful papers in CPSP (2553 citations) and General Hospital Psychiatry (1666 citations).Among the top fifteen most cited publications, three authors contributed two articles each. For example, Brown published two highly cited articles in JPSP (4585 citations) as well as in Journal of Consulting and Clinical Psychology , which publishes articles regarding prevention and treatment in all areas of clinical and clinical\u2013health psychology, and especially on topics that appeal to a broad readership. The journal addresses a wide range of topics that include epidemiology, the use of psychological services, as well as healthcare economics of behavioral therapy.The most cited source journal is JPSP, which publishes original papers in all areas of personality and social psychology, including attitude and social cognition, interpersonal relations and group processes, as well as personality processes and individual differences. Three highly cited articles were from CPSP , the official publication of the American Psychological Association Division 12, the Society of Clinical Psychology. The journal publishes papers regarding developments in the science and practice of clinical psychology and related mental health fields. Two articles were from the The total number of publications, total citations, and CP (citations/publication) can be used to analyze the impact of papers published in leading countries. The countries producing the most publications on mindfulness and meditation were the USA, England, Australia, Canada, Germany, the People\u2019s Republic of China, The Netherlands, Spain, Italy, and India . The USANine of the ten most prolific institutions in the mindfulness and meditation field were located in the USA. The top three institutions were Harvard University, the University of Toronto, and the University of Washington. The top three institutions for total citations were Harvard University , the University of Massachusetts , and the University of Toronto , while articles from the University of Massachusetts (86.56), the University of Toronto (56.81), and the University of Wisconsin (51.24) generated the highest CP .Mindfulness Journal began recently, in 2010, as a journal dedicated to the mindfulness field, it has published the largest number of articles (1288), followed by Frontiers in Psychology (442) and Annals of Behavioral Medicine (269). Mindfulness ranked first in total citations , followed by Behavior Research and Therapy (9601 citations) and Personal and Individual Differences (6084 citations). Behavior Research and Therapy ranked first in CP (76.81), followed by the Journal of Clinical Psychology (54.39) and Consciousness and Cognition (38.33). Three articles were cited more than 1000 times, and these were Hayes et al. (2006) [Behavior Research and Therapy (2327 citations), Shapiro et al. (2006) [Journal of Clinical Psychology (1273 citations), and Davidson et al. (2003) [Psychological Medicine (1237 citations).. (2006)  from Behchology 4 and Anna. (2003)  from PsyThe results of our analysis of collaborations among countries (regions), institutions, and authors are presented in Link strength, literature quantity, and citations are the indicators of collaborative degree. The number of literature access was set to 30, and 264 of the 10,495 institutions meeting the standards were displayed. Keywords represent the highly concentrated content of literature research. The co-occurrence frequency of keywords can reflect dynamic trends of mindfulness and meditation research. Keywords with high frequencies reflect the focus of the research field. They identify advanced research methods, hot issues to be solved urgently, or academic topics of interest in particular timeframes.If two items (such as articles) are cited together in the references of a cited item, they are co-cited. The number of co-citations can be used to measure the similarity and correlation between articles. Journal co-citations, article co-citations, and keyword co-citations can be analyzed according to different project contents.Through the analysis of co-cited documents, we can obtain a knowledge base of a particular field. The research frontier is composed of a collection of cited literature that comprises these knowledge bases.The VOSviewer identified 96,779 journals. A co-citation relationship is defined by the simultaneous citations of two papers in a third paper . ReferenNext, the literature was divided into clusters. The log-likelihood test algorithm was used to extract nominal terms from the keywords of the cited literature and to name the clusters . To bettPublications receiving a surging citation frequency reflect emerging trends in scientific research fields. Citation bursts suggest increased scholarly attention to the corresponding publications. CiteSpace provides burst detection that can detect large changes in the number of citations in a particular timeframe, and is used to identify the declining or increasing use of a topic word or keyword. Our study provided a comprehensive perspective of the evolution and development of mindfulness and meditation literature. By using bibliometric methods and customized text mining techniques, we analyzed distribution , collaboration , and document co-citations .Journal of Nervous and Mental Disease. Consequently, mindfulness and meditation research have a long history. However, the numbers of mindfulness and meditation-related publications fluctuated at low levels during the 20th century. Since 2004, the number of publications has increased by more than 30% every few years. The citation rate has increased by more than 30% in over half of the years since 2002. At the same time, the prevailing trend in mindfulness and meditation literature has been towards increased collaboration among countries, institutions, and authors.First, the number of publications and citations may reflect the overall development of the mindfulness and meditation field. No papers on mindfulness and meditation were published until over half a century ago, when Deikman  publisheSecond, from the perspective of distribution, the USA has been the center of global collaboration, and its strength of cooperation has been much higher than that of other countries. The USA also has led other countries in total numbers of publications and citations. However, Canada ranked first in the CP. From the perspective of research institutions, Harvard University ranked first in total numbers of publications and citations, while the University of Massachusetts ranked first in the CP. Nine of the top ten institutions in the global field of mindfulness and meditation are located in the United States. Harvard Medical School has been at the center of inter-institution collaboration. Taken together, our data indicate that the USA is in the core position in the field of mindfulness and meditation.Mindfulness ranked first for the most published articles and citations. However, Behavior Research and Therapy ranked first in the CP. From the perspective of journal co-citation analysis, JPSP has the most co-citations and the largest link strength, followed by Mindfulness. Brown and Ryan are the most cited authors, due to multiple citations of their article: \u201cThe benefits of being present: Mindfulness and its role in psychological well-being\u201d [Third, in terms of the influence of journals and authors, l-being\u201d .Fourth, keyword analysis disclosed that in general, physical and mental health disorders such as depression, anxiety, stress, emotion regulation, and quality of life have been the primary research foci in the field of mindfulness and meditation, which reflects its wide therapeutic applications. At the same time, a large number of randomized controlled trials and meta-analyses have been completed. Researchers have also paid attention to validity of measurement tools and the mechanism of mindfulness and meditation.Mindfulness, and JCCP are the leading journals in the field of mindfulness and meditation. The common concerns of scholars include reviews and meta-analyses of the clinical utility of mindfulness and meditation, and these include the classic articles by the developers of MBSR, MBCT, and ACT, and mindfulness-related questionnaires. The timeline of cluster analysis discloses that before 2010, hypertension, cancer, mindfulness, generalized anxiety disorder, and other topics received great attention. In the decade since 2010, scholars have shown interest in meta-analysis, attention, and self-assessment, and keen attention to mindfulness-based interventions. The development of MAAS and FFMQ questionnaires and the studies of the clinical efficacy of mindfulness and meditation showed the strongest bursts. A review of the effect of MBCT on preventing recurrent depression showed the earliest citation burst.Fifth, JPSP, Recently, another article using the bibliometric method to analyze mindfulness hotspots was published . In contCitation bursts reflect the emerging trends in scientific research fields and suggest the future directions. Tang et al., (2015)  showed tIt is essential to pay attention to misinformation and poor methodology in previous mindfulness studies, with a particular focus on assessment, mindfulness training, possible alternative effects, and intersection with brain imaging in the future . ScholarFurthermore, effectiveness studies that carefully consider how to reach out to communities of need with evidence-based, cost-effective, and sustainable mindfulness interventions are needed in the coming years . The timAlthough meditation can be roughly divided into focused attention meditation and open monitoring meditation, it is difficult to separate specific meditation techniques , so the subcategories of meditation were not compared in this study.The names of the clusters were obtained by extracting terms from the keywords of the references through the log likelihood test algorithm. Since over 19,752 articles were identified, it was impossible for the authors to refine and analyze the content of each article. Since the articles were not randomly checked as to whether they are related to the topic, this may be problematic because some terms, such as meditation, have multiple meanings in English, some of which are irrelevant. Another major limitation is that the search was limited to databases  that mainly include English publications, excluding most journals published in other languages. This will bias the results. For example, if Chinese or Korean databases were included, the results may be very different from those of a large number of papers in East Asia.As an interdisciplinary science of quantitative analysis, bibliometrics can predict the status and development trend of mindfulness and meditation. Despite these advantages, it cannot recommend which method is better through indicators such as effect size, as in meta-analysis. Furthermore, bibliometric analysis is mainly based on the abstract, title, keywords, and references, without checking the full text of the paper, which also affects the final results.In conclusion, this study provided a comprehensive review and intuitive analysis of publications related to mindfulness and meditation from 1900 to 2021. Using two effective bibliometric tools, VOSviewer and CiteSpace, this paper analyzed status and development trends of this field from many perspectives, and may inform future research in the field of mindfulness and meditation."}
{"text": "Handbook of Positive Youth Development: Advancing Research, Policy, and Practice in Global Contexts edited by Profs. Radosveta Dimitrova and Nora Wiium combine theory, empirical research, and practical considerations for relevant policy and practice. The volume includes 37 distinctive chapters covering a multitude of theoretical and methodological approaches with youth and young adults from diverse cultures, ethnics, and sociodemographic backgrounds. With unique samples and global approaches to research, policy, and practice, this volume presents the most inclusive collection of Positive Youth Development (PYD) among youth and emerging adults to date.The The introductory chapter provides an overview of the main models of PYD, namely, the developmental assets , one of the leading scholars in PYD research and intervention, especially in Asia. In his brief overview, Shek summarizes several unique features and relevant conceptual and methodological contributions. Next, all 37 chapters are organized along with two major categories with empirical contributions, including a substantial number of youth and emerging adults  in major geographical continents, many of which are neglected in the research literature on adolescence. Part I, Positive Youth Development in Global Contexts; Part II, Positive Youth Development Applications and Interventions were structured to represent first, the most neglected cultural contexts and populations around the globe. The final chapter by John Geldhof, Svea Olsen, and Asia Thogmartin , leading PYD scholars in the U.S. and globally, represents an overview of the contributions to the PYD field, with a relevant outlook for research, policy, and practice. This volume represents a valuable scholarly resource for students, researchers, lecturers, and practitioners, interested to promote and advance PYD scholarship globally and specifically in underrepresented contexts.This volume begins with a handbook may be useful for social scientists, psychological, mental and public health professionals, researchers, practitioners, and youth leaders interested in promoting PYD from a variety of disciplines .The editors recommend this exciting volume to students, researchers, specialists, and stakeholders, such as policymakers who are committed to improving the lives of young people globally. This The author confirms being the sole contributor of this work and has approved it for publication.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "With the unprecedented expansion of COVID-19 in the world since December 2019, Iran\u2019s health system, like other countries, faced various challenges in managing the disease, which led to numerous experiences and lessons learned. This study was conducted to identify these challenges regarding unique political, economic, and cultural issues, which could help other countries with similar situations.The present study was performed using a qualitative multi-method approach with a content analysis method. The data were collected through in-depth and semi-structured interviews and focused group discussions with 60 key persons who were selected purposefully, including policymakers, health care workers, and affected people by the disease, and the review of all available national reports between February 21, 2020, and March 22, 2021. The data collection and analysis were done simultaneously.Identified critical challenges for the management of COVID-19 in the health system were limited evidence and scientific controversies, poor social prevention and social inequalities, burnout and sustained workload among healthcare workers, improper management of resources and equipment, the lack of a guideline for contact tracing, and patient flow management, and mental health problems in the community.According to our results, measures should be taken to conduct a continuous comprehensive risk assessment and develop a national response plan with an emphasis on precise contact tracing, active screening, patient flow, paying attention to the psychological and social dimensions of the disease, and also transparency of social inequalities in the face of risk factors of the COVID-19. Also, the social protection programs should become a vital tool for policymakers and supporting the vulnerable groups using the capacity of the community and international cooperation to develop a vaccine, which is difficult to procure due to the sanctions. The pandemic of coronavirus disease 2019 (COVID-19) has led to a high rate of morbidity and mortality and imposed a burden of billions of dollars [The rapid spread of the disease with several waves and peaks for around a year and a half has imposed a lot of pressure on the health system and the other parts of the community worldwide. Many health care professionals are on the front lines of battling the COVID-19 public health crisis, and many hospitals are overwhelmed with suspected or infected cases of COVID-19. This global pandemic can be characterized by the complexity of its origin, the speed of its spread, and the unpredictability of its scale and impact . QuarantThere is still significant ambiguity as the pandemic continues to evolve. COVID-19 vaccines have started to be rolled out in countries worldwide, but this does not mean the crisis is close to being solved or people can return to normal life . We are On February 19, 2020, Iran confirmed two patients that were infected with the COVID-19 in Qom city, and more cases were reported in Tehran in a few days later . The sprThe present study was carried out with a multi-method approach using qualitative content analysis to explore a deeper understanding of the experiences gained from managing COVID-19 in Iran. The study was started with a focus group discussion (FGD.) with 60 key persons in five groups of people with different experiences and backgrounds from various departments to explore the health system\u2019s challenges to manage COVID-19 in Iran. These FGDs were conducted at two intervals of 3\u2009months, started in August 2020.Following FGDs and to develop the explored concepts, in-depth individual interviews were conducted. It is noteworthy that according to the rules of social distance at the time of the COVID-19 outbreak, the interviews were conducted by telephone or via Skype. A total of 60 people participated in FGDs, of whom 30 cases were recruited for in-depth interviews. The study participants were selected purposefully and sampling was continued until saturation  between February 21, 2020, and March 22, 2021.Simultaneously with data collection, qualitative content analysis was performed through the Graneheim and Lundman approach. In addition to the content of the selected documents and reports, the text of the FGDs and interviews was also transcribed and then, read several times, and the key points and concepts related to the objectives of the research were identified. Data were analyzed concurrently with data collection using content analysis. Interview transcripts were read to grasp participants\u2019 perceptions and then, the meaning units were identified and coded with conceptual labels. Preliminary coding was performed and then, the codes were permanently compared in terms of similarity and difference. After this stage, each set of similar codes developed sub-categories and categories, and finally, challenges were explored \u201314.This study has several strengths. The information was collected and analyzed since the first time the country formed the Coronavirus Headquarters . Also, to improve the study power, the multi-method approach, including individual interviews, FGDs, and document analysis, was used.To evaluate the trustworthiness of the findings, Guba and Lincoln\u2019s criteria, including credibility, transferability, dependability, and confirmability were applied . The resTo explore the challenges to manage COVID-19 in Iran, 60 people from different disciplines were studied  Measures to change the health behaviors of the community and improve self-care; 2) Social distance plans; and 3) Active screening, finding patients, and isolating COVID-19 cases, which were not wholly fulfilled.These interventions caused Iran to have acceptable success in the relative control of the first wave of the COVID-19 for several weeks. Our results showed that despite the efforts made, due to the limited evidence and scientific controversies, severe sanctions, the insufficient preparedness of society and the health system, lack of a plan for risk communication and community engagement, and after an early reopening, challenges arose in the management of the disease and the number of deaths and hospitalized people has increased for several times. The challenges explored by the study were classified into six main categories: the limited evidence and scientific controversies, inadequate attention to political, social, cultural, and economic issues and community involvement, burnout and sustained workload of health care workers, improper management of the resources and equipment, lack of updated and agreed guidelines for contact tracing and patient flow, and long-lasting community mental health problems and shortcomings in the support of vulnerable groups by the society.The nature of the COVID-19 and the way(s) it had spread globally are still unknown, which has led to the rapid spread of the disease in different countries. The transmission potential in asymptomatic, symptomatic, mild, and severe cases remains unknown. In some cases of COVID-19, we face inconsistencies between laboratory diagnosis and clinical and radiographic findings. In line with this part of the results, some studies have focused on the unknown nature of the virus and its complex etiologies , 17.In the early onset of a pandemic, there were discrepancies in the recommendations from health authorities, such as the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) . The undThe political, social, cultural, and economic status of society was recognized as an influential factor. Social and religious norms, especially in traditional societies, affect the level of exposure of people. The existence of religious and traditional ceremonies that are accompanied by crowds has been an influential factor, and these aggregations have made social distancing measures more difficult , 25. TheIn some cases, some people due to poor economic conditions have not been able to provide disinfectants and masks, making it impossible to break the chain of infection. During the pandemic, different countries, based on their cultural needs and financial ability, have used different strategies and programs to control the disease. In India, the announcement of a nationwide home quarantine for 3\u00a0weeks from March 26, 2020, and the help of police forces to prevent people from leaving their homes, closing cultural and religious centers, stopping the tourism industry, and holding some popular Indian sports, such as cricket without spectators were some actions to control the disease . The impThe intensive work of health care providers during COVID-19 physically and emotionally has made them exhausted . AdequatIn this regard, Brazil has listed the benefits of official employees and employers from the short-term work programs supported by the government and unemployment insurance and payment for the first 15\u2009days of sick leave to the employees who have tested positive for COVID-19. India has also allocated medical insurance for health care providers . In GermImproper management of resources and equipment was found to be one of the most effective barriers to control COVID-19 in this study. Several studies have also shown the importance of supply chain impact and resource scarcity \u201337.Equipment, such as PPE, ventilators, oxygen, and diagnostic kits should be available to control the disease . ProvidiContact tracing is an essential control measure to break the chains of COVID-19 transmission . BecauseFinally, to manage the next wave of the disease, it is recommended to make a clear decision on when to reopen educational centers, monitoring the implementation of social distancing protocols, establishing more strict and serious rules for traffic restrictions, quarantine of contacted and vulnerable people, real-time exchange of information with establishing a trustable communication with the people to educate and accompany them for quarantine and social distancing. Providing appropriate and timely social support for vulnerable groups can decrease the number of patients and deaths. Supporting the country to procure vaccines at least for vulnerable groups by the international community can help the health system to manage the next coming waves or peaks.Some limitations should be considered when interpreting the results of this study. The main limitation of this study like other qualitative studies is the lack of generalizability of the results, which is related to the nature and philosophical assumptions of the qualitative paradigm, which our study is not an exception. Because of the pandemic, it was not possible to do face-to-face interviews, which could help to explore more in-depth experiences of the study participants and probe unclear points of view. Moreover, some health care workers and policymakers were reluctant to participate in the study and share their experiences, and finally, some related reports were not available for analysis. To overcome these limitations, we tried to use the triangulation approach for data gathering, including FGD, in-depth individual interviews and document analysis, and selecting participants with maximum diversity of experiences.The results of this study indicated that considering the scientific controversies and using trustworthy evidence, paying attention to the political, social, cultural, and economic situation, burnout and sustained workload of health care workers, effective management of the resources and equipment, developing updated and agreed guidelines for contact tracing and patient flow, and planning for mental health in the community, and national social protection program are crucial factors to manage COVID-19. Assessing these challenges in the health system in response to COVID-19 can improve the knowledge of service providers and can be served as a primary framework for planning by the health system to enhance readiness to manage this long-lasting and devastating event and similar situations. This study indicated the need for public participation in the whole process of disease management, paying attention to social inequality in the face of the disease, and the need to address various aspects of the disease to deal with the disease. Continuous risk assessment, predicting possible scenarios for similar conditions, and developing a comprehensive national response plan are also recommended. Longitudinal studies are needed to fully understand the symptoms, the time of the pathogenesis, and the long-term effects of the disease on health and psychological, social, and other dimensions. Moreover, transparency of social inequalities faces risk factors so that sometimes economic resources are not eligible enough to provide adequate support to different groups in the society, especially vulnerable people. In Iran, extensive sanctions and insufficient resources have reduced the access of vulnerable groups to the vaccine, needed resources, and services. We believe that the complete transfer of disease management to the health sector has sometimes led to a lack of attention to other influential aspects of the disease, such as economic, social, and cultural dimensions. Countries that reopened early without a reduction in transmission rate are suffering from new spikes of contamination. However, countries that quarantined quickly and rigorously could control the virus more effectively. Finally, a strong risk communication strategy should remind citizens that the pandemic is not over, and also international collaboration is critical for manage this devastating pandemic."}
{"text": "The Clark Tibbitts Award lecture will feature an address by Debra Dobbs, PhD, FGSA in memory of the 2021 award recipient, Kathryn Hyer, PhD, FGSA. AGHE's Clark Tibbitts Award was established in 1980 and named for an architect of the field of gerontological education. The award is given each year to an individual or organization that has made an outstanding contribution to the advancement of gerontology and geriatrics education. The Hiram J. Friedsam Award lecture will feature an address by the 2021 award recipient, Pamela Elfenbein, MSW, PhD, FAGHE, HS-BCP. Hiram J. Friedsam was the professor, co-founder, and director of the Center for Studies in Aging and dean of the School of Community Service at the University of Northern Texas. Dr. Friedsam was an outstanding teacher, researcher, colleague, and mentor to students, faculty, and administrators, as well as a past president of AGHE. The purpose of this award is to recognize those who emulate Dr. Friedsam's excellence in mentorship."}
{"text": "International Journal of Women's Dermatology (IJWD), everyone agreed that making our reach as inclusive and international as possible was critically important. The WDS has members from five continents and, to that end, both the IJWD\u2019s editorial board and advisory board also have international representation across the globe, including Argentina, Australia, Brazil, Denmark, France, Iran, India, Israel, Germany, Greece, the Philippines, and the United States. What does international actually mean? According to the Oxford English dictionary, international means \u201cacross several countries\u201d; hence, the inclusion of articles from North America among articles from South America, Europe, the Middle East, Asia, and Oceania does not mean that articles contributed from the United States are not international. Otherwise, the term international would be misrepresented in a U.S.-centric view of the world.When the board of the Women's Dermatologic Society (WDS) voted in 2013 to approve the proposal by board members Drs. Dedee Murrell and Jane Grant-Kels to explore the feasibility of developing the Within the IJWD, our focus is not just on the skin and hair disease of women and their families, but also on issues faced by women in the field of dermatology in their careers. Dermatology is one of the most competitive fields of medicine to gain entry into and requires top grades in medical school, research and publications, and connections to go beyond just training and into a successful academic, public hospital, or private practice career, along with hopefully a good personal life. The IJWD's January 2020 issue focused on the gender gap in academic dermatology and the supporting the personal and professional lives of female dermatologists. The IJWD March 2021 issue focused on skin of color and diversity and inclusion initiatives. Both issues highlighted many of these aspects for patients and dermatologists alike .Another way that the IJWD and WDS foster the careers of women in dermatology is to enable them to submit and publish interesting case letters, research letters, clinical pearls, editorials, review articles, and original research to our journal. In this issue, our signature piece, the Women's Health Highlight, comes from India regarding an issue very important to women: hirsutism . We alsoInternational Journal of Dermatology, whose editor is also an Egyptian woman, Dr. Rokea el Azhary, from the Mayo Clinic. Cindy was born in Princeton, New Jersey, and was a Fulbright scholar in French-speaking Guinea, Africa. There, she met her future husband, who also became a Fulbright scholar in the United States. Cindy ran the ISD almost single handedly for many years. She died tragically in a car accident in Maryland  Froehlich . For morMaryland .The ISD's mentorship program, currently co-chaired by IJWD editorial board members Prof. Rashmi Sarkar from India and Dr. Martin Kassir from Dallas, has supported both female and male dermatologists from poor countries to learn from experts in other countries for periods of up to 3 months . Cindy w"}
{"text": "Conclusions: The approval lag of vaccines was observed in the Asia-Pacific region, indicating a gap between the Asia-pacific region and the US and EU in regard to access to new vaccines. Future studies need to analyze the background factors related to the gap in availability and vaccine approval lag in the Asia-Pacific region and assess the impact of vaccine approval lag in the region.Background: The introduction of new vaccines has been delayed in some countries in the Asia-Pacific region, which has led to delays in accessing vaccines for target patients. However, the approval lag of vaccines in the Asia-Pacific region has not been assessed. The objective of this study is to assess the availability and approval lag of vaccines in Asia-Pacific countries and compare them among Asia-Pacific countries, the United States (US), and Europe (EU). Methods: The information on vaccines prequalified by the World Health Organization (WHO) between 2010 and 2019 was obtained primarily from the WHO website. The date of approval of the WHO prequalified vaccine in Australia, India, South Korea, Thailand, Singapore, Malaysia, the US, and EU was retrieved from the official website of national regulatory agencies. The vaccines were divided into two groups based on their first approval pathway, that is, vaccines that were first approved by SRA  and those that were first approved by non-SRA. The absolute approval lag represented the availability of the vaccine. Relative approval lag represented the lag time between the approval date of the country of interest and the first global approval date and was measured as the median approval lag. A Mann\u2013Whitney U test was used to examine statistical differences between relative approval lag between the SRA first and the non-SRA first groups. Results: A total of 92 vaccines were prequalified by the WHO between 2010 and 2019, but only 61 vaccines were included in the analysis. Over 50% of vaccines were first licensed by non-SRAs. Of all the WHO-prequalified vaccines, the median approval lag in the ASEAN countries in this study was longer than those in the US and EU, with a median of 30 months in Australia, 15 months in South Korea, 52 months in Thailand, and 23 months in Singapore, compared to 0 months in the US and EU. The differences in approval lags between SRA first vaccines and non-SRA first vaccines were statistically significant in South Korea and Thailand ( Nearly two-thirds of the world\u2019s population live in the Asia-Pacific region. The region has a high diversity in cultural, political, economic, and other areas that influence vaccine development, implementation, and registration ,2. In thHowever, the transformation was not equal across countries, and high-income and low-middle income countries still have different vaccine development, implementation, and registration processes. The differences in vaccine development in the region include all steps of vaccine innovation, production, and consumption. The region includes China, India, Indonesia, and Vietnam, which are eligible countries or graduate countries from the Global Alliance for Vaccines and Immunization (GAVI), a global public\u2013private health corporation to help poor countries obtain access to vaccines with full financial support . HoweverThere is a delay in the introduction of new vaccines in some countries in the region . The delAsian-Pacific countries do not have a central regulatory approval process like the European Medicines Agency (EMA) in Europe or the Pan American Health Organization (PAHO), which coordinates regional vaccination programs and centrally purchases eligible vaccines . The divThere are several efforts to streamline regulatory requirements between countries and regions. There are also efforts to encourage mutual recognition practices between national regulatory authorities in an effort to preserve resources and time and avoid redundancy in Asia . For exaVaccines are a highly cost-effective intervention to prevent infectious diseases with rare serious adverse reactions . EffectiDespite the fact that understanding drug lag for vaccines is crucial for public health, there is no comparative study on the approval lag of vaccines in the Asia-Pacific region. We fill the gap in the literature and evaluate the availability and approval lag of vaccines in Asia-Pacific countries and compare among Asia-Pacific countries, the US, and EU.We collected information on vaccines that were prequalified by WHO between 1 January 2010, and 31 December 2019. The WHO prequalification is a systematic process to assess and ensure that healthcare products comply with international standards of quality, safety, and efficacy . WHO preInformation about commercial names, vaccine types, and dates of prequalification was retrieved from the WHO website. Information about the date of approval of the WHO prequalified vaccine in selected Asia-Pacific countries, the US FDA, and EMA was retrieved from the official websites of the drug approval agencies for each country .There were prequalified 92 prequalified vaccines between 1 January 2010 and 31 December 2019. We excluded different doses of the same vaccine products and used the fastest prequalified date among different doses of the same vaccine. We excluded vaccines that do not have proprietary brand names because of the difficulty encountered in collecting approval data and approved dates. Ultimately, 61 vaccines were evaluated in the present study .http://www.who.int/medicines/regulation/sras/en/ (accessed on 22 January 2021)) and those that were first approved by non-SRA (non-SRA first). The stringent regulatory authorities (SRA) are the national regulatory agencies, which are the members or observers, or associates of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) [The 61 vaccines we extracted were divided into two groups based on their first approval pathway, that is, vaccines that were first approved by the stringent regulatory authority (SRA first) (the stringent regulatory authority (SRA) Australia, Austria, Belgium, Bulgaria, Canada, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Japan, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland, United Kingdom, and United States of America . Organizse (ICH) .The vaccine approval date refers to the date of regulatory approval by the national regulatory authorities, including the US Food and Drug Administration (US FDA), the European Medicines Agency (EMA), the Therapeutic Goods Administration in Australia, the Central Drugs Standard Control Organization (CDSCO) in India, the Ministry of Food and Drug Safety (MFDS) in South Korea, the Thai Food and Drug Administration in Thailand, the Health Sciences Authority (HSA) in Singapore, and the National Pharmaceutical Regulatory Agency (NPRA) in Malaysia.We assessed and described the approval lag in terms of \u201cabsolute approval lag\u201d and \u201crelative approval lag\u201d. Absolute approval lag is the percentage of newly approved vaccines in the countries of interest out of the total number of all studied vaccines. Relative approval lag is the delay in approval in a study country after the drug\u2019s first approval .p-value of \u22640.05 was considered to indicate statistical significance. Statistical analysis was performed using SPSS version 25 .Continuous variables were shown as the median and range, and categorical variables were shown as the number and percentage. The median was used to compute drug lag, as it is less sensitive to extreme values than the average. The Mann\u2013Whitney U test was used to examine the statistical difference between the relative approval lag between the SRA first and non-SRA first groups. A Characteristics of WHO-prequalified vaccines are summarized in The absolute approval lags of the studied vaccines are shown in Vaccines first approved and manufactured in the US or the EU are available in all selected countries. Those approved and manufactured in India are available in all selected Asian countries and EU, and those approved and manufactured in South Korea are licensed only in their own country and ASEAN, including Thailand, Singapore, and Malaysia .Diphtheria\u2013tetanus\u2013pertussis, hepatitis A, influenza A meningococcal, pneumococcal, and rotavirus vaccines were licensed in all selected countries. Among all vaccine types, influenza vaccines accounted for the largest proportion of the studied WHO-prequalified vaccines . South Korea approved 60% of the studied WHO-prequalified influenza vaccines . The Ebola vaccine was only approved in the US and EU, while Japanese encephalitis vaccines were only approved in Asian countries .Relative approval lags of the studied WHO prequalified vaccines are summarized in The relative approval lag of WHO prequalified vaccines by vaccine type is shown in The difference in relative approval lag between the SRA first and non-SRA first groups was examined only in India, South Korea, and Thailand because non-SRA first vaccines were not available in the US and because of the lack of approval date data for non-SRA first vaccines in other countries. Our findings showed that the difference between the relative approval lag between SRA first and non-SRA first groups in South Korea and Thailand is statistically significant .This study aims to evaluate the availability of vaccines and the delay in access to vaccines in Asia-Pacific countries. Our results found that the non-SRA first vaccines were over a half of the WHO-prequalified vaccines, with 34.4% and 16.4% being first approved by India and South Korea, respectively. Usually, the vaccine manufacturing country is the first country to approve the vaccines. India and South Korea are members of the Developing Countries Vaccine Manufacturers Network (DCVMN), which has the capacity to manufacture and supply high-quality vaccines at affordable prices. The DCVMN plays an important role in supplying vaccines in developing countries , which aFor the relative approval lag of all vaccines and SRA-first vaccines, the Asia-Pacific countries have a longer relative approval lag than the US and the EU. Our finding of the longer approval lag in Asia compared to the US and EU was consistent with previous studies that assessed the approval lag in cancer drugs in India , inflammSoutheast Asian countries, such as Thailand, Malaysia, and Singapore, use the ASEAN (the Association of Southeast Asian Nations) Common Technical Dossier (CTD) format ,25,26, wThe approval lag in the SRA first group in Thailand is shorter than those in the non-SRA first group. This may be because the SRA is more strict in requirements and review for approval than non-SRA, and, in Thailand, pharmaceutical products that have already been approved by the SRA can use an accelerated process to speed up the registration of vaccines . This waPneumococcal vaccines have the shortest median approval lag. Pneumococcal infection is one of the major vaccine-preventable diseases  and a maDue to the difficulty of collecting vaccine approval data and approval dates, some data may be missing, especially for Malaysia and India. These countries have no online searchable databases for vaccines; the approval data from India was obtained from a summary of product characteristics, and the approval data from Malaysia was obtained from a Registered Product List. The challenge in data collection resulted in the small sample size in the analysis. Therefore, the relative drug lag in some countries might not represent the actual relative drug lag in those countries. The analysis of possible reasons behind the delays in approval of vaccines in the Asia-Pacific region is not conducted in this study, due to the limitation of data available. The same question needs to be addressed for vaccine approval for coronavirus disease (COVID-19) in future studies.The SRA has more facilities and experts to review vaccines for marketing authorization compared to the non-SRA. The marketing authorization in SRA is usually faster than in non-SRA, and thus, people in the SRA can get access to vaccines faster than in the non-SRA. At the same time, the case of Australia and India need further attention. India has quick access to the vaccines it manufactures while Australia has a slow marketing authorization process compared to India, Singapore, or Korea . This obRegardless, our study has merit by showing the approval lag of vaccines in the Asia-Pacific region, indicating a gap between the Asia-Pacific region and the US and EU in regard to access to new vaccines. Vaccination is a cost-effective intervention and one of the most successful methods to prevent infectious diseases and improve health status. Access to vaccines can also save time and money and reduce the social and economic burden of the disease. Therefore, continued efforts to reduce the approval lag for vaccines are essential for public health in the region. Future studies need to analyze the background factors related to the gap in availability and vaccine approval lag in the Asia-Pacific region and assess the impact of vaccine approval lag in the region.The gap in vaccine availability may be attributed to the incidence and disease burden, financial resources, and inclusion in national immunization programs. The vaccine approval lag in the Asia-Pacific region may be attributed to the differences in vaccine development and registration process in between countries and regions, low disease attention and awareness, low disease incidence and burden in the region, and the non-national immunization programs vaccines."}
{"text": "The space station is a large-scale and comprehensive research facility capable of long-term human habitation in near-Earth space, with systematic support by space transport and widely covered tracking, telemetry, command and communication. It allows extensive and long-term research under the special conditions of space and responds to urgent scientific needs in space in a timely manner.\u2009000 experiments have been conducted, including large-scale scientific research and important technology verification, opening new research directions for space life science and human science, as well as microgravity science that uses microgravity conditions to study the movement of matter and basic physical laws. These experiments also expanded research into space astronomy, solar system science, Earth science, the space environment and new technology, thus playing an irreplaceable role in the human understanding of nature, and promoting scientific and technological advances.Since the first manned space flight in 1961, two emerging trends have influenced international human space activities. The first trend is manned space exploration represented by the remarkable Apollo program that landed astronauts on the moon. To date, some human space projects have ambitious plans to explore the moon and beyond. The second trend is space science research performed by astronauts in space. Dozens of space laboratories and space stations have been launched, such as the Salute series laboratory, Skylab, the shuttle-borne series laboratory, Mir Space Station and International Space Station currently still in operation. About 20In the past, the development of space science in China was limited by the small scale of space activities and the lack of opportunities for space experiments. Now, construction on the China Space Station (CSS) has begun, with the core module launched in 2021. It will become the most important near-Earth space laboratory for China and the world in the next 10 years. As a result of China's 30-year effort in manned projects, the CSS offers the opportunity for large-scale scientific research that will benefit Chinese scientists and their international peers.Space life science and human research will investigate the nature of life phenomena and their reactions to microgravity conditions, biomedical issues relating to long-term space exploration, and biotechnology for maintaining human health. Microgravity physics will focus on fundamental physical laws, as well as basic research for application in fluid mechanics, thermophysics and combustion and materials science, with a goal of supporting ground industries. Space astronomy and Earth science will aim to deepen our understanding of dark matter, dark energy, compact objects, galaxy formation and evolution, and the global changes of the Earth. New space technology will develop and verify a new generation of space technology for science and space application.Research in four areas has been planned for the CSS. In order to support research in various fields, the CSS is developing major supporting research facilities such as the 2-meter-diameter China Sky Survey Telescope and the High Energy Cosmic-Radiation Detector. Fourteen experimental racks and three extravehicular exposure devices have been deployed, including the Life and Ecology Research Rack, Biotechnology Research Rack, Fluid Physics Research Rack, Cold Atom Physics Research Rack, High Precision Time-Frequency System, High-Temperature Materials Research Rack, Container-Free Materials Processing Rack and Combustion Sciences Research Rack. Further scientific planning and upgrading of experimental devices will continue in the future.The CSS is fully open to international researchers, and guides for the open solicitation of research proposals will be regularly issued. International scientists may submit proposals through the China Manned Space Engineering Office, the United Nations Committee on the Peaceful Uses of Outer Space, or national space agencies under bilateral cooperation agreements.Chinese scientists look forward to extensive cooperation with scientists around the globe, and hope that research activities in the CSS will make a unique contribution to our collective understanding of nature. Through effective dissemination of scientific findings, CSS research programs will promote an understanding and passion for science to the general public, especially to young people."}
{"text": "Similarly, guidelines for cancer treatment and reference to the WHO List of Essential Medicines are specified in the cancer-related plans of 53% (82 of 155) and 30% (45 of 150) of countries, respectively.3 Beyond service delivery, other health system building blocks such as health workforce, financing, and governance issues remain poorly addressed. Consequently, cancer care is often fragmented and difficult to navigate.Despite many low- and middle-income countries (LMICs) advancing in the development of national cancer control plans, governments are often constrained in their capacity to deliver on the full spectrum of cancer services with most plans unfunded. A study of publicly available cancer-related plans from 158 countries found that a mere 45% (70 of 155) of countries have specified radiotherapy services in their plans.4 This built on UICC's advocacy efforts to advance global resolutions for palliative care and an expanded essential medicines list, adopted by the WHO Member States in 2014 and 2016, respectively, as well as the overarching Cancer Resolution adopted in 2017.In response, the Union for International Cancer Control (UICC), with its network of more than 1,100 member organizations, established a new program of action to mobilize and engage civil society in driving access to cancer treatment.9 These measures were evidence of readiness to support core cancer services, evidence of an active civil society and engagement with other sectors, and evidence of progress in the implementation of national commitments to cancer and NCD control measures.First launched in 2017, the city-based initiative City Cancer Challenge leveraged the reputation of UICC as a trusted civil society partner with the power to convene diverse stakeholders. Through its extensive global membership in LMICs, relationships with patient groups, national cancer institutes, cancer registries, professional associations, and industry partners, UICC was able to rapidly engage a first set of so-called key learning cities. Specifically, Asuncion, Paraguay; Cali, Colombia; Kumasi, Ghana; and Yangon, Myanmar, were selected against three measures of readiness assessed using data collected by WHO, other UN Agencies, and UICC members reporting on cancer and NCD control.The convening of the major decision makers in the cancer care ecosystem in these cities provided the initial impetus for creating a locally led, multistakeholder, and multilevel governance approach to assess local needs and design data-driven solutions to cancer care. With City Cancer Challenge Foundation (C/Can) established as a standalone foundation in 2019, and now operational in nine cities . The recognition of the role of cities in achieving the Sustainable Development Goals through goal 11 has provided an alternative framework whereby global, national, and local health goals are aligned and cities are vehicles of implementation. In this way, cities' proximity to local users and providers is best used to drive locally led solutions that are context-specific. City-led initiatives for hypertension, tobacco control, and diabetes,19 Georgia is a key example wherein the current health care system is a blend of privately owned hospitals and state-owned small-scale health care providers.20 Taking a multisectoral approach to address fragmentation in care and improve the quality, standardization and financial coverage of cancer care were identified by local stakeholders as major priorities in Tbilisi through the city-wide needs assessment, which involved 174 professionals from 27 institutions including the Ministry of Refugees and Accommodation of Georgia, Tbilisi City Hall, the National Center for Disease Control and Public Health of Georgia, and the Georgian Patients Union. An agreed objective was to increase accessibility to internationally recognized treatment standards for oncologic patients and, specifically, to reduce out-of-pocket spending on cancer services. The response was that in 2020, the Government of Georgia announced the expansion of cancer medicines covered by the Universal Healthcare Program together with an increase in financial coverage per patient, per annum.21 The approach in Georgia underscores how coordinated engagement and collaboration across sectors can help to address collective priorities and, more broadly, in this case, to support the Government of Georgia's commitment to provide universal health coverage.22 Moreover, it supports the adoption of a multilevel governance approach  to promote dialogue and inform priority setting. This approach can also be a catalyst for filling city-level gaps and securing investment in public health services, by communicating data-driven priorities to regional and national governments. This was the case in Colombia, whereby the city-wide needs assessment involving 186 health professionals in Cali highlighted gaps in access to cancer services in the public system and health system fragmentation.23 In alignment with the national strategy24 and international best practices,25 this prompted a feasibility study for the implementation of a Comprehensive Cancer Care Center within the reference tertiary public hospital, which services the entire Valle del Cauca region. As a result, Colombia's Ministry of Health and the regional government of Valle del Cauca have jointly supported the creation of the center through investment in infrastructure and equipment for medical imaging, radiotherapy, and pathology to strengthen existing services and meet future demand.27As the complexity of health systems grows, and with the increasing presence of private oncology providers, intersectoral partnerships and facilitated stakeholder communications can promote the elimination of cancer-related inequities.29 Even with this support, however, ongoing threats to implementation must be managed. For example, the strains placed on the national health system and local health professionals by the global coronavirus pandemic require new strategies to support local leaders to sustain activities.Maintaining high-level commitment, even during changes in political leadership, is central to sustainable system improvements as well as financing and delivery of outcomes. In Paraguay, a change in President in 2018 risked deprioritizing cancer in the national health agenda and withdrawal of support for C/Can's activities in Asuncion. Through strong leadership from the bipartisan City Executive Committee (convened by C/Can) and targeted communications, the first national cancer law was adopted under the new government's leadership.Finally, community partnerships are critical in developing solutions that respond to the needs of the most vulnerable. Local governments and providers have everyday contact with health care professionals and patients with cancer and their families and are closest to their concerns and priorities. Across C/Can's first seven cities, more than 900 patients and 1,200 health care professionals have been engaged in the city needs assessment process. Additionally, local professional associations, patient associations, and civil society representatives are engaged from the outset as part of the local decision-making structure.30 responds to the urgent need to reduce inequities in access to breast cancer diagnosis, multimodality treatment, and palliative care services. The development of these guidelines provides a roadmap to improve the coordination of cancer care and supports cities to lead on gender-responsive policies that meet the specific needs and barriers to care faced by women in their communities. Importantly, these local efforts can be scaled through initiatives such as the WHO Global Breast Cancer Initiative and Global Strategy to Accelerate the Elimination of Cervical Cancer.32All C/Can cities have demonstrated readiness and commitment to adopt these enablers through a memorandum of understanding between government authorities, civil society, and C/Can. This agreement also commits cities to lead on collaborative, evidence-informed planning and execution of city-level projects that will drive common goals to improve cancer outcomes. In the case of Yangon, by the end of 2020, resource-appropriate breast and cervical cancer guidelines and multidisciplinary team methodologies in pathology, pain management, and radiotherapy have been developed through the C/Can process with city and national stakeholders and international experts. These collaborative efforts also formed the basis for a new resource, which will be scaled to all cities. The guide for developing resource-appropriate breast cancer management guidelines, developed in partnership with the Breast Health Global Initiative,29 Specific attention is given to the actions taken to activate, strengthen, and multiply effective health services, workforce, and infrastructure. Three papers in this series address pathology, radiotherapy, and multidisciplinary care and collectively show how C/Can applies a multistakeholder and multilevel governance approach to respond to cities' needs. Case studies will also be used to showcase knowledge exchange between individuals, institutions, and cities on planning and uptake of best practices and highlight common challenges to successful implementation.Informed by these insights garnered in the first cities, this special series presents the C/Can approach as it currently stands following 4 years of iterative and adaptive change. The first paper in the series provides a detailed assessment of this framework, specifying the activities at each stage, as well as the outputs, processes, and practices across the lifecycle of the intervention.In the final paper, C/Can's fit-for-purpose Monitoring, Evaluation, and Learning Framework to measure progress and impact over time will be described. Integral to an ongoing process of continuous learning and iteration, the framework is designed to provide data-driven insights into what is working well, as well as what adjustments may be needed to drive improvements in the approach.As C/Can continues to validate this city-led approach, further refinement will be required. Technical cooperation to strengthen each of the six pillars of the health system is at the core of C/Can's model. As C/Can grows its reach, the unique needs of each new city require recalibrating the delicate balance between increasing efficiency by replicating existing city solutions and further customization of technical cooperation offerings for local context. Second is a further understanding of the complex adaptive nature of health systems. In the current context with all cities managing the additional strain of the global pandemic, C/Can will need to go beyond the six pillars and focus on their interconnectedness and the political, social, and economic influences affecting health system resilience in each city. Third is the need to build data capacity at the individual, institutional, and policy levels. Quality data are a prerequisite to be responsive to the local context and leverage the expertise, resources, and commitments of C/Can's network stakeholders and partners. Experience of running data collection processes in seven of the nine cities has highlighted the challenges of collecting quality systems-level data. These include low levels of data literacy, lack of organizational processes for the ethical use and sharing of data, and policy barriers to effective and responsible use of systems data. As an emerging area of work, in 2021, C/Can is piloting new data quality processes and policies as well as a customized data platform. A collaboration with the University of Malaya, Greater Petaling, will explore how to support data-and-analytics activities at scale in C/Can cities in ways that build local data capacity and inform policy change.C/Can will continue to integrate on-the-ground learnings to scale, adapt, and validate its approach, and contribute to a robust evidence base for the effective implementation of locally adapted cancer care solutions in LMICs."}
{"text": "The Association of Southeastern Biologists was founded in 1937 with the goal of increasing the contact and collaboration between scientists in the southeastern United States (US). With the exception of two years during World War II and one year during the COVID-19 pandemic, the Association has met annually to promote research and education in the biological sciences by providing a student-friendly networking environment. In recent years, the Association has placed an increased focus on diversity, equity, and inclusion among elected and appointed leaders, among participants in the annual meeting, and in the development of funding and other opportunities for students. This work prompted us to review the history of our Association, including periods of racial segregation and inequity, and focus on our current efforts to promote access and inclusion by students and scientists from myriad underrepresented groups. In so doing, the past provides us with the opportunity to cast a vision for the future of the Association. In this paper, we seek to share the journey of the Association of Southeastern Biologists in this regard so that we may be transparent, exposing the missteps and amplifying the successes of our organization. We envision this work as a first step toward creating a more open and inclusive scientific community for the future. Professional societies play a critical role in disseminating scientific discoveries and forging collaboration among scientists. These organizations typically fall into two categories: 1) national or international organizations with large meetings that move across a broad geographical area or 2) smaller statewide and regional meetings and organizations. To our knowledge, since its founding in 1937, the Association of Southeastern Biologists (ASB) has been the only scientific association that spans the entire Southeastern US and is one of the largest regional, multi-disciplinary biological associations in the country. The ASB operates with the goal of increasing contact and collaboration between scientists in the region, representing biologists from many sub-disciplines, including student, faculty, and non-academic professionals. While the ASB prides itself on being a working association with an active and engaged membership, the past several years have served as a period of reflection on our growth and values, specifically as they relate to diversity, equity, and inclusion. Upon reflection, we feel that the ASB, as a broad-reaching organization, is uniquely positioned to drive change not only within our own association but across academic institutions represented within the ASB, and our practice may serve as a model to other scientific societies.As we in the ASB leadership reflect on our history , we encoTo better foster communication between biologists in the Southeastern US, the ASB was officially established as a scientific association at an invitational meeting at the University of Georgia in 1937 . The inaHistories of the ASB  acknowleIn the 1950s, adherence to Jim Crow Laws would, unfortunately, limit participation of Black scientists in ASB functions. In 1954, Dr. James H.M. Henderson, a plant physiologist from Tuskegee University, was denied registration to the annual meeting held in Baton Rouge, Louisiana . Dr. HenRacial integration of the ASB would not occur until the late 1950s. In 1958, Dr. Lafayette Frederick, a Black plant biologist then at Southern University in Baton Rouge, Louisiana, was recommended to attend the annual meeting of the ASB in Gainesville, Florida . He tookvia the 1990 American Institute of Biological Sciences (AIBS) Conclave of Presidents. The event, held in Washington D.C., was attended by ASB President Frank Day. In his \u201cA View from Here\u201d column, A key turning point in the ASB\u2019s efforts in diversity, equity, and inclusion came ASB members were involved in organizing and presenting at the 41st Annual Meeting of AIBS in Richmond, Virginia. Included in this meeting were a symposium, roundtable, and reception focused on minorities in biology . In thatad hoc committee on Women, Minority, and Handicapped Affairs that was tasked with organizing \u201cactivities and programs which encourage and enhance the involvement of underrepresented groups in biology\u201d  complete a comprehensive strategic plan for the Association that clearly integrates diversity, equity, and inclusion throughout; 2) pursue an external assessment of the Association\u2019s diversity, equity, and inclusion activities; 3) increase engagement of members with disabilities to improve accessibility to both content and activities; 4) collaborate with HBCUs and other Minority Serving Institutions (MSIs) currently active in the ASB to strengthen and build additional partnerships; 5) engage first-generation and underrepresented students and their mentors in the application process for diversity, equity, and inclusion support awards; and 6) pursue external funding for mentorship activities.The ASB was established in the segregated South, and it is clear that past actions of the Association caused harm to established and incipient scientists. Lasting social change must come from within, and it is guided by the actions of individuals. As we move forward, we recognize that there are still many more steps that the ASB must take in order to be truly supportive of all of its members. These efforts include working to be actively anti-racist, to provide support and mentoring opportunities for historically excluded students and faculty, to value and champion diversity within our scientific society, and to fight for equality and inclusivity in our communities. To truly achieve these steps, we acknowledge that we need to continue to be reflective, build on the expertise of scientists and individuals working to address diversity, equity, and inclusion issues within our association and more broadly, and to honor the legacy of our past heroes and champions within the ASB, including Dr. Mary Stuart MacDougall, Dr. Lafayette Frederick, and others who helped break down barriers that prevented the ASB from being a truly inclusive organization. In closing, we invite all members of the ASB and ASB\u2019s friends, partners, and affiliates throughout the Southeastern US to join us in these efforts."}
{"text": "Background: Coronavirus Diesease-2019 (COVID-19) outbreak has led to the suspension of the activities of dental schools. Therefore, reorganizing clinical settings and supporting services as quickly as possible has received much attention to reopen dental schools. The present study aimed to evaluate the applicability of the Intervention Mapping (IM) approach for designing, implementing, and evaluating an intervention program to prevent and control COVID-19 in dental schools.Methods: Following the IM protocol, six steps were completed in the planning and development of an intervention, targeting, and management of Dental School during the COVID-19 pandemic.Results: The information obtained from the needs assessment revealed that the COVID-19 outbreak prevention was associated with the use of personal protective equipment by all target groups, infection control measures taken in the environment, preparation of the environment and equipment, changes in the treatment plan according to the COVID-19 pandemic, changing the admission process of patients, and reduction of attendance of target groups in the school are linked with. In this study, determinant factors affecting the COVID-19 prevention at the individual level were identified based on the Protection Motivation Theory (PMT). In this program, various methods, such as presentation of information, modeling role, and persuasion measures, were utilized and the practical programs included educational films and group discussions implemented.Conclusions: Our findings indicated that intervention in dental environments on the basis of the IM process can develop a comprehensive and structured program in the dental school and hence can reduce the risk of the COVID-19 infection. In recent months, the high prevalence of the new coronavirus disease-2019 (COVID-19) is considered an international public health concern (Due to the high transmissibility of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), close contact between the patients and dentists, nature of dental procedures , 4, and The activities of dental schools have been resumed by imposing some restrictions from June 21, 2020 in Iran due to the educational needs of students and the medical needs of patients. Given the vast number of patients and their close contact with students, teachers, and staff in the dental schools, some managerial, educational, and environmental interventions are necessary to be implemented for the protection of all stockholders. To reopen the schools, it is required to provide immediate educational, clinical, and support services .The Centers for Disease Control and Prevention (CDC), American Dental Association (ADA), and WHO have provided some effective practical guidelines for controlling the prevalence of COVID-19 in dental settings . HoweverIt is a protocol that helps to design multilevel health promotion interventions and selects appropriate implementation strategies . IM consStep 1: Conducting needs assessmentStep 2: Specifying change objectivesStep 3: Selecting theory-based methods and practical strategiesStep 4: Developing program componentsStep 5: Specifying implementationStep 6: Generating evaluation plan .Steps 1\u20134 focus on the presentation of multilevel interventions for improving health behaviors and environmental conditions.In the first step of IM, planners evaluate assets and needs.At this stage, all representatives, such as executives and those who are responsible for protecting the intervention, were involved in the program to determine required measures for implementing the program and identifying determinants (obstacles and facilitators). To involve patients in the program, a committee called the COVID-19 Prevention Committee at the School of Dentistry (CPDS) was formed on May 21, 2020. The members of this committee consist of the representatives of the students, the chairman of the infection control committee of the school, representative of the university teachers, staff representative, manager of the nursing office, patient representative, an IT official of the school, representative of the department of financial and administrative affairs of the school, the head of public affairs, the dean of the school, and some SHS2020 standard company's representatives. The recognized stakeholders were in both individual and environmental levels. The team manager (Head of the School) determined the responsibilities of each team member and the decision-making structure. During this session, the members of the three teams, namely, education, infection control, and logistics, were separately assigned for performing relevant activities.To assign all actors, barriers, and potential facilitators of implementing the intervention, it was necessary to conduct a needs assessment. For this reason, the brainstorming method was used in CPDS, and the results of the previous regular evaluation that have already been conducted in the school were applied. Moreover, the environmental conditions were observed and evaluated.At this point, social, epidemiological, and behavioral-environmental analyses were performed. The needs assessment of the present study was focused on the school as the target group, such as teachers, students, staff , and patients. This entailed a review of literature on determinants and factors associated with the prevalence of COVID-19 in dental settings and the role of behaviorally and environmentally predetermined risk factors in the rise of the prevalence of COVID-19 and its determinants. The committee used the experimental data, theoretical references, and collected new data  to prepare a list of behavioral and environmental risk factors affecting the spread of COVID-19 and its determinants. In this phase, recognition of the school capabilities was achieved.At this stage, CPDS identified the expected changes in the behavioral and environmental factors, which were already determined in the needs assessment stage. The prioritization of behavioral and environmental consequences was performed according to their importance and variability by literature review and the consensus between the members of the CPDS committee. Afterward, functional objectives were determined for each behavioral and environmental consequence and their determinants, and a matrix of change objectives was plotted for each program level. We used brainstorming, a review of literature, and constructs of health promotion theories to identify the determinants.In this step of CPDS, the brainstorming method and literature review were used to identify the appropriate methods and strategies affecting the determinants in step 2. During this process, a summary of the theoretical methods proposed by Bartholomew et al. was applied . SpecialIn this step, the intervention content was proposed by the CPDS team, and the protocols of implementation, activities, and training materials were produced. The cultural adaptation of these programs was conducted through consultation with the program stakeholders. Then, the scope, sequence, communication channels, themes, and a list of required materials were provided and documented. Meanwhile, a review of the existing training materials was performed to determine whether the training materials have already been consistent with the objectives of this program or not. Afterward, the required training materials were produced and pre-tested.At this step, the potential adopters and implementers of the program were identified. A review of the transplantation system (CPDS) was also performed. Then, the functional objectives of adoption, implementation , and program survival were identified. In the next stage, the determinants of adoption, implementation, and survival of the program were determined using the brainstorming method and literature review. Based on the importance and variability, the prioritization of the change objectives was conducted. Then, appropriate methods and strategies affecting the determinants of adoption, implementation, and survival of the program were selected, and the intervention was designed and developed to use the program.In the final stage of IM, a plan was provided by the planners to evaluate the effectiveness and quality of the intervention . In the A checklist was designed for the evaluation of behavioral and environmental factors, performance objectives, determinants, and change objectives. A checklist was also designed for the process evaluation. Evaluation indicators and criteria were determined, and the evaluation plan was documented. To evaluate the program, the context, input, process, and product (CIPP) evaluation checklist was utilized . The evaThe protocol of this study was approved by the Ethics Committee of the Hamadan University of Medical Sciences . The questionnaire was anonymous, and informed consent was obtained from the participants in the survey. Participation in the study was voluntary.As of May 21, 2020, a total of 129,341 cases with COVID-19 have been laboratory confirmed and 7,249 deaths diagnosed ; and theOne of the key points in the control of infectious disease epidemics is designing interventions to emphasize the simultaneous increase of perceived fear and threat and perceived efficacy  for disease prevention and self-efficacy. Therefore, Protection Motivation Theory (PMT) was used to better understand the performance of preventive behaviors at an individual level .A high commitment of management to implement the intervention, high level of staff education, access to new device/equipment, sufficient budget, sufficient workforce to implement the intervention, and presence of qualified professors in the field of infection control were among the strengths of the faculty.Based on the information obtained from the needs assessment stage, two objectives of the program  were considered to prevent the spread of the COVID-19. For the target group, such as students and professors, the program was defined at the individual level as the use of appropriate personal protective equipment and suitable treatment measures to prevent the spread of COVID-19 .In the target group of administrative staff and patients, the implementation of the preventive behaviors to prevent the transmission and spread of COVID-19 was considered as the program objective at the individual level.Due to the important role of the medical staff and service personnel in infection control, the use of appropriate personal protective equipment and precise infection control measures among them was considered at the individual level in addition to the other staff.In addition, the objectives of the program for environmental factors were to prepare the environment and equipment, change the system of queuing and admission of patients, and reduce the capacity of target groups in the faculty. According to the program objectives, performance objectives were defined at the individual level for students, professors, administrative staff, medical staff, and patients, and the performance objectives were defined at the environmental level for providers .After identifying the functional objectives, the important and changeable determinants of these objectives were selected for each level based on the results of the IM phase. For the individual level, PMT was selected as a framework for describing factors in relation to preventive behaviors of COVID-19 . AnotherFinally, for providers  at the environmental level, the knowledge of the latest COVID-19 prevention guidelines in dental settings, barriers, attitudes, and outcome expectations were chosen as determinants. Next, the matrix of change objectives, which is derived from the intersection of performance objectives with determinants, was formed for each level of intervention .These performance objectives have been developed based on the protocols of the WHO, CDC, and the Ministry of Health and Medical Education of Iran \u201311.To reduce the presence of target groups in the school, contact-less treatment and remote learning were considered. This intervention was performed by using a telephone or online appointment system, teledentistry, implementation of virtual teaching, phone or online screening of patients, and installation of the Picture Archiving and Communication Systems software (PACS). The patient screening was conducted through a telephone call or appointment system so that before making an appointment, the patient was asked to complete the COVD-19 screening. After completing the screening form, if he/she was not identified as a high-risk case, was referred to oral diseases resident to do teledentistry. At this level, patients would express their symptoms and problems, and then if necessary, would send a photograph of their mouth to the oral diseases resident. The resident determines whether the person needs essential or urgent treatment or not based on the patient history and the provided photograph. An appointment was considered for the patients who need special treatments.Virtual teaching was considered for theoretical courses. Adobe connect platform was considered for theoretical courses and webinar.The installation of PACS software, which reduces paper records, increases the speed and accuracy of diagnoses and subsequently reduces the patient waiting time and their contact with staff, students, and faculty in the department. The PACS software could increase the speed and accuracy of diagnoses and subsequently reduce the patient waiting time and their contact with staff, students and faculty in the department.At this stage, all the change objectives were organized by the relevant determinants, and the methods of each category of the objectives were identified through the brainstorming method. Afterward, a theoretical and experimental review was performed to identify the appropriate methods and strategies for changing determinants.The strategy planning team determined the strategies in two ways, such as  brainstoIn this step, a final intervention framework was produced for implementation. Based on the needs assessment data and the additional focus group discussion with the target group, to collect the data regarding intervention material preferences, the planning team provided a list of intervention materials and activities. In practical, in this intervention, the COVID-19 instructions recommended by Iran's Ministry of Health and the instructions in relation to infection control were considered , ward managers, infection control team of the school, and the representatives of SHS2020 standard.Then, the executive team was informed about the methods and strategies for implementation of the intervention in different target groups and the tasks of the designated teams in detail.The instructions of the Ministry of Health were also provided for the executors.Context, Input, Process, and Product evaluation checklist was used to evaluate the program . This chContext, Input, Process, and Product components were selectively used in different sequences and generally at the same time depending on the need for specific evaluations . In thisEvaluation in this study encompassed the following steps:1. Contractual agreements: A clear understanding of the evaluation that needs to be conducted was established.2. Assessing the conditions and programming context: The needs, strengths and weaknesses, threats, opportunities, and problems in the faculty environment were assessed and evaluated. This step was consistent with the needs assessment phase and performed concurrently with this phase.3. Evaluation of the program inputs: Existing strategies and programs, capacity and feasibility of the designed program, evaluation of budget and equipment, tools, and materials required to conduct the program were assessed and evaluated. This step was also performed with the needs assessment phase.4. Evaluation of the program processes: Monitoring, documentation, and evaluation of the program activities were performed, and representatives of SHS2020 standard were involved in monitoring, observation, preserving photographic records, and providing periodic progress reports on the program implementation. At this stage, the checklists were prepared and completed by the standard representatives through observation. By photography and preparing a report regarding the documentation and intervention processes and the periodic progress reports to the faculty officials, they were informed of the program process. This time, it was determined whether all the modules of the program have been implemented? Does the program run according to the predetermined sequences and strategies? Did all the target groups receive the program? To what extent are the targets groups have involved in the program? Is the predetermined performance objective accomplished?The satisfaction of the target groups related to the intervention was also questioned.5. Evaluation of the program consequences: The information about the acceptance, modification, or rejection of the program was evaluated by asking from the target groups. The outcomes of this program included: increasing knowledge, perceived threat, perceived efficiency, reducing barriers to understanding, and increasing preventive behaviors against COVID-19 infection, which is obtained through completing the PMT questionnaire by staff, faculty, and students before and after the intervention.6. Evaluation of the effectiveness of program: The results of the quality and importance of the program must be evaluated. In this regard, the effectiveness of the interventions will be evaluated by the number of involved cases in dental school related to therapeutic and educational processes 3 months after the intervention. After performing above six evaluation steps by the representatives of BRSM Company and providing a report on the observance of applicable professional standards to the faculty officials, the identified defects were fixed. Moreover, the head office of the BRSM Company was invited to refer to the faculty for the final evaluation of the program. After conducting the final evaluations by the faculty, the evaluators of this company, on 28 June, 2020, considered the faculty to be eligible for the SHS2020 standard certification .7. Sustainability evaluation: This stage that will be carried out by BRSM Company 6 months after the initial evaluation, it will be determined to what extent the program has been successfully institutionalized and will continue over time.8. The final synthesis report: Consistent reports of evaluation findings were collected and communicated to the faculty stakeholders. Reports on the program background, implementation, and results of the program were presented to a wide range of audiences, and they were informed of the interventions carried out and the results of the evaluation by BRSM.The present study describes the process design, content, and evaluation of COVID-19 preventive intervention in dental schools. This study for the first time provides practical and simple guidelines for reopening dental schools and providing dental services during the COVID-19 epidemic. Due to the lack of a global protocol for dental services during this pandemic, dental services have been partially or completely disrupted in many countries. In this regard, the lack of standard protocols can increase the prevalence of COVID-19 in dental health centers.While some national health institutions, such as the NHS, have provided guidance and advice for managing clinical dental emergencies during epidemics . This inIn this study, IM was used as a conceptual framework for the intervention design. Although the design of the intervention was a time-consuming process, it can lead to the implementation of the intervention with a systematic and evidence-based approach.The Centers for Disease Control and Prevention, ADA, and WHO provided some recommendations for the control of the prevalence of COVID-19 for dentists and dental staff, such as patient screening, infection control , behavioral measures , and treatment measures  .The first essential step for the safe management of patients during the pandemic is investigating risk level of patient through screening patients to cut the transmission chain and evaluating the chief complaint of the patients . These cThe most important measures to control the infection included selecting one person to supply the disinfectants for surfaces, equipment, and tools. At the beginning of each day, this person prepared the appropriate disinfectants for the surfaces, equipment, and tools according to the standard protocol and provided them for the medical staff in different wards. Isolation of well-ventilated dental chair unit  was conducted as another important measure of infection control .Fear arousal strategy as behaviors that protect people against life-threatening conditions (such as COVID-19) is often used as an effective way to promote health, prevent disease, and adopt healthy behaviors in society . HoweverStaff training was also conducted in small groups in large spaces with proper ventilation.In the present study, the intervention was designed based on the latest scientific findings in the field of COVID-19 as another important measure. Therefore, a scientific research team was formed to access the latest scientific findings through searching and then inform the planning team every 72 h. The planning team examines the received information scientifically, evaluates their compliance with the facilities and policies of the organization, makes the necessary changes in the program, and informs the project implementers. However, finding a balance between previous and new findings and constantly updating the information regarding the transmission and prevention ways of COVID-19 are still challenges, especially in dentistry.This study had some limitations at the time of implementation of the intervention. These limitations were related to insufficient scientific information about the nature of the virus like its transmission modes, and incubation time, and due to constant updating information, the effectiveness of the preventive methods remains a challenge.This study describes the performance of the Iranian School of Dentistry in developing disease prevention strategies during the COVID-19 pandemic based on the IM process. Our findings indicated that the intervention in dental settings based on the IM process leads to a comprehensive and structured program in dental schools. Therefore, the teamwork can consider the necessary changes in the running programs as the global and national guidelines for the epidemic change. Therefore, it can be concluded that intervention in dental environments based on the IM process can develop a comprehensive and structured program in the dental school.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding authors.The studies involving human participants were reviewed and approved by the Hamadan University of Medical Sciences Ethics Committee . This study and the method of obtaining consent were approved by the Ethics Committee. The questionnaire was anonymous and informed consent was considered as agreeing to participate in the survey. Participation in the study was voluntary. The patients/participants provided their written informed consent to participate in this study.AM, SS, SB, NR, AH, MM, HK, and OA contributed to the study concept and design. SS, NR, BB, OA, and AP contributed to the acquisition of data. SS, MM, and AP contributed to the initial drafting of the manuscript. SS, AM, AH, and SB contributed to study supervision. All authors contributed to the interpretation of data and critical revision of the report.We acknowledge funding from the Hamadan University of Medical Sciences (9905283448).The content is solely the responsibility of the authors.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "This article aims to present concepts and clinical practices recommended to approach people with active sex life. These concepts are an integral part of the recommendations of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections (STI), published by the Ministry of Health of Brazil in 2020. The article proposes a comprehensive approach to sexuality for health promotion. It presents significant aspects of the communication process that must develop, without prejudice and judgment, focusing on sexual and reproductive health. It also highlights relevant points about the exercise of sexuality at specific stages of life, recommending assessment of risks and vulnerabilities and screening for STI and condom use. In this way, it is possible to contribute to exercise their sexuality fully, responsibly, and safely. Sexual health is the physical, emotional, mental, and social wellbeing associated with the exercise of sexuality, with sexual and reproductive rights considered fundamental. This article aims at updating the chapter on Sexual Health: an approach centered on sexually active individuals of the Clinical Protocol and Therapeutical Guidelines (PDCT) for Comprehensive Care for People with Sexually Transmitted Infections (STI) 2020The PDCT was published by the Health Surveillance Department of the Brazilian Ministry of Health, based on official recommendations and discussions with experts. The National Committee approved it for Technology Incorporation to the Unified Health System (Conitec) in 2018Sexual and reproductive rights are considered fundamental, together with the rights to life, food, health, housing, and education for the complete exercise of citizenshipThe communication process plays a significant role in the improvement of the professional-patient relationship and, as a consequence, for the adherence to the recommendations and treatmentHealth services must promote environments favorable to the dialog and embrace the different dimensions of the exercise of sexuality by sexually active individuals. We recommend a gradual approach, advancing from general aspects to the most specific onesTo establish an association of trust, we need a clear and transparent approach, adequate to receptivity and the life context of the persons, which must be recognized as active individuals in the care process,We recommend to the professional to assure that the person is comfortable to talk about such themes, informing them that those are questions made routinely in the healthcare service, regardless of sex, sexual orientation, age, professional activity, and marital status. Emphasis should be placed on the secrecy and confidentiality of informationTelemedicine has currently been gaining ground in disclosing information, promotion and prevention, expanding the scope of healthcare services, especially in a continental country with regions that are hard to reach. Useful communication techniques in servicing people with STI are also needed in telemedicineAdolescence is a period of significant biological, psychological and social transformations. Physical alterations, social interactions and the awakening of new interests reflect fast and profound changes that characterize this life stage. The way adolescents express and live sexuality is influenced by the quality of emotional and affective associations experienced with relevant people in childhood, integration with peers, transformation arising from growth and development, the start of reproductive capacity, beliefs, moral patterns, myths, and taboos, as well as the traditions of the family or society in which they are insertedIn this stage, values, attitudes, habits, and behaviors are being formed, transformed, and consolidated, making adolescents more vulnerable, mainly because parents or guardians, school, and even health staff tend not to approach the aspects regarding the exercise of sexuality. Therefore, many times adolescents start their sexual lives without due orientationHealthcare services can play a fundamental role, disclosing to adolescents information contributing to the awakening of a healthy sexual life and prevention of STI and unintended pregnancy. Such orientation must be based on dialog, allowing for autonomy and responsible attitudesDuring gestation, sexual relations do not pose a risk to pregnancy, except in unique obstetric situations . However, we should not ignore the possibility of a pregnant woman getting an STI that harms the gestation's prognosis, or vertically transmitting the disease. For this reason, healthcare staff must approach routine questions associated with the sexual health of pregnant women and their sexual partners and offer HIV, syphilis, and hepatitis B and C tests in prenatal care,-Older adults presented an increase in the number of HIV and syphilis cases over the last years, drawing attention to the role of sexuality in this age group,,In risk assessment for STI in sexually active individuals, we recommend investigating structured questions, identifying factors associated with sexual practices and behaviors, and alcohol and drug use. From the contents obtained, it is possible to make an adequate assessment for risk management and identify opportunities for recommending preventive actions. The professional must individually provide the attendance, and in a private environmentRisk assessment can guide STI tracing. After identifying clinical cases, it is crucial to call and treat the sexual partnerships, aiming to interrupt the chain of infection, prevent complications, and avoid reinfectionsEuropean guidelines recommend managing sexual partners of people with STI, indicating emotional support and contact identification and notification, through a strategy guided by pattern operational procedure for control, monitoring, treatment, and report of cases,Brazil presents a trend of HIV and syphilis increase in the population between 13 and 29 years of ageIt is important to trace some infections, such as chlamydia and gonococcus, aiming at preventing pelvic inflammatory disease that, even if asymptomatic, can reduce chances of pregnancyUsing female, or male condoms is a preventive strategy that should be offered to sexually active people, in order to reduce the risk of HIV and other STI transmission and prevent pregnancyThe offer of condoms must take place without the quantity restrictions and without requiring identification documents. Healthcare professionals must incorporate sexuality into services to sexually active individuals, mainly those with STI complaints. This approach must develop, without prejudice and judgment, with a focus on sexual and reproductive health. In this way, it is possible to contribute to exercise their sexuality fully, responsibly, and safely. The right preventive approach can favor the decrease of STIs and their consequences."}
{"text": "The New England Journal of Medicine commenting on two studies on sex bias in the management of coronary heart diseases, published on the same journal issue [Dr. Bernardine Healy was a cardiologist known, among many other remarkable things, for being the first woman nominated as Director of the NIH. In 1991, Dr. Healy, who died prematurely in 2011, wrote an editorial for al issue . This waAfter 30 years, where are we now? After the Fourth World Conference on Women organized by the United Nations in 1995, we had to wait until the new millennium to have WHO adopting gender-oriented policies and until 2009 to have a written strategy to enhance, expand and institutionalize WHO\u2019s capacity to analyze the role of gender and sex in health, as well as to monitor and address systemic and avoidable gender-based inequalities in health . As statHowever, of course, healthcare inequalities are only a part of the major problem of gender-based inequalities. In 2006, the World Economic Forum started publishing the Global Gender Gap Report annually, expressing an index designed to measure gender equality throughout the world. The Global Gender Gap Index has the intention of tracking progress on gaps between women and men in health, education, economics and politics. Across the four categories, the largest gender disparity is in the political field, the second being in economics. To date, in the whole world, only 25% of political seats are occupied by women and only 21% of ministers are women; in some countries, women are not represented at all. In addition, in the last 50 years, in 56% of the countries examined in the report, there has never been a female head of state, including in our country, Italy, or in the United States [Lancet, Dr. Mauvais-Jarvis and his co-authors discussed how women differ from men in medicine [In the 22 August 2020 issue of the medicine . Heart, medicine . This hamedicine . Again, medicine . The sammedicine .All these are the reasons why NIH in the 1990s decided that women\u2019s health was a priority, and one of the first acts was to fund a multidisciplinary, multi-institute intervention study, the Women\u2019s Health Initiative, addressed to identifying the major causes of death, disability and frailty among middle-aged and older women. However, as we said before, 30 years have passed and yet we still have the feeling that a lot needs to be done before equity between genders/sexes can be achieved. Perhaps the new political course in the United States, with a very determined, professionally proud academic First Lady and an equally determined female Vice-President, will finally give the decisive push to change the scenario."}
{"text": "Every August the USA National Psoriasis Foundation (NPS), launches the National Psoriasis Month to spread the knowledge about the etiopathology of psoriasis, to inform about available treatments, and to support and unite those affected. As psoriasis is often mistakenly perceived as infectious and patients can be victims of social stigmatisation, it is pivotal to promote awareness of what psoriasis is and is not and to fight the discrimination suffered by people living with it.Psoriasis is a chronic, immune-mediated inflammatory skin disease possibly resulting from a defect in proliferation and differentiation of skin cells associated with inflammatory cell infiltration. This process causes skin cells to accumulate and form plaques that itch, burn, and sting. These plaques appear on any part of the body, but are most often found on the elbows, knees, and scalp. Psoriasis scaly patches can range from a few spots of dandruff-like scaling to major eruptions that cover large areas, including the entire body. In addition, according to the NPS there are at least five types of psoriasis. Including the most common form with plaques, psoriasis also occurs in guttate, inverse, pustular, and erythrodermic forms. Of note, psoriasis is not limited to the skin, but can produce systemic effects and can be associated with psoriatic arthritis, cardiovascular disorders, and diabetes, as reported by WHO in the Global Report on Psoriasis, in 2016.The New England Journal of Medicine, report that a monthly injection of bimekizumab, can reduce psoriasis plaques of 90% after only 16 weeks of treatment. Bimekizumab, compared with other biologics like secukinumab and adalimumab, stands out with the highest rate of skin clearance and the ability to treat psoriatic arthritis, one of the most common and painful comorbidities of psoriasis. As the cause of psoriasis is still unknown, treatments are only available to control symptoms and often need to be taken continuously.According to the US Centers for Disease Control and Prevention, psoriasis is one of the most common chronic cutaneous dermatitis, which, in 2021, affects more than 7\u20225 million people in the USA and approximately 125 million people worldwide. Given the poor characterisation of this disease, those with psoriasis also suffered from a lack of effective treatments. From the beginning of the 20th century, different manifestations of psoriasis were treated with topical corticosteroids, phototherapy, systemic and topical retinoids, and narrowband UVB. In the early 2000s, the serendipitous discovery of the benefit of cyclosporine led to the development of drugs first targeting T-cells and subsequently to the cytokine mediators. Targeting cytokines, paved the way to the development, in 2021, of the drug bimekizumab. Research from the University of Manchester, UK, and Salford Royal NHS Foundation Trust, UK, published this July in Dermatology in August, 2020, highlight how psoriasis can also significantly affect quality of life of the patients, causing great physical, emotional, and social burden. Disfiguring manifestations of psoriasis can lead to depression and other psychological problems. The presence of severe psoriatic plaques that eventually can crack and bleed and that are highly visible on the body, might trigger a negative reaction in others and, since psoriasis is wrongly considered infectious by many, some patients might be stigmatised by people in their communities. Patients with psoriasis can also experience self-stigmatisation, and thus start to avoid others, limit their social relations, abandon their work, and ultimately, completely alienate themselves from the society. Moreover, not only psoriatic lesions visible to others, but also those that are usually covered and unseen  can be a cause of shame and isolation.Jankowiak and colleagues, from Medical University of Bia\u0142ystok Poland, in a study published in Improving awareness of psoriasis among the lay public will help to finally debunk the myth of psoriasis as contagious. An informed understanding of this chronic skin disease would broaden social acceptance and provide better support for people living with this condition. National Psoriasis Month, this August, is an opportunity to promote awareness of the physical, emotional, and social challenges that people with this chronic disease are still facing. Health care in addition to the management of the skin lesions and screening for associated comorbidities should also require psychological evaluation and support for patients with psoriasis. Let us eradicate once and for all the myth of psoriasis as an infectious disease.EClinicalMedicine"}
{"text": "To survey the application of PDCA  process management in day operation ward and the influence of nursing quality and safety. N = 20), and the PDCA process management was implemented from March 2020 to March 2021 as the research group (N = 20). Twenty nurses and patients were selected as subjects in two periods of time. The nursing quality, the score of individual quality control examination in clinical department, the nursing quality of operating room, the incidence of adverse events and nursing errors, the number of problems existing in the quality management of nursing documents, and the score of nursing satisfaction were accessed.  The routine nursing management was carried out in our hospital from March 2019 to March 2020, which was set as the control group (P < 0.05). In terms of the scores of individual quality control examination in clinical departments, the scores of ward management, rescue, therapeutic articles, drug management, first-level nursing, nursing documents, and head nurses in the study group were greater compared to the control (P < 0.05). In terms of the operating room nursing quality score, the instrument management, instrument preparation, nurses' cooperation skills, disinfection and isolation quality, and the total score of the study group were above the control (P < 0.05). In terms of the incidence of operative adverse events and nursing errors, the incidence of nosocomial infection, iatrogenic injury, information check error, equipment failure, violation of operation regulations, ECG monitoring error, infusion operation error, and medication error in the study group was lower compared to the control (P < 0.05). According to the comparison of the number of problems existing in the quality management of nursing documents, the number of problems in temperature sheet, medical order, evaluation sheet, nursing record, and other nursing documents in the study group was lower than the control (P < 0.05). The scores of nursing communication, professional technology, nursing service attitude, nursing environment, and knowledge education in the study group were higher in contrast to the control (P < 0.05).  In the comparison of nursing quality, the nursing safety, specialty quality, and nursing norms of the study group were higher compared to the control ( The application of PDCA management can effectively enhance the nursing quality and safety of the day operation ward, further facilitate the quality of hospital nursing work, and improve patient satisfaction, which exert great potential, and application value in the management of day ward in the future. The operating room is not only the key management department of the hospital but also an important place for patients to receive surgical treatment. To a certain extent, the quality of nursing management of the operating room is an important reflection of the medical quality of the hospital, so improving the quality of nursing management of the operating room is beneficial to improve the level of hospital management. Owing to the particularity of nursing in operating room, the current nursing management in operating room is mainly routine management. Although this qualitative method can evaluate the working status and nursing quality of nurses, it has subjective and one-sided restrictions, which will lead to poor management effect. In the long run, it may have an impact on the enthusiasm of nurses, resulting in low work efficiency in the operating room and then affect the satisfaction of patients , 2. In vN = 20), which was set as the control group, and the PDCA process management was implemented from March 2020 to March 2021 as the research group (N = 20). Twenty nurses and patients were selected as subjects in two periods of time. Of the control, the age of nurses was 20-54 years old, with (31.65 \u00b1 1.44) average years old, including 1 male and 19 female, with an average age of (45.67 \u00b1 3.64) years (15-83 years), including 12 males and 8 females. Of the study, the age of nurses was 20-54 years old, with an average of (31.56 \u00b1 1.68) years, including 1 male and 19 female, with an average age of (45.68 \u00b1 3.55) years (13-83 years), including 11 males and 9 females. The general data of nurses and patients of the two were not statistically significant. The study was approved by the Medical Ethics Committee of our hospital.The routine nursing management was conducted in our hospital from March 2019 to March 2020  stage P (planning stage): a nursing quality management committee was set up to carry out work under the leadership of the hospital quality management committee. The chairman was the dean in charge of nursing work, the vice-chairman was the director of the nursing department, and the members were departmental leaders and committee secretaries. Set up the quality management framework of quality management leading group, quality control team leader, head nurse, and nurse. The head of the quality control team is headed by the director of the nursing department or the head nurse of the major department, and the team member is composed of the head nurse. Meanwhile, all quality control team leaders and team members are required to make hospital nursing quality assessment plans from five aspects of nursing quality evaluation standards: ward management, rescue and treatment materials management, special nursing level basic nursing management, nursing document management, and head nurse management. In order to realize the virtuous circle of assessment, introduce the incentive competition mechanism, formulate the nursing quality competition activity plan, and formulate the whole staff training plan at the implementation level. (2) Stage D (implementation stage): training is carried out according to the plan for decision-making and implementation. Aiming at the decision-making level: organize the members of the quality management leading group to learn the relevant knowledge of total quality management and PDCA management and require to write a relevant summary, and the leaders of each quality control team together with the team members should carefully study the detailed explanation of quality standards and assess the relevant knowledge, so as to improve the inspection ability. Organize the detailed explanation of the evaluation standard of the learning quality management of the head nurse in the whole hospital and require the head nurse of each department to formulate the improvement plan one by one according to the existing problems in the department, combined with the content of the quality standard, the rectification plan is specifically responsible for by the head nurse, and the whole staff is required to participate. And submit it to the nursing department for approval, and after approval, the head nurse will organize the whole department to carry out the implementation. For the implementation level: hold the quality management-related knowledge training and assessment of the whole hospital, and the assessment items shall be subject to the written examination; the head nurses are required to organize regular scientific meetings to discuss and clarify the quality standards and assessment methods at the scientific meetings. Analyze the errors in the inspection process of the department to find out the existing gap and carry out the division of labor and rectification, and require each department to set up corresponding internal quality control teams, so that everyone has their own responsibility and emphasis, so as to form a good atmosphere for everyone to participate in quality management; nurses should be familiar with their respective management responsibilities and improvement plans for undergraduate problems. Carry on the implementation according to the plan: the implementation process adopts the cycle management mode, that is, the head nurse implements the fixed responsibility cycle management to the nurse, the quality control team leader implements the fixed department cycle management to the head nurse, and the quality improvement leading group implements the fixed item cycle management to the quality control team leader. The head nurse carries out the circular management of responsibility to the nurses, and according to the rectification plan, the head nurse implements the management responsibilities from five aspects: ward management, rescue and treatment materials management, special nursing level basic nursing management, nursing document management and head nurse management to the five responsible persons of the quality control team in the department, and the five responsible persons, respectively, implement the management duties of each nurse according to the Kone group plan. The head of the quality control team shall carry out the cycle management of the department to the head nurse, carry out the relevant inspection to each department according to the standards of each quality control group, and adjust the inspection contents at any time according to the results. The quality improvement leading group implements the fixed cycle management to the quality control team leader, and the quality improvement leading group implements the management responsibilities of five projects, such as ward management, rescue and treatment materials management, special first-level basic nursing management, nursing document management, and head nurse management, to each quality control team leader. (3) Stage C (inspection stage): first self-examination, scientific examination, then quality control group inspection, and finally focus on inspection. Self-examination: nurses should first conduct self-examination according to nursing quality evaluation standards, including daily job responsibilities and management responsibilities, and make standardized records. Scientific investigation: the head nurse made a comprehensive examination once a week according to the evaluation standard of nursing quality. And make standard records and regularly report to the nursing department in the form of accounts. Quality control group inspection: nursing expert supervision group according to the plan to check each clinical department of the hospital once a quarter, key departments once a month. The focus of the inspection is the quality improvement points in the rectification and reform plan of each department, and strive to take the problems existing in the last inspection as the focus of the next inspection. Key check: the nursing expert supervision group takes the common problems and key points and weak links in nursing work as the quality improvement points of the whole hospital to conduct random checks. (4) Stage A (summary and treatment stage) summing up the results of self-examination: nurses are required to report and communicate the results of self-examination in the early shift every day; the head nurse analyzes the evaluation results according to the results of the examination and discusses them at the meeting of science and technology. Timely revision of objectives, improvement measures, and timely follow-up of the progress of the plan and link the results of quality evaluation with the distribution of labor services in the department. The examination results of the nursing expert supervision group were reported at the hospital quality management committee and reported to the whole hospital in the form of OA, the centralized problems were analyzed at the head nurse meeting, and the improvement measures and suggestions were fed back to the relevant clinical departments in time; for the advantages, we should consider how to maintain them in the next cycle. Put forward new problems: the new problems and the common problems existing in the hospital were summarized and put forward by the nursing expert supervision group, which were improved as a continuous quality improvement project, and the standard and plan schedule were revised. The successful experience and shortcomings should be used as the driving force and basis to promote the next PDCA cycle.Nursing quality : the nurThis research uses the \u201cEvaluation Standard of Nursing quality Control in Clinical Department,\u201d which is being used by the nursing department of this hospital in the assessment of nursing quality in clinical department, as the evaluation index. The evaluation standard is the standard of nursing quality management revised by the members of the joint nursing expert supervision group of the nursing department of the hospital with reference to \u201cEvaluation Indexes of the third-level General Hospital of the Ministry of Health\u201d  and  was to represent the counting data, and \u03c72 test was used. The difference was statistically significant when P < 0.05.Using SPSS21.0 statistical software, before statistical analysis, the measurement data were tested by normal distribution and variance homogeneity analysis to meet the requirements of normal distribution or approximate normal distribution, expressed as P < 0.05). All the results are presented in Compared to the control, in the comparison of nursing quality, the nursing safety, specialty quality, and nursing norms in the study group were higher (P < 0.05). All the results are illustrated in Compared to the control, in terms of the scores of individual quality control examination in clinical departments, the scores of ward management, rescue, therapeutic articles, drug management, first-level nursing, nursing documents, and head nurses in the study group were higher (P < 0.05). All the results are shown in Compared to the control, in terms of the operating room nursing quality score, the instrument management, instrument preparation, nurses' cooperation skills, disinfection and isolation quality, and the total score were higher in the study group (P < 0.05). All the results are illustrated in Compared to the control, in terms of the incidence of operative adverse events and nursing errors, the incidence of nosocomial infection, iatrogenic injury, information check error, equipment failure, violation of operation regulations, ECG monitoring error, infusion operation error, and medication error in the study group was lower (P < 0.05). All the results are illustrated in According to the comparison of the number of problems existing in the quality management of nursing documents, compared with the control, the number of problems in temperature sheet, medical order, evaluation sheet, nursing record, and other nursing documents in the study group was lower (P < 0.05). All the results are shown in Compared to control, the scores of nursing communication, professional technology, nursing service attitude, nursing environment, and knowledge education in the study group were higher (With the advancement of the traditional medical model and the implementation of the new medical reform, the requirements of the society and patients for the medical quality and nursing service quality of the hospital are increasing, which renders the nursing management, especially the nursing quality management, become particularly important , 13. NurPDCA cycle was put forward by Dr. Deming, an American quality management expert in the 1950s. Its main content is the abbreviation of plan, do, check, and action. It is the basic tool of total quality management . The PDCIn view of the results of our current study, the nursing quality, nursing safety, specialty quality, and nursing norms were higher in the study group. With regard to the scores of individual quality control examination, the scores of ward management, rescue, therapeutic articles, drug management, first-level nursing, nursing documents, and head nurses were higher in the study group. According to the comparison of the number of problems existing in the quality management of nursing documents, the number of problems in temperature sheet, medical order, evaluation sheet, nursing record, and other nursing documents was lower in the study group. The writing of nursing records not only reflects the dynamic changes of patients' medical and nursing process and condition during hospitalization but also is the basis for evaluating the professional ability of nurses and nursing quality management. In this study, the problems of nursing documents mainly exist in temperature sheet, doctor's order, evaluation sheet, and nursing record. Through comprehensive analysis, nurses' lack of understanding of the rigor and importance of nursing records, heavy burden on nursing staff, and untimely quality control of nursing records is the main reason for the nonstandard writing of nursing records , 27. ThrIn this study, the scores of nursing quality in operating room, equipment management, equipment preparation, nurses' cooperation skills, disinfection and isolation quality, and total score were higher in the study group. With regard to the incidence of operative adverse events and nursing errors, the incidence of nosocomial infection, iatrogenic injury, information check error, equipment failure, violation of operation regulations, ECG monitoring error, infusion operation error, and medication error was lower in the study group. The scores of nursing communication, professional technology, nursing service attitude, nursing environment, and knowledge education in the study group were higher than those in the control group. The possible reason for our results is that in the past, nursing quality management has been dominated by experience management, that is, \u201chousekeeping\u201d or \u201cpaternalistic\u201d management mode, which is lack of science and effectiveness and lack of guarantee for nursing quality . In receTaken together, the adoption of PDCA process management can effectively enhance the nursing quality and safety of the day operation ward, further improve the quality of hospital nursing work, and elevate patient satisfaction. This new nursing model based on PDCA will exert great potential and application value in the management of day ward in the future."}
{"text": "Monoclonal antibodies with high efficiency and specificity are one of the best strategies to diagnose and treat a variety of diseases such as cancer, autoimmunity, and inflammatory diseases. The market for monoclonal therapeutic antibodies (MTAs) has grown dramatically in the past decade.  Given the importance of these issues, developing countries spend a high cost on importing or producing MTAs annually. This study intends to examine the market of monoclonal therapeutic antibodies in Iran and predict the future growth rate of this market using the obtained data.  Data on the status of MTAs in the country (from 2008 to 2018) were obtained from the Food and Drug Deputy of Mazandaran University of Medical Sciences. The market status of MTAs was studied based on the dosage forms, application, and price. Then, the market outlook was predicted up to year 2025.  The results showed that 58.8% of all MTAs were humanized, and 86% of all antibody-based drugs were used to treat cancer. Sales of MTA-based medications will reach $454 million by 2025 and are projected to grow significantly in the future.  Given the increasing technology of the production of MTAs and their use in targeted therapies worldwide, their consumption market in Iran is expected to grow significantly. Antibodies are glycoproteins that are produced by B lymphocytes in response to antigens, bind specifically to antigens, and play an important role in immune defense  1]. Ant. Ant1]. mAbs are divided into four types according to their origin: murine mAbs, chimeric, humanized, and fully human . Murine The most crucial drawback of this type of mAbs is the high immunogenicity, which leads to the production of human antimouse antibody (HAMA) responses that decrease its immunogenicity and efficacy. Because of these problems, other antibodies were designed that decrease the antihuman immunogenicity , 8. ChimToday, thanks to the tremendous technological advances in the production of antibodies, our increased knowledge of the pathogenesis of many diseases, as well as the approach of physicians to personalized medicine, has led to the dramatic growth of the production of these MTA products . TherefoThe largest share (50%) of the MTA market belongs to North America, followed by Latin America, Western Europe, Eastern Europe, Asia-Pacific, the Middle East, Africa, and Japan . DevelopOn the contrary, an increase in the discovery and production of mAbs and an increase in our understanding of diseases at the molecular level, as well as a targeted treatment approach for many chronic diseases by physicians, have led to the increasing use of MTAs worldwide. This study intends to examine the market of monoclonal therapeutic antibodies in Iran and predict the future growth rate of this market using the obtained data. Accordingly, we first discussed the market situation over the last thirteen years with well-documented data and then predicted the market situation by 2025.Data on the status of MTAs in the country over the past thirteen years (2006 to 2018) are obtained from the Food and Drug Deputy of Mazandaran University of Medical Sciences. The data include the brand and generic name of the medication, dosage forms, amount or quantity required, and the price of the drug in US dollars. Since some of the arbitrators needed to be produced domestically, all prices were calculated in US dollars to equalize the cost of supplying MTA drugs.The data were categorized by type and source, type of the original construct, clinical application, target molecule, and prices in US dollars. All the data were analyzed using Excel software.We used root-mean-square error (RMSE), mean absolute error (MAE), symmetric mean absolute percentage error (SMAPE), ease of movement (EMV), and R2 indexes (indicators) to analyze the annual use of MTAs and predict 5-year need. According to the results, the trend line has been calculated over the past thirteen years. Also, the EMV index examined the changes in the mean total costs and considered cost fluctuations (oscillations) based on useful indicators over the past thirteen years. Finally, an estimated model based on the MTA requirement by 2025 is calculated for our country.The distribution of MTAs uses from 2006 to 2018, as shown in The frequency of clinical applications of MTAs was calculated each year. Furthermore, from all, 86% were used in cancer and only about 14% in chronic inflammatory diseases . In the As shown in Given the high consumption of MTAs in the last thirteen years and an increasing trend over the previous years, a consumption estimating model was presented in the coming years. As shown in Monoclonal antibodies with high efficiency, specificity, and less toxic effects are targeted tools for the development of personalized medicine for the diagnosis and treatment of various diseases, including cancer, inflammatory diseases, autoimmune disorders, and infectious diseases. More than hundreds of MTAs have been developed for over 30 years, and some have been approved. Although the MTA market has grown dramatically in the world, the major suppliers are the United States, Europe, Latin America, Asia, and Japan. In this study, we have evaluated the MTA market in Iran over the past thirteen years based on the therapeutic area and dosage form to provide a predictive model by 2025. The results showed that the source of all MTAs was 23.5% chimeric, 58.8% humanized, and 17.7% fully human. These data are consistent with the overall development of the MTA over time. As in the early years (2001 and 2002), the major (70%) MTAs were chimeric antibodies.However, due to the immunogenicity problems of chimeric antibodies, the contribution of these types of antibodies in the global MTA market has decreased significantly. Instead, humanized and fully human MTAs rapidly replaced chimeric antibodies in the treatment of many disorders due to their low immunogenicity. Adalimumab was the first humanized antibody approved by the FDA in 2003 . It, theOver the past two decades, monoclonal antibodies designed to target tumor cells or improve immune system exhaustion with fewer side effects and high efficacy have rapidly increased due to increased understanding of genomic studies and technological advances \u201324. It iTaken together, given the increasing technology of the production of these drugs and their use in targeted therapies worldwide, their consumption market in Iran is expected to grow significantly. Given the high cost of MTAs and the increasing need to use them in the near future, there should be an opportunity to improve investment in the research and development of MTA production technology in Iran to meet both domestic demand and export opportunity."}
{"text": "In the last few years, there has been an emphasis on the importance of health literacy (HL) and health education (HE) as basic tools to empower individuals and the community. The increasing interest in HL and HE has been observed through the evolution of publications and the nature of the main trends in the last few years. Knowing how HL and HE have evolved in scientific publications can help us to identify trends and set work priorities in this scope. Based on this, a bibliometric analysis (from 2000 to 2021) was conducted in two phases: first, an analysis was performed on the publications included in the Web of Science (WOS); second, a more specific analysis was conducted on the Core Collection from WOS. The data were analyzed with two software programs, the and Bibliometrix package for RStudio, and VOSviewer to analyze number of publications, citations, authors, collaborations, keywords trends, keywords evolutions and clusters of related terms. A total of 1799 articles were found in the first phase, and 727 in the second. The results from both analyses showed that the publications increased unequally until 2020, and considerably decreased in 2021; however, in spite of this, the number of citations remained constant. Likewise, five word clusters related with HL and HE were identified. D. Nutbeam stood out as the most prolific author on the subject, the USA as the country with the most publications, and the International Journal of Environmental Research and Public Health as having the most articles on the subject. This analysis may be a useful and helpful tool for future studies on the subject. The origins of the concept of Health Literacy (HL) go back to 1974, when S.K. Simonds associated it with another closely-related concept, Health Education (HE) . PosteriLikewise, delving further into the framework of the European Health Literacy Project, HL also contemplates the competences of individuals in understanding, evaluating and applying health information to maintain and improve the quality of life .There are three levels in HL: (i) functional: basic competences of reading and writing to act efficiently in a health context; (ii) interactive: cognitive and social skills that allow for active participation in subjects related to health; and (iii) critical: competences associated with the making of decisions starting with a critical analysis and the use of information to participate in health actions ,11. ThesAside from these three levels, there are three dimensions based on a conceptual model with respect to HL, and which must be considered to ensure the correct literacy in this area: attention and care; prevention of diseases, and health promotion. Starting with these three dimensions, we find four more, which refer to the processing of information, based on the logical model: accessing, understanding, processing, and application of the information received about health subjects ,12,13,14The interest of the general population and the need to implement real HL in education contexts has increased, given its high impact on health results, in which a greater HL is associated with a better state of health. In this sense, many studies ,16,17 haThe health crisis due to COVID-19 has further highlighted, if possible, the need for HL through the implementation of HE, given that the general population has had to rapidly learn and apply a set of health measures and protocols to contain the expansion of SARS-CoV-2 ,22,23.The evolution of HL and HE concepts has become consolidated in the last few decades. Thus, the objective of this review is to conduct a quantitative bibliometric analysis to discover what the advances and changes have been with respect to HL and HE in the last few years. The results obtained will allow us to identify the trends and priorities in this field, as this method is efficient and effective for quantitatively describing the influence of a subject through time ,25,26,27The bibliometric analysis was performed with the Web of Science (WOS) database, due to their well- and deeply cited interconnections in several research areas through the Web of Science Core Collection (WOSSC), allowing us to perform a precise and specific analysis of publications, authors, citations, and keywords. For this, a search was conducted for articles which included the subject TS = . The inclusion criteria were: (a) articles published between 1 January 2000 and 31 December 2021, and (b) original articles in any language, and the exclusion criteria were: (c) any type of articles not considered originals . To ensure the inclusion of all articles and avoid problems with database updates, the search was completed in a single day on 31 December 2021. The screening according to the inclusion and exclusion criteria was performed in two phases. The first phase directly utilized the filters offered in the database, and the second was performed with the article\u2019s titles. The search and selection results are shown in the The search for articles to be analyzed was conducted in two phases. In the first one, we worked with WOS \u201cAll Databases\u201d, the searches of which are based on seven databases, and whose results provide a general view of all recorded documents in them. The results obtained in the first phase allowed us to identify the database WOSCC as the most appropriate for the second phase of analysis. For this reason, in the second one, we performed a more precise bibliometric analysis using WOSSC, where keywords, citations or authors were analyzed through their occurrence or as a cluster of concepts using two specific software for this purpose: Bibliometrix 3.1.4 for RStudio and VOSviewer.Likewise, a double screening was performed, the first with \u201cAll Databases\u201d, and the second, more specific one with the WOSCC database, for a more in-depth bibliometric analysis. In both cases, the following information was extracted: year of publication, number of citations, authors, journals, areas of research, countries, languages, and keywords.For the selection of studies, two of the authors (LS and AE) independently evaluated the articles. Any disagreement in the selection of articles was resolved via consensus with the third author (AR) of the present article.The statistical analysis was performed with two specific programs, the \u201cBibliometrix 3.1.4\u201d package  of RStudLikewise, VOSviewer was used to analyze and visualize the bibliometric networks of the keywords (50 keywords with frequency more than 20 occurrences). The aim of this co-occurrence analysis, through the application of the KeyWords Plus and author\u2019s keywords, was to view the networks according to the number of citations and their temporality.The results are organized starting from a more general analysis (through the \u201cAll Databases\u201d), to a more specific one (using WOSCC).\u00ae, 60.81% in Current Contents Connect, and 42.52% in CABI: CAB Abstracts. The other databases contained in WOS only included less than 5% of the articles found in this search.The search in All Databases provided 2353 initial records. Once the inclusion criteria and the selection of articles according to their titles were applied, a total of 1799 articles were selected. Of these, 84.04% were found in the WOSCC, 81.32% in MEDLINEDespite the number of articles published increasing since the year 2000, this increase was not uniform, and it was observed that some years  were more productive that the years right after. The year with the most publications was 2020, with a total of 253 articles .With respect to the number of citations of the articles included in the analysis, these were cited 35,455 times, 32,932 when excluding self-citations. The maximum number of citations in a single year was in 2020 (5000 citations), coinciding with the greater number of publications. The five most productive years were, from most to least, the following: 2020, 2019, 2021, 2018, and 2015 see .With respect to the most prolific authors in the period studied, the top five were: A.F. Jorm and M.S. Wolf with 13 publications each, D. Nutbeam and D.W. Baker with 11 publications, and T.C. Davis with 10 publications.n = 53, 2.95%), Journal of Health Communication , BMC Public Health , Patient Education and Counseling  and Health Promotion Practice .With respect to the journals with the greatest number of publications on HL and HE, the following stood out, according to number of publications: International Journal of Environmental Research and Public Health , Health Care Science Services , Education Educational Research , Psychology  and Nursing .Regarding to the areas of research in which the most articles were published, the following were underlined: Public Environmental Occupational Health , Australia , China , Canada  and Germany . Additionally, the most utilized languages used in these articles were: English , well ahead of Chinese , with smaller percentages found for German, Korean, Portuguese, and Spanish.Lastly, with respect to the countries that published the most on the subject, the following were found: the USA , Current Content Connect (66.99%), CABI:CAB Abstracts (29.16%), SciELO (2.61%) and KCI-Korean Journal Databases (0.14%) .The trend, with respect to publications and the number of citations, increased from the year 2000 until 2020, reaching a total of 129 publication and 2011 citations in the latter. On the contrary, the number of publications in 2021 decreased to 92 publications, although the number of citations was practically unchanged, with a total of 2002 .As for the number of overall citations, the articles were cited 11,807 times, 11,194 times excluding the self-citations. The top five articles cited accumulated a total of 3573 citations (mean = 714.6). The two most cited articles ,34 correWith respect to the authors who published the most between 2000 and 2021, we found D. Nutbeam , Health Education Journal (2.89%), Health Promotion International (2.20%), BMC Public Health (2.06%) and American Journal of Health Education (1.65%) . The firAs for the number of citations, the five most cited journals were: Patient Education and Counseling with 530 citations, BMC Public Health with 568 citations, Health Promotion International with 417 citations, the Journal of General Internal Medicine with 403 citations and the Journal of Health Communication with 364 citations.According to Journal Citation Reports, the impact factor of the journals with the most publications were between 3390 and 1299, in four different areas of knowledge , which were all classified between the Q1 and Q4 quartiles .n = 321); Health Care Science Services ; Nursing ; Education Educational Research ; and General Internal Medicine .From the WOS analysis, it was found that the top five research areas, according to the number of articles, were: Public, Environmental and Occupational Health  did not establish a relationship with other countries that were not part of their same cluster, while another four were also found which did not have a relationship between countries within the same cluster, but instead had a relationship with the other three clusters .With respect to the affiliations of the authors, the University of Sydney  was identified as the one which possessed the greatest number of publications with 59 articles, followed by the University of California\u2014including all campuses (USA) with 43 articles, and Columbia (USA) and Emory (USA) universities, with 32 publications each. As for the countries with the most citations, among the top ten, we identified: USA with 4256 citations, Australia with 3968, China with 703, Canada with 508, the Netherlands with 337, United Kingdom with 203, Germany with 197, Brazil with 139, Finland with 127 and New Zealand with 89.n = 698) were published in English, 1.38% (n = 10) in German, and with a percentage of less than 1%, from higher to lower: Portuguese, Spanish, Chinese, French, Hungarian, Malay, and Turkish.As for the language of the publication, 96% , with a minimum of 20 occurrences, a threshold of 50 was identified. In the resulting network map, it was observed that the ten words with a greater occurrence were health literacy (422 times), health education (263) knowledge (114), education (107), and care (100) .Cluster 1 : adults, barriers, behaviors, cancer, disparities, health, knowledge, management, perceptions, prevalence, risk, united-states and women.Cluster 2 : adolescent, attitudes, beliefs, depression, disorders, impact, interventions, mental health, mental health literacy, people, program and stigma.Cluster 3 : adherence, care, health communication, health education, health literacy, information, internet, literacy, patient education, quality and readability.Cluster 4 : adolescents, association, behavior, children, oral health, outcomes and validation.Cluster 5 : communication, education, health promotion, intervention, prevention, promotion and public-health.Five clusters were underlined in this network, whose main concepts were:The five clusters have a common node with HL and HE, with both terms acting as a hinge to the different subfields represented by each cluster. By delving deeper into these five clusters, some similarities are identified between clusters 1 and 3, including terms more focused on the concepts of illnesses, adultness, caring, and other terms related with diseases. Likewise, clusters 2 and 4 include terms related with adolescents and children, prevention, health knowledge and prevention of mental health issues. Finally, cluster 5 contains more general terms such as education, promotion, or prevention in health .Lastly, a three-field plot was created, limited to five variables per column, in which the countries with the highest scientific production, the most important keywords, and the journals with the highest number of publications, were paired. It was observed that the countries with a greater number of publications mainly utilized four of the most relevant words . These same words were included in articles published in four of the five journals that published the most, except for the journal Health Promotion International .The objective of this bibliometric analysis was to analyze the evolution and trends in the publications on HL and HE, and due to this, the two-phase analysis strategy allowed us to focus the results in a manner that was more specific and useful for obtaining reliable results. Since WOS and Scopus have similar characteristics in terms of bibliometric parameters that can be analyzed, we chose WOS because it allows a more robust evaluation of the documents housed in this database .As far as we know, this is the first bibliometric analysis on HL and HE conducted at the international level. Although a similar study was published in 2008 , there aFinally, although some specific results could be comparable, such as number of publications per year, the development of new tools for bibliometric analyses allowed us to increase the number of results obtained, their complexity and the way they are displayed.The searches carried out during each phase of the analysis identified uniform results for the number of publications. Thus, in both phases , an increase in the number of publications was observed from the year 2000 to 2020, and this increase was irregular in this 20-year period, with a decrease in the number of publications in specific years. In spite of this, there was a progressive and constant increase in the number of publications from 2016 to 2020, once again decreasing in 2021.As for the number of publications that were most cited, D. Nutbeam was identified as the most cited author in the last 20 years on this subject, becoming the main axis for the rest of the authors who published articles on HL and HE. His two most cited articles ,34 were It must be highlighted that despite the Health Promotion International journal being the first journal to publish on this subject, the International Journal of Environmental Research and Public Health currently has the largest number of publications, and is also the one with the highest impact factor according to the Journal Citation Report.As for the citations, the journals with the most citations related with HL and HE were Patient Education and Counseling and Health Promotion International. However, the most cited article, at present, was published in the Health Promotion International journal, which also had the highest H-Index compared to the other journals analyzed in this study. Likewise, of the top five cited articles, four of them were found in the category Public, Environmental and Occupational Health, which indicates that this category accumulates the highest number of citations on the subjects of HL and HE.Lastly, even though D. Nutbeam was the most cited author, he did not have the highest number of publications on the subject, although he came in second place; this indicates that although D. Nutbeam was the promoter of the subject, as of today, there are other authors who have contributed more to the growth of this field of study.With respect to countries and languages, the searches in the two phases coincided in that the USA was the country with the most publications (>39%), and English the most utilized, with 93% of the articles published in this language. These data were expected if the affiliations with the greatest number of publications are analyzed. Thus, the USA is the first country in terms of scientific contribution if we analyze the three universities with the most publications: University of California\u2014including all campuses (USA), University of Columbia (USA), and Emory University (USA), while Australia is second; even though the University of Sydney publishes the most on the subjects of HL and HE, it does not exceed the number of publications from American universities.At the same time, a set of countries that acted as central nodes in the network of collaborations were identified, when publishing articles on the subject. These were: USA, Canada, United Kingdom, Australia, New Zealand, South Africa, Netherlands and Germany. This indicates that the USA and Australia lead and channel the HL and HE subject, as shown by the number of citations they accumulate, which is higher than 1000 in both cases.Unlike the study of Kondilis , focusedThe bibliometric analysis of the keywords conducted only through the WOSCC with the KeyWords Plus, the author\u2019s keywords, and both together, indicated clear differences between the terms used, which is reasonable, given that the analysis was performed through the concepts health literacy and health education, so that the most relevant words utilized by the authors were these two, compared to the other terms. However, when analyzing the KeyWords Plus, meaning the keywords that are automatically generated from the titles of the articles cited, the most important words that were identified, from most to least, were: care, knowledge, education, health literacy and literacy, exceeding the concepts searched, care and knowledge, which suggests the non-existence of a correlation between keywords that the authors include in the section \u201ckeywords\u201d, which are utilized to entitle their article. This indicates that the terms HL and HE are considered as general concepts which encompass other more specific terms, and are therefore the least utilized to define the issues that will be discussed in each of the articles published on the subject.The analysis of the keywords through time revealed the same trend. Before 2016, the words were focused through the prism of disease and a nursing point of view, including KeyWords Plus such as patient, skills, disease, readability, primary care, information, internet and prevention; and author\u2019s keywords such as: nursing, readability, physical activity, adherence and patient education. During the 2016\u20132018 period, words that were oriented towards education, health, and prevalence started to be used, with keywords such as knowledge, care, prevalence, risk, and health literacy, identified with KeyWords Plus, and oral health, health, health education, education, health promotion and health literacy as author\u2019s keywords. Lastly, starting in 2019, the trend and direction changed, and HL and HE began to be associated with mental health, with KeyWords Plus such as: impact, people, behaviors, and as author\u2019s keywords: adolescent, mental health literacy, mental health, health information and COVID-19. This change in the trend throughout the years demonstrates the versatility of HL and HE, as they adapt to the needs detected in health-related aspects.This increase has been of such magnitude that the keywords associated with the subject have acquired a privileged position, as shown in In the case of mental health, the results obtained from the calculations performed in the study showed that this subject has become more important and relevant in the last few years, not only in terms of mental health as an issue, but also as a challenge in health literacy in specific groups, and in society in general ,41.Focusing on other more recent keywords such as COVID-19, up to 100 different publications from PubMed are retrieved, which include the terms COVID-19 and health literacy combined in their title. As several authors indicate, the situation of the COVID-19 pandemic has implied challenges not only in the diagnosis or treatment of this disease, but also in different areas such as health literacy ,22,23. Ohealth promotion.Lastly, and as a summary, a large homogeneity was found among the top five countries, author\u2019s keywords, and journals. That is, the top five countries published articles about the four most important keywords , and almost all of these appeared in the top five journals. It is interesting to highlight that given that the USA was the country with the most publications, these contained half of all the most relevant keywords, and only one of the five journals did not publish an article about one of the keywords; these are the Health Promotion International journal, and the keyword The main limitations of this study are that since it is a bibliometric analysis of two very broad concepts such as HL and HE, the results obtained may have yielded results that, though concise, do not allow the identification of specific relationships between HL, HE and other more specific concepts. In turn, this leads to another limitation: parameters such as transience index, m-Quotient or track citations and collaborations were not calculated, due to the large and variated number of terms related with HL and HE identified in the five different clusters see . Thus, fThis is the first study in which a complete bibliometric analysis was conducted on Health Literacy (HL) and Health Education (HE) at the international level. As shown by the increasing number of publications, HL and HE have acquired, in the last two decades, a greater importance and relevance in the area of public health publications.The number of publications over the last ten years indicates an expanding interest on this topic. Furthermore, the large number of terms closely related with HL and HE, identified in this study in five different clusters, shows the extensive scope that these two concepts have in health. The focus on what issues are relevant, in terms of HL and HE have evolved through the years going form aspects more related to illness, care and adultness, to others more closely to adolescents and children, prevention of mental health issues and even COVID-19. It can be perceived that, due to the challenges experienced in recent years with the COVID-19 pandemic situation, in the coming years the research in HL and HE will be relevant in mental health literacy. How to act, from the area of HE on vulnerable populations such as adolescents, how to increase knowledge on mental health management, how to modify their beliefs and attitudes or how to reduce the stigma on mental health will be the new challenges to face.The results shown here can guide those who are approaching HL and HE for the first time, providing them relevant information to incentive the research in specific subfields on this subject.HL and HE are very broad concepts covering many different keywords. Deeper bibliometric analyses are required, in which specific cluster of terms are considered, to learn more about differences in the evolution of scientific production on this field.In any case, the information shown in this study is a useful tool that can stimulate new studies and collaborations between researchers from different areas and approaches within the HL and HE."}
{"text": "Many stakeholders are involved in the complicated process of policy making in integrated early childhood development (IECD). In other words, there are many challenges for IECD policy making in developing countries, including Iran. The aim of this study was to identify potential stakeholders and their interactions in IECD policy making in Iran.A mixed-methods study was conducted in two phases in 2018. First, forty semi-structured interviews and a review of IECD-related documents were conducted to identify potential stakeholders and their roles. Second, using a designed checklist, these stakeholders were assessed for power, interest, and position in IECD policy making. Then, a map of stakeholders and a three-dimensional stakeholder analysis figure were designed.The results of this study showed that various stakeholders, including governmental, semi-governmental, social, non-governmental and international organizations, potentially influence IECD policy in Iran. They were found to have diverse levels of power, interest and position in this regard, leading to their different impacts on the process. This diversity is assumed to have affected their levels of participation and support. Also, we found that the stakeholders with a high-power level do not have a high level of interest in, or support for, IECD policy. In general, organizational competition, complicated inter-sectoral nature of this process, insufficient budget, insufficient awareness about the importance of IECD, lack of priority given to IECD in relevant organizations, economical views rather than developmental perspectives, and lack of commitment among top managers are the reasons why this policy enjoys a low degree of support.There are weaknesses in effective interactions and relationships among IECD policy stakeholders. This will lead to the lack of equal opportunities for optimal early childhood development. To improve this process, advocacy from high-level authorities of the organizations, negotiation with child-friendly groups, establishing a body to coordinate and oversee children\u2019s affairs, using the capacity of non-governmental organizations, strengthening inter-sectoral collaboration by clarifying the roles and responsibilities of stakeholders and the relationships between them, and increasing public awareness can be helpful. Early child development (ECD) is a scientific approach to understand children\u2019s growth and development in the early years and includes several areas which are likely to interact with each other. These areas are physical, cognitive, emotional, social, and spiritual domains . Based oThe idea of human development arose with the basic argument that human progress cannot be measured only by per capita income. In addition to having a good income, cultivating and developing human talents and capacities should be considered in this process. In fact, human development depends on many factors such as life expectancy, education, health, and environment . EconomiAdvancements in neuroscience also provided a scientific basis for re-emphasizing the vital importance of ECD. According to studies in neuroscience, brain develops at its fastest rate in early childhood, and this development, in addition to heredity, is influenced by many variables such as poverty , parentaThe health system in Iran has a unique structure and governance in that the Ministry of Health and Medical Education (MoHME) is the stewardship of the health system . The MoHGiven the interdisciplinary and multidisciplinary nature of early childhood development, the participation of different stakeholders in any stage of the policy-making process is very important and their role in the success or failure of early childhood development policy is clear . Even thThis study was conducted in two phases. In the first phase, a qualitative study was designed to identify potential stakeholders and explore their roles, powers, interests and positions in IECD policy making process. In the second phase, a quantitative approach was used to assess the powers, interests and positions of these stakeholders and draw a map as well as a three-dimensional analysis figure of the stakeholders.Using a qualitative content analysis approach, the policy documents related to different fields of IECD including health, nutrition, education, early care as well as national upstream documents, laws, and international policies from 1964 to 2018 were reviewed in this study. The websites of several organizations such as the Ministry of Health and Medical Education, the Social Welfare Organization, the Ministry of Cooperatives, Labor, and Social Welfare, the Ministry of Education, the Parliament, Judicial System of Iran, the World Health Organization, the UNICEF and several other organizations were searched. In this line, the researchers resorted to personal and organizational relationships to identify and have access to relevant reports and documents. Finally, 64 national and 10 international documents and reports were identified and reviewed. Also, the literature was reviewed to identify all the relevant stakeholders and discover their roles, powers, positions, and interests.The other major method for data collection was face-to-face semi-structured interviews with purposefully identified policy makers (PM), managers (M), informed academics and researchers (Aca), NGOs\u2019 representatives (NGO-R), and children\u2019s service providers (CSP) in the child field from different organizations including the Ministry of Health and Medical Education, the Social Welfare Organization, the Ministry of Education, the Ministry of Cooperatives, Labor, and Social Welfare, the Ministry of Justice, Children\u2019s Medical Center, the Parliament, the Society for Protecting the Rights of the Child (SPRC), the universities and the research centers, etc. Forty interviews each lasting for 30\u201390\u00a0min were conducted from October 2017 to June 2018 to reach data saturation. All interviews took place in the interviewees\u2019 workplaces. The researchers used a literature-based and tailored interview guide. Before the interviews, necessary information regarding the study and its objectives were given to the participants and informed consent was obtained from them verbally. Moreover, they were assured that their information would remain confidential and the data of the study would be analyzed anonymously. The following questions were investigated during the interviews: What organizations, institutions, bodies, or persons are the potential stakeholders in IECD policy making? How do you see their roles, powers, interests, effects and interactions in this regard? Are they properly and adequately involved in the policy-making process? What are your suggestions for improving stakeholders\u2019 collaborations in IECD policy-making process?The interviews were transcribed verbatim and a thematic content analysis approach was used to analyze the data. Finally, to ensure the accuracy of our interpretations, the transcripts were shared with the participants who were asked to confirm their statements.In this phase of the study, we designed a checklist which contained the identified potential stakeholders and their roles in order to evaluate them in terms of power, interest and position. We asked the participants in the former phase to score each dimension. In this regard, the scores included numbers 1, 3, 5 and 7 , the Intellectual Development Center for Children and Adolescents, high specialized councils , the Ministry of Agriculture, the Environmental Protection Organization, religious institutions, the Relief Committee, the Ministry of Industry, Mine and Trade, the Health Insurance Organization, the Ministry of Sport and Youth, the Ministry of Roads and Urban Development, The Police Force of the Islamic Republic of Iran, the Ministry of Communications and Information Technology, municipalities, the Ministry of Economic Affairs and Finance, the Ministry of Science, Research and Technology, and the Ministry of Culture and Islamic Guidance. In Table\u00a0\u201cThe Ministry of Education shows low interest in ECD. For example, our kindergarten coverage rate is 10\u2009%, and 90\u2009% of children do not have access to these services at all because kindergarten and preschool education are not free and such educational services are not important in our country\u201d (PM 21).\u201cI want to say that there is insufficient understanding of the importance of ECD at the highest levels of the Ministry of Social Welfare or the Ministry of Health. For example, the implemented actions in the health children\u2019s department do not achieve its goal because it is not a priority for the Ministry of Health\u201d (PM 36).Based on our results, the non-governmental organizations, the Intellectual Development Center for Children and Adolescents, the families, the Children\u2019s Service Providers and the international organizations such as the UNICEF and the World Health Organization had the highest interest in IECD policy. However, their full capacity is not used in policy making. The Ministry of Health and Medical Education and the Social Welfare Organization are rated medium in the domain of interest. According to the interviewees, ECD is not a priority among high-level managers of these organizations, with only the middle level managers of these organizations being interested in this policy. On the other hand, stakeholders such as the Ministry of Cooperatives, Labor and Social Welfare, the Ministry of Education, municipalities, the Planning and Budget Organization, the Judiciary System, the Parliament, high specialized councils, the mass media, religious institutions, the Ministry of Economic Affairs and Finance, the Ministry of the Interior, the Ministry of Culture and Islamic Guidance, the Ministry of Science, Research and Technology, the Ministry of Agriculture, the Ministry of Industry, Mines and Trade, the Ministry of Roads and Urban Development, the Ministry of Communication and Information Technology, universities, scientific associations and related research centers, the Health Insurance Organization, the Relief Committee, The Police Force of the Islamic Republic of Iran, and the Environmental Protection Organization are among the organizations have low interest in IECD policy. The most important reasons for the lack of interest among some stakeholders, as stated in the interviews, include the lack of sufficient awareness of IECD and its importance thereby giving priority to other issues, considering children like other people in the community and not paying attention to their particular needs as unique members of the community, the lack of awareness of their own indirect role in ECD by affecting the environment in which children live, the large number of missions and tasks so that the development of childhood is overlooked among other missions, and the dominance of economic perspectives over developmental concerns.\u201cNon-governmental organizations can play a very good role in this field. Unfortunately, in our country, these organizations are not very strong, and if they gain power, they will become semi-governmental organizations and will not be allowed to operate independently.\u201d (M 7).\u201cTo implement the integrated early childhood development policy, the Ministry of the Interior can be considered as one of the most powerful stakeholders because this program will be implemented as pilot in the three provinces of Kerman, Tehran and Kermanshah. And well, the provincial governments under the Ministry of the Interior have a very effective role here.\u201d (PM 12).Participants rated the non-governmental organizations, the families, the Intellectual Development Center for Children and Adolescents, and the children\u2019s service providers as the least powerful stakeholders in IECD policy. Among them, the Social Welfare Organization, universities, research centers and scientific associations, the Environmental Protection Organization, the Health Insurance Organization, the Police Force of the Islamic Republic of Iran, and the international organizations were classified as medium-level in terms of power. Interestingly, many organizations with low interest in IECD had high power. However, for various reasons such as the lack of structure, the lack of interest, the lack of commitment in senior managers, the conflicting interests, and the different views and approaches, they seemed not to have used their power in IECD policy-making process. Such organizations included the Ministry of Cooperatives, Labor and Social Welfare, the Ministry of Education, municipalities, the Planning and Budget Organization, the Judiciary System, the Parliament, high specialized councils, the mass media, religious institutions, the Ministry of Economic Affairs and Finance, the Ministry of the Interior, the Ministry of Culture and Islamic Guidance, the Ministry of Science, Research and Technology, the Ministry of Agriculture, the Ministry of Industry, Mines and Trade, the Ministry of Roads and Urban Development, the Ministry of Communications and Information Technology, and the Relief Committee.\u201cThere is a lot of competition between organizations involved in early childhood development policy and therefore there is no serious intention to support this policy and most of them show a low level position\u201d (CSP 16).\u201cThis program has not so far been supported well in the country, and many stakeholders who can play a critical role in this regard, such as the Judiciary System, the Parliament, the Ministry of Education, the Ministry of Welfare, etc. have not paid much attention and support for early childhood development and related policies and programs.\u201d (Aca 3).Most of the identified potential stakeholders had medium or low support positions. Stakeholders like the high specialized councils, the Ministry of the Interior, the mass media, the Planning and Budget Organization, universities, research centers and scientific associations, the Ministry of Agriculture, the Environmental Protection Organization, religious institutions, the Ministry of Industry, Mine and Trade, the Health Insurance Organization, the Ministry of Roads and Urban Development, The Police Force of the Islamic Republic of Iran, the Ministry of Communications and Information Technology, municipalities, the Ministry of Economic Affairs and Finance, the Ministry of Science, Research and Technology, and the Ministry of Culture and Islamic Guidance were rated as having a low level of position. Additionally, the Ministry of Health and Medical Education, the Social Welfare Organization, the Ministry of Cooperatives, Labor, and Social Welfare, the Ministry of Education, the Judicial Power, the Parliament, children\u2019s service providers, international organizations and the Ministry of Sport and Youth had a medium level of position. On the other hand, the non-governmental organizations, the families and the Intellectual Development Center for Children and Adolescents were among stakeholders with a high level of position. The participants stated that the main organizations involved in IECD policy, including the Ministry of Health and Medical Education, the Social Welfare Organization and the Ministry of Education, have not yet been able to show a strong supportive position toward this policy despite the fact that they work together to design a policy document for IECD. In this line, one of the important reasons mentioned in the interviews is that these organizations have spent most of their time and energy competing for program ownership or leadership. In some interviews, it is also mentioned that the position of most organizations is not appropriate as far as inter-sectoral issues are concerned.Also, in the three-dimensional stakeholder analysis figure Fig.\u00a0, the relThe results of this study show that many stakeholders play a role in ECD. The identified stakeholders have different interests, powers and positions towards IECD policy so that those with a high power do not have a high interest or position towards this policy and vice versa. Identifying stakeholders and their coalitions and interests in relation to ECD policies is crucial as this will clearly reflect the multiplicity of interests among various stakeholders, including those whose interests are threatened or reinforced by IECD policy. On the other hand, volunteers from different organizations have the time, capacity and resources to help this vulnerable community through stakeholders\u2019 analysis which can be used to focus on their capacities .Based on our study, although some stakeholders in the ECD policies such as the non-governmental organizations and the families have high interest in relation to ECD, their capacities and interests are not used in IECD policy-making process. The family, as the social institution in which the child grows up, has a very effective role in the development of children, and the best policies will fail if the families do not accompany the policies. In this regard, Sharpley emphasizes the role of parents as stakeholders in ECD policies. He states that parents have rights in terms of guidance, care and education of their children. They are also legal representatives who work for, and on behalf of, their children to the effect that they are required to provide the physical and emotional needs of their children including shelter, nutrition, health, education, and safety. Therefore, it is necessary to use their potential and interest in supporting early childhood development policies since the families\u2019 interests and enthusiasm can be increased through these interactions and the parents\u2019 peace of mind can be guaranteed. He also states that parents are one of the most important stakeholders who need workshops and training related to child development, which empowers them and helps them break negative cycles . Based oAccording to the results of this study, various factors such as government ownership, lack of proper communication channels, and cumbersome administrative procedures and laws have prevented the use of the capacities of NGOs in the ECD policy process. Sharpley referred to NGOs as stakeholders that are familiar with ECD programs. He states that they can also participate in charitable activities such as providing toys and food which contribute to children\u2019s development . Also, NAccording to the findings of our study, children\u2019s service providers are ignored by the policymakers despite their high interest for participating in IECD policy-making process, and the top-down approach to policy-making in our country prevents them from influencing the policy-making process. However, according to available evidence, top-down and bottom-up approaches should be combined and used simultaneously so that we can employ the strengths of both approaches and cover their weaknesses. This approach allows us to use the capacity of street-level stakeholders in policy-making . Also, iIn terms of power and position, the results of this study indicate that most stakeholders with low-medium interest and position in IECD policy have high power in the policy-making process. This power originates from numerous factors including the number of resources , the ability to make use of these resources, the ability to influence other stakeholders, and legal legitimacy. However, as mentioned earlier, they have not used their power in IECD policy making for various reasons such as the lack of structure, the lack of interest, the lack of commitment in senior managers, the conflict of interest, and the different views and approaches. Strategies related to negotiation, advocacy, communication, promotion of inter-sectoral collaboration, and integrated approaches have been proposed to encourage these stakeholders to support the early childhood development policy. These strategies are mentioned in various forms in the literature. Since ECD has necessarily emerged as an inter-sectoral issue, and that an integrated approach essentially puts inter-sectoral collaboration systems on its agenda, countries seek an integrated approach to ECD policy planning that helps all sectors contribute to the improvement of children\u2019s survival, growth, development, and success in school . In thisThe results of this study show that due to the inter-sectoral nature of early childhood development and its broad scope, many potential stakeholders are influenced by this policy. Our results also show that the stakeholders who are in the category of high-power stakeholders do not have much interest or high supportive position towards this issue, which leads to a gap in this regard. The potential capacities and resources of all stakeholders, including NGOs, families, service providers, or street-level stakeholders, cannot be used due to this gap. Also, the power and influence of many stakeholders will not be used, which will result in the lack of equal opportunities for optimal development of children in the early years of life. Ultimately, the vital role of ECD in increasing human capital and sustainable development of society will be ignored. Based on our findings, strategies such as negotiation, advocacy, awareness-raising, empowerment, creating effective communication channels, adopting coherent approaches, promoting inter-sectoral collaboration, establishing leadership and coordinating organizations, using the capacities of street-level stakeholders, and promoting international cooperation can be effective in managing the stakeholders.This study was done as the first study on stakeholder analysis of IECD policy-making process in Iran. The results of our study can be used for the management of potential stakeholders in this regard. However, our study had two main limitations; the first was the extensive research environment due to the inter-sectoral nature of the ECD and the diversity of groups involved in policy-making in this regard. The second was the difficult access to relevant experts and policy makers due to their busy schedules or lack of interest in participating in research. For this reason, a number of participants did not complete and return the checklists in the second phase of the study."}
{"text": "European Journal of Hybrid Imaging (EJHI) opened to contributions in February 2017 and was launched in October of the same year, as a platform to publish papers focused on the use of hybrid and multimodality imaging in clinical practice, clinical trials, and pre-clinical research. EJHI was born as the last member of the EJNMMI family of journals and is now well integrated into the scientific workflow of the family.The EJHI can ensure the rapid and widespread distribution of published articles. The open access model offers a fast and reliable way to disseminate knowledge, and publication can be supported with several funding schemes when authors have no resources available to them. In this respect, the European Association of Nuclear Medicine (EANM) has supported the publication of relevant papers with a sponsorship program. The EANM program helped authors who would otherwise lack Open Access funding publish in EJHI, and the resulting research has contributed greatly to both to the field and the success of the journal. This program will be continued next year, in order to facilitate the successful positioning of the journal in the scientific community.As an Open Access journal, EJHI has received contributions not only from the nuclear medicine community but also from authors in other disciplines that involve hybrid imaging.In less than 2\u2009years of life, the EJHI received 49 manuscripts, of which 37 were accepted and 3 are currently under revision. In 2017 only, the articles published in EJHI were downloaded 587 times, with a usage factor of 122.As of September 2018, the A fast and effective peer review process is practiced at the journal, in line with the characteristics of the EJNMMI family of journals, and this ensures the rapid appraisal of manuscripts.European Journal of Hybrid Imaging has a brief, but very successful, history.When taken together, we have all the arguments to say that the European Journal of Hybrid Imaging, as of January 1, 2019. At the same time, Arturo Chiti will become the Editor-in-Chief of the European Journal of Nuclear Medicine and Molecular Imaging, continuing his efforts in the EANM family of journals.To continue this trend, Springer Nature and EANM, in agreement with Arturo Chiti, have asked Francesco Giammarile to become the Editor-in-Chief of the EJHI, driving the journal towards an established position within the scientific journals in its field.Prof. Giammarile will ensure a smooth transition and the continued growth of the Arturo Chiti, Humanitas University and Humanitas Clinical and Research Center, Milan, Italy.Francesco Giammarile, International Atomic Energy Agency, Vienna, Austria."}
{"text": "Dear Editor,Adult gluteal granuloma (AGG) is an inflammatory dermatosis that occurs in adults or the elderly on skin exposed to prolonged contact with feces and urine. It presents as well-demarcated areas of erythema, edema, scaling, papules, nodules, erosions, and ulcerations. On histopathological analysis, there is no granuloma, but there is acanthosis, spongiosis, varying degrees of a mixed superficial and deep inflammatory infiltrate, and proliferation of vessels in the dermis.An 86-year-old man presented with erythematous, infiltrated, well-defined plaques, with a slightly scaling border and central clearing, asymptomatic, on the lateral aspects of the hips for six months . The patCandida albicans, occlusion and halogenated corticosteroids are possible pathogenic factors.Gluteal granuloma is an inflammatory condition, most commonly observed in infanthood, in the form of papules and nodules in the diaper area. Of uncertain etiology, it is believed that a skin reaction occurs to the repeated contact with irritating substances present in feces, urine and cleaning utensils. Infection by The pH of normal skin is approximately 5.5; while that of urine is around 6 or higher, when there is bacteriuria or infection by urease-producing bacteria, an environment that increases the activity of lipases and proteases, impairs the skin barrier and predisposes to the action of local irritants. Our patient had a urinary pH of 8.5 and bacteriuria, corroborating the findings reported by Isogai et al.The distribution of the lesions is related to the patient\u2019s position, with nodules located in the scrotum and labia majora of patients who remain seated for a long time, and nodules around the anus in bedridden patients.Recently, dermoscopic findings have been described in a case of AGG, showing papillae with rounded white areas surrounded by erythema and serrated white borders. These papillae were separated by fissures and contained a whitish mesh, comedo-like openings and dotted vessels under the greatest magnification.Keeping the skin clean and dry is the main treatment and the best form of prevention. There are individual reports or case series and, in most of them, topical treatments, including corticosteroids, have failed. The use of topical corticosteroids was effective in two patients.With the aging of the population and the increase in the number of incontinent individuals, we will possibly face this entity more frequently, justifying the importance of learning about it.None declared.Anna Karoline Gouveia de Oliveira: Drafting and editing of the manuscript.Neusa Yuriko Sakai Valente: Approval of the final version of the manuscript; drafting and editing of the manuscript; intellectual participation in propaedeutic and/or therapeutic conduct of the studied cases; critical review of the manuscript.Thais do Amaral Carneiro Cunha: Intellectual participation in propaedeutic and/or therapeutic conduct of the studied cases.Agatha Ramos Oppenheimer: Intellectual participation in propaedeutic and/or therapeutic conduct of the studied cases.None declared."}
{"text": "Studies on Cognitive Processes in Translation aims to integrate these two research paradigms and systematically explore the theories, methods and frontier issues of studies on cognitive processes in translation.Since Krings  first prThe book has five chapters. Chapter 1 reviews the development course, main objectives and research contents of studies on cognitive processes in translation both in China and abroad, and points out that there are two generations of language cognitive views in the research of cognitive translatology, namely, the first generation of classic objectivism cognition and the second generation of connectionism and situated/embedded/embodied cognition. The author proposes that from the perspective of the second generation of cognitive science, the primary goal of studies on cognitive processes in translation is to focus on more cognitive psychological processes involved in translation, expand and deepen the understanding of the translator's internal cognitive behaviors, and explore deeper secrets in the brain.Chapter 2 mainly discusses the research methods applied in studies on cognitive processes in translation. According to the data sources and measurement indicators, the author classifies research methods of cognitive processes in translation into five categories: verbal reports, behavioral measurement, physiological measurement, text analysis, and supplementary methods. This chapter introduces the application of the above five categories in the studies on cognitive processes in translation, and analyzes the advantages and disadvantages of each research method. Finally, it discusses the feasibility and prospect of multi-element mutual verification/triangulating in the studies on translation processes.Chapter 3 focuses on the descriptive and explanatory models of cognitive processes in translation. In view of lack of consistency in the theoretical framework of the existing studies on cognitive processes in translation, this chapter, based on the macro perspective of cognitive science, makes a clearer positioning of the theoretical starting points, perspectives and presuppositions reflected in various cognitive process models. It focuses on the influential translation process models, such as Bell's translation process model, Alves and Gon\u00e7alves' relevance-connectionism model, PACTE translation competence model, translatorial cognition and action network, Kintsch's construction-integration model, hence making clear the future research directions.Chapter 4 reviews the existing researches on translator's real-time cognitive processing with several core constructs as the main line, and comments on the basic assumptions, cognitive dimensions, and limitations. Based on the second generation of cognitive science paradigm, especially from the perspective of cognitive linguistics, this chapter also looks forward to the future of real-time cognitive processing of translation.Chapter 5 first explores the influences of the changes of translation workspace and the development of translation technology on the translation processes, and then discusses the theoretical frameworks of contextualized cognition, socio-cultural cognition, affective cognition, unconscious cognition, and common cognitive process in translation, as well as the existing empirical researches, and looks into the trends of future researches.Chapter 6 is the conclusion of the whole book, which summarizes the relevant research fields and problems mentioned in the above chapters, and discusses how to meet the challenges and promote the studies on cognitive processes in translation to the unknown field. The author argues that cognitive translatology must innovate and integrate its methodology; the importance of conceptual research and theoretical research should not be ignored; it is necessary to explore the practical influences or applications of studies on cognitive processes in translation and interpretation.Studies on Cognitive Processes in Translation an excellent book with both practicability and collectability for post-graduate students, researchers, and scholars interested in studies on cognitive processes in translation.As a monograph exploring the studies on cognitive processes in translation, this book embodies the trend of interdisciplinary research, that is, the research methods and new technologies of psycholinguistics and cognitive science are constantly applied to the studies on cognitive processes in translation, realizing the mutual benefit and win-win development among disciplines. As far as the research content is concerned, this book has the characteristics of both theoretical reviews and experimental researches. The theoretical review not only reviews and rethinks the related researches in this field, but also points out the problems to be solved or the research trend, which has important reference value for future researches. As for experimental researches, this book expands the scope of studies on cognitive processes in translation and deepens the research of old topics. It is one of the representative works reflecting the current research progress of studies on cognitive processes in translation. This book is characterized by distinct theme, rigorous structure, and strong objectivity. Therefore, it is these qualities that make However, there still remain some respects worth Tan Yesheng's further elaboration. Firstly, although the experimental studies in this book mention the application of neuroimaging techniques, such as electroencephalogram, functional magnetic resonance imaging, and current skin test, in the study of cognitive processes in translation, these currently frequently-applied methods in the fields of psycholinguistics and cognitive science are not expounded in details. Secondly, the book does not involve the reception study in the processes of translation. In other words, it only deals with the processes of the translator's understanding, transformation and expression, rather than the reception process of the target readers. Finally, the book would be more comprehensive if it included more studies in China.QY has written the book review and approved the submitted version for publication.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "Each year, millions of visitors crowd the halls of the vast ensemble of museums in New York City, among which are some of the most prestigious and highly visited cultural heritage sites in the United States Fig.\u00a0. These hThe Metropolitan Museum of Art (The Met) and The Museum of Modern Art (MoMA) are currently the only two New York City museums with full-time scientific staff. In addition to carrying out research in house, scientists at both institutions have actively pursued successful collaborations with colleagues in academia. While conservators may have varying degrees of scientific training and access to basic instrumentation, a scientist\u2019s highly specialized skills and broad technical expertise are often desirable to embark on in-depth investigations and address high-impact questions. To meet the scientific needs of the New York City museum community and nurture opportunities for collaboration among neighbor institutions in the cultural heritage field, in September 2016 The Met\u2019s Department of Scientific Research (DSR) launched the Network Initiative for Conservation Science, or NICS, with financial support from The Andrew W. Mellon Foundation. Growing out of a history of informal collaborations between The Met\u2019s DSR and other New York City museums, NICS is a 6-year program aiming to share The Met\u2019s resources, expertise, and state-of-the-art scientific research facilities with partner institutions free of charge. NICS currently supports 11 museums and cultural heritage institutions in New York City, including the American Museum of Natural History, the Brooklyn Museum, the Central Park Conservancy, the Cooper-Hewitt Smithsonian Design Museum, The Frick Collection, the Hispanic Museum & Library, The Morgan Library & Museum, MoMA, The New York Public Library, the Solomon R. Guggenheim Museum, and The Whitney Museum of American Art.NICS aims to promote sustainable research and advance scholarship in art history, archaeology, conservation, and science; to provide in-depth characterization of the materials and techniques used to create artifacts of archaeological, historical, and artistic relevance; to offer insight into the state of preservation and degradation of artworks; to develop innovative methodologies for the monitoring, stabilization, and repair of these objects; and to create an interface through which needs, capabilities, and knowledge can be shared at no cost among\u00a0all institutions in the program. To date, NICS has served as a crucial resource for New York City museums and cultural heritage institutions, allowing members to probe in-depth scientific research questions as well as answer basic requests in the service of art conservation and preservation. Along with the use of benchtop instrumentation available in The Met\u2019s DSR, NICS scientists have created a mobile laboratory that can be employed for in-situ analysis of unmovable objects, and have also relied on external research facilities through national and international collaborations. Since the beginning of the program, the team has carried out collaborative work on 70 projects, focusing on over 300 objects that span a broad range of media, cultures, and historical periods Fig.\u00a0. PresentThis collection, including 8 articles, presents findings from some of the most relevant and fascinating projects that the NICS team has pursued in collaboration with other New York City museums. Among the topics discussed are discoveries on the repainting of Alexander Calder\u2019s motorized sculptures , the deg"}
{"text": "The history of healthy city planning can be traced back to the beginning of the 19th century. Since the industrialization period, the harsh living conditions of cities and the outbreak of infectious diseases have promoted the coordinated development of urban planning and public health, and people have gradually realized the importance of urban design and planning to the health of residents. After searching keywords related to health city and urban planning, and excluding repeated, non-English, and unrelated papers, this work retrieved 2582 documents as the basic data . Additionally, CiteSpace was used to analyze document co-citation, cooperation network, and topic co-occurrence. Subsequently, random forest algorithm was used to predict the probability of citation. Overall, this work found that the hot spots of healthy urban planning are physical activity, green space, urban green space, and mental health. It also shows the diversification of themes and the development trend of cross-fields in the field of healthy urban planning. In addition, the article found that two factors, namely, the average number of citations of the first author and whether the article belongs to the field of environmental research, have a great impact on the number of citations of the article. This work is of practical significance to relevant practitioners and researchers, because it provides guidance for hot topics and future research directions in the field of healthy urban planning. The squalid living conditions of industrialized cities and communicable disease outbreaks in the 19th century gave rise to both the urban planning and public health professions ,3, whichIn the 1980s, the World Health Organization (WHO) officially proposed the healthy city project in Europe in 1986 and took five years as a phase to promote the development of healthy cities ,15. ThisIn the 1990s, with the broad spread of health city projects, more countries formed a cooperative network and integrated healthy city planning into their national policies. Germany further strengthened their health city network at the annual general meeting (AGM) in Greifswald, and emphasized the importance of health impact assessment and urban planning . Korea uAt the beginning of the 21st century, concepts such as City Health Development Planning (CHDP)  and HealIn terms of research, the themes of healthy city planning are widely distributed, which relates to impact of urban morphology ,36,37, eThe rest of this paper is organized as follows: In Bibliometric analysis is used for the quantitative analysis of books, articles, or other publications ,66 and hThis work will use CiteSpace to conduct a bibliometric analysis on the field of healthy urban planning. To have a deeper understanding of future research trends in this field, this work will also use the random forest algorithm to explore the influencing factors of literature citations using the characteristics of the article , and key research fields are used to predict hotspots and trends in the field of healthy urban planning.In summary, this work combines two different methods to jointly analyze the current and future research focus of healthy urban planning. As for the research design, we presented an outline of the research process in In step one for data acquisition, this work uses the core set of the WOS as the data source. Considering that our research focuses on healthy urban planning, which is the combination of health city and urban planning, we searched for papers of which the research topics, titles, or keywords contain \u201chealthy city\u201d (including synonyms) and the WOS categories that are highly related to urban planning . The specific search formula is TS =  OR TI =  OR AK =  AND WC = . The time span is 1 January 1981\u201331 December 2020, and the retrieval time is 28 January 2021.In step two for data processing, we firstly sorted out the papers of which the document type was articles (including reviews) and excluded non-English papers. Secondly, we removed the repeated articles. Finally, we manually excluded papers that were unrelated to the theme of healthy urban planning; finally, 2582 articles were obtained for CiteSpace analysis. The workflow above followed the criteria of Database Search , which iThen, the random forest algorithm analysis of this work uses the literature data of 2582 articles obtained in the WOS as the basis. The initial data from the WOS for each article included information of the Web of Science Core Collection field tags, such as AU (author), TI (title), etc. We selected terms that could be used in random forest part, reorganized them into 22 forecast influence factors, and divided them into the following three types: publication, author, and document. After calculation and statistics, the influencing factors such as the categories, names, sources, and statistical methods of all the influencing factors, were listed in (1)Analysis processIn this work, we used CiteSpace to conduct bibliometric analysis in the field of healthy urban planning from the aspects of cooperation network at the national, institutional, and individual scales; co-citation analysis of highly cited authors, journals and references; and theme analysis such as keywords co-occurrence.(2)Analysis typeThis research used CiteSpace 5.7.R3 (64-bit)-(c)2003-2021 Chaomei Chen to analyze the co-citation status, cooperation status, and sudden changes (burst detection of words or items through time) of keywords to determine the internal structure of the field, knowledge database of different periods of time, research hotspots, and research frontiers,91,92,93a.Cooperation Network AnalysisResearch on the country and institutional cooperation network is conducive to exploring the spatial and geographic distribution of published articles. Additionally, the author of the study has a key role in reflecting the research ability and evaluating the development of the academic field.b.Co-citation AnalysisWe must pay attention to the citation frequency of articles to identify the core authors and journals in a certain field. Moreover, from the topic distribution of the reference literature, we can see the knowledge base of the healthy urban planning field and provide reference values for subsequent research.c.Thematic Co-occurrence AnalysisThe co-occurrence of keywords can reflect the research hotspots of the subject field and provide auxiliary support for scientific research effectively. Additionally, the keyword explosive detection map is to detect keywords with a rapid increase in frequency in the short term, which reflects the occurrence of hot spots more directly.(1)Modeling processReferring to previous studies , we used(2)Random sampling was performed on the sample data set with replacement to obtain a data set with the same size sample.Specify the mtry value, that is, randomly generate mtry variables for the binary tree on the node, and the choice of the binary tree variables still meets the principle of minimum node impurity.Establish a fully grown decision tree to train all the extracted data sets.The final result is obtained by counting the average of the possible results of all decision trees.Algorithm stepsRandom forest is an ensemble learning algorithm that is based on decision trees, which was proposed in 2001 by Leo Breiman  along wi(3)Parameter SelectionAccording to the above steps, we organize the data set and build a random forest model. The model structure is shown in a.Root mean square error (RMSE).The root mean square error (RMSE) corresponds to the square root of the ratio of the square of the deviation between the predicted value and the true value to the number of observations n. It is used to measure the deviation between the predicted value and the true value. The smaller the value is, the smaller the deviation between the predicted value and the true value is, and the higher the prediction accuracy of the model is. Thus, the prediction model needs to seek to minimize the RMSE of the model training set.b.Decision tree (ntree).This work uses the test set to evaluate the performance of the model for predicting the number of citations in the literature. During the parameter selection process, the number of decision trees (ntree) is fixed to 500 for the following two reasons: first, the more trees exist, the more wasteful the computer\u2019s performance will be. Second, after a certain number of models, the performance of the model remains basically stable, and the improvement of model performance with the increase in the number of trees is very small. Subsequently, this work optimizes the value of the number of predictors (mtry) randomly selected by each tree by searching in discrete intervals of 1\u202660.c.K-fold cross-validation.To establish a more accurate prediction model under the condition of a smaller amount of data, this paper used K-fold cross-validation to perform k = 10 repeated k-fold cross-validation, which means that the training set is divided into k sub-samples, a single sub-sample is retained as the verification data, the other k-1 samples are used for training, the cross-validation is repeated k times, each sub-sample is verified once, the results are averaged k times, and an optimal result is finally obtained.d.Ranking of Influencing FactorsIn the random forest prediction model, increased mean squared error (%IncMSE) refers to the expected value of the square of the difference between the estimated value of the parameter and the true value of the parameter caused by the change in the predictive index. The larger the value is, the greater the impact of the factor on the prediction model is. This article uses %IncMSE value  to determine the factors that have the greatest impact on the number of citations in the literature.After data processing, a series of networks were generated to determine the state for healthy urban planning research. The 2582 articles were listed according to their year of publication. Then, networks of country, institution, author, journal, keywords, were derived using CiteSpace. Then, the outcome of random forest algorithm showed the most important influence factor of an article in this field as well as the future trend of the healthy urban planning area.The analysis of publishing was divided into the following two parts: publication volume and publication year, then the WOS category analysis of the literature. The analysis of the publication volume and the publication year can clearly show the development process of the healthy urban planning area. Additionally, the WOS category analysis of the literature can clearly show the distribution of disciplines in the research field of healthy urban planning.According to the growth curve of healthy urban planning research, it is divided into the following three stages: preparation period, budding period, and development period. Notably, its stage node has a corresponding relationship with the WHO healthy city project.(1) Preparation period 1981\u20131992 (I). Before 1993, less than 10 articles on healthy urban planning were issued each year, and the growth was extremely slow. This phenomenon may be related to the initial proposal of the concept of a healthy city, and the research was in the exploratory stage.(2) Budding period 1993\u20132007 . A series of research results on healthy urban planning appeared in this period ,103, and(3) Development period 2008\u20132020 . Since 2008, issues related to healthy cities have gradually become one of the most concerned issues for scientists, government decision makers, various countries, and international organizations in the related fields. Moreover, the number of documents has grown rapidly since 2008, and its growth rate is much greater than the preparation and budding periods. In 2020, 407 related documents were produced, and 2236 documents were produced in 12 years.In general, the amount of literature related to healthy city planning has increased exponentially in 40 years, and the growth cycle of its literature is basically the same as the development cycle of healthy city projects. The promotion and publicity of healthy city projects have had a certain impact on the academic research of healthy urban planning.The exported literature covers 44 WOS categories. There are three analysis types of this work using CiteSpace, including Cooperation network analysis, Co-citation Analysis, and Thematic Co-occurrence Analysis. From these networks, the development context of the healthy urban planning area can be completely presented.(1)Country Cooperation Network AnalysisCooperation networks exist among countries, institutions, as well as authors. We used CiteSpace to build the following three individual networks: a country, an institutional, and an author cooperation network to explore the cooperation relationship within the field of healthy urban planning.The country cooperation network of healthy urban planning research is shown in (2)Institutional Cooperation Network AnalysisAs shown in (3)Author Cooperation Network AnalysisBased on 2582 articles by 6550 different authors, (1)Author Co-cited Network AnalysisIn this work, we conducted the co-citation analysis from the perspectives of the author, journals, and references, in order to identify the core authors and journals of the healthy urban planning area and the knowledge bases of this area.(2)Network Analysis of Co-cited JournalsAccording to the analysis of the co-cited journals, the distribution of the journals cited has a vivid reflection in the field of healthy urban planning.Landscape and Urban Planning is the journal with the most co-citations , and its citations and centrality are much higher than other journals. This result indicates that Landscape and Urban Planning has a high reference value for research in the field of healthy urban planning. The second journal is Health & Place , and the third is Urban Forestry & Urban Greening . These three journals serve as the core nodes that have established connections with other nodes.(3)Co-citation Analysis of ReferencesWhat can be seen from (1)Co-occurrence of Key WordsKeywords are important in our research of the healthy urban planning area. In this work, we used the co-occurrence of keywords, the timeline of keywords, as well as the burst detection of keywords to identify the hot spots of this research area.(2)Timeline of Key WordsThe words health, city, urban, and environment are too broad in meaning to be analyzed. What can be seen from (3)Burst Detection of Key WordsThe result of the random forest algorithm of this work can be presented from the following three perspectives that can show the most significant characteristics of this analysis: overall result, the WOS field, and country or region.In terms of the volume of publications, the number of documents related to healthy urban planning has generally shown an exponential increase in 40 years, and the growth cycle of its documents is basically the same as the development cycle of healthy urban projects. The promotion and publicity of healthy city projects has an impact on academic research in healthy urban planning. Then, we found out that the field of healthy urban planning is highly interdisciplinary. In addition to the fields related to urban research, it also has a certain degree of intersection with economics, environmental science, and ecology.In terms of cooperation networks, at the level of national cooperation, except for Denmark, Scotland, Finland, Switzerland, and Sweden, four other countries, China, Brazil, New Zealand, and France, have each formed a certain scale of cooperation, and most of the other countries have not formed a certain scale of cooperation groups. The United Kingdom, the United States, Australia, the Netherlands, and many other countries play an important role in the cooperation network of healthy urban planning. At the level of institutional cooperation, the University of Hong Kong and University of Illinois are fruitful contributors in this field with a higher number of and more in-depth publications. At the micro level of author cooperation, some small-scale cooperation networks have been formed but without very central authors.Landscape and Urban Planning, Health & Place, and Urban Forestry & Urban Greening were the core journals in the field of healthy urban planning. In terms of co-cited references, the impact of urban green space landscape on residents\u2019 psychology; the behavior, emotion, health and spatial quality evaluation of people related to urban green space; and the walkability of the space and its impact on the health of residents, partial clustering provides a powerful reference for the study of healthy urban planning.In terms of co-citation analysis, among the authors, WHO, Hartig T, and Kaplan are among the top three in terms of citations. In terms of the journals co-cited, In terms of thematic co-occurrence, the hot spots in the field of healthy urban planning are physical activity, green space, and mental health. According to the analysis of the keyword timeline, the research of healthy urban planning not only focuses on the planning and design of urban space and green space resources but also considers the health factors of urban residents. Moreover, the clustering of keywords has a certain inclusion relationship with the clusters co-cited in the literature, which reflects that the field of healthy urban planning is gradually expanding and becoming diversified. In addition, through explosive testing, the hot words of healthy urban planning changed rapidly and were not sustainable.After having a more comprehensive understanding of the field of healthy urban planning, this work used the random forest algorithm to establish a model to predict and rank the factors that influence the citation of literature in the field of healthy urban planning. Taken together, top three influence factors which have dominant influence on the number of citations of the document are: the number of times the first author\u2019s articles have been cited, the number of pages, the journal\u2018s impact factor. The two influencing factors, namely, whether it is a single author and the diversity of the research direction, also have high %incMSE values, showing that multi-author cooperation and multi-disciplinary literature have the potential of being highly cited to a certain extent. Among the influencing factors related to the WOS fields, the %IncMSE values of Environmental Studies, Geography, Regional and Urban Planning, and Ecology are all high, suggesting that the frequency of the citations of documents which overlap with these fields in healthy urban planning research may increase to some extent. Among the five countries with the largest number of publications in the field of healthy urban planning, China\u2019s %incMSE value ranks first, which may indicate that Chinese researchers have made relatively significant progress in the field of healthy urban planning. Therefore, according to this result, it may be a good choice to cooperate with Chinese researchers. However, this does not mean to deny the contribution of any other country in the research of this field. It is only the objective result produced from the selected 2582 articles. What we really want to do is encourage international cross-country cooperation and enhance the international cooperation network in this fieldHealthy urban planning is a field under rapid development. Over the past few decades, countries have made unremitting efforts to make our cities healthier. In this work, CiteSpace data visualization analysis and a random forest algorithm are used to analyze the articles on the healthy urban planning area in the WOS core database from 1981 to 2020 (as of 31 December 2020). The conclusions are as follows:(1) The field of healthy city planning has developed rapidly in the past 40 years, the number of annual articles of healthy urban planning research has increased from 2 to 407 exponentially. In the meantime, this field is growing more and more interdisciplinary.Landscape and Urban Planning, Health & Place, and Urban Forestry & Urban Greening are the core journals in the field of healthy urban planning, having the highest co-cited frequency. Moreover, the research hotspots are wide and changing rapidly, mainly focusing on physical activity, urban green space, mental health, etc., which also reflects that the field of healthy city planning is gradually expanding and diversifying.(2) A certain scale of cooperation network has been formed, where the United Kingdom, the United States, Australia, etc., and the University of Hong Kong, University of Illinois, etc., are in an important position. This may be relative to the promotion of the WHO healthy city project. Additionally, (3) Based on the analysis result of the random forest algorithm, for related researchers, it is advantageous to consider international cross-country cooperation, interdisciplinary themes, and multi-author cooperation when studying in the field of healthy urban planning in the future, especially considering fields such as Environmental Studies, Geography, Regional and Urban Planning, and Ecology.The emerging trends and patterns identified using CiteSpace and the prediction results of the random forest algorithm provide novel, interesting, and comprehensive views on how to conduct healthy urban planning research. Based on the conclusion, this article has provided some suggestions for future research: First, the research direction of future healthy urban planning should not only focus on the planning and design of urban space and green space resources but also consider the physical and mental health of urban residents. Specifically, the research on green space needs to consider factors such as human activities and mental health. Second, this study found that the field of healthy urban planning is highly interdisciplinary. At the same time, multi-author cooperation and multi-disciplinary literature have the potential to be highly cited, thereby showing that the field of healthy urban planning is looking forward to the new cross-cutting of knowledge to bring about differences to the field. Healthy urban planning itself involves multi-disciplinary knowledge, such as urban research, geography, environmental science, landscape architecture, public health, and medicine. Strengthening the cross-cooperation among various disciplines and conducting joint research can help analyze the fundamentals of healthy urban development and understand the essential relationship between the city and people\u2019s healthy life and also provide us with multiple perspectives to explore the characteristics of the rules behind the harmonious relationship of people and city.Despite the contribution of this work, the research still has some shortcomings and limitations. First, the research data are only selected to analyze the literature data in the largest global database of scientific publications , but other international databases  are not"}
{"text": "In January 2018, the Minister of Health, Labour and Welfare, Japan, released an amended Guideline on the Prevention of Specified Infectious Diseases on Acquired Immunodeficiency Syndrome (AIDS) to propose measures to control the human immunodeficiency virus (HIV)/AIDS. Content analysis was performed to examine the strengths, weaknesses, opportunities, and threats of the guidelines in the context of the ongoing COVID-19 pandemic, thus aiming to promote discussions on the guideline itself and the national HIV/AIDS strategy in Japan in the years ahead. The strengths included the incorporation of the latest scientific advancements, clarification of high-risk populations, an alignment with measures against sexually transmitted diseases (STDs), and willingness towards international cooperation in the Asia-Pacific region. The weaknesses that were exposed included a lack of explicit targets for controlling and containing HIV/AIDS, insufficient descriptions about pre-exposure prophylaxis (PrEP), and aggregated discussions on HIV/AIDS among foreign residents. Although several opportunities for re-energizing the discussions around HIV/AIDS were recognized, insufficient political will and funding, along with the emergence of the ongoing COVID-19 pandemic, could operate as threats. Addressing barriers that were recognized before 2019 and exposed due to the COVID-19 pandemic, and tackling underlying health inequalities through the concept of social determinants of health will be critical. Although the annual numbers of newly reported human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) patients have peaked at 1126 in 2008 and 484 in 2013, respectively, followed by a slightly decreasing trend, and the prevalence of HIV remains low in Japan, HIV/AIDS has been a critical public health issue in Japan [In Japan, countermeasures against HIV/AIDS were implemented by following the Act on the Prevention of Infectious Diseases and Medical Care for Patients with Infectious Diseases. The guideline that is specific to HIV/AIDS was first launched in 1999 and has been amended three times . The latTherefore, the primary objective of this study is to examine the strengths, weaknesses, opportunities, and threats of the Guidelines on the Prevention of Specified Infectious Diseases on AIDS in Japan. The guidelines were published in 2018, but the context of the ongoing COVID-19 pandemic has prompted urgent consideration of opportunities and threats that are external to the guidelines; thus, there is a need to promote discussions on the guidelines themselves, to reconsider the national HIV/AIDS strategy in Japan, and to provide policy recommendations to inform the next updates.To analyze the potential impact of the guidelines, highlight internal strengths (S) and weaknesses (W), and clarify the external opportunities (O) and threats (T), the methodology of a SWOT analysis has been employed in line with previous analysis on the Updated National HIV/AIDS Strategy in the U.S. . This meTwo steps were undertaken for the investigation. First, the latest Guidelines on Prevention of Specified Infectious Diseases on AIDS in Japan were identified  and analOverall, five strengths were extracted from the analysis. First, the guidelines touched on recent scientific evidence regarding HIV/AIDS, such as treatment as prevention (T as P) and emphasized the importance of early detection and treatment to improve prognosis. In this context, progress in the research of the UNAIDS cascade both at national and regional levels was highlighted, and it was argued that an oral consent process for testing is possible. In addition, the guidelines noted the shift from cure to care of older HIV/AIDS patients. Second, the definition of a risk population was revisited to follow the consensus of key affected populations (KAPs), as defined by international organizations such as the World Health Organization (WHO). Additionally, MSM were recognized as the most prioritized group for consideration, and the healthcare services for foreign residents with HIV/AIDS and cooperation with non-governmental organizations were highlighted.Third, to raise public awareness and knowledge, the guidelines emphasized the need for targeted health promotion at educational institutions for adolescents, among the MSM community, and at healthcare facilities for healthcare workers. The guidelines emphasized the role of healthcare workers in social engagement and the need to enhance their understanding of HIV/AIDS, as well as the importance of taking standard precautions to mitigate fear and anxiety among healthcare workers who are unfamiliar with HIV/AIDS. Fourth, HIV/AIDS and sexually transmitted diseases (STDs) share similar characteristics in prevention, detection, treatment, and supportive care, and inter-collaboration between countermeasures against HIV/AIDS and STDs has been heavily emphasized. In the guidelines on HIV/AIDS, the shared approaches and challenges, along with the importance of simultaneous testing of HIV and STDs, were discussed. Fifth, the necessity of international collaboration, especially in the Asia-Pacific region, was noted.Although the guidelines have several strengths, including mention of the scientific advancements in HIV/AIDS research, they also have several weaknesses. First and foremost, there is a lack of reference to scientific evidence and clearly delineated goals. There is also a lack of reference to the extent to which early detection and treatment have contributed to reducing HIV prevalence. Additionally, the numbers of the UNAIDS cascade on achieving 90-90-90 have not been presented. The risk populations were summarized and presented, but an estimated number of each population was not presented in the data. The slogan of \u201cUndetectable = Untransmissible (U = U)\u201d that has been primarily advocated by the Prevention Access Campaign  was missSecond, despite the increasing trend and potential usefulness of postal HIV testing as suggested by the high demand among MSM , effectiFirst, there has been a re-energized recognition of the importance of early treatment of HIV/AIDS in Japan. The latest guideline on anti-HIV treatment recommends that treatment should begin for all people living with HIV, regardless of their CD4 counts. Second, though very modest among Organisation for Economic Co-operation and Development (OECD) countries, the inclusivity of legal lesbian, gay, bisexual, transgender, and intersex (LGBTI) persons in Japan has been improving , and theOne of the biggest threats is the lack of an overall strategy against HIV/AIDS in Japan. The guidelines were published by the Minister of Health, but there has been a lack of sector-wide political will to end HIV/AIDS in Japan. Second, Japan still lacks an individual registration system for people living with HIV/AIDS (PLWHA) . This imFinally, the current COVID-19 pandemic could work as a threat to advancing discussions on HIV/AIDS as public health centers were overwhelmed by the COVID-19 pandemic ,5 and a The results of the analysis on the strengths, weaknesses, threats, and opportunities are summarized below .This is the first SWOT analysis of the updated Guidelines on the Prevention of Specified Infectious Diseases of AIDS in Japan that reflects on the current COVID-19 pandemic. Several challenges faced in the development of countermeasures against HIV/AIDS were extracted from this study. To consider potential solutions, the discussion will be separated into four pillars.To prevent HIV infection, effective biomedical, behavioral, and structural interventions need to be combined . Highly To prevent the transmission of HIV, behavioral change based on the risk profiles of each individual has been emphasized, and the latest guidelines also try to accelerate health promotion campaigns in various settings, such as households, regions, schools, and offices. As PLWHA are still marginalized in the context of Japan, sufficient promotion campaigns that aim to prevent social prejudice and discrimination are vital. Moreover, enhancing the recognition of HIV/AIDS among healthcare workers and enhancing community engagement will be crucial where the HIV prevalence is relatively low and treatment of HIV patients is generally conducted in specific hospitals.Further, the transmission of HIV has been triggered among MSM through unsafe sexual activities . HoweverIn Japan, the biggest challenge in achieving the UNAIDS cascade on 90-90-90 by 2020 and 95-95-95 by 2025 has been in the first component: 90% of all people living with HIV will know their HIV status. Previous modelling and epidemiological analysis suggested that the diagnosed proportion of HIV in Japan has not reached 90% ,31. DespBefore the emergence of the COVID-19 pandemic, there was already discussion on the issue of access to testing in Japan. Accessibility to sexual health services was limited, especially for MSM , and socThe COVID-19 pandemic has emerged as a significant threat for PLWHA. Clinically, HIV has been acknowledged as one of significant risk factors for SARS-CoV-2 infection, and the higher mortality by the COVID-19 among PLWHA, which was assumed to be brought by the relatively complicated immune response, was reported, suggesting the necessity of careful consideration to PLWHA . AdditioThe global AIDS response to date has suggested several key components, such as political leadership, the engagement of civil society and PLWHA themselves, and multi-sectoral collaboration and sector-wide partnerships ,23. ThesIt should be noted, however, that the leadership and increased political commitment at higher levels to contain HIV and engage civil society and PLWHA are relatively limited in Japan. Unfortunately, there is still no central registry of PLWHA; hence, monitoring and evaluation of links to HIV care from the latest data are impossible. HIV testing at healthcare facilities in outpatient settings is not free, which has resulted in HIV testing hesitancy among both healthcare workers and patients. The lack of data and information could make it challenging to grasp the overall picture of HIV and PLWHA in Japan, and the possibility of double counting has not been eliminated. Therefore, creating a large cohort that is worth monitoring and evaluating for HIV transmission dynamics, sexual behaviors, and number of partners  should be urgently considered. This will help evaluate and achieve the UNAIDS cascade and promote targeted interventions based on risk profiles.As this study aimed to highlight major points in the current guidelines and incorporate the context of COVID-19, ensuring the comprehensiveness is one of limitations. However, as major challenges are connected to minor issues at sub-national levels, what this study has pointed out could be elaborated in each region, and it is expected that this could be referenced for further discussion.This is the first study to analyze the current Guideline on HIV/AIDS by incorporating the perspectives of ongoing COVID-19 pandemic in Japan. To contain HIV/AIDS transmission and achieve the UNAIDS cascade, several weaknesses and threats were analyzed, which were exaggerated by the COVID-19 pandemic. There is an urgent need to address barriers that were recognized before 2019 and exposed due to the COVID-19 pandemic, tackle underlying health inequalities by employing the concept of social determinants of health, and ramp up discussions on the national HIV/AIDS strategy."}
{"text": "Cultural heritage, especially the fine arts, plays an invaluable role in the cultural, historical, and economic growth of our societies. Works of fine arts are primarily developed for aesthetic purposes and are mainly expressed through painting, sculpture, and architecture. In recent years, owing to technological improvements and drastic cost reductions, a large-scale digitization effort has been made, which has led to the increasing availability of large, digitized fine art collections. Coupled with recent advances in pattern recognition and computer vision, this availability has provided, especially researchers in these fields, with new opportunities to assist the art community by using automatic tools to further analyze and understand works of fine arts. Among other benefits, a deeper understanding of the fine arts has the potential to make works more accessible to a wider population, both in terms of fruition and creation, thus supporting the spread of culture.The call for papers for the Special Issue \u201cFine Art Pattern Extraction and Recognition\u201d was opened to anyone wishing to present advancements in the state of the art, innovative research, ongoing projects, and academic and industrial reports on the application of visual pattern extraction and recognition, for a better understanding and fruition of works of fine arts. The Special Issue solicited contributions from researchers in diverse areas such as pattern recognition, computer vision, artificial intelligence, and image processing. Furthermore, we also solicited the submission of papers as an extension of the works presented at the homonymous workshop we organized at the 25th International Conference on Pattern Recognition .The Special Issue received several submissions, which underwent a rigorous peer review process. After the review process, 11 articles were selected based on the ratings and comments. The published articles cover various applications of cultural heritage and digital humanities research; focus on different branches fine arts such as painting, architecture, and photography; and develop and apply a range of techniques, from image processing to computer vision, based on handcrafted features and deep learning.Artworks are subject to alterations over time due to various factors such as natural aging, external agents, inadequate conservation treatments, etc. Hence, techniques for monitoring, preserving, and restoring cultural heritage artifacts have become crucial. To this end, Daffara and Marini  present In their contribution, Banfi and Mandelli  exploiteOther contributions have addressed the problem of high-level semantic analysis and the interpretation of artworks. With the advent of digitized art collections, such an analysis has acquired increasing importance as a means of providing new information within digital art image repositories, supporting both enthusiasts and experts in finding and comparing artworks. To this end, computer vision techniques are good candidates to aid in the automatic categorization and retrieval of artworks. Following this line of research, Pinciroli Vago et al.  experimeTo support art historical research, Sindel et al.  did not Journal of Imaging for their endless support in making this Special Issue possible. We hope it will benefit the scientific community and increase interest in this exciting area of research.We express our sincere gratitude to the authors for their contributions, to the reviewers for their efforts in reviewing the manuscripts, and to the editorial staff of the MDPI"}
{"text": "In the original article, we neglected to include the funder Canadian Institutes of Health Research, 201803PJT-159700 to JW.s for Xiaoxue Ma. As well as having affiliations 1 and 2, XM should also have Canadian Center for Vaccinology, IWK Health Centre, Halifax, NS, Canada.In the original article, there was an error in the affiliationIn the original article, Jun Wang was not included as an author. The corrected Author Contributions Statement appears below.XM and SN created the research concept, designed and wrote the manuscript. JW was involved in the modification of the manuscript. All authors contributed to the article and approved the submitted version.The authors apologize for these errors and state that this does not change the scientific conclusions of the article in any way. The original article has been updated."}
{"text": "The COVID-19 infections have profoundly and negatively impacted the whole world. Hence, we have modeled the dynamic spread of global COVID-19 infections with the connectedness approach based on the TVP-VAR model, using the data of confirmed COVID-19 cases during the period of March 23rd, 2020 to September 10th, 2021 in 18 countries. The results imply that, (i) the United States, the United Kingdom and Indonesia are global epidemic centers, among which the United States has the highest degree of the contagion of the COVID-19 infections, which is stable. South Korea, France and Italy are the main receiver of the contagion of the COVID-19 infections, and South Korea has been the most severely affected by the overseas epidemic; (ii) there is a negative correlation between the timeliness, effectiveness and mandatory nature of government policies and the risk of the associated countries COVID-19 epidemic affecting, as well as the magnitude of the net contagion of domestic COVID-19; (iii) the severity of domestic COVID-19 epidemics in the United States and Canada, Canada and Mexico, Indonesia and Canada is almost equivalent, especially for the United States, Canada and Mexico, whose domestic epidemics are with the same tendency; (iv) the COVID-19 epidemic has spread though not only the central divergence manner and chain mode of transmission, but also the way of feedback loop. Thus, more efforts should be made by the governments to enhance the pertinence and compulsion of their epidemic prevention policies and establish a systematic and efficient risk assessment mechanism for public health emergencies. In December 2019, the COVID-19 epidemic merged in Wuhan, China, which has multiple characteristics, including high infectivity. The number of patients increased drastically at the beginning of the outbreak, due to the above characteristics of the epidemic  and generalized forecast error variance decomposition (GFEVD) developed by Koop et al.  and Pesai. We compute the differences between a J-step-ahead forecast where once the COVID-19 epidemic of country i broke out and once where the COVID-19 epidemic of country i did not break out. The differences can be accounted for to measure the magnitude of the contagion of country i, which can be calculated by the following:J represents the forecast horizon, \u03b4j,t represents the selection vector with one on the jth position and zero otherwise, and Ft\u22121 represents the information set until t \u2212 1.The GIRFs represent the responses of all countries following a change of COVID-19 in country i. This is calculated as follows:i to country j, which is calculated as follows:j to country i can be calculated as follows:i to country j as the contagion of the COVID-19 epidemic from country i to country j minus the contagion of the COVID-19 epidemic from country j to country i. This is calculated as follows:Subsequently, we compute the GFEVD, which can be interpreted as the variance share one country has on others. These shares are then normalized, so that each row sums up to one, meaning that all countries together explain 100% of the COVID-19 epidemic of country i to other sample countries (TOitContagion). The expression is as follows:i from other sample countries (FROMit Contagion), the expression is as follows:TOitContagion and FROMit Contagion, such as from Formula (16):NETit are positive, it means that the impact of country i on other countries in the network is greater than the reaction of other countries in the network. On the contrary, if NETit are negative, country i is impacted by other countries in the network and accepts their net contagion.Based on the above study, we can calculate the magnitude of the contagion effect of COVID-19 epidemic between a country and other sample countries, such as the COVID-19 contagion transmitted by country Formulas  and 14)i to otheAs per the situation of COVID-19 epidemic around the world, we selected eighteen G20 countries in which EU and China are not included in are selected as sample with a wide range  and other countries on one country (From Contagion) and the net contagion of the sample countries, as shown in The contagion roles played by most countries in the sample are stable to some extent; the United States, Canada, Mexico, the United Kingdom, Brazil, Russia, Indonesia, Turkey have strong contagion impact from a dynamic perspective. Additionally, the net contagion of each country is often negatively correlated with the effectivity, timeliness, and mandatory nature of the domestic anti-epidemic policies, especially under the trend of global economic integration. For example, the contagion of COVID-19 in the United States has been at a high level for a significant amount of time, and the reasons are as follows: first, the compulsory and urgent epidemic prevention of American government authorities who regard economic and employment data as political weights is insufficient, and partisan disputes are also an important obstacle to domestic anti-epidemic measures and the protection of people's right to life and health. Second, given the serious hollowing out of the American manufacturing industry, emergency reserve resources of medical supplies like respirators and masks are sufficient. As shown by the data provided by United States Health Secretary Azar, emergency reserves of medical supplies in the United States included only about 12 million medical-grade N95 masks and 30 million surgical masks, which has not been enough. Moreover, the partial privatization of medical institutions and medical insurance companies has led to high medical costs, which exacerbates the Matthew effect. Third, as the center of global economy, the United States maintains close economic and trade ties with other economies. For example, the United States is the core country in the North Atlantic Treaty Organization and a former member and leading country of the TPP Agreement, so the contagion of the United States' COVID-19 epidemic has been facilitated by the cross-border flow of resources, technology, and talents among these countries.The levels of severity and external infectivity of the COVID-19 epidemic in Canada and Mexico are also high because the United States borders Canada to the north and Mexico to the south. Canada and Mexico's fluctuation trends of \u201cFrom Contagion,\u201d \u201cTo Contagion\u201d and \u201cNet Contagion\u201d levels are particularly similar to those in the United States, and the tendency of the epidemic among the three countries is synchronized to some extent, which will necessitate higher requirements for epidemic prevention work in North America. In addition, Brazil also has a high magnitude of net contagion, which is closely related to the increasingly close economic and trade ties between Brazil and the United States. The United States has become Brazil's second largest trading partner since 2014, and a series of trade agreements has been signed by 2020, which has created a transmission link between the United States and Brazil, making the COVID-19 epidemic within the two countries resonate and form a negative cycle. Thus, Brazil's COVID-19 epidemic is spreading globally through the trend of economic globalization and population mobility globalization. At the same time, the frequent outbreaks of COVID-19 under the unfavorable domestic anti-epidemic situation in Brazil are also a critical reason for the country's high contagion level. The Indonesian government's slackness in preventing the epidemic and a lack of medical resources is also driving factors for the high cross-border contagion level under the continuous improvement of global economic integration.Along with population mobility which aggravates the contagion and severity of domestic COVID-19 epidemics  such as There are still some countries in the sample\u2014such as South Korea, Italy and France\u2014that have always been affected by COVID-19 epidemics in other countries. Among them, the country most significantly affected by the overseas epidemic is South Korea, which has actively adopted China's recommendations for confronting the COVID-19 pandemic, adopting plans for detection, tracking, isolation, and treatment, and frequently introducing policies to combat the epidemic. However, the effectiveness of domestic epidemic prevention and control has been seriously weakened by domestic party disputes. Moreover, religious groups have spread infections and refused to cooperate, continuously amplifying the speed of cross-border transmission and diffusion risk of overseas epidemics. In the meantime, complex and fragile domestic epidemic prevention environment, which include domestic employment pressure and frequent anti-COVID-19 vaccine activities, have also resulted in Italy and France becoming receiver of the contagion of the overseas epidemic.The dynamic circumstances of the COVID-19 epidemic in various countries can be fully reflected via the measurement of the dynamic contagion of the COVID-19 epidemic in sample countries, which can also depict the role and its dynamic changes of each country's epidemic in time dimension. Moreover, it is meaningful to further analyze the micro-structure of COVID-19 cross-border contagion in various countries based on research on infection from one country to other countries and from other countries to one country, to clarify the cross-border contagion path. Thus, we will capture and identify the microscopic structure of the COVID-19 epidemic among countries, and then clarify the dynamic characteristics of the contagion.We depict the net contagion of the COVID-19 epidemic among sample countries. The results shown in Europe is another main source of COVID-19 outbreaks, and the United Kingdom and Turkey are the main disseminators, and the United Kingdom has higher contagion level than Turkey. Both countries have persistent contagion on Japan, Australia and German, and the contagion effect of the epidemic between Turkey and German is increasing. The main reason for this increase is that there are a large number of Turkish immigrants in German, with close population mobility between the two countries, and the increase of population mobility after October 2020 under the staged relaxation of anti-epidemic measures has been a fuse for intensifying the transnational spread of COVID-19.As far as Asian countries and African countries are concerned, Russia and Indonesia whose spread paths have global characteristics are at a high level of net contagion. For example, South Africa, India and Canada can be affected across borders by the COVID-19 of Indonesia, which regards tourism that provides the conditions for the early global diffusion of domestic COVID-19 as the pillar industry of its domestic economy, as shown in Based on the sample countries, South Korea, France and Italy are intensively affected by the COVID-19 of countries around the world, as shown in Regarding the three major COVID-19 receiver\u2014which are South Korea, France and Italy\u2014South Korea still maintains the net receiver of the epidemic identity, which indicates that strengthening the intensity of prevention of abroad epidemic affecting is the top priority for South Korea, in its attempt to effectively control the domestic COVID-19 epidemic situation.There are still some countries with low net contagion level and in which the contagion direction has changed repeatedly during the sample period due to the slight dynamic change of COVID-19, such as Mexico and Canada, the United States and Canada, the United States and Indonesia, Indonesia and Canada, the United Kingdom and Canada and so on, as displayed in This paper is based on research on the micro-structure of the dynamic spread of COVID-19 epidemic among countries around the world. According to the dynamic contagion of COVID-19 between two countries, we rank the main \u201cFrom\u201d countries and \u201cTo\u201d countries of the single economy, recording the top three countries, which effectively depict the tendency of domestic COVID-19 impact in sample countries. This depiction provides theoretical basis for countries to prevent the contagion of COVID-19 from overseas, control the overflow impact of domestic epidemics, and provide a decision-making reference for the government to issue relevant policies.In The COVID-19 epidemic not only spreads directly in a central divergent way, but also transmits indirectly through a complex network. For example, in the United States, as shown in At present, the major transmitters of the contagion of the COVID-19 epidemic including the United States, the United Kingdom and Indonesia should not only strengthen their domestic epidemic prevention, but also increase their efforts to control cross-border transmission of their own epidemics, especially for those countries with the deepest epidemic correlations, such as South Korea, France, Italy, Australia and South Africa. As for the major receivers of COVID-19, purposefully controlling overseas epidemic input and temporarily weakening the associations with sources countries of the epidemic are crucial prerequisites to avoid the frequent and repeated outbreak of domestic epidemics and to ensure macroeconomic stabilization and recovery.In this article, the connectedness approach based on the TVP-VAR model is used to construct a dynamic contagion index to model the global dynamic spread of COVID-19. The main conclusions of this paper are as follows:First, the United States, the United Kingdom and Indonesia are the global epidemic centers, among which the United States has the highest level of COVID-19 epidemic contagion with contagion stability. Canada and Mexico who are geographically close to the United States, also have strong cross-border infectivity, and all three countries demonstrate the same development tendencies for their domestic epidemics, which necessitates higher requirements for anti-epidemic work in North America. South Korea, France and Italy are the major receivers of COVID-19 around the world, among which South Korea is the most seriously affected by overseas epidemics. Additionally, the promotion of compulsory, timely and effective anti-epidemic policies can impose a negative effect on the input from foreign COVID-19 epidemics, weakening their contagion of domestic epidemics.Second, the severity of domestic COVID-19 epidemics in some countries is in an equal position according to the results. These countries include Mexico and Canada, the United States and Mexico, the United States and Canada, the United States and Indonesia, Indonesia and Canada, the United Kingdom and Canada, Turkey and South Africa, Saudi Arabia and German and so on, which means that the conclusion that the United States, the United Kingdom and Indonesia are the centers of the global COVID-19 epidemic is robust.Third, the global COVID-19 pandemic centering on the United States, the United Kingdom and Indonesia, not only spreads directly from near center to far, but also transmits indirectly through chain unidirectional conduction.Some policy implications can be drawn from the above conclusions: first, governments should enhance the pertinence and compulsion of their epidemic prevention policies, which should include setting up graded early warning and emergency response mechanisms for different major infectious countries, and using big data and other technologies to collect the customs entry information of various overseas personnel quickly. They should also include monitoring the flow of cross-border personnel to observe the national epidemic in real time and effectively reduce the risk of overseas epidemics affecting. In addition, it is still necessary to establish a punishment mechanism compatible with anti-epidemic policies, which can reduce the risk of the outward spread of COVID-19 in the country. Second, a systematic and efficient risk assessment mechanism for public health emergencies with unified powers and responsibilities should be established; at the same time, adhering to the policy of \u201cputting prevention first,\u201d continuously increasing capital investment for risk assessment, strengthening the construction of specialized teams for risk assessment, and establishing a normalization mechanism for risk assessment are of vital importance. Additionally, the rights and responsibilities of the risk assessment team should be clearly defined in a legal form, and the mechanism arrangement for the risk assessment of public health emergencies should also be established to ensure timely identification of the input risks of overseas epidemics. Finally, countries should prioritize actively guiding public opinion, strengthening the supervision of public opinion, and releasing authentic and reliable information to maintain the stability of the domestic market in the post-epidemic era. Meanwhile, counseling public psychological, avoiding the spread of panic, and being wary of the risk that domestic and foreign capitals exaggerate the COVID-19 epidemic and speculate about the market to undermine domestic economic order cannot be ignored.This paper discusses the path of the global COVID-19 spread, the degree of the contagion and the transmission tendency of the epidemic. The limitation of our reasoning is the lack of integration of theoretical modeling for the dynamics of epidemiology. Future longitudinal studies are needed to focus on the basic unit of the global COVID-19 epidemic transmission, and the clustering pattern of the contagion.https://coronavirus.jhu.edu/data.Publicly available datasets were analyzed in this study. This data can be found here: LX: conceptualization, validation, writing original draft, supervision, and funding acquisition. SM: methodology and writing\u2014review and editing. LY: writing\u2014review and editing and visualization. WW: software, data curation, project administration, and visualization. ZY: resources, formal analysis, and editing. All authors contributed to the article and approved the submitted version.We acknowledge the financial support from Shandong Provincial Natural Science Foundation (Grant Number: ZR2020QG032), Shandong Provincial Social Science Planning Office (Grant Numbers: 21DGLJ12 and 21DJJJ02), Taishan Scholars Program of Shandong Province, China (Grant Numbers: ts201712059 and tsqn201909135) and Youth Innovative Talent Technology Program of Shandong Province, China (Grant Number: 2019RWE004). All errors remain our own.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "This paper explores the role and place of national, regional, and international society collaborations in addressing the major global burden of rheumatic heart disease (RHD). On the same order of HIV, RHD affects over 40 million people worldwide. In this article, we will outline the background and current therapeutic landscape for cardiac surgery in low- and middle-income countries (LMICs) including the resource-constrained settings within which RHD surgery often occurs. This creates numerous challenges to delivering adequate surgical care and post-operative management for RHD patients, and thus provides some context for a growing movement for and applicability of structural heart approaches, innovative valve replacement technologies, and minimally invasive techniques in this setting. Intertwined and building from this context will be the remainder of the paper which elaborates how national, regional, and international societies have collaborated to address rheumatic heart disease in the past  with a focus on primary and secondary prevention. We then provide the recent history and context of the growing movement for how surgery has become front and center in the discussion of addressing RHD through the passing of the Cape Town Declaration. Rheumatic heart disease (RHD) affects up to 40 million individuals globally . Caused These efforts are commendable and will be elaborated upon further in this article. The current therapeutic landscape for addressing RHD is multidimensional and has many challenges. We will first provide a review of the therapeutic ecology of RHD treatment, specifically focusing on the current state of affairs of cardiac surgery for RHD in LMICs . This diSurgery is a cornerstone of any health care system. Nevertheless, it has been estimated that worldwide 5 billion people lack access to safe or affordable surgery and anesthesia . For carMortality due to RHD is high in LMICs, especially among young individuals. For example, a recent study by Okello et. al.  reportedIn order for more patients to be able to receive treatment and to improve the safety of post-operative care for patients receiving surgery, the majority of these patients urgently require two major developments in replacement valves to address their needs. The first, and perhaps most pressing requirement is for improved valve design, incorporating long-lasting valve leaflet materials that will allow implantation into young patients without the need for anticoagulation. The other area in need of attention is to develop and implement simplified and reproducible transcatheter procedures that can deploy such valves cost-effectively, thereby significantly increasing the capacity of low-volume hospitals . A combiThere are many challenges to delivering sustainable cardiac surgical care in LMICs. On a broad scale, these include lack of health care infrastructure, critical gaps in the health care workforce, lack of training opportunities for critical providers, insufficient funding at the government level, competing health care priorities, and poor tracking of outcomes . SpecifiOther challenges appear on a more local level in terms of advancing the cardiac surgical agenda. For example, there are few regional centers of excellence for cardiac surgery in sub-Saharan Africa. While centers throughout the continent do perform cardiac surgery, few pathways exist for collaboration. Furthermore, training of key providers, and the volume to support such training is still lacking .The concept of a role for international agencies and academic societies in collaborating to address capacity for cardiac surgery in the developing world is, in and of itself, a relatively recent initiative. Societies serve as an integral part of the academic and service community in terms of addressing and promoting clinical care, research, and education in cardiac surgery. In this section, we will provide a brief history of recent conferences with resultant publications and importantly policy documents which have been integral to the further advancement of the agenda to combat RHD.In October 2005, delegates to the 1st All Africa Workshop on Rheumatic Fever and Rheumatic Heart Disease gathered in the Drakensberg mountains, South Africa and called out and acknowledged the large burden of RHD on the continent with an appreciation for the sociopolitical nature of its endemicity. The result was what has come to be known as the Drakensberg Declaration, with authors representing institutions from across the continent and the world including individuals representing the University of Cape Town, New York Medical College, University of Ibadan, University of Ghana Medical School, University of Melbourne, World Health Organization, University of Zimbabwe, Harare, University of Nairobi and the University of Libreville, to name a few . The resIn 2013, the World Heart Federation called for a reduction in premature RHD mortality by 25% by 2025 and the World Congress of Paediatric Cardiology and Cardiac Surgery brought together over 300 delegates at the 2nd RHD forum to discuss needs, opportunities and research in RHD, including the need for access to surgery in LMICs \u201328. One Local societies in endemic countries have played an important role in maintaining momentum, promoting partnerships, and outlining a clear and detailed path forward for curbing the burden of RHD e.g., Algerian Society of Cardiology. And, in the period between 1990 and 2015, deaths, disability-adjusted life years (DALYs) and years of life lost have all decreased. All this notwithstanding, however, new estimates of the prevalence of RHD are as high as 40 million, with stabilization of the mortality estimates in the 2019 Global burden of disease reports and it is estimated that as many as 300\u2013400 operations per million population surgical procedures are needed for RHD patients in certain LMIC settings . In lighConvened by Professor Peter Zilla, the then-Chair of the Christiaan Barnard Division of Cardiothoracic Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa, delegates and signatories of the Cape Town Declaration represented cardiothoracic/cardiovascular societies from across the globe, such as the Society of Thoracic Surgeons, American Association for Thoracic Surgery, Australian and New Zealand Society of Cardiac and Thoracic Surgeons, Society of Cardiothoracic Surgeons of South Africa, Pan-African Society of Cardiology, Brazilian Society of Cardiovascular Surgery, European Association for Cardio-Thoracic Surgery, World Heart Federation, Asian Society for Cardiovascular and Thoracic Surgery, Chinese Society for Thoracic and Cardiovascular Surgery, Pan-African Society for Cardiothoracic Surgery, and the South African Heart Association. Additionally, delegates represented many humanitarian organizations, governments, industry and academia .The overarching theme of the Cape Town Declaration is unique to the previous multi-sectorial and international declarations and communiques. For perhaps the first time in modern history, surgery was front and center. The mission of the Cape Town Declaration was \u201cto urge all relevant entities within the international cardiac surgery, industry and government sectors to commit to develop and implement an effective strategy to address the scourge of RHD in the developing world through increased access to life-saving cardiac surgery\u201d . This waThe CSIA recently announced its endorsement of two pilot sites in Rwanda and Mozambique, including King Faisal Hospital Kigali (Rwanda) and Hospital Central Maputo (Mozambique) . InternaAdditionally, groups such as the CSIA can leverage and build upon previously existing efforts and strong networks of collaboration that have manifested from the All-Africa Workshops on Rheumatic Fever and RHD. The CSIA plans to partner and build on ongoing efforts in the region to build a robust, prospective, multicenter registry for RHD surgical patients, including following them in the post-operative period. Previous registry work, such as the REMEDY and VALVAFRIC, have made important contributions to our understanding of RHD in LMICs , 38. SmaAs we look to the future of cardiac surgery for RHD, it is clear it will continue to require a multisectoral and multidisciplinary effort. As part of that effort, we should not underestimate the role that collaborations between international societies, agencies, and other involved parties can play in furthering the agenda to reduce the enormous burden of RHD. Recent history has demonstrated that some trends for RHD mortality and morbidity have moved in the right direction, and international collaborations may have played a major role in achieving that. Nevertheless, the surgical burden of RHD remains high, and heretofore has been largely unaddressed. For many patients with symptomatic RHD and major valvular pathology, surgery remains the only effective treatment. Manifest through these new collaborations, we anticipate that cardiac surgical societies have a crucial role in ensuring increased access to life-saving cardiac surgery for RHD in the developing world. In doing so, we will begin to realize the vision of the Cape Town Declaration, the Addis Ababa Communique, and the many other declarations and hopes that have been laid bare to address and curb the burden of RHD for the most vulnerable populations.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding authors.All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "The importance of silence has been emphasized in both ancient and modern traditions  held in Assisi, Italy in the summer of 2019. The Research Topic is the culmination of the effort to accumulate and present multiple approaches on silence and initiate new dialogues, and it includes both empirical and theoretical accounts, as well as reviews, for exploring silence.Srinivasan's contribution, which is an investigation on traditional statements about a state of consciousness without content in Indian tradition and its actual possibility in light of a current neurophysiological model of minimal phenomenal experience (MPE). Another paper by Paoletti and Ben-Soussan introduces the concept of silence as a tool for sensory saturation that can be hypothetically utilized to produce states of consciousness without content, discussing this hypothesis in the framework of the Sphere Model of Consciousness. In another paper, Josipovic and Miskovic addresses the differences between MPE and non-dual awareness.Theoretical contributions include three papers which consider silence in relation to the study of consciousness without content or with minimal content: one is Glicksohn and Ben-Soussan focus on absorption, visionary experiences and their electrophysiological correlates, pointing out that silence has a role as a creative stimulus for producing a spiritual experience. Woods et al. use evidence synthesis based on expert texts from three meditative traditions, namely Shamatha, Trascendental, and Still Meditation, with the key finding that silence has a particular connection with stillness, and the absence of concepts, mental noise, thoughts, and disturbance. Pintimalli et al. study the effects of a new meditative technique, and explore the relationship between first-person reports related to silence, space, and self-consciousness. Finally, Ben-Soussan et al. utilized neurophenomenology to explore the connection between first-person reports of silence and neuroanatomical changes.Empirical contributions included four studies, utilizing diverse disciplinary and methodological approaches. Pfeifer and Wittmann analyse the literature and present an exploration of the perception of silence, by exposing individuals to several minutes of silence in different contexts, finding that silence increases relaxation, improves mood states, and alters the perception of time and the orientation toward the present moment. Venditti et al. review a growing body of literature exploring epigenetic changes related with different meditative practices, such as mindfulness meditation, Vipassana, Yoga, Tai Chi, and Quadrato Motor Training. Finally, Naor and Mayseless focus on the experience of solitude in the wilderness, by exploring how the wilderness solo is experienced and understood, specifically as contributing to therapeutic outcome and personal growth. They review the empirical and theoretical literature, pointing to the significance of solitude and silence, to enhance a sense of personal belonging and purpose.In terms of reviews, In conclusion, research on silence offers many challenges, including for example, a common definition of silence , capturing this phenomenon in neuroscientific setups, or measuring it by scales. However, considering silence's possible benefits for the individual and societal level, overcoming such obstacles to research is highly warranted. We further propose that future studies should be conducted in the interface between psychology and education, particularly important in the current pandemic times, to explore how loneliness can be positively re-interpreted as silence and solitude and thus affect well-being differently. We wish to thank Frontiers for their support, the guest editors, authors, and reviewers for their precious time and contribution. We hope that this Research Topic will serve as another step toward integrating the literature on, as well as enrich our understanding of the beauty and utility of silence.All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The handling Editor declared a shared affiliation, though no other collaboration, with one of the authors FC."}
{"text": "We read with great interest of the report by Rosen and colleagues  about thFirst, in Rosen\u2019s study , the patSecond, Rosen and colleagues  reportedThird, in Rosen\u2019s study , most paIn summary, combining this lack of accuracy of comparison of APP and non-APP patients, and the possibly late initiation of APP in the moderate to severe ARF COVID-19 patients, a priori chance of finding a difference in intubation was low and may explain the negative findings for the APP. And further analysis with data from comparison of non-APP populations and prolonged APP group, especially in patients support with HFNC and prolonged APP, is needed for a more settled conclusion."}
{"text": "This Special Issue aimed to gather high-quality advancements in theoretical and practical aspects of computer recognition, pattern recognition, image processing and machine learning , including, in particular, novel implementations of these techniques in the areas of modern telecommunications and cybersecurity. As almost all human activities have been moved online due to the pandemic, novel robust and efficient approaches and further research have been in higher demand in the field of computer science and telecommunication.The selected authors of the contributions presented on 12th International Conference on Computer Recognition Systems (CORES) and the 12th International Conference on Image Processing and Communications (IP&C), held jointly with the 22nd International Conference on Advanced Computer Systems (ACS), were invited to submit extended versions of their original papers for this Special Issue. Our multi-conference took place in June 2021. This Special Issue was open to other submissions outside of the conference, too.Finally, after a rigorous review process, we accepted 13 interesting papers in various domains and applications of computer recognition, image processing and communications.Image processing can be applied in numerous areas of our daily lives: for entertainment, security and also improving medicine. This type of computer vision implementation was presented in . In thisIn , the autThe authors in  focused In the article , a novelThe papers ,6 addresIn , a novelIn , the proIn , the autIn , the autThe authors of  establis"}
{"text": "The time at which we write these lines is a dramatic time of war. The Russian invasion of Ukraine seriously re-addresses the importance of studying and assessing bio\u2013cultural diversities, but also of celebrating and even advocating for their dynamic preservation; this richness may, in fact, represent one of the most potent means of fostering respect for others\u2019 cultures, social sustainability, and therefore, lasting peace.Bio\u2013cultural diversities, or eco-diversities , are theUsing linguistic , cross-cIndeed, eco-cultural diversities need to be recognized and evaluated by the scientific community, and their evolution, complexities, and fascinating aesthetics require further research in the years to come. Celebration of the immense diversity of life in all of its forms is particularly essential across educational platforms, in order to train new generations of citizens and scholars and avoid repetition of the tragedies that are currently unfolding before our eyes."}
{"text": "The Wisconsin Longitudinal Study (WLS) has followed a sample of one in three Wisconsin high school graduates from the class of 1957 for over 64 years, making it an excellent data source for researchers interested in linking early and midlife characteristics to a wide range of later-life outcomes. The WLS is unique among major studies of aging cohorts for its duration of follow up, the inclusion of siblings, and the combination of rich social and health information. This symposium will provide an overview of the WLS, describe recent data collection and linkages, and introduce ongoing efforts to diversify the educational and racial/ethnic composition of the study sample. WLS data cover nearly every aspect of the participants\u2019 lives from early life socioeconomic background, schooling, family, and work, to physical and mental health, social participation, civic engagement, well-being, and cognition. The study is linked to administrative data including Medicare records, Social Security records, mortality records, and resource data on primary and secondary schools attended by participants as well as characteristics of their employers, industries, and communities of residence. Recent data collection efforts have generated a wealth of new biological and cognitive information, including genetic data collected from saliva and blood samples, measures of the gut microbiome, and derived polygenic scores for educational attainment, cognitive performance, depression, and subjective well-being. The currently-fielding ILIAD effort is implementing rigorous AD diagnostic protocols to track the progression of dementia across cognitive phenotypes. The symposium will conclude with practical information on accessing and using the data."}
{"text": "The health problems caused by insufficient exercise are becoming more and more serious, which is a serious threat to human health, especially the increase in patients with chronic diseases, which brings a heavy burden to medical and health care, and even triggers a public health crisis. In order to cope with the health threats people face, how to promote the synergistic effect of sports and medical health under the background of the integration of Chinese and Western medicine has become an important issue in building a healthy China life cycle. This article is aimed at studying the application of integrated traditional Chinese and Western medicine in pharmacy and health. Through the research of multiproblem collaborative governance of sports and medicine, the mechanism to promote multidisciplinary collaborative governance was established, and the realization of the integration of sports and medicine was promoted, extending some college students in a university in a certain city and studied the experiment of the influence of exercise on health. Experiments showed that 34.8% of students who exercise almost daily were in very healthy conditions, and 47.8% of healthy students were also unhealthy or prone to illness. The 62.1% of students exercising three to four times a week are healthy, proving that sports has a certain impact on human health and has a certain reference significance for the integration of sports and medicine. Many scholars have conducted research on the combination of Chinese and Western medicine in sports and pharmacy and have drawn many effective conclusions. Weng et al. proposed that the combination of sports and medicine can effectively reduce body fat, improve the blood lipid level of obese patients, and regulate the endocrine system and has a certain preventive effect on the occurrence of hypertension and diabetes . Wang etThis paper focuses on the health effects of exercise in modern medicine. Health management methods of sports were analyzed first, such as collaborative management methods, multidisciplinary collaborative therapy methods, and comprehensive management methods of sports and modern medicine, followed by a questionnaire survey. The design of the study experiment identified the subjects and analyzed the structure of the subjects. Finally, questionnaire experiments and extended experiments were performed to further determine the effectiveness of sport in modern medicine. It has a certain role in promoting the integration of modern medicine and sports.From the perspective of synergy and governance theory, cooperative governance is a process of using public power, reasonable regulation, and scientific methods to manage public affairs from a multifaceted perspective of society, adopting a collective cooperative governance model for governance, and ultimately enhancing public welfare. The concept of cooperative governance clearly shows that the single issue of government services has undergone a fundamental change in role. Market organizations, social organizations, and the public can all participate in the management of social public affairs. With regard to democratization, limited power, and power distribution, many problems can be resolved in depth, and there is no longer a relationship of control and dependence between people . The cooMulti-issue collaborative governance includes two words: \u201cmultiple issues\u201d and \u201ccollaborative governance.\u201d The basic concept is that many problems achieve the goal of collaborative governance. From the perspective of coordination theory, multientity coordination governance emphasizes the realization of the \u201cmultientity\u201d coordination goal and the reasonable effectiveness of the interentity coordination mechanism. Traditional management is in a relatively closed, one-dimensional organizational system. Under the conditions of concepts, systems, power, and coercion, it cannot fully mobilize resources, information, technology, and interests among different issues, resulting in low management efficiency. Multiagent collaborative governance focuses on the sustainable development of society and the maximization of social public interests. Higher-level government departments and local authorities work together to protect national public interests across borders and regions. To achieve the above goals, the most basic condition is the logical distribution, operation and restriction of power among many issues. Therefore, the concept of multi-issue collaborative governance is: in the existing regulatory system, in order to achieve the goal of public interest, the government, market, society and other parties negotiate to resolve contradictions and contradictions, and continue to advance .Based on the concept of sports medicine integrated collaborative governance, sports medicine integrated collaborative governance is the practical application of the collaborative governance theory in the field of sports medicine integrated. Management agency is a way to coordinate the integration of sports and medicine .The governance bodies are diversified, and the leading government departments, functional management departments, service organizations, group organizations, and other multiple bodies collaborate to form a new institutional order, and the dimensions involved are far beyond a traditional body Governance goals are coordinated, based on the goal of maximizing health promotion benefits; government entities are guided by the top-level institutional design from the perspective of fairness and justice to lead the medical integration system; for-profit organizations are from the perspective of market efficiency; we use capital guidance mechanisms to stimulate the body, medical integration technology innovation, and service promotion; from the perspective of social welfare, social organizations use voluntary mechanisms to fill government failures and market failures Subsystems work together. From the perspective of system theory, the business structure of the integration of sports and medicine covers multiple health service fields such as disease prevention, disease nonmedical intervention, disease rehabilitation, health fitness, and sports medicine supervision. The maintenance of this system requires a \u201ctwo-wheel drive\u201d around the two main subsystems of sports and medical treatment, with multiple main bodies working together .Based on the common pursuit of value, all subjects enjoy equal governance, independence, and mutual dependence. Therefore, the concept of coordinated management of sports medicine is defined as referring to the governance system based on health promotion . Many isThrough various channels to obtain information, we adjust the research framework, find their own research direction and ideas, learn rich sports and modern medicine related information and principles, consult relevant sports policies, regulations and drugs, collect and choose influential scholars' literature, especially Chinese and Western sports literature, sports theory, theory of traditional Chinese and Western medicine comparative literature, analysis and sorting, in-depth understanding of the content, and modern medicine integration of sports and development direction, to provide theoretical support and methodology guidance for this article.Sports collaborative governance and multidisciplinary medical integration initially involved sports, medical treatment, governance and many other fields, and the discussion of their problems was the result of multidisciplinary cross and knowledge integration. Therefore, we conducted in-depth interviews with experts in sports, medicine, management, rehabilitation, and other related fields, listening to opinions and suggestions from multiple angles, trying to design a more comprehensive research path, and improving the scientificity and practicability of the research.Before designing the questionnaire, according to the purpose and importance of the research, we read relevant literature, books, and policy papers and referred to relevant domestic and foreign research, including questionnaires and research reports of relevant institutions at home and abroad. On this basis, the relevant topics are classified and analyzed, the questionnaire design is carried out through expert suggestions, and the question and answer design in the questionnaire is rationally arranged. When determining the question and answer, it is necessary to fully consider the respondent's age, culture, occupation, income, and other factors and adopt simple and clear question-and-answer options. We use two-choice and multiple-choice questions when setting answer options.After the initial completion of the questionnaire design, 50 residents were randomly selected for pre-survey, the questionnaire was returned, and through group discussions, expert interviews and other methods, some questions and answers were repeatedly considered and revised, and the questions needed to complete the questionnaire were repeatedly considered and revised. After combining the opinions of experts, the overall quality of the questionnaire was continuously improved, and the design of the questionnaire was finally completed. The content involved in the questionnaire mainly includes the basic information of the surveyed person  and issues related to sports rehabilitation cognition, attitude, and behavior.Before conducting the questionnaire survey experiment, it is necessary to estimate the sample of the experimenters participating in the experiment. The sample size estimation formula is shown as follows:\u03c0 is the population rate, \u03b4 is the allowable error, and u is the standardized normal variable. Based on formula  Research Object. The survey team was divided into 6 groups, and random questionnaire surveys were conducted on several universities in a certain city. The requirements of the experimental subjects were as follows: living in a certain city for more than one year, age more than 18 years of age, clear consciousness, capable of autonomous activities, voluntarily cooperate, and be able to complete the questionnaire survey.(2) Research Methods. First, I designed the questionnaire myself based on reading of the relevant literature. The questionnaire was repeatedly revised through a preliminary survey, and the questionnaire content was finally determined by peer experts. The researchers will then have to receive uniform training. The training content mainly included the purpose and significance of the questionnaire, the specific content and method of the filling of the questionnaire, the process of the questionnaire collection, and the handling of the specific questions during the research process. The filling methods and requirements of the site questionnaire shall be distributed and returned on site. Questionnaire collectors should check the integrity of the questionnaire timely manner to ensure the quality and effectiveness of the survey.Consult with rehabilitation experts and sports rehabilitation professors to formulate interview outlines and research plans and evaluate questionnairesBefore the survey, conduct unified training and guidance for the personnel participating in the survey. The content of the training includes the meaning and content of the survey, the precautions of the questionnaire issuance, and the recovery process, and the uniform standards and methods of the survey must be ensuredAfter the questionnaires are collected, they will be sorted out in time, and questionnaires with too much information missing and not filled in as required are eliminatedA special person will verify the questionnaire and randomly select 5% of the questionnaire for verification. The criteria for rejection are as follows: the questionnaire is not filled in completely, the same answer is selected for the entire questionnaire, and the same answer is selected for 10 consecutive questions or more in the questionnaireThe questionnaire was filled out anonymously, and a total of 300 copies were distributed online and offline, of which 100 were distributed offline and 200 were distributed online. The recovery rate was 96%. The average completion time was 2 minutes and 40 seconds, of which 280 were valid answers, with 8 invalid answer sheets. The effective answer rate was 93%.(1) Gender Structure and Education Level. First, we analyze the gender institution and education level of the respondents, so as to better grasp the process of the questionnaire survey experiment at this time. The basic situation is shown in As can be seen from The results show that nearly half of the students at Jilin University use sports applications. Among them, the utilization rate of undergraduates is about 38%, and students with masters or above is about 47%. In contrast, students with a master's degree or above may prefer to use sports applications because they offer fewer courses than undergraduate students.(2) Self-Recognition of Health Status. Again, on the basis of the previous experiments, the self-identification survey of the health status of the experimental population was conducted, analyzing the structure of the health status and the proportion of the population, and analyzing the overall status of the whole experimental group.The experimental results are shown in It can be seen from (3) Cross-Analysis of Health Status and Exercise Status. After conducting a health status survey, on this basis, we conducted a cross-analysis with the experimental subjects' weekly exercise status to study the effect of physical exercise and health status. The experimental results are shown in It can be seen from In order to further study the impact of physical exercise on health, an extended experiment was conducted on 130 students who exercise less than twice and are unhealthy and easily get sick. In the experiment, the students are divided into two groups, each with 65 people. Each group will take exercise tests at least 4 times a week. The types of exercises include running, jumping, gymnastics, football, and basketball; the other group is the control group; no exercise test is required and just follow the previous lifestyle habits. A month later, we compared the physical conditions of the two groups. The results of the experiment are shown in It can be seen from With the continuous development of the society, the medical and health care system is also constantly developing and improving, the national health has also achieved results, and the people's health has also been effectively improved. However, with the rapid development of social economy, lifestyle changes, industrialization, aging, and the deterioration of the ecological environment have brought new challenges to the health work of the whole people. Although the enthusiasm for sports activity has increased in recent years, important indicators of assessing physical health tend to deteriorate year by year. In the face of complex and changeable physical health conditions, it is difficult for the existing \u201cmedication\u201d medical system to meet the above health challenges, resulting in high financial costs. Therefore, under the context of integrated traditional Chinese and Western medicine, integrated traditional Chinese and Western medicine has a certain practical significance.The integration of sports and modern medicine is the implementation process to meet the public health needs. In the context of the new era, it is of not only theoretical significance to study the relationship between the effects of multiple problems and the mechanism promoting the integration of sports and modern medicine. This study is closely related around the proposed questions and has provided results through systematic research but also has inevitable shortcomings. For example, when designing a research framework, measuring health is very subjective. According to factors such as time, the research plan is mainly to evaluate the health of students. It cannot really reflect the students' real physical condition. This is relatively one-sided. There are also deficiencies in regression analysis, and these defects, we hope to improve in future experiments."}
{"text": "Depression is one of the common mental illnesses. Because it is an important complication of diabetes, its association with changes in insulin levels and insulin resistance, the causative factors of diabetes, has attracted widespread attention. However, the association between insulin and depression has not been systematically studied through bibliometric and visual analysis. This study is based on 3131 publications of Web of Science to identify the current research status and research trends in this field. The results show that since 2010, the number of publications has been growing rapidly. Cooperative network analysis shows that the United States, the University of Toronto and Roger S Mcintyre are the most influential countries, research institutes and scholars, respectively. Insulin resistance, obesity, and metabolic syndrome are hot topics in this field. Analysis of keywords and references reveals that \u201csex hormones,\u201d is new research area that constantly emerging. As far as we know, this study is the first one to visualize the association between depression and insulin and predict potential future research trends through bibliometric and visual analysis. Depression, a common mental illness that severely reduces the quality of life, is accompanied by a high incidence of suicide. In 2008, WHO predicted that depression would rank first cause of burden of disease worldwide . The keyDiabetes, metabolic disorder caused by insufficient insulin secretion or insulin utilization disorder. Studies have found that insulin deficiency or insulin resistance can also be observed in patients with depression .Insulin, a protein hormone secreted by pancreatic \u03b2 cell, is the only hormone in the mammal body that could lower blood glucose, and promote the synthesis of glycogen, fat, and protein. Insulin was isolated by Frederick Grant Banting and Charles Herbert Best in 1921 , which iThe mechanism of depression as a complication of insulin deficiency or insulin resistance is not fully clear, however, appears to have a few routes.There is evidence that depression and diabetes could share same symptoms, especially the misalignment of the HPA axis, could cause insulin resistance, cardiovascular disease, depression, type 2 diabetes, and increased mortality . InsulinPublications have proved the connection between insulin and depression. However, as far as we know, no one has systematically analyzed the subject of this field by means of bibliometric analysis. Therefore, study aims to comprehensively analyze current status and development trend on the link between insulin and depression from 2010 to 2020 through bibliometrics. Previous reviews only rely on individuals to study the research through literature summary and extraction, cannot fully reflect the temporal and spatial distribution of researcher, institution, and journal. Moreover, it is difficult to visualize the internal structure of the knowledge base and research focus, and rarely find systematic, comprehensive, and visual research.Bibliometric analysis was proposed in 1969, by Pritchard, and plays an important role in reflecting the characteristic and future trend , 21. In Investigate the output and growth trends of publications in the field of the association between insulin and depression.Investigate the core countries/regions, institutions, authors, and journals.Identify international scientific cooperation network between countries/regions, institutions, and authors.Explore key themes, hotspots, and research trends.Our research aims to fill the gaps and effectively observe the development of this field. The research results are helpful for studying the association between depression and insulin and helping follow-up researchers to determine journal publications and collaborators. Timely analysis of keywords, themes, and research trends could promote the development to the elucidation of the cause, prevention, and treatment of depression.This study uses CiteSpace5.7.R4 (64-bit) to analyze existing research related to insulin and depression, and aims to provide reference, scientific, and intuitive. CiteSpace, a Java application which could perform bibliometric analysis, created by Professor Chen Chaomei  . First, Bibliometric analysis bases on a specific range of database. The database is from: WOSCC. In order to avoid the prejudice caused by the database update, we conducted a literature search from the WOSCC on February 22, 2021.The search time range is from 2010 to 2020. Insulin and depression are included in the search strategy: TS = insulin AND TS = depressions OR depression OR depressive OR depressed OR despondent.In this study, the search criterion in the WOSCC database is as follows:Time frame: 2010 to 2020;Document type: articles and reviews;No species restriction;Language: EnglishA total of 3179 records were retrieved. Then we excluded \u201cBOOK CHAPTER,\u201d \u201cRETRACTED PUBLICATION,\u201d \u201cEARLY ACCESS,\u201d and \u201cPROCEEDINGS PAPER.\u201d Finally, 3,131 documents were determined. The analysis in this study uses WOSCC to analyze the publication output, web of science subject category, publication year, IF and other functions.N = 50.After that, the selected documents were imported into CiteSpace, and time span was 2010\u20132020. Select the node based on the type of analysis need to perform. The specific parameter settings in CiteSpace are as follows: Time slicing: January 2010\u2013December 2020, Term source: Title, Abstract, Author Keywords and Keyword Plus, Node type: Author, Institution, Country, Keyword, Reference, Cited Author and Cited Journal, Link strength: Cosine, Selection Criteria: Top In the generated map, the color of the circular nodes represents the time when the article was published. The thickness of the node is positively related to the frequency, the thickness of the line describes the strength between the projects, and the color of the line describes the year when the two projects first collaborated. The nodes in the map represent elements such as author, country/region, or institution. The link lines between the nodes indicate the collaboration relationship. The larger the circle, the more articles published. The wider the line, the stronger the relationship. The outermost purple ring represents the center level .After sorting out countries/regions, institutions, authors, and their relationship, researchers could find teams for potential cooperation. A highly concentrated ranking of keywords and references and research on burstness can be used to analyze research status and hotspots, and further explore to future research trends in the field of insulin and depression.The change in the number of papers is an important indicator that can visually show the development trend of the field. From 2010 to 2020, the annual publications on insulin and depression included a total of 3,131 related articles. The distribution is shown in In 2013 and 2017, publications grew rapidly. In 2017, the number of publications exceeded 300. Although, the number of publications declined in 2014, 2016, and 2020, the number of papers published each year is basically on the rise.Seventy-five countries or regions have contributed to publications in the field of research on the association between depression and insulin. The network diagram of collaboration between countries/regions is shown in From 2010 to 2020, a total of 3,131 institutions in this field published papers. Articles on the association between insulin and depression have been published in 1,125 different journals. Highly cited references refer to publications that are cited a lot and have a wide range of influence. The repetition of the theme in the literature shows that both exercise and polycystic ovary syndrome are research hotspots.Co-occurring keywords can be used for analysis to discover research hotspots. The co-occurring keyword map of this study is shown in As shown in According to Co-occurring keywords and clusters, insulin resistance, diabetes, and metabolic syndrome are all hot research topics. The density of insulin receptors in the amygdala and hippocampus is high, and insulin resistance is highly correlated with cognitive and learning deficits . The earKeyword burstness detection can track hot topics and research trends. The blue line represents the time interval, and the red line represents the duration of the citation outbreak, shows the evolution of hot topics. Hot topics from myocardial infarction, coronary heart disease, growth hormone, energy balance, and so on. Turn to bariatric surgery, oxidativestress, glucose homeostasis, lipid profile, psychological stress, gestational diabete. Keywords that last until 2020 include: meta-analysis, hap axi, cell, lipid profile, psychological stress, gestational diabete, which reflect the latest research trends.According to the results of Experiments have shown that the relief of depression caused by exercise is related to the regulation of HPA axis homeostasis by exercise , 38 and Insulin can also increase the speed of neuronal serotonin synthesis . InsulinAlthough, there is no article explaining the direct relationship between exercise, depression, and insulin. Based on the common mechanism of the effect of insulin on depression and the effect of exercise on depression, it can be speculated that the positive effect of exercise on metabolic homeostasis may be due to the recovery of insulin levels in the body. These publications provide a therapeutic target for future research and the concurrent of diabetic and depression.The explosion of burstness keywords can also be used to analyze the development of research. As the On the other hand, according to the results of P < 0.0001)  . AlthougHyperinsulinemia caused by insulin resistance acts on gonadotropins together with luteinizing hormone (LH) increases androgen production in follicular membrane cells and reduces the production of sex hormone binding globulin in the liver, leading to the body's production of a hyperandrogen state , 54. RapThis study has some limitations. First, our research selected the core database of Web of Science and only selected English articles, which may lead to incomplete research. Second, the quality of articles is not completely guaranteed, and the impact factor is not limited. These reasons may lead to certain deviations in the research results. Third, this article cannot ensure that every publication is fully related to the subject that meets the search criteria. However, we have collected enough publications to reflect the overall state of the field.This study is based on bibliometric analysis and systematically evaluated the association between insulin and depression through 3,131 publications of Web of Science from 2010 to 2020. According to the analysis of the publications and references, it could be found that the study of shared mechanisms between depression and metabolic diseases caused by changes in insulin levels or insulin resistance has attracted widespread attention. Both the United States and China have made significant contributions to the number of publications. Research institutions in the United States, England, and Canada have contributed to the centrality of publications. Combining the burstness analysis of keywords and references, possible directions for future research could be determined. Firstly, future research needs to be no longer limited to the study of the effects of insulin on a single disease, but to link diseases with shared mechanisms to explore in-depth molecular mechanisms and find new directions for disease treatment, such as depression, diabetes, polycystic ovary syndrome. In addition, research on insulin and depression is no longer limited to traditional perspectives such as nutrient metabolism, monoamine neurotransmitters, and HPA axis. Research of the effects of changes of sex hormone and insulin levels in female perinatal and menopausal on depression will increase. This timely review analyzes the results of the association between insulin and depression may promote the development of this field and laying foundation for future research.XZ wrote the first draft of the manuscript. YS provided the critical revisions. Both authors revised the manuscript and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "Lacazia loboi, typically found in tropical and subtropical geographical areas. Transmission occurs through traumatic inoculation into the skin, especially in exposed areas, of men who work in contact with the soil. Lesions are restricted to the skin and subcutaneous tissue, with a keloid-like appearance in most cases. The occurrence of squamous cell carcinoma on skin lesions with a long evolution is well known; however, there are scarce reports of lobomycosis that developed into squamous cell carcinoma. The authors report a patient from the Brazilian Amazon region, with lobomycosis and carcinomatous degeneration, with an unfavorable outcome, due to late diagnosis.Lobomycosis is a chronic granulomatous infection caused by the yeast  A Brazilian indigenous male, 83 years old, farmer, from Santa Izabel do Rio Negro, state of Amazonas, Brazil, presented with disseminated skin lesions on his limbs for 30 years. He had a previous history of hypertension and worked with extractivism.Upon physical examination, he had multiple keloid-like nodules on the upper and lower limbs. A vegetating lesion was seen on his right medial malleolus  and the The histopathological examination of these two more recent lesions disclosed a thinned epidermis, hyalinization, and thickening of collagen fibers, in addition to the presence of multinucleated giant cells containing birefringent rounded fungal structures. Grocott staining, depicted these structures more clearly A. DirectHistopathology of the left upper limb tumor showed a dense lymphocytic inflammatory infiltrate, presence of horn pearls and proliferation of squamous cells with moderate pleomorphism, hypertrophic and hyperchromatic nuclei, establishing a diagnosis of squamous cell carcinoma (SCC) B.Immunohistochemistry revealed an infiltrating epithelial neoplasia with squamous differentiation and positivity for P63, CK5/6 and GATA3.The oncological surgeon's opinion was requested, but the surgery for the excision of the SCC would be a large one and contraindicated in this patient due to his age, comorbidities and critical clinical condition. It was decided to implement palliative care and one month after hospital discharge, the patient died.Lacazia loboi, and its highest incidence is found in Central and South America, especially in the Amazon river basin.2Lobomycosis, also called lacaziosis, keloid blastomycosis or Jorge Lobo's disease is a chronic granulomatous infection that can affect humans and dolphins. The etiological agent is the fungus Malignant transformation can occur on chronic ulcers, fistulas, and scars of different etiologies, including infectious ones, such as leprosy, tuberculosis, and lobomycosis. SCC is the most common skin cancer in these cases and results from the malignant proliferation of keratinocytes.There is no description in the literature of the dermoscopy of lobomycosis lesions. The findings of this case show the dermoscopy performed on a nodular lesion on the leg of this patient, with areas of hyperpigmentation interspersed with hypopigmentation, scales, blood crusts, and several black dots. Vascular structures were not observed .Figure 4The choice of treatment is defined by the clinical presentation of the disease. In unifocal and localized forms, the surgical procedure is the most indicated treatment, and it can be associated with oral medications such as clofazimine, dapsone, and itraconazole, aiming to avoid recurrence. The combination of itraconazole and cryotherapy may be helpful in patients with large, multifocal lesions.5Patients with long-term lobomycosis associated whith SCC are rare. An early diagnosis and careful follow-up of these patients are essential to prevent the progression of the lesions and carcinomatous degeneration.None declared.Wanessa da Costa Lima: Approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.Sidharta Quercia Gadelha: Design and planning of the study; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature, critical review of the manuscript.Mara L\u00facia Gomes de Souza: Approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.Virginia Vilasboas Figueiras: Approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.None declared."}
{"text": "The BRICS Forum, an independent international organization encouraging commercial, political, and cultural cooperation between Brazil, Russia, India, China, and South Africa, was formed in 2011, and these countries have a significant influence on their regional affairs. These nations were hit by COVID-19 at different times, and all adopted home quarantine to reduce the spread of the virus. We present a comparative analysis of actions of psychology and potential outcomes during the COVID-19 pandemic in BRICS nations regarding five aspects: psychology in health policies, social roles of psychology, socioeconomic context, actions for the general population, and health professionals during stage 1 of the pandemic, and possible actions in stage 2. Various types of actions were taken by psychologists in BRICS, with different levels of coordinated cooperation with respective governmental and non-governmental organizations, multiple and parallel efforts from different scientific societies, and professional regulatory agencies. Scientific societies have had an important role in coordinating some of these efforts, especially because they congregate the psychologists from different parts of these countries, improving communication and access to key information. The aim of these actions varies from improving situational skills and competences to increase the accessibility of psychological services and provide psychoeducation and telepsychology. We will consider the social importance of these actions within these countries as a global opportunity for psychology to stage in a complex context involving human health. The way psychology in BRICS will face this challenging situation is likely to produce important regional influence, stimulate scientific contribution, and increase the accessibility of psychology. BRICS is the group composed of five major emerging countries: Brazil, Russia, India, China, and South Africa, which, together, represent about 42% of the population, 30% of the territory, 23% of Global Gross Domestic Product (GDP), and 18% of the global trade. Since 2009, these countries have sought to establish fairer international governance, developed sectoral cooperation in different areas, such as science, technology and innovation, economics, finances, business, education, and security , taking into account sociocultural differences and the particular attempt to strengthen health systems in these developing countries.https://www.scimagojr.com/countryrank.php?area=3200&year=2019). If the BRICS were a country , we would be third in the scientific production of psychology, behind the USA and the UK, well-ahead of Germany. Therefore, we present an analysis of actions of psychology and potential outcomes just after the outbreak of COVID-19 in the BRICS nations regarding five aspects: psychology in health policies, social roles of psychology, socioeconomic context, actions for the general population, and health professionals during stage 1 of the pandemic, and possible actions in stage 2. Finally, we consider a comparative analysis of these actions. Before this analysis, we characterize the psychology in the BRICS countries.In this sense, this perspective article discusses the actions of psychology as a science and profession, represented by several scientific societies and councils, governmental and non-governmental organizations, and universities, in combating the pandemic of COVID-19, in the countries that form the alliance of the BRICS. This proposal is important, given that we are among the 25 countries that most produce science in psychology, in a list of 173 countries (http://www2.cfp.org.br/infografico/quantos-somos/), working in individual practice, healthcare, education, organizations, and research. Profession and formation have been regulated by Federal law No. 4,119 since 1962. Federal Council of Psychology (FCP) has been the organization responsible for professional registration and regulation since 1972. Brazilian Society of Psychology (BSP) has congregated all areas of scientific and professional psychology since 1971  with 22,985 enrolled students, after the Higher Education project that intensified the expansion, democratization, interiorization, and internationalization of Higher Education  have become important devices for the integration of professional psychologists in public policies since the 2000s. Both were responsible for the insertion of psychologists to the most diverse municipalities and locations in the country to a contingent, estimated in 8,000 psychologists in Reference Centers for Social Assistance (CRAS and CREAS) and 40,000 psychologists in SUS , one of the oldest psychological societies in the world, which was founded in 1885. The purpose of the creation of RPS was the development of \u201cpsychology, in its compositions, applications, and history, and the spread of psychological knowledge in Russia (RPS).\u201d Members of the society were world-famous scientists who have made substantial contribution to the formation and development of psychological science: L. S. Vygotsky, A. R. Luria, A. N. Leontiev, P. Ya. Galperin, and other leading scientists of the Russian Academy of Sciences and the Russian Academy educations, leading psychologists of the largest scientific and educational organizations. Together with the Federal Educational and Methodological Association in the Field of Higher Education, RPS organizes scientific and methodological support for the preparation of federal state educational standards of higher professional education and basic professional educational programs in the field of psychological education.Psychology as a discipline started in 1916 when the first department of psychology was established at the University of Calcutta, India. Later, departments of psychology were established at the University of Mysore in 1924, University of Madras (1943), University of Kerala (1957), Utkal University (1958), University of Bombay (1959), Allahabad University (1961), and the University of Delhi (1964). Psychology was also introduced in the various Indian Institutes of Technology and Management setup later. During the years, various psychology associations were formed, and it is difficult to give the exact number of associations in the country. The Indian Psychological Association was established in 1925, Indian Psychoanalytic Society in 1922, and later on, Indian Association of Clinical Psychology, National Academy of Psychology (NAOP), Indian Academy of Applied Psychology, and several other associations focusing on health, school psychology, community psychology, counseling and guidance, and about 20 regional associations in the different states, besides numerous local chapters. The idea of a federation of associations has been mooted and felt important and announced in 2014, but much needs to be done. The focus of these associations has been more on academic work and awareness generation than psychological services, except for a few. The National Academy of Psychology (NAOP) is a member of the International Union of Psychological Sciences and participates regularly and actively in its programs. It is also a member of the Asia Pacific Association of Psychology and engages in collaborative endeavors, including programs in disaster management.The Rehabilitation Council of India (RCI) regulates the professional programs in clinical and rehabilitation psychology , the first psychology department , the Chinese Psychological Association , and the first research institute (1929), Institute of Psychology, Academia Sinica   in 1980, and the International Association of Applied Psychology (IAAP) in 1984. CPS hosted the 28th International Congress of Psychology, held in Beijing on August 8\u201313, 2004, under the auspices of IUPsyS. CPS and CAMH, jointly in cooperation with Beijing University (Department of Psychology), held the fifth World Congress of Psychotherapy in Beijing in October 2008. In 2 years, CPS will host the 30th International Congress of Applied Psychology in Beijing, July 2022.Psychology is taught in China at both undergraduate and postgraduate levels, in 815 universities and institutes that offer postgraduate programs, 114 have master programs in psychology  and 30 universities have doctorial level programs in psychology in 2020 (China Education online).In 2002, the China Ministry of Labor and Social Security launched a certification for psychological counselors, based on the National Standards on Psychological Counseling. The new certification was given to 1.2 million counselors who fulfilled the basic requirement, took the training, and passed a national examination. It enables private psychotherapy practice and psychological counseling in general public settings, such as hospitals, universities, primary and secondary schools, entrepreneurs, and communities.Regulation of the practice of medicine and allied professions in South Africa dates back to the late nineteenth century when the then Colonial Medical Council of the Cape Province was established in terms of Section 18 of the Medical and Pharmacy Act of 1891. At that time, the Cape Province was nominally under the British colonial rule, which lasted until 1910, when the Union of South Africa was formed in 1910. In 1928, the South African Medical and Dental Council (SAMDC) was appointed in terms of Act Number 13 of 1928, which was amended in 1974  is the largest of these associations, with over 1,000 members  but did not provide psychological care. Quarantine, lockdown, or other measures of social distancing were recommended at the discretion of governors and mayors but not by the Ministry of Health. In a controversial attitude, the Brazilian president not only did not recommend social distancing but also stimulated social gathering on public appearance in front of the official presidential palace, visiting shops and buying from street vendors in Bras\u00edlia with national media coverage. These mixed messages concerning the severity of the pandemics were considered as a menace by the international community ; State University of Londrina (www.uelcontracoronavirus.com)]. Federal University of Rio Grande do Sul associated with the Ministry of Health organized a call center to offer psychological support to health professionals involved in COVID-19 (https://sites.google.com/hcpa.edu.br/telepsi/), using an open platform for training and research. In the same way, Oswaldo Cruz Foundation of Bras\u00edlia (Fiocruz), a research institution linked to Ministry of Health, produced a series of e-books about coronavirus . From this material, an online course was created for several health professional categories, including psychologists. After completing this training, professionals will be allowed to use a telepsychology platform provided by Fiocruz.Universities are providing teleservices . In total, more than 1,000 psychologists participate in the work of hotlines of federal and regional significance.While organizing psychological assistance in the usual ways (in person) is not possible, the possibilities of online counseling are widely used. The Russian Psychological Society, the Russian Academy of Education, Faculty of Psychology, Lomonosov Moscow State University organized several hotlines for psychological assistance [including a united 24/7 hotline on the website of COVID-19, organized by the Russian Government  took an active initiative in extending its services during the time of COVID-19. It was the first professional organization to launch online counseling in the first week of April 2020 for anyone directly or indirectly affected by COVID-19 or the lockdown-related psychological issues. The first initiative was in Hyderabad under the banner of \u201cSERV,\u201d an acronym for \u201cSocial Emotional Rehabilitation of Virus Victims.\u201d This was launched in collaboration with UNICEF, Action Aid, Dr. Reddy Foundation-School Improvement Programme, APTS Social Service Forum, and Asha Hospital. Counselors with the highest academic background and years of experience are available on a helpline 24 \u00d7 7. Encouraged by the response, the AHP started similar helplines in collaboration with Sri Padmavathy Mahila University Thirupathy, Andhra Pradesh, Orissa Central University, Koraput, Odisha, Calcutta University, West Bengal and Bangalore, Karnataka in collaboration with UNICEF. The counselors attended thousands of calls from different parts of the country as well as a few calls from Indians residing in other countries. In initial months, the calls related to general anxiety of the \u201cfear of unknown\u201d; insomnia; interpersonal conflicts due to home confinement leading to a situation called \u201chome crowding\u201d; the anxiety of frontline health care workers; the psychological distress of people in quarantine centers; panic attacks of people of all ages, gender, and geographical location; anxiety of students due to uncertainty of examination schedule; financial problems; non-availability/accessibility of regular medicines due to lockdown; precipitation of pre-existing mental health problems; issues related to migrant labor; and also calls from victims of domestic violence, to name a few. Apart from COVID-19/Lockdown-related problems, the helpline has been receiving calls related to other psychosocial problems. Because of this, the helplines are continuing through, and the number of COVID-19-related calls has been gradually reducing.Several initiatives were taken by other associations as well (which will be discussed in a later section); however, looking at the population of the country, the problems are immense and can be tackled only with the combined efforts of all. More and more psychologists should be involved by the government in these times as in when there is a second wave of COVID-19 later in the year, mental health concerns are going to become pivotal. Many people have lost their jobs, and as time passes and they do not get economic relief, mental health concerns are going to become acute. It is not to say that mental health concerns are not important now. The concerns because of lockdown are related to fear, anxiety, social isolation, lack of human stimulation, working from home, and making the fine balance between home and work. Once the lockdown is lifted, as no society can be in a state of complete lockdown, the fear is related to a surge in cases of corona infections, disease, death; all of which may lead to serious mental health concerns. Psychology associations should make the government start focusing more on mental health issues of the most vulnerable sections of the society.News items and images not related to COVID-19 times were shared and created fear and panic among citizens. The government is tackling the problem of fake news by requesting social media platforms to remove and not promote messages that will weaken the government's efforts during these times. The media is continuously being requested to play a very responsible role and help in countering fake news. Some news channels are doing a commendable job of alerting people to fake news. In these times, responsible sharing of news has to be followed, but, as is the current situation, fake news is rampant. Irresponsible forwarding of messages on social media should be avoided. The Government of India has recently issued a directive, asking social media companies to voluntarily curb fake news and misinformation related to the coronavirus on their platforms. This is considered as an important step to prevent the community transmission of the disease. A lot of psychology research shows that, in times with a lot of uncertainty, rumors and propaganda of various kinds have easy acceptability among the masses. Stern and prompt actions are needed; otherwise, it will play havoc with people's life and health. Together with the government, it is also important that we, citizens, not only exercise caution but debunk such messages.https://www.gov.br/pt-br/servicos/solicitar-auxilio-emergencial-de-r-600-covid-19).About 13 million Brazilians live in favelas. Hygiene recommendations are near impossible to follow in these environments because of the high demographic density and lack of treated water. Communities in favelas have organized themselves to implement measures on their own , deficient health systems are expected to collapse. This could worsen with a peak in the number of cases since up to 75% of the population in the least developed countries do not have access to hygienic supplies. Other social conditions, such as precarious urban planning and overpopulation, deficient waste management services, and even traffic jams that prevent access to health care, can contribute to drastic growth in the number of cases of COVID-19 .Many private companies have decided to help various segments of society, with hygiene items, food, clothing, and water donations, supported by the tax incentive laws. One example of organized action of the private sector is Todos pela Sa\u00fade  to reduce the risk of contagion. People also live in villages and share utensils, which increases the chance of contamination. Indigenous communities also live in areas where there is limited access to healthcare, particularly intensive care beds . If a professional chooses to provide online psychological services, he or she must follow previous guidelines (CFP Resolution No. 11/2018) and register to do so in the respective Regional Psychology Council.https://www.sbponline.org.br). Moreover, links with relevant information about the pandemic from reliable sources were also made available by SBP.The Brazilian Society of Psychology (BPS) constituted a Working Group of professional researchers who sought to base their actions on developing strategies for training and supporting this professional category in coping with the situation of COVID-19. The work was developed using scientific and technical criteria, using evidence to support their decisions and guidelines. The first step was to publish fascicles, available free online at the SBP homepage  and the first psychological aids: welcoming and active listening, psychoeducation, helplessness approach, focuses on despair, coping fear, focus on hope, problem-solving, assessment of ideation, and suicide risk. The fourth topic deals with the stigmatization of health professionals. It contextualizes the problem, defines stigma , and provides management strategies, such as access to information, awareness, and ethical posture. In the fifth topic, recommendations are presented for the on-line and online professional practice of psychology in the face of the COVID-19 pandemic. It addresses the alternatives on how to offer the first psychological help to health professionals working in hospitals. It guides through how to proceed with online, voluntary, in-person, and hospital care. The sixth topic deals with mourning and reviews the concept, demonstrating the physical and emotional reactions experienced in this process and the alternatives for the psychologists to address this theme. In the seventh topic, issues related to the management of conflicts in the family are presented. It discusses how isolation predisposes to the appearance of conflicts and presents strategies for handling the situation, with steps for resolving conflicts. The eighth topic discusses the management of sleep disorders in the context of coping with COVID-19. It demonstrates how the pandemic can predispose to sleep disorders and identifies management strategies. The ninth topic presents the theme of psychological support for parents of children from 0 to 11 years old during the COVID-19 pandemic. It seeks to provide support for the psychologists to work with parents and provides behavioral management strategies during isolation. The 10th topic addresses issues related to violence against women. The different forms, phases, and consequences of this type of violence are defined. Alternative actions are presented, as well as techniques and devices that are usually used in the situation.https://sites.google.com/hcpa.edu.br/telepsi/) is an initiative of the Ministry of Health of the Brazilian Government, in partnership with the Hospital de Cl\u00ednicas de Porto Alegre, which received the support of several academic institutions and societies, including the Brazilian Society for Psychology. In TelePSI, contracted psychologists and psychiatrists offer psychological and psychiatric consultations to manage stress, anxiety, depression, and irritability in health professionals and students, teachers of all levels of education, and professionals of essential services. They receive specific online training and supervision, and data are collected to compare the effectiveness of different interventions are clinical and scientific supervision group for evaluating different types of psychotherapy for emotional problems during the pandemic, and disseminating psychoeducational materials. Oswaldo Cruz Foundation of Bras\u00edlia (Fiocruz) planned a similar teleservice provided by trained volunteer psychologists.The TelePSI Project (http://xn--n1abc.xn--p1ai/news/themes/8462/), as well as their promotion through Federal and regional media regularly. During 2 months, representatives of the Russian Psychological Society made more than 150 interviews to the media and more than 30 interviews on Federal and Regional TV channels in the frame of talk shows, expert talks, etc., making recommendations for the public concerning the organization of the daily routine, coping with anxiety and stress, organizing activities for children, and exposing relevant fake news.Psychologists have been actively involved in informing the public about how to organize their lives in conditions of self-isolation with children, the elderly, alone, etc. RPS has elaborated recommendations for various groups of the population on organizing the activities during the period of isolation , Moscow Electronic School (http://mes.mosedu.ru/present-en/), which is an official all-Russian resource for schooling as well as other resources, such as Yandex.Uchebniki (https://education.yandex.ru/home/), \u226aAdvance\u226b, \u226aiSpring\u226b, \u226aInternetUrok.ru\u226b, \u226aUnicraft\u226b, etc. The actual collision of the norms of family life and the norms of the school in the situation of the distant organization of the educational process led to conflicts between teachers and parents, and increased stress. RPS has developed relevant recommendations for both teachers and parents to optimize the organization of the educational process and normalize relations between family and school.No less challenging was the situation and the organization of the distant educational process at schools and preschools. The transition to distance learning became possible, thanks to the previously introduced Russian Electronic School .Leading specialists of the Faculty of Psychology of the Lomonosov Moscow State University, the Russian Academy of Education, and the Russian Psychological Society, together with the Federal Medical Biological Agency of Russia, and, personally, its head, Veronika Skvortsova, had developed \u201cpsychological thermometers\u201d for adult patients and patient-children and medical staff who provide medical care for patients with COVID-19 , which represents India in the IUPsyS; the Indian Association of Clinical Psychology (ICAP); and Indian Academy of Applied Psychology (IAAP). As discussed by Manickam , togetheIndia's experiences in the pandemic of COVID-19 have shown that a better public health system with special programs based on various sections of the society is needed , as a self-regulated professional organization of clinical and counseling psychology, devoted itself to the psychological aid after the outbreak of the COVID-19 pandemic and explored effective approaches and methods for psychological aid!1. Speak up as professionals. The Registration Work Committee started to work on January 23 and issued a written proposal to all the psychological professionals across the nation on January 26, and advocated that all the psychological aid should be integrated in the national framework in fighting the COVID-19, and underlined the need of multi-department cooperation. It reaffirmed the professional ethics and strongly emphasized that all the psychological aid should be conducted scientific orderly and conform to professional standards.2. Set up an organizational structure. The Registration Work Committee set up the organizational structure on January 25 and established several working groups with different functions to ensure orderly development, including the supervision group, the popular science dissemination, the information resource acquisition, and so on.3. Give full play to the superiority of the Registration System members. A group of 161 registered clinical psychology supervisors, who were willing to supervise, was released to the public on the WeChat Official Account, providing free supervisory resources for counselors, and psychotherapists.4. Enhance the competencies in psychological aid. The sudden outbreak of the COVID-19 emerged in a fast spread and affected widely, and as a result, most psychological aids were conducted through hotlines, including the popularization of the medical knowledge of the COVID-19. The Registration Working Committee decided to work in a pyramid model due to the specialties of the COVID-19, referring to training registered psychology supervisors and providing guidelines and approaches for them to supervise counselors and therapists who work in the front line. From January 28 to May 20, a total of 32 training sessions and supervision have been arranged for registered supervisors with a total of more than 1,600 participants. Nearly 10 million people received training and supervision focused on hotlines, psychological stress, and crisis intervention provided by the trained supervisors.5. Timely release professional guidance documents as a leading professional organization. Guidelines for Psychological Aid Hotline under the Contagion Fight, Guidelines for Online Psychological Aid under the Contagion Fight, Ethics for Psychological Hotline (First Draft), and Ethics for Online Counseling (First Draft) were released continuously from January 31, leading professionals to conduct within competencies and comply with the ethics.6. Cooperate with governmental officials and peer colleagues from other professionals . To cooperate with the National Health Commission, the competent government department for psychological aid during the COVID-19 pandemic. The Registration Work Committee put forward targeted psychological aid policies for the country and the specific population affected by the epidemic, for e.g., timely proposing the overall plan of psychological aid construction for the Arch hospitals built in Wuhan. Besides, it joins hands with other academic organizations, such as the Chinese Association for Mental Health, China Association of Social Psychology, in fighting against the COVID-19 pandemic to share resources and joint proposals.7. Promote the popular science on the major media. Make knowledge dissemination of audio or videos programs on how to promote mental health in the pandemic period and provide the public with knowledge and methods on mental health to adjust the mentality and be positive and optimistic.\u2026 an area that has more than 5 infected people per 100,000 people or where the new infections are increasing at a fast pace\u201d . The medical insurance companies have also come out in support of telehealth services by assuring psychologists and other health professionals that they will reimburse the service providers for this alternative service [for e.g., see Discovery Health Due to the restrictions imposed on individuals during the pandemic, the Health Professions Council of South Africa (HPCSA) had to revise its guidelines on the provision of online health services. In its original General Ethical Guidelines for Good Practice in Telemedicine, the HPCSA discouraged health practitioners from routinely servicing their patients virtually , constant monitoring (weekly or fortnightly) by the technicians , weekly individual attendance for severe cases only  (only one patient and one companion at a time) or home care, after screening for COVID-19 symptoms.Health institutions  started to provide psychological care for families of inpatients or those who died as a result of COVID-19 and health professionals who care for these patients. Networks were organized to provide psychological assistance for health professionals by universities, associations, and groups of psychologists. Besides, starting in May 2020, online psychological care by SUS is foreseen for health professionals  to develop evidence-based recommendations to decrease negative effects and increase positive consequences of self-isolation. The results obtained showed no differences in the levels of psychological well-being, significantly lowered levels of depression, anxiety, and stress during the period and higher levels of anxiety and stress during the period. It was shown that studying the impact of the pandemic on the mental health of students requires attention to possible dynamics of their mental state within relatively short periods and gender differences.Representatives of RPS, as well as researchers all over the world, are actively engaged in monitoring the mental conditions of various population groups across Russia, identifying factors that are crucial to the successful accommodation to the period of self-isolation and building strategies for future. RPS, in collaboration with the leading Russian universities supported by The Ministry of Science and Higher Education of the Russian Federation, has started a project \u201cResearch at Home.\u201d The purpose of this research is to assess psychological well-being among the student population  Firstly, recruit psychologists with competence. CPS developed competence-enhancement programs for clinical psychologists right after the lockdown, in the end of January. The registration system of CPS has kept training registered psychologists, especially for crisis intervention to improve their competence in providing qualified services for all those in need. (2) Secondly, developing a response system in cooperation with governmental agencies. CPS work together with government agencies, NGOs, and foundations. They try to make sure that the strategic plans are active and sustainable. (3) Thirdly, target key groups in need of psychological service. CPS work with hospitals, schools, and community staff to find the key groups who have psychological problems, mental disorders, or even PTSD.All institutions have voluntarily done their work. Psychologists set up hotlines, sent out teams working on the frontline, especially Wuhan City. And some of them edited books, developed apps and online programs for psychological services and counseling, and online psychotherapy and teletherapy.Psychological services have been mentioned by China President Xi Jin-ping in his talks three times since the lockdown. Psychologists have been integrated in the work team for crisis intervention at both the national level and the provincial level. Medical teams were recruited in other provinces and sent to Wuhan or other cities in Hubei Provinces, and psychologists were included in those teams. Ten psychologists had been recommended and included in the National Team of Crisis Intervention, leading by the China Ministry of Crisis Intervention.Psychological support has been provided in many ways. Counseling or psychotherapy has been provided for free all around China, especially for inhabitants in Wuhan City. Both Division of Personality and Division of Counseling or Clinical Psychology of CPS are affiliated to Central China Normal University, which is located in Wuhan City. Many colleagues working in the School of Psychology there have become the key team members working in the epicenter ever since the lockdown. Almost all universities with a department or school of psychology set up hotlines; for e.g., ShanDong Normal University, located in Ji'nan City, the capital of Shandong province, provides hotline service for the general population in Shandong province. A similar case holds for almost all capital cities of provinces across China.For knowledge dissemination, many books have been edited, and many web pages have been developed. These can provide psychological knowledge and skills, helping people to adjust and cope with the COVID-19 pandemic. Technology was also employed to assist mental health. Different self-help apps have been developed to help general population online. Also, a wearable wristband with real-time physiological data acquisition, was used by nurses and doctors who work in frontline hospitals. The wristband recorded physical health parameters, mental health parameters and physical activity, providing a quick screening assessment of their  health status.The COVID-19 outbreak happened during the spring festival, which is a very unique opportunity for family members gathering together. And family dynamics have become a very strong basis of coping with the pandemic. The interpersonal relationship has never been so intensively tied. In this context, CPS has launched a Peace Mind Program, initiated by the Division of Crisis Intervention and Division of Psychological Institutions, together with the Institute of Psychology, Chinese Academy of Sciences. The Peace Mind Program has begun on January 28, right after the Spring Festival. They provided 94 lectures for either professional psychologists or for common civilians to disseminate psychological knowledge and skills. Online psychological assistance was also provided for different groups and professions, especially for policemen, medical professionals, and social workers in communities. We provide a hotline where people can find help or counseling for themselves or for their relatives.Another initiative, so-called \u201cThousands of Psychological Institutions for the Peaceful Mind,\u201d is a volunteer recruiting program. The program has recruited about 3,000 psychologists, and more than 400 institutions were involved in the program.Altogether, 454 organizations were recruited in the Peace Mind Program to provide service in different settings. More than 1,300 medical staff received psychological services, including group therapy, an audio program for stress management. Two thousand four hundred sixty-three institutions have been provided psychological counseling services. More than 4,220 counseling sessions have been provided for individuals. Colleagues in China have composed more than 5,330 essays for knowledge dissemination to the public. For hotlines, nearly 100,000 counseling calls have been received; 77,000 online counseling inquiries have been provided. One hundred seventy-five thousand joined the 1-week program through the APP we developed, with 70% of the users finished the whole program. We also developed a self-evaluation questionnaire, and 187,000 individuals finished the online evaluation. For the video and audio program, we published online, there are more than 1 million views for the lectures, and more than two million play for the audio programs.Research and project funding has been provided for those initiatives. All work we have done is to find the key groups in need. We realized that there is, still, a lot of work to be done. We hope that international communication and cooperation will give us more understanding of the mental and behavioral reaction to the COVID-19 pandemic and to the crisis in general.For psychologists, we need to study more on mental and behavioral reactions in a crisis like this and how to provide effective services in the future. For psychologists in China, teamwork, especially work with government agencies and NGOs at different levels from national, provincial, city, and community levels, is very important.Psychology as a profession in China needs legislation. Psychology as a discipline is very well-developed, but the legal status of the professional psychology profession is not quite stable. We have two kinds of mental health services: one is represented by psychiatrists and the other one is represented by clinical psychologists. These two versions of mental health services, of course, differ in many ways.As part of the comprehensive national response, the South African government is implementing an eight-stage process to manage the COVID-19 pandemic see . The eigAs from the beginning of June 2020, the country will transition into Stage 5, which coincides with alert Level 3 of the risk-adjusted response. Looking at COVID-19 provided the context for the first comparative analysis of psychology status in the BRICS nations. As directors of national scientific societies, the authors have worked for the past 3 years to develop BRICS Union of Psychologists, before COVID-19. We have also worked on international communication and cooperation ever since the outbreak of COVID-19. For example, we have participated in the zoom meeting hosted by American Psychological Association at least twice a week, which aims at collecting information from colleagues around the globe.In the comparative analysis of the actions of psychology in the BRICS countries, the first question that stands out is that the political and economic management of each country influenced the modus operandi of each representation of psychology. Psychological societies received support, encouragement, and even a direct political call for public policy actions for crisis management, psychoeducation, first psychological aids, and active listening directed to the public . Moreover, all societies have engaged in confronting COVID-19 in public health at various levels, considering the impacts on mental health.Although psychology acts to promote mental health in BRICS, only in Russia that psychology had a strong role in remote education in these early months of COVID-19. On the other hand, psychology in China was quickly organized, and this will speed up the required legislation and professional preparedness. In China and Russia, the scientific societies worked closer and integrated with the government. In Brazil, psychologists are integrated into the public health system, and a large number of psychologists are registered in a federal regulatory council of their own, but telepsychology is underdeveloped; state governments are working with Federal and State Universities to provide telepsychology during COVID-19. In India and Brazil, there is a prevalent sense of dichotomized world view, in contrast with the strong interpersonal strengthening described in China.Countries with large social inequalities faced more socioeconomic gaps that affect mental health, further straddling the health system weaknesses, as shown by Brazil, India, and South Africa. The interface between the socioeconomic and political moment might have contributed to the exacerbation of mental health issues in the early months of COVID-19. The various psychology organizations in these countries have tried to organize themselves independently or seeking to sensitize governments to articulate actions in favor of minority groups . In general, interventions introduced included payment of a social relief grant or of a distress grant to the unemployed and an increase in the social grant amount paid to the indigent. Also, technological and/or socioeconomic inequalities in countries like Brazil, India, and South Africa did not allow online services  to reach everyone , in contrast to online education in Russia and hotlines, apps and wearables in China.Despite this deficient access to online services in some of the BRICS nations, the expanded and extensive insertion of the telepsychology happened in all of them. The guidelines on this modality of online intervention were different for each nation and had to be reformulated due to the situation. In Brazil and South Africa, there were regulations being discussed under pressure, reformulated and adapted to the context of COVID-19.Psychology has different roles in their societies, and the pandemic exacerbated the strengths and exposed some of the weakness. In a long and continuous tradition of Russian psychology, the government actions have a place for education, mental health, and refined identification, and intervention is possible, for instance, in emerging cyberbullying. China, the first country of the epicenter of the pandemic, has been working in this crisis, using previous experience and an organized psychological intervention in many levels of psychological care contextualized, with the support of integrated and expanded political and economic management that helped in facing the emotional issues. India has a prolific amount of actions and a recent mental care policy that will probably catalyze the experiences during the pandemic into better mental health services. Psychology in South Africa has a strong regulatory link with other health professions; as a result, the strategies were set for all health professions, and psychology benefited from that despite the low contingent of psychologists. In contrast, despite of the high contingent of psychologists in Brazil, telepsychology was not stimulated, and the strong public health system did not offer telepsychology to the general population; universities and scientific societies are leading the actions in mental health during COVID-19 in independent initiatives amid a complex political context. In general, psychology in BRICS has been making pioneer contributions during COVID-19 times.Psychoeducation of the general population and building competencies of psychologists to work during and after the crisis are the main aims in BRICS. The different approaches of each country are related to the role of psychology in society, equity, and social context. The use of digital platforms and telepsychology has been one important resource that gives visibility to psychology and expands mental health care. In general, it is expected that there will be an increased role of psychologists in providing cultural sensitive intervention and information on socioemotional skills.KA and LB: design, integration of the authors' comments, and final manuscript. KA, LB, MM, MS, AP, MT, JM, AV, PS, BH, and TS: writing the draft. All the authors contributed to manuscript revision, read, and approved the submitted version.AP was employed by Bee Touch. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "This manuscript is a brief biography and reminiscence of Dr. Robert H. Heptinstall, a preeminent nephropathologist who had a major and formative impact on the field of nephropathology, and on nephrology in general. In his tour-de-force textbook of renal pathology, he brought the assessment of diseases of the kidney into the modern era. This textbook, now Heptinstall\u2019s Textbook of Renal Pathology, will extend his seminal influence well into the future. Dr. Robert Hodgson Heptinstall, one of the founding fathers of modern renal pathology, passed away on January 5, 2021 at the age of 100. \u201cHeppy\u201d was born in Keswick, Cumberland, England and received his medical education at Kings College London, Charing Cross Hospital Medical School, and London University. As a young physician, from 1944 to 1947 he served in the Royal Army Medical Corps in India, Burma, Siam and the Dutch East Indies as infantry medical officer and operational medical officer for special forces. During this time, he cared for prisoners of war, and was profoundly affected by this experience. In 1947 he returned to Charing Cross Hospital where he had initially trained as a surgeon. However, he decided to change his focus to pathology, a decision which led him to seek pathology training at St. Mary\u2019s Hospital , the International Society of Nephrology (ISN), and was a founding member of the Renal Pathology Club, now the Renal Pathology Society (RPS). Heppy was president of the RPS from 1980 to 1983. He was also an honorary member of the American Society of Clinical Pathology, and the Danish Society of Nephrology.Heppy was the compleat academic pathology. He founded the renal biopsy service at Johns Hopkins, had an active research laboratory, and also loved to teach. Arguably his crowning contribution to education in renal pathology and nephrology was his textbook, The Pathology of the Kidney, first published in 1966. The book was a major advance in the field, as it incorporated the findings from clinical biopsies of the kidney as well as surgical and autopsy specimens. The writing of this text was a Herculean effort, occupying evenings and weekends for a long period of time. The book was extremely well-received, and a second edition followed, incorporating findings from immunofluorescence and electron microscopy as well as routine histology. This text, now called Heptinstalls Pathology of the Kidney, is in its seventh edition, with multiple editors and chapter authors, a vibrant part of Heppy\u2019s legacy.While Heppy was a dedicated renal pathologist, he was also very influential in the broader nephrology community. As noted, he served on editorial boards of a number of influential nephrology journals. In addition, he was active in professional nephrology societies. He held a number of offices in the American Society of Nephrology, and served as president of the ASN from 1972 to 1973. He was also active in the International Society of Nephrology, serving as vice-president of the society from 1981 to 1984. His high profile in the field, and his textbook, which is a major resource for nephrologists as well as pathologists, helped establish the close relationship between the two disciplines that continues to the day.Another important part of Heppy\u2019s life was his family. He married Ann Porter in the years after the war, and she was his life companion. Together they had seven children. Ann, as well as three of their children, predeceased him. The remaining children, Jonathan, James, Caroline and Gillian were very supportive in his later years. He also enjoyed his eight grandchildren and one great- grandchild. In retirement, Heppy lived independently until late in life, and remained active and engaged, avidly following medicine, sports and politics, and reading history. He retained a phenomenal memory as well as his wit and sense of humor. He was very convivial and enjoyed visiting with colleagues- he was a legendary story teller. His daughter Caroline Heptinstall Jones and her family provided a home for him in later years, and helped entertain friends and colleagues who came to visit him.In addition to leadership roles in professional societies and journals, Heppy garnered many awards in his lifetime. These include the Gold Medal from the Danish Society of Nephrology, the David M Hume Memorial Award from the National Kidney Foundation, and the Jean Hamburger Award from the ISN. In his honor, in 2011 the Renal Pathology Society named their life-time achievement award in his honor. In 2020, the Johns Hopkins Department of Pathology established a fellowship in his honor. Heppy was truly \u201cone of a kind\u201d- we will not see his like again."}
{"text": "Kawasaki Disease is an acute and self-limited systemic inflammatory and febrile illness, which is the most common cause of acquired heart disease in children in developed countries. The incidence of KD in Asian countries is high. But, data is not available from the Middle East. So, the aim of this study was to develop an MDS to set up a national registry for KD to estimate the burden of disease in Iran.This cross-sectional and descriptive study was conducted in 2020. Literature review, data collection from patients medical records, and expert panel approach were used to design this MDS. Data elements with a Content Validity Ratio (CVR) of more than 0.56 were selected as the MDS of the registry.Overall, 99 data elements were recognized. Of which, 51 and 48 data elements were verified and rejected, respectively. Moreover, 17 data elements were added as required by experts. Eventually, 68 data elements were chosen as the MDS of the national KD registry of IRAN; of which, 17 and 51 data elements were classified as administrative and clinical data, respectively.These precise, integrated, and comprehensive developed data elements and the national KD registry will lead to effective disease management and thus, improve the quality of care and, consequently, improve public health. Kawasaki disease (KD), an acute and self-limited systemic inflammatory and febrile illness occurs generally in children under 5 years old , 2. AlmoKD is the most common cause of acquired heart disease in children in developed countries . The patSince KD is a major cause of acquired heart disease in children, and due to the sudden death because of coronary aneurysms and thrombosis, effective management of KD is significantly beneficial for public health. Active supervision and management could potentially lead to long-term benefits for patients, practitioners, and society by facilitating the recognition, prevention, and treatment of KD cases. It also yields cost reduction at the national level . It has The registry is a database that uses minimum data set (MDS) to accurately analyze the burden of disease , 18. IdeThe aim of the MDS is to determine the data elements that need to be gathered and to develop a database as a comprehensive source of precise information for decision-makers and policymakers . MoreoveThere are some issues in Iran related to the implementation of diseases include data elements duplication in healthcare forms, lack of unified health information systems, and eventually, lack of national standard minimum data sets . Given tThis cross-sectional and descriptive study was conducted in 2020. Literature review, data collection from patients medical records, and expert panel approach were used to design this MDS. In the first phase, a literature review was carried out to specify all possible data elements to be included in the final minimum data set. Articles, forms, guidelines, and reports on the internet were reviewed. We carried out a systematic review of ISI Web of Science, PubMed, Scopus, Google Scholar, and Persian databases to recognize all References related to the MDS of KD which were published until February 2020 . We usedThe search strategy was limited to English and Persian languages. The included criteria were full-text articles, guidelines, forms, and reports from reliable sources published until February 2020. Other types of resources including abstracts without full-text, non-peer-reviewed articles, letters to editors, short communication, even forms and reports from weblogs were excluded. Then, data elements were evoked and recorded into a checklist. In addition, data was collected from patients medical records based on the International Classification of Diseases-10th Revision (ICD-10) related to KD. The final checklist included data elements got from the literature review and patients' medical records. Data elements were split into two categories: administrative and clinical.In the next phase, an expert panel was held to appraise and specify the MDS of KD. Ten pediatric specialists with more than 5 years of experience in KD treatment from different universities of medical sciences participated in this panel. We sent the aim of the study, the process of identifying MDS, and the extracted MDS to all experts, 2 weeks before starting the panel. Experts' initial opinions on the data elements were collected and calculated using the Delphi method. Content Validity Ratio (CVR) of more than 0.62 was considered as a condition of expert consensus on the acceptance of data elements as the final MDS for the KD national registry. Participants were also asked to propose any additional comments on desired MDS such as other data elements that were necessary for the KD registry according to their opinion. After collecting all comments and calculating CVR for each element, we held a focus group and brainstorming sessions for discussing elements which either were scored <0.62 or were proposed by experts. Due to the prevalence of COVID-19 disease, sessions were conducted using Skype software. Sessions continued until panel members reached a consensus to determine the final data elements. After discussion on each identified data element, at the end of the third session, by sending the finalized data elements to each member of the panel, they were asked to announce their decisive agreement with the selected elements to the secretary of the panel in case of final confirmation.The result of the systematic review showed despite the importance of KD, there is no specific registration program for KD in the world. All countries report their statistics based on the cross-sectional surveys, mostly annual, of hospital admission and discharge data. Only some KD case report forms were found in the United States, Korea, and Hong Kong. As a result, in order to develop the minimum data set for the national KD registry in Iran, we used these forms along with the guidelines for diagnosis, treatment, and management of KD found in different countries and the extracted data elements from medical records of patients in pediatric hospitals in Iran.Overall, 99 data elements were recognized. Of which, 51 and 48 data elements were verified and rejected, respectively. Moreover, 17 data elements were added as required by experts. Eventually, 68 data elements were chosen as the MDS of the national KD registry of IRAN entitled (IR-KDMDS). The final minimum data set was divided into administrative and clinical categories with 17 and 51 data elements, respectively. The demographic characteristics of the experts are shown in The administrative data consists of demographic data such as full name, national code, sex, and age. The clinical data elements contain patient's hospitalization data, patient's history data , major criteria of KD, patient\u2032s body organs review, and finally, diagnostic and therapeutic procedures including laboratory tests, other paraclinical evaluations, drug, and surgical treatments. The complete elements of IR-KDMDS are presented in Kawasaki disease is one of the most common childhood vasculitis that can lead to serious complications, considerable morbidity, and mortality. Proper and timely treatment of disease can prevent these complications, and this indicates the importance of early and accurate diagnosis of the disease . Up to nUnfortunately, our review has shown that there is no specific registry for regular data collection of KD patients. Therefore, the minimum data set was designed in this study, and as a result, the KD National Registration System of Iran is the first attempt to collect comprehensive data on KD in the world.Each MDS possesses diverse data elements containing demographic, administrative, and clinical data such as health status, procedures, medications, treatments, and outcomes , 27. BasSome of our data elements, like some demographic and therapeutic procedures data, are common with other registries and guidelines for KD diagnosis, management, and treatment in the world and especially with what had been defined in KD case report forms in the USA, Korea, and Hong Kong \u201330. AparThe authors' review indicates despite the notable increasing incidence of disease, there is no KD-related registry in the world. Hence, the result of this study is the first effort to design a national KD registry. It is expected that defining precise, integrated, and comprehensive data elements and developing the IR-KDMDS will lead to effective disease management and thus improve the quality of care and, consequently, improve public health.The momentous strength of this project is the process of determining the MDS. IR-KDMDS is the outcome of the brainstorming, negotiation, and consensus of experts in several fields related to KD. Hence, it has been comprehensively containing all aspects of diagnosis, treatment, and management of KD.This article provides the first comprehensive MDS for developing a systematic KD registry in the world. Therefore, it is useful for designing and implementing a nationwide registry with the purpose of gathering all desired data from all patients across the country for determining the burden of disease and making decisions for effective management of the disease.The original contributions presented in the study are included in the article/MR designed the project. ZQ, LS, and MN performed the project. ZQ performed the analytic calculations. ZQ and MR wrote the manuscript. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "The Vaccines journal had the most publications, with 425 articles. The US Department of Health & Human Services granted the most research. In 2019, studies were focused on the topics of COVID-19 virus identification and ways to deal with it; in 2020, studies focused on the topics of COVID-19 and vaccines, whereas in 2021, they focused on the topics of COVID-19 vaccines and their effects, vaccines hesitancy, the role of healthcare workers in COVID-19, as well as discussions about these vaccines in the social media. Conclusions: Recognition of the most important actors , research trends, and fields of study on the COVID-19 vaccine can be useful for researchers, countries, and policy makers in the field of science and health to make decisions and better understand these vaccines.This study attempted to draw the present and future perspective of the COVID-19 vaccine by identifying the most important scientists and their scientific contexts, trends of research topics, and relationships between different entities. Methods: To achieve this purpose, bibliometric and scientometric techniques were used to analyze 6288 scientific documents contributing to COVID-19 vaccines from the beginning of 2019 to 13 December 2021, indexed in the Web of Science. Results: The United States (US) had the greatest impact by publishing 2104 documents and receiving 32,958 citations. The US and the UK countries had the highest level of scientific collaborations with 192 collaborative studies. The University of Oxford and the Harvard Medical School were the most active institutions, and the University of Oxford and Emory University were the most influential institutions. Pollard AJ and Lambe T had the most publications and the highest citations and h-index. T Lambe, SC Gilbert, M Voysey, and AJ Pollard from the University of Oxford had the highest number of co-authorships. More than 19% of the research was conducted in the field of immunology.  The new coronavirus, or COVID-19, is a deadly virus common between humans and animals . The panHowever, a vaccine is a biological preparation that provides acquired active immunity to a specific disease . The maiIn the section on research and technologies in the field of vaccines, we are witnessing the emergence of interdisciplinary fields, research collaborations, and new research fronts to transform the future of science and technology in this field. Identifying and evaluating research, research areas, and research fronts in COVID-19 vaccines familiarize researchers and related organizations with current and future research trends in this field and help them to better conduct training programs in this field. The present study helps to identify important interdisciplinary topics and research areas resulting from scientific publications, the most prolific and influential researchers, institutions, countries, and journals that publish new research on coronavirus vaccines and develops a plan for future research collaborations.Therefore, considering the importance of using vaccines in the prevention and control of pandemics and following an increase of scientific publications on the COVID-19 vaccine, attention to scientometric studies to assess the research productivity and collaborations of various disciplines, researchers, and institutions of the world in this field have gained a special importance. Therefore, the current research aims to draw the present and future perspective of the COVID-19 vaccine studies by identifying the most important actors and their scientific fields, trends in research topics, and relationships between different entities.Some studies by ,14,18,19According to the objectives of the present research, the method of bibliometric and scientometric analysis was used to analyze scientific publications on the COVID-19 vaccines. The population of this research consists of all documents on the COVID-19 vaccines from 2019 to 13 December 2021 indexed in the Web of Science database. The methodology of this research was divided into two parts, which are described in detail below.The search strategy was such that in the first step, the Clarivate Analytics Web of Science (WoS) Core Collection was selected ,21. Nextwww.track.org was used (19 January 2022) to gather information about the type of vaccine, primary developers, and status of approving countries. Additionally, information on the doses purchased from each vaccine was collected from the app.powerbi.com website. The website www.RAPS.org (accessed on 19 January 2022) was also used to identify vaccine-producing countries.In other words, the website of COVID-19 vaccines All extracted files were analyzed using HistCite , Publish or Perish , VOSviewer , CiteSpace , and Bibliometrix R Package software . The analysis process was such that the capabilities of HistCite software were used to analyze information about authors, institutions, countries, and journals . In addiThe analysis showed that the US, Italy, China, and the United Kingdom (UK) conducted the most research on COVID-19 vaccines, and the height of the countries\u2019 rectangles indicates that. Furthermore, most of the US studies have focused on COVID-19, COVID-19 Vaccination, COVID-19 Vaccines, Vaccine hesitancy, and COVID-19 Vaccines BNT162B2; these studies have been led by many researchers. Additionally, most Italia research has focused on topics, such as COVID-19, COVID-19 Vaccination, COVID-19 Vaccines, Vaccine hesitancy, COVID-19 Vaccines BNT162B2, and COVID-19 Pandemic; these studies have been conducted mostly by researchers such as AJ Pollard, T Lambe, L Kilmek, PK Aley, and M Voysey. However, Chinese and UK researchers, similarly to American researchers, focused on COVID-19, COVID-19 Vaccination, COVID-19 Vaccines, Vaccine hesitancy, and COVID-19 Vaccines BNT162B2.Additionally, based on the results of Vaccines, Vaccine, Human Vaccines & Immunotherapeutics.To analyze the bibliographic information from documents on the COVID-19 vaccines, a three-field plot of institutions, keywords, and journals was designed, which allows us to identify institutions that have studied topics on the COVID-19 vaccines and provides the possibility to identify the field of journals that published such studies. As shown in In total, 122 countries contributed to the publication of studies on the COVID-19 vaccine, and the findings of the most active countries are presented in Vaccines journal with 425 articles and the Vaccine journal with 185 articles had the highest number of publications in the field of COVID-19 vaccines. Studies published in the New England Journal of Medicine and the Lancet had the greatest citation impact on the scientific community, receiving 12,861 citations and 6776 citations, respectively, which could obtain significant citations in this field. The results of New England Journal of Medicine with IF 91,245, and the lowest impact factor belongs to the International Journal of Environmental Research and Public Health with IF 3.39. Among them, 10 journals were Q1, 2 journals Q2 and Q3. Furthermore, The results of Vaccines journal has been on an upward trend, which shows the special attention of this journal to the publication of studies on COVID vaccines. Overall, the journal has increased its number of studies from 13 in 2020 to 411 in 2021. It is followed by Vaccine and Human Vaccines & Immunotherapeutics, which were other research channels for researchers to publish studies on the COVID-19 vaccines in these years. These journals published 30 and 29 studies in 2020 and 155 and 145 studies in 2021, respectively.Continuing to review the results of the publication of studies by journals, According to the results presented in Immunology area, which could probably indicate that researchers in this field, in addition to treating and producing vaccines for this epidemic, also examined the types of immune responses to these vaccines. Furthermore, General & Internal Medicine with 1054 and Research Experimental Medicine with 834 studies were other active areas in this field. In total, researchers in these three areas played an influential role in the research outputs on the COVID-19 vaccines by publishing more than 49 percent of the studies. Additionally, the situation of other active and productive areas in this field is presented in The findings of England (the UK) and Germany, on the other hand, are other productive countries in this field, which is in the #1 cluster called the sociodemographic factor. China is also the source of the corona outbreak in cluster #2, and Italy and Russia in clusters #4 and #0 called the effective COVID-19 genomics and COVID-19 vaccines, are paying close attention to aspects of new strains and variants COVID-19 and COVID-19 vaccines.Due to the widespread prevalence of COVID-19 worldwide and its new mutations, many studies have been conducted by researchers on therapeutic and pharmacological methods to treat COVID-19 and to develop a vaccine to control the disease. According to the latest statistics approved by the World Health Organization, the number of patients with \u201cCOVID-19\u201d disease in the world has reached 270,791,973 people, and the deaths of 5,318,216 people have been confirmed due to this disease. On 15 December 2021, more than 8,200,642,671 people worldwide had been vaccinated against the virus [The findings related to the trend of publications related to the COVID-19 vaccines indicate a significant increase compared to 2019 and 2020, meaning that more than 90 percent of these publications have been produced in 2021. Therefore, a reason for the significant increase in releasing research related to COVID-19 vaccines in 2021 may be the decline in global resilience faced with this epidemic and a more deadly strain of the virus, which prompted researchers to conduct further studies on the field of making and producing vaccines and finally controlling and eradicating this disease. Overall, the findings of researchers and institutions with the highest number of research publications showed that Pollard AJ and Lambe T of the University of Oxford had the highest number of publications on studies related to the COVID-19 vaccines. The findings from the most active research institutes also indicated that the University of Oxford in the UK and the Harvard Medical School in the US, as the most active institutions, played a more prominent role than other institutes in studies on the COVID-19 vaccines. The above results agree with the findings of Ay et al. .The findings from leading countries in studies on the COVID-19 vaccines showed that researchers from the US published the most publications in this field; the results of Surulinathi et al.  and Ay eVaccines and Vaccine journals published the largest number of studies on the COVID-19 vaccines during the desired period. These journals are published by MDPI and Elsevier publications, respectively, and in terms of ranking of the Web of Science journals, they are ranked Q2 and Q3, respectively, and are in a good position in terms of impact factor. However, a review of support organizations for COVID-19 vaccine studies showed that the U.S. Department of Health & Human Services, with 437 studies, and the National Institutes of Health (NIH) from the US, with 408 studies, provided the most support from published studies on the COVID-19 vaccines. Additionally, the results related to the thematic fields of published studies showed that researchers in the field of Immunology with 1244 studies (19.8%), the field of General & Internal Medicine with 1054 studies (16.8%), and the field of Research Experimental Medicine with 834 studies (13.3%) percentage) had the most scientific publications in this field, which in the study Ay et al. [The results of the journals that published research on the COVID-19 vaccines showed that the researchers published their scientific publications in 1321 journals. Among them, the y et al. , these tThe state of research on the COVID-19 vaccines based on the time zone map showed that the initial studies in 2019 were more focused on identifying the COVID-19 virus and ways to combat it . However, the scientific research of researchers in 2020 has led to topics, such as COVID-19 and vaccines , which indicates their serious attention to the development of vaccines to control and treat the disease. Finally, the research trend of studies in 2021 on topics, such as COVID-19 vaccines and their types and effects, vaccines hesitancy, the role of healthcare workers in COVID-19, as well as discussions on these vaccines on social media has been more than other studies.Findings on the interconnected map of countries and research institutes showed that the US has paid serious attention to scientific activities about the production of COVID-19 vaccine, vaccination, and sociodemographic factor. The universities of Oxford, Harvard Medical School, Tel Aviv, Washington, and the London School of Hygiene & Tropical Medicine have also been major research institutes in the field of COVID-19 vaccines.Generally, this study examined the trend of publications on the COVID-19 vaccines from the perspective of scientometric and depicted the topics and fields of study of countries, institutions, and researchers and the collaboration between them in this field. The findings of this study can be valuable through the identification and analysis of the most important actors , the research process and fields of study in the COVID-19 vaccine for researchers, countries, and policymakers in the fields of medical sciences and health to make better decisions and understand and ultimately progress in this field. There may also be more research in the future on other types of vaccines and comparing their effectiveness on mutated strains of the virus, vaccine acceptance, long-term side effects of these vaccines, COVID-19 vaccination from various perspectives, and other related topics due to the more prominent keywords, such as \u201cCOVID-19 vaccine\u201d and \u201cCOVID-19 vaccination\u201d, which can also increase the upward trend of publication compared to recent years. Finally, there is a need to increase opportunities for financial support, more scientific collaborations, understanding and analyzing research of leading countries, and emulating them from different angles to make appropriate decisions."}
{"text": "Background: Since the beginning of the coronavirus disease 2019 (COVID-19) epidemic in Iran, the control and management of the epidemic were headed by the National Headquarter for the Control of COVID-19 Epidemic through setting up different scientific committees, including the COVID-19 National Epidemiology Committee. The present study reviews the missions, structures, achievements, and challenges of the Epidemiology Committee.Study design: A rapid reviewMethods: All relevant reports, documents, guidelines, published literature, and surveillance data related to the establishment, visions, missions, roles, activities, and outputs of the COVID-19 Epidemiology Committee were critically reviewed in this study.Results: The efforts of the committee\u2019s working groups may have impacted improvements in data registration/usage, provincial data quality at provincial levels, and perception of the epidemic situation in the provinces. The committees have also played role in informing the policies in different stages of the epidemic through routine or problem-based data/evidence analyses, epidemic investigations, and mathematical modeling.Conclusions: The structure and experience gained by the committee can be used in similar situations within and outside the country. To further improve the impacts of our activities, it is essential to have effective interaction, collaboration, and data flow between the committee and a broad range of organizations within and outside the Ministry of Health and Medical Education. Iran was among the first countries infected with the virus after the epidemic in Wuhan, China . The primary cases in Iran were identified and reported on 19 February 2020 in Qom . Soon after that, many more cases were identified in other provinces of the country, with some provinces being highly affected in the early phase of the epidemic, including Tehran, Gilan, Mazandaran, Qom, and Golestan .Since the beginning of 2020, the coronavirus disease 2019 (COVID-19) pandemic has affected more than 200 countries worldwide, with millions of infections and thousands of mortalities .Since the start of the epidemic, Iran has adopted a wide range of control policies in order to mitigate the rate of epidemic spread. One of the key efforts involved the establishment of the National Headquarter for the Control of COVID-19 Epidemic (NHCCE). The Supreme National Security Council assigned headquarters as the principal entity responsible for the development and communication of COVID-19 mitigation policies. The council appointed Iran\u2019s minister of health as the leader of the NHCCE  After the establishment of the NHCCE, different scientific committees were formed by the NHCCE leader in order to provide scientific support for mitigation policies in each area. The COVID-19 National Epidemiology Committee, as one of these scientific committees, was formed in February 2020 in the Ministry of Health and Medical Education (MoHME). This study reviews the missions, objectives, structures, achievements, and challenges of the National COVID-19 Epidemiology Committee in Iran by October 2020.. It has been discussed that countries that have had and used their previous experiences in dealing with emerging infections, such as China and South Korea, have been better able to efficiently respond to the COVID-19 pandemic . Notably, some countries without previous experience also acted successfully in responding to the epidemic. The experience of these countries is of high value and needs to be disseminated in more detail. Some of the known lessons from New Zealand\u2019s pandemic response include rapid science-based risk assessment linked to early decisive government action, implementation of interventions at various levels , provision of empathic leadership, and effective communication of key messages to the public by the prime minister . For the experiences to be re-usable, it is necessary to have them published. In many countries, different health sectors/committees/disciplines have initiated publishing their experiences and lessons learned from responding to the COVID-19 pandemic .Learning from experiences has been widely recommended by leadership scholars  This review aimed to convey the experience gained by the COVID-19 Epidemiology Committee in Iran, including the lessons learned by all its achievements and shortcomings/barriers, to help leaders better organize similar activities in the future. The mission is to compile the results of local and international epidemiological studies, mathematical models, and expert opinions in order to promote evidence-oriented policymaking. To achieve this goal, the committee has the following objectives:The investigation of the current status and prediction of the trend of COVID-19 in the country The investigation of the epidemiological models of COVID-19 in the country and the world Leading the epidemic investigations of COVID-19 at national and subnational levels A review of the documents and findings of studies published in high-standard scientific journals about COVID-19  The current study critically reviewed all relevant reports, documents, guidelines, published literature, and surveillance data related to the establishment, visions, missions, roles, activities, and outputs of the COVID-19 Epidemiology Committee in Iran. A. Intrasectoral collaborators A diverse group of multidisciplinary intrasectoral collaborators is deemed necessary to accomplish the missions of the committee. Therefore, the committee collaborates with the following entities as its major intrasectoral collaborators:The NHCCE Vice-Chancellor of Health Affairs, MoHME, Iran Vice-Chancellor in Treatment Affairs, MoHME, Iran Deputy of Research and Technology, MoHME, Iran Food and Drug Organization, MoHME, Iran Deputy of Nursing, MoHME, Iran Statistics and Information Technology Center, MoHME, Iran National Diagnostic Laboratory Network, Pasteur Institute of Iran Medical Sciences universities  B. Intersectoral collaboratorsWorld Health Organization Country Office, Iran Iranian Academy of Medical Sciences, Iran Research Center of the Islamic Consultative Assembly, Iran Sharif University of Technology, Iran  In order to achieve its missions, a wide range of expertise formed the core members of the COVID-19 Epidemiology Committee. The composition brings together scientific and/or executive managers/members in various health-related fields, either in the MoHME or medical universities. This has provided a more comprehensive perspective of the epidemic features. Such diversity has also facilitated the intersectoral communication and information flow with the areas at the disposal of committee members. In addition to its core members, the committee has a close working relationship with more than 100 colleagues. These colleagues mainly collaborate within one or more working groups of the committee.A diverse set of working groups was formed in order to aid the committee to achieve its objectives. The description of each working group and its main tasks, outputs, and achievements are provided below. Description and objectives: The objectives of the COVID-19 Surveillance Data Management Core Group include compiling, organizing, cleaning, and analyzing COVID-19 surveillance data. The National COVID-19 data are deposited in some independent databases , which contain the clinical data of hospitalized suspected and confirmed COVID-19 cases, and SIB portal, which contains outpatients\u2019 data and screening information. The working group manages data cleaning and analysis, the main results of which are communicated with policymakers to inform decision processes. The working group also uses the data to monitor the accuracy of surveillance data collection, registration, and flow from the local settings  to upper levels within the MoHME. Feedback is provided to the working entities whenever needed.Outputs and impacts: The work performed in this group has improved data registration of hospitals and medical universities. The results of these analyses have also informed the preliminary case definition and clinical management guidelines for COVID-19 in Iran and many decisions processed to control the epidemic in the country. B. Provincial Epidemiology SubcommitteeDescription and objectives: This working group was formed to facilitate the provision of high-resolution perspectives on the epidemiological features of COVID-19 within each province. To this end, provincial COVID-19 epidemiology committees were formed in each province. The committees were responsible for leading province-level outbreak investigation, contact tracing, epidemiological data gathering, and surveillance data cleaning and analysis. The committees were responsible for providing weekly reports about the epidemiological profile of the province to the National Epidemiology Committee. Feedbacks were provided whenever needed. The National COVID-19 Epidemiology Committee also facilitated logistic issues faced by the provincial committees.Outputs and impacts: During the early months of the epidemic, investigations were weekly prepared by provincial committees and dispatched to the COVID-19 Epidemiology Committee. Subsequently, the reports were sent once a month. These reports are now the premise of provincial determination and intervention measures. C. Analysis of Provincial Epidemic TrendsDescription and objectives: This working group aimed to determine the epidemic trend of COVID-19 in different provinces of Iran. Accordingly, since the beginning of the epidemic and based on the rate of COVID-19 cumulative incidence, the provinces of Iran are classified into three categories, namely high-, medium-, and low-incidence provinces. The provinces can move between these categories over time given their epidemic status. The trend of daily confirmed cases and mortalities are analyzed every 7 days. In each analysis, the changes in the number of confirmed and mortality cases within the past 5 days are calculated by averaging the numbers in a specified day and a day before and after that. Given the trend of morbidity and mortality, the provincial trend is inferred as upward, downward, or stable. These analyses show if a province approaches a new epidemic pick or has passed one. Provinces with controversial data can also be detected in these analyses, where the source of controversy can then be identified.Outputs and impacts: The factsheets published by this working group provided the policymakers at the MoHME and medical universities with information about the possible course of the epidemic in different provinces. These analyses can detect incompatibility in the data of the provinces. In such cases, the feedback was immediately provided for the province, which has ultimately improved the reporting quality of the provinces. D. National Daily Situation Reports for COVID-19Description and objectives: The National Daily Situation Reports for COVID-19 working group was formed to provide national COVID-19 situation reports for a broad audience of caring individuals within and outside the country. The national COVID-19 surveillance data is being analyzed, validated, and aggregated. The data sources for daily reports mainly include the MCMC and HIS databases (for inpatients) as well as the SIB portal (for outpatients). The reports contain basic epidemiological features of confirmed and mortality cases, including the national daily trend of infection, mortality, and recovery, age and gender distributions, prevalence of different comorbidities, and trends of case fatality rate and intensive care unit admission.Outputs and impacts: By 20 October 2020, 62 daily situation reports have been released by the National Epidemiology Committee both in Persian and English, some of which have provided basic information required for policymaking either in the clinical or public health settings (access to daily situation reports ). E. Model-Based Analyses and Forecast of COVID-19 TrendDescription and objectives: To inform the decision, the modeling working group was responsible for the development of simulation-based analyses to respond to the questions coming up over the course of the epidemic. For this purpose, the first modeling report forecasted the possible number of COVID-19 infections, hospitalizations, and mortalities in the whole country and Tehran  using compartmental dynamic models. The first modeling report was the estimation of the number of medical equipment required under different levels of social distancing. The results were used to inform policies and practices at the moment. The models were developed based on a domestic model in collaboration with Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran, and using an international developed model  in collaboration with the University of Oxford, England. Other models that are developed upon emerging practical questions include the prediction of the effects of closing schools and universities, holy shrines, and other nonpharmaceutical interventions on the number of COVID-19 infections, hospitalizations, and mortalities. Moreover, some reports on the burden of disease and economic impact of the epidemic were prepared (access to daily situation reports ).Outputs and impacts: Eight policy reports (seven based on domestic models and one based on the CoMo model) were delivered to the MoHME, evaluating the effect of interventions or predicting future trends. F. Evidence Mapping and SummarizationDescription and objectives: The mission of this working group is the improvement of the current research awareness by providing the audiences with a summary report of the high-quality evidence in Persian. Major activities include the provision of summary research and journal watches in Persian. To this end, scientific information and research results of COVID-19 from various international and domestic credible sources, including scientific journals, related organizations, news agencies, and research centers, are collected by a group of 20 students and health experts every day. The topics cover various aspects of COVID-19. The summarization task is performed using a standard \u201cdata extraction\u201d template. The template contains different headings that should be filled, including \u201cmain results\u201d, \u201ckey message of the study\u201d, \u201cstudy title\u201d, \u201carticle publication date\u201d, \u201cjournal name\u201d, \u201ctarget audiences\u201d, \u201cstudy samples\u201d, \u201cconclusions\u201d, and \u201clessons to be learned\u201d. These summaries are utilized by a wide range of audiences, including policymakers, managers, therapists, and the general population.Similar to the reports of other working groups, the above-mentioned documents are also uploaded regularly on the official website of the COVID-19 Epidemiology Committee. These materials are also distributed within a broad network of audiences either in hard copy or electronic formats. Outputs and impacts: Within the 4 months, more than 850 evidence summaries have been uploaded, receiving more than 200,000 website views by the target audiences. The process takes about 2-3 h every day. G. Documentation Core GroupDescription and objectives: The objectives of this working group were to share Iran experiences for the control of the COVID-19 pandemic that can be used in future emergencies, document efforts/ interventions, success stories, challenges, innovations, and suggestions for the better management of emergencies by the chancellor of universities, all relevant sectors, and senior management within MoHME. In addition to its core members, this working group enjoyed the collaboration and engagement of a focal point from each of the universities of medical sciences and health services and a focal point from 28 relevant departments within MoHME. This working group interviewed around 30 heads of the organization and deputy ministers from other sectors that were documented in one of the below-published documents.Outputs and impacts: To date, four documents have been published that are summarized below. In addition, two others are on the way . 1. Islamic Republic of Iran actions in prevention, diagnosis, and management of COVID-19 that is published in 150 copies in 88 pages and shared on different websites. The document summarizes MoHME policies, strategies, and action points during the first 2 months of the pandemic in 6 main sections, namely governance, action points, international and public relations, emergency unit and Red Crescent actions, provision of medicines and personal protective equipment, and medical education, research, and students affairs. 2. \u201cThe First-Line Care Providers\u201d that is published in 100 copies in 70 pages. Considering substantial efforts of the care providers, namely community health workers at rural health houses, family experts at urban health posts, nurses and midwives at hospitals, and emergency and laboratory experts, it was decided to document some examples of dedicated and sacrificed efforts of these first-line care providers in the current review. 3. Intersectoral Collaboration and Partnership is published in 200 copies in 164 pages and shared on different websites. In this study, the researchers identified a few relevant questions related to each sector and made an appointment with the head of the organization/deputy ministers in different sectors. The members of the documentation committee were divided into three main groups and met the highest authority within the relevant sectors. The main interventions, challenges, innovations, and suggestions for improvement in emergency management were also among the key questions raised in these interviews. 4. Preparedness and Response for the Control of COVID-19 (in English) in Islamic Republic of Iran that is published in 200 copies in 82 pages and shared on different websites in addition to shared hard copies to all United Nation agencies and foreign embassies located in Tehran. To share the policies, strategies and main interventions of Iran in controlling the COVID-19 pandemic and in line with Global World Health Organization guidelines for emergency preparedness and response, this document is prepared in partnership and coordination with the relevant departments within MoHME. The main contents of the document include epidemiological studies, health governance, policies and strategies for the prevention, diagnosis, and treatment of COVID-19, screening standards, implementation of health protocols, use of the Primary Health Care (PHC) network in national screening, community engagement and empowerment, international collaboration and partnership, summary of nursing, midwifery, and emergency units, and Red Crescent Society and environmental health protocols and standards. The field and scope of the work in the Epidemiology Committee have a strong inter/intra-organizational character. To convert COVID-19-relevant data and information into policy, it is required to have effective communication, collaboration, and data/information flow between the committee and a wide range of sectors/organizations within and outside MoHME. To date, one of the main challenges has been effective and timely coordination between the committee and these sectors. The COVID-19 surveillance data are deposited in more than one database, with different databases covering part of the data, such as laboratory, outpatient, and inpatient data. Combining the aforementioned databases poses important challenges in data cleaning, data verification, and linkage of different databases. On the other hand, while putting the stress on COVID-19 data registration in the local settings has led to the completeness of the data, it has also had important side effects. Firstly, the efforts have already posed a heavy workload to the local staff, leading to occupational burnout in some staff. Secondly, emphasizing the diagnosis and data registration of COVID-19 has overshadowed the surveillance of other respiratory infections, especially influenza. Finally, the infection of some of the committee\u2019s key members with COVID-19 during the early phases of the epidemic diminished the workforce that could actively collaborate with the committee to fulfill its missions. This challenge highlighted the necessity of protection against infection for those involved in critical positions during the epidemics. The structure and the experience gained by the committee can be used in similar situations within and outside the country. To further improve the impacts of our activities, it is essential to have effective interaction, collaboration, and data flow between the committee and a broad range of organizations within and outside the MoHME. We would like to thank all the colleagues in the working groups of the Epidemiology committee who contributed to the defined activities, and helped the committee to achieve its goals. Aliakbar Haghdoost holds the position of the Deputy Minister of Education in MoHME and Mohammad Mehdi Gouya holds the position of the head of Iran\u2019s Center for Disease Control and Prevention in MoHME. The rest of the authors declare that there is no conflict of interest. The authors received no funding for this study.Activities: Data curing, modeling, outbreak analysis, evidence mapping, and documentation.The compilation of coronavirus disease 2019-related data from different sources remains a challenge.Rapid committee formation helped in keeping pace with the epidemic growth rate."}
{"text": "This obituary highlights a number of contributions by Professor Jan Beneken (1934\u20132021) to modeling of human physiology and pharmacology and to simulation-based training. European modeling and simulation pioneer Professor Jan Beneken, born in Arnhem, The Netherlands on 20 March 1934, passed away in Eindhoven, The Netherlands, on 23 September 2021. This obituary focusses on the impact of Dr. Beneken on simulation-based training, established via his groundbreaking research on modeling of human physiology and pharmacology, via his mentorship of the team at the University of Florida that invented the Human Patient Simulator, and via the recent Jan Beneken conferences.Dr. Beneken obtained his electrical engineering degree from the University of Delft, The Netherlands, in 1958, and his PhD in mathematics and natural sciences from the University of Utrecht, The Netherlands, in 1965. After working for the Netherlands Organization for Applied Scientific Research, he became a full-time professor of Medical Electrical Engineering at the Technical University, Eindhoven, The Netherlands, and served in that function from 1973 until 1995. He was the dean of the Faculty of Electrical Engineering from 1993 until 1995. He was the first president of the COMAC-BME, a coordinating committee of the European Commission for the research area Biomedical Engineering, from 1982 until 1990. He was a co-founder of the European Society for Engineering and Medicine (ESEM), and one of the founders of the journal Technology in Healthcare [His 1965 PhD thesis  presentsDrs. Beneken and Joachim (Nik) Gravenstein acted as mentors to the team at the University of Florida that invented the Human Patient Simulator between 1988 and 1994 , 7. TogeTwo Jan Beneken conferences on modeling and simulation of human physiology took place in Eindhoven, The Netherlands, in 2013, and in Nijmegen, The Netherlands, in 2015. These conferences brought together several generations of Dutch and some other European modelers. Dr. Beneken was actively involved in the organization of the conferences and a stimulating presence during the debates. In 2017, the conference was held at the University of Twente, Enschede, The Netherlands, and with Dr. Beneken\u2019s assent renamed to Applied Modeling in Acute Care (AMAC). The broader international coverage of the conferences was confirmed in 2019, when the conference was held in Canberra, Australia. The keynote lecture was given by Nobel prize winner Dr. Brian Schmidt, and Dr. Debra Nestel, Editor in Chief of Advances in Simulation at the time, presented a plenary lecture. Dr. Beneken pre-recorded a brief overview of his career and presented the Jan Beneken award to a promising young modeling researcher from the Australian National University  Via his research on modeling of human physiology and pharmacology, his mentorship of the team that invented the Human Patient Simulator, and his active participation in the conferences that bear his name, Professor Jan Beneken (1934-2021) made decisive contributions to simulation-based training in Europe and beyond."}
{"text": "Objective: This study aimed to examine the effectiveness of containment strategies and mitigation strategies to provide a reference for controlling the ongoing global spread of the pandemic.Methods: We extracted publicly available data from various official websites between January 1 and December 31, 2020, summarized the strategies implemented in China, South Korea, Singapore, the United States, the United Kingdom, and France, and assessed the effectiveness of the prevention and control measures adopted by these countries with the daily new cases and mortality rate per 100,000 population.Results: China, South Korea, and Singapore adopted containment strategies, which maintained a proactive approach by identifying and managing cases, tracking and isolating close contacts. China and Singapore had a similar epidemic curve and the new daily cases. As of December 31, 2020, the new daily cases of China and Singapore were below 100 with the mortality rates per 100,000 population of 0.3 and 0.5, respectively. But the new daily case of South Korea was as high as 1,029, with a mortality rate per 100,000 population of 1.8. In contrast, the United States, the United Kingdom, and France responded with mitigation strategies that focus on treating severe cases and those with underlying conditions. They had similar epidemic curves and mortality rates per 100,000 population. The United States had up to 234,133 new confirmed cases per day, and the mortality rate per 100,000 population was 107, while the United Kingdom had 56,029 new confirmed cases per day and the mortality rate per 100,000 population was 108, and France had 20,042 new cases per day, with a mortality rate per 100,000 population of 99.Conclusions: China, Korea, and Singapore, which implemented strict containment measures, had significant outbreak control. Meanwhile, the successful practices in China, Singapore, and South Korea show that the containment strategies were practices that work especially at the individual level identifying and managing the infected patients and their close contacts. In the United States, the United Kingdom, and France, which implemented the mitigation policies, the effect of epidemic prevention and control was not significant that the epidemic continued or even increased epidemic relatively quickly. The coronavirus disease 2019 (COVID-19) is continuing to spread worldwide. As of Feb 23, 2021, the COVID-19 outbreak has caused 112,222,860 confirmed cases and 2,483,930 death cases. The number of new cases outside China exceeded 290,000, the total of confirmed cases was more than 110 million, and the total number of death cases was more than 2.47 million  outbreak in 2015 and the severe acute respiratory syndrome (SARS) outbreak in 2003, respectively, in responding to COVID-19. Based on the three core principles of openness, transparency, and creative innovation, South Korea was able to effectively implement the strategy of 3Ts of testing, tracing, and treatment . HoweverCompared with China, South Korea, and Singapore, where the COVID-19 infections occurred earlier, the United States, the United Kingdom, and France seemed slow to respond to the COVID-19 outbreak and preferred to adopt mitigation strategies. The aggressive measures of the US federal government could date back to a national emergency declaration on March 13, 2020. Since then, the United States has adopted a combination of \u201ccontainment\u201d and \u201cmitigation\u201d strategies, with multiple channels and means of response and increasing support for prevention and control.The government did not take more measures to control the COVID-19 epidemic before mid-March, 2020. However, the British government began implementing the mitigation strategies based on the theory of \u201cherd immunity\u201d until the outbreak in Italy and Spain were nearly out of control in March due to the confirmed cases of Italy was exceeded 5,000 per day, and total deaths exceeded 1,000; and the confirmed cases of Spain was nearly 10,000 per day, and total deaths exceeded 1,000 , 13. SubAs shown in Whether in the new confirmed cases per day, or the mortality rate per 100,000 population, the difference is significantly remarkable between China, South Korea, and Singapore, which implemented the containment strategies, and the United States, the United Kingdom, and France, which took the mitigation strategies. There are differences in healthcare workers, health systems, health authority model, political systems, and cultural customs among China, South Korea, Singapore, the United States, the United Kingdom, and France, so their prevention and control strategies combat the COVID-19 outbreak differ. China, South Korea, and Singapore have maintained a proactive approach in responding to the COVID-19 outbreak by identifying and managing cases, tracking and isolating close contacts, and strictly restricting or controlling population movement when feasible and appropriate. Although no large-scale embargoes were implemented in Singapore and South Korea, and the outbreak rebounded in South Korea, these three countries have adopted a containment strategy based on the nature of prevention and control policies. In contrast, the United States, the United Kingdom, and France have implemented nationwide lockdown; however, these three countries focus on treating the severe cases and those with underlying conditions, and they have implemented measures that are essentially mitigation strategies.China's experience with SARS exposed weaknesses in the public health system and prompted a rethink of epidemic prevention policies. The government subsequently invested 6.8 billion RMB (US$850 million) to establish a new three-level network of disease control and prevention systems . MeanwhiSimilar to China, after the SARS epidemic in 2003, Singapore invested a lot of resources in improving its epidemic prevention system, establishing an interdepartmental working group pre-planning system that can be activated immediately when it encounters a public health crisis and operates in a whole-of-government manner. It has also established a public health system that includes community general clinics, public hospitals, and the National Centre for Infectious Diseases , 22. SinSouth Korea experienced a public health crisis caused by MERS in 2015, which exposed a weakness in the national health disaster response system. Since then, improvements have been made at all levels and throughout the public and private health sectors to protect society from the threat of emerging infectious diseases , 24. AftThe United States is a wealthy country and has a well-developed healthcare system, but it has relatively poor health status and healthcare coverage and does not provide its population with the best and most equitable healthcare treatment. The US insurance system is primarily based on private employers, and individual coverage is voluntary . Based oThe United Kingdom has a well-established and respected universal healthcare system (NHS) that invests heavily in public health, but the shortage of personal protective equipment (PPE) and the deaths of healthcare workers in the early phases of pandemic posed a significant risk to the patients and healthcare workers . MeanwhiFrance benefits from its universal health insurance system, relatively large number of healthcare professionals and hospital beds, but the French system is complex, and the notoriously weak coordination between the different parts of the care system makes it more difficult for primary and social care providers and hospitals to mount a joint response. In addition, France experienced months-long protests and strikes by healthcare workers before the COVID-19 outbreak coming . In factThis study found that each country has implemented a series of non-pharmaceutical interventions at four levels of the epidemic: containment and surveillance, healthcare, border control, and community and society, but the effectiveness of the prevention and control measures were different among these six countries. China, South Korea, and Singapore, due to their experience with previous MERS and SARS epidemics, responding quickly, implementing strict interventions, and control the spread of the epidemic to keep the daily new cases and mortality rate per 100,000 population low. However, there are differences in the group behaviors of social people, such as community closure, home isolation, and social behavior self-discipline. In China, when a COVID-19 case was confirmed in a region, the community was immediately put under strict control or even lockdown, and large-scale nucleic acid testing of residents in the community, as well as tracing and home quarantine of close contacts. In addition, criminal detention will be imposed on those who conceal their travel and hinder the prevention and control of the epidemic. Also, people must wear masks to take public transports or to enter public places.In Singapore, mask-wearing continues to be mandatory in public transport and all public places . In addiIn contrast, the United States, the United Kingdom, and France, due to their lenient approach at the beginning of the epidemic, made the subsequent fight against the epidemic more difficult. Although a series of non-pharmaceutical interventions were implemented, and these countries have initiated vaccination programs for COVID-19, the results seem to be less than satisfactory. Of course, there are some reasons why implementing a strict containment strategy is simply not possible in the United States, the United Kingdom, and France. There are at least two reasons for this. The primary reason is that these are homes of intense liberal democratic norms, and the government cannot simply impose any type of lockdown. In Sweden, it is even constitutionally forbidden to impose lockdown unless there is a war . There wThis study compared prevention and control strategies among China, Singapore, South Korea, the United States, the United Kingdom, and France, and examined the effectiveness of containment strategies and mitigation strategies. However, this study also has limitations that need to be considered. Other studies should be developed in order to confirm what has been achieved. Such as we can further work on the population-based epidemiological studies, respectively, in these six countries to improve non-pharmaceutical interventions.Based on this study it seems that China, Korea, and Singapore, which implemented strict containment measures, had significant outbreak control. In the United States, the United Kingdom, and France, which implemented mitigation policies, the effect of epidemic prevention and control was not significant that the epidemic continued or even increased relatively quickly. However, until the vaccine is globally available and effective, countries still need to address the current COVID-19 epidemic with non-pharmacological measures to avoid further damage. Meanwhile, the successful practices in China, Singapore, and South Korea show that containment strategies were practices that work especially at the individual level identifying and managing infected patients and their close contacts.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.HC and GS conceived the paper and study guarantors. HC, YZ, XW, MY, and JJ collected the data. HC drafted the manuscript. LS, YZ, XW, MY, and JJ revised the manuscript. GS contributed to the critical revision of the manuscript for important intellectual content and approved the final version of the manuscript. All authors have read and approved the final manuscript.This work was supported by the National Social Science Fund of China (no. 16BGL184).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher."}
{"text": "Disruptive behavior creates a dysfunctional culture that has a negative impact on work relations and influences the quality of care and safety of the patient. The objective of the present work is to provide the best methodological quality scientific evidence available on disruptive behavior at a hospital, the aspect associated with the safety of the patient, and its impact on quality of care. For this, we included studies that addressed the prevalence of disruptive behaviors observed in the area of hospital health and its professionals. The selection, eligibility, data extraction and evaluation of the risk of bias stages were conducted by two researchers, and any discrepancies were solved by a third researcher. The data presented show that disruptive behaviors are frequently observed in the daily life of health professionals, and compromise the quality of care, the safety of the patient, and can lead to adverse effects. The results presented indicate that the appearance of disruptive behaviors compromises the quality of care, the safety of the patient, and the appearance of adverse effects, and can also affect the physical and mental health of the health professionals. PROSPERO registration number: CRD42021248798. Although no clear consensus exists about the definition of disruptive behavior, authors agree that it creates a dysfunctional culture that has a negative impact on work relations, making difficult interpersonal communication and influencing the quality of care and safety of the patient ,5,6,7,8.According to Meneses et al. , the maiIn 2008, the Joint Commission International (JCAHO) considered disruptive behavior as threatening, inappropriate behavior, which has a deconstructive effect on the culture of safety, and for this reason, considered it as a Sentinel Event Alert 40, indicating the importance of preventing, managing, and controlling these behaviors among health professionals, including the managing board of the organization. It proposes eleven institutional strategies, highlighting effective and affective leadership and communication. It states that it is the responsibility of the institution to control a hostile environment and provide a proactive culture for safer care, aside from underlining the increase in healthcare costs .Disruptive behaviors are perceived by health professionals as predictors of adverse events (53%), negative impacts with damage to health care (73%), and a contributor to mortality (25%) . In thisHicks et al.  found a Therefore, the objective of the present systematic review is to provide the scientific evidence with the best methodological quality, on disruptive behavior at a hospital, the aspects related to the associated safety of the patient, and its impact on the quality of care.This systematic review study was conducted based on the updated version of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses  ,17. ThisThe eligibility criteria adopted in the review are related to the research questions: Which are the most frequent disruptive behaviors in the hospital environment and what are their impacts on the safety of the patient? Which are the triggers of these disruptive behaviors perceived by the health professionals?Therefore, the inclusion criteria were chosen to start with a condition, context, and population (CoCoPop) . Thus, tAs result, studies with non-resident students and studies conducted strictly with the administration of hospital institutions were excluded.Initially, various search strategies were tried in each database. Based on the greater sensitivity and specificity, a standardized search strategy was defined, after which two researchers performed the search independently. The search terms and descriptors .After the search was conducted in the databases, the article files were collected with the application Rayyan, with which an initial verification was performed to detect the presence of duplicate articles.During the selection phase, the titles and abstracts of the articles were read to evaluate their compliance with the eligibility criteria. Then, the complete text of the articles selected was read. Additionally, the references from these articles were examined to detect studies that could be potentially relevant. At all the stages, two reviewers were responsible for the reading of the articles, and when a divergence was observed, a third reviewer was consulted.The general information and methodology utilized were collected from each study: title, first author, year of publication, country, the objective of the study, type of disruptive behavior and its frequency, impact on the safety of the patient, and quality of attention, and lastly, type of measuring tools, data analysis, and main results.The JBI scale (Joanna Bridges Institute)  was utilThe general information and the methods applied in the study were extracted. We collected the name of the authors and year of publication, the size of the sample, the measurement instruments utilized in the evaluation of disruptive behaviors, and the main results presented in each study. There was high heterogeneity in the characteristics and size of the samples, in the results, and in the measurement instruments. For these reasons, quantitative synthesis of the data was not possible.The search in the different databases provided 233 articles, which were screened to evaluate their eligibility. Of these, two were eliminated because they were duplicates. After reading the titles and abstracts, and after reading the complete articles, 12 articles were selected for their systematic review ,29,30,31Of the 12 studies selected, five were conducted in the Unites States ,26,28,29As for the measurement instruments, high heterogeneity was observed. Different types of scales and questionnaires, validated and adapted to each studied population, were applied. Additionally, these were provided printed or virtually ,29,30,31The consequences of these disruptive behaviors are documented by health professionals. It was observed that its occurrence can compromise the quality of care, patient safety, and lead to adverse effects ,21,25,27In general, the high prevalence of disruptive behaviors and consequences on the quality and safety of the patient, as well as the physical and mental damage of the health professionals re-enforces the need to monitor these behaviors and actions oriented towards collaborative work .With respect to the evaluation of the methodological quality, some weaknesses were found in the evaluation of the exposure, the definition of the criteria to standardize the measurement of the condition, the identification of confounding factors, and the strategies to face these variables . However, some studies showed an excellent methodological quality ,26,27.The results presented in this systematic review indicate that the appearance of disruptive behaviors can compromise the quality of care, the safety of the patient, and can lead to adverse effects. In the studies included, it was observed that these behaviors can affect the physical and mental health of the health professionals, independently of their profession and length of employment.At present, the studies on this subject are mainly cross-sectional, through the use of a questionnaire, and are mainly focused on four broad dimensions that are associated with the safety of the patient and the quality of care, considering the possible adverse effects experienced during the process of care derived from the different disruptive behaviors. These dimensions are: Motives and prevalence of disruptive behavior in the health context where the individual factors, the environmental factors, the organizational factors, and the social factors, are relevant, with important correlations observed between abuse and gender, physical abuse and position, and physical abuse and level of education that have generated at least one observed disruptive behavior ,32,33; pWith respect to the social-labor variables, a study that analyzed the reports of the notifications observed more disruptive behaviors in the category \u201cphysicians\u201d (81%) compared to 52% in the category \u201cnursing\u201d. It was observed that these behaviors result in stress (97%), job dissatisfaction and compromised patient safety (53%), quality of care (72%) and errors (70%) .Another study addressed 2821 nurses, who indicated the existence of a relationship between disruptive behavior and gender. Women indicated that they suffered more verbal and physical abuse than men [The main limitation of the study is related to the absence of clinical trial studies on disruptive behaviors associated with patient safety. Given the heterogeneity of the studies included in the systematic review, a meta-analysis was not possible. Therefore, the findings of this systematic review have led to an update in scientific knowledge in this area, and the results can be further utilized to facilitate decision-making and the implementation of new health policies.The results presented in this systematic review indicate that the appearance of disruptive behaviors compromises the quality of care in the hospital setting. These disruptive behaviors  lead to negative consequences, such as the safety of the patient, the appearance of adverse effects, and can also affect the physical and mental health of the health professionals, independently of their profession and the length of employment. Most importantly, it is hoped that these data can be used to develop organizational policies to enhance the workplace and positive patient outcomes within a healthy work environment."}
{"text": "Working the One health strategy in developing countries is a challenge, due to structural weaknesses or deprivation of financial, human, and material resources. Brazil has policies and programs that would allow continuous and systematic monitoring of human, animal, and environmental health, recommending strategies for control and prevention. For animals, there are components of the Epidemiological Surveillance of zoonosis and Animal Health Programs. To guarantee food safety, there are Health Surveillance services and support of the Agropecuary Defense in the inspection of these products, productive environments, and their inputs. Environmental Surveillance Services monitor water and air quality, which may influence health. For human health, these and other services related to Health Surveillance, such as Worker Health and Epidemiological Surveillance, which has a training program responsible for forming professionals groups to respond effectively to emergencies in public health are available. Therefore, Brazil has instruments that may allow integrated planning and intervention based on the One Health initiative. However, the consolidation of this faces several challenges, such as insufficient resources, professional alienation, and lack of the recognition of the importance of animal and environmental health for the maintenance of human and planetary well-being. This culminates in disarticulation, lack of communication, and integration between organizations. Thus, efforts to share attributions and responsibilities must be consolidated, overcoming the verticality of the actions, promoting efficiency and effectiveness. Finally, this perspective aims to describe the government instruments that constitute potential national efforts and the challenges for the consolidation of the One Health initiative in Brazil. One Health is an integrative and cooperative health initiative, with a transdisciplinary approach to health promotion and surveillance at the local, regional, national or global level, aiming to achieve optimal health conditions, given the recognition of the interconnection and interdependence between human, animals, and the environment , 2.Historically, the perspective that environmental health affects humans has existed since the classical era. Hippocrates stated that biological and environmental conditions affect human health . Afterwath century, pathologist Robert Virchow coined the term \u201czoonosis,\u201d to name diseases transmitted from animals to humans, based on his observations with helminths, believing that there is no separation between animal and human health , World Health Organization (WHO), Food and Agriculture Organization of the United Nations (FAO), and the World Organization for Animal Health (OIE) have recently established a cooperation to promote the perspective of One Health, encouraging the implementation of government policies and programs guided by it \u201311.To this end, the Global Health Security Agenda (GHSA) was signed in 2014 with more than 64 nations and international non-governmental organizations supporting the collaborative approach. This will accelerate the consolidation and compliance of the requirements from the OIE Terrestrial and Aquatic Animal Health Codes, the WHO International Health Regulations (IHR), and other global health regulations for planetary health , 12, 13.Despite the increase in rhetoric and support for the One Health model, it is difficult to find authentic examples of multidisciplinary or multi-sectoral efforts that transcend traditional public, animal, and environmental health \u201csilos\u201d , 14.The ability to face threats to public and animal health effectively and efficiently requires effort and proper planning. A prerequisite for this is the training and capacitation of the public and private health sectors. However, this, within the One Health strategy, remains a challenge, especially for developing countries. This stems from competing priorities, insufficient and fragmented funding, with a lack of integration and communication between sectors , 15.Some positive international experiences in this path have been reported, such as the One Health Workforce (OHW) project by the United States Agency for International Development (USAID). This aims to build partnerships with institutions and leaders in Africa and Southeast Asia to assist in the identification of technical, collaborative, and organizational characteristics, important for the development of the workforce in alignment with the goals established in the GHSA and by the Joint External Evaluation\u2013 International Health Regulations (JEE \u2013 IHR) , 17.In Latin America, the incorporation of the One Health strategy into government plans is timid and the integration of animal, environmental and human programs and sectors is insignificant \u201311.In Brazil, the One Health concept itself requires recognition by health professionals and is not acknowledged by important entities such as the Federal Council of Medicine. As an effect, the power of interventions and control strategies over the environmental causes of diseases is limited, and these activities are often restricted to veterinary professionals. On the other hand, public policies for Health Surveillance (HS) have allowed the gradual insertion of One Health supportive efforts in health practices, however with little integration between their organizations , 17, 18.An adequate surveillance system, with a strong laboratory network, is the key component of any disease prevention and control strategy. To develop an effective One Health implementation plan, it is necessary to reexamine how the existing systems are structured, resourced, and managed. These analyzes would contribute to the development and sustainability of the synergy between human, animal, and environmental health initiatives \u201314, 19.Thus, this perspective article aims to present the potential, successes and challenges of government health strategies, programs and policies in Brazil, from One Health point of view. The present discussion is based on the analysis of the official documents, legislation and health informational systems.One of the most important aspects of pathogen control at the human, animal, and environmental interface is the development of appropriate scientific-based Surveillance and Risk Management policies that respect transboundary regulations , 14, 19.In Brazil, there is a complex system for monitoring human, animal, and environmental health conditions, based on the Health Surveillance System (HSS) and in the use of epidemiology as a planning tool. This system is supported by organizations such as the Minist\u00e9rio da Agricultura Pecu\u00e1ria e Abastecimento- MAPA  and the Sistema \u00danico de Sa\u00fade- SUS  and its respective policies, programs, regulations, and health information systems as summarized in Brazil's health system emerged due to an organizational restructuring and popular social movements. With the implementation of this universal and integral system, normative actions created for stimulation of the HSS, brought with it the redefinition of health practices, allowing their greater integration with epidemiology. This surveillance system is based on four main pillars, focused mainly on conditions that affect human health, namely: Epidemiological, Sanitary, Environmental and Occupational Health Surveillance Systems \u201315, 50.The National Environmental Health Surveillance System performs continuous and systematic monitoring of environmental conditions that may interfere with human and animal health such as water, soil, air, biological factors and vectors, environmental disasters, and accidents with contaminants. The operational instruments to make this viable are VIGI\u00c1GUA , VIGIPEQ , VIGISOLO , VIGIAR , and VIGIDESASTRES  , 46\u201348.The Epidemiological (ES) component of the Surveillance System is responsible for systematic monitoring of adverse health events, and control measures proposition, consolidated by the National ES System and its sub-areas, allowing significant advances in the capacity to respond to health problems. ES monitors communicable and non-communicable diseases and other health problems, such as accidents, violence, and a strategic area, that performs Zoonosis Surveillance, recognizing the importance of the animal-human bond. The latter is responsible for monitoring the progress of animal diseases and accidents with venomous animals. The recognition of the importance of zoonotic diseases by the health system is extremely relevant; both for management and for the health care itself, since, on average 60\u201380% of human diseases are of animal origin , 51\u201353.In the context of ES, Brazil also has a Training program in Applied Epidemiology to the Services of the Unified Health System- EpiSUS, part of the Department of Surveillance of Communicable Diseases of the Health Surveillance System. This program counts with multidisciplinary teams, aiming to enhance the ability to respond to public health emergencies and encourage the exchange of professionals and experiences at national and international levels, to improve the national technical capacity in field epidemiology, becoming an international reference in this field , 53\u201357.The Occupational Health Surveillance, part of HSS, monitors occupational risk factors and determinants of human health conditions that are related to the production and labor processes, as well as the ones related to the work environment , 54\u201357.The Sanitary Surveillance System, coordinated by ANVISA, the national agency for Sanitary Surveillance, works in the regulation, control, and inspection of goods, products, and environments that are directly or indirectly related to health conditions, from production to consumption. It is recognized as a set of integrated institutional, administrative, programmatic, and social strategies, guided by public policies that aim the elimination, reduction, or prevention of individual and collective health risks, based on comprehensive services and actions that are essential to the health defense and promotion. This breadth of activities justifies the fact that these actions are developed as a democratic and participatory exercise and in an articulated way, to guarantee the quality of products, services, and environments, fundamental aspects for global health. Therefore, the Sanitary Surveillance is not restricted to purely technical actions, but its driving axes are actions aimed at the strengthening of the society and citizenship to promote health and preventing risks, damages or injuries , 55, 58.Also responsible for One Health, regarding animal health, food safety, trade and transit of products of animal and vegetable origin are the programs subjected to MAPA, the institution responsible for the National Agropecuary Defense , 57, 58.The Agropecuary Defense relates to all stages of agricultural and livestock production, since the registration and inspection of agricultural inputs; production, industrialization, inspection and trade of products and by-products of animal and vegetable origin; besides acting in the import and export of inputs and products, as well as in the transit of these products and animals. In this way, it would not only promote and protect animal, human and environmental health but also help to increase economic incentives by promoting security and adding value to agricultural products , 59\u201363.Also subject to the National Agricultural Defense services, are the Animal Health Programs, namely: National Equine Health Program, National Poultry Health Program, National Program for the Control and Eradication of Brucellosis and Tuberculosis, National Goat and Sheep Health Program, National Herbivore Rabies Control Program, National Apiculture Health Program, National Program for the Eradication and Prevention of Foot-and-Mouth Disease, coordinated by MAPA , 61\u201364.These programs aim to prevent, control, or eradicate diseases of public health importance or that may threaten international trade, ensuring animal health through health education activities; epidemiological studies; the inspection of breeding establishments, fiscalization of agricultural events and animal transit, notifying the occurrence of these diseases, in addition to guaranteeing the competitive value of the products in the international market , 61\u201364.Furthermore, an operational instrument for Agropecuary Defense is VIGIAGRO, MAPA's instance that regulates the flow of animals, products, and agricultural inputs in frontiers, to ensure their safety and quality, preventing or minimizing potential risks to the One health , 64\u201366.In this construct, the programs and services presented have the potential for the insertion of the multidisciplinary and integrative approach of One Health, with intra and intersectoral collaboration Tis approach is appropriate to the current context of growing concerns about the consequences of the interactions between humans, animals, and the environment, in a productive framework based on capitalist ideals , 67\u201369.The importance of the policies and operationalization referred in this perspective article is acknowledged, but several challenges are found for the consolidation of its potential, the main ones being the disarticulation, the verticality of the actions, and the overlapping of attributions \u20135.The central goals of the One Health model include altering the organization's work from a vertical and hierarchical approach to a horizontal and integrated one, in addition to moving from individual \u201csilos\u201d to a transdisciplinary functioning , 2, 14.The difficulties in achieving these goals and in the integration between the spheres that work animal, human, and environmental health start in the professional training of those who work in these fields. Few individuals enter the workforce with crosscutting skills to thrive in transdisciplinary or multi-sectoral teams , 15.The increase in the number and distribution of qualified personnel has proved to be one of the main limitations in most developing regions. This limitation, added to the financial, structural, and bureaucratic constraint faced by this sector, prevents it from satisfactorily exercising its potential, putting global health at risk .The need and benefits of an integrated surveillance system to better understand the emergence and epidemiology of diseases have been demonstrated. This should count with a health care notification system and a comprehensive national database including environmental monitoring, human and animal health diagnostic systems, essential components of an integrated surveillance system, and for the implementation of One Health \u201315, 61.Brazil has all these components, but they do not articulate or communicate. Even more, they sometimes overlap their attributions and compete for authority and hierarchy. The information produced by different organizations, rarely crosses that 'silo' that produced them, even though it could support health actions as a whole, producing and using information and communication in a shared way, to better instrumentalize the intervention .For example, information on the incidence and prevalence of work-related illnesses could be used to modify production processes, minimizing the risks and potential damage. The occurrence of water and foodborne diseases could contribute to the improvement of the performance of Agropecuary Defense, among others. Just as, information about environmental health can be useful to guide all production processes, to help understanding the epidemiology and natural history of diseases, allowing the intervention in their origins. This would promote cheaper, more assertive, and definitive solutions to health problems and demands, making individuals, animals, and the environment healthier, more productive, and sustainable \u201315.While some progress has been done, there is a need for continued investment and political commitment to address the persistent challenges in public health. As it can be seen in the The One Health initiatives are of complex consolidation from both a political, technical, and sanitary perspective , 14, 15.The lack of articulation and use of health information for planning interventions can be evidenced with a contemporary example. The COVID-19 pandemic and the recent worsening of it at the national level in early 2021 are the results of a lack of planning and intervention by governmental health spheres that have proved inefficient and non-resolute. Instead of applying the information, fees, numbers to equip their infrastructure and instruct their professionals, the highest governmental spheres have chosen to hide and fragment the health information consolidated by the Epidemiological Surveillance Systems and not apply it for planning and structuring measures to mitigate the health crisis \u201372.The integration and articulation between health actions, organizations, and policies would promote greater effectiveness and efficiency of health interventions, promoting global health and expanding the response capacity. However, there are still restrict limits to the autonomy of federal entities in Brazil, perpetuating an excess of verticality in programs and decisions, which makes it difficult to move toward the integration of surveillance systems in the perspective of democratizing the health practices , 59, 73.The action of these entities and services should be in the sense of sharing attributions and responsibilities, without leaving behind the technical specification of each of the areas. This would imply new roles, as well as new dynamics, relationships, and innovative practices at all levels, which denotes the complexity and challenge of its implementation , 73, 74.Thus, it is proposed to work, from the One Health approach, in an articulated and integrated set of actions, which assume specific configurations according to the environmental, animal, and human health situation of each territory, transcending the institutionalized spaces of the health services system, the verticality, and hierarchy of agencies and programs. Thus, seeking a dialogue between \u201ccause control,\u201d \u201crisk control\u201d and \u201cdamage control\u201d through the redefinition of the object, the means of work, activities, and technical and social relations , 13, 15.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.The authors contributed equally to all phases of the manuscript construction and revision.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "It has been 5 months since the COVID-19 outbroke in Wuhan, China, at the end of 2019. Despite the small sigh of relief in China, the situation seems to be growing more intense in the rest of the world, as the number of cases of confirmed SARS-CoV-2 infection continues to increase. What is truly worrying is the condition of healthcare professionals. On March 25th, the number of medical personnel with confirmed infection had reached nearly 6,500 in Spain, representing almost 14% of the country's total cases, while in Italy, there was about 7,400, nearly one-tenth of its total cases , including masks, gowns, gloves, and eye protection. As far as we know, however, surging demand for PPE has become a major issue in different areas that has given rise to an interregional scramble for medical resources, potentially intensifying the stress of the disadvantaged areas Durkee, . The shoThe COVID-19 pandemic is a global issue that no one can face alone. During the height of the epidemic, the Chinese government made every effort to curb outbreaks, mobilizing nationwide resources to support the fierce battle in Hubei, specifically in Wuhan (Chinese Center for Disease Control and Prevention, Meanwhile, Guangdong, the most crowded province in China with a population of 115.21 million (Statistics Bureau of Guangdong Province, The government acted quickly. Guangdong launched the first level response to major public health emergencies in late January (Health Commission of Guangdong Province, Health workers have been getting the attention they deserve. A series of comprehensive, supportive policies for frontline medical staff, issued on February by the Guangdong government (Xinkuaibao, In response to the shortage of PPEs, the government called for a strengthening of the coordination of the production, supply, and distribution of medical supplies, ensuring the supply of important materials and giving priority to the needs of frontline medical staff and patients. They also established an online reporting system for inventory based on a comprehensive investigation of the stock and consumption; in addition, they established a system for the coordination of allocating supplies at the provincial and municipal levels to resolve the urgent shortages through centralized mobilization and emergency allocation (Southern Metropolis Daily, The joint effort of the government and the public showed to be effective on flattening the curve in the province with over one hundred million people: by May 1st, the total number of confirmed infections in Guangdong was 1,588, with only eight cases of death (Health Commission of Guangdong Province, According to our experience in the past 4 months, it is vitally important to consider how to wisely collect and manage the medical resources during this challenging time, and it is crucial that available resources are made full use of wherever they are needed. It can be an option to address the shortages of medical supplies and workforces by facilitating international collaboration and interregional exchange or share of resources, experiences, and ideas, if possible.Strategies regarding how to protect and preserve the healthcare workforces should be developed, with careful consideration of the roles for older personnel (Buerhaus et al., In addition, offering accessible mental health services under the direction of expert psychotherapists or psychiatrists for workers in need should be considered. Such measures include but are not limited to: providing a safe, undisturbed space for rest and expressing concerns and emotions; helping to deal with negative feelings potentially associated with an unusual amount of deaths and critical patients; and providing information about how to identify and cope with the mental issues of patients or themselves, such as irritability, serious anxiety, or panic attacks.All in all, it is crucial to ensure accessible resources work at their full capacity and to protect and support healthcare workers, in order to sustain the normal function of health systems all over the world in this crisis. Hopefully, more collaboration and coordination will help us bring the war to an early end.YH, MW, and BZ have contributed to the conception, editing, and revision of the manuscript, approve the final version to be published, and agree to be accountable for all aspects of the work.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "Oral cancer represents a worldwide public health problem, being among the most prevalent, associated with high morbidity and mortality rates. This systematic review aimed to review the causes of the delayed diagnosis of oral cancer mainly in the elderly, in developed and developing countries. Search strategy was developed for MEDLINE databases (via PubMed), EMBASE, Web of Science, SCOPUS, and LILACS and for grey literature , without language or period restrictions. The risk of bias was assessed using instruments from the Joanna Briggs Institute and the quality of evidence according to the GRADE system. The search resulted in 14,473 records, of which only 13 met the eligibility criteria. The total sample was 1,705 participants, with a predominance of males. All studies included reported causes of delayed diagnosis of oral cancer related to the patient and five also reported causes related to health professionals. The scarce knowledge of the population was pointed out as the main cause of delayed diagnosis of this cancer. Regarding the risk of bias, ten studies were classified as low risk and three, as moderate risk. The quality of the evidence was very low for the outcome related to delayed diagnosis of oral cancer. Wide dissemination of information on oral cancer is needed, especially for the elderly, such as its initial signs and symptoms, in developed and developing countries. Further studies should be conducted to better understand the causes of delayed diagnosis of oral cancer in countries with different socioeconomic statuses. Key words:Delayed diagnosis, mouth neoplasms, oral neoplasm, aged. Oral cancer is among the ten most prevalent types of cancer in the world, associated with high mortality and morbidity rates, representing a worldwide public health problem. This cancer is more frequent in men aged over 40 years and has multifactorial etiology, resulting from the interaction of several risk factors, being the main ones smoking and excessive consumption of alcoholic beverages . In the These projections show the importance of knowing the characteristics of oral cancer, enabling the promotion of preventive actions and early diagnosis . These aThe stages of tumors are classified according to the Classification System of Malignant Tumors (TNM) recommended by the International Union for Cancer Control (UCC). They receive graduations based on the anatomical extension of the disease, usually from T0 to T4, from N0 to N3, and from M0 to M1. The first one (T), respectively, consider the characteristics of the primary tumor, the second (N) the characteristics of the lymph nodes of the lymphatic drainage chains of the organ in which the tumor is located, and the M the presence or absence of distant metastases. T3 or T4 classifications represent advanced stages of cancer , which a- Protocol and registerThis review was reported according to the items of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) . A study- Eligibility criteriaThe acronym PECOS  was used to formulate the research question of this systematic review, the population was defined as the elderly, the exposure as oral cancer, the primary outcome as causes of delay, and the study design as observational ones. Therefore, the following question was established: \"Is there a difference in the causes of the delayed diagnosis of oral cancer mainly in the elderly in developed and developing countries?\"The inclusion criteria consisted of observational studies, without language or period restriction, which evaluated the diagnosis of oral cancer in the elderly. The following exclusion criteria were applied: 1) studies that did not include participants aged 60 years or older; 2) studies that did not evaluate the causes of late diagnosis; 3) studies that did not report data related to the causes of late diagnosis only for oral cancer; 4) studies that performed evaluations only to the treatment of oral cancer. Furthermore, experimental studies, reviews, letters, abstracts, opinion articles, case reports, case series, and book chapters were excluded.This review was conducted to verify the causes of the delayed diagnosis, especially in the elderly, due to the high incidence of oral cancer in this population and the frequent presence of unfavorable systemic conditions, which hinder the diagnosis, treatment and cure of this disease . Given tFinally, the criteria proposed by the United Nations Development Programme (UNDP) of the United Nations (UN) was adopted to classify developed and developing countries. These criteria are based on the degree of wealth, level of industrialization and development, Gross Domestic Product (GDP), per capita income, and the Human Development Index (HDI), which represents a comparative measure of countries regarding wealth, literacy, education, life expectancy and birth expectancy .- Search strategyThe literature search was conducted by two independent researchers [AMCL and CSLDP], at MEDLINE databases (via PubMed), EMBASE, Web of Science, SCOPUS and LILACS, and in the gray literature .With the collaboration of a librarian, a search strategy was set up for PubMed and adapted to the other databases. The strategy adopted sought to rescue as many studies as possible related to the subject. For this, the descriptors indexed in the Health Science Descriptors (DeCS) and in the Medical Subject Headings (Mesh Terms) were used, with the Boolean operators AND and OR, as described in - Selection of the studiesThe reference manager, Mendeley\u00ae Desktop, was used to remove duplicate records and organize primary studies.The study selection process was carried out in two phases and independently by two reviewers [AMCL and CSLDP]. In the first phase, the two reviewers used Rayyan software (Qatar Computing Research Institute) to exclude studies that did not meet the eligibility criteria . In the - Data extraction and qualitative synthesisThe information of the selected studies was collected by the first reviewer [AMCL] and confirmed by the second reviewer [CSLDP]. The data collected were: author, year of publication, country of study, type of study, general sample, participants\u2019 age, sample loss, form of data collection, and reported causes for the delayed diagnosis of oral cancer.- Assessment of methodological qualityThe methodological quality was evaluated using checklists for analytical cross-sectional and qualitative studies from Joanna Briggs Institute ,14. IndeThe evaluation of methodological heterogeneity among the eligible studies was evaluated regarding the study design, the sample , quality of measurements and results. Finally, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to classify the quality of evidence for the outcome related to the delayed diagnosis of oral cancer, according to the following criteria: risk of bias, inconsistency, indirect evidence, inaccuracy or publication bias. Based on the GRADE criteria, for each serious concern, a level of evidence was lowered and non-randomized clinical studies started with a low classification .Initially, 13,708 records were identified from the electronic databases and gray literature. After excluding duplicates, 9,284 were analyzed with the reading of titles and abstracts, and 71 articles were selected for full reading. After that, 59 articles were excluded because they did not meet the eligibility criteria, resulting in 12 articles included. A search update was carried out in May 2021, where 764 records were identified. After excluding duplicates, 626 studies were analyzed with the reading of titles and abstracts, selecting 01 article for full reading, which was included, resulting in 13 articles included in this review (Fig. All studies reported causes of delayed diagnosis of oral cancer related to the patient and 5 also reported causes of delayed diagnosis related to health professionals. Among the causes of delay related to the patient, the lack of knowledge about oral cancer, its risk factors and the signs and symptoms of the disease were reported in all studies. These aspects are due to the difficulty of visualization and identification of the initial lesions, neglect of the signs and initial symptoms due to absence of pain, without impairment of function, leading the participants to consider the symptoms as normal and something secondary. Hope for spontaneous cure, self-medication, fear of diagnosis and coping with the disease, financial restrictions and difficulty in accessing specialized professionals were also reported ,17-28.The causes of delay related to professionals were reported in only five studies, four of them conducted in developing countries -20 and o- Characteristics of the studiesOf the included studies, 13 were observational, four retrospective and two qualitative, published between 1994 and 2020 . Of thes- Methodological qualityMost of the included studies presented a low risk of bias in their evaluation. Of the 11 observational studies, eight presented low risk of bias and three moderate risk Fig. . For theThe results of this systematic review indicate that the population's lack of knowledge about the signs and symptoms of oral cancer and the devaluation of self-care are extremely related to the delayed diagnosis of this cancer.The sample studies performed their analyzes considering the elderly population along with other age groups, with no reporting of categorizations. A higher prevalence of participants aged \u2265 60 years was identified in the sample, resulting in the hypothesis of greater delay in the diagnosis of oral cancer in this population. Regarding gender in the incidence of oral cancer, the prevalence of males in the sample corroborates other primary studies not included in this review and data from the World Health Organization . This diThe studies conducted in developed and developing countries included in this review identified the difficulty of visualization and/or identification of oral lesions and the absence of symptoms of the initial lesions as the main cause in the delayed diagnosis of oral cancer related to the patient ,17-28. Tet al. [2006] (In developing countries, fear of diagnosis and negative coping with the disease were also reported as causes of patient delay, probably related to the negative belief of the population that a cancer diagnosis is a death sentence ,18,24. S. 2006]  in the U  in the et al. [2016] (In developed countries, the population has greater access to health services when compared to developing countries, which does not always happen when it comes to a specialized service. As reported in the study by Ligier . [2016] , which c. [2016] , the popAlthough it has not been reported in the studies included in this review, some authors associate the presence of comorbidities with the delay in the diagnosis of oral cancer. This suggests that patients already debilitated, due to the presence of other diseases, especially those dependent or bedridden, ignore or deny new oral symptoms . The impWith the severity of the pandemic, anxiety and the population\u2019s fear of becoming infected with COVID-19 has led patients to underestimate the signs and symptoms of other serious diseases, which may lead to delays in the diagnosis of oral cancer . Thus, tet al. [2003] (Among the included studies that evaluated the causes of the delayed diagnosis of oral cancer related to professionals in developing countries, the difficulty in recognizing oral cancer lesions early, incorrect diagnosis, and wrong treatments were prevalent. These causes were also reported in the study by Onizawa . 2003] , perform. [2003] ,17-20.03 , perfThe early diagnosis of oral cancer contributes to the implementation of appropriate treatment in early stages of disease evolution, with less invasive surgeries, faster convalescence and better patient survival . On the The methodological quality analysis showed that most studies presented a low risk of bias. However, there was a high methodological heterogeneity among the included studies, related to the use of several instruments to analyze the delayed diagnosis and the inclusion of a wide age group, which hindered summarizing and comparing the results, limiting this review. Some studies did not present the clinical staging of tumors through the TNM System, information relevant to the classification of late diagnosis of oral cancer. Moreover, the possible loss of information in retrospective studies and the lack of studies conducted simultaneously in developed and developing countries, adopting the same methodology, hindering comparing more accurately and analyzing the results carefully. The low level of awareness and knowledge about oral cancer by the population and health professionals shows the need for actions aimed at health education with an emphasis on prevention and early diagnosis of oral cancer, to reduce the high mortality and morbidity rates and, consequently, improve the survival of the population, especially the elderly. The causes of oral cancer delayed diagnosis in countries with different socioeconomic statuses need further clarification.Despite the lack of methodological standardization, the causes of delayed oral cancer diagnosis were related to the scarce knowledge of patients and health professionals in developed and developing countries. A proposal for a future study is to investigate, in addition to the causes that hinder early diagnosis in the elderly, the reasons for abandonment and/or non-oral cancer treatment."}
{"text": "Cognitive linguistics is a branch of linguistics. Based on the theory of the second generation of cognitive science and experiential philosophy, it was born on the basis of opposing the transformational generative grammar of mainstream linguistics and began to take shape from the late 1980s to the 1990s. Cognitive linguistics involves artificial intelligence, linguistics, psychology, systems theory, and other disciplines. Aiming at the innate view held by generative linguistics, it proposes that the creation, learning and application of language must be explained through human cognition, because cognitive ability is the foundation of human knowledge.As a relatively new research paradigm in linguistic studies, Cognitive Linguistics has made a lot of remarkable achievements both in theory and in practice in the past 40 years. It has been widely used and become a multidisciplinary, interdisciplinary, and transdisciplinary school of linguistics. Cognitive Linguistics is closely related to psycholinguistics and systemic functional linguistics. It is based on cognitive science, and the research of cognitive linguistics is to use cognitive psychology and linguistic theory to study the relationship between representation, concept, and language structure. Psycholinguistics is based on psychology, it involves language memory, phonological perception, language learning, and so on. Compared with Systemic Functional Linguistics, Cognitive Linguistics focuses more on the internal factors of the speaker, that is, the psychological mechanism and the generation and exchange of meaning in the cognitive process. Systemic Functional Linguistics focuses on the social communication of language, and studies language from the social function and use situation of language.The Routledge Handbook of cognitive linguistics gives a comprehensive introduction to cognitive linguistics. It covers the key areas of cognitive linguistics and contains a wide range of perspectives and methods in this area .The first part of the book covers basic theories and hypotheses. This is the most important chapter in which readers can understand the basic concepts and historical developments of cognitive linguistics, including cognitive semantics, frame semantics, natural semantic metalanguage, along with cognitive grammar, construction grammar, and word grammar.Part 2 collects the most popular topics in cognitive linguisticsis, mainly about cognitive pragmatics, cognitive poetics, metaphor, metonymy, humor, construal, iconicity, and image schemas, categorization, embodiment, motivation, constructionalization, intersubjectivity, grounding, multimodality, and linguistic synaesthesia, and so on. This chapter presents the most mainstream research of cognitive linguistics for researchers.Part 3 of the book focuses on relationships and interfaces between cognitive linguistics and other areas, including figurative language, gesture, signed languages, cultural linguistics, language acquisition and pedagogy, linguistic typology, digital lexicography, and translation studies. It shows the integration of cognitive linguistics and other research fields or disciplines.For students and young researchers, the last chapter should not be missed. Studies in this chapter look to new horizons in cognitive linguistics, presenting a series of approaches to social, diachronic, neuroscientific, biological, ecological, multimodal, and quantitative studies. Following the pace of these studies, we can further explore and develop the research of cognitive linguistics.In sum, this book introduces the latest development of cognitive linguistics and predicts its future development. It makes a rational analysis of the criticisms of other schools on cognitive linguistics, and puts forward the direction of improvement and efforts. The book has its own characteristics compared with other books on cognitive linguistics. Some books in this area only introduce or summarize the results of previous studies. Researchers in this book not only analyze the previous theories in detail and systematically, but also express their own views and point out the development direction of cognitive linguistics.Cognitive linguistics is not a single language theory, but represents a research paradigm. It holds that people's daily experience is regarded as the basis of language use, and it focuses on explaining the inseparable relationship between language and general cognitive ability. Although these linguistic theories are different, their basic assumptions about language are almost the same. They all agree with the basic viewpoints, but differ in the specific linguistic phenomena discussed and concerned.Unfortunately, most of the articles in this book are still using traditional western research frameworks, methods and corpus, so its interpretation tends to have certain western contextual background and characteristics. Studies of Cognitive Linguistics still has a long way to go in China. Looking forward to the development of cognitive linguistics, Chinese scholars should make full use of the advantages of Chinese, Chinese dialects and the diversity of minority languages in China, fully describe and compare the similarities and differences of these languages and dialects and their causes, so as to provide unique and richer evidence for revealing the influence of language on cognitive style and cultural development. At the same time, through the theory of cognitive linguistics, we can deeply explore the cognitive style and cultural background behind Chinese grammar, truly reveal the characteristics of Chinese grammar and pragmatics, and make contributions to the theory of general linguistics.Throughout the development of Cognitive Linguistics in the past 40 years, it has achieved remarkable achievements both in theory and practice. With the development of cognitive linguistics, the core concepts of category theory, metaphor/metonymy theory, cognitive semantics, and construction grammar have made great progress. At the same time, it also integrates with other disciplines, such as neurolinguistics, psycholinguistics, sociolinguistics and philosophy, and promotes each other's development. In addition, how to use the theory to better understand the process of second language acquisition and effectively carry out language teaching activities has become the focus of scholars' discussion in recent years. But at the same time, this book, as well as Cognitive Linguistics, is still worthy of improvement. Studies in this book, as well as many other Cognitive Linguistic studies, often focused on introspective research methods and restricts itself to oral language studies, many theoretical hypotheses are put forward but fewer empirical studies have been done. Individual differences and social factors in language are often ignored.The Routledge Handbook of Cognitive Linguistics still provides the most up-to-date research on Cognitive Linguistics. The book describes a systematic research paradigm and comprehensively interpret Cognitive Linguistic studies from an international perspective. It offers a starting point of studies in this area, and provides new frameworks for analyzing and interpreting languages. This book will be a vital resource and a very thought-provoking reference for all students and researchers working in this area.However, YY has written the book review. QS was YY's colleague, he helped to examine and modify the review. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "In developing countries, low levels of awareness, cost and organizational constraints on access to specialized care contribute to inadequate patient help-seeking behavior. As much as 95% of cancer patients in developing countries are diagnosed at late to end stage disease. Consequently, treatment outcome is dismally poor and a vicious cycle sets in, with public mystification of cancer and the admonishment of cancer medicine as a futile effort, all, to the further detriment of patient help-seeking behavior and treatment engagement. The situation spirals down, when the practice of cancer medicine is not gratifying to the medical practitioner and does not appeal as a medical specialty to those in training. The future of cancer medicine in developing countries thus hinges on the demystification of cancer through positive information, coupled to an effective organization that allows for the optimal use of available resources, facilitates access to specialized care and promotes the flow of knowledge and technology amongst various stakeholders. This paper strives to make a cogent argument and highlight the capital importance of information and communication technologies in organizing and leveraging scarce resources for cancer education, research and practice in developing countries. Developing countries currently bear fifty-percent of the global cancer burden and, are projected to bear sixty-percent by the year 2020 . The risIn the wake of an overwhelming cancer case-incidence, an already over-extended healthcare system gives way. Presently, because of low levels of awareness and the cost and organizational constraints on access to specialized care as much as 95% of cancer patients in developing countries are diagnosed at late or end stage disease -8. ConseBy contrast, with existing knowledge and technology, the concerted action of governments, non-governmental organizations and healthcare systems in developed countries can prevent a third of cancers, provide treatment to another third and palliative care to those in need . While tHistorically, the sharing advantage of nascent technologies has spurred leaps and bounds in human development. This is evident in the telescoping timelines of human development milestones, from a ten thousandth year lapse for the onset of the agricultural revolution, to a four hundredth year lapse for the scientific revolution and then a one hundredth year lapse for the industrial revolution. In order, the information revolution heralds an unsurpassed leap in national, international and global development, by granting access to knowledge, cognitive tools and organizational support and permitting a greater fraction of the global community to actualize their human potentials and participate in a global intelligent network.By virtue of its sharing advantage (portability and affordability), developing countries have in recent times, known an excess of 263% growth in telecommunications and Internet connectivity ,21. The Knowledge, positive information and advocacy are cornerstones of cancer survivorship ,26. In dInformation engenders research and research engenders information. To this end, the Internet would not only serve the informational and educational purposes, but would inherently result in the digitization of data, procedures and processes and set up the quintessence of a rigorous and viable research enterprise: speed, control, accountability, cost-containment and patient-provider engagement and satisfaction ,30.Optimal cancer patient care is multidisciplinary and at its bare minimum, calls for the timely and concerted opinion and action of the patient; the primary care physician; the pathologist; the medical oncologist; the radiation oncologist and the surgical oncologist . In the The strength of ICTs should be harnessed to engage a south-south and north-south dynamic. While laudable efforts are being made towards building the cancer control capacity of developing countries, by transfering technology from developed countries ,33, the The author is a UICC fellow and member of the UICC expert review panel, focusing on the area of cancer information and education."}
{"text": "The Internet is changing how people receive health information and health care. All who use the Internet for health-related purposes must join together to create an environment of trusted relationships to assure high quality information and services; protect privacy; and enhance the value of the Internet for both consumers and providers of health information, products, and services. The goal of the e-Health Code of Ethics is to ensure that people worldwide can confidently and with full understanding of known risks realise the potential of the Internet in managing their own health and the health of those in their care. The final e-Health Code of Ethics, presented in this paper, has been prepared as a result of the \"e-Health Ethics Summit,\" which convened in Washington DC on 31 January 2000 - 2 February 2000. The summit, organized by the Internet Healthcare Coalition and hosted by the World Health Organisation/Pan-American Health Organisation (WHO/PAHO), was attended by a panel of about 50 invited experts from all over the world and produced the foundation for a draft code, which was released 18 February [Note: Abstract, keywords, acknowledgements and references have been added by the editor and are not part of the final Code. All people who use the Internet for health-related purposes-patients, health care professionals and administrators, researchers, those who create or sell health products or services, and other stakeholders-must join together to create a safe environment and enhance the value of the Internet for meeting health care needs.Because health information, products, and services have the potential both to improve health and to do harm, organisations and individuals that provide health information on the Internet have obligations to be trustworthy, provide high quality content, protect users' privacy, and adhere to standards of best practices for online commerce and online professional services in health care.People who use Internet health sites and services share a responsibility to help assure the value and integrity of the health Internet by exercising judgment in using sites, products, and services, and by providing meaningful feedback about online health information, products, and services.Health information includes information for staying well, preventing and managing disease, and making other decisions related to health and health care.It includes information for making decisions about health products and health services.It may be in the form of data, text, audio, and/or video.It may involve enhancements through programming and interactivity.Health products include drugs, medical devices, and other goods used to diagnose and treat illnesses or injuries or to maintain health. Health products include both drugs and medical devices subject to regulatory approval by agencies such as the U.S. Food and Drug Administration or U.K. Medicines Control Agency and vitamin, herbal, or other nutritional supplements and other products not subject to such regulatory oversight.Health services include specific, personal medical care or advice; management of medical records; communication between health care providers and/or patients and health plans or insurers, or health care facilities regarding treatment decisions, claims, billing for services, etc.; and other services provided to support health care.Health services also include listserves, bulletin boards, chat rooms, and other online venues for the exchange of health information.Like health information, health services may be in the form of data, text, audio, and/or video, and may involve enhancements through programming and interactivity.Anyone who uses the Internet for health-related reasons has a right to expect that organisations and individuals who provide health information, products or services online will uphold the following guiding principles:"}
{"text": "The synergies among biology, computing and other formal disciplines continue to produce a unique blend of domain-specific and methodological advances that is shaping the very fabrics of the new scientific method. Among the many examples of this phenomenon, the one offered by the unrelenting growth of bioinformatics and computational biology is unique in that nowhere else is the native lexicon of a natural science more directly conducive to digital representation and manipulation.Research in Computational Molecular Biology Tenth Annual International Conference on (RECOMB 2006), which was held in Venice, Italy, on April 2\u20135, 2006. The RECOMB conference series was started in 1997 by Sorin Istrail, Pavel Pevzner and Michael Waterman. The previous meetings were held in Santa Fe, NM (USA); New York, NY (USA); Lyon, France; Tokyo, Japan; Montr\u00e9al, Canada; Washington, DC (USA); Berlin, Germany; San Diego, CA (USA); and Boston, MA (USA). RECOMB 2006 was hosted by University of Padova in the Venice Convention Center at Cinema Palace, Venice Lido, Italy.The research articles contained in this Supplement originate from posters presented at the The Tenth Edition of RECOMB was special in several ways. For one, the Program Committee, consisting of 38 specialists of the highest distinction in the field, included all past Committee and Conference Chairs as well as the Members of the Steering Committee. The Committee selected 40 papers out of the received submissions of well over 200. Some of the accepted papers were further expanded and refereed in order to appear in the special issue traditionally devoted to the Conference. For the Tenth Edition, however, in view of the high quality of the contributions submitted for poster presentation, it was felt that another Special Issue, devoted to expanded and duly refereed versions of poster submissions was also warranted.Thus, the present Supplement constitutes one more innovation brought about by the Tenth Anniversary of RECOMB. The eight enclosed papers emerged at the outset of a rigid selection and review and represent a vivid snapshot of work mature enough to be reported within vibrant frameworks still in the making. We hope that they will start one more tradition for RECOMB.This Issue was made possible thanks to the effort of many, in particular, the special task force set up for handling posters, which consisted of Luca Bortolussi , Giovanni Ciriello , Matteo Comin , Claudio Garrutti , Giosu\u00e9 Lo Bosco , Sabrina Mantaci  Cinzia Pizzi , Simone Scalabrin , and Nicola Vitacolonna .We are also grateful to the external reviewers, the members of the Steering Committee and other colleagues who helped in the process. Finally, we express our thanks to the institutions and corporations who provided financial support for the conference: Broad Institute of MIT and Harvard, USA; College of Computing, Georgia Tech., USA; Department of Energy, USA; Department of Information Engineering, University of Padova, Italy; IBM Corporation, USA; ISMB, International Society for Computational Biology; AICA, Italian Association for Informatics and Automatic Computation; National Science Foundation, USA; University of Padova, Italy."}
{"text": "The Appalachian mountains comprise a system of ranges that begins in Quebec, Canada, passes through New York, and reaches south along the U.S. eastern seaboard to Georgia and Alabama. Portions of the mountain system are in 12 states and include ranges such as the Allegheny Mountains of Pennsylvania and the Great Smoky Mountains of Tennessee. The land is heavily forested, rocky, and sparsely populated. Traditionally, the region known as Appalachia offered two sources of income: mining in the north and farming in the south.In the 18th century, the primary inhabitants of Appalachia were American Indians, particularly the Shawnee tribes in the north and the Cherokee tribes in the south. European immigrants from Scotland, England, and Ireland followed. The descendents of these groups and of southern African Americans now comprise the primary populations of Appalachia. The northern and southern communities of this region have distinct cultures, especially in music. Coal miner songs such as \"Sixteen Tons\" speak to the dangers and miseries for miners and their families who reside in northern Appalachia. In southern Appalachia, vocal and instrumental music is drawn from the traditional mountain instruments of banjo and fiddle.But one common cultural trait is shared by northern and southern mountain people: poverty. Overall, the people of Appalachia are unemployed more often than people in the rest of the United States, have a lower median family income, and have lower educational levels . They alPreventing Chronic Disease (PCD) explores health-risk behaviors among the Appalachian populations. We thank Dr Eugene Lengerich of The Pennsylvania State University for serving as guest editor on this topic.Where there is poverty, there are high rates of disease. Compared with the U.S. population as a whole, residents of Appalachia have higher death rates from heart disease, cancer, cerebrovascular disease, obstructive pulmonary disease, diabetes, and infant mortality. In this issue, PCD music that reflects the region's multicultural blend.Henry Reed (1884\u20131968) was an accomplished West Virginia fiddler with a broad repertoire of traditional Appalachian tunes. In 1966 and 1967, folklorist Alan Jabbour recorded 184 of Reed's tunes; this collection is now housed in the American Folklife Center at the Library of Congress . In the"}
{"text": "By Ronald J. TrentAmsterdam:Elsevier, 2005. 320 pp. ISBN: 0-12-699057-3, $79.95Molecular Medicine: An Introductory Text, like the previous editions, continues to provide a contemporary and succinct overview of DNA in medicine. Chapter topics include a history of molecular medicine, DNA, RNA, genes, and chromosomes; Mendelian genetic traits; complex genetic traits; genomics, proteomics, and bioinformatics; genetic and cellular therapies; reproduction and development; infectious diseases; forensic medicine and science; and ethical, legal, and social issues. The new chapters added to this edition represent the developments in genomics, proteomics, and bioinformatics.The third edition of Molecular Medicine valuable because the author pulls together a comprehensive assessment, highlighting Internet-based resources that greatly assist readers in further exploring the depths and details of the related topics.Many books describe DNA in medicine, from monographs to multiple-author heavy volumes, but the uniqueness of this single-author introductory textbook of molecular medicine is that it simplifies the seemingly complex concepts of DNA in medicine so that readers can find an easy entry into the world of molecular medicine. This certainly helps medical students and biomedical researcher trainees to grasp the fundamentals of the field. This book also contains many clinical examples that make the reading more relevant to practice and raise the level of interest. Senior scientists and health care professionals will also find This introductory textbook presents a well-balanced incorporation of the basic concepts, applicable clinical examples, advances in molecular biology and their impact on medicine, and gaps that will be filled by further developments in DNA biology and medicine. Emphasizing the role of DNA in molecular medicine, the book provides an interesting history of the development in DNA knowledge, covering the early discovery of DNA structure to the completion of human genome project. Detailed relationships among DNA structure, biology, and medicine highlight the role of DNA in medicine, which is further enhanced by an explanation of traditional and complex genetic traits. The incorporation of genomics, proteomics, and bioinformatics adds a new dimension. The author\u2019s presentation of the principles of using DNA information for genetic and cellular therapies and their applications for reproduction and development, infectious diseases, forensic medicine, and basic science provides a more practical view of DNA in medicine. Finally, the discussion of ethical and legal issues, of concern to the public, brings health care professionals and laboratory scientists an awareness of the social implications of molecular medicine.The author\u2019s definition of molecular medicine in this book\u2014used to describe the role that knowledge of DNA is having on medical practice\u2014may mislead readers to assume that molecular medicine has to do only with the manipulation of DNA. Posttranslational modification of proteins is a critical part of molecular medicine. Although the author has covered this aspect within the context of the book, the definition should have considered the independent role of proteins in molecular medicine as a basis for the text.This book can be recommended to medical students, health care providers, and laboratory researchers as an entry-level textbook, introductory reference, and fundamental resource for knowledge of molecular medicine. It would easily open the door for all medical professionals to molecular medicine, its past, present, and future."}
{"text": "This paper reviews trends and issues in health and in the information and communication technologies (ICT) market as they relate to the deployment of eHealth solutions in Latin America and the Caribbean. Heretofore designed for industrialized countries and large organizations, eHealth solutions are being proposed as an answer to a variety of health-system management problems and health care demands faced by all health organizations including those in developing societies. Particularly, eHealth is seen as especially useful in the operational support of the new health care models being implemented in many countries. The authors examine those developments vis-\u00e0-vis the characteristics of the Latin American and the Caribbean health-sector organizational preparedness and technological infrastructure, and propose policy and organizational actions to foster the development of eHealth solutions in the region. Advances in ICT and the dissemination of networked data processing created a new environment of universal access to information and the globalization of communications, businesses, and services. In the health sector, this trend is exemplified by the growing consolidation of eHealth - an area distinguished by the combined utilization of electronic communication and information technology to transmit, store, and retrieve digital data for clinical, educational, and administrative purposes, both at the local site and at distant sites. Barely in use before 1999, the concept of eHealth evolved to serve as a general designation to characterize not only networked health applications, but also virtually everything related to computers and medicine. It followed a trend started by other \"e-words,\" such as e-Commerce, e-Business, e-Finance, e-Learning, e-Government, e-Solutions, and e-Strategies . Among lMost eHealth solutions build on e-Commerce and e-Government strategies and experiences in using Internet-based networked technologies to rethink, redesign, and rework how businesses and public services operate. Typically, such developments have been aimed at the improvement of productivity, effectiveness, and efficiency, both internally and in the relationships with clients, customers, suppliers, and partners. Reaping the full benefits of such innovative data processing and use depends on the clear definition of goals, collaboration among stakeholders, technology infrastructure, systems integration, standards, and the implementation of performance metrics.The business imperative for eHealth is concrete, is driven by the operational requirements of health reforms, and is aligned to many of the determinants found to be relevant in e-Commerce - 8:Growth of a global marketplace and the ubiquity of interactive communications.Networks of producers, suppliers, customers, and clients.Global demand for telehealth services is estimated to be of US $1.25 trillion, of which about two-thirds is for direct services and the rest for second opinion, consumer information, continuing education, management, and other services.Leasing, membership, service agreement, and strategic-alliance models replace traditional business organizations based on ownership of physical assets and long-term structures.Lifetime value of customer retention replaces \"one-time sell.\"Economies of speed, forecasting demand, and customer service and satisfaction replace economies of scale and impersonal service provision.Customization capable of achieving a \"one-of-a-kind\" product or service.Leveling effect by reducing entry barriers, thus allowing small firms and poor countries and populations to have access to markets, information, and other resources, and therefore balancing the vertical integration competitive advantage of large corporations.The essence of eHealth, as in e-Commerce, is reliable transaction delivery in a fast-changing environment involving people, processes, and a business infrastructure focused on the ill or healthy citizen. In developed countries, eHealth has rapidly evolved from the delivery of online medical content toward the adaptation of generic e-Commerce solutions to the processing of health-related administrative transactions and logistical support of clinical tasks. Emerging eHealth applications are oriented to professional networking, integration of the clinical care process management, and the provision of Web-based health information and patient care, including remote monitoring and health care. This expanded view of eHealth has been promoted as the final stage in bringing the entire health care industry online.The health sector faces two demands that appear, on first examination, to be contradictory: firstly, to provide expanded and equitable access to quality health care services and, secondly, to reduce or at least control the rising costs of health care services. Although the health sector is key to the welfare of the population and the formation of human capital, the sector has not kept pace with the momentum of change that the region has experienced in recent years in other areas of economic, political, and social life.Health sector expenditures in Latin America and the Caribbean comprise 6% to 17% of the service sector that, in turn accounts for 50% to 65% of the GDP (Gross Domestic Product) in almost all countries. The market for health goods and services in the countries of the region represent 9% of the global health market, about half of that for the European Union, above that of the combined markets of Eastern Europe and Central Asia, and just below that of East Asia and the Pacific. The average per capita expenditure on health in 1999 was US $452 followed by US $1868 for the European Union, US $2206 for Canada, and US $3978 for the United States. (PPP dollars). PPP (Purchase Power Parity) relates to the purchase value of the dollar at the local market. PPP rates allow a standard comparison of real price levels between countries. The PPP for a specific country is based on market price surveys conducted by the International Comparison Program, a joint project of the World Bank and the regional economic commissions of the United Nations. The present values of PPP are based on the last survey done in 1996 and is based on a 1993 reference year.There is a marked variation  in the nChanging demographics (particularly age structures) and lifestyles  highlight the need to reorient care models. In high-income and middle-income countries, about 40% of the population has one or more chronic conditions and, in many societies, chronic conditions account for up to two-thirds of health care expenditures. In each care setting, a limited set of health conditions account for most of the cost due to the growing demand on the care system for additional and high-cost diagnostic and therapeutic resources. Significant opportunities do exist to improve health status but there are still a considerable number of preventable diseases and premature deaths, both in absolute and relative terms, and there is great inequity of access to basic health services resulting in regions, communities, and social groups being left without access to the most basic health care.In most countries, the health sector is underfinanced; this has led to quantitative and qualitative deficiencies in the delivery of health services and to growing gaps in basic care. There is inefficient allocation of scarce resources and lack of coordination between health subsectors, institutions, and other social agents and stakeholders - with duplication of efforts, overlapping responsibilities, and resource wastage. All countries are in some stage of sector reform, a process aimed at introducing substantive changes in the health sector and in the relationships among stakeholders and the roles they perform, with a view to increasing equity in benefits, efficiency in management, and effectiveness in satisfying the health needs and expectations of the population .Health reform processes have many facets and there is no single model being adopted by all countries. Each country is moving at a different pace in the implementation of its own particular health system model but the economic and globalization changes of the last 10 years have brought a new urgency to the reform processes. There are, however, common trends and responses that characterize most health sector reform processes occurring in the region: (a) the universalization of a high cost-benefit basic package of health services; (b) a set of standardized public health interventions; (c) cost containment and recovery; (d) administrative decentralization and operation of health care services; (e) recognition of the role of the private subsector and the intersectorality of health interventions ; (f) health models oriented towards primary care and centered on people; (g) focus on quality and accountability; and (h) moving away from the reactive delivery of care to a more proactive management approach of the health status of individuals and population groups . With thTechnology distribution and access problems represent the most acute issue in the dissemination of ICT applications. In a more limited focus, the \"digital divide\" encapsulates the dramatic worldwide variation in access to computer-based information technologies, usually more narrowly in terms of levels of Internet access, available to individuals and communities. Information-technology utilization inequalities are found in both industrialized and developing countries and are determined by level of education and income .Digital divides, like social and economic divides, exist within and not just between societies and are integral parts of a much broader and intractable \"development divide\" that include insufficient telecommunications infrastructure, high telecommunications tariffs, inappropriate or weak policies, organizational inefficiency, lack of locally-created content, and uneven ability to derive economic and social benefits from information-intensive activities - 18. TheIn the health sector, development and digital divides between industrialized and Latin American countries are wider than the gap observed in other productive and social sectors. In some cases, the changes brought about by the privatization of health care did add to the already high degree of structural inequity that prevails in the countries of the region. Besides achieving reliable transaction delivery, a technologically successful \"e-Architecture\" must provide superior client service, customization of products and services, interactivity, and maximum convenience .The deployment and operation of \"e-Solutions\" share technology-infrastructure and operational-deployment issues involving reliability of service that directly depend on: (a) degree of information preparedness and information technology insertion in society; (b) appropriate and functioning network, hardware and software platforms, and physical infrastructure; (c) the understanding of market relationships among the different actors in the informatics and telecommunications areas; (d) managing knowledge about health, individual client medical history, environment, and enterprises; (e) data-protection measures and regulatory framework to ensure transaction security; and (f) auditing processes that are quite different from traditional paper-trail solutions. A pervasive public-sector information infrastructure (\"infostructure\"), the essential prerequisite for continuous health care to the community, is still an incipient component of health systems. Penetration of information systems in health institutions is low. The hospital subsector is the area better served by information systems. Considering all facilities, public hospitals, including those belonging to the social security, account for 44.51%; private total 46.98%; philanthropic total 7.75%; and military the remaining 0.75%. There are significant differences in the utilization of computerized information systems. The relative distribution of information systems shows that social-security hospital facilities constitute only 5.29% of all establishments, but 50% have computerized information systems, followed by philanthropic (39.3%), private (36.7%), military (23.2%), and public non-social security (21.5%). However, in the group of all hospitals with computerized systems, private hospitals represent the majority (54.7%). The disparity between the existence of systems in the two types of public hospitals  is evident.Facility size is a major determinant in the capability of an institution to implement ICT and in the selection of the portfolio of applications. Of all Latin American and Caribbean hospitals, 10027 (60.53%) have 50 or fewer beds  and of tIn the past decade, the information technology sector in Latin America and the Caribbean consistently showed a growth of 17%, above all other world regions. During the last 5 years there has been fast expansion of the telecommunications market (from 7 million fixed-line and 50 million mobile subscribers in 1995 to 25.3 million and 69 million subscribers respectively in the year 2000) and very fast diffusion of the Internet . Investments in ICT as percentage of the GDP is comparable to that of developed countries although the absolute value per capita is low . Data usLow penetration of telephony, averaging 12% in the region and cost of annual subscription , and very low ownership of personal computers , and low Internet connectivity (average 3%) are major challenges to be overcome . About 2Poor telecommunications infrastructure, limited number of Internet Service Providers (ISPs), lack of access to international bandwidth, and lack of affordable Internet-access costs are readiness issues that continue to be major impediments to diffusion of Internet applications to the point of care in developing societies. Dependable connectivity is needed for reliable transactions. Fast connectivity is still limited and is usually by dial-up access. A study across different industries showed that only about one-third of the connected organizations in the region had access with speed higher than 56 Kbps (Kilobits per second) .The access-site problem can be further illustrated by the result of a 1999 survey of 42744 physicians in Brazil . The study revealed that 52% used the Internet - a level of diffusion equivalent to the general US population - however, when 23603 physicians users were asked from where they predominantly accessed the Internet, 85% indicated their home, 10% the office, and only 2% and 3% indicated the site as the university or the hospital respectively. In comparison, US physicians have the following Web access profile: 40% at the workplace, 56% at the office, 87% at home, and only 7% were not connected.On a positive note, reform of the telecommunications sector is bringing significant improvement in services and drop in tariffs as a result of greater competition and expanding markets. With the recent rapid trade liberalization and modernization of the telecommunications sector in Latin America and the Caribbean, the telecommunications infrastructure is improving. One-fourth of the 89 major public telephone operators that were privatized throughout the world by the end of 1999 were in Latin America and the Caribbean .Many market segments are becoming increasingly information-technology dependent as part of globalization ,22- 24. As is usually the case with innovation, the agents that first move into the market quickly attain a dominant position, block the entry of new competitors, and capture a large part of potential proceeds. It has been stated that the success of developed countries, particularly the United States, in taking advantage of ICT partly reflects its flexible and competitive markets. Possibly, smaller benefits can be expected in more-regulated economies or in the case of implementation environments characterized by rigid labor and trade rules and by inefficient commodity markets and capital exchanges .Cross-border challenges are particularly pressing due to the growing number of national, international, and nongovernmental actors involved in transnational and global concerns. Market capture by strong, organized, and well-funded health-provider organizations, some of international nature, is happening at a fast pace in Latin America and regulatory methods have been advocated to safeguard local competition. Intangible health \"e-Solutions\" products and services offered by foreign providers - as is the case with investment, insurance, knowledge dissemination, and health care applications - present great challenges to developing and poorly-developed countries and may result in flight of capital, tax evasion, employment reduction, capture of the health market, and \"cultural colonization.\"In the area of information technology, the emphasis of intellectual rights has changed from the protection of the author/inventor to that of the investor. Implications for developing countries , welfareIntellectual property rights have been a major area of concern and conflict. The promotion of innovation is essential to any development strategy, particularly to increase international competitiveness of national enterprises. However, limiting acquisition of innovative technology only to those that are captured by the patent system (\"inventions\") makes a society permanently dependent on external sources. The universalization of standards for protection of intellectual-property rights has been enabled by the World Trade Organization General Agreement on Trade and Services (GATS) adopted in 1995 at the Uruguay Round of negotiations, reinforcing protection in 3 key information technology areas: computer programs, databases, and design of the layout of integrated circuits. Stakeholders concerned with such issues include nation-states; multinational business organizations; subregional trade blocks, and integration groups . In addition, country initiatives, professional and nongovernmental groups, and international organizations provide an operational and legal framework for tackling these issues. Some of these entities are being increasingly overwhelmed by market access challenges not envisioned before the diffusion of ICT.People are central in the value-added creation of eHealth products and services and an organization's human resource is the key to success . SystemsMany public health organizations in Latin America and the Caribbean are not taking advantage of existing ICT opportunities and most existing information systems are inadequate to meeting the requirements of the new models of health care being deployed in the context of health-reform initiatives. Besides the common perception among physicians that health-information systems are mostly a source for scientific and technical information, often public health authorities have a view of clinical-administrative information systems that is obsolete and frozen in a \"statistical-epidemiological\" archetype, designed for the collection of numerical data representing only counts of events and mostly generating only highly-aggregated statistical data and time series related to mortality, morbidity, and to service utilization and coverage. Those information systems have very little practical interest to direct-care professionals and unit managers and are far behind in providing the logistical and longitudinal individual client-based data required to operate and manage the sort of health care models being deployed in many countries.Worse still, most public health authorities are totally oblivious to the broad variety of possibilities offered by modern information and communication technologies to manage client-based data, support operations, and mine large databases. Indeed, the health sector has not applied the range of options provided by information and telecommunication technologies as effectively as have other social sectors, and health has been conspicuously underrepresented in national technology-development policies and plans. Such concerns have also been raised by traditional national statistics organizations .As a counterpoint to the passiveness of the public sector, private providers and health groups recognized that a \"different\" type of information system and data elements are required to run their organizations and survive in a competitive environment driven by increasing consumer demands and expectations and to deliver personalized evidence-based services. Besides using ICT resources to boost productive specialization  there are many new areas of application that are rapidly gaining ground and reducing care costs while improving the continuity and quality of care - 30. TheResources, products, and markets that are highly specialized, closed, and regulated are being swiftly opened to new players in a marketplace that is still mostly unregulated and, at the same time, when novel and untried health reform models are being introduced. These circumstances carry with them a very high unpredictability of outcomes. Although businesses and public organizations are adapting with varying speed to new processes and models, the organizational \"culture,\" and the nature and frequency of those business-environment changes may create friction, desirable and undesirable impacts, and personal behaviors that may impede the sequence of the expected project results. Broad objectives are difficult to achieve, the best strategy is to identify the most-repetitive tasks associated with significant costs - eg, the automation of claims and reimbursement procedures - and then proceed area by area. The results of the experience with e-Commerce and e-Business over the last 2 years clearly show that the emergence, adaptation, and real-world deployment of new technologies is a complex issue teeming with uncertainties. For a number of reasons, chiefly related to the technology employed, even in the most-industrialized and computer-literate societies e-Commerce has not developed smoothly.Unfounded vendor-driven expectations of how the Internet will revolutionize health care have too often overshot their target . OverestThe lesson to be learned for eHealth is that technology is a tool, which can be justified economically only if organizations deploy it in a real-practice environment and closely track how managers and direct-care professionals are using it. This requires the stepwise development and implementation of processes and metrics to monitor productivity and impact ,31,32.Web enabling business and government operations is expensive. The United States can be used as a case example: Internet-based marketplaces can lower operational costs and improve efficiencies but deployment expenses will ordinarily cost a typical business US $5.4 million to US $23 million over 5 years. Required procedures involve changing procurement processes, integrating online and internal systems, buying applications, and paying transactions fees and intermediaries. In general, such costs have the following distribution: 32% for internal preparation; 26% for initial contracts and fees; 20% for ongoing internal management; and 22% for ongoing fees and external services . It is dAs providers and insurers soon realized, the simple automation of current processes and services and putting them in a Web-enabled environment is not feasible . A greatData security and privacy of personal health data are universal concerns and a high-priority issue in many countries. There is a growing concern regarding the protection of health records against intrusion, unauthorized use, data corruption, intentional or unintentional damage, theft, and fraud. Health data transmitted over national and international networks offer unprecedented opportunities for better patient care and community health interventions by facilitating data exchange among professionals but pose new challenges to confidentiality. The promise of the Internet to improve care by timely access to the right information can only be realized through secure connections shared across all platforms.Given the sensitive nature of health care information, and the high degree of dependence of health professionals on trustworthy records, the issues of reliability , security , and privacy (subject of data can control its use and dissemination) are of particular significance and must be clearly and effectively addressed by health and health-related organizations and professionals. Reliability, security, and privacy are accomplished by the implementation of a number of preventive and protective policies, tools, and actions that address the areas of physical protection, data integrity, access to information resources, and protection against unauthorized disclosure of information ,35. A coThis is probably one of the most serious issues in the area of Internet-based interactive health communications. The Internet offers unprecedented power to provide all users of health care information - patients, professionals, families, caregivers, educators, researchers, insurers, regulators, and policymakers - with data of unprecedented timeliness, accuracy, depth, and diversity. Yet it is equally clear that the very qualities that make the Internet such a rich marketplace of ideas - its decentralized structure, its global reach, its leveling of access to the tools of publication, its immediacy of response, and its ability to facilitate free-ranging interchange - also make the Web a channel for potential misinformation, concealed bias, covert self-dealing, and evasion of legitimate regulation. It is very difficult to ascertain and provide recommendations about the credibility, motives, sponsorship, and eventual conflicts of interest in the more than 50000 health Web sites in existence. Many websites are profit driven, others promote unproven and even dangerous forms of treatment or products, while others may be well intentioned, but contain misleading or false information ,36- 47.The Presidential Declaration of the 1998 Summit of the Americas and a number of international meetings held since then  made clear that all countries of the Americas have a common stake in improving access to and delivery of health care through communications and information technology. The recommendations presented here follow the spirit of the principles agreed by the governments of the region in the above-mentioned high-level meetings.The immediate objective is to promote the deployment of core eHealth applications and support functions by incorporating an advanced informatics component into health programs and projects, supported by a combination of funding programs, incentive grant programs, and prototype development funding programs. Elements for the development and implementation of a comprehensive national technology and policy vision, mission, and action plans for eHealth must address the following issues:Develop a telecommunications infrastructure that is comprehensive, reliable, ubiquitous, and compatible across applications - such an infrastructure must provide affordable bandwidth that is sufficient to serve the wide variety of users' specific needs. Its development will be dependent upon the continued deregulation of the telecommunications industry and will involve the leveraged use of many ICT technologies that have been spawned by and for other industries.Provide technological interfaces that facilitate effective use of the infrastructure and its component systems - these interfaces may involve systems capable of rendering information from multiple modalities, in conjunction with a variety of applications as aids to health services operational support and decision making. They will require modularity and connectivity compliant with standardized interface protocols.Implement legal and regulatory infrastructure that will facilitate medical communication - at the professional level, such issues as interstate/province licensure and credentialing of service providers must be addressed, the telecommunications and information industries must develop rational and affordable tariff structures, and legislation must be passed to ensure the protection of personal health information.Implement rational and technologically-neutral policies for public and private payers - coverage and payment policies should be established to address the entire range of eHealth applications and technologies. Means should be developed for assessing the appropriateness of health services provided via telemedicine applications. Outcome-based quality-improvement programs will be of great importance in assuring quality and cost-effective medical care.Make available appropriate content to consumers, patients, and service providers with the objective of enhancing health care outcomes - the process for conveying quality evidence-based information must permit the user to follow the links between data, inferences, and conclusions. Authentication, access control, confidentiality, integrity, and attribution are key requirements for health-related advice and decision making.A retrospective of experiences shows that continuity and sustainability of information-systems projects continue to be a major problem in the region. Externally-funded projects frequently collapse upon funding termination and this demonstrates that all projects need justification in terms of cost-benefit and long-term financial sustainability besides organizational capacity to develop and implement information systems. This further indicates that spreading the financial risk across several stakeholders may be appropriate as cost sharing increases overall awareness, utilization, and long-term potential for success.Standards development and implementation must be carried out with the public and private sectors to achieve consensus on a set of information principles for the collection, transfer, storage, and use of health data over national and global information infrastructures. Standards will be defined by a consortium of users; researchers; government, technical and scientific bodies; and the industry at 3 distinct levels: first, in terms of standardization of data and information; second, in terms of the computational facilities required to manipulate and store the information; and third, in terms of telecommunications facilities, employed to transfer information among dispersed sites.Six areas are envisioned for government involvement in eHealth development and deployment: (a) promotion of education, training, and national planning capacity in information systems and technology; (b) convening groups for the implementation of standards; (c) providing funding for research and development; (d) ensuring the equitable distribution of resources, particularly to places and people considered by private enterprise to provide low opportunities for profit; (e) protecting rights of privacy, intellectual property, and security; and (f) overcoming the jurisdictional barriers to cooperation, particularly when there are conflicting regulations.The attainment of this mandate involves participation of a large number of stakeholders, but the coordinating effort will necessarily concentrate on the public sector.Only a more-active role of government and public-private partnerships in supporting appropriate technology transfer and adaptation through indigenous research and development and the implementation of specific policies to protect local development will create an environment conducive to a reduction of the present ICT development divide. Increasing the general population's capacity to take advantage of information and communication technologies requires heavy investment in general education and training in computer skills. A serious problem for Latin America and the non-English speaking Caribbean is that most of the Internet is directed to native speakers of English and most sites and exchanges are carried out in English. Even physicians, who can generally be expected to have a working knowledge of English, may have problems with such sites. This means that investment is required to develop applications, user interfaces, and contents in national languages.Developing countries of Latin America and the Caribbean may take advantage of the accumulated knowledge and mistakes and may leapfrog developmental stages; however, this is not expected to be readily achieved due to the barriers posed by the general institutional underdevelopment, low income, illiteracy, and financial constraints that afflict many countries. It is improbable that the bridging of the health-sector development divide will be accomplished easily. In industrialized countries, it took several decades and countless institutional and organizational transformations for the consolidation of economic, institutional, and technological changes and the crystallization of long-term structural patterns necessary for information and communication technologies to spread to vast sectors of the society.The current health-sector organizational structure and national regulatory framework in Latin America and the Caribbean are not conducive to problem-oriented, interdisciplinary, rapid-response collaborative technical work, and the implementation of political, regulatory, and managerial tasks required to address multifaceted complex technological problems. Organizational and human-resources development through awareness programs, education of health staff, continuous training, and career opportunities must be institutionalized from the inception of the developmental effort. Transference of technical expertise and the appropriation of knowledge by health personnel are necessary for the full participation of end-users in the development process and the best insurance for successful implementations. Success in the deployment of institutional eHealth applications depends on the existence of staff with the right mix of skills in all functions and levels. Recommended strategies include:A structured human-resource development program defined with the goal of increasing awareness of eHealth opportunities and training health professionals to assume a leadership role and actively participate in all aspects of systems design and implementation.The training strategy will take into account issues associated with: the development, the organizational environment in which systems are expected to operate, and the specific circumstances of the local health system. The following guidelines for training should be implemented: identify target groups based on functions and training needs; develop training programs to meet identified target groups' needs; and establish a network of training focal points, taking into account the specific organization and circumstances of national characteristics and local health-unit requirements and undertakings.Target groups to be considered are: those who originate, collect and supply data; operational decision makers ; managers, planners, and policy makers; information systems managers; information technology and computing specialists; data analysts; and statisticians and researchers.Each country will develop its own strategy for initial and continuing training in health-information systems, considering the overall development of health information systems and its particular health care, educational, research, and market environment.Given that the worldwide market for information technology, products, and services in 2001 was valued at US $1086 billion and expected to grow 32% to US $1436 billion by 2004 , developDevelopment of Health Informatics in the region must be conducted in the context of a framework linking public, private, and social efforts to speed the development of priority ICT solutions. Technical knowledge, experience, and financial investments needed to establish large and complex information system projects require tapping into resources and expertise that no single organization retains. Public and private institutions, academic organizations, the industry, and financing agents must find ways to pool their assets through project partnerships and to add social value to applications of informatics by providing new employment opportunities, socioeconomic development, and educational opportunities, by promoting health, and by supporting cost-effective health services.In the international setting, cooperation between developed and less-developed countries is essential but special care must be taken to avoid interventionist behavior that ignores users' real needs, fails to understand host capacities, demands action without allowing sufficient time for conceptual assimilation, neglects cultural constraints, and ignores hosts' knowledge basis. As in many other areas of international cooperation the danger is to have too much too soon or too little too late. A possible framework for collaborative work should include support to international health issues, health care reform implementation, application development, education, and economic and technological cooperation.By demonstrating that social projects, especially health care and education, can be advanced through improved information infrastructure, international technical cooperation and multilateral agencies must collaborate with national and international authorities and experts to demand that funding institutions finance projects in such areas. Consistent with these objectives, governments must demand that international and multilateral agencies must promote and support technical cooperation activities in the development of eHealth, primarily involving knowledge transfer, technical support, facilitation of the exchange of experiences between countries, and fostering the use of appropriate technology and knowledge assets. Priority areas for technical cooperation include: priority assessment, technology evaluation and selection criteria, implementation issues, emerging technologies linking patients and providers, access to knowledge databases, consumer informatics, and the utilization of Internet and Internet-enabled technologies.Many Latin American and Caribbean countries are committed to reform their telecommunications systems. They recognize that progress in the telecommunications sector is essential to establishing health informatics and to ensuring the global competitiveness of their economies, and attention has been on liberalizing the markets. Recommendations include actions in the following areas: market access issues ; standards ; regulation ; promoting competition ; and protecting technology and intellectual-property rights.Experts agree that to be effective and efficient the health care industry must operate in a digital environment, encompassing connectivity, commerce, and community/content sites. But no one can pinpoint exactly when everything will converge. Nudging the health sector toward compliance is a valid and effective approach. The European and Canadian health care systems have used this strategy and HIPAA, the US federal Health Insurance Portability & Accountability Act, is a prime example of how the industry can be coached into complying with a variety of guidelines related to standardization, security, and privacy. In effect, HIPAA is forcing an eHealth solution on the US health care industry.Health care organizations in Latin America and the Caribbean, particularly in the public sector, are not yet prepared to adopt ICT effectively. The goal of a national health ICT vision and strategic plan of action is to establish a coherent national arrangement directed to facilitating projects and infrastructure development, maximizing the benefits for invested financial resources, and enabling people to accept and function more effectively in an informatized, evidence-based, and competitive health practice environment.Governments should focus on their role as sponsors of basic scientific and technological research, bridging the digital divide, fostering public-private partnerships, managing international cooperation efforts, and establishing the regulatory and incentive components. All stakeholders must work collaboratively to grapple with the many standardization and infrastructure-development issues and the transnational and global eHealth aspects that must be addressed in a comprehensive manner. International aspects of eHealth services form a critical and urgent area still to be addressed by the World Trade Organization and regional trade blocks. Legislation proposals should be initiated to ensure that the technology does not abridge patients' rights to confidentiality or security of medical records, and that agreement on practice parameters be developed to include aspects related to informed consent, physician liability, nonphysician liability, reimbursement, practice standards, and physician-patient relationships.The public sector, the industry, and partnerships have the responsibility for assuming an active leadership role in educating the medical community and in coordinating and encouraging the effective implementation of relevant applications. Health organizations must be provided with information about the opportunities as well as the risks of eHealth solutions. Technology-evaluation sources and results must be made available and health managers must be guided in the difficult process of specifying systems, procuring, acquiring, and contracting for ICT products and services. Knowledge repositories must be established in cooperation with the industry, centers for technology evaluation, academic research groups, and centers of excellence."}
{"text": "Herman P. Schwan [1915\u20132005] was a distinguished scientist and engineer, and a founding father of the field of biomedical engineering. A man of integrity, Schwan influenced the lives of many, including his wife and children, and his many students and colleagues. Active in science until nearly the end of his life, he will be very much missed by his family and many colleagues. Herman Paul Schwan, renowned scientist and engineer, loving and devoted husband and father, died quietly in his home in Radnor, Pennsylvania on March 17, 2005. Herman P. Schwan was born in Aachen, Germany in 1915. He obtained the German superior school certificate with distinction in Goettingen, 1934. He studied mathematics, physics, and engineering in Goettingen and then biophysics in Frankfurt. He obtained his Ph.D. in biophysics at the University of Frankfurt in 1940 with distinction, his teaching certificate at the University and his professional doctorate (Dr. habil) in the fields of physics and biophysics in 1946.Schwan worked in 1936\u201337 and again in 1938 with Telefunken on high frequency and microwave measuring techniques. He became a research associate with the Max Planck Institute of Biophysics in Frankfurt in 1937, an assistant professor with the University of Frankfurt and associate director of the Max Planck Institute in 1946. In 1947 he came to the United States, working at the Aeromedical Equipment Laboratory of the U.S. Naval Base in Philadelphia. He joined the University of Pennsylvania in 1950. In 1952 he was appointed Head of the Electromedical Division of the Moore School and in 1961 Chairman of the Graduate School of Arts and Sciences Group on Biomedical Electronic Engineering. In 1972 he became Chairman of the Bioengineering Department. He retired as the Alfred Fitler Moore Professor Emeritus in 1983.Over the course of his long career, Schwan published more than 300 scientific papers and gave countless lectures. He received numerous awards in recognition of his contributions, including the Edison Medal of the IEEE and the first d'Arsonval Award of the Bioelectromagnetics Society, membership in the National Academy of Engineering, and several honorary degrees. An extended biography of Schwan was published recently in the Annual Reviews of Biomedical Engineering .As a scientist, Schwan is best known for many biophysical studies related to electrical properties of cells and tissues, and on nonthermal mechanisms of interaction of fields with biological systems. He discovered or provided important theoretical insights into phenomena such as the large low-frequency dielectric dispersion that is found in biological material, and electrically induced forces on cells.2  became the basis for exposure standards in the U.S. and elsewhere. Among his many other committee activities in this field, he chaired the committee that established the first (1965) U.S. exposure limit for radiofrequency energy, for the American National Standards Institute. This standard evolved into the present IEEE C95.1 standard and was widely influential in the development of exposure limits around the world.Schwan was also deeply involved in the issue of possible health effects of nonionizing electromagnetic fields. His letter to the U.S. Navy in 1953, proposing a safe limit for human exposure to microwave energy of 100 W/mSchwan was married in 1949 to Anne Marie Del Borrello of Philadelphia. In addition to his wife, Herman is survived by five children and six grandchildren. He was a mentor to all of them, first and foremost teaching them always to think for themselves and never to just follow the crowd. A man of integrity, Schwan influenced the lives of many, including his wife and children, and his many students and colleagues."}
{"text": "The ultimate goal of this program announcement is to encourage the development of health research that integrates knowledge from the biomedical and social sciences. This involves the further development of health-related social science research relevant to the missions of the NIH Institutes and Centers (ICs) and the development of multi- or interdisciplinary research that blends the theories and approaches of the social and biomedical sciences. Within the broad spectrum of research identified in this announcement, applicants are encouraged (but are not required) to employ multiple  levels of analysis.This announcement invites applications to 1) elucidate basic social and cultural constructs and processes used in health research; 2) clarify social and cultural factors in the etiology and consequences of health and illness; 3) link basic research to practice for improving prevention, treatment, health services, and dissemination; and 4) explore ethical issues in social and cultural research related to health.http://obssr.od.nih.gov/Documents/Conferences_And_Workshops/HigherLevels_Final.PDF. Also see \u201cSocial Science and Health Research: Growth at the NIH,\u201d American Journal of Public Health, 94(1) Jan. 2004:22\u201328. You may request these publications from the Office of Behavioral and Social Sciences Research, Office of the Director, National Institutes of Health, Bethesda, MD 20892.This program announcement is a conversion and revision of PA-02-043 and is based on recommendations submitted to the NIH in conjunction with the conference titled \u201cToward Higher Levels of Analysis: Progress and Promise in Research on Social and Cultural Dimensions of Health,\u201d 27\u201328 June 2000, Bethesda, MD. For a summary of the conference, see Social scientists have made significant strides in shedding light on the basic social and cultural structures and processes that influence health. Social and cultural factors influence health by affecting exposure and vulnerability to disease, risk-taking behaviors, the effectiveness of health promotion efforts, and access to, availability of, and quality of health care. Social and cultural factors also play a role in shaping perceptions of and responses to health problems and the impact of poor health on individuals lives and well-being. In addition, such factors contribute to understanding societal and population processes such as current and changing rates of morbidity, survival, and mortality.Numerous reports from the Institute of Medicine and National Research Council have pointed to the importance of social and cultural factors for health and the opportunities for improving health through a better understanding of mechanisms linking the social and cultural environment to specific health outcomes. To realize these opportunities, social science research related to health must be further developed and ultimately integrated into interdisciplinary, multilevel studies of health. Linking research from the macrosocietal levels, through behavioral and psychological levels, to the biology of disease will provide the integrative health research necessary to fully understand health and illness.This program announcement invites applications for research on the social and cultural dimensions of health in five areas: 1) basic social and cultural constructs and processes used in health research; 2) etiology of health and illness; 3) consequences of poor health for individuals and social groups; 4) linking science to practice to improve prevention, treatment, health services, and dissemination; 5) ethical issues in social and cultural research.http://www.nih.gov/icd/.The goal of this announcement is to encourage further development of health-related social sciences research relevant to the missions of the ICs. These missions encompass a broad range of scientific questions related to the health and well-being of our nation's people. Information about the specific missions of the ICs participating in this program announcement is posted at Advances in social science research on health depend on a foundation of basic theory and knowledge that describes social structures, the dynamics of social and cultural processes, and the ways in which individuals are located in and interact with the environment, social structures, and cultural factors. Several key sociodemographic constructs, including race, ethnicity, gender, age, and socioeconomic status, are widely used in studies of the etiology of health and disease and in research that describes and monitors the distribution of disease across social categories, geographic areas, and time. However, the meanings of such constructs depend on their cultural, geographical, and historical context, and their utility in health research depends on their use in ways that are theoretically and historically grounded. In addition, the concept of culture requires careful theoretical grounding in health studies. Most social scientists agree that the concept of culture is complex and implies a dynamic and ever-changing process.This program announcement encourages research on basic social and cultural constructs and processes in the following areas:Research is needed to explore the implications of different conceptualizations and measurements of social stratification systems and processes, such as socioeconomic status (SES) and social class, age, gender, and race/ethnicity for understanding health at the individual and higher levels of aggregation . Research to improve the monitoring and understanding of inequalities in health and disease among diverse groups, and the implications for monitoring of strategies used to measure basic constructs such as socioeconomic status and social class, age, gender, race, and ethnicity.Critical Perspectives on Racial and Ethnic Differences in Health in Late Life, Washington, DC:National Academies Press, 2004.)The National Research Council\u2018s study of Critical Perspectives on Racial and Ethnic Differences in Health and Late Life discusses several issues related to racial and ethnic inequalities in health, including the nature of racial and ethnic differences, an outline of causal pathways implicated in health disparities, and a research agenda in the field of racial and ethnic differences in health. , and in social or professional organizations. However, at these levels processes contributing to social cohesion, social support, social control, social and cultural conflict, and the development and enforcement of social and cultural norms play a larger role. In families and small groups, interpersonal processes such as conflict and support, socialization, and sharing of resources play a dominant role.A valuable contribution of the social sciences is to understand health and disease not solely as an individual biological problem, but as a social phenomenon associated with social ties and other forms of social influences. From this perspective, research must address how mechanisms that link social and cultural phenomena to health operate within and emerge from specific social contexts. Social contexts provide the stage for social and cultural factors to influence health, and the characteristics of social context directly affect social and cultural processes.This program announcement encourages research on topics and questions such as the following:Research is needed to improve understanding of how macrolevel  factors, such as social policies, structures, and cultural norms, are linked to microlevel  factors, such as a person's behaviors, and ultimately to health. What are the causal pathways that lead from the sociocultural environment to general vulnerability to disease and disease-specific outcomes? Research that integrates theories and methods from the social and biomedical sciences is particularly encouraged to address these questions.Essential are studies of the implications for health of the characteristics and content of network ties and of how individuals and groups organize themselves into networks and other social arrangements, including the mechanisms through which social integration/ cohesion, social influence, and other social processes affect the health of individuals and contribute to health disparities. More research is needed on cultural processes and belief systems , at the individual, family, community, and institutional levels, and their relationships to health, including recovery from disease and addiction, with particular attention to potential mediating mechanisms .Research is considered necessary on the role of social contexts  in mediating or moderating sociocultural influences on health of individuals. Studies are required to conceptualize and measure social contexts in order to specify which particular aspects of social context are relevant to health and the mechanisms through which they operate. This includes research on how health policies impact on diverse populations, such as those defined by immigration status, gender, race/ethnicity, sexual orientation, or age, and on the pathways through which social policies  affect the health of diverse populations.Connections among health, functional capacity, and productivity are complex and difficult to disentangle, but empirical research is emerging that addresses the consequences of poor health for economic well-being at the individual, family, and population levels. Understanding the consequences of health and illness is important to the mission of the NIH. First, health disparities among groups varying in SES result in part from the reciprocal influence of SES on health and health on SES. The nature of these feedbacks needs to be fully understood if we are to understand the mechanisms underlying health disparities. Second, the value of investment in improving health can be only partially understood by focusing on health outcomes alone. For example, improvements in quality of life resulting from social, economic, and cultural change at both the individual and societal level are an important part of the picture.This program announcement encourages research on the consequences of poor health, such as the following:Research is desired on self care or self-regulation  as a response to illness and in the management of health conditions, considering the influence of social, cultural, and economic factors on the adoption and consequences of this strategy.Required are investigations of the coping strategies people use to adapt to illness and disability, the influence of social, cultural, and economic factors on these strategies, and the impact of these strategies on health and well-being at the individual, family, and community level. Research on the consequences of death and dying for the health and well-being of the deceased's relatives and friends as well as on the coping strategies people use to adapt to illness, disability, and death of a relative or close friend.Needed are studies of stigma across physical and mental health conditions (including addictions), care settings, outcomes and groups, including research on the social and cultural origins of stigmatization of illnesses. What are the implications of stigma for access to care and treatment? How does stigma affect outcomes across health conditions?http://grants.nih.gov/grants/guide/rfa-files/RFA-TW-01-001.html)Research is necessary to examine how the health of individuals impacts upon macrolevel processes and systems is also needed. How does the health of individual members of a group  affect the composition and functioning of the group? Also of interest is research on the influence of poor health on economic performance of organizations and societies. .Research is needed on cultural competence at multiple levels, including health systems, agencies and providers, with an emphasis on primary care and mental health settings. Also, research is essential to define what constitutes \u201cculturally competent care,\u201d develop and test different models (best practices) of culturally competent care, and test models in randomized controlled trials. Research is desired that explores the interface between traditional/ alternative and allopathic/Western medicine and health maintenance practices and identifies the circumstances under which either or both function more effectively.Research on the development, dissemination, and accessibility of new therapies, technologies and services, such as retrovirals and antipsychotics. How do social and cultural factors affect these processes and what impact do they have on services and treatment? How do social, cultural, economic, and policy mechanisms influence equitable access to health care and the quality of care received?Research is essential on the processes through which social and behavioral interventions are incorporated into general practice. What accounts for success or failure ? How does this differ from the adoption of biomedical treatments and interventions? Systematic research is required on methods to increase the adoption of tested and effective preventive interventions, treatment models, and service delivery strategies. Also increased research is needed that will allow rigorous comparisons of the effects of alternative methods of diffusion and dissemination.The development of new and more complex research methods in the social sciences, combined with dramatic advances in computing power, complicates standard ethical concerns of confidentiality, privacy, and consent. Higher levels of analysis imply analysis of data at the group, institution, or community level, raising the prospects of consent at these levels and how such consent might be obtained. Sensitivity exists not only at the individual level but also for the groups and institutions with which individuals affiliate.This program announcement encourages social sciences research on ethical issues in the following areas:Ethical issues arising from research that links the individual to groups, organizations, neighborhoods, or communities.Threats to confidentiality of data collected in multilevel studies by advancing statistical methods for masking or altering individual data and studying how such procedures impinge on the ability to conduct valid analyses.Unintended consequences of research aimed at understanding variation among individuals and among groups. How can we avoid overemphasizing individual and group differences and thereby reinforcing existing patterns of stratification in health care or other areas?Community consultation in research projects involving identified population groups. How can individual informed consent best be accomplished in this setting?This Funding Opportunity Announcement (FOA) will use the Research Project Grant (R01) award mechanism.The applicant will be solely responsible for planning, directing, and executing the proposed project.http://grants.nih.gov/grants/funding/modular/modular.htm).This FOA uses \u201cJust-in-Time\u201d information concepts. It also uses the modular as well as the non-modular budget formats , use the PHS398 Modular Budget component provided in the SF424 (R&R) Application Package and SF424 (R&R) Application Guide .U.S. applicants requesting more than $250,000 in annual direct costs and all foreign applicants must complete and submit budget requests using the Research & Related Budget component found in the application package for this FOA. See NOT-OD-06-096Applicants must download the SF424 (R&R) application forms and the SF424 (R&R) Application Guide for this FOA through Grants.gov/Apply.Note: Only the forms package directly attached to a specific FOA can be used. You will not be able to use any other SF424 (R&R) forms , although some of the \"Attachment\" files may be useable for more than one FOA.GrantsInfo@nih.gov.For further assistance, contact GrantsInfo, 301-435-0714, (telecommunications for the hearing impaired: TTY 301-451-0088), or by e-mail:http://grants.nih.gov/grants/funding/submission-schedule.htm.The application submission dates are available at http://grants.nih.gov/grants/guide/pa-files/PA-07-045.html.The complete version of this PA is available at http://grants.nih.gov/grants/guide/pa-files/PA-07-045.html.Contacts: The complete list of agency contacts is available at Reference: PA-07-045."}
{"text": "EHP provided a much-needed overview of the prevalence of environment noise and its effects on health  and to interact with noise exposure yielding either additive or synergistic impairment of the auditory apparatus. Research on such processes has received support in the United States from multiple agencies, including the National Institute of Environmental Health Sciences, the National Institute for Deafness and Other Communication Disorders, the National Institute for Occupational Safety and Health, and the U.S. Environmental Protection Agency.The January 2005 issue of n health . Indeed,Occupational epidemiology studies have demonstrated noise\u2013chemical interactions in the workplace, and laboratory animal models have been effective in identifying ototoxicants, establishing dosimetry, identifying targets of toxicity, and determining the mechanisms for such ototoxicity. For example, occupational epidemiologic studies of In laboratory animals, the pioneer experiments on the ototoxicity of solvents were initiated by Pryor and Rebert in the 1980s e.g., . Since tUsing developmental models, In this laboratory, we have demonstrated that a series of chemical contaminants with potential to disrupt intrinsic antioxidant pathways or to enhance reactive oxygen species (ROS) generation can produce permanent hearing loss in the presence of noise. These agents include carbon monoxide , 2000, hThe existing evidence has clear implications for both environmental and occupational health, and it highlights the continuing need for research on the issue. In Europe, the scientific information available has influenced public health policy. In February 2003, the"}
{"text": "Saline Systems addresses the publication needs of scientists conducting basic and applied research on coastal and inland saline environments and their flora and fauna. The journal covers research at all levels, from individual genes to whole genomes and entire ecosystems. Rapid progress in the molecular biology and microbial ecology of halotolerant and halophilic organisms and the sensitivity of many saline environments warrants an online journal with fast turnaround times. Many saline environments are threatened and the need for an Open Access journal to address the dissemination and sharing of knowledge on their conservation and management is compelling. Saline Systems provides an interdisciplinary forum for scientists working within all of the relevant fields. Saline Systems is being launched to address the publication needs of researchers exploring all aspects of saline environments. The journal is timely because rapid progress is being made in the molecular biology, genomics, and ecology of halotolerant and halophilic organisms inhabiting saline environments [ronments ,2. The aSaline environments, including coastal and inland ecosystems, harbour a substantial fraction of the biodiversity of the world. These serve as a major source of food for humankind through commercial fishing and aquaculture. About 3 billion people live near coastal communities, and escalating population growth and development are degrading the habitats critical to biodiversity and threatening the sustained vitality of coastal economies . GreaterThe primary aim of the journal is to enhance communication between and among scientists concerned with saline environments. Integration is intended to foster a deeper understanding of these critical environments world-wide, and of the halophilic and halotolerant organisms which inhabit them, as well as the underlying fundamental processes operating in them. Integration of knowledge at various levels is the hallmark of the systems biology approach. Such an approach permits information from interdisciplinary studies, from genetics and genomics, through physiology and biochemistry, to ecology and environmental biology, to be considered together, and sets the stage for predictive modelling of systems.Saline Systems include both coastal and inland regions, including natural lakes, marshes, springs, lagoons, and estuaries, and solar panes and other evaporitic and arid environments, and also their diverse micro- and macro-flora and -fauna. Specific approaches and research areas of interest include (1) the genomics, molecular biology, and environmental biology of halophilic and halotolerant organisms; (2) the limnology of salt lakes including microbial ecology, biogeochemical cycling, paleolimnology, and trophic and ecosystem dynamics; (3) the biodiversity, conservation, and resource management of saline environments; and (4) biotechnological applications of saline environments, including aquaculture.The environments of concern to Saline Systems covers the entire scope of the journal. The editorial board membership includes experts in the chemistry and biology of saline environments, including general limnology and biogeography, nutrient cycling, ecological modelling, and biostatistics, biology, taxonomy and phylogeny of halophilic archaea and bacteria, biology and ecology of halotolerant eukaryotes, including algae, fungi, protists, invertebrates, and plants, biology of Artemia, crustaceans, fish, and waterbirds, genomics and postgenomics of micro- and macroflora and fauna of saline environments, and aquatic conservation biology.The expertise of the editorial board of Saline Systems is an Open Access, online journal publishing high quality manuscripts on all aspects of basic and applied research on halophilic organisms and saline environments. A wide range of article types are published in the journal: research, book reviews, database articles, commentaries, methodology articles, short reports and reviews. Articles in Saline Systems are submitted and peer-reviewed via an online manuscript handling system, and accepted articles are published online immediately upon acceptance. In addition to the journal web site, the full text of each Open Access article is permanently archived in online repositories separate from the journal, including PubMed Central [Saline Systems become universally accessible online, and so an author's work can be freely read by anyone at no cost. Moreover, the authors hold copyright for their work, and they may grant anyone the right to reproduce and disseminate the article, provided that it is correctly cited and no errors are introduced [ Central , the US troduced .Saline Systems' policy of Open Access is highly beneficial for science and the general public. Traditional barriers to accessing research results are removed, resulting in dissemination to the widest possible audience. Authors become free to reproduce and distribute their work, for example on their institution's website. Articles are accessible beyond the traditional scientific audiences through increasingly powerful web search engines, which likely results in greater citations and higher impact [Saline Systems is not limited by library budgets, which are increasingly strained. Research published in the journal is accessible to all citizens, not just those with access to a library with a subscription. Importantly, scientists from resource-poor countries and institutions, as long as they have a connection to the internet [Saline Systems. It is very likely that our policy of Open Access will contribute toward levelling the scientific playing field and advance science.r impact ,8. Accesinternet , can accSaline Systems is that decisions about a manuscript are based solely on the quality of the work, not on whether the authors' can pay the article-processing charge. A fraction of the papers published in Saline Systems will have publication fees waived, at the discretion of the editors. Editors have no financial incentive or competing interest in articles published in the journal, and journal policies are intended primarily to advance science. We invite the entire community of scientists to contribute to the success of this timely field and its Open Access journal, Saline Systems.Another important policy of"}
{"text": "The main objective of the developed Digital Textbook is to present the Technology associated to the most important Diagnostic and Treatment Procedures, applied in contemporary Biomedical Practice. The target-group of this on-line volume comprise of both, students and those who are already engaged in professional work, such as physicians, nurses, engineers, physicists and other people trained in health-care related activities.The educational method used includes the presentation of the physical principles, upon which the procedures and equipment under investigation are based, as well as, the most common technical implementation of them. Furthermore, care has be taken to relate the described devices to the corresponding Hospital Departments or Health-Care Facilities, and some simple demonstrations and quizzes are included, that give the user the opportunity to become a little bit more familiar with the clinical hardware. For the development of the digital textbook, HTML was used, so that it can be used on any platform. The content of the presentation is a combination of theoretical knowledge and practice oriented information. Because of the enormous extend of the subject matter, the structure of the text, is rather that of an overview. The languages used are Greek and English.The developed system consists of educational modules, which presently include topics on the following subjects:In vivo Diagnostics Technology.In vitro Diagnostics Technology.Medical Imaging Technology.Operating Room and Intensive Care Technology.Radiation Treatment Technology.Environmental Protection in the Modern Hospital.Hospital Organization and Biomedical Technology Management.The textbook covers educational needs concerning the physical principles, the most common implementations of the medical equipment and the management of the infra-structure of the basic units of the modern Hospital. The new electronic media may offer a cost-effective \"digital alternative\", for individuals and Institutions. An appropriate combination of traditional and on-line educational activities, could contribute to the promotion of interdisciplinary research and to the improving of the interaction between senior and junior colleagues, in the training procedure."}
{"text": "The authors note that the above article  containeZandagi Nawin located in the Dai Afghanan section of the city.Second, the name of the outreach and NEP program in Kabul is Last, the current locations for counseling and prevention activities are Kabul, Herat, Faizabad, Gardez, and Kandahar with Nejat Center (Kabul) and GTZ working as separate entities. GTZ is working with NGO partners KOR in Kabul and Faizabad, with Wadan in Gardez and Kandahar, and with SHRO in Herat. We apologize for any misrepresentation and thank Dr. Bayan Shairshah for bringing this to our attention."}
{"text": "The first results from the population-based cancer registry for the city of Hanoi, in northern Vietnam, are presented. In men, incidence rates are moderate-low with the most common cancers being lung, stomach and liver. Cancer of the penis, reportedly very common in early case series from Vietnam, is now rarely seen. In women, incidence rates are low with the most common cancer, breast cancer, having a recorded incidence similar to that in China. Cervix cancer incidence is very low, which contrasts strongly with hospital series from the south of Vietnam, and of 30 years earlier in Hanoi. The incidence of choriocarcinoma is high, and that of nasopharynx cancer (in both sexes) moderately so; both findings are typical of southeast Asian populations. The incidence rates are coherent with the results from recent studies of Vietnamese migrants in the USA and UK."}
{"text": "Successful commercial marketing can mean the difference between a company's profit and loss, jobs or layoffs, growth or bankruptcy. Mention the word marketing to public health professionals, and you may get blank stares, head shakes, or looks of confusion . Marketing is not well-known or understood in the public health community, in part because it is rarely taught in public health or medical schools. Nonetheless, the time has come to increase our awareness, training, and application of health marketing strategies and principles, because the field holds great promise for increasing the adoption of health promotion and protection information and interventions.Mention the word benefit the organization and its stakeholders\" (emphasis added). The Centers for Disease Control and Prevention (CDC) has adapted this definition by defining health marketing as \"creating, communicating, and delivering health information and interventions using consumer-centered and science-based strategies to protect and promote the health of diverse populations.\" Health marketing uses the science and strategies of commercial marketing to promote its products, namely, evidence-based health information and interventions. Although the ultimate goal of commercial marketing is to benefit the product \"sellers\" and shareholders, the ultimate goal of health marketing is to benefit the product \"consumers\" and the public.As we grapple with ways to best reach the public and improve health, principles of commercial marketing are an underused resource. According to the American Marketing Association , marketiThe science and practice of health marketing draws heavily from several related and often overlapping disciplines and models. Market research, marketing strategy, and public relations allow for a customer-focused approach and an emphasis on strategic planning and dissemination. Health communication, risk communication, and health promotion provide a theoretical and practical basis for message development, design, and delivery. Health marketing also draws on such diverse disciplines as relationship management; social marketing; mass and speech communication; public affairs and journalism; health education; instructional design; sociology and psychology; and the creation of audio, video, and multimedia products, among others. Almost all of the aforementioned health marketing foundations emphasize the fundamental importance of audience engagement, a creative aesthetic, and extensive formative evaluation.Preventing Chronic Disease, Maibach et al , one of the newest among 12 national centers at CDC, was established in 2004 as a result of an agencywide strategic planning process known as the Futures Initiative. The mission of NCHM is to protect and promote health and advance CDC's goals through innovative health marketing programs, products, and services that are consumer centered, high impact, and science based. All of NCHM's people and programs are committed to being customer centered by identifying and meeting the needs of our audiences and partners; being high impact by leveraging our assets, strengths, and partnerships for maximum health impact; and being science based by using and generating scientific evidence and established best practices.product design, research, and development, with our primary product being CDC's science-based health information and messages. This group includes professionals in health communication, risk and crisis communication, market research and evaluation, marketing strategy, behavioral science, and our newest area consisting of multilingual translation, cultural communication, and health literacy activities. Maibach et al note the importance of customer research to effective marketing programs, and this NCHM unit has expertise in all aspects of customer and market research, as well as access to audience-specific databases and resources useful for developing messages and campaigns. Working with subject matter and communication experts throughout CDC, this group has extensive experience developing urgent and planned health messages and campaigns on almost any health issue for diverse audiences throughout the United States and the world.NCHM's activities and capacities fall into four functional categories of marketing. First, we have a unit focused on product production and packaging, and its primary products are health information and messages. This group includes professionals in graphic art and design; audio, video, and multimedia production; animation; photography; Web development; broadcast engineering; and instructional design and production experts in other related fields. The group also has access to state-of-the art design, media, and production technology through the Global Communications Center that recently opened on the CDC campus in Atlanta, Ga.Second, NCHM has a unit focused on product distribution, which contains many of CDC's external communication channels through which health information and message products are disseminated and delivered. Maibach et al note that marketing and distribution channels are generally considered to be the most important element in the marketing mix, and CDC is fortunate to have many powerful channels for communicating with health professionals and partners, including the Morbidity and Mortality Weekly Report (MMWR), the Guide to Community Preventive Services, the Epidemic Information Exchange (Epi-X), the Health Alert Network (HAN), a professional conference exhibit booth, and many others. CDC's channels for communicating with the public include CDC's Web site (www.cdc.gov), the CDC hotline (800-CDC-INFO), the Global Communications Center gallery and exhibits, the forthcoming HHS-TV channel on the Dish Network,\u00a0and many others. Together, we have a powerful array of distribution channels with which our customers can easily access and implement our products and programs.Third, we have a unit focused on customer relationship management, which coordinates CDC's new and ongoing relationships with our external partners. The active input from and relationships with our partners are one of CDC's greatest strengths. This unit works with collaborators throughout CDC to make our partner relationships as strong and as engaging as possible. As CDC's director, Dr Julie Gerberding, has noted, \"CDC's partners, current and future, are critical to achieving our public health goals and to delivering our products.\"Finally, we have a unit focused on As Maibach et al explain, partners can also serve as a \"powerful and sustainable distribution channel.\" In addition to relationship management, we work closely with our partners to encourage the public distribution and amplification of CDC's health information and to ensure greater alignment and consistency of health messages, particularly during crises or emergencies. Maibach et al also note the importance of engaging all sectors of society, including emerging public health partners such as for-profit businesses. NCHM actively works with all partnership sectors, including public health systems, health care organizations, education institutions and groups, and faith and community organizations, and has recently embarked on projects to form several new partnerships and products to serve for-profit businesses.Through our health marketing work, we strive to achieve our vision: a world in which all people actively use accessible, accurate, relevant, and timely health information and interventions to protect and promote their health and the health of their families and communities. Like the application of marketing to public health, NCHM is in its early days. More research, evaluation, and accumulated experience are required to effectively translate and apply the principles of marketing to public health.At the end of their article, Maibach et al state that significant public health resources, including training, should focus on health marketing strategies and that NCHM should cultivate these opportunities to blend marketing and public health. We accept our leadership role in this endeavor. We call on our colleagues and partners in public health and health marketing at all levels from all sectors to become involved and advocate for the advancement and proliferation of this discipline and perspective. Through our collaborative efforts, the blank stares, head shakes, and looks of confusion will turn to knowing, affirmative nods and smiles of recognition and understanding. We thank Maibach et al for drawing attention to marketing's usefulness and potential in advancing the field of public health."}
{"text": "Natural philosophy once spanned the fields of philosophy, science, and medicine. Scientific disciplines and medical specialties have rapidly achieved independence, and the availability of the internet and open-access publishing promises a further expansion of knowledge. Nevertheless, a consideration of the grounding concepts and ethical principles that underlie health care remains paramount. It is timely, therefore, to contribute to the global conversation on health care with an open-access journal that focuses on addressing the conceptual basis of medicine and related disciplines, considering the ethical aspects of clinical practice, and exploring its intersection with the humanities (including history of medicine). Open-access publishing has been a spectacular innovation for science and medicine, giving readers rapid and free access to new information, and launching a global conversation on health care. Health care researchers and practitioners have, in turn, busily produced new basic experiments, clinical trials, and reviews and guidelines for publication on the world-wide web, spurring further virtual debate and discussion. It is timely, we believe, to contribute to this conversation by making space for an open-access journal that takes a particularly broad view of health care, addressing the conceptual basis of medicine and related disciplines, considering the ethical aspects of clinical practice, and exploring its intersection with the humanities (including history of medicine).Those interested in the conceptual and historical roots of medicine will not need reminding that early on work in natural philosophy spanned philosophy, science, and medicine. While scientific advances have led to the development of an ever-growing range of scientific disciplines and medical specialties, a consideration of the grounding concepts and ethical principles that underlie health care remains as crucial as ever. Indeed, advances in knowledge, and changes in practice, mean that these grounding concepts and ethical principles require constant reconsideration and reworking. This, then, is the work of philosophy of medicine, of bioethics, and of work at the overlap between the clinic and the humanities.Philosophy, Ethics, and Humanities in Medicine is the first open-access journal that aims to expand the discussion on health care by focusing on the intersection between philosophy, ethics, and the humanities and clinical theory and practice. The arguments for open access have been outlined previously; authors are ensured of wide dissemination of their work and are at liberty to further reproduce and disseminate their articles, readers can find articles on standard search engines and obtain ready access regardless of the quality of their libraries, and taxpayers are easily able to review the outputs of publicly funded research [To our knowledge research . The advIn the spirit of open-access publishing and the internet conversation on health care, we will encourage a broad range of submissions, hoping to attract authors from different disciplines. Details of our editorial board and editorial policy are available on the journal's website . The jouWe hope that those working at the intersection between philosophy, ethics, the humanities and clinical theory and practice will become increasingly aware of the value of open-access publication, and will use the journal to contribute to the ongoing global conversation on health care. We are aware, on the other hand, that this is an intersection that has relatively little funding and few full-time researchers, and so attracting a steady flow of articles and discussion represents a considerable challenge. But if the good practice of medicine necessarily requires a good conceptual base \u2013 then we have little choice but to launch this journal, and to attempt to extend the virtual debate on health care to address its foundational constructs and practices.Dan Stein has received research grants and/or consultancy honoraria from Astrazeneca, Eli-Lilly, GlaxoSmithKline, Lundbeck, Orion, Pfizer, Pharmacia, Roche, Servier, Solvay, Sumitomo, and Wyeth."}
{"text": "Concerning the 25 year history and milestones of the National Toxicology Program (NTP), Among others, Congressman David Obey (Wisconsin) was convinced by Rall and key colleagues that a coordinated national program was needed to better promote the health of the American people by protecting them from exposures to hazardous chemicals in the workplace, environment, and home. Obey was instrumental in getting Congress to endorse this need for a national program and, after Rall\u2019s untimely death, encouraged Congress to name the main structure housing NIEHS/NTP in Research Triangle Park, North Carolina, as the David P. Rall Building.Rall was supported in this innovative and monumental NTP-forming effort by several other distinguished pioneers in environmental health research and public health, including Eula Bingham, then director of the Occupational Safety and Health Administration; Joseph Califano, then Secretary of the Department of Health, Education, and Welfare ; Donald Fredrickson, then director of the National Institutes of Health; Donald Kennedy, then director of the Food and Drug Administration; Cesare Maltoni, then director of the Bologna Centre for the Prevention and Detection of Tumours and Oncological Research; Norton Nelson, then director of the Institute of Environmental Medicine  New York University School of Medicine; Irving Selikoff, then director of the Mt. Sinai Medical Center in New York City ; Lorenzo Tomatis, then chief of the Unit of Chemical Carcinogenesis, International Agency for Research on Cancer (later director of IARC); and Arthur Upton, then director of the National Cancer Institute.Report on Carcinogens (Environmental Health Perspectives. Of course, during his illustrious career as physician, assistant surgeon general, scientist, and staunch public health advocate, Rall made many more and varied contributions to basic sciences and public health (Also, during that NTP-formative era, Rall helped establish the 1978 Public Law that initiated the innovative cinogens . Now in c health .David P. Rall, a dedicated physician and scientist, is among a relativity small group of exceptional public servants who have had a deep and lasting positive impact on human health by showing us how to understand and improve the environment in which we live, work, and play. To many of us who joined with him to make a safer environment, we clearly recognize the void he has left."}
{"text": "Research in the fields of Preventive Medicine, Occupational/Environmental Medicine, Epidemiology and Public Health play an important role in the advancement of knowledge. In order to map the research production around the world we performed a bibliometric analysis in the above fields.All articles published by different world regions in the above mentioned scientific fields and cited in the Journal Citation Reports (JCR) database of the Institute for Scientific Information (ISI) during the period 1995 and 2003, were evaluated. The research production of different world regions was adjusted for: a) the gross domestic product in 1995 US dollars, and b) the population size of each region.A total of 48,861 articles were retrieved and categorized. The USA led the research production in all three subcategories. The percentage of articles published by USA researchers was 43%, 44% and 61% in the Preventive Medicine, Epidemiology, and Public Health subcategories, respectively. Canada and Western Europe shared the second position in the first two subcategories, while Oceania researchers ranked second in the field of Public Health.USA researchers maintain a leadership position in the production of scientific articles in the fields of Preventive Medicine, Occupational/Environmental Medicine and Epidemiology, at a level similar to other scientific disciplines, while USA contribution to science in the field of Public Health is by all means outstanding. Less developed regions would need to support their researchers in the above fields in order to improve scientific production and advancement of knowledge in their countries. The fields of Preventive Medicine, Occupational/Environmental Medicine, Epidemiology and Public Health constitute scientific fields, along with clinical medicine, which play an important role on people's health around the world -3. ReseaWhile, the academic community strives to identify the best approach to assess the quantity and quality of research production between different geographical boundaries, languages and scientific disciplines, most scientists agree on the utility of the impact factor as well as additional adjusted indicators for international comparisons . SeveralFor example, Gehanno JF et al has reported that 1.4% of journals in the field of Occupational Health  account for 27% of published articles in the field, while Navarro A et al have reported that one or more institutions in the United States contributed over 40% of articles in Occupational Health ,19. In aIn the current investigation, we sought to identify and quantify the research production of different world regions in the fields of Preventive Medicine, Occupational and Environmental Medicine, Epidemiology, and Public Health around the world.The methodology we used in our study parallels other bibliometric studies performed by our research group in order to evaluate research productivity in specific scientific disciplines -17.We searched for articles published between 1995 and 2003 and included in the category of the \"Preventive and Occupational Medicine, Epidemiology and Public Health\", of the Journal Citation Reports (JCR) database of the Institute for Scientific Information (ISI) and the PubMed database ,24. At tThe articles' origin was assigned by searching the address of the first author of each article, which is registered in the PubMed database. For each search in the PubMed database, a phrase consisting of four parts joined together by the so-called Boolean operators, i.e. AND, OR, and NOT was used in the search field. Moreover, each separate search was limited to a specific year. Publication types such as letters, editorials, and news reports were excluded from the analysis. The results of these searches  were summed up.Out of 89 journals included in the journal category investigated during the period 1999\u20132003, a total of 72 journals were included in our study. A further division of these journals into three subcategories was performed; the first subcategory included journals with main focus on Preventive, Occupational and Environmental Medicine , the second on Epidemiology , and the third on Public Health .For the purpose of our study, the world was divided into 9 regions; United States of America (USA), Canada, Western Europe, Japan, Oceania, Asia (excluding Japan), Eastern Europe, Latin America and the Caribbean, and Africa; a classification based on a combination of geographic, economic and scientific criteria.The sum of articles produced by all different world regions in a journal was compared to the actual total number of articles published in that journal for a specific year. This number was obtained again from PubMed by not using any address limits. In this way we were able to check for missed or unretrieved addresses. We considered a search result acceptable if less than 5% of the total articles of a specific journal during a year were missed by our methodology, otherwise we performed manual searches for the author's address. To strengthen the methodological validity of our study, two investigators independently performed data collection. In cases of disagreement between the two investigators the results were discussed in meetings of all investigators of our research group.The index of quantity of research productivity was the number of published articles. The quality of research productivity was estimated by the mean impact factor of the examined journals for each published article. Finally, the product of the number of articles published in a journal multiplied by the corresponding impact factor of its journal, for each year studied, was considered as an integrated index of the quantity and quality of research productivity. The sum of these products from all journals, for each world region within a year, was assigned as a \"total research product\" for each world region.In order to evaluate factors possibly associated with the research published in Preventive and Occupational/Environmental Medicine, Epidemiology, and Public Health journals, we used relevant \"World Development Indicators\" from the online databases of the World Bank . The resUsing the methodology described above, we managed to retrieve and categorize 48,681 out of 49,980 articles, (97.4%) from the implicated journals indexed in PubMed during the study period. In tables As shown in Table Similar rankings for USA, Canada, and Western Europe are seen in Table Finally, data from the 28 Public Health journals are presented in Table In all of the 3 subcategories examined, the annual number of published articles worldwide showed an increasing trend, a phenomenon that was more pronounced in the \"Public Health\" subcategory . Even after overall adjustment for gross domestic product and population size, USA continued to lead. However, Canada researchers ranked first when scientific production was adjusted for gross domestic product in the fields of Preventive Medicine, Occupational/Environmental Medicine and Epidemiology. Furthermore, we found that four regions of the world with more than 50% of the world's population have minimal contribution in the scientific fields studied.Our results support previous findings suggesting that the majority of research published in scientific journals is carried out in the developed world . It is aSeveral limitations of our current investigation have been cited previously and would also apply -17. MostIn summary, we found that the USA, Western Europe, Canada and Oceania are the leading regions in the research production in the fields of Preventive/Occupational/Environmental Medicine, Epidemiology and Public Health, with the USA being far ahead especially in the subcategory of Public Health. We believe that our findings clearly indicate the need to promote research in the above fields in less developed regions of the world. Promoting research in less developed areas such as Africa, Asia, Latin America and Eastern Europe, may involve but not limited to the development of infrastructure including research and academic institutes, the improvement of current collaborative partnerships with developed nations, increased sponsorship and support from world agencies such as the World Health Organization and the United Nations, and the implementation of programs including free access to online journals and translation services for scientific articles published in languages other than the English language. All of the above are likely to increase research and development in the less developed regions of the world and improve peoples' health through the diffusion of knowledge and the implementation of large-scale research projects.ISI \u2013 Institute for Scientific InformationGDP \u2013 Gross Domestic ProductJCR \u2013 Journal Citation ReportsThe author(s) declare that they have no competing interests.MEF had the idea for the study and developed the methodology in collaboration with ESS. Both authors supervised the data collection, analysis and interpretation. Also, both authors contributed to the writing of the manuscript and approved its final version.The authors would like to thank Ms. Paraskevi A. Papastamataki, RN, and Dr. Ioannis A. Bliziotis, MD, for their help in the collection and analysis of data.The pre-publication history for this paper can be accessed here:"}
{"text": "A workshop of the Project on Evaluation of Screening Programmes of the International Union against Cancer (UICC) was held in Lyon, France. on November 20-22, 1984. The focus of the workshop was on screening for gynaecological cancer, especially for cancer of the cervix uteri. This report summarizes the presentations, conclusions and recommendations from the workshop."}
{"text": "A case-control study was undertaken to investigate the role of diet in women with breast cancer, and in two groups of women with benign breast disease: epithelial hyperplasia, and fibrocystic disease without hyperplasia. The study provides data which suggest that the consumption of red meat, savoury meals  and of starches is disadvantageous, while the consumption of chicken and fish, and of fruit, appears to be beneficial. These patterns were present for both the breast cancer patients and the patients with benign epithelial hyperplasia. One-third of breast cancer patients had changed their diet after their diagnosis, compared to only around 12% in controls and patients with benign breast disease. Overall, the women studied had changed their diet to reduce their intake of sugars, dairy products and meat, and increased their intake of poultry, fish, fruit and vegetables over the past decade; but the breast cancer group was less likely to have made this change."}
{"text": "Cancer mortality during 1970-85 of immigrants from East and West Africa and the Caribbean to England and Wales is described. Overall cancer mortality was raised in West African males , and non-significantly raised in West African females  compared to mortality in the England and Wales-born population. Much of the increased risk was due to very high rates of liver cancer in males , but rates were also raised for a wide range of other cancers in each sex. Only lung and brain cancer had significantly decreased mortality. In East Africans, overall cancer mortality was low in males , and in females . Mortality was significantly low for cancers of the stomach, pancreas and testis, and Hodgkin's disease in males, for cervical cancer in females, and for lung cancer and melanoma in both sexes. Cancer sites with significantly raised mortality included oropharyngeal cancer, leukaemia, and multiple myeloma in both sexes. In Caribbean immigrants overall cancer rates were significantly low in males  and in females . Mortality was significantly low for many cancers including colorectal, lung, testis and brain cancers. Mortality was significantly raised only for cancer of the prostate in males, of the placenta in females, and of the liver, non-Hodgkin's lymphoma and multiple myeloma in both sexes. Overall, mortality was high from prostatic cancer and liver cancer, and was low from brain cancer, in predominantly ethnic African immigrant groups. Both East and West African immigrants had raised rates of leukaemia. All of the migrant groups had high rates of multiple myeloma and low rates of testicular, ovarian and lung cancer. Genetic and environmental factors that may contribute to these patterns are discussed."}
{"text": "The article on influenza in tropical regions by Viboud and colleagues outlines an alarming global burden of influenza, with an estimated one million annual deaths worldwide . We woul2; population 23 million), officially known as the Republic of China, is located on the Tropic of Cancer. Taiwan lost its United Nation membership in 1971 to its rival, the People's Republic of China, but maintains official diplomatic relations with 25 countries and de facto relations with many nations. Taiwan has one of the highest levels of life expectancy in Asia, and it has eradicated infectious diseases such as the bubonic plague in 1948, smallpox in 1955, rabies in 1959, malaria in 1965, and polio in 2000. Taiwan became the first country in the world to implement a hepatitis B immunization program. Taiwan also initiated active vaccination programs against diptheria, pertussis, and tetanus in 1955, Japanese encephalitis in 1969, measles in 1978, hepatitis B in 1984, rubella in 1986, hepatitis A in 1995, and influenza in 1998. Valuable lessons may be learned from Taiwan's experience in public health and its response to disease outbreaks and crises.Taiwan . It has therefore been excluded from the Global Outbreak Alert and Response Network (GOARN). During the time of the enterovirus outbreak, Taiwan did not get any assistance from the WHO but managed to combat the outbreak. The avian flu scare of 1997 was controlled in Hong Kong because of timely action, aided by the WHO. If Taiwan is to respond effectively to similar outbreaks of global epidemics in the future, it will certainly need the cooperation of the WHO. Although the WHO is a non-political agency, because of pressure from the People's Republic of China, which considers Taiwan as a renegade province, Taiwan has been marginalized. Regardless of this, Taiwan has contributed over US$180 million since 1995 in medical and humanitarian aid to 95 countries, and it plans to make further donations. Therefore, excluding Taiwan from the WHO's GOARN is counterproductive from both medical and ethical standpoints.Taiwan, through its own efforts, has managed to improve public health remarkably, despite having no assistance from the WHO. It certainly has the potential to assist developing nations in the fight against emerging disease outbreaks, so other countries can seek Taiwan's expertise to fight against infectious diseases in the near future."}
{"text": "Medical data, disseminated in the Web or available in other digital forms, usually include clinical information obtained by the case history, signals related to bodily functions which are collected from in vivo diagnostic procedures, data acquired through in vitro diagnostic tests, images related to the morphology and the functions of the body and, finally, information related to various therapeutic interventions. Although these data, on the one hand, constitute cost-effective and practical means, augmenting equality in medical training, on the other, they result in a new type of fragmentation and compartmentalization of the patient's body and personality, thus endangering the interpersonal relation between him and the physician. Further, the use of the Web, combined with other traditional ways of distribution of medical data, such as published epidemiological studies and case-studies presentation in conferences and textbooks, intensifies the risk of eliminating the individual characteristics of the specific patient, in favor of the impersonal condition.The main challenge of a decision supporting system employing various educational means in web-sites or elsewhere, is the incorporation of social and ethical premises into the mode of the presentation of the medical inferences employed. This, however, necessitates the identification of the ethical issues which are involved in decisions made in a health care context and it requires the codification and the classification of the ethical problems. Additionally, this procedure should be employed in all sectors and the ensuing activities of the health-care providers, since problems are not identical nor do they carry the same weight in all real-world incidents.The authors argue, on the basis of a ten-year period of experience in the inter-disciplinary education of health-care professionals, that this goal can be reached only by the appropriate systematic instruction of all those -in the contemporary health-care system- involved in decision-making training. This means that the methods of reasoning employed in the inferences made in the various medical specialties should become common knowledge and that the acquaintance with the social and ethical issues, present in health care delivery, should be sine qua non.Such an educational process would contribute to the promotion of inter- disciplinary research and it would address, in an effective manner, the problem of intra-specialty communication in medicine. It would permit also the demonstration of the common characteristics of the reasoning models employed since the time Hippocrates."}
{"text": "For vaccines to reach the greatest number of people requires access, accelerated regional disease control, and the development of public health infrastructure. This is the second of two articles in the October 2005 issue on ways to create practical markets for vaccines.Thinking of ways to create practical markets for vaccines poses some interesting challenges, particularly in the context of introducing new and underutilized vaccines. In a complex, ever-changing world, making vaccines, whether they are new or old, available to children and families who need them most should be a top priority . Models Access to preventive and other health services covers several factors, including access to health units and hospitals, trained staff providing quality services, cost-effective technologies, the best use of available technologies, and information to improve the community's knowledge base and best practices.Inherently, improved access also addresses issues of equity. Equity is a critical cross-cutting concept that drives much of the work of PAHO and member countries. For vaccines, the challenge has always been, and will continue to be, to ensure that all communities benefit from the potential impact of these technologies .The initiative to eliminate rubella and congenital rubella syndrome in the Americas serves as an example of PAHO's member countries seizing the opportunity to ensure access, while promoting the ultimate goal of disease control , and the improvement of the public-health infrastructure . These ePublic-sector capacity development creates regional independence.In the Americas, targeting high-risk districts with low immunization coverage for special attention also promotes improved access and accelerated disease control. Efforts to strengthen leadership, management, and supervision of program activities have been essential for the success of this strategy. Districts that have less than 95% coverage are targeted for special training, outreach, and follow-up. This targeting helps ensure that even in middle-income countries the substantial disparities that exist in health are addressed. To that end, PAHO's member countries have conducted the annual Vaccination Week in the Americas, during which all countries attempt to reach and vaccinate marginalized, poor populations [In the context of access and equity, there is concern about global approaches to support only countries with average annual per capita income of less than $1,000, such as the approach taken by the Global Alliance for Vaccines and Immunization, thus limiting the scope of work and benefits that impoverished children and families could otherwise receive in the Americas. Currently, only six countries are eligible to receive support from the Global Alliance for Vaccines and Immunization: Bolivia, Cuba, Guyana, Haiti, Honduras, and Nicaragua\u2014representing only 7% of the population of the Caribbean and Latin America. However, 11% of people in the Caribbean and Latin America live below the international poverty line  [In the Americas, efforts to control disease over the last 20 years have led to significant improvements in the public-health infrastructure, particularly in the area of program management, surveillance, and public-health laboratories. In some countries, such as Brazil, the development of public-sector capacity for vaccine production was also a top priority. Such public-sector capacity development creates regional independence, competition to reduce vaccine prices among private-sector producers, and dependable supply chains that are sustained and that contribute to intercountry cooperation . CurrentFuture approaches that attempt to enhance practical markets for vaccines and that enhance the introduction of new and underutilized vaccines should consider prioritizing the following: access and equity for as much of the population as is possible, well-implemented accelerated disease-control and prevention strategies, and development of a public-health infrastructure.The general approach also requires high-level political commitment, adequate attention to management, supervision, and logistics, and sound technical strategies. The opportunity to address widespread disparities in health that exist in low- and low-middle-income countries that otherwise do not benefit from Global Alliance for Vaccines and Immunization's marketing approaches will be a huge challenge for the future. PAHO will continue to make the support of immunization to member countries a priority."}
{"text": "A strong network of state, provincial, federal, and regional partner agencies and organizations populate the GLIN with essential information for use by policy makers and others with an interest in the region.The Great Lakes Information Network (GLIN) is a partnership of public and private organizations managed by the Great Lakes Commission, an eight-state compact agency. The GLIN website, located at The site\u2019s homepage is divided into six different topic sections, plus a daily news page featuring current news articles, press releases, announcements, and links to information about lake conditions and weather forecasts. Visitors can sign up to receive daily news or to submit stories.The Great Lakes section of the site features an interactive map of the region. Clicking on different geographic areas brings up state-, province-, or lake-specific news as well as links to general resources , economic profiles, environmental information, and tourism sites.Science and the Environment Bulletin, and the Commission for Environmental Cooperation\u2019s summary of environmental law in North America.The Environment section of the GLIN site groups information into five topics, each with several subtopics. The main topics are Air and Land, Water, Flora and Fauna, Pollution, and References. Subtopics include sustainable development, air toxics, human health, toxic contamination, and environmental justice, among many others. This section also provides an overview of the Great Lakes natural environment and general resources including an online atlas of the region published by the U.S. Environmental Protection Agency, back and current issues of Environment Canada\u2019s Similarly, the Economy section includes information grouped under the main topics of Business Development, Business and Environment, and References, with agriculture, energy, economic development, and transportation among the subtopics.Aimed specifically for teachers, the Education portion of the site features free online \u201cmini-lesson\u201d modules for students in elementary through high school. Subjects covered in the lessons include the natural environment, geography, and pollution. The natural environment module features information on water diversion out of the region, invasive species, and protection of water quality. The causes and effects of Great Lakes pollution is the main focus of the pollution unit, which also includes a section on urban sprawl. An online glossary helps students with unfamiliar terms used throughout the modules.The Maps and GIS (geographic information systems) section of the site offers resources to help visitors customize their own Great Lakes map using GIS data , online mapping tools, and a gallery of free downloadable maps. The types of maps offered range from ecological assessment maps to satellite images.Finally, the Tourism section of the site, with its extensive list of local recreational, cultural, and historical offerings, provides one small hint of the richness of this magnificent natural resource we call the Great Lakes."}
{"text": "The endocrine system encompasses the thyroid gland, the hypothalamus, the pancreas, the adrenal cortex, the thyroid, the parathyroid, and the male and female reproductive glands. Two large and well-established societies, The Endocrine Society and the Society for Endocrinology, serve the practitioners of this field. Both groups have established websites to keep their members and the general public aware of newsworthy events and developments in the field, and to educate those laypeople wishing to learn more about the subject.http://www.endo-society.org/, features quick links so that information and materials can be pulled up by either subject or visitor\u2019s role . Among the 16 subjects featured are cardiovascular function, diabetes/insulin, genetics/genomics, male reproduction, and female reproduction. Also gathered in one area of the homepage are quick links to the society\u2019s five publications, membership information, a member directory, and a subscription page.The site of The Endocrine Society, The Endocrine Society\u2019s homepage features two news sections, one of news in the general media, the other of updates within the society itself. Also available from the homepage is information on the society\u2019s annual meeting, other society events, and related external events. Visitors can also select a quick link to The Hormone Foundation, the public education affiliate of the society, which offers basic information about the endocrine system, its function, and its associated diseases and disorders.The Endocrine Edge, a free monthly online newsletter geared toward the public with the latest news from the society and the field of endocrinology.In the Press Room portion of the site is information on the America Weighs In campaign. This program focuses on educating the media, policy makers, and the general public about the role that endocrinologists play in researching and treating obesity. The Press Room also features a link to http://www.endocrinology.org/, provides information about the Bristol, England\u2013based organization and its programs. The society is affiliated with five journals, all accessible from a page on the website. The society also publishes a free quarterly newsletter, The Endocrinologist, which contains society news, general news, and feature articles.The Society for Endocrinology site, The website also offers listings of grants and fellowships, society conferences, training courses sponsored by the society, and a calendar of events. The society sponsors a number of travel grants and has five research grant programs. There is also a page on books of interest to those in the field, which includes ordering information and short descriptions.Endocrine Nursing News newsletter with reports from members and meeting notes. Past issues are available on the society website through the Endocrine Nurses link. Another subgroup are the Young Endocrinologists. Formed to support endocrinologists for up to six years after they receive their Ph.D., this group runs educational courses, provides career advice, and organizes special sessions at the Society of Endocrinology and British Endocrine Society meetings.In 1997, the Society for Endocrinology established a committee for endocrinology nurses. This committee organizes conferences and an annual training course, and publishes the quarterly"}
{"text": "Cyberspace is a fast-changing, globally-networked, multicultural, and multilingual information environment with vast possibilities -9. It caThe Internet offers unprecedented power to provide users of healthcare information - patients, professionals, families, caregivers, educators, researchers, insurers, regulators, and policymakers - with data of unprecedented timeliness, accuracy, depth, and diversity. The very qualities that make the Internet such a rich marketplace of ideas - its decentralized structure, global reach, leveling of access to the tools of publication, immediacy of response, and ability to facilitate free-ranging interchange - also make it an exceptional channel for potential misinformation, unethical use, concealed bias, covert self-dealing, fraudulent practices, and evasion of legitimate regulation.There are many inadequacies concerning national and international controls and legislation, especially regarding the issue of jurisdiction; and urgent need for an internationally accepted policy framework that addresses basic rights and responsibilities of users and providers. Freedom of access to information and expression and the protection of users' data security and privacy are especially critical topics. Decisions and initiatives related to cyberspace law and ethics issues in health and healthcare must necessarily involve experts from a variety of knowledge domains involving civil and criminal law, medical ethics (bioethics), computing ethics, medical computing, and legal medicine.Given the sensitive nature of health care information, and the high degree of dependence of health professionals on reliable records, the issues of integrity, security, privacy, and confidentiality are of particular significance and must be clearly and effectively addressed by health and health-related organizations and professionals. Two factors make the matter a subject of preeminent significance: the intrinsically sensitive nature of patient data; and the growing use of network computing, particularly the Internet, for healthcare information processing. The growth of off-site processing and storage of electronic health records by application services providers (ASPs) adds a new dimension to those issues.Maintaining and safeguarding the integrity and physical protection of data and systems, privacy and confidentiality of individual health information, quality of content, and the protection of consumers and online health industry commercial interests against unethical practices, are the areas of greatest concern in the implementation and use of Internet and other interactive applications in health and healthcare.Privacy involves many aspects -18, and Electronic transactions involve important regulatory and legal issues not yet fully addressed. Vigilance in the maintenance of legal and ethical standards in the advertising, promotion, and sale of medical products through the Internet is required. Those standards include: approval of products, devices, and drugs by regulatory agencies at the site where the purchaser resides; the determination where the transaction occurred - in the purchaser's or the vendor's jurisdiction; and which courts and law will govern any disputes .Although there is a general agreement among conscientious professionals that all health websites should be held to the same standard and that the introduction of some form of \"seal of approval\" is an interesting proposition, enforcement is still a nebulous area. Particularly in the international setting there are complex issues of jurisdiction not yet addressed by laws or agreements.A number of organizations, government agencies, and scientific publishers have been active in the establishment of standards and methods to measure and assure credibility of health websites. One of the first players is the Health on the Net Foundation, established in 1996 ,33. AnotAlthough security, privacy, and confidentiality are matters of concern in telecommunication-based clinical applications, and indeed major features of it, such applications raise new challenges regarding professional conduct and accountability, technical standards, licensure, and reimbursement ,48. LiabThe society and public authorities have the responsibility to make information considered as of \"public good\" universally available for educational, cultural, and social needs. The challenge is to define and implement concepts, such as public domain contents and universal access to networks and services; and to promote public welfare while encouraging private initiatives and protecting human dignity, personal rights, fair use, intellectual property rights, and rightful economic interests.Traditionally, local standards are considered the yardstick against which health practice is evaluated, and they determine the parameters for eventual litigation. Remote conduction of health interventions brings forth, however, a whole new range of issues and ethical aspects in the telecare patient-provider relationship. Those issues have been reviewed and recommendations regarding a code of practice proposed ,13. GuidLicensing and professional standards of care providers and regulation of e-commerce is done in many countries on a regional or state level. Validation of professional licensure, alternative and non-approved health practice, contending with fraudulent practice and misleading claims, regulation, and legal jurisdiction problems on a national and international basis are major regulatory and quality assurance problems in these circumstances.The health sector has not addressed information security in a comprehensive manner. Healthcare organizations face a great variety of security, privacy, and confidentiality risks and must be made fully responsible for maintaining all aspects of security and confidentiality of data and information. Eventual conflicts between data sharing, data security, and confidentiality must be addressed early in the process of systems procurement and development and after implementation. Some health organizations have implemented security features in their information systems, but most organizations do not have written rules or procedures for their employees who are authorized to access client's information, such as policies on disclosure of sensitive information, or personnel policies dictating the types of disciplinary actions that will be taken if staff violate policies. Nevertheless, regulations and technical standards for privacy assurance and maintenance of data integrity and access security must be reasonable, in terms of recognizing the realities of health care delivery, the variability of application environments, and the diversity of national ethical values and legal systems.Developing countries are particularly affected by the rapid expansion of interactive communication technologies - increasingly, governments, professional organizations, advocacy groups, and users in developing countries have expressed their concerns about the impact of such happenings. Particularly, there is great apprehension about the reliability of healthcare information, new forms of health practice, advertising and commercial processes, content appropriateness, and privacy, as they pertain to the Internet. Multilateral or international agencies and national technical cooperation agencies are promoting the deployment of IHC applications, but have mainly focused on technological infrastructure development; little has been done regarding contents, human resources, impact evaluation, and ethical and legal aspects ,8,50-53.Ethical and regulatory questions, and national and international legislation addressing the many issues related to quality of information in the Internet, e-commerce, and telemedicine are a matter of present concern of many international organizations. The United Nations, and particularly UNESCO, the International Telecommunications Union (ITU), the World Health Organization (WHO), the World Trade Organization (WTO), regional trade blocks , and multilateral agencies such as the World Bank and the Inter American Development Bank have been in the forefront of initiatives directed to the promotion of exchanges in this area.Those are urgent and controversial issues that must be addressed jointly and comprehensively by international organizations, national and international scientific and technical societies, service providers, industry organizations, and users' interest groups, and not only from the viewpoint of legal or commercial interests. The United Nations specialized agencies, government organizations, independent and nonaligned consensus groups ,36,54-56Roberto J. Rodrigues, Member, JMIR Editorial BoardRegional Advisor in Health Services Information Technology, Essential Drugs and Technology Program, Division of Health Systems and Services Development, Pan American Health Organization / World Health Organization, Washington, D.C., USA"}
{"text": "As individuals take a larger role in managing their own healthcare, more consumers are independently seeking out health information via the Internet. Health professionals are also turning to the Internet to keep informed and interact with their patients. Given the vast amount of healthcare data available on the Internet, the Internet Healthcare Coalition was created to promote quality health resources online and to ensure that consumers and professionals are able to find reliable, quality information online.The Coalition is an international, non-partisan, non-profit organization dedicated to promoting quality healthcare resources on the Internet. Founded in 1997, the Coalition's membership represents every sector of the Internet health space, including consumers, patient advocates, commercial developers of health information, health professionals, medical librarians, government officials, and pharmaceutical manufacturers. The goal of the Coalition is to educate healthcare consumers, health professionals, and others about the evolving issues relating to the quality of Internet health resources and information.The Coalition is dedicated to:Educating healthcare consumers, professionals, educators, marketers, and both healthcare and mainstream media, as well as public policymakers on the full range of uses of the Internet - current and potential - to deliver high-quality healthcare information and services.Furnishing clear models, not only of good and bad sources of online healthcare information and services, but of the potentially disparate methods of evaluating disparate sources of information - from product- or disease-information sites developed by regulated manufacturers, to peer-reviewed electronic publications and patient support groups.Publicizing and promoting the use of currently available resources and developing new resources that exemplify ethical, innovative, and high-quality uses of the Internet to deliver healthcare information and services.Acting as a representative of our constituencies in areas of mutual concern before public policymakers and with the media.The Coalition consults with various government agencies including the World Health Organization (WHO), the US Food and Drug Administration (FDA), and the US Federal Trade Commission (FTC) on broader-based efforts to promote credible healthcare information and combat health fraud online. To that end the Coalition formed an Internet Health Fraud Resources Working Group which will work with the FTC to develop, coordinate, and promote a global online health-fraud reporting web site, which will link to authorities with jurisdiction over illegal or fraudulent online healthcare activities. Using this resource, consumers and healthcare professionals anywhere in the world can be sure that their complaints are transmitted to the appropriate authorities for action.The Coalition holds an annual conference, \"Quality Healthcare Information on the Net,\" each year in October or November for key thought leaders in the healthcare industry and government representatives to exchange their thoughts and opinions about the problems associated with and solutions to healthcare and the Internet. In October 1999, responding to calls from within the Internet Health community, the Coalition launched its ongoing \"eHealth Ethics Initiative\" to provide a forum for the development of a universal set of ethical principles for health-related Web sites.http://www.ihealthcoalition.org            The Coalition can be found at"}
{"text": "For more than a hundred years, the United States has operated a decentralized vital statistics system as an essential component of public health. Statistics based on births and deaths registered in the United States are a primary source of data used to track health status, to plan, implement, and evaluate health and social services, and to set health policy. The national vital statistics system provides nearly complete, continuous, and comparable federal, state, and local data. The system, however, is based on outmoded vital registration practices and structures, which raises concerns about data quality, timeliness, and the lack of real-time linkage capabilities. While many organizations are working together to address these issues and have made notable achievements, questions remain to be answered. Efforts to rejuvenate the nation's vital statistics system will need to expand dramatically to provide public health with a timely, high-quality, and flexible system to monitor vital health outcomes at the local, state, and national levels. For more than a hundred years, the United States has operated a decentralized vital statistics system as an essential component of public health. Statistics based on births and deaths registered in the United States are a primary source of data used to track the health status of the U.S. population, to plan, implement, and evaluate health and social services for children, families, and adults, and to set health policy at the national, state, and local levels. Data on access to prenatal care, maternal risk factors, infant mortality, disparities in health status, changes in the rankings of causes of death, life expectancy, years of potential life lost, and other pregnancy and mortality indicators provide the staples for public policy and programmatic debates about improving health and health services delivery. Unlike any other public health data system, the national vital statistics system provides nearly complete, continuous, and comparable federal, state, and local data to public health officials and programs. This strength enables population-based analysis and comparisons to be undertaken at the national, state, and local levels by age, race, ethnicity, and sex. For example, with more than two million deaths each year, disparities in the leading causes of death by race and age can be monitored and compared at the local, state, and national levels. Rare and emerging causes of death can be identified, and using both the underlying and contributing causes of death, the impact of such diseases as hypertension, diabetes, and atherosclerosis on mortality can be measured.Despite the importance of the nation's vital statistics system, it is based on outmoded vital registration practices and systems, a fact that raises concerns about data quality, timeliness, and the lack of real-time linkage capabilities for the more than six million annual vital events. To resolve these issues, vital registration requires more complete automation at the level of primary data collection and changes in the relationships among the providers of source records, the state registration offices, and the National Center for Health Statistics (NCHS). For example, for almost 20 years, states have been using electronic birth certificate systems. While this is a significant step forward, states continue to operate dual paper and electronic systems, with the paper record considered the official legal document. To compound these problems, the current electronic systems for vital registration at the state level have been difficult to modify, causing many states to delay implementation of the 2003 revisions to the U.S. standard certificates, which would provide a wealth of new information. Collection of death information continues to be primarily a paper-based process, unchanged at the local and state levels for the last half century. Funeral directors are responsible for collecting demographic information on the decedent from the next of kin, while attending physicians, medical examiners, or coroners provide and certify medical information on cause of death. Demographic and medical information are brought together manually by passing the paper certificate back and forth; the certificate data does not become computerized until reaching the state vital registration office, sometimes after considerable delay. The lack of automation at the source precludes timely follow-back to improve data quality and does not take advantage of existing internal systems of funeral directors and physicians. The Internet is not even used for electronic data transfer between data providers and state registration offices.To address these problems, the National Association of Public Health Statistics and Information Systems, NCHS, and the Social Security Administration have developed a partnership to improve the responsiveness of state vital registration and statistics systems. Their objective is to improve the timeliness, quality, and sustainability of these systems by adopting national, consensus-based standards and guidelines. It will be necessary to go beyond modifying existing registration systems. State processes and systems must dovetail with local data providers' processes and systems. Stand-alone systems and paper-based processes can no longer be considered adequate. An overarching consensus within this partnership is that business practices within state vital records offices and data providers must be documented and then updated to be more efficient and effective in light of today's technology and that these systems must be driven by national consensus-based standards and guidelines. The resulting reengineered state systems will use the 2003 version of the U.S. standard certificates of live birth, death, and fetal death. Reengineered systems will include efficient methods for capturing data, standard data-collection instruments, coding specifications, query guidelines, standardized definitions, and Health-Level-7\u2013based standardized messaging. As the Public Health Information Network expands and is knitted together with a National Health Information Infrastructure, these reengineered vital statistics systems will need to be integrated with other health information systems, such as those for immunizations, newborn screening, and hearing screening, and with electronic systems used by data providers, including hospitals, physicians, and funeral homes.The national partnership and its consensus process have already had some notable accomplishments, including the development of functional requirements for reengineered birth and death registration. The consensus national requirements will serve as the foundation for the design, development, and implementation of reengineered, Internet-based vital records and statistics systems for states. The most daunting challenge still to be overcome is the funding of the development and implementation of new systems, especially the automated reporting of deaths by the thousands of funeral directors and physicians who now manually provide mortality data.Many questions are yet to be answered. What is the most effective way to retrieve quality medical information from the attending physician, coroner, or medical examiner? How can funeral directors and physicians be connected electronically and share with the state confidential information about the decedent in a secure environment? At what level of specificity do prompts and data edits for the medical information obtained from the physician become counterproductive? How can the state vital statistics systems take advantage of the data systems already in use by funeral directors and medical examiners? Efforts are currently underway to address these questions. Efforts to rejuvenate the nation's vital statistics system are encouraging, but they will need to expand dramatically to provide public health with a timely, high-quality, and flexible system to monitor vital health outcomes at the local, state, and national levels."}
{"text": "If compared with printed media, the prospect for the success of health-related WWW publications lies in the added value of motivation and efficacy, due to the multi-modal coding of contents, in the possibility to provide search facilities and the flexibility of interaction with the user. An important advantage over the off-line distribution of disks or CD-ROMs is the automated diffusion and update of the contents. Whereas more and more medical WWW sites are launched, their acceptance and utilisation, especially in medical education is still unsatisfactory. Obviously, one reason for this phenomenon is the lack of quality. Many authors, developers and software publishers ignore that the design of high-quality electronic publications is a cost-intensive process. As key qualifications we identify: domain competence, software engineering skills, media production proficiency, GUI design competence, and didactic qualifications. On behalf of the German Association of Medical Informatics, Biometry and Epidemiology (GMDS), the authors have co-ordinated the development of a catalogue of \"Quality Criteria for Electronic Publications in Medicine\". This catalogue defines as Electronic Publications in Medicine any software containing health-related generic knowledge, with WWW publications being an important group. The criteria catalogue is divided into the sections contents, technical aspects, coding of information, ergonomy, dialogue and didactics. According to these items, typical faults and deficiencies of medical electronic publications are elucidated and possible solutions are given. Our criteria are intended to support the formative evaluation during the development of electronic publications, and to provide a basis for the summative evaluation of medical WWW and offline publications. The catalogue of \"Quality Criteria for Electronic Publications in Medicine\" is available in German, English, Portuguese and Spanish, at: http://www.imbi.uni-freiburg.de/medinf/gmdsqc/."}
{"text": "In 1998, the unique and experimental \"Looking over the horizon - An Internet-based International Course in Comparative Healthcare Management\" started. The course is a component of the larger project on \"Promoting International Co-operation and Understanding in Healthcare Management\". It is funded by the Canada-European Community Program for Co-operation in Higher Education and Training - a joint initiative between the Canadian Government and the European Commission.The purpose of the course is to enable graduate students from participating countries - Canada, Germany, Finland, and Ireland - to become better healthcare managers by learning more about their own and each others' healthcare systems and management processes. The course is structured around an introductory module  and four theme modules: Financing and Funding, Healthcare Delivery Issues, Impact of Health System Reform, and Evidence-based Management. The technology used for the delivery of the course is WebCT, a web-based distance learning software developed at the University of British Colombia. WebCT provides a large number of functions both for students - e.g.,e-mail, bulletin boards, chat rooms, and calendar - and for instructors - e.g., student tracking, page tracking, chat room log files, and marking management. Instructors are able to design the whole course, receive students' assignments, and post their assessments, via the World Wide Web.From January to April 1999, 25 students participated in the second course (19 students in the first course in 1998). The tracking function of the WebCT system was used to get some data about the students' activities. In 15 weeks, the students read an average number of 585  contributions -- i.e. the sometimes very profound messages posted by students and instructors --, whereas they posted 26  own contributions. The high activity of students is a typical characteristic of this student-centred course. Students have the opportunity and responsibility to be both students and teachers for the others. The role of the instructor, however, changes from that of the source of knowledge to that of a supervisor. Therefore students themselves can significantly increase the quality of the course.So far, 44 students participated in the course. For all of them, it has been a valuable experience of learning, which both increased their knowledge of national and international management issues and improved their technical skills on the field of the new medium Internet. The possibility to provide international courses via the Internet gives a new dimension to world-wide medical education and should be used very intensively. For the part of \"Looking over the Horizon\", the course is planned to expand on more students and even more countries."}
{"text": "EHP address the application of toxicogenomics data in the risk assessment and regulatory processes. Also addressing these issues is the National Research Council/National Academy of Sciences Committee on Emerging Issues and Data on Environmental Contaminants. (http://dels.nas.edu/emergingissues/index.asp). This committee, formed at the request of the National Institute of Environmental Health Sciences (NIEHS), provides a public forum for discussing emerging issues in environmental toxicology.The two editorials in this issue of The committee comprises experts from academia, industry, and public interest groups whose specialties include toxicology, toxicogenomics, genetics, bioinformatics, risk assessment, medical ethics, epidemiology, communications, public health. In addition, a U.S. federal government liaison group has been created to work with the committee with representatives from the NIEHS, the Centers for Disease Control and Prevention, the Environmental Protection Agency, the Food and Drug Administration, the Department of Agriculture, the Department of Energy, the Occupational Safety and Health Administration, the Department of Defense, and the Department of Transportation.A subcommittee is being formed to write a \u201cConsensus Report on the Applications of Toxicogenomic Technologies to Predictive Toxicology.\u201d This report will highlight how the study of gene and protein activities and other biological processes can improve the characterization of toxic substances and their potential risks. Ultimately, this report should show how major new or anticipated uses of these technologies could improve the protection of public health and the environment."}
{"text": "Existence of doctors with high performance is one of the necessary conditions to provide high quality services. There are different motivations, which could affect their performance. Recognizing Factors which effect the performance of doctors as an effective force in health care centers is necessary. The aim of this article was evaluate the effective factors which influence on clinical performance of general surgery of Tehran University of Medical Sciences in 2015.This is a cross-sectional qualitative-quantitative study. This research conducted in 3 phases-phases I: (use of library studies and databases to collect data), phase II: localization of detected factors in first phase by using the Delphi technique and phase III: prioritizing the affecting factors on performance of doctors by using qualitative interviews.12 articles were analyzed from 300 abstracts during the evaluation process. The output of assessment identified 23 factors was sent to surgeons and their assistants for obtaining their opinions. Quantitative analysis of the findings showed that \u201cwork qualification\u201d (86.1%) and \u201cmanagers and supervisors style\u201d (50%) have respectively the most and the least impact on the performance of doctors. Finally 18 effective factors were identified and prioritized in the performance of general surgeons.The results showed that motivation and performance is not a single operating parameter and it depends on several factors according to cultural background. Therefore it is necessary to design, implementation and monitoring based on key determinants of effective interventions due to cultural background. Human resources are intellectual and capable factors that can create powerful and dynamic organization by optimizing the use of other resources . ObviousThis cross-sectional quantity-quality study research was conducted in three phases. The first phase, research: In this phase, information on performance evaluation, motivational factors of improving performance, and factors affecting the performance of doctors was collected using databases including The National Library of Medicine, Pub Med, EMBASE, Science Direct, Scopus, Springer link, and Google Scholar.The second phase, indigenousness of the identified factors: In this step, using the results of the first stage, the Delphi technique was used to criticize and validate initial list, the identified factors affecting the operation of general surgeons were presented to participants  and their feedback was collected.The third phase, prioritizing the factors affecting the performance of physicians: In the final stage of the project, researchers discussed the factors affecting the performance of the doctors in focused group sessions and ranked these factors in order of their depth of effect.The findings are adjusted in four sectors including: the results of the comprehensive review of studies, quantitative analysis of questionnaires, qualitative analysis of interviews, and summarizing the findings of the study.The findings of the comprehensive review of studiesIn this phase of the study, the most important keywords and databases, including Google Scholar, Pub Med, Pro Quest, Cochran library, ISI web of knowledge, Scopus, and Embase (1990 to present) were studied.The study began with a literature review of 300 abstracts. After inspection, 154 abstracts were excluded because of remoteness from the subject and 146 articles were evaluated. The assessment output was 12 articles. The information of 12 articles were evaluated in \u201cgeneral information\u201d and \u201cspecific information\u201d aspects. General information included: title, first author, year of publication, the performer country, the country of field of study, the journal, and the aim; and specific information included: author, type of study, method of data collection, data analysis, and findings. After assessing and analyzing the articles, identified themes were extracted and factors affecting employees\u2019 performance were listed case by case.The primary identified themes were divided into three categories: personal factors, job and its nature, and organizational factors and job environment. The output was provided to general surgeons as the table below.Analysis of demographic variablesIn the current study, 22% of the samples aged 30 to 39 years, 38.9% of them aged 40 to 49 years, 5.6% of them aged between 50 and 59 years, and 5.6% were over 60 years old. 33.3% of the participants were female, 66.7% were men. Minimum job experience was 2 years and maximum was 20 years. 25% of the samples had less than 5 years of job experience, 81% of them less than 10 years, 92% less than 15 years, and 100% of them less than 20 years.The output of the first stage of DelphiAfter the implementation of the first phase of Delphi, the results were determined as follows. Given that more than 50% had over 60% consensual opinions, the following consensus was achieved in the first phase of Delphi.Qualitative analysis of interviewsIn this study, with implementation of Delphi, an open question was asked from participants to complete and correct the identified factors. In this part, we analyzed the conducted interviews qualitatively. The conceptual framework in the process of qualitative analysis was corrected, if necessary, and some of the subgroups of concept changed in this process. Finally, 3 topics and 11 sub-topics were identified in examining the relationship between the insurer and hospitals.In the final phase of the study, the results of the implementation of the Delphi techniques and analysis of interviews led to identify factors affecting function of general surgeons. In this section, these factors are presented in a table.The health and treatment sector account for a large part of costs and doctors has a very significant role, so their performance is evident on health sequences of the country. The results of the current study showed the role of factors of competence, passion, experience, and knowledge of the person from the job and salary payment method on general surgeons\u2019 performance.Competence to do the job, interest, and understanding of the job have been identified as the most influential factors on performance of physicians. Similar to the study of Method of payment ranked fourth, which was among factors with a score high. Muhdi and et al. also state that the payment method can potentially affect the performance . Marce aPersonal characteristics such as age, sex, and type of personality were the factors affecting physicians \u2018motivation. Four factors, including factors affecting psychological condition, type of view, professional responsibility, and job conscientious, were the most important items reported by interviewees in this area. These factors have been emphasized in Heydari\u2019s study  and the 2. One of the participants said in this regard: \u201cI suppose, job security should be evident. As too much or too little of it can be both damaging and harmful\u201d (Interview 12), which is similar to Heydari\u2019s results, conducted on prioritization of stressors affecting job performance of staff of Uremia University of Medical Sciences, reported negative factors affecting the performance , organizational factors affecting the performance negatively . Special jobs induce boredom and disgust after a while and weakens the job motivation in individuals that can be overcome by diversifying jobs, promoting employment, and providing further education .In study of The findings show the effect of variable intrinsic factors on physicians\u2019 performance and study Mathieu\u2019s study and et al.  also conThe results showed that physicians\u2019 motivation and function is not a single operating parameter and several factors play a role with regard to cultural background. Therefore, it is necessary to implement and monitor more effective interventions based on key determinants or cultural background design. The health authorities should pay more attention to the importance and role of factors affecting job motivation. Individual factors, such as the competence to do the job, interest in the job, person\u2019s knowledge of the job and its importance, personality type, age, and work background (experience); and organizational factors, such as the tariff, payment method , possibility of development and scientific progress, job security (employment type), diversity in the job, professional responsibility, and job\u2019s professional relationships are the most important effectors of performance. Thus, health authorities should pay attention to the role of these factors and plan long-term to improve motivation and consequently the performance of physicians and prevent them from leaving the system and the country.ContributorsFF contributed to the conception and design of the work, and the acquisition, analysis and interpretation of data, and drafted the paper. EM, JN, TY, SFandARFcontributed to the conception and design of the work, and the acquisition, analysis and interpretation of data. EM contributed to the conception and design of the work, and the acquisition and interpretation of data. All authors contributed to the revision of the paper and approved the final manuscript for publication. All authors have agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved."}
{"text": "Bernard Zinman, Programme Committee Chair of the International Diabetes Federation (IDF) World Diabetes Congress 2015, talks about the scientific programme highlights, the experience of attending the Congress and his involvement in diabetes care and research. Bernard Zinman is Director of the Leadership Sinai Centre for Diabetes and holds the Sam and Judy Pencer Family Chair in Diabetes Research at Mount Sinai Hospital and the University of Toronto, Canada. He is Professor of Medicine at the University of Toronto and Senior Scientist at the Samuel Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Ontario, Canada. The International Diabetes Federation (IDF) World Diabetes Congress (WDC) 2015 will be held in an outstanding venue in Vancouver, Canada. The programme will comprise symposia, debates, workshops, meet-the-expert and poster discussion sessions, and will present recent advances in six distinct streams including: Basic and Clinical Science, Diabetes in Indigenous Peoples, Education and Integrated Care, Global Challenges in Health, Public Health and Epidemiology and Living with Diabetes.Members of broad-based multi-disciplinary diabetes health care teams, individuals active in diabetes organisations, people with diabetes, diabetes-related industries and health ministries of various government sectors will all benefit from the diverse programme.The uniqueness of the IDF WDC derives from its international flavour, the diverse background of its participants and the integration of cutting-edge research with education and clinical care. It truly is a unique event for people involved with every component of the diabetes community to meet and exchange ideas.My background in biochemistry and passion for research directed me to a career as a clinician scientist in endocrinology with a major focus in diabetes.To effectively address the epidemic of diabetes we need three approaches. First, we need to develop effective strategies to prevent diabetes with a focus on reversing the increasing rates of obesity and physical inactivity particularly as it relates to our children. Second, we need to develop and implement effective diabetes treatment regimens very early on in the course of the disease to prevent the devastating complications of diabetes. And finally, for those with diabetes and complications, we need to screen efficiently for these complications and apply effective treatment before they become disabling and affect the long-term outcomes and quality of life."}
{"text": "Andrija \u0160tampar School of Public Health celebrates its 90th anniversary. The School was opened on October 3, 1927 as a result of professor Andrija \u0160tampar\u2019s vision and many years of work. At the beginning of its activity, the School of Public Health was a joint organization with the Hygienic Institute. At that time, the School\u2019s task was to study circumstances that could adversely affect public health and to educate people about major health issues. State-of-the-art technology was used, including several film workshops, which produced quite a number of educational films regarding public health.This year In 1947, the School became part of the University of Zagreb School of Medicine. From its beginnings to the present day, the most important role of the School has been education of medical doctors at all levels in the range of fields, from outpatient health care to public health competencies. The School maintains postgraduate courses in hygiene and social medicine and primary health care. The first postgraduate study in public health took place in 1947.Specialization in general practice or family medicine at the School started in 1960. It was the first such program globally. Nowadays, at the Andrija \u0160tampar School of Public Health medical students continuously gain public health knowledge and skills within different courses. Postgraduate specialist studies in family medicine, school and adolescent medicine, occupational health and sports medicine, public health medicine, epidemiology, and health management are also provided at the School. In addition, the School contributes to postgraduate doctoral studies \u201cBiomedicine and Health\u201d at the University of Zagreb School of Medicine.During its history, the inner structure of the School underwent changes several times. Departments and institutes were founded and closed, merged or separated. Today, within the School of Public Health, along with the Library \u201cAndrija \u0160tampar\u201d, the Office of Educational Technology and the Secretariat, there are five departments of the School of Medicine including Department of Social Medicine and Health Care Organization, Department for Medical Statistics, Epidemiology and Medical Informatics, Department of Health Ecology, Occupational Health and Sports Medicine with the Laboratory for Water and Balneoclimatology Research, Department of Medical Sociology and Health Economics, and Department of Family Medicine.The social, epidemiological, technological, and political circumstances over the course of 90 years have changed constantly. Today, almost nothing is the same as it was at the time of the School\u2019s foundation. Immediate goals and tasks are necessarily also different, but the strategy that leads to health for all remains unchanged. From its foundation to the present day, the School has been an exceptional and recognizable project that set high goals for national health policy and medical profession. Many of these goals have been realized in a magnificent way. The School has changed the destiny of a large number of people positively. It began with health projects in Turopolje and continued in neighboring and remote countries and continents. We have partnered in projects with colleagues from many countries including Japan, China, the Netherlands, the United Kingdom, the United States, and others. Today, the School is part of the European and global network of public health education and research institutions. It actively cooperates with the Association of Schools of Public Health in the European Region (ASPHER) and the World Health Organization (WHO). The School includes two WHO Collaborating Centers, the one for HIV strategic information and the one for Occupational Health.As long as illness and disease occur, as long as there are health problems in individuals and vulnerable population groups, our School of Public Health continues with its mission. Andrija \u0160tampar, our founder, our great teacher and visionary, has set high educational goals for public health professionals. Previous goals of sanitation and fight against infectious diseases, malaria, and tuberculosis are today largely replaced by new challenges posed by cardiovascular diseases and addiction and mental health issues. Today, in the 21st century, the School\u2019s task is to convey new insights through contemporary communication channels and technologies, supporting public health with best available scientific evidence and translational research, building the bridge between public health theory and practice. Working together, academic researchers and local communities bring us into a realistic world of needs and opportunities. By strengthening public health competency in local communities, we provide citizens with support in achieving better health. The translation circuit loop is closed by simultaneous application of accumulated knowledge, both in practice planning and management for health and in teaching at the graduate, specialist, and doctoral level.Our main aim in the years to come is to sensitize young researchers and promote their inclusion into public health science to ensure better understanding and functioning of the health care system as a whole."}
{"text": "Long-lasting insecticide-treated nets and/or indoor residual spraying, associated with case management, are key interventions in the control of malaria in Africa. The objective of this study is to comment on the role of social and behavior change communication as a potential key intervention in the control of malaria in Mozambique. Malaria is a major public health problem in the world, with approximately 207 million cases and 627,000 deaths per year. Most of the cases (80.0%) and deaths (90.0%) occur in AfricaMalaria is endemic in Mozambique and it represents 45.0% of all the cases observed in outpatient appointments and 56.0% of the admissions in pediatric wards,,The use of long-lasting insecticide-treated nets (henceforth referred as \u201cinsecticide-treated nets\u201d) and/or indoor residual spraying (henceforth \u201cIRS\u201d) can reduce malaria morbidity and mortality, especially in children and pregnant womenThere are three determinants of malaria distribution: i) the epidemiological triad: mosquito, parasite, and human; II) environmental factors; and, III) global factorsanopheles gambiae s.s. and anopheles funestus, has a leading role as vector in sub-Saharan Africa and in Mozambique. It is responsible for the sporogonic cycle of the parasite.The mosquito, particularly plasmodium falciparum, the most deadly of all the species in sub-Saharan Africa and in Mozambique, and the human being complete the epidemiological triad of the occurrence of the disease,The parasite, in particular ,Among the environmental factors, we highlight: temperature, relative humidity, and rainfall, which promote or inhibit the development of the vector in certain parametersThere is a strong negative correlation between the Human Development Index (HDI) and the prevalence of malaria in Mozambique by province, with Pearson coefficient of -0.8 and coefficient of determination of 64.3% .,36,,,Studies and the World Health Organization suggest that insecticide-treated nets and/or IRS associated with case management are key interventions in the fight against malariaRo of malaria is directly proportional to the vector capacity (C) that is the potential number of secondary cases originating from a primary case, in one day. The term refers to the combination of the components that determine the effectiveness of a local population of mosquitoes in transmitting malaria. Although the human host is the beginning and end of the sequence, the term refers to the stages of the insect, and not the ones that occur in the human hostRo. The higher Ro means high malaria prevalence in a given region.The m), II) number of blood intakes per mosquito in one day (a), III) efficiency of the malaria transmission system (b), IV) possibility of a mosquito becoming infectious (pn)Vectorial capacity (C) is directly influenced by: i) number of female mosquitoes per person , the socio-ecological model, and the social and behavior change communication.According to the Brazilian National Commission on SDOH, SDOH are social, economic, cultural, ethnic/racial, psychological, and behavioral factors that influence the occurrence of health problems and their risk factors in the population. The Commission on Social Determinants of Health of the WHO adopts a shorter definition, according to which SDOH are the social conditions in which persons live and workThe Dahlgren and Whitehead model about the SDOH establishes four layers of determinants: i) proximal , ii) social and community networks, iii) living and working conditions, and iv) distal From the socio-ecological model, the various levels of influence are examined to find the critical point for changes, as well as the individual motivation and knowledge and the social/gender norms, skills, and, favorable environment. This model considers the individual behavior as the product of multiple individual, social, and environmental influences, and it combines the individual change in order to influence the social context in which the individual operates. In this model, the levels of analysis are represented by rings that show the domains of influence and the persons representing them at each level. The first ring, named \u201cindividual\u201d, represents the most affected persons. The second and third rings represent the persons who have direct contact with those most affected and who influence their attitudes, beliefs, and actions, shaping the community and gender norms and/or access to, and demand for, community resources and existing services. The fourth ring, the widest, includes those who indirectly influence those most affected by the issue and represents the favorable environmentMozambique, as many countries in sub-Saharan Africa, has a high illiteracy rateSocial and behavior change communication (SBCC) is an interactive, researched, and planned process that aims to change social conditions and individual behaviorsThe sharing of information about measures of malaria prevention through \u201csocial and community networks\u201d (second layer in the Dahlgren and Whitehead model) and rings two and three of the Social-Ecological Model may influence the education of persons and their individual and/or collective lifestyles.,In communities where the engagement in the fight against malaria has been achieved, programs for the control and elimination of malaria can be successful,,Factors such as exposure to messages, risk perception, self-efficacy, response efficacy, and knowledge on the transmission and symptoms of malaria are associated with preventive behaviorsThe use of various approaches can be a synergistic strategyApproaches using community radio, pamphlets, lectures, dances, theater, community dialogs, among others, should be considered as synergistic approaches and not as replacements for one or the other. These approaches of SBCC should be a process of mobilization and empowerment of the community, used to provide information, skills, and confidence to communities to gain control over decisions related to their own lives.The network of community volunteers that make a health committee, in addition to community leaders, volunteers from religious faiths, political parties, traditional health practitioners, all trained in malaria prevention and different approaches of SBCC, can be a precious resource to support health professionals and fortify the key malaria interventions: insecticide-treated nets and/or IRS associated with case management.Teachers, especially in the primary education, may also be promoters of behavior change when transmitting malaria knowledge to students. This will influence their future behavior toward malaria prevention. On the other hand, students will be able to disseminate information in their communities and households.Innovative ways to transmit preventive messages on malaria for behavior change should be explored to increase the effectiveness of the synergism of the channels of SBCC.The provision of key interventions for vector control (insecticide-treated nets and/or IRS) and case management may not be enough to reduce the burden of malaria in Mozambique. Social and behavior change communication can play an important role which might be of similar and/or greater value than vector control. Interventions on social and community networks may be an important point of access for the various methodologies and approaches of social and behavior change communication."}
{"text": "Revista de Sa\u00fade P\u00fablica, in the 50 years of its publication. A narrative review study was carried out using PubMed, as it is the search database that indexes all issues of the journal. From 1967 to 2015, 162 manuscripts specifically focused on oral health themes were published. This theme was present in all volumes of the journal, with increasing participation over the years. Dental caries was the most studied theme, constantly present in the journal since its first issue. Periodontal disease, fluorosis, malocclusions, and other themes emerged even before the decline of dental caries indicators. Oral health policy is the most recurring theme in the last two decades. Revista de Sa\u00fade P\u00fablica has been an important vehicle for dissemination, communication, and reflection on oral health, contributing in a relevant way to the technical-scientific interaction between professionals in this field.This study describes the scientific production on oral health diffused in  To guide this action, it is essential to conduct epidemiological studies, of planning and management, and studies on social sciences in health specifically focusing on such conditions in its multiple dimensions.Revista de Sa\u00fade P\u00fablica (RSP). When celebrating its 40 years, we noted that oral health was one of the main thematic areas of the journalThis understanding permeates the entire history of On the occasion of RSP\u2019s 50th anniversary, the present study aimed at describing the scientific production on oral health issues diffused in the journal throughout its history.We carried out a narrative review study. For the retrieval of the published articles, we used the PubMed search database, which indexes all issues of the journal. Two examiners conducted the search independently and resolved conflicts by consensus. The selected articles were classified in subthemes and synthesis for presentation purposes.From 1967 to 2015, RSP published 162 manuscripts specifically focused on oral health themes, including original articles, theoretical review, reviews, editorials, and previous notes. The Dental caries was the oral health condition that most motivated studies on the pages of RSP. It was also a constant theme during the five decades of the journal. Sixty-nine articles assessed the prevalence of dental caries in the population in general and in specific groups, inequality in its distribution, preventive resources, and methodological aspects of the forms of measuring the severity.,Already in its early years, dental caries prevalence was described for different cities, having as reference the addition of fluoride in the water supply systemAnticipating the concern with social inequalities in health, pioneering studies addressed differences in the prevalence of dental caries according to social strata. In the first issue of RSP, Souza et al.In the latest period, a decline in the prevalence of dental caries was observed. Articles published in RSP described and analyzed empirical data justifying this observation. Narvai et al.,,However, the decline in dental caries prevalence was accompanied by increased inequality of their indicators between the social strata. This phenomenon, referred to as polarization of dental caries experienceMethodological aspects of measures of dental caries in the population also motivated pioneering studies on RSP. In 1973, SouzaAnalytical techniques widely used in studies on public health also had pioneer application to the area of oral health in the pages of RSP. Linear regression,,Still considering original themes of research in oral health, RSP has published studies that, in time, have had an impact on the prevention of dental caries. Mouthwashes and topical applications of fluoride gel in mouth trays were object of study already in the first volumes of the journal, becoming popular in BrazilThe aging of the population, a theme so important to contemporary public health, motivated studies on oral health in RSP in different periods. Dental caries, periodontal disease, dental loss, and prosthetic use were discussed, in 1992, in a study identifying the need for specific odontological policies and programs for older peopleFigueiredo et al.The welfare of professionals working with oral health have also motivated studies. Regarding the decrease in risk of infection of these professionals, Martins and BarretoEven before the decline of dental caries indicators, other oral health themes emerged as public health problems, requiring action of health authorities and health services. In particular, several studies of RSP focused on distribution, forms of measurement, associated factors, and consequences of malocclusion, gingival inflammation, and periodontal diseases, conditions widely prevalent.Tomita et al.Dental fluorosis, another emerging theme on the agenda of priorities in public health, was present in the pages of RSP in the last two decades of its 50 years. Studies with different methodological schemes assessed its prevalence and its perception by the population as well as the related beliefs and attitudes. Lima and Cury,Oral cancer and orofacial clefts are less prevalent conditions; but their severity justifies the inclusion on the agenda of priorities in public health. These themes are also present in RSP, in the latest period. Loffredo et al. estimated the incidence of oral clefts in BrazilThe planning of dental services for patients requiring special care has also been the object of studies published in RSP. Oliveira et al.The study on oral health policies stood out in the last two decades. About a third of the articles published in RSP in this period addressed oral health policies and related issues of the planning and management of dental services. Such studies proposed and evaluated programs such as fluoridation of the water supply network, preventive procedures and of oral health promotion, the importance of the auxiliary professionals composing oral health teams in direct provision of services, and the dental care in public and private networks.Even before the Brazilian Unified Health System (SUS) was deployed, Vitor Gomes PintoLacerda et al.Camargo et al.Programa Brasil Sorridente (Smiling Brazil Program), Scherer and SchererOn the occasion of the ten-year anniversary of the RSP has been an important vehicle of communication of scientific knowledge in the field of collective oral health. Since its first issue, and in all its volumes, the journal has been publishing search results about oral health themes of interest to public health, contributing to scientific reflection, professional training, and health planning. The Brazilian Ministry of Health recognized the importance of the journal for the scientific communication in the field of oral health, choosing it to publish, in 2013, a supplement to studies describing and analyzing the results of the National Survey on Oral Health, the epidemiological survey, also known as SBBrasil 2010.Dental caries has held a prominent position in the published articles. It was also the study on dental caries that, in part, promoted the discussion of methodological innovations, both in terms of its evaluation in epidemiological investigations, and in statistical techniques of analysis. Over time, other harms to oral health, such as adverse periodontal conditions,fluorosis, malocclusions, and oral cancer, were explored according to varied theoretical-methodological perspectives and linked to the Brazilian context.The growth of publications in the thematic area of policies, planning, management, and evaluation of oral health services sought to answer, among other priorities, the problem represented by dental caries, including demands for qualified services to handle its direct demonstration or more severe consequences. Publications diffused in RSP expose a set of major transformations in scientific thought and valuation of the oral health theme.The synthetic description of these studies provides identifying the involvement of different oral health themes in the evolution of the agenda of priorities in public health. The journal has been employed by researchers in the field as an instrument of dissemination, communication, and reflection of scientific knowledge, contributing in a relevant way to education and technical, scientific, and professional interaction."}
{"text": "To construct and validate a nursing care protocol in anesthesia. methodological study of face and content validation, judging clarity, relevance,pertinence and comprehensiveness of a care protocol, elaborated from theintegrative review of previous literature and based on the conceptual model ofassistance perioperative nursing of Castellanos and Jouclas. The protocol wasevaluated by five anesthesiologists and nurses from the surgical center. Theresults were analyzed through the content validity index. among the 119 items assessed by experts, 11 (9.2%) instrument items presentedcontent validity index of <80% and were changed. The items with disagreementwere related to the selection and availability of materials and equipment,especially before anesthetic induction. The content validity index, obtained forthe different items, proposed after the amendments mentioned, ranged from 80 to100%, in the three periods of anesthesia, indicating the proper validity of theproposed content. the nursing care protocol in anesthesia was considered valid. Anesthesia allows the patient comfort during surgery, once the choice of the anesthesiacategory is based on the type, duration and approach required during the surgicalprocedure, associated with the clinical, mental and psychological conditions of thepatient. Thus, the types of anesthesia are classified in general, regional andsedation-General anesthesia is necessary for procedures that require complete immobility andunconsciousness. It can be classified in three ways, defined as total venous, when onlyvenous drugs are infused, such as propofol and etomidate, general inhalation, whenadministration of inhalational anesthetics like sevoflurane, desflurane. The associationbetween venous and inhalational anesthetics is defined as general balancedanesthesiaThe general anesthesia is constituted by the reversible unconsciousness, immobility,analgesia and autonomic reflex block, whose components are hypnosis, analgesia, musclerelaxation and neuro-vegetative blockHypnosis is characterized by suppression of consciousness, obtained through the use ofinducing agents such as midazolam, propofol and etomidate. Analgesia consists of therelief or absence of pain by the use of drugs such as opioids and anti-inflammatories.Muscle relaxation occurs through the reduction of muscle tone, with the administrationof relaxants such as succinylcholine, atracurium and rocuronium. The neuro-vegetativeblock occurs after adequate hypnosis and analgesia, with an attenuated response of theautonomic nervous system to the surgical stimulus, such as changes in heart rate, bloodpressure and sweatingRegional anesthesia is selected for surgical procedures that address upper or lowerlimbs, abdomen or pelvic region. It can be performed by epidural nerve block,subarachnoid or plexus nerve block, with the administration of local anesthetics such asxylocaine, ropivacaine,Sedation is aimed at patient comfort in small or ambulatory surgical procedures,contributing to the reduction of anxiety, analgesia, decreased movement and maintenanceof hemodynamic stability, mainly respiratory pattern and cardiovascular functionAdverse events related to health care and patient safety endangerment originate fromhuman error, lack of teamwork and organizational failures-Studies indicate that adverse events related to anesthesia involve mainly therespiratory system, cardiovascular system, errors in the execution of regional blocks,equipment and device failures, adverse reactions to medications and lesions related tosurgical decision-The events of the respiratory system are caused by intubation difficulty, inadequateventilation and oxygenation, aspiration, early extubation and airway obstruction-Concerning the cardiovascular system, adverse events are characterized by hemorrhages,bleeding, hydroelectrolytic imbalances and stroke. Equipment and device failures includethe use of central and peripheral catheters, anesthesia equipment, burns and firescaused by the use of electric scalpel and thermal blanket-Adverse drug reactions are due to incorrect dose administration and inadequateanalgesia-The main events in regional blocks are accidental dural puncture, high blockade, cardiacarrest, inadequate analgesia, trauma and catheter retention-It should be noted, however, that the mortality risk associated with theanesthetic-surgical procedure has been reduced in the last 50 years due to initiativesfor patient safety in anesthesia, which produced a higher quality of perioperativecare-These initiatives involved the advancement of training, certification and education ofprofessionals for teamwork, development of medications and techniques, improvement ofmonitoring standards, greater quality in the risk assessment of the patient for surgery,along with the standardization behaviors through care protocolsFor the same purpose of care, the health care security, the American Committee onQuality and Health Care of the Institute of Medicine (IOM) presented, in 1999, thereport To err is human: building a safer health system, proposing the governmentalcreation of a patient safety center that defined national goals for promoting safety andpreventing errors related to health careAs a result of mortality and morbidity rates caused by surgical procedures, in 2002, TheNational Assembly of World Health Organization (WHO), released a resolution aimed atsafety during anesthetic-surgical interventions, establishing standards of qualityhealth services, including the implementation of safe anesthesia-The Safe Surgeries Saves Lives program was launched in 2008 by the WHO, with thedevelopment of a checklist that directed the assistance performed before the anestheticinduction periods, surgical incision and removal of the operating room-The checklist, among several actions, provides for the anesthetic procedure, thechecking of the functioning, availability of necessary equipment and materials, patientidentification, verification of available tests, evaluation of risks associated withdifficult airway via and blood loss, induction of anesthesia (assist) and reversal(check).The period before anesthetic induction consisted of interventions to organize thematerials and equipment required for anesthesia. The period of anesthetic inductionincluded direct assistance to the patient care and support to the anesthesiologist. Inthe reversal period, interventions were defined to check vital signs and record of thecare performed.The first version of the protocol was composed of interventions, involving the threeassistance periods, evaluated by a group of five experts, regarding content validitycriteria, clarity of items, relevance and completeness of contentThe modifications of the interventions were performed regarding the presentation andstructure, considering the result of the calculation of the Content Validity Index (CVI)for each intervention and suggestions of the experts.The main changes suggested were the improvement of the writing of the items, especiallyin the pre-induction period, and separation of materials and equipment into distinctitems, so that the professional only indicates the devices related to the type ofsurgery that will be performedIn the induction period, the judges suggested revisions of the items regarding nursingnotes and records, avoiding duplication of information, checking the patient\u2019s historyand allergies directly in the medical chart, as well as reviewing the care of theanesthesiologist, such as assessment of ventilation and venous punctureBefore the suggestions, a second version of the care protocol was elaborated, withchanges in the items regarding the appearance and form of presentation, followed by anew stage of face and content validation by five specialists.In the second version of the care protocol, brief orientation of the objectives and formof completion of the instrument preceded the described periods. Following, the nursinginterventions for each period were described.The total validity of an instrument is measured by face, content, construct andcriterion-related validityThe validity of face represents how much a measure seems to be related to the specificcontent of the evaluated instrument, that is to say, if the content is understood bywhom uses the instrumentContent validity consists of representativeness level of the concept that the instrumentintends to measure and provides the items evaluation, according to clarity, relevance,pertinence and comprehensiveness of content totally agree, (four) I agree, (three) neither agree nor disagree, (two)disagree, (one) totally disagree. On items where disagreement was found, the expertscould suggest modifications regarding the proposed content.The Likert scale is used to measure the opinions, beliefs or attitudes of therespondents of a questionnaire or instrument, through a sequence of affirmations thatallows different levels of agreement. Depending on the research phenomenon and theresearcher\u2019s objectives, odd or pair number of response options may accompany eachstatement, and responses vary from totally disagree to totally agreeThe researcher made e-mail contact with the experts and sent an electronic questionnaire(Google Docs), a presentation letter and the assistance protocol, defining theobjectives of the study, instructions on the completion and importance of documentevaluation by the experts.-In the scientific literature, it is recommended that the number of specialists selectedvaries between three and ten individualsThe selection of experts may vary according to the time of clinical experience of theparticipants, publications and specialization in the area of the research phenomenon,so, in this study, the experts were selected for their work as researchers/specialistsin the field of anesthesiology and/or perioperative nursing.At the end of the protocol evaluation by the expert group, the data were treated andanalyzed by the CVI, which measures the proportion or percentage of agreement amongexperts on certain items of an instrumentIn this study, the highest scores were adopted for the CVI calculation, that is,responses (four) agree and (five) totally agree for each item, divided by the totalnumber of specialists, excluding values from one to three. The acceptable agreement ratefor this proportion was defined as 80% or higherThis study was approved by the Research Ethics Committee of the Nursing School of theUniversity of S\u00e3o Paulo, under n\u00ba 612310.The care protocol was evaluated by five specialists, four nurses and oneanesthesiologist. Among the professionals, two are nursing professors and work in publiceducation institutions, two nurses working at surgical center and one is a coordinatorof private anesthesia service.The age of the experts varied between 29 and 58 years (average of 41 years) and theaverage time of professional training was 17 years.Regarding face validity, all experts stated that the graphical presentation, theguidelines for the filling form and the sequence structure of the items allowed anadequate reading and understanding of the care to be performed by the nurse during theanesthetic procedure.Among the 119 items evaluated, only 11 (9.2%) items of the protocol presented CVI<80%, as presented in Most of the disagreements among the specialists occurred in the period before anestheticinduction, in which the evaluated items presented CVI ranging from 40 to 100% in theclarity criteria, from 80 to 100% in relevance, from 60 to 100% in pertinence and from40 to 100% in completeness of content.Regarding the item of operation of the anesthesia equipment, the experts considered theneed for guidance on the test of the equipment and the evaluation of its operation,taking into account the diversity of brands and models. In addition, experts recommendedthe establishment of a minimum number of available breathing circuit and modification ofthe wording of the item, definition of the saturation percentage (color modification) ofsoda lime and the need for exchange .The experts suggested the definition of the type of blood pressure cuff, according tothe physical characteristics of the patient, together with the establishment of theMultiparameter monitor alarm, according to the patient\u2019s age group (adult or child).Regarding airway materials, there were considerations regarding the separation of theendotracheal tube of different sizes, according to the patient\u2019s physicalcharacteristics and type of surgery .The experts stated that for the clarity and completeness of content of the itemsdescribing the intubation materials, it is necessary to choose the patient\u2019s face maskand gastric tube, considering characteristics such as age and weight .In the items on difficult airway, experts advised to better define the parameters ofchoice of materials such as the tracheostomy tube and the esophagus-tracheal tube(combitube) .In the period of anesthetic induction, the evaluated items presented CVI from 80 to 100%in the criteria of clarity, relevance and pertinence and CVI from 60 to 100% in thecompleteness of content. The only item with disagreement was patient monitoring, forwhich it was suggested to explain the type of sensor used for temperature verification.In the period of anesthesia reversal, there was no change in the initially proposeditems, which presented CVI from 80 to 100% in the criteria of clarity and completenessof content, 100% in the criteria of relevance and pertinence.Following the evaluation of the experts\u2019 suggestions, the items were modified andsubmitted to a new round of evaluations and the CVI was recalculated, as presented inThe results indicated a good agreement between the items evaluated by the specialists,considering that only 9.2% generated some type of disagreement and the divergences weremainly related to the criteria of choice, availability and selection of materials forthe anesthetic procedure in the pre-induction period.Most of the items of the induction period and all items of anesthesia reversal wereconsidered valid by the specialists, affirming the importance of the care performed bythe nurse in a surgical room.The standardization of care offered by nursing during the anesthetic act contributes tothe determination of the nursing role within this area, establishing a package ofactions legally allowed in the country.--In Brazil, care and performance standards are clear for anesthesiologists-During anesthesia-surgical procedure, the presence of an anesthesiologist is required inthe surgical room, the supply of supplemental oxygen to patients undergoing generalanesthesia, monitoring of oxygen saturation by pulse oximetry and ventilation,circulation control and heart rate monitoring, measurement of blood pressure every fiveminutes, body temperature measurement and regular evaluation of anesthetic depth byclinical observation-All these measures seek to prevent adverse events. Thus, it is considered that thedefinition of care standards, with the identification of potential risks and necessarymeasures for the safety of interventions, combined with inter-professional work and goodcommunication, can improve health care processes and outcomes In 1993, the American Society of Anesthesiologists (ASA), aiming at the adequateplanning of anesthesia care and reduction of postoperative morbidity and mortality,considering the reality of each health service and the types of equipment available,developed a checklist, revised in 2008, which contained actions for execution beforeanesthetic inductionThe checklist suggested items, some of which are also covered by this protocol, such asthe anesthesia equipment operating test, soda lime check, auxiliary oxygen supplyavailability and bag-valve-mask device, vacuum for aspiration, availability ofmonitoring system and alarms, with emphasis on pulse oximetry and capnography,verification of the flow of gases and adequate pressure for ventilation in theanesthesia equipment, as well as the registration of any conference procedure-It is worth noting that WHO recommends minimum standards of assistance/care inanesthesia during anesthesia-surgical procedures. They involve the planning of materialsand medicines in health services, equipment testing, monitoring care, according to thecomplexity of the clientele served and the hospital institution. These measures can bedefined as highly recommended, recommended and suggestedThe highly recommended standards in anesthesia are mandatory standards, that is,applicable to all types of institutions that perform procedures under anesthesia, fromsmall hospitals to referral hospitals.-Therefore, several items contemplated in the protocol must be properly checked andrecorded, among them the availability and operation of materials in the operating roomand materials for airway , oral and nasopharyngeal Guedel cannula, aspiration system andhumidifiers), evaluation of anesthesia equipment , , blood and fluids available, monitors with alarms attached,stethoscope, sphygmomanometer and thermometer-Studies have shown that the use of checklists for the organization of anestheticinduction care can assist in the detection of errors and negligence in relation to care,reducing failures during anesthesia and surgery, by means of appropriate equipment andmaterial checks, in addition to promoting the exchange of information amongprofessionals about the clinical conditions of the patient and critical aspects such asallergies and difficult airway, thus improving the perception of professionals aboutteamwork and prevention of damages, aspects that, together, contribute for patientsafetyAll the professionals aligned with the scientific basis that guides the care to beperformed, as well as the definition of limits and performance roles, contribute to agreater synchronism between the anesthetic procedure and the activities, and, therefore,a greater probability of success interventions. As a limitation, in this study, nopilot-application of the protocol was performed.The nursing care protocol in anesthesia was validated with good agreement amongspecialists, and 90.8% of the items were considered adequate in the first round.The nursing care protocol was developed within the limits of professional performance,without overlapping functions or violation of the law of professional practice, and canguide the role of the nurse during anesthesia. With this, it is possible to standardizecare behaviors in different institutions, guaranteeing greater support to nurses intheir performance in the anesthetic procedure, with the anesthesiologist.It is emphasized that the nurse\u2019s use of the care protocol should be linked to theexistence of systematized technical and scientific knowledge about the actions to beperformed during anesthesia, stating the importance of their presence in a surgical roomfor care activities.Thus, it is believed that this direction of nursing work, in anesthesia, can evidencethe importance of nurses\u2019 work in a surgical center, even in the face of thedifficulties experienced in the performance of roles within health institutions and ininteraction with the medical team.Future work is needed to evaluate the practical application and feasibility of using thecare protocol in different realities."}
{"text": "Attractiveness plays a central role in human non-verbal communication and has been broadly examined in diverse subfields of contemporary psychology. Researchers have garnered compelling evidence in support of the evolutionary functions of physical attractiveness and its role in our daily lives, while at the same time, having largely ignored the significant contribution of non-visual modalities and the relationships among them. Acoustic and olfactory cues can, separately or in combination, strongly influence the perceived attractiveness of an individual and therefore attitudes and actions toward that person. Here, we discuss the relative importance of visual, auditory and olfactory traits in judgments of attractiveness, and review neural and behavioral studies that support the highly complex and multimodal nature of person perception. Further, we discuss three alternative evolutionary hypotheses aimed at explaining the function of multiple indices of attractiveness. In this review, we provide several lines of evidence supporting the importance of the voice, body odor, and facial and body appearance in the perception of attractiveness and mate preferences, and therefore the critical need to incorporate cross-modal perception and multisensory integration into future research on human physical attractiveness. Physical attractiveness plays a central role in the assessment of human mate value. This has made it a widely examined topic in contemporary psychology and biology. The variables that determine mate value, such as health, sexual maturity and reproductive potential, are often not directly observable. However, numerous studies have shown that these indices of mate value predict measures and ratings of physical attractiveness , researchers have focused disproportionately on visual indicators of attractiveness, underplaying the influence of scent and voice. In a recent and relatively broad theoretical review of prosocial biases in favor of attractive people, Idea of the review: PS, KP, AS, and MK. Wrote the manuscript: AG, KP, AS, JH, MK, DP, SR, and PS.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "Department of Health and Human Services, the task force is an independent, nonfederal, panel of public health and prevention experts whose members are appointed by the director of CDC. The task force provides information for a wide range of persons who make decisions about programs, services, and other interventions to improve population health. Although CDC provides administrative, scientific, and technical support for the task force, the recommendations developed are those of the task force and do not undergo review or approval by CDC."}
{"text": "The exponential development of high-throughput technologies in the last decades, supporting and improving the OMICS science, has allowed uncovering successfully the complexity of the organizational network patterns in the cell's metabolism to the plant phenome, founding the science of system biology  expression gradient (regulated by miR165/6), which therefore has a higher concentration in internal xylem tissue. Thus, xylem tissue within the stele is defined, among other factors, by the expression of PHB, which is restricted to xylem and procambium by miR165/6, specifically expressed in the endoderm.In addition to intracellular complexity, the interaction between neighboring cells plays an important role in the responses to environmental conditions, and the plant metabolism organization as a whole. In plants, plasmodesmata connect the cytoplasts of adjacent cells across the cell wall, allowing intercellular transport and communication to adjacent cells within a tissue or organ, allowing exchange of small molecules, such as ions, sugars, and phytohormones, as well as larger molecules, including proteins, RNA, and viruses  , and thus increase the uncertainties of the bottom-up predictability models, since physiological changes in specific tissues may have non-local causes. For instance, a local application of high light results in the activation of a ROS wave, allowing an increase in stress tolerance accompanied by the accumulation of photorespiratory amino acids, including Glycine and Serine, in non-stimulated tissues  until the end of twenty and beginning of twenty-first centuries, occidental science was successful to uncover the layers of complexity underlying to the biological organisms, opening the OMICS era with the genome. But the \u201cwhole picture\u201d was not clear yet. As exemplified in the previous sections, some problems have challenged the determinism from below, and then the Cartesian synthesis was boosted to explore higher levels of organization, inaugurating the System Biology thinking. The knowledge that has being built on transcriptome, proteome and, specially, the metabolome , the interpretation of the data shall consider the context in which the particular scale is embedded. Ultimately, in studies that intent to contribute for improvement of crop yield, the plant phenotype  should have the final word of the meaning of the changes from the lower levels of organization, since one genotype can be translated in many phenotypes when developed under different environmental conditions (Tardieu et al., MdA and GS contributed equally to the discussion of the topic.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "Apoptosis has been a biological phenomenon of intense interest for 20 years, but the earlier morphological features of apoptosis have not been determined hitherto. Using the methods of semi- and ultrathin sections, the livers of intact embryos and young rats have been studied under the effect of cycloheximide to determine morphological features of an early stage of apoptosis. It is discovered that both in hepatoblasts and hepatocytes, apoptosis, besides the well-known stages, also includes an early contact stage, distinguishing features of which are agglutination of bound ribosomes (breaking of translation), elimination of the nucleolus, reduction of free polysomes , formation of cytoplasmic excrescences, and cell shape changes. The early stage of apoptosis is characterized by close contact with neighboring cells. At a certain phase of the contact stage of apoptosis, the nucleolus reappears in the nucleus and the number of free polysomes in the cytoplasm increases, which suggests the renewal of synthesis of new RNA and proteins. Close contact of differentiating and mitotic hepatoblasts with apoptotic cells indicates a certain functional relationship between these cells that is realized not only by micropinocytosis, but through gap junctions as well. We assume that the apoptotic cell, besides proteolytic products, can contain newly synthesized, low-molecular substances, the relocation of which from apoptotic to neighboring cells may contribute to both functional activity and proliferation of adjacent hepatoblasts and, therefore, the function of apoptosis may not be limited only to the elimination of harmful, damaged, and unwanted cells."}
{"text": "The Belgian Association of Hospital Pharmacists (BAHP) is a professional and scientific association representing all pharmacists who work in hospital institutions, whether private or public, university, general or psychiatric. This association was created in 1953. The aim of this short paper is to tell the history of its continuous development in a few words. The main development is reviewed from 1950 to now including: regulation, professional association roles, agreement and continuing education, development of clinical pharmacy, and updating of university training program. A new decree for the hospital pharmacist is in the course of being finalized, including new technologies: automated dispensing, automated compounding, centralization of sterile compounding, e-learning, traceability of medical devices and clinical pharmacy. On 10 May 2013, the Belgian Association of Hospital Pharmacists (BAHP) celebrated 60 years of existence and became a Royal Society.Created in 1953, this professional and scientific association represents all pharmacists who work in hospital institutions, whether private or public, university, general or psychiatric.The aim of this short paper is to tell the history of this development in a few words.Moniteur [Different royal decrees (RD) regulate the professional life of a Belgian hospital pharmacist. The first appeared in 1978 in the Moniteur . At the Moniteur  and the Moniteur , followiMoniteur .The RD of 4 March 1991 fixes the standards which a hospital pharmacist must satisfy to be approved, which went on to significantly regulate the general and specific tasks of the pharmacist within his/her hospital institution, creating on the same occasion the term \u201cFonction hospitali\u00e8re\u201d in order to classify hospital pharmacy within it . The phaBelgian hospital pharmacists are responsible for pharmaceutical specialties, extemporaneous preparations, antiseptics and disinfectants, registered dietary products, medical and surgical equipment, implants and prostheses, radio isotopes, medical gases and products that are under investigation by clinical trials.The tasks are identical to pharmacists around the world: the individualized distribution of medicines, the preparation of non sterile and sterile medicines, the supply, stocking and appropriate storage of medicines, and the analysis and quality control of raw materials and medicines.The specific tasks are very numerous: the organization of an effective, safe and economic system of distribution in the various hospital units; integration into multidisciplinary teams in order to optimize therapeutic efficacy and safety; the collection, processing and distribution, in a structured manner, of all the necessary pharmacological, toxicological and pharmaco-technical information concerning the medicines used in the hospital; active collaboration with the nursing staff regarding the use of medicines; the organization and promotion, in collaboration with the medical team, of pharmacovigilance activities; partial responsibility for the sanitary arrangements for hospitalized patients and discharged patients, in collaboration with the medical and nursing staff; making available for the hospital departments antiseptic and disinfectant solutions of an appropriate quality for the therapeutic necessities; guaranteeing at a qualitative level the daily activities of the sterilization unit; supervision of the galenical preparation of injectable solutions of radio-pharmaceuticals; drawing up, in collaboration with the doctor in charge of the hospital, an annual report, of the hospital as a whole and by department, of the consumption and cost of the medical treatment, and a report on the relation between the consumption of medicines and the pathologies treated in the hospital; contribution to clinical trials whenever they are performed in the hospital; contribution to the rapid and suitable treatment of cases of poisoning .The particular title of hospital pharmacist was also created in 2003.The RD of 11 June 2003  describeFor the extension of such recognition, the pharmacist must prove that he has obtained accreditation of 120 points during the validity period of its approval or over five years.From the beginning of its creation, the Belgian association has organized training courses. These courses are then modeled on the matters described in RD of 2003.Points can also be obtained by attendance at national and international conferences, presentation of oral communications, and publications of posters. That is why the Belgian delegation is often important to the congress of the European Association of Hospital Pharmacy and the European Society of Clinical pharmacy, for example ,11.The development of clinical pharmacy began with isolated initiatives, mainly in university hospitals .The first studies were published on geriatric inpatients .In March 2007, Rudy Demotte, the Minister of Social Affairs and Public Health at the time, launched a call for clinical pharmacy projects from general and university hospitals in Belgium. This call for proposals was in response to ongoing efforts by the Belgian Association of Hospital Pharmacists to increase funding for clinical pharmacy in the country ,15.Proposals needed to specify the exact nature of a temporarily funded position, and on which ward or wards work would take place. Altogether, 80 proposals were received by the National Network of the Pharmaceutical and Therapeutic Committee (NN-PTC). Twenty-seven were selected for funding, which included 13 full-time and 15 half-time staff posts in clinical pharmacy in the areas of pain treatment, nutrition and seamless medication care in oncology, cardiology, intensive care units and geriatrics. Positions were filled, and the first evaluations of the projects by the hospitals were sent to the ministry by the end of the year. Two further reports were required before the end of the projects on 31 December 2008. The projects and accompanying reports should aid in demonstrating the positive impact of clinical pharmacists on patients and medical staff in a variety of areas, and hopefully serve as successful pilot projects for ongoing funding for more hospitals in Belgium. In January 2009, these 27 projects of clinical pharmacy were permanently established . At the The establishment of a specialization in hospital pharmacy in Belgium began in the late 1970s and consisted of three certificates: galenic formulation, pharmacology and hospital management. Since then, in other European countries, the duration of specialization studies has increased.Furthermore, the content of the subjects taught and their diversity increased. Finally, the hospital pharmacist was involved in more and more areas and continuing education was not enough. An adaptation of study specialization was necessary.In September 2010, a new training program for hospital pharmacists was established by all of the universities in Belgium. Sixty-five student posts were opened, 39 in the Flemish-speaking community and 26 in the French-speaking community ,19. The The courses are taught by academic professors, lecturers, and ground health professionals.The first practical module, entitled \u201cDrugs supply chain\u201d, includes the organization and management of a hospital pharmacy, the supply chain and the following topics: control processes and quality management, and information management on both drug and clinical trials.Module 2, entitled \u201cHospital hygiene and central sterilization\u201d, includes management of antibiotic therapy, organization and management of medical devices, supply chain and similar products .Module 3, entitled \u201cClinical pharmacy\u201d, covers clinical pharmacy and pharmaceutical care in at least one ward  but also includes activities relating to the remit of the Pharmaceutical and Therapeutic Committee.Module 4, entitled \u201cProduction\u201d, includes the production and/or reconstitution of chemotherapy, radiopharmaceutical drugs and other preparations, including pharmaceutical and sterile preparations. These three parts must cover, in addition to the production itself, all control and quality assurance aspects.The duration of each module is six months and the four modules are taken in sequence. The academic module is spread out over two years, at a rate of one day/week at the universities. This two-year program replaces the previous one-year program and is described in a written work which can be published. Currently, there is no English language version.In September 2013, the program was extended to three years and the number of candidates was adjusted to 50. During the third year, the candidate may make the choice of one or two of the four modules described previously. The candidates are also strongly invited to do periods in other hospitals inside and outside Belgium. This third year will be ended on September 2016. Is it too early to make a conclusion at this time but the periods in another hospital met a big success with a preference for France and Quebec.Pharmakon, the official journal of Belgian hospital pharmacy, has existed since 1969. For over 40 years, the Belgian hospital pharmacists were kept abreast of developments in their discipline by Dutch, French and sometimes English publications.The candidates must also publish the results of their work as posters or publications. Journal de Pharmaciede Belgique in 2013. The publications of candidates and hospital pharmacists are now easily accessible [However, for many reasons , the paper merged with the cessible .The RD of March 1991 is outdated and must be updated. A new decree was published in 2009 concerning community pharmacists . A new d"}
{"text": "Department of Health and Human Services, the task force is an independent, nonfederal, uncompensated panel of public health and prevention experts whose members are appointed by the Director of CDC. The task force provides information for a wide range of decision makers on programs, services, and policies aimed at improving population health. Although CDC provides administrative, research, and technical support for the task force, the recommendations developed are those of the task force and do not undergo review or approval by CDC."}
{"text": "Fast Track to End AIDS by 2030 program and the recent changes in the Guidelines on When to Start Antiretroviral Therapy and on Pre-exposure Prophylaxis for HIV. The success of developing HIV treatment cascades in low- and middle-income countries will require the development of National Health Identification Systems. The success of programs like Universal Health Coverage, under the recently ratified Sustainable Development Goals is also contingent on the availability of personal health information for communicable and non-communicable diseases.As increasing amounts of personal information are being collected through a plethora of electronic modalities by statutory and non-statutory organizations, ensuring the confidentiality and security of such information has become a major issue globally. While the use of many of these media can be beneficial to individuals or populations, they can also be open to abuse by individuals or statutory and non-statutory organizations. Recent examples include collection of personal information by national security systems and the development of national programs like the Chinese Social Credit System. In many low- and middle-income countries, an increasing amount of personal health information is being collected. The collection of personal health information is necessary, in order to develop longitudinal medical records and to monitor and evaluate the use, cost, outcome, and impact of health services at facility, sub-national, and national levels. However, if personal health information is not held confidentially and securely, individuals with communicable or non-communicable diseases (NCDs) may be reluctant to use preventive or therapeutic health services, due to fear of being stigmatized or discriminated against. While policymakers and other stakeholders in these countries recognize the need to develop and implement policies for protecting the privacy, confidentiality and security of personal health information, to date few of these countries have developed, let alone implemented, coherent policies. The global HIV response continues to emphasize the importance of collecting HIV-health information, recently re-iterated by the Guidance for countries to develop and implement their own guidelines for protecting HIV-information formed the basis of identifying a number of fundamental principles, governing the areas of privacy, confidentiality and security. The use of individual-level data must balance maximizing the benefits from their most effective and fullest use, and minimizing harm resulting from their malicious or inadvertent release.These general principles are described in this paper, as along with a bibliography referring to more detailed technical information. A country assessment tool and user's manual, based on these principles, have been developed to support countries to assess the privacy, confidentiality, and security of personal health information at facility, data warehouse/repository, and national levels. The successful development and implementation of national guidance will require strong collaboration at local, regional, and national levels, and this is a pre-condition for the successful implementation of a range of national and global programs.This paper is a call for action for stakeholders in low- and middle-income countries to develop and implement such coherent policies and provides fundamental principles governing the areas of privacy, confidentiality, and security of personal health information being collected in low- and middle-income countries. Fast Track to End AIDS by 2030 treatment targets, including \u201890-90-90\u2019 and \u201895-95-95\u2019 (UNAIDS recently announced that 15 million people living with HIV (PLHIV) were on anti-retroviral therapy (ART) . The nee5-95-95\u2019 .Universal Health Coverage  working with colleagues from CDC Atlanta and UNAIDS. These drafts were extensively reviewed, and eventually, a draft was discussed and reviewed by participants at a workshop held in Lusaka, Zambia, in 2012 Data StorageData Backup (not included at policy level)Authorization and Access ControlData ReleaseTransmission SecurityData DisposalThe major headings include a series of subheadings and relevant questions as can be seen in the example of Governance and Policy below:PolicyGovernance StructureReview of Security PracticesResponsibilities and TrainingMonitoring Security BreachesConducting Risk AssessmentsConnectivity to Other NetworksBased on discussions with relevant members of the MOH, the tool was field-tested in two primary, two secondary, and two tertiary care facilities. In addition, the tool was also field-tested at a national data warehouse and at the national policy level. A work-plan was developed, based on discussions between relevant members of MOH, CDC and UNAIDS, other government officials, health and legal professionals, and members of civil society that also agreed to participate in the process.The primary method of data collection was through small group interviews, reaching consensus on each question of the assessment tool. Additionally, if policies or procedures existed in that department a copy of the guidelines was requested. The field-test documented responses to the questions by identifying the existing national policies, legislation, technical guidelines, including scope and coverage, for the sole purpose of assessing the questions on the tool and its ability to capture the data of interest.In general, constructive comments and suggestions were made regarding changes to the assessment tool. Although most of the questions were easy to understand, they elicited rich discussions, which did increase the length of the meetings. This enabled consensus to be reached on each question. In most instances, the discussion eventually focused on how the assessment tool should be rolled out, implemented, or moved forward in terms of informing policies and procedures. Only 18 questions, out of a total of 168 questions in the tool, needed to be modified or clarified. The field-test confirmed that the assessment tool had been well understood by informants and produced useful information.Interim Guidelines on Protecting the Confidentiality and Security of HIV Information. However, the assessment tool is a general tool and does not need major adaptation to be useful in country.The approach used in selecting and vetting the questions was considered to have been thorough based on the feedback session held at the end of the field-test. The scope of the assessment tool was considered to have adequately covered all facets of confidentiality and security and dealt with all relevant aspects of the The activities described above have led to the identification of a number of fundamental principles, governing the areas of privacy, confidentiality, and security . These pThe purpose of defining personal health information confidentiality and security principles is to ensure that health data are available and used to serve the improvement of health, as well as the reduction of harm, for all people, healthy and not healthy. Pursuing this goal involves an ongoing process of refining the balance between maximizing of benefits, which can and should come from the wise and fullest use of data, and protection from harm, which can result from either malicious or inadvertent inappropriate release of individually identifiable data. Appropriate policies, procedures, and technical methods must be balanced to protect both individual and public rights.Personal health information is generally obtained at the point of care, where services are delivered to individuals. Personal identifiable information is individual-level information that includes personal identifiers such as names and addresses. They are managed at community and health facilities whether sponsored by the public sector, NGOs, the private sector, or international organizations. However, in some cases such data are stored in regional or national databases. This category of data also includes national identification numbers, which can be directly linked to individual patients across different databases across various social sectors, for example, the social security number in the United States.The public health goal is to safeguard the health of communities through the collection, analysis, dissemination, and use of health data, which must be carefully balanced with the individual's right to privacy and confidentiality. Guidelines must allow for consideration of relevant cultural norms, which may influence these policies, while ethical principles should guide decision-making regarding the appropriate use and dissemination of data. Overall, guiding principles should be based on human rights principles.For protecting personal health information, three interrelated concepts have an impact on the development and implementation of protections for sensitive data. These are privacy, confidentiality, and security. Privacy is both a legal and an ethical concept. The legal concept refers to the legal protection that has been accorded to an individual to control both access to and use of personal information and provides the overall framework within which both confidentiality and security are implemented. Confidentiality relates to the right of individuals to protection of their data during storage, transfer, and use, in order to prevent unauthorized disclosure of that information to third parties. Security is a collection of technical approaches that address issues covering physical, electronic, and procedural aspects of protecting information collected as part of the scale-up of HIV services.The risk of harm following a breach of confidentiality varies with the national or local context according to levels of stigma, lack of comprehensive public health safety nets, legal traditions of respect of privacy, religious perspectives, and other local conditions. Within countries, privacy and confidentiality laws should be in place, or developed if not already in place, and relevant parameters of privacy or confidentiality laws must be reviewed and known by those involved with the data at all administrative levels. The greatest threats to electronic information systems are generally not from outside attack, but rather from issues inherent in the system design and implementation. These threats fall into two categories: non-availability of data due to system failure and user errors.Development and review of confidentiality and security laws and procedures should include active participation from relevant stakeholders, including civil society and community members, healthcare professionals, information technology specialists, and legal and ethical experts.Funding organizations should comply with these standards and have an obligation to make adequate funding available to implement them, sufficient to ensure protection of the data collected and used. Funding organization must also require that maintaining these standards is a condition for funding of any implementing partners or agencies.A number of organizational procedures need to be followed to ensure safeguards for the collection, transfer, storage, use, dissemination, and disposal of personal identified data and other information. Policies and procedures developed must cover both paper-based and electronic systems. Countries and organizations at all levels of the healthcare system should have a written policy that defines security procedures concerning the way data are collected, stored, transferred, and released. The policies need to be implemented at all relevant levels, and staff must understand the policies and to have signed an agreement stating that they will implement them as part of their work. This will also require training new staff and updating all staff on the relevant procedures.Data may be shared between organizations provided that the data are used for legitimate health purposes. The confidentiality and security measures of the organization receiving the data need to be equivalent to those that collected the data.These principles give rise to a number of operational recommendations. It is critical that written security procedures be produced, defining how data should be collected, stored, transferred, and released. These written policies should be accessible, understood, and implemented at all organizational and administrative levels. Staff members need to confirm, in writing, that they have read and understood the policies and that they will adhere to them .Individuals who are authorized to access personal health information should also receive appropriate training, at regular intervals. Security strategies and related laws and policies should be continuously reviewed, independently assessed, and revised when required .Cross-sectional or longitudinal paper-based or electronic information, collected as part of clinical management, need to be stored in locked cabinets or locked computers, respectively, within a locked room and a secured building. Paper-based information should be transported in secure briefcases, transmitted by secured fax or using protected mail services within or between organizations . GeograpSecurity breaches and loss of confidentiality require investigation. Organizations and individuals who are unable to adequately protect the confidentiality and security of identifiable information should be held accountable and appropriate penalties imposed. Improvements then need to be implemented . ConfideIt is important to delineate potential limits and restrictions on access to personal data. For example, individual-level information should generally not be shared with law enforcement, immigration control, management of the public welfare system, or other non-health functions without consent from the individual to whom the information relates, except in circumstances involving the threat of imminent danger of grave physical harm to individuals or populations . The devThese are just some of the operational issues associated with maintaining the confidentiality and security of personal health information. For detailed information on some of the specific issues surrounding these and other related technical issues, the extended bibliography  can refeIf the personal identifiable health information is not kept confidential and secure, under-pinned by relevant privacy laws, people with communicable or non-communicable diseases may be stigmatized and discriminated against, hampering therapeutic and preventive health measures at individual and population levels . FurtherThe collection of personal health information will also enable more detailed information to be available for monitoring and evaluating the use, cost, outcome, and impact of services at facility, sub-national, and national levels . SystemsHowever, there continues to be a general lack of interest and progressive action in this area. So far, few countries have systematically developed, let alone, implemented such policies. Why is this occurring?Possible reasons for this general lack of progress may be due to a variety of reasons. These may include cultural reasons where the local culture does not recognize the need for individual privacy or confidentiality of personal information, the relative lack of development of the country's healthcare and health information systems, perceived financial costs of the development and implementation of such guidelines, and possible disagreements as to which statutory or non-statutory organization ought to have access to such data. However, if countries do not currently invest in their health information systems as part of developing their healthcare system, the long-term social and financial costs are likely to exceed the necessary short-term investment .The development of healthcare systems may provide an opportunity for countries to develop and implement such guidelines. For instance, countries in Asia, sub-Saharan Africa, and the Caribbean are currently in the process of developing unique healthcare identifiers. Such identifiers should, however, be developed and implemented in parallel with national guidelines on the privacy, confidentiality, and security of personal health information .To assist countries in this process, an UNAIDS/PEPFAR assessment tool and user manual have been finalized and are available in paper-format in English , 36, whiFast Track to End AIDS by 2030 (Personal information is increasingly being collected and used by local, national, and global statutory and non-statutory organizations as part of the broader utilization of Big Data . The suc by 2030 , impleme by 2030  and the  by 2030  and the Click here for additional data file."}
{"text": "Pain is a homeostatic mechanism that intervenes to protect the organism from harmful stimuli that could damage its integrity. It is made up of two components: the sensory-discriminative component, which identifies the provenance and characteristics of the type of pain; and the affective-motivational component, on which emotional reflexes, following the painful sensation, depend.There is a system for pain control at an encephalic and spinal level, principally made up of the periaqueductal grey matter, the periventricular area, the nucleus raphe magnus, and the pain-inhibition complex situated in the posterior horns of the spinal cord. Through the activation of these pain-control systems, the nervous system suppresses the afference of pain signals. Endogenous opioids represent another analgesic system.In the course of various studies on pain transmission in Down patients, the reduced tolerance of pain and the incapacity to give a qualitative and quantitative description emerged in a powerful way. All of these aspects cause difficulty in evaluating pain. This is linked to several learning difficulties. However, it cannot be excluded that in these anomalies of pain perception, both the anatomical and the neurotransmitter alteration, typical of this syndrome, may hold a certain importance.This fact may have important clinical repercussions that could affect the choice of therapeutic and rehabilitative schemes for treatment of pathologies in which pain is the dominant symptom, such as postoperative pain. It could influence research on analgesics that are more suitable for these patients, the evaluation of the depth of analgesia during surgical operation, and ultimately, absence of obvious pain manifestations. In conclusion, alterations of the central nervous system, neurotransmitters, pain transmission, and all related problems should be considered in the management of pain in patients with Down's syndrome, especially by algologists and anesthesiologists."}
{"text": "To analyze whether socioeconomic and clinical aspects and the aspects of healthy life habits are associated with the quality of life of persons living with HIV/AIDS. This is a cross-sectional exploratory quantitative research, with 227 persons living with HIV/AIDS, treated at two hospitals of reference between April 2012 and June 2014. We used structured questionnaires to assess socioeconomic aspects , clinical parameters , and practice of physical exercise. To assess quality of life, we used the Quality of Life questionnaire (HAT-QoL). For characterization of the socioeconomic and clinical data and domains of quality of life, we conducted a descriptive analysis . We applied linear regression, following a hierarchical model for each domain of quality of life. The domains that presented lower averages for quality of life were financial concern, concern with confidentiality, general function, and satisfaction with life. We found associations with the variables of socioeconomic status and physical exercise, therapy, and physical exercise for the last two domains, consecutively. The quality of life of persons living with HIV/AIDS shows losses, especially in the financial and confidentiality areas, followed by general function of the body and satisfaction with life, in which socioeconomic and clinical aspects and healthy living habits, such as the practice of physical exercise, are determining factors for this reality. Acquired Immunodeficiency Syndrome (AIDS), initially considered an acute and fatal disease, currently has a profile of chronic diseaseThe QOL covers multifactorial characteristics, reflecting individual and collective experience, knowledge, and values in the historical, cultural and social time lived,,Given these characteristics, the investigation on the QOL of PLWHA becomes essential, especially because of the development of the infection, the need for drug treatment, increased survival, and life with the stigmatizing disease. All these aspects must be observed with the socio-economic characteristics and habits of life, in order to identify negative factors that contribute to biopsychosocial problemsGiven this context, this study aimed to analyze whether socioeconomic and clinical aspects and the aspects of healthy life habits are associated with the quality of life of persons living with HIV/AIDS.This is an exploratory descriptive cross-sectional studyThe sample was non-probabilistic and consecutive; among the 275 patients approached and invited to participate in the research by the evaluators after medical consultation, 46 refused because of unavailability of time or lack of interest in participating, and two did not complete the interview. Thus, 227 persons living with HIV of both genders participated in this study.Inclusion criteria were: diagnosis of infection of HIV/AIDS, being in clinical follow-up in the Specialized Care Service in HIV/AIDS, and being aged 18 years or more, of both genders. We excluded individuals who had any type of medical or cognitive condition that would prevent them from understanding the research procedures .The data were collected from personal interviews in a reserved location. The research tools were applied by two previously trained evaluators, using structured questionnaires, which assessed the socioeconomic and demographic aspects .Regarding clinical parameters, we inquired about the time of disease diagnosis and the use and time of medication. Data on clinical stage of infection, CD4 T-cell count, and viral load were obtained from the most recent exam record in the chart.To assess the QOL, we used the questionnaire Quality of Life (HAT-QoL), proposed by Holmes and SheaTo answer the questions, subjects were told to think about their QOL in the last four weeks. The answers of the instrument have a five-point Likert scale: all the time, most of the time, part of the time, little time, never. In each domain, zero is the lowest score and 100 is the best possible score. Thus, the higher the score, the lower the impact of HIV infection is in the QOL of individuals.We calculated the frequencies, averages, and standard deviations of the socioeconomic, clinical, and score data of the domains of quality of life. Subsequently, we selected the variables to be included in multiple regression models in order to eliminate the variables that showed no association with each domain of QOL from the model. In this analysis, Student\u2019s t-test was used to compare the average scores for each domain between the levels of each variable, and the variables that had a value of p < 0.10 were selected for inclusion in the regression models.For the multivariate analysis, multiple linear regressions were used. In each regression, the dependent variable was one of the domains of QOL and the independent variables were all the variables selected in the respective bivariate analysis. In each model developed, the independent variables that showed no significant association (p < 0.05) with the dependent variable were eliminated in a step-by-step process. The results are presented as adjusted point estimates of the difference in the score of each domain between the levels of each independent variable and their 95% confidence intervals.Of the 227 individuals, 131 were men and 96 were women, and average age of 40.3 (SD = 11.5) years. The characteristics of the population of the study are presented in The multiple linear regression model can be seen in In this study, we analyzed the QOL and association between socioeconomic and clinical aspects and healthy living habits in PLWHA. We saw that the most affected domains of QOL were financial concerns, concerns about confidentiality, general function, and satisfaction with life, which were associated, respectively, with the variables: socioeconomic status and physical exercise, therapy, and only physical exercise for the last two domains .,,,,The negative results for financial concerns and concerns about confidentiality corroborate with studies that have used the HAT-QoL and identified negative behavior in these domains,,,-The domain of concern with confidentiality was associated with only the variable of therapy, corresponding to 86.8% of the persons taking antiretroviral drugs. This result is not in agreement with the study of Passos and Souza, who have identified worse QOL associated with \u201cnot taking antiretroviral drugs\u201d,General function and satisfaction with life were associated with the variable of physical exercise and were the subsequent domains that presented the lowest averages. The justification for this is due to the negative behavior found by not practicing physical exercise as a healthy habit. There are reports in the literature on the association between QOL of persons who exercise, exactly because of the changes in lifestyle, which allow the improvement of body composition, metabolism efficiency, joint mobility, posture, cognitive functions, perception of self-image, and socialization, thus improving the overall function and satisfaction with lifeThe domains of health concerns, acceptance of HIV, concerns about medication, and sexual function presented positive averages for QOL.3, which reassures the PLWHA, as this value reduces the concerns about the prognosis of deathThe domain of health concerns was associated with age, physical exercise, and CD4 T-cell. For the first result, we observed that the association presented positive behavior of QOL with advancing age in this study. This result differs from that found by Soares et al.In the analysis of the domain of acceptance of HIV, we observed association with \u201cbeing over 37 years\u201d and \u201cno practice of physical exercise\u201d. The association with age can arise from the fact that older persons are more mature and thus better accept their health condition3). These data agree with the study of Passos and Souza, who have identified worse QOL associated with female and age (< 47 years)The domain of concerns about medication was positive for QOL and was associated with gender , age (> 37 years), physical exercise (no practice) and CD4 T-cell (> 350 cells/mm,Finally, among the analysis of QOL, the domain of sexual function presented one of the best averages. High score or better QOL in this aspect is due to the associations found with males, leading us to two hypotheses: either the men actually have a healthy sex life, or, because of cultural issues or even shame, men deny the impairment of their sexual lifeThe main limitation of the study arises from the impossibility of causal inferences, as it is a cross-sectional study. However, the study shows many determinants for the QOL of PLWHA, emphasizing that, when socioeconomic and clinical factors and life habits are not adequate, losses in quality of life can be emphasized.We conclude that the quality of life of persons living with HIV/AIDS presents losses, mainly in the financial and confidentiality areas, followed by general function of the body and satisfaction with life. Additionally, the domains of general function, satisfaction with life, health concerns, acceptance of HIV, financial concerns, and concerns about medication are associated with no exercise, showing that this factor, as well as some socioeconomic factors, are determinants for the QOL of PLWHA.From the premise that both the practice of physical exercise and socioeconomic factors are determinant for the quality of life of the population studied, we suggest the creation of public policies focused on both aspects, such as the encouragement of physical exercise and good nutrition. These guidelines would support the traditional treatment, providing the complete follow-up of PLWHA, from the strengthening of the multidisciplinary team. Such assistance would address the clinical, psychological, physical, and social aspects, which directly reflect on the QOL of the persons living with HIV/AIDS."}
{"text": "In the Americas, leishmaniasis is endemic in 18 countries, and from 2001 through 2015, 17 countries reported 843,931 cases of cutaneous and mucocutaneous leishmaniasis, and 12 countries reported 52,176 cases of visceral leishmaniasis. A Regional Information System (SisLeish) was created in order to provide knowledge of the distribution and tendency of this disease to analyze and monitor the leishmaniasis status. This article analyses the performance and progress of SisLeish from 2012\u20132015.modus operandi of the system and indicators utilized.The performance of SisLeish was evaluated by country adhesion, data completeness and delay in entering the data, and also by the SWOT technique. Furthermore, we outlined the structure and In 2012, only 18% of the countries entered the data in SisLeish before the deadline, where 66.7% and 50% of the countries with autochthonous CL/ML and VL reported their cases to the system, respectively. Whereas in 2015, 59% of the countries reached the deadline, where 94.4% and 58.3% of the countries reported their CL/ML and VL data, respectively. Regarding data completeness, there was great progress for different variables since its launch, such as gender, which had an approximately 100% improvement from 2012 to 2015. The SWOT analysis of SisLeish showed 12 strengths, 11 opportunities, seven weaknesses and six threats.From 2012\u20132015 there has been an improvement in the adhesion, quality and data completeness, showing the effort of the majority of the countries to enhance their national database. The SWOT analysis demonstrated that strengths and opportunities exceed weaknesses and threats; however, it highlighted the system frailties and challenges that need to be addressed. Furthermore, it has stimulated several National Programs to advance their surveillance system. Therefore, SisLeish has become an essential tool to prioritize areas, assist in decision-making processes, and to guide surveillance and control actions. there has been an improvement in the adhesion, quality and data completeness and the results show the effort of the majority of the countries to improve their national database in terms of completeness and availability. Furthermore, it has stimulated several programs to advance their surveillance system and program, and has been an alternative for countries that currently do not have a national information system available. SisLeish has become an essential tool to prioritize areas, where the occurrence of leishmaniasis requires additional attention, assist in the decision-making process, and to guide surveillance and control actions. This article analyses the performance and progress of SisLeish from 2012\u20132015.Leishmaniasis is among the most neglected diseases and remains a challenge for surveillance and control programs. In response to this challenge, the Regional Program for Leishmaniasis (PAHO/WHO), with the support of advisors and representatives from endemic countries, have created a Regional Information System (SisLeish), based on epidemiological and operational indicators, to provide knowledge of the distribution and tendency of this disease to analyze and monitor the leishmaniasis status in the Americas. Since the implementation of SisLeish,  Leishmania from the Trypanosomatidae family [Lutzomyia is the most important vector in the Americas [Leishmaniasis is an infectious disease caused by protozoan parasites of the genus e family . It is aAmericas . LeishmaAmericas , 3, and Americas , 4\u20137.Since mid-2000, the World Health Organization (WHO) has worked intensely to integrate leishmaniasis into the political agenda. In 2007, during the World Health Assembly, Member States adopted the Resolution WHA 60.13, assuming the commitment to strengthen the surveillance and control of leishmaniasis, which was reaffirmed by the approval of the Pan-American Health Organization (PAHO)/WHO Resolution, CD 49\u201319. During a meeting between the PAHO/WHO and representatives from endemic countries of the Americas, in 2008, the participants suggested the development of a regional tool to collect epidemiological data of leishmaniasis, which would standardize, update and release the information to all countries. In 2011, the individual Regional Program for Leishmaniasis (RPL) was instituted by the PAHO/WHO, with the main goals of improving the surveillance and control actions in the Americas, and supporting endemic countries through cooperation, technical consultations and mechanisms to strengthen these actions.The RPL began defining the epidemiological variables and operation indicators to monitor this disease in the region, in 2012, along with advisors of the PAHO\u2019s communicable diseases, representatives of Leishmaniasis National Programs, and Surveillance Services from endemic countries. In sequence, the RPL developed the Leishmaniasis Regional Information System (SisLeish), which was validated and refined at different stages by the National Programs. The official system was presented during the Leishmaniasis Regional Meeting, held in Panama City on October, 2013, embodying efforts from all endemic countries of the Americas. SisLeish is a simple tool for analysing and monitoring leishmaniasis in the Americas. The system is based on epidemiological and operational indicators, allowing knowledge of distribution and tendency of this disease in the region.In the Americas, leishmaniasis is endemic in 18 countries, and from 2001 through 2015, 17 countries reported 843,931 cases of cutaneous (CL) and mucocutaneous leishmaniasis (MCL), and 12 countries reported 52,176 cases of visceral leishmaniasis (VL) [Health indicators are the synthesis of measures, which contain information about distinct attributes and dimensions, as well the performance of a health system, and they must reflect the sanitary status of a population and be suitable for surveillance of health conditions . TherefoRaw single indicators are widely used in traditional epidemiology to compare situations across different countries and regions, as these are often readily available in most countries and are easy to interpret and to compare , 12. On modus operandi of the system and the indicators utilized. This study is intended as a reference to inform current or potential stakeholders involved with leishmaniasis to promote awareness and use of this initiative.The objective of this article is to analyse the performance and progress of SisLeish from 2012 to 2015. Additionally, this article provides a deep overview of the structure and SisLeish is an on-line health information system, available in Spanish, developed with the purpose of being a simple tool and user-friendly system for inclusion and consolidation of data, and analysis of leishmaniasis in the Americas. The same provides knowledge and allows monitoring through information from epidemiological and operational indicators of distribution and tendency in the region.All data available in SisLeish are provided by the Leishmaniasis National Programs or their equivalents from each country that report cases of leishmaniasis, in the Americas. People with access to SisLeish are users appointed by the Ministry of Health (MoH), who are responsible for entering annual information regarding leishmaniasis occurrence and population.th of each year.The users enter their annual aggregated leishmaniasis data at the second administrative sub-national level. Moreover, the endemic State Members of the region have agreed upon an annual deadline to enter all of the leishmaniasis data, which is April 30ASP.NET with the Microsoft SQL Database Server Engine and the Crystal Report to generate data reports and information. This system is structured across three modules: i) module for epidemiological information, such as demographic data, clinical forms, confirmed cases of leishmaniasis by diagnostic criteria and progression of the disease (recovery or death); ii) module for surveillance, control and assistance; iii) specific module for species of Leishmania and suspected/involved vectors in the transmission, by region or country. Additionally, the output information is displayed in form of reports and is available by region, sub-region, and country at the first and second sub-national administrative level.SisLeish is a dynamic web page system created in th). Countries that have their own information system may fill the data into a standard issued table and import this table into the system; this process is currently being done by only two countries (Brazil and Colombia). Countries that do not have an information system are required to enter manually the data into the system through web forms. Afterwards, the data is imported into the database of the system and the indicators are calculated, generating different outputs, such as demographic, clinical form, diagnosis, treatment, and progression reports, at the first and second sub-national administrative level. These outputs are analyzed and used for epidemiological reports and mapping of the data.The users have a specific login to access SisLeish and are responsible for entering the leishmaniasis, population and surveillance, control and assistance data collected annually in their country , created by the United Nations Geographic Information Working Group . The carFor the SisLeish analyses, we evaluated the system performance in aspects such as country adhesion and data completeness. Furthermore, we used the strengths-weaknesses-opportunities-threats (SWOT) technique, which is a simple tool to analyze different types of scenarios and support planning, management and improvement of projects, systems and companies . This stBy 2015, all endemic countries have been granted access to SisLeish .In 2012, six of the 12 countries with autochthonous VL reported data to SisLeish , and 12 of the 18 countries with CL/ML transmission reported their cases . As for 2015, seven countries reported VL cases  and 17 reported CL/MCL cases . Further details of the progress on country adhesion can be observed in th of each year), in 2012 only three (18%) countries did meet the deadline, increasing to 10 (59%) countries in 2015. The results are shown in Regarding the established deadline to enter the annual data  analysis are summarized in This study describes SisLeish, which is an information system that consolidates and analyses the leishmaniasis data, and allows monitoring and knowledge of the epidemiological status of 18 countries in the Americas. One of the main objectives behind the development of this system was to provide information to the countries and Regional Programs in order to guide surveillance and control actions, against CL/ML and VL, within the countries and to assist the definition of regional technical cooperation priorities.Leishmania [In the Americas, leishmaniasis produces different clinical forms involving distinct species of ishmania . The conThere has been a considerable improvement in the adhesion, quality and data completeness. We observed a decrease in the delay to meet the established deadline to enter data into the system by the reduction of the median of days after the due date from 2012 (71 days after deadline) to 2015 (-1days after deadline). The results of SisLeish show the effort of the majority of the countries to improve their national database in terms of completeness and availability, mainly for CL/ML data, which is of compulsory notification in all of the endemic countries. In fact, SisLeish has stimulated several country programs to advance their surveillance system, and has been of particular incentive for countries that currently do not have a national information system available. For some countries, nevertheless, the notification of cases is aggregated at the second sub-national administrative level, which means a limitation in the quality of information provided by these countries. Thus, quantity and quality of information remain the main limiting factors of SisLeish, such as the well-known underreporting of leishmaniasis cases , 18, andThis information system has become an essential tool to improve knowledge and prioritize areas where the occurrence of leishmaniasis requires additional attention. The areas are identified utilizing the information provided by three single indicators, on the occurrence of leishmaniasis, and the results of the CICL. The solely use of single indicators  could lead, however, to an incomplete, or even misleading, interpretation of the occurrence. For instance, the relevance of an area with high number of cases could be \u201cdiluted\u201d when accounting for the population and/or surface area, potentially deflecting the real problem. In contrast, the CICL allows combining the different indicators of occurrence, presenting their overall standardized additive value. Additionally, the Jenks natural breaks classification method allowed SisLeish to provide meaningful results on how to split the different categories of the CICL, in \u201cnatural clusters\u201d. Thus, for example, SisLeish is able to identify areas with particularly very high results in the CICL, compared with the other categories, which are denoted as \u201cvery intense transmission\u201d. These groups are clearly differentiated areas, since the Jenks method seeks to reduce the variance within classes while maximizing the variance between them . Other wWhen choosing health indicators it is essential to understand the nature of the data and the purpose behind the development of an indicator, otherwise the indicators could actually confuse or misguide decision-makers . In SisLDespite knowing the limitations of the use of single indicators for decision-making processes, the composite indicator for VL is still unavailable in the system. Brazil represents 96% of the VL cases in the Americas, and since 2003 the Brazilian MoH has been stratifying the areas of transmission, based exclusively on the average of human cases from the previous three years, to direct the surveillance and control actions. In addition to the limitation of the \u201caverage of cases\u201d indicator, there is also a need to include other relevant epidemiological data, such as vector, infected dogs, among others; however, these additional data are not fully available and do not hold the required quality to be incorporated in an epidemiological analyses. In this context, due to a request from the Brazilian MoH, the RPL is currently working to combine the data available in the system into another composite indicator for VL.The visualization of the categorized data and indicators in maps allows a better understanding of the leishmaniasis epidemiological status. The database geocoding of SisLeish, at the first and second sub-national administrative levels, allows systematic mapping, which enables geographical monitoring of the occurrence. Hence, the data should be available at the most disaggregated administrative level to facilitate local analyses that contribute to the guidance and effectiveness of surveillance and control actions , 22. TheThrough the use of geographical information systems tools , 25, 26,Acceptance and implementation of an information system is one of the greatest challenges for epidemiological surveillance programs, which require continuous monitoring to reinforce the countries commitment to share information. Furthermore, SisLeish is providing support to sub-regional projects for cross-border surveillance, facilitating the exchange of information on the occurrence of leishmaniasis in the country borders. Additionally, SisLeish has developed a pilot alert system for VL in the borders of the MERCOSUR countries, which allows data sharing on phlebotomine presence, human and canine VL cases. Likewise, a surveillance, control and assistance module was created in 2015 to monitor and follow up with National Programs; this module was designed to become compatible with the database from the WHO, in order to reduce efforts and to avoid database duplicity. At first, this module had a low adhesion, only incorporating the data from two countries; nonetheless, there was a rise to nine countries in 2015.Despite being a simple methodology, the SWOT analysis has been increasingly used by managers and professionals to identify the strengths, weaknesses, opportunities and threats of programs, services or systems, to define and select appropriate strategies to improve actions and goals , 28. FigCurrently, SisLeish is undergoing a restructuring to enhance its functionality, which implies an improvement of the graphic and geographic interfaces, with the addition of interactive reports and maps, and providing public access to its information. Likewise, the system is being translated into the three main regional languages ; given that nowadays it is only available in Spanish.Since the implementation of SisLeish, the adhesion is continually growing, and presently has the data from all endemic countries available in the system. Therefore, it is imperative to continue encouraging countries to report their data, through improvements and an ongoing evolution of the system, so it can remain as an important surveillance tool in order to guide and implement actions."}
{"text": "Department of Health and Human Services, the task force is an independent, nonfederal, uncompensated panel of public health and prevention experts whose members are appointed by the Director of CDC. The task force provides information for a wide range of decision makers on programs, services, and policies aimed at improving population health. Although CDC provides administrative, research, and technical support for the task force, the recommendations developed are those of the task force and do not undergo review or approval by CDC."}
{"text": "Essential physiological functions in eukaryotic cells, such as release of hormones and digestive enzymes, neurotransmission, and intercellular signaling, are all achieved by cell secretion. In regulated  secretion, membrane-bound secretory vesicles dock and transiently fuse with specialized, permanent, plasma membrane structures, called porosomes or fusion pores. Porosomes are supramolecular, cup-shaped lipoprotein structures at the cell plasma membrane that mediate and control the release of vesicle cargo to the outside of the cell. The sizes of porosomes range from 150nm in diameter in acinar cells of the exocrine pancreas to 12nm in neurons. In recent years, significant progress has been made in our understanding of the porosome and the cellular activities required for cell secretion, such as membrane fusion and swelling of secretory vesicles. The discovery of the porosome complex and the molecular mechanism of cell secretion are summarized in this article."}
{"text": "The famous Professor Eliot Sorel from GWU, DHC and \u201cCarol Davila\u201d University of Medicine and Pharmacy in Bucharest affirmed that: \u201cHealth, healthcare and the transformations in the health systems need complementary innovations at the level of the professions in the health field, as far as education and training is concerned. Moreover, a new approach regarding health, healthcare, health and research systems is needed together with the creation of a new partnership between the bidders, consumers, decision makers, private, public and non-governmental sectors in all the countries, the economies with low, medium and high incomes\u201d. In the welcoming note of the 4th Edition of \u201cCarol Davila\u201d University of Medicine and Pharmacy Congress, which took place in June at the Palace of Parliament, the distinguished Academician, Ioanel Sinescu, Rector of \u201cCarol Davila\u201d University of Medicine and Pharmacy in Bucharest, Romania, stated: \u201cIn a context of new beginnings, in order for this project to be continued, so as to keep the tradition of organizing this event alive, we need bold people, solidarity and common effort, which should be in agreement with a strategy that we should all build together. I am talking about the involvement of all the members of \u201cCarol Davila\u201d University of Medicine and Pharmacy in Bucharest, Romania\u201d.In order to materialize these ideas, \u201cCarol Davila\u201d University of Medicine and Pharmacy increased its valuable academic teaching staff with six remarkable personalities who are worldwide famous. Prof. C. ChappleMember of the Royal College of Surgeons in Great Britain  and secretary general of the European Association of Urology, Professor Christopher Chapple graduated from the University of London as Bachelor of Medicine and Bachelor of Surgery. From the beginning, he had a keen interest in LUTS, female incontinence and reconstructive surgery, and has performed surgeries regarding the functional reconstruction of the urinary tract, later developing the European School of Urology on behalf of the European Association of Urology. In 2006, he was appointed Visiting Professor of Urology at the Sheffield Hallam University and in 2013, he became Honorary Professor of Urology at the University of Sheffield. Aside from being a brilliant surgeon, he is already responsible for more than 350 scientific articles published in prestigious journals and more than 50 books or chapters in the field of urology, with a great impact on the professional life and activity of the urological community. Moreover, he has also been acting as Editor in Chief of the journal \u201cNeurourology and Urodynamics\u201d, which is the official journal of the International Continence Society and the Section of Urodynamic and Female Urology of the American Urological Association, and, in 2011, he was awarded the St. Peter\u2019s Medal of the British Association of Urological Surgeons. Professor Chapple was the first to localize the alpha-receptor subtypes within the human prostate, has thoroughly investigated the mechanisms involved in the alpha adrenergic and muscarinic innervations, urothelial relaxing factor, neurokinins and purinoceptors. He has ongoing projects on tissue engineering for autologous buccal mucosa for urethroplasty, and has been envisioning new approaches in the management of pelvic floor prolapse and stress urinary incontinence.Prof. D. AtarProf. D. Atar is the Head of Research at Oslo University Hospital, Norway. He holds a full Professorship in Cardiology at the University of Oslo, along with a Visiting Associate Professorship at the Johns Hopkins University, Baltimore, United States. He first went to Denmark, where he trained in internal medicine and cardiology at the University of Copenhagen. During 1990 and 1994, Professor Dan Atar moved to Baltimore, where he continued his career at the University of Maryland and the Johns Hopkins University, in the field of cardiology and as a researcher in heart problems. Later, he went to the University of Zurich, where he was trained in interventional cardiology, and where he became a cardiology faculty member, under the guidance of Thomas L\u00fcscher, Editor in Chief of the European Heart Journal. His research focuses on myocardial biomarkers, myocardial function in myocardial infarction, particularly regarding the aspect of prevention of reperfusion injury, heart failure, and cardiovascular pharmacology. He has written more than 300 articles and book chapters and has more than 35,000 citations and a Hirsch Index of 56. At the same time, he is Associate Editor of journal \u201cCardiology\u201d and member of the Editorial Board of the \u201cEuropean Heart Journal\u201d and \u201cCardiovascular Diabetology\u201d. Consequently to his outstanding activity, he received a number of Awards such as: Research Award of the International Society of Heart Research in 1994, Cardiology Award of the Swiss Heart Foundation in 1996, \u201cAndreas Gr\u00fcntzig Award in Interventional Cardiology\u201d in 1997), and the Scientific Award of the Norwegian Society of Cardiology in 2014.Prof. Piotr Radziszewski, MD, PhDProfessor Piotr Radziszewski graduated from the School of Medicine \u2013 University of Medicine of Silesia, in Katowice, Poland.He was Head of the Neurourology Research Unit in the Department of Urology of the Medical University of Warsaw, fellow of the European Board of Urology, Head of the Urogynecology and Functional Urology Unit and Chairman of the Department of General, Oncological, and Functional Urology of Medical University of Warsaw. The European Association of Urology acknowledged his interest and activity in the field of Neurourology and Urodynamics by appointing him as a member of the \u201cBoard of the Functional and Female Urology Section\u201d of the European Association of Urology and as member of the \u201cGuidelines Committee on Neurogenic Bladder\u201d.He is also a member of the Neurology Committee and of the Educational Committee of the International Continence Society. Professor Piotr Radziszewski published over 250 original articles in prestigious medical journals and authored 18 book chapters and 3 books. He is a member of the Editorial Board of many prestigious international medical publications such as \u201cNeurourology and Urodynamics\u201d, the \u201cCentral European Journal of Urology\u201d, \u201cAnnals of Urology\u201d, \u201cArchives of Medical Sciences\u201d, \u201cUrologia Internationalis\u201d.In October 2015, the President of Poland, Andrew Duda, appointed Professor Piotr Radziszewski as a member of the Healthcare Committee of the National Development Council.Prof. L. SchmettererProf. L. Schmetterer graduated from the Technical University of Vienna in 1986 and University of Vienna Medical School in 1989. He is currently an Extraordinary Professor at the Centre of Medical Physics and Biomedical Engineering and at the Department of Clinical Pharmacology, Medical University of Vienna.Professor Leopold Schmetterer has published over 270 original papers and reviews in Diabetes, Diabetes Care, Neurology, Ophthalmology, Progress in Retinal and Eye, his impact factor being of 10 and his works being cited over 11000 times. He is the author of a milestone book about Ocular Blood Flow  and coauthor of more than 30 book chapters.He owns 16 patents, among them 10 in the field of OCT (Ocular Coherence Tomography).He was President of EVER (European Association for Vision and Eye Research), member of the board of the Austrian Science Foundation and he is member of the editorial board of many international scientific journals including the highest ranked ophthalmological ones.Recently, as recognition of his scientific contribution, it has been proposed to join one of the most famous and respected research institutions of the world: SERI (Singapore Eye Research Institute).Prof. V. Shah, MD, PhDProf. Vinod Shah, MD, PhD is a Pharmacy graduate with Gold Medal from Madras University, India, worked for 5 years in the pharmaceutical industry, Sarabhai Chemicals, Baroda, India, and from 1975 joined US FDA (Food and Drug Administration) in the Division of Biopharmaceutics. He has received several FDA Awards including Award of Merit , Scientific Achievement Award (2000), Commendable Service Award (2000) and Distinguished Career Service Award (2005). He is author/co-author of over 300 scientific papers and is a co-editor of five books. He was an Adjunct Professor at College of Pharmacy, University of Kentucky (2001-2011), a visiting professor at University of Philippines Manila, etc. Vinod Shah, MD, PhD is also an Honorary Member of Indian Pharmaceutical Association (2003), Honorary Member of Hungarian Society for Experimental and Clinical Pharmacology (2012). He is a recipient of FIP Industrial Pharmacy Award (2001 and 2008); IDMA - Eminent Pharmaceutical Analyst Award, India (2009) and SPDS Excellence Award, India (2014). He was the President of the American Association of Pharmaceutical Scientist (AAPS) in 2003 and a member of the International Affairs Committee of AAPS (2003-2014). Prof. F. HuismanProfessor Frank Huisman is a member of Utrecht University in Netherlands. He was President of the European Association of History of Medicine (EAHMH). He started his academic career in the field of history of medicine and medical ethics at the University of Amsterdam, where he completed his PhD studies with a paper regarding the beginnings of the medical system and of modernity in Netherlands, which received the Lindeboom academic award. He continued his career in the Department of History of Medicine at the University of Maastricht and, in 2006, he became a Professor of History of Medicine at the University of Utrecht, where he currently activates. Professor Huisman is involved in the activity of one of the most important centers of scientific research in Europe, Descartes Centre for the History and Philosophy of the Sciences and the Humanities. The range of his interdisciplinary preoccupations in the field of history of medicine and of interdisciplinarity between medicine, society and human sciences, is impressive: history and ethics of health systems, analysis of the pharmaceutical infrastructure in medicine - De Nederlandse farmaceutische industrie in de negentiende en twintigste eeuw , history of medical culture and of the concepts of medical school, theory and terminology of medicine. He has also made wide researches in the following fields: History, Philosophy, and Ethics of the sciences of life. Another excellence field is his preoccupation for opening histories and medical biographies in Europe in the context of scientific internationalization, which he highlighted with important, highly cited studies, such as Locating Medical History, The Stories and Their Meanings  and Dictionary of Medical Biography (the Netherlands and Flanders).He is also actively involved in interdisciplinary research commissions in the University of Utrecht and the University of Maastricht - Historical and Comparative Studies of the Sciences and Humanities.Moreover, Professor Huisman has many leading positions at the European and national level, being the Head of some prestigious medical organizations and societies. In addition, between 2009 and 2011 he was the President of the European Association of History of Medicine (EAHMH). He was also the unique author and co-author of many important books. The scientific studies published in the last 10 years alone prove the polyvalent mind of a true humanist scientist, recognized at the international level as an authority in the field.Executive EditorProf. Dr. Eng. Victor Lorin Purcarea"}
{"text": "Chlorinated dioxins are the group of environmental pollutants consisting of 210 chlorinated dibenzo-p-dioxins and dibenzofurans. They are highly toxic and persistent. They are lipophilic and can easily biomagnify in the food chain, hence posing a serious threat to human health. The daily consumption of low-level contaminated food, mainly of animal origin, leads to the accumulation of dioxins in the human body. The exposures of the general human population to dioxins and the specific issues of a risk assessment of dioxin pose serious concerns in public environmental and nutritional health. This paper reviews the analysis of chlorinated dioxins in ground beef. The sources of contamination of chlorinated dioxins in ground beef are first reviewed to form a basis for a clear understanding of the health implications of chlorinated dioxins in the human food chain and why it is necessary to monitor the level of dioxins in animal food products, especially ground beef. The methods of collection, sampling, and processing of ground beef, and the methods of sample clean up prior to the analysis, are reviewed. Emphasis is laid on the new techniques that are available and that might be effective in the analysis of chlorinated dioxins in ground beef. Among these new methods and techniques are: the synergistic combination of ELISA/GC/MS, direct sample introduction to /GC/MS-MS, automated clean-up method, and the supercritical fluid extraction methods. The possible treatments of results from each method and technique are discussed and their respective efficiencies are compared. Finally, quality control and quality assurance parameters are evaluated for levels of accuracy, reproducibility, and precision."}
{"text": "Department of Health and Human Services, the task force is an independent, nonfederal, uncompensated panel of public health and prevention experts whose members are appointed by the Director of CDC. The task force provides information for a wide range of decision makers on programs, services, and policies aimed at improving population health. Although CDC provides administrative, research, and technical support for the task force, the recommendations developed are those of the task force and do not undergo review or approval by CDC."}
{"text": "The process of peer review for submissions to scientific journals is a well-established and widely used procedure. Review by one's peers is a well-recognised and long-standing method of appraisal. Throughout all branches of science, medicine, humanities, art, literature, politics, sport, and in fact almost all areas of human endeavour, the judgement of work by an individual or group of experts in similar fields of study is the most rigorous and valuable form of recognition. \u201cPeer review\u201d, as this process is commonly known, is an important method of assuring quality, relevance and novelty of work. However, is there still room for improvement in the procedural aspects of peer review?"}
{"text": "The fifteenth plenary meeting of the International Standards Organization (ISO)/Technical Committee (TC) 108 on Mechanical Vibration and Shock was held at NBS Gaithersburg from March 30 through April 10, 1987. Approximately 130 delegates from 15 countries participated in the two weeks of meetings of the technical committee its four subcommittees, and nearly all of its 27 working groups.The American National Standards Institute (ANSI), the U.S. member body, has held the secretariat for this committee since the latter was established in 1963. Presently, 17 countries are participating and 26 others are observer members. The committee maintains liaison with other TC\u2019s of ISO and of the International Electrotechnical Commission (IEC. The chairman for the current term is Robert G. Bartheld of Siemens Energy & Automation; the secretary is Avril Brenig, standards manager of the Acoustical Society of America, which organization has administered the TC 108 Secretariat on behalf of ANSI.Opening the plenary session, the director of NBS, Ernest Ambler, reviewed the contributions to standardization of ISO in general and of TC 108 in particular; he also stressed the communality of interests between NBS and the voluntary standards community. The working meetings that followed addressed standardization in such diverse areas as balancing machines, vibration control on vehicles and structures, calibration of vibration and shock measuring instruments, and evaluation of human exposure to mechanical shock and vibration. Those standards ranged from some very specific problems, such as \u201crotor-shaft-key convention,\u201d to rather general ones, like \"mechanical transmissibility of the human body in the z-direction.\u201dIn response to the needs of manufacturers and users, new work items were established, for example, classification of environmental vibration conditions, of concern to users and makers of sensitive equipment, including computers. Several new working groups were created, while others, having completed their tasks, were dissolved. The importance of cooperation and liaison between WG\u2019s and TC\u2019s was emphasized. A new joint working group, consisting of experts from TC 108 and TC 70 on Internal Combustion Engines, will be called into existence to standardize the measurement and evaluation of vibration of reciprocating machines. Also, the collaboration with IEC/SC50A in the development of procedures to assess the shock resistance of mechanical systems will be continued. In all, 30 resolutions pertaining to confirmation or upgrading of standards, establishment of new work items, and creation or dissolution of working groups were adopted at the closing plenary meeting of TC 108.In the closing meeting, Rasa Rajeswaran, representative of the ISO Central Secretariat, expressed appreciation to NBS and to ANSI on behalf of all the delegates. The meeting was closed by William Rockwell, vice president of ANSI. The next plenary meeting is to be held in Shanghai, China, in September 1988."}
{"text": "Pasteur Institute of Iran (PII) is known for its history of benefaction by exquisite characters, the most prominent of who is the family of Farman Farmaian.Dr. Sabar Mirza Farman Farmaian, born in 1912 in Tehran, resided as the director of PII for a period of six years (1971-1977). Furthermore, he devoted his house (located in Shemiranat) for the establishment of a center to study and combat infectious diseases. Both of these events had a significant impact on the fate of PII.He was born to a famous family of Farman Farmaian. His father, Abdol-Hossein Mirza Farman Farmaian, the grandson of Abbas Mirza and Fath-Ali Shah, was born in 1852, in Tabriz. He was known as \u201cSalar Lashkar\u201d and \u201cFarman Farma\u201d. He finished his elementary studies at Dar ul-Funun, after which he went to an Austrian school to learn military skills. He held numerous critical positions during 1881-1919. These include the chief of Kerman and Azerbaijan military troops, governor of Kerman, Tehran, Fars, Khorasan, and Kermanshah, as well as the minister of War, Justice and the Interior. The most prominent of all is his chair as the prime minister during the reign of Ahmad Shah Qajar.In 1922, due to his passion for promotion of health, Abdol-Hossein Farman Farmaian dedicated a vast piece of land  for the expansion of Pasteur Institute of Iran. He is also the benefactor of other medical establishments, including the well-known Firoozabadi Hospital, in Tehran. His five sons, namely Firouz Nosrat-ed-Dowleh, Sabar Mirza, Abbas Mirza, Mohammad Vali Mirza, and Mohammad Hossein Mirza Firouz, all held ministerial positions at one time or another[Initially, Firouz Nosrat-ed-Dowleh, who was the Foreign Minister of Ahmad Shah Qajar in 1919, in cooperation with Zka\u2019almlk, Dr. Mohammad Loqman-e-Adham, Dr. Hakim al- Doleh and Dr. Mahmoud Khan, established Pasteur Institute of Iran, based on the Paris Memorandum of Understanding.Sabar Mirza Farman Farmaian was trained at home in childhood. Sabar Mirza was a small boy who went to Fars Province for one of the missions of his father who was the governor of this province. At the end of the mission, the eight-year-old Sabar Mirza returned to Tehran. At the age of 12, Sabar went to France to continue his education by his father request. After receiving diploma, he started to study medicine in France. He continued his study in medicine in Switzerland and received his degree in 1983 from the University of Geneva[In 1939, due to his father\u2019s illness, he returned to Iran. After his father\u2019s death, he spent his two-year military service as the physician in the army. Then, in the ministry of health, he was the supervisor of health problems in the west of the country. In the summer of 1942, he was appointed as the head of the health center in Hamadan and continued his job until 1943. He was then appointed as the manager of the Malaria Eradication and Control Program in Iran. He was able to control this disease extensively in Iran in three years.Due to his interest, he went to England to study communicable and tropical diseases and received his public health diploma from London School of Hygiene and Tropical Medicine in 1946. He took care of his younger brother and sisters and did his best for the well-being of Farman Farmaian Family.th July 1952, he became the minister of health in Mossadegh government and continued till 8th June 1953. Then, for a short time, he became the governor of Fars Province. After 1953 Coup and Dr. Mossadegh\u2019s fall, Sabar was forced to leave Iran. Immediately, the World Health Organization (WHO) invited him to work as its representative in Beirut and Cairo during which he implemented various health projects in African countries. He was selected as an expert in the scientific committees of WHO.Dr. Farman Farmaian was one of the strong supporters of Dr. Mohammad Mossadegh during the nationalization of the Iran oil industry movement in 1953. On the 26th WHO Malaria expert meeting in Geneva, as the head of the Department of Tropical Medicine of Tehran University and head of the Institute of Parasitology and Malariology. There, he was selected as one of the main members of the committee for controlling Malaria in the south-west of Asia, including Philippines, Cambodia and Vietnam. He also worked as WHO advisor for some time. In this regard, WHO appointed him as one of the best Malaria experts known in the world.In 1960, Dr. Sabar attended the 13In 1971, the Iranian government invited Dr. Sabar to come back to Iran and work as the director of Pasteur Institute of Iran. He was in this position for six years (1971-1977) before being retired. At that time, production and research in Pasteur institute of Iran were conducted in a single building. Dr. Sabar decided to separate them. Therefore, he purchased a land at Karaj Road for this purpose. He also provided modern laboratory devices for the institute. Employees of PII remember Dr. Sabar\u2019s time as a time of good management, good behavior and effort,4.After being retired, he continued medicine at his home in Shemiranat. Farman Farmaian Family started a fellowship program for the researchers who were interested in the social, political history, culture and civilization of Iran with focus on the Qajar dynasty (1794-1925) in the International Institute of Social History in Amsterdam, the Netherlands.Few months before his death, on November 2005, Dr. Sabar devoted his home in Shemiranat  for the establishment of a vaccination clinic against infectious diseases as well as specialized laboratories of Pasteur Institute of Iran for medical researchers. This new branch of PII started to work on October 2007. This place, formerly, was used as the summer camp of Abdol-Hossein Mirza Farman Farmaian when, in 1929, it was given to Sabar Mirza Farman Farmaian. In addition, proceeds from the sale of his furniture were all spent on studying medical students. Dr. Farman Farmaian died on May 19th, 2006. He was buried in Behesht-e Zahra Cemetery in Tehran. He never got married.One of the reasons of Dr. Sabar\u2019s success was his growth in a big and rich family who was interested in science and could dispatch their children to aboard for continuing their education. Dr. Sabar brother, Firouz Nosrat-ed-Dowleh, was one of the first creators of the Pasteur Institute of Iran and his father was the devotee of this institute. For six years, he was the director of the Pasteur Institute of Iran and devoted his home for improving the institute. Farman Farmaian Family and the Pasteur Institute of Iran are closely related to each other. Owing to the feeling of other-kindness, he devoted part of his life to control malaria in different parts of the world, including Asia and Africa. He was a warm-blooded man working with great people like Dr. Mohammad Mossadegh, his cousin. His valuable life is a worthy part of history of medicine in Iran.Peace be upon his soul."}
{"text": "Reason for Corrigendum:1College of Plant Protection, Hunan Agricultural University, Hunan, China, and 3Department of Entomology, University of Kentucky, Lexington, KY, USA). The authors apologize for this oversight. This error does not change the scientific conclusions of the article in any way.In the original article, we neglected to mention the additional affiliation of Xuguo Zhou (The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "Therefore, emphasizing on the need for more value-based and patient-centred care, and for the scaling-up of an integrated care model for mental and neurological disorders is important. An integrated care model encompasses the whole care process, from prodromal, early diagnosis to disease management and patient empowerment.The European Brain Council, an organization promoting research in Europe on health and disorders of the brain to improve the quality of life of those living with such disorders, initiated a two-year research project on the value of treatment.. The project included case studies on schizophrenia, Alzheimer disease, epilepsy, headache, normal pressure hydrocephalus, Parkinson disease, multiple sclerosis, restless legs syndrome and stroke. The study\u2019s research framework included the testing of an integrated model and the development of a series of qualitative and quantitative benchmarks to identify treatment gaps and causal factors along the continuum of care in a patient care pathway analysis. The study also estimated the socioeconomic impact and health gains from best practice health-care interventions with an economic evaluation. Case studies were analysed in collaboration with hundreds of experts from the European Brain Council in line with the research framework, applying empirical evidence from different European countries.The value of treatment for brain disorders \u2013 policy white paper.In June 2017, the council published the outcome of these case studies in ,For instance, the treatment success rate in schizophrenia can be improved if patients at risk are identified, psychotic symptoms are detected early and treatment is initiated in the prodromal phase. Depending on the stage of the disorder, antipsychotic medication, psychosocial interventions or both, are needed."}
{"text": "Dr. Nicholas J. MacDonald should be included in the author byline. Dr. MacDonald should be listed as the eleventh author, and with the affiliation 3: Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America. The contributions of this author are as follows: Conception and design of the work, acquisition of data, or analysis and interpretation of data; drafting the article or revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of work; conceptualization; methodology; investigation; and resources."}
{"text": "Sino-Japanese Symposium on Coagulation, Fibrinolysis, and Platelet first held in Hanchow, China in 1990, and again in Taipei, Taiwan in 1992. Thanks to the persistence and hard work of the conference founders and the participation of colleagues from countries around the world, that small, oligo-country conference has evolved into a regional conference now held every two years in cities of the Asia-Pacific region. Since its launch in Taipei, Taiwan in 2000, the APSTH Congress has been, and is now recognized as a key event in our field of thrombosis and hemostasis research.It begins with the State of the Art 2016: Research and Review from the 9th Congress of the Asian-Pacific Society on Thrombosis and Hemostasis, the first-ever publication of our APSTH conference proceedings. Truly, another big milestone.Taiwan has the honor of hosting the congress for the second time in 16 years with a program designed to foster international exchange and friendship in the pursuit of the newest medical knowledge on thrombosis and hemostasis. The best proof of our persistence in this endeavor is now lying before you, Thrombosis Journal, Dr. Yukio Ozaki, and Rachael Sykes from the supplements team at BioMed Central, and the support of Toby Hung, Jeff Boice, and Shih-Yao Lin which were instrumental and invaluable in the preparation and publication of these proceedings. Thank you all.The contributions in this first edition of APSTH proceedings consist of a balanced mixture of basic and clinical research and review papers. It is our hope that this APSTH publication will provide insight and help to advance our understanding in the various fields of thrombosis and hemostasis. We are grateful to the contributing authors for their excellent work. We are indebted to the many international reviewers who rose to the challenge of publication time constraints to provide us their insights and opinions. We wish to acknowledge the guidance of the editorial office of We wish you happy reading.Supplement Editorial Committee, APSTH 2016Ming-Ching Shen, organizerShu-Wha Lin, co-editorChing-Ping Tseng, co-editorJiaan-Der Wang, co-editor"}
{"text": "Prospective cohort studies are considered ideal choices to study multiple outcomes and risk factors for Non-communicable diseases (NCDs). Our aim is to set-up the protocol and analyze risk factors, incidence rates, prevalence, trends, and the models of environmental and genetic determinants of NCDs and their outcomes as well as interaction among such determinants.Shahrekord cohort study (SCS) that is a population-based prospective, study on a cohort consisting of people aged 35-70\u00a0years started in November 2015 in Iran. The sample size of the original cohort is at least 10,000 people. Annual follow-ups  of the cohort were designed to be conducted up to 2036. Exposures  were measured by relevant standard methods and questionnaires. Incidence of common NCDs , trend of risk factors, hospitalization, disability, and death were considered the outcomes of the cohort. The definition of disease was determined based on the International Classification of Diseases 10th version (ICD-10). Routine hematologic and biochemical tests were conducted and an all-inclusive biobank  of the cohort was stored for future studies. All steps of data collection and examinations are directly monitored by the quality control team.The SCS is a unique study conducted in southwest of Iran that is a notable work given the climate conditions and ethnicity population  of this region. By providing high quality the protocol and introduce it, the SCS can serve as a solid foundation for management and researchers in southwest of Iran. The SCS provides prerequisites for collaboration and regional, national, and international studies on NCDs. Data are available at the modeling in health research center, Shahrekord University of Medical Sciences, Shahrekord, Iran, for any collaboration. In the recent years, policymaking, planning, and decision-making in public health and health system have entered a new phase of evolution that is widely known as evidence-based decision-making . AdoptinIn addition to affecting mortality rate, chronic diseases cause inability and influence productivity. Chronic diseases are associated with high prevalence, incidence, and disability-adjusted life year (DALY) in Iran, with various patterns in different provinces, as with other countries \u201318. For It is widely acknowledged that smoking, obesity, increased intake of salt, and inappropriate lifestyle have adverse effects on health in Ch&B province, other provinces of Iran, and even other countries , 23\u201328. http://persiancohort.com , and university/executive. At university level, the members of the quality control team are faculty members of the departments of epidemiology and biostatistics, biochemistry, and laboratory sciences. To control field quality, this team also includes three people with master\u2019s degree on epidemiology, biostatistics, and laboratory sciences. All steps of data collection such as census, invitation, examinations, interview, and sampling as well as taking tests and recording their results are directly monitored by the quality control team.The participants complete the executive steps. A checklist is used to monitor the steps and the duration of measuring the exposures. If a participant does not complete any executive step, the reason is recorded and the participant required to have the relevant document till the completion of the executive steps so that he/she can receive the Cohort Identification Card. The checklists data are compared to those registered in the electronic questionnaire by the quality control team to remove potential inconsistencies. The accuracy of the completed items are examined with reference to the outputs of the electronic questionnaire that were converted to an MS Excel file. Every month, three interviews are conducted with each participant, as the interviewer is blind, and the interviews are recorded. The methods of the interviews and the accuracy of the collected data are examined. In some cases, the participants are randomly asked to refer to the Cohort Center again to recomplete a section of the questionnaire  to examine the consistency of the data drawn after each administration. Besides that, a central quality control team of the PERSIAN Cohort monitors affiliated studies regularly and meticulously according to a well-developed protocol. Field quality, the performance of the interviewers, and the calibration of the used equipment are assessed, monitored, and evaluated according to the processes of each part of the interviews and using a checklist daily, weekly, monthly, once every 3\u00a0months and annually and the results are recorded.The SCS is a unique study conducted in southwest of Iran that is a notable work given the climate conditions and various population  of this region. Aimed to study chronic NCDs and associated factors, this study can, in the first place, serve as a solid foundation for planning and policymaking in healthcare field and the control of common diseases of the region, provinces of Iran and secondly, be useful for other countries of the Eastern Mediterranean and even worldwide. Although a number of cohort studies were or are being conducted in the Eastern Mediterranean, the current study, representing one of the centers of the PERSIAN Cohort, can provide highly valuable evidence on precision medicine. Notably, the main exposures are measured and registered in the SCS as with other centers of the PERSIAN Cohort. Although the SCS was started a little late following other centers of the PERSIAN Cohort, this delayed initiation became an opportunity as the executors could observe, visit, and gain experience with already initiated cohort studies. As a result, in the SCS, the PERSIAN Cohort Protocol is being thoroughly followed and, according to the codified protocol, certain variables that are likely to play confounding role in analyzing associations and outcomes or be colliders are measured and registered as well. Therefore, an advantage of the SCS over other centers of the PERSIAN Cohort, is taking the EKG, pulmonary function test, and pulse oximetry, measuring body composition, general health, social health, chronic stressor, coping strategies, health literacy, and low back pain as well as conducting examinations for rheumatologic disorders using valid and nativized questionnaires. SCS provides useful evidence for research in social epidemiology, NCDs epidemiology, health services research and genetic epidemiology. In certain centers of the PERSIAN Cohort, a number of these variables are studied. For example, in the Yazd Cohort Study, spirometry is taken, in the Azar Cohort Study, rheumatic diseases are investigated , and in"}
{"text": "Dr. Ada Maria de Barcelos Alves should be included in the author byline instead of the Acknowledgments. She should be listed as the seventh author and affiliated with Laboratory of Biotechnology and Physiology of Viral Infections, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil. The contributions of this author are as follows: Conceived and designed the experiments, performed the experiments, analyzed the data, and contributed reagents/materials/analysis tools."}
{"text": "One of the special features of IJPR is the publication of special topic issues. This special issue is dedicated exclusively to articles about the field of Pharmacognosy. Pharmacognosy that means the science of medicine has a long history in Iran. Despite the fact that the word was first used in German literature about 200 years ago, its history dates back to 1,000 years ago in Iranian traditional medicine. The documents recorded by the Iranian ancient pioneer physicians, who made important contributions to the field, such as Rhazes, Avicenna, Jorjani, etc. have comprehensively referred to the principles of this science. Due to the variability of climate and geography, vegetation is very rich and strong in Iran. Thus, pharmacognosy research status in this country (and the world) is on the rise and the number of articles and documents obtained from this research is on the increase.In this issue, several articles from authors in various fields of pharmacognosy have been offered. The result of these researches highlight the importance of antioxidant and cytotoxicity of plants , pharmacological activities on animal models, bioassay-guided studies, evaluation of plant effect used in Iranian traditional medicine, clinical trials, the analysis of essential oils, phytochemistry, antibacterial activity, various biological effects, etc. All of these areas may potentially lead the pharmaceutical and medical world to new natural sources for future drug discovery. In addition, IJPR special issues represent outstanding articles by scientists in the field of natural products research. This issue of IJPR is dedicated to Prof. Hossein-zadeh, Mashhad, Iran, for his lifetime achievement. I would like to take this opportunity to thank all reviewers of this special issue for their commitment and hard work. Without their dedication and tremendous efforts, this issue would not have been possible.It is hoped that these papers can document an increase in the Iranian traditional medicine and lead to the development of new drugs effective in the treatment of diseases.Faraz Mojab is currently working as a professor in Department of Pharmacognosy, School of the Pharmacy, Shaheed Beheshti University of Medical Sciences, Tehran. He can be reached at sfmojab@sbmu.ac.ir"}
{"text": "The application of transcranial direct current stimulation (tDCS) has moved from the laboratory to the wider community. This form of non-invasive brain stimulation has been shown in a number of controlled animal and human experiments, over nearly five decades, to modulate brain physiology, cognitive functions, and behavior. While its effects are variable across and within individuals, it is not unreasonable to state that tDCS harbors the potential to enhance executive and physical human performance. In a society increasingly driven to succeed with less effort, performance enhancement with an intervention that has an excellent safety record, is well tolerated, relatively inexpensive and readily available, is particularly appealing. Here, we offer a perspective on tDCS for the enhancement of physical performance in sport. The ethical and legal implications of the transition of tDCS from academic experimental work to general-public use, are discussed elsewhere  tDCS  on trained cyclists , the Football Players Health Study at Harvard University, and Harvard Catalyst|The Harvard Clinical and Translational Science Center .The content is solely the responsibility of the authors and does not necessarily represent the official views ofHarvard Catalyst,Harvard University and its affiliated academic health care centers, the National Institutes of Health, or the Sidney R. Baer Jr. Foundation.AP serves on the scientific advisory boards for Nexstim, Neuronix, Starlab Neuroscience, Neuroelectrics, Axilum Robotics, Magstim Inc., and Neosync; and is listed as an inventor on several issued and pending patents on the real-time integration of transcranial magnetic stimulation with electroencephalography and magnetic resonance imaging. The other authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "Fig. 1).The imposing series of personalities from the whole world, who were awarded the \u201cDoctor Honoris Causa\u201d title by \u201cCarol Davila\u201d University of Medicine and Pharmacy in Bucharest, the biggest and oldest University of Medicine in Romania, opened in 1966 by Prof. A. Butendandt from Max Planck Institute in Germany and Laureate of Nobel Prize, continued with three great academic personalities in the field of Dentistry  from the University of Bonn, Germany, in 1971, and in 1972 his DMD  also in Bonn. He has been Chairman of the Department of Operative Dentistry and Periodontology at the University of Regensburg, Dean of the Faculty of Medicine of the University in Regensburg, and, for more than 20 years, Dean of the Faculty of Dental Medicine of the same university. Moreover, he has been member and President of the Senate of the University in Regensburg .He has been President of several national dental associations such as German Association for Operative Dentistry (DGZ), German Scientific Society for Dentistry (DGZMK) and German Association for Professors in Dentistry (VHZM). He has later been elected Honorary Member of these associations. Fig. 3).At the international level, Prof. Schmalz, MD, PhD has been elected President of the Continental European Division of the International Association for Dental Research (IADR) as well as for the Pan European Region (including Israel) of the same association. He was also President of the Pulp Biology and Regeneration group of IADR . Prof. Schmalz, MD, PhD has published more than 250 articles in PubMed listed journals, with a Hirsch index of 24, and over 1800 citations. For his scientific work, he received more than 35 prices and awards, among which the \u201cEuropean Award for Substitution of Animal Experimentation\u201d, Anny Eck-Hieff Prize for the \u201cDevelopment of an in-vitro pulp chamber system for toxicity testing of filling materials in dentistry\u201d, \u201cDistinguished Scientist Award\u201d for his achievements in Pulp Biology Research, \u201cDistinguished Service Award\u201d, and \u201cAward of Excellence\u201d of the European Federation of Conservative Dentistry. He is Adjunct Senior Scientist at the Houston Center for Biomaterials and Biomimetics, University of Texas and Member and Senator of the German National Academy of Sciences. Since 2014, he has been guest Professor at the Dental School of the University of Bern, Switzerland. In 2015, he received the Doctor Honoris Causa (Dr. h.c.) distinction from \u201cIuliu Hatieganu\u201d University in Cluj-Napoca, Romania  at the Dental School of the National and Kapodistrian University of Athens, in 2012.He was member of the Senate of the same University (for five periods) and became Head of the OMFS Department during 2014-2016. During 1999-2016, he was Director of the OMFS University Clinic at the \"A. Kyriakou\" Children's Hospital of Athens having performed more than 1500 major surgeries of the maxillofacial regions in Children and Adolescents mainly including fractures, benign and malignant odontogenic and non-odontogenic tumors, arteriovenous malformations, clefts and syndromes involving the maxillofacial regions. He was also acting as Director of the post-graduate program on \u201dDentoalveolar Surgery\u201d, Dental School, University of Athens (2012-2017). Fig. 5). He has also been President of the Hellenic Association of Oral and Maxillofacial Surgery (2006-2008 and 2014-2017) and Editor-in-Chief of its official Journal, \"Archives of the Hellenic Association of Oral and Maxillofacial Surgery\". He is member of the European Association for Craniomaxillofacial Surgery, Councilor for Greece (2010-2016), member of the Editorial Board and reviewer of its official Journal .He has also been honorary guest speaker in 14 European countries . He is founding member of the Strasburg Osteosynthesis Research Group (SORG), a leading international scientific Organization with state of art statements concerning treatment of skeletal diseases of face and skull. Recently (2017), his team won the first prize of this group, concerning a research project dealing with syndromic and non-syndromic children treated with mandibular distraction osteogenesis. His main fields of interest are maxillofacial traumatology and oncology for children, orthognathic surgery, clefts, distraction osteogenesis, implantology, and oral surgery  for both local and systemic diseases. Specifically, he developed a new toolbox to unmask \"hidden\" proteins in saliva, to concentrate and increase signal intensity of protein biomarkers using traditional lateral flow immunoassay tests as a platform for OF rapid diagnostic tests.Fig. 7). His work was supported by many research agencies (more than 30) including the Israeli Science Foundation, United States-Israel Binational Science Foundation, German-Israel Science Foundation, Ministry of Sciences, and Ministry of Health. His work was published in many international leading journals and awarded by many prizes. Prof. Palmon, MD, PhD has served as the president of the Israeli Division of the IADR, Director of the Graduate Program in Bio-Medical Dental Sciences and the Chairman of the Institute of Dental Sciences at The Hebrew University .Within the university system, Prof. Palmon engaged in the administrative leading. Prof. Palmon, is currently serving as the Dean of the Hebrew University-Hadassah, Faculty of Dental Medicine, for a second term, and is the founder and director of the Hebrew University Teaching and Learning Center, the director of MEITAL, which is the Israeli Inter-University Center for e-Learning and management member of the Israeli university forum of teaching and learning centers (The event took place on 15-18 March 2018 in the imposing Boardroom of the Rectorate of \"Carol Davila\" University of Medicine and Pharmacy in Bucharest, during the second edition of the International Congress of Dental Medicine, dedicated to the 70 years jubilee from the founding of the Dentistry Faculty. Executive Editor Professor Eng. Victor Lorin Purcarea, PhD"}
{"text": "In 2018, the Latin American Journal of Nursing (RLAE) reaches 25 years of uninterruptedpublication of articles, resulting from research developed in Brazil and abroad, thuscontributing to the progress of scientific knowledge on nursing and other sciences of thehealth sector in an effective way.The journal is one of the dissemination vehicles of the Nursing School of Ribeir\u00e3o Preto,which belongs to the University of S\u00e3o Paulo, and it is a Collaborating Center of the WorldHealth Organization for Nursing Research Development. Its 25 volumes published since 1993were composed of articles, originals and literature reviews, strictly selected by renownedresearchers who, voluntarily, contributed to add greater quality to the content of theevaluated articles. The journal adopts the peer review system and has 734 active advisers,of which 30% are foreigners. In addition to the articles, we have also publishededitorials, enabling the discussion of ideas in the academic community on relevant subjectsfor the health and nursing sectors, and seeking to foster the development of studies withstrong scientific evidence.The adopted editorial management seeks excellence in editorial quality, integrity in thedissemination of knowledge, as well as the sustainability of the journal,internationalization and broadening of its visibility. Among some of the strategies used byus, we should cite: the use of an electronic administrative system for processing articles,the use of a similarity detection tool and guides to improve texts, as well as the adoptionof the continuous publishing system (rolling pass).Ad hoc advisers,and those who work in the technical support ,who focused their efforts on accomplishing the complex and continuous editorial demandsrelated to scientific sources, information technologies, licenses and copyright laws,standardizations, database indexing criteria, storage and digital article transfertechniques, analysis of bibliometric indicators, use of digital identifiers, amongothers.For us, speaking about editorial management is gratifying, as it reminds us of a workdeveloped in partnership with a group of dedicated and skilled professionals who haveparticipated throughout these years and who currently participate in the Board ofDirectors, Publishing Committee and Editorial Board, as We have been honored to take part in the Editorial Committee of RLAE since the publicationof its first issue and, since April 1999, to work as the scientific editor-in-chief of thejournal. It is worth highlighting that we were preceded by the editors: Prof. Dr. OlgaMaiomoni Aguillar (1992-1995) and Prof. Dr. Maria Aparecida Tedesch Cano (1995 - March1999).The journal had Prof. Dr. Marcia Bucchi Alencastre as vice-president of the PublishingCommittee (1993-1995), who was succeeded by Prof. Dr. Maria Helena Palucci Marziale (1996 -March 1999) and Prof. Dr. Isabel Am\u00e9lia Costa Mendes (April 1999 - August 2009); and, since2009, Prof. Dr. Regina Aparecida Garcia de Lima is the scientific editor.Currently, the Publishing Committee is composed of a scientific editor-in-chief, ascientific editor and thirteen associated editors, of which 40% are linked toteaching/research institutions from abroad. The dynamics adopted by the journal andsupported by the Congregation of the institution, aimed at allowing the continuity of thework of a same scientific editor-in-chief during the last 19 years, enabled the developmentof sequential editorial actions in line with the demands of the field of knowledge and withthe editorial tendencies, besides assigning indicators of quality and visibility of thejournal in the scientific community.Until December 2017, we published 2,725 articles of authors from Argentina, Australia,Bolivia, Brazil, Canada, Chile, China, Colombia, Costa Rica, Cuba, El Salvador, Ecuador,Spain, France, Guatemala, Honduras, Iran, Italy, Mexico, Nicaragua, Peru, Portugal, UnitedKingdom, Sweden, Tanzania, Turkey and Venezuela.This journal is indexed in 21 international and national databases and has its articlesdisseminated, in open access, on the website of the journal (magazine) and in national andinternational journal portals, and articles may also be accessed by the RLAE applicationthrough mobile phones (iOS/Android systems).Arquivos Brasileiros de Cardiologia ,Ci\u00eancia & Sa\u00fade Coletiva , Cadernos deSa\u00fade P\u00fablica  and Estudos Avan\u00e7ados .RLAE has the particularity of being pioneer on indexing articles in internationaldatabases. When compared to nursing journals published in Brazil and Latin America, it wasthe first nursing journal published in Brazil to integrate the Web of Science and theJournal Citation Reports; the first Brazilian journal of the sector to provide its entirecollection in open access and published in three languages \u200b\u200b; and the only nursing journal, published in Brazil, classified in stratum A1 inQualis/Journals/CAPES - nursing sector. In the last available indicators dated 2016, RLAEobtained the impact factor in the Journal Citation Reports (JCR) of 0.634 in the bienniumand 0.884 in the quinquennium; and in the Scopus/SCIMAGO\u2019s Journal & Country Rank(SJR), it obtained SJR of 0.394 and H-index of 28. The journal heads the SciELO BrazilRanking - Top 10 journals with more hits in the period 2015-2017RLAE is one of the journals with the greatest number of downloads in the JournalsRepository of the University of S\u00e3o Paulo, which is regarded as one of the 50 bestrepositories in the world. Through information provided by the Integrated Library System ofthe University of S\u00e3o Paulo (SIBiUSP) in January 2018, we noted that, in the last fouryears, the RLAE articles had more than one and a half million downloads, which were held bya public from Brazil , United States of America , Mexico ,Portugal , Peru , Colombia , Spain , Germany ,Venezuela , Ecuador , Mozambique , United Kingdom , among othercountries. This data is considered an important indicator of the national and internationalexpression of the journal in question.In We noted that there is a divergence of themes in the articles most searched by readers ofthe journal according to each of the languages, and this data will influence the futurecalls of articles, since the practice of induction of articles about issues relevant to thesector and linked to the national and international research guidelines is part of theeditorial strategies undertaken. We draw attention to the open call for the submission ofarticles about \u201cHuman resources in health and nursing\u201d, with priority for the topics\u201cInterprofessional education\u201d, \u201cPractice\u201d and \u201cSkills\u201d.Preprints), which has long beenemployed in the fields of physics and mathematics to advance the pace of dissemination ofinformation, but with resistance of acceptance in the health sector, due to the fact thatthe articles uploaded in repositories do not undergo the evaluation of scientificreviewers; and also that, once published on the Internet, an article is no longer new forthe repository, and this is an important fact for scientific journals that aim to publishnew and reliable knowledge, which may entail scientific advancement. Nevertheless, with theonset of new repositories , itappears that prepresses will no longer be restricted to the physical and social sciences(Currently, the demand for RLAE and other journals of this sector is to decide on theadherence to the repository of prepresses (Accordingly, we celebrate the trajectory covered and continue the relentless pursuit forstrategies capable of enabling us to further improve the editorial management of thisjournal and fulfill the new demands that may arise."}
{"text": "Dear Colleagues,This year marks the 20th anniversary of establishment of the Eurasian Association of Gastroenterology (EAG). Decision about establishing this society was carried in 1996 in Antalya (Turkey) during the days of Turkish National Congress of Gastroenterology, when some famous Turkish scientists and participants from Turkish-origin foreign countries discussed about need in some society for closer scientific contacts between gastroenterologists and surgeons of their countries. The organization of such a scientific association with headquarters in Ankara has been approved by all participants of a meeting and the charter of new society has been prepared and approved soon. Turkey, Azerbaijan, Kazakhstan, Uzbekistan, Kyrgyzstan, Turkmenistan, and Northern Cyprus became full members of the created society. According to the charter, main aims and goals of new society were establishment of scientific cooperation, the constant exchange of ideas, and experience among scientistsgastroenterologists and surgeons from these countries, familiar with one another\u2019s achievements, such as help for improvement of professional levels of doctors-specialists. For achievement, these goals were decided carrying the Congresses of EAG no later than once a year in one of the member countries of Association. The first International Euroasian Congress has been carried out in 1997 in the capital of Azerbaijan-- Baku city.The Congress that was carried out with assistance of the government of Azerbaijan had 35 scientists from five foreign countries and about 500 Azerbaijani doctors. Upon completion of Congress, representatives from member countries of new Association have noted the success of the held forum and have emphasized the importance of such meetings for specialists of their countries.In the next years, the Euroasian Congresses of Gastroenterologists and Surgery was carried out in Kazakhstan (1998), Turkey (1999), Uzbekistan (2000), Kyrgyzstan (2001), and again in Azerbaijan (2003).In 2004, Professor of Ankara University, Hasan Ozkan was elected as the President of the Association and till date he successfully directs this scientific organization. It should be noted that in the next Euroasian Congress of Gastroenterologists in Ankara held in 2004, the meeting was held between the new management of Association with members of the international scientific committee of society where a number of important questions were discussed.So, during the meeting participants had expressed opinion about the necessesity of some changes in a format of the held scientific forums. It has been noted that scientists from other non-Turkish-origin countries show a great interest to scientific Congresses of EAG and they repeatedly address to presidium of society about inclusion of their countries in Association like full members of society. Considering it, full members of Association in the next years will be elected in Ukraine, Georgia, \u00ddran, Russia, Bangladesh, Bulgaria, Pakistan, Bosnia and Herzegovine, Egypt, Albania, Moldova, and other countries. For this reason, the next Congresses of EAG have been carried successfully out in the countries which became new members of the organization\u2014Georgia (2005) and \u00ddran (2007).The Azerbaijani surgeons and gastroenterologists are one of the most active participants of all events held by EAG from the moment of its establishment. The big and irreplaceable role in formation of EAG and its work belongs to the famous Azerbaijani scientist- academician Beyukkishi Agayev. Under his management in the capital of Azerbaijan, the Congresses of EAG have been carried out six times .In Azerbaijan as well as in other countries, interest of doctors to these significant scientific meetings has grown from year to year that is a graphic evidence of the acquired authority of EAG on the scientific world. So, in the first Congress held in Baku, there were 35 foreign scientists from five countries; whereas in the Congress held in 2013, the foreign delegation was presented by 162 doctors representing the leading medical clinics and universities of 25 countries. Their articles and lectures about modern problems of surgery and gastroenterology, information about new views on diagnostics, and treatment of a number of diseases had a huge value for all participants of the Congress and of course for the young Azerbaijani doctors and residents who were taking the first steps in science.In these Congresses, together with the well-known Azerbaijani scientists (which held in Baku in different years) famous scientists from different countries also took part: H. \u00d6zkan, A. D\u00f6kmeci, S. \u00dcnal, N. \u00d6rmeci, \u00dd. Balik, Y. Bayraktar, S. Y\u00fdlmaz (Turkey) A. Nakao, F. Akbar, H. Miroyama (Japan), R. Gish, S. Gupta (USA), M. Farthing (UK), F. Ezzat, A. Sami (Germany), N. Lygidakis (Greece), M. Abdel Vahab (Egypt), E. Galperin, V. Sandrikov (Russia), A. Hacibayev (Uzbekistan), E. Gerich (Ukraine), M. Al Mahtab (Bangladesh), G. Parodi , J.Heyat (Iran), and others.These Congresses were widely highlighted on local television, on pages of newspapers, scientific journals, and the web sites. A number of participants of the Congress have had official meetings with heads of the Ministry of Health of the Republic and the Azerbaijan Medical University. During these meetings, the Azerbaijani heads emphasized value and role of such scientific forums for scientists and doctors of Azerbaijan, about the need of close contacts among experts for increasing their professional level.Azerbaijani Association of Surgeons and Gastroenterologists (AASG) established in 1997 played a big role in formation and development of surgery and gastroenterology in Azerbaijan. AASG unites more than 1,000 surgeons and gastroenterologists who work in the leading clinics of Baku, scientific institutes, regional hospitals, and polyclinics. The association holds permanent meetings, conferences, and symposiums with participation of foreign experts, where topical issues on diagnostics and treatment of various diseases are discussed. Much attention is paid on questions of prevention and modern methods of treatment of viral hepatitis, surgical and endoscopic treatment of the biliary strictures, parasitic cysts of a liver, a hepatocellular carcinoma, and so on. Because of activity of the AASG, doctors have an opportunity for being informed constantly about the achievements of medicine, new methods of diagnostics, and alternative ways of treatment of various diseases.With an initiative and support of AASG, a number of doctors from Azerbaijan take advanced training courses in the leading clinics of Baku and foreign countries. In 2005, the Association started the journal \u201cCerrahiyye\u201d (Surgery) whose editorial board includes scientists from 16 countries. The journal publishes materials not only in Azerbaijani, but also in English and Russian languages, so scientists from various countries of Europe, Asia and America have published their articles in journal of AASG.Azerbaijani surgeons and gastroenterologists is playing an important role in cooperation between AASG with EAG. This cooperation allowed a great number of young doctors from Azerbaijan to have scientific trainings and increasing the professional level in the leading clinics of Turkey. With assistance of our Turkish colleagues, a lot of qualified specialists who in recent years have been trained in Ankara, Istanbul, and Izmir are now actively working in the leading clinics and scientific divisions of Azerbaijan institues.In Antalya (Turkey) from April 27th to May 1st of 2016 has passed the XV Congress of Euroasian Gastroenterologists and Surgeons under the chairmanship of the president of EAG, Professor H. \u00d6zkan. In the Congress that was organized at a very high level, guests from various countries have highly appreciated activity of society and have emphasized its role in the development of science and preparation of high-quality specialists. In Antalya, they disscussed some prospects of further works and taken a decision about carrying out the next EAG Congress in 2017 in Sarajevo. I am sure that this Congress in the territory of ancient Bosnia will open new prospects in activity of EAG and will serve expansion of structure of Association at the expense of the new countries from the European region.I want you all to note that Euroasian Journal of Hepato-Gastoenterology is playing a very important role in collaboration and connection among scientists from the Euroasian countries and increasing of the EAG\u2019s authority in the scientific world since 2011. In a short period, this journal has become very popular among readers from many countries, including Azerbaijan. Here of course is a big merit of Editor-in-Chief of the journal, Prof Hasan \u00d6zkan, co-Editor-in-Chief, Prof Fazle Akbar, and Executive Editor, Prof. Mamun-Al-Mahtab.I want to wish all my colleagues a very good health and success in their professional activity and to wish EAG and Editorial board of EJOHG prosperity and further strengthening of the international scientific authority.Rauf M AghayevPofessor, Department of Surgical Diseases-IIAzerbaijan Medical University,Baku, AzerbaijanEuroasian Journal of Hepato-Gastroenterology"}
{"text": "The checklist was applied to 16nurses of 8 surgical units and submitted for validation by a group of eightexperts using the Delphi method online. the instrument was validated and it was achieved a mean score \u22651, level ofagreement \u226575% and Cronbach\u2019s alpha >0.90. The final version included 97 safetyindicators organized into six categories: identification, preoperative, immediatepostoperative, immediate postoperative, other surgical complications, and hospitaldischarge. the Surgical Safety Checklist in the Pre and Postoperative periods is anotherstrategy to promote patient safety, as it allows the monitoring of predictivesigns and symptoms of surgical complications and the early detection of adverseevents. Nurses\u2019 decision-making processes encompass knowledge in the area of care andmanagement, with an emphasis on patient care. However, for their success, they mustoccur in line with planning and evaluation, based on an appropriate information system.The information within a health service not only favors decision making, but also thestructuring of innovative strategies that significantly help in the management. This isthe challenge, from a wider perspective, for the insertion and performance of nurses inthe organizational structure of health systemschecklists, may promote the early identification of the mostfrequent problems in the planning of nursing care during hospital stay, discharge plandevelopment and guidance on home careAmong the management actions is the decision making of the nurses, it is possible tohighlight those actions related to patient safety aiming at the prediction and reductionof complications, as well as the early detection of aggravations and adverse events inthe postoperative periodchecklist for the safety of surgical patients, was a study conductedby experts of the World Health Organization (WHO) in eight countries . In total 7,688 patientswere investigated, of which 3,733 were investigated prior to the use of thechecklist and 3,955 after filling out thechecklist, which showed a 36% reduction in surgical complications, 47%in mortality, 50% in infection rates and 25% in the need for a new surgicalintervention. It was concluded that the use of the checklistpractically doubled the possibility of using safe care standards during surgicaltreatment of the patientsThe initial milestone, which demonstrated the benefits of using aChecklist (SSC) werehighlighted in the WHO Second Global Patient Security Challenge. In Brazil, the Ministryof Health has implemented the Safe Surgeries Programme and recommends the use of SSCbefore anesthetic induction, before the surgical incision and at the end of the surgery,before the patient leaves the operating roomThese results on the use of the Surgical Safety checklists areconsidered instruments to coordinate care, promote team union and reduce postoperativecomplications. Such complications frequently involve pneumonia, pulmonary embolism, deepvein thrombosis, surgical site infection, unplanned return to the operating room, bloodloss, death, suture dehiscence, cerebrovascular accident, acute myocardial infarction,vascular graft failure, systemic inflammatory response syndrome, septic shock, cardiacarrest and acute renal failureA systematic review concluded that surgical safety checklists is a practice encouragedby reducing memory and intuition dependenceOther studies show that the use of checklist in the pre and postoperative periods in the hospitalsurgical units. This allows identifying the appropriate preparation of the patientsbefore their referral to the surgical center, as well as the predictive signs ofpostoperative complications. Considering that the WHO SSC model is applicable in surgical centers, that is, inperioperative moments , it is justified the need for aspecific Another study concluded that the prevention of problems related to the safety ofsurgical patient should also be focused on the pre and postoperative periods, as it isestimated that 19% of incidents are associated with the organization of services andcarechecklists for otherin-hospital services, as a way of stimulating the safety cultureThe WHO recommends the development of new checklist for patients in the pre and postoperative periods insurgical hospitalization units.The objective of this study was to develop, evaluate and validate a surgical safetyMethodological study, with a quantitative approach, conducted in a large public teachinghospital, located in the South Region of Brazil, from March 2013 to October 2014, withthe participation of 16 nurses of eight surgical services . checklist forpatients in the pre and postoperative periods (SSCPP) was guided by the principles ofthe Safe Surgery Saves Lives Programme of the WHO: simplicity, applicability andmeasurement capacity of the checklist-type instrument to the safesurgeryPlan, Do, Check, Act)The development, assessment and validation of the The methodological steps of the implementation of the PDCA Cycle are presented asfollows. checklist. The Planning Phase consisted of three meetings: the first one with nurses of surgicalunits, for awareness on the surgical safety, identification of gaps and analysis ofproblems related to the surgical safety of patients in hospitalization units,presentation, agreement with the research project and signing of the Informed ConsentForm (TCLE). The inclusion criteria were: nurses who have been working for more thanfour weeks in a surgical unit and with a 20 hours weekly shift or over; as exclusioncriteria: nurses on probationary period, on vacation, or nurses away from work onsick leave. The sample consisted of 16 nurses, all professionals of 8 surgical units.Two other meetings took place in continuity with the Action Plan, for the preparationand implementation of a pilot test of the checklist; b) two workshops were held with the nurses to improveversion 1, resulting in version 2 of the checklist. Two actions were taken in this phase: a) together with the participating nurses, theresearchers identified and listed the items for version 1 of thechecklist wassubjected to a pilot test in the surgical units. The size of the sample was not set,and each nurse was asked to fill out as many instruments as possible during the pilottest period. The researchers have followed up the instrument by means of daily visitsin the eight units; the researchers were responsible for clarifying doubts,encouraging the filling out the instrument and taking note of the suggestions infield diaries. At this stage of the PDCA Cycle, version 2 of the checklist, and definitionof version 3. At the end of the three-month period, suggestions were considered, such aswords/sentences exchange, exclusion or inclusion of items in the instrument,completion of the necessary changes in the checklist tothe validation process by the Committee of Experts, using the Delphi method, throughan online panel to reach a consensus. It was established a minimum concordance of 70%for the results of the Average Ranking (AR) in the assessmentThis phase refers to the submission of version 3 of the checklist. On the side of the23 questions, there was a specific space to write the comments of the experts.The data collection instrument was named the Experts Form and was composed of 23questions, distributed in three blocks according to the Likert scale, with thefollowing weights: (-2) Strongly Disagree, (-1) Disagree, (0) Indifferent, (+1) Agreeand (+2) Strongly Agree. In the first block, with nine questions, the assessmentfocused on the effectiveness and comprehension of the writing of the items,application to the practice and contribution to the construction of knowledge. In thesecond block, with eight questions, the content of the questions related to patientsafety, the need for inclusion and/or exclusion of items, the contributions of theinstrument to care planning and the possibility of its replication were assessed. Inthe third block, with six questions, the assessment focused on the content, form,applicability and credibility of the checklist, as well as the Experts Form, theinvitation letter and the TCLE were sent by electronic mail, and a 14 days deadlinewas set out for feedback. The recruitment of the experts was carried out using theCNPq Lattes Platform, among those PhDs with expertise in surgicalclinic, publications related to the safety of the surgical patient and who agreed toparticipate in the research.Version 3 of the Acceptance or rejection of the suggestions was based on their consistency with theWHO Safe Surgery Saves Lives Manual. The number of assessment rounds was notpreviously set, but there would be as many as necessary to reach consensus. To evaluate the reliability of the results, the Cronbach\u2019s alpha test was used tocorrelate the answers of the experts when the options are staggered , as described in the Experts Form. In this respect, the following criteria wasused: >0.90 - excellent; 0.81 to 0.90 - good; 0.71 to 0.80 - acceptable; 0.61 to0.70 - questionable; 0.51 to 0.60 - poor and 0.41 to 0.50 - unacceptable. The development of the study followed the national and international standards ofresearch ethics on human beings and was approved by the Ethics Committee underprotocol number 546.183. The confidentiality of nurses and experts was ensured by theabsence of identification throughout the data collection process.The 16 nurses participating in the research, all women, with an average age of 40 years,postgraduated and more than 10 years of employment relationship with the hospital understudy, worked in care and/or management positions in the surgical units.The results of the methodological research are presented according to the progressionand application of the PDCA Cycle and its respective phases.(Plan) - Planning Phase - there were three meetings with thenurses participating in the study, from March to April 2013, when the Action Plans werewritten and approved aiming at the development and subsequent implementation of thepilot test of the checklist.(1) P Do) - Development Phase - in meetings with nurses, the mainelements of care provided to patients in the pre and postoperative periods in clinicalpractice were listed. The relationships of care provided by the nurses resulted in thepreliminary design of version 1 of the checklist, followed by workshopsto improve that version, resulting in version 2 of the instrument. This phase took placefrom June 2013 and March 2014.(2) D (Check) - Checking Phase - version 2 of thechecklist was subjected to assessment and changes in the form andcontent, by means of a pilot test, with the application and filling out of 450checklists, in eight surgical hospitalization services from April toMay 2014. After analysis of the results of the instrument, the necessary changessuggested by the participating nurses were made, resulting in version 3, called theSurgical Safety Checklist in the Pre and Postperative periods(SSCPP).(3) C ((Act) - Action Phase - after the assessment and developmentphases of the SSCPP, the selection and recruitment of the experts for the validation ofits form and content was initiated by using the Delphi method online. As for thetraining process of the group of Brazilian experts, 16 professionals were contacted,from the invitation letter, of which eight accepted to be part of this study. (4) A The committee of experts was composed of two professors of surgical nursing care, twospecialists in surgical nursing, two nurses with specialization in patient safety andtwo surgeons. averageranking of the three blocks of questions. The SSCPP underwent two rounds of assessment by the experts, from June 2014, a consensusemerged and version 4 of the instrument is shown next. The results below refer to theresponses of the Experts Form, with levels of agreement and average ranking \u22651. average ranking \u22651, in the first round of assessment by using theDelphi method. checklist; the item \u201cFall\u201d was excluded because it was anincident and not a complication; and the item \u201cdehiscence\u201d was removed because it wasalready placed in category IV (immediate postoperative period), referring to theevaluation of the surgical site.After the first round of the Delphi method, at the suggestion of the experts, theexpression \u201cdemarcated surgical site\u201d was included in category II . In category III , the experts requested space to describethe type and location of the drainage and inclusion of the word \u201cothers\u201d, with space towrite in the item related to permeable venous access. In category V (complications), thetitle was \u201cOther postoperative complications\u201d, and the types of shock were added -\u201cseptic\u201d, \u201chypovolemic\u201d, \u201ccardiogenic\u201d, \u201cneurogenic\u201d and \u201cother\u201d - with space to write.As for the exclusion, there were only changes in category V. The item PTE (PulmonaryThromboembolism) was removed because the term VTE (Venous Thromboembolism) was alreadyin the average ranking \u22651.38.In general, the requests of the experts were more related to the presentation of theitems than to the content of the instrument. It is inferred that the structure of theitems of the manuscript corresponds to the need of checking the surgical safety. Aftermodifications, the instrument was submitted to the second round of assessment by theDelphi method, and all questions assessed by the experts reached a level of agreement\u226588% and The Cronbach\u2019s alpha test was used to check the reliability of the SSCPP. The resultsshowed an index of reliability of 0.9515 for the characteristics and purposes, 0.9396for the possibilities of its use and 0.9858 for the general assessment.The experts validated the form and content of the SSCPP instrument, which includes 97indicators of safety distributed in six categories: identification, preoperative,immediate postoperative, postoperative, other surgical complications and hospitaldischarge . The category Identification of the SSCPP includes information about the patient andother indicators of surgical safety, as suggested by WHO: right patient, right surgeryand right side. These data provide minimal information, but aim to avoid adverse eventsand ensure the quality of care. In the category of the preoperative period, the actions of the nurse are listed torecognize and register items, such as: clinical history and other mandatory documents,imaging tests, preoperative preparation according to the surgical indication andidentification devices.In the category postoperative period, the SSCPP lists items such as: level ofconsciousness, stability of vital signs, nausea/vomiting, type of anesthesia, skinconditions and tissue perfusion of extremities, drainage systems, surgical dressing,mobility/sensitivity of the limbs, postoperative medical prescription, transoperativenursing record, postanesthetic recovery and recommendations. In the category of the immediate postoperative period, the SSCPP contemplates theevaluation of the patient\u2019s pain: Respiratory, Digestive and Urinary, Cardiovascular andTegumentary Systems, in addition to the evaluation of the surgical site.The central focus of the category hospital discharge is the register and guidelines forhome care, outpatient return, and post-surgical clinical reevaluation. It includesreports on general patient status, devices and surgical wound evaluation.This study was an example of the feasibility of implementation of the PDCA Cycle as anorganizational method, recommended for processes of continuous quality improvement. ThePDCA Cycle is in line with the experimental scientific method, as it promotes theprediction of the results to be achieved, in addition to making it possible to measurethe results and evaluate the impact of health interventionsPlan, Do, Check, Act)to elaborate and evaluate a surgical safety checklist model, for thepre and postoperative periods, to be used in hospitalization units, was based on theparticipation and dialogue with nurses of surgical units. It served as a guide to bringto reality the needs and decisions of care, in a methodological and resolutive way. Thejoint efforts of researchers and nurses demonstrated their willingness and interest ininnovate, bring practicality and give impact to the care actions of nursing teams.The development of the phases of the PDCA Cycle (For the nurse who participated in this study, this was a moment of convergence betweenthe theoretical and managerial knowledge and the experience of professional practice,adding value to the research. The observation of attributes such as simplicity,applicability and the possibility of measurement contributed to the guidance on thedevelopment of the instrument, as well as to the possibility of turning a new workinginstrument more feasible. It should be considered that instruments such as PDCA help in improving safety quality,however, require from the nursing professionals the incorporation of behavioral changes,continuous expansion and dissemination of knowledge, development of skills and,consequently, changes in attitude. Although this instrument has been widely accepted inthe area of health, providing structure for changes in the quality of services in thearea in question, it is necessary to improve the patterns for the assessment aiming attheir use, in a systematic and rigorous wayIt can be understood, then, that the use of PDCA served for the purposes of this study,the development and assessment of the SSCPP and its standardization for use, resultingin the version validated in the hospital. This is the conclusion of implementing thePDCA cycles, however, the implementation of this method and the assessment of theresults of its impact should occur in practice.In another study aiming at estimating the prevalence of risk in a surgical clinic, 750hospitalizations were studied, among 5,672 records of incidents, and 218 werecharacterized as adverse events, as they caused harm to the patient. The most frequentincidents were acute postoperative pain, unplanned removal of tubular devices, probeand/or drain, failures in technical procedures requiring surgical intervention, as wellas adverse and allergic reactions to medications, hospital infections; pressure ulcers,falls, inadequate maintenance of medical equipment, adverse reactions or lack of bloodproducts and deathchecklist has demonstrated that the instrument can preventperioperative errors and complications, reducing the rates of postoperativecomplications and mortality, besides providing a greater patient safety and improvedcommunication among the care teamA systematic review on the impacts and the implementation of a surgicalchecklistsmay contribute to reduce harms to patients. In addition to guiding the evaluation in theperioperative period, the information stored in these lists can also serve to feeddatabases, and provide support for health institutions and professionalsThe results of the mentioned studies reveal that the use of However, a validated instrument, as shown here, can provide more reliability for patientsafety, reducing the costs of the health system and, in this scenario, the nurse is theprofessional who collaborates for this reality. In all areas of knowledge, includingnursing, the development of validated assessment instruments is a complex process.However, it allows to recognize avoidable risk situations, to plan awareness actions, aswell as to favor professional development. In addition, they call for reliability andconsistency, as they reflect the quality of the measurementThe results of this study confirm the reliability of SSCPP and its contribution to thepractice of surgical nursing. The confirmation of its reliability shows that theinstrument serves to assess the quality of care, effectively manage care aiming at theidentification of avoidable risks, and allows corrective actions and readjustment in theobjectives through administrative and educational strategiesThe overall assessment of SSCPP was based on the information that, in North America, theimplementation of this instrument caused an increase in the frequency of validationstudies in the nursing area, increasing the relevance of assessment and measurement ofthe outcomes of this professional practicechecklists are likelyto be effective, depending on the implementation process of each hospitalchecklist, such as organizational and cultural factorswithin each hospital. One strategy for achieving success is the continuousfeedback from professionals of the service to the hospitaladministration in order to identify the factors that prevent the effectiveimplementation of checklists for safe surgeries. In addition, theeffectiveness of a checklist will depend on the ability of theinstitution\u2019s leaders to implement it, and on the adaptation measures needed for eachchecking instrument-It is important to highlight that the impacts of checklist may serve as an example of good clinicalpractice and contribute to the development of safety behaviors.In this context, it is recommended including contents related to patient safety in theundergraduate and postgraduate nursing courses, as well as the training in healthservicesThis instrument may represent a guideline for pre and postoperative care in thehospitalization units, providing indicators to assess the quality of care and enablingthe development of new strategies for the improment of health services. The development of this study allowed the elaboration, assessment and validation of theSSCPP for surgical safety, based on the guidelines and objectives of the WHO SafeSurgery Saves Lives Programme. By consensus among the participants, it was consideredthat this tool is capable of assisting nurses in their clinical practice. At the end of this research, SSCPP was standardized for use in the institution. TheSSCPP favours the adoption of preventive actions, as well as the monitoring of warningsigns and symptoms, the early detection of complications and the minimization of risksfor the patient. This instrument also contributes to the planning of the nursinginterventions and improvement of the communication among the multiprofessional team onthe care provided. The result of this research may be an effective and efficientinstrument for the safety of the surgical patient, in addition to being adaptable toother health care contexts.checklist only in a public and teachinghospital was a limitation of this study. It is recommended to use this instrument inother health services and, when necessary, adjust it according to the context of theinstitution.The implementation of this"}
{"text": "To improve the usability, availability, quality, and timeliness of surveillance data as part of the CDC Surveillance Strategy  strategy to streamline NNDSS and access to data for users; NMI is a component of the CDC Surveillance Strategy. This consolidation of information reflects the recommendations of a CDC-wide workgroup, consisting of representatives from the CDC Excellence in Science Committee, the Surveillance Science Advisory Group, and"}
{"text": "CFTR gene enables the phenotype\u2013genotype association studies (including the response to drugs), considering the wide clinical and laboratory spectrum dependent on the mutual action of genotype, environment, and lifestyle. Regarding the CF disease, personalized medicine is the treatment directed at the symptoms, and this treatment is adjusted depending on the patient\u2019s phenotype. However, more recently, the term precision medicine began to be widely used, although its correct application and understanding are still vague and poorly characterized. In precision medicine, we understand the individual as a response to the interrelation between environment, lifestyle, and genetic factors, which enabled the advent of new therapeutic models, such as conventional drugs adjustment by individual patient dosage and drug type and response, development of new drugs , genome editing by homologous recombination, zinc finger nucleases, TALEN (transcription activator-like effector nuclease), CRISPR-Cas9 , and gene therapy. Thus, we introduced the terms personalized medicine and precision medicine based on the CF.The advent of the knowledge on human genetics, by the identification of disease-associated variants, culminated in the understanding of human variability. With the genetic knowledge, the specificity of the clinical phenotype and the drug response of each individual were understood. Using the cystic fibrosis (CF) as an example, the new terms that emerged such as personalized medicine and precision medicine can be characterized. The genetic knowledge in CF is broad and the presence of a monogenic disease caused by mutations in the  Currently, numerous and significant advances have been achieved on the pathophysiological and genetic knowledge of numerous diseases. These advances are associated with the advent of new technologies related to diagnosis, treatment, and reduction of costs from genetic studies and implementation of new management approaches, resulting mainly from multicenter studies and meta-analyses. These studies have shown significant population variability and enabled the implementation of databases with numerous genetic variants, including mutations and polymorphisms .Figure 1).The importance of these skills to the internist, researchers, geneticist, and other health professionals is that, increasingly, every disease is demonstrated as a complex of many diseases, regarding the symptoms, divided into numerous genotypes, phenotypes, and endotypes . In recent decades, the implementation of genetic knowledge on CF occurred, mostly, by obtaining and using new methods to identify genetic variants .CFTR gene in chromosome 7q31.2 (CFTR)  . From thCFTR gene, not every spectrum of the disease is known or even understood, including the interaction between socioeconomic status and health outcomes , as well as the response to the treatment and new therapeutic modalities. In recent years, CF has been a model for numerous studies , and, in most of them, genetics and management go hand in hand , and theFigures 2).On the other hand, based on the knowledge gained from the molecular study, the implementation of the personalized medicine occurred, mainly, for the new read-through drugs, enhancers, CFTR protein stabilizers and amplifier compounds  , who described the ubiquity of the individual variation, both in cases of diseases and in the identification of the human variability .Figure 1). In CF, we have multiple gravity phenotypes and clinical manifestations that are described and come from complex interactions between mutations in the CFTR gene, modifier genes, environment, and lifestyle .In precision medicine, the molecular information maximizes the accuracy with which the patients are categorized and treated, i.e., we have an endotype (or phenotypic variant) of a disease, which comes from a gene or group of genes and their interaction with the environmental factor and lifestyle   traditional medicine should not be denied and must be recognized as the basis of precision medicine; (ii) precision medicine is not equal to simple convergence of new technologies \u2013 the relevant information for genomic knowledge requires effective integration with classical genetics, metabolomics, and clinical phenotypes  to compose an individual and complete biological database, and contribute to diagnosis and treatment that are based on the patient\u2019s individuality; (iii) precision medicine is not equal to a simple and individualized drug, but a medicine that combines standardization and individualization .On the other hand, the implementation of precision medicine presents barriers that need to be overcome, such as: (i) regulation by governmental and medical entities, including the use of new ethical regulations; (ii) high cost for its implementation and for the pharmacological treatments obtained from the knowledge acquired; (iii) how to use and disclose information appropriately; (iv) how to approach and direct what will be done with patients who are part of the research projects before the status of the Government, the pharmaceutical industry and expectations of patients and/or family members; (v) analysis of bioinformatics that is still limited; (vi) the computational data analysis system needs to be better implemented; (vii) construction of prediction and interaction programs for clinical, laboratory, and genetic evaluation; (viii) large-scale sequencing, as well as punctual, also not available to all individuals who may benefit from the future of precision medicine . MoreovePrecision medicine, despite the use of complex techniques and data analysis, still follows the analysis model of reconstruction, based on the reductionist theory, showing difficulty in understanding the adaptive degree of the body regarding change, as well as the quest to control the precision of the method applied. Thus, we should seek a model to study and apply precision medicine at the holistic level, which is a barrier we will have to overcome for greater development in the application of the theory in the next years .Cystic fibrosis is one of the most important examples to describe the precision medicine. However, the problems found in CF for precision medicine treatment are complex to be solved, although CF is a monogenic disease. However, when dealing with other diseases, such as asthma, which is complex \u2013 resulting from the interaction of the environment with multiple genes (polygenic): each gene determines a small fraction in response to the drug used \u2013 the use of complete and complex tools that determine metabolic networks for polygenic modulation must be implemented and enables the use of precision medicine  and/or tResearchers on CF offered us the publication of numerous studies, which enabled new prospects for the treatment of the disease, especially the pulmonary disease, with studies focusing on precision medicine . Thus, tFigure 2).Despite the numerous studies on CF, there are still doubts about the applicability of precision medicine, then called personalized medicine, when we considered the read-through drugs, enhancers, stabilizers, and amplifiers . MoreoveCFTR molecular dynamics enabled the understanding of the interaction between the different effectors of the metabolic pathway that composes the CFTR protein expression and the evolution in the treatment and knowledge of the new drugs   and genoctitious .CFTR gene, with reduction of age for the beginning of drug use  in which the drug exists, there is lack of therapeutic efficacy. Another limiting factor is the high cost related to the diagnosis and application of precision medicine drugs. We must also consider the need to expand medical education for the new era of genetics, with broad knowledge of human genetic diversity and applicability in the treatment and follow-up of various diseases, including the CF disease.In recent years, many advances have been made in medical genetics, which led to the development of personalized medicine and precision medicine, making real a dream of many researchers, family members, and patients.Personalized medicine is the treatment directed to the symptoms, and this treatment is adjusted depending on the patient\u2019s phenotype. However, more recently, the term precision medicine began to be widely used although its correct application and understanding are still vague and poorly characterized. In precision medicine, we understand the individual as a response to the interrelation between environment, lifestyle, and genetic factors, which enabled the advent of new therapeutic models, such as conventional drugs adjustment by individual patient dosage and drug type and response, new drugs development ,genome editing by homologous recombination, zinc finger nucleases, TALEN, CRISPR-Cas9, and gene therapy. Thus, this mini review introduced the terms personalized medicine and precision medicine based on the CF.1 and has been successful in adding data from healthy individuals that could contribute in future studies of precision medicine.Many of the problems related to the implementation of precision medicine could be solved with initiatives such as the BIPMed, which gathers members of five CEPIDs  supported by the FAPESP (S\u00e3o Paulo Research Foundation). The BIPMed is the first public genomic database in Latin AmericaFM was responsible for gathering bibliographic data, writing the draft, editing, and submitting the article to the journal. CB and JR revised the manuscript, made a critical revision, and gave the approval for the final submission.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "In the last two years, progress has been observed in the incorporation ofInterprofessional Education (IPE) into policies on human resources for health in thecountries of the Region of the Americas.The Pan American Health Organization/ World Health Organization (PAHO/WHO) has encouragedits Member States to adopt the approach and support policymakers in expanding itsusePAHO\u2019s Strategy on Human Resources for Universal Access to Health and Universal HealthCoveragePAHO/WHO has adopted a series of initiatives to provide policymakers with proposals toestablish commitments to incorporate IPE as an innovative approach to the transformationof health systems, with the above-mentioned strategy as a point of reference. Among other actions, on 5-6 December 2017, the second regional technical meeting on IPEwas held in Brasilia, Brazil. The event, organized jointly with the Ministry of Healthof Brazil, was attended by representatives from different parts of the world, 22 of themfrom countries of the Region of the Americas. The purpose of the meeting was to discussprocesses for incorporating IPE into policies on human resources for health, toestablish a common agenda for strengthening IPE in the Region of the Americas, to fosterthe preparation of action plans to implement the approach, and to formalize theestablishment of the Regional Network for Interprofessional Education in the Americasand the approval of its directives. As a result, 18 countries presented action plans for the implementation of IPE in theirhealth policies between 2018 and 2019. The content of the proposals, for the most part,includes aspects that denote the clear commitment of governments to defining nationalpolicies that promote the adoption of IPE by educational and health institutions,promoting activities to strengthen institutional support, review curricular content, anddevelop teaching staff capable of working with IPE. According to the WHO 2010 Framework for Action on Interprofessional Education andCollaborative Practice(3), EIP can be difficult to explain, understand, and implement,since health professionals believe they are acting collaboratively, when in fact theysimply work together with other professionals from a multiprofessional perspectiveThe challenge now is to give continuity to the plan, and results have already beenachieved. The Regional Network for Interprofessional Education in the Americas(REIP)Bolivia, Brazil, Cuba, Chile, Honduras, and Peru are moving forward with proposals toincorporate IPE into the curricular guidelines of undergraduate courses in the area ofhealth and to formulate proposals for teacher qualifications. Argentina and Guiana arediscussing proposals for carrying out research in this area. And Guatemala, Nicaragua,Panama, and Venezuela have presented strategies for the qualification of health serviceprofessionals, making use of the theoretical and methodological bases of IPE. Some countries, such as the Dominican Republic and Suriname, are proposing theestablishment of National IPE Networks, while others, such as Paraguay, Uruguay,Colombia, and Costa Rica, are conducting surveys on the subject at the national level. It is expected that, though cooperation with PAHO/WHO, countries will be able toimplement IPE as a potential approach to strengthening their health systems. In thecurrent global context, it is no longer enough for health professionals to be moreprofessional; they also need to be interprofessional."}
{"text": "On electron microscopic radioautograms obtained from each animal, the numbers of mitochondria, the numbers of labeled mitochondria, and the mitochondrial labeling index labeled with 3H-leucine that showed protein synthesis in each hepatocyte, both mononucleate and binucleate cells, were counted and the averages in respective aging groups were compared. From the results, it was demonstrated that the numbers of mitochondria, the numbers of labeled mitochondria, and the labeling indices of intramitochondrial protein syntheses in both mononucleate and binucleate hepatocytes of mice at various ages increased due to development of animals. The numbers of mitochondria, the numbers of labeled mitochondria, and the labeling indices of intramitochondrial protein synthesis in binucleate hepatocytes were more than those of mononucleate hepatocytes at the same aging stages.In order to study the aging changes of intramitochondrial protein synthesis in mouse hepatocytes, 10 groups of aging mice, each consisting of three individuals, total 30, from fetal day 19 to postnatal year 2, were injected with"}
{"text": "The European Federation of NeuroRehabilitation Societies (EFNRS) is the most representative European organization dedicated to neurorehabilitation, an international non-profit organization centered on research, education, intellectual and scientific exchanges, advocacy, and philanthropic activities in the medical field of neurorehabilitation and of the related expertise branches. EFNRS includes all the neurorehabilitation societies in the European Union countries, to which experts and scientific researchers in the whole world, dedicated to this special and important field, are added. With its permanent headquarters in Vienna, According to the statutory provisions, the election of the new president of the European Federation of NeuroRehabilitation Societies, for a two years mandate, took place at the end of last month, during the Fourth Edition of the European Congress of NeuroRehabilitation (ECNR), in Switzerland, Lausanne. As a new recognition of the continuity of performances of the Romanian doctors and of the Romanian School of Medicine in the world medical field, Romanian Neurology received another confirmation of its incontestable value through the election of Prof. Dafin Mure\u015fanu, MD, PhD, in this honorary position.\u201cA new and prestigious recognition of value and professional completion of the Romanian School of NeuroRehabilitation at an European level, confirmed by the vote offered to Prof. Dafin Fior Mure\u015fanu, MD, PhD, of leading, as president, the European Federation of NeuroRehabilitation Societies (EFNRS), the most representative European organization dedicated to neurorehabilitation\u201d. This event is presented in a news bulletin of the European Federation of NeuroRehabilitation Societies as Before his election as president, Prof. Dafin Mure\u015fanu, MD, PhD, was vice-president of EFNR and, for almost ten years, he coordinated the whole package of educational programs at a European level, also contributing to the development strategy of the modules in the future educational program, dedicated to obtaining the competency in neurorehabilitation. Prof. Dafin Mure\u015fanu, MD, PhD, is currently the director of the Department of Neurosciences in \u201cIuliu Ha\u0163ieganu\u201d University of Medicine and Pharmacy, Cluj Napoca, member of the Academy of Medical Sciences in Romania, co-president of the Scientific Panel of Neurorehabilitation of the European Academy of Neurology, president of the Society for the Study of Neuroprotection and Neuroplasticity, and, until May this year, he was president of the Romanian Society of Neurology. Dafin Mure\u015fanu, MD, PhD, with modesty.\u201cDuring the last 10 years I have been working so hard for this European Federation, in which all the neurorehabilitation societies in each European state are included. I held the position of vice-president, dealing with aspects and projects regarding education and communication and, during this biannual congress that took part in Lausanne, I was, to my surprise, proposed and elected president of the European Federation, despite some dislikes from the Nordic countries, let\u2019s say, structural, towards Romania, I did not receive any negative vote. This represents a new beginning, horizon, and recognition for the neurorehabilitation in Romania. No matter what, I consider that I have done many good things and I have opened many paths in this field. However, I believe that we will be looked at differently and this has already started happening. In this new position, I intend to promote an educational program at the level of a European MBA program, which should be able to offer a position and sketch the framework of this subspecialty, which we would like to turn into specialty. Moreover, my intention is that, together, we will place Romania better on the world map. The vote received from the EFNRS members honors me and, at the same time, makes me fulfill my promises and duties. My election in such an important position is the result of a decade of team work both at a European and at an international level\u201d, declared Prof. Distinguished Professor Dafin Mure\u015fanu considers that Romania has a high potential for top research, for the investigation and study of new directions, in the benefit of the patients, and can be and must be a good partner for the most important groups of international research.Through the same effort sustained by the whole team at the EFNRS level we will continue the project of the integrated approach of neurorehabilitation in all its dimensions, motor, cognitive, and emotional. This desideratum cannot be reached without a proportional contribution of all the specialties involved, eventually in the reconstruction of the human being in all its dimensions after the great existential impact, the suffering due to the disease\u201d, noted the new president of the European Federation of NeuroRehabilitation Societies, at the beginning of his mandate.\u201eExecutive EditorProfessor Eng. Victor Lorin Purcarea, PhD."}
{"text": "Testicular cancer (TC) remains as a relatively infrequent tumor type, considered about 1% of all men cancers worldwide . TC may In GLOBOCAN project, the estimated number of new cases and deaths of TC in a region or country in 2015, 2020, 2025, 2030 and 2035 is calculated by multiplying the age-specific rates estimated for 2012, by the corresponding expected population for 2015, 2020, 2025, 2030 and 2035. Based on GLOBOCAN project in the world in 2012, the number of 55266 new cases of TC was observed that among them 52305 cases (94.64%) were in the age group below 65 yr and 2961 cases (05.35%) were in the age group 65 yr and older. Moreover, in this year, the number of 10351 cases of death were observed that among them 7790 cases (75.25%) were in the age group below 65 yr and 2561 cases (24.75%) were in the age group 65 yr and older. According to the predictions in the years 2015, 2020, 2025, 2030 and 2035, the number of new cases of TC in the world respectively is equal to 57209, 60007, 62903, 65827 and 68351 cases. Besides, the number of deaths of TC respectively be equal to10904, 11790, 12781, 13847 and 14886 .However, the number of incidence and mortality of TC will be increasing trend, but this increase will be more in the age group 65 yr and older. Thus, diagnosis and treatment of patients with TC in the early stages of disease lead to improving the quality of life and survival rate of patients."}
{"text": "The data were analyzed in accordance with the stages of Rodger's conceptual model. The following were included: books and articles in full, published in Portuguese, English or Spanish, which addressed CT in the teaching and practice of Nursing; articles which did not address aspects related to the concept of CT were excluded.  the sample was made up of 42 works. As a substitute term, emphasis is placed on 'analytical thinking', and, as a related factor, decision-making. In order, the most frequent preceding and consequent attributes were: ability to analyze, training of the student nurse, and clinical decision-making. As the implications of CT, emphasis is placed on achieving effective results in care for the patient, family and community.  CT is a cognitive skill which involves analysis, logical reasoning and clinical judgment, geared towards the resolution of problems, and standing out in the training and practice of the nurse with a view to accurate clinical decision-making and the achieving of effective results. A total of 529 works were located in the databases mentioned. In the second stage, undertaken in February 2015, the authors proceeded to consult with the Cinahl, Lilacs and Bdenf databasesIn the third stage, for collection of the relevant data, identification of the attributes, and the contextual basis of the conceptIn the fourth stage, for analysis of the data and identification of their characteristicsIn the fifth stage, implications or hypotheses for continuity of the development of the concept were listedOf the 42 works selected for analysis, eight were text books and 34 were articles, with 28 (66.6%) published in English, 12 (28.6%) in Portuguese, and two (4.8%) in Spanish. Of these, the oldest dated from 1997, and the most recent from September 2014: items were included by title, authors, and cataloguing data of the book or periodical . The resThe identification of the substitute terms represents the first approximation with the concept to be analyzedDifferently from the substitute terms, the concepts related to CT  have a lCT is characterized by higher-level thinking, which involves knowledge, experiences, dispositions (attitudes or habits of mind) and intellectual abilities. These essential characteristics, or attributes, were identified in the empirical material for analysis as skills and dispositions for CT, and are presented in The antecedents, like the consequences of a concept, are conditioned to a contextual basis, in this case, the concept of CT in Nursing. In addition to this, they are related to the situational, temporal, sociocultural and course-related contexts of the profession at the present timeThe implications and hypotheses represent, respectively, the results and possibilities to be achieved,The concept of CT remains little clarified in the Nursing literatureBased on the empirical material researched, the most frequent substitute term was analytical thinking, followed by critical-creative thinking. These substitute terms, to the contrary of clinical reasoning, are synonyms, as they present a semantic interconnection with CT. As a result, when a nurse assesses a patient's health problem, observing, examining, recognizing and raising hypotheses regarding health problems, she is using analytical thinking, which can also be termed CT-) and clinical reasoning,,On the other hand, the related factors  have a c,-Another term which has been described many times coupled with CT, nearly forming a single term, is the concept of reflexive thinkingGenerally speaking, the identification of the substitute terms and related factors, respectively, made it possible to broaden the list of synonymous concepts and those which are interrelated. As a result, the related concepts allow the correct application of words which contain within themselves similar philosophical presuppositions, in this case, CT. Besides this, they assist in the understanding of the application of the concept of CT in the context of the practice of the student or nurse, and its importance for diagnostic reasoning, clinical judgment and efficacious decision-making. The attributes bring together a real definition of the concept, different from the nominal definition provided in dictionaries, which simply substitute one word or expression with another which is synonymous) describes a significant proportion of the attributes identified in this study, such that these constitute the characteristics examined in most of the psychometric scales for assessing the development of CT. It is inferred, based on these results, that in the literature there is a major influence of the Delphi Report,,,) or the ability to break something down in order to achieve an understanding of a given situation. It is believed that this skill is essential in academic and professional activity in Nursing, in that the understanding of the whole is limited to analysis of the parts, whether in the learning of a technique or in taking the patient history.In the literature analyzed, the skill mentioned most frequently for a critical thinker was \"analysis\",) or impartiality in assessment, overcoming preconceptions in a rational way for prudent judgment and later decision-making. However, as studies indicate,,The most frequent disposition was \"open-mindedness\",) is underlined as a necessary path to developing CT skills. As a result, for the improvement in the attributes of CT, the student or professional of Nursing must adopt a stance of seeking, in a careful, rational and active way, the improvement of the cognitive and affective aspects which are inherent to her professional and personal activities,,-) as phenomena which have leveraged the discussions and highlighted the importance of training nurses in the skill of thinking critically. Based on the categories presented in ) bestow curricular flexibility, which viabilizes pedagogical projects geared towards specific goals or demands. As a result, there is the possibility of a teaching permeated by CT, as it progresses towards problematizing training, linking teaching, work and community. In Brazil, the DCNs,,) and the scientific and technological advance-,,Another aspect also evidenced as a predecessor of CT was the seeking of better results in clinical practice,,The challenge of training a nurse who is capable of acting in a way that responds to the demands of a society in constant transformation is closely related to the need for cognitive, attitudinal and instrumental development so as to seek better results in practice and in health managementThe consequences of a concept are closely related to the antecedents and must follow them,,-) and \"clinical reasoning\",,The consequence identified with the highest frequency was \"clinical decision-making\",) which assessed the structural elements of CT in 20 nurses from emergency services corroborated these findings, as it emphasized the importance of CT for clinical decision-making, as well as its interconnection in the managerial, multi-professional and teaching ambits. It is relevant to emphasize that the first three consequent terms identified previously also appeared as related concepts in For effective decision-making based in CT, therefore, persistent effort is required for examining any situation or supposed form of knowledge in the light of evidence which supports new conclusions in regard to it,,,The main implications and hypotheses listed in ,-For this, it is important to consider CT as a process of dynamic and continuous improvement which can be learnt by the nurse. As a result, the improvement of reasoning skills, the constant search for new knowledge, the aim of solving problems and issuing judgments is required, enabling the nurse to predict, diagnose and validate the conclusions obtained, always reviewing these critically) assessed CT skills in 134 students, at two points: upon entering the undergraduate course in Nursing, and three years later, after graduating, using the Health Sciences Reasoning Test. It was concluded that the students significantly increased their CT scores after progressing through the course, principally improving their abilities in analysis and deduction. The students who had the highest scores in the test had better academic performance. These results corroborate the importance of the undergraduate course in helping the students to progress in their CT skills. One longitudinal Australian study,,As indicated by the works analyzedThe concept analysis, based in Rodger's evolutionary model, clarified the phenomenon and allowed a correct understanding of CT, with implications for education and care in Nursing. As antecedents of the concept, emphasis was placed on the need for training in critical thinking while still on the undergraduate course, with a consequent search for better results in clinical practice. This being the case, the main concepts related to CT are those which make up the stages of the Nursing Process, such as decision-making, clinical judgment, and clinical reasoning. As a result, the understanding of the related factors, attributes, antecedents and consequences of CT made it possible to infer CT as a cognitive skill which involves a process of analysis, logical reasoning and clinical judgment, geared towards problem resolution. From this perspective, it has been emphasized in the training and care practice of the nurse, with a view to accurate clinical decision-making and to achieving effective results in the Nursing interventions for the patient, family and community.As limitations of the study, the fact is highlighted that studies were selected from Latin American databases, with the exception of Cinahl. However, the study met the needs of the multicentric RIIEE project. As a consequence, broader studies become important, considering that the concept changes over time. Furthermore, it is necessary to develop the clarification of the concept of CT in other areas of knowledge."}
{"text": "Department of Health and Human Services, the task force is an independent, nonfederal, uncompensated panel of public health and prevention experts whose members are appointed by the Director of CDC. The task force provides information for a wide range of decision makers on programs, services, and policies aimed at improving population health. Although CDC provides administrative, research, and technical support for the task force, the recommendations developed are those of the task force and do not undergo review or approval by CDC."}
{"text": "The nature of global health networks is an important contributor to influence in the global health arena. However, in this editorial the necessarily brief overview of each of eight topics gives a limited picture and does not do justice to the many contextual differences which influence status in the global governance arena and, perhaps more importantly, the status and nature of the health networks themselves.Shiffman\u2019s1 is more between industry and public health networks rather than within or between them). They have succeeded in influencing sympathetic governments and this despite longstanding evidence of the industry\u2019s subversion of alcohol research3 and effective alcohol policy . Another important influence is a relative lack of informed advocates at national level and funding opportunities at both national and global level. This reflects the diffuse nature of alcohol related harm which makes a causal contribution to 60 diseases, and with much harm outside of the traditional health arena ; this has reduced the likelihood of support from any particular quarter, unlike the involvement of cancer and heart health charities in tobacco control. This relative lack of funding is one of the main factors inhibiting the development of the alcohol network.It is certainly possible to draw a strong contrast between the Global Alcohol Policy Alliance (GAPA) and the Framework Convention Alliance, despite the comparable levels of harm experienced globally, and many reasons underpin this difference. One of the more influential has been the role of the industry. Since the widespread commercialisation of the production of both commodities the transnational alcohol corporations, learning from the adverse experience of tobacco, have done an excellent job of framing the problem definition to suit their ends . GAPA has active regional networks, particularly active in Africa which is one of the key foci for the transnational alcohol corporations at the present time. The 2015 biennial conference of the GAPA attracted participants from 60 countries, many from LMICs and funded by development agencies. In 2016 GAPA worked with several member states to ensure the challenges raised by the proliferation of alcohol marketing in the digital world was discussed in a Side Event at the World Health Assembly, and the need for a legally binding international health response was raised.Despite this, considerable progress has been made in recent years and it is not now accurate to characterise the GAPA network as consisting \u2018predominantly of researchers from North American and European institutes\u2019  is urgent, given the ambitions of the transnational alcohol producers in the emerging economies of the world. Their expansion is assisted by the proliferation of economic agreements weakening national governments\u2019 role in protecting their populations and the expansion of alcohol marketing in the global digital world. This is why GAPA has determined to advocate for a stronger response in the form of an international binding treaty to control alcohol supply, marketing and the role of the industry in alcohol policy development.There is much to do and Shiffman\u2019s analysisSigned by GAPA Board Members:Professor Sally Casswell, GAPA Chairperson, Massey University, New ZealandProfessor Isidore Obot, GAPA Vice Chair, School of Public Health and Policy, Morgan State University, Baltimore MD, USA and Adjunct Professor of Psychology University of Uyo, NigeriaProfessor David Jernigan, GAPA Chair Scientific Committee, Johns Hopkins Bloomberg School of Public Health, USA\u00d8ystein Bakke, GAPA Secretary, FORUT\u2014Campaign for Development and Solidarity, NorwayDr. Pham Thi Hoang Anh, Country Director, HealthBridge, VietnamDr. Kumnuan Ungchusak, Board Member, Thai Health Promotion Foundation, ThailandSavera Kalideen, Advocacy Manager, Soul City Institute, South AfricaMs. Paula Johns, REDEH \u2013 Human Development Network; founder and director of the ACT Tobacco Control Alliance,\u00a0BrazilMr. Derek Rutherford, past Chair of the Global Alcohol Policy Alliance, UKProfessor Thomas F Babor, University of Connecticut School of Medicine, USAMr. Sven-Olov Carlsson, past President, IOGT InternationalProfessor Sungsoo Chun, Sahmyook University, South KoreaMr. George Hacker, past Director, Alcohol Policies at Centre for Science in the Public Interest, USAProfessor Ronaldo Laranjeira, Federal University of S\u00e3o Paulo, UNIFESP, Brazil, and Alcohol and Drug Research Unit of UNIADProfessor Charles Parry, Alcohol & Drug Abuse Research Unit, South African Medical Research Council, South AfricaNot applicable.Author declares that she has no competing interests.SC is the single author of the paper, but all board members read and approved the letter."}
{"text": "Journal of Patient-Reported Outcomes (JPRO), we are excited to announce the launch of a new journal sponsored by the International Society for Quality of Life Research (ISOQOL). JPRO is intended to complement and extend ISOQOL\u2019s existing journal, Quality of Life Research. Clearly, Quality of Life Research has a long and successful history of publishing research on methods and applications of health-related quality of life (HRQL) and patient-reported outcomes (PROs). Given increased HRQL and PRO research, and the wider application of these outcomes across a variety of health care and population health settings, there is a need for more publication outlets for scientifically sound PRO research.As founding Co-Editors-in-Chief of the Journal of Patient-Reported Outcomes focus on high quality research in five major areas: (1) PROs in clinical trials; (2) applications of PROs in clinical practice; (3) patient, family, community and public engagement in PRO research; (4) qualitative studies on the development and application of PROs; and (5) social and behavioral determinants of health and PRO measures. These focus areas are only some examples of the types of papers that are considered for publication in JPRO. JPRO is a peer-reviewed journal, with occasional special non-peer reviewed articles relevant to the journal\u2019s aims and scope.The aims and scope of the JPRO are able to present and discuss new and more comprehensive evidence on treatment effects, on measurement properties, interpretation, and the performance of the PRO measures based on data from these clinical studies. The CONSORT extension on PROs will serve as a guide for reviewing the reporting of HRQL and PROs from clinical trials [For many clinical trials, space limitations in clinical journals often preclude reporting on the HRQL and other PRO results in full. We encourage the publication of comprehensive analyses and reporting of evidence based on the use of PROs in clinical trials and other clinical studies. Authors of papers in l trials .JPRO. Methods for, and applications of, individual-level and group-level PRO applications from research studies are considered for publication. Applications such as quality improvement, benchmarking, patient experience with care, decision aids, communication, patient and provider satisfaction, adherence, patient management , and other patient outcomes relying on PROs are considered for publication in JPRO.Increasingly, PROs are being implemented in clinical practice settings to inform patient management and for assessing the quality of health care. The application of PRO measures across health care systems and for use in real-world comparative effectiveness studies are of interest to JPRO. Methods and applications to engage patients, family members, and members of the general public in the process of PRO-related research, and the evaluation of the effects of such engagement, are of interest. Similarly research and evaluations of engaging patients and the general public related to PRO policy formulation and clinical guidelines are welcome, as is participatory action research that use PROs.Patient, family, and community engagement in the planning and implementation of clinical studies and the evaluation of treatments and health care system interventions is growing rapidly . The devJPRO. Studies that give patients a voice and report patient stories using PROs are also welcome.Qualitative methods are frequently used in the development and evaluation of new and existing PRO measures, and increasingly used in conjunction with clinical trials. These studies increase understanding of the effects and burden of illness, and provide more complete understanding of the effects of treatment from the patient perspective. Papers reporting on these activities, the assessment of the usefulness of various qualitative methods for these purposes, and improvements in qualitative methods are considered for publication by JPRO welcomes submissions that report on studies that include HRQL outcomes and other PROs.Studies reporting on cross-sectional and longitudinal observational studies examining the social and behavioral determinants of health with PRO measures are considered for publication, including studies of both general and chronic disease populations. Such studies might examine the antecedents of health-related outcomes such as social support, health-related behaviors, and patient adherence. JPRO considers review articles, brief communications, commentaries, editorials, and reviews of recent books and software advances relevant to the stated aims and scope of the journal, although in general, JPRO does not publish case reports, papers reporting study designs, pilot studies, and feasibility studies.In addition, JPRO and to encouraging sound research and science related to HRQL and PRO applications in clinical trials and clinical practice. Over the past 25\u00a0years, we have seen continued and exciting developments in HRQL and PRO research and methods, and we hope to encourage further the reporting of these methods and results in JPRO. To paraphrase a historic moment in cinema, \u201cthis is the beginning of a beautiful journal\u201d. We look forward to your support and participation in developing and advancing the new journal.As the inaugural Co-Editors-In-Chief, we are looking forward to the successful development of"}
{"text": "In the last decades,this \"classic\" view of the Middle Ages has been gradually modified with advancesin historiographical studies and the history of science. During that period inWestern Europe, knowledge about the human body suffered a regression in terms ofanatomy and physiology, with the predominance of religious conceptions mainlyabout diseases and their treatments. Knowledge on the cardiovascular system andheart diseases has been classically described as a repetition of the conceptsdeveloped by Galen from the dissection of animals and his keen sense ofobservation. However, the Middle East, especially Persia, was the birth place ofa lot of intellectuals who preserved the ancient knowledge of the Greeks whilebuilding new knowledge and practices, especially from the 8th to the13th century. The invasion of the Arabs in North of Africa andthe Iberian Peninsula and the eclosion of the Crusades resulted in a greatercontact between the East and the West, which in turn brought on the arrival ofthe Arab medical knowledge, among others, to 12th century Europe.Such fact contributed to an extremely important change in the scientific medicalknowledge in the West, leading to the incorporation of different concepts andpractices in the field of cardiovascular Medicine. The new way of teaching andpracticing Medicine of the great Arab doctors, together with the teachinghospitals and foundations in the Koran, transformed the Medicine practiced inEurope definitely. The objective of this paper is to describe the knowledgedrawn up from the Middle Ages about the cardiovascular system, its understandingand therapeutic approach to cardiologists and cardiovascular surgeons.The historical period called the Middle Ages, a long interval between the5 It relates mainly to Western Europe, but it is also extended tothe Byzantine Empire and the Arab kingdoms in the East. The medieval period wasgiven this name by the intellectual people of the 16th century. Eager torevive the Ancient History and its knowledge, they defined the Middle Ages  as the period of time betweentheirs and the ancient ones. Quickly, it was called the Dark Ages because ofreligious predominance, especially by the Christians in the West, as well as thealleged delays in several areas of knowledge and the precarious living conditions ofthe time,2.The Middle Ages is the time period commonly defined between the 5rd and 5th centuries; the plague between the 6th and8th centuries,reducing the population level in Europe to the lowest number since the secondcentury; and the Black Death, between the 14th and 17thcenturies, which caused the death of 1/8 to 2/3 of the European population,depending on the region.Although it is difficult to have reliable statistical estimates in the period due tothe precarious sources, life expectancy was between 20 and 30 years and themortality rate was about 30 and 40 thousand individuals a year, mainly because ofepidemics.This period fits into the models of ancient society, related to quality andexpectancy of life. It is typical of pre-industrial societies, since there were highbirth and death rates, which suffered variations from insurgencies or facts contraryto population growth, such as: plagues, climate change, wars and food shortages.Three great epidemics weakened Medieval Europe. The epidemics of malaria between the3,5. Thus, the act of taking care ofpatients becomes an obligation of religious people , themedical practice becomes an act of charity and hospitals become places which provide more comfort thancure. However, sickpeople were also treated at a distance and in fear because of the possibility ofcontagion, both physical and spiritual. In this context, the barber-surgeons,healers and women who manipulated herbs were increasingly required for medicaltreatment, even by religious people. Medical practice in the West only becomesacademic when doctors are graduated from universities, from the 12thcentury on. Even with universities and physicians with academic knowledge, onlyafter long efforts, between the 13th and 15th centuries, themedical profession became more valued and more required than the healers andbarber-surgeons.Medicine in the Western Middle Ages gained new forms with the religious predominanceof Christianity. Body and soul are interconnected in a complex philosophical andtheological dualism. Diseases and body ailments are seen as consequences of sinsinflicted to God, as the classic example of leprosy, present in theScriptures. Galen'sideas were incorporated and considered dogmas by the Catholic Church. Faith andreligious rituals were the basis to face diseases and epidemics, besides promotingrituals and attitudes which involved prejudice, \"witch hunts\" and hystericalbehavior by the heavily present society in the Middle Ages(10th-15th centuries). Gradually, the Western worldrenewed its knowledge in different fields, particularly in Medicine, as a result ofthe scientific and cultural splendor happening in the Islamic world. Such scientificsplendor comes to Europe through the knowledge generated by the Arabs, in thereading of Greek texts and new ways to conduct medical training and patient care,while in contact with the Arab world. The purpose of this review is to present theknowledge created in the Middle Ages on the cardiovascular system and also theadvances in understanding diseases and approaches that emerged in the MiddleAges.Medicine theoretical knowledge was based on Galen's formulations (four humors) andextrapolations about anatomy and physiology of the cardiovascular system from animaldissectionsth to the 10th century, is marked mainly by theformation of Germanic kingdoms in Europe, the expansion of Christianity, thefounding of the Catholic Church as an institution, along with the organizationof the Carolingian Empire (800-888) and the formation of the Christian kingdoms,arising from their fragmentation. With the emergence of the Carolingian Empire,suzerain-vassal relations are developed, as well as feudal society. Thepopulation level in Europe suffered a decline because of food shortages and thespread of the plague, being gradually restored at the end of this period due tofurther exploration of fields and forests for agriculture. The High Middle Agesis marked by political stability of the Byzantine Empire in the East, the riseof Islam, and the Arab expansion into Christian territories,9.The Middle Ages is commonly divided into two periods: the Early and Late MiddleAges. The first period, characterized as the time interval from the5thand 15th centuries, is marked by several social, economic andpolitical changes in Europe. There was a strengthening of the feudal societybetween the 11th and 13th centuries, predominantlyagrarian and stratified ones, politically defragmented and under the Church'scultural and social control. However, at the same time, there was increasedpopulation growth, development and spread of cities all over Europe, greatcultural development in arts, literature, education, philosophy and science.This time is also marked by a closer contact between East and West, through theCrusades, trade relations, as well as religious and secular expeditions in orderto know and absorb the knowledge of the Arab people. The final centuries of theMiddle Ages (14th and 15th) are marked by political andreligious crises, the plague outbreak and the European territorial expansion, which promote and permeate great changes that mark the followingcenturies,9.On the other hand, the Late Middle Ages, the period between the 11th century, the practice of curing the body wasclosely connected to that of curing the soul, considering the most identifieddiseases as physical expressions of sins. This way, the task of taking care ofthe sick people is relegated to the religious, including monks, nuns and secularclergy, and to the laypeople who had practical experience on how to deal withthe sick. Hospitals are institutions that took a long time to be built inmedieval Europe, except for Spain, under Muslim control. It can be noticed,before the 13th century, the presence of specific places inmonasteries to deal with itinerant sick people and monks, and also the houses ofGod , placeswhere the major concern was the person's soul salvation, not the cure of thebody itself. Even after the existence of hospitals, from the 13thcentury on, such places were considered a place to provide more comfort than thecure itself-7. Doctors, as professionals, also arise afterthe 12th and 13th centuries, with the creation ofuniversities and the breaking of knowledge monopoly practiced by the monks.Until then, the School of Salerno, founded in the 10th century, wasone of the few learning centers in Europe for medical practices. Despitegraduating from universities, doctors had to make a great effort for theiracademic and practical knowledge to be recognized as the only ones viable inpatients' treatment, constantly fighting against the practice of healers,barber-surgeons, superstitious and quacks, until the end of the MiddleAges.The medical practice itself can be verified in the temporal extents of the MiddleAges. Before the 13nd century by Claudius Galen (129 - 199?). Originallyfrom Pergamum, a Greek city under Roman rule, Galen made use of the majesticcity library, with more than 200 thousand books, to study all the philosophical,scientific and Greek Medicine literature of the time. Galen also made use of theinformation stored in the School of Alexandria, the main learning center of thetime, where he could find the largest library of the Ancient times and completeskeletons, thereby allowing him to study the human body thoroughly. Then, hebecame famous in Greek Roman Medicine,10,11 . After purification, the blood would pass from the rightside to the left by small invisible pores, there it would be again combined withair and pneuma, then it would be distributed throughout thebody; here, he identified the aorta and the pulmonary veins on the left side. Inaddition, Galen gave great importance to the liver, which would turn digestedfood into blood and then send it to the heart to be filtered. Despite achievinggreat advancements regarding blood circulation throughout the body, Galen saidthat the venous and arterial systems were completely separated and notconnected,13,14 , who belonged to one of those tribes, was acaravan merchant for most of his life. From the age of 30 on, he started toreceive revelations from Angel Gabriel. Those revelations were orallytransmitted among the Arabs and later formed the holy book of Islam, theQur'an , are theQur'an (revelation given directly by Allah to Muhammad) andthe Hadeeth . Here,we may see a great importance given to medical knowledge. Arab teachers anddoctors encouraged and constantly searched for new knowledge and research thatresulted in major discoveries based on the sacred writings. Every disease hadbeen created by God and He had created a cure for each of them, not only curesand spiritual treatments, but also the treatment received by doctors wasencouraged, since it was one of the ways whereby God provided the cure for humandiseases. Most of the teachings regarding healing and disease preventioncontained in the sacred books refer to lifestyle, food and personal hygienehabits, besides containing some guidelines on minor surgeries. For all that, theappreciation of doctors as healers authorized by God allowed for theconstruction of new knowledge about the anatomy and physiology of the humanbody, as well as diseases and their treatments discovered by Arabdoctors,20.On the other hand, even regarding the religious aspect, we notice some facts thatcontributed greatly to the development of Arab Medicine. The two sacred Islamicbooks which compose the Sacred Law, or In addition to information on treatments and cures of diseases in general, thesacred writings bring great information about specific heart diseases, and alsophysiological and anatomical information. The heart is considered the center ofemotions, actions, intentions, desires and knowledge, and, many times, thediseases are related to the emotional state  andeven to the spiritual one .Al- Watin (aorta).Nevertheless, besides the spiritual view, there are several references of ananatomical knowledge of the heart, like a muscle, as in the passage in whichAngel Gabriel would have performed a surgery on Muhammad, extracting a bloodclot from his heart. There is also reference to the knowledge of veins andarteries and their vital importance, because the sacred books say that Godcreated man's life and could take it, cutting either his jugular vein or theQur'an.Such references about medical concepts in the sacred books can be derived fromthe contact Muhammad had with doctors graduated from school-hospitals. Many ofthe Arab tribe nomads attended those hospitals, like the Gundishapur one, inorder to go back to their tribes and treat the sick people there. Muhammad hadgreat contact with the doctor al-Harith bin Kalada, who influenced him mainly onhygiene notions present in the th and 13th centuries, provided the advancement ofmedical science knowledge at school-hospitals; this knowledge was based onancient writings and practical experiences, supported by philosophical andreligious bases. Besides thegeneral field of Medicine, there was a great development in knowledge about theheart, regarding its anatomy and physiology, diseases and their treatments. Todemonstrate the scientific advancement of that time, we have chosen three Arabdoctors who showed important contributions to the knowledge of thecardiovascular system: Haly Abbas (? 930-994), Avicenna, or Ibn Sina (980-1037)and Ibn al-Nafis (1210-1288)  .th century, who lived at atime between two great names of Arab Medicine: Rhazes and Avicenna. He was thecourt physician of Adud al-Dawla-Fana Khusraw (936-983), king of Persia, andalso at Azodi Hospital in Baghdad, where he wrote his most important piece ofwork \"The Complete Book of Medical Art\" , or \"The Royal Book\" . It is in this encyclopedic book that we can find thegreatest references by Haly Abbas concerning the knowledge of the heart, inwhich we notice his remarkable effort to reject some of Aristotle's and Galen'soutdated ideas. On the question of the venous and arterial system, Haly Abbasmade the first distinctions between veins and arteries based on their thickness,in addition to a detailed description about the descending aorta of the thoracicstructure,21. Yet, his greatestcontribution was making one of the first mentions about a connection between thevenous and arterial system, describing it in the following way in the \"RoyalBook\": \"...There are some foramina within the non-pulsating vessels[veins] that open to the pulsating vessels[arteries]...\".Haly Abbas was a Persian physician of the 10,21.Furthermore, he made great advancements in the anatomical description of theheart, although not with the nomenclature being used nowadays. He described theheart as two main chambers, one on the right and another on the left, the latterbeing where the arteries would have their origin, and considering the liver theorigin of the veins. He also recognized the existence of two atria and twoauricles as well as the aortic and mitral valves, describing theircharacteristics and the presence of the pericardiumQur'an, and becoming a famous doctor at the ageof 18. He wrote more than 450 books, namely about astronomy, logic, philosophyand Medicine treaties. Avicenna wrote all this literature living a troubled lifeof persecution and escapes due to his political opposition to the Persiangovernment. His major works on Medicine are: \"Canon of Medicine\" , \"The book on drugs for cardiac diseases\", and the less well-known\"Book on Pulsology\" . He made greatprogress in the anatomical knowledge of the heart, although he had accepted someof Galen's misconceptions, such as the existence of pores connecting the twoventricles of the heart, allowing the passage of blood from the right to theleft side. He recognized the origin of the arteries on the left side of theheart and veins in the liver; moreover, he identified the difference between thethickness of the left and right ventricle walls. In addition, he was the firstto mention the difference in atria and ventricles contractions, as well as theexistence of capillary circulation-26 , which consistedof 300 volumes, though it was not completed, and the \"Commentary on Anatomy inAvicenna's Canon\" , comprised of 80volumes. Ibn Al-Nafis stands out for the clear criticism of Galen and Avicenna,pointing out the flaws and mistakes in their theories, which was somethingalmost unthinkable to be done at a time when the ancient writings representedthe truth. Most likely he had dissected human bodies to have his greatestachievement: the discovery of the pulmonary circulation-35  or invisible pores .The blood from the right chamber must flow through the vena arteriosa(pulmonary artery) to the lungs, spread through its substance, be mingledwith air while in the lungs, pass through the arteria venosa (pulmonaryvein) to reach the left chamber of the heart to form the vitalspirit\".Ib-Al-Nafis described the pulmonary circulation like this: \".Moreover, he was the first to describe the role of coronary arteries, which aretruly responsible for nourishing the heart,36.All this knowledge produced by the Arab masters, added to the varioustranslations of the Greek classics into their language, reached the ChristianWest and changed deeply the way of teaching and practicing Medicine. The mostremarkable contact between the Christian West and the Muslim East was clearlywarlike. The crusades greatly marked the way of thinking of the time, causinggreat aversion to Islam in Europe, especially among the religious ones. However,the contact with Arab culture as a result of the Crusades conduced to a searchfor Arab works and their translations in order to better understand the enemyagainst whom the Christian West foughtth century,keeping constant trade with the East, and the Muslim-ruled Iberia was quite opento contact with the European Christians, considering they were coming from atradition of tolerance toward Christians and Jews within their own boundaries.It was through those commercial and cultural contact centers that Arab scrollsentered the Western Christian world, being translated into Latin and influencingmany intellectuals of the time. Particularly noteworthy is a doctor called Constantine,the African, who worked for forty years in Syria, India, Egypt and Ethiopiabefore taking part in the doctors' and teachers' group at Salerno school, thefirst medical school in Europe. He came up with several manuscripts, extensivebackground and medical techniques. Thus, Greek classics which were forgotten for a long timein the West, such as Hippocrates', Galen's and Aristotle's, as well as newwritings made by the Arabs in the fields of philosophy, arithmetic, Medicine,among others, entered the medieval Christian area early in the Late Middle Ages.During this period of time, between the 12th and 13thcenturies, Europe experienced an outbreak and growth of cities, the creation ofthe first universities and a greater knowledge secularization. Arab works, then,were read by intellectuals, scholars and even religious people, modifyinggradually the philosophical and scientific conceptions of medievalEurope,36.Italy had already flourished in business since the 11th and 15th centuries, thegraduated doctors fought against healers and barber-surgeons, with the purposeof being recognized as the most prepared ones to deal with patients. Moreover,it is when the need for body anatomy knowledge in medical training arose inEurope. In 1240, Emperor Frederick II, of Naples, insisted that it was necessaryfor the surgeons to have anatomy training. However, the first milestone in thehistory of public dissections at universities, in terms of teaching, occurredonly in 1315, in Bologna, by physician Mondino De' Luzzi; the same happened inMontpellier, only in 1376, and in Paris in 1407. Despite being discreet andfacing various religious difficulties, this first step towards an observationscience marked the beginning of progress made in the Renaissance in Italy,mainly in the medical field.Therefore, the great names of the Renaissance, such as Leonardo Da Vinci,Michael Servetus, Andreas Vesalius and William Harvey could dissect and observecorpses, making great advances in Medicine and especially on the knowledge ofthe cardiovascular system,21,37, probably being great readers of Arab works on thesubject. Michael Servetus in his \"Christianismi Restitutio\"work of 1553 talks about Ibn Al- Nafis' great advances regarding pulmonarycirculation, compiling part of his work. But, not mentioning the Arab author,pretending to be the original author of the groundbreaking discoveries until notlong after finding Ibn Al- Nafis' books,33-35.The reading of Arab medical works and the change in the intellectual scene inEurope generate important transformations in Medicine at the time. Gradually,professionals who had only practical knowledge go to universities in search ofgreater knowledge. During the 13Medicine and cardiovascular science in the medieval times, rather than presenting agreat stagnation, received important contributions from philosophical ideas, as wellas Arab medical knowledge. Arab medical science had already made great contributionsin the sacred books of Islam, in particular on disease prevention and thecardiovascular system anatomy. At the same time, bright doctors and teachers,especially Avicenna, revolutionized cardiovascular knowledge, founded and taught atthe first school-hospitals, and refuted the traditional knowledge present in Galen'swork. During this time, when Europe remained under the aegis of the Catholic Church,it received strong and definite influence from the Arabs, such as the creation ofthe first medical schools and universities. That influence provided advancesconcerning the knowledge of the cardiovascular system produced in theRenaissance."}
{"text": "The was an error in the Competing Interests section. The correct version of the section is available below.Dr. Gregory Hand has received consultancy fees from the National Institutes of Health (NIH) and grants from the NIH, and The Coca-Cola Company. Dr. Steven Blair receives book royalties  from Human Kinetics; honoraria for service on the Scientific/Medical Advisory Boards for Clarity, Technogym, Santech, and Jenny Craig; and honoraria for lectures and consultations from scientific, educational, and lay groups which are donated to the University of South Carolina or not-for-profit organizations. Dr. Blair is a consultant on research projects with the University of Texas-Southwestern Medical School and the University of Miami. During the past 5-year period Dr. Blair has received research grants from The Coca-Cola Company, the National Institutes of Health, and Department of Defense. Funding for the study was provided by an unrestricted research grant from The Coca-Cola Company. The sponsor of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of the report, and does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.The corresponding author should be contacted at: archer.edwardc@gmail.com"}
{"text": "The 31st Annual Meeting of the International Society for Traumatic Stress Studies (ISTSS), November 5\u20137, 2015, was a vibrant and stimulating conference, with many highlights from the opening on the 10th anniversary of Hurricane Katrina; the keynotes of Anke Ehlers, John Krystal, and Regina Sullivan; the vivid panel discussions with recognized leaders in the field of traumatic stress studies; inspiring and eloquent presentations by master methodologists and clinicians; and much more. The atmosphere was excellent, not only within the conference venue, but also outside\u2014we were in The Big Easy. For those who missed it, and for those who like to refresh their memories, we have assembled here in this special issue the highlights of the ISTSS-2015!The topic of the meeting was \u201cBack to Basics: Integrating Clinical and Scientific Knowledge to Advance the Field of Trauma.\u201d Basic science in the field of stress and trauma has always been an important platform for the development of evidence-based treatments for posttraumatic stress disorder (PTSD). In the past 20 years, research on the effects of trauma and processes of recovery has evolved at great pace. We also know that, despite these advances, the vast majority of those affected by traumatic stress still do not receive optimal care, and even when they do, many patients are not cured after treatment and remain deeply affected by their experiences  and their international partner ISTSS have a long-standing collaboration Gersons,  and we aWith this special issue that presents highlights of the ISTSS-2015, we hope to boost future critical discussions on the advancement of science and evidence-based treatments, and challenge all of you to engage in this process. To optimally advance the field of trauma, we need clever scientists and dedicated clinicians. However, to stay open-minded in this world of constant change and dominant ideologies, we also need \u201cdisrupters, disbelievers, sceptics, and revolutionaries\u201d (see Yehuda et al., Bernet Elzinga Institute of Psychology Section Clinical Psychology Leiden University Leiden, The NetherlandsChristian Schmahl Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Medical Faculty Mannheim/Heidelberg University Mannheim, GermanyMiranda Olff Department of Psychiatry, Academic Medical Center University of Amsterdam Amsterdam, The NetherlandsDiemen, The NetherlandsArq Psychotrauma Expert Group"}
{"text": "Researchers and academic institutions need assessment and rating to measure their performance. The criteria are designed to evaluate quality and adequacy of research and welcome by most universities as an international process to increase monitoring academic achievements. The study aimed to evaluate the increasing trend in global ranking of Iranian medical universities websites emphasizing on comparative approach.This is a cross-sectional study involving websites of Iranian medical universities. Sampling was conducted by census selecting universities affiliated to the Ministry of Health in webometrics rating system. Web sites of Iranian medical universities were investigated based on the webometrics indicators, global ranking as well as the process of changing their rating. Universities of medical sciences were associated with improved ratings in seven periods from Jan 2012 until Jan 2015.The highest rank was in Jan 2014. Tehran University of Medical Sciences ranked the first in all periods. The highest ratings were about impact factor in universities of medical sciences reflecting the low level of this index in university websites. The least ranking was observed in type 1 universities.Despite the criticisms and weaknesses of these webometrics criteria, they are critical to this equation and should be checked for authenticity and suitability of goals. Therefore, localizing these criteria by the advantages model, ranking systems features, continuous development and medical universities evaluation based on these indicators provide new opportunities for the development of the country especially through online media. Researchers and academic institutions increasingly need assessment and rating as a measure of individual and organizational performance. This is an international process. Increasing surveillance on the academic achievements through the assessment of excellence in research , UK research assessment, Performance-Based Research Funding in New Zealand have attracted the attention of the universities. All these criteria manifest the quality and efficiency of research . Rating The development of this ranking can lead to the development of scientific institutions while providing support for investment in research .Today, the web is an important tool for formal and informal communication and cooperation among individuals including researchers. Increased number of indexed web pages paved the way for the emergence of the methods and measures of web resources .Website and access to the web visibility of the university is one of the important factors for the success of the university; therefore, evaluation and ranking of universities\u2019 websites is as crucial as evaluation and ranking of research and educational activities of universities. Thus, evaluation of universities on the web is one of the priorities of the country as a tool for evaluating the academic and research performance of universities .The number of web pages in the university websiteTotal number of PowerPoint, Word and PDF files available on the website of the universityThe qualitative papers of the university among the 10% most cited articles in SCImago website .Ranking systems of university websites recognize internet as a source for large volumes of documents and a tool to disseminate and access knowledge. Rankings of Shanghai, Times and QS are some of the most important systems of the world university rankings. Indicators such as scientific achievements, professional judgment score, quality of education, the number of foreign students, winners of the Nobel Prize are evaluated in most of these systems. Webometrics Rating system examines the overview and comprehensive images of a university . It alsoThe number of links to the university website (2015) Webometrics is introduced as the quantitative aspects of the structure and use of information resources, structures and web technologies outlining approaches to information and bibliometrics. It also takes into grant four main areas of analysis of the content and structure of the web, web use and technologies applied to the web. Webometrics may become one of the most interesting research areas for a wide array of electronic information , 9.Thus, considering the importance of academic websites, this study examined websites based on the Webometrics in order to improve in webometrics ranking and to reveal a complete perspective of the status of science and research in the field of health in the country and the presence and success of the universities of medical sciences.In this cross-sectional study, the population of the research included websites of Iranian medical universities. Sampling was conducted by census. In the first stage, all medical universities were recovered in terms of ranking in the webometrics database by selecting the Asia and Iran, respectively. Then, type one, two and three universities of Ministry of Health and Medical Education were separated in webometrics database in terms of rating among the items recovered. Secondly, web content of universities was investigated based on the webometrics indicators (presented in Jan 2015), their national webometrics ranking and changes in their rating at 7 periods . The increasing trend in ranking of websites of recovered universities was compared using descriptive statistics . Web ranking of universities in global webometrics ranking system is done on 4 criteria including Presence (the number of web pages in the university website), Openness , Excellence  and Impact (the number of links to the university website).Rank status and development of medical universities is as follows with regard to webometrics ranking results in the time of Jan 2012 until Jan 2015:Medical universities of Tehran, Isfahan, and Shiraz ranked first and third, respectively in Jan 2012. Medical universities of Lorestan (43%), Tehran (35%), Isfahan (31%), Shahrekord (29%), Kermanshah (25%) and Mazandaran (24%) showed considerable growth. The results suggested that 74% of medical universities have been associated with increased global ranking in Jan 2012 and the total number was 35 universities.Rating of universities in Kerman, Mazandaran, Arak, Kurdistan, Tehran, Kermanshah, Semnan, Birjand, Babol, and Hamadan indicated a growth more than 20% in Jul 2012 compared to the first results of the ranking in Jul 2011. 61.4% of medical universities in 2012 were associated with an increase in global ranking .Three medical universities of Tehran, Isfahan, and Shahid Beheshti received top ratings in Jan 2013 and medical universities of Qazvin, Gonabad, Kurdistan, Hormozgan, Arak and Bushehr showed a growth more than 20% compared to the previous rating. 61.4% of medical universities in 2013 were associated with an increase in global ranking .Three medical universities of Tehran, Shiraz, and Isfahan received top ratings in Jul 2013 and medical universities of Fasa, North Khorasan, and Army indicated a growth more than 20% compared to the previous rating. Twenty-six percent of medical universities in 2013 were associated with an increase in global ranking . Medical universities of Dezful and Torbat were also added to the list of webometrics ranking.Medical universities of Tehran, Shiraz, and Isfahan received top ratings in Jan 2014 and medical universities of North Khorasan, Gonabad, Ahvaz, Army, Lorestan, Zahedan, Qom, Hamadan, Mashhad, and Shiraz showed an increase more than 25% compared to the previous rating. 91.6% of medical universities in Jan 2014 were associated with an increase in global ranking. Medical universities of Isfahan, Arak, and Fasa also showed degradation.Medical universities of Tehran, Tarbiat Modares, and Shiraz received top ratings in Jul 2014 and medical universities of Ardebil, Modares, Shahrekord, Qazvin, Kashan, Kerman and Shiraz indicated a growth more than 40% compared to the previous rating. 81.2% of medical universities in Jul 2014 were associated with an increase in global ranking. The nine medical universities of Semnam, Zahedan, Sabzevar, Babol, Tavanbakshi, Torbat Heydarieh, Yasouj, Qom, and Dezful also indicated a ranking decrease.Medical universities of Tehran, Shahid Beheshti, and Isfahan received top ratings in Jan 2015; while, medical universities of Kordestan, Torbat Heydarieh, Rafsanjan and Birjand indicated a growth more than 15% compared to the previous rating. Among 50 universities of medical sciences in the global webometrics ranking, 44% associated with improved global ranking in recent rating. They are generally ranked 37.2% lower than the previous rating. The medical universities of IAU, Shiraz, North Khorasan, Lorestan, Isfahan, Tavanbakshi, Dezful, Zahedan, Hormozgan, Sabzevar, Babol, Kerman, Ilam, Yasouj, Qom, Fasa, Tabriz, Jahrom, Arak, Shahed, Golestan, Zabol, Qazvin, Gonabad, Shahroud, Kermanshah, Ardebil and Hamedan also indicated a backward .The highest index in rating is observed in universities of Tehran, Birjand and Shiraz, respectively and the lowest rank is seen in universities of Torbat Heydarieh and IAU. The highest impact indicator is observed in universities of Tehran, Tarbiat Modares, and Shahid Beheshti; whereas, the lowest impact indicator is seen in Sabzevar University. The highest rank in the field of excellence indicator is observed in the universities of Tehran, Tarbiat Modares, and Shahid Beheshti. The average index of rating showed that the highest rank results from impact factor. It is determined by numeration of external links to university subdomains. This obviously is more important than the other indices with a 50% of allocation. External link indicates the reputation of the organization, academic performance, value and usefulness of services presented in web pages. They are obtained by two important suppliers named Majestic SEO and Ahrefs given that the highest rating reflects a low level of this index in the university websites .The study of growth rate in type 1 medical universities indicated that the highest growth rate is seen in medical universities of Kerman, Shahid Beheshti, and Tehran, while, medical universities of Ahvaz and Isfahan faced with negative growth. If severance of years is considered, the greatest growth in Jan 2015 is seen in Shahid Beheshti University of Medical Sciences (12%) and the highest negative growth is seen in Shiraz University of Medical Sciences (79%). The greatest growth in Jul 2014 is seen by Kerman University of Medical Sciences (42%) and the highest negative growth is seen in Mashhad University of Medical Sciences (15%). The highest growth in Jan 2014 is manifested in Ahvaz University of Medical Sciences (27%), whereas, the highest negative growth is seen in Kerman University of Medical Sciences (9%). All universities had negative growth in Jul 2013 and the highest negative growth is seen in Ahvaz. %). The best growth in Jan 2013 is seen in Isfahan University of Medical Sciences (37%); whereas, medical universities of Shiraz, Tabriz, and Mashhad presented a negative growth. The greatest growth in Jul 2012 is seen in Kerman University of Medical Sciences (54%); unlike this, the highest negative growth is seen in Isfahan University of Medical Sciences (77%). If we consider the whole period of rating, the greatest growth in Jul 2012 is manifested in Kerman University of Medical Sciences and the highest negative growth is seen in Shiraz University of Medical Sciences in Jan 2015 .The study of growth rate in type 2 medical universities indicated that the highest growth rate is seen in medical universities of Arak, Hormozgan, and Qazvin; while, medical universities of Lorestan, Semnan, and Shahed faced with negative growth.If we consider the severance of the years, the following universities indicated considerable growth: Rafsanjan with 16% growth in Jan 2015, Ardebil with 55% growth in Jul 2014, Zahedan with 35% growth in Jan 2014, Babol with 16% growth in Jul 2013, Qazvin with 52% growth in Jan 2013, Zahedan with 50% growth in Jul 2012 .The study of growth rate in type 3 medical universities indicated that the highest growth rate is seen in medical universities of Kurdistan, Army, and North Khorasan; whereas, medical universities of Jahrom and Sabzevar faced with negative growth. If the severance of the years is considered, the following universities indicated considerable growth: Kordestan with 32% growth in Jan 2015, Gonabad with 47% growth in Jul 2014, Fasa with 46% growth in Jan 2014, Qom with 50% growth in Jul 2013, Shahrekord with 51% growth in Jan 2013, Kordestan with 33% growth in Jul 2012. Universities of North Khorasan, Torbat Heydarieh and Dezful have been inserted in webometrics rating system from Jul 2013 .Active presence on the Web and publication of research findings are considered as performance indicator of universities and research institutes in the assessment of development. Websites must continually be evaluated in terms of the importance for websites, applicability, and success in achieving the goals. Webometrics assessment of websites of universities and research institutes also has the advantage that puts the spotlight on the current situation and the performance of universities in relation to the web environment from one side. On the other hand, leaders of these organizations try to provide the necessary conditions for their institutions for the active presence on the web according to international standards in order to gain further credibility. Therefore, the universities should care about periodic evaluations. This study elaborates the ranking of the national medical universities. Medical universities of Tehran, Shahid Beheshti, and Isfahan received top ratings in Jan 2015 and medical universities of Kordestan, Torbat Heydarieh, Rafsanjan and Birjand indicated a growth more than 15% compared to the previous rating. Recent results suggest that among 50 universities of medical sciences in the global webometrics ranking, 44% associated with improved global ranking in recent rating. They are generally ranked 37.2% lower than the previous rating. The medical universities of IAU, Shiraz, North Khorasan, Lorestan, Isfahan, Tavanbakshi, Dezful, Zahedan, Hormozgan, Sabzevar, Babol, Kerman, Ilam, Yasouj, Qom, Fasa, Tabriz, Jahrom, Arak, Shahed, Golestan, Zabol, Qazvin, Gonabad, Shahroud, Kermanshah, Ardebil and Hamedan also indicated a decrease.There are different rating fluctuations in type 1, type 2 and type 3 medical universities considering the above findings from Jul 2012 to Jan 2015. The most promotion at this time was seen in medical universities of Kerman, Qazvin, Fars, Qom, Ardebil and Kurdistan . The most growth in rating of all medical universities is seen in Jan 2014 and the lowest growth is seen in Jan 2015. Changing the method of calculation is one of the reasons to justify this change and negative fluctuation, to calculate the index, previously known as scholar; the results of the evaluation from Google scholar search engine were also used in addition to Scimago.The ranking fluctuations and downgrading during different time is reported . In a reThe findings of the evaluation system of universities and research institutes websites at Regional Information Center for Science and Technology suggest that medical universities of Tehran, Isfahan, and Shiraz are in the top rankings, respectively. Shahid Beheshti University of Medical Sciences is in the fifth ranking conveying the successful results .Although there is a positive correlation between webometrics rating of webometrics system and other university ranking systems, the results of the ranking become somewhat different by using different criteria in the ranking systems . HEEACT The webometrics rating of universities in Jan 2015 includes significant points, websites of medical universities of Tehran, Isfahan and Shahid Beheshti in the presence index; websites of medical universities of Tehran, Isfahan and Shahid Beheshti in the impact factor index; in terms of access to rich files the medical universities of Tehran, Birjand and Shiraz; and finally the medical universities of Tehran, Tarbiat Modares, and Shahid Beheshti showed the best science ranking index. The Medical University of Tehran exceeds the points both in web presence and number of links involved followed by two universities of Guilan and Mashhad . A web sth, while the Rich files ranking appeared to be the third nationally  have been completely observed by the authors."}
{"text": "Exosomes and ectosomes, extracellular vesicles of two types generated by all cells at multivesicular bodies and the plasma membrane, respectively, play critical roles in physiology and pathology. A key mechanism of their function, analogous for both types of vesicles, is the fusion of their membrane to the plasma membrane of specific target cells, followed by discharge to the cytoplasm of their luminal cargo containing proteins, RNAs, and DNA. Here we summarize the present knowledge about the interactions, binding and fusions of vesicles with the cell plasma membrane. The sequence initiates with dynamic interactions, during which vesicles roll over the plasma membrane, followed by the binding of specific membrane proteins to their cell receptors. Membrane binding is then converted rapidly into fusion by mechanisms analogous to those of retroviruses. Specifically, proteins of the extracellular vesicle membranes are structurally rearranged, and their hydrophobic sequences insert into the target cell plasma membrane which undergoes lipid reorganization, protein restructuring and membrane dimpling. Single fusions are not the only process of vesicle/cell interactions. Upon intracellular reassembly of their luminal cargoes, vesicles can be regenerated, released and fused horizontally to other target cells. Fusions of extracellular vesicles are relevant also for specific therapy processes, now intensely investigated. During the last 15 years, exosomes and ectosomes, the two types of extracellular vesicles (EVs) endowed with physiological and pathological functions, have been among the structures attracting the greatest attention in the scientific community. Exosomes were identified in 2000 as the vesicles trapped within multivesicular bodies (MVBs). Their release to the extracellular space takes place upon the exocytosis of the latter organelles .Numerous aspects of exosome and ectosome generation are known to be different. Among these are the sites of their origin, at the MVBs and the plasma membrane; the length of their intracellular life before discharge, long for exosomes  and much shorter for ectosomes (a few tens of seconds for their generation at the plasma membrane); their size ; the mechanisms for the accumulation, within their luminal content, of proteins and other macromolecules indicated here as their cargo. In addition, the two types of EVs are often considered molecularly different. Thus, quite a few proteins were proposed as markers of exosomes. Recent studies, however, have shown many such molecules to be present also in ectosomes, although at lower levels. Real markers now recognized, specific of either type of EV, are few. Nevertheless, they remain useful for the identification of the two EVs [Once generated and released, the destinies of the two types of EVs become similar, if not identical. Fractions of both types of EVs undergo dissolution of their membrane. As a consequence, the factors accumulated in their cargo are released to the extracellular space. Most other EVs, however, do not dissolve, but pursue their navigation in the extracellular fluid. In vivo, the navigation of some of them is long-term, sufficient to reach the large fluids of the bodies. Other EVs, however, remain local, establishing interactions with cells defined here as target cells. Such interactions are at least of two types. Some EVs, taken up by various forms of endocytosis, can either be discharged into lysosomes or fuse with endocytic membranes, with ensuing release of their cargo into the cytoplasm. Alternatively, the binding of EVs to target cells is followed by their fusion with the plasma membrane. The different conditions of the two pathways, acidic within endosomes, near neutral in the extracellular space, appear critical for the EV membrane fusion. The process occurring upon uptake of EVs  into endosomes has been extensively investigated and recently illustrated in comprehensive reviews ,5. In coAs already mentioned, exosomes and ectosomes are generated and released by all types of cells. This property may suggest the two types of EVs to be homogeneous in terms of composition. This is not the case. The two EV types are, in fact, distinct in composition. This can be the case of EVs released from different cells. Even when EVs originate from the same type of cell, some of their properties can be different, depending on reasons such as the state of development of their cells of origin, their functions, and the degree of their stimulation. Large differences have been reported also between wild-type EVs and the analogous EVs of cancer cells . These dIn order to clarify in detail the properties of the EV-cell interactions, the investigation has been expanded using new approaches by which the temporality and the dynamics of the process can be established . ExcelleIn view of the specificities summarized above, the variable properties of the EV-cell interactions can be attributed to the genes expressed by the original and target cells. Specifically, the interactions appear due to the cell surface proteins necessary for EV binding and compatible for the ensuing fusion to get started.N-ethylmaleimide-sensitive protein receptor (SNARE), which have nothing to do with the surface binding and fusion processes. Among the latter processes, the ones previously intensely investigated are virus fusions, which occur with the participation of four classes of proteins [Binding and fusion of EVs to the external surface of their target cells should be first distinguished from the apparently analogous fusion processes taking place inside the cell, during organelle traffic, exocytosis, endocytosis and other events. Intracellular binding and fusion require the involvement of various proteins, including actin, other cytoskeletal proteins and numerous forms of soluble proteins . ProteinThe initial interactions of EVs are expected to require specific, high affinity binding of at least two surface proteins, one protruding from the EVs, the other from the plasma membrane of the target cells. The surface proteins of class I, syncytin-1 and syncytin-2, were discovered on placental trophoblast plasma membrane, where they participate in the cell-to-cell fusion process ,13. ThesN-glycosylations of the protein [The interest in these proteins was greatly increased by the identification of two high affinity binding proteins, the receptors Major Facilitator Superfamily Domain 2a (MFSD2a) and Soluble Carrier Family 1 (ASCT-2). These proteins belong to families of carbohydrate and neutral amino acid transporters, respectively ,19,20. P protein . Interes protein . Moreove protein . SummingThe knowledge about EV/target cell fusion , analogoDuring the time between the pre-folding and post-folding of their fusogenic proteins, the EV and cell plasma membranes become continuous . This prEV transfer from the cell of origin to a target cell does not necessarily account for a complete interaction process. In target cells, in fact, the cargo and membrane molecules transferred upon EV fusion can accumulate again into vesicles that are released and then fuse to other target cells. This horizontal transfer, taking place among the cells of a tissue, could be expanded also to other cell types, contributing to many physiological processes such as coagulation, stem cell renewal and expansion, and also to the pathogenesis of diseases including inflammation diseases , diabetes, and the growth, invasion and metastases of tumors ,25,26,27Knowledge about their origin and properties stimulated the idea of employing EVs for therapy . A problThe task of the present review was the demonstration that specific binding and fusion of EVs with the plasma membrane of target cells is a process of great interest for cell physiology and pathology. Binding and fusion of EVs does occur also upon their uptake by the endocytic system, extensively presented in ,5. HowevThe EVs are often defined as structures that have displaced the external borders of cells, from the plasma membrane to the limit of their navigation. The findings reported here have documented additional properties of EVs including, among others, their horizontal intercellular transfer of macromolecules; their target cell signaling induced by the intercellular traffic of macromolecules; their long-term control of gene expression. The identification of these and other extraordinary processes has introduced new concepts and ideas, not only in cell biology and physiology, but also in medicine. At present, in fact, the role of EVs is being evaluated also by procedures employed for the diagnosis, prognosis, evaluation and therapy of single patients. Based on the results of their intense, ongoing investigation, the EVs can therefore be envisaged as new tools, employed for the progress of biomedical sciences, destined to be further expanded in the next few years."}
{"text": "The use of green plants to remove, contain, inactivate, or degrade harmful environmental contaminants  is an emerging technology. In this paper, an overview is given of existing information concerning the use of plants for the remediation of metal-contaminated soils. Both site decontamination (phytoextraction) and stabilization techniques (phytostabilization) are described. In addition to the plant itself, the use of soil amendments for mobilization (in case of phytoextraction) and immobilization (in case of phytostabilization) is discussed. Also, the economical impacts of changed land-use, eventual valorization of biomass, and cost-benefit aspects of phytoremediation are treated. In spite of the growing public and commercial interest and success, more fundamental research is needed still to better exploit the metabolic diversity of the plants themselves, but also to better understand the complex interactions between metals, soil, plant roots, and micro-organisms (bacteria and mycorrhiza) in the rhizosphere. Further, more demonstration experiments are needed to measure the underlying economics, for publicacceptance and last but not least, to convince policy makers."}
{"text": "In article , severalInternational Journal of Molecular Sciences is a member of COPE and takes research integrity, including the correct reporting of figures, very seriously.The article will be marked as retracted. The"}
{"text": "Nursing and research,nursing care. Maria Ivete Ribeiro de Oliveira, Dean of the University of BahiaSchool of Nursing, stated in an keynote lecture the need for a systematized body ofscientific knowledge, which, grounded on nursing theories, would be the basis forgeneralizations, in order to proceed with further investigations, new knowledge and,consequently, the renewal and modernization of professional practice.Research is an instrument by which the researcher obtains tools to strengthen the science,but it is also a political act that, as a social practice, contributes to the improvementof the quality of life of the human being. The first issues related to the development ofnursing research in Brazil were approached in the official agenda of the 16th BrazilianCongress of Nursing, in 1964, in Salvador/Bahia, entitled, The discussions resulted in important decisions. The Brazilian Association of Nursing(Associa\u00e7\u00e3o Brasileira de Enfermagem - ABEn) was recommended to encourage nursing schoolsto prepare: their faculty for research, by means of courses and seminars on researchmethodology; nurses for using research in daily work, producing elements to evaluate thecare providedThe Brazilian nurses dedicated to research can be classified according to the internationalcriteria, namely: the generation of pioneers, which emerged in the 1950s; the generation ofthose who were self-taught, which emerged in the 1960s; the generation of individualacademic development, which appeared in the 1970s; the generation of systematic andcollective production, which was established around the 1980s and 1990s; and in 2000s, thegeneration of scientific production, oriented toward the care settings, through theso-called \u201cgood practices\u201d, and practices based on evidenceBeginning in the 1970s, Brazilian nursing started to develop its own knowledge, based onnursing theories, with the aim of systematization of the care provided by professionals,and stimulating the research of new objects from different qualitative perspectives.,which stated that scientific findings were more reliable as a basis for clinical decisionsthan the opinions of authorities, which influenced the other health disciplines of theworldMaslow\u2019s theory of basic human needs and the classification of Jo\u00e3oMohana, Wanda de Aguiar Horta, proposed the methodology called the \u201cNursing Process\u201d ,which was and still is widely used throughout the countryTechnological advances in the health area and the competitive labor market stimulatednurses to consider specificities of therapeutic care and the identification of nursing\u2019srole in the multiprofessional team. This path motivated the development of specificknowledge, by means of theoretical elaborations, providing a new manner of perceiving thephenomena involved in the care practice. Thus, the need to investigate the objects ofnursing with new glasses was disseminated, and qualitative research was used; with that,nursing actions were improved, based on scientific theory. In the 1970s, according toThe limited use and impact of scientific production related to nursing in the practicesetting needs consideration when referring to nursing research in Brazil, as a challenge ofthe present times. Several hypotheses can be assigned to this, but it is necessary toenable the dissemination and impact of the knowledge produced, as an issue of socialresponsibility, and considering that, according to ethical and moral reasoning, knowledgemust always be shared for the good of humanity. We need to fight for the visibility ofnursing researchHowever, it is necessary to understand nursing research as a manner of growth, developmentand valuing of the profession for society, and not only as an instrument that nurses use inorder to obtain knowledge for their daily practice. This means the awakening andunderstanding of a class that is perceived not only as a work force, but also one thatpartakes of the full exercise of a profession, making use of the incessant search forknowledge.In the last 30 years, the scientific knowledge production generated in postgraduateprograms, applied to the health needs of the Brazilian population, has enabled an effectivearticulation of the centers of formation of doctorally- and masters-prepared nurses withthe society, in a practice that favored different contexts of health and disease. This newknowledge also renews and modernizes undergraduate education, as well as improve thenursing care in a cycle that establishes and nurtures the work of the profession.(The nursing profession, and that of health in general, followed the evolution of thetechnological and computational resources for generation and use of information, favoringthe improvement of actions aimed at attending the population. In the last decades,initiatives for the development of nursing research, whether individual, collaborative ormulti-centered, have multiplied all over the world, with the objective of improving theprovision of quality care, patient safety and more effective health policies.Evidence-based practices, clinical research, systematic reviews, convergent-care research,historical studies, phenomenological studies and social representations, have the samegoal: to answer questions of professional practice I believe that the Brazilian scientific nursing community has expressed concern inpromoting, funding and encouraging the development of intervention research, or, in otherwords, research that provokes changes in care practice, in the face of important healthproblems. The vacuum that still needs to be filled, in my view, is the strengthening ofstudies that really aim at the transformation and integration between the scientificcommunity and the care community. Partnerships between schools, health services, andscientists are essential, with a change of roles from the one who produces the knowledgeand the one who applies the knowledge that has been produced."}
{"text": "From May 29 to May 31 2017, the imposing building of the Palace of Parliament hosted the fifth Edition of the Congress of \u201cCarol Davila\u201d University of Medicine and Pharmacy, Bucharest, the oldest and most important University of Medicine and Pharmacy in Romania, on the anniversary of 160 years since it was founded. Under the already famous motto, \u201cInitiation, Evolution, Excellency\u201d, 35 scientific sessions took place in five session rooms, in which prestigious speakers from Romania and from abroad presented their latest works and researches in the field of Medicine. The participation was numerous, as always, over 300 papers drawing the public\u2019s attention through novelty and originality, the young researchers being remarked through enthusiasm and innovation. The plenary sessions that should be mentioned are the following: Plenary session organized in collaboration with the Romanian Association of Urology: Updates in Urology; Multiple/ Plenary session Neurology: Alzheimer\u2019s Disease \u2013 A multifactorial etiology disorder, A matter of complex interactions; Plenary session Cardiology: Heart failure in the comorbidities context; Plenary session Endocrinology: Parathyroid Diseases: Growing incidence or better diagnosis?; Plenary session organized in collaboration with the Romanian Society of Surgery and Traumatology: Research today and tomorrow. Moreover, the latest subjects that were discussed and that enjoyed a numerous participation and a special attention, are the following: Unrestricted Educational Grant from Biomedica: High-end molecular technologies in human diagnostic; Impact of atrial fibrillation in hematological, endocrine, gastroenterological, and neurological disorders; Interdisciplinary researches for innovative therapeutical systems development; From fundamental neuroscience to clinical practice in child and adolescent psychiatry; Patient-physician communication: Online communities, ethical perspectives, and patient satisfaction; Romanian Geriatrics and Gerontology at 65 years of presence in Europe: Prevention, intervention or anti-aging; Interdisciplinarity from the Dental Medicine perspective; Contemporaneity and interdisciplinarity in pediatric pathology; Multidisciplinary approach of the coronary artery disease: From the atherosclerotic plaque to management.Many prizes were awarded to the best of the best, such as Young Investigator Award , Young Investigator Award , and Young Investigator Award , prizes that presupposed the financial support of their participation in international prestigious congresses. The opening ceremony was honored by some famous Romanian personalities such as Pavel Nastase \u2013 The Ministry of National Education, Serban-Constantin Valeca \u2013 The Ministry of Research and Innovation, Corina Pop \u2013Secretary of State, Ministry of Health, Diana Paun \u2013 Presidential Consultant, Sorin Cimpeanu \u2013 President of the Rectors\u2019 Council, Mircea Dumitru \u2013 Rector of University of Bucharest, Mihnea Costoiu \u2013 Rector of Polytechnic University in Bucharest.A special moment of the opening ceremony was the one of unveiling the bust of the founder of the Romanian Medical School, General Doctor Carol Davila, which was sculpted by the famous sculptor, Rodion Gheorghita and given to \u201cCarol Davila\u201d University of Medicine and Pharmacy, Bucharest. In his speech on that occasion, the sculptor mentioned that among the 79 sculptures of the incomparable Constantin Brancusi, that no longer exist, that was the 26th, which he managed \u201cto bring back to life\u201d from a photo, his dream being the realizing of \u201can infinity column\u201d of 50 meters, which he would place in front of the Palace of Parliament. The Congress also occasioned the awarding of the \u201cHonoris Causa\u201d title to some remarkable personalities in the field of universal medicine. ARNULF STENZLHe was born on August 2, 1955 in Klagenfurt, Austria. From 1973 to 1980, he studied at the Medical School, Karl-Franzens University in Graz, and in 1980, he obtained the title of Doctor medicinae universalis (M.D.). From 1990 to 1992, he was Assistant professor in the Department of Urology, Inselspital, University of Bern, Switzerland, and from 1992 to 2002, he was Professor in the Department of Urology, University of Innsbruck, Austria. In 2002, he became Head of the Department of Urology, in Eberhard-Karls University Tuebingen, in Tubingen, Germany. He is member of many associations and committees in the medical field, such as Austrian Urological Association, German Urological Association, Austrian Association of Experimental Surgery, European Society of Urologic Oncology, and Endocrinology (ESUOE), Educational Committee of the Austrian Urological Association, Scientific Committee \u201cPolish Journal of Urology\u201d, Vice chairman of the MITT , since 2006 and Chairman of the Reinhard-Nagel Foundation Board, since 2013.In his entire career in Medicine, he was offered many awards, such as AUA Annual Audio-Visual Award, in 1994 ; Honorary Member of the Bristol Urological Institute, Bristol, UK, in November 1997; Best study-center of the year 2005/ 2006, German Association of Urologic Oncology, in 2006; Werner-St\u00e4hler-memorial prize of the South-west German Association of Urology, in 2007, 2009, 2010 and 2011, etc. Moreover, he is the owner of some patents for important discoveries in the field of Urology, such as C-Trap, an implantable device that treats urinary incontinence. PETAR M. SEFEROVI\u0106He was born on January 20, 1951 in Belgrade. At present, he is the President-elect of the Heart Failure Association of the ESC, Corresponding member of the Serbian Academy of Sciences and Arts, Chair of internal medicine in Belgrade University School of Medicine and President of the Heart Failure Society of Serbia.Regarding his education, he became Professor in 1996 in Belgrade University School of Medicine, in 1994 he became Head of Cardiology II, Department of Cardiology, University Institute for Cardiovascular Diseases, Belgrade, Serbian and Montenegro, and in 1994 he became Expert for Myocardial and Pericardial Diseases, Fed. Ministry of Science. Moreover, in 1982 he became Specialist in Internal Medicine. He is member of the European Society of Cardiology Activities such as HFA Board, Executive Committee of HFA Board, and was a Scientific Chairperson of the Heart Failure Association Annual Meeting in 2012. Even more, he is fellow of the European Society of Cardiology, member of the American College of Cardiology, honorary member of the Cardiac Promotion Society in Marburg, Germany, member of the Scientific Executive Committee of the International Academy of Cardiology and fellow of the Serbian Medical Association and Yugoslav Society of Cardiology.As far as his research is concerned, he made studies regarding the heart muscle disease and pericardial disease, as well as invasive and interventional cardiology. JENS RASSWEILERProf. Rassweiler studied Medicine at the Universities of Stuttgart, Freiburg, and Tuebingen, in Germany. In 1982, he started his urological education at the Katharinenhospital Stuttgart and was directly involved in the clinical introduction of ESWL, URS, and PCNL. From 1988 to 1994, he served as Vice-chairman at the Medical School in Mannheim. He was the first German surgeon to perform a laparoscopic nephrectomy in 1992. In 1994, he became the Head of the Department of Urology at Klinikum Heilbronn, Academic Hospital of University of Heidelberg.Prof. Rassweiler is an active member of various urological societies and member in the editorial board of a variety of international journals in the field of Medicine. In 1999, he received the Best Publication Award from the EAU. He also served in the board of the European School of Urology from 1999 to 2010. Since 2008, he has served as Chairman of the EAU Section of Uro-technology (ESUT). In 2009, he was President of the World Congress of Endourology & SWL, which he organized in Munich together with Prof. Christian Chaussy. He was President of the Engineering Society of Urologic Surgeons (EUS) and became President of the German Shock Wave Society in 2010. In the same year, he received the title \u201cDoctor Honoris Causa\u201d from \u201cVictor Babes\u201d University in Timisoara, Romania and, in 2013, he received the title \u201cDoctor Honoris Causa\u201d from \u201cIuliu Hatieganu\u201d University of Medicine in Cluj-Napoca, Romania.In 2016, he was elected Chairman of the EAU-section Office and recipient of the Gustav-Simon-Medal by the South-west German Society of Urology (SWDGU). In 2017, he was elected member of the American Association of Genitourinary Surgeons (AAGUS).He is honorary member of the Endourological Societies of Hungary, Chile, Poland, Italy, and Turkey and honorary member of the Polish and Bulgarian Association of Urology. Professor Rassweiler has published more than 400 articles and more than 150 book chapters.JOHN PAUL BILEZIKIANHe is currently Professor of Medicine and Professor of Pharmacology at the College of Physicians & Surgeons, Columbia University; Vice chair of the Department of Medicine for International Education and Research and Chief, Emeritus, of the Division of Endocrinology and Director of the Metabolic Bone Diseases Program at Columbia University Medical Center. In 1965, he graduated Magna Cum Laude from Harvard College, Cambridge, Massachusetts (B.A. in Biochemistry). In 1969, he became M.D., after graduating the College of Physicians and Surgeons, from Columbia University, in New York. He is member of the International Board of Medical Advisors, Yerevan State Medical University, Yerevan, Armenia; Director of the Annual Symposia on Osteoporosis, Yerevan State Medical University and American University of Armenia, Yerevan, Armenia. Moreover, from 2008 until present, he has been International Advisor of the Chinese Journal of Osteoporosis and Bone Mineral Research, and from 2011, he has been activating in the International Advisory Board of the Glucocorticoid Induced Osteoporosis Skeletal Endocrinology Group. From 2013 to 2015, he was member of the Scientific Statement Task Force of the Endocrine Society. Moreover, from 1983 to 1987 he was the Editor of \u201cEndocrinology\u201d. Starting from 2005 he has been Section Editor of the Journal of Women\u2019s Health, member of the Editorial Board of \u201cJournal of Clinical Densitometry\u201d (from 2011), and, from 2016 he has been member of the editorial board of \u201cOsteoporosis and Sarcopenia\u201d. He was offered many awards and distinctions, among which the following should be mentioned: L.J. Henderson Prize in Biochemistry, by Harvard College, in 1965; Lifetime Achievement Award by the Armenian American Medical Society of California, in 2006; Laureate Distinguished Educator Award by The Endocrine Society, in 2014; Oscar Gluck Humanitarian Award, by the International Society for Clinical Densitometry, in 2014; Honorary Member, by the Russian Osteoporosis Association, in 2017, etc. He has an impressive number of citations in ISI Web of Science and an h-index of 83. ANDREAS LEITHNERHe was born on April 23, 1974 in Vienna, Austria. From 1984 to 1998, he studied at the Medical Faculty of Vienna University. In 2005, he graduated venia docendi for \u201corthopaedics and orthopedic surgery\u201d at the Medical University in Graz, thus obtaining the Austrian Specialist Diploma in Orthopaedic Surgery. From 2012 to 2016, he was Head of the Department of Orthopaedic Surgery, Medical University in Graz, and starting from 2017, he has been Head of the Department of Orthopaedics and Trauma Surgery, Medical University, in Graz. He is currently member of the Vienna Society of Physicians (since 2000); member of the German Society of Orthopaedic Surgery (DGOOC), (since 2009); member of the European Orthopaedic Research Society (EORS) (since 2012) and member of the Austrian Society of Orthopaedics and Traumatology (OGOuT), (since 2016). Moreover, he is General Secretary of the Austrian Society of Orthopaedic Surgery (OGO), since 2015, and Board Member of the same society. Since 2012, he has been the Editorial Board Member of \u201cSarcoma\u201d; since 2015, he has been member of the \u201cWorld Journal of Clinical Oncology\u201d and, since the same year, he has been member of the \u201cScientific Reports\u201d. Even more, he was the reviewer of the following journals: Acta Orthopaedica (2012-2016), American Journal of Clinical Oncology (2006-2012), NioMed Research International (2016), BMC Cancer (2012), etc. BENGT WINBLADStarting from 2000, he has been the Head of the Division for Neurogeriatrics, Department of Neurobiology, Care Sciences, and Society. Moreover, he has been the Director of the Clinical Trial Unit, Memory Clinic, Karolinska University Hospital, in Huddinge, starting from 2013, and Director of the Swedish Brain Power (Center for Early Diagnosis and Therapy Research for Neurodegenerative diseases \u2013 a Swedish Network), starting from 2005. From 2014 to 2015, he was Director of the Center for Alzheimer Research at Karolinska Institutet. Moreover, from 1987 to 2013 he was Chief Physician, at the Geriatric Clinic, Karolinska University Hospital, Huddinge, in Sweden. Regarding his professional activity, he is Chair of the EADC (European Alzheimer Disease Consortium), was Member of the Nobel Assembly for the Prize of Medicine and Physiology, in KI, in Stockholm (1988-2010) and also Chairman of the Department of Clinical Neuroscience and Family Medicine, in KI, Stockholm (1993-1999). Among all the awards he received, the following should be mentioned: 1997 \u2013 The Royal Swedish Academy of Medical Sciences Award for Dementia Research; 2002 \u2013 The Nordic Prize in Gerontology; 2008 \u2013 Award given by the Alzheimer\u2019s Association, US, \u201cBengt Winblad Lifetime Achievement Awards in AD\u201d to be given out every year at ICAD conferences; 2010 \u2013 Wajlit and Eric Forsgrens Award; 2013 \u2013 Research and Education Award 2013 by Queen Silvia Foundation; 2015 \u2013 The Swedish \u201dHj\u00e4rnfonden Jubilee Award\u201d; 2016 \u2013 Alzheimer Association \u201dHenry Wisniewsky Life Time Achievement\u201d award.As far as his publishing activity is concerned, he published a total number of 1270 papers, he has a number of 53.591 citations, and his h-index is 114. In the closing ceremony of the Congress, the Rector of \u201cCarol Davila\u201d University of Medicine and Pharmacy in Bucharest, Academician Ioanel Sinescu, especially thanked all the participants from the University, the whole country and abroad, and, at the same time, reminded them that \u201cCarol Davila\u201d University of Medicine and Pharmacy in Bucharest is the first university of medicine in Romania, which enjoys a well deserved prestige and recognition in the national and international academic environment, being a true leader of the Romanian medical education. Executive EditorProfessor Eng. Victor Lorin Purcarea, PhD."}
{"text": "Despite sound scientific knowledge and evidence that any exposure to asbestos fibers in all of its forms, are carcinogenic to humans, its presence, use and trade is still substantial, including in the World Health Organization (WHO) European Region. Banning the production and use of all forms of asbestos, as recommended by the International Labour Organization (ILO) and WHO, has been proven as the most efficient evidence-based strategy to eliminate Asbestos Related Diseases (ARDs). To effectively move elimination of ARDs forward, attaining a greater understanding of key stakeholders perspectives was identified as an important action. The WHO Regional Office for Europe, the European Centre for Environment and Health, undertook semi-structured interviews, and follow-up discussions with diverse representatives dealing professionally with asbestos. The interview questionnaire was developed based on the current ARDs WHO Report, the Evidence Implementation Model for Public Health and categories of the theory of diffusion. Data were attained on three main questions within the interview questionnaire: (1) Identifying barriers to implementation of WHO evidence-based asbestos recommendations; (2) Describing roles of key stakeholders; and, (3) Proposing possible solutions. The results demonstrated use of sound and convincing scientific evidence along with economic evidence and facilitators can be used to achieve evidence-based policy development, and comprehensive diverse actions. Despite sound scientific knowledge and evidence that any exposure to asbestos fibers in all of its forms, are carcinogenic to humans, its presence, use, and trade is still substantial, globally and regionally, including in the World Health Organization (WHO) European Region ,2,3. GloEvidence-based strategies for the elimination of asbestos related diseases (ARDs) exist. Banning the production and use of all forms of asbestos as recommended by the International Labour Organization (ILO) and WHO, has been proven as the most efficient evidence-based strategy to eliminate ARDs . Still, In addition to detecting diseases, establishing appropriate surveillance systems, and protection, while undertaking asbestos removal, appropriate replacement, and safe and efficient waste management should be consistently occurring throughout the WHO European Region, to address inequities created by harmful exposure to asbestos ,8.(1)There are no observable mid-or-long-term negative economic impacts from bans or a decline in asbestos production or consumption at the country-level, and no observable persistent negative effects at the regional level;(2)There are substantial and increasing costs associated with the continuing production and use of asbestos, with the potential to far outweigh the short-term economic benefits.Currently, some of the countries that did not introduce the ban of the use of asbestos are challenging this recommendation, often using economic arguments. They argue that the introduction of the ban of the use of all forms of asbestos will have negative economic impacts on national, private sector, and household income at national and regional levels . Yet, avTo effectively move elimination of ARDs forward, attaining greater understanding of key stakeholders perspectives and needs was identified as an important action. Therefore, the WHO Regional Office for Europe, the European Centre for Environment and Health , undertook in 2016 a stakeholder analysis.The aim of this analysis was to attain deeper insights of key stakeholders opinions and perspectives across different sectors and policy fields regarding the promotion of evidence-based national policies for the elimination of ARDs and the potential influence and ability of the stakeholders concerned to make the change towards non-asbestos working and living environments. This stakeholder analysis contributed, in particular, to one of the commitments of the Parma Declaration to develop national programmes to eliminate ARDs by 2015 and reconfirmed in the Ostrava Declaration 2017 ,10.(1)dentifying barriers to the implementation of WHO evidence-based asbestos recommendations;(2)describing necessary and effective roles and actions of key sectors and stakeholders;(3)proposing possible solutions, facilitators and next steps towards non-asbestos working and living environments, including policies for the elimination of ARDs.The research method was qualitative and explorative, combining interviews and discussions with stakeholders. The questionnaire for the semi-structured interviews was developed based on information from a current ARDs WHO report  and the Interviewees were identified by WHO/ECEH and contained a selected sample of country representatives, experts, intergovernmental organisations, nongovernmental organisations, and European Commission (EC) representatives, dealing with asbestos issues in their respective professional area. All of the interviewees gave their informed consent for inclusion before they participated in the interviews and the study was conducted in accordance with the Declaration of Helsinki and WHO protocol. Interviews were conducted using telephone or Skype by the first author. Language of the interviews was English or Russian (with the assistance of a Russian interpreter). The first interview conducted also served as a pre-test and adjustments for clarity were made accordingly. Confidentiality of interviews was communicated to the interviewee and agreed upon. Interviews were transcribed verbatim into a corresponding questionnaire template. Clarifications to the participant\u2019s comments were obtained by e-mail where required.Content analysis of the interviews was undertaken to provide concise summaries of participants\u2019 responses. Findings were grouped corresponding to the three interview themes noted above ,13.A preliminary report of this analysis was circulated and presented to participants of the WHO meeting: \u201cAssessing the economic costs of the health impacts of environment and occupational factors: the economic dimension of asbestos\u201d, 18\u201319 May 2016, Bonn, Germany. The preliminary results were validated by a plenary session, question, and answer discussion period, working group discussions and a final plenary reporting session. The results of the working group and plenary discussions were integrated into a preliminary and final text to prepare this article.A total of 21 stakeholders from 18 organisations participated in the stakeholder analysis interview process. A further 24 country representatives from 12 WHO European Countries and 20 temporary advisors from 16 institutions participated in the above cited WHO asbestos meeting. Data from stakeholders are presented on the three main questions within the interview questionnaire.Lack of political will, commitment, clear vision, goals, and targets to effectively address the negative impact of asbestos is often not identified, agreed upon or achieved by policy makers.Introducing a total ban of the use of all forms of asbestos is a complex undertaking that requires the collaboration of many sectors and disciplines to achieve effective action. Often collaborators may take some of the tasks or actions within their remit, but responsibility to lead and manage the whole chain of events is lacking.Often financial and political interests are placed above health concerns, including the assumed important positive economic impact of the production, and marketing of asbestos on national, private sector, and household income. Currently the economic health costs of ARDs are predominately the burden of society  and not industry. Costs for safe asbestos identification, removal, replacement, and waste management are high. Illegal removal of asbestos is underway (at reduced costs) that does not meet safety requirements, leaving the general public exposed to even greater health risks.There is a lack of awareness, understanding and knowledge regarding the issue of the negative health impacts of asbestos. This includes how to effectively address the harmful effects of under-reporting the negative impacts of asbestos and knowledge gaps of the real economic dimension of the use and production of asbestos in parts of Europe. This lack of information, knowledge, and expertise to undertake and finance asbestos removal, safe waste disposal, and replacement with safe alternatives affects many countries at this time.Data and registries on exposures, risk groups, mortality, morbidity, trends, short and long-term costs, essential to demonstrate the true impact of asbestos, are not readily available in many countries. Data are also not standardised in Europe to allow for cross-country comparisons. There is a need for evaluation methodologies, such as cost benefit analysis to support policy-solutions. Understanding when and how much asbestos needs to be removed, the associated costs of removal and replacement, and then how that compares to the negative health impact costs are needed.Banning the use of all forms of asbestos as recommended by the ILO and WHO can be a challenging strategy to adopt, implement and enforce due to its inherent complexity. Few Member States with no asbestos banning legislation are not in agreement with this recommendation, claiming that in their countries there is no evidence of negative impacts on health from all forms of asbestos. Several Member States stated that more and better knowledge and awareness are required to meet European Union (EU) regulations/directives for occupational health and safety of asbestos removal and building renovations.Currently, there is a lack of political will amongst policy-makers from several asbestos producing and using countries in banning asbestos as the most efficient way to eliminate asbestos-related diseases, as the benefits are only realised decades later and not during their immediate political term. Varying economic and social settings in countries create additional barriers to reducing the negative impact of asbestos. These include communities with: mines, natural forms of asbestos, extensive existence of asbestos in road infrastructure, and the majority of public and private buildings containing asbestos. Furthermore, research related to health is sometimes financed by the asbestos industry itself, and in some cases are used as questionable \u201cevidence\u201d for policy solutions. As well, an influx of migrant workers with limited language skills in their newly employed location may also lead to limited awareness or knowledge of asbestos risks and a challenge to monitor. This includes lack of training and training material not available in migrant workers native language and often no migrant worker occupational health protection.Key messages to the public and decision-makers are lacking regarding: risks, impacts, revealing false claims, illegal trade, international conventions, and declarations not being upheld, prevention measures, safe removal, total real costs, and valid information sources.Interviewees and workshop participants expressed their strong opinion that a whole-of-government and whole-of-society approach would be required to successfully address all of the negative impacts of asbestos. This means that all levels of government and all related sectors, using cross-ministerial committees. Governments need to consider the long-term health effects to balance the immediate financial or political demands and interests asbestos appears to provide.Even in the countries that introduced the total ban of use of all forms of asbestos, removal of the existing asbestos is still potentially a significant risk to health if the appropriate measures are not applied. Having that in mind, the responsibility of the industry, both in asbestos producing and asbestos using countries, as well as in the countries with introduced bans, can not disregard including compensation funds for ARD victims. Industry also needs to share knowledge on safe removal practices and safe alternatives to asbestos to help build a win/win situation.Stakeholders with knowledge and information should ensure evidence and good practices are shared, widely communicated, and advocated to increase their adoption, implementation, and monitoring. Research also needs to be accessible and widely communicated, including the use of plain language summaries, tailored to each target audience to help move research into practice and thereby support effective knowledge translation.Communicators also have a strong role to bring greater attention to the issue and apply pressure to attain action to protect and safeguard workers and the society as a whole. They need to be engaged and empowered as key stakeholders in the process. Therefore, all of society has an important role to play to address the negative impacts of asbestos.Government plans, programmes, and policies to support early identification, removal, transition, and waste management of asbestos to new, safer, and efficient alternatives, with the involvement of all key stakeholders should be investigated. This should include investigation of funding schemes, such as a percentage of programme funds for victims\u2019 compensation from asbestos producing industries, as already demonstrated in some Member States.Establishment of an agency/task force/observatory/knowledge centre at the European level to provide support to countries for the adoption and implementation of evidence-based strategies to enhance awareness raising; capacity building; standardisation; and, consistency and stability of various approaches for diagnosis, surveillance, trends, policy approaches, funding, and budgeting models was proposed by stakeholders. This would include implementing more effective legislation to protect employees and the health of the general public, as well as, the identification of funding sources and should be discussed in collaboration with WHO, EC, European Agency for Safety and Health at Work (EU-OSHA), ILO, Organization for Economic Co-operation and Development (OECD) see , and othKey stakeholders and especially intergovernmental organisations and nongovernmental organisations should jointly advocate for a total ban on the use of all forms of asbestos throughout the WHO European Region. Economic arguments learnt from the Bonn workshop should provide additional evidence and proposals to support this action.The total impact costs of asbestos at the local, regional, and national levels, including long-term health consequences, asbestos identification, removal, replacement, and waste management are needed, and the cost responsibilities of all the parties should be calculated. This could include, short-mid-long term budgeting strategies, impact assessments, cost benefit analysis, such as cost of asbestos substitutes, and case examples of building costs with asbestos when compared to safer alternatives, as well as landfill management costs.Collaboration with industry and other key stakeholders for effective and efficient strategies on identification, safe removal, transition to safe alternatives and waste management of asbestos need further investigation.Further research on the effective use of new technologies and availability of low cost, safe, and easy to use alternatives should be conducted and communicate results widely.More case studies and good examples of how countries are addressing the issue of asbestos, specifically including removal guidelines/legal criteria and cost examples of safe removal, waste management, and replacement schemes, as compared to the negative health impact costs could be shared.Standardised and harmonised data registration systems for ARDs in all of the countries to ensure effective monitoring should be put in place. Countries with long-established, effective data collection systems, could share methodologies for establishing and sustaining such data collection systems. The sharing of misinformation that are contrary to evidence and positions widely accepted and published by the majority of the scientific and expert community need to be immediately addressed. False statements are to be rejected and widely communicated.Visibility, awareness, and education of all target audiences, from the general public, workers, professionals, and governments on such topics as early detection and risk group identification for youth and migrant workers exposed to asbestos, require improvement. Targeted tools and resources should be determined on evidence-based strategies and include better use of science.Further to these proposed solutions and next steps, participants also provided specific suggestions WHO should undertake to facilitate actions to address the negative health impacts of asbestos. These are described in Even though addressing the elimination of ARDs is a challenging issue within a complex system, use of sound and convincing scientific evidence along with different types of economic evidence and or facilitators can be used to achieve evidence-based policy development, and comprehensive diverse actions . ExposurEnhanced, early engagement and cooperation of diverse sectors and stakeholders throughout the entire process of adoption, implementation, and monitoring of evidence-based policies and programmes to eliminate ARDs, based on a whole-of-government and whole-of-society approach, will support the knowledge translation process, as seen in other evidence implementation research . OverallGreater efforts to transfer evidence-based strategies and knowledge into practice are essential to reduce ARDs. Particularly, attention in synthesising, translating, and disseminating evidence into concise, clear, easy to understand, and convincing information is needed, such as, economic arguments designed for each specific target audience, context, and cultural setting . This shWell-established national cancer registers and national registers of occupational diseases are the key resources for registering asbestos-related morbidity. Awareness, diagnostic procedures, and criteria, notification and registration of ARDs vary between countries and are in need of strengthening and harmonisation. There is still a need to strengthen research on the prevention, diagnosis, and treatment of ARDs. The main areas for action include capacity building of health care providers for the appropriate diagnostics of ARDs, active surveillance of ARDs; better diagnoses of ARDs; and, epidemiological investigation of individual cases of ARDs. In addition to establishing appropriate links between exposures and ARDs; medical research into the treatment of mesothelioma to improve the quality of life and the survival rate, effective early intervention followed by early detection of ARDs is essential.Identifying barriers that impact the uptake of policies and programmes for the elimination of ARDs, and standardise and harmonise ways these can be addressed is critical ,20. SuchIt should be noted that some contexts in interview statements made may not be precise, as not all of the participants and interviewees were fluent in both English and Russian and should be viewed as a limitation of the study. Assistance of English/Russian interpreters were used to support the data and information gathering for both the interviews and the workshop to allow participants to fully engage and enhance the accuracy of communication.The substantial and increasing costs associated with the continued production and use of asbestos far outweigh the short-term and often only local economic benefits, and use of sound and convincing scientific and economic evidence in combination can be used to make convincing arguments to support the uptake of evidence-based policy actions. Key stakeholders, including WHO needs to be empowered to take on a leadership role to advance the uptake of evidence-informed policies and programmes to further the 2030 Agenda for achieving the United Nations Sustainable Development Goals that includes goal number 12, \u201cResponsible Consumption and Production\u201d . This sh"}
{"text": "Genomes, Proteomes and Bioinformatics \u2013 a special database article entitled \u201cGSA: Genome Sequence Archive\u201d In the 2017 first issue of this Journal \u2013 The past half century has witnessed great advances in molecular biology. The deciphering of the genetic code and the establishment of the central dogma following the discovery of the DNA double helix formed a solid theoretical basis for the field of life sciences. On the other hand, the influential works by Frederick Sanger and others to determine the peptide, tRNA, and DNA sequences, as well as the fundamental endeavor by John Kendrew and Max Perutz to solve the three-dimensional structure of proteins, marked the beginning of the accumulation of molecular biological data.https://en.wikipedia.org/wiki/Margaret_Oakley_Dayhoff). Two years later, Amos Bairoch, a graduate student at the University of Geneva, Switzerland started to annotate protein sequences by manually adding functional and other information into each entry, and created another protein sequence database Swiss-Prot (https://en.wikipedia.org/wiki/Amos_Bairoch).The first efforts to collect protein sequence data were made by Margaret Dayhoff, a bioinformatics pioneer at the US National Biomedical Research Foundation (NBRF). In 1965, she published a book \u201cAtlas of protein sequence and structure\u201d with 65 sequences she can find then, and updated it in several new editions in the following years. This is the prototype of the first protein sequence database Protein Information Resource (PIR). Based on the sequences of several protein families, she constructed the amino acid substitution scoring matrix PAM, which is still widely used in sequence alignment and database similarity search. PIR went online in 1984 and can be searched through telephone line (The first protein structure database Protein Data Bank (PDB) was established in 1971. Different from the protein sequence databases, in terms of the organization history, it was a joint effort by partners from the Europe and the US. As stated in its first announcement as Crystallography News on Nature New Biology i.e., EMBL-Bank, or sometimes simply refer to EMBL.By the end of the 1970s, Sanger sequencing became a routine work and DNA sequences started to accumulate. It was foresighted by prominent scientists that it was time to set up a nucleotide sequence database since large-scale DNA sequencing was on its way. In 1979, a group of computational biologists headed by Walter Goad at the Los Alamos National Laboratory in the US began to collect nucleotide sequences and developed algorithms to analyze DNA and protein sequences. The popular Smith-Waterman algorithm for local sequence alignment was just one of these tools. The nucleotide sequence database GenBank started to operate in 1982 sponsored by the National Institutes of Health (NIH), together with several other US funding agencies including the National Science Foundation (NSF), the Department of Energy (DOE), and the Department of Defense (DOD). In the same year, the European Molecular Biology Laboratory (EMBL) located in Heidelberg, Germany announced the first release of the European Nucleotide Data Library under the same name of the organization, By the end of 1980s, the sequence databases of nucleic acids and proteins, as well as the protein structure databases, already contained considerable number of entries, while software tools for analyzing the sequence and structure data became available on mini- and micro-computers. At the same time, the NSFnet, a pilot project of research and education network supported by the NSF started to serve several computing centers in the US. Proposed by the late senator Claude Pepper, the National Center for Biotechnology Information (NCBI) located at the north capital was set up in November, 1988, as a division of the National Library of Medicine. As a biomedical information resource center, NCBI has been serving not only NIH partners, but also the worldwide community of molecular biologists. Under the leadership of David Lipman, the director of the center, NCBI became the largest bioinformatics center in the world. Hundreds of databases and software tools, such as the biomedical abstract database PubMed, the reference sequence database RefSeq, and the database similarity search tool BLAST, are available freely for everyone. In 1989, NCBI started to maintain and distribute GenBank as one of the core data resources.The European Bioinformatics Institute (EBI) was created in 1994. It is located in the Wellcome Trust genome campus in south Cambridge, UK. As an outstation of the EMBL, EBI is funded mainly by the European Community and most of the EBI staff are from the European member states. It has been playing a significant role in bioinformatics services for more than 20\u00a0years not only for Europe but also for the rest of the world, as the second largest resource center next to NCBI. In addition to the nucleotide database EMBL-Bank, EBI also hosts various databases including the genome repository ENSEMBL, the database of protein families and domains InterPro, and the ontology of gene functions and processes Gene Ontology.http://www.wwpdb.org/). Soon after, the International Nucleotide Sequence Database Collaboration , another triple alliance originating from GenBank of NCBI, EMBL-Bank of EBI, and the Japanese newcomer DDBJ, was launched in 2005. In the same year, the international universal protein sequence database UniProt was founded (http://www.uniprot.org/). UniProt consists of three components, Swiss-Prot from the Switzerland, PIR from the US, and TrEMBL, a database of automatically translated amino acid sequences from the coding regions of EMBL nucleotide sequences.The creation of the NCBI, a US government-supported center, and the EBI sponsored by the European Community secures the long-term sustainability of bioinformatics services at national and international levels. In the meantime, the formation of the international collaboration of three core databases of molecular biology, the nucleotide sequence, the protein sequence, and the protein structure, came into age. In 2003, three partners responsible for the maintenance and distribution of macromolecular structures, PDBe at EBI, PDBj from Japan, and the Research Collaboratory for Structural Bioinformatics (RCSB) PDB in the US, signed an agreement to form a world-wide consortium  https://gold.jgi.doe.gov/), a total of 265,734 organisms have already been, or are being sequenced The birth of the Internet at the beginning of the 1990s opens a new era, the era of information age. Proposed by Nobel Prize laureate Walter Gilbert in his prospective article published on Nature in January 1991 To meet the need of big data demands, it is of essence to build a national infrastructure for bioinformatics resources and services in China. Unfortunately, it remains as a dream for bio-scientists despite endless advocacy and efforts from two generations of prominent scientists of the field in the last three decades http://www.embnet.org/), and other international bioinformatics centers came to exchange experiences on bioinformatics research and services. Most recently, the first meeting of the international scientific advisory board of BIGD was held. The efforts were well appreciated by the field\u2019s experts, such as board members from NCBI, EBI, DDBJ, and other international bioinformatics institutions.Fortunately, the GSA project is the first step toward this direction. Sequence data generated by around 200 projects from 39 institutions have already been submitted to this system since it went online in December 2015, and it is recognized internationally as indicated by the publication of these projects on several international journals. Moreover, the GSA project is just one of the main activities of the BIGD I don\u2019t think we can get a Nobel prize by what we are doing so, but the Nobel prize winners know what we are doing for\u201d.Although the BIGD is still in its infancy, I hope that, it can grow up quickly and healthily, with steady support from governmental funding agencies and from the community, and ultimately become a national bioinformatics center. Finally, I would also like to say a few words borrowed from the UK bioinformatician Alan Bleasby, to the members of the BIGD, \u201cThe author declares no competing interests."}
{"text": "In clinical practice, patients can present with many different diseases, often both somatic and mental. Holistic medicine will try to see the diseases as a whole, as symptoms of a more fundamental imbalance in the state of being. The holistic physician must help the patient to recover existence and a good relationship with self. According to the life mission theory, theory of character, and holistic process theory of healing, recovering the purpose of life (the life mission) is essential for the patient to regain life, love, and trust in order to find happiness and realize the true purpose of life. We illustrate the power of the holistic medical approach with a case study of an invalidated female artist, aged 42 years, who suffered from multiple severe health problems, many of which had been chronic for years. She had a combination of neurological disturbances , immunological disturbances , hormonal disturbances (14 days of menstruation in each cycle), muscle disturbances (neck tensions), mental disturbances , abdominal complaints, hemorrhoids, and more. The treatment was a combined strategy of improving the general quality of life, recovering her human character and purpose of life , and processing the local blockages, thus healing most of her many different diseases in a treatment using 30 h of intense holistic therapy over a period of 18 months."}
{"text": "Arboviruses have been emerging in different parts of the world due to genetic changes in the virus, alteration of the host and vector population dynamics, or because of anthropogenic environmental factors. These viruses\u2019 capacity for adaptation is notable, as well as the likelihood of their emergence and establishment in new geographic areas. In Brazilian epidemiologic scenario, the most common arboviruses are DENV, CHIKV, and ZIKV, although others may spread in the country. Little is yet known of the impact of viral co-circulation, which would theoretically result in more intense viremia or other immunological alterations that could trigger autoimmune diseases, such as Guillain-Barr\u00e9 syndrome. The impact on morbidity and mortality intensifies as extensive epidemics lead to a high number of affected individuals, severe cases, and implications for health services, mainly due to the absence of treatment, vaccines, and effective prevention and control measures. Culex and Aedes genera, although a number of arboviruses can be transmitted by other arthropods, such as sand flies and ticksArboviruses (ARthropod-Borne VIRUS) have caused much concern in public health worldwide. This set is composed of hundreds of viruses that share the characteristic of transmission by arthropods \u2013 mostly hematophagous mosquitoes \u2013, although they are not necessarily phylogenetically relatedAlphavirus (Togaviridae family) and Flavivirus (Flaviviridae family) genera; other members important to human health are from the Bunyaviridae, Reoviridae, and Rhabdoviridae familiesMost arboviruses belong to the Haemagogus genus, for which the vertebrate hosts are mammal. In humans, it causes fever, headache, exanthema, and arthralgia; however, cases of sustained transmission were not observed. There is evidence of the adaptive capacity of MAYV to alternative cycles involving birds and humansThis group of RNA viruses represents major genetic plasticity and high mutation frequency, which allows them to adapt to vertebrate and invertebrate hostsCulex genus, and its main host is birdsThe West Nile Virus (WNV) can cause epidemics even in urban areas, as occurs in the United States. It is transmitted by mosquitoes of the Haemagogus leucocelaenus as the main vector and Aedes serratus for transmissionThe emergent lineage of yellow fever virus in the South region in 2008The dramatic dissemination of dengue in the Americas in the last decades has been well documented, with over two million notified cases in 2015 (until December 8th), adding up to 1.5 million in Brazil, with 811 deaths and an incidence rate of 763 per 100 thousand inhabitantsA. albopictus vector through the alteration of a protein in the viral envelope E1 (E1-A226V), which was followed by other adaptive steps. This increased the ability of CHIKV to infect and spread in that vector, an abundant species in the Indian Ocean islands and in other regions of Asia,Another forthcoming arbovirus is CHIKV, which began pandemic expansion in 2004. A mutation in an African lineage of CHIKV allowed it to adapt well to the ,A. aegypti. Genetic changes among viral lineages allowed the virus to better adapt to the vector and to human transmissionThe ZIKV, identified for the first time in Uganda in 1947, had its first documented outbreak only in 2007 in Micronesia. Since then, the transmission area has spread to islands in the Pacific Ocean, especially during a great epidemic in Polynesia in October 2013,,,The co-circulation of infection by DENV, CHIKV, and ZIKV in Brazil makes clinical management difficult due to similarities; it has implications in the transmission in older people, pregnant women, and young children, and presents a still limited laboratorial rear-guard. Little is yet known of the impact of the co-circulation of this virus. As in the case of reinfection by different serotypes of DENV, the interaction of arboviruses  could theoretically result in more intense viremia or other immunological alterations which, in turn, would trigger autoimmune diseases such as Guillain-Barr\u00e9 syndromeFlaviviridae family pose a real threat of epidemic circulation in Brazil, including WNV, the most common arbovirus in the world. Since its introduction in 1999, this virus has rapidly expanded throughout the Americas. In the first decade of the 21st century, a phenotypical variation increased the efficiency of transmission in Culex ssp. mosquitoes,Alphavirus genus, and the Oropouche virus (OROV), of the Orthobunyavirus genus from the Bunyaviridae family, have been frequently identified in the Amazonian region in patients with nonspecific feverish conditions or with neurological damage,,Flavivirus genus), suggesting possible emergence.Other arboviruses of the The clinical manifestations of infection by arbovirus can vary from light feverish undifferentiated disease to neurological, articular, and hemorrhagic feverish syndromes. Frequently, severe cases are only identified after viral circulation in extensive epidemics, many times reflecting the unpredictable impact on morbidity and mortality, while the occurrence, until now, has been restricted to isolated cases or small outbreaks.,,Deaths by CHIKV in epidemics were not known until the epidemic of Reunion Island in the Indian Ocean, where severe neurological cases were registered  and perinatal transmission with encephalitis and retardation of neuro-psychomotor development in childrenDengue, after its re-emergence in the context of major epidemics, hyperendimicity and co-circulation of various serotypes, has also been associated with the rise in severe cases throughout the world. Immunity obtained in previous infections leads to the amplification mediated by ADE (antibody dependent enhancement) antibodies, with high viremia and release of inflammatory markers in reinfections by different serotypes, particularly in the second infectionsUntil the emergence of WNV in Romania, with a fatality rate of 10%, the neurological forms were considered rareThe impact of arboviruses on morbidity and mortality intensifies as the extended epidemics assume a great number of affected individuals, with implications on the health services, mainly in light of the absence of treatment, vaccines, and other effective methods of prevention and control.Flaviviridae family), Oropouche (Bunyaviridae family), Venezuelan encephalitis virus, and Mayaro (Togaviridae family), all of which can be associated with severe cases, especially if extensive epidemics occur. All of them have proven to be capable of transmission via potentially urban arthropods of the Diptera order, such as Culicoides paraensis, Aedes ssp., and Culex ssp., which are widely occurring in the countryOn the other hand, environmental pressure has led to the selection of viral lineages that cause more intense viremia and, consequently, higher pathogeny of the disease, as in the case of CHIKV and WNV. These viruses are highly adaptable, and can easily emerge and establish themselves in new geographic areas, suggesting that new and old viruses could potentially reappear. A few arboviruses with higher potential of circulation in Brazil are Saint Louis and West Nile , possibility of causing extensive epidemics, universal susceptibility, and occurrence of high numbers of severe cases, with neurological, articular, and hemorrhagic damage. The introduction of any arbovirus in an indemnified environment or one with the presence of the vector should never be neglected.The fight against emerging arboviruses requires wide-ranging policies and interventions involving various sectors of society, not only the health sector.Aedes in the Americas was associated with climate change, deforestation, disorganized urbanization, growth of cities, absence of water and basic sanitation, and population displacement. These factors define the paths of the diseases, influenced by the pressure of the viral mutation and genetic adaptations of the viruses to hosts, vectors, and new environments. Despite difficulties regarding socioeconomic and environmental factors, the health sector has responsibilities, such as investments in the prevention, diagnosis, and treatment of infections; for example, in the particularly critical case of pregnant women affected by ZIKV.The definitive establishment of The development of vaccines has been a challenge for many study groups in Brazil and worldwide, considering its proven viability for various Flaviviruses.Investments in the qualification of the actions of epidemiologic, virologic, vectorial, and epizootic surveillance are urgent in the country, especially during times of risks important to public health. International collaboration is essential for the early identification of the entrance of new pathogens in indemnified regions; however, integrated policies and actions are particularly strategic in a country the size of Brazil.Perplexity regarding the spread of ZIKV and CHIKV and their impact in Brazil were sufficient to establish a state of public health emergency by the Ministry of Health and World Health Organization, almost two years after the entrance of the virus in the country. This condition implied an intense mobilization of resources and articulations among states and municipals to combat viral circulation, which took on huge proportions. Thus, the epidemiologic investigation and suspicion of other arboviruses must be part of the epidemiologic surveillance routines and concerns of national public health to predict new epidemiologic emergences. On the other hand, the efforts are essential to the development and improvement of agile, sensitive diagnostic exams with little cross-reactions with other arboviruses \u2013 specific immunobiologicals and synthesis of antiviral medication, mainly due to the infection of pregnant women by ZIKV. Joint actions in research and the fight against the vectors could affect the expansion of emerging viruses, such as infection by CHIKV and ZIKV, the greatest concerns in the country at the moment."}
{"text": "Large programmatic grants advance the missions of funding agencies or organizations. This article describes the programmatic impact of using \u201chierarchical\u201d logic models in two Centers funded by the National Institute of Occupational Safety and Health (NIOSH) that were designed to achieve NIOSH goals. Such models are supportive of priority setting, policy implementation, and effective evaluation.Two NIOSH Centers, an Agricultural Center and an Occupational Safety and Health Education and Research Center, used the same hierarchical logic model process to support the NIOSH programmatic goal of improving worker health and safety in their respective occupational categories. The logic model development processes were led by the same evaluator.Case studies describe the utilization of \u201chierarchical\u201d logic models: in each case, NIOSH was the \u201cgrandparent\u201d, the Center was its descendant (parent) and the cores were the children. This lineage was articulated through the Center-wide logic model and through the logic model of each of its core programmatic areas (core). The Center-wide logic model ensured that the Center\u2019s goals, and the intended outcomes and impact of its work were linked to the mission and goals of NIOSH. Each core\u2019s logic model articulated how its goals, activities, and outcomes were specifically linked to the Center-wide model.A hierarchical logic model process ensures that the objectives of the funding agency or organization are addressed, and enables stakeholders to articulate the linkages between each layer. This facilitates the process of developing, implementing and evaluating programmatic elements within the framework of strategic planning. Program planners, evaluators and other stakeholders use logic models to clearly articulate the links between proposed program goals, resources, activities, outcomes, and impacts of their initiatives. This systemic approach to program planning and evaluation provides a road map for the program and assists programs to define strategies that will lead to success. In building logic models, stakeholders must define a program theory to provide a rationale for how the activities will lead to outcomes \u20135. InvolLogic models can provide a productive framework for effective planning and a depiction of the process of change of an intervention. Most often presented as sequenced diagrams or flow charts, logic models demonstrate relationships among the following components: Statement of a problem, various causal and mitigating factors related to that problem, available resources to address the problem, intervention goals and planned activities, and anticipated short and long-term outcomes. This traditional logic model framework may be augmented to include consideration of key factors that may hinder and/or enhance the well-being of the target population, or attainment of the goal set, and may affect the program at the individual, family, programmatic/organizational or policy level.Institutes and organizations often fund large programmatic grants to support a specific mission or goal. In that case, it is particularly important that the programmatic grant demonstrate the ways in which it will serve to advance that mission. A \u201chierarchical\u201d logic model process is one way to depict these relationships . The purhttp://www.cdc.gov/niosh/oep/agctrhom.html). The NIOSH-supported Ag/ERC Centers also conduct research and implement prevention projects to address the Nation\u2019s occupational health and safety problems. These programs are all operated out of the Office of the Director and managed by the Director of the Office of Extramural Coordination and Special Projects. As special projects of the Education and Information Division, Training Research and Evaluation Branch, they are vulnerable to budget cuts. Therefore, it is even more important that they demonstrate that they advance the NIOSH mission of improving worker occupational health and safety.NIOSH funds programs to support occupational safety and health research and education. Their theoretical framework  is that in creating infrastructure to support programmatic activities with sets of \u201ccore\u201d resources, worker occupational health and safety will be improved and occupational injury and fatalities will be decreased. NISOH has invested resources in 10 Agricultural Safety and Health Research Centers (Ag Centers); 18 regional university-based Education and Research Centers (ERCs); and 34 Training Project Grants that train occupational health professionals and researchers to help meet the increasing demand for occupational physicians, occupational nurses, industrial hygienists and safety professionals , which is organized into 10 programs representing different industry sectors. Since 1996, NORA has become the national research framework for occupational safety and health. NIOSH collaborates with many organizations  to advance occupational health and safety research. The collaboration may be as research partners, users of NIOSH technology and scientific findings, peer reviewers, recipients of research grants and contracts, or sources of equipment, technology, or knowledge for advancing research.Over time NIOSH guidance for program evaluation and requirements improved. Yet, at the time of this study, the program announcements listed evaluation as one of required administrative components, but did not provide substantive direction as to how the evaluation should be conducted.In order to assist in the NIOSH mission of improving the health of farmers, fishers, and foresters, 10 Ag Centers were established in 1990 as part of the National Program for Occupational Safety and Health in Agriculture. Each Ag Center conducts surveillance, research, education, and prevention projects to address regional agricultural safety and health issues. Each Ag Center fills a unique geographic niche to engage community stakeholders in initiatives to reduce health disparities among disadvantaged groups. A 2012 review of the Ag Center initiatives found their impact to be notable, and highlighted the significant reduction in child death rates due to exposure to agricultural worksite risk and the adoption of safer technologies and/or devices in some agricultural worksites .Each Ag Center re-competes for NIOSH funding every 5 years. In the 2010 proposal application request (PAR), applicants were required to include three major components: Internal cores, research projects and an evaluation program. Internal cores included (1) Administrative and Planning, (2) Feasibility/Pilot Studies and Emerging Issues, and (3) Outreach. Research projects were categorized as Research, Education/Translation or Prevention/Intervention. Each applicant was required to have internal and external advisory committees.Established in 1977, the ERCs are part of a network of training grants that ensure an adequate supply of qualified professional occupational safety and health practitioners (OS&H) and researchers. The ERCs, located in each of the 10 Federal Department of Health and Human Services (DHHS) Regions, offer multidisciplinary educational training, continuing education and outreach programs to train OS&H professionals.http://www.cdc.gov/niosh/oep/ercreports.html).Currently, ERCs are housed in 18 academic institutions that address OS&H training and research in a cross-cutting, integrated manner. Each institution provides interdisciplinary graduate training in the core areas of Industrial Hygiene, Occupational Health Nursing, Occupational Medicine, Occupational Safety, and allied OS&H fields. The multidisciplinary approach results in cross-fertilization among the various disciplines. The number of professionals engaged in research and practices to promote occupational safety and health has substantially increased through ERCs initiatives  activities that are implemented in collaboration with other institutions, businesses, community groups, or agencies located within the region. ERCs are encouraged to address geographic needs and to implement innovative strategies to impact the practitioner environment.The Southwest Center for Agricultural Health, Injury Prevention, and Education (SW Center) was created in late 1995 at the University of Texas Health Northeast to serve Arkansas, Louisiana, New Mexico, Oklahoma and Texas through research and outreach aimed at reducing injuries and fatalities among agriculture, forestry and fishing (AFF) workers and their families. The mission of the SW Center, to improve the safety and health of agricultural, forestry and fishing workers, is accomplished through research, intervention and education projects. These projects build and leverage a network of strategic partners who represent the diversity of the workforce and the range of agricultural production in the region. The SW Center is guided by an External Advisory Committee (EAC) and an Internal Advisory Committee (IAC). The EAC is composed of a multidisciplinary group of experts in dairy, agriculture, forestry, logging, beef cattle, veterinary medicine, migrant farmworkers and commercial fishing. These advisors represent expertise from each of the states served by the SW Center. The IAC provides advice to the SW Center director to support effective management of the Center.The Mountain and Plains Education and Research Center (MAP ERC) was established in 2007 and includes the University of Colorado, Colorado State University, National Jewish Health, Denver Health and Hospital Authority and the University of New Mexico Health Sciences Center. Spanning from the borders of Canada to Mexico, the MAP ERC helps meet the occupational health education and research needs of Colorado, New Mexico, Arizona, Montana, Wyoming, North Dakota and South Dakota. The MAP ERC is guided by an External Advisory Panel (EAP) and an Internal Executive Committee (IEC). The EAP represents labor, industry, government, academic, and professional organizations. The IEC provides advice to the MAP ERC director to support effective management of its Center.The senior author was the evaluator. She worked with the SW Center and the MAP ERC to create logic models for their Centers, programmatic cores and research projects. In both cases, the mission of NIOSH and the purpose of the Centers in attaining NIOSH goals were considered in the development of the program components. Although there was no requirement to use logic models for program planning and evaluation, the evaluator coordinated the effort to incorporate logic models in the program development and evaluation process. This process helped articulate the connection between the Center\u2019s goals and NIOSH objectives, and ensured that the program components supported the Center goals. As a result, both Centers developed Center-wide logic models to address NIOSH goals, the NORA goals, and the specific activities in the NIOSH logic model . Within The logic model development process began during the preparation phase for the renewal application for the SW Center in the fall of 2010. The SW Center staff and research PIs worked with the evaluator to create the SW Center-wide logic model and the logic models for the individual components and research projects. Most of the work was done virtually, over the phone and through email. The format used in the SW Center logic models includes six columns: Assumptions, Resources, Outputs, Activities, Intermediate Outcomes, and Overall Impact (Sector and Center) .The group of hierarchical logic models for the SW Center was: Center-wide (parent), Outreach and Program Evaluation Pilot Studies/Emerging Issues (children), and four Research Projects (grandchildren).The SW Center staff set out to revise and re-envision its strategic plan at the time the renewal grant was awarded. The logic models were used as resources for this process. A committee was formed from EAC, IAC, PIs, evaluation experts and staff to update the existing SW Center strategic plan. Goals are shown in Strategic planning for the MAP ERC occurred after initial funding and again after the award of the competing renewal in 2010. The MAP ERC goals were developed as part of the application for the Center funding in a process that involved reviewing NIOSH and MAP ERC goals and setting priorities for the funding cycle . These pThe group of logic models for MAP ERC was: Center-Wide (parent), Outreach, Continuing Education, Residency Programs, Interdisciplinary Coordination, Research Training, Community, Diversity, and Program Evaluation . As compared to the set of logic models for the SW Center, the MAP-ERC suite of logic models represents programmatic initiatives; thus there were no grandchildren.For this paper, we highlight the hierarchical thread (the family tree) from the NIOSH goal to its corresponding Center goals. As described above, NIOSH was the \u201cgrandparent\u201d, the Center was its descendant (parent) and the cores were the children. To demonstrate the hierarchy, each case study below demonstrates the links between one of the Center goals to the goals, objectives, and activities of its Outreach Core, as this component was a requirement for both the SW Center and MAP ERC. In the case of the SW Center, we include the linkages between the Outreach Core and a research project to complete our example. In the ERC, we depict the relationships between the Center and its Outreach and Research Training Cores.The SW Center Outreach Core engages and expands its network of strategic partners to design, deliver and evaluate educational products and programs to raise awareness of safety and health issues, diminish exposure risks, improve the adoption of best practices, and consequently reduce injuries and fatalities to AFF workers and their families. This is accomplished through regular communication with stakeholders, capacity building activities, and topic/population based interventions that are informed by regional experts. The Outreach Core has its own goals.The Outreach Core is designed to help the SW Center meet NIOSH Strategic Goals 2 and 3 . The NIODuring the logic model development process, the Outreach Core aligned its activities to the SW Center-wide Strategic Plan. The items in the activities, outcomes and impact columns from the Outreach Core logic model align with those in the SW Center-wide logic model outcomes and impacts in The Outreach Core itself had goals , which bSimilarly, the evaluation followed a hierarchical pathway. Progress reports collected information about the activities in the Vietnamese Shrimper research project and the Outreach Core. The summative evaluation examined the attainment of the Center-Wide goals, the evidence for which are the data documenting activities, intermediate outcomes and impact of the Outreach Core and the Vietnamese Shrimper research project.One role of the MAP ERC Outreach Core was to convene the community OS&H workforce in the region, in collaboration with professional societies, labor organizations, Native American and Latino communities, government, industry groups, community organizations, and other ERCs. Hundreds of organizations were engaged in raising the profile of OS&H issues among the broader community.The MAP ERC Outreach Core logic model provides detail about the relationship between the MAP ERC Center-wide goals and the goals and outcomes for the Outreach Core. Similar to the SW Center, the Outreach Core created its own goals . Within The case studies described above demonstrate the ways in which a hierarchical logic model process may be used to link goals and outcomes between the funder , and two of its major initiatives, the Ag Centers and the ERCs. NIOSH articulated its goals for the Ag Centers and the ERCs  in its lThe senior author worked as the leader of the evaluation for both the SW Center and the MAP ERC. In both cases, the logic model process began in the application period and was refined once the Center was funded. The SW Center was funded in September 2012 and the MAP ERC was funded in August 2010. The results described in this manuscript depict evaluation in action: each set of hierarchies was tailored to the structure and lineage of each Center and what was needed to accomplish each Center\u2019s goals, which were determined by the NIOSH goals. The major difference between the two hierarchies is that one favors depth (SW Center) and the other favor breadth (MAP ERC).The logic model hierarchy mirrors the multi-level and nested characteristics that underlie the rationale for hierarchical linear modeling in statistics  and the Hierarchical logic models are appropriate for all large intramural and extramural program projects, because they reflect the goals of the agency (in this case NIOSH) and therefore the rationale for the program project or initiative. The hierarchical logic model process helps agencies prepare funding announcements and reports to Congress or other constituencies that assess the degree to which an agency is attaining its own goals. As an example, the evaluation of the Ag Centers by the National Academies of Science was facilitated by explicit linkages between agency goals, objectives and initiatives and the corresponding goals, objectives and activities of the Centers .The hierarchical logic model approach is very helpful at the Center level for orientation of all stakeholders to include internal and external advisory boards, site monitors and study sections to understand program goals, practices, and rationale. Furthermore, the hierarchical logic model process offers a common purpose between the evaluation team, program staff, and stakeholders.The hierarchical logic model approach allowed the MAP ERC personnel to further prioritize areas where multiple programmatic areas were designed to meet the same goals and coordinate activities, tracking and increased impact. This coordination of activities minimizes duplication of efforts and central tracking allows for higher level decisions about what activities are more successful than others, across programs.The logic models are a living portrait of evaluation in action. The use of a hierarchical logic model process aids the federal government to manage, integrate and coordinate a large complex system of varied and diverse programmatic elements, thereby ensuring that its goals are attained."}
{"text": "Global Breast Cancer (BC) is the most common non-skin malignancy, nearly a third of newly diagnosed cancers in the United States and the second leading cause of mortality in women throughout the world was BC , 2. BetwIn GLOBOCAN project, the expected number of new cancer cases or deaths in a country or region in 2015\u20132035 is computed by multiplying the age-specific incidence/mortality rates estimated for 2012, by the corresponding expected population for 2015\u20132035. In Iran, based on the GLOBOCAN project in 2012, the number of BC in woman was 9795 case and the number of new case have an increase in the next few years, so in 2015, 2020, 2025, 2030 and 2035 the number of new cases were 10982, 12684, 14920, 17346 and 19328, respectively. Therefore, in 2035 compare 2012 the numbers of new case were nearly 2 times. In addition, in 2012, the numbers of death from BC was 3304 and in the next few years, we have increase in the number of death from BC, so in 2015, 2020, 2025, 2030 and 2035 the numbers of deaths were 3742, 4394, 5248, 6220 and 7138. We expect that Iranian population structure, the greatest increase in the number of new cases and deaths from BC observe in age group (ages >= 65), so in 2035 compared to 2012, the number of new case and mortality will be 3 times, while in the age group below 65 yr, the increase is about 1.8 times , Fig. 1.We predicted the number of incidence and mortality of BC in Iran between 2012 and 2035. Although these results should be taken with caution given that they were obtained using prediction methods, it is important to highlight that there is a trend for increased incidence and mortality of BC in Iran. For this reason, in addition to planning for prevention of disease occurrence in the population at risk, the health policy makers should anticipate and provide diagnostic tools, therapeutic facilities, and skilled healthcare workers to cope with these additional patients in the next few years."}
{"text": "Psycho-oncology in Korea was introduced among the circle of consultation-liaison psychiatrists, in the 1990s. For almost 25\u00a0years, the field has been developing at a steady pace as the psychosocial needs of patients with cancer continue to increase. In this study, we review the history of psycho-oncology in Korea, in a chronological order, within the domains of clinical practice, research activity, training, and public policy.Before the 1990s, patients with cancer with psychiatric comorbidities were usually taken care of by consultation-liaison psychiatrists in general hospitals. In 1993, psycho-oncology was first introduced by psychiatrists. Psychologists, nurses, and social workers have also been increasingly involved in providing psychosocial care for patients with cancer. Professionals from various disciplines began to communicate, and agreed to found the Korean Psycho-Oncology Study Group (KPOSG) in 2006, the first academic society in this field. In 2009, National Cancer Center published the \u201cRecommendations for Distress Management in Patients with Cancer\u201d, which are consensus-based guidelines for Korean patients. In 2014, the KPOSG was dissolved and absorbed into a new organization, the Korean Psycho-Oncology Society (KPOS). It functions as a center of development of psycho-oncology, publishing official journals, and hosting annual conferences. There are many challenges, including, low awareness of psycho-oncology, presence of undertreated psychiatric disorders in patients with cancer, shortage of well-trained psycho-oncologists, stigma, and suicide risk. It is important to improve the cancer care system to the extent that psycho-oncology is integrated with mainstream oncology. Considering the socio-cultural characteristics of Korean cancer care, a Korean model of distress management is being prepared by the KPOS.This article provides an overview of the development, current issues, and future challenges of psycho-oncology in Korea. Through its long journey to overcome the many barriers and stigmas of cancer and mental illnesses, psycho-oncology is now acknowledged as an essential part of integrated supportive care in cancer. Active research and international cooperation can gradually shape the Korean model of distress management. The age-standardized rate (ASR) of cancer incidence in Korea has decreased from 303.8 per 100,000 in 2011, to 290.5 in 2013. Cancer has, however, been the most common cause of deaths in Korea since 1983; the disease accounted for 28.3% of all deaths in 2013. The age-standardized rate of cancer mortality has decreased by 2.7%, annually, from 2002 to 2013. The 5-year cancer relative survival rate has improved, from 41.2% in 1993\u20131995, to 69.4% in 2009\u20132013. The number of Korean cancer survivors has increased steadily, with 1,370,049 having been identified, as of January 1, 2014 [The diagnosis and treatment of cancer is often accompanied by psychosocial distress of patients and their families. Psychosocial distress increases the risk of psychopathology, lowers the quality of life of patients with cancer, and has a direct, or indirect negative impact on treatment and prognosis \u20134. BecauPsycho-Oncology, dealing with the psychological, social, and spiritual aspects of cancer, is recognized as an essential part of integrated cancer care in many developed countries. Since the World Health Organization (WHO) declared \u201cno health without mental health\u201d and emphasized on the importance of mental health, the need for psycho-oncological intervention has increased even further , 7. PsycSeveral studies that review the history of psycho-oncology have been published in Korea \u201310. HoweThe psychiatric problems of patients with cancer had been recognized in Korea long before the field of psycho-oncology was introduced, in the 1990s. Psychiatrists were interested in cancer-related psychiatric disorders, such as delirium and adjustment disorder. Consultation and liaison activities were carried out by psychiatrists mainly at general hospitals. As early as the 1970s, and through the 1980s, research papers were published in the areas of diagnosis and treatment of psychiatric disorders, truth-telling practice, hospice and end-of life care, and psychosocial interventions for patients with cancer and families. In the 1990s, hospice/palliative care, such as pain management for patients with advanced cancer, was extensively studied with the development of the hospice movement in the 1980s, and 1990s, in Korea. That was the basis of the establishment of the current hospice care system. Although studies on the quality of life, psychological symptoms of caregivers and patients with cancer, and the adaptation of the family of patients with cancer had begun to increase in the 1990s, there were limitations because of the lack of objective tools to measure such parameters.In 1993, the concept of psycho-oncology was introduced for the first time at a symposium in the annual conference of the Korean Society of Psychosomatic Medicine . The hisIn 1996, the Ministry of Health and Welfare of the Korean Government launched a National Cancer Control Planning Board, which embarked on the First Cancer Control 10-Year Plan (1996\u20132005). As the control tower of the national cancer control programs, the National Cancer Center (NCC) was established in 2000. The first decade of the 21st century witnessed a big increase of cancer centers and hospitals, in order to accommodate the increasing numbers of patients with cancer. Because issues regarding the quality of life of patients, during and after treatment, were raised, their psychosocial needs were increasingly addressed.Although the Cancer Control Act, legislated in 2003, did not stipulate the psychosocial aspects of cancer, the importance of quality of life and palliative care were stressed in the Second 10-year Cancer Control Plan (2006\u20132015).Research activities in the related fields of psycho-oncology were enriched with the establishment of the Korean Society for Hospice and Palliative Care in 1998 and the Korean Oncology Nursing Society established in 2002.Since the 2000s, with Korean the validation of assessment tools for the symptoms and quality of life of patients with cancer and their caregivers, psycho-oncological studies using such tools have increased dramatically.The Korean Psycho-Oncology Study Group (KPOSG) was founded in 2006, with members from multidisciplinary mental health, and related professionals. It was organized by a core group of psychiatrists, psychologists, and nurses. They shared expertise in the field of psycho-oncology through participating in monthly seminars and cooperative clinical studies. The first conference on psycho-oncology, led by members of the KPOSG, was held in April 2007. They presented topics on the overview of psycho-oncology, research, and clinical practice, at the symposium of the Institute of Human Behavioral Medicine, Seoul National University. They also organized a symposium titled, \u201cMental Suffering of Patients with Cancer, How to Help?\u201d at the 9th Cancer Control Forum, sponsored by the National Cancer Control Planning Board, in November of 2007. The KPOSG has continued to hold annual academic conferences since 2010. Those conferences have attracted attention from both people in academia and the general public.In 2008, the group conducted at reliability and validity study of the Korean version of the problem list and distress thermometer , one of \u201cThe Recommendations for Distress Management in Korean Patients with Cancer\u201d was published in 2009, by the National Cancer Center, with a grant from the National Research and Development Program for Cancer Control , 12. In With an increasing acceptance of the importance of communication in quality cancer care, NCC introduced communications skills training (CST), using the manual of the Japanese SHARE protocol translated into Korean. NCC continues to hold CST workshops for its doctors, nurses, and other employees and is trying to expand this training nationwide.The Korean Psycho-Oncology Society (KPOS) was founded on September 26, 2014 [The diagnosis of cancer is not considered a death sentence any more. Cancer will, however, continue to be a major health threat to people all over the world, because of the fatality and chronicity associated with the disease. Because there is an increased acceptance of the importance of quality of life in patients with cancer and families, a steady development of psycho-oncology in Korea has become possible. Awareness of psycho-oncology is still low, and the psychiatric disorders of patients with cancer tend to be under-diagnosed, and undertreated, in actual clinical practice , 16. OnlAccording to the International Federation of Psycho-oncology Societies\u2019 report on the disparities in psychosocial care, the development of psycho-oncology in Korea was graded as \u201cisolated care provision\u2019 , compareIt is important to improve the cancer care system, so that psycho-oncology is well integrated with mainstream oncology. In the Third National Cancer Control Plan (2016\u20132020), the scope of cancer care has been expanded, to include the quality of life of cancer survivors. The Korean government is planning to establish 13 regional integrated supportive care centers in provinces, for cancer survivors living in the community, by 2020. Those centers are going to provide comprehensive supportive care, including psychosocial service, rehabilitation, and nutritional counseling. Korean psycho-oncologists are moving toward integrated cancer care that incorporates psychosocial care as an essential component of patient care.Although the needs for mental health professionals in the field of psycho-oncology are increasing, there is a shortage of well-trained psycho-oncologists in Korea. The Advanced Program for Psycho-Oncology (APPO), developed by NCC in 2015, is the first course to train psycho-oncologists. It is a 12-week program for psychiatrists, psychologists, social workers, and other healthcare professionals interested in psycho-oncology. Further development and expansion of training programs for psycho-oncologists would help expand the number of experts in psycho-oncology in Korea.The effectiveness of psychosocial interventions should be proved further in order to raise awareness of psycho-oncology. Large-scale clinical studies need to be done to support the biopsychosocial model for cancer treatment.Cancer stigma often causes psychosocial distress. According to a national survey in Korea, more than half of the public had negative attitudes, stereotypes, and discriminating attitudes toward patients with cancer in spite of clinical progress and improved survivorship . A recenCancer is an illness that increases the risk of suicide in Asian countries \u201322. One With the development of information and communication technology, e-health and m-health are emerging. In psycho-oncology, there have been various studies to improve self-management and support patients with cancer, using mobile applications , tablet Psycho-oncological knowledge can be universally applied, and it is beyond race, culture, and socioeconomic status; however, it is necessary to consider the socio-cultural specificity of each country. Considering the socio-cultural characteristics of Korean cancer care, a Korean model of distress management is being prepared by the KPOS, with a revision in the recommendation published in 2008.The KPOS, as the only academic group of psycho-oncology in Korea, should tighten the cooperation with the International Psycho-Oncology Society (IPOS) and other academic communities in the world.International cooperation with many East-Asian experts who share similar cultural and healthcare system backgrounds would help with the promotion of psycho-oncology in Korea.The introduction of psycho-oncology to Korea was relatively late, and its growth was not fast enough, compared to Western countries and Japan. There has, however, been a steady development of psycho-oncology, with a successful launching of a national academic society and growing numbers of enthusiastic professionals in Korea. This article provided a brief overview of the development, current issues, and future challenges of psycho-oncology in Korea. Psycho-oncology should be an integral part of integrated supportive care for cancer in Korea."}
{"text": "Independent of who made the first Review in health literature, it is possible to state that the development of the fundamental concepts on Systematic Review and Meta-analysis is attributable to the Cochrane initiative, that signalized the need to gather scientific evidence based on the opinion of medical specialists . It is nKey elements of the model are transparency and reproducibility search methods, which include registration of the title, publication of the protocol and periodic updating in subsequent systematic reviews. At same time at the UK Cochrane Center in Oxford, it was initiated the development of statistical methods for data synthesis, which great influenced on the specifications of the software, especially in relation to meta-analysis . ThroughThe items involved in the development of the systematic review, specifically for interventions based on randomized assays, also had their initial definition by the Cochrane Handbook 1994), inserted in its software (RevMan). But in the same way as systematic revisions, it has become a universal process, as well as initiatives have emerged to disseminate these fundamental elements, such as the PRISMA  , which h, inserteSome major phenomena justified the improvement, the democratization and the expansion of the checklist for systematic reviews, through the creation of PRISMA (2005): the knowledge of driving and publication of systematic reviews has expanded, the concepts of risk of bias were extended, including observational studies, and the synthesis of the evidence used by the authors has become increasingly focused on to address practical issues, making the eligibility criteria of the increasingly inclusive evidence. The PRISMA consists of a \u201cchecklist\u201d of 27 items and a 4-stage flow diagram essential for the dissemination and publication, transparent and rigorous, of the methods and results of the systematic review .In the same way, to broaden the global Systematic Reviews of quality, the Center for Reviews and Dissemination (CRD), at York University, which is part of the National Institute of Health Research (NIHR) in the UK, and produces systematic reviews and evaluations of health technology, has developed a record of systematic reviews, the international prospective register of systematic reviews (PROSPERO) . PROSPERSo Int Braz J Urol is adopting the PRISMA checklist, including the PROSPERO\u2019s register, within the rules needed to submitted any systematic review with or without meta-analysis. The authors can access the checklist and flow diagram at Prisma-Statement and the registration at Prospero electronic address, that need to be sent with the whole submission.Certainly, with this initiative, the level of the Systematic Review and Meta-analysis available in the Int Braz J Urol will be with highest level, consistence and credibility.Faculdade de Medicina da Universidade de S\u00e3o Paulo (FMUSP),Projeto Diretrizes - Associa\u00e7\u00e3o M\u00e9dica Brasileira (AMB),S\u00e3o Paulo, SP, BrasilWanderley Marques Bernardo"}
{"text": "The Physician's Pledgend General Assembly of the World Medical Association, Geneva, Switzerland, September 1948 and amended by the 22nd World Medical Assembly, Sydney, Australia, August 1968 and the 35th World Medical Assembly, Venice, Italy, October 1983 and the 46th WMA General Assembly, Stockholm, Sweden, September 1994 and editorially revised by the 170th WMA Council Session, Divonne-les-Bains, France, May 2005 and the 173rd WMA Council Session, Divonne-les-Bains, France, May 2006 and the WMA General Assembly, Chicago, United States, October 2017.Adopted by the 2AS A MEMBER OF THE MEDICAL PROFESSION:I SOLEMNLY PLEDGE to dedicate my life to the service of humanity;THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration;I WILL RESPECT the autonomy and dignity of my patient;I WILL MAINTAIN the utmost respect for human life;I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing, or any other factor to intervene between my duty and my patient;I WILL RESPECT the secrets that are confided in me, even after the patient has died;I WILL PRACTISE my profession with conscience and dignity and in accordance with good medical practice;I WILL FOSTER the honour and noble traditions of the medical profession;I WILL GIVE to my teachers, colleagues, and students the respect and gratitude that is their due;I WILL SHARE my medical knowledge for the benefit of the patient and the advancement of health care;I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard;I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat;I MAKE THESE PROMISES solemnly, freely, and upon my honour.\u00a92017 World Medical Association Inc. All Rights Reserved. All intellectual property rights in the Declaration of Geneva are vested in the World Medical Association."}
{"text": "Biennial Conference of the European Association for the History of Medicine and Health \u2013 The Body Politic: States in the History of Medicine and Health, an extremely important European meeting in the field of history of medicine, whose main organizer was the European Association for the History of Medicine and Health, took place in the amphitheatre of \u201cCarol Davila\u201d University of Medicine and Pharmacy, Bucharest, during August 30 and September 02, 2017.Hosted for the first time by a East European country, the conference enjoyed the participation of some remarkable personalities in the academic world such as doctors, historians, anthropologists, demographers, and occasioned an interesting and useful exchange of opinions, mainly regarding the role of politics in the development of medicine in history, benefitting from the participation of some prestigious publishing houses and raising the interest of many participants.Prof. Dr. Octavian Buda, President of the European Association for the History of Medicine and Health, EAHMH, and the Head of Discipline of History of Medicine in the Preclinical 3 Department, \u201cComplimentary Sciences\u201d, affirmed: \u201cI hope this conference will have positive outcomes, so that we will be able to raise the interest of the researchers in the Occident regarding the study of history of medicine of these complex fields in the Eastern Europe, such as Romania, with the starting of some academic collaboration projects between the Western and Eastern Europe\u201d.Prof. Dr. Mircea Beuran, President of the Senate of \u201cCarol Davila\u201d University of Medicine and Pharmacy, Bucharest performed the welcoming speech of the conference. Other speakers were Prof. Dr. Catalin Cirstoiu, Dean of \u201cCarol Davila\u201d University of Medicine and Pharmacy, Bucharest; Prof. Dr. Mircea Dumitru, Rector of the University of Bucharest and Prof. Dr. Octavian Buda, President of EAHMH.The conference took place under the patronage of two important academic institutions: Academy of Medical Sciences and Academy of Scientists, and reunited over 150 participants from 22 countries, also enjoying the presence of four keynote speakers.Among the most important personalities who activate in the fields of human and medical sciences and took part in the event were Prof. Dr. Roberta Bivins - University of Warwick, England; Prof. Dr. Harry Oosterhuis - University of Maastricht, Netherlands; Prof. Dr. Constantin Goschler \u2013 University of Bochum, Germany and of course, Prof. Dr. Mircea Dumitru, Rector of the University of Bucharest.2017 EAHMH Book Award Prize was awarded for the best book published in the field of history of medicine and went to Cristian Berco for his book \u201cFrom Body to Community. Venereal Disease and Society in Baroque Spain\u201d, published by University of Toronto Press in 2016 and Pieter van Foreest Student Prize, which is offered to students and PhD students for the best paper presented in the conference, prize that was awarded to Kinga Jeczminska for the paper \u201cPolitical Factors in Abandoning Lobotomy in Poland in the 1950s\u201d.Executive EditorProfessor Eng. Victor Lorin Purcarea, PhD."}
{"text": "This global humanitarian crisis has spurred vigorous local, national, and international debates regarding the risk of infectious diseases that migrants pose to the countries and citizens who offer them shelter. In these debates, some have advocated tightened control and oversight of immigration, acceptance of refugees, and international travel. In this context, it is essential to maintain established U.S. policy toward human migration and global health that is evidence based and upholds the value of compassion, as well as key principles in international human rights law.Human migration is at an all-time high, with one in every 122 humans now either a refugee, internally displaced, or seeking asylum , experience informs us that limiting migration and the flow of refugees will, by itself, have little impact on the control of infectious diseases. Migrants represent only a small fraction of international travelers entering the United States. Thus, preventing their entry will not have a major impact on the influx of infections. International travel, once considered exotic, is now commonplace. Over 70 million U.S. citizens travel abroad yearly for commerce, trade, tourism, teaching, faith-based missions and other public service efforts, and military deployment. In contrast, about 1 million legal immigrants and 70,000\u201390,000 refugees enter the United States yearly.Although travel restrictions may be warranted under extreme circumstances of epidemics and pandemics, as spelled out by the World Health Organization International Health Regulations (cdc.gov/zika/geo/united-states.html). Furthermore, some \u201ctropical\u201d infections we may fear from migrants are already endemic, albeit uncommon, in parts of the United States, including viral infections, tuberculosis, Chagas disease, leishmaniasis, and soil-transmitted helminth infections. Restrictions on travel and population movement cannot keep these diseases out of our country. They are already here.Unlike U.S. citizens, who travel freely without health screenings or restrictions, legal migrants and refugees who enter the country must meet entry criteria that include thorough screening and treatment of infectious diseases. American travelers returning to the United States have proven to be highly efficient in spreading some infectious diseases. For example, of the almost 4,500 recognized cases of Zika virus infection to date in the United States, over 95% were travel related (In addition to maintaining a humane and evidence-based U.S. policy on migration, we must continue to engage and invest in programs that improve the health of vulnerable populations worldwide. Reaching out to enhance the well-being of those whose lives has been torn apart by war and oppression should be a fundamental and perhaps defining American principle. Programs for populations in need around the world should not be considered antiquated historical notions or reflective of an outmoded inscription on the Statue of Liberty. Indeed, U.S. government leaders from both sides of the political aisle have championed programs aimed at global health, including the creation of the Peace Corps by President John F. Kennedy in 1961, and the President's Emergency Plan for AIDS Relief and President's Malaria Initiative by President George W. Bush in 2003 and 2005, respectively. Additional efforts have been shared with other developed countries, notably the Global Fund to Fight AIDS, Tuberculosis, and Malaria. These well-managed programs have offered enormous benefits to the citizens of the developing world, but they have also directly benefitted the United States, by helping to control some of the most important infectious diseases that threaten all of us, by building diplomatic bridges of good will with populations around the world, and by exemplifying the best of American values of kindness and compassion.Progress in diagnosing, managing, and preventing tropical infectious diseases will be facilitated by biomedical research in the developing world, where greater prevalence of many infections allows adequate sample size for studies that would not be possible through research conducted only in the United States. New drugs, vaccines, and control measures that result from these research efforts will be available for the benefit of all, including those in the United States. Maintaining this research will require continued funding for U.S.-based agencies and programs that support global health research and service, including the National Institutes of Health, Centers for Disease Control and Prevention, U.S. Agency for International Development, and many Department of Defense programs.The American Society of Tropical Medicine and Hygiene, the largest international organization of experts dedicated to reducing the worldwide burden of tropical infectious disease and improving global health, deeply understands that vigilance in the control of global disease is in the best interest of all. To that end, we will continue to work with the U.S. Congress, the White House, and global health stakeholders in support of evidence-based policies and programs to protect the health of people both inside and outside the United States. Maintenance of evidence-based policies concerning migration and strong investment in global infectious disease research and programs are the right thing to do, and they are the smart thing to do."}
{"text": "After an introduction by Dr Johanna Takkinen, Head of Disease Programme Food- and Waterborne Diseases and Zoonoses at the European Centre for Disease Prevention and Control, Stockholm, Sweden, Professor Sylvie van der Werf, Head of the Molecular Genetics of RNA Viruses Unit, Institut Pasteur, Paris, France, will talk about viral zoonotic diseases and point out intrinsic and extrinsic factors influencing the dynamics of spillover from animals to humans. Professor Luca Guardabassi, Department of Veterinary Disease Biology, University Copenhagen, Denmark, will then speak about the need for antimicrobial stewardship in animals and highlight the possible role of companion animals in the direct transmission of resistant pathogens to humans resulting from their close physical contact.The connection between the environment, food, animals and humans with respect to human well-being, sustainable development and health is intuitive. The \u2018One Health\u2019 concept encompasses a multidisciplinary, holistic approach to sustain the health and well-being of humans and animals as well as their living environment. One Health has gained increasing attention and importance in the past years owing to the continued growth of the world\u2019s population, predicted to be 9 billion by the year 2050, the opportunities and challenges of a technology-driven, interconnected world, as well as man-made and other changes in our environment that influence the emergence and re-emergence of communicable diseases and conditions.The seminar will be open to all ESCAIDE participants. Due to the limited number of seats in the room, participants are welcome on a first come, first serve basis.here .Read more about ESCAIDE here .Read more about the Seminar"}
{"text": "To the Editor: Drancourt and Raoult ( pestis by ectoparasites, such as lice and fleas, by close contact with infected humans can sustain outbreaks and epidemics. The outbreak of pneumonic plague in Madagascar in 2017 (Y. pestis should not be dismissed. However, until a substantial epidemic has been documented with this proven etiology, this explanation of plagues, both historical and modern, must remain in the realm of conjecture.The role of ectoparasites in the transmission of"}
{"text": "Revista de Sa\u00fade P\u00fablica (RSP), between 1967 and 2015. All the fascicles of RSP, in the period, were accessed via SciELO platform, which provides all articles online. We selected and classified the articles according to the main topics of scientific production in the area of Policy, Planning and Management. Revista de Sa\u00fade P\u00fablica has published 343 articles on this subject, with significant growth in the last two decades. The most discussed topics were Health Economics, Primary Health-care, Access and Use of Health Services, and Evaluation of Services and Programs. In the last decade, the topics of Policy and Access to Medicines and Public-Private Relationship, including judicialization, gained importance. The pages of RSP embraced the vast and diverse production of Policy, Planning and Management in its first 50 years, contributing to the consolidation of the area in Brazil.We carried out a narrative review of the scientific production in the area of Policy, Planning and Management in  Revista de Sa\u00fade P\u00fablica (RSP), a Rodolfo Mascarenhas\u2019 articleIn the first pages of ,The period of emergence of RSP coincides with the international consolidation of the field of study of Public Policies, Policy Science or Policy Studies, which in Brazil was named Public Policy Analysis, among them those of HealthIn the last 50 years, Brazil has substantively changed its demographic, social, political, and economic profile. The Brazilian health system also changed: the meritocratic model, with access conditioned to formal labor market integration, was replaced by a universal system with the creation of the Brazilian Unified Health System (SUS). The achievements and challenges faced in that process were countless. However, despite the significant increase in the access to health services, ensuring universality and integrality is still a challengeThe great changes described in the paragraph above can be read in the pages of RSP published in the past 50 years, as well as the several discussions by researchers of the area. Nothing more appropriate than, on the occasion of the 50th anniversary of RSP, revisiting all this period. Thus, this study aimed to describe the articles on PPM published between 1967 and 2015 in RSP.In this study of narrative review, all fascicles of RSP were accessed via SciELO platform, which provides all articles online. The articles were selected and classified according to the main topics of the scientific production in the area of PPM, listed previously in researches conducted by Levcovitz et al.We included all published articles, classified as: original articles, special articles, comments, notes, updates, and reviews. We also analyzed Institutional Technical Notes and, more recently, articles published in the section of Public Health Practice.In the pages of RSP of the last 50 years, 343 articles were published in the area of PPM. During this period, RSP has gone from biannual publication in the first five years, to quarterly in the nine subsequent years, and bimonthly and in the last 36 years. Approaches with quantitative methods were the most common ones; the topics directly related to power issues in the analysis of Health Policies (Politics) were published more rarely.A cross-sectional look over the five decades of RSP shows the permanence of some topics. The most covered ones were: Economics of Health, Primary Health-care, Access and Use of Health Services, and Evaluation of Services and Programs. More recently, the topics of Policy and Access to Medicines and Public-Private Relationship, including judicialization, gained importance.,The evolution of the number of articles published over the decades (blocks) and triennia (row) can be viewed in the -From 1967 to 1976, 44 articles that talked about the national and state political scenario were published. Jo\u00e3o Yunes\u2019 studies,,The provision of ambulatory and hospital health services to the welfare population, by the National Institute of Social Security, has been discussed in the articles by Lima Gon\u00e7alves et al.The 1980s were a moment of production growth in the area of PPM: proposals for reform of the sector in the Country; the end of the military dictatorship; the establishment of several local health systems; and the proposal for the creation of SUS inspired several studies,,,,,,,Between 1987 and 1996, 44 articles were published in the area of PPM. The main topics discussed were Health EconomicsTeixeira,,,,,,,,,The field of PPM has increased significantly in the last years of the 20th century and in early 21st century, with progressive inclusion of topics of interest and new theoretical approaches,During the same period, the Institutional Technical Reports presented central topics of health policies: Family Health Program,,,,,,Specific policies were an important topic in RSP, especially Oral Healthquilombola populationIn recent years, RSP has started to address the Policy and Access to Medicines, an issue that lies at the center of agendas of the most distinguished health systems around the world. The article by Granjeiro et al.The access to medicines has interface with two central topics in the analysis of health policies in the 21st century: judicialization and evaluation of technological incorporation, which will be highlighted below.,,SUS has been affected by increasing litigations that, if on the one hand make explicit the overlapping between health and juridical systems in Brazil, on the other, refer to the issues of equality and of the relation between individual and collective rights. The articles of Marques and Dallari,,,,,,,,Articles on the evaluation of medicines acquisition, from cost effectiveness studies, were published recently on RSP,,,,,,More recently, several criticisms have been made to the more formalist character of Health Economics. Proposals have been developed to discuss health from its specificities as commodity and economic good, as social right and space of capital accumulation, and the contradictions arising therefromThe pages of RSP sheltered a wide and diverse production of PPM in its 50 years, contributing to the consolidation of the area in Brazil. The academic community and policy makers found, in RSP, a place for fraternal debate, for discussion of the main policy proposals for health systems and services in Brazil and Latin America, for new methodological approaches, and for introducing new topics of interest.The goal of Brazilian Public Health of building a universal health system in a country with immense social inequalities as Brazil was reflected in many of the lines published in RSP. The challenges and obstacles of this goal have been the subject of increasingly frequent reflection on RSP issues.In its 50 years of trajectory, RSP showed its commitment to the principles of SUS and to the improvement of living and health conditions of more than 200 million Brazilians. The area of PPM has many challenges; among them, the study of the complex political and economic relations of the Brazilian health system is an eternally unfinished task, which will surely continue in the next pages of RSP."}
{"text": "To assess the costs of the Smoking Cessation Program in the Brazilian Unified Health System and estimate the cost of its full implementation in a Brazilian municipality. The intensive behavioral therapy and treatment for smoking cessation includes consultations, cognitive-behavioral group therapy sessions, and use of medicines. The costs of care and management of the program were estimated using micro-costing methods. The full implementation of the program in the municipality of Goiania, Goias was set as its expansion to meet the demand of all smokers motivated to quit in the municipality that would seek care at Brazilian Unified Health System. We considered direct medical and non-medical costs: human resources, medicines, consumables, general expenses, transport, travels, events, and capital costs. We included costs of federal, state, and municipal levels. The perspective of the analysis was that from the Brazilian Unified Health System. Sensitivity analysis was performed by varying parameters concerning the amount of activities and resources used. Data sources included a sample of primary care health units, municipal and state secretariats of health, and the Brazilian Ministry of Health. The costs were estimated in Brazilian Real (R$) for the year of 2010. The cost of the program in Goiania was R$429,079, with 78.0% regarding behavioral therapy and treatment of smoking. The cost per patient was R$534, and, per quitter, R$1,435. The full implementation of the program in the municipality of Goiania would generate a cost of R$20.28 million to attend 35,323 smokers. The Smoking Cessation Program has good performance in terms of cost per patient that quit smoking. In view of the burden of smoking in Brazil, the treatment for smoking cessation must be considered as a priority in allocating health resources. Smoking is an epidemic disease arising from nicotine addiction and is the leading cause of preventable deaths in the world, estimated in 6 million annuallyThe economic burden of smoking to society is also significant. The annual expenses with treatment of tobacco-related diseases and the loss of productivity resulting from the morbidity and mortality of smoking have generated an economic burden of U$193 billion in the United States between 2000-2004,In Brazil, smoking resulted in 130,000 deaths in 2008, 13.0% of total deaths, already surpassing international estimates of 10.0% of deaths attributable to tobacco in 2015. The costs of treating tobacco-related diseases amounted to R$21 billion in 2011, considering the public and supplemental health systemsSince the 1980s, the Brazilian Ministry of Health has been adopting various actions for smoking control, which culminated in the creation of the National Smoking Control Program, coordinated by the National Cancer Institute (INCA) since the early 1990sIn the treatment model adopted by Brazil, after initial assessment appointment, smokers receive intensive cognitive-behavioral therapy, which combines cognitive interventions with training of behavioral skillsThe program is managed articulately by the federal, state, and municipal levels of SUS management. The trainings, technical support to activities, and distribution of used inputs are done \u201ccascading\u201d, from the federal to the municipal level. Educational materials and medicines are supplied by the Ministry of Health, and may be supplemented by the states and municipalities. The information is collected and consolidated from the local to the central level.,,,,,The effectiveness of brief counseling, intensive group therapy, NRT, and bupropion was evidenced by several meta-analysesIn view of the scarcity of resources for health, as well as of effectiveness, we must also consider the costs of health programs. These are still an essential part of health economic evaluations that compare treatment alternatives, producing information on the costs and benefits of them, thus orienting the decision-makingStudies conducted in the United States indicated costs of smoking treatment programs per participant of U$67 (brief telephone counseling without NRT), U$268 (intensive counseling associated with NRT)The cost estimate of the Smoking Cessation Program in Brazil is, therefore, an important subsidy to support SUS managers in planning actions and maximizing the use of resources, as well as in decision-making regarding their prioritization, guiding the efficient allocation of resources.The aim of this study was to estimate the costs of the program in a Brazilian municipality, including the treatment of the smoker and program management, considering the different levels of management involved. We also estimated costs if the service was expanded to fully meet the demand of the municipality\u2019s smokers motivated to quit.Cost study of the Smoking Cessation Program, implemented in primary health care. The unit of analysis was the municipality of Goiania, adopting the year of 2010 as time frame, both for measurement of data and valuation of inputs. We considered the perspective of SUS, funder of the program in the public health sector in Brazil, including direct medical and non-medical costs and management costs. Indirect costs were not considered.The activities were identified and grouped into components of the two program axes: behavioral therapy and treatment of smoking and management. The behavioral therapy and treatment axis comprises the following components: (i) consultations , including initial clinical evaluation and return visits; (ii) intensive cognitive-behavioral therapy sessions, including their preparation and execution; and (iii) phamacotherapy. In Goiania, the group sessions are conducted over six months. The brief counseling was not considered. The management axis includes two components: (i) technical support and (ii) training.The costs of behavioral therapy and treatment of smoking were estimated considering a convenience sample of health facilities and extrapolated to the municipality as a whole, also using data available to all groups and patients attended. The sample was selected considering the following criteria: (i) systematization and availability of information; (ii) time of implementation of the program; (iii) quantity of groups; (iv) type of health facility; and (v) location. Six facilities were selected, considering different types and locations, with the largest number of groups, deployment time, and better quality of information. The program management costs were was estimated considering the activities carried out by municipal, state, and federal coordinations of the program.The activities of the two axes of the program were estimated by micro-costing, measuring the amount used of each resource and assigning it the corresponding unit value. The resources used were identified as cost items and categorized as medical and non-medical costs, considering recurrent and capital costs. The cost structure, according to the components and axes of the program, is presented in Shared costs with other health programs and actions were assigned to the Smoking Cessation Program using as an indicator of the attributable fraction the proportion of professionals\u2019 time dedicated to the program in relation to the total time of the goal activities of the health unit or, in the case of management, of the administrative sector where the coordination of the program is.,In the sampled health facilities, the costing of the behavioral therapy and treatment was made by therapeutic group, according to the specific care configuration adopted in the facility regarding the frequency and duration of activities and professionals involved. The data were obtained in interviews with the coordinators of the groups. The professionals\u2019 time dedicated to the cognitive-behavioral therapy sessions was obtained in individual interviews, considering the average time for the cost estimate. The time of the consultations and of the dispensation of medicines was arbitrated considering the literatureTo estimate the cost of the behavioral therapy and treatment in the municipality as a whole, we considered that all smokers attended in 2010 (n = 803) underwent a common configuration of care. The parameters used in the base scenario of costs estimate of each component of behavioral and treatment and the respective data source are presented in The cost with human resources was obtained by multiplying the frequency of the activity by the number of professionals involved, by the time of duration, and by the average remuneration of professionals, plus employers\u2019 charges. The remaining medical costs were added to the value obtained (cost with clinic equipment for consultations and cost with NRT and antidepressants for medicine treatment). Non-medical costs were estimated based on the percentage they represented in relation to medical costs in the sampled health facilities. The sum of medical and non-medical costs was multiplied by the number of patients seen, for consultations and pharmacotherapy, and by the number of groups (n = 44), for sessions. In the consultations, patients receiving or not medicines were stratified, considering that patients present at the fourth session of cognitive-behavioral therapy made return visits. The sum of the total cost with consultations, sessions of behavioral therapy, and pharmacotherapy resulted in the total cost of the therapy and treatment of smoking.Management costs were estimated for each realm of management. The data were obtained with the program coordinators, in administrative records and management information systems of the three realms. The fraction of federal and state cost attributable to the municipality of Goiania was obtained based on the number of cities managed by these coordinations. The total of management assigned to the municipality was divided between the groups conducted.The The results are presented as total cost of the program, per group, stratified by cost item, component, and funding source. Cost per patient was estimated by dividing the cost of the program among all patients attended at the first session of cognitive-behavioral therapy. The cost per patient that quit smoking corresponds to the total cost divided by the patients who were not smoking at the end of the treatment.,,The expansion of the program to meet the demand of all smokers motivated to quit smoking in the municipality was set as full implementation. For the estimation of the number of smokers to be attended, we considered the prevalence of smokers in the population with 15 years or more of age (17.0%)The smokers were distributed by the three components of the behavioral therapy and treatment, according to common care configuration of the municipality, considering maximum efficiency: all primary care facilities conducting two groups of 15 smokers per year, with provision of medicines to 84.0% of them, according to the degree of dependence to nicotine of the 2010 patients, measured by Fagerstr\u00f6m test. The cost of management was estimated by multiplying the annual cost of 2010 by the number of years required for all smokers to access treatment.A sensitivity analysis was performed to assess the impact of the variation of parameters on the results of the behavioral therapy and treatment costs. Many parameters not known or with different values on different sources of information were analyzed. In addition to the base scenario, three new scenarios were created: (i) SMS-Goiania Guidance \u2013 considering recommendations or administrative records of the municipal coordination of the program; (ii-iii) Minimum and Maximum, considering respectively minimum and maximum values found in the sampled units and data sources .The research project was approved by the Research Ethics Committee of the Hospital das Cl\u00ednicas of the Universidade Federal de Goias (Protocol 155/2011).In the sampled health facilities, the cost of the behavioral therapy and treatment per therapeutic group, composed of eight to 36 smokers, ranged from R$2,937 to R$9,864. From this total, medical costs accounted for, in average, 85.8% and human resources costs, 73.1% (ranging from 62.3% to 90.2%). Including management costs, the total cost of the Smoking Cessation Program per group ranged between R$5,130 and R$12,057. The greater participation in the funding of the program came from the municipality, responsible for 78.2% of the total cost, followed by the federal (13.6%) and state level (8.4%). The largest federal participation was related to medication, and the Ministry of Health was responsible for 67.7% of the total cost with NRT and bupropion.In the municipality as a whole, 44 groups of six to 55 smokers were conducted, generating a total program cost of R$429,079 in the base scenario, with 78.0% regarding the behavioral therapy and treatment for smoking cessation. The component of greater participation in the costs of the behavioral therapy and treatment were of cognitive-behavioral therapy sessions (54.0%), followed by pharmacotherapy (24.3%), and consultations (21.7%). The average cost per patient was R$ 534, and, per quitter, R$1,435. The average cost of pharmacotherapy per patient who used NRT or bupropion was R$174. In the sensitivity analysis, the results varied in the minimum and maximum scenarios, but not in the SMS-Goiania Guidance scenario .The full implementation of the program would require R$20.28 million, benefiting 35,323 smokers motivated to quit smoking, out of a total of 175,331 smokers, representing R$574 per patient. From this total, the behavioral therapy and treatment cost would be R$19.05 million, and the management cost, R$1.24 million. In the sensitivity analysis, the total cost ranged between R$13.61 and R$34.35 millionThis study contributes to the knowledge of the costs of the Smoking Cessation Program in Brazil, estimating the costs not only of treatment, but also of the program management in the three management levels, with cost per patient that quit smoking close to the smaller ones referred to in the international literature.,,The comparison of the results with the literature is difficult, given the methodological variations concerning the considered perspective of analysis, assumptions, costing method, and cost itemsThe proportion of costs with pharmacotherapy in Goiania (24.3%) was not high, resembling the observed in the program evaluated in Switzerland (22.8%)The cost with medicines per patient, including NRT and bupropion, which ranged from R$174 to R$194 in the different scenarios, differs from the findings of another national studyThis study has strengths and limitations. The costing methodology used allowed us to identify resources with a high degree of detail, giving precision to the results, in a comprehensive approach, which also considered the program management. Some limitations arise from the difficulty of estimating the cost and the portion attributable to the program of activities, such as the dissemination and the process of buying medicines. At the federal level, we did not include transportation costs, general expenses, and capital costs. However, as these costs were not influential in the cost of the municipal and state management, we believe that they would not significantly increase the costs at the federal level. Another limitation refers to information about smoking cessation, obtained based on the patients\u2019 self-report, without biochemistry confirmation of abstinence.When estimating the costs of full implementation, we have incurred in uncertainties on various parameters. The number of smokers to be treated may be underestimated, because we considered only the most advanced stage of motivation for treatment, while the previous stage has been mentioned as a predictor of success,Despite the cost variation described, interventions for smoking cessation have been considered highly cost-effective,,In Brazil, 82.0% of lung cancer cases, one of the main tobacco-related diseases, are attributable to smoking. Their treatment in specialized public hospital was estimated in R$28,901 in 2006 for patients with a history of smoking, cost significantly higher than the cost per patient that quit smoking in the Smoking Cessation ProgramCorroborating the evidence available in the international literature, this study suggests that the Smoking Cessation Program, implemented on SUS about a decade ago, has good performance regarding the cost per patient that quit smoking in Goiania, a municipality that follows the treatment model recommended nationally. This cost can be even smaller with increasing access and demand management, diluting the costs of program management and promoting greater use of the cognitive-behavioral therapy sessions.In view of the major impact of smoking in the morbidity and mortality of the Brazilian population, the high cost of treating tobacco-related diseases, and the favorable cost-effectiveness of interventions for treatment of smoking, the Smoking Cessation Program must be considered a priority when planning the allocation of health resources. The evidence that the total funding of treatment, i.e., without additional cost to the patient, results in higher rates of abstinence reinforces such recommendationWe suggest the conduction of studies to assess the indication of treatment of smoking for SUS users in clinical practice, assisting in the development of strategies for referencing patients and increasing the scope of the program. Also, studies about the cost-effectiveness of the program are needed to provide more subsidies for the decision-making of managers as to their prioritization and encouragement."}
{"text": "We read the conclusions of Lerche et al.  with greDespite the recent interest in finding biomarkers for Parkinson's disease  to thoroughly evaluate the data, as well as making use of integration models which can capture interplay between biomarkers that would have otherwise been hidden Azuaje, .Study concept and design: YA, TA, and MM; Acquisition of data: YA; Analysis and interpretation: YA, MM; Critical revision of manuscript: YA, TA, and MM; Study supervision: TA, MM.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer ND and handling Editor declared their shared affiliation, and the handling Editor states that the process nevertheless met the standards of a fair and objective review."}
{"text": "Addition of an AuthorLeo R. Quinlan was not included as an author in the published article. The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way.The original article have been updated.AR-M conceived the study, designed the study and drafted the first version of the manuscript AS, CP-L, DR-M, and MMA contributed to the study design, and performed algorithmic work and statistical analysis. They contributed to and approved the final version of the manuscript. SA, BM, PQ, BG, GV, PB, DS and LRQ performed the field work and approved the final version of the manuscript. AB, HL, AC, RA, TC, and GOL contributed to the study design and data collection in their respective study site. They contributed to and approved the final version of the manuscript. JC contributed to the study conception, coordinated the project in the different study sites and approved the final version of the manuscript.AR-M, AS, CP-L, JA, and JC are shareholders of Sense4Care, which is a spin-off company, which may commercialize the results of this research device in future. These authors declare that the possible commercialization of the product is a research outcome, not being the design, the analysis, the interpretation of the results, or the conclusions being affected by commercial interests. All other authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "Department of Health and Human Services, the task force is an independent, nonfederal, uncompensated panel of public health and prevention experts whose members are appointed by the Director of CDC. The task force provides information for a wide range of decision makers on programs, services, and policies aimed at improving population health. Although CDC provides administrative, research, and technical support for the task force, the recommendations developed are those of the task force and do not undergo review or approval by CDC."}
{"text": "This study focuses on the attributes of students of physical therapy in order to compare the profiles of students of physical therapy (PT) in two institutions of higher learning in Israel: Ben Gurion University (BGU) and the Academic College of Judea and Samaria (ACJS). This study focuses on a department where studies have an occupational/applicative/practical orientation and high status in the higher education system. Findings of this study indicate broad similarities in the profiles of students at both institutions in relation to their age, family status, country of origin, number of siblings, parental education, and financial status of student family of origin. On the other hand, students at both institutions differed in terms of gender composition, students' employment status, the source of payment for tuition, and in their academic attainments prior to admission. Specifically, students of physical therapy at ACJS had lower academic achievements prior to their admission and reported having been rejected by other physical therapy programs. Students at ACJS placed higher importance on factors relating to the quality of instruction including teacher involvement, competitiveness, organization, control, and orientation to the study material. Students at BGU attributed greater importance to teachers' support. Findings support a thesis of a converging system of higher education in Israel, traditionally dominated by national universities and regional colleges, a relatively recent phenomenon."}
{"text": "During preoperative evaluation for anesthesia in the Down patient, it is important to focus attention on the functional conditions of the patient and systems that frequently show anomalies. One of the challenges of evaluating pre-operative conditions and potential risks in the Down patient is the lack of a gold-standard evaluation score; cervical spine abnormalities, reduced dimensions and malformations of the airways, neurological changes, respiratory and cardiac disease, as well as endocrinological and metabolic alterations. We suggest, as a possible method of evaluation for patients with mental retardation and possible malformations, a new scale which takes the functional and mental conditions into account: the Sensorial, Psychological, Anatomical, Biological, Operational and Surgical (SPABOS) Compliance Score."}
{"text": "To demonstrate the importance of using the family genogram in pediatric consultation, as an analysis tool to evaluate the degradation of parental bonding and also violence against children.\u00ae-2016 software. In order to evaluate the quality of bonding, the following items were included in the genograms: violence against children, drug addiction, neglect, mental disorder, type of relationship among family members. A qualitative study was conducted in 2011 wherein 63 children, aged between 2 and 6 years, enrolled in a slum nursery, was studied. In order to construct the genogram, data were collected in four stages: pediatric evaluation at nursery; interview with caregivers; interview with teachers; and interview with the nursery coordinator. The data about the families were used to construct the genograms with the aid of GenoPro The evaluated children and their families generated 55 genograms. In 38 of them, functional family arrangements, and close or very close emotional ties were observed. In 17 cases, situations involving physical, emotional, or sexual violence against children were perceived. Among these, four represented extreme cases, with fraying parental bonding, and dysfunctional family arrangements. In these families, chemical addiction was prevalent among multiple members, as well as severe mental disorder, persistent physical and verbal abuse, and sexual abuse. The use of the genogram helps to identify at an early stage the degradation of parental bonding and violence against children, and when it is incorporated into the pediatric practice routine, it may contribute to the promotion of the comprehensive health care of the child, regardless of the presence of social vulnerability. In modern society, a family arrangement is one of the different configurations that the family can embrace, such as multigenerational family, extended family, and reconstructed family.The family can be both protective against the development of mental disorder and it can turn into a triggering factor. When the mother is an alcohol consumer, an environment with low cohesion and organization, as well as great incidence of domestic violence, is observed.Sierra and Mesquita analyzed children and adolescents and concluded that intra-household violence perpetrated by the parents, as well as privation and negligence, represent high chances of causing psychological and physical damage, and the consequent delay in the full development of the child.,Among the innovative practices that provide a broader view of the child\u2019s universe, the family genogram stands out.Therefore, this study aimed at describing the use of the family genogram in the pediatric appointment as a tool to analyze the degradation of parental bonding and violence against children.The study consisted of a qualitative study, conducted in a philanthropic day-care facility in the city of Guarulhos, S\u00e3o Paulo. The institution is managed by a religious order and is located at the border of the road Fern\u00e3o Dias. The population of this investigation included 63 children, aged between 2 and 6 years, enrolled in the day-care facility in 2011, corresponding to 55 family genograms.To build the genogram, data collection about the children took place in four moments: at the pediatric evaluation in the daycare, by analyzing the school records; interviewing the person in charge of the child; interviewing the teachers; and interviewing the day-care coordinator. First, the mother or tutor was interviewed with a structured questionnaire. Then, the teacher in charge of the child was interviewed in order to obtain additional information such as parental involvement in the children\u2019s routine at the daycare, health care, and signs of violence or sexual abuse. At last, the religious woman in charge of the facility was interviewed, since she had major influence on the community and had extensive knowledge about the families. In this interview, it was possible to collect information regarding the use of alcohol and other drugs by the family members, the quality and type of family bonds, and the history of physical and sexual abuse.\u00ae-2016 , in which the symbols represent the individuals, and the lines translate relationships between the individuals.,The structured questionnaire, applied during the interview of the mothers or tutors, involved the following data: general conditions of the child, identification and obstetric history of the mother, lifestyle and household, child\u2019s medical history, family structure, qualification of the head of the family, work status, type of household, family monthly income, registration in the social program Bolsa Fam\u00edlia, marital status, number of residents in the household, basic sanitation conditions, and presence of an electric network. Data about the families were used to build the family genograms, with the software GenoProThe research project was approved by the Research and Ethics Committee (CAAE n. 0051.1.186.000-11), and the Informed Consent Form was signed by the children\u2019s parents or tutors after agreeing to participate in the study.The children assessed and their respective families generated 55 genograms; 38 showed functional family arrangements, with close or very close affectional bonds. Despite being socially vulnerable, most families had in place protective nuclear arrangements and functional dynamics for the child. By considering the levels in the spectrum of violence, in these families the mild form stood out. Parental bonding was strong, and physical or verbal aggression was a reproduction of models coming from paternal education. Another experience presented in these groups, with less frequency, was negligence. Parental bonding was weakened by paternal mental disorders, single-parent relationships, chemical dependence, or a mother with multiple partners.In 17 of the analyzed cases, there were situations involving physical, emotional, or sexual violence against children. The most extreme cases of violence, with weak parental bonding, occurred in families with dysfunctional arrangements. In these cases, the prevalent scenario was chemical dependence of many family members, severe mental disorder, persistent verbal and physical aggression, and sexual abuse. The child often took the role of the adult, being in charge of taking care of family members. The results present the family genograms of children who have been victims of extreme violence. The child is represented by the first letter of his or her name (as shown in Genogram F  shows a Genogram R  presentsThe families assisted at the daycare facility, living in a condition of social vulnerability, represent a heterogeneous community, concerning both family arrangements and the quality of parental bonding. When the pediatrician evaluates the child guided by the practice that is limited to the biomedical model, it is not possible to consider the complexity of interactions in the family household, which contribute to the child\u2019s health. The action of not recognizing family dynamics may result in limited and mistaken interventions addressed to determining the real needs of the patient and his or her family, which is negative for full care.,Therefore, the use of the family genogram will enable the analysis of the psychosocial context of the children, their families and diseases, favoring the identification of stressful factors in the family context. Its applicability starts in the pediatric outpatient clinic, contributing to the construction of clinical reasoning and judgment, and goes to emergency care situations, in which the traditional model does not provide satisfactory answers to the clinical situations of the child. The conditions in which the biomedical model shows its limitations the most involve complex family contexts, with children\u2019s behavioral issues, mental disorder, chemical dependence, and intra-household violence.The children in this study did not have clinical complaints; however, by analyzing their genograms, the vulnerability to several forms of violence became clear. All families assessed, showed high level of social vulnerability, including different family arrangements and a wide spectrum of parental bonding quality, reaching extreme degradation. In these families, the bond is weakened by maternal mental disorders, single-parent relationships with the absence of the father, chemical dependence or presence of multiple partners. It was observed that violence defined as the intentional use of physical force or power, actually put to use or threatened, self-inflicted, inter-personal or collective, leading to or with high chances of injury, psychological damage, developmental deficiencies, or privation and death, which were the reality of these families - with a variation in the level of intense and type.In dysfunctional family arrangements, the child\u2019s physical and psychic health is under constant threat. Therefore, if the children and their families do not receive the proper assistance from supportive and protective networks, they can evolve to a long cycle of disturbances, thus perpetuating violence.,,,,The life of this child with alcoholic parents has been associated with the development of mental and behavioral disorders, such as depression, anxiety, affectional disorders, low school performance, and emotional insecurity.In the four families assessed with the genogram, the presence of family violence associated with alcohol or drug abuse by one or both parents was observed; in these cases, the children of these families had their parents as their single affectional bond. Therefore, all children in these families are subject to developing some sort of mental or behavioral disorder throughout their lives. According to the daycare, at least one child in every analyzed family presented difficulties in school performance, in socializing with other kids, and in establishing an affectional bond with the teachers.The results of this study demonstrate the importance of using the family genogram in the pediatric appointment, in extreme cases, as a tool to analyze the degradation of parental bonding and violence against children; however, this resource also allows to assess the exposure of the child to several types of stressful factors in less extreme cases. The genogram allows the pediatrician to assess the structure and the functionality of the family, as well as the role of the child in the household. Its construction is dynamic and should be completed after each appointment, according to the transformations in the lifecycles of the family. Therefore, the quality of parental bonding is shown, and violence against children can be perceived in its genesis, even at milder levels.Despite being similar to a genealogical tree, its complexity and comprehension is much larger. Its configuration is more like a relational map of family members, whose symbols have been standardized since the early 1980s, by the North-American Care Research Group. The symbols characterizing the male individuals are squares, and female figures are circles. The affectional relationships are drawn with lines, according to the intensity and type. The graphic presentation in a single page, in the medical record, allows the health team involved in childcare to be aware of the available data. This information often involves delicate situations, regarding difficult family relations, which are, however, relevant to understand an acute or chronic condition and to construct adequate therapeutic projects.Its incorporation in different scenarios of pediatric clinical practice could, in fact, contribute to the promotion of full health care for the child, increase the resoluteness of the care provided, assist the family to find new ways to see its members, promote more ways to rescue autonomy in their own therapeutic plan regardless of the presence of social vulnerabilities."}
{"text": "Pioneerism with theinterval of evaluation extended from three to four years, and the record and collection ofdata of the Programs through an Furthermore, the criteria used for evaluation of Academic Programs were improved and betterdelineation, identity, productivity and evaluation process of Professional Master Programswere implemented, which were exhaustively discussed and constructed with peer collaborationin seminars and forums, in addition to the exercise of a partial evaluation of the Programswith wide debate of results in a Seminar entitled \u201cHalf Term Picture\u201d. The incorporation ofan evaluation process with a quality seal for the books produced in the Area was also implemented in the quadrennium 2013-2016, joining the traditional process ofqualification of periodicals in force.Fifty-three academic programs and 21 professional master programs in operation in the fiveregions of the country were evaluated, showing an increase of nearly 30% in the presentquadrennium, in relation to the 2010-2012 triennium, with a still asymmetrical distributionof courses, which are concentrated in the Southeast (42.9%), with advances in the Northeast(25.9%) and South (21.4%), and low numbers in the Midwest (8.0%) and North (1.8%)In this group, professional master programs stand out for their remarkable expansion in thelast six years, with a relative growth of 156%, representing 20.5% of the approved coursesof the Nursing Area in December 2016. These courses target the training of professionalsfor health services and the consolidation of the Unified Health SystemIn view of the strengthening of Nursing as Subject and Science, the expansion of the offerof PhD programs and interinstitutional academic cooperation initiatives became evident.With 38 doctoral programs, although none in the North of the country, the investments toreduce the asymmetries have been directed through academic solidarity, evidenced especiallyin the Federal and State Universities of Amazonas, Federal University of Acre andUniversity of Rond\u00f4nia, with the offer of special classes outside the Headquarterfacilities, in the \u201cInter-institutional Doctoral program\u201d (Dinter). The expansion of doctoral training has also been demonstrated beyond the borders of thecountry, reaching Latin America, with the assistance to implement Stricto Sensu Programsand reception of foreign professionals to conduct courses in the headquarters of thePrograms. Solidary actions of international academic cooperation, such as the offer of aDinter to PUC-Chile, and training of doctors to countries such as Mexico, Peru andColombia, among others, strengthen the Nursing Area and the Brazilian Programs.3.Since the implementation of the first course in 1972ranking of theScopus/SCImago database in 2006 to the seventh in 2016 in terms of number of documents,overtaking the United States, United Kingdom, Australia, Canada, France and China. Thechallenge is to maintain stability in the ranking in citation ofpublications and raise the position in the H index, which has remained at 96, correspondingto the 22nd placeThe quantitative-qualitative growth of the Programs reverberated in the expressivescientific production evidenced in this quadrennium, which counted the publication of16,321 articles, representing a relative growth of 77% in relation to the last triennium.The impact of this production can be seen in the international projection of BrazilianNursing, in the jump from the eleventh position in the expertise of professors who, as seen in the evaluationof the Programs, have worked on many and diverse work fronts in institutions, associations,societies, scientific journals and international events. The international visibility of Researchers and Programs of the Nursing Area is expressedthrough various activities that take place in the framework of agreements, technicalcooperation and other types of interinstitutional partnerships, as well as initiatives ofincentive of research and events that increase mobility actions of researchers andstudents. These insertions have resulted in institutional academic ackowledgement,objectified in the stricto sensu postgraduate education, financed research, relevantpositions in the management/headship of services and academia, among others. The data haveshown the good placement or mobility of graduates with a rise in the labor market.Because these are programs whose goal is to qualify professionals, indicators to evaluatethe insertion of new doctors in the labor market have also been applied in the evaluationof the Area and have evidenced the important work carried out in the field ofInternationalization has been the target of Nursing training, with expansion ofinternational collaborative networks, exchanges of professors and students, and attractionof foreign professionals for qualification in Brazil, both in master\u2019s and doctoralcourses, reaffirming the excellence of the Programs of the Area. In the meantime, thescientific production of international circulation is the one that most strongly evidencesthe capillarity of diffusion and recognition of the Nursing Science produced in Brazil, somuch that 40% of the weight of the evaluation of potential programs classified as 6 and 7regarding international excellence is attributed to this aspect, followed by internationalparticipation (25%) and complemented by the analysis of indicators of faculty leadership(15%), nucleation (10%), and solidarity (10%)When this scientific production is done in partnership with foreign researchers, itdistinguishes and discriminates the international excellence of the Programs. In thisquadriennium, among the 3,198 articles produced by the seven programs to whichinternational excellence (6 and 7) was assigned, 10.7% were published with foreignauthors.Besides increased scientific production, the number of qualified journals in which theNursing Programs have published increased by 30%, from 1,213 in the previous triennium to1,579 in the present quadriennium, 39% of them with JCR/WoS and 53% with H/SCImagoindexDespite the increase of collaborative and multicentric research in partnership with foreignresearchers, with consequent increase in joint scientific production, this aspect of theinternationalization process still needs to improve, as well as the development oftechnological production in the Nursing Area, co-advising, double degrees, provision ofclassess in the English language and the raising of funds in foreign agencies/institutions.These represent challenges to be overcome in the coming years, requiring a strategic planwith actions to be implemented by the Programs.In the process of evaluation of the present quadrennium, there were pioneerisms, as said,but portrayed achievements in itself, in the overcoming of adversities of the contemporaryworld, of shortage of funding, and of the impacts of retirement plans that imply thereformulation of the teaching staff. Nonetheless, the Area is aware of the challenges to befaced and remains firmly committed to advancing in training and evaluation processes thatcause impacts with quality, applicable, and change-generating academic-scientificproducts."}
{"text": "Recent research indicates that (a) the perception and expression of facial emotion are lateralized to a great extent in the right hemisphere, and, (b) whereas facial expressions of emotion embody universal signals, culture-specific learning moderates the expression and interpretation of these emotions. In the present article, we review the literature on laterality and universality, and propose that, although some components of facial expressions of emotion are governed biologically, others are culturally influenced. We suggest that the left side of the face is more expressive of emotions, is more uninhibited, and displays culture-specific emotional norms. The right side of face, on the other hand, is less susceptible to cultural display norms and exhibits more universal emotional signals."}
{"text": "Zhong He was not included in the author byline. He should be listed as the tenth author and affiliated with the Division of Infectious Diseases, Vaccine & Gene Therapy Institute of Florida, Port Saint Lucie, Florida, USA. The contributions of this author are as follows: Performed the experiments and Analyzed the data."}
{"text": "Department of Health and Human Services, the task force is an independent, nonfederal, uncompensated panel of public health and prevention experts whose members are appointed by the Director of CDC. The task force provides information for a wide range of decision makers on programs, services, and policies aimed at improving population health. Although CDC provides administrative, research, and technical support for the task force, the recommendations developed are those of the task force and do not undergo review or approval by CDC."}
{"text": "Flora of Republicae Popularis Sinicae . He was also a leading character in the history of botanical collection by Chinese botanists, and published hundreds of new genera and species, including the famous \u201cliving fossil\u201d plant\u2014Cathaya argyrophylla Chun et Kuang , a leading botanist and taxonomist , CAS and Guangxi Institute of Plant Research Fig.\u00a0. MoreoveSunyatsenia in China, co-founded the Botanical Society of China, and served as the editor and president of The Chinese Journal of Botany. In honor of his great contributions, many plants were named after him, such as the genera Chunia, Chuniophoenix, Chunechites, and the species Lindera chunii, Neolitsea chui and Vernonia chunii, etc  and published by Commercial Press in 1922.The following year, Huan-Yong Chen was appointed as a professor of forestry at the University of Nanking and started teaching at National Southeast University in 1922, where he worked together with Xian-Su Hu , Zhi Bing (\u79c9\u5fd7) and other renowned biologists in China Fig.\u00a0. In 1922In 1927, Prof. Huan-Yong Chen was appointed as a professor in Sun Yat-Sen University, and in the following year, he founded and directed a new institute of botany in the university. He helped to establish the professional and qualified herbarium in Southern China in 1928. Furthermore, he made specimens exchanges with more than 60 countries and obtained more than 30,000 foreign specimens to enrich the specimens for herbarium in the 1920s. This herbarium is still considered as one of the top three Herbariums in China till now. In 1929, Prof. Chen was appointed as the first director of Institute of Agriculture and Forestry, which was the predecessor of SCBG. Since then, he devoted his entire life as the director of SCBG and donated hundreds of publications to the library of SCBG. In 1935, he also founded the Economic Institute of Botany in Guangxi University and served as the first director, and he was also involved in the design and construction of the Guilin Botanical Garden Hu, .Deriration of Genera Names, the English version of Chinese Seed Plant Identification, and books for teaching Latin: Question from botanical latin and Eseential Latin for Chinese taxonomy botany. In 1930, he established and edited Sunyatsenia, the first Chinese professional plant taxonomy journal in English, and till 1948, 7 volumes 26 issues were published . This journal gained a great reputation and received awards from home and abroad by its high quality and professional articles.As an educator, Prof. Chen trained numerous famous botanists including Ren-chang Qin, Feng-Huai Chen, Ying Jiang , et al. He also edited and compiled a number of textbooks and reference books for teaching, for example, the Latin version of Icones Plantarum Sincarum from 1925 to 1932, in which they reviewed all the published illustrations and descriptions of Chinese plants. The scientific researches on the flora in South China gradually expanded under Prof. Chen\u2019s leadership. In 1933, Chong-Shu Qian, Xian-Su Hu and Huan-Yong Chen were invited to found the Botanical Society of China, and in the same year, Prof. Chen was appointed as the editor and academic council member of The Chinese Journal of Botany. In 1936, he became the president of The Chinese Journal of Botany, after serving as vice president since 1934.Prof. Chen became well-known as the leading botanist in South China by both Chinese and foreign scientists in 1930s. He collaborated with Xian-Su Hu and published five volumes of During World War II and the War of Resistance against Japanese Aggression, in order to preserve thousands of precious specimens and literatures, Prof. Chen risked his life to ship them from Guangzhou to Hong Kong. In 1938, with his staff, he managed to keep on doing researches in the Kowlong office until Hongkong was also occupied in 1941. In 1942, he moved the stuff back to Guangzhou in order to continue his research. At that time, he was forced to collaborate with the Puppet Government (Japanese forces), which brought him into trouble in 1945 when the nationalist government accused him for collaborating with the enemy . Although the charges were squashed later, the development and the research work of the institute were badly affected by the lack of research funding and the war.In spite of those adverse situations, Prof. Chen still chose to stay in Mainland rather than Taiwan when P. R. China was established in 1949. He became the first director of SCBG in 1954. In the same year, he was elected as a member of the first National People\u2019s Congress (NPC), and was subsequently reappointed for second and third NPCs. He was also, a faculty member of Biology and Earth Sciences department in Chinese Academy of Sciences (CAS). In 1955, Prof. Chen was elected as one of the first academicians in CAS for his outstanding contribution in the field of botany and taxonomy, which is the highest honor for a Chinese scientist.Cathaya with Ke-Ren Kuang  and published the famous \u201cliving fossil\u201d plant\u2014Cathaya argyrophylla Chunet Kuang. In addition, he described more than 100 new species and more than 10 new genera including Tsoongiodendron (Magnoliaceae) and Zenia (Fabaceae) within ten years  and later he led a team to complete a survey of the Flora of Guangzhou, which was the first Chinese endemic flora survey completed by Chinese botanists. He also participated in the publication of the Flora in Hainan. In 1963, Prof. Chen was elected as academic chairman of the 30th anniversary conference for Botanical Society of China in Beijing and a member of Academic Committee of Institute of Botany, CAS .In 1959, Prof. Chen was appointed as the Associate Editor-in-Chief of Prof. Chen was born mixed-blood parentage, his father was a Chinese Consul in Cuba and his mother was a Spanish Cuban. In addition, he studied and lived in the US for decades, which broadened his international viewpoints and understanding of both eastern and western cultures. He was good at both English and professional Latin, which gave him more opportunities to present and improve the perception of Chinese botanical researches. In fact, before 1949, most of his thesis and academic articles were written in English or Latin.Species Muscorum Frondosorum , which was a significant milestone of a worldwide appreciation of Chinese botanists. In 1936, Prof. Chen was awarded as Honorary Vice President of British Gladiolus Society, and appointed as a member of Massachusetts Horticulture Society . In 1951, at the symposium on Origin and distribution of cultivated plants of South Asia held in New Delhi, India, Prof. Chen presented his research work as the head of the delegation of CAS. He also visited several Plant Research Centers on behalf of CAS and helped identify plant specimens in Leningrad (Saint Petersburg), former Soviet Union in 1958  kept a life-long friendship with him ever since they meet in 1920. Dr. Merrill donated a lot of precious publications to the library and specimens to the herbarium, and also wrote an article for the first issue of the journal South China Morning Post (Chen, In addition to his botanic research, Prof. Chen was also interested in literature. He read lots of European and American novels from the library during his study at Harvard University and some of his poems were published in the Hong Kong newspaper st Chen, .Memorial collections of Huan-Yong Chen was published in 1996 to memorize all his endeavors to the development of SCBG.Prof. Chen passed away in 1971, and left countless treasures for the next generations. In 1978, a memorial meeting was held by Guangdong Academy of Sciences. Many government officials and scientists attended this meeting to greet Prof. Chen\u2019s outstanding contributions to the development of Chinese botanical sciences. In 1996 and 2006 respectively, his bronze statues were built in the Herbarium and the garden of SCBG. And the internal book of As one of the most outstanding botanists in 20th century and one of the pioneers and founders of modern plant taxonomy in China, with a strong determination to establish the modern Chinese botanical research, Prof. Chen considered the development of Chinese botanical science as his life-long mission. He was blessed to do what he loved, and made his dream come true-to set up China\u2019s own botanical research, Herbarium, botanical library, Chinese flora, botanical gardens/institutions and natural reserves, which were deeply respected all over the world."}
{"text": "Health-related quality of life (HRQOL) measures are used to assess the multifaceted impact of disease, and determine the utility and associated disability. In addition, the impact of medical interventions must be assessed by psychometrically robust HRQOL measures based on a comprehensive and dynamic model. To develop such a model, the concepts of life, its quality, domains, essence, and purpose must be properly and clearly understood. The correct understanding of these entities is specifically important for patient-centered medicine and has universal implications for all fields of human endeavor. Therefore, in order to explore questions about life and quality of life adequately, every necessary field of knowledge should be employed. A multilinguistic and etymological appraisal reveals that life is related to medicine, freedom, being, soul, and spirit, all of which must therefore be considered in its conceptualization."}
{"text": "Editor-in-chief of the Journal of Intensive Care. To date, this Journal, which was launched in October 2013, as the official journal of the Japanese Society of Intensive Care Medicine (JSICM), has been outstandingly led by Professor Satoshi Gando, the founding Editor-in-chief. Being an international journal, the members of Advisory and Editorial Board embrace many worldwide leaders in the intensive care field. Based on their continuous and persevering efforts, in addition to the enthusiastic contribution by all authors and/or researchers, we are proud of a number of remarkable and significant articles published in the first stage of this newborn journal. In the first 2\u00a0years after its launch, more than 55% of the submissions came from Japanese researchers and/or intensivists; now, almost 75% of the submissions come from researchers in other areas of the world, including North America and Europe, as well as Asia, Middle East, and Oceania , implying that the journal is close to obtaining Social Sciences Citations Index value .Owing to the countless journals that have been launched in the last decade, international journals must now compete with each other within the same field of medicine. By the end of 2017, there were 57 and 137 journals including the term, intensive care and critical care, respectively. To prevail and thereby step forward in these types of struggles between the journals, we must continue to work hard on improving both the academic and clinical quality of this journal by publishing high-quality articles and simultaneously providing more constructive peer-review processes. To date, all articles published in the Towards the Second Stage as an international journal, the Journal of Intensive Care shall work hard to contribute to the development of state-of-the-art intensive care and to thereby amend both the short- and long-term outcomes of critically ill patients. Our Editorial Board members earnestly look forward to a number of submissions from all over the world that will further improve the state of intensive care better than today."}
{"text": "After publication of the original article , it cameDr. Papp contributed to the conception, design, and initial draft of the study protocol, so the Author contributions section of the article should be revised as follows:Author contributionsAll authors contributed to the development of the trial protocol and approved the final manuscript. KS led the development of the operations manual and standardization of data collection, undertook initial drafting of the manuscript, and is involved in the overall coordination of the multi-site study. LS, SW, and KM conceived the study, obtained funding, drafted the initial protocol, and are responsible for the communication of the study results. Guidance on clinical data, participant examinations, and study procedures were provided by SW, KM, ML, and MY. JR contributed to the design of this pilot study. SW, KM, ML, MY, NL, and MS led the study at the site responsible for patient recruitment, follow-up, and clinical evaluation. EP contributed to the conception, design, and initial draft of the study protocol.Dr. Papp has no conflicts of interest to declare."}
{"text": "Department of Health and Human Services, the task force is an independent, nonfederal, uncompensated panel of public health and prevention experts whose members are appointed by the director of CDC. The task force provides information for a wide range of decision makers on programs, services, and policies aimed at improving population health. Although CDC provides administrative, research, and technical support for the task force, the recommendations developed are those of the task force and do not undergo review or approval by CDC."}
{"text": "Disease Selection: The Way Disease Changed the World by Roger Webber is written in the tradition of Rats, Lice and History by Hans Zinsser; Guns, Germs and Steel: The Fates of Human Societies by Jared M. Diamond; and Viruses, Plagues, and History by Michael B.A. Oldstone. These volumes focus on the role of diseases, particularly infectious diseases, in history. Compared with the others, however, Dr. Webber\u2019s book is more focused on the effects of diseases on natural selection and evolution. These factors sometimes work in parallel and sometimes in opposition but always in highly complex and often unpredictable ways. The book is clearly written for a knowledgeable lay audience, a difficult task when covering evolution, microbiology, a wide variety of diseases and modes of their transmission, and immunologic responses to those diseases.The book begins with a brief review of the origins of life on earth, including a discussion of the earliest life forms, the archaea and bacteria. Dr. Webber then describes the development of the various means of reproduction and their effects on the evolution of species and increasing complexity of life forms. In the first chapter, he covers the evolution of sexual reproduction and its effect on survival of species. Later, he discusses the role of diseases and the likely influence of endogenous viruses in the evolution of higher life forms, including humans.Plasmodium spp., the cause of malaria. When the role of mosquitoes in transmission of malaria and other diseases was recognized in the 19th century, the complexity of biological relationships at all levels was revealed. For instance, because mosquitoes are damaged by blood infected with filarial parasites, those mosquitoes are less likely to transmit other disease agents such as those that cause malaria.Human ancestors originated in Africa and, to this day, this continent contains a unique variety of infectious agents that have likely effected human evolution. Malaria, for example, has probably led to the ability of populations to sustain sickle cell anemia because of the relative resistance of sickle red cells to Smallpox, plague, influenza, and other diseases have killed large percentages of the world\u2019s populations at various times in the past. When smallpox and measles were brought to the New World, by Europeans who were carrying variola and measles viruses, indigenous populations in South America suffered great loss of life. After these epidemics, mortality rates for survivors and their progeny were lower than for newly exposed persons who became ill. This lends support to the concept of selection of populations resistant to diseases after substantial proportions of the populations have been killed by these diseases. Later chapters deal with the effects of war, breast feeding, diet, climate change, migration, and domesticated animals on the evolution of human beings.Dr. Webber has succeeded in the ambitious task of describing the evolution of a broad range of organisms and their interrelationships during that process, with special emphasis on how diseases have influenced the evolution of humans. The book is clearly written, and many will find the index and extensive references useful. It will be an enjoyable read for audiences with a broad range of expertise in the biological sciences."}
{"text": "To understand the implementation quality of the Tier 1 Program of the Project P.A.T.H.S., two observers carried out process evaluation in six schools randomly selected from the participating schools in the form of systematic observations of 12 units. Results showed that the overall level of program adherence was generally high, ranging from 50% to 95%, with an average of 84.5%. High implementation quality of the program in the areas of student interest, student participation and involvement, classroom control, use of interactive delivery method, use of strategies to enhance student motivation, instructors familiarity with the students, opportunity for reflection, degree of achievement of the objectives, quality of preparation, overall implementation quality, and success of implementation was also observed. The findings provide support for the implementation quality of the program."}
{"text": "This study determines the influence of the different soil components and of the cation-exchange capacity on the adsorption and retention of different heavy metals: cadmium, chromium, copper, nickel, lead and zinc. In order to do so, regression models were created through decision trees and the importance of soil components was assessed. Used variables were: humified organic matter, specific cation-exchange capacity, percentages of sand and silt, proportions of Mn, Fe and Al oxides and hematite, and the proportion of quartz, plagioclase and mica, and the proportions of the different clays: kaolinite, vermiculite, gibbsite and chlorite. The most important components in the obtained models were vermiculite and gibbsite, especially for the adsorption of cadmium and zinc, while clays were less relevant. Oxides are less important than clays, especially for the adsorption of chromium and lead and the retention of chromium, copper and lead. Heavy metal contamination id defined as excessive contamination from a series of metal elements, most of which are potentially toxic for the organism in a given ecosystem . As for Although contamination by these elements affects all the levels in an ecosystem ,4, the mAspergillus niger and Penicilium sp tolerating Cr and Cd 59].Kaolinite is the most important clay for copper retention, just like in the case of adsorption. As for oxides, they show a lower importance, and Mn oxides are not importance, so their affinity with copper is low, although they can be associated with clays for a higher efficiency .For nickel retention, kaolinite is the most important clay, followed by gibbsite. As for oxides, Fe oxides are the most important ones, although their importance is lower than the coefficient of kaolinite, which means clays predict the retention of this metal better than oxides .In lead retention, the most important clay is gibbsite. The contribution of oxides is not very important, although they are important for . HematitIn zinc retention, gibbsite is the most important clay, while Fe oxides are the most important oxides when these compounds are considered, although they do not appear in the optimal tree. This contribution by clays, together with the fact that the percentage of silt is the most important variable for Zn retention, coincides with the descriptions by , 46.Machine Learning) enables to know how the migration of inorganic pollution, both metallic and non-metallic, occurs.With these techniques, it is possible to study how it affects the different components of an ecosystem depending on its characteristics , where iCynodon dactilon and Humulus scandens [From a broader perspective, these techniques enable us to know what the most serious contamination problems are and to select the best bioremediation method, if it is possible. This was the case with the selection of the best plant species for the restoration of the dump in a manganese mine, where different aspects, such as the concentration of heavy metals, were studied. Apart from manganese, cadmium, copper and zinc were mainly found. After studying the accumulation of heavy metals, it was found that the best species for revegetation were scandens .As general conclusions, the following can be mentioned:2 in all metals retention and absorption, except in the case of Zn retention, in which there was no change.Regression tree models (CART) allowed ranking the relative importance of the different soil components according to their relevance coefficients, on the adsorption and retention of 6 metals using 14 different soils. The cross-validation method allowed the improving of the models in terms of RThe behaviour of the different adsorption and retention models for the 6 studied metals are different, with the first variable splitting the regression tree being quite variable.The metals can be sorted out in two groups. One of them includes Cd, Ni and Zn, which generally show a high importance of the texture components such as the percentage of sand. The other group, including Cr, Cu and Pb, shows that the exchange capacity, humified organic matter and the proportion of hematite are the most important variables, as it happens in , 46.Lastly, in some cases, there are cases of co-adsorption of several metals or of to components having a joint adsorption, as it happens with gibbsite in the adsorption of chromium . As for S1 Table(PDF)Click here for additional data file."}
{"text": "The perspective of the integrated health system has a network of care withmultiple integration dimensions among subsystems as nuclear representation,relating the clinical aspects and governance to the representations andcollective values. The normative integration aims to ensure coherence betweenthe system of representations and values of society simultaneously with theinterfaces of clinical and functional integration. It builds a bridge withgovernance, which allows, through their skills, management of all systemcomponents, encouraging cooperation, communication and information, in order toensure the population under their responsibility to access excellence services,exceeding their expectations. The integration of care consists of a durablecoordination of clinical practices for those who suffer from health problems inorder to ensure continuity and full range of the required professional servicesand organizations, coordinated in time and space, in accordance with theavailable knowledge. It is possible to establish the type of health equipmentfor each level of care for patients with congenital heart diseases. Thisstrategy intends to offer timely care in appropriate moments and places,efficiently, operating cooperatively an interdependently, with ongoing exchangeof its resources. Thus, situational integration establishes the systemconnection with the assessment environment that proposes to carry out valuejudgment, guided by an objective worldview, about an intervention or any of itscomponents, in order to objectify the decision making. Similarly,the executive power can directly influence and create an appropriate environment for thewritten norms, and the more participatory, lower the risk of distortions in itsdeliberations. No less important than discuss the justifications and methodology of itsimplementation is to set goals and metrics for evaluation. Setting goals in light ofsocial needs and political and economic reality is a negotiation exercise whose outcomemust meet the principles as equity and integrity, which are in the guidelines of theUnified Health System (SUS), even not experienced in its completeness.In this thread, the society acquires the condition and the capacity to share with otheragents the political control, thus, providing the responsibility to maintain, adapt andexpand its scope.Consequently, the society starts to communicate with the system through an integrationand control link.The sensitization of the political environment moves towards influencing the decisions ofthe executive power, and, thus, enables continuity of the agreed actions, which shouldbe more of a monitoring agent of the results. Even at the strategic level, the executivepower, with its bureaucratic status, are entitled to format the normative content bybringing the knowledge of the SUS guidelines, conducting health actions. In thisenvironment, the budget is allocated to all stages of the policies; however, theidealized amount is not accompanied by sufficient financial resources to solve theproblems, which is explained by the lack of knowledge on the project size or thedeliberate restriction of the budget to health. Anyhow, the financial failure willimpact over the implementation of the policy and determine its degree ofeffectiveness..The normative integration aims to ensure coherence between the system of representationsand values of society simultaneously with the interfaces of clinical and functionalintegrationIt builds a bridge with governance, which allows, through their skills, management of allsystem components, encouraging cooperation, communication and information, in order toensure the population under their responsibility to access excellence services,exceeding their expectations.Due to the complexity surrounding the governance, another organizational level was instituted beyond the tactical level, formed by financial andadministrative environments, structural, in order to give expression to vital sectors inthe development, maintenance and results of care networks. This organizational level iscomposed by logistics and information technology. The interface among theseenvironments, functional integration, ensures a common coordination, guided by a systemof agile and flexible information with ability to make decisions about responsibility,attributions and financial resources..The logistics systems are technological solutions, strongly anchored in informationtechnology, and linked to the concept of vertical integration. It consists in therealization of an effective system of reference and counter-reference of people andefficient exchange of goods and information over the health care and supportsystems.Another structural pillar in the integrated care networks in the governance environment,the information technology, had a significant development in recent decades and is afunctional support, whether strategic or operational, of the providers of health careorganizations. Its application extends quickness in providing information and sharingknowledge, enabling effective and agile decisions, as well as better coordination amongentities. It also requires further information and capacity to handle problems relatedto confidential informationThe governance interface, responsible for tactical and structural actions, andoperational and clinical level, is done by clinical integration, which is based onmanagement strategies, finance, logistics and information in an effort to provide theclinical practice of multidisciplinary skills with a view to providing comprehensivecare to a given population..The integration of care consists of a durable coordination of clinical practices forthose who suffer from health problems in order to ensure continuity and full range ofthe required professional services and organizations, coordinated in time and space, inaccordance with the available knowledge. The integration of clinical teams has as mainattributes the multidisciplinary constitution of its members and its structural andparticipatory inclusion in the care networkBasic content of health care networks emerge from this definition: denote mission andcommon objectives; operate cooperatively and interdependently; constantly interchangetheir resources; are established without hierarchy among components, organize themselvesin a polyarchic way in which all health care points are equally important; imply acontinuum of care in primary, secondary and tertiary levels; call for a comprehensivecare with promotional, preventive, curative, caregivers, rehabilitative and palliativeinterventions; work under the coordination of primary health care; provide timely carein appropriate moments and places, offer safe and effective services in line with theavailable evidence; focus on the full cycle of care to a health condition; have clearhealth and economic responsibilities for its population; and produce a value for itspopulation .The first point of care is the primary care, which can be understood as defined in theAlma Ata Conference, in 1978:.\"[...] essential health care based on practical technologies, scientificallyreasoned and socially acceptable, made universally accessible to individuals andfamilies in the community through their full participation and at a cost thatthe community and country can maintain at every stage of their development, inthe spirit of self-reliance and selfdetermination. It is the first level ofcontact of individuals, family and community with the national health system,whereby health care are taken as close as possible to where people live andwork, and constitutes the first element of a continuing health careprocess\".The other components of health care networks are the points of secondary and tertiarycare, the network nodes where they offer certain specialized services produced by aunique production function. They are distinguished by their respective technologydensities, and tertiary points are technologically denser than the secondary points and,therefore, tend to be more spatially concentratedIt is possible to establish the type of health equipment for each level of care forpatients with congenital heart diseases. This strategy intends to offer timely care inappropriate moments and places, efficiently, operating cooperatively aninterdependently, with ongoing exchange of its resources . (The integration of clinical care in the primary, secondary and tertiary care dimensionsis linked to the concept of vertical integration, which refers to the combination,within the same organization or an interorganizational alliance, previously independentproduction units, but whose products are input from one unit to another ., compiling definitions, say that vertical integration is thecreation of a single management entity of two or more entities that provide services inlevels of care in order to improve the overall health status of a population in acertain geo-demographic regional context. For the WHO, vertical integration considers the aggregation ofinputs, provision and service management related to the prevention, promotion,diagnosis, treatment and rehabilitation of health. It is a synonymous term with theservices related to access, quality, user satisfaction and efficiency.By the same measure, Santana & CostaThe motivating factors to overcome the fragmentation of health care systems are the lowertransaction costs in the system and increased productivity for optimal use of commonresources., the division betweenprimary and secondary health care essentially corresponds to a preferred provider, sincethe perception of the consumer is focused on health care, unaware if it suffers from aproblem of 'primary' or 'secondary' nature.In customer perceptiveness asymmetrically informed in the face of supply agent in adisease situation, there is no perception and consecutively the capacity of decision toopt for health care consumption that offers varying levels of care. According toCostaIn this way, you can determine for each unit providing clinical care in the variouslevels of care, which services are made available to the user, observing concepts ofvertical integration ..In this context, territorial integration emerges, which enables the system to establishthe health needs of a specific population, under its responsibility, according to therisks, and implement and evaluate sanitary interventions for this population and toprovide care for people in the context of their culture and their preferences.Planning processes, organization, management and financing of health policy must be basedon knowledge of the regional reality historically constituted and expressed in updatedindicators of demographic, socioeconomic, political, epidemiological and sanitarynature, in other words, specific spaces and population. Such information and indicatorsshould be organized and articulated in models to establish causal relationships able toguide and support the action of the State in effective policies for intervention inreality.The knowledge of the regional reality depends on the recognition of professional andequipment deficits able to offer specialized care to specific population segment.Therefore, it is priority to establish a formal system of allocation of resources withappropriate geographical distribution of health facilities, human resources and programsso that professional activities cover the entire spectrum of comprehensive, primary,secondary, tertiary and long-term cares, with all agreements, connections and referenceneeded, mechanisms established to integrate various levels and institutions in acoherent and capable group to meet all patients' needs, within a definedpopulation-based scenario.In conclusion, situational integration establishes the system connection with theassessment environment that proposes to carry out value judgment, guided by an objectiveworldview, about an intervention or any of its components, in order to objectify thedecision making. Agents must be willing to reevaluate their logics, interests andspecific cultures to accept the proposed objectives, the method of work in pursuit ofcommon goals, more ambitious than the sectored and welfare ones"}
{"text": "Response to the 2014\u20132015 Ebola virus disease (EVD) outbreak in Sierra Leone overwhelmed the national capacity to contain it and necessitated a massive international response and strong coordination platform. Consequently, the Sierra Leone Government, with support of the international humanitarian community, established and implemented various models for national coordination of the outbreak. In this article, we review the strengths and limitations of the EVD outbreak response coordination systems in Sierra Leone and propose recommendations for improving coordination of similar outbreaks in the future.There were two main frameworks used for the coordination of the outbreak; the Emergency Operation Center (EOC) and the National Ebola Response Center (NERC). We observed an improvement in outbreak coordination as the management mechanism evolved from the EOC to the NERC. Both coordination systems had their advantages and disadvantages; however, the NERC coordination mechanism appeared to be more robust. We identified challenges, such as competition and duplication of efforts between the numerous coordination groups, slow resource mobilization, inadequate capacity of NERC/EOC staff for health coordination, and an overtly centralized coordination and decision-making system as the main coordination challenges during the outbreak.We recommend the establishment of EOCs with simple incident management system-based coordination prior to outbreaks, strong government leadership, decentralization of coordination systems, and functions to the epicenter of outbreaks, with clear demarcation of roles and responsibilities between different levels, regular training of key coordination leaders, and better community participation as methods to improve coordination of future disease outbreaks. With a total of 14,122 suspected, probable, and confirmed cases, and 3,955 deaths in all 14 health districts, the 2014\u20132015 Ebola virus disease (EVD) outbreak in Sierra Leone was the single largest in the history of the disease .Involvement of numerous national and international partners in the outbreak response necessitated the establishment of a strong EVD outbreak response coordination platform. In response to this, the Sierra Leone Government, with support from the international humanitarian community, established and implemented various frameworks for the national coordination of the outbreak from July 2014 until November 2015 , when thHealth coordination aims to ensure a coordinated and effective approach to emergency health program planning, implementation, supervision, and monitoring. It plays a critical role in ensuring available resources are effectively deployed and used, activities are well planned and synchronized and complement each other so that any gaps in the response operation are efficiently identified and resolved . OutbreaDuring our time supporting the outbreak response in Sierra Leone  was used as the coordination model, whereas from October 2014 until the end of the outbreak, the Sierra Leone Government established a command and control style incident management system (IMS), called the National Ebola Response Center (NERC), to coordinate the outbreak.Under the EOC coordination framework, three main EVD coordination groups, a national EOC, a Presidential task force, and a national EVD task force, were established at the national level Figure . The natA Presidential EVD task force, chaired by the Head of State, provided overall policy, strategic, and political direction for the outbreak response. An inter-ministerial committee, which included relevant cabinet ministers, heads of relevant multilateral agencies such as the United Nations (UN) and international non-governmental organizations (NGOs) and bilateral partners such as US Centers for Disease Prevention and Control and Public Health England, oversaw implementation of the decisions of the Presidential task force. A national EVD task force was also established, with the aim of involving a broader spectrum of national, district, and community stakeholders in the EVD response. In reality, this task force, which only met on a few occasions, did not function effectively.At the district level, the EOC coordination structure (district Ebola task forces) comprised five technical components; coordination; epidemiology/surveillance/laboratory; case management/infection control; social mobilization/psychosocial support; and logistics. The district task forces were chaired by the district council Chairmen, who organized daily meetings; each technical group also met on a daily basis. The coordination component included the leads for all the technical components, and discussions in these meetings were similar to those of the district task force meetings. At the supra-national level, a multiagency body, known as the Sub-regional Ebola Operations Coordinating Center (SEOCC), based in Conakry, Guinea, which coordinated the international and cross-border aspects of the outbreak and provided technical support to the national EOCs, was operational from June to October 2014.The NERC, which succeeded the EOC in October 2014, was more sophisticated and incorporated a civil\u2013military cooperative style of coordination, with deployment of Sierra Leonean and other foreign military personnel to support coordination and operation of the EVD response. It was chaired by a Chief Executive Officer who reported directly to the Head of State. Under this coordination framework, the operational and technical aspects of the outbreak response were clearly separated, with the establishment of a situation room that focused on monitoring the operational aspects of the outbreak, and the CMO leading the technical aspects, which were similar to the former EOC  was subsequently established to strengthen leadership and bridge the communication gap between the two main NERC groups; the situation room and the technical components. Structures similar to the NERC, District Ebola Response Centers (DERCs), with district Ebola situation rooms and Ebola response components, each with a district coordinator, were established at the district level. In October 2014, the United Nations Mission for Ebola Emergency Response (UNMEER) replaced the SEOCC. National and district offices of UNMEER were established in the three principally affected countries in October 2014, each with its own coordinator.In general, we observed progressive improvements in the coordination of the outbreak . HoweverAt the initial implementation stages of the NERC system, there was a lack of clarity about the roles, responsibilities, and channels of communication between the different coordination groups. This was particularly evident with the District Health Management Teams (DHMT), which comprised the district EOCs and the newly established DERCs. The same situation was experienced at the national level, with the technical components operating independently from the operational components, without effective collaboration with the NERC (and the Ebola situation room).Communication between the operational and technical components of the NERC was often suboptimal, at both district and national levels. This was mainly because of a lack of understanding of the new coordination mechanism, as no orientation was provided on the new mechanisms for civil\u2013military cooperation. This often resulted in duplication of efforts and unnecessary competition between the two NERC groups . This was reflected in the production of different technical epidemiological information by both groups.Furthermore, there were at least three EVD coordinators at the district level  leading to tension and conflict over control of the outbreak response. In districts such as Bombali, Port Loko, Kambia, and Western Area, foreign military personnel were also designated as coordinators, further compounding this conflict. Technical meetings were held with no clear mechanism for conveying recommendations to the main coordinating group. The i-PACT system was established to provide technical advice and improve communication between the two main coordination groups of the NERC at the national level; however, it achieved limited success. There was no direct funding to facilitate coordination between national and district level technical components.The community was involved in the coordination of the response at the district level, through regular participation of the paramount Chiefs at daily DERC meetings. This was however, not sufficient to obtain the full cooperation of community members on response activities such as active case finding, contact tracing, burials, and social mobilization. It appeared that the inadequate cooperation was because of misconceptions and fear. One of which was the perception that the treatment centers represented \u201cpoints of no return\u201d; whoever was taken there was thought not likely to return to the community alive. This resulted in community resistance, which was a distinct feature of this outbreak , 9.During the initial stages of the outbreak, the management of some of the coordination meetings was poor; meetings were unnecessarily long, and some did not reach any concrete decisions. This was evidenced by poorly prepared minutes and the lack of clear mechanisms for follow-up on agreed action points. Consequently, there were often delays of several days to weeks before action points were implemented. This often resulted in apathetic officials, poor attendance, and repeated discussions of the same topics.Many officials were members of multiple technical components or coordination groups, and the roles of other officials overlapped, resulting in the engagement of some of the key actors in frequent and prolonged meetings. For instance, the district Ebola task forces and their technical coordination component essentially included the same people and discussed the same issues. Slight reductions in these challenges were noted under the NERC system, which streamlined the number, participation in, and duration of coordination meetings. For example, the national Ebola situation room met twice a day for a maximum of 1\u2009h. Conversely, this led to concerns from some partners about the limited time for in-depth discussions of critical issues.Our observations highlighted multiple EVD information sharing channels and situation reports, each conveying different information and epidemiological data. This often fueled disagreements between partners resulting in poor use of the available data to guide the ongoing response. For instance, many stakeholders had different data collection guidelines and reporting formats, which challenged data aggregation at the national level. This resulted in poor coordination of the EVD data collection system and several versions of the national EVD database, each of which had its own limitations . At the We observed that weak coordination of the mobilization, and deployment of the resources required for the EVD outbreak response was one of the most critical challenges for effective control of the outbreak, particularly during the early phases. The logistical components were unable to estimate or quantify available logistics, supplies, and essential medicines. This led to inaccurate forecasts, which often resulted in insufficient supplies, as most medical supplies were imported. This was largely because of multiple supply chain systems, many of which were not captured in the national EVD inventory systems. The EVD resources, which were channeled through the EOC and NERC systems, often arrived late at the district level because of the bureaucratic financial and logistical management systems of both the EOC and NERC.Furthermore, the EVD coordination hubs (and associated resources) were often not located in appropriate places. This resulted in a breakdown in communication between the field teams and coordination hubs and delays in receiving the required support to the field teams. For example in Koinadugu district, although the epicenter of the outbreak was in Neine, a remote chiefdom at least 4\u20135\u2009h drive from the district headquarters, the outbreak coordination mechanisms and resources were predominantly located at the district headquarters. This severely limited the initial response to the outbreak in that area.The supervision, monitoring, and evaluation component of the EVD coordination system was observed to be weak, late into the outbreak response. There was no clear system for ensuring support supervision from national to district levels and from district to ward levels, to ensure that corrective action was taken when required. Thus it was difficult to ensure the quality of interventions and to rapidly identify gaps in the response effort. From July 2015, the NERC, supported by partners, established a critical monitoring team to monitor the quality of the response in districts reporting cases, as well as the preparedness level in districts that were not reporting.Coordination of outbreak response efforts plays a part in breaking the chain of transmission but will not ultimately control it single-handedly. Nevertheless, effective coordination of disease outbreak response should be an integral and critical component of overall outbreak control interventions . EffectiCoordination practices during the EVD outbreak highlighted improvement in outbreak coordination, as the mechanism evolved from the EOC to the NERC . Our obsWe observed several pitfalls, common to both coordination frameworks (EOC and NERC), which should be avoided during future outbreaks. These included competition and duplication of efforts between the numerous coordination groups; poor communication and relationships between the national and district coordination groups; weak and bureaucratic response components; and inadequate logistics and supplies. Other challenges include slow resource mobilization and disbursement because of bureaucratic systems; inadequate capacity of NERC/EOC staff for health coordination; overtly centralized and top-heavy coordination; and a decision-making system that concentrated on Freetown and district headquarters. Our observations also highlighted that although UNMEER was established to enhance outbreak coordination, its impact was limited  because We believe that early implementation of an IMS coordination system, such as the NERC, which is based on humanitarian cluster coordination principles, combined with a command and control style of coordination would have provided opportunities for better coordination of the outbreak response at the initial stages \u201318. ThisBased on our observations, we propose five recommendations to improve a coordinated response needed to control this type of disease outbreak in the future.First, all countries should establish EOCs, with simple IMS-based coordination mechanisms as part of outbreak preparedness and response efforts. Such centers should be led and maintained by the government , 19 to eSecond, decentralization of coordination systems and functions to the epicenter of outbreaks, with a clear demarcation of roles and responsibilities between the national, districts, and local levels should be encouraged. The national level should focus on technical guidance, policy and strategy development, resource mobilization, and technical oversight, while the district should be empowered to conduct the day-to-day coordination and operation of the outbreak response.Third, on-the-job training of all key coordination leaders to ensure better understanding of the coordination mechanism and enhance their coordination capacity is critical to enhance effective coordination. The content of such training should include general principles of health coordination, management of coordination meetings, strategies for identification and filling of critical gaps in the response, communication, conflict management, and inventory/logistics management skills.Fourth, better community engagement and participation in the coordination of future EVD outbreaks control is imperative. Modalities for ensuring better engagement of the community, such as conducting ongoing anthropological studies to better understand the community context and cultural norms should be prioritized.Finally, operational researches and monitoring and evaluation systems are needed to better understand outbreak coordination dynamics and to assess the effectiveness of health coordination mechanisms during disease outbreak responses in resource constrained settings, such as in the countries affected by Ebola.OO, ML, and NN were WHO Ebola response national technical coordinators in Sierra Leone at various times. In this capacity, they represented WHO in the EOC/NERC and were actively involved in the operations of these bodies. AC was WHO liaison officer to the EOC/NERC and was involved in the establishment and day-to-day management of the bodies. AA, IC, and K-BK were WHO district Ebola response coordinators in various districts. In this capacity, they represented WHO in the district EOC/DERC and were actively involved in the coordination of the outbreak at the district level. NS was WHO data management support to Western Area district, one of the epicenters of the outbreak, and participated actively in the coordination of the surveillance and epidemiology component. FD is a staff of MOHS Sierra Leone who was based in the EOC/NERC and actively participated in their establishment and day-to-day management.OO, ML, AC, AA, and IC conceived and coordinated the study. OO, ML, AC, IC, AA, NN, NS, K-BK, and FD drafted the manuscript. All authors read and provided significant inputs into the final draft of the manuscript, agreed to be accountable for all aspects of the work, and approved the final draft of the manuscript for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The handling Editor declared a past coauthorship with the authors and states that the process nevertheless met the standards of a fair and objective review."}
{"text": "Plague remains a public health concern worldwide, particularly in old foci. Multiple epidemics of this disease have been recorded throughout the history of Iran. Despite the long-standing history of human plague in Iran, it remains difficult to obtain an accurate overview of the history and current status of plague in Iran.In this review, available data and reports on cases and outbreaks of human plague in the past and present in Iran and in neighboring countries were collected, and information was compiled regarding when, where, and how many cases occurred.This paper considers the history of plague in Persia (the predecessor of today\u2019s Iran) and has a brief review of plague in countries in the World Health Organization Eastern Mediterranean Region, including a range of countries in the Middle East and North Africa.Yersinia pestis has been reported among rodents and dogs in western Iran, more attention should be paid to disease monitoring in areas with previously reported human cases and in high-risk regions with previous epizootic and enzootic activity.Since Iran has experienced outbreaks of plague for several centuries, neighboring countries have reported the disease in recent years, the disease can be silent for decades, and the circulation of  Yersinia pestis, which was discovered in 1894 by Alexandre Yersin [Xenopsylla genus, in particular X. cheopis. Living in rural areas, hunting or trapping animals, and keeping cats and dogs increase the risk of infection among humans [Plague is a life-threatening infectious disease that is still endemic in some areas around the world. It is caused by the bacillus e Yersin ,3. The mg humans . The disY. pestis circulates at low levels in the rodent population in endemic foci of the disease [Y. pestis has also been used in bioterrorism in the past and its usage in the future for such purposes is not difficult to imagine [As  disease , outbrea disease ,6. Y. pe imagine . Studies imagine ,9, whichY. pestis has been reported throughout the world, and plague is enzootic in rodents in Africa, North and South America, and Asia  [There have been three great world pandemics of plague. The first one, known as the Justinian plague, occurred in the Byzantine Empire (Constantinople) in the 6th century Common Era (CE) and spread through the Middle East, the Mediterranean, and Europe. The second pandemic, known as the Black Death, began in India, China, and some regions of Russia, and reached Western Europe in 1347 CE. The third pandemic was the Hong Kong epidemic that started in 1855 CE in Yunnan Province, China ,4. Y. pet Union) ,10,11. At Union) .Some plague endemic foci still exist in central Asia; western Arabia (the Asir region); the Middle East, with a center in Iranian Kurdistan; central and southern Africa, and northwestern India -16. BetwPlague is one of the oldest infectious diseases in Iran, and has had devastating effects on the human population of Iran throughout history. Our understanding of plague pandemics has rapidly expanded in the last decade, largely due to molecular approaches, but much remains to be understood regarding past plague epidemics in various parts of the world, particularly in Iran, as Persia was the greatest empire in the Middle East for much of its history.The region of Kurdistan, north of the Zagros Mountains in Iran and stretching across southern Turkey and the north of Iraq and Syria, is considered one of the most significant endemic foci of plague worldwide -25.This review considers the history of plague in Persia (the predecessor of today\u2019s Iran) and incorporates a brief review of the countries in the WHO Eastern Mediterranean Region, consisting of several countries in the Middle East and North Africa that have frequently experienced plague outbreaks in recent decades, including Afghanistan, Bahrain, Iraq, Jordan, Kuwait, Lebanon, Saudi Arabia, Syria, United Arab Emirates, Yemen, Egypt, Libya, Morocco, and Tunisia.Historically, the territory of the Persian Empire encompassed all of today\u2019s Iran, Iraq, Lebanon, Jordan, Armenia, Turkey, and Syria, as well as parts of Saudi Arabia, Afghanistan, Pakistan, the Caucasus, Central Asia, and Egypt.2 , Iran ranks eighteenth in size among the countries of the world. Iran has a variable arid climate, in which most of the relatively scant annual precipitation falls between October and April. Seven percent of the country is forested.Iran is a Middle Eastern country, located south of the Caspian Sea and north of the Persian Gulf and Gulf of Oman. It shares borders with Iraq, Turkey, Azerbaijan, Turkmenistan, Armenia, Afghanistan, and Pakistan. With an area of 1,648,000 kmHistorical records show that plague has been active in Iran for centuries; however, insufficient information, invalid documentation, the misclassification of plague as a different infectious disease such as cholera, and the way in which plague has interacted with social dynamics have hindered the analysis of plague outbreaks over time.Plague frequently recurred in Iran throughout history, but the dating and characterization of the nature of plague outbreaks remain imprecise. The rapid expansion of plague with high mortality rates may have been related to sparse treatment centers, a poor public health system, the absence of effective quarantine arrangements, washing the dead bodies in rivers before burial, and transferring corpses to sacred places such as Mashhad, Qom, Najaf, and Karbala . Plague In 543 CE, plague reached what is now modern Iran after passing from Italy to Syria, Palestine, and Iraq, and infected the Persian imperial army and the population at that time . In 544 Kit\u0101b al-Malakiyy. Abu Sahl \u2018Isa ibn Yahya al-Masihi al-Jorjani (960-1000 CE) wrote an article about plague; and, interestingly, the Canon of Medicine of Avicenna (980-1037 CE) noted the clinical signs of bubonic plague and Esmail Jorjani (1042-1137 CE) mentioned inguinal lymphadenopathy as a sign of bubonic plague [To the best of our knowledge, no concrete documentation exists of plague outbreaks and the impact of the plague on Persia between 689 and 1270 CE; it seems, though, that plague continued to spread throughout Persia, remaining endemic after the outbreaks of 689 until the middle of the thirteenth century. Ali ibn al-Abbas al-Majusi (933-1000 CE) described plague in his medical book titled c plague .The Travels of Marco Polo, he mentioned that the city gates were closed due to the plague [Marco Polo, the famous Italian merchant traveler, reached the city of Tabriz, in northwestern Iran, in 1270 and in e plague .Several outbreaks of human plague occurred during the Safavid period (1495-1735 CE), affecting areas in northern Iran such as Gilan, Tabriz, Qazvin, and Ardabil. Another outbreak occurred in Qom, another city in the north, which continued for five years with 12,000 deaths. After the collapse of the Safavid Dynasty and the occupation of Iran by Afghan invaders, another plague outbreak was recorded in Gilan in 1727 CE. In 1731 CE, approximately 20,000 people died due to a plague outbreak in Hamadan and the western region of Iran .In the epidemics of 1772-1773 CE in Iran, quarantine practices were introduced into the Persian Gulf region for first time . This ouIn 1800, a plague outbreak started in the city of Mosul, northern Iraq, and spread to Baghdad and Istanbul. The authorities introduced quarantine measures to prevent the spread of the plague to India. During this wave, the workers of the British East India Company were moved to a village outside Basra. This led to no reports of plague among European residents .In 1830, an epidemic of plague affected the entire Persian Gulf region. The disease began in the fall of 1830 with an outbreak in Tabriz, northern Iran, which led to the death of 30,000 people and the relocation of the Iranian capital from Tabriz to Ardabil ,38. In 1A plague epidemic in western Iran, in the Kurdistan, Kermanshah, and Hamadan regions, led to thousands of deaths from 1829 to 1835 and in 1870 . In 1876Mohammad Razi Tabatabai, the senior physician of the army during the reign of King Naser al-Din Shah Qajar wrote a book on plague in 1875, in which he described the medical practices of the time and discussed control strategies for plague . BetweenA plague epidemic in a village north of Sabzevar, Khorasan Province in northwest Iran killed 37 individuals in 1877 . AnotherIn 1877, an epidemic of the disease was again reported in the cities of Rasht, Bushehr, and Kermanshah. Following that, a devastating epidemic occurred in the regions around the Persian Gulf; as a result, British forces founded the first quarantine center on Hengam Island, Bushehr, to prevent further transmission of the disease to other points of the country .The plague epidemic in 1906 in the province of Sistan and Baluchestan, southeastern Iran, was restricted to the regions around Sistan Lake, and it is believed that the infection was transmitted to this area via old clothes imported from India .During the plague epidemics between 1910 and 1911 in Bushehr, in southern Iran, people fled the city, leading to a negative economic impact . In 1912In 1913, outbreaks were seen in two provinces in Iran: one in Kurdistan in the west, and the other in Khorasan, in the east . A plaguSome of the plague outbreaks occurred in the area where the Anglo-Persian Oil Company, an English company, was actively extracting petroleum in the southern part of the country. The measures that were taken by this company had a great impact on the control of plague in the area. In 1925, plague vaccination started in the southern areas of Iran and 4,553 individuals were vaccinated. Houses were disinfected and with any new report of the disease, serious actions were taken, such as disinfection of all clothing, isolation of the patient, destruction of the house (with recompense), and prohibition of rebuilding on that spot .Meriones genus, including M. libycus, M. persicus, M. vinogradovi, M. tristrami, plays an important role in the persistence of plague. The latter two species are extremely sensitive to the causative agent of the disease, whereas the first two are resistant. The presence of plague in Kurdistan thus depends on the ecological interplay between susceptible and resistant rodent species living in close contact. Along with these species, other types of rodents are present, such as Microtus, Mesocricetus, Allactaga and Cristolus; these rodents are less frequently found and play a minor role in the epizootic evolution of the region [Plague was not reported again for 23 years until an outbreak in Kurdistan, western Iran, in 1947 . Due to e region . In 1953e region  concludePulex irritans, starting with rare cases of plague contracted in the fields. Such instances of inter-human transmission of plague, originating in villages, tend to die out rapidly due to the sparse population of the villages, the long distances between them, and the paucity of means of communication. However, when imported into an urban area with a denser human population, plague can immediately become the terrifying disease it was during the Middle Ages [Marcel Baltazard, the former director of the Pasteur Institute of Iran, and his Iranian colleagues studied 14,102 rodents in this region in 1966 and 1967, and found 66 infected rodents . During dle Ages . The lasdle Ages .Y. pestis could remain alive for several years in the burrows of dead rodents, and then re-infect the new rodents colonizing these empty burrows. In addition to the well-established rodent-flea-rodent cycle, they demonstrated the existence of the burrow-rodent-burrow cycle, allowing the inter-epizootic maintenance of the plague bacillus in its endemic foci [A major discovery resulting from the studies of these researchers in Kurdistan was the concept of burrowing plague . It was mic foci .Y. pestis were isolated from wild rodents  and from their fleas (Xenopsylla conformis and Nosopsylla iranus iranus) [The surveillance of regions surrounding the plague focus in Kurdistan, involving the study of wild rodents, revealed the existence of an epizootic center in Sarab in eastern Azerbaijan Province, north of Kurdistan, where plague had not yet been reported . In this iranus) .The surveillance of plague in Kurdistan by the Pasteur Institute of Iran revealed that the disease remained silent for a period of between three to five years in its natural foci and then reappeared in its rodent hosts ,54,55. TY. pestis infections were observed in the 1,800 rodents and 36,000 fleas monitored [The monitoring of plague continued from 1978 to 2001 through the Research Center for Emerging and Reemerging Infectious Diseases, located in Akanlu village in Hamadan. It concentrated on monitoring the disease in rodents, and positive rodents and/or fleas were identified. According to studies of the Pasteur Institute of Iran surveillance team during the Iran-Iraq war (1980-1988), in the areas affected by war, no onitored .A recent study in 2011 and 2012, conducted at the Research Center for Emerging and Reemerging Infectious Diseases (Akanlu), of the border area between Kurdistan and Hamadan provinces showed that 1.02% of the rodent population and 3.42% of dogs were positive for the antibody against the bacteria, implying that this focus is still active .Y. pestis are difficult to characterize. Using molecular biology technology on the few available strains from Iran and Kurdistan revealed that all isolates belonged to the Medievalis biovar [Y. pestis in Iran and its neighboring countries will hopefully supply strong evidence to fill the gaps on how the bacterium entered and circulated in Persia (Iran), and which biovar and genotypes of Y. pestis affected this region.Because most cases of plague outbreaks occurred before the emergence of microbiology, both the history and the historical population structure of s biovar , indicats biovar ,61, the s biovar ,63 and sIt is clear that plague frequently recurred in the Middle East and North Africa for over half a millennium, but the dating and the characterization of the nature of the plague outbreaks are fairly imprecise. Nevertheless, an attempt has been made to describe the periodicity and nature of recurrences of plague. The rapidity and the severity of these outbreaks raise the question of the endemicity of plague in this region.Roughly over the past century, plague outbreaks have been seen in at least 14 countries in the WHO Eastern Mediterranean Region in the Middle East and North Africa ; all of The WHO Expert Committee on Plague determined plague to be endemic in Afghanistan in its report in 1953 . EnzootiIn 1529 CE, an outbreak of plague occurred in Bahrain; leading to the failure of a Portuguese attack on this region. A plague epidemic in the Arabian littoral also affected Bahrain in 1773 ,67,68. Fal-Ashraf (the Notables) was recorded in Iraq and Syria [Throughout its history, Iraq has experienced multiple epidemics of plague . In 716 nd Syria . In an end Syria ,71. A plnd Syria . From 19nd Syria ,72.Plague in Jordan was first seen in the seventh century . In 1997The plague outbreak of 1773 CE in Iraq spread to Kuwait, leading to an outbreak in this region .This country has been affected by plague in a variety of ways over the ages and has played a significant role in transmitting the disease to other parts of the world. The plague epidemic in Marseille, France, in 1720 led to 50,000 deaths and occurred via transmission of the infection by a ship from Lebanon . In 1900This country has experienced several outbreaks of plague in the past . An outbThe circulation of plague among Syria, Palestine, and Egypt occurred regularly throughout history ,78. AccoIn 1914 and 1924, imported cases of plague were reported in Dubai .Y. pestis confirmed the nature of this outbreak in 1969.The oldest recorded case of human plague in Yemen occurred near the border with Saudi Arabia, in Asir Province, in 1815, and is believed to have spread to Jeddah and Mecca . The isoArvicanthis niloticus, and ectoparasites in combination with trade with Asia, Africa, and the Mediterranean, as well as the Nile floods, suggests that it is possible that Y. pestis was primarily a disease of the Nile rat, indicating that Egypt may have been the most probable point of origin of bubonic plague as an epidemic disease [In 1347 CE, plague reached Alexandria in Egypt, most likely through the port\u2019s trade with Constantinople and ports on the Black Sea . Between disease . In 1940 disease . The reeBetween 1913 and 1920, multiple outbreaks occurred in Libya, with the largest taking place in 1917 in Benghazi, where 1,449 people died of plague . Twelve The first plague cases reported in Morocco were in 1909 among 25 military stations in Casablanca. A severe epidemic with 8,000 to 10,000 deaths took place in 1911. Between 1940 and 1945, almost 5,400 cases were reported in Morocco in the regions of Chaouia, Agadir, Marrakech, Rabat, Doukkala, and Port Lyautey ,90. AnotPlague has not been very prevalent in Tunisia , althougAccording to the WHO Expert Committee on Plague (1959) , and fieAlmost all of the countries in the Middle East and North Africa have reported human plague outbreaks, although less focus has been placed on epidemics of plague in wildlife. In the last 50 years, human plague outbreaks have been reported in Saudi Arabia ,76, AfghY. pestis in Iran.The presence of exemplary studies on the wildlife population in Iran may be due to the existence of a research center founded in 1952 as part of the Pasteur Institute of Iran; at this center, extensive studies have been carried out on rodents and other animal hosts of Comprehensive studies of locations with historical records of human plague could help clarify the current status of the disease in this region. Otherwise, without adequate knowledge and preparation, human plague outbreaks are expected to continue.Y. pestis has been observed among rodents and dogs in western Iran, more attention should be paid to disease monitoring in areas with previously reported human cases and in high-risk regions with previous epizootic and enzootic activity. Plague should be more strongly emphasized in the medical education system in Iran. It is highly recommended that general practitioners and healthcare workers obtain adequate knowledge of the natural cycle of Y. pestis and the clinical signs of plague in order to help them identify the disease. Moreover, further studies are needed to better clarify the epidemiology of plague in Iran.The lack of reports of human plague over the past 50 years does not necessarily imply that the disease has not occurred among humans in Iran. Since Iran has experienced outbreaks of plague for several centuries, neighboring countries have reported the disease in recent years, the disease can be silent for decades, and the circulation of Finally, the following suggestions may be made to improve the surveillance of plague in Iran: 1) Health staff and practitioners in areas with prior outbreaks of plague, as well as in the eastern and western border areas of Iran, should be trained to be aware of this disease. 2) A standard protocol should be designed for preparing and dispatching suspected samples from all over the country to the Pasteur Institute of Iran. 3) Educational materials on plague in the form of pamphlets, seminars, and conferences concerning zoonotic diseases should be prepared and disseminated. 4) The Research Center for Emerging and Reemerging Diseases of the Pasteur Institute of Iran (Akanlu) should be equipped and empowered as the main center of surveillance, research, and education about plague and other emerging and reemerging diseases in Iran."}
{"text": "Physical Condition (2004), of the NursingOutcomes Classification (NOC) for its precise use in clinical practice. cross-culturally adapt to the Spanish context and make a new proposal for thenursing outcome, Physical Condition, was conducted and supported by theopinion of 26 experts. The data was obtained through an electronic form, anda quantitative analysis was conducted, using the SPSS software. a cross-cultural adaptation study and a proposal for the nursing outcome,Physical Condition, received agreement from 26experts, with a mean score greater than 7.6 for adequacy of the outcomedefinition and its indicators, and 8.5 for the relevance of the indicators.the version adapted to the Spanish context was obtained and the proposal ofthe outcome, Physical Condition were obtained. The results obtainedindicate a high level of adequacy and relevance, an instrument of greatutility in the clinic, and research was obtained to evaluate theinterventions directed to the improvement of the physical condition.the version adapted to the Spanish context and a new proposal for Thus a concept calledConsidering this, nurses, who work first hand with the population that suffers theeffects of an increase in sedentary lifestylehysical Condition Related to Health,Physical Condition (2004), and obtaining empiricalevidence of content validity and consensus of the proposed outcome, PhysicalCondition Related to Health, to be important because it is determinantthat an instrument adapted cross-culturally is adequately developed and validatedthrough the analysis of satisfactory psychometric propertiesPhysical condition (2004),is linked to the health field and is composed of 13 indicators related to the healthstatus of a person that can be assessed with a 5-point Likert scale, in which a \u00ab5\u00bbis the best possible score and a \u00ab1\u00bb is the worst possible scoreFinally, we considered that nurses rarely use objective measures to evaluate thePPhysical Condition(2004), of the 5th edition of the NOC, to the Spanish context andto make a consensus proposal by expert opinion of the nursing outcome,Physical Condition Related to Health.The objectives of this study were to cross-culturally adapt the nursing outcome,Physical Condition, and of its indicators, from the NOCclassification, 5th edition The study that was conducted was a cross-cultural adaptation of the nursing outcome,Thus, to achieve the objectives, the study was conducted in two different phases:Physical Condition, ofthe 5th Edition NOC, to the Spanish context.Phase 1. - Adaptation of the nursing outcome, The transcultural adaptation of the original version to the Spanish context wasconducted according the process described by Beaton et al.Physical Condition, were performed from the source language(English) to the target language (Spanish), obtaining two versions in Spanish, namedrespectively, translation 1 (T1) and translation 2 (T2). In this first stage, theresearchers and the translators compared both translations, and the discrepanciesthat arose were agreed upon. The translations were performed by two bilingualtranslators whose mother tongue was Spanish, and who had different professionalprofiles. Translator 1 was a health sciences and physical education professional,specifically, a graduate in psychology and a professional athlete with knowledgeabout the concepts that the measuring instrument evaluates. Translator 2 was agraduate professional in English studies, who had no knowledge of the concepts ofthe instrument, and was not related to health sciences or physical activity. 2)Synthesis of the translations: in this stage, starting from the two translationsinto Spanish (T1 and T2) and the original version, we made a synthesis of thesetranslations to obtain a common version called translation 12 (T12). 3) Backtranslation: starting from the T12 version, and without knowing or seeing theoriginal version, two translators translated the instrument into the originallanguage, to make sure that the translated version reflected the same indicatorscontained in the original version, resulting in two versions in English, calledback-translation 1 (RT1) and back-translation 2 (RT2). In the third stage, the twotranslators that produced the back translations, RT1 and RT2, were two people whosemother tongue was English and who did not have knowledge about the concepts exploredin the measuring instrument, nor were they trained in the health sciences or inphysical activity; in particular, they were graduates in English philology whoworked as teachers and researchers at the Catholic University of San Antonio deMurcia (Spain). 4) Expert Panel: At this stage, a panel of experts was created,consisting of all the translators who had prepared the different translations. Thegroup of experts consolidated all the versions of the measuring instrument, theoriginal version and each of the different translations , withtheir corresponding reports on the contributions of the translators, creating afinal consensus version in Spanish.1) Initial translation: first, two translations of the nursing outcome,Physical Condition, of the NOC 5th edition, basedon the opinion of experts.Phase 2 - New proposal of the revised version of the instrument for measuring thenursing outcome, Physical Condition Related toHealth, through the opinion of experts, to obtain theoretical evidenceof face, consensus and content validity. After the bibliographic search in differentdatabases  and the creationof a proposal of the definition of the nursing outcome, Physical ConditionRelated to Health, and of the main components detected in theliterature: cardiorespiratory capacity, musculoskeletal capacity, weight and bodycomposition, and motor capacityPhysical Condition Related to Health. The purpose of theform was explained to them in the e-mail, and they were asked to participatevoluntarily in the research study, as well as provided instructions for correctcompletion. The form was developed through the electronic application, Google Forms.In it, the experts had to evaluate, on a scale of 1 to 10, the suitability of theproposed definition, where 1 = not at all adequate, and 10 = totally adequate.Likewise, the experts also had to assess the relevance of the different proposedindicators of the outcome, Physical Condition Related to Health,with a scale from 1 to 10, where 1 = not relevant and 10 = very relevant, and thesuitability of the definition proposed for each indicator. They were also allowed toexpress, through an open question, any other personal contribution on the definitionof the outcome, and the relevance or suitability of the proposed indicators. On theother hand, in the last sections of the form, a question was included asking theexperts to indicate which indicator they considered as the gold standard among thoseproposed, if they considered it appropriate, and what others indicators of thePhysical Condition Related to Health were considered relevantbut not included in the proposed definition. The statistical analysis performed foreach definition was a calculation of the arithmetic mean of theadequacy variable. Thus, we were able to measure the level ofadequacy that the experts assigned to each definition, in which the higher the scoreobtained, the better adequacy, and vice versa. Likewise, the limits of thedistribution and variance were calculated to measure the degree of consensus; highvariance scores indicate a greater degree of discrepancy over the adequacy of thedefinitions, while low scores indicate a lower degree of discrepancy. For therelevance variable, the mean, variance, limits of thedistribution, frequency, and percentage were also calculated, according to thescores assigned by the experts to each proposed indicator. 2) Proposal of therevised version of the instrument for measuring the nursing outcome,Physical Condition, of the NOC 5th edition: according to thescores obtained from the group of experts that showed the high level of adequacy andrelevance, and starting from the consensus of the definition and of the indicatorsof the outcome under study, we proceeded to establish the indicators of the proposednursing outcome, called Physical Conditionrelated to health, as the gold standard indicator, carrying out anew proposal for the revised version of the nursing outcome, PhysicalCondition of the NOC 5th edition.The second phase of the investigation was composed of the stages described below. 1)Quantitative analysis of the definition of The software used for the statistical analysis of the data of both variables wasSPSS, version 24.The present study was approved by the Clinical Research Ethics Committee of theHospital Cl\u00ednico Universitario Virgen de la Arrixaca, belonging to Health Area 1(Murcia-West).Physical Condition, ofthe NOC 5th edition, to the Spanish context.Phase 1. - Adaptation of the nursing outcome, PhysicalCondition of the NOC 5th edition, show the translated versions of saidoutcome that are detailed in The results obtained in the first phase of the study, that is, the cross-culturaladaptation to the Spanish context of the nursing outcome, Physical Condition, of the NOC 5th edition, basedon expert opinion.Phase 2. - New proposal of the revised version of the instrument for measuring thenursing outcome, Physical Condition Related to Health. The origin of the expertswho participated in the round of work shows the diversity of health and physicalactivity professionals, who teach, conduct research or provide direct care invarious centers and services of sports medicine, Chair in sports, and faculties ofhealth sciences , whocontributed their knowledge to this study. Likewise, the largest number of expertscame from the nursing faculty at the Facultad de Enfermer\u00eda de la UniversidadCat\u00f3lica San Antonio de Murcia, as presented in In the second phase of the study, 26 forms were obtained, duly completed, with theopinion of the selected experts on the definition of the proposed nursing outcome,Physical Condition Related toHealth, as well as in the indicators raised, representing a high levelof adequacy. However, although there were differences between the assigned scores,the variance had low values, as can be seen in The statistical analysis of the data showed that the scores obtained afterconsultation with the experts revealed mean scores above 7.6 in the adequacy of thedefinition of the proposed nursing outcome, In relation to the statistical analysis of the scores obtained for the relevance ofthe indicators of the proposed outcome, the average scores were above 8.15, whichindicates high relevance, and the variance was low, revealing low discrepancybetween the contributions of the experts . A majorPhysicalCondition Related to Health, the results obtained suggested theinclusion of these indicators: muscle elasticity, fat-freemass, mobility or range of motion, bodyfatpercentage, and speed of reaction, although all ofthem had a very low percentage (3.85% -11.54%). However, body fatpercentage was the indicator that had the highest score (11.54%)and was included in the proposal, due to its significance in the assessment ofphysical condition in the health fieldAs for other indicators suggested by the group of experts for cardiorespiratory capacity indicator was the one with thehighest assigned score (34.62%), therefore, since it is an essential component ofPhysical Condition Related to HealthRegarding the star indicator raised by the group of experts, thePhysicalCondition Related to Health, was developed and agreed to by 26 experts,comprised of seven indicators; this proposal is presented next to the originalversion, in As a final result of the study, the proposal of the nursing outcome, Physical Condition, (T1 and T2) by the selected translatorsfacilitated the conceptual, cultural, idiomatic, and semantic adaptation in theSpanish context by these translators, resulting in a final synthesized version ofEnglish to Spanish (T12). The following phases of back translationand synthesis of the back translations contributed to theverification of the suitability of the T12 version, thus allowing us to initiate thesecond stage of the investigation.The use of a measuring instrument in a clinical environment, different from the oneof origin, requires a process of cultural adaptation to verify semanticequivalencePhysical Condition, of the5th edition NOC classification, adapted to the Spanish context, and agreed upon byconsulting experts, the definition of the outcome, Physical ConditionRelated to Health, had a high level of adequacy for which saiddefinition was proposed for the revised nursing outcome, since the physicalcondition not only implies carrying out physical activities with vigorExpert judgment is a fundamental procedure that would beframed within the content validityIn the proposal of the nursing outcome, The changes made to the label, definition and indicators of the proposed version,with respect to the original version of the 5th Edition NOC, in English, indicatethat the original nursing outcome required revision for its precise use in theclinical setting, and in the Spanish context.Physical Condition, amodification has been made by introducing a more specific label to the area ofinterest and study, that is, Physical Condition Related to Health.The concept of physical condition related to health encompasses those components ofphysical condition that are linked to the health status of a person, and that may bedetermined by the performance of physical activity on a regular basisRegarding the label of the nursing outcome, PhysicalCondition, of the 5th edition NOC, this did not cover the totality ofthe set of aspects referred to by the concept of Physical Condition Relatedto Health, as it is a very brief and incomplete definition. Afterconsultation with the experts, the definition of the proposed version of theoutcome, Physical Condition Related to Health, was agreed upon anddeveloped to obtain a Spanish version adapted semantically and culturally from therevised nursing outcome: a set of biological qualities that allow people tocarry out their daily life activities with vigor and caution, without excessivefatigue and with enough energy to enjoy leisure activities and face unforeseenemergencies.In reference to the definition of the nursing outcome, -musclestrength and body mass index, as they are allcomponents of the physical condition in the health fieldperformance of physical activities, performance of routineexercise, physical conditioning, blood pressure, target heart rate duringexercise, and resting heart rate, since, although some authors,cardiovascular function andrespiratory function, were replaced bycardiorespiratory capacity component, waist-hipratio was replaced by waist circumference, andjoint flexibility was replaced by flexibility.Finally, we have included 2 new indicators that are balance andbodyfat percentage, since they are essential dimensions of the physicalcondition related to health -Mentioning the indicators of the nursing outcome studied, and according to theopinion of the experts consulted, since it is considered that the evaluation processconducted by a committee of experts on the content of the items demonstrates contentvalidity of the adapted instrument for the other culture The knowledge of the adult population\u2019s state of physical condition is an importantindicator of health, and there is currently a deficit of instruments and studieswritten in Spanish that assess it-Physical Condition (2004), to the Spanish contextand the proposal of the outcome, Physical Condition Related toHealth, validated conceptually, through the opinion of a group ofexperts, it is a great contribution for its safe use in clinical practice, in theSpanish context.Currently there are few instruments that allow us to evaluate physical condition in asimple, economic, and accurate wayThe content validation evaluation analyzes the representativeness or adequacy of thecontent of the measuring instrumentPhysicalCondition (2004), of the 5th Edition NOC when being adaptedcross-culturally from the original English version, to the Spanish context,obtaining a version in Spanish language with the same semantic equivalences. It isconsidered that the conceptual validation of nursing outcomes is highly relevant forthe development of standardized nursing language, since it contributes to theimprovement of communication among nursing professionals, the application anddocumentation of the nursing process and the advancement of nursing knowledge.The study updated the existing knowledge on the nursing outcome, Physical Condition Related to Health,reflects the state of health studied in a more precise way, which will be able tofacilitate the systematized planning and implementation of nursing care for nurses.However, the importance of continuing the analysis of the rest of the psychometricproperties, in future studies, is highlighted.The proposed nursing outcome,"}
{"text": "We live in a time of amazing speed in the production, diffusion and interconnection of knowledge. This rapid pace has transformed the way children think, learn, and interpret information. The school, a space for formal learning, takes a strong sociocultural and affective role in this context, particularly in Brazil, a country with so many inequalities. Thus, the role of using current teaching methods -, which allow for the improvement of skills, development of individualized and motivating teaching strategies and potentialities - also compensates for differences, reducing the inequality of opportunities. In this sense, it is key to strengthen and identify weaknesses early on, and to develop the confronting potential of the most vulnerable children. Hence the need for extensive interdisciplinary approaches to health and education professionals, both for the identification and selection of effective rehabilitation strategies in face of learning difficulties.It is estimated that around 15-20% of children at the beginning of schooling have difficulties in learning, and these estimates can reach 30 to 50% if the first six years of schooling are analyzed. Poor school performance, defined as a lower-than-expected academic achievement for a given age, cognitive abilities, and schooling, is complex and multifactorial. It includes Learning Difficulties related to multiple factors - such as low socioenvironmental opportunities and emotional conflicts - to Learning Disorders of a neurobiological nature - such as dyslexia, dyscalculia and Attention Deficit/Hyperactivity Disorder. Poor school performance, regardless of etiology, affects the various spheres of the child\u2019s relational network, leading to emotional problems such as anxiety, low self-esteem, and demotivation.Recognizing how the child assesses their own performance and level of satisfaction with life starts with the metacognitive premise that the developing child is able to express themselves and access their subjectivity. The study \u201cQuality of life and self-perception of health of children with poor school performance"}
{"text": "Department of Health and Human Services, the task force is an independent, nonfederal, uncompensated panel of public health and prevention experts whose members are appointed by the Director of CDC. The task force provides information for a wide range of decision makers on programs, services, and policies aimed at improving population health. Although CDC provides administrative, research, and technical support for the task force, the recommendations developed are those of the task force and do not undergo review or approval by CDC."}
{"text": "Technological advancements rapidly propel the field of genome research. Advances in genetics and genomics such as the sequence of the human genome, the human haplotype map, open access databases, cheaper genotyping and chemical genomics, have transformed basic and translational biomedical research. Several projects in the field of genomic and personalized medicine have been conducted at the Center for Life Sciences in Nazarbayev University. The prioritized areas of research include: genomics of multifactorial diseases, cancer genomics, bioinformatics, genetics of infectious diseases and population genomics. At present, DNA-based risk assessment for common complex diseases, application of molecular signatures for cancer diagnosis and prognosis, genome-guided therapy, and dose selection of therapeutic drugs are the important issues in personalized medicine.To further develop genomic and biomedical projects at Center for Life Sciences, the development of bioinformatics research and infrastructure and the establishment of new collaborations in the field are essential.Widespread use of genetic tools will allow the identification of diseases before the onset of clinical symptoms, the individualization of drug treatment, and could induce individual behavioral changes on the basis of calculated disease risk. However, many challenges remain for the successful translation of genomic knowledge and technologies into health advances, such as medicines and diagnostics.It is important to integrate research and education in the fields of genomics, personalized medicine, and bioinformatics, which will be possible with opening of the new Medical Faculty at Nazarbayev University. People in practice and training need to be educated about the key concepts of genomics and engaged so they can effectively apply their knowledge in a matter that will bring the era of genomic medicine to patient care. This requires the development of well-equipped laboratories, bioinformatics, as well as qualified trained physicians and laboratory staff."}
{"text": "To improve the usability, availability, quality, and timeliness of surveillance data as part of the CDC Surveillance Strategy  strategy to streamline NNDSS and access to data for users; NMI is a component of the CDC Surveillance Strategy. This consolidation of information also is in response to the recommendations of a CDC-wide workgroup, consisting of representatives from the CDC Excellence in Science Committee, the Surveillance Science Advisory Group, and"}
{"text": "Quaternary prevention consists in the identification of persons at risk of excessive medicalization and their protection against new unnecessary interventions, avoiding iatrogenic damages. Here, we argue about the importance of quaternary prevention in specific primary and secondary prevention. The recent great development of preventive medicine, biomedicalization of risks and their treatment as if they were diseases, and the powerful influence of the commercial interests of pharmaceutical industries on the production of medical-sanitary knowledge alter classifications, create diseases and pre-diseases, lower cutoff points, and erase the distinction between prevention and healing. This situation converts larger amounts of asymptomatic persons into sick individuals and diverts clinical attention and resources from sick persons to the healthy, from older adults to young persons, and from the poor to the rich. Quaternary prevention facilitates and induces the development and systematization of operational knowledge and guidelines to contain hypermedicalization and the damages of preventive actions in professional care, especially in primary health care. Quaternary prevention (P4) is a relatively recent concept (and practice), which means the identification of persons at risk of excessive medicalization and their protection from further unnecessary interventions, avoiding iatrogenic damages and proposing ethically acceptable measuresThe objective of this article is to present the relevance of P4 specifically for primary and secondary prevention activitiesPreventive behaviors have always existed and followed the history of health care and sickness practices in societies, including contemporary Western medicine or biomedicine. However, what we now call preventive medicine began in the first half of the twentieth century, having more presence in its second half. It consisted of a movement to construct a preventive attitude to influence medical professionals, who were then accused of focusing on curativistic actions, that is the diagnosis and cure of diseases. Preventive medicine was characterized by three premises: (1) focus on the individual and the family, (2) performed in the daily practice of physicians, (3) \u201crepresents a major transformation in the medical practice [...] and is based on the development of a new attitude by the physician\u201d Arouca2, p.12.The fundamental theoretical basis of this movement was the model of the natural history of diseaseThe \u2018natural history of diseases\u2019 is a relative concept that should not be generalized today beyond some infectious diseases, since it was developed around them in the nineteenth century. Its reality is dubious even in many infectious processes  and also in lupus erythematosus, schizophrenia, diabetes, lumbar disc hernia, dementia, depression, and breast cancerIf the preventive medicine movement is not evaluated as successful in the twentieth century, today the incorporation of preventive actions in medical practice has advanced greatly, especially from the development of preventive pharmacological treatments, whose most famous example may be statins, for the reduction of cholesterol levelsQuaternary prevention focuses on all clinical and health activities, including other types of prevention. It concerns the necessary self-containment of this activity, now notoriously known to be a significant health riskLeavell and ClarkQuaternary prevention induces critical evaluation and reaction in physicians, health professionals, and professionals and managers of health systems about themselves and their activity, in an operational manner, including the questioning of their technical and ethical limits and the recognition of influences that affect decisions and preventive behaviors. It points to the construction of good practices, against cultural, technical, and institutional tendencies, which are sometimes harmful to individual and collective health. Unlike primary, secondary, and tertiary prevention, the objective of P4 is the action of professionals and health systems, especially primary health care (PHC) professionals, who have the same origin as P4primum non nocere\u201d, it is relatively novel, since this principle has always referred to an ethics that was only spoken and generically proclaimed,Although P4 seems to repeat the old medicine principle \u201cQuaternary prevention in prevention induces an organized discussion and a collective recognition of professionals and the health system about problematic situations, in which interventionist and overmedicalizing attitudes, potentially more harmful, are common, which demand guiding knowledge for containment and correction. This opens space for the construction of guidelines that need to be systematized to better protect users from the damages and risks produced by preventive clinical-health action.Among other factors, the therapeutic limits and the adverse effects of biomedicine for chronic diseases associated with their increasing costs and social and cultural changes that constitute a health paradox have paved the way for the emergence of a preventive change in biomedicine.Barski,The biomedicalization and management of prevention and treatment of isolated individual risks as chronic diseases operate within a cultural industry in which there is an obsessive search for present and future health, becoming a moral obligation, value, and fashion. It puts pressure on citizens to submit to biomedical knowledges, linked to the consumption of products, services, and technologies, in addition to holding them accountable for behavioral changes that are often difficult or even unfeasibleIn this context, the operational, conceptual, and methodological aspects of preventive medicine were made possible and driven by the great development of the production of knowledge centered on the notion of risk, especially the so-called clinical epidemiology or evidence-based medicine. This evidence-based medicine strongly diverted prevention to interventions on individuals and their risks. There was an intense \u201cpredominance of the individual over the collective, from the technical to the political, from the natural to the social, from the care physician to the sanitary physician, from the private to the public\u201d Ayres3, p.236The identification (and treatment) of risk factors as part of prevention began a new era in public health, focused on individual intervention. The definitions of disease have been changing over time, becoming more inclusive, with lower diagnostic thresholds. In addition, risk factors are being managed in clinical practice as if they were diseases . In this process, the difference between prevention and cure is becoming increasingly blurredMedical practice in the twenty-first century has been changing, broadly incorporating preventive attitudes and actions. Individual preventive interventions are being disseminated, based on professional and institutional clinical decisions, especially in PHC. Preventive guidelines invade medical knowledge and practice, as well as clinical guidelines and institutional norms and regulationsIn the production of biomedical knowledge, the maneuvers to lower cutoff points for diagnoses of increased risk have intensified and legitimized this process. The expansion of the number of risk factors expands the area of action of preventive intervention, also expanding the number of potentially treatable situations. Specifically, this means the increasingly early biomedicalization and intervention in \u201cpre-disease\u201d states and risk factors, with ever more rigid and difficult-to-reach targets requiring the use of medications. This occurs, for example, with hypertension, hypercholesterolemia, obesity, and osteopenia. The consequent commercialization of drugs for asymptomatic persons substantially contributes with the expansion of these markets and increases polypharmacy, especially in older adults, generating increased iatrogenesis. In addition, it increases costs for society and health services. Finally, this increasingly common and present trend can reduce the quality of life by converting healthy persons into chronic patients,With the progressive elimination of the distinction between prevention and cure, the generation of pseudo-diseases and \u201cpre-diseases\u201d, and the medicalization of risks, preventive and therapeutic clinical demands are created for national health systems and medical practice, especially in PHC, being these demands largely not considered as medical problems in the past and mostly disconnected from the feeling of sickness. In addition, preventive actions have been indicated without adequate foundation, being accumulated in professional practices and, consequently, increasing the chance of iatrogenic damagesAs a psychological, cultural, and technical consequence, users  and professionals have progressively less tolerance to the oscillations and variations of the individual health and disease process. This lower tolerance produces demand and pressure for increasingly early interventions. Thus, we have a decrease in the margin of normality and an increase in the pathological and higher risk spectrum, this one managed as a disease. Therefore, more diagnoses and preventive actions are carried out, with complementary tests and drugs; and the interval of safety, the margin between benefits and risks, decreases. \u201cPatients are increasingly being treated with a greater degree of diagnostic and therapeutic resources\u201d  and quality of the evidences in relation to their final results, to evaluate the balance between its damages and benefitsQuaternary prevention in prevention induces the production, systematization, and collectivization of critical knowledge, strict technical criteria, and careful ethical requirements by guiding professional and institutional preventive actions. It can contribute to prevent the excessive medicalization of prevention and reduce its damages, several not being perceived by users and professionals."}
{"text": "To search in the scientific literature for nursing diagnoses identified in adult/elderly patients undergoing antineoplastic chemotherapy in an outpatient setting.Review of studies published in Portuguese, English, or Spanish which were searched in five electronic databases in March 2016, using the descriptors nursing process, nursing diagnosis, neoplasms, drug therapy and hospital outpatient clinic.In the four studies selected for review, 40 nursing diagnoses were identified, namely unbalanced nutrition, less than body requirements, risk of deficient fluid volume, diarrhoea, fatigue, impaired home maintenance, deficient knowledge, disturbed body image, interrupted family processes, ineffective sexuality pattern, anxiety, powerlessness, fear, readiness for enhanced religiosity, risk of infection, impaired dentition, risk of impaired skin integrity, acute pain, and nausea.The nursing diagnoses identified can support the selection of interventions and the creation of nursing guidelines in outpatient oncology services. The present study deals with the diagnostic stage of the nursing process. Defined as a clinical judgment based on the data collected in the nursing history, culminating in decision making about the diagnostic concepts that represent the responses of the person, family or community at a given moment in the health-disease process, nursing diagnosis (ND) is the basis for the selection of interventions aimed at achieving results for which the nurse is responsible .According to Resolution No. 358/2009 of the Federal Nursing Council, the disciplinary body for professional nursing practice in Brazil, the nursing process must be carried out deliberately and systematically in all public and private environments in which professional nursing care takes place. Therefore, it should be formally documented in order to highlight the contribution of nursing to the health care of the population and, consequently, to increase visibility and professional recognition [In oncology services, the nursing process is imperative due to the high frequency of physical and psychological damage that compromises patients\u2019 quality of life . This isThe estimation for Brazil for the years 2016\u20132017  indicateGiven this estimate and knowing that cancer patients are frequently treated with antineoplastic outpatient chemotherapy, nurses working in oncology outpatient services should provide care with a focus on the individual\u2019s needs, using the ND as a tool in the context of nursing process for selecting interventions with the goal of improving patients\u2019 responses to the proposed antineoplastic treatment. Considering the lack of publications on ND in oncology and the fact that knowledge of common NDs in this area can strengthen the nursing process, in addition to providing oncology nurses with support for decision-making, choosing the best interventions, and performing a quality clinical practice, the objective of this study was to search in the scientific literature for NDs identified in adults/seniors undergoing antineoplastic chemotherapy in an outpatient setting.This is a review of the scientific literature which involved gathering, analysing and synthesising, in a systematic and orderly way, results of studies that investigated NDs in adults and seniors undergoing outpatient chemotherapy according to the following steps: formulation of the guiding question, search of the study literature, interpretation and synthesis of the evidence from the selected studies. The guiding question for this review was the following: Which nursing diagnoses have already been identified in adults/seniors undergoing anticancer chemotherapy in an outpatient setting?Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health (CINAHL), Latin American and Caribbean Literature in Health Sciences (LILACS), Scientific Electronic Library Online (SciELO), and Nursing Database (BDENF). As a search strategy, 12 different combinations of the descriptors were used: Nursing Process (Nursing Process), Nursing Diagnosis (Nursing Diagnosis), Neoplasms (Neoplasms), Chemotherapy (Drug Therapy) and Outpatients Clinics Hospital  .In March 2016, with no restrictions on the nature of the study or language, two authors independently searched for indexed studies in the electronic databases ospital) . The selNANDA International [The criteria for inclusion of studies in the review were as follows: be published in original article format in English, Spanish, or Portuguese; having as study subjects adult and/or elderly individuals undergoing antineoplastic chemotherapy on an outpatient basis and; the NDs being identified in this population, according to national  Taxonominational .5,941 studies were found in the MEDLINE database, in addition to 186 in CINAHL, 227 in LILACS 227, 152 in BDENF, and 17 in SciELO, for a total of 6,523 studies, which were then preselected from those with titles and abstracts which met the criteria explained previously. In the MEDLINE database, two studies were preselected, in CINAHL nine, in LILACS eight, in BDENF three, and SciELO none, for a total of 22 studies. After elimination of duplicates and reading of the studies in full, the final sample of studies selected for the present review consisted of four original papers . The refIn order to extract information from the articles selected for the review, a data collection form was developed in which all NDs identified by each of the selected articles were listed. The form also allowed us to obtain information on the authors, country, and year of publication of the article, with objectives, design, data source, sample type, conclusions and recommendations for nursing practice. The interpretation and synthesis of the evidence gathered from the selected articles was done in a descriptive manner, allowing the reader to understand each study included in the review, and considering the quality criteria established by nursing students .NANDA International [A summary of the main features of the articles included in the review is presented in national  Taxonominational , while aAs all studies selected for the review are descriptive, the low level of quality of the evidence generated by them is highlighted: level 6, on a scale of 1 to 7, where level 1 represents the highest quality Evidence .Of the 34 actual NDs and six risks identified, at least half of the component articles in the review described the following: unbalanced nutrition, less than body requirements, risk of deficient fluid volume, diarrhoea, fatigue, impaired home maintenance, deficient knowledge, disturbed body image, interrupted family processes, ineffective sexuality pattern, anxiety, powerlessness, fear, readiness for enhanced religiosity, risk of infection, impaired dentition, risk of impaired skin integrity, acute pain, and nausea .In order to provide an overview of the most common NDs in adults/seniors undergoing outpatient chemotherapy and thus to provide support for the decision-making of the oncology nurse during the completion of the nursing process, the present review identified 40 ND: 34 real and six at risk. Only in the growth/development domain, no NDs were identified, which was expected, as in this domain there are only NDs related to age-appropriate development (childhood and adolescence) .All articles selected have described the ND body image disorder, defined as confusion in the mental image of the physical self . AntineoOnly one selected article  did not The ND of anxiety was described by almost all the articles components of this review \u20138, 10. DAn experimental study that evaluated the effect of prayer on the anxiety of cancer patients in chemotherapy treatment  showed tDefined as a response to the perceived threat that is consciously recognised as a hazard, the ND Fear  was alsoIn view of this, it is important to note that anxiety and fear are among the defining characteristics of ND. Defined as a perception of lack of comfort, relief and transcendence in the physical, psychospiritual, environmental, cultural and/or social dimensions, the ND acute pain  was idenNausea and diarrhoea are frequent toxic effects caused by antineoplastic chemotherapy . DiarrhoNDs nausea and unbalanced nutrition: less than bodily needs have a defining characteristic in common, food aversion . A hypotIt is worth noted that diarrhoea is also one of the defining characteristics of unbalanced nutrition ND: less than body requirements . IncreasThe impaired dentition ND, defined as rupture in dental developmental/eruption patterns or structural integrity of each tooth , was ideA selected study  for thisPowerlessness is an ND that is defined by the lived experience of lack of control over a situation, including a perception that the actions themselves do not significantly affect a result . One of The ND Interrupted family process, defined as change in relationships and/or family functioning , was desThe ND pattern of ineffective sexuality, defined as an expression of concern about one\u2019s own sexuality, was also described by two studies selected to compose the review , 9. ThesThe ND deficient knowledge, defined as absence or deficiency of cognitive information related to a specific topic , was ideIn the present review, six of the 40 nursing diagnoses identified were at risk. The fact that the majority of NDs are real indicates that nursing care for adults/seniors undergoing outpatient anticancer chemotherapy is focused on health recovery. On the other hand, the identification of risk NDs also suggests that nurses are concerned about preventive aspects of care.Defined as vulnerability to invasion and multiplication of pathogenic organisms, which may compromise health, risk of infection  was idenBoth ND risk of impaired skin integrity, defined as vulnerability to alteration in the epidermis and/or dermis, and ND deficient fluid volume, defined as vulnerability to decreased intravascular, interstitial and/or intracellular fluid, have pharmacological agents as a related risk factor . It is kAs all the studies selected for this review have a descriptive character, we must highlight the low level of the quality of the evidence generated by them . HoweverAmong the limitations of this review we point out the search and selection of studies in the form of a research article indexed in electronic databases only and the different characteristics of the populations of the studies that comprise it: two were conducted on women with breast cancer , one on Given the scarcity of publications on the diagnostic phase of the oncology nursing process, the 40 NDs identified by the present review point to the complexity of the care provided to patients undergoing chemotherapy in an outpatient setting. If used as a guide for the investigation of NDs among adult/elderly users of oncology outpatient services, the results of this review may contribute to the advancement and improvement of the nursing process.The authors declare that there are no conflicts of interest.RTJ participated in the design and outline of the article, bibliographic research, data analysis and interpretation, discussion of results, writing, and final approval of the article.RAFG participated in the bibliographic research, data analysis and interpretation, critical review, and final approval of the article.DCL participated in the bibliographic research, critical review, and final approval of the article.HFG, EMP, and EFPJ participated in the critical review and final approval of the article."}
{"text": "The Nursing area is increasingly faced with the challenge to prepare its professionals for the performance of technical and non-technical skills. In this sense, simulations, particularly high-fidelity ones, have been recognized as allies, with advantages for patient safety, teamwork, cost reduction in the real scenario and the handling of emotions of the learners. Herein, we are interested in considering the non-technical skills, whose relevance is based in knowing that a significant portion of the adverse events- The term non-technical skill, which comes from the aviation area in the '90s and is used in different areas, including health, refers to the cognitive and social skills and the personal resources that complement the technical skills and contribute to the safety and effective performance of tasks. Or, in the words of authors of the area of healthSuccessful teaching examples reinforce the use of simulations, in various scenarios and in varying degrees of complexity, as in nurse-patient communication development, interprofessional relations in critical situations or emergencies, teamwork, communication of bad news, ethical dilemmas, intra-team conflicts, management of stressful situations, leadership exercises, among others. Therefore, they point to development opportunities in the attitudinal, behavioral, ethical and moral fields. In addition to the clinical scenarios traditionally used in simulations for the development of non-technical skills, other forms of simulation, involving games or virtual environments, are mentioned in the literature. The contribution of Second LifeOne of the crucial points in the teaching or training of skills, especially non-technical ones, is their assessment. Models for this end have pointed to the use of indicators of (observable) behaviors. A recent review of the literatureSome of the currently known assessment tools in the area of health follow the recommendations of the European taxonomy of pilots' non-technical skills (NOTECHS)We highlight that both the instruments created for the medical area, which assess professional behaviors in anesthesia and surgery procedures or the perceptions of interactions between the team during surgery, among others, and those instruments created by nursing, which assess the clinical judgments of nurses, among others, are relevant and contribute for the assessment of non-technical skills in simulation situations, especially if accurate and composed of observable indicators.However, there is still a long way to go regarding the training and assessment of these skills in the context of large-scale events, such as accidents or natural disasters, in particular for the development of behaviors or skills of collaboration, negotiation and communicationThe familiarization with such a teaching technique and the tools to assess these skills, essential to the professional exercise, taking advantage of their potential, has been a challenge for the area of health, in particular nursing. It is up to trainers and institutions to both acknowledge such contributions and prepare themselves for their effective use."}
{"text": "In the published article, affiliations 1 and 2 were switched. Affiliation 1 should be: Department of Applied Microbiology and Biotechnology, School of Biotechnology, Yeungnam University, Gyeongsan, South Korea. Affiliation 2 should be: Department of Biotechnology, Daegu University, Gyeongsan, South Korea.The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "Background: The Chilean health system has undergone profound reforms since 1990, while going through political upheaval and facing demographic, health, and economic transformations. The full information requirements to develop an evidence-informed process implied the best possible use of the available data, as well as efforts to improve information systems.Objective: To examine, from a historical perspective, the use of evidence during the health sector reforms undertaken in Chile from 1990 to date, and to identify the factors that have both determined improvements in the data and facilitated their use.Methods: A qualitative methodological approach was followed to review the Chilean experience with data on decision-making. We use as the primary source our first-hand experience as officials of the Ministry of Health (MOH) and the Ministry of Finance before and during the reform period considered. A literature review was also conducted, using documents from official sources, historical accounts, books, policy reports, and articles published in indexed journals reviewing and discussing the reform process, looking for the use of data.Results: The Chilean health-care reform process was intensive in its use and production of information. The MOH conducted several studies on the burden of disease, efficacy of interventions, cost-effectiveness, out-of-pocket payments, fiscal impact, social preferences, and other factors. Policy and prioritization frameworks developed by international agencies strongly influenced the use of data and the study\u2019s agenda.Conclusions: The Chilean example provides evidence that tradition, receptiveness to foreign ideas, and benchmarking with international data determined the use of data, facilitated by the political influence of physicians and, later, other technocrats. Internationally comparable statistics are also shown to play a significant role in the policy debate. This article is a case study of the development in Chile of a culture of data use and evidence-informed policy-making over several decades, during which Chile went through many major political upheavals and faced demographic, health, and economic transformations. The article examines the use of evidence during the health sector reforms undertaken in Chile from 1990 to date. It analyses its context, from a historical perspective, and attempts to identify the factors that have both determined national data improvement and facilitated their use. The Chilean example provides evidence that tradition, receptiveness to foreign ideas, and benchmarking with international data shaped the use of data, assisted by the political influence of physicians and, later, other technocrats. Except for during the Pinochet dictatorship, the long-term political driver in decision-making has been the pursuit of equality.This article covers six main topics. The first four sections focus on the drivers and uses of national data and national estimates. The second part, with two sections, discusses first the use of domestic and global estimates, and secondly, how to build capacities for data collection, analysis, and interpretation for policy-making.This article uses a qualitative methodological approach to undertake a case study of the Chilean experience with data on decision-making. As primary sources of information, we use our first-hand experience as officials of the Ministry of Health (MOH) and the Ministry of Finance during the 2005 health reform policy formulation and later discussion in Congress, and before since 1990.Secondly, the methodological strategy included a literature review, considering official sources from the MOH, the World Bank, and the Chilean National Library of Congress, as well as several books, historical accounts, and policy reports documenting health policy-making in Chile during the twentieth century. The review was complemented by a systematic MEDLINE search using the terms \u2018Health Care Reform [MESH] and Chile [MESH]\u2019 and \u2018Chile [MESH] and AUGE [all fields]\u2019 . From the resulting items, only those describing health reforms were finally considered, looking specifically for the use of data.Chile is a South American country with a population of nearly 18 million people, 81\u00a0years of life expectancy at birth, and high per-capita income, but where inequality remains one of the greatest challenges . Health Although total health expenditure has increased, Chile has one of the lowest figures for total health spending among Organisation for Economic Co-operation and Development (OECD) countries. It has a low proportion of public expenditure on health  and is second only to the USA regarding the share of private financing, mainly the result of out-of-pocket payment by individuals. According to the OECD, health financing in Chile \u2018remains inefficient and inequitable\u2019 ,7.Chile has a long tradition of collecting and publishing national statistics. In 1843, the statistical service was established, and in the same year the population censuses law was enacted ,10.It has been suggested that European liberal ideas greatly influenced the development of a medical culture with a deep interest in social problems, which furthered social policies in health. Indeed, liberal trade and openness during the war of independence allowed the unrestricted arrival of many European physicians, especially from the UK and France. They had significant professional and social prestige, and influenced the creation of the medical school, with a positivist approach based on evidence and scientific rigour. Some of them also developed successful political careers ,12. In tAn early example of health policies based on a scientific approach is the enactment of the Mother\u2013Son Law in 1936, which aimed to reduce infant mortality and prevent the causes of disease and premature disability. The Minister of Health, Cruz-Coke, was a prominent physician, a scholar, and a leading researcher. At the beginning of his administration, he commissioned several studies to support effective evidence-based policies. He also enacted the Preventive Medicine Law in 1938, which enforced periodic screening tests to detect and provide prompt treatment to priority health problems, such as tuberculosis (TB) and syphilis. His surveys and data analysis provided evidence of the burden of avoidable morbidity and mortality among the working class, due to the lack of access to health care. Cruz-Coke was elected to the Senate (the upper house of parliament) for the Conservative Party after his period in the Ministry. He unsuccessfully ran for president in 1946, remaining in the Senate for several years \u201317.The single most significant development was Salvador Allende\u00b4s book \u2018La Realidad M\u00e9dico-Social Chilena\u2019 , which offers an outstanding example of the use of national data, along with global comparative analysis, to underpin a health policy proposal. The book was a real manifesto of social epidemiology, and is considered the starting point of the Social Medicine movement in Latin America ,19.Allende, Minister of Health at the time, describes the situation of a country in which 73% of the population lived in poverty. The infant mortality rate was 250 per 1000 live births, almost the highest recorded in the world at that time, and only half of the children born each year would live beyond the age of 10\u00a0years. This was very different from what we see today, where the infant mortality rate is slightly over seven per 1000 live births. Chilean society showed marked structural inequalities, which were exacerbated by the 1939 Chilean earthquake .According to Waitzkin, in his book Allende conceptualized illness as a disturbance of the individual fostered by social deprivation, a vision deeply influenced by Virchow\u00b4s views about the social determinants of health . AllendeThe consequences of the earthquake contributed to the sense of urgency around the need to unify and reform the health and social security systems created in previous decades. Then, in 1941, Allende sent a bill to Congress to implement a health system based on socialized medicine. Ten years later, the law was enacted, with significant changes, creating the National Health Service (NHS), the first in the Americas to guarantee universal health care  ,23.The NHS, which operated through a countrywide network of services, had a profound impact on health indicators, with a sharp decline in TB mortality and a progressive improvement of maternal and child indicators . HoweverThe restoration of democracy in 1990, with the promotion of social justice with macroeconomic balance and growth as centrepieces of the Chilean government\u2019s development agenda, brought new impetus to the development of social statistics and inequality analysis to underpin policy-making in health .During the dictatorship, health expenditure was sharply reduced, with no investment in hospital infrastructure for 17\u00a0years. Primary-care level expansion was maintained, however, devoted mainly to maternal and child health problems. A comprehensive national health information system existed, collecting demographic, epidemiological, and health resource utilization data. Nevertheless, there was little practical use of this data for health situation analysis or health needs assessments, while financial analysis was the primary planning activity. Conversely, owing to the political emphasis on efficiency and targeting to alleviate extreme poverty, new instruments were developed, such as the Socio-Economic Characterization Survey (known by its acronym CASEN) to measure poverty and allocate social aid, including health care ,24.By 1990, the health system was in a deep crisis caused not only by a lack of resources, but also by inefficiency in service delivery, related to distortions of health financing mechanisms. The lack of complementarity among different levels of care was a critical problem, as was the inadequate response to changing health needs associated with the demographic transition. Government policies favoured primary health care and the private sector, neglecting the modernization and maintenance of public hospitals. Cardiovascular diseases had been the leading cause of death since 1970, but the priority in spending and health-care resources went to maternal and child health and communicable diseases; an enormous unmet demand for specialist care and tertiary hospitalizations existed ,27.This was the context within which in 1990 the Chilean government initiated a health reform, with financial and technical assistance from the World Bank, aiming to improve the effectiveness, efficiency, and quality of health services, particularly for poor people. Economists specializing in social policies provided the technical leadership for the reform, which involved numerous young professionals: economists, engineers, lawyers, and physicians. Many of them later took up important positions in the government and international organizations; a generation of technocrats.The preparatory phase consisted of several studies, covering all components and entities of the health system. The findings of these studies led to the reorganization of the MOH and transformation of payment methods, from fee for service to prospective per-capita and diagnosis-related payment in primary health care and hospitals, respectively. In parallel, investments in health facilities for a new health-care model were implemented, including new ambulatory facilities, designed to deliver secondary and tertiary services ,28.However, the reform maintained the structural design inherited from the Pinochet dictatorship. As a result of the introduction of market justice in social health insurance during the 1980s, the health system became highly segmented, a strong determinant of inequality in access to health care. The incoming government had other significant challenges in the early 1990s, to restore democracy and demonstrate good governance. There simply was no political ground for structural changes in the health sector, and there has not been so far.In 1994, the World Bank published its report \u2018Chile: the adult health policy challenge\u2019, which analysed the implications of demographic and epidemiological trends for health-care expenditure and intervention programmes. The first ever estimates of the Chilean burden of diseases and injuries, measured in disability-adjusted life-years (DALYs), were produced, based on simulations of national mortality data. These provided the basis for the definition of health priorities and health technology assessment .In the previous year, the World Bank had published its controversial \u2018World Development Report 1993: Investing in health\u2019, which proposed packages of public health measures and essential clinical care priorities for health spending, based on the estimation of the burden of disease and the cost-effectiveness of interventions. Influenced by these ideas, the Minister of Health \u2013 an economist \u2013 decided to carry out a national estimation of DALYs based on national empirical data rather than the earlier statistical models used by the World Bank. This was the third such study in Latin America, after Mexico and Colombia. Chilean professionals from the MOH executed the study, with direct technical assistance from Harvard University. A study of social preferences in health, using qualitative research methods, was conducted in parallel by the MOH. Both studies were designed to support decision-making for prioritizing investments in health ,31.Since their introduction, there have been many criticisms of the use of DALYs, partly because of their complexity, but also owing to ethical problems and controversies around the use of parameters such as the differential societal value of individuals at different ages, the disability weights, and the discount rate . This coHowever, DALYs were instrumental in emphasizing the importance of leading causes of disability, such as depression, substance abuse, and musculoskeletal disorders. Chileans were conscious of the relevance of these health needs in a rapidly ageing population, as shown in health perception studies, and this helped to validate the use of the indicator.The results of the burden of diseases study had a profound impact on reorienting health policies . The stuHealth inequality between population groups and inequality in access to health care were the focus of attention during this period. In 1998, the MOH, together with the Pan American Health Organization, convened an international seminar on \u2018Equity and efficiency in decision-making in health\u2019, fostering broader discussion on these issues. The main topics were the impact of the social determinants of health, geographical inequality in the burden of diseases, and the mismatch of the health system to the priority needs. The burden of disease demonstrates the preponderance of non-communicable diseases, and despite increased investment during the 1990s, the public health system still lacked the resources to address the new health priorities. Therefore, the private\u2013public gap remained a significant equality concern ,36.The discussion also covered MOH strategies to address inequality in access, including the new public insurance (FONASA) prioritizing the benefits mechanism, such as the \u2018program of complex services\u2019, based primarily on cost and waiting lists, instead of epidemiological criteria.In 2000, a new cycle of health reforms began in an attempt to reduce inequalities. The Chilean government implemented an innovative second-generation health reform, the central focus of which was the recognition of the right to health. A physician headed the Inter-ministerial Committee leading the process, which involved the Ministries of Health and Finance, and the General Secretariat of the Presidency . On thisThe first step was the definition of health objectives for the decade 2000\u20132010, called \u2018Objetivos Sanitarios para la D\u00e9cada 2000\u20132010\u2019 (OS2000-10) . OS2000-The primary instrument for achieving health goals was the creation of a regime of explicit health guarantees (known by the acronym AUGE) for prioritized health problems  . The lawA legal decree, signed by both the Minister of Health and the Minister of Finance, defines for each of the 80 problems the requisites of eligibility, the maximum waiting times, the list of health interventions covered, and the co-payment limit. It is the responsibility of the medical insurance provider, either public or private, to comply with these guarantees. This establishes the minimum effective health coverage for every individual, regardless of their level of contribution. This feature is considered one of the main achievements of the reform ,27,39.Before the reform, the Chilean Constitution only stated second-generation rights regarding health care. The jurisprudence considers these as a mere statement of intention, and therefore the state and the courts are not obliged to enforce them, except for the right to choose the health system, either public or private. Since the reforms, AUGE has constituted the core of the constitutional right to health, which may be enforceable in compliance with both the AUGE law and the constitutional mandate \u201342.AUGE was progressively implemented, beginning with 25 health problems in 2005 and reaching 80 in 2013. Priority setting used three criteria: (1) priority diseases, as defined in the health objectives of the decade; (2) the existing interventions already covered by the public insurance through the \u2018program of complex services\u2019; and (3) social preferences, including the use of the \u2018rule of rescue\u2019, the imperative that people feel to help identifiable individuals facing avoidable death ,44. The The AUGE law sets a schedule of mandatory technical, epidemiological, and economic studies that support decision-making for updating the priority list every 3\u00a0years through a legal decree . The preNew epidemiological and statistical tools were developed to monitor the outcome and impact of the reform, which strengthened the public health surveillance system. To begin, the MOH implemented the AUGE information system, which oversees the compliance with the four legal guarantees. In addition, a national health survey, with biomarkers, was implemented, along with two other surveys on quality of life and patient satisfaction and health spending. Lastly, health questions of the CASEN household survey were adapted to measure access to and utilization of health services. Thereby, it is now possible to disaggregate access according to age, gender, ethnic origin, socio-economic status, health insurance, residence, and migrant status. It also has questions about AUGE use and perception.Even before its enactment, the AUGE law was the target of severe criticism. One of the earliest and more relevant reproaches was the risk of neglect of non-priority health problems. The waiting lists for these have worsened, despite interventions to reduce them ,47.The entitlement to timely access obliges health insurers that exceed the maximum waiting time to purchase health interventions outside their network. In practice, FONASA (the public insurer) has been unable to fully comply, owing to shortages of specialists, hospital beds, and technology in public facilities. Thus, the public sector has been increasingly purchasing services from private providers, leading to rising costs and reinforcing the underfunding of public health providers.Clearly, AUGE has been unable to overcome the problems generated by a fragmented system, segmented by income and health status. During the parliamentary discussion of the bill, right-wing parties rejected the setting up of a compensation fund to finance AUGE, designed to pool risks and create solidarity between the public and private sectors .On the other hand, in the 10\u00a0years since its implementation, the reform has shown benefits regarding access and health impact. Chilean\u00b4s utilization of health-care services has increased, although gaps between the richest and the poorer people remain . For exaIn Chile, national data are used for decision-making and health policy design, while data and global estimates are used for comparative purposes. They serve to benchmark progress and identify areas with potential for improvement. In the absence of national data, it is customary to use global estimates, such as in the case of rare diseases, or for health intervention efficacy analysis, which is usually performed based on international data.The World Health Organization (WHO) traditionally considers Chile among the countries with reliable statistics ,53. DiscIn 2010, Chile joined the OECD. This has involved a challenge for the national statistical systems, which have had to adapt to the measurements and standards of this organization. In practice, the accession to the OECD has meant changing the tradition of benchmarking progress against other Latin American countries. Thus, Chile, which had long been used to its position as the best performing country for health in the region, suddenly found itself classified among the worst performers among members of the OECD ,7,54.This new performance benchmarking has fuelled debate in the academic and political environment, and shows the potential impact of comparative cross-country benchmarking based on sound empirical data.Among the main challenges for the future is the need to strengthen the health information infrastructure to improve the opportunity of data, to incorporate quality of care indicators, and to provide disaggregation to monitor equality in health coverage. The different surveys allow us to disaggregate data by gender, socio-economic and minority group status, but this is not the case for administrative registries. In a study on universal health coverage (UHC) in Chile, we described the shortcomings of the MOH registries, which impede to assess equality in health coverage for many public health programmes, such as vaccination, TB, HIV/AIDS, antenatal care, and birth control .It is also relevant to update studies on the national and subnational burden of diseases, cost-effectiveness, and social preferences, to bring AUGE coverage up to date. There is an ample window of opportunity to improve health system performance through the use of both national data and international benchmarking.The struggle to adapt health services to changing health needs is one of the primary challenges for many low- and middle-income countries. During the past decade, Chile has opted for a data-driven priority setting and rights-based approach in health reforms, providing entitled access to health care for priority diseases. In support of this process, the MOH strengthened its information systems and created new tools to monitor results, clearing a path for other countries to follow. However, it did not change the structural conditions of the segmented health system, which is a common situation in many Latin American countries. The Chilean example has shown some gains in health status, but a persistent inequality in access to health care. It is also an example of what Schuftan has described as \u2018being sucked into dreaming that technical solutions in public health would right the wrongs\u2019 . NeverthSome factors associated with using data in decision-making persistently appear throughout history. Among them are the openness to foreign influences, first derived from the arrival of European doctors with liberal ideals, and then the international comparative analysis as an element of judgement about the national situation. It is also important to acknowledge the importance of policy and prioritization frameworks developed by international agencies.In Chile, doctors have been influential political players in making health policy decisions, taking a positivist, data-based approach, which is currently adopted by economists. The definition of inter-ministerial working teams, addressing health problems from health, economic, and political perspectives, has helped to maintain a tradition of making decisions based on the use of data in the health sector. As the backbone of policy development, there is an ongoing need to confront structural inequalities, a feature of Chilean society that we have failed to remedy ,57.The use of studies and national data starting during the 1990s and in the reform of 2005 give an impression of continuity in the line of thought, but in practice, the systematic adoption of evidence-informed policy and prioritization proceeded patchily .10.3402/There was no planned connection between the 1990s\u2019 studies and the health reform that began in 2000 and resulted in the AUGE law. The authorities belonged to the same political coalition, but with different perspectives about the health sector.We maintain that the studies performed during the 1990s, on the burden of diseases and cost-effectiveness of health interventions, were used because some technical teams that worked on them stayed at MOH during both periods. As already mentioned, the studies were not intended to implement a system of enforceable rights for priority diseases; they were carried out to support investment decisions on health-care infrastructure and medical equipment. However, the health authorities responsible for the 2005 reform saw that those studies could give them a technical substrate for prioritization.Having human resources capable of generating and analysing information is certainly a necessary condition for the use of data in decision-making, but it is not a sufficient one. The authorities can make decisions with or without data, so the technical experts and statistical analysts have the responsibility to provide the best information available in a timely and understandable manner. There is a liaison between technical knowledge and the political authorities, which requires physical closeness between the two worlds. For example, the institutionalization of analytical capacity at the MOH, first in the department of epidemiology and later with the creation of the department of statistics and health economics, gave rise to the division of health planning. This division is responsible for formulating the national health strategy and the development of the necessary studies for AUGE.It is also important to have budgets to support operational research aimed at solving specific problems of the health system, which enables the creation of links between the worlds of academia and public health management.The Chilean experience shows that the availability of technical expertise in the MOH facilitated the use of national data in decision-making processes of the reforms from the 1990s onwards. However, the maintenance of such capacities can never be taken for granted and requires constant vigilance. Job instability and career shortcomings discourage the retention of professionals in the public service, and also threaten the political independence of the health information system.Currently, the directors of both the National Statistical Institute and the Civil Registry and Identification Service are recruited through an open and competitive process, carried out by consultants and conducted by the public Senior Executive Service System (SESS). In contrast, directors of the health statistics and epidemiology departments at MOH are appointed by the authority, and only a minority of civil servants at MOH have tenure. During recent shifts of government, all of the directors mentioned above were replaced, despite their connection with SESS. The turnover of staff members coincided with serious problems in the quality of data, such as the failure of the last population census (2012), polemics about poverty measurements, and health population surveys being suspended or delayed ,59.Despite these problems, the country has maintained the discipline of decennial health plans; the current one is the national health strategy 2011\u20132020 . Also, rFinally, global estimates and global commitments such as UHC and sustainable development goals play a major role in mobilizing the political will of the leaders to invest in their information systems and generate evidence for decision-making. Transparency in the handling of data by agencies such as the WHO and accountability of international commitments are strong incentives for resource mobilization for capacity building in the capture, analysis, and use of data.Chile\u2019s experience with international estimates, particularly in the 1990s, shows how these can have an influence within a country, even though national estimates take precedence in local decision-making. The global progress in methods to provide comprehensive estimates of the burden of disease has led to advances in analyses in Chile, with international technical support, and influences the national analytical work, including estimates. In addition, internationally comparable statistics are a valuable input into the policy debate."}
{"text": "Professor Mirko Tos, the best otorhinolaryngologist in the World, passed away on January 16, 2018, in Denmark at the age of 87. His books are the leading textbooks used to teach otologic surgery. He published nearly 700 articles and was the most productive otolaryngologist at the peak of his career  Days-New Advances in Otology Symposium, the 5th Balkan Congress of ORL&HNS, and the Trakya Society of ORL&HNS Meeting on Secretory Otitis Media, respectively. He was always happy for being in Edirne and never refused us (Prof. Mirko Tos, besides having many invitations from several countries, also visited Trakya University and Edirne several times and gave important lectures here. His first visit was in 2001, again in 2006, and his final trip was in 2010. He was the guest of honor and the invited speaker at all three meetings: the 2fused us .Prof. Tos was originally from Slovenia and moved to Denmark in 1957 . He becaBalkan Medical Journal (In addition to his well-known textbooks, he has several surgical techniques for the treatment of ear diseases, classifications, and theories for otologic pathologies. His classification of cartilage tympanoplasties was first published in 2007 in his article published in the Trakya University Medical Faculty Journal, currently entitled, the  Journal . Additio Journal .One of the memorable mottos of Prof. Tos is that \u201cspeak depending on your own data!\u201d . He ofteDenmark was the best country in the world regarding the number of articles published in SCIE per number of inhabitants during the end of the 90s . This stProf. Tos has also been the Honorary Member of the Balkan Society of ORL&HNS and the Trakya Society of ORL&HNS. We have shared many memories, which are not forgettable . He has"}
{"text": "However, it is important to observe the proportion of vegetables and cereals in the diet, which may change according to the culture of each place and country, causing higher or lower risk.Plants have the potential to absorb and accumulate larger amounts of several heavy metals. In studying heavy metal contents in vegetables fertilized with wastewater in India, Singh et al.  found thThe use of waste as a source of nutrients in plant production systems, traditional, and organic, is common worldwide, and important strategy for nutrient cycling. However, long-term application of such waste causes the increase of HM concentrations in soils, increasing HM uptake by plants and assimilation in edible organs such as grains, as indicated by the data presented in Table RdRC: wrote the first draft of the manuscript. MS: organized the database. JC, LG, CC: senior researchers in the field of soil science. They made specific contributions of the area. FR: senior researchers in the field of plant physiology. They made specific contributions of the area. ML: senior researchers in the field of agroecology. They made specific contributions of the area. All authors contributed to the revision of the manuscript, read and approved the version sent.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "There were several errors in the author byline.Drs. Lingxia Jiang and Pawel Gajer were mistakenly omitted from the author byline. Lingxia Jiang should be listed as the tenth author and is affiliated with the Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, United States of America. Her contributions were as follows: Optimized the Affymetrix tiling chip protocol and processed all the Affymetrix tiling GeneChips (>125). Contributed to the analysis of the GeneChip data.Pawel Gajer should be listed as the 11th author and is affilated with the Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, United States of America. His contributions were as follows: Developed the algorithm to extract SNP data from the microbial Affymetrix whole genome tiling GeneChip. Processed the GeneChip and extracted SNP data.The eighth author's name appears incorrectly. It should be: Carla B. Trim.The sixth author, Jacques Ravel, should appear as the fourteenth author."}
{"text": "A large-scale trial has been started in the United Kingdom with the aim of evaluating the effectiveness of different methods for the early detection of breast cancer. Two populations, each of 25,000 women aged 45-64 are invited for annual screening by mammography and/or clinical examination. Two further populations, one of 25,000 and one of 40,000 women in the same age range, are invited for education sessions in breast self-examination, and 4 control populations, totalling 120,000 women, are offered no additional services beyond conventional diagnostic facilities. All breast histology, both benign and malignant, in all women in the study is recorded, as are the findings, management and follow-up of all breast cancers. Changes in the populations, and deaths from all causes, are also recorded. This is essentially a non-randomized trial, though in one of the screening centres, where an education programme about breast cancer is provided for the whole population, only women registered with certain randomly selected general practices are invited to be screened. The principal means of evaluation will be the comparison of the mortality rates from breast cancer in each of the study populations. Costs, in terms of use of health resources, unnecessary surgery and radiation hazard, will be assessed. Additional aspects of the trial include studies of women's attitudes to early detection, and of the aetiology of breast cancer."}
{"text": "An estimated 70% or more of emerging infectious disease agents have some form of vector. The author of this book, Norman Gratz, a medical entomologist, has written a very valuable resource on vectorborne and rodentborne diseases found in Europe and North America. His book includes information on diseases transmitted by mosquitoes, ticks, rodents, mites, sandflies, fleas, lice, biting midges, diptera, triatomines, and cockroaches. As a text, it is impressive that one man has such a breadth of knowledge of these diseases, although some credit must go to Mike Service, who helped prepare the manuscript for publication after the death of the author.Unlike most books on this subject, which concentrate on describing the agent and its molecular properties, this book focuses on public health aspects of the diseases, and most chapters are divided on the basis of the vector that carries the agents. The chapters describe the history of the agents and details of incidence by country, year, and important ecologic parameters. The details of the number of cases of each disease by year are particularly impressive. Many chapters have a conclusion section with an overview of the public health importance of the disease, interpretation of the risk of the disease, and identification of our knowledge gaps. In addition, some chapters are devoted to the economic effects of vectorborne and rodentborne diseases in Europe and North America.This is a very readable text or reference book for those who want to know about a specific vectorborne or rodentborne disease in Europe or North America through 2003\u20132004. The only weakness I could find is that although the word \u201ccontrol\u201d is used in the title, the book contains relatively little information on this subject. However, the depth of other areas compensates for a lack of information about control.Overall, I recommend this to anyone who needs a reference book on vectorborne and rodentborne diseases. All we need now is an equivalent reference for such diseases in Africa, Asia, Australasia, and South America!"}
{"text": "Genetics Selection Evolution 2009 41:5), we found several errors in the published Table Three, concerning the computation of contribution to within-breed diversity (CW). We apologize to the readers for these errors, which are corrected in the present erratum.After the recent publication of our article (Leroy,  Table Three , and the Pearson correlation between D and \u0394GDT was found to be -0.59 (P = 0.008).Errors concern the computation of the  Foulley . In the In spite of the above modifications, the populations that contributed most to the total diversity, according to the approaches of Ollivier and Foulley  and CabaD, which are now MER, LAND and POT, instead of BOUL, MER and POIT.On the contrary, when considering the eight breeds classified as endangered or endangered/maintained by the FAO  and the approach of Ollivier and Foulley , a changFinally, since the discussion on breed conservation is based on the use of several other methods and parameters, the above new results do not change our recommendations on which breeds specifically need support."}
{"text": "Overwhelming evidence shows that hazardous work, working conditions, and environment fail to maintain homeostasis results in death or severe disability. Up to the 1980s, governments did not pay major attention to occupational health in developing countries, including India. The Bhopal Gas Tragedy, in 1984, was the turning point in the history of health and safety in India. It was time for the government to think deeply and review the existing legislative measures, for the upliftment of the occupational health situation in India. However, all the services remain grossly underutilized because of inadequate strategies, policies, and the lack of a proper monitoring mechanism, for occupational workers. The present study reviews the fact that Inaction or Destruction of Demands, Use of Power, Appeal to the existing bias of the system, and Exportation and Flexibility of the workers are some of the main reasons for the alarming situation of the Occupational Health Policy (OHP) in India. The existing and traditional condition of the laborers before and after independence is also highlighted in this article. Finally the threats are identified and options are provided to improve the health conditions of the workers. Health is multifactorial and helps people to live well, work well, and enjoy themselves. It is inTo summarize, in most cases budget allocations are inadequate to support the occupational health activities set up by governments and enterprises, which tends to kill occupational health in its stage of implementation, as exemplified in many developing countries.\u201312 In orThe overall article is divided into three major sections. Concept of health-related problems associated with the workers, which is supported by epidemiological evidence. To understand the labor hierarchy in India workers are classified through social stratification in the next section. The threats and options related to the strategies and policies are reviewed and presented in the last section of the article, followed by the conclusion.The conventional thinking on health dismisses it as a largely personal issue, something that is primarily influenced by personal behavior, habits, lifestyles, and so on. However, a range of historical and scientific evidence shows that the health of the communities and population is decisively influenced by a broad level of personnel. For example, Bimal a laborer employed in a Jute Mill Industry earned Rs. 60 per day, well below the stipulated minimum wage, in the Malda district of West Bengal. However, when the company incurred losses, the management decided to declare a lock-out, and closed the company. Therefore, his family had no option but to work as \u2018contract laborers\u2019 in a Brick Company and to live in a poor unhygienic slum area for a long time. One day while carrying bricks, he slipped off the ramp, broke his spine, and died. There was no compensation for his family, and as a consequence his young child had to carry water for other laborers working in the brick company. However, the tragedy of the story was that unknown to the child or the consumers of the water, the water contained trace elements of arsenic. (Self-reported).The 1931, the Royal Commission found the state of working and living conditions of Indian labor to be \u2018horrible\u2019. Almost aThe World Health Organization estimates occupational health risks as the tenth leading cause of morbidity and mortality. The burdet al., have estimated an annual incidence of occupational disease between 924,700 and 1,902,300; and 121,000 deaths in India.[The interconnection between socioeconomic factors such as poverty, income, occupation, class, and so on, and health have a long history, which has been explained by many great philosophers, such as, Villerme, Engels, Chadwick, Mckeown's, Dubos, Marmot, and Wilkinson, in their own style. Despite proper evidence from epidemiological data or information systems, several pieces of information are available from to understand the occupational health situation in India. DGFASLI indicates that such linkages need to be contextualized within the developmental discourse globally. Leigh etin India.Work hazards are also responsible for occupational diseases, and this was first identified in 1948. The Indian Council of Medical Research reported that the prevalence rates of silicosis in Bihar mines is 34.1%,, and of Census 2001 reported that the growth percentage for female workers wais higher than that for male workers from 1991 to 2001. The proportion of the male: Female working population, which was 78:22 in 1991, changed to 68:32, in 2001. This increase rate led to certain concerns, such as, adverse effects on reproduction, exposure to toxic chemicals in the workplace, musculoskeletal disorders, because neither the tasks nor the equipment they used were adapted to their build and physiology. In addition, the female workers had specific stress-related disorders, resulting from job discrimination , a double burden of work (workplace and home), and sexual harassment. OccupatiTherefore, to decisively improve the health of a large group of people; the right approach must be in the form of a movement that moves toward a specific goal that is conducive to health. Innovative interventions including work organization change, participatory training, cleaner production, control banding, national and international coalitions, and participatory approaches to improving the work environment are needed.In India, with local medievalism and multinational modernism existing side by side, the traditional labor-oriented markets have changed toward more automation and mechanization. Here, depending upon who is employed to work where, how, and at what level of exposure to hazard labor \u2014 the history of India may be divided into three broad categories of permanent, temporary, and contract workers. In this The report of the Labor Investigation Committee in India revealed that here, in both industrial and agricultural sectors, caste composition and social hierarchy have been noted at the national level. As a result of this, most of the low-caste families and tribes, including Harijans, are engaged in low-level occupations, such as, coolies, earth movers, rickshaw pullers, and so on, and are mostly migrant laborers, coming from the states of Bihar, Uttar Pradesh, West Bengal, and Madhya Pradesh.\u201327In India, the power for recruitment is under the hand of intermediates of factory owners commonly known as \u2018Sardars\u2019 or \u2018Mistrys\u2019. These jobbers have the power to engage and dismiss workers and the practice of bribes is common for both employment and non-employment. False promises of high wages, housing, and short working hours, are common methods for attracting laborers. A reportThe study of Majumdar and Singh indicates that \u2018unskilled labor\u2019 mostly lived in unhygienic environments, resulting in a high rate of malnutrition and communicable diseases. In this Therefore, social inequality has serious implications, not only at the work places, but also in the house. Labor frParticipation of the workforce in the industrial sector is on the rise since our independence in 1947. It was argued that the expansion of industries and job opportunities were the first demands of development, without which achievement of health becomes mere talk. As, the In developing countries, governments mainly claim health-related policies that favor the workers' health needs. In this respect it is worth mentioning that the elitist35 as welInaction or destruction of demand was found to be an effective reason for non-decision making, which assigns low priority to occupational health. Here, the powerful may not attend to, listen to or hear demands as articulated by the less powerful. If such Under funding and poor economy kills initiatives that propagate toward improved occupational health.Role of higher authority and trade unions at work places.Corruption among the workers regarding implementation of occupational, health-related programs.In developing countries like India, the legislation designed to deal with occupational health matters is broad and even profuse in many cases. However, sometimes it cannot be applicable even to basic matters. Some of the most obvious problems are the lack of national and international funding, human and technical resources, weak strategies and policies, and more reasons, thereby weakening the idea of implementing health and safety programs.23 India The main reason for underfunding is lack of political will rather than lack of funds. Study ofLack of implementation, however, seems to be an effective agreement between trade unions, resulting in a formation of a new kind of conflict between workers and management in both the organized as well as the unorganized sectors. A laborer of a Cotton Industry in Ahmedabad reported to me that managers hold a dual role in the industry; they signed a negotiated agreement with trade unions obligating the companies to provide a personal protective device to every worker. However, this agreement remained on paper only, hence, the companies had to provide only a few workers with personal protective devices.Corruption, greediness, and lack of knowledge of health and safety among the workers not only fails to bring about a successful escape from poverty, but also pushes both the informal and formal sectors of economy toward vulnerabilities. Governmental as well as non-governmental schemes are sometimes found to be ineffective due the above-mentioned reasons, which are reflected from the experience of my own home town that is Malda. National Thermal Power Corporation (NTPC), Malda distributed insulated shoes for the safety of laborers, but the tragedy of the fact is that the laborers themselves sell their own shoes to get money and demand for the next shoes. Such a situation reflects how corruption, carelessness, and biasness among the workers are responsible for the failure of occupational health policies in India.Sometimes demands also get stifled through exercise of power. Public and private officials generally use power to suffocate occupational health measures through mechanisms such as centralization and monopolization of the decision-making power and weakening of organized groups through cooptation.Monopolization of decision making at the activity level causes certain impacts on occupational health. First, it isolates workers' leaders from the decision-making over health and safety issues at workplaces. Second, Most of the developing countries and their trade unions are not independent organizations. Therefore, occupational health and safety demands are diffused by reducing the potential power of trade unions through cooptation strategies, as found in Latin America and Africa. SimilarlDecision of non-making can also be evidenced through an appeal to the existing bias of the system. The poweDue to globalization, the world economy and the factors responsible for the economy take an interesting meaning all over the developing countries, including India. It was found that laborers working in the informal sector had been exported from developing countries to the industrially developed countries. The forceful shift of workers not only affected the living and working conditions of the workers, but it also might be the probable cause of the very precarious situation today. Progressive disappearance of the benefactor state, significant reduction of social budgets, minimum social policies with little effect to reduce poverty, fiscal savings, furious competitiveness, weakened unions, dispersed social resistance, and the feeling of obligation to give priority to employment or income over job characteristics and quality are some of the prevailing effects of globalization.In India the Occupational Health Services System operates at different levels and is linked to different levels of ministry and organization. It is diagrammatically represented in To answer the question, the factors and socioeconomic variables are to be identified. The concept of non-decision making emerged through attempts to theorize power relations in the society. The three contrasting theoretical perspectives \u2013 pluralist, elitist, and structuralist features prominently explain power relation issues.The pluralist perspective, rooted in the liberal democracy view, assumes the power to drive the policy process. The elitIn view of the plethora of deteriorating conditions in occupational health in India, certain welfare schemes and services were also present before independence. The Royal Commission noted that investment in health not only promoted the well-being of workers, but was also bound to produce a great economic advantage. It coverSince 1929, there were 39 inspectors for eight provinces, with 8129 factories, whose main task was to report accidents and working conditions of laborers. From the Labor Investigation Committee Report, 1940, it was found that the incidence of accidents from that period was low. Till theSince independence, the national government initiated different schemes, acts, and research institutions. After independence some legal provisions for the protection of working groups are: The Factories Act (1948), the Plantation Labor Act, 1951, the Dock Workers  Act, 1986, the Building and other Construction Workers (Regulation and the Employment and Conditions of Service) Act, 1996, the Beedi and Cigar Workers (Conditions of Employment) Act, 1966, Child labor (Prohibition and Regulation) Act, and the Insecticides Act, 1968. Legal provisions for the mining industry comprise of: The Mines Act 1952; 1955, Mines Rules; 1957, Coal mines regulation; 1961, Metalliferous mines regulation; and 1989, Oil mines regulation. The BhopThe Adarkar Commission further concretized the welfare scheme by enacting the Employees State Insurance (ESI) act for the laborers, in 1948, after independence. The Act covered the insured workers and their families for sickness, maternity, employment injury, disability, and dependence. The NatiImprovement of occupational health requires strengthened organization and appropriate leadership in trade unions, conscious workers, who are able to control the work process, and generation of unbiased information about occupational health risks. Strategies and steps for the improved conditions of occupational health status include:India urgently requires a modern occupational health safety (OHS) legislation with adequate enforcement, machinery, laws, occupational medicine, and a proper awareness program, to catch up with the rest of the worldHealth awareness and factors to measure the safety analysis of the laborers working in particular industryEmpowering positive trade unions so that they can play a key role in demanding occupational health improvementsMaking professionals available through training and development and enabling them to play an active role in the generation of information and knowledge through proper researchWork should be given depending upon two principles, which are, \u2018worker fit for job\u2019 and \u2018fit the job for worker\u2019, so that the employer generates interest on the work and avoids lack of attentionNeed for policymakers to change their attitude toward occupational health and recognize that occupational health improvement is a vehicle for socioeconomic developmentImpose a strict vigilance upon hazardous materials by investigators. The government should also weigh the pros and cons between environment and health costs of our people and cost of importing them from elsewhereThe labor report of West Bengal, India, records only minute details on hospital facilities and some data from ESI, with regard to the public health systems, which is not sufficient to understand the health and sociology of the workers. In India, however, there is no possible source from where we can get the actual report of allocation of money for the laborers. We have to depend on published reports and sources such as the Employment State Insurance (ESI), Workers Compensation Act (WCT), New Industrial Policy (NIP), Social Insurance, and so on, for allotment of money to occupational health, but only for organized and formal sectors, and not for the unorganized sectors. Therefore, it is necessary to record the life time job history, job titles, information on past occupations, industries, occupational conditions, and identification of other causal confounders. Record books for toxicity of chemicals, group of chemicals, industrial processes, and other complex mixtures along with their carcinogenic effects must also be kept. Issuing of job/occupation cards for the workers like ration card can be done for keeping recordsSurveillance of diseases in industrial belts, maintenance of death certificates, and using record-linkage techniques between various resources may also potentially improve the research on occupational healthQuality assurance, creating awareness, accreditation, and capacity building (strengthening skills and developing competencies) will be needed in the field of occupational health. Model programs and pilot projects/surveys may be undertaken with the support from ILO/WHO and different NGOs like the Indian Association of Occupational Health (IAOH), for the unorganized sector."}
{"text": "Mary E H Mandels, who spearheaded the US Army's national bioconversion studies for four decades and was an early proponent of conversion of waste biomass to readily bioconvertible sugars for the production of chemicals and transportation fuels such as ethanol, died 17 February 2008 at Natick, MA, USA. She was 90. Citation Classics [Dr Mandels spent her lifelong research career at the US Army Natick Research Laboratory (NLABS), just west of Boston, MA, USA Figure . InitialClassics   and plant physiology  with minMary, as she was known by colleagues and friends, was the eldest of five children, born to Sherman Gray and Mary Bolger Hickox at Middletown Springs, VT, USA on 12 September 1917. The family soon moved to Waterbury, CT, USA. Growing up in the Great Depression, Mary was a leader to her three sisters Corinne, Alice and Eleanor and brother Sherman, and they remained close throughout their lives. Her father was appreciative of her educational goals, yet though she had won acceptance to Cornell he still had to be nudged by Mary's science teacher to give her the support to attend college. Subsequently her mother died while she was a freshman, and then he insisted that Mary continue with her studies rather than help at home with the raising of her siblings. In 1942 she married fellow Cornell graduate student Gabriel Mandels, her studies (1939 to 1947) being disrupted by World War II. After the war and with their family established, Mary began her lifelong research career at the US Army Natick Laboratories in 1955. Her husband Gabriel had previously worked at what was then the Quartermaster Research Laboratories in Philadelphia.Trichoderma sp. QM6a , Dr Mandels' role was to address production of foods for the military in 'hostile' environments, the latter ranging from Antarctica to the battlefield to extended space missions. The preparation of 'in house' unconventional foods was addressed through consideration of plant culture  and single cell protein (SCP) in fermentors, both exciting topics at that time. The latter included consideration of cellulolytic microbes.Mary was reassigned to the Bioengineering, Science and Advanced Technology Laboratory in 1971, and with Elwyn Reese retiring in 1972 she went on to head this group Figure . With thThe importance of the 'wastes to transportation fuel' approach was widely recognised by the press, bringing national fame to the US Army Natick program Figure . Mary, wShe is survived by her children, Joan Mandels Roche (and John Roche), Suffield, CT, USA, and Peter Mandels, Sherborne, MA, USA, her granddaughter, Susan Roche, Portland, ME, USA, grandson Stephen Roche, Spring Valley, CA, USA, and her sisters Eleanor Hickox, Isle of Wight, UK and Alice Selzer, Oxnard, CA, USA. Her husband, Gabe, predeceased her in 1981.Neoloboptera mandelsae [Neoloboptera mandelsae should not be confused with Salganea mandelsi, named in honour of her husband Gabriel R Mandels [Mary and her family were keen hikers, skiers and campers. She was an enthusiastic gardener and perceptive naturalist. To stop by at her Natick home was always refreshing, often enhanced by a walk with her at the Broadmoor Audubon Sanctuary, Natick or the Garden in the Woods, Framingham where she bubbled forth with her insight of the local birds, plants and mushrooms. Mary was respected as a naturalist and it gave her great pleasure to have had an insect named in her honour: andelsae  (Neolobo Mandels ). Roth cau courant and quite outspoken on current and Army affairs. In the latter vein, Mary was concerned with the interactive role of civilians working for the military and expressed her experiences through The history of the pioneering research laboratory (unpublished) and Reflections on the United States military 1941-1987 [. The latter article is reproduced in this issue (7). Her granddaughter's memoire will also be available on this site. .Mary's breadth of knowledge was remarkable, and she was Trichoderma sp., was isolated from a dead rotting soldier whereas it was in fact from a rotting cotton shelter half (bivouac) from Bougainville Island in the Solomon Islands [There are legendary stories from the Natick program. The 'waste' substrates included both old shredded money and hydropulped confidential government documents . In like manner, the front pages of 50 of the top newspapers were processed  to sugar, the comment being that the Army made 'the front page news totally digestible'. Other legends need to be put to rest. Thus reporters wanted to say that the original mould,  Islands .Citation Classics [Mary clearly broke the invisible ceiling promotion barrier that thwarted so many women of her era. For her insight and accomplishments Dr Mandels received continual acclaim: the Civil Servant of the Year (Northeast) 1962, Gold Star for Research 1962 and 1972, US Army Research and Development Achievement Award 1972, Federal Employee of the Year 1973, Exceptional Civilian Service Award 1977, the Marvin Johnson Award, Fermentation Division, American Chemical Society with Elwyn Reese 1982 Figure , and the"}
{"text": "Catalytic high-pressure reactions play an important role in classic bulk chemistry. The optimization of common reactions, the search for new and more effective catalysts, and the increasing use of catalytic pressure reactions in the field of drug development call for high-parallel reaction systems. A crucial task of current developments, apart from the parameters of pressure, temperature, and number of reaction chambers, is, in this respect, the systems' integration into complex laboratoryautomation environments."}
{"text": "Cytokines and their receptors are involved in the pathophysiology of many diseases. Here we present a detailed review on cytokines, receptors and signalling routes, and show that one important lesson from cytokine biology is the complex and diverse regulation of cytokine activity. The activity of cytokines is controlled at the level of transcription, translation, storage, processing, posttranslational modification, trapping, binding by soluble proteins, and receptor number and/or function. Translation of this diverse regulation in strategies aimed at the control of cytokine activity will result in the development of more specific and selective drugs to treat diseases."}
{"text": "Family-centred services in the context of HIV/AIDS acknowledge a broad view of a \"family system\" and ideally include comprehensive treatment and care, community agencies and coordinated case management. The importance of family-centred care for children affected by HIV/AIDS has been recognized for some time. There is a clear confluence of changing social realities and the needs of children in families affected by HIV and AIDS, but a change of paradigm in rendering services to children through families, in both high-prevalence and concentrated epidemic settings, has been slow to emerge.Despite a wide variety of model approaches, interventions, whether medical or psychosocial, still tend to target individuals rather than families. It has become clear that an individualistic approach to children affected by HIV and AIDS leads to confusion and misdirection of the global, national and local response. The almost exclusive focus on orphans, defined initially as a child who had lost one or both parents to AIDS, has occluded appreciation of the broader impact on children exposed to risk in other ways and the impact of the epidemic on families, communities and services for children. In addition, it led to narrowly focused, small-scale social welfare and case management approaches with little impact on government action, global and national policy, integration with health and education interventions, and increased funding.National social protection programmes that strengthen families are now established in several countries hard hit by AIDS, and large-scale pilots are underway in others. These efforts are supported by international and national development agencies, increasingly by governments and, more recently, by UNAIDS and the global AIDS community.There is no doubt that this is the beginning of a road and that there is still a long way to go, including basic research on families, family interventions, and effectiveness and costs of family-centred approaches. It is also clear that many of the institutions that are intended to serve families sometimes fail and frequently even combat non-traditional families. The idea that health and social services for children should be family centred is not new, but it has yet to take hold in the area of greatest need for millions of children worldwide - those affected by HIV and AIDS and related risk factors, whether these be poverty and migration or injecting drug use.Family-centred services for children, rooted in the consumer-led movements of the 1960s, emerged towards the end of the twentieth century, initially in the fields of paediatric and geriatric care. For example, research on the adverse effects of separating young children from their caregivers led to policies that welcomed family members to be with their children during hospitalization and to participate in their children's care, especially if the clinical regime depended on continued active engagement of the family in the children's treatment and rehabilitation. As awareness of the embeddedness of the wellbeing of all individuals in social relationships and networks grew, family-centred services began to be accepted as a model for intervention [Advocates of family-centred services for children point out that the family is the basic unit of care for children, with primary responsibility for the delivery of services to children and the greatest influence on a child's health and wellbeing prior to, during and subsequent to interventions by health and social welfare professionals. These convictions have driven fundamental changes in health legislation and practice in both the United States and elsewhere, according rights to families to be fully involved in the health and wellbeing of children ,2.The core concepts of family-centred care for children were first formally articulated in 1987 . While m1. Families are constant in the lives of children (and adults) while interventions through programmes and services are intermittent and generally short lived.2. Families must be variously and inclusively defined.3. Family-centred approaches are comprehensive and integrated.4. Love and care within families, when recognized and reinforced, promote improved coping and wellness among children and adults.Initial resistance by health professionals to the involvement of families in treatment were countered by evidence that revealed few, if any, ill effects of involving families, even in intensive care environments , as wellExtensive experience of family-centred services has been gained, amongst others, in the care of children with chronic conditions , disabilThe importance of family-centred care for children affected by HIV/AIDS has long been recognized in the United States ,11-15. TLevine  speaks oThe World AIDS Day Newsletter  pointed Such definitions both respect traditional notions of family, as well as recognizing non-traditional forms of commitment arising from changes in reproductive biology, laws governing interpersonal obligations, acceptance of same-sex relationships, and deep association based on shared experience. In this sense, AIDS is a catalyst in expanding definitions of \"family\" to reflect the reality of contemporary life. More and more people live in non-traditional families, or \"families of choice\" , made upet al [There is a clear confluence of changing social realities and the needs of children in families affected by HIV and AIDS, but a change of paradigm in rendering services to children through families, in both high-prevalence and concentrated epidemic settings, has been slow to emerge. Rotheram et al  argue thet al . Despiteet al -25.Yet, when an individual is affected by HIV/AIDS, their family is inevitably affected ,27. RiskEarly into the new millennium, it became clear that an individualistic approach to children affected by HIV and AIDS was leading to confusion, and misdirecting, rather than amplifying, the global, national and local response . There wIt was under these conditions that the Joint Learning Initiative on Children and AIDS (JLICA) was launched in 2006. The JLICA was modelled on the Joint Learning Initiative on Human Resources for Health , as an ihttp://www.jlica.org, these arguments are set out in detail in Richter [et al [Spanning two years, the learning groups worked in a wide variety of ways, including by commissioning papers and through meetings, live and electronic debates, and a learning collaborative. The JLICA's final report was hailed as setting a new agenda for children , calling Richter , Richter Richter , and Ricr [et al .The death of a parent is an unspeakable loss for any child, an experience exacerbated by illness and suffering, potential loss of economic support, dislocation and separation from siblings. Adult deaths from AIDS continue to increase in the absence of antiretroviral treatment. But to focus only on orphans is to miss the bigger picture: 88% of so-called \"orphaned\" children have a surviving parent , and morDespite this, pitifully few resources and services are directed at bolstering and protecting this front line. Fewer than 15% of families caring for orphans and vulnerable children in 2007 were estimated to have received any assistance from external agencies . It has Surviving parents and families who take in children of relatives experience the stresses of increased dependency and, across the world, become poorer ,48. The The assumption that families are collapsing has led to a burgeoning of orphanages and other forms of institutional care drawing resources, even those intended to assist children affected by AIDS, away from families into expensive alternatives with known adverse effects on children's health and development . While tAt its heart, AIDS can be thought of as a family disease. In high-prevalence environments, transmission occurs mainly in the family, between parents and children  and betwLevine  argues tAmong these extremely marginalized groups, families are also inevitably affected, whether in their roles as parents, spouses, partners, siblings, children or intimate others . DespiteThe JLICA made strong recommendations regarding strengthening families through social protection and income transfers, on the one hand, and family strengthening through family-centred services on the other.Social protection for families affected by HIV/AIDS is part of a groundswell of provision and demand for increased protection against destitution and improved social security, including for the poorest families in the poorest parts of the world ,39,49,66http://www.ccaba.org), a network of child-focused foundations advised by researchers and advocates, started The Road to Vienna, an initiative to explore the nature of family-centred services, evidence for their feasibility and effectiveness, barriers to their expansion, and their relevance to especially marginalized populations. The initiative began with a meeting in Nairobi in late September 2009, piggy backed onto the first African Conference on \"Promoting Family-Based Care for Children in Africa\", organized by the African Network for the Prevention and Protection against Child Abuse and Neglect and its partners. Ten presentations were made on various aspects of familycentred services, including applications to prevention of mother to child transmission, antiretroviral (ARV) treatment for children, early child development services, and depression; five of these presentations appear as papers in this special issue .The second prong of the response - family strengthening through family-centred services for children affected by HIV and AIDS - has yet to receive similar levels of endorsement and commitment. In response, the Coalition on Children Affected by AIDS . What became clear from this meeting is the almost complete lack of research in this area, and a strong desire by people in marginalized groups to receive services to support their families and legal reform to help them to be good parents.A second meeting was convened in Geneva in February 2010, in partnership with the International AIDS Society, to consider family-centred services for children and families of people in especially marginalized groups . Seven presentations were made, together with a panel discussion, with strong participation from people representing affected groups. Three of these presentations appear as papers in this special issue  sometimes fail and, importantly, frequently even combat non-traditional families. The latter may, at worst, be prosecuted for their lifestyle and lose custody of their children and, at least, be excluded from decisions about treatment, and be excluded from insurance benefits and/or home tenancy when a partner dies.The author declares that they have no competing interests.LMR conceived the review, conducted the search for materials and wrote the paper.LMR co-chaired Learning Group 1: Strengthening Families in the Joint Learning Initiative on Children and AIDS (JLICA) and is a member on the Committee of the Coalition on Children Affected by AIDS (CCABA). Executive Director, Child, Youth, Family and Social Development, Human Sciences Research Council, South Africa; Honorary Professor, Department of Psychology, University of KwaZulu-Natal, South Africa; Honorary Professor, Department of Paediatrics and Child Health, University of Witwatersrand, South Africa; Honorary Research Associate, University of Oxford, United Kingdom; Visiting Scholar, Harvard, University, United States."}
{"text": "The last century witnessed the birth, growth, and maturation of community medicine as a scientific discipline. However, changes in the health scenario at the turn of the century posed several challenges to academic community medicine. Due to demographic and epidemiologic transition the disease burden of chronic non-communicable diseases and injuries is rising whereas communicable diseases, malnutrition, maternal and child health problems are yet to be overcome. With rapid industrial growth, environmental and occupational health problems are also likely to pose a bigger threat to population health. Moreover, the existing health system, which is based on a biomedical model of disease prevention and control, is not adequately geared to face these challenges.The core function of academic community medicine is to study the health and disease in defined communities, identify their health needs, plan and evaluate programs so as to effectively meet their health needs. However, in the present era of globalization, social policies at the national and international level have a profound influence on the health of communities. This calls for new approaches to tackle determinants of health at the local and global level. To face the emerging challenges community physicians not only need thorough knowledge of epidemiological and bio-statistical methods, but also need to know the relevant aspects of the social, political, economic and environmental sciences, and the principles of administration and management. Applying this knowledge to identify health determinants, development of public policies and plans to address these determinants, management and evaluation of health programs requires a variety of skills, a challenging task indeed. This calls for integration of biomedical, ecological and sociological approaches with academic community medicine so as to have the desired impact on population health.th century, the practice of hygiene, that emphasized specific preventive measures such as personal cleanliness and environmental sanitation, became the main tool of public health for prevention and control of infectious diseases.The role of social policy as a primary determinant of population health was emphasized by Rudolf Virchow, a pathologist who is considered to be the father of social medicine. McKeown th century, with the emergence of chronic non-communicable diseases, integration of the biomedical and sociological approaches formed the core philosophy of preventive and social medicine. The assimilation of family medicine with preventive and social medicine to meet the needs of primary heath care gave birth to community medicine in the health centers of South Africa. can do. He/she should not only be able to deal with common medical, surgical, obstetrical, pediatric problems, and emergencies in a Primary or Community Health Center having facilities for conducting deliveries, admitting patients, and running round the clock emergency service but should also be able to manage health services at these levels. Five such multitasked physicians enabled to meet family health needs are a very cost effective substitute for five specialists at the Community Health Center.As the role of health in socio-economic development is becoming clearer, governments are allocating more resources to public health. Hence, the requirement of public health human resources will increase manifold in the near future. Indian public health standards have specified the requirement of a public health professional in each of the community development blocks, the Integrated Disease Surveillance Project is recruiting an epidemiologist in every district of India, and the National Rural Health Mission has also created the position of public health manager in most health institutions. Therefore, institutional capacity for development of public health human resources by initiation of certificate, diploma and degree courses of one to two year duration for pre-service and in-service candidates from medical, nursing, laboratory, nutrition, environment, biology and social science streams should be accorded due priority. A three-year bachelor of public health course can be a good addition for augmenting the already depleted supervisory cadre in the public health system. Substantial restructuring of the curricula is required for development of competencies not only in epidemiology, health management, heath education, and health informatics, but also in public policy, health economics, environmental and occupational health, and health promotion. In the short-term, existing professional resources from allied disciplines can be co-opted to build the required capacity in community medicine and public health, two sides of the same coin."}
{"text": "The results are presented of a case-control study conducted in the north of Iran. The main aim was to study factors identified in a previous study as potentially causally related to cancer of the oesophagus. Other tumours  were included to distinguish findings specific for oesophageal cancer from general characteristics of cancer patients, due for example to ascertainment bias, and to verify that expected associations, such as between lung cancer and cigarette smoking, would emerge under the prevailing field conditions. Two controls were chosen per case, matched for village of residence, age, sex and language group, Reinterviewing was performed to a limited extent to assess the accuracy of replies to questionnaires. The following were found not to be associated with oesophageal cancer: consumption of sheep's milk and yoghurt, sesame oil, chewing of nass, making of carpets, use of pregnancy diets, salting and sun-drying of meat and use of wild spinach. The use of opium, bread and tea could not be assessed in the retrospective framework. Strongly associated with risk of oesophageal cancer were low socio-economic status and low intake of fresh fruit and vegetables. The two factors each had an independent effect, and were more marked for oesophageal cancer than for the other tumours."}
{"text": "There is a decrease in the number of new midwives, resulting from the shutdown of midwifery education program in hospitals due to a decrease in birthrate in the Republic of Korea. To solve this problem, the current medical laws on midwifery education system in Korea should be revised; nurse-midwifery specialist programs must be established in educational institutes with nursing programs. To support this argument, the midwifery education programs of America, Europe, Australia, and Japan have been discussed, and a nurse-midwifery specialist curriculum at the master's level, based on the nurse-practitioner system of Korea, has been suggested. Since this assertion is very important and urgent for solving the future population problem of Korea and providing health care for women and children, it should be realized into action immediately. The midwife is a health professional with a nursing license, who has also obtained a midwife license after receiving one year of midwifery education and passing a national licensing examination. According to Article 3 of the Enforcement Ordinance of Medical Code, midwifery education must be performed in \"obstetrics/gynecology and pediatric hospitals with the average of a hundred or more childbirths per month.\" Therefore, most directors of hospitals submit a request to the Ministry of Health and Welfare and perform midwifery education programs? In order to become a midwife, one must receive a yearlong education in a hospital that provides this midwifery program, pass the national examination and receive a license from the Ministry of Health and Welfare. Up until 1991, more than 200 students received midwifery education and applied for the national licensing examination . However, due to the sudden decrease in birth rate (1.16) [http://www.uic.edu/nursing/):In the United States, a nurse with a nursing license can become a certified nurse midwife after completing M.A. curriculum for two or more years with options of midwifery classes and passing the license examination operated by the ACNM (America College of Nurse-Midwives) DOA (Division of Accreditation). Midwifery programs are available in schools with medical or nursing schools, and the curriculum and education periods differ among institutions. In order to improve and maintain the quality of American midwifery education, the different curriculums of institutions are evaluated and approved according to the standards of the ACNM. The ACNM presents the core abilities for midwifery work and requires curriculums to be based on it. This core ability is revised and modified every five years to comply with the changing demands of society. Therefore, the midwifery curriculum of American universities offers 40 to 50credits to meet the ACNM standards. Students can choose 2-year, 2-and-half-year, or 3-year programs depending on their status as full- or half-time students. The nurse-midwifery curriculum of United States is the certified nurse midwife program, and thesis writing is or is not mandatory depending on the universities. A thesis is required for entering the doctorate program later on but not when students aim to enter general practice; in this case, practice is emphasized in place of thesis writing. The following is an introduction to the curriculum of University of Illinois, in which a thesis is mandatory. The educational purpose of the midwifery education program at the University of Illinois at Chicago, College of Nursing, is as follows  midwifery education program consists of a 2-year midwifery education after achieving a nursing license. Instead of thesis writing, practice is more heavily emphasized. Students take common subjects in the first year and concentrate on studying and practicing midwife-related subjects in the second. Each semester, theory and practice are carried out in parallel. In the first year, students take gynecology, primary health care, health care of pregnant women, practice; in the second year, students take, labor & delivery, postpartum, health care of newborn, practice, law, management, elective. In total, students take 44 credits: 22 in their major, and 22 in common and related subjects.The Shenandoah University . Thus, current medical law must be revised first of all.The laws that need to be revised in order to enable nurse-midwifery education in graduate school are: medical law article 6, related to the license of nurse-midwives; medical law enforcement regulation article 3, related to medical institutions, educational institutes, and the number of students related to midwifery education; and order of Ministry of Health and Welfare article 4, \"containing the subjects and practicum of midwifery practice program explained in \"Nurse-midwife who possess nursing license and have finished one-year midwifery practice program in medical institutions approved by the Minister of Health and Welfare.\" This article should be altered as follows: \"Nurse-midwife who possess nursing license and have finished a master's program in nurse-midwifery curriculum at a nursing education institute.\"Nurse-midwives perform family-centered, professional midwifery and are not only involved in the delivery process but also the whole lives of women. Nurse-midwives also act as leaders in midwifery education, practice, and policy. Those who wish to improve themselves more academically can connect their studies to doctorate programs, thereby contributing to the theoretical improvements of midwifery. This enables the exchange of knowledge and techniques between midwives around the world.Currently in Korea, the Order of Ministry of Health and Welfare Issue 712, regulations of midwifery practice article 4, clarifies that a midwifery practice program must consist of program studies and practice of 40 hours per week, requiring a total of 200 hours of program studies, 1,720 hours of practice, and over 20 direct birth assistant. Because this article must be adjusted for a master's-degree level of nurse-midwifery curriculum, we suggest the following adjustments.Nurse-midwife education curriculums have been designed based on 1) the midwifery regulation of World Health Organization (WHO) , 2) a coThe mission of nurse-midwifery specialist programs is to educate nurse-midwives who can provide safe, comprehensive, evidence-based health care to women. Nurse-midwives who have completed this program will work as midwives in both hospitals and the community and be primary health care specialists in public health centers. This proposed masters in midwifery program, by providing comprehensive health care and appropriate health education throughout a woman's life span, promotes health maintenance and enhancement and prevention of diseases. Primary health care, reproductive health care, health care during pregnancy, labor & delivery, postpartum women, contraception & family planning, newborn & infant health, and family health care classes are offered. Nurse-midwives provide health care based on knowledge of health science that focuses on midwifery work and on women and family-centered practice. Nurse-midwives respect women's decisions and different cultures and lifestyles, as well as the individuality and spiritual dignity of every woman.Nurse-midwifery specialist programs provide nurse-midwives with the following abilities:professional knowledge as clinical nurse-midwivesthe ability to provide not only scientific knowledge on reproductive health and specific, comprehensive knowledge related to it, but also evidence-based health carethe ability to consider, plan, practice, and evaluate objects through the nursing process in diverse practice situationsthe knowledge, attitude, and technique to have problem-solving capacity in emergenciescreativity and the ability to use oneself as an instrument?the ability to cooperate with other health care personnel in diverse health care systemsthe ability to contribute to society by realizing their rights and duties as professionals, clinical practice researchers, educators, and scholarsThis curriculum is based on the Nurse-Practitioner program approved by the Ministry of Health and Welfare, which consists of 13 credits of common theory subjects, 10 mandatory credits, and 10 practice credits .The evaluation of nurse-midwives is based on the standards of nurse-practitioners provided by the Ministry of Health and Welfare.The curriculum of nurse-midwifery education is evaluated every 5 years by the Midwifery Education Evaluation Committee in Korea Midwife Association. The details to be evaluated are the educational philosophy and purpose, the qualification of faculties and preceptors, facilities (for study and practice), present conditions of study and practice standards, status of educational institutes and practice centers, and scholarship offers, etc.The ratio of successful applicants for national examination.The ratio and conditions of graduated students' employment.      This paper explained the necessity of revising the current medical laws to increase of numbers of midwife and improve the quality of Korean midwives and suggested specific revisions of medical laws and graduate level curriculum for nurse-midwifery education. These suggestions must be realized in order to provide a sufficient number of high quality midwives. Not only that, it is necessary to realize the childbirth encouragement policy of Ministry of Health and Welfare and the worldwide health policy of WHO, which promotes \"less Caesarian section delivery, more natural childbirth.\" As this proposal is very urgent and important for Korean health policy, it should be realized into action immediately."}
{"text": "Secular and cohort trends in mortality from cancer in Scotland during 1953-93, and incidence during 1960-90, were analysed using individual records from the national mortality and registration files. For certain cancer sites, the secular analyses of mortality were extended back to 1911 by use of published data. Mortality from cancer at older ages in Scotland has increased over the last 40 years. In each sex, this trend has been dominated by the effects of smoking: all-cancer rates and rates of lung cancer, now the most common fatal cancer in men and in women in Scotland, reached a peak in the cohort of men born at the turn of the century and the cohort of women born in the 1920s. For much of the period, the Scottish all-age rates of lung cancer were the highest reported in the world; they are now decreasing on a secular basis in men, but are still increasing in women. There have also been large increases at older ages in the incidence and mortality rates for cancer of the prostate in recent years. bladder cancer, nervous system cancer, non-Hodgkin's lymphoma, myeloma and leukaemia; for each there is likely to be a considerable artefactual element to the increase, with differing degrees of possibility that there may in addition be an element of real increase. Substantial decreases in mortality at all ages have occurred for stomach and colorectal cancers and substantial increases at all ages for pleural cancer and melanoma. Rates of mortality from breast cancer, the most common cancer in women in Scotland, have generally increased over the past 80 years; a temporary cessation in this upward trend occurred in the years during and after the Second World War, and recently rates have turned downward, probably at least in part because of better treatment. Mortality from ovarian cancer, the second most common reproductive-related female tumour in Scotland, has also increased at older ages. At younger ages, mortality from cancer in Scotland has decreased, especially in men, whereas incidence has not. This divergence, which has been a consequence of better treatment, has occurred especially for cancers of the testis and ovary, Hodgkin's disease and leukaemia. There have been increases at young adult ages, however, in both mortality from and incidence of oral and pharyngeal, oesophageal and laryngeal cancers in men, and melanoma and non-Hodgkin's lymphoma in each sex. Cervical cancer rates at young ages also increased, but this trend has reversed for incidence in the most recent birth cohorts. Incidence rates have also increased for testicular cancer in young adults and leukaemia in children. With the possible exceptions of non-Hodgkin's lymphoma and childhood leukaemia, the increasing rates are likely largely to reflect real rises in incidence, and they highlight the need for investigation of the causes of these cancers, and, when causes are known, for preventive action."}
{"text": "Considering the data and including two patients of the authors, there exist only 18 authentic cases of primary malignant melanoma of the lower respiratory tract and/or the lung. The tumor was localizedin the endobronchial space in 7 cases and only once in the trachea. Endobronchial localization, togetherwith the involvement of the surrounding lung tissue, was found in two cases, whereas in 8 patients,the tumor was found exclusively in the lung parenchyma. Successful resection could beperformed in 14 of the 18 cases. Survival was influenced primarily by operability, and on actual sizeand extension. The authors question the role of the obduction in the diagnostic criteria, because mostof the survivors, even up to ten years postsurgery were considered primary. Apart from the variousimaging methods, diagnostic endoscopy  and the histology of the biopsy materialare major aides in the diagnosis of primary character, location, and operability, as well as in theelaboration of the surgical plans, than it is usual in cases of other tumors."}
{"text": "Purpose. To study the evolution of concepts concerning gastrointestinal stromal tumours (GISTs) over 30 years.Discussion. GISTs have been, for more than 30 years, the subject of considerable controversy regarding their line of differentiation as well as the prediction of their behaviour. Furthermore, once they spread within the peritoneal cavity, they are extremely hard to control. The recent findings of c-Kit mutations and the immunohistochemical detection of the product of this gene, KIT or CD117, in the mainly non-myogenic subset of this family of tumours, has led to a reappraisal of this group of lesions, which, with some exceptions, is now thought to be derived from the interstitial cells of Cajal, and this has facilitated a clearer definition of their pathological spectrum. In this article, we review chronologically the evolution of the concept of GIST with the gradual application of electron microscopy, immunohistochemistry, DNA ploidy analysis. We discuss the impact of these techniques on the pathological assessment and clinical management of GISTs."}
{"text": "Dear Editor,Prof Barrie Jones on 19 August 2009 in Tauranga, New Zealand, aged 88.It was with great sadness that we learnt of the death of He was admired worldwide for his work in developing the concept of prevention of blindness and for establishing the International Centre for Eye Health  in 1981. He was in fact responsible for encouraging the launch of the first issues of this journal. However, your readers may not be aware of his major contributions, earlier in his career as first clinical professor of ophthalmology in the University of London, to the science and management of corneal and external eye disease.Barrie first addressed the range of virus infections of the eye seen in London, writing about adenovirus infection and corneal involvement by the vaccinia virus. He conducted much laboratory research on herpes simplex infection, and randomised trials of interferon, idoxuridine, trifluorothymidine, adenine arabinoside, and ultimately acyclovir. A rational approach was developed to the management of different stages of herpetic keratitis, including mechanical debridement, when to use corticosteroids, and the role of corneal grafting.1Although a much less common cause of keratitis than in tropical countries, fungi nonetheless caused serious corneal infections in London. Barrie and his colleagues cultivated and tested the sensitivity of every fungus isolate to many different potential new drugs. He emphasized that the variations in sensitivity within each species were so great that it was necessary to base rational therapy on the results of sensitivity testing of each patient's own fungus.2Barrie Jones was widely known as an authority on many aspects of trachoma. He developed methods of isolation, culture, and laboratory diagnosis. In extensive field studies in Tunisia, Iraq, and Iran he elucidated the seasonal dynamics of transmission of blinding hyperendemic trachoma, recognising the importance of multicyclic re-infection and the role of flies in transmission in these countries. He carried out trials of early potential vaccines and of chemotherapy.3He investigated and wrote about an astonishing range of other corneal conditions, including infections by amoebae, vernal and other allergic types of keratoconjuntivitis, Thygeson's superficial punctate keratitis, pemphigoid, and dry eye syndromes. In the operating theatre, he pioneered new surgery of the lacrimal canaliculi and duct and improved the techniques, postoperative management, and outcomes of corneal grafting.When, around 1980, he turned the full energy of his thinking to the questions of blindness prevention, it was informed by this rich background of laboratory and clinical experience."}
{"text": "SirIn a combined analysis of the Nurses' Health Study and the Health Professional Follow-up Study, on a total of 206 women and 143 men with cancer of the pancreas, In order to provide further information on the issue, we updated the analysis of a case\u2013control study conducted in Italy between 1983 and 1992  and corresponding 95% confidence intervals (CI) were estimated using unconditional multiple logistic regression models, including terms for age, education, tobacco consumption, body mass index, and history of diabetes.Thus, our findings are consistent with those of the Nurses' Health Study and the Health Professional Follow-up Studies ("}
{"text": "Cardiac Children of the World), was founded in Milan in 1994 by paediatric cardiac surgeon Alessandro Frigiola, and anaesthesiologist Silvia Cirri. The driving force behind the association is a passion for providing treatment and hope to disadvantaged children with congenital heart diseases in developing countries. The association has support from cardiac surgeons and cardiologists in Italy, as well as from famous cardio-surgical centres around the world, including the Mayo Clinic in Rochester, Minn; Great Ormond Street Children\u2019s Hospital in London, England; and l\u2019H\u00f4pital des Enfants-Malades in Paris, France [The Italian charity organisation: \u201cAssociazione bambini cardiopatici nel mondo\u201d  are treated in San Donato . The inauguration of the Shisong Cardiac Centre took place in November 2009 [Shisong Cardiac Centre is the only cardio-surgical Center in Central/West Africa, equipped with ultra modern technologies and prepared to offer a wide range of cardiology services including diagnosis and treatment of congenital heart defects, coronary artery disease, valvular heart disease and electrophysiology. It will handle non-invasive cardiology; that is, diagnostic testing for patients with suspected cardiac problems through tests such as electrocardiography, holter, stress test, three-dimensional colour, pulsed and continuous doppler- echocardiography; it will offer both diagnostic and interventional catheterism in a hemodynamic laboratory, implantation of permanent mono, bicameral pace makers and defibrillators. Open-heart surgeries with extracorporeal circulation will also be performed at the centre. The Project is jointly sponsored by the Tertiary Sisters of St. Francis, the Bambini Cardiopatici nel Mondo Association and Cuore Fratello Association in Milan  for an overall cost of 4 billion FCFA (800 millions USD).The planning for inauguration went far beyond the spectrum of Shisong Hospital to involve all the Tertiary Sisters of St. Francis in Cameroon, Nigeria and the Republic of Central Africa; and an equal concern of the Bishop of Kumbo, Mgr. George Nkuo. The collaboration with the Senior Divisional Officer for Bui, Mr. Panjuouno Daniel and all the civil administrators of Bui, together with the Mayor of Kumbo Council, Mr. Donatus Njong, was phenomenal, a pace setter, indeed! At the divisional level Commissions were set to cater for various aspects such as road maintenance in town, accommodation, coordination, security, decoration and entertainment; and these set the actual celebration running at a grander scale!\u201cEven if the Prime Minister, the Minister, the Ambassadors and the Italian delegation were not to be present, we would still have a reason to celebrate this gift that has been brought to our environment by the Catholic Church through the Tertiary Sisters of St. Francis,\u201d said the SDO of Kumbo at a preparatory meeting, which set everyone on their toes. The Cardiac Center was inaugurated by the Minister of Public Health, His Excellency Andre Mama Fouda, who stood as the personal representative of Cameroon\u2019s Head of State. He proclaimed the Cardiac Center as the national reference Center, to the high applause of the multitude and promised subventions and other forms of reinforcement.In the inaugural high Mass presided by his Eminence Cardinal Tumi Wirghan, he lauded Shisong Hospital for its excellent healthcare practice over the years and warned the medical staff against the encroaching hostile climate and lack of respect for life, and other gross deviations from the social teachings of the Church, threatening African today. In the same vein, Bishop George Nkuo, in his welcome address, invited all to pray and added that the facility in Shisong Hospital would give the Tertiary Sisters of St. Francis the opportunity to expand the scope and quality of their service.Sr. Jethro Nkenglefac, Manager of the Cardiac Center, says she is aware of some major challenges involved in running a Cardiac Center, and therefore, is prepared to put up appropriate strategies for success. While thanking the Cameroon Government and its people for the support offered during its construction, she earnestly appealed to the public to make good use of the facility, to refer it to others within and beyond Cameroon, and to contribute in establishing the solidarity health scheme that would enable every person to benefit from specialized facility irrespective of social, racial or economic status.\u201cThe Shisong-Bamenda and the Shisong-Foumban roads are not good for our patients,\u201d said Sr. Euphrasia Yuh, Provincial Superior of the Tertiary Sisters of St. Francis, as she pleaded for the support of Cameroonian Government. The question of roads and electricity was common in the addresses of the Mayor of Kumbo, the Italian Ambassador to Cameroon, the Major Superior of the Capuchins, and those of the two Partner-Associations. And, in fact, an 83-person delegation was getting ready to pour from Italy and France unto the Cameroonian soil, consisting of cardiac surgeons, specialized nurses, politicians, donors, journalists, and members of the two Associations. Professor Alessandro Frigiola, pediatric and adult cardiac surgeon and Founding President of Bambini Cardiopatici nel Mondo, visited Cameroon for the first time and symbolically operated the first two patients in the new theater on November 20 2009. Subsequent surgeries will be performed by Dr. Alessandro Giamberti and Dr. Charles Mvondo.Don Claudio Maggioni, the Milan-based diocesan priest who first dreamed of the Cardiac Center in a developing world, said he was humbled to witness the extent to which the mustard seed had spread and the number of birds that take shelter in its branches. Marking the inauguration was the medical conference under the theme \u201cpediatric and adult cardiology\u201d, which brought together guest speakers from Italy, France, and Cameroon. Participants involved health personnel from most of the health institutions in Bui and beyond."}
{"text": "The Author Contributions are incorrect. The text should read: Project outline and experimental design was originated by JG, TW, TZ, and ML. JG, TW, and TZ performed the experiments and analyzed the data. All authors contributed intellectually to data interpretation and manuscript preparation, and approved the final version of the manuscript."}
{"text": "Change is a constant for Emerging Infectious Diseases. Since its inception in 1995, the journal has undergone many transformations: its content has broadened, its format has become more distinctive, and its frequency of publication has increased, from quarterly to bimonthly in 1999 and now to monthly with this issue. Yet, amidst all the changes, Emerging Infectious Diseases has found its niche in the ranks of scientific journals, serving the needs of professionals in infectious diseases and many related disciplines. In 7 short years, the journal has achieved a high impact factor ; indexing in Medline, Current Contents, and other major databases; translations into Spanish, Japanese, Chinese, and French; and a circulation of more than 45,000 subscribers to its print and electronic versions. The journal has also provided a new communication channel through which to encourage global investigation and dialogue on the many issues, challenges, and opportunities posed by emerging infectious diseases.The goals of the journal stem directly from the Centers for Disease Control and Prevention\u2019s (CDC\u2019s) action plan against emerging infections: recognition of new and reemerging infections; understanding of factors involved in disease emergence, prevention, and elimination; and fast and broad dissemination of reliable information on emerging infections around the world. Toward these goals, the journal 1) provides information on factors known to influence emergence: microbial adaptation and change, human demographics and behavior, technology and industry, economic development and land use, international travel and commerce, and the breakdown of public health measures; 2) reports laboratory and epidemiologic findings within a broader public health perspective; 3) provides timely updates of infectious disease trends and research ; 4) publishes reports of interest to researchers in infectious diseases and related sciences, as well as to public health generalists learning the scientific basis for prevention programs; 5) encourages insightful analysis and commentary, stimulating global interest in and discussion of emerging infectious disease issues; and 6) harnesses electronic technology to expedite and enhance global dissemination of emerging infectious disease information. In pursuing these goals, the journal has set a high standard of quality, not only for its peer-reviewed scientific content but also for the readability and accessibility of this content. A modern journal functions in a fast-paced world of information overload, instant access, overburdened scientific audience, and the accidental broader audience created by the World-Wide Web. To fulfill the increasing expectations of an expanding audience that includes scientists in many disciplines, public health generalists, students, and the public, articles are edited for language, communication effectiveness, style, and length. The human aspect of scientific research is always kept in the forefront by the association of scientific research with works of art on the journal\u2019s cover and by \u201cAnother Dimension\u201d articles, reminding the reader that, in the end, the purpose of all scientific endeavor is the betterment of humanity and the improvement of the quality of life for all people. The journal relies on a broad international authorship base and rigorous independent peer review to provide accurate and reliable scientific information on emerging infections, free of charge, around the globe. The journal draws authors and readers from professionals in infectious diseases and many other scientific disciplines in the United States and abroad, specialists in academia, industry, clinical practice, and public health, as well as economics, demography, and sociology. To expedite dissemination of up-to-the-minute information, from its inception Emerging Infectious Diseases has published articles online ahead of print. Morbillivirus in Australia, tuberculosis trends in Japan, antimicrobial resistance in Europe, infectious disease emergence in New Zealand, genomics and bacterial pathogenesis, amphibian population declines, the role of migratory birds in the spread of West Nile virus, infections in the health-care setting, bovine spongiform encephalopathy and variant Creutzfeldt-Jakob disease, and bioterrorism.Since 1995, Emerging Infectious Diseases has published new scientific research, analysis and commentary, policy reviews, and concise synopses on a broad array of infectious disease topics. Coverage has included topics as diverse as In 2002, the journal remains at the crossroads of change. Upon my retirement from CDC, D. Peter Drotman, a senior scientist with the National Center for Infectious Diseases, became Interim Editor while a search is conducted for a new Editor-in-Chief. To the role of Interim Editor, Dr. Drotman brings a broad knowledge of infectious diseases, effective leadership, and boundless enthusiasm. A veteran of the successful World Health Organization Smallpox Eradication Programme, he was among the first CDC scientists assigned to investigate cases of what was later to be named AIDS.West Nile virus in the United States and the use of Bacillus anthracis in recent bioterrorism attacks are reminders of the need for vigilance and the undiminished potential for global dissemination of infectious agents.In the meantime, infections continue to emerge: new infections resulting from changes or evolution of existing organisms, known infections spreading to new geographic areas or populations, previously unrecognized infections appearing in areas undergoing ecologic transformation, old infections reemerging as a result of antimicrobial resistance in known agents or breakdowns in public health measures. The recent appearance of As a monthly journal in 2002, Emerging Infectious Diseases will continue to track and analyze infectious disease trends and to encourage investigation and timely communication of emerging threats and critical related issues around the world. Advances in electronic publishing allow unprecedented speed in disseminating public health information and create new opportunities for innovation and improvements in communication. Electronic submission and peer review of manuscripts, online publication ahead of print, online-only publication, and convenient links to other sources of biomedical information are only the beginning."}
{"text": "The public health burden caused by cardiovascular disease (CVD) continues to adversely affect individuals in terms of cost, life expectancy, medical, pharmaceutical and hospital care. This burden has been excessive in the case of African Americans. The objective of this paper is to chronicle the procedures and processes that were implemented in the development of the Jackson Heart Study Coordinating Center. The Jackson Heart Study (JHS) is a population-based investigation of traditional and emerging risk factors that predict progression to CVD among African Americans. In response to the struggle against CVD, the Jackson Heart Study has convened a professional, technical, and administrative staff with specific competence in the operation of a coordinating center to handle the wide variety of areas related to CVD studies. The Jackson Heart Study Coordinating Center (JHSCC) was created to assure validity of the JHS findings and provide the resources necessary to meet comprehensive statistical needs ; data management , and administrative support. The JHSCC began with a commitment to support study functions in order to increase participant recruitment, retention and safety, meet regulatory requirements, prepare progress reports, and facilitate effective communication with the community and between all JHS centers. The JHSCC facilitates the efforts of the JHS scientists through the development and implementation of the study protocol. The efforts of the JHSCC have resulted in the successful preparation of scientific reports and manuscripts for publication and presentation of study findings and results. In summary, the JHSCC has emerged as an effective research mechanism that serves as the driving force behind the Jackson Heart Study activities. The JHS is a study of the characteristics of cardiovascular disease (CVD) in African Americans in Mississippi, examining traditional and emerging risk factors that predict progression to clinically detected CVD. The objective of this paper is to chronicle the procedures and processes that were implemented in the development of the Jackson Heart Study Coordinating Center. In recent times, CVD has been documented as a major cause of death in the United States. Approximately 64 million people in the United States have some form of CVD . The pubAs part of its role in the three institution partnership that comprises the Jackson Heart Study, Jackson State University was entrusted with the task of developing and managing the Jackson Heart Study Coordinating Center (JHSCC). The activities of the JHSCC were designed to provide opportunities for scientists to participate in ventures that would eventually lead to a reduction in the disparities in health care and health services that are now prevalent in Mississippi . Among aThe JHSCC collaborates with the National Heart, Lung, and Blood Institute (NHLBI) that has a field office located on site at the Jackson Medical Mall, Jackson, Mississippi; and the National Center on Minority Health and Health Disparities (NCMHD). The NHLBI Field Site Office team participates in surveillance activities, manuscript development and publication and presentation activities. These activities are fundamental to maintaining the scientific rigor and productivity of the study, and the JHSCC benefits immensely from the continuous involvement of the NHLBI and its Field Center staff.2.Jackson Heart Study researchers are studying a sample of 5,301 men and women aged 21 years or older who were recruited from the tri-county area of Hinds, Madison and Rankin counties in the Jackson Metropolitan Area. The cohort comprised 3,394 females and 1,907 males. Each participant receives an extensive physical examination and interview to obtain data on coronary status and function, standard coronary risk factors, socio-demographic factors, lifestyle factors, and psychosocial factors. Selected examinations and interview questions are repeated allowing the scientific investigators to comprehensively study the progression of CVD. Blood samples are analyzed and stored for future studies. DNA is extracted and stored for study of candidate genes and possibly, genome-wide scanning. Participants are monitored annually for identification and characterization of CVD events. In order to successfully undertake the enormous task of examining CVD in African Americans, the Jackson Heart Study comprises a professional, technical, and administrative staff with specific competence in the operation of a coordinating center to handle the wide variety of areas related to CVD studies.2.1.Jackson State University was funded beginning October 15, 1997 to develop plans for the provision of the typical functions of a coordinating center for the Jackson Heart Study (JHS) utilizing The University of North Carolina at Chapel Hill, through its established Coordinating Center, provided consultation to the planning committee. The primary mission was to assure validity of the JHS findings and provide the resources and expertise necessary to meet comprehensive statistical needs ; data management , and administrative support. The JHSCC also participated in activities that supported participant recruitment and retention through the Community Partnership Office which maintains collaborative enduring relationships with community groups and leads the efforts to provide community public health education, and to apprise the community periodically of JHS study by delivering progress reports. Several individuals played key roles in the early stages of the JHSCC to plan, develop, maintain, and monitor the effective management of the JHSCC activities. They are the following:Robert Garrison, Principal Investigator Coordinating Center, with responsibility for the overall direction, administration and scientific aspects of the coordinating center, was the representative of the Coordinating Center on the steering committee. He was later replaced by Daniel Sarpong in that capacity. In addition, Dr. Sarpong participated in policies and procedures development, training, data management activities, cost control, staff management, and report writing, and developed SAS programs for statistical data analysis.Mary Lou Gutierrez-Mohamed, Coordinating Center Coordinator, had primary responsibility for the coordination of the Coordinating Center programmatic activities and participated in the development of the manual of operations, OMB protocols, quality assurance and control, training, data collection, recruitment and retention surveys, and reports development.Gail Hughes, Co-Principal Investigator and Assistant Director, assisted the Principal Investigator in the planning and implementation of all the tasks of the Coordinating Center. She was involved in protocol development issues, sub-studies, ancillary studies, and statistical analysis of data.Joseph Cameron, Community Mobilization Director, provided overall programmatic direction to the Jackson Heart Study Community Mobilization effort, focus group planning and implementation, media outreach and community surveillance. He participated in the recruitment and retention efforts. He was later replaced by Donna Antoine LaVigne, and this department was renamed the Community Partnership for Awareness Education with Dr. Antoine-LaVigne coordinating the community mobilization-implementation plans, marketing efforts, workshops, conferences, focus groups and public relations.Pramod Anugu, Systems Analyst, provided database system and application support to the study. He designed, implemented, and maintained the systems for regular analysis and dissemination of data; he prepared data-driven reports, maintained and updated the web-sites and the communication systems (LAN etc.).Gregory Wilson served as Senior SAS Analyst/Programmer, responsible for preparing the consolidated database, implementing the data management procedures and programming for transfer and import of exam center, laboratory, and reading center data into the consolidated database. He was also responsible for overall statistical computing programming for the study.Clifton Addison, Statistical Programmer/Clinic Liaison participated in statistical computing programming for the study, OMB protocols, quality assurance and control, manuscript development and training. As Clinic Liaison, he was responsible for training and certification of Exam Center staff in preparation for the participants\u2019 exam visits.Brenda Campbell-Jenkins, Research Associate had responsibility for the collection of research materials, preparation of paper forms, question-by-question instructions, and OMB protocols. She served as the Coordinator of the Publications and Presentations Subcommittee and the Ancillary Subcommittee. She also assisted in the QC monitoring of exam clinic through reviewing forms, re-certification documentation, and other standard QC procedures. She maintained detailed and organized records of procedures and served as the repository for all JHS research related information.Lavon Young, Data Entry Assistant/Information Processing Specialist, with responsibility for forms development, preparation of screen layouts for the DMS, and routine data checks, assisted in monitoring retention and follow-up of the cohort through weekly reports in the early stages of the study. She was responsible for formulating, planning and coordinating the layout and typesetting for various documents using advanced software applications.Danita Graham, Contracts Administrator, with primary responsibility for the coordination of the Coordinating Center programmatic activities, as well as the fiscal management of the study, coordinated all purchases for the Jackson Heart Study, communicated with reading centers, sub-contractors, and consultants on all contracts management issues; she tracked expenditures and developed all in-house financial reports for the Coordinating Center, as well as the ancillary administrative budget for Jackson Heart Study.Clara Fortner, Senior Program Coordinator, coordinated, facilitated, and managed activities of the Project Director Office and held overall administrative responsibility for the management of the JHS offices. She supervised all clerical staff and student assistants, developed personnel and steering committee reports, oversaw travel logistics for meetings of staff, sub-contractors, boards, and committees. She also served as the recording secretary of the steering committee.Planning a study of this magnitude with a partnership among three institutions was an organizational challenge that required an atmosphere of cooperation among the institutions in the planning phase. During this planning phase, the principal activities included designing the survey instruments, developing a sampling plan and examination components; creating manuals of operations and training of staff. It also included pre-testing all data collection forms; implementing procedures for processing data and specimens; performing quality control and data analysis, and obtaining Office of Management and Budget (OMB) study clearance.2.2.The JHSCC plays a major role in instrument design, data collection, quality control monitoring, data processing, and statistical analysis in order to document procedures. The leadership at the coordinating center is committed to direct the study through the following sub-committees: Quality Assurance, Publications, Community Mobilization, Operations, Imaging, Laboratory, and Morbidity and Mortality. The JHSCC Director is responsible for maintaining the management structure of the coordinating center and assuring cooperation of all institutional investigators and staff to achieve the goals of the study. He is assisted by a staff of biostatisticians, data analysts, research associates, research assistants, and additional support staff. Participant reports, including summaries of participants\u2019 clinic visits, data quality and timeliness reports, safety reports, inventory information, follow-up status summaries, and reports of unusual problems, are provided by the JHSCC to the entire JHS team.The JHSCC works in conjunction with the Jackson Heart Study Steering Committee to develop, implement, and monitor procedures to insure confidentiality and privacy in all the data collection stations as well as within the JHSCC. Details about the Jackson Heart Study Steering Committee are chronicled elsewhere. The responsibility for the protection of participants is an integral component of the operational procedures. The JHSCC is committed to ensuring the strictest level of confidentiality by discussing and monitoring procedures during hiring, re-certification, and limiting access, and protecting machine readable data with encryption. The JHSCC plays a major role in protocol development and oversight, instrument design, data collection, quality control monitoring, data processing, and statistical analysis in order to document procedures. Furthermore, it acquires and manages subcontracts for Reading Centers and related activities, cohort recruitment through community mobilization and administrative support.2.3.The JHSCC facilitates and coordinates the development of the forms, assures uniform implementation of the study protocol and coordinates the maintenance of the Manuals of Operations, providing expert guidance and dependable direction. Manuals of Operations are distributed to all study investigators, and are also located on a study-specific Web Site maintained by the JHSCC. These manuals serve as the main reference for central training of staff, and as a refresher course for staff prior to completing re-certification exercises. The protocols include the Examination Center Operations, Follow-up of health status, and Data and Specimen Collection and Transmittal. The quality assurance and quality control manual includes training and certification requirements, site visit and data audit methods, and procedures for replicate data collection. These documents provide detailed written standard operating procedures that govern the data collection, processing, storage and transmittal, quality assurance, and publication necessary for implementation of the scientific objectives and methods of the study protocols.The JHSCC guides the development, integration, and production of all Manuals of Operation, under the direction of the Steering Committee, including a detailed set of question-by-question instructions (QXQs) for each of the interview instruments for the target groups. Protocol development, staff training, and pilot testing were performed in the first 18 months of the study. The first examination took place over a four year period, from September 2000 to April 2004. It was followed by a second examination period beginning in September 2005 that ended in December 2008. A third examination period began in February 2009. Participants are contacted every 9 to 12 months throughout the study to assess clinical morbidity and mortality. Data analysis began in the last few months of 2004, and this focus will continue for the rest of the study and beyond.2.4.A database management program was developed with an overriding emphasis on ensuring system efficiency and system security. The JHSCC used a uniform approach to security across computer systems and databases. The guidelines required that proper authorization be identified as the first step in the creation of an account. Also included, as part of the security process, was the development of a standard convention for usernames and passwords. In addition, specific procedures were outlined and documented for JHS data management and data protection .During the planning phase of the JHS, systems were developed for examination data, administrative data, follow up data, and the event or surveillance data. Comprehensive data management is provided throughout all phases of data collection. A highly skilled team is on staff to design and develop computer applications for data collection, and to execute plans for central data acquisition, management, analysis, quality control measures, the recruitment and retention tracking system, and surveillance protocols. These staff members also possess expertise in the methods used to coordinate and manage this complex epidemiological study which include recruitment, clinic visits, networks, laboratories, reading centers, and follow-up of participants. Their responsibilities also include assisting in organizing protocol and procedures and monitoring recruitment and follow-up of study participants.Although the JHSCC started out using paper data collection systems, the transition was soon made to a commercial data management system that was customized over the first two years of operation. This completely electronic data entry and data management system uses commercial customized software or commercial database management system (DBMS) such as Oracle, Oracle Clinical or Clintrial4 and applications developed by the systems analysts. A tested data backup system has been integrated and regular backups are done. Each PC is connected to a central server for administrative and communications functions with standardized, secure e-mail and scheduling software for both the JHSCC and the Exam Center (EC). Communication between the Exam Center (EC) and JHSCC can be done using e-mail and other electronic means. Paper communication and FAX communication are also available means of communication. A secure dial-up capability is provided as a backup to direct internet connection for authorized JHSCC and EC personnel, and all systems are protected from power failure by means of uninterruptible power supplies.The JHSCC supports a Jackson Heart Study public web site and maintains secure web and file transfer protocol (ftp) sites for controlled information transfer and releases of data residing on the fast, high volume server. The JHSCC also maintains an effective intranet through the use of the secure web pages and secure ftp sites. The public web site publishes general news and technical information approved for public use.The JHSCC has developed documentation and training programs for all data collection software, instruments, and forms used by the Exam Center (EC) personnel. The system includes procedures for regular sampling inspection of intermediate and final data products for comparison to source information, and data correction and feedback to the EC and reading centers, when data quality problems are encountered. When data are being entered and electronically sent to the database, the staff conducts range checking and database consistency checking, and arranges site visits to observe data collection quality. As a contingency plan, backup systems using paper forms are provided in situations where computer system failures interrupt data collection. This system also includes an analysis management protocol with procedures for tracking data analysis requests, archiving analysis results and programs and error checking and verification of analyses. Data quality is optimized by the data entry, management and reporting system that is resistant to data error and data loss.2.5.An important function of the JHSCC is the evaluation of the suitability of medical and scientific expertise in cardiovascular medicine and the management of contracts and contractual arrangements with consultants specializing in analysis and interpretation of special JHS investigations. The JHSCC works with the NHLBI staff and the examination center to establish the framework for the subcontracts, the selection criteria, and solicitations, in accordance with NHLBI guidelines. This JHSCC oversees all budgets, in addition to contracts with the central processing unit for supplies at Jackson State University, a Central Laboratory, and Reading Centers including carotid ultrasound, electrocardiography (ECG), echocardiogram (ECHO), pulmonary function, diet and other special core center operations. A detailed work plan for each subcontractor is compiled indicating how each aspect of the work is to be accomplished. The JHSCC maintains information on how each sub-contractor\u2019s project is to be organized and staffed, along with the management of important events or tasks with the objective of monitoring their operations to ensure that their proposed scope of work is completed in a timely and cost-effective manner. The details of the reading centers operations are chronicled elsewhere .The JHSCC purchases, distributes, and maintains all mechanical and electronic equipment related to computer hardware and software and clinic furnishings that can not be provided by the JHS centers. Such hardware includes workstations, file servers, laser printers and network components, such as wiring, hubs and connectors. The laboratories and reading centers will receive a stand-alone workstation on which to run the inventory and, if necessary, a data management system. The JHSCC is also responsible for developing, in conjunction with the laboratories and reading centers, a schedule for calibration and maintenance of the equipment. The JHSCC assembles and monitors the information on equipment calibration and maintenance for inclusion in the quality assurance reports.2.6.Staff of the JHSCC created a community mobilization plan to develop partnerships within the community and enhance methods for fostering recruitment and cohort retention in the JHS. Community mobilization, though not a traditional function of a coordinating center, was helpful in facilitating access to a stable population of African Americans from which the cohort was derived. The community mobilization arm of the JHSCC is titled the \u201cCommunity Partnership for Awareness Education\u201d. This component makes JHSCC unique compared to other Data Coordinating Centers. Among its main functions are addressing factors that may influence people to participate in long-term research studies, promoting ongoing community support for the Jackson Heart Study, and disseminating information about CVD risk factors to the community. The community mobilization plan undergoes periodic modification to adapt to specific needs of the study and the community, and much of this is executed through a comprehensive community involvement plan that includes the development and implementation of an extensive media campaign. The Community Partnership Subcommittee functions as the oversight advisory committee for this division of the JHSCC and is composed of JHS staff along with representation from the community. This subcommittee meets regularly to monitor progress of the JHS mobilization activities, evaluate JHS directions and achievements regarding recruitment/retention, and to make recommendations for improvements. Barriers and facilitators to African Americans\u2019 participation in research were documented by the planning committee prior to implementation of the JHS.Knowledge about older African Americans and their involvement and influence in recruitment are essential to understanding recruitment success and pitfalls in ethnic minority research . Most Af2.7.The Coordinating Center provides the scientific leadership committees with accurate and timely reports on study progress. Performance reports, including participant accrual summaries, data quality and timeliness reports, safety reports, inventory information, follow-up status summaries, and reports of unusual problems, are provided to all JHS components. The Coordinating Center provides administrative support for the meetings of the JHS Steering Committee and all JHS subcommittees, and conference calls. Annual meetings of the NHLBI/JHS Observational Study Monitoring Board (OSMB) are arranged and managed as part of the administrative support provided by the JHSCC. The Coordinating Center also provides audiovisual equipment, and makes special arrangements to facilitate the successful culmination of proceedings.2.8.The Research Support Unit is responsible for providing technical support, as well as training and support for the rest of the JHS departments. Because of the overwhelming nature of research, the Research Support Unit was established to facilitate accessibility, problem solving and project development for beginning researchers and seasoned professionals alike. These staff members are dedicated to assisting interested individuals or groups with understanding and implementing Jackson Heart Study protocol and procedures, and meeting deadlines for deliverables. This unit\u2019s primary goal is to support and assist policy and practice. The Research Support Unit of the JHSCC also facilitates entry and editing of data from the examination site and reading centers; follows up on missing or erroneous data; does quality control monitoring through data checks and monitoring visits; prepares reports on study progress and coordinates and monitors interim contact with study participants by the examination center.Several mechanisms have been developed to monitor quality control. The JHSCC provides documentation, training and user support along with regular assessment by observing exams and interviews in which direct entry is taking place. The JHSCC establishes staff training and certification procedures, internal quality control programs and data quality procedures. A schedule has been developed for periodic re-certification, calibration of equipment, and pretest of procedures. Protocols have been developed to monitor through direct observation , quantitative monitoring (random repeat measurement of inter- and intra-staff), reporting results , and action on results .The JHSCC is designated as the repository of all JHS data; responsible for preparation and dissemination of QC reports using tabulated data, summary statistics, and identifying specific QC problems. The JHSCC developed the Quality Control Protocol, and provides operational support for the quality control committee, through the maintenance of central logs of data quality problems and solutions. Data quality is assured by providing training and pre-testing, performance monitoring, quality control and online documentation. Quality Control is an ongoing monitoring process to detect deviations from protocol standards and procedures. Such monitoring activities take place at identified points during data collection and processing.2.9.The JHSCC has responsibility for developing and implementing pre-testing procedures. These procedures are developed for each component of data collection and field tested, and a detailed evaluation is provided to the Steering Committee (SC). The Biostatistics Unit possesses vast knowledge and understanding of scientific issues related to the study rationale and design, including the importance of the research questions and hypotheses, knowledge of CVD, and understanding of state-of-the-art analysis methods. Statisticians in the Biostatistics department possess expertise related to study design and analytical methods. This group takes the leadership in preparation of scientific reports and manuscripts for peer-reviewed publication. The JHSCC Biostatics Unit provides statistical analytical support for all JHS investigators and collaborators at other institutions.3.3.1.The investigators and staff of the JHSCC have demonstrated the capacity and the personal and technical expertise to design, organize, and efficiently execute data management and analysis and related responsibilities for a large-scale epidemiological study. Jackson State University has succeeded in establishing a functioning Coordinating Center capable of carrying out the epidemiological, biostatistical, data base management and data storage center resource functions for the Jackson Heart Study (JHS). The JHSCC has demonstrated the leadership and ability to coordinate statistical, medical, data management, and the fiscal/administrative expertise to provide leadership for the operation of a first-class Coordinating Center. The JHSCC continues to meet some very important objectives; to assist medical professionals in their research, understanding, analyses and dissemination of CVD discoveries; to report findings and circulate information to the community in an appropriate, relevant and culturally sensitive manner with the ultimate goal of improving the quality of life.The development and implementation of the JHSCC has led to the opening of several opportunities for public health students to engage in hands-on research training. The Jackson Heart Study research training opportunities include research projects that can lead to Masters theses or doctoral dissertations. In addition, the JHSCC regularly engages students from local and national colleges/universities in research assistantships and summer internships to prepare them for careers in the medical and public health fields. Through the development and successful implementation of the JHSCC, the Jackson Heart Study continually seeks to fulfill its obligation for capacity building in the African-American community."}
{"text": "Almost 40 years ago, in 1969, the Cuyahoga River caught fire as it flowed through Akron and Cleveland, Ohio. Although it was not the only river to burn, the image of this burning river\u2014the terrible wronging of nature\u2014became a symbol of the urgency for a transformation of environmental policy for the environmental movement of the 1970s, driving the creation of the U.S. Environmental Protection Agency (EPA) and the rapid passage of major new environmental laws and regulations.Staphylococcus aureus), and the return of highly pathogenic avian influenza , SARS (severe acute respiratory syndrome), MRSA (methicillin-resistant nfluenza . To paranfluenza , we haveSalmonella, Clostridium, enteroviruses, hepatitis A virus, Cryptosporidium, and Giardia. These are among the most common causes of infectious disease in the United States. In the rivers and streams flowing through Baltimore to the Inner Harbor of the Chesapeake Bay, researchers at Johns Hopkins University have found the same dangerous brew of disease-causing organisms. We carried out a study of urban anglers\u2014people who fish in the urban watershed of Baltimore\u2014and reported that, although some fish have elevated levels of polychlorinated biphenyls or mercury, anglers are at immediate risk of infection by Cryptosporidium merely by handling caught fish and crabs (Although the Cuyahoga River doesn\u2019t burn, it is still in critical condition, filled with viruses, bacteria, and microparasites . The fisnd crabs .The modern environmental movement began with a long overdue call to action concerning pesticides and other industrial chemicals . AlthougThese are environmental health issues of the highest priority. The National Institute of Environmental Health Sciences has a critical role in improving our knowledge on the role of the environment in the emergence and dispersion of infectious pathogens and human disease, including ecologic cycling of pathogens, the regulation of reservoirs of antimicrobial resistance, and the persistence of pathogens in soils and other media."}
{"text": "Neglected tropical diseases (NTDs) exist and persist for social and economic reasons that enable the vectors and pathogens to take advantage of changes in the behavioral and physical environment. Persistent poverty at household, community, and national levels, and inequalities within and between sectors, contribute to the perpetuation and re-emergence of NTDs. Changes in production and habitat affect the physical environment, so that agricultural development, mining and forestry, rapid industrialization, and urbanization all result in changes in human uses of the environment, exposure to vectors, and vulnerability to infection. Concurrently, political instability and lack of resources limit the capacity of governments to manage environments, control disease transmission, and ensure an effective health system. Social, cultural, economic, and political factors interact and influence government capacity and individual willingness to reduce the risks of infection and transmission, and to recognize and treat disease. Understanding the dynamic interaction of diverse factors in varying contexts is a complex task, yet critical for successful health promotion, disease prevention, and disease control. Many of the research techniques and tools needed for this purpose are available in the applied social sciences. In this article we use this term broadly, and so include behavioral, population and economic social sciences, social and cultural epidemiology, and the multiple disciplines of public health, health services, and health policy and planning. These latter fields, informed by foundational social science theory and methods, include health promotion, health communication, and heath education.Social science health researchers have attended particularly to HIV/AIDS, and more recently to malaria and tuberculosis (TB), reflecting the prevalence and resistance to control of these diseases and their emphasis in the United Nations Millenium Development Goals. Other infectious diseases, by default, have slipped into a \u201cneglected\u201d category. These include most \u201ctropical\u201d diseases, such as Chagas disease, dengue, human African trypanosomiasis, leishmaniasis, leprosy, lymphatic filariasis, schistosomiasis, and onchocerciasis. The inclusion of these diverse diseases as \u201cneglected\u201d refers not only to their status relative to HIV, TB, and malaria. Their neglect reflects their epidemiology: they are prevalent among the poorest and most marginalized of the world's population. More than 70% of countries and territories affected by NTDs are low-income and lower middle-income countries, and 100% of low-income countries are affected by at least five NTDs In recent years, however, NTDs have received increasing international interest, partly in response to promising advances in drug development. Concerted efforts are being made also to promote innovative public health approaches such as integrated delivery of multiple interventions The focus of this review was established at an expert consultation in which we participated, hosted by TDR on April 23\u201324, 2007. The experts convened to examine the current status of applied social science research in tropical disease control, identify ongoing challenges, and develop a strategy to mainstream gender and the social sciences within TDR. Priority areas for the review were based on consensus panel discussion. Literature reviewed was identified through MeSH heading searches in Web of Science, PubMed, and Scopus using various combinations of terms including social science, tropical diseases, neglected diseases, gender, and poverty. The review also drew on research funded by TDR and work conducted by TDR-trained scientists, represented both in peer-reviewed journals and in grey literature. Our aim was to inform developments in the identified key areas, and reflecting this aim, we have not sought to cover comprehensively all social science research in tropical and neglected diseases. In addition, we do not necessarily reflect the views of WHO, nor specifically those of TDR.The research themes and priorities for social research on NTDs reflect evolving approaches and discourses in international public health and the specific public health challenges of the era. In the early 1950s, well before the international health community would coin the term \u201cneglected tropical diseases,\u201d public health practitioners involved in infectious disease control programs had developed a keen interest in applied social science research. Considerable work began to focus on understanding reasons for adverse reactions to vertical infectious disease control efforts In the 1970s, primary health care, community participation, and support for horizontal health care systems emerged as important concepts and tools to address health inequalities. TDR was established as a joint special program of the United Nations Development Programme (UNDP), the World Bank, and WHO  to counteract the neglect in research and development efforts for tools to combat infectious diseases among the poor TDR funded a significant number of young scholars for higher degrees as well as an expanding number of research projects through the Research Strengthening Group and the Steering Committee on Social and Economic Research, and after 1994, through various initiatives and task forces on applied field research Over the decades, a considerable sub-literature on social sciences in infectious diseases and their control has emerged, including chapters in textbooks of tropical medicine In the mid 1990s, \u201cupstream\u201d issues such as globalization, equity, gender, and human rights gained increasing prominence in international health. In 2000, a new TDR Steering Committee on Social, Economic, and Behavioural Research (SEB) was established with the mandate to build on, promote, and support social research identifying constraints in, and opportunities for, infectious disease control and prevention in resource-poor settings. Emphasis was placed on elucidating social, cultural, economic, health-systems, and policy-related factors, and proposing strategic solutions to barriers in disease control and public health. In contrast to the work of the earlier committees, attention now was placed on social research that would address large-scale, \u201ctransnational\u201d issues and challenges in relation to infectious diseases and their control. Researchers were encouraged, in this context, to attend to the societal and economic impact of globalization as well as specific disease and health-systems factors The research programs and related training of social scientists have consolidated the role of social sciences in the tropical disease agenda, particularly with respect to a stronger evidence base on the social determinants of health, on potential areas for interventions, and on preliminary developments in the area of implementation research. However, major challenges remain in understanding the complex interactions of community, household, personal, and governmental factors that maintain health and produce disease, and in finding effective ways to address these issues at various political levels.As reflected in the bibliography, the social science and applied health literature on infectious diseases of poverty is substantial, but uneven across diseases, themes, regions, and institutions. There is, for example, greater attention to communities who are vulnerable to disease, and less to institutions involved in disease prevention and control. Below, we draw attention to what we regard now as the most urgent and emerging research questions.Continued research is needed on the implementation of interventions and control programs to ensure a critical evidence base to inform the effective, sustained, and embedded adoption of interventions by communities Increased urbanization is partly driven by economic changes, but also by environmental and climate change, resulting in changed patterns of land use and residence, and changes in vector habitat and behavior. Global warming has both direct and indirect effects on the distribution and prevalence of NTDs, highlighting the need for further research on the links between society, environment, agriculture, and human health, and the relationship of these factors to the control of neglected vector-borne diseases such as dengue Notwithstanding growing attention to health programs, health services, and access to care, research is still required to explore how access to health services is conditioned by poverty and inequality, as shaped by structural and political-economic factors . In an emerging research agenda, there is a need to move to explore practical ways to disrupt disease transmission and enhance accessibility of care. Because of changes in land use, climate, and population demographics, and subsequent changes in the distribution of NTDs and continuing risk of drug resistance, there is a need too for ongoing research on the maintenance of disease control in areas of low prevalence. This will enable monitoring and prevent resurgence, without the need for resource-intensive programs. The various roles of the not-for-profit sector, industries, and civil society need further exploration. There are also continuing questions regarding government and population interactions, governance and government institutions The research on gender has almost without exception focused on issues affecting women with a disregard for how gender affects the disease experience of men. The fluid nature of the concept of gender and its dynamic interaction with other determinants of vulnerability, such as socioeconomic status, ethnicity, and age, also remain poorly understood. Our understanding of the significance of and interactions between gender differences and other social and economic variables is sparse, and little work has been conducted to apply our current knowledge from gender studies to the development of gendered policy and practice across all aspects of the health sector, including human resources and capacity building. These issues need to be understood within a broader political and environmental context that takes into account issues such as inequality, political instability and violence, displacement, and globalization New biomedical priority areas need to be enhanced by social science research. Innovative vector control interventions and new drugs and diagnostics need to be considered in terms of their introduction, acceptability, and adherence, and the integration of such innovations as a component of community-based interventions. Research needs to be undertaken on the acceptability and utilization of drugs in multi-intervention approaches for disease control , including in relation to the acceptability and affordability of new approaches and new drug regimes. People in endemic areas frequently have multiple infections; however, limited work has been undertaken on the social implications of this. Other areas requiring greater attention include decision-making regarding treatment, the impact of complex treatments, particularly when a person has more than one communicable and/or non-communicable disease, willingness to carry the cost of treatment for recurrent infections, and attitudes towards side effects.Research needs to be continued on the supply and distribution of drugs, including in relation to the proliferation of counterfeit drugs, the failure or inability to adhere to prescribed treatment regimes, the illegal circulation of drugs, and other questions on the use of pharmaceuticals and the roles of the private sector TDR's social research activities address both basic social science and implementation research issues, including most recently research on community-directed interventions for major health problems in Africa The hierarchical structure of personnel within the health sector in many disease-endemic countries stems from a colonial legacy that privileges the knowledge and contributions of biomedically trained personnel, and fails to appreciate fully the importance of engaging with a range of health professionals, such as lay providers, volunteer workers, and traditional specialists, to enhance the effectiveness of behavioral, household, and community-based interventions While social scientists need to engage in research related to health policy, administration, and management, in countries where NTDs are endemic, there are still few applied social scientists working on health-related questions, and a limited understanding within the health sector of the contributions that they might make. Further, for non-medically trained health service personnel engaged in research and in the design and delivery of programs, there is usually a limited career trajectory: social scientists are typically employed at levels not commensurate with their qualifications, without opportunities to utilize their specialized skills. This lack of recognition serves as a disincentive for those with the capacity to return to or remain within the health sector, contributes to their dissatisfaction in improving health services, limits the quality of applied social science research, and inhibits the translation of relevant social science findings into practice.The research themes that we believe to be of key importance in the years to come fall into two broad areas. One relates to globalization and its impacts: global warming and changes in the epidemiology of disease, urbanization, anthropogenic environmental change, and the availability, cost, and distribution of drugs. The other area relates to the control of disease, and in this context, to community participation, government\u2013community partnerships, PPPs, health services research, and strategies for control of both single diseases and multiple infectious diseases. It will take time to nurture and strengthen new areas of research, not least if they are breaking new ground and are conceptually difficult; it will also take time, and is always complex, to sustain the small group of researchers working in these fields in endemic countries. Strategies and resource allocation need to be based on long-term outcomes.NTDs are referred to often as diseases of poverty, but implicit in the use of the term poverty is the tight inter-relationship of poverty and inequality. This reference to poverty extends to include individuals, households, communities, and countries. It refers to the individuals and households affected by infectious diseases, the effects of continuing, untreated infection, and the impoverishment that occurs as a direct result of disease and the high costs of health care. It refers to the material circumstances of communities at risk\u2014in poor, isolated, and ill-served rural areas and in the sub-standard conditions of urban slums and squatter settlements. It acknowledges, too, the difficulties faced by countries too poor to provide the infrastructure, human resources, and services that reduce the toll of such infections, and that are crippled by international debt and economic disadvantage in ways that are echoed in the incidence and prevalence of diseases. A social science perspective on diseases of poverty is critical to ensure that equity remains an underlying principle in policy development, research, advocacy/dialogue, legislation, resource allocation, planning, implementation, and monitoring of programs and projects.Social research has drawn attention to the difficulties in ensuring effective and sustained interventions for NTDs in both urban and rural communities, and in environments that have been disrupted by war, resettlement, and migration.Gender has a major impact on the distribution of disease, risks of transmission, and diagnosis and patterns of care. However, the links between gender differences and other social and economic variables, such as socioeconomic status, ethnicity, and age, are poorly understood.Social research on community diagnosis, treatment, and control highlights the importance of community participation for the successful introduction, acceptability, and adherence of innovative vector control interventions and new drugs and diagnostics."}
{"text": "Philosophy, Ethics and Humanities in Medicine (PEHM) responds to these realities by providing a forum for deep discussion of the philosophical bases of science and medicine, so as to attempt to depict 1) the intensity and complexity of the intersection of philosophy and ethics; 2) how this intersection is revealed in research and therapeutics, and 3) how philosophical premises might ground ethical analyses and approaches that are necessary for sound medical care. Simply put, the vision and mission of PEHM is to generate thought and reflection upon the richness of the situations and relationships that are intrinsic to medicine.In an accompanying interview, Prof. Edmund Pellegrino reflects upon a life in medicine and bioethics, and offers his perspectives on the current and future state of these fields. Professor Pellegrino reiterates his oft-cited view of the inextricability of philosophy, ethics and the humanities in science and clinical medicine. This intertwinement must be acknowledged and regarded in any consideration of the nature and extent of the myriad possibilities and problems that can and will arise in medicine, and in the moral decisions mandated by its circumstances. in medicine is important, as it communicates an appreciation for ethics and humanitarian concern(s) as essential to each and all of the dimensions that contribute to and constitute medicine as a profession and practice. The papers appearing in PEHM illustrate this, and also seek to inform, educate, and at times, provoke debate and controversy. This year has seen a fine complement of papers: some re-examining longstanding questions and constructs of medicine [The notion of philosophy, ethics and humanities medicine -3; othermedicine -10, and medicine -14 Certamedicine , that havide infra), as both commentary upon the ongoing discussion of the issue at hand - and Prof. Papadimos' paper.Each and all of these themes are relevant - and controversial - in light of recent healthcare reforms and the changing climate of healthcare provision. There is some question as to whether Aristotle actually endorsed healthcare as a right, and Prof. Pellegrino  has raised this point by noting specific citations from Annas, Long, Miller, Schofield, et al.  The readPellegrino calls for \"...broader conversation...about the whether any classical foundation exists for the right to healthcare\", and recently, John K. Hall and Mark V. Boswell have asserted that while physicians - and, might I add, patients - may like to think of healthcare as a human right, ethics and law do not provide clear support for this position . As thesBut it is important to bear in mind that legislators do not render patient care, clinicians do, and I urge that we view this task scopiously, so as to obtain an enhanced appreciation for the professional responsibilities for healthcare that arise from what the most current scientific findings - and the humanities - reveal about health, disease and illness. This may provide deeper insight to why and how the realties - and philosophy and ethics - of medicine should inform healthcare policy. Toward these ends, it might be meaningful to reflect upon the teachings of the past. Aristotle's depiction of the interdependence of science, practical wisdom, philosophy, ethics, and politics is just as relevant today as it was centuries ago . It speaAs Aristotle recognized, a healthy citizenry makes for a stronger republic. But achieving such goals is reliant, at least in part, upon responsibilities borne by the \"strong\"  to mitigate the plight of the weak . Yet, whatever the system of medical care may turn out to be, it will be enacted in an increasingly technophilic milieu that is steeped in - and influenced by - a market mindset that is quick to commoditize resources, services and goods. To ethically navigate this socio-economic landscape, clinicians might do well to heed Aristotle's call for virtue and temperance, for despite the fact that technology has dramatically enhanced the quality of health and healthcare, the imprudent use of any technology - old or new- can be problematic, if not  erroneous -22. The This decision remains the province of the clinician, in concert with individual patients' needs and values. Yet, the latitude to make such decisions - and provide such care - must be enabled by guidelines, policy and law. Medicine - as profession and practice - does not occur in a socio-political vacuum, and as David Nash has stated, it is important to understand \"...the political, educational and economic forces that are helping shape the future practice of medicine...\" . To do sPEHM can facilitate such positive change by providing a forum for intellectual reflection and discussion that gives rise to fresh ideas and directions that are required if meaningfully sound progress - if not true paradigmatic shift - are to occur. Thus, in some small way, our work together in this journal might contribute to the preservation of something old and valuable  as we forge ahead and shape a new, viable -and better - medicine for the future.Clinicians, philosophers, ethicists, and policy-makers must be well-informed of the facts, circumstances, needs and values of involved agents, and the contingencies, exigencies and potential consequences that are both intrinsic to medicine, and that could be affected by guidelines and reforms. That such policy reforms have been posed reveals an awareness of changing problems and current inadequacies within the systems and conduct of medicine, and an expanding conventional wisdom that has identified the need for health care to \"work better\" -26. My h"}
{"text": "Communities of practice and social-professional networks are generally considered to enhance workplace experience and enable organizational success. However, despite the remarkable growth in interest in the role of collaborating structures in a range of industries, there is a paucity of empirical research to support this view. Nor is there a convincing model for their systematic evaluation, despite the significant potential benefits in answering the core question: how well do groups of professionals work together and how could they be organised to work together more effectively? This research project will produce a rigorous evaluation methodology and deliver supporting tools for the benefit of researchers, policymakers, practitioners and consumers within the health system and other sectors. Given the prevalence and importance of communities of practice and social networks, and the extent of investments in them, this project represents a scientific innovation of national and international significance.Working in four conceptual phases the project will employ a combination of qualitative and quantitative methods to develop, design, field-test, refine and finalise an evaluation framework. Once available the framework will be used to evaluate simulated, and then later existing, health care communities of practice and social-professional networks to assess their effectiveness in achieving desired outcomes. Peak stakeholder groups have agreed to involve a wide range of members and participant organisations, and will facilitate access to various policy, managerial and clinical networks.Given its scope and size, the project represents a valuable opportunity to achieve breakthroughs at two levels; firstly, by introducing novel and innovative aims and methods into the social research process and, secondly, through the resulting evaluation framework and tools. We anticipate valuable outcomes in the improved understanding of organisational performance and delivery of care. The project's wider appeal lies in transferring this understanding to other health jurisdictions and to other industries and sectors, both nationally and internationally. This means not merely publishing the results, but contextually interpreting them, and translating them to advance the knowledge base and enable widespread institutional and organisational application. Scholars within the health , aviatioCommunities of practice can be defined as \"groups of people who share a concern, a set of problems, or passion about a topic, and who deepen their knowledge and expertise in this area by interacting on an ongoing basis\" . Social These kinds of clustered relationships abound in health care and other industries. They can be naturally-occurring  or mandated  . They caCommunities of practice ,22 and sAt the same time, potentially negative consequences have been noted. Wenger and colleagues argue that communities of practice can encourage the hoarding of information to the detriment of others, curtail improvement and progress, and create in-group and out-group rivalries . BuchanaAlthough interest in communities of practice and social networks in industry settings has grown remarkably, no convincing model for their systematic evaluation has eventuated. Many authoritative commentators agree that analytic evaluation methods and tools are lacking -34. ThusClinicians, like other professionals, work best when they are allowed to flourish in groupings of their own interests and preference, are empowered ... and nurtured and influenced by their peers rather than controlled by others\"  will employ new approaches.We will inform our work using theories on teams , inter-pThis is a comprehensive effort to execute a rigorous evaluation methodology, and deliver tools for the benefit of researchers, policymakers, practitioners and consumers. We have the opportunity to achieve both meaningful and transferable advances in the knowledge base of the discipline and to incorporate novel and innovative aims and concepts into the project design. Through the support of key stakeholders within the Australian health system, we will have access to a wide range of workplace communities and networks, including hundreds of clinicians, to test and refine our models. The overarching aims, phases, objectives, methods and outcomes in the approach are depicted in Figure The methodology is conceptualised in four major phases, matched to the aims and objectives and commensurate with the research approach. Each phase has two components, and involves a little over a year's work to achieve the project's objectives.The project will produce an evaluation framework founded on empirically-grounded evaluation principles. Initially we will drill further into the literature and derive from this assessment a set of fundamental, working evaluation principles. Work feeding into this process includes seminal contributions by Wenger and colleagues ,22,30 anSecondly, armed with the initial framework, we will design a preliminary evaluation model. There are many evaluation types , but ourThirdly, in phase 2, we aim to test the model and tools across a focused sample of communities of practice and social-professional networks. Peak Australian stakeholder groups have agreed to involve a wide range of members and participant organisations in this study. These include networks or communities of clinicians identified by the National Institute of Clinical Studies, accreditation surveyors of the Australian Council on Healthcare Standards, managerial members of the Australian College of Health Service Executives and clinical, managerial and policy groups associated with the Clinical Excellence Commission. We will identify, in conjunction with these stakeholder partners, representative samples of differing types of communities of practices and social-professional networks  and enrol them in our study. We aim to make comparisons between groups and across group types.The testing component will yield experience which will, fourthly, enable us to refine the tools, including their validity and reliability. Differing approaches to examine validity and reliability will be taken. Work on the reliability of social network data is important, and optimum outcomes can be achieved by re-applying social network questionnaires and comparing consistency of results -58. We hPhase 3 involves two components: fifthly, simulating the systems dynamics  of commuHaving derived the refined evaluation framework, model and tools we will seventhly apply them on a large scale to a sample of communities of practice and social networks identified across Australia, covering the public and private sectors, in order to achieve a sample broadly representative of the health care system. In this phase we will gather sufficient data on communities of practice and social-professional networks to assess their value, and judge the extent to which they contribute to work satisfaction, motivation, recruitment and retention, performance, resilience, safety and renewal. We will test the results and calibrate them against the predictive simulation data drawn from phase 3.This leads to our eighth component - a review of the research outcomes to interpret results and make final observations on the findings. We will use an arm's length, expert panel to triangulate judgements. Such a process further strengthens project outcomes, closing the feedback loop and helping to determine whether communities of practice and social-professional networks realise the results intended for them.This protocol provides a conceptual framework and research design for evaluating hard-to-research social science manifestations which are key determinants of health systems performance. A multi-methods, phased research design is important and innovative, and has been matched to the phenomena under investigation. This represents a bold approach to creating and then testing an evaluation model.Investigating and evaluating complex organisational constructs such as communities of practice and social-professional networks is challenging. Conducting research in naturalistic settings, examining behavioural and attitudinal factors in context, is a key strength. The research design recognises this, and applies a complex systems approach to the examination of complex systems phenomena. Repeated, staged testing of progress with the model introduces validity, reliability and rigour. Incorporating measures of organisational performance in the design increases the potential for robust correlations. Having undertaken extensive literature analyses of both communities of practice and social-professional networks, we have laid a sound platform to aid understanding and provide theoretical and empirical building blocks to our research studies.Objective measures are hard to achieve in social science research, as is generalisability, thus we have incorporated triangulation techniques in our design and seek transferability of findings rather than strict generalisability. Nevertheless, our results by definition will fall short of the gold standard, and will not produce level 1 evidence. Balancing this limitation is the reality that a strict test of this kind cannot be applied against research in this mould. Thus, other safeguards, including seeking data from multiple sources and assessing the extent to which they converge or diverge, constitute an effective, alternative approach.This is a large, comprehensive research project which will deliver outcomes both specifically relevant to health systems and transferable to the large number of organisations, systems and sectors which are affected by the effectiveness, or otherwise, of communities of practice and social-professional networks. In developing a rigorous evaluation methodology and delivering tools for researchers, policymakers, practitioners and consumers, the research project also demonstrates innovation and tests novel approaches in design. By interpreting and translating results for applications both within and beyond the health system, the project will advance understanding of how professionals work together, and how to optimise this interaction to improve organisational effectiveness and service delivery.The authors declare that they have no competing interests.JB and JIW designed the study, phases, protocol and instruments, and wrote the manuscript. GR, FC, JP and JW are members of the research team, and commented on an earlier draft of the manuscript. DB, SH, CH and BJ are industry partners, are members of the expert advisory committee, and provided input into the initial conceptualisation of the project. JC, NC, AG and LB-M commented on an earlier draft of the manuscript, and are members of the expert advisory committee. DD commented on an earlier draft of the manuscript and developed the ethics application, and steered it through the approval process. All authors approved the final version of the manuscript.The pre-publication history for this paper can be accessed here:"}
{"text": "Sir,The World Health Organization (WHO) defines palliative care as the active total care of the patient, whose disease is not responsive to curative treatment. Control of pain, other symptoms, and the psychological, social, and spiritual problems are paramount. The goal of palliative treatment is the achievement of the best possible quality of life (QOL) for patients and their families. PalliatiCommunity need and the role of palliative care - As per the WHO figures, around one million new cases of cancer are diagnosed each year. About one-third of the patients are being treated for cancer and three-fourth is in terminal stages, and have pain. There is a need to increase the awareness among the community with regard to palliative care and its role at the end stage of any chronic illness. Greater awareness of palliative care should make it easier for professionals to combine active treatment and a supportive approach. People with disabling, progressive illnesses expect active care, but they also seek comfort, control, and dignity. The barriers to effective communication about emotional and end-of-life issues are well recognized.Palliative care: Indian scenario - The message of palliative care has become a movement in several parts of India in a short span of time. The past two decades have seen palpable changes in the mindset of healthcare providers, and policy makers with respect to the urgency of providing palliative care. Every ho"}
{"text": "Communication theory and techniques, aided by the electronic revolution, provide new opportunities and challenges for the effective transfer of laboratory, epidemiologic, surveillance, and other public health data to the public who funds them. We review the applicability of communication theory, particularly the audience-source-message-channel meta-model, to emerging infectious disease issues. Emergence of new infectious organisms, microbial resistance to therapeutic drugs, and increased emphasis on prevention have expanded the role of communication as a vital component of public health practice. In the absence of cure, as in AIDS and many other public health problems, an effectively crafted and disseminated prevention message is the key control measure. Applying communication theory to disease prevention messages can increase the effectiveness of the messages and improve public health."}
{"text": "The aetiologic fractions due to smoking and chewing tobacco have been quantified for the first time, for cancers of the oral cavity, oropharynx, hypopharynx, larynx and oesophagus. The overall aetiologic fractions due to smoking and/or chewing tobacco have been found to be 70% for cancer of the oral cavity, 84% for the oropharynx, and about 75% for the hypopharynx and larynx. In cancer of the oesophagus, however, the fraction is only 50%, showing that another factor or factors play an equal role in the aetiology of cancer of this site. At each of the sites studied, it was found that the two factors, smoking and chewing, acted synergistically, though in varying degrees."}
{"text": "Allopathic practitioners in India are outnumbered by practitioners of traditional Indian medicine and homeopathy (TIMH), which is used by up to two-thirds of its population to help meet primary health care needs, particularly in rural areas. India has an estimated 2.5 million HIV infected persons. However, little is known about TIMH use, safety or efficacy in HIV/AIDS management in India, which has one of the largest indigenous medical systems in the world. The purpose of this review was to assess the quality of peer-reviewed, published literature on TIMH for HIV/AIDS care and treatment.Of 206 original articles reviewed, 21 laboratory studies, 17 clinical studies, and 6 previous reviews of the literature were identified that covered at least one system of TIMH, which includes Ayurveda, Unani medicine, Siddha medicine, homeopathy, yoga and naturopathy. Most studies examined either Ayurvedic or homeopathic treatments. Only 4 of these studies were randomized controlled trials, and only 10 were published in MEDLINE-indexed journals. Overall, the studies reported positive effects and even \"cure\" and reversal of HIV infection, but frequent methodological flaws call into question their internal and external validity. Common reasons for poor quality included small sample sizes, high drop-out rates, design flaws such as selection of inappropriate or weak outcome measures, flaws in statistical analysis, and reporting flaws such as lack of details on products and their standardization, poor or no description of randomization, and incomplete reporting of study results.This review exposes a broad gap between the widespread use of TIMH therapies for HIV/AIDS, and the dearth of high-quality data supporting their effectiveness and safety. In light of the suboptimal effectiveness of vaccines, barrier methods and behavior change strategies for prevention of HIV infection and the cost and side effects of antiretroviral therapy (ART) for its treatment, it is both important and urgent to develop and implement a rigorous research agenda to investigate the potential risks and benefits of TIMH and to identify its role in the management of HIV/AIDS and associated illnesses in India. The Indian health system has perhaps the world's largest community-based indigenous system of medicine, and it includes Ayurveda, Unani medicine, Siddha medicine, yoga and naturopathy.  These foIndia has a long history of traditional medicine that is well established and integrated within the overall medical structure of the country. ,9 In facTo address some of these issues, the Indian government established the Department of Indian Systems of Medicine and Homeopathy in 1995 and later renamed it the Department of Ayurveda, Yoga-Naturopathy, Unani, Siddha and Homoeopathy (AYUSH), which is part of the Ministry of Health and Family Welfare. The mission of AYUSH includes: a) an initiative for integrating AYUSH with modern, allopathic medicine; b) attention to standardization of compounds and quality control; c) assessing and standardizing TIMH education in institutions around India that teach TIMH; d) improving the availability of raw material that will be used in the manufacturing of TIMH compounds; and e) prioritizing research on TIMH. The Indian Government has also established a Central Council for Research in each of these core areas, as well as separate Directorates of AYUSH in 18 Indian States. Not all TIMH is perceived equally in India. For example, yoga and healthy diet \u2013 which are often incorporated into the Ayurveda, yoga and naturopathy traditions \u2013 are considered beneficial by both TIMH and allopathic providers. However, many of the Ayurvedic herbal preparations and homeopathic treatments for conditions such as tuberculosis and HIV are discouraged by allopathic organizations such as the Indian Medical Association, or in allopathic medical schools, since data are lacking to support the use of such treatments.  Use of TCaraka Samhita and Sushruta Samhita, which are the primary texts on Ayurvedic medicine, describe eight branches of Ayurvedic medicine: internal medicine, surgery, treatment of head and neck disease, toxicology, psychiatry, sexual vitality, rejuvenation and care of the elderly, and gynecology, obstetrics and pediatrics. . Only studies in English were reviewed. Bibliographies of review and other relevant articles were searched for relevant Indian literature, as well as a bibliography of Indian medicine  and sevein vivo, in vitro and in clinical studies. Abstracts from the initial electronic searches were searched to select studies that met the following inclusion criteria: English-language, peer-reviewed literature, published after the first case reported of HIV in India in 1986 through October 2008. Randomized controlled trials, experimental studies, observational studies, descriptive studies, and reviews of HIV and TIMH were included, while ethnographic literature was excluded.We examined studies focused on the impact of TIMH on HIV/AIDS Two reviewers (MF and CC) independently screened the titles and abstracts of all of the literature collected through the searches. If both reviewers agreed that the abstract was relevant, the full article was accessed and a second phase of screening was conducted. All studies passing these screening phases were included in the full descriptive review.Of 206 original articles reviewed, 36 were relevant and met the inclusion criteria described above. These 36 articles contained 38 relevant studies, 21 laboratory and 17 clinical. The majority of articles were excluded because they were not based on actual research studies, were not in English, or were surveys of TIMH usage. A bibliography of all included studies can be found in Additional File A total of 6 previous reviews of the literature were identified that covered at least one system of TIMH. The review by Vermani and Garg  on TIMH This literature review identified 38 individual studies  that are relevant to TIMH and HIV/AIDS. Most studied Ayurvedic herbs and homeopathic preparations, and none of the articles reviewed addressed naturopathy or Unani medicine.Gossypium spp.), Phyllanthus niruri, curcumin (Curcuma longa), and neem (Azadirachta indica). Many studies used a controlled experimental model, with uninfected or mock infected cells as the controls. Almost all of these studies reported positive effects on HIV infection rates; however, many of these studies had significant methodological flaws, lacked information about product standardization, and had insufficient outcome measures and reporting.Since the goal of this review was to assess the quality of published literature on TIMH for HIV/AIDS treatment and care, our main focus was on clinical research. However, 21 laboratory studies met the inclusion criteria and are summarized in Additional File Boxus sempervirens),  should be replicated to determine whether these initial positive effects can be confirmed and whether future research is justified. Future studies would benefit from larger samples, stronger designs, and clearer descriptions of populations, controls and intervention components under study. Imperative for reliability and validity is greater care in analysis and reporting of results.Due to their methodological shortcomings, studies included in this review that reported positive effects [such as those of Boxwood (virens),  Andrograculata),  neem (Azindica),  and the Significant roadblocks to achieving these research goals exist. A broad spectrum of TIMH practices is currently in use, but there is limited availability of scientific information on which to build testable hypotheses. It is difficult to fit non-Western clinical practices that are often individualized for each patient into the Western, reductionist scientific model. Finally, there is a general lack of scientific expertise or a research culture within the TIMH practice community and a weak TIMH clinical perspective in the scientific community. The majority of TIMH research has been conducted outside the traditional setting in which the therapy was created and is practiced, which seriously limits the model validity and generalizability of research findings.  To overcAs previously stated, TIMH providers outnumber allopathic providers in India and serve as the primary method for delivering primary care for a majority of India's population. Across the socioeconomic spectrum, private medical facilities are the preferred source of care ,77. IndiWhile it would be imprudent to promote use of TIMH in place of allopathic medicines for HIV/AIDS, we propose that consideration be given by the Indian Medical Association to recognizing TIMH providers and to training them in providing coordinated care  to the millions of HIV infected patients for whom they already provide care. Furthermore, we propose that a sound, evidence-based model of integrative HIV/AIDS care that is based on enhanced cross-training and collaboration between TIMH and allopathic practitioners and solid safety and effectiveness data, has the potential for improving health outcomes among HIV positive individuals in India.In summary, this review exposes a broad gap between the current widespread use of TIMH therapies for HIV/AIDS in India, and the research base supporting their effectiveness, efficacy and safety. The therapeutic effects of TIMH for HIV/AIDS cannot be established based on the current literature; most studies published to date in the English-language literature lack sufficient clarity and rigor of reporting to assess reliably and quantitatively the quality of results. The lack of high-quality evidence highlights the need for rigorous investigation of both whole systems of TIMH, as well as individual therapies. In light of the suboptimal effectiveness of vaccines, ART, barrier methods and behavior change strategies for prevention and cure of HIV infection, it is both important and urgent to develop a collaborative research agenda that uses rigorous methodologies to investigate, evaluate and better understand the role of TIMH in managing HIV/AIDS and associated illnesses in India.The authors declare that they have no competing interests.MF participated in the conception and design, acquisition of data, analysis and interpretation, drafting and critical revision of the manuscript, material support and supervisionCC participated in the conception and design, acquisition of data, analysis and interpretation, drafting and critical revision of the manuscript, material support and supervisionDQ participated in analysis and interpretation of data, drafting the manuscript, and material support.WBJ participated in the conception and design, analysis and interpretation of data, critical revision of the manuscript, obtaining funding and supervision.AG participated in the conception and design, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript, administrative support and supervision.AA participated in the conception and design, analysis and interpretation of data, critical revision of the manuscript, and supervision.IC participated in the conception and design, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript and supervision.Bibliography of included studies.Click here for fileSummaries and critiques of included studies.Click here for fileTable of laboratory studies.Click here for fileTable of clinical studies.Click here for file"}
{"text": "Rickettsia NomenclatureOn  Rickettsia sibirica infections in Spain and Portugal. The authors identify the agent both as a subspecies  was first discovered in the 1930s, and its etiologic agent, If, and when, the subspecies names are validated, they are likely to be adopted and routinely used in the literature. Rickettsial taxonomy continues to evolve, and future changes should be determined by critical scientific judgments and general consensus within the scientific community.Bartonella spp. diseases and Q fever.Dr Massung is chief of the Rickettsial Zoonoses Branch, Division of Viral and Rickettsial Diseases, National Center for Zoonotic, Vector-borne and Enteric Diseases, Centers for Disease Control and Prevention. His research interests include laboratory and epidemiologic investigations targeting the detection, prevention, and control of rickettsial and"}
{"text": "This report on the health of Canadian women is intended to: (i) determine the extent to which currently available data can be used to provide gender-relevant insights into women's health; (ii) provide information to support the development of health policy, public health programs, and interventions aimed at improving the health of Canadian women; and (iii) serve as the basis for further indicator development. The report provides information and descriptive statistics on determinants of health, health status, and health outcomes for Canadian women. To the extent possible, each chapter presents new, gender-relevant information on a health condition or issue identified as important to women's health during national expert and stakeholder consultations in 1999. Where data or appropriate data are lacking, this is documented. Recommendations for change are made at the end of each chapter, accompanied by a discussion of the gaps in and policy implications of the findings.A number of jurisdictions have recognized the need for information on gender and health -4. In thIt is generally agreed that differences in health status and health outcomes between individuals-and between men and women-are determined by factors beyond biology. Global forces, including cultural, political, and ecological change, have a powerful effect on health. Against this global backdrop, a complex set of factors-such as socio-cultural and transition experiences, education, income, social status, housing, employment, health services, personal health practices, and the physical environment-comes into play. For example, in developed countries, cultural and economic shifts in attitude toward women's participation in the labour force and control over reproductive decisions have led many women to delay childbirth.The Women's Health Surveillance Report adopts the broad definition of women's health that provided the framework for the discussion on women and health at the Fourth World Conference on Women (the Beijing Conference), held in September 1995:Women's health involves women's emotional, social, cultural, spiritual and physical well-being and is determined by the social, political and economic context of women's lives as well as by biology. This broad definition recognizes the validity of women's life experiences and women's own beliefs and experiences of health. Every woman should be provided with the opportunity to achieve, sustain and maintain health as defined by that woman herself to her full potential. Further, this report attempts to take a gender-sensitive approach to health information where possible, taking into account the context of individual's lives . Its aim in part is to inform future gender-based analyses.The authors of individual chapters have made use of population data from large Canadian surveys and administrative databases. Data chosen for analysis depended largely on the availability of the databases at the time of chapter development. Although such data sources can provide interesting insights, they also have limitations. For example, while they usually include a breakdown of the data by sex, they often do not provide sufficient measures by which to explore the influence of gender as determined by the context of women's lives. For example, depression is a major cause of disability worldwide. In Canada, as in other developed countries, the prevalence of depression is the same among boys and girls. After puberty, however, women are about twice as likely as men to experience a depressive episode ,7. Tradi* The views expressed in this report do not necessarily represent the views of the Canadian Population Health Initiative, the Canadian Institute for Health Information or Health Canada."}
{"text": "Norman Bleehen came from an orthodox Jewish background and was much influenced by the great value both sides of his rabbinical family placed on academic achievement. He took pride in having studied and worked in internationally recognised centres of excellence at the universities of Oxford, London, Cambridge and Stanford.Born in Manchester in 1930, he grew up in London. In 1947, he won a scholarship to Exeter College Oxford to read Medicine, taking an additional year to do a BA in Physiology and Biochemistry. A Medical Research Council (MRC) studentship allowed him to study aspects of the action of insulin in the Biochemistry Department, for which he was awarded the Gotch Memorial prize. During his years in Oxford, he was President of the Oxford University Jewish Society and was influential in the Interuniversity Jewish Federation.In 1952, he began his clinical training at the Middlesex Hospital Medical School, qualifying in 1955. En route, he won prizes for forensic medicine, orthopaedic surgery, and radiology and radiotherapy. A house job in the radiotherapy department at the Middlesex set the direction of Norman's future career. He much impressed the then head, Professor (later Sir) Brian Windeyer. In 1957, he gained Membership of the Royal College of Physicians, before entering the Royal Army Medical Corps for his national service, initially at the British Military Hospital in Hanover and then, in 1958, in occupied Berlin. There the allied powers, Britain, the United States, France and Russia, shared responsibility, on a rotating monthly basis, for the War Criminals' gaol at Spandau. The only inmates were Baldur von Schirach, Albert Speer and, Hitler's ex-deputy, Rudolf Hess. When the British were mounting the guard, it was Norman's task to examine each inmate weekly, and to produce a report. As a committed Jew, he was deeply concerned about taking medical responsibility for these particular war criminals. Consulting his commanding officer brought the reminder: \u2018This is the army, and that is your job\u2019. But Berlin was not all duty; Norman was able to enjoy the city, especially the excellent opera.On demobilisation in 1959, Norman returned to the Middlesex Hospital. He was to specialise in radiotherapy and gain a Fellowship of the Royal College of Radiologists. In 1966, the MRC awarded him a Lilly travelling fellowship to Stanford University, where he worked in Professor Henry Kaplan's department, much acclaimed for its excellence in relating laboratory research to treating patients. This appealed to Norman's intellect and profoundly influenced his future professional life. He thoroughly enjoyed Stanford, telling tales of never-to-be-forgotten fishing trips. Although offered a faculty post there, he chose to return to the Middlesex, where Sir Brian Windeyer had suggested that he might ultimately succeed him. Initially, the Duchess of Bedford Research Fellow, in 1969 he was appointed Professor of Radiotherapy and head of the Academic Department of Radiotherapy. He began a laboratory-based research programme alongside his clinical work and started to build the team he would subsequently take to Cambridge. That summer he met Tirza Loeb, an attractive Israeli/Australian PhD student whom he married after a whirlwind romance. They lived in a beautiful modern house in Highgate, where walls of glass gave them maximum pleasure from their garden: a growing enthusiasm. There they extended generous hospitality and friendship to Norman's rapidly expanding circle of colleagues and friends from all over the world.In 1975, the MRC invited Norman to set up a clinical and research unit in Cambridge at Addenbrooke's Hospital. He became Director of the MRC Clinical Oncology and Radiotherapeutics Unit (CORU). Cambridge University created a Department of Clinical Oncology endowed by the Cancer Research Campaign (now Cancer Research UK), and he was elected its first Professor of Clinical Oncology and Radiotherapeutics in the same year. Under his direction, this developed into one of the country's leading academic oncology units, both clinically and scientifically.Clinically, his interests were the treatment of brain tumours, especially gliomas, and lung cancer, both challenging diseases where new treatments were needed to improve dismal prognoses. All novel cancer treatments must be tested for efficacy against the current best practise. At this time in the mid-1970s, national cancer clinical trials supported by the MRC were proliferating rapidly. The statistical and data management tasks associated with the good design and successful conduct of clinical trials are substantial, and as Chairman of the MRC Cancer Therapy Committee, Norman recognised the need for a dedicated MRC group to carry out these tasks. He proposed that a Cancer Trials Office (CTO) be set up within his Cambridge Unit. It was inaugurated in 1977, taking over responsibility for ongoing trials as well for as setting up new ones. The CTO was one of his major achievements; its success led the MRC to create an independent Cancer Trials Unit.The team Norman gathered at CORU worked on both fundamental tumour biology and the development and optimisation of radiotherapy and chemotherapy. His personal research interests were in the development and trial of drugs to increase the efficacy of radiotherapy, and in the use of heat to improve radiotherapy and chemotherapy. In the course of Phase I trials of radiosensitisers and chemosensitisers, and many other clinical studies, he trained a new generation of investigative clinical oncologists and radiotherapists: now influential consultants and professors in today's oncology. The research students and post-doctoral scientists of CORU, now scattered around the world, are senior academics or hold powerful positions in the pharmaceutical industry: a potent legacy of his unit and of his leadership. Norman displayed an enviable flair for choosing people who would work together productively in a strong atmosphere of camaraderie. He was always very supportive of his staff, and invariably delivered on his promises to them, a rare quality which was much valued.A substantial body of publications, in excess of 400, bear his name. Norman also took time to serve on numerous UK boards and committees, frequently as chairman, as well in range of international organisations, primarily in Europe. He represented the UK government in the Europe Against Cancer Programme; being passionate about smoking prevention campaigns. He served on the editorial boards of numerous cancer-related journals. He was nonetheless, a rather modest man, who did not pursue the limelight, but the worth of his work was recognised and he received many honours and awards. He was most proud of his 1990 honorary doctorate from the University of Bologna, the oldest university in the world, and his CBE for services to medicine, received in 1994, at the height of his career and influence.Norman and Tirza were very hospitable; family, friends, colleagues and visitors, many from overseas, enjoyed their lovingly tended garden and beautiful house in quiet leafy Cambridge. An asparagus bed, particularly suited to the local soil, was Norman's special enthusiasm. Their nephews and niece have had a second home with them throughout their lives, two are continuing the medical tradition.Norman retired in 1995, and while he remained a Fellow of St John's College and continued to serve on a variety of committees, he was able to indulge his enthusiasm for opera and his garden and to travel more extensively with Tirza, especially to her family in Australia. While there he fell ill with lung cancer, a cruel fate for a man who had spent so much of his professional career treating the disease, who had never smoked and had worked hard to deter people from smoking. Ever an academic clinician, Norman gained new insights into the disease and was gratified to find them taken up in clinical trials."}
{"text": "The rapid changes in the healthcare system, with revolutionary advancements in imaging, along with the lack of any existing imaging standards in our country, have raised the need for an accreditation structure. The Quality Council of India (QCI) has therefore introduced standards for medical imaging services, focusing on the control of services, personnel, imaging processes and procedures, facility and environment, equipment, and documentation, as well as risk control and safety. This article deals briefly with the standards structured by the QCI for accreditation of imaging services. Changing market forces, increasing health awareness, the advent of medical tourism and health insurance, and the entry of the corporate sector into health delivery have raised the demand for quality in healthcare services. Initial attempts were made by the Bureau of Indian Standards in the late 1980s, when the organization set down the standards for the voluntary accreditation of 30-, 100-, and 250-bedded hospitals. The National Institute of Health and Family Welfare specified rules for hospitals with more than 50 beds. Health is a state responsibility in India and therefore attempts have also been made in some states to frame standards for hospitals. However, such compartmentalized initiatives have led to further fragmentation of an already segmented sector. Realizing the need to establish a uniform accreditation structure across the country, which would suit Indian conditions and at the same time be credible in the eyes of international observers, an inter-ministerial taskforce was set up in 1991. As an outcome of its recommendations, the Quality Council of India (QCI) was established in 1997, as an autonomous body, with the mandate to establish and operate a national accreditation structure and to obtain international recognition for its accreditation schemes.The National Accreditation Board for Hospitals and Healthcare Providers (NABH) was set up under the QCI to establish and operate accreditation programs for healthcare organizations. Diagnostic imaging forms an integral part of healthcare. The clinical advantages of these services are enormous and imaging affects critical decision-making at every stage of patient management. However, it could also represent an unnecessary cost to healthcare systems in the country, if the quality provided is less than optimal. The phenomenal growth in diagnostic imaging in the last two decades has further enhanced the importance of this field. NABH for healthcare takes into account some major aspects of imaging services in a hospital, although its role and scope are limited. Hence, to assess the quality and safety of imaging services and to have a method for the monitoring of quality standards, a basic accreditation program has been introduced in the country. These standards reflect the expectation of good services from the viewpoint of the service provider, the patient, and the referrer, as well as the safety regulatory bodies. These standards also take into consideration the requirements of safety and service standards of the Atomic Energy Regulatory Board (AERB) and the Pre-Natal Sex Determination (PNDT) regulations relevant to our country.PET/CT, SPECT, radionuclide imaging and therapy, and so on.The medical imaging services (MIS) cover investigations of patients that provide imaging information for the diagnosis, prevention, and treatment of disease or assessment of health. It includes conventional radiation-based diagnostic radiology as well as a wide variety of specialized techniques including USG, Doppler studies, bone densitometry, CT scan, MRI, The MIS also include in its scope, the arrangements for requisition, patient identification, choice of appropriate (most informative and cost-effective) imaging techniques, patient information, patient consent, patient preparation, performance of imaging procedures, interpretation, reporting, and advice regarding the result, in addition to the consideration of safety and ethics in diagnostic imaging services.Medical imaging standards are applicable to single and multiple service providers as well as hospital services. They include all modalities related to x-rays, fluoroscopy-based investigative and interventional procedures, mammography and related interventional procedures, bone mineral densitometry, USG, diagnostic as well as interventional, Doppler, MRI, CT scan, nuclear medicine, and procedures such as, radiofrequency ablation and laser / cryo / thermoablation.The standards have been grouped into six chapters dealing with all aspects of imaging services, from control of services, facilty and environment, imaging processes and procedures, equipment, documentation of records and control of risk and safety. Every chapter, after a brief description that explains its purpose, sets out a number of standards that need to be objectively assessed. The defined standards are patient-focused, cover the functions and systems of medical imaging as a whole, interventional as well as nuclear medicine service, and address the dimensions of quality, and support quality improvement. The standards take into account the need for all statutory compliance \u2014 AERB, Preconception and Prenatal Diagnostic Techniques (PC-PNDT), pollution control, and so on.The MIS standards emphasize the need to work collaboratively with clinical colleagues, to agree upon and select the appropriate imaging pathways to ensure diagnosis and / or treatment within a defined time frame, with minimal delays. The services have to be patient-focused and respectful to the patient and address their specific requirements. Proper attention has to be given to ensure the patients' privacy, dignity, and security. It is also essential to encourage the patients and their attendants to give feedback and to use this feedback for the betterment of the service delivery. The MIS, as per the guidelines, must provide a facility that is safe, clean, comfortable, and fit for the staff, patients, and others. The MIS has to ensure the provision of safe water, electricity, bio-waste and sewage disposal, and so on. The organization must have in place plans for the management of disasters and emergencies within the facility.The MIS have to ensure that all images are acquired and reported in accordance with the agreed protocols, by competent staff working within their defined scope of practice. Optimal diagnostic quality, with essential image characteristics, must be obtained in accordance with the best current practices. Interventional procedures must be conducted as per the defined protocols, by competent staff. It is also essential to ensure that drugs, isotopes, contrast media, and radiopharmaceuticals are stored, prescribed, prepared, and administered safely as per the statutory requirements. There have to be appropriate arrangements to deal with adverse reactions promptly, efficiently, and effectively.The management of staff has to be effective, fair, consistent, and supportive. The service contracts are to be managed effectively and efficiently to ensure high-quality care to patients. The organization should have a well-documented performance-appraisal system to be used as a tool for further development.The MIS has a duty to ensure appropriate procurement, installation, operation, maintenance, quality assurance, and replacement of all equipment, including ancillary equipment, such as, resuscitation equipment, protective clothing, and consumables. Records pertaining to the same should be maintained.The MIS have a duty to ensure that documents pertaining to policies, procedures, applicable laws and regulations, as well as guidelines for dealing with vulnerable patients , obstetric patients, patients being administered sedation or anesthesia, and patients undergoing radiation, interventional or nuclear medicine services, are in place. It is the duty of the MIS to manage, store, and transfer all data in a secure manner, which must adhere to the statutory requirements (if any).The MIS have a duty to ensure that the organization has arrangements and general protection measures for staff, patients, and others, to restrict exposure to ionizing radiation and risks associated with the use of MRI, ablative and therapeutic devices, radionuclides, and so on. The organization has a duty to minimize and manage risk due to potentially violent and / or aggressive behavior in the facility. The management should promote a good and safe ambience, be prepared to manage adverse healthcare events, and minimize the risks associated with fire, electrocution, and other disasters.Accreditation of medical diagnostic services is the need of the hour. NABH accreditation for MIS is based on optimum standards and professional accountability, and encourages healthcare organizations to pursue excellence. The formulated standards have focused on statutory compliance, patient and staff safety, improved workflow, learning, self-development, improved performance, and reduction of risk. Its assessment relies on establishing management and technical competence in terms of accreditation standards, for delivering all the services within its scope. It goes beyond compliance and calls for the pursuit of excellence on a continuing basis."}
{"text": "Experimental reality in molecular and cell biology, as revealed by advanced research technologies and methods, is manifestly inconsistent with the design perspective on the cell, thus creating an apparent paradox: where do order and reproducibility in living systems come from if not from design?I suggest that the very idea of biological design (whether evolutionary or intelligent) is a misconception rooted in the time-honored and thus understandably precious error of interpreting living systems/organizations in terms of classical mechanics and equilibrium thermodynamics. This error, introduced by the founders and perpetuated due to institutionalization of science, is responsible for the majority of inconsistencies, contradictions, and absurdities plaguing modern sciences, including one of the most startling paradoxes - although almost everyone agrees that any living organization is an open nonequilibrium system of continuous energy/matter flow, almost everyone interprets and models living systems/organizations in terms of classical mechanics, equilibrium thermodynamics, and engineering, i.e., in terms and concepts that are fundamentally incompatible with the physics of life.The reinterpretation of biomolecules, cells, organisms, ecosystems, and societies in terms of open nonequilibrium organizations of energy/matter flow suggests that, in the domain of life, order and reproducibility do not come from design. Instead, they are natural and inevitable outcomes of self-organizing activities of evolutionary successful, and thus persistent, organizations co-evolving on multiple spatiotemporal scales as biomolecules, cells, organisms, ecosystems, and societies. The process of self-organization on all scales is driven by economic competition, obeys empirical laws of nonequilibrium thermodynamics, and is facilitated and, thus, accelerated by memories of living experience persisting in the form of evolutionary successful living organizations and their constituents. The cell is a fundamental building block of all living organisms. A typical cell represents a highly concentrated  aqueousTo understand design means to control the designed. Naturally, in order to gain some measure of control over our diseases and inevitable aging and death, we direct our best efforts and resources at deciphering the evolutionary design of the cell, using our most reliable and successful analytical methods, reductionism and reverse engineering. The incessant and rapid progress of research technology enables us to isolate and analyze increasingly smaller parts on an increasingly larger scale with increasingly better precision and at an increasingly faster pace. We have sequenced our own genome and know the blueprints of almost every protein and RNA produced in our cells. Modern biophysical and computational methods allow us to analyze individual proteins on both population and single-molecule levels, as well as to scrutinize and model protein structure and dynamics at atomic resolution and on multiple timescales, from femtoseconds to seconds. Internationally coordinated initiatives in structural genomics aim at high-throughput determination of all relevant biomolecular structures, with thousands of protein structures being deposited in the Protein Data Bank each year. Mass spectrometry-based proteomics technologies allow us to obtain \"parts lists\" for virtually any macromolecular complex, organelle, or sub-cellular structure. Robotics-assisted large-scale protein interaction studies reveal the relationships between individual parts of the cellular machinery on the scale of whole proteomes. Hundreds of years' expertise in engineering is combined with the unprecedented powers of modern computational technologies to equip systems biology for the analysis and modeling of systems of almost any degree of complexity. Paradoxically, extraordinary advances in our understanding of the parts do not seem to bring about significant progress in our understanding of the whole. In fact, it appears that the design of the cell becomes increasingly elusive as experimental data accumulate.Comparative analysis of the \"parts lists\" obtained for various organelles, sub-cellular structures, and macromolecular complexes suggests, for example, that there may be no pre-defined locations for individual proteins inside the cell, but rather statistically preferred ones. Moreover, even statistically preferred spatiotemporal distributions of proteins inside the cell are not fixed. Instead, they appear to change on multiple scales of space and time upon changes in the internal state of the cell and/or its environment ,4. The fDefying traditional, static views on proteins embodied in such metaphors as \"locks,\" \"keys,\" and \"Lego blocks,\" recent technological and conceptual advances in protein biophysics have brought about a new image of the protein as a highly dynamic, versatile, and continuously changing physicochemical organization -13. It ia choice, for they can interact with different partners, join different macromolecular organizations, perform different actions, and contribute in different ways to the functioning of diverse macromolecular complexes and structures.The so-called natively unfolded proteins, which do not possess a defined structure when isolated in solution, but acquire a structure upon interactions with other molecules, represent an extreme example of protein ambiguity and plasticity. The discovery of intrinsically disordered proteins came as a total surprise, for the concept of natively unfolded proteins is incommensurate within the design perspective on the cell . SubsequTo summarize, the experimental reality in molecular and cell biology, as revealed by advanced technologies and methods, is manifestly inconsistent with the design perspective on the cell, creating an apparent paradox: where do order and reproducibility in living systems come from if not from design?A recent theoretical study may provide an answer to this and other questions accumulated in biology over many years of research. This study demonstrates that the experimental reality in molecular and cell biology becomes largely devoid of paradoxes, inconsistencies and contradictions, and is thus best understood if the cell and biological organization in general are reinterpreted within an alternative paradigm of biological organization based on the concepts and empirical laws of nonequilibrium thermodynamics .nonequilibrium physicochemical system of interacting molecules, the vast majority of researchers working in molecular and cell biology continue to treat and interpret the cell and its components in terms of classical mechanics, equilibrium thermodynamics, and engineering, i.e., in terms and concepts that are fundamentally incompatible with the physical nature of the cell, thus faithfully reproducing and reinforcing the mistakes and misconceptions of the founders. This is in itself a good example demonstrating that many things in life can be faithfully reproduced in the absence of any design.Whether explicitly stated or tacitly implied, the phenomena studied in molecular and cell biology are traditionally interpreted and rationalized within the conceptual framework of classical physics, i.e., classical mechanics and equilibrium thermodynamics. This is not particularly surprising, for the foundations of molecular and cell biology were laid down by physicists and biochemists whose mental structures and, thus, habitual interpretations were shaped by their rigorous training in classical physics and engineering. Accordingly, as exemplified by the first paragraph of this article, the conventional image of the cell came to carry within it all the familiar logic, inferences, and assumptions of classical physics and engineering, including the belief that the order and reproducibility observed in living systems are a consequence of design. What is really surprising is that, even though today very few scientists would argue that the cell is not an open organization of relationships between interacting components, a form, but not physical components comprising a given macrostructure. Members come and go, but the organization persists. Normally, the same set of interacting microcomponents can generate multiple alternative organizational configurations differing in the organization of energy/matter exchanges transiently maintained among the interacting components that make up and flow through a given configuration. As a consequence, macrostructures emerging in far-from-equilibrium systems are dynamic in two different senses, for they display both configurational dynamics and flow dynamics [Studies of relatively simple inorganic nonequilibrium systems such as the Belousov-Zhabotinsky (BZ) reaction, Benard instability Figure , and othdynamics .is an open nonequilibrium physicochemical system of interacting molecules, the cell is expected to exist and function as a complex metastable organization of conjugated fluxes, steady-state compartments, and interdependent gradients. This implies that molecular partitioning, ordering, and macro-organization within the cell are not pre-determined by a pre-existing design, but are driven by the same physical principles and forces that drive self-organization in open, inorganic, far-from-equilibrium systems studied in the field of nonequilibrium thermodynamics. As suggested elsewhere [Since the cell lsewhere , one of lsewhere -29, the The other empirical (self-) organizational laws of nonequilibrium thermodynamics that are especially helpful in understanding the organizational dynamics of living systems are as follows. Increasing the rate of energy/matter flow through an open nonequilibrium organization/system of interacting components normally leads to the growth of the organization/system in size and complexity. The increase in complexity proceeds through stepwise organizational transitions from states of relatively low order (low negative entropy) to states of relatively high order (high negative entropy) and is accompanied by the formation of multiscale organizational hierarchies. Maintaining a nonequilibrium organization/system at a given level of order and complexity requires a continuous and stable flux of energy/matter through the system. Decreasing the rate of energy/matter flow through an organization/system leads to a stepwise hierarchical relaxation of its organizational structure and a loss of complexity and order, ultimately culminating in the dissolution and death of the organization .flow rates of their constituents (nonequilibrium thermodynamics) and not concentrations, as commonly assumed (equilibrium thermodynamics) [One of the practically important predictions that can be immediately made from these empirical laws is that the critical parameters defining the physiological state of any living system, such as the cell or the organism, for example, are ynamics) . Indeed,ynamics) . At the The cell should thus be pictured as a multiscale system of structured circulation of energy/matter forms in which individual configurations of energy/matter flow are manifested as steady-state sub-cellular structures, compartments, complexes, and macromolecules that make up the cell. Various metastable configurations/patterns of flowing energy/matter continuously compete and cooperate one with another in order to obtain and to ensure stable and accelerating flows of energy/matter passing through them, which they require for their maintenance and growth within the cellular economy they comprise. In a conceptually analogous way, various business, social, and political organizations compete and cooperate one with another in order to obtain and ensure stable and accelerating flows of resources passing through them, which they require for their maintenance and growth within the socio-politico-economic system they form ,32. Thosanima ex anima principle, another fundamental difference between nonliving nonequilibrium systems and living nonequilibrium organizations is that, while nonliving macrostructures emerge and persist only when provided with a flux of energy/matter, living nonequilibrium organizations strive to live long and prosper, i.e., to persist as specific dynamic structures and to grow in size, complexity, and influence. As a consequence, at each and every level of the biological organizational hierarchy, living nonequilibrium organizations continuously compete and cooperate one with another as they search for, obtain, transform, and exchange energy/matter forms to ensure a continuous and accelerating flux of energy/matter, which they need both individually (hence competition) and collectively (hence cooperation) for their maintenance and growth in size, complexity, and influence. As time passes, surviving life forms become increasingly interconnected and integrated - both within and across organizational levels and spatiotemporal scales - into a multiscale continuum of structured energy/matter circulation/flow, which favors cooperation and organization over unbridled competition. In this way, proteins and other molecules self-organize into cells, cells self-organize into organisms, organisms self-organize into ecosystems and organizations, and organizations self-organize into economies [In addition to what can be called the conomies .individual choice as a force of both innovation and conservation becomes a decisive factor in organizational dynamics, either promoting or inhibiting the survival and success of the developing and adapting whole.To summarize, the self-organization of living systems is driven by economic competition, obeys empirical laws of nonequilibrium thermodynamics, and is facilitated and, thus, accelerated by memories of living experience embodied in the adaptive structures and dynamics of interacting constituents. Because the structures and dynamics  of individual constituents at all levels of organizational hierarchy always remain ambiguous and unspecified, albeit shaped by evolution and experience, the knowledge or intelligence, a combined and self-organized product of living experience represented by and preserved in the structures and dynamics of interdependent and interconnected living organizations co-evolving on multiple scales of space and time. Evolutionary memories in the form of proteins, cells, organisms, ecosystems, organizations, and economies continuously recall the past by virtue of their own incessant reproduction, adapt to the present by making individual choices and acting upon them, and mold the future by interacting with and molding their environments that, in turn, mold them. In this way, the past, the present, and the future, as well as multiple spatiotemporal scales, converge within one self-organizing process of life. Life is intelligence. Intelligence implies and involves order, reproducibility, continuous change and development, but no design. Life/intelligence is an open-ended, evolving structure-process of energy/matter flow, a stream of consciousness. And we all are a part of it.To conclude, in the domain of life, order and reproducibility do not come from design. Instead, they come from what can be called The author declares that they have no competing interests.AK is the sole author of this paper and is responsible for developing the concepts and for writing and revising the manuscript."}
{"text": "The applications of remote sensing and geographic information systems (GIS) to vector-borne and helminthic diseases have progressed far beyond the pretty pictures which dominated their early use. As Wood et al. indicate in the last chapter, the number of papers in the area has increased drastically over the last decade, in number and sophistication. The editors of this special volume of Advances in Parasitology have been in the forefront of applying statistical and biological approaches to the mapping of vector-borne diseases and have brought together experts to review existing knowledge, identify gaps in understanding, and describe future applications of these powerful approaches. This book is a timely overview of satellite imagery, GIS, and spatial statistics. The emphasis is on vector-borne diseases, with one chapter devoted to helminthic diseases. With the exception of the chapter on spatial statistic and GIS, there is little mention of other epidemiologic applications . The book is divided into three parts: three introductory chapters describing the methodology; four chapters which review the applications and provide examples from the authors\u2019 experiences in studying African trypanosomiases, malaria, tick-borne diseases, and human helminthic diseases; and three concluding chapters which describe environmental variables, disease risk forecasting, and the education about and future of remote sensing in human health.Although remote sensing, GIS, and spatial statistics have been reviewed separately elsewhere, the encompassing review, the inclusion of lists of URLs, and the extensive references make the introductory chapters timely and instructive for new users. The audiences that will benefit most from the book include researchers and public health administrators who want to integrate these tools into research, surveillance, and control efforts. This audience, as well as more experienced users, can gain much from the chapters that provide examples of specific applications derived from deep understanding of the biology of disease. The chapters by Rogers, Randolph, and Brooker and Michael, in particular, are based their own research and expertise in trypanosomiasis, tick-borne diseases, and helminthic diseases, respectively.Remote sensing and GIS are particularly relevant to emerging infectious diseases. The chapter entitled Forecasting Disease Risk for Epidemic Preparedness provides a road map for developing early warning systems. While this chapter, like the rest of the book, is clearly written by advocates of the applications of remote sensing and GIS, the authors remain aware of critical issues, such as the distinction between statistical and biological models and the notion that insights gained by false negatives and positives predicted by models are as important as successful predictions. Other issues that have hampered more extensive applications of remote sensing and GIS to vector-borne diseases include lack of training, gaps in data , inadequate tools for data gathering, and limits on management and understanding. This book goes a long way to address these issues and is likely to lead to more and improved applications of remote sensing and GIS."}
{"text": "Francisella tularensis: Biology, Pathogenicity, Epidemiology, and Biodefense, published by Blackwell Publishing Limited on behalf of the New York Academy of Sciences. This book is a much-needed comprehensive overview of recent research on the causative agent of tularemia, a potentially serious illness that occurs naturally in the United States. F. tularensis is a marvel among vector-borne agents of infectious disease. It has a wide geographic distribution (covering most of the Northern Hemisphere) and can be transmitted through a variety of routes including 1) tick or insect bites; 2) handling of infected animals; 3) contact with or ingestion of water, food, or soil; and 4) inhalation of contaminated aerosols. Indeed, F. tularensis is notorious for infecting laboratory workers and is a potential bioterrorism agent. The bacterium includes 4 biovars, with the pathogenic type A recently shown to consist of at least 2 subtypes in North America. Natural transmission cycles of F. tularensis are complex and poorly understood.I am pleased to recommend F. tularensis as a disease agent in humans and the 1970s, but few studies focused on this pathogen during the 1980s and 1990s. The recent designations of F.tularensis by the National Institute of Allergy and Infectious Diseases as a priority A pathogen and a potential bioterrorism agent has resulted in an explosion of new studies on this intriguing pathogen. Primary focal points of these studies have included vaccine development, improved pathogen detection methods, evaluation of the genetic variability of F. tularensis biovars commonly associated with human disease, description of the F. tularensis genome, and determination of virulence factors. The wealth of information gained from recent studies is elegantly outlined by an impressive group of world leaders in the field of tularemia research. Chapter topics vary from molecular epidemiology, evolution, and ecology of Francisella to genetics, genomics, and proteomics of F. tularensis, molecular and genetic basis of pathogenesis of F. tularensis, animal models, immunity and immunopathogenesis, diagnosis and therapy, vaccine development, and biosafety issues.Research on a broad variety of topics was carried out between the 1914 recognition of F. tularensis, and the role of different transmission routes to humans. As the field of F. tularensis and tularemia research moves forward in the 21st century, the explosion of knowledge related to genetics, immunology, and pathogenesis of F. tularensis needs to be complemented by renewed studies on natural transmission cycles, transmission routes to humans, and epidemiology.Reflecting a disturbing paucity of epidemiologic and field-oriented studies in the past 20 years, especially in North America, only a few chapters include some information on epidemiology, natural transmission cycles of"}
{"text": "Human enteric viruses and protozoal parasites are important causes of emerging food and waterborne disease. Epidemiologic investigation and detection of the agents in clinical, food, and water specimens, which are traditionally used to establish the cause of disease outbreaks, are either cumbersome, expensive, and frequently unavailable or unattempted for the important food and waterborne enteric viruses and protozoa. However, the recent introduction of regulatory testing mandates, alternative testing strategies, and increased epidemiologic surveillance for food and waterborne disease should significantly improve the ability to detect and control these agents. We discuss new methods of investigating foodborne viral and parasitic disease and the future of these methods in recognizing, identifying, and controlling disease agents."}
{"text": "Cancer incidence during 1972-90 in Asian migrants to New South Wales, Australia, is described. Overall cancer incidence was lower than in the Australia born in most migrant groups, and this reached significance in migrants born in China/Taiwan, the Philippines, Vietnam and India/Sri Lanka, and in male migrants born in Indonesia. For the majority of cancers, rates were more similar to those in the Australia born than to those in the countries of birth. For cancers of the breast, colorectum and prostate, rates were relatively low in the countries of birth, but migrants generally exhibited rates nearer those of the Australia born. For cancers of the liver and cervix and, in India/Sri Lanka-born migrants, of the oral cavity, incidence was relatively high in the countries of birth but tended to be lower, nearer Australia-born rates, in the migrants. For these cancers, environmental factors related to the migrant's adopted country, and migrant selection, appeared to have a major effect on the risk of cancer. For certain other cancers, incidence was more similar to that in the countries of birth. Nasopharyngeal cancer, and lung cancer in females, had high rates in both the countries of birth and in migrants to Australia. Nasopharyngeal cancer rates were highest in China/Taiwan and Hong Kong-born migrants, and were also significantly high in migrants from Malaysia/Singapore, Vietnam and the Philippines. Rates of lung cancer were significantly high in women born in China/Taiwan, and the excess was greater for adenocarcinoma than for squamous cell carcinoma. Melanoma had low rates in both the migrants and in the countries of birth. For these cancers, it was probable that genetic factors, or environmental factors acting prior to migration, were important in causation."}
{"text": "On Friday, 21 September 2007, in Lyon, France, we lost a great human being, a staunch advocate for public health, a thorough and delving scientist, and a humanitarian par excellence. Lorenzo Tomatis, MD, above all, was a learned teacher and creative innovator. His accomplishments are legion, and his far-reaching impact on human health, including the well-being of future generations, will be impossible to replace. Tomatis was clearly a true pioneer and admired leader in primary disease prevention. He stands tall among other giants and trailblazers of environmental health science and public health advocacy including Cesare Maltoni, Norton Nelson, David Rall, and Irving Selikoff. At the same time, Tomatis was respected, admired, and loved by his colleagues and fellow public health advocates as a man whose warmth, humor, strength, and sweetness were as compelling as his command of science.IARC Monographs on the Evaluation of Carcinogenic Risk to Humans . Since 1972, when the first monograph was published, this series of nearly 100 volumes has provided objective evaluations of carcinogenicity on agents, mixtures, and exposure circumstances. Not only did Tomatis design and develop the IARC Monographs, he was a principal leader in the scientific community in recognizing the essential value of transplacental and transgenerational carcinogenesis and developing methodologies to determine the influence of early-life exposures. Then and over time, these innovations spurred further primary prevention strategies of action and additional experimental derivatives. As a champion of modern carcinogenesis bioassays, Tomatis led the difficult course of defining the applicability and utility of these experimental animal findings for preventing cancers in humans, especially in workers and children.During his tenure at the International Agency for Research on Cancer (IARC), Tomatis was instrumental in creating what has come to be recognized and known as the monument of primary prevention of cancer: the Tomatis was born in Sassoferrato, Italy, and began his professional career upon graduating from the University of Turin with a degree in medicine in 1953, in hygiene and preventive medicine in 1955, and in occupational health in 1957. Tomatis recognized early on that, although he enjoyed serving the medical needs of individuals, his passion for fostering public health, merged with scientific undergirding, led him to new and different challenges. In 1959, newly arrived at the University of Chicago, he began studying occupational disease and became immersed in cancer research, particularly cancer causation. Almost immediately he recognized the obvious value and significance of preventing disease, particularly occupational cancers, rather than relying on the then-current direction of cancer diagnoses and treatment. His lifework was ultimately dedicated to this vital mission.IARC Monographs. This public health breakthrough had instantaneous and, as we now know, enduring impact throughout the world. In fact, IARC quickly became known predominantly for the IARC Monographs, its most visible and useful product. This international recognition of the value and authority of the IARC Monographs was bolstered by the impartial and scientific process initiated by Tomatis for evaluating chemical carcinogens. Tomatis and IARC staff brought together working groups of independent scientists with vast knowledge of chemical carcinogenesis to evaluate the available information used to prepare the objective IARC Monographs.In 1967, Tomatis moved to Lyon, France, as one of the first leadership employees of the newly established IARC. Upon arriving, he formed the Unit of Chemical Carcinogenesis. There he envisioned and began to effectuate more than a monolithic cancer research program\u2014he insisted on a solid effort on primary prevention of cancer. His view on prevention came to fruition in 1972 with the publication of the first volume of the In January 1982, in recognition of his outstanding career and contributions in understanding cancer causation and prevention, Tomatis was elected by the World Health Organization (WHO) member nations as the second director of IARC. He was reelected and served as director for a full 12 years, until his retirement in December 1993. During his tenure at IARC, Tomatis and the international IARC staff developed a mutual respect and appreciation for each other and were unified in promoting the agency\u2019s mission of improving public health through primary disease prevention. Upon retirement from IARC/WHO, he served as scientific director of the Institute of Child Health \u201cBurlo Garofolo\u201d in Trieste, Italy, from 1996 to 1999.Shortly thereafter, Tomatis joined the National Institute of Environmental Health Sciences (NIEHS) in North Carolina to focus on issues that he had little time to pursue while serving as the director of IARC. Under the International Scholar Program, Tomatis worked at the NIEHS for six summers, sharing his professional experience and writing important papers on environmental public health and prevention. During that time, he was also the chairman of the Scientific Committee of the International Society of Doctors for the Environment in Arezzo, Italy.The Unlimited Research 1974, Seen from the Inside 1981, Natural History of the Researcher 1985, The Laboratory 1993, The Reelection 1996, and The Refugee 2005.Tomatis was born in Italy, worked in the United States, and spent most of his professional career in France; he was a person of immense global scientific and public health impact. Able to speak four languages\u2014Italian, French, English, and German\u2014Tomatis traveled the world to spread his undiluted message of primary prevention of diseases, especially cancer. He was as prolific as he was dedicated to protecting the environment, including workplaces and public health, and he was an early and long-standing champion of environmental and social justice. Much of his science is captured in 10 books and more than 350 scientific papers. Being a renaissance man, Tomatis also wrote books for the public based on his medical, scientific, and humanitarian experiences: His gifts to humanity are well recognized in saved lives and a cadre of scientists influenced by his magnanimity, honesty, sense of ethics, and moral character. Most will remember Tomatis for his brilliance in science and public health thought, but he will more likely be venerated for his generosity and compassion. His heroic scientific determination and his adventurous spirit and love of people inspired Tomatis to live life to its fullest. He is survived by his wife, Delia, in Trieste, and their son, Paolo, who lives and works in Rome.His gifts to humanity are well recognized in saved lives and a cadre of scientists influenced by his magnanimity, honesty, sense of ethics, and moral character."}
{"text": "In the globalized political economy of the late 20th century, increasing social, political, and economic interdependence is occurring as a result of the rapid movement of people, images, values, and financial transactions across national borders. Another consequence of the increase in transnational trade, travel, and migration is the greater risk of cross-border transmission of infectious diseases. As the world becomes more interconnected, diseases spread more rapidly and effectively. With more than one million people crossing international borders every day, and with the globalization of food production, manufacturing, and marketing, the risk of infectious disease transmission is greater. Economic globalization has also increased the need for governmental budget austerity, and consequent national preparedness has been eroded. The emergence of new infectious diseases, as well as the reemergence of old ones, thus represents a crucial transnational policy issue. These problems cannot be resolved by national governments alone; they require international cooperation. This article analyzes the role of foodborne disease surveillance programs, nationally and internationally, in the control of foodborne diseases."}
{"text": "In the present paper, we consider the impact of HIV/AIDS on human development in African countries, showing that, beyond health issues, this disease should and must be seen as a global development concern, affecting all components of human development. Consequently, we stress the necessity of multidisciplinary approaches that model, estimate and predict the real impact of HIV/AIDS on human development of African countries in order to optimise the strategies proposed by national countries, international institutions and their partners.In our search strategy, we relied on secondary information, mainly through National Human Development Reports of some African countries and regular publications released by the United Nations (UN), United Nations Development Programme (UNDP), World Health Organization (WHO) and the World Bank. We restricted ourselves to reports dealing explicitly with the impact of HIV/AIDS on human development in African countries.HIV/AIDS is affecting the global human development of African countries through its devastating impact on health and demographic indicators such as life expectancy at birth, healthcare assistance, age and sex distribution, economic indicators like income, work force, and economic growth, education and knowledge acquisition and other indicators like governance, gender inequality and human rights.On the basis of the national reports reviewed, it appears clearly that HIV/AIDS is no longer a crisis only for the healthcare sector, but presents a challenge to all sectors. Consequently, HIV/AIDS is a development question and should be viewed as such. The disease is impeding development by imposing a steady decline in the key indicators of human development and hence reversing the social and economic gains that African countries are striving to attain. Being at the same time a cause and consequence of poverty and underdevelopment, it constitutes a challenge to human security and human development by diminishing the chances of alleviating poverty and hunger, achieving universal primary education, promoting gender equality, reducing child and maternal mortality, and ensuring environmental sustainability. Since 1990, five main composite indices were developed by the United Nations to measure the average achievements in basic human development (human development index (HDI), gender-related development index (GDI), human poverty indices (HPI-1 and HPI-2) and the gender empowerment measure (GEM) . HDI is In the present paper, we consider the impact of HIV/AIDS on human development in African countries, showing that, beyond health issues, this disease should and must be seen as a global development concern, affecting education and knowledge acquisition, income and social status, productivity and economic growth, and other direct and indirect components of human development such as gender equality and human rights. Consequently, we stress the necessity of multidisciplinary approaches that model, estimate and predict the real impact of HIV/AIDS on human development of African countries in order to optimise the strategies proposed by national countries, international institutions and their partners.In our search strategy, we relied on secondary information mainly through National Human Development Reports of some African countries and regular publications released by the United Nations (UN), United Nations Development Programme (UNDP), World Health Organization (WHO) and the World Bank. For national reports, we restricted ourselves to the eight National Human Development Reports which dealt explicitly with the impact of HIV/AIDS globally on human development, or partially on its components during the last years.With malnutrition as a common contributor, the five biggest infectious killers in the world are HIV/AIDS, malaria, tuberculosis, acute respiratory infections and diarrhoeal disease, responsible for nearly 80% of the total infectious disease burden and claiming about 12 million people per year Table  5]. Des. Des5]. During the last decades, the prevalence and incidence of HIV/AIDS have seen an exponential growth Figure . AfricanThe 2007 Zambia Human Development Report (HDR) focuses on the sixth Millennium Development Goal (MDG), which is combating HIV/AIDS, malaria and other diseases. Under the title \"Enhancing household capacity to respond to HIV and AIDS\" , it is iStressing the danger of the growing prevalence of HIV/AIDS Table , the MozKenya National HDR 2006 has dealt with HIV/AIDS as a challenge to human security and human development . As streUnder the title \"reversing HIV/AIDS in Malawi\", the Malawi HDR 2005 devoted a chapter to the impact of HIV and AIDS on households welfare, orphaned children, the extended family, educational and health sectors, agricultural production, business and public service delivery. The chapter concludes that HIV and AIDS have the potential to reverse those gains made in human development in the last few years .According to the Benin HDR 2005, HIV/AIDS is at the same time a cause and consequence of poverty and underdevelopment . AccordiThe prevalence of HIV/AIDS varies according to different regions of Benin. The region with the highest prevalence has the lower life expectancy index Table .Zimbabwe HDR 2003 \"towards reducing vulnerability: the ultimate war for survival\", states that HIV/AIDS is impeding development by imposing a steady decline in the key indicators of human development. The report concludes that it is critical that the relationship between epidemic and human development be acknowledged at all levels and that the principles of sustainable development be a major focus and priority of the country's policies and programmes . ZimbabwSouth Africa HDR 2003 indicates the magnitude and far-reaching consequences of the HIV/AIDS pandemic, stressing that the disease is no longer a crisis only for the healthcare sector, but presents a challenge to all sectors . The repUnder the title \"Towards an AIDS-Free generation\" , the BotAs indicated in Table In 1999, the Commission on Macroeconomics and Health was established to explore the relationship between health and economic development. In the report published by the commission in 2001, empirical evidence was provided on how investing in health can achieve economic development and poverty reduction. It was indicated that, by 2010, eight million lives per year could be saved by essential interventions against infectious diseases and nutritional deficiencies, resulting in economic benefits adding up to more than US$ 360 per year by 2015 . In ordeHowever, beyond the international agreement on principles, at the 7-year juncture, most African countries, have made little (if any) headway in preventing and controlling the HIV/AIDS epidemics in particular, nor in reducing the rates of extreme poverty and making progress in the MDGs targeted for 2015 in general ,24. MeanHIV/AIDS is directly affecting heath and demographic indicators such as mortality rates, life expectancy, and sex and age distributions. By 2000-2005, Zimbabwe, Botswana, Swaziland and Lesotho have lost respectively 35, 28, 28 and 24 years of life expectancy ,18-20. MThe burden of the disease is not felt only at individual level; it affects households, communities and the whole nation  ,15,17. MContrary to the majority of diseases, HIV/AIDS kills and disables adults in the most productive part of their lives. Consequently, it is affecting business, investment, industry and agricultural sustainability, and ultimately reducing families' income and economic growth. Although at different degrees, all the national reports reviewed stress the negative impact of HIV/AIDS on income at individual, community and national levels -18.At the moment, it is difficult to estimate precisely the real economic impact of HIV/AIDS on the whole African continent. However, many tentative estimates have been made. In 2000, the World Health Organization estimated a yearly reduction of 1% of the GDP in the most affected African countries. In 2002, UNAIDS gave a much higher estimation of 2.6%. According to the Macroeconomics and Health Commission, in 2001, the cost of HIV/AIDS was between 11.7% and 35.1% of the Gross National Product in Africa . For SouThese partial and sometimes controversial estimates, combined with the paucity of national data, indicate the necessity of global interdisciplinary studies that can model, estimate and predict the economic impact of HIV/AIDS in Africa.As stressed in the MDGs, education is essential for human development and needs to be enhanced especially in low- and medium-income countries. Unfortunately, HIV/AIDS is reversing the trend towards the achievement of universal primary education in most African countries. In Africa, less than 65% of children are enrolled in primary school ,29 and tOn the basis of the national reports reviewed, it appears clearly that HIV/AIDS is no longer a crisis only for the healthcare sector, but presents a challenge to all sectors . ConsequWe are aware of the importance of the topic considered in this paper and the necessity to deal with it seriously and precisely. However, our search relied only on published data by different African countries and international institutions. Consequently, we were limited to data and the numbers available and this may be frustrating not to give a complete panorama of this interesting subject.This paper is dedicated to African children afflicted by poverty and HIV/AIDS epidemics.The author declares that they have no competing interests."}
{"text": "Pulmonary hypertension (PH) is a very complex disease, characterized by a progressive increase of pulmonary vascular resistance and pulmonary artery pressure, leading to right ventricular failure and death. The mediIn 1987, three PH patients decided to change this very dismal picture for those who suffered from PH. At that time there was not much hope and little knowledge, secondary to very few and inconsistent research activities. The three patients, Dorothy Olson, Teresa Knazik, and Shirley Brown met each other through the National Organization for Rare Disorders (NORD) and were soon joined by a fourth person, Pat Paton. These four agreed to organize their work in order to: help patients and their families in coping with this devastating disease, provide networking opportunities to end the feeling of loneliness of a rare illness, assist in locating doctors and medical facilities with expertise in managing PH, form support groups to allow patients to communicate with others, and begin to publish a newsletter that would build a sense of community.Only three years later, the Pulmonary Hypertension Association (PHA) was formed by more than 100 members, and a newsletter, \u201cPathlight\u201d, was published. A Scientific Advisory Board was created and a PH hotline number for patients (manned by a patient volunteer) was established. In 1994, PHA held its first International Conference. Since 1994, PHA has grown to an organization of more than 3,400 members, which includes patients, caregivers, physicians, and other professionals treating the disease.The Saudi Advisory Group for Pulmonary Hypertension (SAPH) has a very similar history. After recognition of lack of PH awareness among local physicians and caregivers, and the very poor outcome of this devastating disease that affects many patients in Saudi Arabia, five Saudi physicians constituted the nucleus of SAPH in 2004. The mission of SAPH was to devote its efforts toward the patients suffering from PH, by support, education, and treatment. The initial goals of SAPH were to carry out a national registry of PH cases all over the Kingdom of Saudi Arabia (KSA), to determine the reliable prevalence of PH in the KSA, to establish updated and complete guidelines for the diagnosis and treatment of this disease, to increase the awareness of PH, and to promote the interest for epidemiological and interventional studies in the field of PH.By 2009, the number of SAPH members increased to more than 65, mostly physicians. The followings were achieved:SAPH is now recognized regionally and somewhat internationally for its services in the field of PH. Since 2007, it has joined and represents the Eastern Mediterranean Region (EMR) office for the global Pulmonary Vascular Research Institute (PVRI)Publication of Saudi Guidelines for the Diagnosis and Management of PAHSAPH has started a national registry for PH in the KSAResearch work: SAPH has recognized the importance of research, and continues to work on raising funds for this particular issue. At present, different research proposals have been forwarded to the SAPH research committee for approval, such as, prevalence of sickle cell and PH in Saudi Arabia (EMR project), Schistosoma and PH in Saudi Arabia (EMR project), high altitude PH, Saudi Experience, genetic studies in Saudi patients with congenital heart disease, Bronchiectasis and PH in Saudi patients, role of selective therapy in submassive pulmonary embolism, and lloprost experience in PH patients in a tertiary care Saudi hospital,www.saph.med.sa. The website describes all the activities of the different task forces and is open to the general public for communication.Website: SAPH has finalized the website, which has both English and Arabic locations. The website address is: Scientific and education: Annual PH Scientific Meetings: Two scientific meetings have already been carried out. The first and second were conducted in Dubai, UAE and Casablanca, Morocco, in the years 2007 and 2009, respectively. The Third Joint (SAPH / PVRI) International PH Meeting  will be held in Sharm El-Sheik, Egypt in April 2010. The scientific activities have also included awareness days for physicians and nurses, PH day, and awareness materials. SAPH is educating the community and the patients (and their families) by distributing articles and media presentations in both Arabic and English. SAPH has decided to start training sessions for Pulmonary and Cardiology Fellows in the field of PH.We, in the SAPH, invite all interested physicians, caregivers, and patients to join this group. We hope that our effort will meet the effort of the others in order to reach our target and to fulfill our mission toward our patients."}
{"text": "George Martin Baer, DVM, MPH, who for many years was chief of the Rabies Laboratory in the Division of Viral and Rickettsial Diseases at the Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA, died suddenly at his home in Mexico City on June 2, 2009, at the age of 73. He was an eminent veterinary virologist whose book, The Natural History of Rabies, the second edition of which was published in 1991, is the major reference work in the field.He has been widely acclaimed as \u201cthe father of oral rabies vaccination\u201d as a result of his discovery of a strain of rabies virus (SAD strain) that immunizes foxes when given into the mouth cavity. His intensive work on the development of baits for vaccine administration to canines paved the way for successful mass fox vaccination campaigns conducted in Switzerland, several other European countries, and Canada.Dr Baer was born in London in 1936, but after the outbreak of World War II his family moved to the United States, and he was brought up in New York. He attended Cornell University in Ithaca, New York, and received a bachelor of science degree in agricultural sciences in 1954 and a Doctor of Veterinary Medicine degree in 1959. In 1961, he earned a Master of Public Health degree from the University of Michigan at Ann Arbor. He then came to CDC as an Epidemic Intelligence Service Officer, initially assigned to the New York State Health Department in Albany, where he first became interested in rabies. He subsequently joined the CDC Southwest Rabies Investigations Laboratory in Las Cruces, New Mexico, and from 1966 through 1969 was a consultant for the Pan American Health Organization in Mexico. He returned to CDC in Atlanta in 1969 to become chief of the Rabies Laboratory and served until his retirement in August 1991. He and his family then moved to Mexico City, where he founded a diagnostic laboratory and continued to use his expertise on rabies as a member of the Mexican International Steering Committee for the Rabies in the Americas Conference.Dr Baer was a valued supporter of and reviewer for Emerging Infectious Diseases and will be greatly missed. We offer our condolences to his wife, Maria Olga, and daughters, Katherine, Alexandra, and Isabella, as well as to his 4 granddaughters."}
{"text": "The Molecular Biology of Cancer; Blackwell Publishing, Oxford (U.K.); 2006. 531 pages, 214 illustrations, ISBN 9-78140-511-814-9, \u00a331.99.Here, a review of \"The Molecular Biology of Cancer\" (Stella Pelengaris and Michael Khan [Editors]) is given. The detailed description of the book is provided here: Pelengaris S, Khan M (Eds):  There are a fair number of books, dealing with cancer biology; unfortunately, they arelimited to certain cancertypes and dated. Here, Pelengaris and Khan familiarize the reader with the cancer cell in Chapter one and selected human cancers in Chapter two. A capturing, comprehensive, clearly written and absolutely accurateintroduction into cancer biology, necessary to understand how tumors evolve, develop and progress is offered in Chapters three through fourteen. This book deserves great praise for the readable presentation of this complex field. Nothing is simplified for the sake of the flow of the text. A brief description of the content of Chapters three to fourteen is presented below.Chapter three focuses on 'nature and nurture in oncogenesis' with emphasis on the role of environmental carcinogens and the influence of environmental as well as individual risk factors on development and progression of cancers along with a brief introduction into the multi-stage-concept of cancers. DNA replication and cell cycle are discussed in Chapter four. Here, concepts like duplication of DNA, addiction of cancer cells to oncogenes and phases/checkpoints of the cell cycle & currently accepted understanding of signaling cascades, utilized to tightly control the progression through the cell are presented and discussed. In turn, the foundation to comprehend one of the hallmarks of cancer \u2013 uncontrolled progression through the cell cycle \u2013 is provided. Logically, interested readers find an introduction into the regulation of growth in Chapter five. For example, growth factors and cognate receptors, signaling pathways, cellular senescence, apoptosis and survival are elegantly introduced and woven into an appropriately simplified view with plenty of cited reference for further reading. A more detailed discussion of oncogenes and tumor suppressor genes is the given in the next two Chapters, followed by an expanded introduction into the cell death in Chapter eight. Cellular senescence is then discussed in Chapter nine, beginning with the classical observation of a crisis in a cultured cell population and ending with a briefing on telomeres. Leaving the basic cellular machinery and moving into genetic instability, Chapter ten opens the horizon for caretaker genes and how signaling machines recognize damaged DNA and regulate and tune the repair process. Epigenetic levels, post-transcriptional modifications of mRNA, RNA interference and post-translational modifications of proteins are presented in Chapter eleven with a narrowed view on cancer biology. It is noteworthy that the rapidly emerging field of RNA biology, e.g. micro and piwi-interacting RNA and non-coding RNA is fairly under-represented.One of the properties of cancer cells is the anchorage-independent growth. Concordantly, the topic, including but not limited to, cell-matrix adhesion, cell-cell interactions and malignancy is discussed in Chapter twelve. Beginning with the architecture of tissues in general, the reader is introduced into the cell biology of the basal membrane, adhesion molecules and, then, the field of cell-cell interactions. With this knowledge, the critical steps in the dissemination of metastases are highlighted, leading to an elegant description of the 'seed and soil' hypothesis. Chapter twelve closes with a perspective on cell invasion. Considering the ever-growing field of cancer immunity research, Chapter thirteen provides an insightful introduction along with a selection of questions, remaining to be addressed. A brief background in innate and adaptive response of the human immune system, including a description of major effector cells, cancer immunosurveillance and immunosuppression and tumor antigens enables a reader to comprehend concepts like antigen-specific therapeutic approaches and the usage of cytokines in cancer management and treatment. How tumor cells invade an immune response is highlighted at the end of Chapter thirteen. Related to the preceding discussion, angiogenesis is introduced in considerable depth in Chapter fourteen; for instance, a discussion of general principles of new vessel growth leads to a reflection on pathological angiogenesis and the role of inhibitors in angiogenesis. Further reading directs to nicely written articles, allowing a more detailed exploration of the accumulating evidence. In sum, the philosophical approach to cancer biology and all related topics discussed in the book, along with well-chosen aphorisms, capture the attention of a reader and stimulate creative reading. Especially pleasing is the construction of chapters into introduction, classical experiments, conclusions and future directions. Study questions and topical suggestions for further readinground the chapter into a rich source of information. Balancing the wealth of molecular and cellular information, it is re-iterated that caring for the cancer patient must be part of any successful attempt to manage or, in the best case, cure this devastating disease. In this context, the book covers aspects of diagnosis and treatment of cancer in order to provide a full view of efforts to understand cancers at the most detailed levels, yielding profound strategies to prevent and cure malignancies. Diagnosis of cancer, its treatment options and the concept of patient care are presented in Chapters fifteen through seventeen. Here, the true synthesis of bench and bedside approaches is marvelously achieved by giving a thoughtful background in the role of molecular pathology in cancer diagnosis and staging, imaging techniques, radio- and chemotherapy, palliative care and the quality of a life at its end with numerous examples of recent developments and practical and ethical issues around cancer research.The only weakness of the bookis the last chapter, dealing with genomic and proteomic approaches in cancer research and diagnostic. While the chapter in itself is superbly written and of outstanding merit, it could have been incorporated into the Chapters three through fourteen, thus, elevating this book to the status of a classical textbook. Students, preparing for exams, seasoned colleagues and laypersons will find it difficult to ignore and resist the book. As the field progresses and new avenues are opened, this textbook will pass the test of time and remain a companion to the community.Molecular Cancer and receives no remuneration for his efforts.C.S. is Deputy Editor of C.S. drafted, finalized and approved of the final version of this article."}
{"text": "Travel is a potent force in the emergence of disease. Migration of humans has been the pathway for disseminating infectious diseases throughout recorded history and will continue to shape the emergence, frequency, and spread of infections in geographic areas and populations. The current volume, speed, and reach of travel are unprecedented. The consequences of travel extend beyond the traveler to the population visited and the ecosystem. When they travel, humans carry their genetic makeup, immunologic sequelae of past infections, cultural preferences, customs, and behavioral patterns. Microbes, animals, and other biologic life also accompany them. Today's massive movement of humans and materials sets the stage for mixing diverse genetic pools at rates and in combinations previously unknown. Concomitant changes in the environment, climate, technology, land use, human behavior, and demographics converge to favor the emergence of infectious diseases caused by a broad range of organisms in humans, as well as in plants and animals."}
{"text": "Journal of Trauma Management & Outcomes an exciting, new, online journal, specifically dedicated to the epidemiology, care, and outcomes of severely injured patients.Welcome to The journal willconsider articles on all aspects of trauma research, with a focus on interventions with proven efficacy or inefficacy in improving clinically relevant outcomes such as mortality, morbidity, quality of life, function, and costs. It will serve as a scientific platform for clinical researchers and practitioners involved in the different stages of caring for patients with musculoskeletal, visceral, and multiple injuries.Journal of Trauma Management & Outcomes together with BioMed Central.Whilst other established journals exist in this field, several factors convinced me, and the fine members of our international Editorial Board , to launFirst, the projections of the World Health Organization on changes in the rank order of the global burden of disease are simply alarming. If they prove true (and there is no reason to doubt the forecasts), trauma will rank third (!) among all causes for disability in 2020 worldwide [Mobility is an integral part of our life, but we also have to deal with its adverse effects. With the exponential growth of motorization in developing nations, especially in Asia, and the demand for more powerful and faster vehicles in the industrial countries, the face of road crashes is changing. Traffic accidents affect both the rich and the poor, but the consequences on health-related outcomes are very different. There are few socio-economic areas where inequities and heterogeneity in health care services have such a strong influence on mortality and morbidity, beginning with proper resuscitation on scene, and not ending with physical and mental rehabilitation.Our interdisciplinary team had the opportunity of implementing accident research and prevention programs in Germany and Vietnam , and it Journal of Trauma Management & Outcomes are open access, meaning they are freely and universally accessible online. In addition, the authors hold copyright for their work and grant anyone the right to reproduce and disseminate the article, provided that it is correctly cited and no errors are introduced. The journal's articles are archived in PubMed Central, the US National Library of Medicine's full-text repository of life science literature, and also in other national repositories.This leads me to the second argument in favor of a new journal: Important biomedical information cannot change the world unless it is accessible to everybody. There are many highly reputed journals in the field, but few of them grant readers access to their full content. All articles published in Publishing online only meets the requirements of a modern world, and the quick turnover of medical information. It also shortens the time from peer-review to publication. All articles will primarily be reviewed in-house, and, if suiting the scope of JTMO, sent out to two or more international peer-reviewers. Peer-review will be conducted in an open manner, which, to my and the Editorial Board's members opinion, increases transparency.Apart from all these advantages, there is a little downer: article processing charges need to be covered by authors. This has, however, not impeded the stable growth in the number of articles available open-access, and taking part in this success story may clearly outweigh the inconvenience of paying for publishing. Also, there are many opportunities to apply for a waiver of processing charges that can be found on our website.JTMO will not publish basic research, but target the key components of modern health care-function, quality of life, and costs.Finally, the findings from basic trauma research contributed importantly to the knowledge of human physiology and pathophysiology. However, the research efforts and discoveries on the cellular, genomic, and molecular level are not paralleled by a similar progress in clinical and population-based research on trauma. Many established diagnostic and therapeutic interventions in trauma care have not yet been proven by studies of high methodological rigor, and we currently know much more about the interplay of cytokines than the quality of life of severely injured patients. BioMed Central who helped us in getting the journal started, the members of the Editorial Board, and, of course, the authors of the first articles who made JTMO the journal of their choice.I am thankful to the wonderful people at JTMO will soon become widely known among authors and readers, for the sake and benefit of trauma patients in a world without borders.I am pleased to lead this journal as the Editor-in-Chief, and I hope that the acronym"}
{"text": "General Practice/Family Medicine is a specialty focused on the provision of comprehensive, continuing, and community oriented, person-centred care. The lack of prestige and the difficulty in attracting trainees to the specialty have been longstanding problems in most countries around the world. In Europe, General Practice/Family Medicine is also hampered for not being recognized as a specialty throughout Europe. As for Portugal, General Practice/Family Medicine is undergoing a massive organizational reform, as well as unprecedented levels of popularity among trainees.General Practice/Family holds tremendous latent potential, and is thus a specialty with a bright future ahead. It could well establish itself as the specialty of the future if it is able to overcome the barriers that currently make of General Practice/Family Medicine an unpopular career choice. It is important to train confident, competent and polyvalent family physicians, but it is also necessary to overhaul payment schemes, to invest in primary care infra-structure and organization, and to continue to attract more and more bright and motivated trainees. General Practice has always lagged behind hospital specialties in terms of pulling power for the future generations of specialists.In a recent article, Dr Juan G\u00e9rvas defined Primary Health Care as \"all the accessible and comprehensive services available to citizens for the follow-up of their health problems. Specialists, Hospitals and emergency departments provide services focused on problems, whereas primary health care is focused on person-centred care.\"According to the European Society of General Practice/Family Medicine (WONCA Europe), \"General practitioners/family doctors are specialist physicians trained in the principles of the discipline. They are personal doctors, primarily responsible for the provision of comprehensive and continuing care to every individual seeking medical care regardless of age, sex and illness. \"Core cThe clinical work of general practitioners/family physicians includes health promotion, family health, prevention and treatment of acute diseases, treatment of chronic diseases, adult health, child health, women's health, mental health, rehabilitation and palliative care/terminal care. In termDespite having a properly defined niche and purpose, General Practice/Family Medicine (GP/FM) suffers from lack of prestige. The causes of that lack of prestige include the contemporary culture of health consumerism and the triumph of the individual upon the population, the lack of awareness on behalf of the upper classes, a routine that is assumed to be too overburdened with trivialities and bureaucracy, the myth of a \"primitive\" and \"non-scientific\" medicine, and the low technological density.Many European countries and other countries around the world are currently struggling with lack of general practitioners/family physicians, which is aggravated by the classic lack of popularity of the field among medical students and junior doctors. In Portugal, this lack of doctors is concentrated in the metropolitan areas of the largest cities, and Dr Lu\u00eds Pisco estimates that between 2013 and 2015, about a third of the actual workforce of 6000 primary care physicians will retire[In Portugal, specialist training in GP/FM was increased from three to four years in 2009, and includes, apart from four different rotations in primary health care, compulsory hospital rotations in gynaecology and obstetrics, paediatrics, mental health/psychiatry, and emergency medicine. It also caters for a number of elective rotations and short rotations aimed at the acquisition of specific skills. FurtherThe author of this article informally surveyed a number of family doctors and vocational trainees through national mailing lists in Portugal and Spain (with around 600 and 450 members respectively), as well as most trainees and tutors from his health care centre, in order to gauge what doctors considered to be the most positive and negative aspects of the specialty. Two members of the Portuguese mailing list and three members of the Spanish mailing list replied. The most positive aspects included being the least hierarchical specialty, the large number of opportunities available, the holistic approach, the possibility of solving the great majority of health problems, the absence of limits in terms of knowledge, and the greater compatibility with family life.The most negative aspects pointed out were the system of fixed salaries and lack of incentives in place, the \"existential crisis\" the specialty is going through in Europe, the greater tendency towards professional stagnation and isolation, the lack of time during appointments, and the limitations to carrying out technical procedures.At a European level, there is a lack of harmonization, as GP/FM is considered a specialty in most but not all European countries,9. StillDenmark, The Netherlands, UK, and Spain have been considered for a long time the leading nations in GP/FM. On the Contrarily to what many people think, GP/FM is alive and well, but there's still a long way to go. There are new challenges, new barriers, new threats, but also new opportunities.st century GP/family physician must be self-confident and believe in oneself, must know how to cooperate with other health care professionals and levels of care, must know how to think in terms of both the individual patient and in terms of the community the patient belongs to, must practice with human and technical quality, must fight against the abuse of technology and the fragmentation of healthcare, and is expected to be prestigious, competent and polyvalent[In order to succeed, the 21olyvalent.st century, and in the case of the Portuguese reality, has been growing frankly in terms of quality and quantity, fuelled in large part thanks to the massive organizational reform of primary health care in Portugal and the fact that General Practice/Family Medicine is already a first choice for many junior doctors in Portugal[General Practice/Family Medicine has great potential for scientific development in the 21 Portugal.It is already widely acknowledged that the countries with the best health systems are usually those with a strong primary care infrastructure: they tend to have healthier populations, fewer health-related disparities and lower overall costs for health care. If thatThe answer is not straightforward. Making General Practice/Family Medicine more attractive is surely part of the equation, but it is also undoubtedly important not to neglect the importance of improving payment schemes, as family physicians tend to earn less than hospital specialists, as well as of investing in primary care infra-structure and organization, like high quality health information technology.It is also important not to forget that there are significant differences between different European countries in terms of the existence of structured curricula for vocational training, funding for structured vocational training, professional recognition of trainers, equity of salary between hospital and GP trainees, and these are issues that must also be addressed in order to increase the appeal of GP/FM.st century medicine.The struggle for European recognition is ongoing, as general practice/family medicine aims to establish itself as the paradigm of 21Tiago Villanueva is a member of the Organizing Committee of the Second Virtual Congress of General Practice/Family Medicine."}
{"text": "Journal of Foot and Ankle Research (JFAR) is a new, open access, peer-reviewed online journal that encompasses all aspects of policy, organisation, delivery and clinical practice related to the assessment, diagnosis, prevention and management of foot and ankle disorders. JFAR will cover a wide range of clinical subject areas, including diabetology, paediatrics, sports medicine, gerontology and geriatrics, foot surgery, physical therapy, dermatology, wound management, radiology, biomechanics and bioengineering, orthotics and prosthetics, as well the broad areas of epidemiology, policy, organisation and delivery of services related to foot and ankle care. The journal encourages submission from all health professionals who manage lower limb conditions, including podiatrists, nurses, physical therapists and physiotherapists, orthopaedists, manual therapists, medical specialists and general medical practitioners, as well as health service researchers concerned with foot and ankle care. All manuscripts will undergo open peer review, and all accepted manuscripts will be freely available on-line using the open access platform of BioMed Central. Journal of Foot and Ankle Research (JFAR) is a new, open access peer-reviewed online journal that encompasses all aspects of policy, organisation, delivery and clinical practice related to the assessment, diagnosis, prevention and management of foot and ankle disorders. JFAR is the official research publication of the Society of Chiropodists and Podiatrists (UK) and the Australasian Podiatry Council. However, the Editorial Board encourages submission from all health professionals who manage lower limb conditions, including podiatrists, nurses, physical therapists and physiotherapists, orthopaedists, manual therapists, medical specialists and general medical practitioners, as well as health service researchers concerned with foot and ankle care.JFAR builds upon a long and proud history of scholarly publication in the podiatry profession. The first foot-related journal in the UK, The Chiropodist, was published by the National Society of Chiropodists in January 1914. The National Society of Chiropodists was wound up in 1915, to be replaced with the Incorporated Society of Chiropodists, which published its first journal as a continuation of The Chiropodist. Following the amalgamation of the Incorporated Society of Chiropodists with four other bodies at the end of 1945, the newly formed Society of Chiropodists produced its first journal, still called The Chiropodist, in January 1946. This incarnation of the journal was continuous up until January 1989, when it was merged with the British Journal of Chiropody . The new journal was still called The Chiropodist, but with a new sub-title: The Journal of British Podiatric Medicine, which became the full title in 1991. The final manifestation of the journal \u2013 the British Journal of Podiatry \u2013 represented a merger between The Journal of British Podiatric Medicine and the British Journal of Podiatric Medicine and Surgery, which occurred in response to the amalgamation of the Podiatry Association, the Association of Chief Chiropody Officers and the Society of Chiropodists to form the Society of Chiropodists and Podiatrists in 1998 [The Chiropodist did have a small number of eager subscribers in \"The Colonies\"  was published. This journal was renamed the Australian Podiatrist in 1974. Most recently, following the amalgamation of the Australian Podiatry Council and the New Zealand Society of Podiatrists to form the Australasian Podiatry Council in 1997, the Australian Podiatrist merged with the New Zealand Journal of Podiatric Medicine to form the Australasian Journal of Podiatric Medicine  was published in November 2007 [Australasian Journal of Podiatric Medicine  was published in December 2007 [Journal of Foot and Ankle Research (JFAR).In 2005, tentative steps were taken to extend the degree of collaboration between the two organisation's journals via the reciprocal publication of selected papers . Finally, following several discussions between 2005 and 2006, including a meeting held during the 21ber 2007 , and thetry Vol. , No. 4 wJFAR, is the world's largest open access publishing company, and currently produces 186 journals.The re-evaluation of scholarly publishing by the Australasian Podiatry Council and Society of Chiropodists and Podiatrists coincided with a major upheaval in biomedical publishing. Motivated by the growth of the internet and a desire to enable wider access to scientific information, the concept of open access publishing gathered considerable momentum in the late 1990s -14. OpenOpen access publishing with Biomed Central offers several significant benefits over the traditional publication model , includiJFAR, this process is streamlined due to BioMed Central's web-based system for submission and for referees to view manuscripts and return their reviews.(i) Rapid peer review: the peer review process in many journals is often frustrating and time-consuming, and may in some cases take over 12 months to complete. For JFAR provides authors with access to a truly global readership in medicine and allied health. PubMed [JFAR \u2013 the Australasian Journal of Podiatric Medicine and the British Journal of Podiatry \u2013 were not indexed in PubMed, and several current foot and ankle journals, such as Foot and Ankle Surgery and The Foot are also not indexed in PubMed. BioMed Central also participates in CrossRef [(ii) High visibility and accessibility: publishing in . PubMed , the worCrossRef  and the CrossRef , allowinJFAR, this unnecessary delay is removed, and articles will be published on-line within a few days of editorial acceptance.(iii) Vastly reduced time period between acceptance of a manuscript and its publication: for most journals, it can take between six and 24 months from acceptance of a paper to final availability in hard copy. This delay occurs because of the need to produce paper issues on a monthly, bimonthly or quarterly basis with a fixed number of pages, which can create a substantial publishing backlog. With (iv) The author retains copyright: with traditional journals, the author transfers ownership of their article to the publisher, who can legally restrict access to the article (even to the point of restricting sharing of the article between colleagues). With open access journals, the author retains copyright and grant any third party the right to use the article freely, as long as its integrity is maintained and its original authors, citation details and publisher are identified.(v) Web-based flexibility: traditional print journals are forced to restrict the size of articles due to the cost of producing printed issues. In some journals, articles are restricted to 2,000 words or less, which creates difficulties for authors and may require the deletion of potentially important information. In addition, many journals charge the author for reproduction of colour images. In contrast, the web interface of BioMed Central journals allows for larger articles, and the unrestricted inclusion of non-written material such as high resolution colour photographs, additional datasets and movie files.Articles published in open access journals are subject to an article processing charge, which helps fund the journal and enables free access to articles worldwide. If the submitting author of a manuscript belongs to an institution that has a subscription to BioMed Central, the article processing charge is waived. There are currently 319 Members and Supporter Members in 34 countries . AuthorsJFAR is supported by the premier bodies of the podiatry professions in Australasia and the UK, the journal will inevitably have a strong podiatry emphasis. However, the editors acknowledge that the management of foot conditions encompasses a range of health care professionals [JFAR will therefore welcome all manuscripts that advance our understanding of foot disorders, irrespective of the professional background or country of origin of the contributing authors. In doing so, we hope to foster greater awareness and collaboration between foot health professionals, and help break down historical, national and political barriers impeding the progress and advancement of foot and ankle care.Scholarly journals exist primarily as an avenue for the dissemination of research findings. For clinical journals, this dissemination should ideally encompass both \"researcher to researcher\" and \"researcher to clinician\" transfer of information, in order to educate clinicians and ultimately improve clinical outcomes for patients. However, it has been argued that journals have several broader roles, such as promoting and reforming the professions they serve . As JFARssionals , and thaJFAR will focus primarily on original research articles, but will also publish editorials, methodology articles, letters to the editor, study protocols and reviews. Case reports will only be considered if they provide unique or important additional insights into the causes or treatment of foot and ankle disorders. In addition, case reports must be evidence-based where good evidence is available [JFAR will initially be reviewed by the editors and subsequently by two external peer reviewers. Reviewers will be asked to indicate whether the manuscript is scientifically sound, relevant and also to indicate the level of interest to foot health professionals.vailable . ManuscrJFAR operates a fully open peer review system, meaning that the identity of the authors is known to the reviewers, and vice versa. There is no evidence that such a system produces better quality reviews or changes reviewers' recommendations compared to traditional \"closed\" peer review [JFAR website.r review . Howeverr review . All corJFAR, provisional versions of articles will be published on our website [JFAR web archives, as well as PubMed, Google Scholar, Scopus and several other scholarly databases. In addition to providing much wider dissemination of research articles , this alication .JFAR hope that the journal will be entertaining, educational, provocative and clinically useful to all health care professionals involved in the management of foot and ankle disorders. We look forward to receiving your submissions, general feedback as to how the journal is progressing and suggestions for how it can be improved.The editors of All authors assisted with drafting the manuscript, and all authors read and approved the final manuscript."}
{"text": "Dr. Paul Tessier's death comes as a rude shock to the Plastic Surgery community all around the world. Dr. Tessier, who was residing in Boulogne, France, was born in Brittany and attended medical school at the Ecole de Medicine in Nantes, France, and received his Doctor of Medicine from the Faculte de Medecine de Paris in 1943. From 1939 until 1941, Dr. Tessier was in military service, the last year of which he spent as a prisoner of war in a German military hospital.In 1942, Dr. Tessier interned with a general surgeon who operated on cleft lip and Dupuytren's contracture. He continued his work in the surgical profession by going to Paris and joining the pediatric surgery service at Hospital St. Joseph in 1944. Later that year, while Paris was still under occupation by Germany, Dr. Tessier became an assistant to the Center of Maxillo-Facial Surgery of the Military Region of Paris in Hospital Puteaux where he remained until 1946. In 1947, the hospital's administration was transferred to Hospital Foch (Paris), and 2 years later, Dr. Tessier became involved in plastic surgery and burn care. In 1949, he returned to Nantes where he became a surgical consultant in ophthalmology.In the mid 1950's, Dr. Tessier began innovative work on finding a way to perform osteotomies to correct congenital midfacial retrusion without the relapse which plagued the performance of the procedure years before by one of his mentors, Sir Harold Gillies. In 1958, he began his initial clinical practice of the overhauled procedure. In discovering the need for bone grafts to fill gaps in the bone that could potentially jeopardize the adjustments made during the procedure, Dr. Tessier started the surgical specialty of cranofacial surgery.Within 3 years, Dr. Tessier had improved on his initial work by providing exposure for much of the procedure through a coronal approach, he had begun to section the arch rather than the body of the zygoma, and he placed bone grafts in the pterygomaxillary gap, all of which gave added stability to the midface segment without requiring an external head frame. In 1967, he performed a number of demonstration procedures for his peers and asked for their vote on whether this new specialty had a place in the practice of surgery. The positive response launched craniofacial surgery into the profession.During the late 1960's and the 1970's, Dr. Tessier developed all of the procedures that are currently used in performing craniofacial surgery: transcranial and subcranial correction of orbital dystopias such as orbital hypertelorism, correction of the facial deformity of Teacher Collins Franceschetti syndrome, and correction of oro-ocular clefts. Also, in the 1970's, Dr. Tessier began traveling to the U.S. in order to demonstrate the procedures in cities such as Philadelphia, Chicago, Houston, Boston, and Norfolk.Using autogeneous bone grafts instead of silicone or acrylic to modify skull and facial contours.Transcranial and subcranial correction of orbital hypertelorism.Techniques for correcting Treacher Collins syndrome.Correction of oro-ocular clefts.Dr. Tessier started to improve surgical techniques to correct craniofacial deformations in mid-1950s. Throughout the 1960s and 1970s, he developed the following methods:The impact of Dr. Tessier's work has affected many surgical specialties, including plastic surgery, otorhinolaryngology, ophthalmology, neurosurgery, trauma surgery, and oral and maxillofacial surgery. Many of his techniques have found significant places in the performance of plastic surgery, where Dr. Tessier's methods of autogenous bone grafts have often been seen as an improvement over the traditional use of silicone or acrylic. He also coined the term SMAS and created the subperiosteal facelift, or masklift. Dr. Tessier's work is so far reaching that virtually everyone performing procedures of the craniofacial specialty were either trained by Dr. Tessier himself, or by surgeons he trained.Because of his work, Dr. Tessier was a founding member of the International Society of Craniofacial Surgery and the European Association of Maxillo-Facial Surgeons, and had been honored many times, including receiving honorary memberships in the American College of Surgeons, the Royal College of Surgeons (London), and the American Society of Plastic Surgeons. In addition, he has been given an honorary degree from Lund University in Sweden.Paul Tessier, MD, FACS (Honorary), was the recipient of the Jacobson Innovation Award of the American College of Surgeons for the year 2000. The purpose of this award is to honor living surgeons, or surgical teams, who have been innovators of a new development or technique in any field of surgery. Dr. Tessier won this award for his original thought combined with the first presentation of work that has led to a milestone in the advancement of surgical care. The fact that Cranio-facial Surgery is so popular the world over is an ample testimony to the greatness of this colossal man of surgical sciences.May his soul rest in peace."}
{"text": "Although the community health service system is now established in China, the utilisation of the community health service institutions is low due to the lack of a gate-keeping role of the primary health service providers and referrals among the three-tiered health service institutions. In addition to this, patients who can afford to pay, often seek best services in big hospitals to guarantee the quality of care. Thus, the need of guiding the patients to the community health services and increasing the utilisation of the community health service institutions is becoming an urgent problem, which hinders the future development of community health services. This study focuses on the question of how to increase the utilisation of Chinese community health centres (HCs).A cross-sectional Base-line Survey of Chinese City Community Health Service System Building using the multi-staged cluster sampling was conducted to collect data from all HCs in 28 key contact cities. Relevant indicators of totally 1790 HCs were analysed. The statistical methods included ANONVA and logistic regression.The analysis suggested several key factors for increasing the outpatient workload (OW) at the HCs: establishing an adequate referral system among the different levels of the health system; enhancing the qualification of health personnel and increasing the compensation by the health insurance for services provided at HCs. Other key factors with a positive effect on the OW included: the government ownership of the HCs, the scale of the institutions, the medical equipment used, the mix of health services provided, and the women in childbearing age in the residence. In order to enhance the efficiency in the Chinese health system, a market-oriented reform under the government's planning was introduced in the health sector in 1980s. The two of the main measures adopted by the government to establish a competitive health service market, included the introduction of a competition among the three-tiered health service institutions and the introduction of patients' out-of-pocket payment directly to the health service providers. In this new health service market, there is a price system laid down by the government for services provided by the health service institutions at different levels. The health service institutions can compete with each other to attract patients from the same level or from a different level, while the patients can freely choose the health service providers they prefer most, and pay the chosen provider directly out-of-pocket. Thus, the traditional gate-keeping role of the primary health service institutions is deserted.The health service institutions compete for patients to be able to generate the revenue that they require. The competition stimulates the health service institutions to update their facilities and equipment, enlarge their scale, enrol excellent physicians by offering liberal wages and benefits, and adopt a positive attitude towards patients' preferences. Thus, there is no waiting list and the efficiency of health reform is overall achieved. But simultaneously, there is a concentration of superior health resources and patients at the third-tiered health service institutions as well as a decline in the use of primary and secondary health service institutions. This results in a serious equity problem, especially with regard to patients without high income, who cannot afford to pay directly to physicians. Therefore, the Chinese government endeavoured to develop a convenient and affordable primary health services - community health service - for the city residents. This mainly involved a transformation of the former health service institutions at the primary level and some health service institutions at the secondary level at the end of 1990s , 2010, 30(2):141-144; \"Analysis of medical insurance reimbursement rates of community health stations sponsored by various entities\". Chinese Journal of Hospital Administration, 2010, 26(3):205-208, and \"The Survey Analysis of the Health insurance Compensation Impact on the Income of City Community Health Center in 28 Chinese Cities\", Chinese Health Economics, 2010,29(4):47-49. etc.JX , lecturer, PhD student at the Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology. Specialty is Health Service Research, and research on Chinese community health care management and policy. The latest published papers include \" The Former Yugoslav Republic of Macedonia Health System Reform Summarization\", Chinese Journal of Maternal and Child Care, 2010, 25(8):1022-1023 and 25(9):1169-1170; \"The Ukraine Health System Reform Summarization in Chinese Journal of Social Medicine in 2009, 26 ( 2 ):82-84; The influence of supporting life environments on the psychological health of the rural five-guarantee aged farmers in Chinese Public Health Care in 2006, etc.WW , lecturer at the Jiangsu University, PhD student at the Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College of Huazhong University of Science and Technology and researches in Health Service and Management. The latest published papers include \" The study of outpatient health staff allocation efficiency of Shenzhen Maternal and Child Care Hopital\" and \"The study of inpatient health staff allocation efficiency of Shenzhen City Maternal and Child Care Hospital \" in Chinese Journal of Social Medicine, 2008, 25(2): 80-82. and \"The Development, Effect and Concerned Issues of Pilot Work of National Community Health Service System Building in Key Contact Cities--Based on the Comprehensive Analysis of the Baseline Survey and Routine Monitoring Data\" in Chinese Journal of Social Medicine, 2009,26 (6):321-325.YL  , PhD student at the Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College of Huazhong University of Science and Technology. Specialty is Health Service Research, and research in Chinese community health service management and policy. The latest published papers include \"Slovakia Health System Reform Summarization\" in Journal of Science Discipline Research; \"The frequency distribution analysis of order rank of scientific paper of first-rate world biomedical scientists--study case of Nobel prize winner of physiology or Medicine\" in Journal of Science and Technology Philosophical Research in 2009.JZ , PhD student at the Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology. Specialty is Health Service Research, and research in Chinese community health service management and policy. \"Progress of medical insurance in community health facilities of the key contact cities\" in Journal of Chinese Health Policy in 2010, \"The comparison analysis of evaluation methods of scientific paper--study case of first-rate world biomedical scientists\" in MP , Assistant professor  at the Department of Health Organisation, Policy and Economics, Faculty of Health, Medicine and Life Sciences, CAPHRI, Maastricht University Medical Center, Maastricht University, The Netherlands. Research areas: health care funding and management, out-of-pocket payments, stated preference methods in policy evaluation. Numerous publications in these research areas.HL , MD, the doctor at Wuhan City Maternal and Child Health Care Centre. He has participated in 8 projects, such as \"The study on the children's physical growth under 7 in the ten provinces in the rural China\", \"The study on the baby anaemia in three counties of Hainan Province\", etc., and accumulated rich experience in the data collection and data analysis, and published some papers on the maternal and child health in the Chinese journals, such as Chinese Child Health Care, Chinese Maternal and Child Health Care, and Behaviour Medicine, etc.PY , PhD, assistant professor, the deputy director of Department of Epidemiology and Health Statistics, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology; the research on biological statistical analysis and its application, and the evaluation of population health promotion performance. He has conducted more than 7 national and provincial projects and published 12 medical college textbooks and more than 20 papers in his field.ZL (1959.9), Professor, PhD supervisor and the director of the Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, the famous national health expert and research on Chinese city community health service management and policy for more than two decades. He has published more than 78 papers on community health service research, and conducted 16 projects from the National Natural Science Foundation, Ministry of Health and Hubei Provinces, and wrote 7 books on health service.The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6963/10/151/prepub"}
{"text": "An author name was incorrectly spelled as Jun Lou. The correct spelling is Jun Luo. The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.In the published article, there was an error in affiliation 1. Instead of, the Department of Cardiology, Affiliated Ganzhou City Hospital, Nanchang University, it should be, the Department of Cardiology, The Affiliated Ganzhou Hospital of Nanchang University.In addition, there was an error in the affiliation(s) for Ming-Sheng Zhou. Instead of, 2 Department of Physiology, Shenyang Medical University, Shenyang, China, 3 Department of Physiology, Jinzhou Medical University, Jinzhou, China, they should only have, 2 Department of Physiology, Shenyang Medical University, Shenyang, China. The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "Writing and editorial assistance was provided by Johna-than Maher, PhD, of BlueSpark Healthcare Communications, and was contracted by Boehringer-Ingelheim Pharmaceuticals, Inc. Dr. Govindan meets the criteria for authorship as recommended by the International Committee of Medical Journal Editors (ICMJE), was fully responsible for all content and editorial decisions, and was involved in all stages of manuscript development. Dr. Govindan received no compensation related to the development of this article.Ramaswamy Govindan has served as a paid consultant or been on the Advisory Board of AstraZeneca; Avantis Medical Systems, Inc.; Bristol-Myers Squibb Company, Boehringer Ingelheim GmbH; and Eli Lilly and Company, and is a member of the Speaker\u2019s Bureau of Eli Lilly and Company and Genentech, Inc."}
{"text": "The ability to control balance during activities of daily living (ADL) is impaired in older adults as a result of deterioration in the sensory systems , the cognitive system , and the musculoskeletal system. Consequently, many older adults face a risk of falling during their ADL. In most cases, falls and related injuries impair the quality of life and result in physical limitations, anxiety, loss of confidence, and fear of falling. Among a variety of fall prevention interventions, adapted physical activity programs have been suggested for improving balance control during ADL. These programs challenge the sensory, cognitive, and musculoskeletal systems while addressing balance constraints such as orientation in space, changes in direction, and the speed or height of the center of mass during static and dynamic situations resembling ADL. The above-mentioned elements can be dealt with through a combination of balance and coordination exercises that challenge the postural control systems in multiple dimensions\u2014including vertical and horizontal changes of the center of mass, standing on unstable surfaces with a reduced base of support, and changing body directions. Consequently, such exercises require environmental information-processing. The combination of dual-task, function-oriented challenges while controlling balance stimulates the sensory and neuromuscular control mechanisms. Among older adults, these programs have been found to improve static and dynamic stability, as well as a number of aspects in the quality of life. Recently, they have also been found to improve cognitive functions such as memory and spatial cognition. Aging is subjected to longitudinal processes as a consequence of physiological changes, such as a higher level of stress, mitochondrial dysfunction, abnormality of inflammatory processes, decreased hormone production, and decreased metabolic rate which can lead to catabolism and degeneration of organs  to present studies examining the effect of performing balance and coordination exercises on various aspects of the quality of life of older people; and (b) to present suggestions for practical applications.The author performed a literature review of available studies on the research topic dealing with different effects of balance and/or coordination exercise programs on various aspects of older adults\u2019 lives. Research studies were selected on the basis of research topics that included the following keywords: balance exercise, coordination exercise, postural control, risk of falling, frailty, and quality of life, found in the world\u2019s acknowledged databases: PubMed, EBSCO , Google Scholar, and Science Direct. The search was not limited by any period of time. From the database/journal searches, 2,333 titles/abstracts were retrieved. The majority of the studies were detected in the Google Scholar database. The titles and abstracts of some identified articles were then checked for relevance. Subsequently, the search was performed again, focusing on the occurrence of at least one keyword in the title or abstract of articles written in English and representing scientific study, thereby significantly narrowing down the selection. Altogether, 326 studies were found. After removing duplicates and titles/abstracts unrelated to the research topic, 25 studies were found to be relevant to the research topic , significantly improved cognitive function  of older adults  while the body is constantly shifting from foot to foot, with the knees and hips held in flexion . During each movement, different parts of the body take turns playing the role of stabilizer and mover, allowing smooth movements to be executed without compromising balance and stability. Older adults who performed this form of exercise were found to have significantly better postural control and stability in conditions with simultaneous disturbance of vision and proprioception, compared to active nonpractitioners . When planning each training session, it is important to keep in mind the participants\u2019 adaptation process to the exercises and to determine the session\u2019s optimum duration, allowing for gradual and safe exposure to new equipment or a new exercise.AD performed the drafting, analyses, and final version of the entire manuscript.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "The Reflective and Critical Thinking was found as a subject, subject content and didactic strategies. Of the 562 subjects reviewed, this type of thinking is found in 46% of the humanities area and 42% in the area of research and professional discipline. It is important to train teachers to achieve coherence between the pedagogical model approach, teaching strategies and evaluations.nursing programs in the Andean region contemplate the critical thinking as cognitive and personals skills of communication. They also use real situations analysis, supervised practice, simulation labs and specifically learning based in problems to develop the capacity to solve them, decision-making and develop communication skills, including analysis, synthesis and evaluation. Moreover, the nursing profession is evolving, so that it is increasingly moving away from the biomedical model of care, focused on the instrumental, to focus on people\u2019s health care, with primacy of dialogue and agreements between the professional and the person under care. As part of a multiprofessional team, this requires changes in the curricular proposal and, in turn, a qualifying teacher for a new profile of graduate, whereby reflection, self-criticism and professional responsibility are developed.Therefore, it is necessary to work intensely to reduce the dichotomies that are present in nursing programs, namely: between theory-practice; training and the reality of professional practice; and the student as a passive part of the teaching-learning process and the professional who is required, active, proactive, creative, analytical, with contextual perspective, flexible, with logical thinking, able to carry out a permanent and continuous search for information, able to contribute with his profession to the solution of health problems..The General Conference of the United Nations Educational, Scientific and Cultural Organization (UNESCO), at its 38th session, held in Paris from 3 to 18 November 2015, \u201cRecommendation about Adult Learning and Education\u201d states in one of its objectives the need to develop people\u2019s capacity to think critically and to act with autonomy and a sense of responsibility(-) and the clinical judgment is the result of this process. The development of the clinical judgment  is one of the most important and challenging tasks of being a nurse. Clinical reasoning precedes clinical judgment and the decision-making that is important in professional and personal life.Critical thinking (CT) is a process and a learning outcome -4 and.In order to achieve professionals with reflective and critical thinking (RACT), it is necessary to make deep changes in the educational dynamics, in the teaching and student roles, in the use of pedagogy and didactics to transmit knowledge, the curricular structure, the strategies of teaching-learning. These changes are expected to be centered on the student, who must actively participate in the learning process in order to achieve greater development of his or her capacities for reasoning, self-learning, self-evaluation, self-management and self-regulation. Likewise, it is expected that teachers to be critical and creative, attending to individual ways of learning, encouraging the development of good thinking in the student.. The world changes fast and new realities arise, so there is a fundamental need of people to develop capabilities that allow them to respond and adapt themselves to these changes.Literature points out that critical thinking is the \u201cessential foundation for education, since it is the basis for adaptation to the individual, social and professional demands of daily life in the 21st century and beyond\u201d. The wo.Critical thinking is \u201cthe process of seeking, obtaining, evaluating, analyzing, synthesizing and conceptualizing information as a guide, to develop self-conscious thinking and the ability to use this information by adding creativity and taking risks\u201d. and, since the end of 1980, various strategies for its teaching have been discussed at all school levels. On the other hand, authors point out the importance of generating opportunities to develop RACT in students. Therefore, some authors emphasize the importance of developing it in all health situations in favor of the patient. The nursing professional developing RACT will know where, when and how to use their knowledge, skills, values and attitudes.Authors pointed out one of the first definitions of critical thinking: \u201cknowledge, skills and attitudes\u201d and, sil levels. On the patient,6-7.The motivation for nurse training in the Andean region became evident in the 1960s. In particular, Colombia generated the first degree program in 1958, which was approved in 1961. In the same period, Venezuela, Ecuador, and Peru initiated undergraduate programs; in the case of Bolivia, it happened only until 1970Sistema de Aseguramiento de la Calidad de la Educaci\u00f3n Superior) was implemented, as well as the Accreditation of the programs and the own regulations or nursing law emerged in each country of the region.The 1980s were marked by the rise of postgraduate programs, increased development of research and the generation of knowledge. The 1990s saw a boom in graduate, specialization, masters, and doctoral programs, the latter especially in education. However, there were also more options for the qualification of nursing professionals for the teaching role. On the other hand, the Higher Education Quality Assurance System  shows the need to expand the research in the area of education, to achieve greater development of research and to work in education and nursing policies and practices. On the other hand, the latter shows the need to implement and evaluate pedagogical and didactic strategies that help the student to develop a critical judgment, justified decision making, comprehensive memory and communicative competence.The literature-11 shRed Iberoamericana de Investigaci\u00f3n en Educaci\u00f3n en Enfermer\u00eda - RIIEE), in 2011, identified as a research priority, \u201cThe development of RACT in nursing students\u201d, within the tree of the problems detected in its research line Higher Education and Nursing. For the development of this research purpose, the Network suggested a multicenter macroproject with the theme \u201cStrategies to develop the RACT in nursing students: situation in Latin America\u201d. In fact, the conceptual paradigm refers to \u201ccritical theory and constructivism, since RACT is an analytical, cyclical, broad and systematic process, but not rigid; its analysis and interpretation allows to have elements for decision-making, as well as to make informed choices\u201d(-).For its part, the Ibero-American Network for Research in Nursing Education , Brazil, the Southern Cone, Europe, and Mexico and the Caribbean. The investigation is planned in three stages: 1. Diagnose; 2. Planning and implementation of interventions; and 3. Evaluation. The diagnostic stage includes: 1. The state of the art on scientific production in RACT and teaching strategies for its development; 2. Characterization of educational strategies for teaching the RACT collected in nursing literature; 3. To determine the development of the RACT competence in the different nursing curriculum; 4. To identify the educational strategies used by teachers to develop the competence of reflective critical thinking in nursing students; 5. To identify levels of critical thinking in nursing students according to the classification of Paul and Elder (unreflective thinker - master thinker). Objectives 4 and 5 are currently being developed..The analysis of the \u201cScientific Production in RACT in Nursing in 1990-2012 in Ibero-America\u201d produced among others the following conclusion: the formation of a critical reader and the investigative process are strategies that help university students to be critical and autonomous and to access more critically to the knowledge of the disciplinary area. For this, teachers are required to make of each moment and situation in the teaching-learning relationship an open forum for reflection, debate, questioning and contrasting of the different perspectives around the area of professional training and society\u2019s problems.After reviewing the literature on the web of science by using the descriptors critical thinking and nursing, education and curriculum, it was not possible to find studies that analyzed the presence of RACT in the curriculum of nursing degree programs. However, it is very striking the motivation to analyze the importance of its development and studies that demonstrate its value, as well as the use of different and combined teaching-learning strategies to achieve the formation of RACT in nursing students.This study was done with the purpose of to evaluate the teaching of transversal competence of the Reflective and Critical Thinking that is fundamental in the decision-making and solution of nursing problems, in degree programs of public and private institutions in the Andean region.Asociaci\u00f3n Latinoamericana de Escuelas y Facultades de Enfermer\u00eda - ALADEFE).The coordinating group of RIIEE developed the research project from which the research groups of each country and region of the Network were made up, integrated by members of the Network and researchers in education and nursing, who are also teachers in Higher Education Institutions (HEI), and mostly with PhD academic level. The HEI in Nursing (HEIN) were identified through the Ministries of Education, the Associations of Schools and Universities of Nursing of each country and the Latin American Association of Schools and Universities of Nursing  and the current ethics legislation in each country, was approved by the Ethics Committee of the University of Antioquia, Colombia, by Act No. CEI-FE 2015-25 on July 31, 2015. The respect for privacy and confidentiality were ensured to each Program Director, with the informed consent signed by each participant. The project was also sent to them and their understanding was guaranteed. In turn, we conceded the right to choose what information they wanted to share. Confidentiality was maintained by institutional coding. Finally, was given a deadline of 15 days to obtain the response of acceptance to participate.The target population of this research were 187 undergraduate nursing programs in the Andean region: Bolivia (47), Colombia (47), Ecuador (21), Peru (62) and Venezuela (10). We considered only the nursing curriculum of the HEI, recognized by the Associations of Schools and Colleges of Nursing of each country or its counterpart, regardless of whether they were public or private. Resulting in the nursing curriculum of 76 Institutions that correspond to the 40.64% HEIN that teach undergraduate nursing in the Andean region: Bolivia (7), Colombia (38), Ecuador (11), Peru (14), and Venezuela (6). Due to the difficulty in obtaining the information, we checked web pages, contacted HEIN members, made contacts by telephone, in some cases, we made personal visits and, finally, the complete program was requested in PDF format for the complete the instrument of the research group. In addition, the HEIN did not refused to participate, but some institutions did not respond to the invitation. The result of this process: 30 institutions accepted to participate and provided the complete information, and out of 46 partial results were obtained. An HEIN database of the names, telephone numbers and e-mail addresses of the authorities in charge of managing the programs was created in order to follow up on their responses.(-).After identifying, during 2011 and 2012, the theoretical and conceptual framework of RACT from different authors and different perspectives , despite the abundance of literature about the subject, we concluded that the concept is very unclear from a nursing point of view-14.However, it was necessary to establish a concept that was accepted by the research group of the Network, that allowed to determine a starting point or consensus to carry out this work and, without detriment to seek some level of fidelity to the multiple approaches of the scholars of this research object, that was understandable for the group and reflected what was intended to be done in its research phases and stages. and Paul; Elder, the elements of the CT and the attitudes of the Critical Thinker proposed by these authors. With the material analyzed, RIIEE constructed the following concept: \u201cReflective and critical thinking is a complex, systematic and deliberate process of reasoning, self-directed and action-oriented. It is primary purpose to choose, based on intellectual and affective processes , the best response options that favor the solution of nursing problems, in well-defined contexts and in accordance with the ethical postulates of the profession that allow it to act with rationality and professional autonomy\u201d.The Network took as a theoretical framework the approaches made by Paul and Paul; Elder, the elutonomy\u201d.The research process included the conceptual and theoretical analysis of the curriculum, the updating of the context of research development in nursing education in each country of the region, the characterization of the HEIN and, finally, the results of the state of the art on teaching strategies for the development of the RACT 1990-2012, Andean region., the curriculum as a macro concept that encompasses the socializing function of the school is at the same time pedagogical ideas, structure of contents in a particular form, precision of them, reflection of educational aspirations more difficult to translate in concrete terms and skills to promote in the students. In Posner, who raised the great number of phenomena involved in the curriculum; Gimeno-Sacrist\u00e1n; P\u00e9rez-G\u00f3mez, there is five categories in which the definitions of curriculum can be articulated: as an organized knowledge structure, production technology system, instructional plan, set of learning experiences and problems solution.Once the exhaustive bibliographic review was carried out, the instrument was designed based on the concept of Stenhouse, the custudents. In Posn Posner, who raez-G\u00f3mez, there Based on the aforementioned, the specific instrument for this investigation was constructed with three parts. The first with 10 items, with general information from the HEI or University. Each University is subdivided into Centers that are parted into Colleges and these are divided into programs: name, geographic location, type of institution, accreditation data, mission, vision, objectives, curricular guidelines for degree programs, web page, and data about who completed the instrument. The second, 28 items, for the College, School, Department or Nursing Program (typology to identify HEIN in the region), with the following subsections: general aspects of the nursing program, character within the institution, number of sites where the program is offered, accreditation data , program justification, mission, vision and objectives of the program, evaluation process, graduation profile, pedagogical model, number of hours and credits, curricular structure (nursing program subjects that correspond to each area or component). Finally, the general characteristics of the teachers: kind of affiliation with the institution, time worked, and maximum educational level achieved. The third, 9 items, for specific information about each of the subjects: name, component or area to which it belongs, number of hours and credits, type of subject , contents, teaching-learning methodologies and evaluation process.The members of the research group carried out an analysis of the validity of the content of the instrument. Afterwards, the pilot test was conducted, starting with its implementation in each of the HEI in which the researchers worked; the results were analyzed and the corresponding adjustments were made in its structure. Subsequently, the adjusted instrument was tested with five members from the region, one from each country, but different from the research group. Because of this test, we decided to design a guide to facilitate the completion of the instrument and ensure objectivity in the collection of information, because of the language differences. It is possible to obtain the final version of the instrument from the authors of the project.Each participant received the letter of invitation, the project, the informed consent, the instrument to collect the information and the corresponding guide for its completion in hands and by e-mail.The information obtained was reviewed and, in some cases, it was necessary to request the complementation of some aspects of the instrument. Then we proceeded to codify the HEI or Universities and the HEIN. The information was included in Excel tables designed with the predetermined categories and subcategories, which were later incorporated into the SPSS statistical analysis program, version 19. The information was processed using descriptive statistics, with frequency distributions and average analysis, and analyzed by institution, by country and as an Andean region, according to the categories and subcategories determined, allowing comparisons between countries and conclusions to be drawn as a region.The analysis of the information was carried out using the deductive-inductive method, considering the objectives of the project and the revised conceptual theoretical framework, with the aim of determining the presence of the RACT, explicit and implicit, in each categories, the coherence of the approaches between University-College-Program, the coherence between the objectives, contents, teaching-learning strategies and the evaluation process in each subject. In this sense, we analyzed the linearity or coherence with respect to what was proposed, developed and evaluated in relation to the RACT and, finally, the contradictions and inconsistencies found in the aforementioned approaches were pointed out. We considered national and international studies about the subject for the analysis and discussion of the results obtained, in addition to the documents mentioned above.According to the information obtained by the research group, the Andean region has 2,552 HEI; 410 with character of universities and 160 are public, 220 are private and 14 are in special regime. There are 167 universities with nursing programs, 146 affiliated and recognized by the respective Associations of Schools and Colleges of Nursing in each country. The number of accredited nursing programs in the Andean region is 43: Colombia (20), Peru (20) and Bolivia (3). Precisely, of the 20 accredited institutions in Colombia, 11 already have their certifications renewed, which are of 8, 6 and 4 years; 5 and 6 years for Ecuador and 3 years for Peru. Bolivia is just beginning the process and Venezuela has no information about it.The total population of HEIN by country was Bolivia 47, Colombia 42, Ecuador 21, Peru 62 and Venezuela 10. A total of 76 HEIN answered: Bolivia 7; Colombia 38; Ecuador 11; Peru 14 and Venezuela, 6. These institutions constituted the sample of the study.Twenty-one of these institutions are certified: in Colombia 20 and in Bolivia 1; 12 did not include this information and 41 were not yet certificated. Of the total number of institutions that provided the information, 47 are public, 26 private and three do not know the information. Administratively, 36 are programs; 22 Colleges; 21 Schools and one Department.The number of hours and credits of the programs showed considerable heterogeneity: the average number of hours was 5,552.3, corresponding on average to 232.11 credits. Regarding the number of hours per credit, the lowest is in Peru, which has 13 hours per credit, and the highest is in Colombia, with 48 hours corresponding to one credit. There are institutions that do not work with credits, especially in Bolivia; others did not included this information, among them Ecuador and Venezuela.The main characteristics of the 912 teachers developing nursing programs in the Andean region are: 501 (54.9%) with a Specialist degree; 634 (69.51%) with a Master\u2019s degree and 58 (6.35%) with a PhD; 249 (27.3%) with a postgraduate degree in Education. and .From a general perspective, it should be noted that of the five countries in the region only Venezuela and Peru explicitly present the RACT in their Organic Law (OL) or Higher Education Law in terms of integral and permanent formation of reflective critical citizens in Peru).The results of RACT\u2019s presence are presented below: Universities or HEI; in Colleges, Programs, Schools and Departments, that is, in HEIN; and in the subjects.receptor and analytical constructor, with critical conscience; as methodology to achieve it, in Colombia and Peru: \u201cpromoting reasoning, the CT and creative\u201d; as a result of learning in Ecuador and Venezuela: capable of solving problems, CT promoter.When analyzing the information of the Universities or HEI, we found the RACT as direct mention, indirect mention and evidence of traditional positions was found. Directly, it was found as a training purpose in Bolivia, Colombia and Peru: integral formation, relation practical theory; and as objective in Colombia: future graduates with ethical conscience, autonomy, democratic spirit and highly qualified.The indirect mention was found as result in the five countries of the Region, as a strategy in Bolivia, Ecuador, Peru and Venezuela: teaching, evaluation as a final product, training in instrumental action, the educational process as providing knowledge.There are still traditional postures: prepare professionals and leaders with CT and social conscience. The second, as a methodological strategy to achieve its development: to develop and implement pedagogical methods that encourage reasoning, CT and creativity, and that encourage habits of discipline and productive work. And the third, as a result of the formation process that includes the subject: Training of critical, self-managed, creative and proactive men and women; and, moreover, refers to the projection and utility: with the promotion of CT and the generation of knowledge, thanks to the strengthening of critical analysis, anticipation and vision of the future and development of viable alternatives to the problems.By going a little deeper into the HEI, we found that 88% (38) consider the RACT: 63% (27) in the mission; 7% (3) in the vision; 51% (22) in the objectives and 30% (13) in the curricular guidelines. Among these, three defining categories were identified. The first, as a training purpose: At HEIN, RACT is expressed in the graduation profile, objectives, curricular guidelines and mission. the training of professionals with scientific, technical, critical, analytical and reflective knowledge, as well as communication, oral and written expression skills; and referred to a critical, creative, participative, supportive, innovative and sensitive attitude towards social change.In a cross-sectional view of what is proposed by curricular programs, three categories were identified to be highlighted. The first, the development of cognitive and personal skills, expressed as promote and develop research, generating knowledge in the different areas of nursing that contribute to universal science and the solution of health problems; and the use of technologies: learns permanently developing the capacity of abstraction, analysis, synthesis and using information technologies. The third, its finality, related to the ability of individuals, families and community groups to interfere and make decisions in the solution of health problems, to provide comprehensive care with the capacity to solve health problems in changing and emerging environments.The second, the way in which its development could be achieved, among which the research stands out: social-critical-constructivist and second, the cognitive - humanistic in four (4). Other models or approaches were also identified, among them: dialectic, technological, psychological, the problematic schools, the Active, Reflective, Dialectic, Innovative and Critical. Finally one institution works with the model based on the pillars of education, in which learning to know, learning to do, learning to be and learning to live together, which includes, educating for life, educating for life, educating for work, educating in society and for society.Concerning the pedagogical models expressed in the HEIN, a variety was found in the denomination. First of all, the constructivist approaches are highlighted in eight (8) Institutions, with some connotations as the model  society.The RACT in the subjects of the programs of Nursing in the Andean regionOnly 29 of the 76 HEIN participants in the study were able to obtain information on subjects (38.15%), and 22 (75.86%) of these in nursing programs, RACT was present in different elements of the subjects. 562 subjects were reviewed, 159 (29%) of which have no information about teaching strategies or evaluation. Moreover, some programs record the same teaching and assessment strategies for all subjects in the program, 45 (8%).Workshop of Critical Thinking and Introduction to CT; second, as a subject content: CT in Nursing, and, third, RACT is evidenced in teaching-learning strategies.The information provided makes it possible to indicate RACT as a subject: The highest percentage of subjects in which RACT is evident correspond to the area of humanities, with 46% (55), in which analysis of real situations, group work, concept maps, role playing and seminars are predominant.In second place, it is in the professional-disciplinary area with 42% (307) subjects with the predominance of the following strategies: supervised clinical practice, clinical case, problem-based learning, simulation laboratories, and the nursing process. The research is in the same place, 42% (41) subjects. The most commonly used strategies are: critical discussions of research reports and articles, project development, workshops, and problem-based learning.In the last place, subjects from the basic or foundation area 144 (24%). Including discussion workshops, concept maps and case studies.presentation and discussion of clinical case, group work, clinical practice, flipchart, observation guides, debates, discussion about specific topics, resolution of case studies, support of the nursing care plan, investigative reports , workshop development.A great variety of strategies have been identified, among them are: the development of competencies, the acquisition of skills, the development of superior cognitive processes, the professional spirit and the development of processes and independence.What is evaluated: the capacity for criticism, analysis and synthesis, evidence of problem solving, case analysis and Nursing Based in Evidences, didactic relationship analysis and fundamental elements of the RACT, conceptual knowledge, written and oral reflections, group work, practical reflections and group discussions.Finally, in some of the subjects, the intentionality of the evaluation of the RACT is explicitly presented: written works about the topics of each seminar in which the proper handling of the bibliography is evidenced, It is evident that traditional evaluation techniques still exist: evaluating procedural aspects, dexterity, motivation and initiative in the procedures, memory evaluation, participation in class, oral and written interventions and, finally, the replication of the topics studied in classes.Therefore, the analyzed programs show interest in including as an important element in their future graduates the development of the RACT. This aspect is vanishing in the development of the subjects. It is evident in the pedagogical strategies, but it is lost until disappearing in most of the evaluative processes.The analysis results of the plans and programs of the HEI and HEIN allow to conclude that the proposes of the Law of Higher Education to develop the RACT in the students does not guarantee that it is included in the subjects and evaluations..What is stated in HEI and HEIN allows us to infer that epistemological and theoretical contradictions are present in the Institutions and among them. It makes necessary an epistemological, theoretical and methodological consideration in order to achieve alignment and coherence between the purposes in the curricular guidelines and what is programmed in the curricular plans for the concrete work with the students. This matter goes against comprehensive training, since it is demonstrated that critical and reflective skills contribute to train professionals with greater ability to care for patients.It should be noted that it is the University or HEI that determines the philosophical bases that will guide the academic units that compose it, so that they, in turn, incorporate these principles into their academic programs. The results show that there is no linearity between the proposals of the university with respect to its mission, vision, objectives, graduation profile, curricular guidelines, and what is proposed in the nursing degree programs. There is more linearity in Institutions with a longer trajectory and development, private and public ones.. The subjects in the professional area use strategies such as case study, supervised clinical practice and other relatively new ones as problem-based learning and simulation laboratories. Strategies that, by involving simulation or potential practical actions, contribute to enhance critical skills and make decisions that lead to the future professional committing fewer errors during the care of patients(-).The analysis of the areas in which the subjects are grouped made it possible to identify that the subjects of the humanities area have the highest percentage of presence of the RACT. This result can be explained by the strategies used, but even more by the subjects under study, since it has been demonstrated that the teaching-learning strategies based on the humanities have a significant impact on the development of skills such as clinical reasoning. The supatients-26.By contrast, it is not the same with the subjects of the foundation or basic area in which it is necessary to return to some knowledge aspects that already exists, such as anatomy, physiology, anthropology, psychology, statistics, among many others. For some students these topics are very difficult and involve, on several occasions, an excellent dose of memory. However, the teaching strategies that develop the RACT are not so frequent. It is important doing more research on this point to sustain if it is true.On the other hand, for the majority of HEIN, training is conceived as qualification and progress achieved by people and as a principle of theories, concepts, methods, models, strategies and courses of pedagogical action that aim to understand and qualify the teaching. In some cases, the transfer of knowledge is approached, but it still underlies the concept of learning as acquisition of knowledge built and finished; the teacher is the one who has the knowledge and the student is who learns what teacher knows.. It includes as proposals the development of social skills, with emphasis on oral and written communication, cognitive skills including problem solving, establish different alternatives, understand the consequences of actions, make decisions and critical thinking. Also, intend to achieve in the student some characteristics of the critical thinker like to be creative, innovative, proactive, analytical, participatory, entrepreneurial, self-critical, supportive, humanistic, ethical and scientific.The curricula of the Andean region include explicit elements that contribute to the development of the RACT, such as reading, writing and reasoning, allowing to the future professional to know how to learn, reason, think creatively, generate and evaluate ideas, make decisions and solve problems. It incthinking. Also, ientific.Regarding the pedagogical models proposed by the HEIN, inconsistencies between the approach of constructivist approach and meaningful learning are evident. The axis is the student and the repetitive approach in the subjects with master class methodology, reading guides and analysis made by teacher, but not by the student. It shows a traditional model centered on the teacher, with an emphasis on memory, comprehension and the application of concepts. Some subjects focus learning on the acquisition of concepts, despite using the integrating project as a teaching-learning strategy, workshops and practice as evaluation. The pretense for the development of the RACT is not in line with the evaluation, with the examination, in the application of contents, since it is centralized in aspects of memory and knowledge, in an asymmetric theory-practice relationship., it is not really concrete how it could be achieved. Strategies such as simple repetition and teaching for the acquisition of concepts show the persistence of the traditional educational models.Although significant learning is intended and the importance of integrating it into the formation of learning approaches with the intention of promoting critical thinking, added with successful learning experiences, it is This study found there is no a clear structure to operationalize the theories of the proposed pedagogical models, even though there are expressions that point to RACT. Thus, the elements important for its development are presented in the teaching and learning strategies in a more remarkable way., from the positivist, rationalist or empirical analyst paradigm, to the humanist and critical curriculum to the socio-critical paradigm and critical thinking based on hermeneutic processes. The social and contextual  aspects that influence and determine the health behaviors of the people are still incipient in the curricula.The curricular guidelines express the intention to transcend technical rationality and behavioral objectives, from trriculum to the rocesses. The sourricula..According to what has been demonstrated, it is possible to state that there is no predominance of a pedagogical model, but a mixture of several models in the same program with varied influences. The presence of the following models was identified: Traditional Pedagogical, Behavioral, Cognitive, and Social Pedagogical, the latter being very tenuous.. Considering these elements, we can assure that the creation of opportunities is present with more intensity in some curricula, and self-evaluation and hetero-evaluation have begun to be implemented especially in public institutions.There are four fundamental elements to forming critical thinkers: first, the question; second, the creation of continuous opportunities to participate in dialogue, debate, research, and critique; third, self-evaluation and hetero-evaluation; and fourth, teachers as models of critical thinkers. Consid.Mentioning the subjects, it is not evident that the thought is motivated by complex kind of questions that encourage exploration, generate evaluation, create concepts and knowledge.. Other authors suggest, for the reports, questions about the purpose, information, concepts, assumptions, implications, points of view and the questions, as elements that favor analysis, the evaluation of ideas and reasoning.The literature points out that the Socratic questions stimulate the student to use existing knowledge, since they promote a greater understanding and integration of new knowledge, they foment the habit of thinking critically,34. Oeasoning,35., problem-based learning, supervised clinical practice, the nursing process and simulation laboratories. In this article, we only refer to two of these strategies, which were selected because of the great advance of information and communications technologies. The growing need to access this kind of infrastructure as a fundamental part in the training of future professionals and as an example of a single teaching and learning strategy is not sufficient to achieve the RACT, rather, the use of different techniques enhance its development, as we will see below.Like other researches, this study found that the most used strategies in the progress of the professional area that promote the development of RACT are the case study,36, plearning, supervpractice, the nu process,38 antories,-38. I.We agree with the conclusion of authors who suggest that Problem-Based Learning and simulation labs are active strategies that develop RACT in nursing students.(-), in addition, it allows to integrate knowledge, to think as a professional, to analyze individual situations in specific contexts from different angles, to use theoretical concepts in the delimitation of a concrete problem. It also stimulates collaborative and team work, the work with different points of view. The question-problem is the motivator in the search for alternative solutions, is useful in simple and complex situations, allows to apply theory in practice, promotes the exchange of ideas, teaches students to learn to control their own thinking and promote the exchange of ideas and intellect. In addition, it helps to incorporate time management and take responsibility. It also facilitates the integration of the four elements of the Nursing metaparadigm: the person receiving the care, health as purpose, the nature of the nursing and the context or environment.The case study, moreover, promotes active learning, helps to solve clinical problems, promotes the development of critical thinking skills-35, i problem. It alsntellect. In addThe case study allows the simultaneous implementation of other strategies that further enhance the development of RACT, such as concept maps, the analysis and selection of scientific evidence, the nursing process, nursing history, role-playing, argued discussion and debate.In contradiction to all the positive aspects of the case study in the development of RACT, the dichotomy between theory and practice in a large number of the curricula reviewed is an obstacle to achieving all the benefits pointed out. Since some teachers are in charge of the development of the theoretical subject in the classroom, others are in charge of their practical part in other spaces that require this care. shows how the promotion of RACT is relevant. In this connection, it highlights the importance of including simulation as a key element in curricula, because it ensures skills in this kind of thinking and gives students the opportunity to show their ability in decision-making, critical thinking and other skills. Other authors emphasize its importance when students reflect it on their thinking process and show how it guided their actions.Regarding the practice based on simulation models, a study shows hthinking and givr skills. Other  actions.. The same author suggests the use of high-level questions to stimulate reason more than memory. He also suggests assigning an observer, who will ensure analysis and reflection on patient safety, communication, teamwork and leadership, among others. The reflection of the group around the whole process carried out will be the end of the laboratory.There is efficiency of simulation laboratories when accompanied by active strategies, such as the conceptual map before each laboratory session, a visual aid that allows the concepts, objectives, justification, expected results and possible complications to be described in a logical manner if the procedure is not carried out in the appropriate manner. The sag others. The reboratory,34..Another study concluded that simulation as a pedagogical method allows students to recognize, interpret and integrate new information with previous knowledge in order to make decisions about the best direction to follow. The authors state that simulation, as an educational method, provides an opportunity to systematically structure learning to help students acquire deep content knowledge and to facilitate the development of thought processes; that simulation experiences stimulate students\u2019 RACT skills and help them become more competent in caring for patients in complex conditions..We agree with what has been found in other studies emphasizing that simulation laboratories by themselves do not guarantee the development of RACT skills, but if combined with other strategies and implemented with adequate pedagogy, the results will be much more effective in terms of CT skills,-38..It is also possible to find correspondence with that was discovered in the State of the Art of scientific production in RACT in the Andean region. The students perceive that \u201cClinical simulation is a valuable strategy for the acquisition, complementation and integration of the theoretical part with the practical part, because it seeks to make decisions according to the CT\u201d.The evaluation of the subjects is cumulative and formative. In some cases, a diagnosis of the level of the student\u2019s participation in the subject is made; it is evaluated in the intermediate and at the end with the objective of promotion to another level. In other cases, a teaching-learning balance is done to verify the fulfillment of the objectives and competences. Self-evaluation and heteroevaluation are increasingly used, implying a process of reflection, analysis and self-criticism..Precisely, evaluation appears as one of the weakest points when analyzing the presence of RACT in curricula. Therefore, we agree that the \u201cbest teaching practice begins by establishing learning outcomes and continues with a focus on helping the student to achieve satisfactory results\u201d. If the proposal is to achieve a higher order thinking, the evaluation will be oriented towards the synthesis, analysis and evaluation of knowledge.Overall, the strong approaches to RACT training formulated at HEI, HEIN, as evidenced by some of the teaching and learning strategies presented in the subjects, become much weaker in the evaluation process, with predominance of traditional evaluation models, and in some cases, the intention to evaluate RACT is outlined.The curricula of Colleges and Schools of Nursing in the Andean region explicitly contemplate reflective and critical thinking in their mission, vision, objectives, graduation profile and didactic strategies, and implicitly as integral formation. However, there is a tension between what is proposed by the HEI and HEIN and what is implemented and evaluated in the subjects. The presence of RACT in the proposed didactic strategies is much more evident, but it is not sufficiently objective or explicit in the evaluation processes.Despite the great diversity of pedagogical models, there is a clear intention to facilitate the development of RACT. In addition, although a constructivist model is proposed centered on the student, dialogical, active, reflexive, innovative and critical, this model is more centered on the teacher than on the student; on knowledge over a relationship between equals; more on results than on the learning process. Likewise, knowledge is considered as something finished, fixed and the ultimate truth.In order to be able to teach the RACT to the nursing student it is necessary to include it in the nursing curriculum, teachers who are professionals in the areas of Education and Nursing and with RACT in their training. Teachers should create spaces for the development of RACT, know and implement the different and complementary didactic strategies that facilitate its learning and that analyze the students in relation to the level of RACT achieved.The authors of this article suggest that the projects currently developed with teachers and students in Ibero-America should be finalized and retaken with the implementation and evaluation of strategies that value the development of RACT.RACT is considered an indispensable element in personal and professional development, in order to have autonomy, confidence, the ability to make decisions, reach clinical judgment and, the most important, provide individualized, comprehensive and human nursing care. In summary, graduates should be able to work as members of the health team with sufficient clarity of the role and identity they should have, because they have to integrate and experience the four paradigms of the Nursing.The complexity of the project due to the number of participating countries and the different research groups;The large number of public and private nursing schools and colleges in the Andean region;The limitation in accessibility to the complete information of the curricula of each institution;The minimal presence of information on the official web pages of each institution, school or nursing college;No response and lack of interest from different schools and nursing colleges, public and private, to participate of this project;Limited access of current and recent updates of the curricula of nursing colleges to develop this project.The research group made efforts to reduce these limitations and devised multiple options that were proposed to the institutions, in order to facilitate the provision of information and its complementation when necessary.The innovation and contributions expected with this research are based fundamentally on documenting and analyzing of the diverse existing evidences about if RACT is contemplated in the nursing curricula or not, the strategies used by teachers to create and promote it in nursing students and the evaluation processes employed. It provides insights about how RACT\u2019s competence in nursing is addressed in the context of the Andean region and other regions of Ibero-America, its weaknesses and strengths, as well as the improvements that can be made. The final intention of the research is to offer, as a network and collegial body, proposals for teaching, learning and evaluation that will enable the empowerment of new generations of nurses, using RACT as a center of innovation and development."}
{"text": "The development of microdevices for blood analysis is an interdisciplinary subject that demands an integration of several research fields such as biotechnology, medicine, chemistry, informatics, optics, electronics, mechanics, and micro/nanotechnologies.Over the last few decades, there has been a notably fast development in the miniaturization of mechanical microdevices, later known as microelectromechanical systems (MEMS), which combine electrical and mechanical components at a microscale level. The integration of microflow and optical components in MEMS microdevices, as well as the development of micropumps and microvalves, have promoted the interest of several research fields dealing with fluid flow and transport phenomena happening at microscale devices. Microfluidic systems have many advantages over macroscale by offering the ability to work with small sample volumes, providing good manipulation and control of samples, decreasing reaction times and allowing parallel operations in one single step. Despite the enormous scientific achievements that microfluidics have had in the last decades in the field of biomedical applications, this technology is still considered in an early stage, with some pullbacks, such as the difficulty to achieve a cost-effective large-scale production, and a lack of complete understanding of the physics of fluids at the microscale level over the biological species. Consequently, enormous efforts have been performed in microfabrication and microfluidics research to enhance the potential of microdevices to develop portable and point-of-care diagnostic devices, particularly for blood analysis. In this special issue, Catarino et al.  present Additionally, the special issue also contains 10 research papers covering different subjects related to microfluidic structures and cells characterization. Particularly, Kawaguchi et al.  have proThree of the research papers focus are focused on assessing the deformability of RBCs in microchannels ,4,5. TakFaustino et al.  have preVilas Boas et al.  reportedKang and Kim  studied Ponmozhi et al.  developeFour research papers studied clinical applications of microfluidic devices, in particular for quantification of tumor markers, as well as the characterization of the morphological properties of other cell cultures and counting cells. In particular, Sugita et al.  developeSince metastatic cancer cells are known to have a smaller cell stiffness than healthy cells, Nakamura et al.  developeGao et al.  developeFinally, Fang et al.  presenteWe hope this issue can provide an opportunity to the engineering and biomedical community, and those who are interested in the general field of MEMS and micro/nanofluidics, to access novel knowledge and information, especially in its applications to biomedical areas. Particularly, we hope this issue can contribute as a display of the latest achievements, breakthroughs, challenges and future trends in microdevices for diagnostics and blood analysis, micro- and nanofluidics, technologies for flows visualization, MEMS, biochips and lab-on-a-chip devices and their application to research and industry. Finally, we would like to congratulate, acknowledge and thank all the authors for submitting their original manuscripts to this special issue, as well as all the reviewers for the time and help to improve the quality of the submitted papers."}
{"text": "However, it is also essential to understandintersectoriality as a technical, administrative and political process that involvesnegotiation and distribution of power, resources and capacities  between the different sectors; and that, therefore, not only demand of asocial vision or a political intention of governance, but also of the development of newmanagement capacities and new institutional commitments.The conceptual framework for action on the social determinants of health revealedthat, in the intersectoral actions, and because of the resistance generated by a loss oforganizational autonomy, a sectoral logic prevails that hinders cooperation, thedistribution of responsibilities and an operational action. In addition, governments donot promote the decentralization of power and the empowerment of civil society.Likewise, the policies are fragmented and with discontinuity in their implementation,management and inspection. Finally, gender and ethnicity, as axes of inequality, as wellas poverty, remain \u201caccounts pending\u201d to implement intersectoral projects. Nevertheless,it also showed that successful intersectoral actions are presented in combination withstrong community participation strategies.A recent scoping reviewThis leads us to think that Health Promotion , the creation of networks , and Health Assets Model  are the keys to face the SHI from an integrationintersectoral approach that drives \u201cHealth in all policies\u201d, allowing the definition ofpolicies and programs together among all sectors, and whose starting point iscross-cutting management.The National Strategy of Equity in Health of the Ministry of Health, Social Services andEquality (2012) of the government of Spain, marked four lines of work, the second being\"promoting and developing intersectoral knowledge and tools\", through the creation ofsectoral bodies, the inclusion of intersectoral objectives in all health plans, equitytraining in the health sector and awareness of the importance of SHI.The intersectoriality cannot be contemplated without Public Engagement, which entails anew model of governance. In this regard, the Madrid City Council launched in 2017 thePlan \"Madrid City of Care\"(4), a strategy of intersectoral action that puts thesustainability of life at the heart of municipal action, seeking a new relationship withcitizens, from the ethics of care, focused on both community empowerment and respect forthe autonomy and diversity of people. It is still early to have results from thisambitious plan, but very encouraging experiences have already been set in motion  that will surely make Madrid acity with greater equity and consequently with more health.To conclude, I would like to emphasize that an intersectoral approach cannot be carriedout without the social participation of all stakeholders. Intersectoriality and socialparticipation are an indissoluble binomial to resolve SHI."}
{"text": "The demographic transition, population aging, and the epidemiological transition in Mexico have modified the burden of the disease profile, and impose important economic, social, and health care challenges, particularly old-age and disability-related care dependency. We describe old age health and dependency conditions, and analyze the supply of services to dependent population, including aging and disability norms and policies, the role of the government and the private sector (profit & non-profit) in the provision of related services. Based on the analysis, it is clear that public strategies for care dependency are practically non-existent and that policies aimed at these populations focus on guaranteeing access to basic health services, an economic income, and social integration. Also, there are no support strategies for family caregivers who currently carry most of the care work. Care dependency strategies to support those who need them as well as those who currently provide them are urgently needed."}
{"text": "Nowadays pesticide residues in agricultural products have become an important challenge and a serious threat to human food security and health. Reduction of pesticides residues should be taken into consideration by public health authorities because of environmental and health problems. The harmful effects of pesticides in humans have included cancer, congenital anomalies, heart disease, Parkinson\u2019s disease and Alzheimer\u2019s disease . HoweverWhile total consumption of agricultural pesticides in developing country accounts for one-third of the world, most acute and chronic pesticide-induced diseases occur in these countries . AccordiThe conditions of the production, distribution and administration of pesticides, the high cost of legal pesticides, the poverty among most farmers and their lack of knowledge about risk of excessive exploitation of pesticides, and finally, lack of strict rules have been resulted the use of nonstandard pesticides in agricultural products , 7. The If the HI is less than 1, there is no obvious risk to the population. However, if it is more than one, it is threatening for consumer health. Using this indicator, the risk of pesticides can be shown quantitatively, and managerial decisions could be made more feasible . In someConsidering the potential health risks of contaminated vegetables and fruits, it is necessary to monitor the concentration of pesticides in vegetables and fruits periodically, and to create strict rules and regulations for proper use of pesticides. In this regard, due to various food habits and different levels of agricultural product consumption in the world, apart from measuring the concentration of pesticide residues, the HI should be evaluated."}
{"text": "Due to the increasing incidence of gastrointestinal (GI) tumors, more and more importance is attached to radical resection and patients' survival, which requires adequate extent of resection and radical lymph node dissection. Blood vessels around the gastrointestinal tract, as anatomical landmarks for tumor resection and lymph node dissection, play a key role in the successful surgery and curative treatment of gastrointestinal tumors. In the isolation of subpyloric area or hepatic flexure of the colon for gastrectomy or right hemicolectomy, lymph node dissection and ligation are often performed at the head of the pancreas and superior mesenteric vein, during which even a minor inadvertent error may lead to unwanted bleeding. Among these blood vessels, the venous system composed of Henle's trunk and its tributaries is the most complex, which has a direct influence on the outcome and postoperative recovery of the patients. There are many variations of Henle's trunk, with complicated courses and various locations, attracting more and more researchers to study it and tried to analyze the influence of its variations on gastrointestinal surgeries. We characterized various variants and tributaries of Henle's trunk using autopsy, vascular casting, 3D CT reconstruction, intraoperative anatomy, and Hisense CAS system and summarized and analyzed the tributaries of Henle's trunk, to determine its influence on GI surgeries. Resection of tumor along blood vessels and lymph node dissection has been the basic procedures in the surgical treatment of GI tumors. Therefore, understanding of the anatomy and variations of the blood vessels determines the result of the surgery and prognosis of the patients. In recent years, Henle's trunk has attracted more and more attention because of its special anatomical position and the role as an anatomical landmark in GI surgeries, and more and more studies were done on it. Various methods have been employed to identify the course and variations of Henle's trunk usage, suggesting its clinical importance and variability and complexity. This study reviewed the definition, construction, variations, and significance in gastrocolic surgeries of Henle's trunk.The concept of gastrocolic venous trunk was first proposed by Henle  in 1868.There are several variations in the formation of the GTH that depend on the number of tributaries of the right colic, which are mainly classified as bipod, tripod, and tetrapod. The right colic vein (RCV) and middle colic vein (MCV) are defined as the tributaries from the marginal veins of the ascending and transverse colon, respectively. When more than two RCVs or MCVs are present, the thickest vein is defined as the main vein, while the thinner vein is called the accessory vein. The SRCV is defined as the tributary from the marginal veins of the hepatic flexure.Studies on blood vessel variations using autopsy and vascular casting have obtained accurate results, but failed to identify some rare variants due to small samples. Results of nearly a hundred studies on Henle's trunk using autopsy and vascular casting are summarized in Surgical procedures are actually based on the anatomy of organs and vasculature, and the anatomy of the complex vasculature, in particular, has a direct influence on the success of surgery. Henle's trunk, a both relatively undiversified but also variable venous trunk, is a key to many surgeries, especially those in the stomach, pancreas, and right side of the colon, which involves the three most common tributaries of Henle's trunk: RGEV, ASPDV, and colic veins. Intraoperative studies on Henle's trunk were summarized in In the 21st century, rapid development of radiology, especially 3D CT reconstruction, enables the establishment of 3D image of the lesion preoperatively. The 3D reconstruction of blood vessels enables the visualization of the patients' vasculature, allowing surgeons to predict difficulties in the procedure and develop appropriate treatment plans. Recent studies on Henle's trunk variations using 3D CT reconstruction are summarized in CAS system, a virtual stereotactic surgical system developed by our hospital in collaboration with Hisense group, can obtain virtual images of the patients' lesions preoperatively, providing basis for the treatment and accurate navigation for the surgery. Recently, Hisense CAS system is used to obtain images of Henle's trunk for the study of its variations, in order to guide the development of surgical plans. Our study included a total of 120 patients, with Henle's trunk identified in 102 (85.0%) of them. We classified Henle's trunk into 2 types and 10 subtypes, and the most common one is those formed by SRCV, as a colic tributary, and GEV and ASPDV, which is found in 31.4% of all patients .In studies using all of the four approaches, expected for intraoperative anatomy, Henle's trunk was identified in more than 80% of patients, suggesting a stable existence of Henle's trunk in the human body . FrequenLymph node metastasis is the main route of metastasis of gastric cancer, and radical dissection of lymph node during the surgery had a direct influence on the outcome and prognosis , 14. TheComplete mesocolic excision (CME) was first proposed by Hohenberger et al. in 1992 on the basis of embryology and anatomy, which brought about a revolution in the radical treatment of colon cancer , 23. CMEIn conclusion, Henle's trunk, which connects the stomach and colon-draining veins, plays an important role in surgeries for the stomach and colon and shall be isolated for vascular ligation and lymph node dissection in many surgical procedures, especially after the rapid development of laparoscopic and robot-assisted surgery in recent years. However, the intraoperative anatomy of Henle's trunk is challenging because of its fixed position and variable combinations of tributaries, which make it difficult to predict its course and lead to increased incidence of bleeding and complications. Many studies have been done in recent years using various radiological approaches to analyze and summarize the variations of Henle's trunk and gained great achievements, which enables acquisition of knowledge of its tributaries and variation preoperatively, to ensure the outcome and prognosis of the patients \u201312, 27."}
{"text": "Snakebite envenoming is a serious global public health problem, and international initiatives, under the coordination of the World Health Organization and its regional offices, are being developed to reduce the impact of this neglected tropical disease. The global availability of safe and effective antivenoms is one of the key aspects in this global strategy. This review discusses the role of public antivenom manufacturing laboratories for ensuring the supply of antivenoms. The difficulties faced by public laboratories are discussed, together with some tasks that need to be implemented for strengthening them. In addition, the concept of \u2018redundancy\u2019 in the supply of antivenoms is emphasized, as a way to cope with the risks associated with the provision of antivenoms by few manufacturers. In general, the public sector should play a leading role, in antivenom availability and other aspects as well, within the global struggle to reduce the mortality and morbidity caused by snakebite envenoming. Snakebite envenoming is a highly relevant public health problem on a global basis that kills and maims several hundred thousand people every year ,2. It haAs a further development, the 71st World Health Assembly, celebrated in Geneva in May 2018, adopted a resolution proposed by 22 countries from five continents, with the leadership of Costa Rica and Colombia, aimed at addressing the burden of snakebite envenoming on a global basis. This historical resolution urges member states to take immediate actions on several lines, with the aim of reducing the burden of this disease. These include: (a) Assessing the magnitude of the problem on a global basis; (b) improving antivenom availability, accessibility, and affordability; (c) promoting transfer of knowledge on this topic between member states; (d) integrating control of snakebite envenoming with efforts to control other diseases; (e) improving access to treatment and rehabilitation services to affected people; (f) providing training to health professionals in the diagnosis and treatment of envenomings; (g) supporting research activities on several aspects of snakebite envenoming; (h) promoting community awareness through culturally contextualized public campaigns; and (i) fostering of cooperation and collaboration between member states, the international community, and other relevant stakeholders. Likewise, this resolution established a number of requests to the Director General of the WHO on this health issue , strengthening the national regulatory agencies, and ensuring an appropriate characterization of the neutralizing efficacy and safety of antivenoms through preclinical and clinical research ,16. In tAccording to the WHO webpage on antivenoms , there a2 fragments as the active substance, by fractionating hyperimmune plasma with a combination of pepsin digestion and salting out procedures. Other products are made of whole IgG molecules, usually obtained by caprylic acid precipitation of non-immunoglobulin plasma proteins, and one manufacturer produces Fab antivenoms by digesting the immunoglobulins from ovine plasma with papain [The heterogeneity of this universe involves not only the volume of production and scope of distribution, but also differences in some technical aspects of antivenom design and production. Most manufacturers use horses for immunization, although one uses sheep , and anoh papain . Producth papain .Besides these variations in the design, and in the immunological and physico-chemical characteristics of antivenoms, there are marked differences in the situation of the infrastructure, laboratory equipment, qualification of technical and professional staff, implementation of GMPs, innovation, and in-process and final quality control of the products . Some maThe public health arena has witnessed significant shifts in the conceptualization of health in the last five decades. The concept of health as a \u2018commodity\u2019, within the context of a market-driven economy, has been fostered, together with trends in developing countries\u2019 governments to reduce the public expenditure in health and other social services . NevertIn this global context, public antivenom manufacturing laboratories have faced significant challenges in the last decades. Public manufacturers of antivenoms were created in many countries during the past century and represent invaluable institutional assets, constituting scientific, technological, and public health patrimonies. In the Americas, the first public institution in charge of manufacturing antivenoms was Instituto Butantan, created in 1901 in S\u00e3o Paulo, Brazil . Then, sSeveral workshops of public antivenom manufacturing laboratories have been organized in Latin America during the last decade to discuss the situation of antivenom production in the region (see for example Ref. ), and exMany public laboratories in charge of antivenom manufacture lack innovation through research and development. Many have not modified the basic technological platform for plasma fractionation and for in-process and final quality control. An example is the improvement in the design of the most adequate combinations of venoms for immunization. Most of the combinations currently used were selected decades ago on the basis of rather empirical criteria. In the last decade there has been an enormous volume of knowledge generated on the biochemistry of snake venoms, including their proteomics, as well as on the cross-reactivity of antivenoms, by using neutralization tests and immunochemical methods, particularly antivenomics ,27,28. LThe immunization protocols require a thorough revision and innovation in aspects such as selection of venom doses to be injected, method of injection , use of novel adjuvants, schedule of venom injections as to avoid the immunosuppressive effects that some venoms exert over others, and a more detailed control of animal health status during immunization. Moreover, the protocols for animal bleeding can be improved through innovation in aspects such as the use of automated plasmapheresis equipment.There are plenty of possibilities to innovate in the technologies used for hyperimmune plasma fractionation in order to generate products of higher purity and better physico-chemical characteristics. Plasma processing groups should evaluate the steps in their fractionation protocols in order to optimize them. As an example, the introduction of caprylic acid fractionation instead of ammonium sulfate precipitation in the preparation of whole IgG antivenoms should be considered . LikewisThere has been a notorious lack of investment in infrastructure and equipment in many public antivenom-manufacturing laboratories. Owing to the growing financial limitations of public institutions and governments along the last decades, some of these laboratories have lagged behind in the need to update their infrastructure and to replace old equipment, with the consequent negative impact in antivenom production. Likewise, maintenance programs for equipment are limited. This has placed a number of laboratories at the brink of shutting down their operation. The solution to this situation demands creative political decisions in order to reinvigorate the financial support for these public laboratories by governments. There are notorious contrasts in the political will of governments of countries in the support of antivenom laboratories. In addition, institutions need to consider the development of public\u2013private partnerships that may contribute to the upgrading of these laboratories. Likewise, international funding agencies in the field of public health should consider supporting public antivenom-manufacturing laboratories of long-standing tradition. The strengthening of public laboratories in various parts of the world is a safeguard for guaranteeing antivenom availability in the midst of ups and downs associated with a market economy.Public antivenom manufacturing laboratories are often understaffed, as a consequence of restrictive policies in governmental institutions. Moreover, there is a deficit in programs aimed at the permanent training and qualification of the existing personnel, which limits innovation. The possibilities for technical and professional staff to attend workshops, courses, and symposia are scant. This trend has to be reverted by establishing permanent training programs, adapted to the needs of the staff of manufacturing laboratories. Such training activities can be coordinated with local universities and other public and private institutions, and funding must be allocated for these activities. Likewise, seminars and group discussions of advances in the field and novel technological developments need to be organized, and an innovative environment should be stimulated within these laboratories. In Latin America, a group of public laboratories have integrated a regional network in which regular workshops have been organized. These activities have had a significant impact in the overall improvement of antivenom availability in the region . In WHO Guidelines for the Production, Control and Regulation of Snake Antivenom Immunoglobulins [One aspect that requires urgent attention in these institutions is the implementation of GMPs at all levels in the chain of antivenom production. For this, professional and technical staff should receive training based on international guidelines, including the lobulins , and theThe tasks described could be achieved more successfully within a frame of international cooperation. To this end, the WHO and its regional offices have a leading role to play by establishing permanent programs for improvement of antivenom production and quality control, based on the diagnosis of the situation of these laboratories. These programs can involve regional workshops and seminars, as well as a variety of activities aimed at enhancing the capacity of manufacturers. At the same time, a dynamic networking activity should be fostered between manufacturing and quality control laboratories, regulatory agencies and research groups in universities and other institutions. For this, the use of information and communication technologies offers great possibilities. In Latin America, the network of public antivenom manufacturing laboratories has established an informal dynamics of inter-group consultations on specific aspects, which has become a useful mechanism for trouble shooting in antivenom production. Technology transfer projects and cooperation contribute to the upgrading of antivenom manufacture in public laboratories.The deficit in resources and personnel is often associated with weak managerial practices which hamper the productivity of these laboratories. Aspects such as estimation of production costs, purchasing and maintenance programs, administration of inventories, organization of the flow of activities, efficient allocation of staff in the production departments, distribution and marketing of antivenoms, and quality assurance programs need to be introduced, evaluated, and improved aiming at increasing the efficiency of antivenom manufacture. Likewise, preparation of strategic development plans and their follow up have to be considered. Overall, modern managerial and organizational procedures should be implemented in order to maximize the use of available resources. The appropriate selection of personnel in charge of managerial roles is of key relevance, as well as the differentiation of the profiles and suitability of people selected for managerial roles and those in charge of the more technical functions in antivenom manufacture.A crisis that took place in Brazil in the 1980s vividly illustrates the relevance of public institutions, including antivenom manufacturers, in ensuring the availability of antivenoms for health systems and the overall attention to snakebite envenoming. Antivenom production in Brazil started with the foundation of Instituto Butantan, in 1901, under the leadership of Vital Brazil Mineiro da Campanha. Then, in 1907 the Funda\u00e7\u00e3o Ezequiel Dias (FUNED) was created in Minas Gerais and, in 1919, Vital Brazil moved to Niteroi, State of Rio de Janeiro, to establish antivenom production at Instituto Vital Brazil. These three public manufactures developed over the next decades; however, at some point in the second half of the 20th century there was a reduction in public investment and innovation in this antivenom-manufacturing industry. By the 1970s, a multinational pharmaceutical company (Syntex do Brasil) was providing the majority of vaccines and antivenoms being used in Brazil. In 1973, the Brazilian government created the National Immunization Program, to take charge of the national immunization programs and the provision of antivenoms as well. This was followed in 1980 by the creation of the Instituto Nacional de Controle de Qualidade em Sa\u00fade . INCQS detected important flaws and deficiencies in the biological products, including antivenoms, and the production of immunobiologicals was halted. As a consequence, Syntex do Brasil decided to permanently stop the manufacture of antivenoms and vaccines, creating a serious national crisis in the supply of these products, since the public laboratories at that point had limitations and were unable to cope with the national demand ,32.In this context, the Brazilian federal government decided to create the National Self-Sufficiency Program in Immunobiologicals, with the goal of making this country self-sufficient in the provision of these essential vaccines and antivenoms, a wise political decision that has had long-term consequences for public health in Brazil. As a follow-up step, a committee for the study of envenomings and the production and testing of antivenoms was created. It was responsible for defining the most adequate combination of venoms to be used in the manufacture of antivenoms, the standardization of the potency tests for assessing antivenom efficacy, and the establishment of reference venoms for the most important snake species, to be used by manufacturers and quality control laboratories. Simultaneously, in 1985, a large investment by the federal government was implemented with the goal of making Brazil self-sufficient in antivenoms and several vaccines. This allowed the national public manufacturing laboratories to develop new infrastructure and significant technological improvements in their facilities. Behind this policy lay the belief that the country should be self-sufficient in the manufacture and distribution of life-saving antivenoms and vaccines through the work of public laboratories.In addition, a national surveillance system for documenting envenomings by bites and stings of animals was developed, together with a national policy of antivenom and vaccine distribution in charge of the National Program of Immunization. Since 1986, antivenom acquisition is centralized by the Brazilian Ministry of Health, and distribution is decentralized to the states and municipalities, which allows free-of-charge availability of antivenom treatment. The production of antivenoms at a national level is coordinated between the Ministry of Health and the four manufacturing laboratories . Likewise, an active research program in public universities and institutes was strengthened, including basic research in the biochemistry, toxicology, and immunology of animal venoms, as well as epidemiological and clinical studies on envenomings and their treatment. In other words, the country decided to control the problem of envenomings by animal bites and stings through a well concerted and supported public program which has consolidated over the decades, and has made this country self-sufficient in the provision of antivenoms and some vaccines, and a leader in toxinological research. For a detailed account on these developments, see Refs. ,32, and This brief historical account provides several lessons: (a) The dependence of a single manufacturer for the provision of an essential medicine, such as antivenom, puts the public health system of a country in a vulnerable position, as this Brazilian experience shows. (b) The public health authorities and, in general, governments should have a leading role for ensuring the availability and accessibility of antivenoms in public health systems. (c) The concept of \u2018redundancy\u2019 in the provision of antivenoms is very well illustrated in this historical example. Brazil has four public laboratories in charge of antivenom manufacture, with different scales and volumes of production, which ensure a steady national supply in close coordination with the Ministry of Health. The benefit of this redundancy is evident when, for technical reasons, one of these laboratories needs to temporarily stop production to carry out maintenance works or remodeling of infrastructure. In those circumstances, the other laboratories provide the necessary volume of antivenoms for the country\u2019s needs. (d) The four laboratories have a close coordination in their activities under a frame of cooperation, hence contributing to the solution of problems that may arise in any of them. (e) This inter-laboratorial coordination with the Ministry of Health ensures that antivenoms manufactured by any laboratory have the same potency and quality control specifications, and all batches of antivenom are evaluated by the INCQS. In summary, the experience of Brazil represents a clear example of the impact of consistent public policies over decades for ensuring the national production and self-sufficient supply of antivenoms.It must be stressed that no single strategy in the field of antivenoms can be recommended for different countries and regions, since the local contexts greatly differ, and appropriate solutions have to be devised for each situation. For example, the concept of redundancy may apply to the combination of private and public, as well as national or international, manufacturing laboratories, and the variable scales of needs and production may demand different approaches, i.e., some countries do not have the conditions to develop their own antivenom-producing laboratories, hence having to rely on manufacturers from abroad. However, the basic idea of redundancy and the need for a strong commitment of public institutions and governments for ensuring antivenom availability remain as key components in the global efforts to reduce the impact of snakebite envenoming. Likewise, ministries of health should have national regulatory agencies with the capacity of evaluate the safety and efficacy of antivenoms produced in the country or imported. Overall, the public sector has to play a leading role in this field, as well as in other aspects of the control of snakebite envenoming.Bothrops asper, Crotalus simus, and Lachesis stenophrys [Bothrops jararaca, B. jararacussu, B. neuwiedi, B. alternatus, and B. moojeni [Bothrops atrox, B. barnetti, B. pictus, B. brazili, and Bothrocophias hyoprora [The concept of redundancy in the availability of antivenoms is well illustrated in the case of Latin America and the Caribbean. Several polyspecific and few monospecific antivenoms are manufactured in the region, with two laboratories (one public and one private) in Argentina, Colombia, and Mexico, four public laboratories in Brazil, and one public laboratory in Bolivia, Peru, Venezuela, and Costa Rica ,19. In aenophrys . On the  moojeni , whereashyoprora . Other chyoprora .Agkistrodon, Atropoides, Bothrops, Bothriechis, Cerrophidion, and Porthidium have demonstrated an extensive pattern of cross neutralization of several of these antivenoms [Bothrops asper, B. atrox, B. jararaca, B. neuwiedi (diporus), and B. neuwiedi (mattogrossensis), polyspecific antivenoms produced in Argentina, Brazil, Bolivia, Peru, Colombia, Costa Rica, and Mexico are effective in the neutralization of lethal, hemorrhagic, coagulant, and myotoxic effects of these venoms, albeit with different values of Median Effective Doses (ED50) [Lachesis in the immunizing mixtures are able to neutralize venoms of the four species of Lachesis [Crotalus sp venoms, two different patterns of venom composition have been described: type I venoms have a predominance of hemorrhagic metalloproteinases over the neurotoxic PLA2 dimer crotoxin, whereas type II venoms has a predominance of crotoxin and low amounts of metalloproteinases [Crotalus sp venoms in South America and Mexico, whereas antivenoms prepared by using type I venoms are effective in Central America and against non-neurotoxic venoms in North America [Despite the variations in the immunization mixtures, various preclinical studies on the neutralizing ability of antivenoms against a wide array of venoms from snake species of the genera tivenoms ,37,38,39s (ED50) ,40. LikeLachesis . Regarditeinases ,43. Thus America ,45,46.This body of evidence gives support to the use of several polyspecific antivenoms in different countries in Latin America. Hence, in the cases of countries that do not manufacture their own antivenoms , or those that may have deficits in their own supplies of antivenoms, several products from other countries can be used, thus constituting a scenario of regional self-sufficiency in antivenom supply. There is a need to further expand the studies on the preclinical efficacy of antivenoms in Latin America as to have a more complete view of the neutralizing spectrum of all antivenoms available in the region. This will help ministries of health and the Pan American Health Organization (PAHO) to know in detail which products could be used in which countries; this, in turn, could lead to regional purchasing schemes which ensure the regional availability of antivenoms. For example, polyspecific antivenoms from various manufacturers have been used in Central American countries, as well as in Colombia, the Guyanas, Paraguay, and Ecuador. This is an example of redundancy in the production and provision of antivenoms, an experience that could be replicated in other regions of the world.Micrurus antivenoms in the Americas, Atractaspis antivenoms in Africa and the Middle East, antivenoms against some \u2018colubrid\u2019 (sensu lato) venoms that can induce fatal accidents in Africa and Asia, and sea snake antivenoms in the Indo-Australian region. These and other \u2018orphan\u2019 antivenoms can be manufactured by public laboratories, under a non-for-profit scheme, and regional coordinated policies by the ministries of health and the regional offices of the WHO could be implemented in order to support their production and to organize distribution policies that ensure availability. Therefore, these antivenoms are relevant not only in the countries where they are manufactured and in those where related snake species are distributed, but they are also highly valuable in countries where exotic snakes are imported for private use, research, or exhibits, and antivenoms are required in the event of an envenoming.One niche where public antivenom manufacturers can play a key role in antivenom availability has to do with the manufacture of \u2018orphan\u2019 antivenoms, that is, antivenoms for the treatment of envenomings by species that inflict few, but potentially fatal, accidents; consequently, these antivenoms have a reduced market and low economic profitability. Examples are Micrurus antivenom by Instituto Clodomiro Picado, with the support of PAHO, during the 1970s [Micrurus antivenoms of wide neutralizing coverage, hopefully in the context of cooperative agreements between various laboratories. Likewise, antivenoms against the \u2018colubrids\u2019 Dispholidus typus and Rhabdophis tigrinus, and against sea snakes (Elapidae) are produced in South Africa, Japan, and Australia, respectively [An example was the development of a Pan-American he 1970s . Althougectively . Owing tAs stated in the Introduction, the global efforts to reduce the impact and suffering caused by snakebite envenomings demand a multi-component, multi-stakeholder strategy involving international and national public health authorities, the scientific and technological research community, antivenom manufacturers and quality control laboratories, national regulatory agencies, university schools in charge of medical and nursing education, local community organizations, non-governmental organizations (NGOs) and foundations that support health programs, health advocacy groups, and others, in order to achieve the goals included in the World Health Assembly\u2019s resolution of May 2018 on snakebite envenomings and in the WHO strategic plan.A key component in this global agenda has to do with the improvement in the availability, accessibility, and affordability of antivenoms. For this, antivenom manufacture must be re-invigorated by initiatives aimed at augmenting provision of safe and effective products. An innovative approach is necessary in order to stimulate a steady growth in antivenom supply by (a) increasing the number of manufacturers worldwide through a policy of incentives; (b) elevating the volume of production by current and new manufacturers; (c) improving the quality of antivenoms by international cooperation networks and technology transfer schemes; (d) strengthening the national regulatory agencies to ensure that only appropriate antivenoms are introduced; (e) establishing financial programs for the consolidation of antivenom manufacturers; (f) introducing novel purchasing schemes that would favor a more stable market and create stimuli for manufacturers to increase their production; and (g) generating international cooperation platforms between antivenom manufacturing laboratories, research groups, health advocacy groups and foundations, and national and regional health authorities to improve antivenom availability and accessibility. Likewise, an increased availability of these products should be linked to interventions for improving their accessibility in remote rural regions where envenomings occur, and to train health personnel in the correct diagnosis and management of snakebite envenoming.To attain these objectives, and to follow the concept of redundancy in antivenom provision, an eclectic universe of manufacturers should be stimulated, including national, regional, and global producers with different scales of production and markets, involving public as well as private laboratories. Some antivenoms may be polyspecific and have a wide geographical range of efficacy, whereas others may have a more restricted regional scope, or be directed against the venom of a single snake species, depending on the particular needs of countries.Within this general landscape, public antivenom manufacturing laboratories have a relevant role to play. The invaluable expertise developed in these laboratories must be harnessed and upgraded, but the lack of political and economic support for many of them during the last decades threatens their productivity and even their existence. This trend should be reverted by ingenious and innovative programs supported by governments and international agencies. As discussed in this work, public laboratories constitute a safeguard for public health systems for the provision of antivenoms, as they are prone to resist the uncertainties of the market-driven antivenom manufacture and distribution."}
{"text": "Background: The Rwanda Human Resources for Health Program (HRH Program) is a 7-year (2012-2019) health professional training initiative led by the Government of Rwanda with the goals of training a large, diverse, and competent health workforce and strengthening the capacity of academic institutions in Rwanda.Methods: The data for this organizational case study was collected through official reports from the Rwanda Ministry of Health (MoH) and 22 participating US academic institutions, databases from the MoH and the College of Medicine and Health Sciences (CMHS) in Rwanda, and surveys completed by the co-authors.Results: In the first 5 years of the HRH Program, a consortium of US academic institutions has deployed an average of 99 visiting faculty per year to support 22 training programs, which are on track to graduate almost 4600 students by 2019. The HRH Program has also built capacity within the CMHS by promoting the recruitment of Rwandan faculty and the establishment of additional partnerships and collaborations with the US academic institutions.Conclusion: The milestones achieved by the HRH Program have been substantial although some challenges persist. These challenges include adequately supporting the visiting faculty; pairing them with Rwandan faculty (twinning); ensuring strong communication and coordination among stakeholders; addressing mismatches in priorities between donors and implementers; the execution of a sustainability strategy; and the decision by one of the donors not to renew funding beyond March 2017. Over the next 2 academic years, it is critical for the sustainability of the 22 training programs supported by the HRH Program that the health-related Schools at the CMHS significantly scale up recruitment of new Rwandan faculty. The HRH Program can serve as a model for other training initiatives implemented in countries affected by a severe shortage of health professionals. In the aftermath of 1994\u2019s genocide, Rwanda was faced with the daunting challenge of rebuilding its devastated institutions and governance infrastructure, including the health system. Over the past 24 years, Rwanda has aggressively pursued excellence across all sectors  by incorporating a strong equity agenda into the national development plan, which was published in 2000 and is known as \u201cVision 2020.\u201d This plan has paved the way for Rwanda\u2019s subsequent development achievements, especially in health, which have included some of the steepest declines in premature mortality observed in recent history across countries and a dramatic increase in the uptake of maternal and child health interventions.2 The majority of practicing physicians, nurses, and midwives were lacking any kind of formal postgraduate degree while a shortage of faculty and limited infrastructure, equipment, and supplies in the country\u2019s health graduate schools and teaching hospitals were preventing Rwanda from increasing the output and improving the quality of the existing training programs. It is to address the health workforce shortage and strengthen the capacity of its health graduate schools that the Government of Rwanda decided to launch the Human Resources for Health Program in Rwanda (HRH Program) in 2012.A core component of Vision 2020 is the establishment of a large, diverse, and competent health workforce. However, by 2011 Rwanda\u2019s ratio of health professionals to general population of 0.72/1000 was still falling significantly short of the World Health Organization\u2019s (WHO\u2019s) recommended (at the time) target of 2.3/1000.3 The key features of the HRH Program are the product of broader changes and progress in the fields of global health and health workforce education over the past ten years.11 Many of these features are aligned with the United Nations\u2019 Sustainable Development Goals, are shared with other US Government-funded health professional training initiatives in sub-Saharan Africa, and include: (a) alignment with responsiveness to local priorities; (b) country ownership; (c) strong stakeholder coordination; (d) funding flexibility; (e) competency-based training and pedagogic innovation; (f) institutional capacity strengthening; and (g) long-term sustainability.16 Similar features are also shared with the WHO\u2019s Global Strategy for Human Resources for Health,17 the WHO\u2019s Guidelines for Transformative Education for Health Professionals,18 and the 5-Year Action Plan for Health Employment and Inclusive Economic Growth by the Organization for Economic Co-Operation and Development, the International Labor Organization, and the WHO.19The HRH Program is an innovative and ambitious 7-year health professional training initiative led by the Government of Rwanda and funded by the US President\u2019s Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention (CDC) and the Global Fund to Fight AIDS, Tuberculosis, and Malaria  with an initial budget of approximately US$150 million.a) increasing the number and competencies of Rwandan faculty; (b) strengthening the capacity of non-academic domains (such as management and administration or equipment and supplies) within the Ministry of Health (MoH), health-related schools, and teaching hospitals; and (c) pursuing additional academic partnerships and collaborations between Rwandan academic institutions and US academic institutions (a) present the activities conducted and milestones achieved by the program; (b) describe the challenges encountered during the program\u2019s implementation; and (c) share good practices adopted and lessons learned by those implementing the program since 2012.The primary goal of the HRH Program is to train a large, diverse, and competent health workforce in Rwanda. The HRH Program also seeks to strengthen the capacity of academic institutions in Rwanda to sustain the training programs initiated and supported by the HRH Program by:  at the University of Rwanda and to the Nursing and Midwifery Schools in Rwamagana and Kabgayi. The CMHS was established in 2013 by bringing together different health-related schools under a single institutional umbrella and is comprised of 5 schools: the School of Medicine and Pharmacy , the School of Nursing and Midwifery (which has 4 separate campuses across the country), the School of Dentistry, the School of Public Health, and the School of Health Sciences  .The US academic institutions were selected by the MoH either because they had already been working effectively for years in Rwanda or because they had already expressed an interest in working in Rwanda and had established reputations as leaders in global health for their respective disciplines or clinical specialties. Because the HRH Program follows a tied-aid model, no academic institutions from countries other than the United States have joined the academic consortium since 2012.The visiting faculty are deployed to Rwanda for 2 to 12 months each year depending on departmental needs and specialty areas. Shorter deployments of 2 to 3 months generally correspond with sub-specialty areas while longer deployments of 6 to 12 months correspond with most clinical specialties and health-related disciplines. Upon graduation, the best performing Rwandan students are expected to be recruited as faculty by the CMHS and gradually replace the visiting faculty.The contributions of the US academic institutions are coordinated by the HRH Program management team within the MoH to maximize synergy and avoid gaps and overlaps in the resources and expertise provided to the CMHS . A steerWith support from The ELMA Foundation  the Clinton Health Access Initiative assisted the MoH in the first 2 years of the HRH Program with program design and the development of administrative, financial, and human resources policies and procedures. Since 2014, the MoH has had complete ownership of the HRH Program and is responsible for coordination and communication among stakeholders.3 The HRH Program was designed so that the MoH would utilize approximately 60% of the funds to cover salary, benefits, travel, and housing for visiting faculty through reimbursements to US academic institutions. The remaining funds are used to improve the equipment and supplies within the CMHS and the teaching hospitals and to support the HRH Program management team within the MoH. All of the US academic institutions agreed to charge an overhead rate of only 7% of their direct costs instead of the much higher rates usually charged for research grants to ensure that the majority of funds available are devoted to cover implementation costs in-country rather than to cover US-based administrative costs. While both the CDC and Global Fund began funding the HRH Program in 2012, the CDC (which covered approximately 70% of the costs) decided to cease funding after March 2017 because of a change in strategy which prioritized a more direct alignment between funding allocation and the pursuit of eradication of HIV/AIDS in Rwanda.Unlike other US bilateral and multilateral global health grants in low-income countries, funds for the HRH Program flow from the donors directly to the MoH rather than through an intermediary or directly to the US academic institutions .3 The HRhttps://www.journalslibrary.nihr.ac.uk/hsdr/hsdr04010#/table11.The authors decided to adopt an organizational case study design, which they believed would not be hindered by the limited amount of data collected in the years preceding this study and would be compatible with a post-hoc evaluation of the HRH Program. In conducting this study, the authors followed the guidelines and the checklist from the National Institute for Health Research for organizational case studies available at: a) Competency-Based Training and Pedagogic Innovations; (b) Changes in Governance and Administration of Training Programs; (c) Procurement of Equipment and Supplies; (d) Recruitment, Retention, and Career Development of Health Workforce in Rwanda; (e) Recruitment and Career Development of Rwandan Faculty; (f) Establishment of Additional Academic Partnerships and Collaborations. No ethics review approval was deemed to be necessary by the leaderships of the MoH and of the CMHS, based on their institutional requirements and policies, as the data collection and analysis for this manuscript fell under the category of \u201cprogram evaluation.\u201dThe data for this organizational case study were collected through a variety of sources and methodologies including official reports from the MoH and the US academic institutions, databases from the HRH Program management team within the MoH, databases from the registrar\u2019s office of the CMHS, and minutes from meetings and conference calls. Additionally, the authors were organized into working groups according to their discipline and clinical specialty and asked to complete a 63-item survey to capture descriptive data related primarily to the activities conducted and non-numerical milestones achieved by the HRH Program within the following programmatic domains: . For the Nursing and Midwifery Schools in Rwamagana and Kabgayi no student enrollment data was available at the time of the analysis. Therefore, the average number of graduates per year between 2013 and 2016 for the training programs offered by these institutions was used to infer the projected number of graduates for 2017, 2018, 2019. No correlation analysis was performed because of the difficulty of accounting for all additional variables linked to an individual milestone. Additionally, no analysis was performed to directly link the implementation of the HRH Program to more distal metrics of success such as improved health outcomes both within the teaching hospitals and across the health system.Since the launch of the HRH Program in 2012, 22 training programs (12 of which did not exist previously) have been supported across 4 health-related disciplines  . In the The majority of visiting faculty recruited and deployed to Rwanda have been graduates of North American academic institutions. In some instances (primarily for nursing and midwifery) the US academic institutions have also recruited and deployed visiting faculty from other sub-Saharan African countries, in order to ensure that the proper mix of technical knowledge and skills and understanding of local context and priorities would be available to stakeholders in Rwanda. Based on the analysis of 64 visiting faculty deployed by a sub-set of 7 academic institutions participating in the HRH Program , approximately 56% of visiting faculty were mid-career at the time of deployment (6-19 years since completion of training), 38% were junior (<5 years) and 22% senior (>20 years). Approximately 55% of the visiting faculty were deployed to Rwanda for six months or longer, and 52% returned to Rwanda at least one more year after their first year of deployment.The Schools at the CMHS have been able to increase the number of students enrolled across the 22 training programs initiated or supported by the HRH Program because of the increased number of faculty available through the US academic institutions. As a result, the HRH Program is on track to graduate an estimated total of 4598 students across these programs ; a signia) because of the need to devote the limited resources and expertise to the newly prioritized training programs; and (b) because new medical graduates opting to join the health workforce as general practitioners  were felt to already possess the proper knowledge and skills required to deliver basic medical, surgical, and obstetrical services.For the discipline of medicine, the training programs which were deprioritized  led to a total loss of 84 new physicians from the original target of 401 new physicians with specialty training, while the training programs which were newly prioritized (master\u2019s degrees in neurosurgery and urology) added only 7 new physicians to the same original target . The MoHThe de-prioritization of the A1 (advanced diploma) to A0 (bachelor\u2019s degree) nursing bridging program led to a loss of approximately 500 new nurses from the original target of 907 new nurses and midwives with bachelor\u2019s degree. The MoH decided to de-prioritize the A1 to A0 nursing bridging program to devote additional resources and expertise to the 8 different tracks within the newly established master\u2019s degree in nursing . In the case of the A2 (entry level) to A1 (advanced diploma) nursing and midwifery bridging program it was difficult for the School at the CMHS to sustain the high enrollment rates necessary to fully meet the ambitious original targets although the increase in training output remained substantial . StudentFor oral health, the higher number of projected graduates is explained by an effort by the School at the CMHS to meet new targets selected by the MoH for dental therapists and dental surgeons, which were higher than those originally selected for the HRH Program . For heaTo ensure their retention within the health workforce, and in exchange for government sponsorship during their training years, the MoH has enforced a mandatory 4- to 5-year contract of employment in the public sector for all new graduates. Additionally, visiting faculty have also supported the development and implementation of continuing professional development programs for practicing health professionals across the 4 health-related disciplines .Mandatory 4- or 5-year contracts for new graduates to work in public sectorContinuing professional development programs and sessions for practicing health professionalsPhysicians: cardiopulmonary resuscitation, child abuse, critical care, external and middle ear diseases, gastroenterology, hematology, emergencymedicine and acute care, infectious diseases, malnutrition, maxillofacial trauma, neonatology, non-communicable diseases, oral health, palliativecare, regional anesthesiaNurses and Midwives: advanced life support, basic life support, critical care, diabetes, evidence-based decision making, infection control,myocardial infarction, oral health, patient assessment and chart documentation, palliative care, viral hepatitisOral health professionals: evidence-based decision making, infection control, oral surgery, periodontology, prosthodonticsHealth administrators and implementers: executive leadership, global health deliveryBetween January 2012 and March 2017, 24 new Rwandan faculty and 31 tutorial assistants have been recruited by the Schools at the CMHS, 22 faculty have been recruited by the Schools of Nursing and Midwifery in Rwamagana and Kabgayi. As of March 2017, approximately 80 additional Rwandan faculty were expected to be recruited by the CMHS no later than by the end of the 2019-2020 academic year . The ratRecruitment of Rwandan faculty has required inter-sectoral partnership. The Schools at the CMHS, in the University of Rwanda, which reports to the Ministry of Education, have developed policies and procedures and secured funds to recruit new Rwandan faculty. Simultaneously, the MoH, which manages the HRH Program and developed the national strategy for health workforce development, has allowed the Schools at the CMHS to recruit some of these graduates as faculty rather than deploying them throughout the country.The HRH Program has strengthened the knowledge and skills of both Rwandan and visiting faculty by establishing a twinning program . Since 2012, Rwandan faculty have collaborated with visiting faculty on a variety of training, research, and health service delivery activities and have also benefited from continuing professional development programs developed and implemented with the support of the visiting faculty .100 Rwandan faculty and students have traveled to the United States to give lectures, participate in clinical clerkships, and pursue further training, while others have presented their work at national, regional, and international conferences. These activities have been funded by additional grants, not by the HRH Program, and highlight the importance of the additional academic partnerships and collaborations established since 2012. The US academic institutions have also benefited significantly from their participation in the HRH Program by providing opportunities to their own faculty and students to engage and pursue careers in global health and to learn and apply innovative approaches to pedagogy and health service delivery.16There are 19 US academic institutions participating in the HRH Program as of April 2017 (ranging from a minimum of 16 to a maximum of 24). Of the 5 academic institutions that have opted to leave the HRH Program since 2012, 2 did so because of changes in their departmental priorities, one because of the heavy administrative burden of managing their contribution to the program, and 2 because of ongoing challenges with the invoicing and reimbursement processes related to the program. The training, research, and health service delivery activities conducted by Rwandan and visiting faculty have led to more than 80 scientific publications .20-100 Ra) competency-based training and pedagogic innovation; (b) stronger management and administration of the training programs; and (c) improvements in equipment and supplies within the Schools at the CMHS and the teaching hospitals  across the health-related disciplines of medicine, nursing and midwifery, oral health, and health management and implementation. While increasing training output, the HRH Program has also sought to improve the quality of the training programs through:  the CMHS were often inconsistent and incomplete and extensive work went into reconciling differences and finding missing information . In retrospect, the resources and expertise available for monitoring and evaluation of the HRH Program were limited and did not enable the MoH and the other stakeholders to perform the needed systematic and in-depth evaluation of the HRH Program\u2019s impact compared to the baseline. The prioritization in the budget (both by the MoH and the donors) of implementation costs, the simultaneous under-estimation of the costs associated with other critically important programmatic components , and the unprecedented scale and complexity of the HRH Program are the main reasons for the mismatch between needs and availability of resources and expertise. In the future, should health professional training initiatives similar to the HRH Program be implemented in other low-income countries, greater attention should be devoted to the establishment of a strong monitoring and evaluation platform. Additionally, all large-scale multi-year global health programs or interventions should include an implementation research component. Post-hoc evaluations conducted a few years after the launch of these programs or interventions, such as the one conducted for this study, are not designed to provide ongoing data-driven feedback to implementers, which is necessary to learn new lessons and improve the quality of implementation in real-time.Linking scale-up and improvement in the quality of training to improvements in the quality of health service delivery and in health outcomes  has been especially challenging. Additionally, the 63-item survey utilized to collect descriptive data did not include open-ended questions on perceived successes, opportunities, and challenges related to the HRH Program. As a result, the authors did not perform a thematic analysis  to identify recurrent themes in the responses provided by the co-authors or other participants in the HRH Program and consolidate them in an empirically validated list of lessons learned. The authors believe that the HRH Program would greatly benefit from a properly resourced external evaluation, which would look beyond the program\u2019s activities and milestones presented in this article and focus instead on the program\u2019s outcomes and more distal metrics of success . The same evaluation could also integrate a quantitative component with a comprehensive and detailed qualitative component through a mixed-methodology study design.Despite the study limitations, important good practices have been adopted and lessons have been learned by the authors  to guideRecruitment of visiting faculty was initially hindered by a limited pool of full-time senior and mid-career candidates, especially for the discipline of medicine, who were preferred by the Schools at the CMHS and by the students. However, if carefully selected and adequately mentored, junior visiting faculty can be equally effective while shorter durations of deployment for senior visiting faculty can be considered if continuity over multiple years is possible. Additionally, some visiting faculty initially struggled to transition to clinical practice in resource-limited settings and adapt to different professional habits and cultural norms. Serial revisions in the orientation training and the presence of a core group of returning visiting faculty have improved this transition but more needs to be done. For example, the HRH Program would benefit from the availability of more comprehensive and updated orientation materials that visiting faculty could review online prior to their deployment to Rwanda.88 Thus, leadership at the MoH and the CMHS recommended a revision of the twinning program in 2016 in which Rwandan and visiting faculty identify and conduct activities of shared academic interest and meet the objectives of the Schools at the CMHS and are then formally evaluated based on their ability to achieve these objectives. However, to this day, the revised twinning program has not been yet implemented broadly or uniformly across all Schools and Departments within the CMHS.Twinning between Rwandan faculty and visiting faculty has worked quite well at times. However, mismatched seniority levels, technical expertise, and academic interests between faculty twins, and difficulties protecting time for Rwandan faculty, as well as formal processes to evaluate and improve twinning, have been persistent challenges.Ensuring coordination and communication among many stakeholders has been difficult, especially in the early years of the HRH Program. It has taken several years to find the right balance between the role of the MoH, which manages the HRH Program and is the primary interlocutor with the US academic institutions, and the Schools at the CMHS, which are the primary recipients of the visiting faculty but whose line Ministry is the Ministry of Education. More importantly, both the Schools at the CMHS and the US academic institutions received insufficient funding for management and administration, which would have allowed them to improve communication and coordination and provide better mentorship and supervision to the visiting faculty. Additional funding would have enabled US based coordinators to travel to Rwanda to support the visiting faculty and establish closer ties with the academic leadership at the CMHS. Since 2012, coordination and communication has generally improved as meetings and conference calls with working groups for health disciplines and clinical specialties  are scheduled more frequently, although such improvement has been inconsistent, especially in the last 12 months, and challenges persist.Despite the positive impact of improvements in equipment and supplies within the Schools at the CMHS and the teaching hospitals, these have been insufficient to entirely address the existing gaps. Additionally, the Schools at the CMHS and the teaching hospitals have lacked the resources and expertise necessary to install and maintain the newly procured equipment which has led to delays and inconsistencies in its utilization. The MoH is now working to strengthen its supply-chain management, installation, and upkeep capacity.4 management of the funds has at times been challenging. Mismatches between fiscal years for the CDC, the Global Fund, the CMHS, and US academic institutions has made it difficult to process payments in a timely manner and track expenditures. Furthermore, funds have come with spending restrictions on critical items such as monitoring and evaluation, equipment, and supplies while renewal of donor commitment has occurred on a year-by-year basis and late within the previous academic year. These delays have hindered recruitment efforts from US academic institutions as numerous ideal candidates eventually have opted to seek other employment opportunities rather than wait until funds were secured.The flow of funds from donors to the MoH rather than directly to the US academic institutions has facilitated country ownership and alignment of the HRH Program to local priorities. Despite this novel funding model,Lastly, the decision by the CDC to cease funding for the HRH Program after March 2017 put a strain on the MoH, the CMHS, and its US partners and has led to approximately a 30% reduction in the number of full time equivalents for visiting faculty deployed to Rwanda for the 2017-2018 academic year compared to what had been originally planned. The number of visiting faculty to be deployed in the 2018-2019 academic year is yet to be finalized but will likely be similar. In the future, greater flexibility in funding expenditures and longer-term commitment from donors will be needed to ensure that initiatives such as the HRH Program achieve their full potential.As this organizational case study demonstrates, the resources and expertise available through the HRH Program have already strengthened the capacity of the Schools at the CMHS.However, the sustainability of these achievements will need to be pursued by all the stakeholders even more deliberately and aggressively. As a result, the academic leadership of the CMHS has finalized a sustainability strategy framework document with goals and objectives to strengthen the capacity of the Schools to sustain the training programs initiated or supported by the HRH Program. More detailed planning will now be needed to determine the precise amount of new Rwandan faculty to be recruited (and outline the process to recruit them), secure additional funds, and establish additional partnerships and collaborations with the US academic institutions that will continue after the HRH Program formally comes to an end.To ensure programmatic sustainability, the HRH Program was designed to gradually replace the visiting faculty with newly recruited Rwandan faculty, to be selected among the new graduates of the training programs initiated or supported by the program. While the transition between visiting faculty and Rwandan faculty has already begun, this effort will need to be scaled up substantially before the end of the HRH Program. Funding available through the Global Fund was utilized to maintain a core group of 56 visiting faculty in Rwanda for the 2017-2018 academic year and will be utilized to maintain a similar number of visiting faculty for at least one more academic year. Simultaneously, some of the responsibility for teaching junior students will also be delegated to adequately mentored and supervised senior students. Additionally, the MoH is considering extending funding for the HRH Program for 3 to 4 years beyond 2019 to ensure a more gradual transition between visiting faculty and Rwandan faculty.Once recruited, the new Rwandan faculty will need to be adequately supported by the Schools at the CMHS and by the visiting faculty, especially in the early stages of their career. The establishment of additional academic partnerships and collaborations with the US academic institutions and eventually the launch of additional training programs  will be critical to ensure that the newly recruited Rwandan faculty are able to further develop professionally and thrive academically.The Schools will also have to further strengthen their capacity across several non-academic domains, such as management and administration, finance, human resources, fund-raising and development. These domains are essential to a high-performing institution but are often overlooked by health professional training initiatives. In retrospect, even though the HRH Program sought to strengthen these non-academic domains, not enough resources and expertise where devoted to them. More importantly, when the HRH Program was first designed, not enough planning went into comprehensively and systematically determining the extent to which these domains needed to be strengthened and the timeline by which this would happen.Regarding the financial sustainability of the HRH Program, the cost of recruiting and deploying visiting faculty and procuring equipment and supplies within the Rwandan academic institutions accounted for the largest proportion of the overall budget. These costs were the highest in the earlier years of the HRH Program, when higher numbers of visiting faculty were needed in-country and the gaps in equipment and supplies were the greatest. The same costs have since decreased significantly now that Rwandan faculty have begun to replace visiting faculty and most of the planned improvements in equipment and supplies have been achieved.The primary costs that the MoH will need to sustain beyond the duration of the HRH Program will be those of the salaries for the increased numbers of Rwandan physicians, nurses, midwives, oral health professionals, and health managers that have joined or are expected to join the public sector. When the HRH Program was first designed, the determination was that the MoH would not need any external funding to cover these costs because of the projected increase in Rwanda\u2019s gross domestic product (GDP) and in the percentage of government spending devoted to the health sector. This determination has not changed.The costs that the Rwandan academic institutions will need to sustain beyond the duration of the HRH Program will be primarily those of the salaries of the newly recruited Rwandan faculty but also the costs of subsidizing tuition fees for increasing numbers of students, further improving equipment and supplies, and further strengthening management and administration and other non-academic domains. While the Ministry of Education and the Schools at the CMHS have devoted additional funds to cover some of these costs, more funding will be necessary to achieve financial sustainability. Diversifying funding sources beyond the CDC and the Global Fund, strengthening the capacity of the CMHS to generate soft money through grants, and decentralizing fund-raising to individual schools and departments at the CMHS and their US partners will be critical. The schools at the CMHS and some of their US partners are already seeking additional funding opportunities, submitting proposals, and in some cases securing funds to sustain their work. However, these efforts will need to be scaled up substantially before the end of the HRH Program.3 Despite some persistent challenges, important lessons have been learned and good practices adopted by the MoH of Rwanda, the Schools at the CMHS, and a consortium of 19 US academic institutions participating in the HRH Program. The authors believe that the HRH Program can serve as a model for other initiatives that seek to address the shortage of qualified health professionals in low-income countries and strengthen the long-term capacity of local academic institutions. Liberia and Sierra Leone, where weak health systems were devastated by the Ebola epidemic,101 as well as other sub-Saharan African countries have expressed an interest in adopting a similar model. To realize their full potential and achieve sustainable impact, initiatives like the HRH Program require strong communication and coordination, adequate policies and procedures to recruit visiting faculty and support them once deployed, significant investment in the recruitment and career development of local faculty, adequate resources devoted to management and administration or infrastructure and equipment, and greater funding flexibility and long-term commitment from donors.The Rwanda HRH Program is an innovative and ambitious initiative that has already substantially scaled up and improved the quality of health professional training in Rwanda.The authors would like to acknowledge the hundreds of visiting faculty who participated in the HRH Program and the leaders and administrators of the MoH, the Schools at the CMHS, and the US academic institutions who rendered the implementation of the HRH Program possible. The authors would also like to acknowledge Laetitia Nyirazinyoye and Libby Abbott who conducted the majority of data collection and analysis for the Mid-Term Review of the HRH Program  and by representatives of the US academic institutions in the core working group for this article as the data collection and analysis for this manuscript fell under the category of \u201cprogram evaluation.\u201dAuthors declare that they have no competing interests.This work was supported by The United States President\u2019s Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention funded the HRH Program from July 2012 until March 2017; The Global Fund to Fight AIDS, Tuberculosis and Malaria, has been funding the HRH Program since July 2012; The ELMA Foundation provided funding for early planning and management and administration assistance of the HRH Program between 2011 and 2013 and for the preparation of this article between January 2015 and December 2016; and The Abundance Foundation provided funding for the preparation of the article between April 2016 and the date of submission.CC and AgB conceptualized the manuscript, wrote the first draft, and led the development of the manuscript. JS, LVA, PC, RR, PEF, RoR, and SR provided feedback on first draft and supported initial development of the manuscript. EsN, JS, and LM provided data and feedback from the Rwanda Ministry of Health. CM, DKT, DoM, JK, PK, and SR provided data and feedback from the leadership of the College of Health Sciences, University of Rwanda. The following authors provided data and feedback on the manuscript related to their respective area of contribution to the Human Resources for Health Program: ACL, CDM, JEO, MD, RTM, and TT for Anesthesiology and Emergency Medicine; AG, CM, JB, and VM for Oral Health; BH-G, DKT, EK, JR, and ReW for Health Management and Implementation; AR, CC, JD, LVA, NT, PEP, ReR, TDW, and VD for Internal Medicine; BB, CAB, DC, DoM, LLM, MadM, MarM, MH, MR, RTK, TLH for Nursing and Midwifery; LB-M, RoW, SR, UM for Obstetrics and Gynecology; BR, DaM for Pathology; JCK, KW, LA, MC, MiK, NM, TR for Pediatrics; GR and SK for Psychiatry; LK and SS for Radiology; AlB, AmB, EmN, FN, JFC, MuK, RG, and RoR for Surgery; MM for 7 Harvard-affiliated institutions; and AS, IM, MeK, PO, and TN for support during HRH program design and initial implementation. AY and JM edited and provided feedback on the manuscript; collected, processed, analyzed data; and supported the development of the manuscript.1Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 2Office of the Vice-Chancellor, University of Rwanda, Kigali, Rwanda. 3Rwanda Human Resources for Health Program Team, Ministry of Health, Kigali, Rwanda. 4Office of the Dean, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda. 5Center for Surgery and Public Health, Brigham and Women\u2019s Hospital, Boston, MA, USA. 6Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA. 7Center for Health Equity, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA. 8Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA. 9Division of Global Health Equity, Department of Medicine, Brigham and Women\u2019s Hospital, Boston, MA, USA. 10Office of the Principal, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda. 11Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University - Western Campus, Ishaka, Uganda. 12School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda. 13Office of the Dean and Department of Oral and Maxillofacial Surgery, Oral Pathology and Oral Medicine, School of Dentistry, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda. 14School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda. 15Department of Anesthesiology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda. 16Department of Ear, Nose, and Throat, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda. 17Department of Internal Medicine, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda. 18School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia. 19Department of General Medicine, Calvary Mater Hospital, Newcastle, NSW, Australia. 20Department of Neurosurgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda. 21Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA. 22Department of Orthopedic Surgery, Rwanda Military Hospital, Kigali, Rwanda. 23Department of Pathology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda. 24Department of Pediatrics, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda. 25Department of Mental Health, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda. 26Department of Radiology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda. 27Department of Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda. 28Yale School of Medicine, New Haven, CT, USA. 29Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, NY, USA. 30Department of Pediatrics, BronxCare Health System, Bronx, NY, USA. 31Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA. 32Division of Hospital Medicine, Department of Pediatrics, Children\u2019s Hospital Los Angeles, Los Angeles, CA, USA. 33Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. 34Global Health Leadership Institute, Yale School of Public Health, New Haven, CT, USA. 35Department of Preventive and Community Dentistry, School of Dentistry, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda. 36University of Global Health Equity, Kigali, Rwanda. 37Clinton Health Access Initiative, Boston, MA, USA. 38Clinton Health Access Initiative, Kigali, Rwanda. 39Office of Global and Community Health, Harvard School of Dental Medicine, Boston, MA, USA. 40Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA. 41Department of General Pediatrics, Boston Children\u2019s Hospital, Boston, MA, USA. 42Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA. 43Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA. 44Department of Pediatrics, Warren Alpert Medical School of Brown University, RI, USA. 45sidHARTe Program, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City, NY, USA. 46Department of Emergency Medicine, Columbia University College of Physicians and Surgeons, New York City, NY, USA. 47Department of Anesthesiology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA. 48Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. 49Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA. 50Department of Surgery, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA. 51Duke Hubert-Yeargan Center for Global Health, Durham, NC, USA. 52Department of Medicine, Duke University School of Medicine, Durham, NC, USA. 53Duke Global Health Institute, Durham, NC, USA. 54Duke University Medical Center, Durham, NC, USA. 55Duke University School of Nursing, Durham, NC, USA. 56Department of Obstetrics & Gynecology and Women\u2019s Health, Albert Einstein College of Medicine, New York City, NY, USA. 57Obstetrics & Gynecology and Women\u2019s Health, Montefiore Medical Center, New York City, NY, USA. 58Division of Nursing, Howard University College of Nursing and Allied Health Sciences, Washington, DC, USA. 59University of Connecticut School of Nursing, Storrs, CT, USA. 60New York University Rory Meyers College of Nursing, New York City, NY, USA. 61University of Illinois at Chicago College of Nursing, Chicago, IL, USA. 62Columbia University School of Nursing, New York City, NY, USA.63Department of Family & Community Health, University of Maryland School of Nursing, Baltimore, MD, USA. 64Global Education and Mentorship, Office of Global Health, University of Maryland School of Nursing, Baltimore, MD, USA. 65Department of Oncology & Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, MD, USA. 66Office of Global Health, University of Maryland School of Nursing, Baltimore, MD, USA. 67Partnerships, Professional Education, and Practice, University of Maryland School of Nursing, Baltimore, MD, USA. 68Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, USA. 69Department of Anesthesiology Perioperative and Pain Medicine, Boston Children\u2019s Hospital, Boston, MA, USA. 70Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA. 71Center for Global Health, American Society for Clinical Pathology, Chicago, IL, USA. 72Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA. 73Department of Psychiatry, Boston Children\u2019s Hospital, Boston, MA, USA. 74Department of Radiology, Brigham and Women\u2019s Hospital, Boston, MA, USA. 75Global Health and Research Programs, Biomedical Research Institute, Brigham and Women\u2019s Hospital, Boston MA, USA. 76Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA. 77Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA. 78Office of the Vice-Chancellor, University of Global Health Equity, Kigali, Rwanda.Multi-year training initiatives based on partnerships between academic institutions in high- and low-income countries can help address theglobal shortage of health professionals.Expatriate local faculty will initially do most of the teaching but can gradually be replaced by new graduates from the training programssupported by such initiatives.Funding flexibility (without excessive restriction on how funds can be spent) and reliable funding availability over multiple years are critical toensuring the success of such initiatives.Sustainability can be achieved through institutional capacity strengthening, which encompasses investments in both academic  as well as non-academic  domains.The establishment of additional partnerships and collaborations between academic institutions in high- and low-income countries is alsocritical for sustainability.Health professional training initiatives like the Human Resources for Health Program (HRH Program) in Rwanda, funded by the US Governmentand the Global Fund for a total budget of approximately US$150 million over 7-years, can help address the global shortage of health professionals.In the first 5 years since the launch of the HRH Program in 2012, a consortium of US academic institutions has deployed an average of 99 facultyper year to support and/or launch 22 training programs, which are on track to train almost 4600 health professionals  by 2019. To ensure sustainability, new graduates from the training programs supported by theHRH Program have begun to gradually replace US faculty. The HRH Program has also served as a catalyst for additional academic partnershipsand collaborations between US and Rwanda academic institutions. These partnerships will also play a critical role in achieving sustainability bypromoting faculty career development and by diversifying funding for academic activities in Rwanda."}
{"text": "Molecules was developed in commemoration of the 100-year Anniversary of the discovery of Heparin. It would have been appropriate to have the lead article in this issue be by Professor Benito Casu, one of the lead pioneers who laid the foundation for the understanding of the heparin structure and function. Unfortunately, professor Casu unexpectedly and regrettably passed away on 11 November 2016. His legacy as a teacher, scientist, leader and a visionary who led a group of scientists at Ronzoni to advance the science of glycosaminoglycans will live for years to come. His diverse interest in this area is well represented in the manuscripts in this Special Issue.Heparin and related drugs have contributed in so many different ways to the drug discovery process, and have provided a platform to understand the pathophysiology of vascular and inflammatory diseases for nearly 100 years. Despite its discovery in 1917 by Jay McLean, then a medical student, the scientific and clinical progress in the understanding of heparin and related drugs has continued to expand. This Special Issue of friendly competition\u201d, regardless of potential competitors, and used to cite a phrase of the Nobel Prize winner Rita Levi Montalcini: \u201cResearch is a tool of knowledge and not a matter of power and competition\u201d.At the G. Ronzoni Institute in Milan , he contributed over the last sixty years to the advancement of the knowledge of polysaccharide chemistry and biochemistry, especially both heparin and glycosaminoglycan (GAG) derivatives, analogs and mimetics. Several of these resulted from translational networks fruitfully set up by Professor Casu, who had the merit of sharing intuitions and projects with scientists, academic institutions, and industry. He had a unique attitude towards \u201cIn 1951, he started his scientific career with brilliant research on starch and cyclodextrins at the G. Ronzoni Institute. In 1969, he was first introduced to heparin during a sabbatical year at McGill University, Montreal (Canada), joining the group of Professor Arthur Perlin. The pioneer NMR studies on the structure and conformational flexibility of heparin provided him an international notoriety ,3. For oStructural characterization studies of heparin pentasaccharide sequence binding to antithrombin, fundamental for anticoagulant activity .Bioactive biotechnological heparins obtained by chemo-enzymatic modification of a biosynthetic precursor of bacterial origin .An honorary doctorate of the Uppsala University (Sweden), awarded in 1998 for outstanding contribution to heparin and GAGs knowledge and development.More recently, as a result of an international collaboration among G. Ronzoni Institute, Alabama University, USA (Prof. Sanderson), and Technion University, Haifa (Israel), granted by NCI, USA, the identification of a new class of non-anticoagulant heparins endowed with antineoplastic activity through the inhibition of heparanase ,7, curreIn the framework of this preface, it is not possible to assess the content and richness of ideas, publications, reviews and patents of Prof. Casu. As a result of translational collaborations with academic institutions and/or industrial partners, the following highlights can be underscored:The traditional interdisciplinary and international network of the Ronzoni Institute, under the guidance of Professor Casu and his group, is well expressed by the contributions of this special issue covering some of the translational steps \u201cfrom bench to bedside\u201d."}
{"text": "In the original article, there was an error. We erroneously reported that peach fruits were delivered to the labs located at the Department of Applied Genetics and Cell Biology at the University of Natural Resources and Life Sciences, Vienna (Austria). Instead, peaches were brought to the Department of Agriculture, Food and Environment (DAFE), University of Pisa, Pisa , where UV-B irradiation and fruit infection were carried out.A correction has been made to Materials and Methods, Plant Material and UV-B Treatments, paragraph 1. Please find below the complete corrected sentence:Prunus persica cv. Royal Majestic, melting phenotype) were purchased from a local supermarket and brought to the laboratory of the Department of Agriculture, Food and Environment (DAFE), University of Pisa, Pisa .Organic peaches (The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "Carlos Chagas was the first \u201cmodern\u201d cardiologist in Brazil.Professor Nelson Botelho ReisPresident of the SBC: 1945-1975 managementCardiology as a medical specialty has been built from scientific knowledge derived frombasic and clinical areas and from the development of technological devices that enabledus to study and understand the cardiovascular system. Two technological disruptivecapacitors were: the stethoscope and the electrocardiogram, which allowed for theconstruction of two new \u201csciences\u201d, the eletroctrocardiography and thephonomecanography. Certainly, the complexity of understanding the eletroctrocardiographyand its electroclinical correlation has made Cardiology to become a specialtyindependent from clinical medicine, in the early 20th century. In the post-war years,technical-scientific developments allowed Cardiology to be prepared to become a solidarea of action, and enabled the new search for therapeutic approaches, which contributedto the increased survival rates observed in basically all cardiopathies.1The foundation of the Brazilian Society of Cardiology (SBC), on August 14, 1943, was animportant mark in our country, which enabled to tie together doctors dedicated tocardiovascular teaching, research and care. Thus, since 2005, the cardiologists day hasbeen celebrated. The SBC and its brand logos have been transformed as it searches toconnect our tradition and the contemporaneity of our cardiology and its internationalinsertion and relevance .1The trajectory of this specialty traverses the emergence of the SBC, the propagation oftraining courses, the creation of the Arquivos Brasileiros de Cardiologia in 1948 andthe first specialists\u2019 titles. Over the years, in association with the hospitalistpractice and the great technological development, Cardiology was divided into specificspecialty areas: emergency cardiology and cardiac intensivism, congenital cardiopathies,cardiac surgery, hemodynamics, echocardiography, electrophysiology, among others. Inorder to understand the future, it is necessary to look back into the past and realizethe huge steps of this specialty, which grows worldwide, aligned with thecontemporaneity of the challenges to prevent and treat cardiovascular diseases in a safemanner, based on guidelines and focusing on the patient.2 In themid-1500s, Andreas Vesalius published a wonderful atlas of anatomy in his \"Fabricius\".In this publication, he called the heart the \"center of life\". This publication correctsthe anatomical mistakes described by Galen and, for many historians, it is the mark ofmodern medicine. Modern cardiology has its beginnings with the publication of the bookDe Motus Cordis, written by the English physician and scientistWilliam Harvey, the father of Cardiology,3 which caused a \u201churricane\u201d in science and medicine when it asserted,based on studies in animals and humans, that the blood goes from the heart throughclosed spaces and returns through veins into the heart.Going back to remote times, we can rescue the registries of the first steps of thespecialty that we call protocardiology. Leonardo da Vinci\u2019s observations, drawings andnotes of the heart, made in 1490, are deemed as pioneering in the history of Cardiology.As author of the first graphic representation of the coronary arteries, he alsoexplained the heart fluid dynamics and defined the formation of the aortic valve cuspand the sinus wall. It is possible to state that Da Vinci was a renaissancecardiologist.Arquivos Brasileiros deCardiologia, in 1986.4 Hereinforces that the clinical-anatomic method was the first method in clinical medicinethat evolved from a simple confirmation (\u201cfindings of necropsy\u201d) or from theverification of the disease in an emerging scientific area, correlating the patient\u2019sclinical picture. Important Italian ; French  and German (Virchow) physicians were fundamental to the construction of thisnew discipline. The Anatomopathology witnessed the emergence of Histology, which broughtto light the importance of examining cells and tissues, and of expanding the correlationand causal mechanisms of diseases. The physicians interested in the area of Cardiologypresented a growing and e robust method to explain the abnormal cardiovascular findingsand necropsy data.The evolution of the history of Cardiology in Brazil was brilliantly revised by professorNelson Botelho Reis and published in the Arquivos Brasileiros de Cardiologia also publishesits traditional anatomoclinical section, an important tool for the formation of youngcardiologists.In our country, the central influence of the cardiovascular anatomoclinical method wasimportant for the formation of cardiologists until the beginning of the 1980\u2019s,initially influenced by Sylvio Carvalhal (S\u00e3o Paulo), Professor Luigi Bogliolo(Rio de Janeiro and Minas Gerais). Also, Professor Manoel Barreto Neto, whom I washonored to be a student of and from whom I received deep knowledge and the strength ofthe anatomoclinical method, along with the findings presented by Professor Raul CarlosPareto Junior. The In the second half of the 19th century, the third stage of Cardiology emerged: theexperimental medicine, the source of the brilliance of writers such as Claude Bernardand Carl Ludwig. The German and French schools made experimental medicine an independentarea and two researchers described the Frank-Starling Law, the first law of the heart.In the 19th century, scientific advances derived from new disciplines such asmicrobiology, immunology, histology and biochemistry. Other sciences were incorporatedinto the study of Cardiology, such as physics and electricity, which contributed to thediscovery of the x-ray and the chord galvanometer. In the future, these would constitutethe basis of cardiac radiology and electrocardiography. In the end of the 19th century,the combination of anatomoclinical data and the recording of stetho-acoustic findingsusing graphic methods (phonomecanographic) consolidated a new pathophysiologicalapproach, and a detailed description was made of a growing number of cardiovascularconditions.5It is possible to assert that the official study of Cardiology, as a science and medicalspecialty, started with the vital contribution of Dr. Carlos Chagas\u2019 studies, whodiagnosed the chagasic cardiomyopathy in 1909, and was responsible for the firsttranslational studies and the publication of the first broad scientific study of acardiac disease in Brazil. In addition, he was responsible for introducing the firstelectrocardiogram, installed in the laboratory of Manguinhos, a valuable and unequivocalcontribution to Brazilian Cardiology.6 In the same period,the dissemination of the electrocardiograph made it possible to develop specificstudies, which resulted in a branch of clinical medicine that became an area of majorinterest for numerous physicians, who began to search for specialty programs in Braziland abroad. This movement, throughout the 1930s, led to the emergence of the medicalspecialty, thanks to the particular interest of this enthusiastic group for thisspecific study, which caused emerging resources to be redirected to the investigation ofcardiovascular diseases, through phonomechanography and electrocardiography. From thismoment, a great process of creation of annual specialty courses began, which initiallywere offered in S\u00e3o Paulo and Rio de Janeiro, even before the constitution of theChair and the formation of this Society, on August 14, 1943. The access to these greattransnational networks, and the whole American continent, benefited the investigation,the learning and trainings that took place until the end of World War II, and was theresult of the internationalization process of the SBC, which maintained the possibilityof interchange between Brazilian and North-American doctors and, consequently, of itsactions together with the American College of Cardiology.7Industry development and migration from rural to urban areas, with the creation ofmetropolitan areas, in the early 1920s, led to a huge change in the eating and workinghabits of the Brazilian population, with the spread of heart diseases among thesociety.Cardiology and cardiologists experienced deep changes in the beginning of the 20thcentury, due to the employment of the electrocardiogram as the cornerstone ofcardiovascular rationale. Another important change was the progressive loss of relevanceof the French school for Cardiology and the emergence of the North-American and Mexicanschools of Cardiology. The Mexican Institute of Cardiology, founded by Ignacio Chaves,in 1944, became a research and education pole in the area of electrocardiography and amodel center of cardiovascular education, attracting Brazilian young people for itsresidence in cardiology, as well as people from other nationalities. Between the 1940\u2019sand 70\u2019s, it would become a global reference center and contribute to important advancesfor the pathophysiology of congenital diseases, pulmonary hypertension, hemodynamics andelectrophysiology. The influence of the North-American school starts to consolidate inthe post-war period, when it incorporates economic resources to professionalize clinicalresearch and construction and new centers of cardiology, as well as into the developmentof cardiac catheterization and myocardial revascularization surgery. The Harvard groupled by Professor Eugene Braunwald consolidates in the discovery of new mechanisms ofdisease and in multicenter therapeutic studies.In the 1980\u2019s and 90\u2019s, noninvasive cardiovascular imaging, echocardiography, myocardialscintigraphy, computerized tomography and cardiac resonance were incorporated and becameincreasingly indispensable for diagnostic, prognostic and therapeutic evaluation.Parallel to this, we started to incorporate the principles of evidence-based medicineinto the process of clinical decision making in the therapeutic area. The BrazilianSociety of Cardiology establishes clinical guidelines to guide the cardiovascularpractice, incorporating and ranking the recommendations to confront severalcardiovascular diseases.8Since the hospitalist practice of our cardiologists, cardiac surgery has been present andof vital importance for the development of our specialty, as well as hemodynamics, bothbeing distinguished as the major departments in the first years of constitution of theSBC. Specialized sectors and equipment in hemodynamics and cardiac surgery, creation ofspecialized health care centers and units, such as the coronary unit and cardiacpostoperative unit, provide specific care, adding knowledge and value to the specialty.With the arrival of the 1980's, there was the dissemination of the use of coronaryangioplasty for the treatment of multiple vessel disease and acute myocardialinfarction, using reperfusion techniques and thrombolytic therapy. The advances ofinterventionist hemodynamics through the use of pharmacological stents, valvuloplastyand prosthesis implantation emerged around the world, and quickly arrived in Brazil,promoting a huge evolution step towards the formation of the specialist in Cardiology,as well as the need for the constitution of teams dedicated to each area.4Nowadays, the SBC consists of 13 active departments, where a total of 14,000 associatesare distributed in 26 regional clusters throughout Brazil, being the largest society inLatin America. Cardiology, in addition to having being the first specialty to establisha Chair at universities and teaching hospitals, was also responsible for the emergenceof accreditation procedures for specialist titles and, nowadays, has the support of8,429 doctors with a specialty degree in Cardiology.All this movement promoted the growing and the development of the SBC, leading to thecreation of the first five specialized Departments: Cardiovascular Surgery Department(1969), Pediatric Cardiovascular Department (1973), Cardiovascular and RespiratoryPhysiology Department (1974), Angiocardiography and Hemodynamic Department (1976) andHypertension Department (1981).lato sensu post-graduationcourses. In line with this demand for specialty courses, the SCB, alongside its regularpublications Arquivos Brasileiros de Cardiologia (Brazilian Archives ofCardiology), International Journal of Cardiovascular Science, the SBCJournal and its guidelines, provides DE (distance education) courses, abroad schedule of events and congresses with online access. In order to respond the needfor expanding translational research, the specialty counts with the possibility ofnetwork research, as in the case of stem-cell therapy, which involved several centers,the support to clinical trials and registries, in addition to epidemiologic studies onthe most prevalent cardiovascular conditions in our field. In the context ofstandardization of conduct and creation of protocols, the SBC dedicates extremedetermination for the development and publication of guidelines on approach andtreatment of the main diseases with high morbidity and mortality nowadays.In addition, several institutions offer In the late 20th century, Brazilian Cardiology constructed a solid legacy andinternational relevance, a trajectory from which renowned fellows were electedrepresentatives of this first century of our specialty .13This new decade emerges with a new design for Cardiology in a digital, connected,patient-focused environment, based on major pillars - artificial intelligence, big-data,robotics, biosensors, telemedicine, devices, sensors and genomics. Together they willsupport the Precision Cardiology paradigm. The need to incorporate into our mindset theidea of the cardiologist approaching the world of innovation and entrepreneurship is anew challenge in the formation of our new cardiologists with emphasis on the developmentof female leadership in cardiology. From the assistance point of view, our integrationwith the population health and family doctors will increase, as well as ourmultidisciplinary approaches, enabling the implementation of lines of care and themonitoring of clinical outcomes and focused on patient safety. This means to know anddominate the triad formed by cardiovascular biomedical knowledge, technology  and humanization. Knowledge moves forward quickly and unstoppable, in a globalmanner, supported and favored by numerous opportunities of knowledge exchange betweenpeers and institutions worldwide. The technology, which promotes the evolution ofDigital and Precision Medicine, favors the access to knowledge, the strengthening ofdiagnosis, the promotion of man-machine interaction and the possibility of personalizingtherapy to its molecular level. And, finally, the rescue of essence: the humanization ofsuch advanced and futuristic Cardiology. A new journey will be necessary into the dailypractice of doctor-patient interaction in order to promote empathy, patient empowermentand sensitivity to the doctor inserted in this new context for this newdecade."}
{"text": "The development of new biomaterials and regenerative medicine strategies appears as a major field of research in periodontology, oral surgery, and esthetic and implant dentistry (the POSEID disciplines) in the current era of tissue engineering and quest for tissue regeneration. Biomaterial research remains the core science of all these opportunities of regenerative treatments of the maxilla and improvement of oral rehabilitation .In our previous special issues in 2015 and 2016, we selected a series of articles with new data on a wide range of topics in biomaterials and regenerative research in periodontology, oral surgery, and esthetic and implant dentistry, and we highlighted how these interconnected fields of research are both transversal (multidisciplinary) and translational . In this 2018 special issue, we selected articles with the same insight and wished to illustrate the complexity of this research field.In our previous editorials in 2015 and 2016, we described particularly the strength, weakness, opportunities, and threats on these disciplines and how research in implantable materials, particularly dental implants (new implant design and surfaces) , is affeIn the 2016 editorial of this special issue, we described particularly some ethical and legal issues related to this field, especially concerning the lack of transparency and control in dental implants  or through the dramatic example of L-PRF (leukocyte- and platelet-rich fibrin) and related blood derivatives  . These mIn 2018, unfortunately, very little has evolved. As a strange matter of fact, the development of these new biomaterials and regenerative medicine strategies seems to have reached a plateau that no one seemed to expect so early, before any major breakthrough or revolution of the clinical paradigms. As we can observe in the current literature, research topics seem to be permanently turning around, and we see currently very little major developments.In this 2018 special issue on new biomaterials and regenerative medicine strategies in periodontology, oral surgery, and esthetic and implant dentistry, we continued our task to gather a meaningful corpus of relevant articles. More than before, a better control of the specialized literature is needed."}
{"text": "Tuberculosis (TB), as the major infectious disease in the world, has devastating consequences for not only humans, but also cattle and several wildlife species. This disease presents additional challenges to human and veterinary health authorities given the zoonotic nature of the pathogens responsible for the disease across species. One of the main public health challenges regarding zoonotic TB (ZTB) caused by Mycobacterium bovis is that the true incidence of this type of TB in humans is not known and is likely to be underestimated. To effectively address challenges posed by ZTB, an integrated One Health approach is needed. In this manuscript, we describe the rationale, major steps, timeline, stakeholders, and important events that led to the assembling of a true integrated multi-institutional and interdisciplinary team that accomplished the ambitious goal of developing a ZTB roadmap, published in October, 2017. It outlines key activities to address the global challenges regarding the prevention, surveillance, diagnosis, and treatment of ZTB. We discuss and emphasize the importance of integrated approaches to be able to accomplish the short (year 2020) and medium term (year 2025) goals outlined in the ZTB roadmap. Mycobacterium tuberculosis complex (MTBC), TB presents additional challenges to human and veterinary health authorities given the zoonotic nature of the pathogens responsible for the disease and the ability of MTBC agents to be shared across species (Mycobacterium tuberculosis (M. tb); worldwide, it is the leading cause of death in humans by an infectious disease (Mycobacterium bovis (M. bovis) is widely distributed around the world  , Avian and Swine Influenza]  have hei species , 5. TB i disease . Bovine he world , 6 and che world . M. boviis (ZTB) \u201311. The is (ZTB) . Further species , 5.M. bovis as a causal agent of TB in people in all low-income, high TB burden countries where bovine TB is endemic, and the inability of laboratory procedures most commonly used to diagnose human TB to identify and differentiate M. bovis from M. tb  is an international scientific organization that works with partners, including governments, academia, and civil society, to fight TB, tobacco use and other lung diseases in low- and middle-income countries, through technical assistance, training, and research. Through its volunteer members, it houses scientific sections that promote areas of specific interest. The Union's ZTB sub-section is a global network of physicians, veterinarians, researchers, economists and social anthropologists that works to understand the dynamics of ZTB, create global awareness, and facilitate multi-institutional collaboration to address the challenges posed by it. Efforts conducted by the ZTB sub-section has led to a continuous and stable increase in the number of activities, attention, and attendees to ZTB-related activities at the annual Union World Conference on Lung Health. For example, at the 2010 conference in Berlin, Germany, there was only one ZTB session (symposium) attended by less than 10 people. Over the last seven years, the ZTB activities at the annual conference have increased to two scientific symposia, one poster session, one meet the expert session, press releases, and a keynote talk on ZTB at the plenary session in South Africa during the 2015 conference. During the last conference in Guadalajara, Mexico in October 2017, an audience of approximately 75 professionals from different disciplines attended each of the two ZTB scientific symposia.Prior to The Union's initial activities to create global awareness of ZTB, in 2010, the WHO, OIE and FAO pioneered One Health approaches under a tripartite partnership, which shares responsibilities and jointly develop and implement integrated strategies for addressing health risks at the human animal-ecosystem interface . The com- College of Veterinary Medicine and Biomedical Sciences, Colorado State University, United States of America- Food and Agriculture Organization (FAO) of the United Nations with its Animal Production and Health Division- International Union Against Tuberculosis and Lung Disease (The Union).- Pan-American Foot-and-Mouth Disease Center (PANAFTOSA) from the Pan American Health Organization/Regional Office for the Americas of the World Health Organization- Roslin Institute, Royal (Dick) School of Veterinary Studies, University of Edinburgh- STOP TB Partnership- United States Centers for Disease Control and Prevention (CDC)- United States Department of Agriculture, Animal and Plant Health Inspection Service,Global TB Programme, andThe Department of Global Capacities, Alert, and Response- World Health Organization (WHO) with its- World Organization for Animal Health (OIE)In March 2014, the ZTB sub-section created a working group to raise awareness of the public health risk posed by ZTB. This working group included participants from key parties including the:One of the accomplishments of this working group was the publication of a manuscript  calling A constellation of events has occurred to bring ZTB to the awareness of scientists, policymakers, government officials and the general public.M. tb or M. bovis, will count toward the achievement of this ambitious goal. For this reason, as countries move toward detecting the 3 million TB cases estimated to be missed annually, and in light of the endorsed WHO \u201cEND TB\u201d strategy, the Tripartite, The Union and the key organizations concerned with human and animal health, agriculture and TB joined forces to develop a Zoonotic TB Road Map outlining medium- and long-term milestones to globally address the prevention, surveillance, diagnostic, and treatment challenges faced by persons with ZTB.In May 2014, the World Health Assembly, WHO's yearly gathering of the world's Ministers of Health, approved the new post-2015 Global TB Strategy. The strategy aims to end, rather than merely control, the global TB epidemic, with targets to reduce TB deaths by 95% and to reduce new cases by 90% between 2015 and 2035, and to ensure that no family is burdened with catastrophic expenses due to TB. It set interim milestones for 2020, 2025, and 2030 . Thus, fIn September 2015, the United Nations declared the end of the Millennium Development Goals and used them as the foundation for the Sustainable Development Goals (SDGs)  for 2015The Stop TB Partnership, the global advocacy organization for TB, published the 4th edition of its Global Plan to End TB, 2016\u20132020 entitled \u201cThe paradigm shift\u201d . This is- Swiss Tropical and Public Health Institute, Switzerland- Animal and Plant Health Agency (APHA), United Kingdom- University of Ibadan, Nigeria- The Global Research Alliance for bovine Tuberculosis (GRAbTB)A meeting co-organized by WHO and The Union, with contributions from leading international organizations for human and animal health, academic institutions, and non-governmental organizations took place at WHO in Geneva. There, the first steps toward formally conceptualizing a roadmap for ZTB began, in which ten priorities were identified to be presented to WHO's Global TB Programme's Strategic Technical Advisory Group (STAG) for TB in June 2016. In addition to the 10 institutions initially working on increasing global awareness of ZTB, the following institutions joined the efforts at this specific meeting:The involvement and participation of GRAbTB was an important addition and played a strategic role in partnering with colleagues focusing in improve the understanding and control of bovine TB and developing novel and improved tools to control the disease at its bovine source . GRAbTB The 10 priorities proposed for the ZTB roadmap were endorsed by the STAG, and a working group was created and tasked to produce and publish a ZTB Road Map during 2017.M. bovis has against pyrazinamide, and the need for longer (12 months) antimicrobial treatment, compared to the standard of 6 months.At the STAG meeting, a former ZTB survivor, from the Masaai community in Kenya shared with the scientific community the challenges she faced while suffering from this disease, which included: initial misdiagnosis, development of extrapulmonary  TB, antimicrobial resistance to anti-TB drugs additional to the inherent resistance During the 47th Union World Conference on Lung Health in Liverpool, England, a British veterinarian and former ZTB patient/survivor also shared his experience and challenges of initial misdiagnosis, extrapulmonary  TB, drug resistance to isoniazid in addition to pyrazinamide, and the longer treatment required while battling ZTB in the year 2013.These patients' testimonies further emphasized that ZTB is not a disease from the past, and highlighted the challenges faced by certain communities at higher risk of contracting ZTB. Both patients emphasized the need of more awareness among the medical community to better diagnose and treat ZTB patients, and thus prevent the additional complications they had to endure.The Heads of State comprising the G20 forum declared that \u201cShaping an interconnected world, calls for a One Health approach to tackling the spread of antimicrobial resistance and highlighted the need to foster research and development for TB\u201d .The Roadmap for ZTB was published and launched at the Union World Conference for Lung Health in Guadalajara, Mexico. The roadmap is the product of efforts of the tripartite partnership on Zoonotic Diseases comprising WHO, OIE, and FAO and The Union, and is available in English, French, and Spanish .over the past 3 years, all efforts, activities, and events related to ZTB were highlighted by a considerable number of local, regional, national, and global media sources including Central News Network (CNN), the British Broadcasting Corporation (BBC), and Le Monde newspaper in France, to name a few.The Zoonotic TB Roadmap  outlinesBox 1\u201cIdentify opportunities for community-tailored interventions that jointly address human and animal health Interventions that jointly address human and animal health can increase health and economic benefits for communities. Sharing of human resources, equipment and transport across sectors can reduce operational costs. This increased cost-effectiveness is especially relevant given the public funding constraints that often exist in settings where people are most at risk of zoonotic TB. For example, outreach childhood immunization campaigns or other existing livestock vaccination or testing programmes conducted in rural communities could be used to concurrently deliver educational and behavior change messages about food safety, to test livestock for bovine TB or, potentially in the future, to implement livestock vaccination campaigns against bovine TB. Interventions must be tailored to the cultural and socioeconomic characteristics of each setting. Community-driven participatory initiatives are key to achieving sustainability.\u201dM. bovis across species. These efforts not only need to focus on preventing transmission from livestock (mostly cattle) to humans, but also, and in parallel, to reduce the prevalence of the disease in both domestic and wildlife species. The availability of improved diagnostic tools for ZTB in different species, as well as the implementation of disease monitoring, surveillance, and prevention strategies in livestock and wildlife species will be a crucial and much needed component to be able to implement comprehensive programs that will account for the complexities ZTB poses due to its zoonotic nature. Finally, including vaccination of wildlife (where feasible), not only has the potential for reducing the burden of disease, but also could play an important role in conservation efforts, especially among endangered and protected species.Although the publication of the ZTB Roadmap represents an unprecedented and historical accomplishment in the fight against global TB , there iImplementing an integrated approach to develop the ZTB road map did not come without the inherent challenges of multidisciplinary and multi-institutional projects. That said, the accomplishment of this milestone in the fight against TB was the vision of a world free of TB, no matter what its source, the strong support of WHO and the Stop TB Partnership, a motivated core group that drove the process by providing clear goals and timelines, being inclusive by inviting all interested parties, and fostering a strong commitment to work together from colleagues and institutions both from the human and animal sectors that previously were working in isolation. This collaboration has opened new doors and opportunities as the world fights to end TB.All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "The 1st Editor-in-Chief of the Asian-Australasian Journal of Animal Sciences (AJAS), Prof. In Kyu Han, a dedicated teacher and research scientist in animal nutrition, passed away on November 1, 2019 at the age of 85, after a brief illness. Prof. Han was born in Seongjoo, Kyungsang buk-do, Korea on October 12, 1934.Prof. In K. Han graduated with a degree in Animal Science from Seoul National University in 1956, and an M.Sc. degree from the same institute in 1958, and was awarded a Ph.D. in mono-gastric animal nutrition from Cornell University in 1965. He spent most of his career at the Seoul National University of Korea (1965\u20132000). As is well known not only in Asia but also worldwide, Prof. Han has been a dedicated teacher, researcher, and administrator for more than 60 years in the area of animal agriculture. He trained more than 170 graduate students, many of whom hold key positions, and contributed to the development of animal science and industry in Korea as well as in the Asian-Australasian Association of Animal Production Societies (AAAP) member countries. As a scientist, Prof. Han published 670 papers in refereed journals, notably in the area of development and utilization of non-conventional animal feeds, amino acids products, and many other ingredients and supplements. Further, he put tremendous effort in the development of Korean feed composition tables and feeding standards for major domestic animal species in Korea, which provided key information and technologies necessary for the modernization of animal agriculture in Korea.Prof. Han was the type of person with a vision and the ability to play key roles in the engineering of many master plans. The creation and establishment of AAAP in 1980 and AJAS in 1988 are two best examples. Prof. Han with 8 pioneers, including Y. Yamada from Japan and S. Jalaludin from Malaysia, master-minded the establishment of AAAP. He played a key role in the development of the organization until today. He hosted the 3rd AAAP Congress in Seoul, and organized the congress in 1985 as one of the most successful meetings in AAAP history. In addition, Prof. Han strived to establish the official journal of the AAAP ever since its creation, and successfully launched the first issue of AJAS in March 1988. He enriched the journal, both in quantity and quality, from its outset until 2001, when he stepped down as editor-in-chief to take up another important position: President of the Korean Academy of Science and Technology. His international interest was extended to the World Association for Animal Production (WAAP), in which he served as vice president for 5 years, and as president for another 5 years. The 8th World Conference on Animal Production (WCAP), which was organized under his leadership in Seoul in 1998, was and still is the most successful conference in WAAP history.Within the context of science in Korea, he engineered the establishment of many local scientific societies and their journals: some examples include the Korean Society of Animal Science and Technology, Korean Society of Animal Nutrition and Feed, and Korean Nutrition Society. Prof. Han held a number of important positions in Korea, and is well-known for his achievements in these positions. He served as the dean of the Agricultural University of Seoul National University for 2 years (1989\u20131991), and was elected as the president of the Korean Academy of Science and Technology for a 3-year term (2001\u20132004), where he facilitated tremendous achievement for both organizations as well as for the development of sciences including agricultural science in Korea. His affection and interest in fostering human resources for the development of animal science and industry in the AAAP region continued even after his retirement. He established the Hans\u2019 Animal Life Science Foundation with a personal donation of almost one million dollars in 2000. The foundation has provided scholarships to not only Korean students, but also many foreign students. Moreover, his foundation sponsored award programs such as the AAAP Animal Science Award and WAAP International Animal Agriculture Award, and supported international meetings (AAAP and WAAP).Prof. Han received several awards: the Korean Scientist Award (1971), National Green Ribbon Medal (2000), Korea Academy of Science and Technology Award (2014), Best SNU Award (2015), and AAAP Animal Science Award (2016).Prof. Han married Mrs. Myung Sook Kim in 1959. He is survived by a son, Changho Han, and three daughters, Miesook Han, Miehie Han, and Miejeong Han. We all share the family members\u2019 sorrow as they go through this most difficult time."}
{"text": "This is atale of continued progress, grounded in the idea that patient care, education, andresearch grow more and grow better if they are developed in harmony.In January 1982, the Medical Genetics Unit of Hospital de Cl\u00ednicas de Porto Alegre (HCPA)began its history in Brazil. It was elevated to a Medical Genetics Service (SGM) in1996, and by the end of 2016, it celebrated its 35In the SGM/HCPA, several units of the Federal University of Rio Grande do Sul state \u2013UFRGS , and several postgraduate programs have become intrinsically interconnected. This heterogeneous and plural composition,acting around the central theme \u201cMedical Genetics,\u201d became the brand of the group, whichinteracts transversally with numerous areas of the HCPA and has several associatedsectors in the Experimental Research Center  and theClinical Research Center.Thus, the different academic, technical, and scientific professionals involved in patientcare activities, which have always been the central axis of the mission of SGM/HCPA,received the support of undergraduate scientific initiation trainees, MSc and PhDstudents, and postdoctoral fellows linked to numerous projects of scientific andclinical research that were developed. In this virtuous circle, the different componentssupported each other and resulted in a very impressive number of consultations,laboratory tests, clinical research protocols, scientific articles, and human resourceformation on various levels.A solid educational platform with several specialized courses was progressively developedwith an accredited medical residency program and a portfolio of different trainingprograms, which were highly demanded by professionals from Brazil and abroad, like theLatin American School of Human and Medical Genetics (ELAG). Specialists andinvestigators from all corners of the world visited SGM/HCPA and contributed with theirexperience and expertise throughout these 35 years.The leadership position was also expressed by the presidency of members of the SGM/HCPAin several scientific societies of this field , Latin American Society of Inborn Errors or Metabolism and Neonatal Screening(SLEIMPN), Latin American Network of Human Genetics (RELAGH), and Brazilian Society ofBiochemistry and Molecular Biology (SBBq), among others, and by the promotion ofmemorable national and international events in the area. It was also expressed byhosting the headquarters of a National Institute of Science and Technology  and the editorial team of aninternational scientific journal .Considered the most complete service of its kind in the Latin American continent, itincluded the combined development of the main pillars of medical genetics , while integratingit with specific programs , and with education, training and research activities.In 2004, the SGM/HCPA was designated by the World Health Organization as a CollaboratingCenter for the Development of Medical Genetic Services in Latin America, and, in 2016,it was qualified by the Brazilian Ministry of Health as a Reference Service in RareDiseases.th anniversary of this successfulhistory (summarized in There is nothing better to mark the 35Guest EditorRoberto Giugliani,Medical Genetics Service, Hospital de Cl\u00ednicas de Porto Alegre, Brazil.Guest Editorial AssistantsMariluce Riegel and Francyne KubaskiMedical Genetics Service, Hospital de Cl\u00ednicas de Porto Alegre, Brazil."}
{"text": "Interests in nanotechnology and its application in medical research, diagnosis, and treatment of diseases continuously grow. The study identified the theoretical and practical principles of ethics in developed countries' nanomedical research to be used as the first step of development of a national nanoethics standard or guideline in Iran and developing countries.The present study was done between 2012\u20132016 in Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran, which comprised a literature review and a comparative study to describe and compare the nanoethics situation and considerations of nanoethics in Australia, Canada, and USA.The main ethical considerations in the three countries contain two major categories, including firstly, the nature of nanoparticles such as its diversity, rapid development of new and not well-defined nanoproducts and particles and unpredictable side effects of such nanoparticles; and secondly, the application of developed nanoparticles in areas such as justice, privacy protection, patient-physician relations, etc.It is controversial to develop an independent nanoethics standard or codes; however, national priorities and concerns, as well as specific nanoethics considerations, should be investigated before deciding to create such standards in each country. Overall, careful considerations have to take into account the justice, privacy protection, the inherent risks of nanomaterials and their possible side effects on patients and other study subjects, as well as considering characteristics of new developed nanoproducts and particles. Interest in nanotechnology and its application in medical research, diagnosis, and treatment of diseases are on a constant growth trend. Every day, a range of novel nano drugs, nano equipment and nanobiochips is introduced to the global market , 2. Despnanotechnology\u201d is composed of the unit prefix \u201cnano\u201d (derived from a Greek word-meaning dwarf) which means one billionth and the word technology. Nanoscience deals with phenomena, properties, and interactions of various substances at the atomic, molecular, and macromolecular levels (sizes of 1\u2013100 nm) where, especially at sizes smaller than 5 nm, materials manifest completely different characteristics compared to larger scales. Nanotechnology is hence the design, manipulation, and production of nanoscale (< 100 nm) equipment and systems through controlling the shape, size, properties, reactions, and performance of structures  has raised particular legal, social, and ethical issues whose neglect would lead to major crises in the future ,12.First sparkles of nanotechnology in Iran were lit in 2001, and two years after the beginning of the studies, \u201cIran Nanotechnology Initiative Council\u201d was established in 2003 with direct support of parliament and presidency . Iran NaConsidering the dramatic development of nanotechnology in Iran, \u201cIran Nanotechnology Safety Network\u201d was established in 2012. The aim of the network is to define national standards, regulations, and instructions on safety, environmental and ethical issues in nanotechnology.The Ethics Committee of this network decided to provide a national standard for nanoethics to be considered in nanotechnology research and products .During last two decades, some national guidelines of ethics in medical research have been developed ; howeverTherefore, the aim of this study was to investigate the status of nanoethics such as ethical considerations in nanomedicine in Australia, Canada, and the US as three pioneers in nanoethics as the first step to be able to define and develop a national standard for nanoethics in Iran. In fact, this comparative study is the first phase of this guideline/standard development in cooperation of \u201cIran Nanotechnology Safety Network\u201d. Therefore, the present study sought to identify and summarize the theoretical and practical principles and considerations of ethics in nanomedical research in three pioneers of nanomedicine  in the light of a comparative study to be used later in development of a national standard/guideline.This comparative study has described and compared situation and considerations of nanoethics in Australia, the US, and Canada as pioneers of nanoethics. Comparative research is a research methodology in which differences and similarities between phenomena are identified through comparisons between countries, cultures or other sectors. It is widely applied in macro sociology to answer questions at the intermediate and macro levels using internal and external analysis. Therefore, the research comprised two distinct levels. At the first level, a literature review was conducted to describe and illuminate the existing status of nanoethics considerations. To this purpose, scientific databases, including PubMed, Scopus, and Web of Science, were searched using nanoethics, nanotechnology, nanomedicine, medical ethics, and ethics in nanotechnology as key terms. The next stage involved a comparative study of the status of nanoethics in, Australia, Canada, and USA. These three countries were selected due to their attention to medical ethics, as well as their keen interest and massive investments in nanomedicine. The available books, article, and online databases were again searched  to extract relevant information in each country.An internal analysis was performed on the extracted information to determine the ethical standards governing nanomedicine studies, along with their strengths and weaknesses, in the target countries and to evaluate such standards based on the cultural context of each society. The ethical aspects of nanomedicine studies were first described in the target countries. The obtained data were further analyzed and summarized with the comparative approach. Finally, the findings of both levels and the ethical considerations in each country were meticulously analyzed.The present study compared three countries in terms of ethical considerations in nanomedicine. The objective was to facilitate the establishment of ethical codes in nanomedicine research in Iran through the identification of the applied approached and developed ethical codes in the mentioned countries. The following sections will thus describe the findings of the comparative study.Medical research and practice are deals directly with human health. As nanotechnology is a novel technology whose consequences cannot be easily predicted due to its nanoscale nature, the existing ethical codes do not seem to suffice. The subject of nanoethics is of particular significance in Iran, a country that is still a novice in this field despite its progress in the number of scientific articles and production of science. In order to facilitate the development of relevant ethical considerations and codes in the country, Ethical considerations in these three countries are summarized in different codes. Each code is more described in literature related to each country. For example, Justice and nano-gap  are described more as followed below. The other items of table are discussed in discussion section of this paper.Justice as an ethical principle in bioresearch implies that all people should receive equal health facilities regardless of their personal characteristics such as ethnicity, gender, or age .Nanotechnology is predicted to develop to more than two-trillion-dollar industry embracing advanced pharmaceutical products, improved medical imaging techniques, more precise surgical instruments, and unpredictable medical breakthroughs . Since sThere are also raising concerns about intellectual property rights in nanotechnology, i.e. patents on nanotechnology might encompass large numbers of applications and thus restrict access to information and technology, especially in developing countries. The nano-gap might also broaden the gap between the rich and the poor in developed countries and make people access to different levels of novel technologies, particularly medical advances, based on their wealth ,36.The increasing application of nanotechnology and nanomedicine warrants attention to ethical issues in this field. Hence, the present study sought to redefine the theoretical and practical principles of ethics in nanomedicine in Iran and three pioneers of nanotechnology .Uncertainty about the fair distribution of the benefits of nanotechnology: The benefits of nanotechnology might be exclusively available to developed countries (and increase the dependence of other nations on these countries) or even worse, to the upper classes of their societies.The risk of disclosure of confidential information: Nanotechnology might be able to access people's personal information without their consent. This would definitely jeopardize privacy protection .Transformation of patient-physician relationships: The achieved progress may lead to the diagnosis of currently incurable diseases. Being diagnosed with an untreatable disease would lead to profound psychological consequences for the patients and their families. Furthermore, knowledge about the existence of incurable diseases (e.g. AIDS) causes a great level of public anxiety. On the other hand, patients may become able to diagnose and treat their own diseases. The possibility of self-diagnosis and self-treatment will result in disastrous social consequences. For instance, in case of diseases with overlapping symptoms, self-treatment may prevent timely and accurate diagnosis of the real disease and cause serious problems in the patient.Increased capabilities of humans: Nanotechnology may provide individuals with the chance to modify their appearance, performance, and even personality. Such possibilities would indubitably raise major ethical issues. This is particularly important when cloning and its consequent concerns, e.g. violation of human dignity, identify challenges, and interference in the laws of nature, are involved.Ethics in Biomedical Research: Since general research in nanotechnology involves human trials, issues related to privacy protection, autonomy, and human dignity are of critical significance in this field. In fact, the unclarity and unpredictability of the possible consequences of nanomaterials may affect the processes of information provision, obtaining informed consent, and privacy protection in nanomedicine research.Ethics in Diagnostic and Therapeutic Applications: Considering the increasing attention to the use of nanotechnology in the diagnosis and treatment of various diseases, the possible adverse effects of such measures on human health and the environment need to be thoroughly evaluated. Moreover, the ethical issues rising from the possible future applications of nanotechnology should be clearly described.Ethics in nanomedicine refers to the ethical issues involved in the use of nanotechnology in medical research and development of diagnostic and therapeutic measures. It is a branch of bioethics, which can be categorized, in turn, under professional ethics. In the three studied countries, the main ethical considerations in nanomedicine can be classified into two major categories. The first group of concerns related to the nature, diversity, and unpredictable side effects of nanoparticles. The second group stemmed from the application of these materials can be summarized as:Due to the absence of a global standard or code of ethics in nanomedicine, developing a comprehensive ethical code would require an interdisciplinary study to identify the different aspects of ethical and social consequences of nanomedicine. This study provides an overview and summarized considerations of nanoethics in three studied countries. Our findings could be used as an overview as the first step to develop a national standard/guideline in Iran and also other countries more involved in nanomedicine.Although some new ethical aspects and different considerations are mentioned in nanomedicine area, but there is a high overlap between common ethical principles of medical ethics and nanoethics; therefore, it is a controversy about development of a new independent field or codes of nanoethics according to previous studies and an independent ethics principles for nanoethics is needed. However, more studies are needed for each country to consider its own context, nanotechnology situation, national needs, concerns, and national medical ethics codes before deciding to develop any national nanoethics codes or standards.Ethical issues  have been completely observed by the authors."}
{"text": "The Donald P. Kent Award is given annually to a member of the The Gerontological Society of America who best exemplifies the highest standards of professional leadership in gerontology through teaching, service, and interpretation of gerontology to the larger society. The Kent lecture will feature an address by the 2018 recipient, Lewis Lipsitz, MD, Hebrew Senior Life. The Robert W. Kleemeier Award is given annually to a member of The Gerontological Society of America in recognition for outstanding research in the field of gerontology. The Kleemeier lecture will feature an address by the 2018 recipient, Keith Whitfield, PhD, Wayne State University."}
{"text": "Vavilov's ideas formed a solid scientific basis for the long-term efforts on securing PGR in ex situ genebanks, both internationally and in Russia. The collection of seeds and living plants at the N.I. Vavilov All Russian Institute of Plant Genetic Resources (VIR) is one of the oldest in the world. The size of the collection increased from 301 accessions in 1901 to over 330,000 accessions in 2017, now representing 64 botanical families, 376 genera, and 2169 species. Acquisition was mainly focused on crops that are suitable for cultivation in Russia such as potatoes, barley, wheat, sorghum, beans, vegetables, forage species, and many others. For over a century, VIR has been providing the materials for breeding programs and research, which resulted in developing new cultivars with unique characteristics such as high yield combined with deceased resistance, improved storability, cold and drought tolerance, or ability to grow on deserts and polluted lands. The main field collection near St. Petersburg and 11 main branches across the country covering a wide spectrum of climatic conditions combined with modern seed storage, in vitro and cryobank facilities, and molecular laboratories form a solid platform for breeding, regeneration, and evaluation of accessions in the collection. This article gives a brief overview of VIR as the leading genebank and breeding center in Russia, its main activities in conservation and utilization of PGR for national food security and its role in developing national policies in this area.N.I. Vavilov was among the first scientists who recognized the high potential value of plant genetic resources (PGR) for humankind. In addition to his fundamental work on the centers of crop origin, he emphasized the importance of collection and  Ex situ collections of cultivated plants and their wild relatives are the basic components of food and environmental security of each sovereign country, including Russia. Their relevance and strategic importance have been recognized in the past decades due to enormous genetic erosion and worldwide extinction of crop varieties, species, and even genera. According to the Food and Agricultural Organization of the United Nations (FAO) (1998), 75% of the world's crop genetic diversity was lost in the 20th century. Moreover, the number and assortment of cultivated plants and their wild species have been significantly reduced. Only 30 agricultural crops provide for 95% of humankind's requirements in high-calorie plant-derived food, and 4 of them, rice, wheat, maize, and potatoes, cover more than 60% of our demand in energy and proteins.Contemporary losses of the diversity and a small number of crops used in production under the global and local climate changes present a serious threat to the entire worldwide community and aggravate the problem of food security. Therefore, in Russia as in many other countries, conservation and sustainable utilization of PGR have acquired national and strategic importance.ex situ is one of the oldest in the world. It was established in October 1894 as the Bureau of Applied Botany under the Scientific Committee at the Ministry of State Property of the Russian Empire. The Bureau gradually evolved into the N.I. Vavilov Institute of Plant Genetic Resources, or VIR, which became the national center of conservation, research, and utilization of PGR.The Russian collection of plant genetic resources (PGR) 2The present status of VIR's collection is the result of the collective efforts of several generations of world-renowned scientists and explorers. The central, and probably the most internationally acknowledged figure in VIR history is Nikolai Ivanovich Vavilov. He was among the first scientists who recognized the exceptional importance and potential value of collecting and preserving the genetic diversity of crop varieties and their wild relatives for humankind. He also laid the foundation for the national and global strategies in PGR conservation and sustainable utilization. Vavilov's theory of the centers of crop origin, his law of homologous series in hereditary variation, fundamental works on geographic distribution of genes, the role of source material in breeding practice, and other publications are internationally renowned. Science historians and Vavilov's biographers usually highlight two stages in his program development. The first stage (1917\u20131929) was mainly devoted to the collection and research of world genetic resources of staple crops and their wild relatives. The second stage (1929\u20131940) was mainly focused on a wide-scale scientific synthesis of the acquired knowledge and development of a theoretical basis of crop biology and breeding.3\u20135The active research and collection work commenced by Vavilov and his team was continued throughout 20th century, but only hampered by World Wars I and II. By 1901, VIR collection of PGR was composed of 301 accessions. In 2015, this number increased to 325,000 unique accessions . During The activities in monitoring, collecting, conservation, documentation, comprehensive study, and effective utilization of global PGR are ongoing and creatively developed on the basis of modern science and technology achievements, with due regard to new economic and political trends.in vitro (750 accessions), and in cryopreservation (1824 accessions). Being the fourth in the world in the number of the preserved accessions, VIR maintains probably the richest botanical, genetic, geographic, and ecological diversity of plant germplasm.The dynamic change of accession numbers in VIR collection during the past years is presented in in vitro or cryogenic storage  of major crops for targeted utilization in breeding programs. New effective alleles, rare ones or those earlier ignored by breeders, which determine photoperiodic sensitivity and response to vernalization, resistance to pathogens and other traits, were identified and mapped. Marking and molecular mapping quantitative trait loci allowed researchers to find, identify, and perform a controlled transfer of chromosome loci determining expression of economically useful traits such as resistance to biotic and abiotic stressors, quality, and productivity. Genetic diversity of accessions in the collection studied by conventional technologies and innovative molecular genetic approaches, including genomics, molecular marking, mapping, and bioinformatics, serves as a powerful base of valuable source material and an instrumental mechanism of effective breeding development. We believe that the diversity of the collection materials, provided that they are safely conserved and sustainably utilized, may promote breeding technologies and priority trends in the 21st century breeding, which are oriented toward the development of high-quality food, optimization of animal feed production, global climate change, \u201cnordification\u201d of crop production, development of novel agro-, bio-, food, chemical, and industrial technologies, biologization and ecologization of agriculture, and resource- and energy-saving policies.13As the national genetic resources center with over 120 years of history, VIR has been responsible for mobilization, conservation, evaluation, and utilization of PGR in Russia and involved in the development of relevant governmental programs and legal instruments. In addition to VIR collection, \u223c50,000 accessions of PGR are held by other organizations in Russia: research institutions, breeding centers, universities, botanical gardens, commercial plant breeding and seed production companies, and on farms. Over 1600 species of crop wild relatives occur in Russia within their natural populations\u2014they are potential carriers of alleles valuable for breeding. Many of them are now under the threat of extinction and require measures toward their safeguarding.The problems of PGR conservation in genebanks, within natural plant communities and on farms, and their sustainable utilization are listed among the five top priorities of national security in most of the world's countries, including Russia. These problems need to be solved both at national and international levels, because countries are not self-sufficient and depend on each other in the context of PGR. To find a successful solution to such problems, relevant international documents have been developed such as the Convention on Biological Diversity, 1992; Global Plan of Action for Plant Genetic Resources for Food and Agriculture, 1996, 2011; International Treaty on Plant Genetic Resources for Food and Agriculture, 2004; and Nagoya Protocol on Access to Genetic Resources, 2011. However, with new challenges of globalization and emergence of new technologies, climate change and rapid genetic erosion, profound modifications should be made in the national and international policies in the area of crop agricultural biodiversity conservation and utilization.The importance of VIR's collections and activities in providing solutions to plant breeding and production problems in Russia as well as their role in solving the problem of food supply has been emphasized at several international forums. The former minister of agriculture, E.B. Skrynnik, informed the delegates at the FAO World Summit on Food Security  that Russia is ready to make VIR's collection available for the worldwide community, considering possible climate changes and the common interest of all countries in the reduction of the starvation and poverty level in the world. However, Russia has not yet joined the International Treaty on Plant Genetic Resources for Food and Agriculture; hence, international distribution of accessions from VIR genebank has been accomplished based on bilateral agreements rather than SMTA.In 2006, VIR developed and proposed the draft of the National Program \u201cConservation and Sustainable Utilization of Crop Genetic Resources,\u201d which envisaged necessary budget funding for effective coordination of PGR activities at the national, regional, and international levels. Despite the first approval, the program was not funded or implemented. Later, genetic resources conservation was prioritized in the list of national programs, which was approved by the President and Government of the Russian Federation. Most recently, joint efforts of the Russian Ministry of Agriculture and VIR helped to develop and coordinate at the ministerial level of stakeholders the draft Federal Law \u201cConcerning Plant Genetic Resources for Agricultural Production,\u201d which will regulate the activities in the areas of collection, regeneration, storage, research, and sustainable utilization of PGR and their collection for agricultural production in the Russian Federation.ex situ and in situ conservation of genetic resources, development of fundamental and applied research in the area of agricultural biodiversity, avoiding duplication of activities, enhancement of valuable plant diversity mobilization possibilities, expansion of the national genetic diversity by targeted collecting missions over Russia and other countries, as well as through international germplasm exchange, and efficient and sustainable utilization of bioresources with the help of new technologies and scientific achievements.The main idea of the proposed National Program is to combine governmental and nongovernmental measures to create the most favorable environment for secure ex situ collections. It will also open the floor for further discussion and adoption of new international agreements, including the issues of access and benefit sharing as well as to implement large-scale and mutually beneficial international and regional cooperation, while observing the national interests.The National Program will support effective coordination of PGR-related activities within the country and help to establish solid partnerships between governmental and private institutions holding Thus, the proposed National Program on Genetic Resources of Cultivated Plants and Their Wild Relatives of the Russian Federation represents the basic instrument and main mechanism in achieving the goals of mobilization, conservation, and sustainable utilization of agricultural biodiversity components, as it would help to implement relevant activities at the national and international levels. The National Program will become an integral part of the National Strategy and National Plan of Action in the area of biodiversity conservation in the Russian Federation."}
{"text": "AbstractChondrichthyes that inhabit the Exclusive Economic Zone (EEZ) of Mexico. The list is based on a literature review of field-specific books, scientific publications and database information from collections and museums worldwide available online such as, the Ocean Biogeographic Information System (OBIS), Global Biodiversity Information Facility (GBIF), Encyclopedia of Life (EOL), iSpecies, FishBase and the National Biodiversity Information System (SNIB\u2013CONABIO). Information was cross-referenced with digital taxonomic systems such as the Catalog of Fishes of the California Academy of Sciences, the World Register of Marine Species (WoRMS), and the Integrated Taxonomic Information System (ITIS). There is a total of two subclasses two divisions, 13 orders, 44 families, 84 genera, and 217 species that represent approximately 18% of all living and described species of chondrichthyans worldwide. For the Mexican Pacific and the Gulf of California, 92 species of chondrichthyans are listed compared to 94 species for the Gulf of Mexico and the Caribbean Sea. Additionally, 31 species listed occur on both coasts of Mexico. The species richness of the Mexican chondrichthyans will surely continue to increase, due to the exploration of deep-water fishing areas in the EEZ.The checklist presented in this study includes the latest taxonomic and systematic modifications and updates (early 2018) for the  Chondrichthyes  inhabiting the waters of the maritime territory and the adjacent and oceanic zones of Mexico, (referred hereinafter as the Exclusive Economic Zone (EEZ)) has always been a difficult issue to address. The causes of the underestimation or overestimation of these species can be diverse  of the chimaeras, sharks, skates, and rays, living in the EEZ of Mexico.In Mexico, an updated inventory of the natural resources relevant to esources . SystemaEEZ were included. The selected taxocenoses were contrasted and compared with the biological stocks recorded in the Ichthyological Collection (IC) (http://coleccion.cicimar.ipn.mx/) of the Centro Interdisciplinario de Ciencias Marinas  from the coast  were consulted to select the species that were registered in the areas defined by the latter author see also  as north6, 2017 whe coast . This geEEZ. This database was cross-referenced with information available online from biological collections and museums worldwide. Global databases consulted included the Ocean Biogeographic Information System .Field-specific books were consulted e.g.,  for compn System , the Glon System , the Encn System , iSpecien System  and the Chondrichthyes taxa were verified using published references from online resources  such as the Catalog of Fishes of the California Academy of Sciences (https://goo.gl/S792vp), World Register of Marine Species (http://www.marinespecies.org/), Integrated Taxonomic Information System (https://www.itis.gov/), and Chondrichthyan Tree of Life (https://sharksrays.org/). Online database searches were carried out between June 22 and November 15 of 2017. The systematic arrangement , one infraclass (Elasmobranchii) with two divisions (Selachii and Batomorphi), 14 orders, 64 families, and 215 genera. The phylogeny includes one order, three families, six genera, and 49 species of chimaeras; nine orders, 34 families, 105 genera, and 517 species of sharks; and four orders, 27 families, 104 genera, and 646 species of skates and rays. For a comparison of the number of species of Chondrichthyes recognized worldwide between 2005 and 2015, see Table The detailed literature review involving the species of chimaeras, sharks, skates, and rays that currently exist worldwide includes 1,212 species . Taxa deChondrichthyes of Mexico may vary slightly within the recent literature , which is currently recognized in two families, Rhinobatidae . Herein, for the species mentioned, we follow the criteria for family allocation of https://sharksrays.org/).The dynamism (or uncertainty) of the classification of ae sensu  and Platae sensu , and in jiformes , Rhinobatiformes , Torpediniformes  and MyliChondrichthyes, in Mexico, there are no records of one family of Holocephali, the Plownose chimaeras, Callorhinchidae (distributed in the south of the American continent); neither for 11 families of sharks: Parascylliidae, Brachaeluridae, Orectolobidae, Hemiscylliidae, Stegostomatidae, Leptochariidae, Hemigaleidae, Pseudotriakidae, Pristiophoridae, Proscylliidae, and Mitsukurinidae ; and finally not for eight families of skates and rays: Glaucostegidae, Hexatrygonidae, Hypnidae, Rhinidae, Narkidae, Plesiobatidae, Urolophidae and Zanobatidae (none of which are distributed in the American continent).Finally, according to the worldwide species richness of Chondrichthyes worldwide, according to Euselachii subclass was the most representative in terms of species richness at 96.3%, while the Holocephali subclass was the least represented at only 3.7%. The chimaeras were represented in the Mexican EEZ exclusively by a single order (Chimaeriformes) with two families. Of these, Rhinochimaeridae was the best represented with two genera, while Hydrolagus (Chimaeridae) was the genus that had the largest number of species (five species). In terms of sharks, the Carcharhiniformes and Squaliformes orders were represented by six families each. Within Carcharhiniformes, the Carcharhinidae family contained seven genera, and Carcharhinus had 18 species resulting with the highest species diversity. Finally, for rays and skates, the order Myliobatiformes was represented by eight families, where the genera Pseudobatos (eight species), Mobula (seven species) and Urotrygon (seven species) were the most diverse at the species level. On the other hand, the family Rajidae (order Rajiformes) contained eight different genera with 27 species , for 123 species. These species belong to two subclasses , with 4.1% of the species (five species). Considering both coasts of Mexico, the species richness for this zone represents 49.59% of the total of Chondrichthyes currently recorded for the EEZ .For this area of the Mexican Chimaeriformes was represented by two families (Chimaeridae and Rhinochimaeridae) with two genera and five species, representing 62.5% of the chimaera species reported for Mexico (Table Harriotta (Rhinochimaeridae) were distributed exclusively on this basin of the Mexican EEZ.The order co Table . The twoCarcharhiniformes were the best represented with six families. Specifically, Carcharhinidae was the most taxonomically diverse with seven genera and 17 species. Of these species, eleven belong to the genus Carcharhinus. The Triakidae family includes three genera and seven species, which five species belonged to the genus Mustelus  contained the highest diversity of batomorph, with seven species  and the Witch guitarfish Z.xyster  are now members of the new family Trygonorrhinidae , the Spotted round ray Urobatismaculatus Garman, 1913 (Myliobatiformes: Urotrygonidae), the Cortez skate Beringrajacortezensis  (Rajiformes: Rajidae) and the Spiny guitarfish Pseudobatosspinosus  (Rhinopristiformes: Rhinobatidae). For the latter species, see the Discussion.In this area, the following species were identified as endemic: the Whitemargin smoothhound The Exclusive Economic Zone of the eastern slope of Mexico was represented by 94 chondrichthyans species that occur only in this area and 31 amphi-American species , belonging to two subclasses , two families, two genera, and three species that represent approximately 40% of the species recorded to date for the Mexican EEZ  had the highest number of genera with five genera, and the Carcharhinus genus had the highest species richness with 14 species , the Disparate angel shark Squatinaheteroptera Castro-Aguirre, Espinosa P\u00e9rez & Huidobro Campos, 2007 the Mexican angel shark S.mexicana Castro-Aguirre, Espinosa P\u00e9rez & Huidobro Campos, 2007 (Squatiniformes: Squatinidae) and one species of skate, the Yucatan skate Leucorajayucatanensis . However, see in Discussion about these Angel shark species.For the Gulf of Mexico and the Caribbean Sea there were three endemic species of sharks: Campeche catshark EEZ of Mexico. Sharks, 27 species, constituted approximately 87% of the total of species followed by four species of rays. Amphi-American chimaeras were not recorded.Thirty-one species of chondrichthyans were recorded on both oceanic basins of the Carcharhinus (Carcharhiniformes: Carcharhinidae) is the richest with seven species, the Bull shark C.leucas , the Oceanic whitetip shark C.longimanus , the Blacktip shark C.limbatus , the Silky shark C.falciformis , the Dusky shark C.obscurus , the Smalltail shark C.porosus  and the Bignose shark C.altimus . The hammerhead sharks of the Sphyrnidae family with distributions on both coasts are the Scalloped hammerhead Sphyrnalewini , the Great hammerhead S.mokarran , the Bonnethead S.tiburo  and the Smooth hammerhead S.zygaena .Among the sharks, the genus Pteroplatytrygonviolacea , the Chupare stingray Styracuraschmardae , the Giant manta Mobulabirostris  and the Common sawfish Pristispristis . The amphi \u2013 American distribution of the species Ginglymostomacirratum Bonnaterre, 1788 (Nurse shark) and Aetobatusnarinari  (the Spotted eagle ray) is not considered in the present study because of the reasons stated in the Discussion.In the case of the batomorphs, only four species are distributed on both coasts of the country, the Pelagic stingray Chondrichthyes inhabiting the EEZ of Mexico  makes it a megadiverse country for this group of species.The species richness of Mexican chimaeras, sharks, skates, and rays, when compared to other Latin American countries, is above the 165 species reported for Brazil ; the 117The total numbers of chondrichthyans fishes herein reported to the species, genus, family, and order levels in this study are 217, 84, 44, and 13, respectively. These numbers are similar to those reported for Mexico by EEZ of Mexico with 111 species (51%). These results are consistent with a previous study by aff. sp. or species herein recognized as synonyms ; Centrophorusniaukang Teng, 1959) or subspecies ).Sharks, in general, are the group with the highest diversity of species in the EEZ of Mexico. This figure is very similar to that reported by Gymnuracrebripunctata , the Lessa\u00b4s butterfly ray Gymnuralessae Yokota & De Carvalho, 2017 (see below), the Brazilian cownose ray Rhinopterabrasiliensis M\u00fcller, 1836, the Fake round ray Urotrygonsimulatrix Miyake & McEachran, 1988, and the Pacific guitarfish Pseudobatosplaniceps   of the total living species of the escribed , it is nescribed , and a gescribed .Trygonorrhinidae and Aetobatidae, respectively) are represented within the EEZ of Mexico, with the records of the species of guitarfish Zapteryxexasperata and Z.xyster (Rhinopristiformes: Trygonorrhinidae) for the coasts of the Pacific Ocean and the Eagle rays Aetobatusnarinari and A.laticeps  (Myliobatiformes: Aetobatidae) for the Atlantic and Pacific Oceans, respectively. Recently, the existence of genetic and morphometric variability in a latitudinal gradient for the guitar species of the Zapteryx genus has been identified and should be studied in more detail  is exclusive to the western Mexican seas of the Mexican EEZ except for three records from Costa Rica. We considered that these latter records are misidentification or a data capture error in the computer platforms previously mentioned. Thus, in the study conducted by According to the information in Myliobatiscalifornica  (Myliobatiformes: Myliobatidae), a situation similar to that previously reported for U.concentricus occurred, because GBIF platform, which would corroborate this hypothesis with the one record of this species in the Gulf of Mexico.In the case of the Bat ray Pseudobatosspinosus  (Rhinopristiformes: Rhinobatidae) had a single record in the databases consulted . Another possibility that has been cited for this record is that it may be a juvenile specimen of another Rhinobatidae species  and the Mexican angel shark (S.mexicana) (both referred as endemic species from the east coast of Mexico), recently Squatinadumeril Lesueur, 1818. Despite the fact that those authors came to the same preliminary conclusion, in this manuscript each Squatina species mentioned, are retained as valid species. Nevertheless, it is highly recommended to do further investigation to demonstrate its taxonomic validity. Such as the Spiny guitarfish, these two species are marked in the checklist with a question mark .For the Disparate angel Shark  and as endemic to this region, excluding the presence of G.cirratum for the Pacific Ocean , considered as an amphi-American species (in fact cosmopolitan species). Currently, based on DNA sequences  and the Pacific chupare ray S.pacifica  were removed from Himantura in Dasyatidae  and the Giant oceanic manta ray M.birostris  within the genus Mobula  as synonymous with the Devil fish M.mobular , are considered by some specialists as a taxonomic decision subject to discussion .The recent taxonomic relocation of the two species of the genus bula see , and theGymnuridae) has limited the distribution of the Smooth butterfly ray Gymnuramicrura  to the southwestern Atlantic and the new species the Lessa\u00b4s butterfly ray Gymnuralessae Yokota & De Carvalho, 2017 occurring in the Gulf of Mexico, north, and central western Atlantic, substituting G.micrura records in that area , the future of the biological classification of ss sensu . Due to ss sensu .Sphyrnidae) from the Gulf of Mexico and the Caribbean Sea. Another study conducted by Mobula (sensu lato Manta, see Rhinopterasteindachneri Evermann & Jenkins, 1891, of the Gulf of California (see also Urotrygon spp. in the southern Gulf of California by the present authors, what could result in the description of new species in the EEZ of Mexico.As a corollary to the above, recently published works or studies in progress can be cited. Thus, see also  is curre"}
{"text": "RND) have a significant prevalence among rare diseases, the European Academy of Neurology (EAN) has diversified its efforts to provide patients with a better access to high-quality and safe care, increased European cooperation in the field of high-quality healthcare, exchanges of positive experiences, in order to improve the diagnosis and treatment needed, and prompt dissemination of research results, by creating centers and thus contributing to the development, evaluation and popularization of medical research.In the past decades, diagnosis and treatment of rare diseases has been and still is a priority of scientific research in the health care field. The high prevalence of these diseases and the very high typological diversity has affected millions of people in the whole world. The specialists in the field have identified over 30 million cases only in the European Union and over a million cases in our country, and, unfortunately, for most of them, they were not able to identify the appropriate treatment. This does not mean that the specialists in the field have given up, but it translates into an intensification of conjoined efforts. As rare neurological diseases (EAN) together with \u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy in Cluj-Napoca, RoNeuro Institute for Neurological Research and Diagnosis, Society for the Study of Neuroprotection and Neuroplasticity, Romanian Society of Neurology and the Academy of Medical Sciences organized the First International Teaching Course for Rare Neurologic Diseases.In this context, in 2017, the European Academy of Neurology (EAN) Task Force meeting, dedicated to rare neurologic diseases, the second meeting took place in Cluj Napoca, at the initiative and with the concrete and effective support of Prof. Dafin Fior Muresanu.At the end of last year, as a natural consequence of the outstanding achievement of the First edition of the European Academy of Neurology (nd European Academy of Neurology (EAN) Task Force meeting and the Rare Neurologic Diseases International Teaching Course has been an ideal framework for discussion, presentation of the efforts made in the diagnosis and treatment of rare neurologic diseases, highlighting the results of individual research, and identifying new approaches.Particularly well received and appreciated, the 2Unfortunately, in neurology and not only, malignancy has an undesirably high frequency, and, although great progress has been made, the correct identification of the causes and the establishment of a proper diagnosis and appropriate treatment require extremely long periods of time and the prospect does not seem sure yet.Prestigious representatives in the European neurology field from Switzerland, Great Britain, Germany, Italy, Belgium, Holland, Finland, Hungary and Romania have participated and the event took place in the generous halls of Grand Hotel Italia, in Cluj-Napoca, generating a wide debate on the evolution of rare neurologic diseases, their diagnosis and treatment, the discovery of new such conditions considered rare, but also the development of special patient records.EAN); Position of rare neurologic diseases and of rare neuromuscular diseases (RNM) in the European Reference Network, small vessels disease (SVD), Huntington\u2019s chorea and Chorea-Acathocytosis, limb-girdle muscular dystrophy, inherited peripheral neuropathies, metabolic neuropathies, epilepsy, FSH, spastic paraparesis, dystonias, Mineral and Metal accumulation into the brain, Late onset Metabolic leukoencephalopathies, Optic neuropathies and CTX, the diagnosis improvement methods in rare neurologic diseases, etc.The event was opened by his Excellency, Emil Boc, General Mayor of Cluj Napoca, and consisted of high interest subjects: Diagnosis and specific care of patients with rare neurologic diseases and the role of the European Academy of Neurology , Professor of Neurology, Chairman Department of Neurosciences \u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy, Cluj-Napoca, Romania, Chairman \u201cRoNeuro\u201d Institute for Neurological Research and Diagnostic, and President of the Society for the Study of Neuroprotection and Neuroplasticity (SSNN).The meeting also included a round table on current therapeutic opportunities for rare neurologic diseases, attended by all speakers, coordinated by EAN) are perfectly justified given that rare neurologic diseases are often underdiagnosed and do not always benefit from efficient treatment. They integrate in the overall efforts to raise awareness and continually improve knowledge in the field, to identify an early diagnosis and special research programs that lead to useful therapies.The efforts of the European Academy of Neurology (The European Academy of Neurology (EAN) joins global collaborative efforts to develop the \u201cso-called orphan drugs\u201d, although in the health industry field, has had many notable successes and recent findings in the genetic fields and biotechnology have forced researchers understand and treat diseases at the molecular level. Information technology is now increasingly included in all health fields and, as stated before, it is necessary that data from different sources, such as laboratory tests, genetic tests, medical images, family history and the patient\u2019s medical record, are easy to store, integrate and analyze.EAN) have resulted in the joint message sent, highlighting the necessity that the results of the research and the accumulated knowledge should be properly shared and integrated in the context of connecting patients, healthcare providers and health institutions, quickly and efficiently, in the interest of the sole beneficiary: the patient.The increasing convergence of medical science with information technology generates significant research results with an impact on life, but, although there are promising scientific and medical technologies, which can be applied, there are still major implementation difficulties. That is why the efforts of the European Academy of Neurology ("}
{"text": "Dr. Hodes will provide an overview of the latest research in basic biology, neuroscience, behavioral and social science, and geriatrics and clinical gerontology supported by the NIA."}
{"text": "The fundamental goal of WOE was to determine whether and how autobiography production can enhance and provide valuable data about African American seniors\u2019 mental health, past and present. The second goal of WOE was to determine whether and how project partners could use the findings from WOE, particularly those about resilience and strategies for coping with challenging situations, as the basis for new interventions, studies, publications, curricula, and educational programs for learners across contexts, generations, levels, and disciplines. Outcomes are illustrated by rich examples of the genesis, history, products and pedagogy of the project."}
{"text": "Policymakers, practitioners, and researchers need a balanced, thoughtful, and analytical resource to meet the challenge of global aging at a rate that\u2019s historically unprecedented. The Journal of Aging & Social Policy (JASP), which was founded in 1989, serves this role by drawing contributions from an international panel of policy analysts and scholars who assume an interdisciplinary perspective in examining and analyzing critical phenomena that affect aging and the development and implementation of programs for elders from a global perspective. Study settings extend beyond the United States to include Europe, the Middle East, Australia, Latin America, Asia, and the Asia-Pacific rim. This presentation will document the scope, content, and focus of JASP, including the rise of international submissions, which now account for approximately half of articles published. Opportunities for publishing in JASP will be discussed; so too will strategies for navigating the peer-review process successfully."}
{"text": "With the characteristics of low cost and open call, crowdsourcing has been widely adopted in many fields, particularly to support the use of surveys, data processing, and the monitoring of public health. The objective of the current study is to analyze the applications, hotspots, and emerging trends of crowdsourcing in the field of public health. Using CiteSpace for the visualization of scientific maps, this study explores the analysis of time-scope, countries and institutions, authors, published journals, keywords, co-references, and citation clusters. The results show that the United States is the country with the most publications regarding crowdsourcing applications for public health. Howe and Brabham are the two leading authors in this field. Further, most of the articles published in this field are found in medical and comprehensive journals. Crowdsourcing in public health is increasing and diversifying. The results of this study will enable and support the analysis of the specific role of crowdsourcing in the public health ecosystem. Crowdsourcing was first definitized by Jeff Howe in 2006, to represent the act of organizations outsourcing their tasks to an undefined and large group of people . BrabhamThe Internet has greatly reduced the cost of information transfer and the boundaries of participating activities. In this context, the concept of health 2.0 has been proposed with the practice of crowdsourcing in the field of health communication . Every hIn recent years, the involvement of crowdsourcing in hygiene and health has been of scholarly interest. Perrine et al. summarized that different types of crowdsourcing projects can be adopted in health promotion, research, and care . Maged eWith 4.02 billion Internet users and 5.14 billion unique mobile subscribers , online Based on the above analysis, we can illustrate the relations and the process of crowdsourcing applications for public health, as shown in Most of the previous studies have only conducted experiments to explore the function of crowdsourcing in the specific field of public health, such as improving public awareness of sexual health, obtaining solutions to medical problems, and collecting medical big data, etc. Limited studies have been published related to a systematic review or overview of crowdsourcing for public health. Among them, some studies extracted data from reports via PubMed, EMBASE, and Google, but no research has utilized the Web of Science (\u201cWOS\u201d) database. The systematic review by Ranard et al. illustrated the scope of crowdsourcing in health and medical research, but only contained 21 studies . The narThis study may contribute to existing research from three aspects. First, this study is the first bibliometrics analysis of crowdsourcing applications for public health using CiteSpace software. We use bibliometric analysis to provide a new insight that was not conducted comprehensively in previous studies. Second, we offer a better understanding of the emerging trends of the adoption of crowdsourcing in the field of public health, through summarizing the role of crowdsourcing in public health. Third, the analytical framework and the results concluded in this study will provide research basis and directions for future bibliometric analysis in public health ecosystem. As this study explores the general application of crowdsourcing in public health, it could serve as a sound foundation for future research that focuses on the specific roles of crowdsourcing in concrete tasks, e.g., surveying, data processing, monitoring, etc.The rest of this study is organized as follows. In 1955 Garfield proposed an approach for searching scientific literature with citation indexes and, since then, citation analysis has gradually become an important research method in the field of scientific metrology . PritchaWe retrieved data from the core collection database of Web of Science (WOS), limiting search to the Science Citation Index (SCI), Social Science Citation Index (SSCI), Conference Proceedings Citation Index- Science (CPCI-S), and Conference Proceedings Citation Index-Social Science & Humanities (CPCI-SSH) ,39. ThisTwo tools were used in the analysis, namely (A) CiteSpace V and (B) Excel 2016. (A) CiteSpace V software was used to conduct visualization and knowledge graph analysis in this study. CiteSpace V is a visual analysis tool developed by Professor Chaomei Chen  based on the JAVA platform, which can realize co-citation analysis, keyword co-occurrence analysis, and collaborative analysis of institutional authors, etc. ,41. CompCiteSpace V with version 5.2.R 2.3.26.2018 for 64-bit windows was used in this study. In the time slicing, the time span was from 2006 to 2019 and the years slice was set as 1. In the text processing, we chose all term source, including title, abstract, author keywords and keywords plus . In addiCitespace V can use annual rings to display the number of papers published by countries, cooperation and centrality. The size of the annual rings serves as the quantity of posts, and the outermost purple circle shows the centrality . We seleThe map in As shown in The author collaboration network of crowdsourcing research was described in J AM MED INFORM ASSN (46). Many papers published on medical journals represent that crowdsourcing has been used as an advanced tool in public health research field. In addition, \u2018Nature\u2019 and \u2018Science\u2019 are comprehensive top-level journals that provide research frontiers and hotspots and build knowledge base for medical, biological, economics, management, and psychology in the field of public health research.The table below illustrates the 11 most journals from the entire 502 of journals according to crowdsourcing applied in public health, as seen in When identifying core journals in a research field, the number of posts is not the only indicator, and the centrality and cited frequency are equally important. The keywords reflect the core and focus of a paper. The top 10 keywords on crowdsourcing applications in public health are listed in Based on co-cited references, CiteSpace V can generate a research evolution graph to display the development of crowdsourcing applications in public health with a time zone version. We selected cited references as the network node and adopted the path search algorithm (pathfinder) to analyze . TherefoThe key research references can reflect the development of crowdsourcing as applied to public health., and the main findings are as follows:In 2011, Behrend used crowdsourcing to collect survey data for behavioral research. The authors present that the application of crowdsourcing is an efficient and appropriate alternative to university participant pools . This paIn 2012, Swan pointed out that contemporary public health faces challenges, including rising costs, worsening outcomes, \u2018diabesity\u2019 epidemics, and an expected shortage of doctors. Crowdsourcing will be an effective tool to collect health big data and to realize the vision of preventive medicine by 2050 .In 2014, Brabham argued that crowdsourcing has the potential to be a method for improving public health science. Crowdsourcing offers several effective ways toward improving health behaviors through participant engagement online, such as the knowledge discovery and management, the distributed human intelligence projects, the broadcast search and the peer-vetted creative production methods . MeanwhiIn 2015, Zhang used crowdsourcing contests to shape a \u201cbottom-up\u201d approach and described two creative contributory contests (CCC) to enhance sexual health campaigns . This stIn 2016, Chandler summarized the MTurk\u2019s (an online crowdsourcing platform) data quality with an emphasis on results related to clinical psychological research. MTurk is a fast and cost-effective approach to collect nonprobability cases that are more diverse than those commonly adopted by psychologists .In 2018, Cr\u00e9quit mapped the diverse adoptions of crowdsourcing in the field of health to assess the health areas that are using crowdsourcing and the crowdsourcing projects used. The application of crowdsourcing is growing in health promotion, exploration, and care. However, the definition of crowdsourcing logistics and crowdsourcing participants\u2019 characteristics is often lacking in research reports .Overall, crowdsourcing has been widely used to collect data, make surveys, solve problems and monitor. Since 2012, crowdsourcing has gained important attention in the field of public health. Many scholars have begun to study the functions of crowdsourcing in personal care, biological agents, sexual health communication, etc. Furthermore, the Amazon Mturk is the most used platform, and data processing is the main type of crowdsourcing in this field. Crowdsourcing contests are an efficient and responsible way for scientists to conduct medical experiment, and to improve the awareness of public health. In addition, we find several research gaps, such as the ethical problems when applying crowdsourcing in public health, characteristics of participants in the crowdsourcing process, the effectiveness of crowdsourcing without the Internet, etc.The title words and keywords can reflect the research focus of publications. Therefore, through the co-occurrence analysis of the title words and keywords, we can explore research hotspots and frontiers in the scientific field. The clusters of keywords and references (extracting title terms) are shown in In Given these results, we can summarize the publication types, application technology, research domains, and distribution. Firstly, the main type of publications is review. It means that many scholars conduct systematic review to describe the applications of crowdsourcing in public health. Next, the Amazon Mturk is the most used platform. In recent years, social media and mobile applications have become new tools to offer health advisory and collect information. Then, with the development of global health, crowdsourcing applications have spread to many regions, especially in China and the United States. Further, the potential of crowdsourcing applications for public health includes surveillance or monitoring, information extraction, design, etc. Finally, research subjects contain stroke, non-smokers, clinical trials, diabetic retinopathy, and health anxiety, however, participants\u2019 characteristics are poorly reported.From a multi-dimensional, time and dynamic perspective, we use CiteSpace V to analyze the development trends and hotspots of crowdsourcing as applied to public health. This study has shown that crowdsourcing is a relevant topic, particularly in recent years and in the field of public health. As we know, this paper is the first bibliometrics analysis of crowdsourcing applications for public health using CiteSpace software. The results in this study contribute from several aspects to our current understanding.First, with regard to the scope of time and space, the amount of crowdsourcing literature has grown sharply, and the application of crowdsourcing has spread to many domains, especially in public health and health communication. At present, the United States occupies a leading position in the domain of crowdsourcing research for public health, followed by England and China. Scholars from the Guangdong Provincial Center for Disease Control and Prevention cooperate with American universities to apply crowdsourcing in sexual health communication and HIV prevention. They are the first research team that have made outstanding contributions to the application of crowdsourcing in the field of public health in China.Second, according to co-authors and types of journals, Howe and Brabham are the two core authors in this field. The World Health Organization has also pointed out the effectiveness of crowdsourcing in some reports. In addition, the results of research on crowdsourcing applications for public health are mainly published in medical and comprehensive journals. Medical journals include the \u2018Journal of Medical Internet Research\u2019, \u2018Lancet\u2019, and \u2018American Journal of Public Health\u2019, etc.\u2014comprehensive journals contain \u2018Nature\u2019, \u2018Science\u2019, and \u2018PloS One\u2019, etc.Third, through co-citation analysis, the use of crowdsourcing in public health is increasing, particularly in preventive medicine, mental health, and personalized prevention, etc. The specific applications of crowdsourcing contain data processing, surveying, surveillance, and problem-solving. Further, the crowdsourcing model not only promotes the application of healthy big data and the construction of intelligent health platform but also pushes the online process of social medical crowdsourcing.Finally, crowdsourcing research in this field focuses on four knowledge domains, namely crowdsourcing as a medium for Internet public health communication, the application of crowdsourcing in the field of prevention and treatment, the role of crowdsourcing in the public health care ecosystem, and applied research of crowdsourcing competitions in infectious diseases and epidemiology. In addition, there are several future research directions to discuss. The first one is the application of other databases for bibliometric analysis, such as Google Scholar, which contains citations available in sources other than the WOS. Second, the WHO emphasize the importance of crowdsourcing competitions to improving public health. Hence, future studies can evaluate the role of crowdsourcing competitions/contests in public health development. Final, future research can consider ethical concerns because personal data and diagnostic results may be shared in the process of crowdsourcing. Our study has some limitations. On the one hand, we did not search the gray literature to identify some unpublished studies. On the other hand, we only consider online crowdsourcing, not including research without the Internet. Therefore, we may underestimate the number of studies adopting crowdsourcing in public health."}
{"text": "In-situ snow measurements conducted by European institutions for operational, research, and energy business applications were surveyed in the framework of the European Cooperation in Science and Technology (COST) Action ES1404, called \u201cA European network for a harmonised monitoring of snow for the benefit of climate change scenarios, hydrology, and numerical weather prediction\u201d. Here we present the results of this survey, which was answered by 125 participants from 99 operational and research institutions, belonging to 38 European countries. The typologies of environments where the snow measurements are performed range from mountain to low elevated plains, including forests, bogs, tundra, urban areas, glaciers, lake ice, and sea ice. Of the respondents, 93% measure snow macrophysical parameters, such as snow presence, snow depth (HS), snow water equivalent (SWE), and snow density. These describe the bulk characteristics of the whole snowpack or of a snow layer, and they are the primary snow properties that are needed for most operational applications . In most cases, these measurements are done with manual methods, although for snow presence, HS, and SWE, automatized methods are also applied by some respondents. Parameters characterizing precipitating and suspended snow , some of which are crucial for the operational services, are measured by 74% of the respondents. Parameters characterizing the snow microstructural properties , the snow electromagnetic properties , and the snow composition (such as impurities and isotopes) are measured by 41%, 26%, and 13% of the respondents, respectively, mostly for research applications. The results of this survey are discussed from the perspective of the need of enhancing the efficiency and coverage of the in-situ observational network applying automatic and cheap measurement methods. Moreover, recommendations for the enhancement and harmonization of the observational network and measurement practices are provided.  Snow is considered the largest gap in the current knowledge of the global water budget . It is aThe advances in the modelling of the snow-electromagnetic interaction e.g., ,8,9,10) ,9,10 8,9Indeed, while the International Classification for Seasonal Snow on the Ground  providesIn order to fill this gap and harmonize the snow monitoring procedure, the European Cooperation in Science and Technology (COST) promoted the Action ES1404 called \u201cHarmosnow\u201d . The aim of the action is to coordinate the effort of harmonizing the snow monitoring practices, by promoting new observing strategies, bringing together different communities, facilitating data transfer, upgrading and enlarging knowledge through networking, exchange and training, and linking them to activities in international agencies and global networks. One of the first activities of Harmosnow was to carry out a survey to obtain an updated picture of the existing variety of snow measurement practices and instrumentations in use by the European institutions. The survey collected a compilation of the measured snow properties and associated measurement techniques that are applied by the participating European countries for a large variety of applications. This paper aims to summarize the results of this survey, providing an overview on the European snow measurements that are carried out for a large variety of applications. Synthesis from the overview enables us to draw recommendations on the best measurement practices and on strategies to increase the effectiveness and the extension of the snow monitoring network.A survey on the measured snow properties and applied instrumentation was carried out among the European institutions through a questionnaire that was designed with the contribution of several partners of Harmosnow with experience on snow observations. The questionnaire only addressed general information, as each respondent was asked to fill it in just once.To get unambiguous answers, despite the absence of standard terminology for many snow properties, and even more importantly for devices or techniques, most of the questions were formulated as multiple choices. This required an investigation on the existing measurable snow properties and measurement instruments. Snow properties were grouped into five categories: snow macrophysical properties, snow microphysical properties, snow electromagnetic properties, precipitating and suspended snow, and snow composition. The measurable parameters that were associated to the snow macrophysical properties, microphysical properties, electromagnetic properties, solid precipitation and snow composition, as well as the existing instruments to measure them, are listed and defined in Snow macrophysical properties describe the bulk characteristics of the whole snowpack or of a snow layer. Some of them, such as snow presence, snow depth (HS), and SWE, are the most important input information for hydrological and numerical weather prediction models, and therefore, they have the most established and wide spread observational network. Others  are mostly measured for snow avalanche forecast, thus in mountain regions only.Snow microphysical properties describe the characteristics of the snow microstructure, such as snow grain shape, snow specific surface area, snow correlation length, etc. . In thehttp://globalcryospherewatch.org/about/about_solidprecip.html). The amount of precipitation is an essential input for all of the models that simulate the snow cover and produce forecasts of weather, avalanches, melt water amount, and floods. Drifting and blowing snow is horizontally transported by the wind through saltation  )The survey on the practices and purposes of the European in-situ snow measurements, carried out in the framework of Harmosnow, enabled the collection of a compilation of the state-of-the-art of in-situ snow operational and research-based snow measurements conducted by the European countries, in a time when new technological solutions are tested and developed. As such, it constitutes the basis for the upgrade and harmonization of the in-situ observation methods, which is one of the main goals of Harmosnow, and for the enlargement of the communities that applied automatized measurements for operational monitoring and frontier techniques for research purposes. The mapping of snow monitoring in Europe obtained through this survey is the needed pre-requisite for the identification of observational gaps and the planning of future long-term snow measurement strategies. Although the snow operational monitoring largely relies on satellite-based observations, in-situ measurements are an essential component of it, as both satellite and ground-based observations are applied in the snow assimilation schemes e.g., ,55,56). ,56. 55,5These results are relevant for the planning of snow observation infrastructures and monitoring programs, as well as for the scientific community\u2014the specialists in specific applications who are familiar with a certain set of snow properties, will generally benefit from knowing the measurement practices that are applied by different communities and in different environments. The measurement practices that are developed on the basis of the knowledge acquired in local institutions and for targeting specific environments will get visibility among a wider audience, eventually broadening their applicability also in other contexts. Moreover, snow properties that are measured for certain purposes may be very relevant for other applications too. Indeed, this work is in line with the recommendation of sharing and comparing techniques between the snow monitoring teams provided by the recent review on the changing Arctic snow cover , which hThe effort spent to send the survey to as many institutions as possible, and the difficulties encountered in order to identify the key responsible persons for snow measurements, evidenced that a much better intra-national collaboration and knowledge-exchange of snow measurement activities is necessary in Europe. The current fragmentation and peculiarities represent a major bottle neck for the necessary harmonization of snow measurements practices in Europe."}
{"text": "This year our conference is twenty-two years old \u2013 its parents proudly boast! Looking back to the first conference, also in Split, one cannot but be grateful that the initial idea took hold and gave the conference its current specific flavor -4. SomewCroatian Medical Journal offer a particularly rich program. The 11th conference will feature some seventy lecturers from institutions that include Mayo Clinic, Harvard Medical School, Columbia University, Memorial Sloan Kettering Cancer Center, University of Pennsylvania, Massachusetts Institute of Technology, Princeton University, Duke University, Max-Planck-Institute, Case Western Reserve University, Pennsylvania State University, The Wistar Institute, George Washington University, Erasmus University Medical Center Rotterdam, Seoul National University College of Medicine, University of New Haven, Nanchang University, and others. More then five hundred participants from more than forty countries will discuss cutting-edge topics in personalized medicine, forensic genetics, and molecular anthropology.This year\u2019s conference and this issue of the It is not out of character for the conference, always with a strong graduate education intent, to open with preconference events. These are, concurrently, the 7th Croatian Congress of Human Genetics  and the Mayo Clinic Short Course on Epigenomics. The conference closes with the short course entitled \u201cInvestigation and Forensic Analysis of Fire and Explosion\u201d given by the forensic science legend Henry Lee. The educational impact is strengthened by the participation of Nobel Prize laureates Ada Yonath, Avram Hershko, Robert Huber, and Paul Modrich; they share not just their seminal scientific contributions, but also personal experience in science and life.www.isabs.net). This year, the American Academy of Forensic Sciences and ISABS jointly organize an interdisciplinary session underlining the importance of proper interpretation of scientific data in court. In addition, the future of personalized medicine is the topic both of the ISABS/Regiomed Kliniken/University of Split joint session and of the Philips Personalized Medicine Session, while St. Catherine Hospital and OneOme, the entity co-founded by Mayo Clinic, will demonstrate the importance of actionable pharmacogenetic testing to increase access to pharmacogenetic testing in Europe.The five-day conference continues the tradition of working in the plenum. Avoiding parallel sessions is in keeping with the idea that the three areas of focus merge. The merger has become evident not only through the employment of analogous or identical genetic and (epi)genomic techniques, but also by sessions and lectures that reach across these disciplines. For the full program, the reader is referred to the ISABS Conferences webpage , studies in regenerative medicine , a genetic analysis of CFTR gene demonstrating the presence of del. F508 mutation and a rare combining deletion and insertion mutation p. Tyr109Glyfs in a patient with cystic fibrosis, and a case report that highlights the potential of pharmacogenomics in therapeutic decision-making while using tyrosine kinase activity inhibitors in patients with chronic myeloid leukemia.This issue of the We are truly indebted to program directors: Manfred Kayser  and Tam\u00e1s \u00d6rd\u00f6g  for providing the cutting-edge and fresh program this year again. Collaboration with Mayo Clinic for more than sixteen years, with the American Academy of Forensic Sciences, and others has never been stronger, leading to the ever increasing depth and breadth of the program.Without the support and commitment of sponsors ISABS 2019 would not be possible. Particularly we thank the Croatian Tourist Board; Croatian Ministries of Tourism, Health, Science and Education as well as that of Economy, Entrepreneurship and Crafts of the Republic of Croatia; Croatian Chamber of Economy; City of Split; County of Split and Dalmatia; Municipality of Podstrana; City of Solin; Privredna banka (Bank of Commerce) Zagreb; Belupo Pharmaceuticals; Podravka Foods; Arona Hospital; Auto Benussi; OneOme LLC; Hrvatska po\u0161ta ; Ballograf AB; Gra\u0111a d.d., and Bauerfeind d.o.o; and Philips as the strategic partner of ISABS. Traditionally, the conference is held under the auspices of the Croatian Academy of Arts and Sciences and in partnership with the Croatian Medical Chamber."}
{"text": "The biological and physiological functions of each food matrix derive from the concerted action of nutrient components and biologically active compounds. Beyond basic nutrition, the dietary components possess beneficial roles, that leads to the advancement of perception of food as functional and nutraceutical. In this Research Topic, new features of nutrients were considered and the boundaries between nutrients and bioactive compounds were explored.The monitoring of the distribution of compound classes in food groups and at different stages of the food chain was considered. Particular attention was given to the categorization of the effects of different processes, storage methods, technologies, packaging systems, etc.; in this regard conventional and innovative methods as well as multi-aspects and factors were taken into consideration.Khoo et al. described characterized Canarium odontophyllum fat extracted using supercritical carbon dioxide, with focus on fatty acid profile.As instance, Evidence of the benefits/risks of nutrients and bioactive compounds were included, taking into account the challenge of, and need for, new biomarkers and innovative assessment methodologies. The new role of nutrition based on a multi-factors approach were also considered.Norwitz et al. on the D-\u03b2-Hydroxybutyrate and its mechanism of action in the multiple cellular pathologies of Parkinson's disease. Another example is given by K\u00fchn et al. on modulation on desaturase expression and fatty acid composition of cultured hepatocytes by resveratrol. It is well-known that there is an increase of number of factors, affecting the content in bioactive components, in line with the new characteristics of food chain.In this regards it is worth mentioning the review of At the same time, the understanding of activities and benefits of nutrients and bioactive compounds in humans is essential. Another focal point in this Research Topic was the uses and applications of bioactive components in the great range of fields, with particular regards nutraceuticals ones \u20133. SeverSekhon-Loodu and Rupasinghe have given a snapshot of beneficial properties of some traditional medicinal plants, with focus on antioxidant, anti-diabetic, and anti-obesity potential. Also Boudreau et al. identified compounds with novel adipogenic bioactivity in distinct fractions of an Artemisia scoparia extract. On the other hand, Nguyen et al. characterized a probiotic beverage from pineapple juice fermented with Lactobacillus and Bifidobacterium strains.As instance, Kumar gives an overview of current status of peptides and peptidomimetics as potential anti-obesity agents.Moreover, innovative applications of bioactive compounds in a technological scenario and nutritional needs, i.e., omics technologies, nanotechnologies, imaging techniques, chemometrics, mobile-based technologies were discussed. As instance, All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "Materials, focuses, mainly, on the applications and key processing aspects of materials, collecting a set of 48 original papers focused on the field of manufacturing engineering and materials processing.Research in the field of materials is very broad, ranging from studies on the structure and properties at the atomic or molecular level to the most complex or sophisticated applications that can be done with them, as well as studies about other aspects related to their processing, use or management. The Special Issue of the Manufacturing Engineering Society (MES), published in the Section \u201cManufacturing Processes and Systems\u201d of the journal  Materials, was born as an initiative from the Manufacturing Engineering Society of Spain, with the aim to spread outstanding works in which the latest cutting-edge advances in the field of manufacturing engineering and materials processing have been presented.The Special Issue of the Manufacturing Engineering Society (MES), published in the Section \u201cManufacturing Processes and Systems\u201d of the journal This Special Issue explored the evolution of traditional manufacturing models towards the new requirements of the Manufacturing Industry 4.0; publishing, finally, 48 papers (47 research papers and one concept paper) in the main topics covered by this Special Issue, concretely in: additive manufacturing and 3D printing; advances and innovations in manufacturing processes; manufacturing systems: machines, equipment and tooling, metrology and quality in manufacturing; product lifecycle management (PLM) technologies; and manufacturing engineering and society. Likewise, in some of them, without being the main or most outstanding subjects of the work, the following topics have been also addressed: sustainable and green manufacturing; manufacturing of new materials; manufacturing automation; design, modeling and simulation in manufacturing engineering; and production planning.Contributions on emerging methods and technologies, such as those related to additive manufacturing and 3D printing ,12,13,14The number of contributions in the \u201cadvances and innovations in manufacturing processes\u201d field has been very remarkable as well, where outstanding works have been presented in the following areas: machining ,22,23,24No less important, as a whole, are the works on: manufacturing systems: machines, equipment and tooling ,40,41,42The Special Issue has been an excellent means of exposing some of the main current lines of research of members and collaborators of the MES, promoting the internationalization of their results and the presence of the MES itself in the international scientific-technical landscape, widely fulfilling the aims initially proposed.Materials; particularly topics related to the processing of materials.It is remarkable how many readings and downloads of papers belonging to this Special Issue have been done, after only three months since the publication of the first work, showing the great interest that all these topics arouse in readers of the journal We want this Special Issue to serve as a posthumous tribute to our colleague and friend Mariano Marcos B\u00e1rcena, who participated very actively in the genesis of this thrilling project, and whose contribution to manufacturing engineering is present in this Special Issue, both explicitly, in a concrete work, and implicitly, in several papers by his research group from the University of Cadiz who have kept working on the investigation lines promoted by him."}
{"text": "The Joseph T. Freeman Award is a lectureship in geriatrics awarded to a prominent physician in the field of aging, both in research and practice. The award was established in 1977 through a bequest from a patient\u2019s estate as a tribute to Dr. Joseph T. Freeman. The Joseph T. Freeman Award lecture will feature an address by the 2019 Freeman Award recipient, Anne Newman, MD, MPH, of the University of Pittsburgh. The Excellence in Rehabilitation of Aging Persons Award is designed to acknowledge outstanding contributions in the field of the rehabilitation of aging individuals. The Excellence in Rehabilitation of Aging Persons Award lecture will feature an address by the 2019 Excellence in Rehabilitation Award recipient, Neil Alexander, MD, of the University of Michigan."}
{"text": "The aim of this work is to develop a software to calculate the economic parameters so as to determine the feasibility of a floating offshore renewable farm in a selected location. The software can calculate the economic parameters of several types of offshore renewable energies, as follows: one renewable energy , and spar; floating wave energy\u2014Pelamis and AquaBuoy), hybrid offshore wind and wave systems (Wave Dragon and W2Power), and combined offshore wind and waves with different systems . The user can select several inputs, such as the location, configuration of the farm, type of floating offshore platform, type of power of the farm, life-cycle of the farm, electric tariff, capital cost, corporate tax, steel cost, percentage of financing, or interest and capacity of the shipyard. The case study is focused on the Galicia region (NW of Spain). The results indicate the economic feasibility of a farm of floating offshore renewable energy in a particular location in terms of its costs, levelized cost of energy (LCOE), internal rate of return (IRR), net present value (NPV), and discounted pay-back period. The tool allows for establishing conclusions about the dependence of the offshore wind resource parameters, the main distances , the parameters of the waves, and the bathymetry of the area selected. Floating offshore renewable energies are those that are installed in deep waters (more than 50 m). They are composed by several main components, namely: energy generators, floating offshore platforms, mooring, anchoring, and electric systems. The main difference between these floating platforms and the fixed platforms  is to calculate several economic parameters of a floating offshore renewable energy farm in a location. The formulation of costs has been previously developed . This soThe user can select the inputs wanted in order to calculate the economic maps of the location selected. The programming language is MATLAB\u00ae , and the software is compatible with Microsoft Windows\u00ae .Firstly, the software calculates the main costs of the life-cycle of the offshore renewable energy farm  generate a map of the energy produced in the specific location selected.In this context, the inputs of the software are see :Internal rate of return of the financed project .Net present value of the financed project .Discounted payback period of the financed project .Levelized cost of energy .The software calculates the economic parameters of the project, considering the energy produced and the total life-cycle cost such as input variables. The economic results obtained are as follows:Regarding the location, the user selects this input and he has three options . These choices condition the map files (in .mat) that the software selects for acting related to scale parameter of the offshore wind resource a, shape Regarding the type of floating platform, the criteria is that they are divided in wind , and matrix. The first consideration takes into account a general equation for the calculation of the energy generated by a wave energy converter considering the period of waves (tion (1) ). TherefThe second type considers the power matrix of the technology. On the other side, the power farm and the life-cycle of the farm are introduced by the user, depending on his needs. The electric tariff, capital cost, corporate tax, and steel cost are values that depend on the market being analyzed. The percentage of financing and the interest are determined by the financing company. Finally, the capacity of the shipyard depends on the shipyard where the platforms were built, mainly its size, and works in development in the moment of building the platforms.Finally, considering the outputs, the equations used are shown in The case of study of the present paper is the Galician region, located in the North-West of Spain  and the economic feasibility of the floating offshore renewable energy farm . Regarding case 1, results depends on the location and they go see : from 6.Regarding Case 2, the results depend on the location, and they go see  from 4.8Regarding case 2, results depends on the location and they go see : from 4.Regarding Case 4, the results depend on the location, and they go see  from 4.1Therefore, considering all of these results, the user can select what is the best technology depending on the location. In this sense, in terms of LCOE, the best technology for the case study is the Case 1 (offshore wind\u2014WindFloat), because it has the smallest LCOE (100.31 \u20ac/MWh), and the worst technology is Case 3 (wave energy-AquaBuoy), with a minimum value of 756.39 \u20ac/MWh. On the other hand, in terms of IRR and NPV, the best value is also for Case 1 with 14.75% and 330.85 \u20ac, respectively, and the worst is Case 3, with values of \u2212173.52% and \u2212581.42 \u20ac, respectively.The objective of this work was to present a software to calculate the most important parameters of the feasibility of a floating offshore renewable farm in a selected location. This tool can be valuable for enterprises or public entities that want to know the best places where an offshore renewable energy farm can be located, because this can compile the software for the economic calculation of the most important types of offshore renewable energies existing in the world.The software can calculate the economic parameters of several types of offshore renewable energies, namely: one renewable energy , hybrid offshore wind and wave systems (Wave Dragon and W2Power), and combined offshore wind and waves with different systems . The user can select several inputs, namely: location, configuration of the farm, type of floating offshore platform, type of calculation of the wave\u2019s energy, power of the farm, life-cycle of the farm, electric tariff, capital cost, corporate tax, steel cost, percentage of financing, interest, and capacity of the shipyard. The economic results are as follows: the cost of each phase of the life-cycle of the project, the total cost of the life-cycle of the farm, the internal rate of return (IRR), the net present value (NPV), the discounted payback period (DPBP), and the levelized cost of energy (LCOE).The case study considered here analysed the Galician region (North-West of Spain), using four alternatives depending on the technology, namely: one renewable energy  and two renewable energies installed separately in the same farm . The software gives the results for the case that the user selects. In this particular case study, the technology that is more economically feasible is the offshore wind (WindFloat) with the best value of LCOE (100.31 \u20ac/MWh), IRR , and the technology with the worst economic values is the wave energy (AquaBuoy), with results of 756.39 \u20ac/MWh (LCOE), \u2212173.52% of IRR, and \u2212581.42 \u20ac of NPV.The results depend on the shape and scale parameters of the offshore wind resources, the distance from farm to shore, distance from farm to shipyard, distance from farm to port, the height and the period of waves, and the bathymetry of the location of study. The results indicate the economic feasibility of a farm of floating offshore renewable energy in a particular location."}
{"text": "The China Association for Science and Technology (CAST) and AAAS/Science are proud to be publishing the first batch of articles in Research, the inaugural Science Partner Journal. Research will publish fundamental research in the life and physical sciences as well as important findings or issues in engineering and applied science. The journal will initially publish original research, reviews, and editorials. Topics of particular interest include, but are not limited to, biology and life sciences, micro- and nano-science, artificial intelligence and information science, new energy studies, mechanical science and engineering, environmental science, emerging materials research, and robotics and advanced manufacturing.The goal of Research is to publish high-quality papers on cutting-edge topics and to establish an international platform for academic exchange, collaboration, and innovation. We expect these published papers to make significant impact in the research community. Outside of the pages of this journal, CAST is also planning to organize an annual international conference on topics relevant to Research, first occurring in China and then moving to other countries in future years. With leading experts invited to be keynote speakers, scientists from all over the world will gather together at this conference to disseminate and exchange their new research achievements. Research, led by Professor Tianhong Cui from the University of Minnesota as the international Editor in Chief, was established together with fifty-five experts from ten countries spread across the disciplines that the journal hopes to cover. The editorial board members are all leading experts in their research domain, including Charles Lieber from Harvard University, John A. Rogers and Yonggang Huang from Northwestern University. The Editor in Chief and the editorial board members will be responsible for a high-quality peer review of submitted articles. A group of four managing editors from CAST in Beijing along with individuals from the AAAS/Science Office of Publishing aid in the daily peer review process, production coordination, and marketing efforts for this new journal.The editorial board ofresearch@cast.org.cn if you would like to learn more about becoming a reviewer or being involved in the editorial board.As the product of international collaboration itself, we know that the success of Research will be the result of the global community of scientists who read, cite, and work with this new journal as authors, editors, and reviewers. We hope that you enjoy reading these articles and future content, and consider submitting your paper to the journal. Please also reach out to the journal's Editorial Office at Tianhong Cui"}
{"text": "PLOS ONE policy. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.There is additional information that needs to be included in the Competing Interests statement. The correct Competing Interests statement is as follows: NG, DJA, PLB, DDH, CN and ASP were employees of the Marine Stewardship Council at the time of this study. TEE, KS, and ADMS were unpaid members of the MSC's Technical Advisory Board. KS was an unpaid member of the MSC\u2019s Board of Trustees. SRV, TAB, JKB, JCD, CC, OD, RH, AEL, RLS, SS, SJT, JTT and NEW did not have direct affiliation with MSC at the time of this study. The groups combined their initially separate but duplicative analyses as part of a National Center for Ecological Analysis and Synthesis (NCEAS) working group. KS additionally declares the following roles: Commissioner with the Australian Fishery Management Authority (since 2004), member of the Lenfest Task Force to develop standards for management of fisheries targeted on forage fish species (2008\u20132012), independent advisor to the Corporate Social Responsibility Committee of the China Fisheries Group (2011\u20132015), and consultant to the Food and Agriculture Organization of the United Nations, authoring a 2008 review of fisheries ecolabelling schemes. Funding was received by RH in the five-year period prior to the publication of this article from sources including fishery/seafood corporations and industry groups, as well as environmental groups and foundations Click here for additional data file."}
{"text": "Didelphis marsupialis) are found throughout the Caribbean island of Trinidad and Tobago. The present work was conducted on 10 skulls and mandibles of the common opossum to describe the osteology and foramina of these skulls and mandibles grossly and radiographically. The information that is garnered can be used to detect, diagnose, and treat head affections, as well as for comparative studies with the skulls and mandibles of other similar species. The skulls and mandibles were prepared and cleaned using standard method. All of the characteristic features of various standards views of the skulls bones, including dorsal, lateral, caudal and midsagittal, and the lateral and caudal views of the mandibles as well as the foramina of the skulls and mandibles were described and discussed. Each skull was divided into long facial and short cranial regions. No supraorbital foramen was observed in the skulls. The tympanic bulla was absent while there was the tympanic process of the alisphenoid. The temporal process of the zygomatic bone, zygomatic process of maxilla, and zygomatic process of the squamosal bone formed the zygomatic arch. The dental formula was confirmed. The bones and foramina of the skull and mandible were similar to other marsupial species and were homologue to that of other mammals.Common opossums ( Didelphis marsupialis, Didelphis aurita, Didelphis albiventris, Didelphis pernigra, Didelphis virginiana, and Didelphis imperfecta [D. marsupialis) are found throughout much of Central and South America and the Caribbean. They are characterized by a thick coat of fur, sharp claws, long whiskers, long tail, and black ring around both eyes as well as large black ears. The common opossum has an economic value as it is sold by hunters for meat in Trinidad and Tobago. The animal uses its head for deglutition and olfaction. The head of the animal has the vital organs, such as brain, eyes, ears, teeth, tongue, lips, and nose [D. albiventris) in Brazil [D. Marsupialis) [Marmosa murina [The genus Didelphis has six species of marsupials that are found only in the Americas, which are perfecta . Common and nose . The skuand nose ,4. Moreoand nose . There wn Brazil , in the upialis) , and in a murina . Thus, tThe skulls of ten  adult common opossums were used. The opossums were obtained to use for research purposes in the School of Veterinary Medicine, Faculty of Medical Sciences, University of the West Indies, Trinidad and Tobago. The skulls were collected, examined and prepared. The skulls were free from any skeletal deformities. The skulls were cut at the occipitoatlantal joint. The skulls were boiled to remove the skin and muscles then left to dry for two weeks. The skulls were bleached in a sealed container for four days in 3% hydrogen peroxide, and then left to dry for two weeks . The groThe skull of the opossum has an elongated facial region and short basicranial region. The bones and foramina of the two regions are described and documented in different standard views.The bony part of the face is formed by the nasal, lacrimal, and zygomatic  bones in the dorsal and lateral aspects of the skull; premaxilla, maxilla in the dorsal, lateral, and ventral aspects; of the skull and pterygoid, ethmoturbinate, and vomer bones in the ventral aspect of the skull. Moreover, the choanal region and hard palate are seen in the ventral aspect of the skull .The hard palate is formed by the palatine bones as well as the palatine processes of the premaxilla and maxilla. The choanae are located at the terminal part of the hard palate. The midsagittal view of the face region of the skull shows the two halves of the nasal cavity separated from each other and from the cranium by the nasal septum and cribriform plate, respectively . Each haThe nasal bones are paired bones in the nasal cavity roof. Each nasal bone is notched to form the dorsal border of the external osseous nasal aperture rostrally. The nasal bones are attached from cranial to caudal with the premaxillae, maxillae and frontals. Neither cranial nasal notch nor foramina are present in the nasal bones. The premaxillae are paired bones that form the lateral and ventral walls of the nasal cavity. Each premaxilla bone houses the alveoli for the five upper incisors. The premaxilla bones are attached to the nasal bones dorsally and to the maxillae caudally. The maxilla bones form the wall of the snout and hard palate laterally and they house the upper canine, upper three premolars and upper four molars. The maxillae are attached to the premaxillae cranially, and with the nasal, frontal, lacrimal, and zygomatic bones caudally. The lacrimal bones form the cranial rim of the orbit. The zygomatic bones are the principal parts of the zygomatic arches. The zygomatic bones have the frontal processes of zygomatic bones. There are many processes that contribute to the formation of the zygomatic arch, such as the temporal process of the zygomatic bone and the zygomatic process of the maxilla, as well as the zygomatic processes of the squamosal and maxilla bones. The palatine bones are paired in the palate and orbit. They have a horizontal process and perpendicular processes that contribute to the hard palate, as well as the orbit and choanae, respectively. The pterygoid bones form the lateral wall and roof of the nasopharyngeal passage. The vomer bone is a thin elongated bone, which contributes to the nasal cavity cranially and articulates with the presphenoid, maxilla and premaxilla bones .The foramina of the facial region  of the sThe bony part of the basicranial region of the skull of the common opossum consists of the frontal and parietal bones in the dorsal and lateral aspects of the skull; the squamosal and external sagittal crest in the dorsal aspect of the skull; the sphenoid bones, temporal, and pterygopalatine fossae in the lateral aspect of the skull; the nuchal crest, occipital condyles, and jugular processes in the caudal aspect of the skull and the base of the cranium, occipital, alisphenoid with its tympanic process, basioccipital; presphenoid, squamosal and petrosal bones, prearticular process, retroarticular process, and mandibular fossa in the ventral aspect of the skull. The midsagittal view of the bsicranial region of the skull shows the cranial cavity which has rostral cranial, middle cranial and caudal cranial fossae. The zygomatic arch is seen clearly in the lateral aspect of the skull .The frontal bone forms the roof of the skull and contributes to the orbital and temporal fossae medially. Cranially, the frontals attaches to the nasals at a roughly V-shaped suture and with the maxilla and the lacrimal by a narrow connection. The frontal bone has a zygomatic process. The parietal bones form the bulk of the roof of the skull caudally, and contributed to the caudal side wall of the braincase. The presphenoid bone is a single bone in the nasopharyngeal passage roof and it contributed to the nasal septum. It contacts with the palatine, pterygoid, and basisphenoid bones. The basisphenoid bone is a single bone occupying the midline of the brain stem and is situated between the presphenoid and basioccipital bones. The basioccipital bone is a single bone that is situated between the petrosal and foramen magnum and it forms the base of the skull. The alisphenoid bone is found on either side of the basisphenoid and fuses with it and it contributes to the base of the skull and side wall of the braincase. The squamosal bone contributes to the braincase, zygomatic arch, and glenoid fossa. The temporomandibular joint is found between the glenoid fossa of the skull and the coronoid process of the mandible. The rostral cranial fossa is situated caudal to the cribriform plate. The bony orbit is formed by the frontal, lacrimal bone, zygomatic bone, maxillary bone, palatine bone, and squamosal bone as well as the basisphenoid and alisphenoid of the sphenoid bone. The dental formula of the ten common opossums is 50 teeth; Incisor (I) 5/4, Canines (C) 1/1, Premolars (Pm) 3/3, Molars (M) 4/4 \u00d7 2 = 50 .The foramina of the cranial region of the skull of the opossum are the external acoustic meatus, the carotic canal, the minor palatine foramen, the stylomastoid foramen, the sphenorbital fissure, the foramen ovale, the foramen rotundum, the jugular foramen, the hypoglossal canal, the transverse canal foramen, the internal acoustic meatus, and the foramen magnum, as well as the rostral and the caudal foramina that formed the pterygoid canal .The mandible is the largest bone of the skull. The left and right mandibles are fused rostrally at the mandibular symphysis, a fibrocartilaginous joint. Each one consists of a body and a ramus. The ramus of the mandible has the coronoid, condylar, and angular processes, as well as the masseteric fossa on its lateral surface. The coronoid process is the largest process of the three processes and it forms the dorsal part of the ramus and extends outward and upward. The condylar process articulates with the skull forming the temporomandibular joint. The angular process is medially directed. The mandible houses the dental alveoli for four incisors, a canine, three premolars, and four molars. There are mandibular foramina on the two rami of the mandible, near the angular processes, while the two mental foramina are present on each side of the body of the mandible laterally .Marmosa murina are described [There is not much available literature reporting on the osteological description of the skull of the common opossum from the Caribbean. However, the skull of the white-eared opossum in South America, the short-tailed opossum, and the marsupial escribed ,7,8, resescribed ,12.Marmosa murina [Mustela putoris furo), in the porcupine (Hystrix cristata), and in the Koala (Phascolarctos cinereus), respectively [The bones of the skull of the male and female common opossum are identical and are similar to that of the white-eared opossum, the short-tailed opossum, and the marsupial a murina ,7,8, resa murina . On the ectively ,14,15,16Marmosa murina [The present results as well as that in the white-eared opossum , in the a murina , and in a murina  stated ta murina ,16.Lutra lutra), in the badger, and in the marten skull [Equius asinus) and the sheep [Monodelphis brevicaudata) [The supraorbital foramen is absent in the skull of the common opossum; a similar result is noticed in the white-eared opossum, in the raccoon, in the otter (en skull ,17,18,19he sheep ,21. HoweMarmosa murina [Similar to the observations in the dog , in the a murina , and in a murina ,22. The The external sagittal crest on the dorsal aspect of the skull of the common opossum is prominent; similar result is recorded in the white-eared opossum , in the Marmosa murina [The zygomatic arch of the common opossum is formed by the temporal process of the zygomatic bone as well as the zygomatic processes of the maxilla and squamosal bones; similar result is noticed in the white-eared opossum , in the a murina , while ta murina . Howevera murina . Moreovea murina .Marmosa murina [The tympanic bulla is absent in the common opossum while there is the tympanic process of the alisphenoid; similar result is observed in the short-tailed opossum  and in ta murina , while ta murina . Meanwhia murina ,19, in ta murina , and in a murina . The ossa murina .The bony part of the hard palate in the common opossum is similar to that in the dog  and in tMarmosa murina [Concerning the nasal septum, the present study reveals that the nasal cavity of the common opossum is divided into right and left halves by the nasal septum, which is cartilaginous in its rostral third and osseous in its caudal two thirds. Similar findings are noticed in the short-tailed opossum , in the a murina , and in a murina ,23.Marmosa murina [The present investigation records that the dental formula in the common opossum corresponds to that of the other opossum such as the white-eared opossum , and thea murina , but it a murina .Marmosa murina [Most of the foramina in the skull of the common opossum are similar with those that are described in the white-eared opossum , in the a murina . Moreovea murina ,7. The ma murina .Marmosa murina [The bones of the cranium of the common opossum are the ethmoid, parietal, sphenoid, frontal and squamosal bones. Similar result is observed in in the white-eared opossum , in the a murina , and in a murina .Marmosa murina [The mandible is the largest bone of the skull of the common opossum; similar result is noticed in the white-eared opossum , in the a murina , and in a murina . Furthera murina  and in ta murina .Knowledge of the detailed description of the osteology and the foramina of the skull and mandible will help the veterinary surgeons and radiologist in the diagnosis and treatment of the head affections of the common opossum, especially since some people in Trinidad started to rear this animal for meat production .The bones and foramina of the skull and mandible of the common opossum were described via the dorsal, ventral, and lateral views, as well as sagittal section of the skull and lateral and caudal views of the mandible. The present study revealed that there was no significant difference between the osteology and foramina of the skull and mandible of the common opossum from the Caribbean island of Trinidad and Tobago when compared with those described in other marsupials and/or other mammals. Moreover, this study can lead to future functional and comparative anatomical and radiological studies"}
{"text": "The concepts of frailty and precarity circulate in social gerontology and studies of aging, with the former a dominant construct, and the latter emerging as a way of linking experiences, insecurities and risks. Although these concepts are used inter-changeably by some authors, their roots, key areas of focus and meanings differ. This paper considers the state of knowledge on frailty, and sets this against the uses of precarity. A After outlining a recent scoping review on precarity that revealed a high number of articles cross-referencing concepts of frailty and vulnerability. the paper distinguishes key aspects of frailty, vulnerability, and precarity. Situating qualitative experiences of each serves as a means to further explore similarities and differences. The paper concludes with reflections on what (if anything) each of these allied concepts may offer understandings of late life, and in particular, the study of disadvantage across the life course and into late life."}
{"text": "Pseudomonas, may contribute to spoilage by the production of histamines in fish tissue.The results of numerous studies indicate that fish possess bacterial populations on or in their skin, gills, digestive tract, and light-emitting organs. In addition, the internal organs  of healthy fish may contain bacteria, but there is debate on whether or not muscle is actually sterile. The numbers and taxonomic composition of the bacterial populations often reflect those of the surrounding water. The role of the bacteria includes the ability to degrade complex molecules , to produce vitamins and polymers, and to be responsible for the emission of light by the light-emitting organs of deep-sea fish. Taxa, including"}
{"text": "The addition of video game-like elements to non-game activities, known as gamification, holds promise with respect to encouraging engagement with, and adherence to, health behaviors and healthcare interventions. Elements of gamification include the introduction of points systems, leaderboards, achievement badges, stories and themes, rewards, progress tracking, and challenges. However, a lack of enthusiasm for, and experience with, video game play by older adults has important implications for the effectiveness of these techniques across the lifespan. Specifically, the age-related \u201cdigital divide\u201d must be considered before applying these approaches to improving the wellbeing, cognition, and health of older adults. This talk will build on the body of research conducted by the Center for Research and Education on Aging and Technology Enhancement (CREATE) focused on gaming and interventions to present best practice guidelines for implementing gamification with older adults."}
{"text": "Lubricating oils used in machines with an open cutting system, such as a saw or harvester, are applied in forest areas, gardening, in the household, and in urban greenery. During the operation of the device with an open cutting system, the lubricating oil is emitted into the environment. Therefore, the use of an oil base and refining additives of petroleum origin in the content of lubricants is associated with a negative impact on health and the environment. The current legal regulations concerning lubricants applicable in the European Union (EU) assess the degree of biodegradability. Legislation permits the use of biodegradable oils at 60% for a period of 28 days. This means that, in practice, lubricating oil considered to be biodegradable can contain up to 50% of the so-called petroleum oil base. The paper aims to draw public attention to the need to reduce the toxicity and harmful effects, due to their composition, of lubricating oils emitted into the environment on health. The authors discuss the impact of petroleum oil lubricants on soils, groundwater, vegetation, and animals, and the impact of petroleum-origin oil mist on health. An overview of test methods for the biodegradability of lubricating oils is presented, including the Organization for Economic Cooperation and Development (OECD) 301 A\u2013F, 310, and 302 A\u2013D tests, as well as their standard equivalents. The current legal regulations regarding the use and control of lubricating oils emitted into the environment are discussed. Legal provisions are divided according to their area of application. Key issues regarding the biodegradability and toxicity of petroleum fractions in lubricating oils are also addressed. It is concluded that lubricating oils, emitted or potentially emitted into the environment, should contain only biodegradable ingredients in order to eliminate the negative impact on both the environment and health. Total biodegradability should be confirmed by widely applied tests. Therefore, a need to develop and implement low-cost and simple control procedures for each type of lubricating oil, ensuring the possibility of an indisputable conclusion about the presence and total absence of petroleum-derived components in oil, as well as the content of natural ingredients, occurs. Lubricating oil is considered as a fluid structural element of machines and devices. Its main task is to create a layer in the form of a microfilm between the moving elements of the device. Due to the specific properties, lubricating oil during operation can fulfill many functions, such as minimization of friction, elimination of scuffing of rubbing machine elements, washing of carbon deposits and micro particles, anti-corrosion, cooling, and other effects. Both environmental and application properties must be supported when the lubricants content is designed. Therefore, it must be characterized not only by an accurate biodegradability rate , but alsThe role of additives is to improve the quality of the lubricating oil. They are often products of an expensive organic synthesis process. As a rule, refining additives are synthetic, organic, or metal-organic chemicals, sometimes products of chemical processing of natural raw materials. The main types of additives are oxidation inhibitors, rheology modifiers, depressants, detergents and dispersants, de-emulsifiers and emulsifiers, lubricants, anti-wear, anti-seize agents, friction modifiers, corrosion and rust inhibitors, passivators, anti-foaming agents, dyes, fragrances, and multifunctional additives. The share of additives in the lubricating oil may range from a few ppm to several percent ,5,6. CurMost of the base oils used for the production of lubricating oils are produced during crude oil processing. This was due to the fact that these oils were characterized by a much lower cost than synthetic or natural base oils ,9. Oils Technological progress and the production trends of modern equipment and machines correspond with a constant increase in the improvements of energy efficiency and consumption. Due to the need to increase the efficiency of machines, there is an increase in demand for more efficient lubricants. Lubricating oils containing a synthetic oil base have been designed to maximize grease performance and bring measurable performance and economic benefits . SynthetSynthetic oils are produced in the processes of the synthesis of petrochemical industry raw materials or in the hydro catalytic process of hydrocarbon backbone conversion from natural gas . In the An increase in interest in the assessment of the impact of lubricating oils on the environment and health motivates research centers and industry to create new technologies for the production of fully biodegradable, lubricating oils of natural origin ,15. ThisDevices with an open cutting system, such as chainsaws and harvesters, are widely used in forest services, but also in households, in urban greenery, and during road works. Lubricating oils used in this type of equipment are emitted into the environment in the form of oil mist and micro droplets. The droplets cover and penetrate soils, ground waters, and may cause a strong effect on the ecosystem . TherefoLubricating oil is emitted into the environment in the form of oil mist and micro drops, posing a major threat to the environment. Strength and effects of interactions of oil derivatives are closely related to the composition, emission volume and frequency in a given area, and properties of a device with an open cutting system ,22. The The film of petroleum substance on the water tank mirror may cause disturbances in the oxygen\u2013gas exchange between the water and the atmosphere, but may also reduce the access of light to the depth of the tank. These limitations may lead to changes in the functioning and metabolic disturbances of aquatic organisms and, as a consequence, to the formation of an oxygen starvation area in the bottom parts of the reservoir, which may lead to ecosystem disorder. Reduction of the photosynthesis process, and increase of the water temperature by absorbing solar radiation, may threaten the proper development of aquatic plants and lead to the eutrophication of the reservoir . EutrophOil pollution also causes serious damage to soils, due to the multistep physicochemical processes leading to a change in the forms and distribution of organic matter, in the range of carbon, water, nitrogen, and phosphorus. As soil is an environment for a variety of microorganisms and higher living organisms, its contamination with petroleum-based lubricants becomes hazardous and a detrimental effect on biological life may occur. The proper functioning of the ecosystem may be disturbed. Mineral oil can clog pores in the soil, resulting in reduced aeration and water infiltration. The presence of petroleum compounds may reduce or limit the permeability of soils, and, consequently, cause the degradation of soils due to oxygen deficit ,25.Eco-toxicity, incomplete biodegradability, and highly probable carcinogenicity of base oils derived from crude oil is an object of public debate regarding long-term health effects of oil application and emission . The rouThe saw chain operator, through the nature of his work, especially in long-term work, such as logging, stays in an environment with a high level of contamination of toxic substances. The oil mist may contain aromatic hydrocarbons, polycyclic aromatic hydrocarbons (PAHs), but also benzene, toluene, or methylbenzene, which a negative influence on the respiratory and nervous systems of the device operator. As shown by research, typical complaints reported after the work of the device operators, are irritations of the eyes and upper respiratory tract, headaches, and fatigue ,28. PetrIn addition, most of the petroleum components are slowly degraded and at the same time subjected to unavoidable interactions with environmental components. Derived products are transformed due to chemical reactions under the influence of sunlight, with reactions with oxygen from the air, as well as with water and soil components. The newly-formed secondary chemicals are mostly much more eco-toxic and often more harmful to health than the original chemical forms. It is estimated that derivatives formed as a result of bioconversion of substances emitted into the environment may also be more harmful than their original precursors ,29. The Estimation of environmental costs is a necessary step for a full economic analysis of the use of wood resources, because it is associated with the introduction of pollutants into the environment, as well as with the use of energy. Environmental costs are a general concept for various costs related to environmental protection and environmental impact. In practice, they are recognized in the calculation of the operating costs of enterprises in a piecemeal manner or are included in aggregate items. So far, harmonized standards have not been developed in terms of measurement principles, documentation, records, and settlement of environmental expenditure in the enterprise. Reporting obligations of entrepreneurs, covering environmental protection, are regulated by numerous legal acts. With regard to environmental costs, there is no comprehensive research specifying their amount and structure in the entire national economy. The Central Statistical Office (Poland) conducts only periodic and fragmentary surveys in this respect, based on data provided by a small number of enterprises. The process of environmental protection includes the use of environmental resources, prevention of threats (preventive activities), limiting the emission of threats (reduction activity), repairing damage (restitution), and managing this activity. Actions for environmental protection require consumption of material and financial resources, labor resources, and use of external services, as a result of which appropriate material and financial results are generated. Resource consumption can be quantitatively measured  . With reCurrently, wood and wood-based materials have about 30,000 applications. They are used in construction, mining, and power engineering, for the production of agricultural and industrial machines, musical instruments, floors, furniture, plates, paper, tools, packaging, sports equipment, toys, and office supplies. The size of the harvested timber is determined by the forest management plan, which is prepared for each forest inspectorate for a period of 10 years. This allows the timber to be harvested within the limits of the production capacity of a given forest.Harvested wood is the basic source of all wood and its acquisition and processing has a noticeable impact on the environment. Wood market leaders are located first of all in Asia, followed by Africa and Europe. Global powers in obtaining wood due to the largest forest area  are Russia, Brazil, Canada, USA, and China. As Europe is considered, Sweden, Germany, France, and Finland have the highest potential to acquire timber. In Europe, the basic legal requirements for forestry operations are compliance with Forest Stewardship Council (FSC) and Program for the Endorsement of Forest Certification (PEFC) systems .3 [3 of wood, while a harvester needs less than half the lubricating oil . Assuming that, on average, 1 m3 of secondary oil needs 0.03 L of lubricating oil, this would mean that 117,576,000 L of oil are emitted into the environment annually  . The cosOil spills pollute the soil and water. Governments, in cooperation with industry, develop standards, regulations, and procedures to reduce the risk of accidents and leaks. However, in the case of streams introduced into the environment in the form of oil mist, such limitations are physically impossible, hence the need to introduce legal regulations regarding the composition of the indicated oils. Legal regulations, in the case of emissions to the environment, should allow application of eco-friendly, completely biodegradable, and harmless  lubricants, preferably of natural origin (based on vegetable oils). Lubricating oils should not; however, contain even small amounts of petroleum components, because they have a negative impact on the environment and health. Some countries are aware of the existing problem. In Germany and Scandinavia, there are about 80 brands of lubricants produced on the basis of vegetable oils. In Austria, all mineral oil-based chainsaw oils are prohibited .In Poland, the Decision of the General Director of Polish National Forests no. 148 (October 2018) regarding access to uniform document templates for forestry services ordering in forest management at the State Forests organizational units, determines that \u201cthe contractor is obliged to equip all machines, tractors, and equipment working on forest surfaces with appropriate sets  for absorbing spilled fuel or oil and other process fluids used in machines, tractors, chainsaws, and other devices working in the forest and using these resources in situations requiring application  to prevent environmental contamination. It is allowed to have and use of canisters with safe tips (dispensers), preventing spilling (overflow) of oil and fuel mixture during refueling of the saw (substitute for fuel and oil absorbing mats)\u201d . In 2017The Coordinating European Council (CEC) has established a methodology for biodegradation tests. Current methods of testing lubricating oils, emitted into the environments, include recommendations for their biodegradability using standard tests. The European Commission Regulation (EC) No. 440/2008 of 30 May 2008, which contains methodologies for biodegradability assessment with the use of tests developed by the Organization for Economic Cooperation and Development OECD 301 A\u2013F), is in force in the European Union, establishing methods in accordance with Regulation (EC) No 1907/2006 of the European Parliament and of the Council on the Registration, Evaluation, Authorization, and Restriction of Chemicals (REACH)  A\u2013F, is . OECD 30The regulations enforced in Poland, as well as in many other countries of the European Union, apart from Scandinavia, allow some of the oils on the market to contain up to approximately 50% of the mineral oil base and still be considered as biodegradable, according to the Decision of the European Commission of 24 June 2011, regarding the award of the ecological label in the European Union to oils and lubricants. Still, commercially available lubricating oils containing up to 50% of petroleum-based components are referred to as biodegradable, which can be misleading for the user deciding to buy them. Thus, an unaware exposure occurs regarding health and the environment . It shouLubricants that enter the environment or which are subjected to emissions to the environment, must meet the biodegradability criteria developed by OECD in 301 A\u2013F tests, which determine the potential biodegradability and properties of oil . Biodegr2, up to a depth of 10 m contaminated with cable insulation oil [The assessment of the biodegradability of lubricants is not straightforward, because they are practically insoluble in water. In addition, the composition of the lubricating oil is varied, depending on the components and the set of refining additives; therefore, it is also necessary to select the appropriate test for the assessment of biodegradability and the use of an appropriate method of sample preparation . Due to tion oil .Bacillus have an impressive biodegradability, using crude oil as the sole source of carbon and energy even in harsh environmental conditions [A similar study to show the potential of bioremediation of contaminated soils was carried out in Boucherville, Quebec, where a leakage of transformer oil was recorded . Accordinditions . Certainnditions . Surfactnditions .2). One needs to consider, that the day on which 10% of the substance volume is biodegraded should not be longer than 10 days [According to the methods included in the legal regulations, it should be checked whether the substance is prone to rapid biodegradation. OECD 301 A\u2013F tests as well as OECD 310 tests are used to assess rapid biodegradation. Tests are performed over a period of 28 days, using stricter conditions, including low concentrations of inadvertent inoculum pre-conditioned to the test substance. When a substance undergoes a high level of biodegradability, it should be considered that it will degrade in the environment in a short time. However, if the substance is not prone to rapid biodegradation, it should be subjected to further testing. OECD 302 A\u2013C tests are used to assess potential biodegradability, which aims to assess the potential biochemical distribution expressed in percent and thus predict the rate of disappearance of the test substance in the environment. For more information on the degradation rate of the substance in the environment, OECD 303 A and B tests are recommended. The 301 and 310 series tests allow you to track the rate of biodegradation and determine if the substance is easily biodegradable. The substance is considered to be biodegradable if it reaches the required biodegradation level of 70% within 28 days (in the case of determining the loss of dissolved organic carbon (DOC/TOC). The substance may also be considered as biodegradable if it reaches the level of biodegradation to at least 60%  or produced CO 10 days ,39,41.Oil meeting the requirements of the OECD 301 B test should be biodegradable under test conditions above 60% for 28 days. It is assumed then that the total distribution of the remaining part of the analyte will take place. Research results indicate that this assumption is valid only for synthetic and natural oils. On the other hand, most of the components derived from crude oil are slowly degraded and, at the same time, undergoes various chemical reactions . TherefoIn relation to the physicochemical properties of mineral oils, these substances are strongly hydrophobic and slightly reactive. As organic substances that do not enter the metabolic pathways, oils and solvents produced on the basis of mineral oils are excreted intact with feces and to some extent in the urine. However, there are reports of a small absorption of this type of compound in the small intestine . In 1966The complexity of the mineral oil-based hydrocarbon structure precludes identification of toxicological hazards based on the properties of a single substance. Toxic kinetics in living organisms, is concluded on the basis of literature reports . The oraThe debate on the toxicity of mineral substances accumulating in living organisms mainly concern those substances that are taken in food. It is also known that paraffins contained in cosmetics and ointments are transferred to human milk through the skin of the breast. The mother passes about 1% of the mineral paraffins accumulated in her body to the child . It shouIt is worth paying attention to the problem of emission of lubricating oils produced from crude oil to the environment. Some literature sources state that every year, during forestry work using chainsaws, as much as 7 million liters of various types of mineral oils enter the soil . Since tThe legal regulations regarding lubricants need to specify the speed and biodegradability potential of lubricants. Unfortunately, current methodologies do not report 100% biodegradability of the substance and the methods of biodegradability assessment are time-consuming and expensive. Therefore, there is a need to develop and implement low-cost and simple control procedures for each type of lubricating oil, ensuring the possibility of an indisputable conclusion about the presence and total absence of petroleum-derived components in oil, as well as the content of natural ingredients.Moreover, legal regulations should require the use of only fully and easily biodegradable lubricating oils, especially those emitted into the environment. Bio-lubricants have emerged as a potential and viable way to replace, totally or partially, mineral oils due to their effectiveness in the boundary lubrication regime for different applications, including devices that work with an open system, such as a cutting saw or harvester ."}
{"text": "Most NH3 emissions in the Czech Republic are produced during the breeding of cattle, pigs, and poultry; therefore, determinating emission factors for these kinds of animals by studying their total number, type of breeding, and subsequent disposal of manure is the solution to the problem of NH3 emissions quantification. This paper summarizes the results of 4 years of research in this area, determining the emission factors and ways of decreasing emissions from the breeding of cattle, pigs, and poultry.The exact quantification of ammonia (NH"}
{"text": "The authors wish to correct the affiliation of co-author Ali Mazin Abdul-Munaim, due to name changes of which he was unaware during his leave of absence. The correct affiliation is Department of Agricultural Machines and Equipment, College of Agricultural Engineering Sciences, University of Baghdad, Baghdad, Iraq. The authors would like to apologize for any inconvenience caused to the readers by these changes."}
{"text": "Late life depression is an important public health problem, which associates with increased risk of morbidity and mortality. Selective serotonin reuptake inhibitors (SSRIs), including fluoxetine, are often prescribed to treat geriatric depression. There is increasing evidence that fluoxetine and other SSRIs exert a wide range of cardiovascular side effects. Furthermore, there is evidence that aging may increase plasma level of SSRIs. In this overview, the potential role of side effects of treatment with fluoxetine and other SSRIs in the pathogenesis of age-related cardiovascular diseases, including atherogenesis, cardiac pathologies, and cerebromicrovascular impairment, is discussed. Major depression occurs in 1% to 3% of older adults and an additional 8% to 16% of elderly patients present with clinically significant depressive symptoms . The proIn this overview, the potential vascular side effects of treatment with fluoxetine and other SSRIs in geriatric patients are considered in terms of both the potential proatherogenic effects of the drug and its ability to impair vascular autoregulatory mechanisms  and other SSRIs, there are relatively few published data characterizing age-related changes in pharmacokinetics of fluoxetine and other SSRIs in older patients.Fluoxetine is well absorbed after oral intake, but it is extensively affected by first-pass metabolism in the liver . Its actThe extent of absorption of other SSRIs, including paroxetine, sertraline, and citalopram, from the gastrointestinal tract is generally good . FollowiThe metabolism of paroxetine, citalopram, and sertraline is impaired in older adults. Steady-state plasma concentrations in the elderly are about twice those measured in younger subjects, and the half-life of paroxetine is twice as long in older adults as in younger individuals . The ste2+ channels, as well as other ion channels , the Oklahoma Center for the Advancement of Science and Technology , the National Institute on Aging , the National Institute of Neurological Disorders and Stroke , the Oklahoma Shared Clinical and Translational Resources (OSCTR) program funded by the National Institute of General Medical Sciences , the Presbyterian Health Foundation . The authors acknowledge the support from the NIA-funded Geroscience Training Program in Oklahoma (T32AG052363).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "According to the notice,up to 136 projects will be contemplated throughout Brazil with initiatives focused onHealth Care Networks, with emphasis on strengthening Primary Health Care (PHC). Theworking groups will be composed of professors, students, and workers from the varioushealth areas who, in a two-year period, will collaborate to implement IPE throughout thenational territory, consolidating it as a macropolitical strategy.\u20134.The CP in health will only be possible if it is based on IPE strategies, in whichstudents learn about, how, and with each other's work, from an understanding of common,specific, and collaborative practices that are articulated and enable, in an intentionalway, the development of skills for collaborative teamwork.In the last decade, the adoption of more active methodological strategies and curricularchanges have enabled changes in the training and health practices that are relevant tothe dynamics of professionals' education. However, even in the face of scientificevidence of significant gains, there is still an incoherence between training and theneeds required by the health system for teamworkThus, the adoption of policies that strengthen IPE may bring transformations to healthpractices, especially in the integration and collaboration among professionals, focusingon the health needs of users and the population, ensuring greater safety of care,reduction of errors by health professionals and costs in the health system. This maycontribute to a strong SUS, capable of providing answers to the problems and healthneeds of the Brazilian population."}
{"text": "The United States is the only major nation to not yet have ratified the United Nations Convention on the Rights of the Child (UNCRC). Recently, there has been an erosion of the rights of children across America, Europe, and elsewhere, but through science, we may have an opportunity to counter some of this alarming trend. In the area of vaccines, the scientific community can raise its voice on the dangers that nonmedical exemptions and delays pose to children at risk for measles, influenza, and other childhood illnesses. Poverty places infants and children at high risk for illness and homelessness. Gun violence and gun-related accidents are killing on average four American children daily, and climate change is promoting global pediatric malnutrition. Increasing international, federal, and state support to seek innovative solutions to these and related issues is a moral imperative. In this Perspective article, Peter Hotez and Arthur Caplan argue that scientists can have important and new roles in limiting recent declines in the rights of children across America (and in some European countries), especially in the areas of child poverty, low vaccination rates, gun violence, and disease and malnutrition due to climate change. In 1989, the United Nations (UN) General Assembly adopted the UN Convention on the Rights of the Child (UNCRC), a treaty recognizing human rights for the world\u2019s children .Beyond failing to ratify a treaty, the rights of children in the US (as well as in Europe) are increasingly being violated due to a rise in intolerant ideologies and ignorance of basic scientific and medical facts. Here, we highlight several key examples in which we feel that children are being unnecessarily placed in harm\u2019s way due to failure to heed established scientific evidence in lieu of ideological or personal beliefs .Promoting vaccine accessAlleviating child povertyTreating and curing neglected diseasesPromoting resilience to climate changeStopping gun violenceTens of thousands of children in the US and in Europe are currently denied the right to be vaccinated against deadly pediatric infectious diseases such as measles, pertussis (whooping cough), and other conditions . BecauseThe latest information indicates that the consequences of vaccine exemptions have been dire, with 14,000 measles cases in Europe between April 2017 and March 2018, mostly in Italy, Romania, and Greece and mostly among those who had not been vaccinated . More thIn 2018, Philip Alston, the UN Special Rapporteur on extreme poverty, delivered his report on America to the UN Human Rights Council, based on his fact-finding mission to the US the previous December [Child poverty is intimately connected with illness. Thus, the US infant mortality rate is approximately 50% higher than the Organization for Economic Cooperation and Development (OECD) average , and thePromoting resilience to the devastation resulting from climate change and global warming must also become an essential component of protecting the health of children. According to UNICEF, the nutritional and health stress of a massive drought in East Africa now jeopardizes the lives of 16 million people . In EthiThe statistics are largely self-explanatory. More than 25,000 American children were killed through gun violence between the years 1999 and 2016, including almost 200 infants, 200 one-year-olds, and almost 300 three-year-olds . Today, There is a growing abandonment of the human rights of children across America and in Europe. Through science, we may have an opportunity to combat this alarming trend. In the area of vaccines, the scientific community must raise its voice on the dangers that vaccine exemptions pose to children at risk for measles, influenza, human papilloma virus (HPV), and other childhood illnesses while refuting false claims that vaccines can cause autism or are unsafe. Similarly, child poverty places infants and children at high risk for emerging and neglected diseases, gun violence is killing on average four American children daily, and climate change is trapping a generation of children in a cycle of malnutrition and long-term health consequences. For each, there is a dearth of international, federal, state, and private support of research to seek innovative solutions and dissemination of findings for these and related issues. The scientific community must bring its enormous expertise to promoting the rights of children and protect them from poverty, illness, and violence. As part of this obligation, it should urge the US Congress to ratify the UNCRC."}
{"text": "To review, in the literature, information regarding changes in the sensory systems of mouth breathers.  The search was conducted in the following databases PubMed, BIREME, LILACS, Web of Science and Scopus. The search was independently carried out by two researchers, following the selection criteria. Original articles that approached mouth breathing and changes in sensory systems published in Portuguese, English and Spanish were published. Literature review of articles, dissertations, book chapters, case studies and editorials were excluded.  We found 719 articles. Among them, 663 were excluded by the title and 22 by the summary. Among the 34 analyzed manuscripts, 23 were repeated and 8 were excluded by reading the full text. Thus, 3 articles were selected for this review.  Most studies presents the occurrence of changes in sensory systems in mouth breathing children. However, sensory reception is a matter of more concern. Besides, the evaluation of sensory systems was not standardized, which may have led to less precise results in the studied population. This organization and modulation allow the human being to select the relevant information and respond adequately to the environment, which enables the realization of daily tasks.,,,,,,In Brazil, it is common to see mouth breathing in children at school age.Therefore, considering breathing as a vital function to individuals and the damages caused by changes in the respiratory method, including the modulation of the information received by the environment, this study aimed at searching for evidence in the literature about the changes in sensory systems presented by mouth breathers. The objective of this study was to search, in the literature, systematically, for studies presenting the possible changes of sensory systems of children who breathe through their mouths.For this review, the bibliographic research was based on the questions \u201cDo mouth breathers present changes in sensory systems?\u201d, and \u201cHow is the processing of sensory information in mouth breathers?\u201d, which were based on the Population, Intervention, Comparison, Outcome (PICO) model, used in the Practice-Based-Evidence (PBE) and recommended for systematic reviews.The systematic reviews are based on clear questions, using systematized and explicit methods aiming at identifying, selecting and critically assessing relevant studies. In this sense, the choice was to use the PRISMA recommendation, a checklist with 27 items and 1 flowchart aiming at assisting authors to improve the quality of their systematic reviews and meta-analyses.Since the studies analyzed presented different characteristics  and \">3,A search was conducted in the platforms PubMed and BIREME, and in the data bases MEDLINE, LILACS, Web of Science and Scopus, from January to February 2017. We used descriptors for the study (DECs and MeSH) - keywords to recover the subjects in the literature - and free terms (FT) - terms not found in DECs and MeSH, but relevant for the study. The crossings of these descriptors were carried out in English, Portuguese and Spanish as follows: Mouth Breathing (MeSH/DECs) AND Sensory Changes (FT) OR Sensation Disorder (MeSH/DECs) OR Somatosensory Disorder (MeSH/DECs) OR Smell Disordersn (MeSH/DECs) OR Smell (MeSH/DECs) OR Touch Perception (MeSH/DECs) OR Touch (MeSH/DECs) OR Labyrinth Vestibule (MeSH/DECs) OR Proprioception (MeSH/DECs) OR Visual changes (MeSH/DECs) OR Vision (MeSH/DECs) OR Taste Changes (MeSH/DECs) OR Taste (MeSH/DECs) OR Hearing Disorders (MeSH/DECs) OR Hearing (MeSH/DECs) OR Sensory Processing (FT).As inclusion criteria, original articles approaching MB and changes in sensory systems were selected, focusing on the processing of the received information. The manuscripts were published in Portuguese, English and Spanish. The literature review articles, dissertations, book chapters, case studies and editorials were excluded, as well as those that did not present in the title, abstract or text the subject approached in this review. Manuscripts that did not specifically report the changes occurred in the sensory systems were also excluded.The articles were selected based on the use of descriptors and FT defined, and the identification was carried out in three steps, as follows:Step 1: reading of the titles of the studies found, and exclusion of those that did not meet any of the inclusion criteria of this study;Step 2: reading of the abstracts of the studies selected in step 1, and exclusion of those that did not meet the inclusion criteria;Step 3: full reading of all studies left from the previous steps, and selection of those which met the inclusion criteria, using a protocol created for this purpose.It is worth to mention that studies repeated in the different databases were only excluded after the full reading, preventing errors in the exclusions.The articles that met all selection criteria and that enabled responses to the questions in this review were selected. The articles were assessed according to the critical review form for quantitative studies,The data of these articles were analyzed in detail through a protocol form created for this study. There, the following aspects were observed: author, year, location, population/sample, assessed sensory system, evaluation used, objective of the study, and main results.The presentation of data considered the relevant points in each article using tables and figures, in order to observe and understand them during the presentation of results and discussion.Seven-hundred and nineteen (719) articles were found after the search for the descriptors and FT. Of these, 104 were found in PubMed; 145 in BIREME; 57 in LILACS; 145 in Web of Science; and 268 in Scopus. According to the eligibility criteria, three articles were selected for this review, according to ,,,,The analyzed articles were published in the past eight years, since there were no studies found in the past six years. Besides, they were all carried out in Brazil, in two different regions (South and Southeast). These factors may be related to the use of the descriptors \u201cmouth/oral breathing\u201d for the collection of articles, and may possibly show the choice of Brazilian authors for defining MB no longer as a symptom of changes in the respiratory system, but as a set of clinical symptoms with varied etiology.,,,,,,,,,The sample was another relevant aspect in the manuscripts, ranging between 97 and 109 individuals. ,Another important factor is the relationship of causes of MB, such as early weaning, prolonged use of baby bottles and pacifiers, besides obstructive sleep disorders, very common in this population.,,,Regarding the sensory systems presented, the studies approached the auditory  and \">3,,,,Among the presented systems, the hearing one, despite not assessed in all articles, shows strong relationship with MB, due to the prevalence of chronic otitis as a consequence of the poor functioning of the auditory tube.,In spite of the close relationship between smell and taste, due to the excitement of taste receptors caused by the influence of smell, and the probable reduction of the latter because of MB,,The article by Roggia et al.,,Referring to the assessment instruments used in the studies, it was possible to observe the lack of standardization, that is, different types of evaluation were used for the same senses  and \">3.,,,Even presenting the evaluation of the sensory systems, the objectives of the study are not addressed to evaluating the processing of sensory information or the relationship with the adaptive response to the environment  and \">3.,,Since sensory processing is in charge of organizing and modulating the information received by the senses, and plays an important executive role, the study of such processing and the adaptive responses given to the environment may justify many of the changes found in mouth breathers, such as lack of concentration, posture and gait changes, as well as differences in social relationship.,,Despite the little relationship with the processing of sensory information, all results presented sensory changes in mouth breathing children, even when not associated with the consequences for the performance of the activities and the quality of life of these individuals  and \">3..The study by Correia et al,,,These findings encourage the need for further studies addressed to the relation of these sensory changes at a central level and the responses to the environment using the processing and perception of sensations. These studies could provide explanations for the behaviors found among mouth breathers, which influence the performance of their activities, and consequently, their quality of life.Therefore, the execution of studies that can deepen the knowledge about the relationship between sensory systems and the behavior of mouth breathing children is suggested, especially concerning the processing of sensory information, the integration of systems and the adaptive responses. Besides, it is important to prioritize the use of instruments that assess these points in a systematic and standardized manner, generating more accurate results.In this review, most studies showed the occurrence of changes in sensory systems among mouth breathing children. Despite these confirmations, there is greater concern in the evaluation of sensory reception, and not in the processing of information. Besides, most studies evaluated the sensory systems in a non-standardized manner, which may have led to less accurate results in the studied population.The review in question showed the need to acquire more knowledge, in order to establish and standardize evaluation instruments for the sensory systems, since this study observed the lack of standardization of these instruments and a great variety in methodology, therefore reducing the reliability of the results.Reaching this evaluation specificity will bring a more reliable diagnosis, and therapeutic planning based on scientific and reliable evidence, considering the relevance of the sensory systems for the performance of daily activities, and, consequently, for the quality of life."}
{"text": "Global aging has proceeded at an unprecedented and accelerating rate. The aging of the population creates both opportunities and challenges for elders, their families, and society in general. Importantly, there is substantial variation in the effects of and response to global aging both within and across nations depending, in part, on prevailing cultural expectations and values, political and economic imperatives, and social and demographic characteristics. Thus, while some regions and countries have responded with innovative policies and programs to better enable the growing cohort of older adults to remain active and engaged in the community, other regions and countries have struggled with their response or barely begun to plan for the rising population of elders. This symposium assembles editors at five leading gerontological journals to demonstrate the role that peer-reviewed scholarship can play in disseminating knowledge that informs gerontological research, policy, and practice internationally. Editors include: Jeffrey Burr, PhD, Research on Aging; Deborah Carr, PhD, Journal of Gerontology: Social Sciences; Edward Alan Miller, PhD, Journal of Aging & Social Policy; Julie Hicks Patrick, PhD, International Journal of Aging & Human Development; and Julie Robison, PhD, The Journal of Applied Gerontology. Each presenter will review the scope, content, and focus of their journals and the role and opportunities for international scholarship. Michael Gusmano, PhD, a leading expert on the economic, political, and social consequences of global aging and International Editor of the Journal of Aging & Social Policy, will serve as discussant."}
{"text": "The XIth International Symposium on Thysanoptera and Tospoviruses co-hosted by the Yunnan Academy of Agricultural Sciences, and Nanjing Agricultural University was held from September 21\u201325 in Kunming, China . The conInternational Symposium on Thysanoptera and Tospoviruses is the most important professional conference in the field of thrips and tospoviruses, and is held every three to four years. Eighteen representatives, including academician Fang Rongxiang from the Chinese Academy of Sciences, Emeritus Professor Thomas L. German from the University of Wisconsin, Professor Diane E. Ullman from the University of California, Davis, Professor Stephane Blanc from the University of Montpellier, Professor Li Yi from Peking University, Professor Zhou Xueping from the Chinese Academy of Agricultural Sciences, Professor Taiyun Wei from the Fujian Agriculture and Forest University, and other colleagues gave plenary presentations . In addiThe participants held heated discussions and in-depth exchanges on the latest research progress at the conference , which pAt the end of the program, two young colleagues from the next generation of tospoviruses and thrips researchers summarized highlights of this conference . Eight b"}
{"text": "The Guest Editors for the PLOS Medicine Special Issue on Maternal and Child Health & Nutrition discuss the published research in the context of global priorities for women's and children's health. The recent 2019 report on the State of Food Security and Nutrition in the World paints a picture of some progress, but also highlights alarming developments in certain areas [PLOS Medicine Special Issue on Maternal and Child Health & Nutrition, important research contributions are provided from three cross-cutting perspectives: the ongoing social and nutritional transitions in societies, the woman-and-child continuum of health and nutrition care, and that of the Developmental Origins of Health and Disease (DOHaD).At the same time, overweight and obesity are increasing in all regions of the world, especially among school-age children and adults. Many low- and middle-income countries suffer a double burden of malnutrition, with maternal and child malnutrition a particular problem, alongside increasing occurrence of adult overweight, insulin resistance, diabetes, and cardiovascular diseases . In the The risk of next-generation overweight and obesity is increased when the mother is obese before conception . CountriBreastfeeding is a fundamental early element of infant nutrition. An analysis of data from 49 African countries over the period 2000\u20132017 showed that an increasing proportion of infants aged under six months were exclusively breastfed, especially in the eastern part of sub-Saharan Africa . There aStunted growth in childhood has both short- and long-term consequences for health, development, and future economic productivity . Our wayThe commercially available versions of ready-to-use therapeutic foods are excellent tools in the management of severe acute malnutrition at hospitals, clinics, and in humanitarian emergencies; and may also be effective for home-based use by routine health services . There aA substantial body of evidence suggests that poor nutrition before and during pregnancy has long-term consequences for future health. The DOHaD paradigm , and theWe are in the midst of the \u201cdecade of action on nutrition\u201d declared at the World Health Assembly in 2016 .PLOS Medicine Special Issue, which will be complemented by related studies to be published in PLOS ONE, new and creative approaches with a focus on research, program development and implementation are key to improving health outcomes for mothers and babies.The global state of maternal and child nutrition shows some progress, but several new challenges are apparent. Nutrition should be promoted throughout the life cycle, but currently we often overlook some of the most critical stages, including adolescence. All sectors of society need to be involved to address these problems, but in the health sector, ownership and accountability are often weak. In the future, population growth and the ongoing climate crisis are expected to intensify food insecurity and increase the risk of undernutrition , which c"}
{"text": "There are multiple errors in the Funding section. The correct funding information is as follows: This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs, through the Lung Cancer Research Program under Award No. W81XWH-15-1-0110 . Opinions, interpretations, conclusions and recommendations are those of the author and are not necessarily endorsed by the Department of Defense. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."}
{"text": "Born in Dinghai County of Zhejiang province in June, 1926, Guan-Fu Zhu began to study at School of Medicine, Tongji University, in October, 1946  of the Virology Committee of the Chinese Society for Microbiology. Prof. Zhu had launched the National Conference on Virology, held by the Virology Committee of the Chinese Society for Microbiology. It has been held biannually since the first meeting in Tianjin, China in July 15\u201319th, 1986, and has become a grand gathering for all the Chinese virologists. The 11th National Conference on Virology held in Wuhan in 2015 attracted more than 1200 participants. Prof. Zhu was active in organizing and participating the academic activities even after retirement, and served as the honorary chairman for the sixth session of Virology Committee and the fifth session of the Microbiology and Immunology Branch of Chinese Medical Association. In 2009, Prof. Zhu, at the age of 83, still attended the 8th National Conference on Virology in Beijing, and communicated with next generation of Chinese virologists.Prof. Zhu had been actively promoting the international communications in the field of virology. On August 27\u201331th, 1990, as the chairman of Virology Committee of the Chinese Society for Microbiology, Prof. Zhu attended the 8th International Conference on Virology in West Berlin, held by the Virology Division of International Union of Microbiological Societies (IUMS)  has been alternately idealized as a culturally symbolic figure of China over the millennia. Prof. Guan-Fu Zhu will be remembered for his great contribution and nobility in character, and we will miss Old Master Zhu forever."}
{"text": "Balkan Medical Journal, the official university/academic journal of Trakya University Faculty of Medicine, is under the ownership of the deanery of the faculty and aims to propagate the current medical scientific knowledge in the Balkan region. The rectorate of Trakya University logistically supports the journal. On the other hand, the editor-in-chief is scientifically independent and cannot be pressurized or manipulated in any way regarding the scientific contents and operation of the journal. Nonetheless, the editor-in-chief has obligations toward the journal owner and editorial board. His/her editorial independence, rights, and responsibilities are aptly described and documented by the international scientific publishing communities. These include the editor\u2019s responsibilities, autonomy, and accountability of the journal\u2019s scientific content ,2,3,4,5.Since its establishment, the Balkan Medical Journal has aimed to select and publish distinctive, original articles in general medicine to contribute to universal scientific knowledge and to share its experience through educational activities for authors, reviewers, and editors . DespiteA careful review of the literature reveals that the Balkan region has taken permanent steps towards institutionalization with the successful publication practices of journals. Croatian Medical Journal stands out as the most significant journal in this regard. A paper by Marusic et al.  in 2005 For a journal to be successful in the international arena, reasonably organized managerial processes are required. Clear definitions of work packages, workflows, duties and responsibilities, and assignment and dismissal criteria are essential for the transparency of managerial processes. The journal\u2019s owner, editor-in-chief, editorial board, publisher, and authors effectively communicating with each other within the framework of rules will prevent chaotic and destructive conflicts that may harm the reputation and its mission. Furthermore, the inscription of such rules promotes scientific autonomy of the editor and prevents misuse of editorial freedom thereby resulting in the continuous success of a journal.The efforts to establish a legal regulation, an agreement between the owner and the editor, and an ombudsman began approximately five years ago for Balkan Medical Journal. A draft text of legal regulation was submitted for discussion to the editorial board at that time. Intensive efforts have been carried out to achieve a certain degree of maturity. Since no other university/academic general medicine journal in Turkey is also indexed in internationally published SCI-E and Medline, it took time for all stakeholders to draft a consensus document. Thanks to the previous editor-in-chief of Balkan Medical Journal and the current vice-rector of Trakya University responsible for scientific journals (Cem Uzun), who has encouraged all editors of Trakya University journal to establish legal regulations, we have a transparent scientific publishing atmosphere to discuss, write, and own individual legal regulation for each journal. Throughout this process, the journal\u2019s management has endeavored to consult the opinions of the journal\u2019s owner and the university legal regulation committee to establish a legal regulation for the journal that is ethical, practical, sustainable, and conforms to the national laws and international scientific values. We believe the journal legal regulation, finalized in January 2019 and presented below, serves as a role model for all scientific circles and the Balkans and will contribute to the advancement of institutional scientific publications of medicine in the region. Nonetheless, this legal regulation is open to being updated and improved whenever needed, as our other policies. The journal\u2019s editorial board extends its gratitude to all current and past employees, the Dean\u2019s Office of the Faculty of Medicine of Trakya University, and to the current rectorate of Trakya University for their valuable contributions and encouragement to building the development of the journal legal regulation to protect editorial freedom and provide successful journal management of all Trakya University scientific journals."}
{"text": "In the published article, there was an error regarding the affiliations for Hedy Kober. As well as having affiliation(s) Department of Psychology, Yale University, New Haven, CT, United States they should also have Department of Psychiatry, Yale University, New Haven, CT, United States. The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way.The original article has been updated.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "When Philippine President Rodrigo R. Duterte assumed office in 2016, his government launched an unprecedented campaign against illegal drugs. The drug problem in the Philippines has primarily been viewed as an issue of law enforcement and criminality, and the government has focused on implementing a policy of criminalization and punishment. The escalation of human rights violations has caught the attention of groups in the Philippines as well as the international community. The Global Health Program of the Association of Pacific Rim Universities (APRU), a non-profit network of 50 universities in the Pacific Rim, held its 2017 annual conference in Manila. A special half-day workshop was held on illicit drug abuse in the Philippines which convened 167 participants from 10 economies and 21 disciplines. The goal of the workshop was to collaboratively develop a policy statement describing the best way to address the drug problem in the Philippines, taking into consideration a public health and human rights approach to the issue. The policy statement is presented here. When Philippine President Rodrigo R. Duterte assumed office on June 30, 2016, his government launched an unprecedented campaign against illegal drugs. He promised to solve the illegal drug problem in the country, which, according to him, was wreaking havoc on the lives of many Filipino families and destroying the future of the Filipino youth. He declared a \u201cwar on drugs\u201d targeting users, peddlers, producers and suppliers, and called for the Philippine criminal justice system to put an end to the drug menace [shabu or \u201cpoor man\u2019s cocaine.\u201d According to a 2012 United Nations report, the Philippines had the highest rate of methamphetamine abuse among countries in East Asia; about 2.2% of Filipinos between the ages 16\u201364 years were methamphetamines users.According to the Dangerous Drugs Board (DDB) , there are 1.8 million current drug users in the Philippines, and 4.8 million Filipinos report having used illegal drugs at least once in their lives . More thThe drug problem in the Philippines has primarily been viewed as an issue of law enforcement and criminality, and the government has focused on implementing a policy of criminalization and punishment. This is evidenced by the fact that since the start of the \u201cwar on drugs,\u201d the Duterte government has utilized punitive measures and has mobilized the Philippine National Police (PNP) and local government units nationwide. With orders from the President, law enforcement agents have engaged in extensive door-to-door operations. One such operation in Manila in August 2017 aimed to \u201cshock and awe\u201d drug dealers and resulted in the killing of 32 people by police in one night [On the basis of mere suspicion of drug use and/or drug dealing, and criminal record, police forces have arrested, detained, and even killed men, women and children in the course of these operations. Male urban poor residents in Metro Manila and other key cities of the country have been especially targeted . During 5The escalation of human rights violations, particularly the increase in killings, both state-perpetrated and vigilante-style, has caught the attention of various groups and sectors in society including the international community. Both police officers and community members have reported fear of being targeted if they fail to support the state-sanctioned killings . After w10Duterte\u2019s war on drugs is morally and legally unjustifiable and has created large-scale human rights violations; and is also counterproductive in addressing the drug problem. International human rights groups and even the United Nations have acknowledged that the country\u2019s drug problem cannot be resolved using a punitive approach, and the imposition of criminal sanctions and that drug users should not be viewed and treated as criminals . Those cThe Association of Pacific Rim Universities (APRU) is a non-profit network of 50 leading research universities in the Pacific Rim region, representing 16 economies, 120,000 faculty members and approximately two million students. Launched in 2007, the APRU Global Health Program (GHP) includes approximately 1,000 faculty, students, and researchers who are actively engaged in global health work. The main objective of the GHP is to advance global health research, education and training in the Pacific Rim, as APRU member institutions respond to global and regional health challenges. Each year, about 300 APRU GHP members gather at the annual global health conference, which is hosted by a rotating member university. In 2017, the University of the Philippines in Manila hosted the conference and included a special half-day workshop on illicit drug abuse in the Philippines.Held on the first day of the annual APRU GHP conference, the workshop convened 167 university professors, students, university administrators, government officials, and employees of non-governmental organizations (NGO), from 21 disciplines, including anthropology, Asian studies, communication, dentistry, development, education, environmental health, ethics, international relations, law, library and information science, medicine, nutrition, nursing, occupational health, pharmaceutical science, physical therapy, political science, psychology, public health, and women\u2019s studies. The participants came from 10 economies: Australia, China, Hong Kong, Indonesia, Japan, Mexico, Nepal, the Philippines, Thailand, and the US. The special workshop was intended to provide a venue for health professionals and workers, academics, researchers, students, health rights advocates, and policy makers to: 1) give an overview on the character and state of the drug problem in the Philippines, including the social and public health implications of the problem and the approaches being used by the government in the Philippines; 2) learn from the experiences of other countries in the handling of the drug and substance abuse problem; and 3) identify appropriate methods and strategies, and the role of the health sector in addressing the problem in the country. The overall goal of the workshop was to collaboratively develop a policy statement describing the best way to address this problem in a matnner that could be disseminated to all the participants and key policymakers both in the Philippines, as well as globally.The workshop included presentations from three speakers and was moderated by Dr. Carissa Paz Dioquino-Maligaso, head of the National Poison Management and Control Center in the Philippines. The first speaker was Dr. Benjamin P. Reyes, Undersecretary of the Philippine Dangerous Drugs Board, who spoke about \u201cthe State of the Philippine Drug and Substance Abuse Problem in the Philippines.\u201d The second speaker was Dr. Joselito Pascual, a medical specialist from the Department of Psychiatry and Behavioral Medicine, at the University of the Philippines General Hospital in Manila. His talk was titled \u201cPsychotropic Drugs and Mental Health.\u201d The final speaker was Patrick Loius B. Angeles, a Policy and Research Officer of the NoBox Transitions Foundation, whose talk was titled \u201cApproaches to Addressing the Drug and Substance Abuse Problem: Learning from the Experiences of Other Countries.\u201d Based on the presentations, a draft of the Manila Declaration on the Drug Problem in the Philippines was drafted by the co-authors of this paper. The statement was then sent to the workshop participants for review and comments. The comments were reviewed and incorporated into the final version, which is presented below.\u201cManila Statement on the Drug Problem in the Philippines\u201dGathering in this workshop with a common issue and concern \u2013 the drug problem in the Philippines and its consequences and how it can be addressed and solved in the best way possible;the drug problem in the Philippines is a complex and multi-faceted problem that includes not only criminal justice issues but also public health issues and with various approaches that can be used in order to solve such;Recognizing that drug control policies and strategies that incorporate evidence-based, socially acceptable, cost-effective, and rights-based approaches that are designed to minimize, if not to eliminate, the adverse health, psychological, social, economic and criminal justice consequences of drug abuse towards the goal of attaining a society that is free from crime and drug and substance abuse;We call for drug dependency and co-dependency, as consequences of drug abuse, are mental and behavioral health problems, and that in some areas in the Philippines injecting drug use comorbidities such as the spread of HIV and AIDS are also apparent, and that current prevention and treatment interventions are not quite adequate to prevent mental disorders, HIV/AIDS and other co-morbid diseases among people who use drugs;Recognizing, further, that primacy of the sanctity/value of human life and the value of human dignity, social protection of the victims of drug abuse and illegal drugs trade must be our primary concern;Affirming that the And that all health, psycho-social, socio-economic and rights-related interventions leading to the reduction or elimination of the adverse health, economic and social consequences of drug abuse and other related co-morbidities such as HIV/AIDS should be considered in all plans and actions toward the control, prevention and treatment of drug and substance abuse;we call on the Philippine government to address the root causes of the illegal drug problem in the Philippines utilizing the aforementioned affirmations. We assert that the drug problem in the country is but a symptom of deeper structural ills rooted in social inequality and injustice, lack of economic and social opportunities, and powerlessness among the Filipino people. Genuine solutions to the drug problem will only be realized with the fulfillment and enjoyment of human rights, allowing them to live in dignity deserving of human beings. As members of educational, scientific and health institutions of the country, being rich and valuable sources of human, material and technological resources, we affirm our commitment to contribute to solving this social ill that the Philippine government has considered to be a major obstacle in the attainment of national development.As a community of health professionals, experts, academics, researchers, students and health advocates, The statement of insights and affirmations on the drug problem in the Philippines is a declaration that is readily applicable to other countries in Asia where approaches to the problem of drug abuse are largely harsh, violent and punitive.As a community of scholars, health professionals, academics, and researchers, we reiterate our conviction that the drug problem in the Philippines is multi-dimensional in character and deeply rooted in the structural causes of poverty, inequality and powerlessness of the Filipino people. Contrary to the government\u2019s position of treating the issues as a problem of criminality and lawlessness, the drug problem must be addressed using a holistic and rights-based approach, requiring the mobilization and involvement of all stakeholders. This is the message and the challenge which we, as members of the Association of Pacific Rim Universities, want to relay to the leaders, policymakers, healthcare professionals, and human rights advocates in the region; we must all work together to protect and promote health and well being of all populations in our region."}
{"text": "Following publication of this article , the autPLOS ONE Editors retract this article.The falsified data and samples significantly impact the validity of the data analyses and results reported in the article. In light of these concerns, in line with the ORI's recommendation, and by agreement of the authors, the LX, HT, AKE, PW, and EMS agree with the retraction."}
{"text": "The corrected Author Contributions Statement appears below.The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.LCo performed microbiota analysis, statistically analyzed all data and wrote the manuscript. LP produced and analyzed butyrate and propionate data and contributed to manuscript writing. MR and GCo organized the clinical work and performed the subject's enrolment. FA, MCo, and GCa performed ddPCR and revised the manuscript. CD produced butyrate and propionate data. MCu, AN, LB, and EB contributed to the metagenomic analysis and to the interpretation of the data. LCh conceived the investigation and contributed to the interpretation of the data. CB designed the epidemiological study, organized the clinical work, and performed the subject's enrolment. RB conceived the investigation, designed the epidemiological study, supervised the general aspects of the work and contributed to manuscript writing. FL conceived the investigation, interpreted the data, wrote the manuscript, and critically supervised the work. All authors reviewed the manuscript."}
{"text": "To analyze the impacts of the care to the population displaced by violence on the health system and the challenges that this entails. This is a narrative review of the national and international literature in PubMed, SciELO, WHO/PAHO, and Bireme. Inclusion criteria were date of publication (from 2000), relation with the subject, and language (Spanish or English). We found 292 documents, of which 91 met the inclusion criteria. The main challenges are the intersectoral, participatory, and integral approach , ensured accessibility to health services, the need for a reliable registration and information system of the population displaced by violence and its characteristics, and the addressing of the biopsychosocial problems of the different groups, especially women, persons with disabilities or infectious diseases, adolescents, children, ethnic minorities, older adults and the lesbian, gay, bisexual, transsexual, and intersexual population. The lack of political will to accept and see the internal displacement by violence and its importance as a humanitarian and public health problem is an obstacle to the adequate and timely care of the population displaced by violence in Mexico. This usually means shortages of resources, family conflicts, health risk behaviors, sexual abuse, physical and mental health problems, and human rights violations,Official statistics on forced displacement are scarce and incomplete in Mexico. The internally population displaced by violence has increased in the country, especially in states such as Chihuahua, Michoac\u00e1n, Sinaloa, Durango, and GuerreroMexico had high internal migration for economic reasons, mainly from the south to the north of the country. It is also a transit point for Central and South American migrants to the United StatesGiven the exposed problem, the objective of the study was to analyze the impacts of the care to populations displaced by violence to the health system and the challenges that this entails.This first approach was based on the identification and analysis of the national and international literature, which contributes with information for the formulation of public policies that allow the preparation, allocation of resources, design, and implementation of national programs that respond to the needs of this vulnerable population.We carried out a narrative review of the literature on forced migration associated with violence and the response of health systems in documents published from 1995 to 2016. We included studies with different methodologies, from any country. The searches in PubMed, SciELO, WHO/PAHO, and Bireme were performed under the following terms in English and Spanish:Health services and/or Health system and internal displacement by violence;Displaced population and health services;Forced displacement and health in Mexico.Inclusion criteria were date of publication, relation with the subject, and language (Spanish or English). Each document was classified by document type, geographical context, and category in relation to the subject .,We found 292 documents, of which 91 met the inclusion criteria. Most (n = 75) were from the Latin America, almost all from Colombia. Of the 11 documents from Mexico, two were directly related to health servicesWe found scarce specific literature on the effect of forced displacement on HS. The articles related to the subject have identified its potential negative impact on human resources, as well as the increase in the needs of drugs, inputs, and infrastructure in health servicesA study on health and forced displacement in Sri Lanka, although focusing on post-conflict, has found three documents on HS. Most focused on the mental health problems of the displaced populationThe article of the International Center for Migration and Health5,12,27\u201330. Some strategies used in Colombia to ensure access were the priority affiliation to social security or the portability of this affiliation, the flexibility to adapt to obstacles such as the frequent absence of identification document, and the care with mobile health brigades and managers29,31\u201333.Some studies have focused on barriers to access to services. The most mentioned ones were the geographic, economic, cultural, and bureaucratic barriers,,Others have mentioned the lack of staff training to handle social and health emergencies, aggravated by the high turnover from the work under stress conditions, lack of resources, and insecurity2,5,26,37\u201339, integrality,4,41\u201343, being it intersectoral4,12,29,44\u201347, participatory,,24,27\u201331,37,43,48\u20135,,,,There is a consensus about the characteristics that the HS should have for displaced populations, such as cultural acceptabilityOther factors have also been identified on the challenges for the HS:,The amount of displaced populations: individual or family (drop by drop) or massive (more than 10 families or 50 persons),The existing resources in the receiving area and previous planning. According to the WHO, the political and security conditions of a country allow predicting possible displacements, planning activities and resources, and creating protocols for when the situation occurs,,,The displacement stage: initial  or in the final settlement stage14,56\u201358.Population type: minority ethnic groups or population similar to the receiving area1,5,27,28,47,59\u201367, with emphasis on childhood, adolescence, adult women, minority ethnic groups, the lesbian, gay, bisexual, transsexual, and intersexual population (LGBTI) population, and persons with disabilities or chronic or infectious disease requiring long-term treatment, such as TB and AIDS  or collective ,,,,,,-Human resources (HR). The health staff needs to be trained on the care of displaced populations,,,Reinforcement of services: in particular SRH,,,The financing of health care for displaced populations was a scarce subject in the documents. There was a consensus that financial resources are scarce or late,,,,,,,,,Other components: different subjects have been addressed, such as intersectoriality, participation, and empowerment of the displaced population,,,Despite underreporting, 281,418 persons are known to be victims of internal displacement forced by violence, mainly in the Northern states and Guerrero, caused by organized crimeThe Arana document on the situation in Chiapas highlights the lack of information to identify population groups and needs for their care, and it reinforces the connection between forced displacement and health\u201cForced displacement is one of the clearest examples of the interdependence between rights. Violation of civil rights of security and free residence from the use of physical and/or psychological force to expel a population unleashes an unpredictable series of negative consequences that hinder the exercise of the right to health and a long list of economic, social, and cultural rights.\u201d (p.79)Forced displacement is an issue that violates human rights. It produces highly frail individuals and groups from a profound deterioration in the quality of life and health and the lack of care by the Government against the right to healthWhile most documents refer to migration by violence from one country to another, rather than internal migration, the diagnosis of the needs of the migrant population generally allows the deduction of the impact and challenges for the HS. In Latin America, most of the literature refers to Colombia, where the magnitude of the problem is enormous and has been assumed as a national priority. This has resulted in a reliable system of registration, strategies, and policies specific to this population and a large number of research and interventions have been carried out by the academia, cities, NGO, and international organizations. For this reason, the Colombian experience is recommended as an example for Mexico,,,,,Based on the results, the main challenges for the Mexican health system would beIntegral, intersectoral, and participatory approach, which requires multidisciplinary teams that are sensitized and trainedEnsuring of the geographical, cultural, economic, and functional accessibility to the HS, taking into account the psychosocial particularities of the displaced population, such as psychosocial trauma  and lack of resources, as well as the limitations of the benefit plan of the Popular Insurance.Presence of a reliable information and registration system for the displaced population and its characteristics, which allows prioritizing activities and groups, with the participation of community leaders that facilitate the approach of the population and the flow of information.Analysis and adaptation of successful experiences of other Latin American countries for the care and reparation of the population displaced by violence.Full addressing of the problems of different groups, especially women, and within them, young women, who, in addition to the specific SRH needs, face the risk of sexual violence and domestic violence because of the gender. In addition, many become the head of a family, thus requiring great psychosocial support.Given the high vulnerability of the displaced population to mental health problems, this problem must be studied and addressed in order to avoid negative individual, family, and social consequences.,,To address these challenges adequately, the Mexican government must recognize the existence of displaced populations to plan resources and design policiesForced displacement accumulates vulnerabilities from losses: political and social rights, family and social networks, and adverse social and health conditions that are present in the receiving areas. These situations increase the burden of the disease and pressure the demand for health services that respond to health needs, particularly mental health needs. The WHO warns about the consequences of conflicts for public health and health systems which may have a decreased ability to respond adequately to new demandsForced displacement is a determinant of social and health inequities. It is closely related to structural factors, such as economic distribution, land, human rights, and intermediate factors such as socioeconomic status and health system. This aspect exposes another challenge for health systems regarding the inter- and trans-sectoral work that favors the social mobilization of players other than those in the health sector to enhance interventions in health services. Health systems should be centered on more comprehensive strategies, such as Primary Health Care and Health Promotion, and focused on Social Determinants, which have close relations.Knowledge about the health problems and needs of the displaced population and its impact on the HS can be used to define programs, strategies, and policies that address this growing problem in Mexico. National and international experiences are an important reference for the country. Colombia has a broad trajectory in this area and has a National System of Integral Care for displaced populations and specific strategies of health care. Strategies include the training of health managers and mobile brigades, in addition to those designed and evaluated with the follow-up of the Pan American Health OrganizationDespite the limitation of the scarcity of specific information on the subject, as shown in the"}
{"text": "The objective of the present study was to investigate the strength and weaknesses of healthcare management during the first 10 days after the earthquake in Sarpol-e Zahab in Kermanshah, Iran.This qualitative, observational study was conducted on November 13\u201323, 2017 in the disaster area, by using content analysis. Data was collected through experts and focus group interviews with professional and healthcare staff, and policy-makers.Our findings were categorized into 7 major groups; environmental health; mental health; mothers, infants and children\u2019s health; field hospital; nutrition; contagious diseases; drug delivery. There were good cooperation and coordination regarding environmental health issues. However, other categories were handled by different organizations and resulted in a chaotic situation.The post-earthquake period is overwhelmed with considerable issues regarding the care of victims and therapeutic measures. Lack of quick, reliable, and appropriate management will result in extensive health issues, including epidemic, worsening of chronic diseases, and exacerbation of mental disorders. Iran is one of the 10 disaster-prone countries in the world with 90% of its population exposed to earthquake and flooding. Statistically speaking, Iran has been ranked six in terms of the incident of natural events . SeveralEzgeleh is a city in Kermanshah Province, located in Ezgeleh district, Salas-e Babajani County, with a population of 1502 people according to 2016 census of population , and an Regarding the importance of the quick and vital responsiveness of the health system, especially the human force and facilities related to health, this study was done and aimed at investigating the strengths, weaknesses, and the health-related needs in the first 10 days after the large earthquake in the west of Iran by interviewing the experts in 2017; it is hoped that the results of the present study would be useful for the probable disasters in the future.This qualitative, observational study was conducted on November 13\u201323, 2017 in regions affected by earthquake including Sarpol-e Zahab, Ezgeleh, Eslamabad-e Gharb, Salas-e Babajani, Kerend-e Gharb, and Qasr-e Shirin in Kermanshah Province. This study was conducted in Sarpol-e Zahab, which is an endemic region of cutaneous leishmaniosis.Data were collected through observation, and in-depth interview with 54 experts and stakeholders, and five focus groups consisting of experts, employees, and policymakers. Since the researcher was an expert of health in disasters, a part of data collection was done with observation. All observations were registered and interviews and meetings were recorded and were analyzed by authors.Inclusions criteria for participants and focus groups; 1) being actively involved in the disaster area, and 2) Working experience of at least for 2 years. Exclusions criteria for participants and focus groups; 1) reluctance to participate in the study.A total number of 54 experts participated in the semi-structured and in-depth interviews. Semi-structured questions about the strengths and challenges of the health system services were asked from the experts. Probing questions were also asked based on the answers of the participants. The interviews lasted approximately 20\u201340 minutes. They were conducted in a quiet place. After each interview, it was immediately transcribed and the weaknesses, strengths, and challenges were extracted.Finally, 5 focus group sessions were held; the number of the people in each of the focus groups varied from 7 to 10 people. The duration of each focus group interview was between 1\u20132 hours. The sessions were directed and coordinated by the researcher. Semi-structured questions were asked from each expert in their profession regarding the undertaken actions, and measures, strengths, weaknesses, challenges, and needs. Each point was discussed in detail if needed. Data were analyzed, using the Inductive and Conventional approach based on the Graneheim and Lundman method.All participants in the study completed the informed consent form, and they could withdraw from the study at any stage of the study. The text of the interview was also completely confidential and the participants\u2019 demographics remained confidential.The research findings were categorized into 7 major groups of environmental health, mental health, mothers\u2019, infants\u2019, and children\u2019s health, field hospital, nutrition, contagious diseases, and drug. The strengths and challenges of each issue are presented below.Strengths: very appropriate measures had been adopted regarding the control and inspection of the drinking water resources, providing healthy water by adding Chlorine, turbidity test, monitoring the mobile water tanks and Chlorine residual testing, visiting the temporary housing camps, monitoring the kitchens, visiting food preparation and distribution centers, and disinfection of the mobile toilets and baths by Chlorine. In the first 8 days after the earthquake, the Chlorine residual in the water was 0 ppm and the turbidity of the urban water was over 5 NTU; however, the Chlorine residual level gradually rose to over 1.5 ppm and turbidity of the water fell to lower than 5 NTU.Challenges: various problems were observed such as lack of human force and the necessary equipment for the environmental health teams, lack of trash bags in the tents of the earthquake survivors, inappropriate burial of garbage, release of leachate in the environment because of raining, inappropriate transportation and distribution of the hot food, distribution of moldy bread and rancid dates among the affected people, disposal of animal manure in rural environments, presence of the corpses of the cattle and livestock in the city, lack or a few number of healthy water tanks and restrooms in the city and villages, and the presence of louse and scabies.Lack of restrooms and weak disposal of wastes and wastewater are two serious dangers which increase the incidence probability of contagious diseases among the earthquake survivors.Strengths: in the affected region, the psychologists screened all of the people and referred the individuals with the acute disorder to the psychiatrist. The actions taken by the mental health team included establishing an effective communication with families, sympathy and expression of feelings in order to gain confidence, and identify primary psychological reactions, and signs and symptoms of anxiety.Challenges: the majority of the disorders reported in the affected region included anxiety, the stress of the reoccurrence of the incident, overexcitement, sleep disorder and insomnia, suicidal tendency, and complaint from religious principles. Furthermore, there was no necessary equipment including whiteboard, marker, color pencil, wax oil crayon, toy, painting notebook, and gift for children which are necessary for the mental health team.I\u2019ve been addressing the people, and I realized that a lot of people were afraid and anxious. And the complaints of religious rituals were much higher\u201d.One of the experts said: \u201cStrengths: some necessary measures were taken for the affected society including visiting and examining the pregnant women and the children below one year old, examining the nutritional status of the infants with breastmilk and needs assessment of the nutrition of children and pregnant women, conducting delivery, visiting the girls and women in reproductive age, providing services for seniors and the children below one year old, helping vulnerable groups, distributing baby formulas, diapers, sanitary pads, baby bottles, distributing the facilities for birth control among people, vaginal examination (if needed), and checking the vital signs and fetal heartbeat.Challenges: lack of contraceptives, especially condoms, lack of fetal electrocardiography, lack of multivitamins and, in some cases, excessive intake of vitamins, lack of midwifery Sonic aids and Pinard, thermometer, otoscope, ophthalmoscopy, flashlight, tongue depressor, gloves and mask, blood pressure measurement device, baby scale, suture thread, and dressing set were seriously felt. Moreover, there were very few drugs such as methyldopa pill, magnesium sulfate and hydralazine ampoule for the pregnant women affected by high blood pressure.Strengths: various medical specialties were accessible in the mobile hospital.Challenges: some field hospitals were located on the outskirts of the city and the considerable point was the very low distance of the 3 field hospitals from each other. The assessment of the location of the field hospitals was very incomplete. There were problems such as imperfect setup of Incident Command System (ICS), absence of the environmental health personnel for spraying the hospital, lack of drugs, surgical instruments, and operating room, lack of the emergency box and surgical sets, lack of a helicopter near the hospital to dispatch sick patients, lack of specialties of orthopedics, internal medicine, emergency medicine, pediatricians, general practitioners and nurses , lack of radiological devices, and few number of security forces in the field hospitals.Strengths: in the first week, the following works were done: quick assessment of the children below 5 years old using mid-upper arm circumference, assessment of the malnutrition status of the children below 5 years old, screening the nutritional status of the infants and nursing mothers, providing proper nutrition to the patients with diabetes and those with high blood pressure, investigating the diet portion of the families, A+D supplements and calcium for the children below 2 years old, iron pill, and multivitamins.Challenges: lack of nutrition specialists was seriously felt in the first 10 days after the earthquake. In the first week after the earthquake, hot food was distributed among the earthquake survivors; there were some problems regarding the health status of the food and its maintenance. The distribution of the expired tuna and canned beans exacerbated the nutritional condition of the people. Lack of coordination between the Ministry of Health and Medical Education and the Red Crescent Society was also seriously felt regarding the food supply and distribution.Strengths: the syndromic care system was established by the employees of the contagious diseases. No case of contagious diseases was discovered in the first 10 days. Pediatric vaccination was carried out based on the immunization program; however, diphtheria and tetanus vaccines were injected in some cases. Fortunately, no case of Cholera, Measles, and Meningitis was observed in the affected region.Challenges: the specialists diagnosed some cases of Pediculosis and Scabies. Due to the cold weather, many people caught a cold. There were many cases of acute bloody diarrhea, especially in the children. Regarding the fact that the affected region is an endemic region of Cutaneous leishmaniosis, there should be an appropriate control over the reduction of the Phlebotomus.One expert said: \u201cGiven that the earthquake has damaged urban and rural water pipes, immediately\u201d the pipes should be replaced or rebuilt to prevent the spread of contagious diseases\u201d.Strengths: most of the drugs were given to those who needed them. The drugs were distributed in especial centers such as health centers, rural health centers, and mobile hospitals.Challenges: There was a severe shortage of these drugs; anti-cough and allergy syrups of Diphenhydramine, Dextromethorphan, and Ketotifen; antibiotics of Amoxicillin, Cefixime, and Azithromycin; the ophthalmic drugs of Sulfacetamide and Chloramphenicol; gastrointestinal pills and painkillers such as gelofen, acetaminophen and Codeine-acetaminophen; Piroxicam gel; and drugs for reducing blood pressure (Captopril) and diabetes (Metformin and Glibenclamide); there was a severe shortage of these drugs. Due to high levels of stress among the earthquake survivors, many of them were affected by Herpes simplex; hence, Aciclovir ointment was consumed to a large extent. There was a shortage of the general drugs such as alcohol pad, sieve, Betadine, the drugs such as gelofen, Chloramphenicol, Betamethasone, Piroxicam gel and A+D, eye drops, and painkillers. The drugs were distributed based on the words of the patients themselves and there was no examination regarding the necessity of the drug by a pharmacist or pharmacist technician; in fact, there was no monitoring.One of the experts said: \u201cHealth care staff distributed widely and widely drugs among people, which could create long-term problems for the people in the future. There is no supervision on the distribution of drugs at all\u201d.Natural disasters mostly occur in the developing countries due to the lack of a comprehensive emergency response program , 12. TheThe study of Udomratn (2008) showed that, after the occurrence of the natural disasters, the prevalence of psychological disorders and social functions, especially the Post-traumatic stress disorder (PTSD) in the earthquake survivors is between 8.6% and 57.3% in terms of intensity, kind of disaster, and individual characteristics . Other sThe incident of infectious diseases increases after the earthquake due to injuries, increased wastes, and the poor environmental health status of the affected region . RespiraFew studies have been conducted on the impacts of the earthquake on the pregnant women , 23. BecIn the great east Japan earthquake, there was lack of soluble drugs such as glucose 50%, oxytocin, phtharal, olopatadine tablets, normal saline, and levothyroxine tablet . The resMany health-related services were provided in Bam earthquake , which wThe Iranian healthcare system, including hospitals, prehospital entities, healthcare centers, and other involved stakeholders need a coordinated readiness plan to cope with new incidents and crises . This neSince Iran is prone to disasters, the occurrence of earthquakes is inevitable. Therefore, it is necessary to plan and implement appropriate measures for higher readiness and mitigation ability. Regional disaster plans for rapid healthcare response should be written, reviewed and revised at least once or twice a year. Furthermore, these plans should be tested by holding table top and operational exercises to identify new risks and weaknesses. Elimination of risks and mitigating disasters consequences enable a quick return to normalcy after a disaster such as an earthquake.There are some limitations to this study. One of the limitations of the study was the lack of access to all key informants for interviewing. Another limitation is the fact that the results reflect the observation by one researcher, whose impression and experience may have had an impact on the comprehension of the results.There were many deficiencies in healthcare response to Kermanshah earthquake, of which the most important one was the intra- and extra-organizational inconsistency and lack of human force and equipment, which resulted in more chaos in the affected region. Since Sarpol-e Zahab is an endemic region of cutaneous leishmaniosis with considerable health issues, rapid and appropriate measures should be implemented to prevent extensive health issues, including epidemics of contagious diseases, worsening of chronic diseases, and the exacerbation of mental disorders. Improved collaboration and coordination among different agencies are a necessary step, which may only be possible by a united regional leadership. Resource management, information-sharing, and training are all natural steps towards an increased healthcare readiness to combat disasters and to provide better services to the victims.Ethical issues  have been completely observed by the authors."}
{"text": "Waste management for municipal solid waste is considered a public health services, providing citizens with a system of disposing of their waste in an environmentally sound and economically feasible way. The amount and composition of waste generated comprise the basic information needed for the planning, operation and optimization of waste management systems. In this study, paper and plastic quantity changes in the MSW  of the region 10 of Tehran city were evaluated. This study was conducted in 6 months, in the summer and autumn seasons, at the region 10 of Tehran city. In this study, paper and plastic were segregated and data were analyzed by SPSS software. The paper parameter of solid wastes was consisted of folder paper, cardboard and used newspaper. The plastic parameter of solid wastes was consisted of plastic materials, plastic house shoes, plastic sack, nylon sack, linoleum, radiology photograph and PET. Samples were collected and weighed daily. The total quantity of paper and plastic portion of this region solid waste were 203,930\u202fKg and 180,101\u202fKg, respectively. The percentage of paper and plastic portion of this region solid waste also were 6.82% and 6.03%, respectively. The analyses showed a significant difference between these parameters and season, some months and days . So, because of the results of this study and economical issues, the paper and plastic segregation from generated source point and recycling them are important. The cornerstone of successful planning for a waste management program is the availability of reliable information about the quantity and the type of material being generated and an understanding about how much of that material that collection program manager can expect to prevent or capture. Effective waste management through MSW composition studies is important for numerous reasons, including the need to estimate material recovery potential, to identify sources of component generation, to facilitate design of processing equipment, to estimate physical, chemical, and thermal properties of the waste and to maintain compliance with national law and European directives. The composition of generated waste is extremely variable as a consequence of seasonal, lifestyle, culture, demographic, geographic, and legislation impacts. This variability makes defining and measuring the composition of waste more difficult and at the same time more essential  Fig. 1,, Fig. 3F2) and is restricted from north by Azadi Ave., from south by Qazvin Ave., from east by Navab highway and from west by Shahidan St.The region 10 is on of the most crowded regions of Tehran city. The Area of this region is about 807\u202fha . Then, for normal parts of those parameters, the One-way ANOVA test and Independent-sample T-test and for abnormal parameters, the Mann-Whitney and Kruskal-Wallis Tests were used. Then, the results were compared with other results of similar studies in Iran and other parts of the world.The normal condition of the data was determined by the Kolmogorov-Smirnov test . This test showed that plastic materials and plastic house shoes were normal and other components were abnormal.In This test method is applied for the determination of the mean composition of MSW based on the collection and manual sorting of a number of samples of waste over a selected time of period covering a 183 days. This test method includes procedures for the collection of a representative sorting sample of unprocessed waste, manual sorting of the waste into individual waste components, data reduction, and reporting of the results. This test method may be applied at landfill sites, waste processing and conversion facilities, and transfer stations. Its level of confidence and precision values are, respectively, 95% and 0.05%.The results of this study showed that the total weight of paper and plastic parameters in the solid waste of this region were 203,930 and 180101\u202fkg, and the percentage of these parameters were 6.82%and 6.02%, respectively.So the total weight of paper and plastic is assumed about 406,745 and 359217\u202fkg, respectively. In comparing the previous study that conducted in 1991 on the solid waste of Tehran province that showed the amount of paper in the solid waste was 10.3% with this study results, it seems that the amount of paper was decreased during last decade . In 2000The Iranian recycling and material recovery organization reported that the income of each kilogram paper and plastic recycling is about 2.5 and 6.5 cents, respectively. By calculating these numbers in the total collected amount of paper and plastic parameters in this region, the total yearly income of paper and plastic recycling is about 10,162 and 23,350 dollars, respectively. So, the special notice from economical point of view to the amount of paper and plastic in the MSW of this region and recycling them is very critical. Unfortunately, the most of MSW of this region is buried without any recycling process and the Tehran municipality organization should make instant and effective decision to recycling the recyclable materials that buried daily."}
{"text": "At the beginning of 2018, and after closing the international symposium on Nanoparticles, Nanomaterials and ApplicationsConcerning the first term, Rational Design, one of the most important subjects when a nanomaterial is designed, is to control the synthetic pathways to ensure the final desired product. A combination of dry and wet synthetic techniques, in conjunction with the adequate chemical and physical characterization methodologies, it is possible to prepare new nanomaterials successfully. This complex issue frequently is a result of multidisciplinary cooperation between chemists, physics, biologist, physicians, material engineers, among other disciplines. The second statement, Multifunctional applications, deals with the use of nanomaterials in fields some time collaboratives, such as drug delivery, cell and tissue imaging, as new antibiotic tools, in environmental detection and removing of contaminants, catalysis, and many industrial applications directly rely on properties such as water solubility, permeability, photostability, cell penetration, magnetic properties, related shape, and size control among others. Nowadays, functionalized nanomaterials play a crucial role in modern research areas because of their unique physical and chemical properties arise from their size and shape.In the international year of the Periodic Table, we can highlight in this collection of papers the use of gold, silver, iron, platinum, molybdenum, titanium, and cobalt as metal precursors among the use of organic@inorganic polymers, and Silica as the chemical protagonist in this collection of papers.Caponetti et al. in Italy reported an elegant paper on Fluorescent Nanoparticles for bioimaging; The use of Gold Nanoparticles for Photothermal therapy was studied by Vines et al. in South Korea and the USA, and also Gold Based Organometallic nanocomposites for Antitumoral activity studies were reported by Dalmases et al. in a collaborative paper including researchers from Spain and Germany, and finally iron was Price et al. including researchers from the United States of America, Saudi Arabia, and Russia. The actually topic of antibiotic resistance and new antibiotic studies was covered using silver nanomaterials by Djafari et al. in Portugal with a manuscript about Silver Nanotriangles as antibacterial tools, and Nuti et al. with the contribution of researchers in Portugal, Spain, and Italy with the synthesis of Mesoporous Silver nanoparticles for antibiotic delivery.Sixty-eight researchers from Portugal, Spain, Italy, Germany, Switzerland, Hungary, Russia, United States of America, Saudi Arabia, South Korea, Taiwan, and Indonesia, submitted 10 original and review articles covering all the aspects highlighted in the title. Related to the contributions in the field of biomedical sciences and applications, Sahroni et al. from Taiwan and Indonesia with Hybrid Nanomaterials for reversible lithium storage based on MoS2, Szab\u00f3 et al. from Hungary and Switzerland present a paper on Titanium based nanomaterials for catalysis applications, Martinez et al. studied several Pt-Co Nanoparticles for CO oxidation, and finally the use of TiO2/Au nanoparticles for hydrogen generation via photocatalysis was explored by May-Masnou et al. from Spain.Catalysis and industrial applications were represented by the contributions of In summary, this Research Topic have explored the state-of-the-art and beyond in the rational design of nanoparticles and nanocomposites, based on metallic, polymeric, or soft raw materials, as well as their different applications in medicine, imaging, drug delivery, catalysis, energy storage, or sensing.For all future technological applications, the rational design of these multifunctional nanomaterials is critical, and in many cases will be controlled by the organic and inorganic chemical reactions involved during the production. The success of their applications relies directly on the photophysical and chemical properties created in the final material, including the emission of light or colourimetric responses, water solubility, selectivity, sensitivity, stability, thermal stability, functionalization, etc.All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "As it may be argued that many surgical interventions provide obvious patient benefits, formal, staged assessment of the efficacy and safety of surgical procedures has historically been and remains uncommon. The majority of innovative surgical procedures have therefore often been developed based on anatomical and pathophysiological principles in an attempt to better manage clinical problems.In this manuscript, we sought to review and contrast the models for pharmaceutical and surgical innovation in North America, including their stages of development and methods of evaluation, monitoring, and regulation. We also aimed to review the present structure of academic surgery, the role of methodological experts and funding in conducting surgical research, and the current system of regulation of innovative surgical procedures. Finally, we highlight the influence that evidence and surgical history, education, training, and culture have on elective and emergency surgical decision-making. The above discussion is used to support the argument that the model used for assessment of innovative pharmaceuticals cannot be applied to that for evaluating surgical innovations. It is also used to support our position that although the evaluation and monitoring of innovative surgical procedures requires a rigorous, fit-for-purpose, and formal system of assessment to protect patient safety and prevent unexpected adverse health outcomes, it will only succeed if it is supported and championed by surgical practice leaders and respects surgical history, education, training, and culture.We conclude the above debate by providing a recommended approach to the evaluation, monitoring, and regulation of surgical innovations, which we hope may be used as a guide for all stakeholders involved in interpreting and/or conducting future surgical research. As it may be argued that many surgical interventions provide obvious patient benefits, formal, staged assessment of the efficacy and safety of surgical procedures has historically been and remains uncommon . The majIn this manuscript, we sought to review and contrast the models for pharmaceutical and surgical innovation in North America, including their stages of development and methods of evaluation, monitoring, and regulation. We also aimed to review the present structure of academic surgery, the role of methodological experts and funding in conducting surgical research, and the current system of regulation of innovative surgical procedures. Finally, we sought to highlight the influence that evidence and surgical history, education, training, and culture have on elective and emergency surgical decision-making. The above discussion is used to support the argument that the model used for assessment of innovative pharmaceuticals cannot be applied to that for evaluating surgical innovations. It is also used to support our position that although the evaluation and monitoring of innovative surgical procedures requires a rigorous, fit-for-purpose, and formal system of assessment to protect patient safety and prevent unexpected adverse health outcomes, it will only succeed if it is supported and championed by surgical practice leaders and respects surgical history, education, training, and culture. We conclude the above debate by providing a recommended approach to the evaluation, monitoring, and regulation of surgical innovations, which we hope may be used as a guide for all stakeholders involved in interpreting and/or conducting future surgical research.Assessment of innovative pharmaceuticals within the United States and Canada occurs within a highly structured model regulated by the U.S. Food and Drug Administration (FDA) and Health Canada, respectively . The devPhase I studies are conducted within a small cohort of healthy volunteers and assess the safety, tolerability, accepted dosage range, and pharmacokinetics of the IND after one or more doses , 5. PhasIn contrast to the highly structured and regulated model of pharmaceutical innovation, the development of innovative surgical procedures remains largely unregulated, unstructured, and variable , 6, 7. DIn the IDEAL model, stage 0 refers to the initial pre-human  work and development, whereas stage 1 is the first time the innovative procedure is performed on a small group of highly selected patients . FrequenDiseases of the Colon & Rectum, Surgery, and the British Journal of Surgery) in the year 2000 were RCTs and that this percentage increased to only 10% in 2010 , permit conclusions to be drawn, and thereby to develop and contribute to generalizable knowledge\u201d, it is frequently challenging to define an innovative surgical procedure as an intervention or research . Thus, uIn part to address this problem, a formal document was issued by the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research in 1979 known as the Belmont Report . AlthougAs a practical system for the development and evaluation of surgical procedures that does not unnecessarily hinder surgical innovation is required, the Balliol Collaboration created recommendations in 2009 that coincide with their proposed model of surgical innovation described above . The Colbefore patient recruitment commences . The. The7]."}
{"text": "Reproductive health of vulnerable adolescent girls is a top priority in global programs. Alcohol consumption, drug abuse, high risk sexual behaviors, sexually transmitted diseases, sexual assault, escape from home, unrestrained sex in the family, history of robbery, imprisonment and living in drug hangouts expose adolescents to different sorts of damage and injury. These adolescent girls are at risk of AIDS and other STDs, unwanted pregnancies, illegal and unsafe abortions, unplanned pregnancy and childbirth, and unsafe motherhood. Therefore, assessing these girls\u2019 reproductive health needs and designing programs to improve their sexual and reproductive health seem to be essential. This study will be conducted to design a comprehensive program for improving the reproductive health of vulnerable adolescent girls.The present study is an exploratory sequential mixed methods study  designed in three phases. In the first phase, a qualitative study will be used to describe the reproductive health needs of vulnerable adolescent girls, identify facilitating and inhibiting factors, and explain the strategies of reproductive health programs for these girls. Participants will be selected in this phase using purposive sampling method, and the data will be collected through semi-structured interviews. The obtained data will be analyzed using conventional qualitative content analysis. In the second phase, through a quantitative study, the strategies obtained from the qualitative study and review of the literature will be provided to reproductive health care providers, experts, policymakers, and planners to prioritize and select the best strategies. In the third phase, the initial draft of the program will be formulated based on prioritized strategies and will be proposed in a panel comprised of specialists in the areas of reproductive and sexual health, health promotion, social injuries and a psychiatrist. Finally, the final program will be developed and presented after obtaining the agreement and approval of the panel members.Designing a program based on a qualitative study, review of the existing evidence and programs, and using the opinions of experts in different areas can lead to different aspects of reproductive and sexual health of vulnerable adolescent girls. On the other hand, taking into account all cultural sensitivities and taboos as well as political, economic and social barriers, the development of such a program can provide the appropriate possibility of presenting comprehensive reproductive and sexual health services to vulnerable adolescent girls and achieve the goals agreed universally. One of the most important components of human health is reproductive health that planning to provide it, especially with particular regard to women and girls, is one of the essential steps in ensuring the health of the family and society. This study can provide strong, comprehensive information and need-based strategies to ensure reproductive health of vulnerable adolescent girls. This study is an exploratory sequential mixed methods design that consists of three phases. A qualitative study is conducted to assess the reproductive health needs of vulnerable adolescent girls, identify facilitating and inhibiting factors, as well as strategies which can help ensure their reproductive health. The participants in this phase will be selected using purposeful sampling method and the data will be collected using semi-structured interviews. The obtained data is analyzed using qualitative content analysis. In the second phase, through a quantitative study and using the SFF method , first introduced by Landsberger, the strategies obtained from the qualitative study and review of the literature will be provided to reproductive health care providers, experts, policymakers, and planners to prioritize and select the best strategies. At the end of this study, the most prioritized strategies are selected. In the third phase, initial drafts of the program will be formulated based on prioritized strategies and will be proposed in a panel comprised of specialists in the areas of reproductive and sexual health, health promotion, social injuries as well as a psychiatrist. Finally, the final program will be developed and presented after obtaining the agreement and approval of the panel members.Designing a program based on a qualitative study, review of the existing evidence and programs, together with using the opinions of experts in different areas can lead to different aspects of reproductive and sexual health of vulnerable adolescent girls. Furthermore, the development of such a program through considering all cultural sensitivities and taboos as well as political, economic and social barriers, can provide the appropriate possibility of presenting comprehensive reproductive and sexual health services to vulnerable adolescent girls and help us in achieving the internationally agreed goals.Reproductive health is one of the most important components of human health. The most important components of reproductive health include informing, educating and counseling on sex and creation of responsibility in both sexes with respect to the cultural conditions of the society, counseling,education and treatment of sexually transmitted infections and sexually transmitted diseases especially AIDS and hepatitis, timely and appropriate prevention and treatment of the complications of abortion, family planning and provision of services in this regard, prevention and appropriate treatment of infertility, provision of prenatal care, safe delivery and postpartum care, especially education and promotion of breastfeeding. The development of programs related to reproductive health and addressing its various components and dimensions at national and international levels is one of the essential steps in ensuring society and family health  . AdolescIt is for these reasons that the provision and promotion of reproductive health among adolescents is one of the most important commitments of societies in achieving Sustainable Development Goals (SDGs), and there is an emphasis on the public access to reproductive health care services and its integration into strategies and programs by 2030 .However, there are still barriers in many countries, especially developing countries, to the design and implementation of reproductive health programs for adolescents. In many cultures, providing reproductive health to this social group faces many challenges . At the Therefore, given the necessity of policymaking and program development before doing any operational action, this study was designed through using an exploratory mixed method to identify the reproductive health needs of vulnerable adolescent girls by taking into account all the factors affecting it in the present situation of the society and, then, develop and present a comprehensive reproductive health program for vulnerable adolescent girls.Describe the reproductive health needs of vulnerable adolescent girls.Identify facilitating and inhibiting of reproductive health factors.Explain the strategies of reproductive health programs for these girls.Decision-making and prioritization of the strategies obtained from the qualitative study and review of the literature by using SFF matrix.The initial draft of the program will be developed based on the prioritized strategies and then modify the program by comments expressed from panel of experts.The present study is an exploratory sequential mixed methods study  designed in three phases. The first phase of the study is a qualitative study to describe and evaluate the reproductive health needs of vulnerable adolescent girls, identify facilitating and inhibiting factors, and explain the strategies of reproductive health programs for these girls. In the second phase, through a quantitative study, the strategies obtained from the qualitative study and review of the literature will be provided to reproductive health care providers, experts, policymakers, and planners. The most prioritized strategies will be selected in this phase. In the third phase, the initial draft of the program will be formulated based on the prioritized strategies and will be proposed in a panel consisting of specialists in the areas of reproductive and sexual health, health promotion, social injuries and a psychiatrist. Finally, after obtaining the agreement and approval of the panel members, the final program will be developed and presented.In the first phase of the study, the reproductive health needs of vulnerable adolescent girls, the factors affecting, and the strategies for providing their reproductive health are explained using in-depth semi-structured interviews which will be analyzed using conventional content analysis. The research setting for this study where the adolescent girls will be interviewed includes health homes in welfare centers, prison health centers, the Department of Prevention in the Ministry of Justice, and drug abuse hangouts. Interviews with service providers, decision-makers and policymakers in the areas of vulnerable women and girls will be conducted in their workplaces including public health centers, private offices of the midwives, gynecologists and psychologists, prison, the branch of social injuries in the Ministry of Justice, the Social Security Branch of the Police, the Department of Social Injury in the Department of Education, the Deputy of public health in the province and the university.The population of study in this phase consists of all vulnerable adolescent girls aged between 12 and 19, reproductive health providers, psychologists, decision-makers and policymakers in the field of reproductive health. Purposive sampling method will be used in this phase of the study. Sampling method with the maximum diversity will be used to ensure the validity of the study. As such, adolescent girls with different ages, education levels, and socioeconomic status will be included in the study. Similarly, decision-makers, policymakers, and service providers are also selected to participate in the study, taking into account the maximum diversity in terms of characteristics such as age, education, work experience, type of specialty, job and organizational position. Sampling and data coding will continue until there is no more new code and saturation is reached.Inclusion criteria for adolescent girls include aged between 12 and 19\u2009years old, starting and maintaining a menstrual cycle, having no known mental illness that requires to be treated and willingness to participate in the study, and for other participants, willingness to participate in the study.For data collection at this phase, we will use in-depth semi-structured individual interviews, field notes, reminder writing and document review. All actions at this phase will be performed taking into account ethical considerations. Prior to the interviews, the participants will be briefed about the purpose of the research, and written or verbal consent will be obtained from them. The scheduled time for the interview, the duration of the interview and the interview location will be chosen based on the preferences of the participants.Conventional qualitative content analysis will be used for data analysis and interpretation.In order to evaluate the accuracy and stability of the data, the four criteria of credibility, dependability, confirmability and transferability will be used .In this phase, the strategies obtained from the qualitative study and review of the literature will be provided to reproductive health service providers, experts, policymakers and reproductive and sexual health planners for decision-making and prioritization. This phase will be conducted quantitatively and using descriptive research method. In this phase, reviews of the literature will be performed using an extensive and in-depth library study  and searching in electronic databases to evaluate the writings related to the subject of study. Searching keywords such as adolescent, vulnerable, unmarried, and reproductive health, all studies published from 2006 to 2019 in -persian or English will be evaluated. For access to this information, PubMed, Science Direct, Web of Science, Cochrane Library, Ovid, Scopus, ProQuest, Magiran, Embase, SID databases will be used. After extracting the strategies, the participants will be provided with a list of strategies in the quantitative phase of the study.Comprehensive health services centers, the offices of midwives, gynecologists, psychologists and psychiatrists, the Department of health in the province, Social Welfare Organization, the Social Deputy of the Police, the Social Injuries Unit of the Justice Ministry, and the Social Injury Units of the Department of Education are considered as the setting of the study.The population of the study consists of the decision-makers and providers of services for vulnerable adolescents include midwives, gynecologists, specialists of reproductive health and health promotion, psychologists, psychiatrists, the authorities of the family health promotion units in the provincial health department, the authorities of social injuries in the police department, the authorities of social injuries in the Ministry of Justice, Social Welfare Organization authorities working in the field of reproductive health, and the authorities of the social injuries unit in the Department of Education.Convenience sampling method is used for this part of the study.Experts and service providers with the minimum of 2\u2009years of work experience and health professionals and policymakers with at least 3\u2009years of work experience who are willing to participate in the study can take part in it.Unwillingness to participate in the study and the questionnaires that are not filled completely.The data collection tool is a two-part questionnaire. The first part deals with the demographic characteristics of the participants, including age, sex, occupation, education, work experience, workplace and job position, and the second part is related to the scoring of the extracted strategies by using SFF matrix. This matrix contains three criteria of importance, necessity and ease of implementation. Each criterion has a score of 1 to 3  and, thus, each matrix or strategy can have a score of 3 to 9. The questionnaire of strategies for reproductive health of vulnerable adolescent girls will be completed in-person or via email by the research population identified based on their expertise and activities related to vulnerable adolescents. At this set time, the researcher will refer to these people frequently and follow the work process in answering the questionnaire. In addition, the participants can contact the researcher by telephone if necessary. After the end of the deadline, the questionnaires are collected by the researcher and the scores for each item are calculated and analyzed. At the end of this study, the most prioritized strategies will be used for the development of the program.The collected data will be analyzed by descriptive statistics methods and using SPSS20 statistical software.In this phase, the initial draft of the program will be developed based on the prioritized strategies. As such, the panel of experts will be used to reach the consensus of experts on the developed draft at this phase. This phase will aim to determine the opinion of experts on the structure and applicability of the program and is performed as a group discussion among experts. In this panel, reproductive health specialists, social injury specialists, psychiatrists, health promotion professionals, and health policymakers and planners are invited, and the draft of the program together with the purpose of the session will be sent to them. Then, the comments expressed in the session, after being approved by all experts, will be used to modify the program.Vulnerable adolescents are one of the social groups that, because of being affected by poverty, addiction, disability, ethnic and gender discrimination, AIDS, exposure to violence or physical, sexual and psychological abuse by peers or adults in the family, school, or society, child marriage and girl circumcision are more at risk than other adolescents . Various"}
{"text": "The School Fruit and Vegetables Scheme (SFVS) implemented by the European Union in 2009/2010 aims to improve the diet of students and to support agricultural markets and environmental sustainability. The objective of this study was to identify the characteristics of the School Fruit and Vegetables Scheme implementation from 2009 to 2017 in Spain and its autonomous communities. A descriptive, longitudinal, observational, and retrospective study was carried out on the basis of document analysis of SFVS reports. We studied the average budget for Spain and its autonomous communities (AC), the number of students enrolled, the cost of the SFVS by student and by day, the duration of the SFVS, the quantity of fruits and vegetables (FV) per student and day (g), the variety of FV, the recommendation to include local, seasonal, and organic foods, and the educational activities (EA). The results were studied by the AC which are territorial entities of Spain. The budget almost doubled during the study, thanks mainly to EU funds. However, the number of students increased only from 18% in 2009 to 20% in 2016. The quantity of FV increased from 2579 to 4000 tons, and the duration of the SFVS increased from 9.8 to 19.6 days. In the AC, there were variations in EA, in the number of enrolled students (7.4% to 45.6%), in the cost per student (from \u20ac2.3 to \u20ac28), and in the duration in days (5.6 to 70 days). The recommendation to include local, seasonal, and organic foods was implemented in five of the eight years studied. The development and scope of the SFVS in Spain are still insufficient to generate an equitable healthy dietary pattern in the school population. However, the SFVS has generated an economic market for agricultural production due to the amount of FV distributed in each academic course. The low intake of fruits and vegetables (FV) is an important risk factor for the development of non-transmissible diseases ,2. PromoFrom this perspective, the European Commission (EC) recognizes the importance of developing a plan to promote the consumption of fruit and vegetables in schools, supported by the EU   which are administrative-territorial entities. For these reasons, the SFVS is carried out at the regional level, although the competent national authority establishes a common framework. Therefore, AC establish, in their respective regional strategies, how and when to distribute the produce. The EC considers the distribution of produce at mealtimes (school canteen) not to be appropriate for three fundamental reasons: control difficulties, inaccessibility of some students to the school canteen, and the possibility of replacing the item with other menu options ,6. The SFVS receives funding from the European Commission, central government, regional governments (autonomous communities) and, in some cases, private companies . The budFor SFVS implementation, authorization requests are solicited annually in accordance with the conditions established by the competent authority of the autonomous community. The State can select schools that meet specific conditions .Following the international recommendations for promoting a healthy diet ,9, the SCurrently, in Spain, the SFVS is being carried out in different AC in a coordinated way between the Ministry of Agriculture, Fishing, and Food (MAPA), the Ministry of Health, Social Services, and Equality, and the Ministry of Education, Culture, and Sports . HoweverWe carried out a descriptive, longitudinal, observational, and retrospective study nationally based on secondary sources. Sources included all the annual SFVS plans in Spain from 2009/2010 to 2016/2017, available on the webpage of MAPA ,19,20.n), duration of the SFVS (days), quantity of FV included (t), varieties of FV (n), recommendation of local foods , seasonal foods  and organic foods , and education activities.The following variables were extracted from the reports consulted and were calculated by academic course (school time period between September and June) and AC: European and state budget (\u20ac), number of students enrolled , the cost of the SFVS per student and per day (\u20ac), the duration of the SFVS (days), the quantity per student (kg), the quantity per student and day (g), and the variety of FV (n). Also, we studied the correlation between cost per student and recommendation of local, seasonal, and organic foods. In order to calculate the average number of students enrolled, the average cost per student, and the average quantity of FV per student, the values were weighted by the number of students enrolled in the SFVS in each studied autonomous community. To calculate the percentage of students covered by the SFVS, we used the target group of students enrolled in each AC between 3 and 18 years of age, as indicated in the regulations [For each AC and academic course, we calculated the average budget financed by the EU and by state , the number of students enrolled in the SFVS  Playful educational activities ; (2) Didactic material ; (3) Visits to the field and/or to farms, fruit and vegetable producers, and marketers of FV; (4) Training sessions ; (5) Cooking workshops ; (6) School gardens that included agricultural workshops and gardening sessions. The number of times each of them was present in the SFVS was counted by the autonomous community and academic course, and the first year of incorporation was identified.Finally, The purpose of this study was to identify the characteristics of the School Fruit and Vegetables Scheme implementation from 2009 to 2017 in Spain and its autonomous communities. The majority of the AC participated in the different editions of the SFVS organizing the distribution of FV along with various educational activities. Although the SFVS had increasing coverage in terms of the students, its scope was limited. In addition, the implementation of the SFVS in each of the AC was very heterogeneous. The SFVS received more and more financial support from the European Union for its implementation, while funding at the state level was progressively reduced. Even so, the quantities of fruits and vegetables provided in the SFVS increased. This, together with the incorporation of local, seasonal, and organic foods in some autonomous regions is in accordance with the strategies to promote a healthy diet and a more sustainable food system.The participation of a large proportion of the autonomous communities in the different editions of the SFVS shows their interest in incorporating the international recommendations in their educational offerings to promote the consumption of fruits and vegetables among the student population. Specifically, childhood is the ideal time to establish healthy eating behaviors, since these will probably persist in adult life ,24,25.The availability of fruits and vegetables in the school environment seems to encourage consumption among children ,27,28, wFurthermore, the distribution of fruits and vegetables alone is not sufficient to establish a healthy eating pattern ,32,33,34However, a large number of theory-based training activities  that are being developed may limit the scope of the educational objectives of the SFVS, given that they emphasize the conceptual objectives of the SFVS more than changing attitudes or procedures. In fact, previous studies show that with recreational\u2013educational activities and cooking workshops, better results are achieved ,36,37,38Furthermore, the heterogeneous development of the SFVS in the autonomous communities observed in the variables studied suggests unequal access to the program for the students according to their place of residence. This could lead to greater inequality in health, especially in families with low incomes and difficulties in accessing adequate food supplies ,29,30. TThe progressive increase in the quantities of fruits and vegetables provided in schools can favor the development of agricultural markets. That is why institutional buying creates a new market for family farmers. Prioritizing the purchase of local, seasonal, and organic foods would contribute to a more sustainable food system ,45. In aWhen interpreting these results, we must remember that the information used came from the annual reports of the SFVS, prepared by the strategy managers in each AC. This can result in certain limitations due to the use of secondary data; as such, we do not have de control of the collection of these data. Also, we have no information on which schools implemented better the SFVS in each AC. However, the reports present the information in a homogeneous way for the different academic courses studied, which allowed us to explore how the SFVS is implemented in Spain. On the other hand, although this study focuses on a single country (Spain), which makes it difficult to extrapolate and generalize the results, the proposed methodology allowed us the describe some characteristics of the implementation and evolution of the SFVS. However, we do not have information about whether the availability of FV was equal in all schools which adhered to the SFVS. This is the first study to explore the scope of the SFVS. Given that the SFVS is an EU strategy, this study can contribute to decision-making to strengthen or introduce changes in the SFVS.The development and scope of the SFVS in Spain are still insufficient to generate an equitable healthy dietary pattern for the students. The SFVS covers a limited percentage of the target group of students and is carried out heterogeneously in the different autonomous communities. This finding is contradictory to the purpose of the SFVS, that is, to improve the dietary pattern of students regardless of their geographic and socioeconomic status. Also, the continuity of the program depends largely on the funds that come from the EU. However, the SFVS has generated a consumer market for agricultural production. This information is related to the fact that, according to the data presented, thanks to the SFVS, a great amount of FV is being distributed. Before the implementation of the SFVS, these quantities were not acquired by schools. Taking into account the potential of the SFVS to improve children\u2019s food consumption in line with sustainable development objectives, it is important to guarantee its implementation. Increasing the Spanish portion of the budget and promoting synergies among the agents involved could improve the coverage and duration of the SFVS, which would help promote sustainable food systems."}
{"text": "On July 6, 2018, at the age of 92, Professor Kimishige Ishizaka has died. Prof. Ishizaka, known as Kimi from his friends and colleagues, together with his wife Teruko, known as Terry, discovered IgE antibodies in 1966. Kimi Ishizaka was born on December 3, 1925, graduated in Medicine in 1948 and obtained his Ph.D. in 1954 at the University of Tokyo, quickly became Chief of the Department of Serology at the National Institute of Health in Japan. From 1957 to 1959 he was a Research Fellow at the California Institute of Technology (CALTECH) in Pasadena under the enlightened guidance of Prof. Dan H. Campbell. From 1962 to 1970 he was Chief of the Department of Immunology at the Children\u2019s Asthma Research Institute at the University of Colorado Medical School. This last period was of fundamental importance in the scientific career of Kimi and Terry Ishizaka who, in 1966, using a series of sophisticated techniques, showed unequivocally the existence in the serum of allergic patients of a new class of immunoglobulins, which was named IgE, later recognized by the WHO. This extraordinary discovery has allowed the development of modern Allergology.The move of the Ishizakas in 1970 to Johns Hopkins University in Baltimore marked a turning point in their scientific evolution. For almost 30\u00a0years an unrepeatable scientific collaboration was realized between the Ishizakas, Basic Immunologists, and the group of Philip Norman and Lawrence M. Lichtenstein, Clinical Immunologists and Allergists. This fantastic scientific interaction was also possible thanks to the proximity of the Divisions of Basic Immunology and Clinical Immunology at the Good Samaritan Hospital of Johns Hopkins University. In that location from 1976 to 1980 I had the fortunate opportunity to meet almost daily Kimi and Terry Ishizaka, to be able to enjoy their precious suggestions and their always constructive criticism and to establish a friendly relationship. In the following years, a number of Italian researchers from different Universities had the opportunity to meet the Ishizakas in Baltimore, to attend their seminars and to interact with their almost always extraordinary collaborators. Among these, it is sufficient to mention Tomio Tada, the discoverer of T suppressor lymphocytes and Tadamitsu Kishimoto, the discoverer of IL-6 and its receptor. Among the few non-Japanese I remember Thomas Platts-Mills, the discoverer of the Dermatophagoides antigens and a member of the Royal Society of London.In 1989, Ishizakas moved to the West Coast and Kimi became first Scientific Director, later President and finally President Emeritus of La Jolla Institute for Allergy and Immunology, one of the most qualified research centers in the world in the field of Immunology.The scientific production of Kimishige Ishizaka is monumental and of the highest level. He will be remembered among the Masters of Immunology for the discovery of IgE and for having elegantly elucidated their role in allergic reactions. For these discoveries, Kimi Ishizaka has received countless and prestigious scientific prizes including the Paul Ehrlich Award, the Emperor Award, the American College of Physicians Award and the First Order of Merit of the Sacred Treasure. Many distinguished Immunologists believe that he deserved to receive Stockholm\u2019s honor for his discovery which revolutionized not only the pathophysiology, but also the immunological therapies of allergic diseases. The latest publication of Prof. Kimishige Ishizaka, entitled \u201cThe Way We Walked with Immunology\u201d , summarizes his extraordinary scientific journey that places him among the giants of modern Immunology.Collegium Internationale Allergologicum. In this role, he honored our country by choosing Sorrento (October 1982) as the site of the X Collegium Internationale Allergologicum, which I had the honor of organizing, under his friendly supervision, together with the late Professors Mario Condorelli and Mario Ricci.Prof. Ishizaka has been President of prestigious Scientific Societies such as the American Academy of Allergy and Clinical Immunology, the American Society of Immunology and the Gianni MaronePast-PresidentCollegium Internationale Allergologicum"}
{"text": "Following publication of this  article,As stated in the article, the authors received approval from the University of Arkansas for Medical Sciences (UAMS) Institutional Review Board (UAMS IRB 2010 approved protocol #130212) where patients were recruited, consented, and participated. However, analysis of the specimens occurred, in part, at CAVHS. The specimens were not de-identified, and thus required approval from the CAVHS IRB prior to initiating this work. The authors explained that they were unaware of the requirements at the time. The CAVHS Chief of Staff and IRB agreed that the investigators had received inadequate education about the ethics approval requirements, and both the study and the program were determined to be non-compliant.PLOS ONE Editors retract this article.Owing to lack of required IRB oversight for the research reported in this article, the All authors did not agree with retraction."}
{"text": "Describe the sampling design and other methodological aspects of the Study of Chronic Diseases (Edoc).Edoc comprises two household surveys with distinct populations, one with adults aged 18 to 59 years (Edoc-A) and another with older adults aged 60 years or more (Edoc-I), living in Rio Branco, Acre. The selection of the participants used complex samples by clusters in two stages of selection, census enumeration areas (CEA) and household. In the first stage, common to both surveys, 40 CEAs were selected with probability proportional to size, and in the second stage, independent for each survey, households were selected with equal probability, and all the residents eligible for each survey were selected. Sampling weights were estimated by the inverse of the product of inclusion probabilities at each stage and then calibrated to produce unbiased population estimates. Interviews were held with questionnaires about socioeconomic and demographic conditions, life habits and health conditions. Anthropometric measures focused on measures of body height, girths and mass, while the vital signs analyzed were blood pressure, heart rate and respiratory rate. Blood and urine samples were collected for analysis.The Edoc comprised 1,701 participants, 685 of Edoc-A and 1,016 of Edoc-I. Considering the loss of information of some participants and the need of studying specific themes with production of population inferences, 16 subsamples of complete information by theme were generated and two subsamples were exclusive of Edoc-I.The Edoc has as important developments the analyses of epidemiological profile of the population from the capital of the state of Acre, contributing to the production of knowledge in public health with useful information for decisions in public health policies. This article aims to document the methods applied in the Study of Chronic Diseases (Edoc) in Rio Branco, state of Acre. This study is composed of two household surveys: one with adults, named Edoc-A, and another with older adults, Edoc-I.Although distinct and independent, these two surveys shared some objectives and methods. This survey aimed to analyze prevalence and factors associated with health problems in adults and older people from Rio Branco, state of Acre. To do so, data about the characteristics of the household were collected in both surveys, such as socioeconomic and demographic conditions, exposure to substances and heavy metals, food and life habits, health conditions. Anthropometry was conducted, and biological material was collected. In the specific case of Edoc-I, data about the functional autonomy and depression were obtained. The samples were collected and selected in two stages (census enumeration area and household), with the first selection stage being common to both surveys.Another important point is that both surveys have distinct and mutually exclusive populations, which allows estimating data for the union of populations and shaping the data of both surveys in an integrated manner.This study describes the survey populations, sampling design, instruments used, training and pilot test, procedure of data collection, data entry and information consistency editing, in addition to setting up the database and the files by theme.The project regarding both surveys was approved by the Research Ethics Committee of the Federal University of Acre, under the Certificate of Ethical Assessment (CAAE) 17543013.0.0000.5010, and all the participants signed the informed consent form.The city of Rio Branco is crossed by the Acre River, which gives its name to the state and divides it into two districts. On July 31, 2010, the state had a population of 336,038 inhabitants, 96,276 households and 338 census enumeration areas (CEAs), which were defined by IBGE for 2010 Population Census (CD2010). Rio Branco was the sixth largest city in the North regionThe survey population of Edoc-A comprises the residents aged 18 to 59 years, while Edoc-I comprises the residents aged 60 years or more. According to CD2010, Rio Branco had 204,094 adult inhabitants and 14,480 older people. Individuals with compromises that hindered communication or the understanding of the questions were excluded from both research populations, as well as pregnant women.Thus, the union of both surveys defines the total survey population of Edoc, i.e. the set of residents aged 18 years or more in the city of Rio Branco.Both surveys used cluster sampling plans in two stages. In the first stage, CEAs with probability proportional to the number of households observed in CD2010 were selected. In the second stage, the households were selected systematically with equal probability for each survey.AAS) needed to estimate a prevalence P with absolute error d and confidence level 1-\u03b1 is given by:According to CochranHowever, the research did not use SRS, but the sampling plan described earlier. To consider the effects of this sampling design in sample size, Pessoa and SilvaThe sample size of Edoc-A was determined by assuming a prevalence of 15% in kidney function alteration among adults (18 to 59 years)The sample size of Edoc-I was estimated using a prevalence of 40% in kidney function alteration among older adultsBefore determining the number of households and CEAs to be selected, the size of the samples were increased to compensate for possible nonresponses, assuming 20% of loss for adults and 12.5% for older adults, who are more easily found in households and tend to refuse to participate less than adults. Thus, samples of adults and seniors went from 652 and 1,148, respectively, totaling 1,800 people being interviewed in both surveys.Then, using the mean of adults (1.482) and older people per household (0.394) in the city, we noted that it was necessary to select 440 and 2,914 households to achieve the sample sizes for adults and seniors, respectively. Once such numbers were fixed, we defined the selection of 40 CEAs, the same for both surveys.i/11 and HHi/73, where HHi is the number of households in CEA i. Thus, although the household selections are independent, a same household could be selected for both surveys. In the selected households, all eligible residents were interviewed. Therefore, there was no selection of residents in households. The The CEAs were selected with probability proportional to size (PPS), to deal with different in cluster sizes. Eleven households were selected, by systematic sampling, for Edoc-A and 73 households for Edoc-I, independently, with interval selection equal to HHThe However, as occurs in all household surveys, there may be nonresponses and biases in the distribution of population by sex and age. The solution usually adopted has been the calibration of sampling weightsThe variables used in the calibration were sex and age group . The population totals used in the calibration of weights by sex and age group was estimated for July 1, 2014 , using the linear trend methodThe comparison of sizes of both samples demonstrates that the loss rate of 20% for the sample of Edoc-A was overestimated , while the loss rate for Edoc-I was well estimated . Additionally, the initial weight leads to an underestimate of 22.1% of the population size, composed by an underestimate of 29.3% for adults and by an overestimate of 43.1% for older adults. In addition, the analysis by sex confirms what is known in sampling as availability bias: women tend to be more available at home to be interviewed, both among adults and older people.However, it was not always possible to obtain all the information about everyone. Thus, nonresponses were observed in different degrees according to the theme. A possibility to handle that would be to adopt a mechanism of probabilistic imputation, which would generate a file with all the information. However, considering the sampling size and the difficulty of ascribing results of laboratory tests or physical assessment, we decided to give a treatment similar to that adopted in the Study of Cardiovascular Risks in Adolescents (Erica), which designed different databases with the variables required for each analysis theme and the set of records with the complete information. Thus, the calibration of weights in each thematic database was used to treat nonresponses and correct possible biases in the calibration variablesSeventeen databases were created, one for the set of interviews (which includes specific nonresponses) and 16 for the subsamples of complete information about each theme. For Edoc-A, fourteen files of complete subsamples were created, which were given the following names: albumin, alcohol, waist circumference, cholesterol, creatinine, diabetes, dyslipidemia, hand grip strength, hemoglobin, hypertension, obesity, metabolic syndrome, smoking and triglycerides. In the case of Edoc-I, two other themes were the subject of exclusive research: functional autonomy and depression.Three semi-structured questionnaires were used for the interviews: 1) household, containing information of family, housing, sanitation and the Socioeconomic ClassificationThe socioeconomic and demographic information included data on place of birth, age, sex, skin color or ethnicity, educational level, marital status, work and occupation. Occupational exposure data included information on toxic agents, route and exposure time.Data on life habits, such as smoking and alcoholism, were the report of daily and occasional consumption, performed before the survey. To collect information on physical activity while commuting to work or school, at work, at home and during leisure time, we used the questions employed in the study of Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey in 2013Still in the module of behavioral information, we used the Quantitative Food Frequency Questionnaire, previously validatedIn the module about health, the questions dealt with history of first-degree relatives for cardiovascular, renal and metabolic morbidities. Questions about self-assessment of health, self-reported morbidities, pain and complaints of the physical state and about the perception of stress were also included. Information about the current use of medication, dose and frequency, through presentation of a prescription or packaging of the product was also obtained, as well as long-term use, for one month or more, of antihypertensive medications, insulin, anti-diabetic medication, antibiotics, non-steroidal anti-inflammatory medications, antidepressant/anti-anxiety drugs and immunosuppressants. The use and evaluation of health services were also investigated.To assess the quality of life, the quality of life questionnaire of the World Health Organization (WHO) was applied, the WHOQOL-BrefAdditionally, to investigate the functional autonomy among older adults, the Activities of Daily Living scale (ADL) was employed, modified by KatzThe anthropometric data included the measurement of weight, height and waist circumferences, hip, arm and calf, following the protocols recommended by the American College of Sports Medicine (ACSM)2), subsequently categorized, as well as the waist circumference, according to WHO criteriaThe body mass index (BMI) was estimated by dividing the weight (kg) by the square of height , determined in accordance with the protocol recommended by the Brazilian Society of CardiologyThe biological material used included blood and urine samples. The blood samples were obtained by peripheral blood collection, with prior antisepsis of the cubital fossa of the participants. Part of the sample taken, 4 ml, was packed in vacuum test tube without anticoagulant and centrifuged at 1,500 rpm for 15 minutes. The serum extracted was stored for biochemical dosage of triglycerides, total cholesterol and fractions: high-density lipoprotein (HDL), low-density lipoprotein (LDL) and very low-density lipoprotein (VLDL).Total cholesterol was dosed by colorimetric enzymatic method COD/PAD, in the same way as fractions  and triglycerides GPO/PAP (Labtest Diagn\u00f3stica). LDL was obtained from VLDL by hydrolysis of different lipolytic enzymes.Four ml of whole blood was packed in a vacuum tube containing 2 mg/ml of ethylenediaminetetraacetic acid (EDTA) for hematological and serum creatinine analysis. The serum creatinine was dosed by traceable enzymatic method of isotope dilution mass spectrometry (IDMS) in an automatic analyzer (Labmax 240 Premium).The complete blood count was performed by electronic cell counting. The differential leukocyte count was performed by microscopic analysis of 200 cells in a blood distension stained by the Romanowsky method.For the analysis of serum glycemia, a 4 ml blood sample was used and stored in vacuum tube containing 2 mg/ml sodium fluoride, being centrifuged before analysis. The dosage used the glucose oxidase method (Labtest Diagn\u00f3stica).For urine samples, approximately 50 ml of the midstream of the first morning urine of each individual were collected. The samples were placed in standard bottles and transported from the collection site to the lab for analysis in controlled temperature. They were processed by physicochemical and microscopic analysis of the sediment. Some of it was centrifuged, and the supernatant was removed for biochemical analysis of albuminuria concentrations.\u00ae (Labtest Diagn\u00f3stica), reacting with a specific antibody.For the urine test type I (ASE), physical, chemical and microscopic analyses were conducted. The amount of albumin and urinary creatinine was determined by turbidimetric analysis POP Kit LabtestThe analyses of biological material were performed in the same laboratory to ensure standardization of procedures.All data collection procedures were performed by qualified personnel, trained and supervised by the coordination of the study. The team of interviewers was composed by students or health professionals who participated in a preparatory course promoted by the coordination to understand the role, function and importance of the interviewer in scientific research, in addition to the familiarity, understanding and application of the instruments. To standardize the interviews, a manual for study and activities basis was prepared.The team responsible for the physical assessment, vital signs and collection of biological samples, named the health team, was composed of health professionals: nurses, physical education professional, nursing and laboratory technicians. All professionals were previously trained in order to understand and standardize the procedures adopted.A pilot study was conducted in a CEA not included in the sample. During mapping, difficulties in locating addresses were corrected, being added the address information and references to the description and visual presentation of the household. Later, interviews were initiated, in which participants were asked to comment on the difficulties in understanding the questions and assess the interviewer and the health team.For quality control of information, the interviews were reconducted, as well as the physical assessments in 20 adults and 30 older people assessed in the pilot study.The mapping of the selected CEA respected the geographical limits and beginning and end established by IBGE, with the election of households always starting by the right limit of each CEA. With the total number of households in each CEA, a calculation was carried out for setting the number of households to be skipped from the first CEA. The households eligible to interview adults, older people or both were indicated in detailed addresses and image in the spreadsheet used by the team of interviewers.The definition of household adopted was the place structurally separate and independent that is intended to be a dwelling for one or more people or that is being used as such. We selected only private households characterized as residences where the relationship was dictated by ties of kinship, domestic dependency or by living standards, such as houses, apartments and dwelling units in single-room houses or tenementsWith the address lists, the trained professionals interviewed all of the people eligible for the study that lived there. In closed households or in the absence of eligible resident, the team returned up to three times to the local, in different periods, for data collection; when they were not successful, the loss was characterized, without replacement of households. At the end of the interview, a date for the collection of blood and urine and for the physical assessment was scheduled. At that time, guidelines were given on the procedures for the collection of biological samples, as well as for the physical assessment: 12-hour fast for blood collection; collection of the first morning urine, disregarding the first part of the flow and after personal hygiene, in individual bottle available and identified by the interviewers; and use of light clothes, preferably shorts or skirt and shirt, for the physical assessment.Data were collected from April to September 2014. Before the assessments, research professionals had to come forward with official identity document with photo. In the previously defined date and time , the team previously trained performed physical assessments and collected blood and urine samples.The results of laboratory tests and physical assessment, upon examination by authorized health professional, were delivered to the participants. In case of alterations, the research team scheduled the appointment with a medical professional in the health unit of reference to the neighborhood. For the schedule of appointments in public health units, partnerships with health departments in the state of Acre and in the city of Rio Branco were conducted.\u00ae program, version 3.5.2.The questionnaires and evaluations were reviewed and coded simultaneously to data collection. The information was coded in featured next to the original question, for easier typing, being subsequently held dual independent typing in Microsoft Office Access, with the adoption of filters to avoid typos. The database was compared and corrected using EpiInfoThe inconsistencies observed were corrected by reviewing the original instruments , without imputation of data."}
{"text": "To explore the safety of the essential medicines recorded in China's list through the comparison of the list of essential medicines of China and the World Health Organization (WHO), as well as the analysis of the basic situation and characteristics of adverse drug reactions (ADRs) on the two essential medicines recorded in China's and WHO lists in order to provide a reference for the improvement of China's list. A retrospective descriptive study was conducted, based on the database in Jiangsu Province ADR Monitoring Center from 2013 to 2015. A total of 266869 cases reports were collected within this period, comparing the differences between the two essential medicines recorded in China's and WHO lists, considering number of ADRs, type of report, and modes of administration. Compare the differences between the two groups of drugs in the presence of new, severe, and new severe adverse events using chi square test. Comparing the two essential medicines list, they have the same 117 species. When comparing ADRs in the two groups, most are antimicrobial, electrolytes, and acid-base balance drugs, regulate water, and are higher in China. In addition, with respect to the number of ADR types in the two groups, there is statistical significance (p<0.001) . Compared to the WHO list of essential drugs, China's list is still to be improved. Essential medicines satisfy people's desire for health; they are selected through cost-effectiveness comparison and according to the current situation, effectiveness, and safety of public health , 2. The Although many reports which used the ADR database to advance the safety of drugs have been published , 6, therChina's national essential medicines list (2015 edition) and WHO model list of essential medicines (19th edition) were obtained from the ministry of health website. Using the database of Jiangsu Province ADR Monitoring Center from 2013 to 2015 to perform a retrospective study, we analyze the differences between the two essential medicines recorded in China's and WHO lists with ADR by the number, type of report, and the way of administration. Analyses employed descriptive statistics and chi square test.There are 373 essential medicines recorded in WHO and 301 in China. The same species are 117. A total of 266869 cases of ADR were discharged within this period, with 76282 cases occurring in essential medicines recorded in China and 48310 cases in WHO. Among them, the most ADR are all anti-infective adjust water, electrolyte, and acid-base balance medicines. The second are respiratory medicines, medicines for pain and palliative care, and gastrointestinal medicines. The number of ADRs of these medicines in China's list is significantly higher than that in WHO .It is presents the characteristics of the type of ADR discharged in the two essential medicines list . CompariIt is illustrate that oral, intravenous drip, external use, local, Yin/intestinal administration, and inhalation are the main modes of administration for adverse reactions to essential medicines recorded in China and WHO list . Also itIn recent years, the ADR reporting systems have been providing a basis for drug safety evaluation. There are authors who showed the necessity and feasibility of using big data to study the research on active monitoring of drugs , 11. AccTherefore, exploring the safety of the drugs recorded in China's essential medicines list based on a large sample is necessary. The results showed that the number of ADRs in China's list was much higher than that of the WHO.It is necessary to discuss the safety of the drugs recorded in China's essential medicines list based on the large sample data. The results showed that the number of ADRs in China's list was much higher than that of the WHO. Among them, anti-infective medicine and regulating water, electrolyte, and acid-base balance drugs have the most ADR  and ChinIn addition, comparing from the type of report , they haIn administration, our study shows that oral and intravenous drips have the highest proportion, in the two essential medicines lists. The other modes of administration have a lower ratio. The reason may be due to injection and injection of sterile powder compared with other medication, endotoxin, pH, osmotic pressure, and particles and other internal factors are more likely to lead to ADR in injection . Oral adTherefore, we should pay close attention to the patient's complaints and first-line clinical feedback of adverse reactions. For the revision of China's essential medicines list, an updated drug manual provides the most stringent basis ."}
{"text": "The economic value of family caregiving, by any measure, dwarfs actual expenditures on formal long-term services and supports (LTSS). This presentation discusses new estimates of the number of caregivers, intensity of caregiving, and the total economic value of family caregiving in 2017 in the United States, and in every state, the District of Columbia, Puerto Rico, and the Virgin Islands, based on a meta-analysis of recent nationally representative surveys of family caregivers. Previous analyses of this type have found that the total economic value of family caregiving has increased steadily from $350 billion in 2005 to $470 billion in 2013. State variation in the incidence, intensity, and economic value of caregiving will be discussed, and key predictors of this variation will be identified."}
{"text": "In the published article, there was an error in affiliation 1. Instead of Department of Medical Physics and Biomedical Engineering, School of Medicine, Shahid Beheshti Medical University, Tehran, Iran, it should be Department of Medical Physics and Biomedical Engineering, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way.The original article has been updated.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest."}
{"text": "Brazil is experiencing one of the fastest rates of population aging worldwideLarge population-based longitudinal studies on aging have been conducted in various countries of the Americas, Europe, and Asia. These studies, known as the Health and Retirement Family of StudiesThe selection of topics covered in these articles was based on the three pillars of the policy framework for active aging of the World Health Organization, i.e., participation, health, and securityHigh levels of social inequality are found in the majority of topics investigated, with the poorest or those with lower educational level affected most. Inequalities are observed in physical activity,One of the goals of the Post-2015 Development Agenda, supported by 193 members states of the United Nations, is to ensure healthy lives and promote well-being for all at all ages"}
{"text": "Epidemiological research on the pathogenesis, diagnosis, and treatment of infectious diseases is a broad field of study with renewed validity in the face of social changes and new threats. The spatio-temporal distribution of diseases is central to the knowledge of their development, transmission, spread, and dynamics.New technologies and geographic information system (GIS) analysis together with highly structured mathematical and statistical techniques have a special utility in describing and analyzing the incidence of infectious diseases. Specifically, Bayesian inference methods allow the analysis of models with complex and flexible structures suitable to represent the diverse characteristics present in each geographical environment and disease.Tuberculosis, hepatitis, human immunodeficiency virus (HIV), influenza, malaria, dengue, zika, and other vector-borne diseases are a constant concern for health authorities, practitioners, and patients. A variety of environmental, climatic, and socio-economic factors underlie their spatio-temporal patterns. In addition, factors such as changes in climate, habits, or land use intervene and complicate the understanding of these processes.This Special Issue compiles contributions on the spatio-temporal analysis of infectious diseases and related themes. The collection of studies presented in this Special Issue contributes to a better understanding of which methods are currently available related with space and time in the data analysis of infectious diseases. These articles provide novel insights into the interaction between space and time in the context of each specific infectious disease, providing new perspectives in the understanding of these pathologies and their extent. A total of 11 manuscripts ,9,10,11 The different works corresponding to these articles were carried out in different geographical areas of several countries: China ,6,7,8,10This volume contains a blend of papers focusing on the modeling, inference, and prediction of the behavior of infectious diseases. The scope of applications covers a wide range of topics. Several infectious diseases are addressed by studying their differentiated characteristics and relating them to relevant explanatory variables. The list of diseases studied includes typhoid and paratyphoid fevers ; Middle While the contributions collected in this Special Issue are encouraging, it is evident that more discussion and research is needed to improve our understanding of the complexity of modeling infectious diseases in the space-time context. I hope that this Special Issue will stimulate and promote new action and research on this important topic."}
{"text": "AGHE\u2019s Clark Tibbits Award was established in 1980 and named for an architect of the field of gerontological education. The award is given each year to an individual or organization that has made an outstanding contribution to the advancement of gerontology and geriatrics education. The Clark Tibbits Award lecture will feature an address by the 2019 award recipient, David Burdick, PhD, of Stockton University. Hiram J. Friedsam was the professor, co-founder, and director of the Center for Studies in Aging and dean of the School of Community Service at the University of North Texas. Dr. Friedsam was an outstanding teacher, researcher, colleague, and mentor to students, faculty, and administrators, as well as a past president of AGHE. The purpose of this award is to recognize those who emulate Dr. Friedsam\u2019s excellence in mentorship. The Hiram J. Friedsam Award lecture will feature an address by the 2019 award recipient, Bradley Fisher, PhD, of Missouri State University."}
{"text": "Date: April 7\u201311, 2019Venue: Grand Walkerhill Seoul, 177 Walkerhill-ro, Gwangjin-gu, Seoul 04963, Koreahttp://wfme2019.orgHomepage: Online Registration Due: March 29, 2019The World Federation for Medical Education (WFME) was established in 1972 by the World Medical Association (WMA) and the World Health Organization (WHO). It is a worldwide organization dedicated to improving the quality of medical education. It also has 6 regional associations of medical education, which correspond to the same areas as the 6 regional organizations of the WHO. Korea is affiliated with the Western Pacific Association for Medical Education, the association of the Western Pacific region, as part of the WHO\u2019s Western Pacific region. The current president of the WFME is Dr. David Gordon, a graduate of the University of Cambridge, United Kingdom, who has served as president of the University of Manchester School of Medicine, president of the Medical School Council, and president of the Association of Medical Schools in Europe.The purpose of the WFME is to provide an international forum for improving the quality of medical education. Its major achievements were the \u2018Edinburgh Declaration\u2019 in 1988, which became a watershed of medical education reforms internationally, followed by the \u2018World Summit and Recommendation in Edinburgh\u2019 in 1993. Subsequently, reforms in medical education based on the \u2018Recommendation\u2019 have been widespread throughout the world.The 2003 World Conference of the WFME in Copenhagen was particularly significant. Medical educators from all over the world attended this conference, after which the WFME published accreditation criteria and standards for basic medical education, postgraduate medical education, and continuing professional development. Since then, it has been adopted as the standard for the evaluation of medical colleges around the world. In addition, the accreditation criteria for postgraduate medical education have been adopted by the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) as a basis for their course programs. The WONCA has already launched an international accreditation program for training courses in family medicine. In 2015, the WFME moved from its Copenhagen office to its current location in Ferney-Voltaire near Geneva.Currently, the WFME Executive Committee consists of the former president, president, vice-president, presidents of 6 regional organizations, and representatives from the WHO, WMA, Educational Commission for Foreign Medical Graduates, International Federation of Medical Students\u2019 Associations, and Junior Doctor Network, which function as medical education associations for all physicians throughout the world.First, it recognizes institutions in each country that work for the accreditation of medical schools.Second, it pursues initiatives to enhance all 3 stages of medical education: basic medical education, postgraduate medical education, and continuing professional development.Third, it publishes the World Directory of Medical Schools and maintains its contents.The WFME is playing an increasingly important role in providing institutional recognition for medical education accreditation institutions in each country. For example, the Korea Institute of Medical Education and Evaluation was the fourth-recognized national institution in the world in 2015 by WFME. It has been designated as the official medical evaluation system of Korea by the Ministry of Education of the Republic of Korea.The WFME has traditionally held academic conferences on an irregular basis, approximately every 10 years. The most recent one was held in Copenhagen, Denmark in 2003. Lund University, the University of Copenhagen in Denmark, and the governments of Sweden and Denmark provided budgetary support to the Secretariat of the WFME. In addition, the United Nations, the WHO, the UNESCO , and the WMA cooperated with each other to ensure that the WFME Conference was successfully held in 2003. More than 700 medical education experts from 75 countries participated in the 2003 conference. Approximately 30 professors from medical schools in Korea participated. After the conference, they established the basis of the accreditation system of medical schools in Korea, which has been implemented since then.The 2013 World Conference was planned to be held in Malm\u00f6, Sweden in 2013; however, due to the economic crisis in Europe that started in Greece in 2013, it was canceled.The WFME has recently been moving away from the United States and Europe-centered organizations to promote medical education development from a broader and more global perspective. The WFME has expressed interest in Korea\u2019s economic growth and the development of medicine in Korea; furthermore, it confirmed the plan to host the next academic conference in Korea at the WFME Implementation Conference held in May 2017.The WFME Conference has never been held outside Europe and the United States. In this context, holding the WFME Conference in Korea is expected to open a new horizon for medical education in Korea and Asia in the 21st century. I am confident that it will be a good opportunity to promote Korea\u2019s international status, as well as to raise awareness of the leading role that East Asia plays in medical education. In particular, the conference is expected to include an event that will provide a breakthrough opportunity for improving the education of residents in Asia. In addition, I believe that it will serve as a very useful opportunity to improve the level of medical education in many countries through its coverage of various content areas, such as medical education evaluation accreditation, licensing examinations, and continuing education."}
{"text": "Scientifically justifiable spatial structure can not only promote the efficient use of regional resources, but can also effectively avoid \u201curban diseases\u201d, such as traffic congestion, housing shortage, resource scarcity, and so on. It is the \u201cregulator\u201d and \u201cbooster\u201d of regional development. Firstly, this paper measures the spatial structure of the Yangtze River Economic Belt from the four dimensions of scale distribution, central structure, spatial connection, and compactness: Gini coefficient of urban scale, urban primacy, regional economic linkage strength, and spatial compactness. Secondly, the optimized Super-Slack Based Measure-Undesirable model is used to evaluate the sustainable development status of the Yangtze River Economic Belt. Finally, a sustainable development correlation analysis model based on regional spatial structure is constructed. Based on the overall perspective of the Yangtze River Economic Belt and the individual perspective of 11 provinces and cities, the relationship between the spatial structure of the Yangtze River Economic Belt and sustainable development is analyzed. It is found that the impact of the four spatial structure indicators on the sustainable development level of the Yangtze River Economic Zone is relatively stable in five different periods. The ranking results are as follows: Gini coefficient of urban scale > urban primacy > regional economic linkage strength > spatial compactness. The Yangtze River Economic Zone covers 11 provinces and cities , accounts for more than 40% of China\u2019s population and total economic output, and occupies 21% of China\u2019s land area [In recent years, the advantages of rapid development previously achieved by low costs of labor as induced by the large population, resource consumption, and environmental degradation are gradually disappearing. However, traditional socioeconomic development has not yet fundamentally changed, which has resulted in the slowdown of economic growth in the YREB, leading to a developmental bottleneck. Simultaneously, problems such as resource shortages, environmental pollution, ecological destruction, and excess capacity of traditional industries are emerging, which ultimately threaten the sustainable development of all provinces and municipalities and even the YREB . On the Regional spatial structure is an important factor affecting the input\u2013output efficiency of various factors of production in the region and is the key to sustainable development. A spatial structure organized in a scientific and rational way can not only optimize the allocation of various factors of production and achieve the best use of goods, but also achieve complementary advantages through the construction of inter-city networks, resulting in a multiplicity of outputs . On the On the other hand, research results based on empirical analysis are relatively few. Scholars such as Fallah , Lee andThe research on the relationship between spatial structure and regional development has the following characteristics and trends: First, when discussing which spatial structure can promote sustainable regional socio-economic development, results are very different. Secondly, there are relatively few quantitative studies on the relationship between spatial structure and sustainable development. Thirdly, the existing research on spatial structure and regional development is based on the perspective of a certain spatial structure. Few studies on the relationship between spatial structure and regional development are based on a variety of spatial structures and carry out comparative analyses.Summarizing the existing research results on the impact of spatial structure on regional socio-economic development, this paper chooses four regional spatial structure indicators, namely, the Gini coefficient of urban scale, urban primacy, regional economic linkage strength, and spatial compactness, from four dimensions of scale distribution, central structure, spatial connection, and compactness to characterize the spatial structure of the 11 provinces and cities of the YREB. Thus, it can reflect not only the spatial distribution and combination of cities in the region, but also the relationship network between cities .G) is calculated as follows:S represents the total GDP of the whole region, n represents the number of cities, and T represents the absolute sum of the difference of GDP scale between each city in the region [Based on the existing research results and the development status of the 11 provinces and cities in the YREB, the Gini coefficient of urban scale is selected to measure whether a reasonable urban hierarchy has been formed within the region. The Gini coefficient is first used to reflect the gap between rich and poor in a country or region. Marshall applied the Gini coefficient to regional development to reflect disparities between cities within a region and so it is also called the Gini coefficient of urban scale . The Gine region .S1, S2, and S3 represent the urban primacy calculated by the two-city index method, the four-city index method and the eleven-city index method respectively. P1, P2, and P3...P11 represent the population size of the first city to the eleventh city respectively. Because in many practical applications, the four-city index method and the eleven-city index method do not show obvious advantages, so this paper still uses the two-city index method to calculate the urban primacy of 11 provinces and cities in the YREB.According to the growth pole theory put forward by Perroux, regional economic growth can spread outward from nodes, and then drive regional development. Therefore, the radiation effect of regional central cities on surrounding cities and regions is also the key research content of regional spatial structure. Based on central structure, this paper employs urban primacy to measure the radiation and influence of the central city in the region. Jefferson defined urban primacy as the ratio of the population size of the first city to that of the second city . With thijr denotes the regional economic linkage strength between two cities iP and jP denote the number of urban employment and iG and jG denote the GDP, and ijD denotes the straight-line distance between the two cities of a given region.According to the theory of spatial interaction, cities in the region are not static and closed, but dynamic and open. There are intricate connection networks among cities in a given region through convection, radiation, and transmission. The interconnection between cities in the region is the concrete manifestation of the flow of various factors of production in the region, and also the internal motive force for the formation and reorganization of regional spatial structure. Among many regional spatial linkages, the importance of economic linkages is most prominent. Therefore, considering the complexity of regional spatial linkages and the importance of economic linkages, this paper refers to relevant research results to represent regional spatial linkages by regional economic linkages . The meaijR is the average regional economic linkage strength between two cities, iP and jP is the number of the employed within a given region, iG and jG represent the GDP between two cities, ijD is the highway distance between the two cities and ijk is the contribution rate of city i to ijr.Incorporating lessons learned from other related studies, this study improves the above model following two crucial aspects . FirstlyI represents the spatial compactness index of the region and S represents the total area of the region [Spatial compactness refers to the degree of spatial concentration of developmental factors such as towns, enterprises, factories, funds, facilities, technology, and expertise in the process of regional development and is the basis of promoting regional intensive and efficient development. Good spatial compactness is the concentrated expression of maximizing regional comprehensive benefits. It can promote the efficient utilization of resources, high spatial output and high-density development. However, too high or too low spatial compactness is not conducive to healthy regional development which can lead to traffic congestion, an excessive concentration of industry and population, and other negative effects. Compact cities are a form of city that promotes the sustainable development of a city from the perspective of the city itself. It is one of the representative theories to promote the sustainable development of cities, which is based on the premise of curbing urban expansion, and through the centralized setting of public facilities, reducing traffic distance, and reducing pollution emissions. Similarly, compact regions promote sustainable development by promoting sustainable development in multiple cities. Compact regions are more resource-saving, high-density and high-efficiency urban architecture as compared to more decentralized areas. As the name suggests, the compactness of regional space index is used to, of course, measure the compactness of regional space. Here, it is expressed as a ratio of the total amount of regional spatial connection to the total area of regional urban areas. As previously described, the most common and important regional spatial connection is economic linkages. Therefore, we use the ratio of total regional economic linkages to the total area of regional urban areas to express the regional spatial compactness. The equation is as follows:e region .To sum up, the Gini coefficient of urban scale based on the dimension of scale distribution reflects the disparity among urban scales in the region, and then is used to measure whether a reasonable urban hierarchy has been formed within the region. The urban primacy index based on the central structure dimension reflects the degree of aggregation of regional comprehensive development elements in the central city, and then is used to measure the radiation and influence of the central city in the region. The index of regional economic linkage strength based on spatial connection dimension reflects the circulation of various factors of production among the cities in the region, and then is used to measure the degree of interconnection among the cities in the region. The spatial compactness index based on spatial compactness dimension reflects the spatial concentration of development factors such as towns, enterprises, factories, funds, facilities, technology and talents in the region, and then is used to measure the spatial compactness of the region.k is the evaluation unit, x, gy and by are the input value, expected output value and non-expected output value respectively; Data envelopment analysis (DEA) is an effective, non-parametric method to solve comprehensive evaluation problems characterized by multi-input, multi-output, and complex systems. Based on relative efficiency, a mathematical programming model is used to evaluate a decision-making unit (DMU) with multiple inputs and outputs from the perspective of inputs and outputs. DEA can eliminate the influence arising from the dimensions of both subjective and objective factors. While measuring the relative efficiency of each DMU, DEA can identify reasons and magnitudes of inefficiency, in addition to providing a basis for improving DMU efficiency. Insofar of these advantages, DEA requires that the product of the number of input and output indicators be less than the number of DMUs, and that the number of input and output indicators be less than twice the total number of DMUs. That is, ,2\u00d7m+q<n . If the ,2\u00d7m+q<n :(6)min\u03c1her DMUs . Based oThe variable meanings of the above model are consistent with Formula 6.Based on International Urban Sustainability Indicators List (IUSIL) and the 2011 McKinsey\u2019s Sustainable Development Index in addition to other relevant literature, and following the three principles of target system design , this paper establishes a comprehensive evaluation index system for sustainable development of the YREB, which includes input(X), expected output(Y), and non-expected output(Y) , as showWhile the most common correlation analysis methods in mathematical statistics mainly include correlation, factor, and principal component analysis, the use of the above methods, however, requires a large amount of relevant data as a prerequisite. Therefore, the grey relational analysis method to overcome this shortcoming has been applied more and more in cases of \u201csmall sample, poor information\u201d. Grey relational analysis is a comparative factor analysis method which aims to quantitatively describe the relative changes between the observed sequences in the development of the system to determine whether there is a close relationship between the sequences. Through a comparative analysis, the degree of the relationship between the impact and the target is ranked. If the two observation sequences have similar change characteristics, it shows that they have a greater degree of correlation, and vice versa. The main result of this model is to determine the primary\u2013secondary, superior\u2013inferior relationship among the various influencing factors .Based on different research perspectives, the measurement results of the grey relational model can be divided into a narrow relational degree and a generalized relational degree . The genThe grey absolute relational degree is calculated by constructing a grey relational model. The grey absolute correlation degree measures the similarity between the four spatial structure indices and the sustainable development level in the grey correlation model.Assuming that the length of The grey relational model is constructed to calculate the relative grey relational degree. The grey relative correlation degree calculates the correlation degree of the change rate between the four spatial structure indexes and the level of sustainable development in the grey correlation model. According to the degrees of both absolute and relative grey correlations obtained from the first step and the second step, the comprehensive grey correlation degree can be calculated. The grey comprehensive correlation degree is the calculation of the weighted average of grey absolute correlation degree and grey relative correlation degree, which can reflect the similarity degree between sequences. At the same time, it also reflects the proximity of the sequence to the change rate of the starting point and can more comprehensively represent the degree of close association between the sequences. The calculation formula is as follows:Statistical data is from the nine provinces and two cities of the YREB  over the 2006\u20132015 period. Because some cities had some adjustment to their administrative periods during this period, to ensure the unity of the study, this paper carries out the following treatment: Bijie and Tongren areas in Guizhou Province were changed to prefecture-level cities in 2011 and 2012, respectively. Before that period, there were no statistics available on Bijie and Tongren, so they were eliminated. As a result, the study area concerns 108 urban areas at or above the prefecture level. Finally, the study area involves 108 urban units at or above the prefecture level. In 2011, the Chinese government abolished Chaohu City, Anhui Province, and classified Lujiang County, Wuwei County, Hanshan County, and He County under their original jurisdictions as Hefei City, Wuhu City, and Ma\u2019anshan City, respectively. Therefore, based on the administrative division of Anhui Province in 2011, this paper adjusts the division scope of Hefei City, Wuhu City, and Ma\u2019anshan City. Data from 108 cities at or above the prefecture level are directly extracted from the 2007\u20132016 China Urban Statistics, Energy Statistics, Environmental Statistics yearbooks, in addition to the relevant statistical yearbooks of the 11 provinces and municipalities. Some of these cities may have data gaps and these are filled by using linear interpolation.According to the determined spatial structure index and the obtained statistical data, this paper first estimates the spatial structure of the 11 provinces and cities in the YREB according to Equations (1)\u2013(5). Based on the comprehensive evaluation index system of regional sustainable development and combined with the derived Super-SBM-Undesirable evaluation model, the sustainable development status of the 11 provinces and cities in the YREB is evaluated. Based on the grey correlation model, the sustainable development level of each province and city is taken as the reference sequence, and the spatial structure index of four major regions of each province and city is taken as the comparison sequence, and the correlation degree of each comparison sequence and reference sequence is calculated by the incremental window length method. Four spatial structure indicators are ranked according to correlation degrees, and the relationship between the spatial structure and sustainable development of the YREB is quantitatively analyzed. The influence of the four spatial structure indicators of the YREB on regional sustainable development is discussed in depth.As mentioned above, results are displayed below in According to the grey comprehensive correlation degree of sustainable development level and four spatial structures in different periods of the YREB listed in Results show that based on equilibrium dimension, the Gini coefficient of urban scale is the most important spatial structural factor affecting YREB sustainable development. That is, in an ideal, healthy area, cities are neither too tightly packed nor too dispersed. Only when reasonable hierarchies are formed and the various factors of production and the division of labor is evenly distributed throughout the different cities in a given region can we improve overall output levels, narrow inter-city gaps and realize sustainable development of a region. From another point of view, based on the perspective of regional structure, in order to promote YREB sustainable development and ensure the continuity of a clear river, it is necessary to strengthen core cities, improve large and medium-sized cities, further develop small and medium-sized cities, and foster the growth of backward areas. Simultaneously, we should build a clear, scientific, and rational urban hierarchy system, strengthen the regional division of labor and cooperation, promote the optimal allocation of resources, and realize the balanced development of the YREB.Second only to the Gini coefficient of urban scale, urban primacy based on the central structural development is the spatial structural factor which affects YREB sustainable development. According to the growth pole theory, regional economic growth diffuses outward from nodes, promotes the circulation and diffusion of production factors, which then drives regional development. In the process of regional development, the agglomeration of various factors of production to the first city can produce economies of agglomeration and scale. On the one hand, it can save transportation costs and minimize energy consumption, effectively utilize and allocate limited resources, and form a more effective market and closer industrial correlation effect. On the other hand, it is also conducive to the spillover of knowledge and technology and the improvement of the efficiency of infrastructure and land use. However, if it agglomerates excessively, it will bring about \u201curban diseases\u201d, such as traffic congestion, housing shortage, and scarcity of resources, which will offset the economic benefits of various factors of production agglomeration to a certain extent. Therefore, cultivating regional growth poles and promoting regional spatial links and diffusion in the YREB are the key steps in promoting regional sustainable development.The spatial compactness index based on the regional connection dimension and spatial compactness index based on the spatial compactness dimension are also important spatial structural factors affecting the sustainable development of the YREB. The interconnection between cities is the internal driving force for the emergence and development of the external form of the regional spatial structure. With the rapid development of economies, the links between cities in the YREB are getting closer and closer. Through convection, radiation, and transmission, the vertical and horizontal links among cities form a complex network. The effects of polarization and radiation, division of labor and cooperation, and system enhancement can be obtained through the agglomeration of various factors of production in the region and the flow between cities, thus enhancing the overall efficiency of the whole region. As compared with the decentralized areas, more compact areas are resource-saving, high-density, and high-efficiency facets of urban architecture. The compactness of space is the basis of promoting the intensive and efficient development of the region. A moderately compact urban system based on the premise of curbing urban expansion can centralize public facilities, effectively reduce traffic distance and pollution emissions, thus promoting the efficient use of resources, high spatial output, and high-density development. However, an excessively compact space can also lead to uneconomical agglomeration, such as traffic congestion, excessive concentration of industry and population. Therefore, in the next stage, the YREB needs to plan a scientific transportation network, optimize the spatial diffusion axis, build a transportation system with distinct characteristics of \u201chigh efficiency, green and environmental protection\u201d, and maximize the reduction of operating costs, so as to strengthen the links between the cities and towns in the YREB and maximize economic benefits. At the same time, in order to promote the sustainable development of the YREB, we must adhere to the idea of high-quality urbanization, curb the unrestrained expansion of cities, adhere to the concept of intensive development, realize land, space, population, and industrial intensive development, and realize the new urbanization development path of intensive use of space, industrial intensive development, and resource intensive recycling.As shown in On the other hand, the ranking results of the 11 provinces and cities in the YREB are relatively stable. They show that in the past development process, the relationship between the spatial structure of provinces and cities and regional sustainable development has remained relatively stable. Of the 55 ranking results, only five changed successively. They are: The period of 2006\u20132013 in Guizhou Province, the period of 2006\u20132015 in Sichuan Province, the period of 2006\u20132015 in Jiangxi Province, the period of 2006\u20132014 in Shanghai, and the period of 2006\u20132012 in Yunnan Province. Among them, the period of 2006\u20132013 in Guizhou and 2006\u20132015 in Sichuan Province changed from urban primacy > Gini coefficient of urban scale > regional economic linkage strength > spatial compactness to Gini coefficient of urban scale > urban primacy > regional economic linkage strength > spatial compactness. The Gini coefficient of urban scale has replaced the urban primacy as the most closely related spatial structure affecting the sustainable development of Guizhou Province and Sichuan Province. The focus of work has shifted to the construction of a reasonable urban hierarchy system. During the period of 2006\u20132015 in Jiangxi Province and 2006\u20132014 in Shanghai, the Gini coefficient of urban scale > urban primacy > regional economic linkage strength > spatial compactness changed to urban primacy > Gini coefficient of urban scale > regional economic linkage strength > spatial compactness. The most closely related factors of spatial structure change from the Gini coefficient of urban scale to urban primacy, and the focus of work shifts to fostering regional growth poles. During the period of 2006\u20132012, Yunnan Province changed from spatial compactness > regional economic linkage strength > urban primacy > Gini coefficient of urban scale to regional economic linkage strength > spatial compactness > Gini coefficient of urban scale > urban primacy. The regional economic linkage strength has become the most important factor affecting the spatial structure of sustainable development in Yunnan Province. The focus of work is to plan a scientific transportation network and strengthen regional linkages. Finally, in the past development process of Anhui, Hubei, Hunan, Jiangsu, Zhejiang, and Chongqing, the impact of spatial structure on regional sustainable development has not changed. From strength to weakness, the correlation is: Gini coefficient of urban scale > urban primacy > regional economic linkage strength > spatial compactness. In the next stage, in order to accelerate the sustainable development of these six provinces and cities, we should attach great importance to the balanced development of the region, rationally allocate various factors of production, and form a reasonable hierarchy and division of labor system in the region.A scientific and reasonable spatial structure can effectively improve the efficiency of regional development and is the \u201cregulator\u201d and \u201cbooster\u201d to promote regional sustainable development. Based on the analysis of the relationship between spatial structure and sustainable development of the Yangtze River Economic Belt, this paper puts forward four policy suggestions, namely, building a reasonable urban system, cultivating regional growth poles, strengthening regional linkages and promoting the high-quality development of regional urbanization, respectively, based on the four spatial structure indicators of Gini coefficient of urban scale, urban primacy, regional economic linkage strength and spatial compactness. In this way, we can rationally optimize and regulate the spatial structure of the YREB and by making the spatial interaction reach the best state, we can maximize the allocation of regional resources and spatial synergies, and accelerate the sustainable development of the YREB.Through the analysis of the relationship between the spatial structure and sustainable development of the YREB, it is found that on the one hand, the Gini coefficient of urban scale is the highest among the four spatial structure indicators and the overall sustainable development of the YREB. Based on this, the key step to promote the sustainable development of the YREB is to construct a reasonable urban hierarchy, strengthen the regional division of labor and cooperation, and realize the optimal allocation of resources. On the other hand, the Gini coefficient of urban scale is also the closest spatial structure factor affecting the sustainable development of Anhui, Guizhou, Hubei, Hunan, Jiangsu, Sichuan, and Chongqing. Therefore, based on the regional spatial structure to promote the sustainable development of these seven provinces and cities, it is also necessary to build a reasonable urban hierarchy system. To sum up, to construct a reasonable urban system in the YREB, firstly, when improving the urban system, the YREB should adhere to the principle of \u201cexpanding core cities, improving large and medium-sized cities, developing small and medium-sized cities, cultivating growth poles in backward areas, forming a scientific and rational urban hierarchy system with distinct levels\u201d, and adhere to the planning pattern of \u201cone axis, two wings, three poles and multiple points\u201d. Secondly, the should strengthen the support to the four western provinces and cities. The government should allow the eastern and central regions to promote the development of the western region and actively guide the transfer of overcapacity industries from eastern to western regions. In view of the underdeveloped cities in the western region, the Chinese government should give some support in policy, capital, and technology, so as to narrow the gap between the 11 provinces and cities in the YREB and promote the optimization and regulation of the urban hierarchy system in the YREB through balanced development. Thirdly, a central government-led coordination mechanism should provide the necessary provincial linkages to allow isolated administrative departments and functional units to be amalgamated into a unified network, leading to the breakdown of administrative barriers, reductions in the cost of approval and improvements in operational efficiency. Fourthly, according to the current development situation of the YREB, the Chinese government should properly strengthen the investment of various production factors in some backward cities, promote the complementarity of advantages among cities by adjusting industrial structure, clarifying urban functions and highlighting urban advantages, enhance core competitiveness, and promote the balanced development of the region.Through the above correlation analysis, it was found overall, urban primacy and sustainable development in the YREB are highly correlated, where, for example, it is the closest spatial structure factor that affects the sustainable development of Jiangxi, Shanghai, and Zhejiang. According to the growth pole theory, regional economic growth diffuses from external nodes, driving the internal development of nearby cities. Therefore, cultivating regional growth poles is a key step in promoting the links and diffusion of various production factors. To cultivate the growth poles in the YREB, we can start from the following three points: First, adhere to the \u201cone axis, two wings, three poles, multi-point\u201d planning pattern. At the same time, relying on the Yangtze River Gold Waterway, all kinds of production factors incline to Shanghai, Wuhan, and Chongqing, so as to enhance the core competitiveness of the three major cities, actively participate in international cooperation and competition, and make them become a national and even international metropolis. And pay attention to the radiation effect of the three big cities, so as to promote the sustainable development of the YREB. Secondly, we should strengthen the core competitiveness of Nanjing, Hangzhou, Changsha, Nanchang, Kunming, Chengdu and other sub-core cities in the YREB. The infrastructure of these cities should be strengthened, their functions clearly identified and then improve the role radiation plays in secondary core cities to the surrounding small and medium-sized cities.According to the previous analysis of the relationship between the spatial structure and sustainable development, it is found that the strength of economic linkages is also highly correlated with sustainable development. Therefore, to promote sustainable development in the YREB, it is important to optimize transportation networks and construct them to be highly efficient and environmentally friendly, in addition to strengthening exchanges between cities and towns. It was also identified that the intensity of spatial connection is the spatial structural factor affecting sustainable development in Yunnan Province. Therefore, from the perspective of spatial structure, improving transportation and strengthening infrastructure and spatial connections among cities in the region all help to promote sustainable development.Optimizing and perfecting the transportation system of the YREB and strengthening regional spatial relations would mainly rely on water and railway transport lines. Firstly, from the perspective of waterway transportation, the Yangtze River Gold Waterway runs across China\u2019s east and west, linking 11 provinces and cities, carrying the important task of circulation and allocation of various factors of production in the YREB. On the basis of a comprehensive and objective analysis of the current situation, in addition to the nature and functions YREB basins, it is suggested that through a rational layout and planning, the dredging of waterways can improve cargo transport volumes. Simultaneously, infrastructure at the Ports of Wuhan, Chongqing, and other important ports can be improved and the construction of an efficient waterway transportation network would lead to higher connectivity between YREB note cities. The accelerated construction of railway transportation, most notably the Shanghai-Chengdu high-speed railway along the Yangtze River should strengthen the links between the eastern and western regions. Similarly, the accelerated construction of the Shanghai-Kunming high-speed railway would strengthen communication between cities south of the Yangtze River. Upgrades to the railway connections between Chengdu-Chongqing, central Yunnan, Chongqing-Kunming and Chongqing-Guizhou should be made to promote the formation of the \u201c1+1+3\u201d urban agglomeration  in southwest China. In addition, we should intensify reform and innovation, build comprehensive transport hubs, strengthen multimodal transport by water, road and air, and build safe, efficient, green and environmentally friendly three-dimensional transport corridors, so as to strengthen the inter-regional links and promote the sustainable development of the YREB.Spatial compactness is also an important factor to promote the sustainable development of the YREB. A moderately compact urban system can promote efficient utilization of resources, high spatial output, and high-density development. However, at the same time, we need to avoid uneconomical effects, such as traffic congestion and the excessive concentration of industry and population. Therefore, in order to achieve the sustainable development of the YREB, we must adhere to the high-quality development of urbanization, minimize blind urban expansion, adhere to the concept of intensive development, take the new road of urbanization development of land, space, population and industrial intensive development. We should also speed up the transformation of the urbanization development mode in the YREB by deepening reform in an all-round way and by removing institutional obstacles. From the extensive development mode of high investment, high pollution, low benefit, and low level to the development mode of intensive, efficient, quality-oriented, and benefit-oriented coordination, thus realizing the sustainable development of the YREB."}
{"text": "There is a growing consensus that researching and developing therapeutic interventions into degenerative aging processes is a necessary condition for improving the health and longevity of the rapidly aging global population Thus, the research and development of therapies against degenerative aging processes (anti-aging) and for prevention of major aging-related diseases is a necessary condition for alleviating the severe economic, healthcare and humanitarian challenges of the global aging society And therefore, promoting the research and development in the field of anti-aging and aging-related disease prevention is becoming an urgent national and international task  How can the field of anti-aging and disease prevention be promoted globally to solve the challenge of bringing effective, safe and accessible anti-aging and preventive therapies to the world as soon as possible? A significant further step was taken toward the solution of this challenge with the establishment of the new Executive Committee on Anti-aging and Disease Prevention, a joint effort of UNESCO and China World Peace Foundation.http://www.isoad.org).The Executive Committee on Anti-aging and Disease Prevention was established in the framework of Science and Technology, Pharmacology and Medicine Themes under an Interactive Atlas along the Silk Roads, UNESCO. The committee inauguration took place during the 2nd (Beijing) Annual International Biomedical Health Conference and the 1st Academician Forum of Transnational Biomedical Field, in Beijing, on December 16, 2019  [th Five-year Plan, and to achieve the first centenary goal and move towards the second centenary goal, in the face of the unprecedented social, technological and demographic changes that have never been experienced in a century. At such a time, the 2nd Annual International Biomedical Health Conference convened in Beijing, responding to President Xi\u2019s call for building a healthy China and a community with shared future for mankind with practical actions!The vital need to address the aging challenge has been increasingly recognized by the Chinese government and stakeholders in China. The year 2019 and the next year will be crucial years for China to formulate the14The conference responded to the increasingly serious crisis of chronic diseases and aging worldwide. Therefore, the conference focused on the global problems of aging and the related rise of chronic major diseases and discussed how biotechnology can creatively provide solutions for human health, in particular in old age. As the aging-related health problems increase, so do increase the capabilities of biomedical science and technology to solve those problems. For example, 5G technology will allow us to develop from information sharing to internet of things (IOT). Artificial intelligence (AI) will greatly improve our ability to understand and solve complex problems, while the breakthroughs in stem cell technologies and other geroprotective therapies will allow us to redefine healthy aging and to completely treat major diseases.In order to implement the great idea of a community with a shared future of mankind, the United Nations Educational, Scientific and Cultural Organization supported the establishment of a professional association on anti-aging research in China through Science and Technology, Pharmacology and Medicine Themes under an Interactive Atlas along the Silk Roads, which was named the Executive Committee on Anti-Aging and Disease Prevention, UNESCO.In order to support the work of the committee, Institute of Biophysics at Chinese Academy of Sciences, Institute of Basic Medicine at Chinese Academy of Medical Sciences, and Shanghai University jointly established the International Joint Academy of Biomedicine as the scientific research base of the International Society on Aging and Disease (ISOAD).The committee and affiliated organizations will invite prominent scientists in the field of biomedicine from all over the world to join the committee on behalf of the scientific research institutes in China and internationally, and carry out this project under an Interactive Atlas along the Silk Roads, UNESCO, so as to promote the latest research achievements and technologies of member states to the world. The committee will form and promote policy recommendations, educational programs and scientific and cultural projects to advance the field of anti-aging and disease prevention worldwide, at the national and international levels.Science, technology and health are important cornerstones for world peace and human prosperity. By promoting the healthy longevity for the global population, the committee will contribute to the task of global cooperation, peace and human wellbeing.Only by relying on the full win-win cooperation of global scientists, and relying on the standardized technical services of various countries, can the great dream of a healthy China and the great goal of a healthy world be achieved, under the active support by the policies in biotechnology and biomedical industry!The conference and its goals were strongly supported by China\u2019s National Development and Reform Commission and other units, with full cooperation of personnel from the biotechnology and biomedical industry all over the world, and with full-hearted active participation by academicians, specialists and peers from around the world.It is hoped that through holding this conference and the further actions of the committee, the international cooperation will be enhanced, and more advanced scientific and technological achievements will be shared and implemented.It is strongly believed that through the efforts of all of us, all the conference participants, all the collaborators, as well as the general public, can benefit from the results of anti-aging research, which has been the real intention for holding this conference and for the establishment of the Executive Committee on Anti-aging and Disease Prevention.Special thanks for implementing this initiative go to Prof. Ante Glibota, Vice-president of the European Academy of Sciences, Arts and Humanities (EASAH), and Prof. Robert Chunhua Zhao, the present Chairman of the International Society on Aging and Disease (ISOAD) who will chair the committee, as well as the excellent and self-less scientists from around the world who helped with the establishment of the Executive Committee on Anti-Aging and Disease Prevention, UNESCO, in China.The conference participants formed the core of the Executive Committee on Anti-aging and Disease Prevention that will be further expanded and reinforced in time. The present committee members include 18 experts from 16 countries and regions: Holly M. Brown-Borg , Antonio Cano , Calogero Caruso , Sasanka Chakrabarti , Georgina Ellison-Hughes , Eric Gilson , Ante Glibota , Armand Keating , Lee Wei Lim , Mitsuo Maruyama , Kyung-Jin Min , Alexey Moskalev , Amanda Salis , Ilia Stambler , Huanxing Su , Brun Ulfhake , Robert Chunhua Zhao , and Kunlin Jin .In addition to the international speakers, a distinguished cohort of prominent Chinese scientists, officials and leaders of industry presented at the conference, including the vice director Hao Chang of International Cooperation Center of National Development and Reform Commission, the chairman Yu Liang of China Health Industry Investment Fund Management, the president Xizhao Dou of National Association of Health Industry, the academician Chengyu Xiong from the Academy of Europe, Tsinghua University, Xiangdong Tan, chairman of Shanghai Magnolia Tan Jiazhen Life Science Development Foundation, the senior Vice-Mayor Linbang Lv of Lanzhou Municipal People\u2019s Government, the district governor Hui Deng of Fucheng District, Mianyang City (China Science and Technology City), Depei Liu, Academician of Chinese Academy of Engineering, Xiangmei Chen, the Honorary Director of Department of Kidney Disease of the PLA General Hospital, Runsheng Chen, Academician of Chinese Academy of Sciences, Changsheng Liu, Academician of Chinese Academy of Sciences, and other distinguished participants.Based on the world-class expertise of the participants, the UNESCO Executive Committee on Anti-Aging and Disease Prevention was launched, and the International Joint Academy of Biomedicine was established.The launch of the UNESCO Executive Committee is a further step along the road toward the global advancement of anti-aging and preventive biomedical research, development and application. The road will be long as many capacities still need to be built and many tasks implemented for the field to live up to its potential. Thus, there is an urgent need to develop action plans and roadmaps, policies and guidelines, consensus positions and educational materials, evaluation criteria and regulatory frameworks, to advance anti-aging and disease prevention worldwide. Such items are still in short supply both at the national and international levels. We hope that through international cooperation, in particular via establishing international expert task forces, these items may be created and disseminated.The reasons to advance the medical research and development (R&D) on anti-aging and disease prevention should be made clear to all, at all levels, from the general public to the decision makers. All should be educated about this R&D, and its vital potential to provide real solutions to prevent major chronic diseases and to improve the health, longevity and quality of life for the elderly population globally.This R&D is already supported by scientific proofs of concept, involving the evidential increase in healthy lifespan in animal models and the emerging technological capabilities to intervene into fundamental aging processes. There are also experimental proofs of the possibility to prevent multiple aging-related diseases by intervening into the aging process as the main contributing factor common to all these diseases, including positive experimental results in humans . Any reiThe innovative, applied results of such research and development will lead to sustainable solutions for a large array of age-related medical and social challenges, that may be globally applicable. The most important of them are the savings in healthcare for chronic age-related diseases and increase in the period of active and productive employment for the elderly population. This will result in their diminished dependence on external entities and the corresponding release of resources for further social and economic development and growth. As it is known, the vast majority of health expenditures and loss of productivity occur in the late development stages of chronic aging-related diseases. Therefore, any postponement of this period by early detection and prevention will create vast humanitarian and economic benefits, both for the individual and the society as a whole . ExcelleDue to these reasons, the investments into the biomedical research and development on anti-aging and prevention of aging-related diseases, can be the most beneficial and profitable for both national and global economy compared to any kind of fundamental or applied research generally and biomedical research in particular. Conversely, the lack of investments into the field can contribute to a future crisis that may be due to the lack of preparedness of the healthcare and welfare systems to provide worthy and sufficient services for the elderly, the lack of adequate solutions for the prevention of systemic economic collapse, as well as for the equitable social and economic inclusion of the elderly.These reasons for the advancement of the anti-aging and preventive biomedicine still need to become more strongly articulated and disseminated, to bring them to the attention and action of the entire society. International expert communities and organizations can have a pivotal role for such articulation and dissemination.The conference furthered this articulation, addressing particular issues involved. The conference participants presented on the various aspects of anti-aging and disease prevention, and related contexts, generally showing the feasibility of improving health in old age by the use of advanced biotechnology. The main topics included: Development of stem cell-based therapies and treatment of aging-related diseases; frontier science and technology of preventive medicine and personalized therapy; integrated development and policy research of new medical technology and health industry; scientific and technological progress in biological anti-aging field and health education in aging society.Within this range, the UNESCO committee members addressed specific areas and topics. Altogether they presented a wide front of past achievements, current work in progress and directions for future advancement for the field of anti-aging and disease prevention.Holly Brown-Borg (USA) provided a thorough overview of the current approaches to targeting the biological mechanisms of aging, constituting the fundamentals of the geroscience strategy for the preventive healthcare for the aged, i.e. measuring and therapeutically targeting the main hallmark mechanisms of aging to prevent multiple age-related diseases (multi-morbidity) and thus extend the healthy lifespan  of the elderly population, with the resulting healthcare, economic and humanitarian benefits.Calogero Caruso  shared the main results of the study of longevity in Sicily, in particular the study of local centenarians, searching for the determinants of their exceptional healthy longevity and resistance to age-related diseases and co-morbidities, including biological (molecular and genetic/epigenetic) factors as well as social and life-style determinants, with the aim to develop and adopt successful healthy longevity intervention strategies for the larger population.Antonio Cano (Spain), though communicating from outside the conference, introduced the perspective of Aging in Spain, focusing on the challenges of facing senescence with a female perspective, in particular with reference to endocrinological problems and treatments of aging-related dysfunction.Sasanka Chakrabarti (India) gave a perspective of aging research, its challenges and prospects for the long term, including issues of transition from animal models to clinical practice, development of aging epidemiology, biomarkers and risk factors, and properly designed anti-aging clinical trials, as well as some policy recommendations, such as improving funding and professional education for the field.Georgina M. Ellison-Hughes (UK) represented a new collaboration model in aging research, the multidisciplinary Aging Research at Kings College London (ARK) consortium. She then presented the highly promising results of their study for rejuvenating the regenerative capacity of the aged heart, one of the main causes of old age morbidity and mortality.Eric Gilson (France), though communicating from outside the conference, introduced another collaborative model, the Inserm Transversal program on aging AGEMED  including 20 French teams covering all topics of aging biology and medical transfer. This is a collaboration model that could be emulated also for international frameworks, emphasizing the need for holistic approaches and international coalition in aging research, development and clinical application.Ante Glibota (France) reported in his speech that the European Academy of Sciences, Arts and Humanities, as UNESCO's consultants, worked closely with the relevant stakeholders for the establishment of the new UNESCO Executive Committee on Anti-Aging and Disease Prevention. He expressed the belief that enhanced international cooperation will enable the collaborators to perform thorough systemic analysis, develop actionable solutions and improve coordination and management of the medical and scientific communities to advance anti-aging technologies and biological strategies. Such international collaborative structures will help involved organizations to develop stem cell and other anti-aging therapies that can prevent diseases, alleviate human suffering and promote human health.Armand Keating (Canada) discussed perspectives on anti-aging research, from its history to its future, with a special focus on hematological aspects of aging. In particular, he emphasized hematopoiesis as a key area of aging research, addressing key diagnostic and therapeutic issues in this research and the need for innovation and development of this area.Lee Wei Lim  introduced the field of electromagnetic deep brain stimulation, which may be a novel and effective therapeutic strategy for a variety of problems of aging, with potential benefits ranging from anti-depression to memory enhancement, and even potentially affecting fundamental whole-body regulatory mechanisms of aging such as hypothalamus regulation.Mitsuo Maruyama (Japan) reported on the severe challenges of the aging society in Japan, and the national programs and centers established to address those problems, including the enhancement of biomedical research and development.Kyung-Jin Min (South Korea) presented an overview of aging research in Korea and their institution in particular, showcasing a broad and intensive search for anti-aging drugs and other interventions in animal models, with the aim of possible translation to humans.Alexey Moskalev (Russia) surveyed the advances in the genetics of longevity and aging, providing an exposition of biomarkers of aging and possible geroprotective interventions  under development. He also introduced several suggestions for the improvement of geriatric healthcare, such as developing new approaches for training medical personnel, creating knowledge bases for early diagnosis, prevention and treatment of age-related diseases and conditions, establishing multi-center clinical studies for age-related disease prevention, and developing panels of biomarkers of aging and geroprotectors.Amanda Salis  made a compelling case for anti-aging dietary interventions, specifically for reducing the diseases of aging via substantial weight loss in people with overweight or obesity in Australia and around the world.Ilia Stambler (Israel) presented the advances of anti-aging R&D regulation and policy in Israel and internationally, the critical need to further develop and implement the policies supportive of the anti-aging field, and some possible directions for their development, such as increasing funding, education and supportive regulatory measures and evaluation standards for the filed that could be designed and promoted via international organizations.Huanxing Su  gave an overview of drug-discovery for aging-related neurodegenerative diseases, focusing on finding natural products and Chinese herbs to treat microinfarcts and vascular dementia.Brun Ulfhake (Sweden) spoke about the mechanisms of the decline in muscle power and mass as the core of organismal aging, and discussed possible actionable interventions, such as diet and exercise. He emphasized that while our current and near-future research will extend our understanding of the underlying processes and pave the way for rational interventions, we need to implement our current knowledge, but never step back on scientific rigor, to combat aging and aging-associated disabilities, and further, to adapt the society to a growing population of the elderly.Robert Chunhua Zhao , in his scientific presentation, reported the results of studies with mesenchymal stem cells and their role in clinical translational medicine. He focused on some of the central problems in translating anti-aging therapies to clinical practice, with stem cells representing a major type of anti-aging therapy, in particular defining the subpopulations of stem cells as the best seed cells for developing anti-aging drugs, novel ways to facilitate the establishment of stem cell engineering technology, as well as the critical issues of defining and validating the safety and efficiency of anti-aging treatments.These were just several subjects of the vast and ongoing discourse. There is no doubt that the broad international academic and public consultation for the advancement of the Anti-aging and Disease Prevention field will continue, within the new UNESCO Committee and other frameworks. We hope that the new committee and allied frameworks will be successful in their work promoting healthy longevity for all through education, science and culture."}
{"text": "How does a hospital-based arts and humanities program build towards a better healthcare system for older patients, caregivers and medical professionals? The Georgetown Lombardi Arts and Humanities Program (AHP) supports the continuum of care by encouraging a creative and constructive response to illness through the use of music, dance, expressive writing and visual arts. Artists-in-residence at MedStar Georgetown University Hospital work throughout the hospital, with in-patients and out-patients, in waiting rooms, intensive care units, and clinics. At the same time, the AHP recognizes the need to introduce the next generation of physicians, nurses, and medical professionals to the benefits of interacting with the arts to improve skills of observation, communication, empathy, and perspective-taking to serve all populations, especially older patients living with chronic illness. The AHP\u2019s educational programs at the National Gallery of Art, and the IONA Senior Day Center will be highlighted along with their supporting evidence base"}
{"text": "In 2019, the Manchester Centre for Audiology and Deafness celebrates its 100thanniversary. To mark the centenary, this special issue is a collection of papersthat showcases current research in Manchester Centre for Audiology and Deafness.The Editorial provides a brief history and description of the Centre and anoverview of the special issue. The Department of Education for the Deaf was founded at The University of Manchesterin 1919. It was the first university department of deaf education in the world. Thedepartment was funded by a donation from the estate of Ellis Llwyd Jones, who wasborn deaf, by his father, businessman Sir James Jones. Irene Goldsack (later Ewing)was the first Ellis Llwyd Jones lecturer. Irene Ewing and her husband Alexander wereresponsible for the fundamental concepts of pediatric audiology. They alsoinfluenced professionals throughout the world on issues pertaining to theidentification and management of childhood deafness. In 1947, Irene Ewing wasawarded the Order of the British Empire for her services to audiology and deafeducation. In 1958, Alexander Ewing was knighted for his services to audiology anddeaf education.Medresco brand) that were issued free of charge by the U.K.National Health Service (NHS) in its foundation year, 1948. In 1944, the Ewingsdeveloped the Distraction Test , which reduced the age of diagnosis of hearing loss from 2 to3\u2009years to 6\u2009months. The Distraction Test was used around the world until the 1990s.The Ewings practiced and advocated for a child-centered focus when teaching deafchildren. This was seen to be unusual, but innovative, as their methods were farremoved from the standard practice of speech drills and rote learning. In 1944,Irene Ewing demonstrated the linguistic and developmental advantages displayed bychildren whose parents had engaged in their early support clinics. The foundationsof early, meaningful interaction are held central to all approaches in the field tothis day.The department has made a number of seminal contributions for patient benefit,particularly with respect to pediatric diagnostics, auditory devices, and deafeducation. In 1928, the department imported an electronic audiometer from the UnitedStates and conducted groundbreaking audiometry research, showing in particular thatdeaf children usually have residual low-frequency hearing that can be enhanced byhearing aids. Physicist Tom Littler from the department was a pioneer in the designof electronic hearing aids. In 1933, he developed a group hearing aid for use inclassrooms and then helped to develop individual aids  publishedChildren, whichwToday, the department, now known as the Manchester Centre for Audiology and Deafness(ManCAD), is stronger than ever, with 14 members of permanent academic staff. Ouraudiology research covers a wide range from the basic physiology of hearing andhearing impairment, noise-induced hearing loss, and hearing and cognition, toauditory devices, advanced diagnostics, and pediatric audiology. The translationalwork in deaf education continues to shape practice in the field and in recent yearshas focused on deaf children with complex needs, effective radio aid use, and thedevelopment of Theory of Mind skills for deaf children and young people. The impactof our research is underpinned by a close relationship with health and educationservice providers and with leading international manufacturers of hearing aids andcochlear implants. ManCAD is also a major provider of training for students ofaudiology and for teachers of the deaf.Manchester has made a world-leading, and life-changing, contribution to audiology anddeaf education in terms of education and training, research across the life span,service development and practice. To mark the ManCAD centenary, Laura Dawes, medicalhistorian, author, and broadcaster, has updated and revised her history of audiologyand deaf education at The University of Manchester .The special issue showcases a range of current audiology research in ManCAD. Advanceddiagnostics has long been a core component of our work at Manchester, and the issueincludes several papers on this theme. The paper by Similarly, our historical research strength in auditory devices continues to thepresent day. Two papers examine the use of electrophysiological responses in theevaluation of hearing aids. The study by The city of Manchester has a somewhat notorious reputation as a source of bothoccupational (cotton mills) and recreational  noise exposure.Perhaps appropriately, the effect of noise exposure on hearing health is a strongcurrent interest in the group. The paper by The papers illustrate the wide range of different approaches used in our research,including genetic testing, audiometry, electrophysiology, psychophysics, speechtesting, subjective quality assessments, questionnaire-based techniques, and the useof big data. With emerging cross-disciplinary projects in cancer treatments,biomarkers, genomics, health informatics and data science, artificial intelligence,health psychology, engineering, and advanced materials, we continue to exploreexciting new directions in audiology research. The expectation is that our next100\u2009years will be even more transformative than the first."}
{"text": "The Society mourns the loss of famed physician-scientist and global health leader Dr. Adel Mahmoud, who died June 11, 2018, in New York City as a result of a brain hemorrhage. He is survived by his wife, Dr. Sally Hodder.Born and raised in Egypt, Dr. Mahmoud received his medical degree from the University of Cairo in 1963. Following a change in political climate, he left Egypt in 1968 to pursue studies in the UK and was awarded a PhD in 1971 from the London School of Hygiene and Tropical Medicine. Committed even at this early stage of his career to the improvement of health in the developing world, he immigrated to the US in 1973 to work as a postdoctoral fellow with the storied Kenneth Warren at Case Western Reserve University, a hub of tropical disease research. Dr. Mahmoud\u2019s early research focused on the role of eosinophils in schistosomiasis, which at the time was a major public health concern in Egypt and remains a significant cause of morbidity in many countries.Dr. Mahmoud succeeded Dr. Warren as head of the Division of Geographic Medicine at Case Western in 1977, where he continued his research on determinants of infection and disease in human schistosomiasis and nurtured the careers of many of today\u2019s well-known tropical medicine investigators before becoming Chairman of the Department of Medicine in 1987. In 1998, he was recruited to serve as President of Merck Vaccines. In this role, his strong influence on global health continued. At Merck, Dr. Mahmoud played a pivotal role in the development and commercialization of vaccines for rotavirus, human papilloma virus, and shingles, as well as a new quadrivalent formulation of measles-mumps-rubella-varicella vaccine. After retiring from Merck in 2006, he moved to Princeton University as a senior policy analyst at the Woodrow Wilson School of Public and International Affairs. He joined the faculty of Princeton in 2011 as a professor in the Department of Molecular Biology and was an integral member of the university\u2019s Global Health Program.Dr. Mahmoud served the research and public health community tirelessly. He was a member of the boards of directors of the Global Alliance for Vaccines and Immunizations, the International AIDS Vaccine Initiative, and the International Vaccine Institute. He served on the National Advisory Allergy and Infectious Diseases Council and was chair of the US Delegation of the US-Japan Cooperative Medical Sciences Program. He was called upon to advise the World Health Organization, the National Institutes of Health, the Centers for Disease Control and Prevention, the Rockefeller Foundation, and the National Academies. Throughout his career he received many honors. He was a Fellow of the American College of Physicians and was elected to the National Academy of Medicine, American Society of Clinical Investigation, and American Association of Physicians. He was president of the Central Society for Clinical Research and the International Society of Infectious Diseases. As a decades-long member of ASTMH, Dr. Mahmoud received the Bailey K. Ashford medal in 1983.https://blogs.princeton.edu/memorial/2018/06/adel-mahmoud/.Dr. Mahmoud will be remembered for his dynamism, wit, charm, and generosity, his dedication to mentoring young physicians and scientists, his sense of service, and his deep commitment to global public health. Remembrances can be contributed to a blog established by Princeton University to honor his life and legacy:"}
{"text": "The prevalence of gestational diabetes mellitus (GDM) is increasing in Iran. Collection of patients\u2019 data is commonly conducted through using medical records. However, for providing a structured reporting based on the information needs, a minimum data set is a fast, inexpensive, and suitable method. For exchanging high-quality data between different healthcare centers and health monitoring organization, the data are required to be uniformly collected and registered. The present study aims at designing an MDS for creating the registry of GDM. The present study is an applied one, conducted in two stages, with a qualitative Delphi method in 2018. In the first stage of the study, it was attempted to extract the data elements of mothers with GDM, through reviewing the related studies and collecting these patients\u2019 data from the medical records. Then, based on the results of the first stage, a questionnaire including demographic, clinical, and pharmaceutical data was distributed among 20 individuals including gynecologists, pharmacists, nurses, and midwives. The validity of the questionnaire was examined by a team of experts and its reliability was examined by using Cronbach\u2019s alpha. Data analysis was conducted using descriptive statistics  and excel. An MDS of gestational diabetes mellitus was developed. This MDS divided into three categories: administrative, clinical, and pharmaceutical with 4, 18, and 2 sections and 35, 199, and 12 data elements, respectively. Determining the minimum data sets of GDM will be an effective step toward integrating and improving data management of patients with GDM. Moreover, it will be possible to store and retrieve the data related to these patients. Gestational diabetes mellitus (GDM) is an increase in a person\u2019s level of blood sugar. GDM is either initiated or diagnosed during pregnancy . In bothThe significance of data collection in GDM indicates the increasing awareness of short-term and long-term effects of this disease for both mothers and infants. A minimum data set for reporting diabetes during pregnancy will result in a better understanding and monitoring of risk factors and their results, including different types of GDM. Moreover, a minimum data set is likely to indicate the significance of monitoring health changes in the population, the effect of gestational interventions, and the services required by pregnant mothers . Given tFurthermore, in order to create a system that is completely compatible with data exchange, it is primarily required to agree on the data elements set . The agrIn their study titled \u201cResults of the first recorded evaluation of a national GDM mellitus register: Challenges in screening, registration, and follow-up for diabetes risk\u201d, Boyle et al. state that the registration of a large number of patients in the Australian GDM registry will result in the provision of sufficient and accurate data for finding the risk factors, having an early diagnosis, improving screening goals, improving treatment results, correcting the lifestyle, and reducing the risk of suffering from post-gestational type 2 diagnosis . CreatinAt present, there is no summary of the information related to patients with GDM in the form of minimum data set for Iran. For collecting high-quality data and creating a system of integrated data as registry, the integration of data is essential for monitoring the status of maternal and neonatal health for two main reasons. Creating a minimum data set for GDM can be regarded as the first step for creating a national registry system of such data. Thus, the present study aims at creating a minimum set of administrative, clinical, and pharmaceutical data of GDM. It is also attempted to apply the same data with purposes of research, education, and pregnant women\u2019s health status monitoring, prevention, and control of this disease by using its statistical results.The present study is an applied one conducted in two stages with a qualitative Delphi method in 2018. In the first step, a review of the literature was conducted to retrieve related data resources. The resources included articles, reports, and forms available on the internet. In this step, a checklist was also used for the extraction of data elements. Searching the articles was conducted on Elsevier, Scopus, PubMed, SID, MagIran, ProQuest databases as well as Google Scholar search engine from 20072017. In the present study, all articles related to minimum data set, registry, and common data elements of GDM were examined and the main data elements were extracted. Sampling was not performed at this stage, and all the relevant literature was retrieved and evaluated based on the inclusion criteria, was then evaluated and the literature review was limited to the English language between 2007 and 2017, in full text from valid sources. The articles, whose full texts were impossible to access in addition to letters to editor, forms, and reports retrieved from websites, were excluded. Literature review was continued until data saturation. Then their desired data elements were entered into the checklist. Materials relevant to the subject were found using a search strategy .Data was also collected from medical records of patients hospitalized due to GDM in ShahidAkhbarabadi Hospital, affiliated to Iran University of Medical Sciences and Arash Women\u2019s Hospital, affiliated to Tehran University of Medical Sciences, two maternity hospitals in Tehran which having been ranked O14 in the ICD-10 classification. Medical records of these patients contained clinical, demographic, and discharge documents that were completed and archived. In order to validate the study, medical records of the patients of Mahdiyeh Educational Hospital affiliated with ShahidBeheshti University of Medical Sciences in the city of Tehran, which is a specialized hospital in obstetrics and gynecology were studied as well. In hospitals, 10 medical records in each O14 category related to GDM based on International Classification of Diseases 10th Revision (ICD-10) were randomly selected. In addition, data elements of emergency forms in hospitals were studied. In order to extract the data elements from the sources listed above, a checklist was used.Collected data were divided into clinical, administrative, and pharmaceutical categories using a checklist. Then, extracted data elements from the literature review and patient medical records, in Iran, were combined and the final content of the checklist was constructed. The administrative data were classified into four categories. Moreover, the clinical and pharmaceutical data were classified in 19 and two categories, respectively. The questionnaire was constructed using the data elements of the mentioned checklist. The questionnaire was composed of five columns with, strongly agree, agree, neutral, disagree and strongly disagree in front of each data element. At the end of each section, a blank row was considered for adding necessary data elements by experts. Content validity of the questionnaire was evaluated by four experts, including two health information management experts, and two obstetrics and gynecology specialists. Test\u2013 retest reliability  was performed to determine the reliability of the questionnaire. The collected data was analyzed using SPSS 19, and a Spearman\u2019s rank correlation coefficient of 84% was achieved. To determine the final data elements of the MDS of the registry related to GDM, data elements were chosen by 20 samples of attending experts through the Decision Delphi technique in two rounds. The research environment was the workplace of gynecologists, pharmacists, nurses, and midwives working at two maternity hospitals in Tehran. These two hospitals were selected because they were teaching-medical hospitals and they accept a high number of pregnant women. The criteria for selecting the experts were being a faculty member and having at least five years\u2019 experience in pregnancy diseases in clinical environments and hospitals. The second group was also required to consist of faculty members working in medical centers and having at least five years\u2019 experience. The third and fourth groups were nurses and midwives working in maternity hospitals with at least five years\u2019 experience. As many as 40 questionnaires were distributed among the experts of the four fields in two rounds (20 questionnaires in the first round and 20 questionnaires in the second round). All of the 40 questionnaires were completed and collected. The criteria for the acceptance of data elements in the final MDS, was the agreement level of experts. Data elements with agreement levels less than 50% were excluded at the first round, 50\u201375% agreement levels entered the second round, and agreement levels more than 75% were accepted in the first round of the Delphi technique. In the second round, an agreement level of 75% was considered on each data element. In the end, final data elements of the MDS were achieved in two rounds.The personal information of the experts, participating in the first and second rounds of Delphi, is presented in However, in the second round of Delphi, the experts agreed upon 80% of the administrative elements and 77% of the clinical elements .The suggested MDS of the gestational diabetes mellitus for Iran is indicated based on the section and the data elements of each category. The MDS of GDM was divided into three categories: administrative with four sections, clinical with 18 sections and pharmaceutical with two sections. The total number of final data elements for administrative, clinical and pharmaceutical categories was 43, 246 and12, respectively. After applying two rounds of the decision Delphi technique, the final data elements for administrative, clinical, and pharmaceutical categories were 35, 199 and12, respectively \u20134. 55 daIn the end, the administrative data elements were categorized in four sections- demographic, healthcare provider, admission and its frequency, and patient indicators. From 43 data elements, the experts agreed on as many as 35 data elements. The clinical data elements were categorized into 19 sections, viz., diagnostic data, symptoms, previous medical history and risk factors, family history, history of previous deliveries, physical and clinical examinations, vaginal examinations, disease prognosis in case of delivery, laboratory data, counseling, permission for treatment and surgery, the current status of pregnancy, pregnancy result, prenatal and postpartum care for women with GDM, anesthesia data, sonography data, blood sugar chart, data related to the diabetic mother\u2019s infant, and the mother\u2019s discharge data.Finally, the experts agreed upon as many as 18 sections including 199 data elements. Given the experts\u2019 lack of agreement, family history section and its data elements were removed .The pharmaceutical data elements were categorized into two sections, i.e., used drugs and substance use dependence, and drugs used related to diabetes. The experts agreed upon as many as 12 data elements, and they were used in the final MDS. The first stage for creating the registry of diabetic pregnant women, requiring constant follow-up, is identifying the information needs in medical centers. Based on the findings of the researcher, the data elements in paper records are commonly incomplete. Given the importance of such data, there are numerous shortcomings for having electronic data. After the poll, the table of the minimum data set was created for designing the registry of GDM. In these tables, the patients\u2019 data were classified into three categories, i.e. administrative, clinical, and pharmaceutical .For determining the patient\u2019s minimum administrative, clinical, and pharmaceutical data, in addition to searching the valid databases, the hospitalized patients\u2019 medical records were examined as well. Moreover, by using the views of all individuals involved in the data collection of the present study , the minimum data set required for creating the GDM registry was created. In this poll, as far as the administrative data section goes, the most important elements were the first name, last name, father\u2019s name, marital status, date of admission, hospitalization date, number of hospitalizations, the name and address of the hospital/healthcare center, hospital/health care center ID, cause of reference, number of references, medical records numberAs for the clinical data, the team participating in the poll determined the essential data. The data elements include symptoms of pain and bleeding, high blood pressure, fever, headache, the starting time of the pain, fetal approximate weight, maternal weight, BMI, and registered HbA1c in the first trimester of pregnancy, delivery lesions, Apgar score, intrauterine death cause (in case of occurrence), and other important elements.In addition to the required data elements, given the experts\u2019 views, the pharmaceutical set needed a separate classification for the essential data of pregnant mothers\u2019 treatment duration. The most important data elements included the data related to current drugs, drug allergy, smoking dependence, smoking addiction, narcotics and their different kinds, the starting time of the diabetic treatment, pharmaceutical treatment/name/dose/prescription time: oral medication, IV/IM medication, external medication, internal therapy, and blood products. The experts agreed upon all of the aforementioned data elements.In Australia, the Australian Institute of Health and Welfare has initiated the project of \u201cThe Pregnant Women\u2019s Dataset\u201d in the form of a minimum data set. One of the most important parts of the present project is collecting minimum data acquired from screening and caring for pregnant mothers with GDM . In thisAlthough the Australian Perinatal National Minimum Data Set contains information about gestational diabetes mellitus, these data have been conducted by applying different methods in different fields. This makes it difficult to compare them on a national level. Thus, applying standard definitions or similar classifications through a minimum data set of GDM is the first step in improving the adaptability of the reports and comparing the data on a national level .\u201cDiabetes in pregnancy outcomes: A systematic review and proposed codification of definitions\u201d, Feig et al. (2015) created a standard definition source for future studies. In the present study, the experts agreed upon the standard maternal and fetal data by examining the studies conducted within 2000\u20132012 as well other resources including the World Health Organization and the statements released by the related scientific communities. For reports of future studies on GDM and collection of the related data, the present study is highly recommended [In a study titled g et al. 15 createSadoughi et al. (2015) have conducted an applied study titled \u201cMinimum data sets of perinatal period for Iran: A Delphi study\u201d. In their study, the minimum data sets of the perinatal period were collected by investigating the minimum data sets of the selected countries, viz., Australia, Canada, New Zealand, the USA, England, and Iran through applying library resources. Then, the recommended minimum data set was validated by providing the experts with a questionnaire. The recommended minimum data set of the perinatal period for Iran was classified in 15 sections. According to the present study, weak documentation and lack of standard data elements are the main integration problems of information systems. Moreover, the present study proposed designing and implementation of perinatal minimum data set . The finIn their study titled \u201cResults of the first recorded evaluation of a national gestational diabetes mellitus register: Challenges in screening, registration, and follow-up for diabetes risk\u201d Boyle et al. (2018) collected the data from three GDM data centers to guarantee the integration of the data; all of the data related to pre- and post-partum cares as well as fetal/neonatal status were recorded as registry . As in tGiven the priority of the Ministry of Health and Medical Education for developing the project of disease registration system, the health outcomes in Iran, and the high prevalence and incidence rate of GDM and its complications for the mother and fetus/infant, designing and implementing the registry system of GDM in Iran is of high significance. The minimum data set of GDM will result in the collection of the national data about the incidence and prevalence of the disease, care strategies and techniques, and the treatment provided for GDM patients. The minimum data set works as a platform for collecting the key data of a disease . By acceThe analysis of the findings of the present study indicated that determining the minimum data set as the first step of GDM registration system\u2019s implementation is of high significance for exchanging integrated health data in the healthcare industry. In fact, applying the minimum data set as the basis and foundation of GDM health registration system will result in designing the web-based electronic records corresponding to the social and health conditions of Iran and having quick access to accurate and comprehensive data of GDM. By planning, evaluating, and monitoring the status of the patients and identifying the shortcomings of providing medical services and its outcomes, it will be easier to arrange policies and plans for the gestational diabetes mellitus and its sufferers on a national level. The practical application of this minimum data set through forms of the GDM registration system for documenting the cares is likely to result in determining the validity and reliability of the data elements, based on the needs of the Iranian healthcare system. If necessary, the minimum data set can be updated according to the new medical protocols for GDM and the needs of the gestational diabetes mellitus registration system\u2019s beneficiaries.This study has been funded and supported by Iran University of Medical Sciences (IUMS); Grant No.96-04-136-31843.The authors confirm that there are no conflicts of interest."}
{"text": "This Special Issue focuses on recent research on the important emerging and neglected tropical diseases (NTDs) in South and South East Asia and Northern Australia. This region stretches from Pakistan in the west to the Philippines in the east, and includes Afghanistan and countries to the east, the Indian subcontinent, mainland South-East Asia, and the tropical regions of Australia. Many of these areas are highly endemic for important NTDs and other tropical diseases, including lymphatic filariasis (LF), soil-transmitted helminthiases (STH) such as hookworm infection, trichuriasis, ascariasis, and strongyloidiasis, rickettsial diseases and arboviral diseases. Several of these diseases are targeted for elimination or enhanced control by the World Health Organization (WHO) in the next 5 to 10 years, although some have chronic lasting sequelae and disability needing lifelong management. Control methods used include preventive chemotherapy, enhanced screening and treatment, intensified disease management, vector control, interruption of human to animal transmission, environmental/sanitation improvements and disability prevention/mitigation. A current list of WHO NTDs is given in Strongyloides stercoralis [Schistosoma japonicum, Ascaris lumbricoides, Trichuris trichiura, and hookworm, in the Philippines [At the time of publication, there have been 11 papers published upon peer review acceptance in this Special Issue, including eight original papers, two review papers and one perspectives piece. They each contribute to a much better understanding of Neglected and Emerging Tropical Diseases in South and Southeast Asia and Northern Australia. The contributions to these topics can be summarized as follows: four submissions on LFs ,3,4,5, frcoralis ; and a srcoralis ; and a slippines . The twolippines , and thelippines .Tropical Medicine and Infectious Disease.The diversity of papers, the depth of the topics and the relative geographical reach of the authors  in this Special Issue confirm the continued collective major interest in this area. This wide-ranging open access collection contributes to a much better understanding on the epidemiology, presentation, diagnosis, treatment, prevention and control of neglected and emerging tropical diseases in South and Southeast Asia and Northern Australia. As the editors of this Special Issue, we trust that you find the content useful, as the authors are pleased to share their knowledge with an international audience. We look forward to future opportunities to update advances in this field and encourage you or publish your work in or propose a Special Issue for"}
{"text": "This symposium will present findings from a National Academy of Social Insurance study panel on Designing State-Based Social Insurance Programs for Long-Term Services and Supports, Paid Leave, and Affordable Child Care. The risk of needing to provide or receive care is universal. Policymakers in several states are now weighing the enactment of new social insurance programs to address the risk of needing long-term services and supports. The study panel has mapped out the key design choices such states would need to consider with regard to program structure, financing, integration with Medicaid, and implementation, and the implications of these choices for elders, people with disabilities, families, providers, and states. The symposium will also present the study panel\u2019s findings with regard to how long-term care benefits could be provided in the context of an integrated care program addressing three often interrelated caregiving risks: long-term services and supports, paid family and medical leave, and early child care and education: Universal Family Care. Finally, implications for emancipatory gerontology, including the impact of the current gaps in our care infrastructure on family caregivers and the care workforce, will be considered."}
{"text": "World Health Organization (WHO) defines tropical diseases as all diseases that occur solely, or principally, in the tropics\u2019 [Historically, tropical medicine emerged from a multidisciplinary background as a result of progress in the areas of public health and hygiene, travel and exploration, biology and evolution, and the germ theory of disease . The Wortropics\u2019 . WHO\u2019s fTropical Medicine and Infectious Disease. It has been endorsed as the Official Journal of The Australasian College of Tropical Medicine (ACTM) and its joint Faculties of Travel Medicine and Expedition and Wilderness Medicine. Both MDPI and the ACTM are celebrating anniversaries this year, being 20 and 25 years old respectively, and are both proud of their respective traditions in the world of publishing. The Australasian College of Tropical Medicine has partnered with long term electronic publisher, MDPI, to develop an international, scientific, open access journal of tropical medicine and infectious disease to be published quarterly online. We have named this new journal, MDPI publishes 150 peer reviewed, scientific, open access, electronic journals in a broad range of fields. It has offices in four cities, being headquartered in Basel, Switzerland and having additional offices in China and Spain. MDPI is a member of all the major professional publisher associations, including OASPA, STM, or COPE and has a strong track record in building the indexing and abstracting support for each of its journals . Part ofAnnals of the ACTM since 1995, initially as conference proceedings and then as a peer-reviewed journal from 2002. All of these are available online [Dictionary of Tropical Medicine [The ACTM is particularly excited about this project being launched in its 25th Anniversary Year. The ACTM itself has been publishing the e online . The ColTropical Medicine and Infectious Disease is to publish authoritative and original articles, critical and systematic reviews, editorials, perspectives, short communications, commentaries, book reviews, letters to the editor and special issues on all aspects of tropical medicine and tropical infectious disease. All articles will be submitted through MDPI\u2019s excellent online journal submission platform and are subject to editorial and peer-review. The MPDI Editorial Process is extremely rigorous [The aim of rigorous , but it Tropical Medicine and Infectious Disease will publish on all tropical diseases of global significance, as well as neglected tropical diseases, as defined from time-to-time by the WHO. The scope of the journal includes, but is not limited to clinical tropical medicine, tropical infectious diseases, parasitology and entomology, bacteriology, mycology and virology, epidemiological and social science studies, chemotherapy and pharmacology, immunology, disease prevention, control and elimination, emerging and re-emerging infectious diseases, emerging public health threats, and global health and One Health.We are very proud to welcome our foundation international Editorial Board, an extremely talented group of more than 20 senior academics and clinicians from six continents with global outreach. We also warmly welcome our Assistant Editor, Anna Liu, who has championed the development of the journal and will be a key contact for both contributors and Editorial Board members. The team will be led by our Editor-in-Chief, John Frean from South Africa, and our Deputy Editor-in-Chief, Peter A. Leggat, AM, from Australia. We will be reviewing and building our Editorial Board and reviewing teams in the coming years and the Editor-in-Chief would welcome nominations from interested leaders in the fields of tropical medicine and infectious disease. We are also looking forward to receiving your research, reviews and other scholarly contributions and we welcome suggestions or ideas that can enhance this new journal.Tropical Medicine and Infectious Disease. On behalf of the Editorial Board, we invite you to submit your manuscripts and suggestions for Special Issues and guest editorials to"}
{"text": "Journal of Global Health, we are committed to ensuring that all processes during the publication of articles in our journal have the same level of transparency and responsibility. As we expect from our authors and reviewers to declare their possible conflicts of interest in relation to the manuscript under consideration for publication in the journal, we also need to declare our commitments and relations that may influence the editorial review process. When one of the decision-making editors submits an article to the Journal, it is reviewed independently from the editor, who has no access to or influence on the review process and editorial decision-making. This is always indicated in the Competing Interests declaration at the end of the published article.As the editors of the As the next step in increasing the transparency of the editorial conflicts of interest  and in oProf. Maru\u0161i\u0107 is fully employed by the University of Split School of Medicine, where she holds a tenured position as Professor and Chair of the Department of Research in Biomedicine and Health. She receives funding support for research from the Croatian Science Foundation and the European Commission under the Horizon 2020 programme.Prof. Maru\u0161i\u0107 holds a position as the Editor in Chief. She occasionally reimburses small travel expenses related to Journal\u2019s work.Honorary Professor, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland, UKVisiting Professor, School of Medicine, University of Sao Paulo, Sao Paulo, BrazilPresident, European Association of Science Editors (until June 2018)Steering Group, EQUATOR NetworkCo-Chair, Cochrane Scientific CommitteeResearch Coordinator, Cochrane CroatiaBalkan Medical JournalAdvisory Board Member, the Prof. Rudan is employed by the University of Edinburgh, where he holds a position as Professor and Co-Director of the Centre for Global Health Research. He is also co-Director of the WHO Collaborating Centre in Population Health Research and Training. He currently receives research funding support from the Gates Foundation.Prof. Rudan holds a position as the co-Editor in Chief. He occasionally reimburses small expenses related to Journal\u2019s work, including travel and consumables.Prof. Rudan has numerous technical advisor appointments to WHO, UNICEF and the World Bank.Prof. Campbell is employed by the University of Edinburgh, where he holds a position as Professor and Co-Director of the Centre for Global Health Research. He is also co-Director of the WHO Collaborating Centre in Population Health Research and Training and co-Director of the NIHR Global Respiratory Health Unit. He currently receives research funding support from the European Commission (Innovative Medicines Initiative), WHO, UK NIHR, Cancer Research UK, UK MRC, Sanofi (for work on specific GI and respiratory infections) and the Gates Foundation.Prof. Rudan holds a position as the co-Editor in Chief. He occasionally reimburses small expenses related to Journal\u2019s work, including travel and consumables.Member, MRC Africa Research Excellence Fund (AREF), College of Experts, since 2016Member, WHO PIP burden of disease advisory group, since 2015Member of international Scientific Advisory Group, INDEPTH network, since 2014Member of Expert Advisory Group for \u201cThe Making of Genomic Medicine Wellcome Trust Programme; University of Edinburgh), since 2013Member, Public Health, Health Services Research and Primary Care  Research Excellence Framework (REF), 2018-2021Numerous technical advisor appointments to WHO in the past 5 years"}
{"text": "Scientific Reports7; Article number: 4295710.1038/srep42957; published online: 02212017; updated: 07042018Jonathan Collins was omitted from the author list in the original version of this Article. This has been corrected in the PDF and HTML versions of the Article, and in the accompanying Supplementary Data file.The Author Contributions section now reads:\u201cDennis Ma and Siyaram Pandey contributed to the conception and design of experiments, execution of experiments, analysis of data, and preparation of the manuscript. Daniel Tarade, Tyler Gilbert, Christopher Pignanelli, Fadi Mansour, Scott Adams, Kyle Stokes, Alexander Dowhayko, and Megan Noel contributed to the execution of experiments and preparation of the manuscript. Sergey Vshyvenko, Jonathan Collins and Tomas Hudlicky synthesized and provided PST analogs for this study and contributed to the preparation of the manuscript. James McNulty provided natural PST for this study and contributed to the preparation of the manuscript\u201d."}
{"text": "The authors of the paper \u201cPerformance, Acceptability, and Usability of Respiratory Rate Timers and Pulse Oximeters When Used by Frontline Health Workers to Detect Symptoms of Pneumonia in Sub-Saharan Africa and Southeast Asia: Protocol for a Two-Phase, Multisite, Mixed-Methods Trial\u201d :e10191), made a mistake in the final stage of proofreading. Kevin Baker should have been listed as affiliated with the Karolinska Institute in Stockholm, Sweden. This affiliation has also been updated to include the Department of Public Health Sciences for all affiliated authors and now reads as follows:Department of Public Health Sciences, Karolinska Institute, Stockholm, SwedenAdditionally, Kevin Baker's address as the corresponding author for this paper has been changed to reflect this new affiliation.The correction will appear in the online version of the paper on the JMIR website on March 7, 2019, together with the publication of this correction notice. Because this was made after submission to PubMed, PubMed Central, and other full-text repositories, the corrected article also has been resubmitted to those repositories."}
{"text": "Lichen is a common chronic inflammatory dermatitis that can affect the skin, mucous membranes and phaneres. The simultaneous involvement of the three compartments is rare and testifies to the severity and activity of the disease. We present a case of this triple involvement. However, the complete muco-cutaneous and phanerienic forms are rare, testify to the severity of the disease and justify a systemic treatment and a regular and long-term monitoring view the risk of degeneration of the mucous lesions. We report the case of this 60-old-man, followed for papular dermatosis, hyperpigmentary, very itchy, generalized, with involvement of the genital mucosa, in the form of erosive balanitis and nails of the hands and feet. The cutaneous histology was in favor of lichen. The biological examinations did not show any dysthyroidism, liver or autoimmune diseases. The patient was placed on systemic and topical corticosteroids. A pigmentogenic evolution of the cutaneous lesions, a beginning of bleaching of the nail lesions and a resistance of the genital lesions were noted."}
{"text": "The reassessment of technologies and services offered by healthcare systems is recent initiative and still without a widely adopted and evaluated method. To a better understanding of this process in Brazil, we have described the health technology reassessment (HTR) performed by the National Committee for Health Technology Incorporation (Conitec) into Brazilian public health system (SUS).A documental, exploratory, descriptive, retrospective study with qualitative-quantitative approach regarding the HTR performed by Conitec from January 2012 to November 2017.After applying the criteria of inclusion and exclusion, we selected 47 technologies for this study. The vast majority of the demands (41 demands) came from the public sector, and only six from the private sector. Most of the requests referred to the exclusion of specific indication; followed by extension of use, withdraw of the technology from SUS, maintenance, and restriction of use. The dimensions of analysis found in the recommendation reports were scientific evidence on efficacy, effectiveness and safety, disease-related issues, issues related to the use of technology, costs, and social participation. However, these dimensions were not included in all analysis, and a standardized structure of the reports has not been observed. The most relevant decision factors considered for decision-making were efficacy, safety and use of the technology.During a six-year period of Conitec actuation, we could find some reassessments of technologies that are available in SUS. We observed that these activities had enabled progress, however, they are still not yet structured, with gaps in the selection process, and the assessment since no methodology and criteria for proper conduct were established. The process of Health Technology Assessment (HTA) considers primarily the results of efficacy studies, mostly from randomized clinical studies. However, despite being essentials, these studies often point out a high degree of uncertainty to the real benefits to the population, which, in many cases, is not proportional to the resources invested ,2. This According to the Brazilian Institute of Geography and Statistics (IBGE), between 2013 and 2014, the final consumption of health goods and services rose from 8.2% to 8.7% of Gross Domestic Product (GDP). In 2015, the health expenditures were R$ 546 billion (9.1% of GDP), with 79.2% of health services and 19% of medicines. The rest referred to the consumption of other medical, ophthalmological, and dental materials. Considering these data, approximately one-fifth of health expenditures is related to the use of medicinal drugs, only surpassed by hospital cost, outpatient and preventive services and sanitary surveillance [It is essential to define tools that can support decision-makers in the adoption and re-evaluation of technologies within health systems. Among many reasons for this approach, we can cite the prospects for an increase in the use of drugs and other health technologies to meet the demands of a population that are progressively expanding associated with an increase in the prevalence of chronic degenerative diseases, together with the highly complex and contextualized analysis for selection of technologies and services.Regarding the adoption of new technologies, there has been much effort in the study of methods used by Health Technology Assessment (HTA) agencies and how to improve them, so that this process can apprehend all the relevant aspects of the intervention in a given context. Consequently, more objective and transparent methodologies and criteria that take into account the perspectives of different stakeholders have been developed and validated in several countries to optimize the allocation of resources and contribute to more consistent decisions before society \u20137.On the other hand, studies on reassessment methodologies to monitor and evaluate the use of technologies are less frequent and have only recently become available; more precisely, since 2006 . The heaSuch a process is fundamental to the quality of care offered to the patient and the sustainability of the health system, as resources could be reinvested in more useful or less expensive health services. Within the technology lifecycle, this phase aims at finding technologies that present inferior results to those that subsidize their adoption or even interventions that are ineffective or harmful to the patient or the health service . Hence, Some studies were conducted targeting low-value practices, which, according to Colla and colleagues, are \"the use of care that is unlikely to benefit the patient given the cost, available alternatives, and preferences of the patient\" . Prasad In another review, Niven and colleagues have reported cardiovascular diseases, arthritis, and menopause as the most common target conditions in de-adoption studies\u2013discontinuation of current clinical practice. The most researched therapies were cyclooxygenase-2 inhibitors (COX-2) and other non-steroidal anti-inflammatory drugs (NSAIDs), hormone replacement therapy and percutaneous coronary intervention .Considering that the low-value practices are a potential waste and can be harmful to the patient\u2019s health, some countries  have already begun monitoring the technology after a certain period past its implementation in the health care system \u201316.During the French health system reform, there was a review of the complete list of reimbursed drugs and those considered ineffective were withdrawn from the health system. In addition to this strategy, there were also others like greater access to average European prices for innovative drugs, stimulation of discounts for over-prescription drugs and programs to increase the prescription of generic medicines. The result of HTR and the further decision not to reimburse the ineffective medications represented an estimated savings of 450 million euros/year, in addition to the savings generated by the implementation of the other reform initiatives (1.7 billion euros / year\u2014period from 2003 to 2007) .These data about the French health system emphasize that combining several strategies to improve technologies management, results in a significant impact on economic resources. However, the sustainability of health systems involves other aspects beyond the financials ones ; such as the continuity of the provided services  and the obtained benefits  . These aIn Brazil, the National Committee for Health Technology Incorporation (Conitec) was established in 2011 to improve the decision-making process in HTA. The primary purpose of this committee is advising the Ministry of Health on decisions related to the adoption, disinvestment or changes in the use of health technologies in SUS, as well as the development or update of clinical protocols or therapeutic guidelines . ConitecConitec creation has promoted advances in the institutionalization of HTA in the Brazilian health system, due to the rationality and use of clinical and economic evidence in decisions about the inclusion of new technologies in SUS. Some studies on the work of the Committee have been published with the purpose of outlining the evaluation process, the demands, and the recommendations about the adoption of technologies \u201312. HoweTherefore, the present study aimed to analyze and characterize the process of HTR carried out by Conitec, focusing on the dimensions of analysis, criteria and decision factors that were relevant for the Committee recommendations.This study is the first step of our project. The full project consists of 5 steps: 1- Review of the current state of HTR carried out by Conitec; 2- Systematic review of the literature; 3- Development of a RTS framework; 4- Pilot study using the RTS framework; 5- Evaluation of the results, adjustments and validation of the RTS framework.We carried out a documental, exploratory, descriptive, retrospective study with qualitative-quantitative approach regarding the HTR performed by Conitec from January 2012 to November 2017.The study comprised the following steps:Selection and classification of technologies;Data extraction;Data analysis.Description of the HTR process and Conitec recommendations from the analysis of (i) consistency in the report on presenting analysis of dimension and criteria as evidence, issues related to the context of disease and technology, costs, public consultation, and others\u2013and (ii) the decision factors for Conitec recommendations.Most of the final decisions were issued as \u201cadoption\u201d or \u201cno adoption\u201d of technology, regardless of the technology is already available in n SUS. Thus, for selecting the reassessed technologies, the types of evaluation requests, and so the final decisions, were reclassified based on the availability of the technology in SUS for the assessed indications, as shown in the All technologies available in SUS, and that were reassessed for an indication already approved within the health system.Health technologies: drugs, vaccines, health devices, and procedures.Reassessed technologies: health technologies  available in SUS, assessed in the same presentation and for the same indication.The reassessment request/decision was an extension of use/not extension of use ; maintenance/delisting from SUS (items c and f), restriction of use (item d); maintenance/exclusion of indication (item e).The exclusion criteria were as follows:Clinical protocols and therapeutic guidelines were not included. Each inclusion, exclusion, and change of use of technologies when drawing up or revising the protocols go through the same process of evaluation of other technologies and are contained in the set of technologies evaluated .New health technologies (in SUS context): technologies that were not available in SUS during the assessment period.Drugs with new concentration, new pharmaceutical form and new route of administration were also considered as new technologies for the health system, and, therefore, excluded from the present study.Technologies with a new indication, although already available in the health system for other clinical situations.The public data were collected directly from the recommendation reports available on the Committee website (January 2012 until November 2017) , namely:Technology name;Amount of technologies by decision: the analysis unit was defined as being the reassessed technology, even in cases where the demand or decision was related to more than one technology;Type of technology: drug, vaccine, device, procedure;Type of applicant: public sector  and private sector ;Indication;Type of assessment (reclassification as described in the method): new technology, new presentation, extension of use (new indication), extension of use , maintenance, restriction of use, exclusion of indication, delisting, exclusion of the International Classification of Diseases (ICD) from the protocol, protocol/guideline approval;Dimensions of analysis and criteria in the recommendation report;Decision factors for the recommendation; andFinal decision.The data related to the dimensions of analysis and criteria were extracted considering the main items in recommendation reports. The data related to the decision factors were collected from the items \u201cfinal considerations\u201d and \u201cfinal recommendation\u201d when the reports presented them. For reports that did not have a standardized structure, the above information was extracted from the full reading of the reports.Statistical analysis was performed using the frequency of the dimensions of analysis, criteria and decision factors presented in the recommendation reports. Then the findings were organized in tables with narrative description and discussion.Conitec had assessed 333 technologies, which includes drugs, vaccines, devices, procedures, and clinical protocols from January 2012 until November 2017 . Among oAfter applying the inclusion and disinvestment criteria described in the method, 47 health technologies were selected (14.1%), whose requests/decisions referred to a reassessment .Among the 47 technologies included in the study, 44 (93.6%) were drugs, two (4.2%) procedures and one vaccine (2.1%). Regarding the type of claimant, 41 (87%) demands originated from the public sector and only six (12.8%) from the private sector. The public demands\u2013from the Ministry of Health and affiliated institutions\u2013related to the extension, restriction, maintenance of use, exclusion of indication or complete delisting from SUS. All these public requests had a favorable recommendation, except the demand for widening the age range for mammography as a breast cancer screening method, which the judgment was unfavorable. All the private demands from pharmaceutical laboratories were to increase the use of the medication; three of them had received a favorable decision and three, unfavorable.Regarding the reason of the requests, the exclusion of some specific indication  was the most mentioned reason. In such cases, the technologies remained in the health system for the previously approved use. Fourteen requirements (29.8%) were made to the extension of the use of a given technology, twelve (25.5%) to delisting from SUS and maintenance and restriction, a request each (2.1%).Rheumatoid arthritis, HIV/AIDS, and hepatitis C were the indications for which most of the technologies were reassessed with seventeen (36.2%), ten (21.2%) and six (12.8%) demand, respectively. The other indications were Crohn's disease (two), multiple sclerosis (two), hepatitis B (two), breast cancer (one) epidermoid carcinoma (one), cystic fibrosis and exocrine pancreatic disease (one), Gaucher disease (one), hepatitis A (one), malaria (one) and congenital syphilis (one).The dimensions of analysis and the criteria for organizing the results were defined based on the information collected. Then, the data were structured according to the dimensions presented in the reports: context regarding the disease and technology, scientific evidence, costs, and social participation Tables  and 3.A little more than half of the evaluations  addressed aspects related to the disease, like its evolution, epidemiological data, diagnosis and treatment offered by the health system. The amount of technology used within the public system was taken into consideration in eight cases (17%). Issues concerning the implementation of technology as the availability of the technology in the Brazilian market, drug thermolability, storage and logistics for distribution and changes on the indications approved by the National Agency of Sanitary Surveillance\u2013ANVISA were considered only in a few analyses .Clinical protocol development or updating had subsidized decisions on 22 technologies (46.8%), all relative to the exclusion of specific technology indication or delisting from SUS. International documents as reports of HTA and clinical protocols had based decisions on an extension of use (change in the treatment line or wide age range) of six technologies (12.8%).Scientific evidence about efficacy, effectiveness or safety were presented in 26 technologies assessment (55.3%). All the reports without scientific evidence were related to decisions of exclusion of the technology from SUS or exclusion of specific indication for a technology. The justifications for these cases were as follows: adjustments in the clinical protocol (14 technologies) with wrong recommendations (drugs recommended to treat conditions without indication in the package insert or without data from scientific literature); replacement of obsolete drugs (seven technologies), unavailability in the market (two technologies), stability/storage (one technology). In nineteen cases that the scientific evidence was lacking, the arguments supporting the decision were related to less efficacy or safety, along with others factors, however, no scientific data were presented in the reports.Of all assessments, clinical results extracted from the SUS database were used only in comparing the performance of interferon beta in the treatment of multiple sclerosis. Follow-up data of around ten years of patients using interferon beta for the treatment of multiple sclerosis in SUS demonstrated a statistically lower performance for intramuscular interferon beta as compared to another interferon beta regarding effectiveness (relapses and death outcomes) and treatment adherence.The budget impact estimates supported 16 decisions (34%)\u2014twelve for extended use  of HIV/AIDS drugs, rheumatoid arthritis, multiple sclerosis, hepatitis A and hepatitis C and another four to an exclusion from the SUS of technologies for HIV/AIDS, hepatitis C and malaria. Seven of these assessments (15%) also used economic studies; being three cost-minimization studies, three cost-effectiveness study, and one a cost-efficacy comparison. All these seven evaluations were related to the requests for extension of use\u2013six cases were for a change treatment line of drugs for rheumatoid arthritis, multiple sclerosis and AIDS, and one for the widening the age range for hepatitis A vaccine.In what concerns the public consultation, thirteen (27.6%) of the assessed technologies had undergone this phase.Although various information was taken into account for Conitec deliberation, some criteria were regarded as crucial for the decision-making Tables  and 3. CQuestions of adhesion, including dosage, route of administration and tolerability, impacted in the evaluations for restriction of use of intramuscular interferon beta, expansion of use of dolutegravir, darunavir and raltegravir, and exclusion of the medicaments fosamprenavir, didanosine, telaprevir and boceprevir from SUS list and exclusion of indications for the use of injectable interferon alfa-2b in the treatment of hepatitis B.In some delisted drugs, like telaprevir, boceprevir, stavudine, indinavir, and didanosine obsolescence was perceived, and more efficient and safer drugs substituted them. The medicament molgramostim, that was not marketed in Brazil due to its adverse events, was also delisted. The obsolescence was also verified in the evaluation of some specific indications of filgrastim and epoetin alfa\u2013situations of complications with the use of telaprevir and boceprevir. With the exclusion of telaprevir and boceprevir, filgrastim and epoetin alfa lost their utility for this indication, although they remained in SUS for other conditions.For most technologies , the criterion of efficacy was essential for the Committee to decide on extension of use (fourteen technologies), exclusion of specific indication for the use of a technology (seventeen technologies), delisting from SUS (nine technologies), maintenance in the health system and restriction of use (one technology each).The fourteen drugs for which the efficacy was essential for decision of extension of use were, related mainly to HIV/AIDS, rheumatoid arthritis and hepatitis C . The other indications were: Gaucher disease, multiple sclerosis, breast neoplasm, and hepatitis A. In the cases of exclusion of indication (17 drugs), this criterion was used majority for drugs for rheumatoid arthritis treatment (14 drugs). At last, the efficacy of drugs for HIV/AIDS (5 drugs) and hepatitis C (2 drugs) was relevant for the de-listing decision-making. So, the relevance of this criterion was observed mainly for drugs related to HIV/AIDS, rheumatoid arthritis and hepatitis, independent of the kind of recommendation.Five technologies did not consider efficacy as a deciding factor for the recommendation. These drugs were related to exclusion from the SUS  and exclusion of indication (Two drugs for hepatitis C).Data effectiveness from the scientific literature and the SUS data were relevant in seven assessment for extension, exclusion, and restriction of use. To evaluate the comparison of the efficacy of interferon beta, we used data from SUS that resulted in the restriction of intramuscular beta interferon use. For the extension of the treatment period with sofosbuvir and daclatasvir, real-world evidence obtained from European patient cirrhotic genotype 3 who received treatment for hepatitis C during 24 weeks showing higher therapeutic successful results rates were essential ,23. Due Information about safety supported the extension of the use of seven technologies, decisions about the exclusion of nine technologies from SUS and exclusion of one specific indication. The extensions of use referred to the change of line , increase in the treatment period (sofosbuvir and daclatasvir) and the increase of age group . In general, the delisted technologies were replaced by others, to maintain options in SUS, so, patients were not uncovered .The costs were relevant for nine recommendations. The budget impact was considered a decision factor in seven decisions about the expansion of use\u2013raltegravir (two decisions), tocilizumab (two decisions), sofosbuvir, daclatasvir and hepatitis A vaccine\u2013and in the exclusions of telaprevir and boceprevir from SUS. The economic evaluation was taken into account to support the extension of use of hepatitis A vacccine.Other information were used to ratify the Committee's recommendations, such as the expansion of indications for registration with the ANVISA , lack of registration in Brazil (Pancrelipase and molgramostim), logistics of the program (Hepatitis A vaccine) and thermolability (Ritonavir).In order to analyze and describe the process of HTR performed by Conitec, 47 technologies were selected. Several requests for reassessment originated in the Ministry of Health, Health Departments and other institutions that comprise SUS, aimed at adapting the technologies within the health system. There were a few private requests\u2014a sixth as compared to the public, and all were to change the treatment line for which the technology was already being offered by the SUS. Therefore, the private requirements did not aim to fully analyze the interventions within the system, but extend it use to a higher number of people.There was only one decision, to the public demands, contrary to the request for widening the age range for mammography as a method of breast cancer prevention because of the uncertainty benefits to the population. For a private application, half of the deliberations was favorable and half-unfavorable to the extension of use.Yuba et al. study evaluated the recommendations of all Conitec evaluations from 2012 to 2016  and alsoRegarding the reason of the requests, the exclusion of some specific indication was the most mentioned reason, followed by extension of the use of a technology and delisting from SUS. These results reflect a worldwide trend in using HTR, which is not focusing on the total exclusion of technology, but rather on refining clinical indications to optimize technology usage and the resources allocation within a healthcare system. In the UK, The National Institute for Health and Clinical Excellence is going towards this direction, having concluded that in practice, few technologies are prone to total disinvestment . In New Conversely, in France, the most active country in adopting the complete disinvestment strategy, a comprehensive review of all 4,490 drugs listed between 2000 and 2004 was conducted. As a result, 835 drugs were excluded from the national list  and 617 drugs had a reduction of reimbursement rate from 65 to 35%. There were contestations by the industry and between 2003 and 2006, a reevaluation of 723 drugs that were previously withdrawn from the list confirmed that 525 of them were insufficient [In Latin America, Agirrezabal et al. named some local disinvestment initiatives, although most of them did not present a comprehensive description of the process used in finding, prioritizing, evaluating, implementing, and the results of the disinvestment. Four studies referred to Brazilian cases, and only one was considered as a potential disinvestment approach . In thisSuch results illustrate and emphasize the difficulty in removing technologies already available in the healthcare system, making it necessary to combine scientific data, in these cases, more detailed and extensive, with the stakeholders' interests. However, generating data that contradict some practices is not always enough, since many physicians continue to administer treatments proven ineffective and even harmful to patients .In this context, policymakers may play a key role in regulating the use of such technologies, and therefore should consider the adoption of active forms of disinvestment, not only those aimed at total exclusion, but also the restriction treatment to subgroups, price or reimbursement rate reductions, encouragement of generic prescribing .Regarding the indication of requests, the vast majority of the technologies reviewed were related to rheumatoid arthritis, HIV/AIDS, and hepatitis, which, along with oncology, represent the leading health topics for new adoption requests . ConsideThus, as highlighted above, reassessments were made based on demands, the vast majority presented by the Ministry of Health itself and departments or organizations linked to SUS. Demand-based assessment is limited by the fact that it does not systematize all technologies that need to be adjusted in the face of new evidence  and those that should be excluded because they are ineffective or unsafe.Studies on disinvestment methodologies point out that the initial stages of selection and prioritization are fundamental to generate greater transparency and enable all technologies to be reviewed ,31,32. SHowever, setting the goal of the HTR program is required to decide on how to select and prioritize technologies, as Sustainability in Health care by Allocating Resources Effectively (SHARE) program in Australia advocates. In this case, \"the aim of the SHARE Program was to establish organization-wide, systematic, integrated, transparent, evidence-based systems and processes for decision-making about disinvestment in the context of resource allocation at Monash Health\" .Other initiatives that have been implemented in Australia sought to refine the indications for resource allocation to ineffective or inappropriately applied health care practices, to subsidize decision-related to ineffective drugs and vaccines in the Pharmaceutical Benefits Scheme (PBS), also, to maximize the patients\u2019 health and the supply sustainability. Some of these programs implemented in a local, regional and national level reported recommendations after RTS, such as: disinvestment of assisted reproduction technologies (in vitro fertilization and intracytoplasmic sperm injection), vitamin B12 and folate tests, discontinuation of public funding of kyphoplasty and percutaneous vertebroplasty for vertebral compression, revisions of colonoscopy items, surgical treatment for obesity, pulmonary artery catheterization, catheterization in ophthalmology, and restriction in the rules for screening for cervical cancer ,36.In Sweden, the nation-wide \u201cUncertainties and Disinvestment Project\u201d was designed to identify scientific uncertainties, to inform and support decision makers in prioritizing and allocating resources within the health services. As a result, there was disinvestment of arthroscopy in arthritis, a corticosteroid to lateral epicondylitis and, clinical replacement versus routine replacement of peripheral venous catheters. In the UK, NICE recommendations based programmes aimed to inform about the financial aspect of resources utilization, safety, effectiveness and health care quality process. Another initiative in the UK intended to reconfigured services to provide more health gain at a reduced total cost .Another point highlighted is the setting of deadlines for HTR, not observed in the Conitec process. Citing the example of other countries a recent systematic review of the sustainability programs and innovations have shown, in most of the studies, that the first evaluations were conducted after two years of the technology implementation ,37. The The dimensions of analysis found in the recommendation reports were scientific evidence on efficacy, effectiveness or safety, disease-related issues, issues related to the use of technology, costs, and social participation. However, these dimensions were not included in all analysis, and a standardized structure of the reports has not been observed.To decision-making, the criteria of efficacy safety and use of the technology were the most relevant for the set of evaluations. These data are in conformance to the primary concern of the health systems from France, Australia, New Zealand, Canada and the UK, that is, to identify safety and efficacy problems that were not previously identified or underestimated in a randomized clinical trial . BesidesAnother critical point to be mentioned was the lack of social participation through public consultation in most of the decisions. Although the argument that some technologies can have a fast-track appraisal process, the rules for this type of evaluation are not well defined. Thus, such technologies were reassessed regardless of the stakeholders' value and preference, which may compromise the legitimacy and acceptability of the decision. In order to achieve greater acceptance of decisions and to identify the potential impacts in the society, HTR process could involve the politicians, clinicians, speciality societies, health system leaders, industry, and patients . In the The decision-making oriented by the results of the technology performance, although not being observed as a regular practice by CONITEC, in other countries, some strategies have been adopted in this sense. Negotiation for price reduction and reduction of reimbursement rates has usually been implemented in countries such as Canada, France, Australia and New Zealand after analyzing the results of technology performance ,39. In aManaged entry agreements (MEAs) contractual agreements also have been used when uncertainty regarding the clinical effectiveness, safety or resource use associated with a technology is high. This kind of agreement distributes the risk of uncertainty between the payers and the manufacturer. In this case, additional further evidence generation is required . FollowiAs limitations to the present study, we point out the reclassification of the decision types by the authors as there is no definition of the term \"reassessment\" in SUS, and this may not reflect the perspective of the technicians and managers who participate in the Conitec deliberations. Moreover, the arguments described in the reports might not explicitly portray the justifications for the decision-making presented during the Committee meeting.The reassessment process has appeared among other strategies for reducing the use of ineffective, less effective or unsafe practices and, consequently, to avoid a resources waste. The results of Conitec six years of work presented initiatives with this goal. Although positive results were obtained, this activity is not yet structured, with gaps regarding the selection phase and reassessment of SUS list of technologies, since it has not been identified method and criteria for its conduction.Therefore, this study reinforces the need to prioritize structuring actions in within the SUS that improve the management of technologies, both those recently incorporated and also these adopted before the establishment of the Committee. Thus, it is suggested the implantation of a monitoring program and HTR, with endorsed methodology and that it contemplates in deepened way implementation questions (barriers and facilitators), stakeholder perspectives, and scientific, social, ethical, and legal questions. Such actions need, inevitably, short-term time and resources, but might add long-term gains in efficiency ,44.Finally, we expect that this study can contribute to the formulation of a systematic, transparent, and objective process for a revision of the list of technologies offered by the Brazilian Public Health System\u2013SUS. Such process can be helpful in defining the \"true\" value of a given technology in real conditions of use, contributing to better quality in the healthcare and sustainability of the healthcare system.S1 Table(XLSX)Click here for additional data file."}
{"text": "Cardiovascular disease (CVD), including coronary artery disease (CHD) and stroke, is the leading cause of death and disease burden globally . An estiOverall, the increasing global burden of disease is alarming and we are challenged with the need for scalable solutions that address prevention and ongoing management. Solutions lie in changes in the individual, family, communities and broader society. Such solutions need to overcome the barriers of distance, capacity and resourcing, while being simple and meaningful to people. Major advances in affordable technology offer an opportunity to maximise effectiveness and reach of health care. In the past decade, there has been rapid proliferation in the number of people who are able to access the Internet, with 4.1 billion people using the Internet globally, increasing from 3.7 billion Internet users in late 2017 . The escAs such, e-Health encompasses the provision of health-related services, hardware devices and software. Examples include the use of the Internet, Bluetooth devices, remote monitoring devices, wearable devices, text-messages and smartphone apps, amongst others. In recent years, there has been rapid expansion of these in the development and delivery of strategies aiming to address a number of health needs across different medical conditions. These strategies include education of patients and healthcare providers, data collection, diagnostics and screening, patient monitoring, treatment support, behavioural change support and communication between patients, health professionals and health services . CurrentMedical Sciences is to explore potential opportunities for e-Health in CVD research and management. The special edition includes a variety of original research papers and reviews that cover development and implementation of several e-Health strategies. All are aimed at using technology to increase reach and enable better delivery of CVD prevention and management.The aim of this Special Edition of The paper by Wang et al.  assessedThe paper by Dowie et al.  reports The paper by Clark et al.  highlighMedical Sciences offers a variety of examples on how e-Health data and strategies can potentially be used to improve the delivery and reach of healthcare. Future research and health services reviews will no doubt continue to explore, define and determine the evidence-base for e-Health and its ultimate contribution in the years to come.In conclusion, the current special edition of"}
{"text": "Ophiocordyceps sinensis (Berk.) G.H. Sung, J.M. Sung, Hywel-Jones & Spatafora, an entomogenous fungus endemic to the Tibetan Plateau, is one of the best known medicinal fungi in China and around the world. It has been documented in literature for hundreds of years and officially classified as a drug in the Chinese Pharmacopeia  and HKAS  and on examination of literature of more than 3600 publications. A total of 203 localities at county level for O. sinensis were recorded and analyzed. Among them, 106 were considered as confirmed distribution sites, 65 as possible distribution sites, 29 as excluded distribution sites, and three as suspicious distribution sites for the fungus  to southern regions and subsequently to northern areas  to organize the survey of the species occurrence through administrative division with the support from the government from prefecture level down to every country, township and village, marking the production area to each mountain, finding the dates of emerging and terminating of the stroma, calculating annual yields based on real harvest; (ii) to determine the site for long-term field observation based on the habitat, fungal genetic background, transportation and living facilities at the location, to conduct the long-term observation with climate, soil and environment factors and also physical, chemical and biological characters, e.g., temperature, humidity, precipitation, organic matter, soil texture, pH, vegetation types, biomass, community structure, animals, soil microbes, and so on, and to monitor the occurrence of the fungus and its host insects, as well as the harvest grazing and human activities; (iii) to establish special natural reserves for the fungus and to carry out the management for sustainable uses of the fungal resources, including local laws and government regulations, time and methods of harvesting, measures for improvement of grassland for the fungus and its host insects, etc.; (iv) to construct the comprehensive database for recording and management of the fungus, its host insects, and the grassland for its survival and reproduction.The extensive survey and long-term field observation for O. sinensis is largely consumed in its dried form as a stroma emerged from a sclerotium which is covered by the exoskeleton of caterpillar larva. The maturity of the stroma is considered very important to the quality of the product. The immature specimens with stromata protruded from intact and solid sclerotium are much more welcomed than those with well grown or mature stromata because the nutritional reserves within stromata have been exhausted. To maintain the medicinal value, the stromata and sclerotia of O. sinensis are harvested before they start to produce and release the spores for reproduction. It is an urgent need to manage the natural resources of O. sinensis which have limited natural production but are so extensively harvested by human overexploitation.Along with market demands,"}
{"text": "Dear Editor,Capecitabine is a chemotherapeutic fluoropyrimidine that acts as a prodrug, being metabolized into 5-fluorouracil through an enzymatic cascade, and is used for treatment of solid colorectal, gastric, and breast tumors. Its use has become popular in recent years due to its similar efficacy when compared to 5-fluorouracil, with a more tolerable toxicity profile and the convenience of oral administration.2/daily. She developed a rash on her face, neck, and scalp after six weeks of capecitabine use. The patient did not present fever, arthralgia, or myalgia. Physical examination showed erythematous, scaly patches along the V-line of the upper chest and interscapular region; there was also diffuse erythema in the androgenetic alopecia region, which pointed to a photosensitive component , and capecitabine was defined as the offending drug.Topical treatment with betamethasone and sun-protective measures were taken and, after capecitabine cessation, the patient showed great improvement of the skin lesions.SCLE is characterized by erythemato-squamous and annular lesions, with remarkable photosensitivity, typically associated with elevated serum levels of anti-Ro antibodies. It can be categorized as drug-induced or idiopathic, both forms being indistinguishable in clinical, serological, and histological aspects.Since the first report of drug-induced SCLE, associated with the use of hydrochlorothiazide, a growing number of medications have been described as culprits for the syndrome.A PubMed and MEDLINE review showed only eight cases of capecitabine-induced SCLE in the literature, and there have been no cases reported in Brazil up to now. This may be caused by an under-reported number of cases and/or may be attributed to our limited experience with the agent, which was only approved by the Brazilian Health Surveillance Agency , the country's organ responsible for drug regulation, in 2015, for the treatment of colorectal, stomach, and breast cancers.Although the pathogenesis behind capecitabine-induced SCLE remains unknown, its growing use in different types of cancer proves necessary the report of dermatological manifestations of the drug. The recognition of this side effect by dermatologists is vital, so that drug-induced SCLE may be included early in the differential diagnosis of patients who are using capecitabine and present skin lesions.None declared.Aroni Rocha: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; critical review of the literature; critical review of the manuscript.Hiram Larangeira de Almeida Jr.: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; intellectual participation in propaedeutic and/or therapeutic conduct of the cases studied; critical review of the literature; critical review of the manuscript.Gustavo Zerwes: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; effective participation in research orientation; intellectual participation in propaedeutic and/or therapeutic conduct of the cases studied; critical review of the literature; critical review of the manuscript.Umberto Lopes de Oliveira Filho: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; effective participation in research orientation; intellectual participation in propaedeutic and/or therapeutic conduct of the cases studied; critical review of the literature; critical review of the manuscript.None declared."}
{"text": "Leishmaniasis represents the important public health problem in the world. One of the main objectives of World Health organization is capacity building of managers and authorities who are involved with diseases control activities.The course was conducted in Esfahan Health Research and Training Center (E.H.R.T.C) in summer 2005 and 2009. The course carried out jointly by the Ministry of Health and Medical Education (MOH) of Iran, World Health Organization-Eastern Mediterranean Regional Office (WHO-EMRO) and School of Public health, Tehran University of Medical Sciences (SPH-TUMS) and designed for medical officers, senior technicians and managers involved in leishmaniasis control. Prior to initiate the course, pre-test evaluations including different subjects on leishmaniasis and its control were carried out. The examinations include multiple choice questions. The duration of the course was 3 weeks. A total of 206 contact hours were taught. The main subjects were Basic epidemiology, Leishmaniasis parasitology, Leishmaniasis entomology, control of vectors and reservoirs, principles of integrated pest management, Field work and Planning. Different methods of teaching including lecture, laboratory, workshop, team work, field exercise and presentation were used. Requirement for achievement of the course was to have at least 60% of the total mark for awarding the diploma certificate.A total of 45 participants from Iraq, Afghanistan and Iran graduated from this course.The course is providing the skill for managers, how to combat against disease in their country and is parallel to the policy of the leishmaniasis control for capacity building in endemic areas of their countries. Leishmania and is transmitted to animals and humans through the bite of certain species of female sand flies  occurs in two forms, Anthroponothic Cutaneous Leishmaniasis (ACL) and Zoonotic Cutaneous Leishmaniasis (ZCL) . The incThe main elements of cutaneous and visceral leishmaniasis control programs in the Islamic Republic of Iran have focused on the establishment of a national committee for leishmaniasis control, are as follows:Strengthening the leishmaniasis surveillance system and establishing a laboratory network from the national to peripheral level, establishment of standard diagnosis and treatment centers, provision of educational programs for different social levels and revision of the national guideline, standardization of case definition and treatment results, early diagnosis and rapid treatment of patients accompanied by dressing wounds to prevent sand fly bites, reservoir control programmes, collecting the rubble and rubbish tips and vector control programs, applying direct agglutination test in periphery levels for visceral leishmaniasis diagnosis, identification and collection of infected owned and stray dogs in visceral leishmaniasis endemic foci, intersectional coordination with related organizations and institutions . LeishmaThe course was organized jointly by the Ministry of Health and Medical Education, Islamic Republic of Iran, The School of Public Health and National Institute of Health Research, Tehran University of Medical Sciences, World Health Organization, Eastern Mediterranean Region (EMRO). It provided the participants with the knowledge and skills in different aspects of leishmaniasis and its control, through small group work, field exercises, exchange of experiences and discussions with qualified specialists.Description, history and geographical distribution of leishmaniasis in the world and Eastern Mediterranean Regional Office (EMRO), Epidemiology of leishmaniasis in Iran and neighboring countries, effects of climate change and disaster on leishmaniasis situation.Clinical manifestation and treatment of old world cutaneous and visceral leishmaniasis: physical systematic, interleisonal, oral drugs, management of visceral leishmaniasisNatural immunity and Acquired immunity, Experience of vaccination in leishmaniasis, serological surveillance of asymptomatic visceral leishmaniasis and case detection, leishmaniasis surveillance in Iran.Methods of studies on human disease: rates, ratios, proportions, prevalence and incidence of leishmaniasis, data presentation: common statistical tests, tables, graphs, charts.Phlebotomus genus.An overview of vectors and reservoirs of leishmaniasis, biology and ecology of sand flies, Taxonomy of sand flies, identification criteria, explaining of identification keys. Identification of sand fly genera: different sub-genera of Leishmania parasites, molecular entomology of leishmaniasis vectors.Sampling methods of sand flies: sucking tube, CDC light traps, funnel traps, sticky oil traps and other techniques, preservation, mounting and identification of sand flies, collection of sand flies on human and animal baits, dissection of sand flies for detection and isolation of Rodent leishmaniasis, biosystematics of rodents, identification of main reservoir hosts, biology, ecology, distribution and behavior of rodents, criteria for incriminating rodents as reservoirs, methods of field and laboratory studies of reservoirs of cutaneous and visceral leishmaniasis, canine visceral leishmaniasis, molecular epizootiology of rodent leishmaniasis.50 and LT90 using Probit analysis, insecticides recommended by WHO against leishmaniasis vectors, formulation of insecticides for residual spraying, measurement and calculation of insecticides for impregnation of bed nets and curtains, safe use and judicious use of insecticides and precaution measures, insecticide storage (condition of safe storage), space spraying, Ultra Low Volume (ULV), thermal fog.Different methods of prevention and control of cutaneous and visceral leishmaniasis, methods for evaluation of leishmaniasis control, different methods for elimination of stray dogs, Leishmanization and its effectiveness in the control of CL in Iran, Vaccine for visceral leishmaniasis, principals of integrated pest management (IPM planning), rodenticides and environmental management and sanitation, destroying of chenopods, different methods of rodent control, insecticide susceptibility tests on sand flies, calculation of LTPhlebotomus genus (laboratory practice), collection of sand flies by different methods , carrying of traps from the field to laboratory, dissection of collected sand flies for detection and isolation of Leishmania parasites, mounting, identification of collected sand flies, collection of rodents by Sherman traps in the field and carrying of them to the laboratory, identification of collected rodent reservoirs, preparations of smears from the ear of each rodent, fixation of slides, staining with Giemsa microscopic examination of slides, isolation of parasites from infected rodents, measurement of rodenticides for application in the field circumstances, preparing of poisoned bait, education of workers, domestic dog examination and control, field application of rodenticides, its monitoring and evaluation impact, visiting households in 3 villages for case finding, examination of people for the presence of ulcers or scars, recording the necessary information on the related forms, preparing smears from ulcers, fixation of slides, staining with Giemsa, microscopically examination of slides, visiting health centers for examination and treatment of patients of CL in Esfahan, different methods of prevention and control of cutaneous and visceral leishmaniasis, methods for evaluation of leishmaniasis control, principals of integrated pest management, Integrated Pets Management (IPM) planning, different methods of rodent control, insecticide susceptibility tests on sand flies, calculation of LT50 and LT90 using probit analysis, insecticides recommended by WHO against leishmaniasis vectors, formulation of insecticides for residual spraying, measurement and calculation of insecticides for preparation of bed nets and curtains, safe use and judicious use of in insecticides and precaution measures, space spraying, ULV, thermal fog, different parts and function of Hudson pump and thermal fog, measurement and calculation of insecticides for impregnation of bed nets and curtains , practical work for indoor residual spraying at the station, collection of sand flies by aspirator from the villages, carrying out insecticide susceptibility tests by WHO standard method on collected sand flies, results of susceptibility tests on sand flies: recording and analysis, suggestion of a control program for an Anthroponetic Cutaneous Leishmaniasis (ACL) focus, suggestion of a control program for a Zoonotic Cutaneous Leishmaniasis (ZCL) focus, suggestion of a control program for a Visceral leishmaniasis (VL) focus.Collection of sand flies by different methods from outdoors and indoors in a rural district (field work) around Esfahan, carrying of traps from the field to laboratory, preservation and mounting of collected sand flies, identification of sand fly genera: different sub-genera of In evaluating the training course, almost all the training units in the module were covered during the period. There were adequate facilities for the delivery of lectures. These include a well-furnished spacious room for lectures with adequate audio-visual equipment. These include a white board, a slide projector and screen and a dedicated computer for the training. Each participant was provided with a copy of the relevant books and handouts. The participants were given practical field experience and laboratory demonstrations. The laboratory was well equipped with dissecting and compound microscopes which made it possible for each participant to individually and independently do the laboratory work. There was enough reference collection of sandflies available for practical work. All the facilitators tried to make the course as participatory as possible and there was very good relationship between the facilitators and the participants. Almost all the participants through verbal communication rated the entire course as very good, delivery of lectures as excellent and practical demonstrations and fieldwork as good. The onsite accommodation for participants enabled all the activities to be organized on time.In general, based on the assessments and interviews, also considering the fact that most of the participants were programme managers and medical health professionals who have had very little knowledge on entomology, vector and reservoir control, the course achieved its purpose of providing them with basic information needed for decision making in disease control activities in their respective countries. The participants and facilitators for the first time shared experiences with regard to vector control activities between different countries. We will recommend that all the participants should be monitored and given the necessary support to enable them contribute to diseases control and elimination activities in their respective countries."}
{"text": "The European Brain Council (EBC) serves as a pan-European platform, bringing together brain researchers, patient advocates, scientists, and clinicians around a common vision for the \u201cbrain space.\u201d At the heart of our advocacy work are accelerating brain research, raising awareness of the challenges associated with brain disorders, reducing stigma and discrimination, and supporting science. Our mission revolves around promoting brain research and brain health at the European level to the benefit of people living with neurological and psychiatric disorders.Brain disorders are highly prevalent diseases that impose a tremendous burden on European society. In 2010, more than 1 in 3 European citizens were affected by a mental or neurological disease , but also to ensure the creation of an appropriate and functioning structure that would enable brain research to be prioritized and efficiently addressed.- The adoption of a brain mission. This idea, suggested by the high-level group, was taken on board of the program proposal and is currently looked into by the European Commission, European Parliament, and the EU member states. The Brain Mission, as proposed by EBC, is aimed to serve as a guiding paper in this process .www.ebra.eu) (Grant agreement No 825348). The overall idea underpinning EBRA is to coordinate and synergize brain research projects and initiatives at both European and global level in order to foster the efficiency of efforts in brain research. EBRA brings together the brain research community at large, the major brain research initiatives, research funding networks, and all relevant stakeholders at the European level and beyond, to ensure the overall delivery of the research potential. Therefore, EBRA was created as platform that would catalyze coordination between brain researchers, clinicians, patients, governments, funders, and public institutions, while fostering global initiatives. EBRA consortium is led by EBC and brings together the Joint Programming on Neurodegenerative Diseases, the Human Brain Project, and the ERANET Neuron. For the next 3 years, the Consortium will work to align and coordinate research strategies across European and global brain initiatives; facilitate the launching of research projects in specific areas in active clusters, and help them to collaborate effectively, share data, and access research infrastructures; and increase the brain research visibility and promote the uptake of EBRA results to key stakeholders.Amidst these political discussions, in November 2018 the EBC launched an EU-funded project The European Brain Research Area (EBRA, Brain research in Europe is a rapidly evolving field, and it has always been at the forefront of science. Nonetheless, the inherent complexity of the nervous system has made our translational capacity more challenging, hence requiring a higher level of integration. EBC, through its EBRA project, remains committed to supporting the strategic vision of favoring a sustained open research community, with high level of collaboration and knowledge-sharing across the borders of various disciplines, to improve the quality of life of all citizens living with a brain condition in Europe."}
{"text": "In the article titled \u201cEfficacy and Safety of Sipjeondaebo-Tang for Anorexia in Patients with Cancer: A Pilot, Randomized, Double-Blind, Placebo-Controlled Trial\u201d , there wThis error in the reporting was brought to the attention of the journal by Professor Edzard Ernst, Emeritus Professor of Complementary Medicine, University of Exeter. The journal and the authors apologize for this misreporting of the conclusions."}
{"text": "Biology and biotechnology have changed dramatically during the past 20 years, in part because of increases in computational capabilities and use of engineering principles to study biology. The advances in supercomputing, data storage capacity, and cloud platforms enable scientists throughout the world to generate, analyze, share, and store vast amounts of data, some of which are biological and much of which may be used to understand the human condition, agricultural systems, evolution, and environmental ecosystems. These advances and applications have enabled: (1) the emergence of data science, which involves the development of new algorithms to analyze and visualize data; and (2) the use of engineering approaches to manipulate or create new biological organisms that have specific functions, such as production of industrial chemical precursors and development of environmental bio-based sensors. Several biological sciences fields harness the capabilities of computer, data, and engineering sciences, including synthetic biology, precision medicine, precision agriculture, and systems biology. These advances and applications are not limited to one country. This capability has economic and physical consequences, but is vulnerable to unauthorized intervention. Healthcare and genomic information of patients, information about pharmaceutical and biotechnology products in development, and results of scientific research have been stolen by state and non-state actors through infiltration of databases and computer systems containing this information. Countries have developed their own policies for governing data generation, access, and sharing with foreign entities, resulting in asymmetry of data sharing. This paper describes security implications of asymmetric access to and use of biological data. Advances in computer science, engineering, and data science have changed research, development, and application of biology and biotechnology in the United States and internationally. Examples of changes include: (a) increased reliance on internet connectivity for research and laboratory operations  the 2018 update of the European Union General Data Protection Regulation  how the data may be exploited by adversaries and what consequences result from this exploitation; and (2) what potential negative effects may arise from digitalization of biotechnology and advanced computation of biological data . Strategies for bridging the biological, cyber, information, and data security include: (a) collaboration between the biological and cybersecurity communities; (b) end-to-end risk assessments; (c) data-specific risk and vulnerability assessments; and (d) application of the NIST Cybersecurity Framework for protecting biological data.Given these potential vulnerabilities, the cybersecurity and biotechnology communities must engage to create best practices and processes to protect data and mitigate risk while reaping the benefits of computing technology applications to biotechnology.Formal collaboration between the biotechnology and biological, information, data, and cyber security communities would enhance efforts toward identification of risks and vulnerabilities associated with data management, provenance, and integrity, and risk mitigation strategies. Technologies are readily available to protect data, but their use must be harmonized worldwide, because protecting data in one database is ineffective if another database remains vulnerable to external threats. Furthermore, organizations may evade regulatory requirements and industry standards in protecting data because of perceived lack of cost savings for implementing cybersecurity measures or lack of awareness of the risks, which could lead to investor, intruder, or adversary access to sensitive information that may be stored in databases or transferred between computers. These vulnerabilities may be exacerbated by limitations of national laws to other sovereign states, and differences in interpretation of the types of data included in the scope of existing laws. These risks could be addressed by conducting an end-to-end risk assessment of the software and equipment involved in the data pipeline within individual organizations, between organizations, and across countries.End-to-end assessments of the data storage, processing, and transport pipeline can identify outstanding vulnerabilities and technical gaps that may be addressed with currently available cyber, information, and data security solutions. This process would enable identification of gaps for which these measures are insufficient and of institutions that are responsible for implementing controls. Without this type of assessment, vulnerabilities may exist along the pipeline without its users' knowledge. A lack of rigorous analysis makes biological data vulnerable to acquisition or alteration by witting adversaries, potentially resulting in theft of intellectual property for commercial gain, foreign government acquisition of genomic data from large portions of a population for undefined purpose or compromise of software and data integrity. At least one country promotes acquisition of data though legitimate commercial practices , talent promotion programs  are critical for reaping the benefits and minimizing the vulnerabilities of advanced electronic computation and mass connectivity. In 2014, the White House explored technology needs for protecting the security and privacy of exposed data, including healthcare data  Cybersecurity Framework to all systems of storage, processing and transport of biological data would help explore where, how, and by whom data is processed with the goal of protecting valuable scientific and health information (National Institute of Standards Technology, These suggestions describe various approaches toward protecting biological data from unauthorized acquisition and use, enhancing efforts to preserve data integrity and provenance, and enabling future benefit of biotechnological advances.KB and PS contributed equally to this manuscript. The concepts, conclusions, and recommendations were generated jointly by the authors and built on their respective expertise in the biological sciences and biosecurity, and computer science and cybersecurity.KB was employed by Gryphon Scientific. PS was employed by Promontory Financial Group, which is an IBM Company. The authors declare that the paper was written in the absence of any commercial or financial relationships that would constitute a conflict of interest."}
{"text": "However, this option has been associated with strong medical, ethical, legal, religious, and media or public concerns and discussions, as in the case of Maltese conjoined twins operated on in the 2000s in the UK -5. In thNowadays, tertiary centers specialized for the treatment of conjoined twins have been established all over the globe ,7 and thCroatian Medical Journal, is both an exciting medical story and evidence of an important success of Croatian medicine. The authors clearly describe the entire diagnostic and treatment process: they recognized conjoined twin fetuses early in the 11th week of gestation, followed them through pregnancy, and confirmed their findings with magnetic resonance imaging (The case report by Grizelj et al on a successful separation of conjoined twins at the University Hospital Center Zagreb , publishThis case clearly shows that a highly dedicated and experienced team of health care professionals, with the help of modern and advanced technology, may recognize, follow, and successfully treat even the extremely complex cases. All this being said, let me congratulate the Croatian team on this outstanding clinical accomplishment, which was not only based on the right and timely clinical decisions, but also reflects the team's high sensitivity to ethical and legal aspects of the case and their professional interaction with the public and media."}
{"text": "Reproductive health is vital for human and infertility is also one of the most important challenges in the reproductive system. Infertility is one of the most common chronic health disorders, regardless of age. The Minimum Data Set (MDS) helps to manage infertility by monitoring and evaluating infertility interventions based on collecting data.The development of MDS is an essential objective in order to implement an infertility monitoring system for the creation of standardized and effective data management through the provision of comprehensive and identical data elements for infertility.This is a descriptive cross-sectional study conducted in 2017. The data has been collected from infertility clinics in the world, as well as WHO, CDC, ASRM, and ESHRE reports.In order to decide on data elements, the Delphi technique was used using a questionnaire that contained data elements which were distributed among 12 experts including one reproductive endocrinology and infertility fellow, six obstetrician-gynecologists, two reproductive biologists, two urologists and one community medicine specialist using the 5 point Likert scale. The questionnaire was divided into two categories: managerial and clinical, each with 4 sections, and 60 and 940 data elements, respectively.MDS is an essential tool for evaluating the infertility process. Using this tool will provide an opportunity to develop a set of quality care criteria that can be used to ensure the quality of infertility care. One of the key issues is the global emphasis on public health policies and programs to increase the population and provide affordable, safe and well-planned and effective services for families . AccordiInfertility is one of the six maternal diseases/consequences which has been neglected in developing countries . InfertiTherefore, in order to fully understand the effects of infertility and measure progress in reducing this problem and to cope with the growth management of data and information, attention to the collection, analysis, interpretation, and use of infertility data are of great importance . MeanwhiThis is a descriptive cross-sectional study conducted in 2017. Information resources, including related articles, reports and forms related to infertility clinics and texts were searched using the following keywords: minimum data set, MDS, core data, infertility, infertility form, IVF registry, ART registry, surveillance system, monitoring system in the PubMed database, Scopus, Cochrane and WHO, CDC and Google scholar websites from 1978 to 2017. Collected data, according to the standards set of American National Standard Institute (ANSI), previous articles and references book were classified into managerial and clinical categories , 24-26 aThe purpose of this research is to develop the MDS required for a national infertility monitoring system in order to accelerate and facilitate the prevention, diagnosis, and follow-up of infertility.This study is a research project as a part of the Maryam zahmatkeshan Ph.D. thesis approved by Tehran University of Medical Sciences. Also, the ethics committee of the university approved this study (IR.TUMS.SPH.REC.1396.4142). Verbal informed consent was obtained from all subjects before the study.SPSS 16 software was used to analyze the data.Of the 12 experts, 75% were female, and 25% were male. MDS was divided into two categories of managerial and clinical, each with 4 sections. The total number of final data elements in the managerial groups was 60 and 940 in the clinical groups. Examples of the managerial and clinical data elements that were accepted as the final set (over 75%) are listed in Clinical data elements were categorized into four parts:Medical history: Causes of Infertility, Sexual history , Previous Examinations, Previous Diseases, Treatments, Tests, Surgeries, Medication, Social History, Family History, and Pregnancy History.Treatment plan: Cycle Characteristics of the Treatment, Specifications of Eggs, Embryos/Blastocyst Profile, Treatments Treatment results: Pregnancy and Childbirth, ComplicationsDonor information.Infertility affects over 15% of couples in reproductive age, and the prevalence of infertility in the world is increasing . An accuIn this study, based on the results obtained by using the Delphi technique, the majority of relevant experts agreed with the proposed model and it is considered suitable for infertility centers. Therefore, the proposed model as the final model of this research is recommended, and its implementation is recommended to infertility centers.Various studies point to the importance of MDS in the development of information management system in different areas such as burns , trauma Identification of the minimum data set is the first step to standardize and integrate the data used in the diagnosis and can be useful in evaluating it . MDS proConsidering the adverse effects of infertility, designing and implementing a comprehensive and appropriate infertility data set model in centers can be an essential step in the creation of infertility monitoring system for high-quality and proper treatment, regular planning for controlling and preventing infertility, allocating credit to infertility centers and clinics and doing research. MDS helps infertility management by providing continuous care of patients, establishing a link between care providers and analyzing the effectiveness of patient care and the community of infertile patients. Through the use of MDS organized as designated forms, patient identification indicators, efficiency indicators of the care process and the quality of the services provided as well as outcome indicators, fertility management was improved. In addition, it will be possible to develop policies, prevent and control infertility and, consequently, improve the quality of care and save costs.It is clear that an important issue in preventing infertility is having access to credible and powerful information systems such as an infertility monitoring system. Although some countries develop and implement infertility management systems, data cannot be compared correctly due to differences in data and lack of international standards. Therefore, the provision of such standards will lead to the development of these systems in other countries.The authors would like to thank all the specialists from the Fasa University of Medical Sciences who participated or otherwise contributed to this study.The authors confirm that there are no conflicts of interest."}
{"text": "Zinc is one of the most important essential trace elements. It is involved in more than 300 enzyme systems and is an indispensable participant in many biochemical processes. Zinc deficiency causes a number of disorders in the human body, the main ones being the delay of growth and puberty, immune disorders, and cognitive dysfunctions. There are over two billion people in the world suffering from zinc deficiency conditions. Acyzol, a zinc-containing medicine, developed as an antidote against carbon monoxide poisoning, demonstrates a wide range of pharmacological activities: Anti-inflammatory, reparative, detoxifying, immunomodulatory, bacteriostatic, hepatoprotective, adaptogenic, antioxidant, antihypoxic, and cardioprotective. The presence of zinc in the composition of Acyzol suggests the potential of the drug in the treatment and prevention of zinc deficiency conditions, such as Prasad\u2019s disease, immune system pathology, alopecia, allergodermatoses, prostate dysfunction, psoriasis, stomatitis, periodontitis, and delayed mental and physical development in children. Currently, the efficiency of Acyzol in the cases of zinc deficiency is shown in a large number of experimental studies. So, Acyzol can be used as a highly effective drug for pharmacologic therapy of a wide range of diseases and conditions and it opens up new perspectives in the treatment and prevention of zinc deficiency conditions.  Essential trace elements, including zinc as a special one, are the functional basis of many enzyme systems; therefore, their deficiency has a negative effect on cell viability. There are approximately 3000 proteins interacting with zinc ,2, a conZinc essentially preserves the structure of DNA, RNA, and ribosomes. As a component of the aminoacyl-tRNA synthetases and the protein chain elongation factor, it plays an important role in the translation process and thus, it is indispensable in many key stages of gene expression. Therefore, nutritional or genetic zinc deficiency disrupts the functioning of all cell cycle phases and genetic apparatus function. In fact, zinc deficiency may result in stunted growth and delay in physical and mental development.Zinc plays a major role in the hormonal status in the human body by directly affecting the production and activity of the hormones of thymus, thyroid glands and pancreas. Zinc regulates several glycolytic processes avoiding diseases, such as type 2 diabetes mellitus and plays an important role in the processes of insulin binding to hepatocytes and lipoprotein synthesis ,14. ZincSalmonella enteritidis, Lysteria monocytogenes, Candida albicans, Toxoplasma gondii, which would increase the risk of incidence of pneumonia, malaria, tuberculosis, measles and other infectious diseases  is a zinc-containing drug with high bioavailability, low toxicity and good tolerability, which was synthesized in the Irkutsk Institute of Chemistry of Siberian Branch of the Russian Academy of Sciences. The structural formula of the compound is shown in Acyzol has a large therapeutic window and it is safe under prolonged (90 days) daily intramuscular injection, intragastrically and peroral administration to experimental animals including mice, rats, and dogs. Acyzol application does not cause pathological changes of biochemical parameters and has no negative effect on the physiological systems of the body and on the structure of the internal organs. The tested formulations are non-irritating; they do not cause allergic reactions, do not have embryotoxic and teratogenic properties, do not affect reproductive function in animals. Acyzol is protected by 14 patents of the Russian Federation.Acyzol is a powerful antidote against acute poisoning with lethal doses of CO, carbon monoxide or carbon oxide, and other products of combustion. It accelerates their elimination from the body and reduces the severity of the intoxication, which contributes to the success of subsequent medical interventions  . The druEffectiveness of Acyzol for the prevention and treatment of toxicohypoxic encephalopathies (TSEs), aggravating the progress of acute intoxications caused by CO and other combustion products, has been studied in experiments and in clinical trials. Administration of Acyzol (intramuscular injections of 6% solution 3 times daily for 7\u221210 days) to patients suffering from CO poisoning is beneficial for reduction of neurological complications. The favorable outcome from TSEs is due to an increase in the CO elimination, correction of non-specific changes in the blood cell composition, stabilization of peroxidation of lipids (POL) and antioxidant system (AOS) POL/AOS, and the elimination of compensatory reactions of the blood circulatory system ,92,93.The mechanism of Acyzol action is due to its influence on the cooperative interaction of the hemoglobin subunits, thereby resulting in the reduction of the relative hemoglobin affinity to carbon monoxide and improvement of the oxygen-binding (decreasing of Hill\u2019s constant) and gas-transport functions of the blood ,94. The A direct chemical effect of the main component of the drug on the blood has been proved by the bio-crystallization method. The effect shows itself in the conversion of heme and globin part of the blood hemoglobin into the product, having an altered protein structure. In this case, the oxyglobin characteristic spectrum is observed. It is consists of the following absorption bands: 414 nm (Soret band), and two ones in the areas of 540 nm and 575 nm (\u03b1 and \u03b2-bands). These \u03b1- and \u03b2-bands almost completely disappear from the spectrum after interaction of Acyzol with blood, indicating the changes of the heme part of hemoglobin, due to the influence of Acyzol  95]. In. In95]. Acyzol is a highly effective zinc-containing drug that provides anti-inflammatory, reparative, detoxifying, immunomodulatory, and bacteriostatic effects. Experimental and clinical studies demonstrate a large therapeutic window of Acyzol. In addition, Levedeva et al. showed the hepatoprotective, adaptogenic, antioxidant, and other cardioprotective activity of Acyzol . The druInterestingly, animal models of hypoxia showed a protective effect of Acyzol . Briefly, Acyzol was administered in a wide dose range (10\u2013150 mg/kg) in mice under various acute hypoxic conditions including hypobaric hypoxia (AHBH), hypoxia with hypercapnia (AHwHc), and hemic hypoxia (AHeH) see  98,99].,99.98,99Acyzol, as a highly effective antihypoxic drug, protects the body in the conditions of low oxygen partial pressure and insufficient oxygenation of hemoglobin, and provides resistance to hypoxia of organs , which are the most sensitive to it ,94.Experimental and clinical studies demonstrate the possibility of creating Acyzol formulations for external use , which will be effective in the treatment of skin diseases  and diseases of mucous membranes .The presence of zinc shows that Acyzol may be used as a promissory for the treatment and prevention of ZDC including Prasad\u2019s disease, immunodeficiencies, alopecia, allergodermatoses, prostate dysfunction, psoriasis, stomatitis, periodontitis, delayed mental and physical development in children, etc. At present, the effectiveness of Acyzol for ZDC correction has been shown on the huge factual material . The use of Acyzol formulations as a pharmacologic agent for pneumonia treatment resulted from acute poisoning with neurotropic agents significantly reduced the mortality rates see  91,99].,99.91,99Similar hepatoprotrotective effect of Acyzol and Silymarin was shown in the preclinical studies, thus providing a rationale for use of Acyzol in complex therapy of toxic hepatitis and hepatosis  100]..100].The study of cardioprotective effectiveness of Acyzol demonstrated pronounced therapeutic effect of the drug in the case of experimental catecholamine myocarditis. Increased contractile activity of the myocardium and decrease in the overload of the right heart were observed; that led to the regression of inflammatory changes in the cardiomycytes, reduced severity of cytolysis and increased intensity of tissue respiration . In the During therapy with Acyzol, an increase in the amplitude of the R, T waves was observed compared to the normal state, which may indicate an increase in the contractile activity of the myocardium. A decrease in the amplitude of the P, R, T waves and an increase in atrioventricular conductivity were also noted  . The results of the study of hemodynamics and organ-specific characteristics on the model of cardiopathic amyloidosis induced by administration of Freund\u2019s adjuvant to male Wistar rats weighing 350\u2212400 g and aged 18\u221224 months show that administration of Acyzol 30 mg/kg intragastrically for 60 days causes a positive preventive effect .The study of psoriatic patients carried out by Abramova TV, Batkaeva EA (2006) showed the efficacy of Acyzol when it administered in a dose of 120 mg 1 time a day for 10 days on the background of the conventional therapy for that disease that included hyposensitization drugs, vitamins, hepatoprotective agents, sedatives, ultraviolet irradiation, and external ointment treatment . AdminisThe course of Acyzol application for 2 months in a dose of 2 capsule (40 mg Zn) per day by military men with a low level of physical development, weight deficit, and increased morbidity level has improved functional status and increased the adaptive capacity of the body. In particular, pulmonary capacity, chest circumference at inspiration and expiration, Erismann index and other functional and physical characteristics of the body have increased . The couExperimental and clinical studies during the treatment of periodontal disease  of varying severity have shown that the use of Acyzol is accompanied by a rapid recovery and stable remission, both in an experimental laboratory and in the clinic . The higWhen patients suffering from type 2 diabetes received Acyzol, a decrease in their blood glucose levels was observed, a month after the start of the treatment .Prophylactic administration of Acyzol is an effective way of the toxic effect correction in the case of chronic lead poisoning. It has been shown that, subcutaneous and intragastric administration of Acyzol in a dose of 30 mg/kg to male Wistar rats reduces lipid peroxidation (LPO) processes, increases the activity of the antioxidant defense enzymes  in blood plasma and reduces malondialdehyde (MDA) content in the membranes of erythrocytes  40]..40].Acyzol as an antihypoxic agent can be used for the treatment of many diseases involving ischemia and hypoxia of viscera, i.e., in medical and surgical practice, in urology, gynecology, dermatology, and for the treatment of functional impotence. Due to its antihypoxic and antioxidant effects, Acyzol can be used in emergency medicine, in surgery for the correction of metabolic acidosis, and for the protection of cell membranes from the effects of LPO products. Acyzol can be recommended for introduction in the obstetric practice as an effective remedy for fetal hypoxia.The application of Acyzol is promising for sports medicine, because the drug increases subjects\u2019 performance and endurance in the training process, owing to zinc replenishment in the enzyme systems, optimization of tissue respiration, and the improvement of the oxygen binding properties of the blood. Acyzol can be recommended for regenerative medicine as a drug that enhances the level of functional reserves of the organism .Zinc-containing preparation of Acyzol acts as a highly effective drug for the pharmacologic therapy of a wide range of diseases and conditions, including hypoxia, toxicohypoxic encephalopathy, periodontal, immune, and heart pathologies. The use of Acyzol opens up new perspectives in the treatment and prevention of ZDC."}
{"text": "The correct statement is: A de-identified dataset is provided in the Supporting Information files. Please contact the corresponding author Peibin Zeng , the Fundamental Research Funds for the Central Universities. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The publisher apologizes for the errors."}
{"text": "The European Board of Ophthalmology (EBO), founded in London in 1992, is a permanent working group of the Ophthalmology Subspecialty Section of the European Union of Medical Specialists (UEMS).The Board has the role of supervising the level of education in Ophthalmology in the European Union. EBO intends to obtain standards of education, and to harmonize knowledge and training across Europe. The main mean for EBO to realize that, alongside the EBO exam, CME control, and Grants is the accreditation of centers aspiring to reach the standards required.The National Delegates of Romania to EBO, Cornel Stefan, MD, PhD, and Assoc. Prof. Marian Burcea, MD, PhD, supported the Department of Ophthalmology of \u201cDr. Carol Davila\u201d Central Military Emergency University Hospital to apply for EBO accreditation.On the 8th and 9th April, an Evaluation Committee from EBO came to Bucharest. The members of the Committee, Tina Xirou, MD, PhD, from Athens, Greece, and Prof. Andreas Wedrich, MD, PhD, from Graz, Austria, spent two days in the Clinic, following the daily activities, mainly the activities of the residents.The staff involved in residents\u2019 training was assessed . The logistics of training \u2013 dedicated spaces, access to textbooks, paper and electronic journals, internet access, time in daily schedule for study seemed to be very important for the assessors. The presence of a simulator for ophthalmic surgery with open access  was much appreciated.For almost three hours, there was a discussion with the residents. During this talk, a lot of topics were clarified: numbers of residents in clinic, number of residents in each year of training, resident/ staff ratio, number of patients/ year, number of surgeries/ year, number of patients in different areas of ophthalmology , the opportunity \u2013 or not \u2013 to follow some time in each of these subspecialties.The clinic obtained a very good evaluation for the diagnostic and therapeutic equipments, which were considered above the level of many units from western countries.The global impression was positive and the assessors presented their data to EBO Accreditation Committee. Two months later, the Department of Ophthalmology of \u201cDr. Carol Davila\u201d Central Military Emergency University Hospital became the first EBO accredited centre in Romania.Editor-in-ChiefMihail Zemba, MD, PhD"}